• 5 months ago
On Tuesday, the House Energy & Commerce Committee held a hearing examining the CDC's priorities.

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Transcript
00:00:00It is designed to, quote, work 24-7 to protect America from health, safety, and security
00:00:06threats both foreign and in the United States.
00:00:09To accomplish our mission, CDC conducts critical science and provides health information that
00:00:14protects our nation against expensive and dangerous health threats and respond when
00:00:18they arise.
00:00:19To know and fully understand the CDC's mission is to realize the history of the agency.
00:00:24Originally established in 1946, the CDC in effect an extension of the Department of Defense
00:00:32and was created to help track malaria internationally.
00:00:35Today the agency operates 23 different centers, institutes, and offices that all have different
00:00:40focuses.
00:00:42We will hear from the directors of six of these centers today about their role in executing
00:00:45the CDC's mission and their vision for the future.
00:00:49Since the COVID-19 pandemic hit our shores, Americans have experienced historic rises
00:00:54in drug overdoses fueled by a tragic rise in illicit fentanyl being trafficked across
00:00:59our southern border, China, Mexico, into the United States.
00:01:04Overdose prevention remains one of the CDC's core responsibilities, but data show rising
00:01:08year-over-year overdose rates and indicating the overdose prevention efforts require some
00:01:13scrutiny.
00:01:14This includes whether federal overdose prevention and response efforts can be streamlined across
00:01:18agencies to help better direct resources to communities most in need.
00:01:23The nation now potentially faces a threat with the H5 avian influenza, which is impacting
00:01:30poultry and dairy farms and has infected 10 farm workers across the United States.
00:01:34While the avian influenza does not currently present imminent harm to humans, my hope is
00:01:38the CDC learns some lessons, as we all did, through COVID-19 and will be adequately prepared
00:01:44to respond if needed.
00:01:46The CDC received over $1 billion in direct funding for a data modernization initiative
00:01:53that has yet to bear fruit.
00:01:55There are outstanding questions about how the funding is being utilized, how much is
00:01:59being utilized, and for the purposes it's being utilized.
00:02:04The agency continues to seek additional data authorities, despite operating over 100 surveillance
00:02:09programs and skepticism around the authorities they already have from the American people,
00:02:15including in my district.
00:02:16We need strong answers to justify why these authorities are needed.
00:02:22While I do give the agency a lot of credit for taking the steps towards much-needed reform
00:02:27and reorganization, I do believe continued increased reflection is needed, particularly
00:02:32for an agency that technically remains unauthorized.
00:02:36The American people deserve a CDC that is accountable to its core mission, preparedness
00:02:41and response to infectious diseases.
00:02:43Otherwise, we risk repeating past failures and placing millions of Americans' lives
00:02:48at stake.
00:02:49I yield.
00:02:50I now recognize the gentlelady from California, Representative Eshoo, for five minutes for
00:02:54an opening statement.
00:02:55Thank you, Mr. Chairman, and good morning, colleagues.
00:02:59It's an honor to welcome six leaders from the CDC this morning.
00:03:05I think it's the very first time that we've had the CDC-centered directors together for
00:03:12a hearing, so my thanks to each of you and welcome again.
00:03:17Since its founding over 80 years ago, the CDC has grown to be, as the chairman just
00:03:24said, the preeminent health agency in the world.
00:03:30It's the first responder to dangerous outbreaks around the globe, a leader in cutting-edge
00:03:37research, and the foundation for our nation's public health infrastructure.
00:03:43The CDC is the largest federal source of funding for state and local public health and prevention
00:03:50programs.
00:03:51I think there are many members that don't realize that.
00:03:55With over 80 percent of the funding we provide to the CDC distributed directly to state and
00:04:02local public health programs.
00:04:05So when the CDC is strong, so are our communities strong, yet there's, I think, a serious mismatch
00:04:14between our public health investment and our nation's public health needs.
00:04:19The U.S. spends more than $4.5 trillion and $14,000 per capita on health care in 2022,
00:04:30but only $19 per person on public health.
00:04:34The pandemic exacerbated this mismatch.
00:04:37Congress poured tens of billions of dollars into the CDC and local public health, but
00:04:43since then, budgets have been slashed.
00:04:46These boom-and-bust cycles, where we overspend during an emergency and underspend to improve
00:04:53basic biosecurity tools, leave our data systems and public health workforce fragile and unprepared.
00:05:01The current House Appropriations Bill to fund the CDC for 2025 continues this trend
00:05:08by cutting the agency's funding by $1.8 billion, a 22 percent reduction from the previous year.
00:05:16The bill also eliminates key CDC programs that our constituents rely on, including the
00:05:22Center for Injury Prevention and Control, home to programs that protect women, children,
00:05:28and families from domestic abuse, sexual violence, and gun violence, ending the HIV Epidemic
00:05:36Initiative, which aims to reduce new HIV infections by 90 percent by 2030, and initiatives to
00:05:44prevent chronic disease and improve children's health.
00:05:49Over 160 medical and public health organizations opposed these cuts because they would severely
00:05:56weaken our public health infrastructure and put millions of Americans at risk.
00:06:02Public health, I think, has become a casualty of partisanship.
00:06:06For example, over a year ago, the bipartisan Pandemic All-Hazardous Preparedness Reauthorization
00:06:13Bill — we have an abbreviation for it, PAPA — fell apart because the majority chose
00:06:20to ignore the hollowed-out public health system and underfund key CDC programs.
00:06:27Our nation has a shortage of 80,000 public health workers, and we're collecting public
00:06:33health data about outbreaks via fax machines and scraps of paper.
00:06:39We've set up the CDC and our local public health agencies to fail, and PAPA has still
00:06:45not been reauthorized.
00:06:48I'm the original author of that legislation.
00:06:51I feel, obviously, very strongly about it.
00:06:55Strengthening public health has been my North Star over my entire tenure in Congress.
00:07:01So I look forward to hearing from the Senate Directors today about how we can move the
00:07:06CDC forward and not backward, because the American people deserve only the best.
00:07:13With that, thank you, Mr. Chairman, and I yield back.
00:07:16Generally yields back.
00:07:17I now recognize the chair of the full committee, Chair Rogers, for five minutes for an opening
00:07:21statement.
00:07:22Thank you, Vice Chair Bouchon.
00:07:25Good morning to my colleagues, and welcome to our witnesses.
00:07:29For decades, America enjoyed its status of having one of the preeminent public health
00:07:34infrastructures in the world.
00:07:36Federal agencies conducted cutting-edge research and facilitated private sector efforts to
00:07:41advance science and keep our citizens safe.
00:07:45Then the COVID-19 pandemic struck.
00:07:48The CDC was established to assist states and localities in controlling infectious disease
00:07:53outbreaks.
00:07:54COVID-19 should have been the agency's moment to shine.
00:07:58Unfortunately, on almost every level, the CDC fell flat.
00:08:03From egregious flaws in testing, confusing and at times blatantly misleading communications
00:08:09mishaps, and one-size-fits-all guidance and mandates, the CDC failed at its primary job
00:08:16of helping states and localities detect, respond to, and control a disease outbreak.
00:08:23These failures beg the question, why did the CDC fail to execute its principal mission
00:08:29at the time of most need?
00:08:32Was it because the agency's focus had strayed too far from its core mission?
00:08:36Is the agency's spread too thin across competing and misguided priorities?
00:08:41And how do we refocus the agency to most effectively meet the needs of the American people?
00:08:48It's notable that between fiscal years 2013 and 2014, noncommunicable disease funding
00:08:55increased by 150%.
00:08:59Over that same period, there's been consistent increases in the rates of chronic diseases,
00:09:05such as diabetes, obesity, and hypertension.
00:09:08There is clearly a disconnect here.
00:09:10Congress has a responsibility to understand what the return on the investment has been.
00:09:15As a committee responsible for overseeing the CDC, we must question the effectiveness
00:09:20of these programs, understand who at the CDC is responsible for evaluating these programs,
00:09:26and whether these investments would be better directed elsewhere.
00:09:30The unfortunate truth is that Americans have lost the faith in their public health agencies,
00:09:36especially in the CDC.
00:09:38The agency's many failures rightfully led people to question whether the guidance being
00:09:42released was actually grounded in science, reason, or even common sense.
00:09:48As our committee helped to uncover, the six-foot social distancing rule just kind of appeared,
00:09:54as Dr. Fauci put it.
00:09:56More recently, Dr. Fauci attributed the decision to mandate the six-foot social distancing
00:10:02rule entirely to CDC.
00:10:06And yet the CDC has failed to explain how it was coming to its conclusions during that
00:10:10time, who was making these decisions, why it was issuing such guidance, and how that
00:10:15guidance would keep people safe.
00:10:17The CDC failed to explain how our understanding of the science evolved and changed over time.
00:10:23And the CDC failed to offer any kind of nuance as to who was vulnerable and who wasn't.
00:10:29These failures led to massive learning loss for our children that set them decades behind,
00:10:36a mental health crisis, and economic hardship.
00:10:40We need the CDC to be successful and credible for the health and future of our nation.
00:10:46But there's a lot of work that needs to be done to restore people's trust.
00:10:50Late last year, we held a hearing with the director of CDC, Dr. Cohen.
00:10:54At that hearing, we heard updates on the CDC-wide Moving Forward initiative.
00:11:00We likely have differing opinions on how productive and effective that initiative has been and
00:11:05the outcomes it has generated.
00:11:07However, I think that that initiative does show that we all agree that work must be done
00:11:13to rebuild public trust in the CDC and our public health institutions.
00:11:19That work will only be successful if the CDC's leadership and your centers and offices
00:11:24are truly committed to reform and are willing to show you can make hard decisions that need
00:11:29to be made.
00:11:31That means admitting where inefficiencies exist and taking accountability for mistakes.
00:11:36It means being honest about what you know and do not know and when you know it.
00:11:40It means making honest attempts to streamline and, perhaps in some cases, eliminate programs
00:11:45that are no longer working for the American people.
00:11:48And it means showing the American people you value their judgment, their individual perspectives,
00:11:53and that you're committed to regaining their trust.
00:11:56My hope is that we can work together to achieve this, starting with today's conversation.
00:12:01Thank you, and I yield back.
00:12:02General, he yields back and now recognize the ranking member of the full committee,
00:12:06Mr. Pallone, for five minutes for an opening statement.
00:12:09Thank you, Mr. Chairman.
00:12:10The Centers for Disease Control and Prevention is recognized domestically and globally as
00:12:15the leading public health authority.
00:12:18And today we'll hear from six center directors at the CDC on the critical role the agency
00:12:22plays in both domestic and global public health.
00:12:25And I thank our witnesses, who are all career public servants, for being here today.
00:12:30This hearing comes at a time when House Republicans continue their extreme partisan assault on
00:12:35the CDC.
00:12:37It never used to be this way.
00:12:39Democrats and Republicans used to work together to strengthen the CDC so it could confront
00:12:44the public crisis of the future.
00:12:46And it's important to remember that since its inception, the CDC's mission has always
00:12:50been focused on improving the everyday lives of all Americans.
00:12:54In 1946, CDC began its work of the primary mission to prevent malaria from spreading
00:12:58across the U.S.
00:13:00With a budget of only $10 million and fewer than 400 employees, the agency built a public
00:13:05health infrastructure to prevent the spread of malaria.
00:13:08And that work has continued ever since.
00:13:10During the 50s, it was the complete elimination of malaria from the United States.
00:13:15In the 60s and 70s, CDC led the way in establishing a national tuberculosis surveillance system
00:13:22and spearheaded rebellion vaccinations.
00:13:25The 80s, 90s, and 2000s, the CDC established the HIV AIDS Awareness and Prevention Campaigns,
00:13:32tobacco cessation programs, the Worldwide Polio Eradication Initiative, and identification
00:13:38of the novel H1N1 virus.
00:13:41Today, the CDC conducts critical science, monitoring, and health guidance to protect
00:13:45our nation against dangerous health threats, including the recent COVID-19 pandemic and
00:13:50ongoing opiate crisis.
00:13:52In fiscal year 23, CDC processed more than 25,000 grants and cooperative agreements to
00:13:58support state, county, and local public health programs.
00:14:01These programs save lives and federal and state health care dollars.
00:14:05And CDC's work has significant health and economic benefits that work to improve the
00:14:09well-being of the American people and to lower overall health care spending.
00:14:14And these programs are making a difference in all of our districts.
00:14:17In my state, for instance, the CDC has provided over $325 million in grant funding for projects
00:14:23ranging from Safe Women and Infant Health at the New Jersey Health Department to critical
00:14:28worker safety programs at Rutgers University.
00:14:31And yet, House Republicans continue to cave to the extreme elements in their party by
00:14:36proposing massive CDC funding cuts and the total elimination of some programs.
00:14:42Earlier this month, the House Appropriations Committee passed a partisan fiscal year 25
00:14:47labor HHS funding bill that includes a $1.8 billion cut in funding from last year for
00:14:53the CDC.
00:14:54And these short-sighted actions threaten the progress we're making to rebuild our nation's
00:14:59public health infrastructure.
00:15:01House Republicans support major cuts to programs that address firearm injuries, opiate overdose
00:15:06prevention, suicide prevention, tobacco prevention, and HIV prevention.
00:15:11Imagine that.
00:15:12Last year, more than 107,000 Americans died of a drug overdose.
00:15:16This is still a national crisis.
00:15:18And yet, House Republicans are looking to cut the opioid overdose prevention and surveillance
00:15:23program by $560 million below last year's funding levels.
00:15:28To me, that defies logic when we all recognize that this opioid crisis continues.
00:15:33And they also threaten boots-on-the-ground programs and local health departments in the
00:15:36communities that we all serve.
00:15:38So there's no doubt that we should always be looking for ways to strengthen our federal
00:15:42agencies.
00:15:43But unfortunately, House Republicans are continuing their attempts to hamstring CDC's ability
00:15:48to fulfill its mission.
00:15:49They failed to reauthorize the Pandemic All-Hazards Preparedness Act.
00:15:53They repeatedly misled the American people about the efficacy of vaccines.
00:15:58And now they're undermining the CDC with an 18 percent cut in funding.
00:16:02And if that's not bad enough, Republicans are pushing Trump's Project 2025, a blueprint
00:16:08for a potential second Trump administration that proposes eliminating the independence
00:16:14of agencies like CDC.
00:16:16Trump's Project 2025 is a plan to consolidate power in the White House and gut check imbalances
00:16:24to the harm of the American people.
00:16:25And Trump's Project 2025 would undermine public health preparedness and lead us vulnerable
00:16:30and unprepared for future public health emergencies.
00:16:33It's the way for the extreme right wing to take control of our Americans' lives and our
00:16:38freedoms.
00:16:39And it's not the path we should be taking.
00:16:41We should be looking to strengthen the CDC for the future, not weaken it.
00:16:44A robust investment in the CDC and its diverse array of programming is vital to America's
00:16:50health and well-being and our leadership position around the world.
00:16:53So I look forward to the testimony today.
00:16:56And I yield back, Mr. Chairman, the balance of my time.
00:16:59And I yield back.
00:17:00I'll now recognize all of our witnesses for today.
00:17:03Dr. Henry Walk, Director of the Office of Readiness and Response.
00:17:08Dr. Jennifer Layden, Director of the Office of Public Health, Data, Surveillance and Technology.
00:17:14Dr. Daniel Jernigan, Director, National Center for Emerging and Zoonotic Infectious Diseases.
00:17:21Dr. Karen Hacker, Director, National Center for Chronic Disease Prevention and Health
00:17:26Promotion.
00:17:27Dr. Dimitri Daskalakis, Director, National Center for Immunization and Respiratory Diseases.
00:17:34And Dr. Allison Arwoody, Director, National Center for Injury Prevention and Control.
00:17:40Dr. Walk, I first recognize you and recognize you for five minutes for your opening statement.
00:17:46Chairs Guthrie and McMorris, Rogers, Ranking Members Eshoo and Pallone, and distinguished
00:17:50members of the committee, it's an honor to appear before you today to discuss how CDC
00:17:55is protecting health and improving lives.
00:17:57I'm Henry Walk, the Director of CDC's Office of Readiness and Response.
00:18:01My colleagues and I are here to discuss CDC's three main priorities, improving readiness
00:18:06and response, improving mental health and preventing overdose and suicide, and supporting
00:18:11young families.
00:18:13To tackle this critical set of priorities that are foundational to all of our health,
00:18:17CDC needs sustained and increased resources and authorities from Congress to help improve
00:18:22CDC's core capabilities in data and analytics, laboratory capacity, a public health workforce
00:18:28that reflects the communities we serve, and domestic and global readiness and response.
00:18:33The mission of the Office of Readiness and Response is to lead and coordinate the agency's
00:18:37response to public health threats at home and abroad.
00:18:41To achieve this mission, we work to prepare CDC and the nation to respond to all public
00:18:45health threats.
00:18:46And once a public health threat is detected, to put our readiness and response capabilities
00:18:50into action at CDC alongside our state and public health partners.
00:18:54I'd like to highlight some specific ways that our work directly enhances CDC's core capabilities
00:19:00and ways we have changed to meet today's public health challenges.
00:19:04CDC is focused on making actionable data available for decision making at all levels of public
00:19:09health.
00:19:10The Office of Readiness and Response supports world-class data through the Response Ready
00:19:15Enterprise Data Integration Platform, otherwise known as REDI, a data modernization success
00:19:20story for how CDC can access, use, and share actionable public health data.
00:19:25REDI pulls data from a wide variety of sources together in one common operating picture and
00:19:30enables users at all levels of government, as well as academia and healthcare, to analyze,
00:19:35visualize, and share that data in real time during a public health response.
00:19:40The platform has fast-tracked data modernization improvements for programs and responses, allowing
00:19:45CDC to collect and analyze data at an unprecedented scale, turning data into action more quickly
00:19:50than ever before.
00:19:52Also housed within the Office of Readiness and Response is CDC's newly established Center
00:19:56for Forecasting and Outbreak Analytics, which generates forecasts and scenario models to
00:20:01extract as much information as possible from the data made available by REDI and other
00:20:05sources to deliver actionable information and guide decision makers as they take actions
00:20:10to protect their communities.
00:20:13Our new CDC Ready Responder Program ensures that our multidisciplinary workforce is trained
00:20:17before a public health event and are ready to respond when and where needed.
00:20:22My team in the Office of Readiness and Response is made up of incredibly dedicated individuals
00:20:27who work around the clock to protect your health.
00:20:30But we need the entire agency to be able to respond to any health threat that comes our
00:20:35way.
00:20:36We're currently managing four infectious disease responses that involve over 500 staff using
00:20:40this new system.
00:20:42This ability to surge staff and to respond faster than ever before represents a significant
00:20:46improvement over how CDC operated prior to COVID and is a key example of how CDC is breaking
00:20:52down silos, leveraging and surging our public health workforce, and prioritizing readiness
00:20:57and response.
00:20:59We're also working to enhance state, tribal, local, and territorial health departments'
00:21:02response capabilities and readiness through the Public Health Emergency Preparedness,
00:21:07or PHEP, program.
00:21:09The PHEP program is a critical source of funding, guidance, and technical assistance
00:21:12for public health departments nationwide.
00:21:15PHEP has the systems, the expertise, and the relationships to continue strengthening America's
00:21:20readiness to respond to the next public health crisis.
00:21:24Like much of CDC's funding to public health departments, PHEP makes up the majority of
00:21:28resources that states and localities have to prepare for emerging threats, and it's
00:21:32important to prioritize sustained and increased resources for this work.
00:21:37Finally, CDC is elevating response readiness science to improve how we evaluate our efforts
00:21:43and implementing strategic priorities that are central to U.S. government's efforts to
00:21:47maintain and strengthen biosafety and biosecurity practices in laboratories working with dangerous
00:21:52pathogens.
00:21:53CDC is working every day to achieve our priorities, but we know we can't do this alone.
00:21:58It will take continued collaboration with public health partners, other government agencies,
00:22:03and the private sector.
00:22:04Critically, we also need support from Congress.
00:22:07All of us want our family and friends to be protected from health threats.
00:22:11That's CDC's job, and we work every day to achieve that mission, but we can't be the
00:22:16national security asset you need without supporting core capabilities and having the tools to
00:22:21get people and data responding to health threats without delay.
00:22:24I look forward to speaking with you today on the ways that we can enhance our collaboration
00:22:28to protect health and improve lives, and I'm happy to answer your questions.
00:22:33Thank you for your testimony.
00:22:34I now recognize Dr. Layden for five minutes.
00:22:38Thank you.
00:22:39Chairs McMorris, Rogers, and Guthrie, ranking members Pallone and Eshoo, and distinguished
00:22:43members of the committee, it is an honor to appear before you today.
00:22:46My name is Jen Layden, and I serve as the director of CDC's Cross-Cutting Data Office,
00:22:51which was established first in 2023 as the agency's first office dedicated to leading
00:22:56a comprehensive public health data strategy and our modernization efforts across the nation's
00:23:01public health data systems.
00:23:03We've all witnessed the importance of timely information to protect our nation, for detecting
00:23:07novel threats, recognizing the early signs of an outbreak, and enabling timely and efficient
00:23:13actions that save lives.
00:23:15Thanks to Congress's investments in data modernization, we are achieving faster, more actionable data
00:23:21so that health and governmental officials at any level can make informed decisions for
00:23:26their communities.
00:23:28Strengthening the nation's readiness and response capacity is a CDC priority.
00:23:32And data modernization is at the heart of that work.
00:23:35Each outbreak underscores our need to strengthen and sustain capacity for early warning of
00:23:40disease threats in real-time situational awareness across all of our jurisdictions.
00:23:46CDC has a comprehensive agency and public health-wide vision in which essential data
00:23:51can be exchanged securely and quickly.
00:23:53We work with and support all programs at CDC, and importantly, partner with many partners,
00:23:59our health departments, health care, and the private sector.
00:24:03We have made tremendous progress in a very short amount of time.
00:24:06For example, we have seen exponential increases in the use of electronic case reporting nationwide,
00:24:11which allows public health authorities to receive critical information within seconds,
00:24:16a dramatic shift from the slow and burdensome manual reporting by fax, manual entry, and
00:24:22phone.
00:24:23And now, more than 38,000 health care facilities across all 50 states leverage this technology,
00:24:29up from only 187 facilities before the pandemic.
00:24:33This allows faster threat detection, swifter action, and saves time by eliminating the
00:24:37need to hand enter the data by our clinicians.
00:24:41Importantly, we are bringing this capacity to rural areas and tribal nations.
00:24:45Just this past year, we have increased the number of critical access hospitals with these
00:24:49capabilities by 78%.
00:24:52Pediatric data is one of our nation's earliest signals of potential health threats.
00:24:56Thanks to data modernization, public health now captures more than 87% of emergency room
00:25:01visits across our nation.
00:25:03This capability allowed us to quickly determine that the concerning signals of pediatric pneumonia
00:25:08that we observed abroad this winter were not being seen here in the US.
00:25:13Additionally, we are now releasing weekly provisional mortality data that used to take
00:25:18months to publish.
00:25:20This improves our nation's ability to detect concerning trends for all sorts of conditions,
00:25:24including opioid deaths and suicides.
00:25:27CDC, thanks to Congress, has invested heavily in data modernization across our jurisdictions,
00:25:33the front line of public health.
00:25:35Prior to joining CDC, I worked at the state and local level of public health.
00:25:39I have experienced the challenges of under-invested data systems, and now I am seeing the impact
00:25:45and positive value of these investments in data modernization.
00:25:49The core capability of data analytics is giving the nation the situational awareness that
00:25:54it needs.
00:25:55For example, jurisdictions can inform their communities now in real time of local trends
00:26:00like respiratory illnesses and toxic chemical exposures, and jurisdictions can more quickly
00:26:05understand maternal mortality trends and causes.
00:26:09Even with these successes, there remains much work to be done.
00:26:13When data exchange is working well, we can detect threats and quickly intervene rapidly.
00:26:18When data exchange is incomplete or slow, information gets missed, and our response
00:26:22is delayed, which means people get sick and more people die.
00:26:26Further progress depends on increase in sustained federal investments to our core capabilities,
00:26:32enabling our nation to have the needed technology to rapidly detect novel health threats, provide
00:26:36state-of-the-art situational awareness, and communicate public health information to our
00:26:41communities.
00:26:42Finally, technology alone cannot achieve this.
00:26:45CDC still relies on voluntary reporting across a fragmented public health data policy framework.
00:26:52Absent the ability to securely access timely and standardized data, we continue to risk
00:26:58delays in detecting novel threats.
00:27:00Outbreaks do not stop at jurisdictional lines.
00:27:03CDC needs updated authority to facilitate timely and standardized data so that our nation
00:27:08has the right data at the right time to respond to any threat.
00:27:12Thank you for this opportunity to share what we are doing to protect Americans' health
00:27:16and improve lives, and I look forward to the conversation.
00:27:18Chairman Lay yields.
00:27:21Now recognize Dr. Jernigan.
00:27:24Five minutes.
00:27:25Chairs McMorris, Rogers, and Guthrie, ranking members Pallone and Eshoo, distinguished members
00:27:31of the committee, it's an honor to appear before you today.
00:27:36My name is Dr. Dan Jernigan, and I serve as the director of the National Center for Emerging
00:27:41and Zoonotic Infectious Diseases at CDC.
00:27:44I'm honored to lead a team that works tirelessly to protect Americans from emerging infectious
00:27:49disease threats by preventing, detecting, and controlling diseases ranging from the
00:27:55common and routine, like foodborne and healthcare-associated infections, to the rare and fatal, like Ebola
00:28:02and anthrax.
00:28:04Americans are safer because CDC responds to infectious disease threats using our world-class
00:28:09laboratories, our data for action, and our scientific experts.
00:28:15Enhancing these core capabilities is my top priority.
00:28:19From Atlanta to Anchorage and in strategic locations around the globe, we prevent, identify,
00:28:25and investigate infectious diseases, drawing upon expertise on over 800 different pathogens
00:28:32that can cause illness and death, like bacteria, parasites like malaria, viruses, and fungi.
00:28:39We maintain expert laboratories, including a high-containment facility to safely perform
00:28:44cutting-edge work to combat and contain the highest-risk pathogens.
00:28:49Without these people and labs, we would not be able to develop more effective vaccines,
00:28:54therapeutics, and diagnostic tools.
00:28:59CDC has refocused our work toward innovative new approaches that have changed the way we
00:29:04do business, like monitoring different pathogens in wastewater, detecting infectious diseases
00:29:10at airports through the traveler-based genomic surveillance, and using advanced molecular
00:29:15detection at all state health departments for tracking pathogens and antibiotic resistance
00:29:20in healthcare settings.
00:29:22We're grateful for congressional support for these efforts, and these are all capabilities
00:29:27that Americans now expect of their public health system.
00:29:31If we don't invest in them, we will lose them.
00:29:35Importantly, we support all 50 state health departments through our Epidemiology and Laboratory
00:29:40Capacity Cooperative Agreement, or also known as ELC, which provides critical support at
00:29:46the state and local level for detecting and controlling infectious diseases in their communities.
00:29:52This funding essentially keeps the lights on for many state infectious disease programs.
00:29:58In 2024, ELC provided over $250 million to health departments for core infectious disease work.
00:30:07We live in a world that is becoming more crowded and connected.
00:30:11The worlds of people, animals, and agriculture are converging.
00:30:16This puts us at greater risk for infectious disease outbreaks.
00:30:20In an interconnected world, a person infected with a virus can travel from a forest in West
00:30:25Africa to a suburb in Dallas before any infectious disease symptoms appear.
00:30:31This is something that we absolutely saw firsthand in 2014 with Ebola.
00:30:37At CDC, we have learned a number of lessons over the last few years, and today you will
00:30:41hear how CDC needs strengthened investments in our cross-cutting, rapid-response capabilities
00:30:48to stay ready for future threats.
00:30:50For my center, this means funding approaches that are nimble and that can address many
00:30:55pathogens, such as emerging infectious diseases, advanced molecular detection, and antimicrobial resistance.
00:31:03We need to have the capability to use our resources to tackle any emerging threat before
00:31:09it becomes an outbreak.
00:31:12Recent years have made the threat of infectious diseases clearer than ever.
00:31:16Americans are relentlessly complex, and they don't respect borders.
00:31:21They constantly evolve, and they disproportionately burden the vulnerable.
00:31:26We can stay ahead of these threats and tackle them head-on, but we need your support for
00:31:30increased and sustained resources for core capabilities and new authorities identified
00:31:36through our lessons learned.
00:31:37So thank you for the opportunity to share the work my center is doing to save lives
00:31:41and protect Americans from health threats, and I look forward to your questions.
00:31:45Thank you for your testimony.
00:31:46I now recognize Dr. Hacker.
00:31:49Five minutes.
00:31:50Excuse me.
00:31:51Is it on?
00:31:52Chairs McMorris, Rogers, and Guthrie, Ranking Members Pallone and Hsu, and distinguished
00:32:00members of the committee, it's an honor to address you today on the work CDC does to
00:32:04protect health and improve lives, including by preventing the nation's leading causes
00:32:09of death.
00:32:10I'm Dr. Karen Hacker, Director of the National Center for Chronic Disease Prevention and
00:32:14Health Promotion, and I am privileged to lead this center full of dedicated experts
00:32:19that translate research into proven strategies that we can all use to prevent chronic health
00:32:24conditions.
00:32:25CDC has been working with communities to understand and prevent chronic diseases for over 60 years.
00:32:31These diseases cause devastating effects on our lives.
00:32:34Cancer, heart disease, and diabetes are the leading causes of death and disability in
00:32:39our country, and 6 out of 10 Americans are living with at least one chronic health condition,
00:32:45and they account for 90% of our country's $4.1 trillion annual health care costs.
00:32:51The successes of the Chronic Disease Center are evidenced every day when people receive
00:32:56timely preventive screenings and services to reduce maternal mortality or reduce disease
00:33:01risk factors like smoking, poor nutrition, or physical inactivity, and better manage
00:33:06conditions like diabetes, high blood pressure, and breast and cervical cancer.
00:33:12Every year, our center provides more than $800 million in support to your states and
00:33:16local communities.
00:33:17Our national programs in cancer, diabetes, heart disease, and smoking prevention have
00:33:22achieved enormous impact over the years at the national and state level.
00:33:26For example, beginning in 2010, CDC translated an NIH-proven intervention into a program
00:33:32that could be carried out at the community level.
00:33:35The National Diabetes Prevention Program became the first nationwide program proven
00:33:39to prevent or delay type 2 diabetes in adults through lifestyle changes, and program participants
00:33:45have reduced their risk by 58%.
00:33:49This is emblematic of CDC's role in making sure that investments in research are not
00:33:53left on a shelf but are reaching our loved ones in our communities and allowing them
00:33:58to live life to their fullest potential.
00:34:01Further, CDC's colorectal cancer program partners with clinics and screened nearly
00:34:06200,000 people for colorectal cancer in the last year.
00:34:10This was a 35% increase from the previous 12-month period, and we know that through
00:34:14screening we are saving lives.
00:34:17And finally, our Tips from Former Smokers campaign has helped 1 million U.S. adults
00:34:22who want to quit successfully quit smoking, saving an estimated $7.3 billion in smoke-related
00:34:29health care costs.
00:34:31And our Empower Vape-Free Youth campaign supports middle and high school educators with tools
00:34:36to talk about the risks of smoking e-cigarettes and nicotine addiction to help students avoid
00:34:41or quit vaping.
00:34:43These programs and CDC's work have made meaningful progress over the past few decades, but we
00:34:48also saw a backsliding as a result of the pandemic.
00:34:51We saw delays and gaps in screening and management of diabetes, hypertension, and other chronic
00:34:56conditions.
00:34:57We saw reductions in physical activity and challenges with healthy eating.
00:35:01And we saw the devastating impact the pandemic can have on our loved ones that suffer from
00:35:05chronic diseases.
00:35:07The Chronic Disease Center was a critical part of the pandemic response, working together
00:35:12with our infectious disease colleagues to identify that obesity and diabetes were strong
00:35:17risk factors for COVID and that COVID patients with severe hypertension were more at risk
00:35:21for hospitalization and 60-day mortality.
00:35:24And it's time to understand the breadth of these consequences and rededicate ourselves
00:35:28to funding and implementing prevention strategies.
00:35:31As part of America's public health agency, CDC's Chronic Disease Center is uniquely focused
00:35:37on preventing the top killers of Americans, a role which no other federal agency fulfills.
00:35:43Through CDC's core capabilities, we use data and workforce to identify disease risk factors,
00:35:48burden, and trends that help us target evidence-based interventions.
00:35:52And we translate academic research and make sure our communities receive the benefits
00:35:56of that research.
00:35:57Complementary to our clinical delivery system, CDC works with communities to implement these
00:36:02evidence-based programs on a population scale to reduce health care costs and save lives.
00:36:08So in closing, prevention is our strongest weapon against chronic diseases.
00:36:13And it not only saves health care costs, but it saves countless lives.
00:36:18But we can't do this work alone.
00:36:20Just as we work with partners across government, nonprofit, community-based organizations,
00:36:24we need help from Congress to continue to support sustained investments and authorizations
00:36:29that emphasize the importance of growing these programs.
00:36:32Thank you for the opportunity to testify, and I look forward to answering your questions.
00:36:37Thank you for your testimony.
00:36:38I now recognize Dr. Daskalakis for five minutes.
00:36:41Chairs McMorris, Rogers, and Guthrie, Vice Chair Bouchard, and ranking members Pallone
00:36:46and Eshoo, and distinguished members of the committee.
00:36:49It is an honor to appear before you today.
00:36:51My name is Dimitri Daskalakis, and I serve as the director of the National Center for
00:36:55Immunization and Respiratory Diseases, or NCIRD.
00:36:59NCIRD plays a critical part in CDC's priorities of strengthening the nation's readiness and
00:37:04response capacity and supporting young families.
00:37:08Our immunization and respiratory disease efforts are supported by dedicated experts who work
00:37:12every day to protect the health and improve the lives of Americans.
00:37:16I've had the privilege to lead this team for the past year, and we've accomplished
00:37:19a lot together.
00:37:20During the 2023-24 respiratory virus season, CDC developed and executed a coordinated response
00:37:27to address the viruses that most frequently cause disease, COVID-19, influenza, and RSV.
00:37:33A core lesson from the pandemic was to improve communication, and we knew that this season
00:37:38was a chance to show how we've improved.
00:37:40CDC provided clear, concise information for healthcare providers and the public to support
00:37:44informed decision-making to protect health and prevent severe illness.
00:37:49Core to this strategy was effective information sharing throughout the country.
00:37:53CDC traveled to communities and worked with trusted messengers to share the importance
00:37:57of immunizations against these viruses, and we created an easy-to-use dashboard where,
00:38:02for the first time, the public could see key indicators for COVID, flu, and RSV all in
00:38:08one place.
00:38:09Through continuous vaccine innovation, we were also able to expand the tools in our
00:38:14toolkit.
00:38:15In addition to new RSV vaccines to protect people over 60 years of age as well as infants,
00:38:20the 2023-24 season was the first time a monoclonal antibody was available to protect infants,
00:38:26young children, and their families from serious illness and hospitalization.
00:38:31CDC responded nimbly to operational challenges when the demand for the new monoclonal antibody
00:38:37was higher than expected.
00:38:39As a result, for the first time, we were able to protect over 40% of newborns from RSV.
00:38:45This antibody proved critically important.
00:38:47Data from last season showed that it was 90% effective in preventing RSV-associated hospitalization
00:38:54in babies.
00:38:56Underlying all of these efforts are CDC's advanced data systems that monitor disease
00:39:00trends and help inform effective public health responses to seasonal and novel outbreaks.
00:39:06These systems ensure timely and accurate information for both routine and emergent
00:39:11disease prevention efforts, strengthening our overall public health infrastructure and
00:39:15protecting our health security.
00:39:17CDC's current response to highly pathogenic avian influenza, also known as H5N1, showcases
00:39:24the importance of these systems.
00:39:26When cattle were infected with H5N1, we swiftly scaled up human disease monitoring, leveraging
00:39:31partnerships with federal, state, and local health departments.
00:39:35Since March 2024, over 1,500 people with exposure to infected cattle have been monitored.
00:39:40Since April 1st, there have been 10 confirmed human cases of H5N1 in people exposed to these
00:39:45infected cattle or poultry.
00:39:47CDC's seasonal influenza surveillance system has also tested more than 32,000 specimens
00:39:53at public health labs across the country since March, using a protocol that can detect this
00:39:58virus in the general population.
00:40:01If we are to continue this work, sustained increased investments in these core capabilities
00:40:06is essential.
00:40:07In addition to disease preparedness and response, we are also engaged in CDC's priority to support
00:40:12young families.
00:40:13This year, we celebrated the 30th anniversary of the Vaccines for Children, or VFC, program,
00:40:19one of the nation's most important public health achievements.
00:40:21VFC has ensured access to recommended life-saving vaccines at no cost for over half of U.S.
00:40:28children.
00:40:29VFC has prevented nearly 500 million illnesses, 1 million deaths, and saved over $2 trillion
00:40:35in societal costs.
00:40:37However, there are still gaps in vaccination coverage.
00:40:40The pandemic disrupted routine immunizations, leaving children and their communities at
00:40:44higher risk for preventable infections.
00:40:47Approximately 250,000 kindergartners are not adequately protected against vaccine-preventable
00:40:52diseases such as measles due to ongoing vaccine hesitancy.
00:40:56This hesitancy has had tangible effects.
00:40:58This year alone, we have identified 11 measles outbreaks and over 150 cases nationwide so
00:41:04far.
00:41:05While VFC has demonstrated its effectiveness in children, no similar program exists in
00:41:09adults.
00:41:10We have had to build adult vaccine programs from scratch during COVID-19 without a permanent
00:41:14Vaccine for Adults program.
00:41:16The next time there is a vaccine-preventable outbreak, we'll be back to square one.
00:41:20CDC is applying lessons learned and changing how we operate by improving our communication
00:41:24and timeliness of data, but we can't do this alone.
00:41:27I look forward to working with you all on bipartisan solutions to support core capabilities
00:41:31and provide the authorities we need to safeguard the American public from new and emerging
00:41:36pathogens.
00:41:37Thank you.
00:41:38Thank you for your testimony.
00:41:40Very much appreciated.
00:41:42Now recognize Dr. Arwady for five minutes.
00:41:47Chairs McMorris, Rogers, and Guthrie, ranking members, Pallone and Eshoo, distinguished
00:41:52members of the committee, it is an honor.
00:41:54My name is Dr. Allison Arwady, and I started as the new director of CDC's National Center
00:41:59for Injury Prevention and Control six months ago.
00:42:03The Injury Center leads all of CDC's efforts across the country to prevent overdose, suicide,
00:42:10adverse childhood experiences, violence across the lifespan, and unintentional injuries from
00:42:16drowning to traumatic brain injuries and older adult falls.
00:42:20I started my career working in public health infectious disease response as an internal
00:42:26medicine doctor and pediatrician.
00:42:28But in recent years, I've increasingly focused on the public health response to injury topics
00:42:33like our country's overdose and suicide crises.
00:42:36Why?
00:42:38Because these are the threats that now kill most Americans in the first half of life,
00:42:43and as such, our top priorities for CDC.
00:42:46Because these deaths are preventable using the same data-driven approaches that public
00:42:51health has used to fight infectious diseases over the last century.
00:42:56Because I love taking care of patients, but I believe we cannot treat our way out of these
00:43:00crises one patient at a time.
00:43:03We simply must invest in the data-driven prevention work of public health.
00:43:08As the nation's health protection agency, CDC protects health and improves lives.
00:43:14Adverse is the leading cause of death for Americans aged 18 to 44, and suicide is the
00:43:20second leading cause of death for Americans aged 10 to 34.
00:43:24In CDC's most recent national youth survey, one in 10 high school students reported that
00:43:30they had not just considered, but had attempted suicide.
00:43:34CDC's community-based, population-level approaches to these crises complement the more clinically-based
00:43:41individual treatment focus of other federal agencies.
00:43:46CDC's Injury Center brings unique and unparalleled data systems, scientific and technical expertise,
00:43:53and strong collaboration and funding to every state health department and hundreds of local
00:43:58coalitions and organizations.
00:44:00More than 80% of the Injury Center's appropriations and 84% of our opioid funding is invested
00:44:07right into state and local partners across the country.
00:44:11Our scientists track how threats are changing in near real time, because overdose threats
00:44:17can evolve as quickly as infectious disease pathogens.
00:44:21CDC labs distribute reference kits to ensure state laboratories can test for more than
00:44:261,400 emerging drug threats.
00:44:29In recent months, CDC-supported data systems and epidemiologists across the U.S. have detected
00:44:35newer threats, like the spread of xylosine, the reemergence of carfentanil, an analog
00:44:40even more dangerous than fentanyl, and the doubling of deaths linked to counterfeit pills.
00:44:46We then support public health departments and partners to use their local threat data
00:44:51to take action, ensuring the overdose-reversal agent naloxone is available where overdoses
00:44:57actually occur, seamlessly connecting individuals and family members to treatment and support
00:45:04after non-fatal overdoses or suicide attempts, and critically, preventing these threats in
00:45:10the first place, with a special focus on adolescents.
00:45:13Thanks to Congress, CDC invests hundreds of millions of dollars annually in 90 state and
00:45:19local health departments through our Overdose Data-to-Action Program.
00:45:24We invest tens of millions more per year to ensure states can rapidly track and respond
00:45:29to changing local patterns in suicidal behavior and other injuries, and we provide wraparound
00:45:34support and training for state and local public health departments.
00:45:38Early this year, the Injury Center has field-deployed expert teams seven times after states and
00:45:43tribes have requested extra assistance with acute local emergencies, like new surges and
00:45:49overdoses or suicide clusters.
00:45:51And there is hope.
00:45:52What we are doing is working, and we cannot stop that work now.
00:45:57Last year, overdose deaths decreased nationally by 3%, the first decline in years.
00:46:05Our suicide prevention funding recipients, focused on veterans, for example, saw a 5.8%
00:46:11suicide reduction in this critical population.
00:46:14The Injury Center has protected Americans for more than 30 years.
00:46:18By focusing on CDC's four core capabilities, data and analytics, lab capacity, public health
00:46:24workforce, and readiness and response, we continue to make progress and build trust.
00:46:29We must continue to collaborate across the federal government and communities.
00:46:33An American has died from an overdose in the five minutes that I have been talking,
00:46:38and an American dies by suicide every 11 minutes.
00:46:41With help from Congress through funding and authorities, CDC remains committed to using
00:46:45data to take action and save lives.
00:46:48Thank you.
00:46:49Thank you for your testimony.
00:46:50We will now begin questioning.
00:46:52I recognize myself for five minutes.
00:46:56I just want to say at the outset, immunization was mentioned.
00:47:00The Doc Caucus, including myself as a physician during the pandemic, led all kinds of efforts
00:47:05to promote vaccination by telling everyone to please talk to your doctor and individualize
00:47:13your medical case, why you should be vaccinated.
00:47:15I just want to say that because some people are mentioning that Republicans didn't support
00:47:20vaccination and I don't think that that was true.
00:47:23It was bipartisan, by the way.
00:47:25I appreciate that we all share a commitment to restoring our trust in the nation's public
00:47:29health agencies.
00:47:30The response to COVID-19 somewhat damaged that trust.
00:47:33I think politics intervened, unfortunately.
00:47:35I do want to say again, the CDC, in my view, is still the preeminent organization in the
00:47:39world for what they do.
00:47:40We now have to convince all of the American people that the CDC can rise to the occasion
00:47:45for the future.
00:47:46I believe we are on our way but have work to do.
00:47:51As we've discussed, the CDC was established as an agency to focus on communicable diseases,
00:47:55but not all of you have jobs that are clearly related to the mission of communicable diseases.
00:48:00I can appreciate that health threats have changed in the last 80 years and the mission
00:48:04has evolved over time, but it remains a fact that the CDC is the primary agency tasked
00:48:09with focusing on preventing the spread of communicable disease and I wonder if the agency
00:48:13has spread itself too thin.
00:48:14COVID-19 showed us that infectious diseases are still very much a present danger to society.
00:48:20I encourage CDC leadership to focus on performing its core mission very well rather than trying
00:48:27to do a lot of things adequately.
00:48:30Dr. Jernigan, I understand you served in the Epidemic Intelligence Service.
00:48:36For those who aren't familiar, the EIS is a program that currently operates a two-year
00:48:39fellowship at CDC.
00:48:41Its alumni have served as essential frontline workers in public health crises and communicable
00:48:46disease outbreaks.
00:48:47Currently, the average EIS class is around 60 to 64 graduates per year.
00:48:52To me, this seems like an underinvestment when there is a widely recognized shortage
00:48:56of well-trained, qualified public health professionals.
00:48:59Fortunately, in its moving forward report, CDC suggested reallocating some of its administrative
00:49:04and academic funds to training programs like EIS.
00:49:08With more positions, I would encourage CDC to provide more slots in state and local areas
00:49:12and focus on establishing relationships with non-federal frontline public health workers
00:49:17and give the CDC real insight into the problems faced by these groups on the ground.
00:49:21So Dr. Jernigan, what are your thoughts on expanding and or reorienting EIS in this way?
00:49:31Thanks very much.
00:49:32As an EIS officer, and a number of us actually here went through that program, it is an incredible
00:49:38program that really allows for there to be leadership at state health departments, leadership
00:49:43at CDC.
00:49:44We certainly support having that program completely supported so that it is able to provide those
00:49:53public health officials that are needed during crises and so totally support the Epidemic
00:49:58Intelligence Service and continued funding for it.
00:50:03Thank you.
00:50:04This question kind of came up by Dr. Deskalok as a testimony about measles.
00:50:12As you probably know, measles has not been an endemic in the United States for a long
00:50:16time.
00:50:17First, could you kind of describe what endemic means so everybody understands that?
00:50:23And are we at risk with vaccine reluctance in children to revisit measles being endemic
00:50:31in the United States of America?
00:50:33Thank you so much for that question.
00:50:35So endemic means ongoing and sustained transmission in the U.S. and we have elimination means
00:50:42that we do not have sustained transmission of measles in the United States.
00:50:47I think that the question is so relevant because we know measles vaccine is safe and effective.
00:50:54Two doses really prevents 95% protection from measles.
00:50:59We know that populations that are under vaccinated are really the populations that are at risk.
00:51:04So the work that we do at CDC and NCIRD to increase vaccine confidence, to remind people
00:51:09of the importance of childhood vaccination is life-saving and also prevents measles on
00:51:14our shores.
00:51:15Yeah, would you estimate around the world the number of deaths per year from measles
00:51:20childhood deaths?
00:51:22I don't have the...
00:51:23I mean, just an estimate.
00:51:24Yeah, I mean, it's on the order of thousands of deaths occur due to measles.
00:51:28And again, we are seeing, you know, we live in a global scenario and as we see measles
00:51:33increasing in other parts of the world, our best line of offense is really defense by
00:51:37making sure our population is adequately vaccinated.
00:51:40And again, the good news is that we aren't seeing anywhere close to what we saw in the
00:51:44pre-vaccine era, but we have had ongoing outbreaks, over 150 cases, and actually 57% of the cases
00:51:53in the last year were hospitalized.
00:51:55So again, emphasizing the importance of MMR vaccination and preventing this childhood
00:52:00illness.
00:52:01Yeah, thanks for that.
00:52:02And I think we have a serious concern about that around the country.
00:52:06I yield back.
00:52:07I now recognize the ranking member of the Health Subcommittee, Ms. Eshoo, for five minutes.
00:52:12Thank you very much.
00:52:13First, I want to compliment each one of you.
00:52:16You gave excellent testimony.
00:52:19And what I like best about each testimony is that anyone that's tuned into this hearing
00:52:29across the country could understand exactly what you do.
00:52:35And so this is, you've just done a terrific job.
00:52:40You know, both the acting chairman and myself have made mention of 80 years, the CDC.
00:52:50But I think that we need to appreciate what's happened over 80 years.
00:52:54I mean, the population of the United States 80 years ago, 1944, we had 138,400,000 population
00:53:06in the United States.
00:53:08Today we're a population of 333.3 million people in our country.
00:53:16So that's almost a triple the population.
00:53:20And with that tripling of a population and really being a global society today, I mean,
00:53:291944, most people really didn't travel anywhere.
00:53:32Now the whole world is crisscrossing the globe on a consistent basis.
00:53:37So the challenges have changed enormously.
00:53:40Dr. Arwadi, in the current funding bill, your center's funding is eliminated.
00:53:49Eliminated.
00:53:50That's pretty chilling after your testimony of what you do.
00:53:56And I especially appreciate your saying, and I did not know this, that overdose rates fell
00:54:05in 2023 for the first time in five years.
00:54:09So how is this, what's going to happen with the elimination of your center?
00:54:15It would be devastating for the work to prevent injuries and violence, including overdose
00:54:20and suicide, if this funding did not exist across the country.
00:54:24Is there any other place in the federal government under HHS where this is tended to?
00:54:32So we work across the federal government.
00:54:34A problem this big, like opioids, for example, requires multiple agencies.
00:54:40Our work at CDC is complementary.
00:54:42It is not duplicative.
00:54:44That CDC, for example, it is our data systems that actually let us know what Americans are
00:54:50overdosing from today.
00:54:52It's the systems that let us have the real-time data.
00:54:55It's the systems that let us know how that threat continues to evolve.
00:54:59And importantly, it's the work that funds the frontline public health response to this
00:55:03threat.
00:55:04I hope that on a quiet basis that my colleagues on the other side of the aisle will talk to
00:55:13some of their colleagues in their caucus about what they have recommended in their appropriation
00:55:19bill, because I think that this is devastating.
00:55:22This is an issue that on both sides of the aisle members have been deeply, deeply concerned
00:55:29about and have experienced in their congressional districts, the number of deaths from overdoses.
00:55:36Now, in public health, and it's the case, I think, especially with AI now, good data
00:55:44is gold.
00:55:46And good data helps to predict viral outbreaks, detect emerging trends and elicit drug use,
00:55:54track diseases and waste water.
00:55:57So to Dr. Layden, does the CDC have access to the health data it needs?
00:56:02And if not, what prevents the CDC from getting that data?
00:56:08How do we fix it?
00:56:09And another question, how do you respond to those who are concerned?
00:56:14I think all of us are always concerned about how the data is used properly.
00:56:22There are some, one of the concerns that's been raised by some members is how the CDC
00:56:28uses its data, and does it track people in their daily lives?
00:56:35Thanks for that important question.
00:56:38So a few things.
00:56:39One, CDC and public health has been underinvested for decades.
00:56:43This has led to delays and gaps in the data that we need for national situational awareness
00:56:48and early threat detection.
00:56:50We've seen the benefit and the impact thanks to data modernization and COVID-related funds
00:56:54over the last four years.
00:56:56Tremendous progress in a very short amount of time.
00:56:59But there's more work to be done.
00:57:00We need continue and increased funding to ensure that not just CDC, but public health
00:57:04broadly can modernize the systems.
00:57:07The systems at the state, local level are the ones that collect the data, act in the
00:57:11front line, and then send the data to CDC.
00:57:14So it goes from the local to you, not the other way around.
00:57:19So that continues to sustain funding with so much of our funds going out to the jurisdictions
00:57:23needed to ensure that we have these robust capabilities.
00:57:26We also need data authorities.
00:57:27We do rely on voluntary reporting that leads to a patchwork of the data that does come
00:57:32to CDC.
00:57:33So when we want and need national situational awareness and early threat detection, having
00:57:38that secure ability to receive that data so that we can act and support the nation and
00:57:44our communities is critical.
00:57:45Well, thank you again to each one of you.
00:57:47I'm going to submit written questions to you.
00:57:51And I think that each of you has done a terrific job today.
00:57:57I yield back, Mr. Chairman.
00:57:58Thank you for your patience.
00:57:59I yield back.
00:58:01Now recognize Dr. Dunn for five minutes.
00:58:07Thank you very much, Mr. Chairman.
00:58:10Thank you to the witnesses from CDC for appearing today.
00:58:13I appreciate the opportunity to examine how the CDC's priorities and their mission protect
00:58:18the health and safety of American people.
00:58:21The agency's response to the COVID-19 pandemic was undoubtedly exposed some failures and
00:58:27shortcomings at the CDC, and that damaged the confidence of the American people in public
00:58:32health systems.
00:58:33And that happened, by the way, worldwide.
00:58:35Surely a lot of that damage was caused by politics.
00:58:40But I think you can agree with me that public health should never be a politicized subject.
00:58:45I'm a doctor.
00:58:47As a former scientist at the Army Center of Biological Warfare, Chemical Warfare, I appreciate
00:58:53the important role CDC is charged with to effectively respond to threats involving communicable
00:59:00diseases.
00:59:01I'm concerned that the CDC has become vulnerable to pressures, to effective political pressures,
00:59:08to effectively focus on important emerging dangers.
00:59:13For example, the CDC, under the Environmental Public Health Tracking Network, operates something
00:59:20called the Environmental Justice Dashboard, which tracks factors like environmental quality,
00:59:27community design, and air quality.
00:59:30In my opinion, the program is at best duplicative with the EPA, and at worst, it's just a waste
00:59:36of resources.
00:59:38It's a little more than a distraction from the important work the CDC, I think, should
00:59:43be focusing on.
00:59:44I also have concerns with how the CDC coordinates with other government agencies in the instance
00:59:51of an epidemic or pandemic like we had.
00:59:54Agencies such as the FDA, ASPR at the HHS, NIH, and the White House, the Office of Preparedness
01:00:02that has been created.
01:00:05I don't know if we can ensure that all of these agencies have clearly defined roles
01:00:10and responsibilities.
01:00:13In November, I raised this concern with CDC Director Cohen, given the example of the illegal
01:00:19Chinese biolab discovered near Sacramento, California, and there was a lackluster response
01:00:26to that at best.
01:00:28They were putatively storing and experimenting with over 20 pathogens, including Ebola, HIV,
01:00:36SARS-CoV-2, and other dangerous diseases.
01:00:40I'm incredibly concerned that without clearly defined roles in the agencies, when we face
01:00:45our next public health emergency, our agencies will just end up pointing the finger at each
01:00:51other again.
01:00:53Dr. Wach, can you explain how the Office of Readiness and Response works with the other
01:01:00agencies to ensure that the federal government is able to meet the next public health emergency
01:01:06with a coordinated effort?
01:01:09Thank you for that question.
01:01:12CDC does work with a number of different agencies on every response, whether it's the White
01:01:17House or across the interagency with FEMA, with ASPR, and this current HPAI outbreak
01:01:23with USDA.
01:01:25So we have a very robust coordination for ASPR in particular.
01:01:30In particular, we have a complementary role.
01:01:33ASPR is focused on, for example, medical countermeasure with BARDA development, and then distribution
01:01:39through the SNS to state and locals.
01:01:43CDC, through its FEP cooperative agreement, actually is really focused on state and locals'
01:01:48capacity to take those medical countermeasures from warehouses, for example, and then get
01:01:53them into arms.
01:01:54And so they work on, our CDC works on capabilities actually within state and local institutions.
01:02:01So that's our unique role here with our-
01:02:03Let me just focus, if I can, just on the Ridley lab for a second.
01:02:07Who the heck should the sheriff have called when he found, when that thing was discovered?
01:02:12I remind you, it was discovered by a housing code inspector.
01:02:17And she talked to the sheriff, and the sheriff, he tried calling the FBI, the CDC, the FDA.
01:02:24He got no response from anybody.
01:02:26Who should he have called?
01:02:29Who's the right person to call for the next time that happens?
01:02:33Normally within that situation, the city of Ridley and the state public health department
01:02:39would be the first to respond.
01:02:40We provide-
01:02:42State health said, we're over our heads here.
01:02:45We need help.
01:02:46And they called the same people, FBI, CDC, everybody.
01:02:50Nobody came for months.
01:02:53They did call CDC.
01:02:54We talked with the California Department of Health.
01:02:57And at that time, the initial call was that they did not need help from our federal select
01:03:01agent program.
01:03:02We continued to converse with them, and then they requested assistance actually for an
01:03:07on-site investigation.
01:03:09We worked with the state and with the city of Ridley, actually, and sent a team and investigated
01:03:16that lab for about two and a half days to look for any dangerous-
01:03:20Who, because we're running out of time, who does the sheriff call next time?
01:03:24Because he didn't get a response this time.
01:03:26For months, I mean, people jabbering back and forth, but nobody showed up who actually
01:03:31has some wherewithal to take care of pathogens like that.
01:03:36Again, normally it would go through state and local government, but of course, our watch
01:03:40team and with the emergency operations center is on standby 24 hours a day.
01:03:45And certainly, we would take that call.
01:03:48Do you imagine that the states all have 50 little centers that can actually respond to
01:03:52something like that?
01:03:54A lab that's, you know, this is a BSL-4 level crisis.
01:03:59Again, we have in every state, actually, in the laboratory response network that actually
01:04:05have the ability, with the connection with CDC, to test for dangerous-
01:04:09Well, I've exceeded my time, but I'm going to submit this in writing, and I dearly want
01:04:13an answer.
01:04:14Who the heck gets called on this stuff?
01:04:16Because nobody responded from the federal government level to that state that was begging
01:04:21for help.
01:04:22And the state public health authorities were begging for help.
01:04:25The sheriff was begging.
01:04:28And it ended up the sheriff cleaning up the mess, which probably isn't a great idea.
01:04:32I yield back.
01:04:33The gentleman yields back.
01:04:34I recognize Dr. Ruiz.
01:04:35Five minutes.
01:04:36Thank you, Mr. Chairman.
01:04:37I would also like to thank the witnesses for being here today and for the important work
01:04:42you do to improve public health in our country.
01:04:46CDC plays a vital role in protecting Americans from both infectious diseases and chronic
01:04:50illnesses, and we see this in CDC's priorities.
01:04:54It's focused on tackling our nation's mental health crisis and the opioid epidemic.
01:04:58It's worked to improve maternal health outcomes and ensure children have access to life-saving
01:05:02vaccinations, and its efforts to bolster the nation's readiness and response capacity
01:05:07to protect against future health emergencies.
01:05:10These are all critical functions of the agency that Congress must continue to support.
01:05:15As ranking member of the Select Subcommittee on the Coronavirus Pandemic, I believe it
01:05:20is critical to ensure the strength of our nation's public health and infectious disease
01:05:25workforce, infrastructure, and data to safeguard public health and prevent future public health
01:05:31emergencies.
01:05:32Dr. Walke, can you share how your office supports states' and local health departments' readiness
01:05:38and response capacity?
01:05:40Yes.
01:05:42Thank you for that question.
01:05:43I want to say at the beginning that about 80 percent of our domestic CDC funding actually
01:05:47goes out to state and supports state and local public health.
01:05:51One of the ways that we support state and local health within my Office of Readiness
01:05:54and Response is through the Public Health Emergency Preparedness Program, which is the
01:05:58largest source of federal funding for public health emergency preparedness and actually
01:06:02CDC's largest domestic grant program.
01:06:05Recently, we awarded over $650 million in 2024 to about 62 recipients, which included
01:06:1150 states, four large localities, and eight U.S. territories and freely associated states.
01:06:18So the FEPP program got its start after 9-11, which demonstrated that public health departments
01:06:22lacked those critical systems for effective emergency response.
01:06:26And over the past two decades, FEPP investments have developed strong public health emergency
01:06:30preparedness programs, including emergency operations centers, this ability that I spoke
01:06:36about to deliver life-saving medical countermeasures, interventions to the public, shots into arms,
01:06:42and also nationwide laboratory and epidemiology surveillance systems.
01:06:47Again, or in addition, we really focused on the public health workforce, and that FEPP
01:06:54program supports almost 6,000 state and local employees through that for public health and
01:06:59for emergency response.
01:07:01So what are your priorities moving forward, and how can Congress help you with those?
01:07:07Again, thank you for that question.
01:07:09You know, we're really focused actually in my office on being able to detect an emerging
01:07:15threat, whether that threat's an infectious disease or an environmental threat as well,
01:07:20for example.
01:07:21And if we can detect that threat, then making sure that CDC and the nation actually can
01:07:26respond in a vigorous way.
01:07:28And one of the ways we do that actually is through supporting those core capabilities,
01:07:33and that's laboratory systems, that's the public health workforce, those are those data
01:07:38modernization systems that we talked about, and those emergency operations systems, the
01:07:42emergency management systems, both domestically and global.
01:07:45So most of the, a number of the threats to the U.S. actually start overseas or abroad,
01:07:51and so we have over 60 country offices spread around the world that are also working with
01:07:56countries to detect those threats and keep those threats from coming to America's shores.
01:08:03And so what can Congress do to help you achieve those priorities?
01:08:07Again, we need sustained funding in order to maintain those core capabilities.
01:08:12We made incredible strides during COVID, but we're at risk of not being able to sustain
01:08:19those data modernization improvements, for example, or the public health workforce that
01:08:23were hired during COVID that actually were not able to keep going.
01:08:28One of the big issues is that we have this supplemental funding, boom and bust funding,
01:08:32whether it was Ebola or whether it was Zika and now COVID.
01:08:35And so we make strides, we make two steps forward, and then we have to take several
01:08:39steps back when that funding goes away.
01:08:41So we need sustained funding for those core capabilities, and we need those authorities
01:08:45actually, whether it's with data or some workplace authorities, in order to do the
01:08:51mission that we're assigned to do.
01:08:52Thank you.
01:08:53I look forward to continuing to support the work you all do at CDC every day to promote
01:08:59the health and safety of the American people and ensure our nation is equipped to respond
01:09:04to public health emergencies in the future.
01:09:06So thank you, and I yield back my time.
01:09:09Gentleman yields back.
01:09:10Now recognize Mr. Latta from Ohio.
01:09:12Five minutes.
01:09:13Thank you, Mr. Chairman.
01:09:14Our nation continues to face existential threats from infections, viruses, and even
01:09:20poisoning from illicit and illegal narcotics.
01:09:23As we recently saw during the COVID-19 pandemic, how we address public health can drastically
01:09:29affect how we live and function in our daily lives.
01:09:33As we look past the COVID-19 pandemic to possible threats on the horizon, I'm concerned with
01:09:38the rise in antimicrobial resistance, AMR.
01:09:43It's crucial that the CDC takes action now to avoid potential catastrophic events.
01:09:49Data from the CDC shows that globally, one person contracts an antibiotic-resistant infection
01:09:56every 11 seconds and every 15 minutes someone dies, and an estimated 2.8 million Americans
01:10:01get antibiotic-resistant infections each year, leading to over 35,000 deaths.
01:10:08If no action beyond the current initiatives are taken, then given the global life expectancy,
01:10:13we'll fall by 1.8 years or the next decade due to AMR.
01:10:19Drug-resistant infections also create a substantial economic burden.
01:10:22The additional costs of treating resistant infections are estimated at $4.6 billion annually
01:10:28in the U.S. alone due to factors like extended hospital stays and more expensive medications.
01:10:35Studies show that only 30 to 50 percent of antibiotics are prescribed appropriately.
01:10:40Dr. Jernigan, what more can be done to strengthen antibiotic stewardship and how should we ensure
01:10:47that diagnostics are being fully utilized to improve the use of the last-line antibiotics?
01:10:54Thank you very much.
01:10:55And I think, as you point out, antimicrobial resistance is a huge problem.
01:10:59It is something that is affecting globally as well as here in the United States, and
01:11:04we do risk, at some point, not being able to have antibiotics to treat routine infections
01:11:09or those really life-threatening infections as well.
01:11:12The things that we're looking at, of course, working with BARDA and ASPR and with others
01:11:16to have better antimicrobial drugs, antifungal drugs, antibacterial drugs, et cetera.
01:11:21But those will take time.
01:11:23We may not even be able to find some of those, so we have to have other things that we're
01:11:26doing to make sure that we're preventing these antimicrobial-resistant infections.
01:11:31One of those is infection prevention and control, so making sure that hospitals have
01:11:35the right way that they know how to control and keep these infections within those facilities
01:11:41and keep transmission from happening there.
01:11:43Also, antimicrobial stewardship, so that we give guidance and we have staff that are in
01:11:49facilities that know exactly what to choose based on what the antibiotic resistance pattern
01:11:54is within that facility.
01:11:56Better diagnostics, like you mentioned, so that we can see where is that AMR coming up,
01:12:01where is it happening.
01:12:03For us, we are supporting state health departments and local health departments with funding
01:12:07so that they have those experts in IPC, infection prevention and control, and antimicrobial resistance,
01:12:13so that we're connecting healthcare and public health in a way that we have not done before,
01:12:18so that we're actually addressing that problem of emerging antimicrobial resistance.
01:12:22Thank you.
01:12:23Dr. Deskalakis, my district has the largest agricultural income-producing district in
01:12:30the state of Ohio, and I'm concerned about the impact AMR has on livestock.
01:12:35What is the CDC doing to address the impact of AMR and infectious diseases on livestock,
01:12:41particularly with the outbreak of avian flu and how it's contagion can spread?
01:12:46Though I'll leave the AMR issue to Dr. Jernigan, I can comment about the importance of the
01:12:52relationship between public health and agriculture in our response to highly pathogenic avian
01:12:57influenza.
01:12:58Those relationships really in that one health strategy that bridge public health and animal
01:13:04health, as Dr. Jernigan said in his testimony, are critical in being able to respond not
01:13:09only to sort of routine events, but also to events like highly pathogenic avian influenza.
01:13:14We have some great models in states where really that close interaction means that farmers
01:13:22are being monitored, farm workers are being monitored, and appropriate testing is happening
01:13:26to identify cases.
01:13:27I'll yield the floor over to Dan to speak specifically about AMR.
01:13:33In terms of the, in our center we have a one health office which actually looks at those
01:13:39issues that do cross agriculture, animals, and humans.
01:13:43Antimicrobial resistance is not just a human problem.
01:13:45We have to work very closely with our other federal agencies and with industry to make
01:13:49sure that antimicrobials that are used for agriculture or animals are not going to lead
01:13:54us down a path where we don't have those antimicrobials to treat infections in humans.
01:13:58Well, in my last 13, 14 seconds, real quickly, because again, when I look at my district
01:14:03and you see what's happened, I mean, we're talking about millions of birds having to
01:14:08be destroyed.
01:14:09We're seeing, you know, going into different types of other herds out there and also humans
01:14:13contracting.
01:14:14What do you see real quickly on the horizon, how we can combat this?
01:14:20In terms of combating antimicrobial resistance in that?
01:14:23Right.
01:14:24And especially when we're talking about on the avian flu.
01:14:26I think the best thing we can do, and I'll actually yield back to you, but I just think
01:14:30surveillance for those pathogens.
01:14:32Thank you very much.
01:14:33Go ahead and answer.
01:14:36Thanks for that question.
01:14:37So I think really sort of capitalizing on the one health strategy is really important.
01:14:43And so creating really good connections with farm workers, good connections with producers
01:14:49to make sure that as we identify animals, we also are closely aligned with public health
01:14:55to make sure that we're monitoring workers.
01:14:57I think we're collaborating very closely with our USDA colleagues who are providing really
01:15:01clear guidance in terms of strategies to address the on the ground events among animals.
01:15:07And again, our public health colleagues working closely to monitor the human health situation.
01:15:11Well, thank you very much.
01:15:12My time has expired.
01:15:13And I think that you're gentleman yields back, recognize Mr. Cardenas for five minutes.
01:15:19Thank you, Chairman Guthrie, and also Ranking Member Eshoo for holding this hearing to
01:15:22discuss the work of the Centers for Disease Control and Prevention.
01:15:26I also want to thank doctor, doctor, doctor, doctor, doctor, doctor for being here today
01:15:31and the work that you do on behalf of the American people every single day.
01:15:35I want to begin by highlighting that this month was the two year anniversary of the
01:15:40launch of the 9 and 8 Suicide and Crisis Lifeline, the national lifeline.
01:15:45The lifeline has helped millions of Americans and demonstrates a bipartisan interagency
01:15:50commitment to meeting the mental health needs of those we represent.
01:15:55Historic investments in the successful transition to the lifeline have gone directly to states,
01:15:59territories and tribes that have been diligently working to improve local response.
01:16:04Through these investments and improving capacity at at call centers, expanding mobile crisis
01:16:09response and developing stabilization facilities, we can continue the vital work needed to overcome
01:16:16the crisis.
01:16:17Despite the progress we've made in the these last two years, we continue to face immense
01:16:23challenges in addressing the mental health needs in our country.
01:16:26For example, a 2022 survey found that half of all adults nationwide had someone in their
01:16:33family that had experienced a severe mental health crisis.
01:16:38Over 13 million people reported seriously considering suicide and over 1.5 million reported
01:16:43suicide attempts.
01:16:45The American people are counting on us to continue working to provide crisis care in
01:16:50these moments of crucial need.
01:16:52It has been an honor to champion the 9 and 8 lifeline and the crisis care continuum throughout
01:16:57my time in Congress.
01:16:59Through this work, it has been continuously clear that we are only as strong as our ability
01:17:03to work together with our agency partners to address the nation's mental health crisis.
01:17:09As we look to address the full spectrum of care, this crisis demands a public health
01:17:14approach to suicide prevention and has proven critical to building, strengthening and meeting
01:17:21Americans where they are.
01:17:23Dr. Arwady, as we have heard cuts to your center will affect your ability to carry out
01:17:29these proven public health interventions.
01:17:32For example, CDC is co-leading the 2024 National Strategy for Suicide Prevention and Federal
01:17:39Action Plan, which commits to a comprehensive whole-of-society approach.
01:17:44So my question to you is, why is taking a public health-focused, comprehensive approach
01:17:48to suicide prevention important to our larger efforts to improve the mental health of all
01:17:54Americans?
01:17:55Thank you so much for that work and that question.
01:17:58As you say, a problem this big requires us to tackle it from all angles and the public
01:18:03health approach is really thinking upstream about how do we recognize that not everyone
01:18:09who may be thinking about suicide or even attempting suicide is connected to a mental
01:18:14health provider.
01:18:15The CDC funds, it's called the National Violent Death Reporting System in every single state
01:18:21and that's where we come to understand some of the risk factors related to suicide.
01:18:27So that's how we know which occupations, for example, may be at higher risk or what
01:18:31other patterns that we see.
01:18:33And from that data, we know that only about half of the people who tragically die by suicide
01:18:39have a diagnosed mental health condition.
01:18:42The other half, some have an undiagnosed mental health condition.
01:18:46But there are others who this is an impulsive decision after a job loss, a relationship
01:18:51loss, some other acute issue in people's lives.
01:18:55And it is so important as our comprehensive suicide prevention program that we fund in
01:19:01about half of the states right now works to make sure that we have folks outside of the
01:19:06medical system and before the crisis system who are trained to recognize the risks of
01:19:12suicide, to counsel folks, to get folks the skills that they need.
01:19:16So we're working with faith leaders.
01:19:17We're working with coaches.
01:19:19We're working with people who are not part of the medical system, but for a problem this
01:19:23big and this widespread, that may be the first individual that someone is talking
01:19:28to.
01:19:29So again, the work of public health in a prevention way, in an upstream way, really complements
01:19:34a lot of that crisis work and the individual treatment work that some other federal agencies
01:19:39focus on.
01:19:40Thank you, Doctor.
01:19:41It's all hands on deck approach, and prevention and intervention early on is key.
01:19:46Dr. Hacker and Dr. Arwady, could each of you briefly share how you are incorporating the
01:19:52improvement of mental health outcomes into the work of your respective centers?
01:20:00So hi.
01:20:01Thank you again for that question.
01:20:03At the Center for Chronic Disease, in particular, we've been very interested in youth mental
01:20:07health issues.
01:20:09We are the center that has the Youth Risk Behavior Surveillance System, which is really
01:20:12the preeminent system that looks at youth self-perception, and that's where we often
01:20:17get our data on youth concerns about suicide, about attempts to have suicide, things like
01:20:23that, which Dr. Arwady already spoke about.
01:20:26In addition, it's called the Division of Adolescent and School Health, has produced a toolkit
01:20:31for folks within education so that they have evidence-based practices to support young
01:20:36people within schools.
01:20:38We are also looking at mental health relevant to things like diabetes, for example.
01:20:42We know there is a real overplay between having a chronic disease and also having mental
01:20:48health issues.
01:20:49Thank you.
01:20:50My time has expired, Mr. Chairman.
01:20:51I'll yield back.
01:20:52The Chairman yields back.
01:20:53I recognize Mr. Bilirakis.
01:20:55Five minutes.
01:20:56Thank you, Doctor.
01:20:57I appreciate it very much.
01:20:58Dr. Layden, the CDC has received at least $1 billion in designated funding for its data
01:21:06modernization initiative.
01:21:09With limited accountability for where the funding has gone, how much has been utilized
01:21:14and for what purposes?
01:21:16The private sector has, again, simultaneously made tremendous strides in this space, but
01:21:22unfortunately we have heard that CDC has not been willing to engage and leverage private
01:21:28sector innovation.
01:21:30Why isn't the private sector being leveraged and better utilized, and what is the return
01:21:36on investment on the hundreds of millions of dollars we have invested in this particular
01:21:40space?
01:21:44Thanks for those questions.
01:21:45Dr. Layden, please.
01:21:46Thank you.
01:21:47Absolutely.
01:21:48Thanks for those questions.
01:21:49I'll start with the investments to data modernization.
01:21:51The first investment occurred in 2019 with $50 million.
01:21:55The progress we've made in data and analytics across not just CDC but at our jurisdictional
01:22:00levels is largely driven by COVID-related funds.
01:22:03Over the last four years, we've been able to provide $1 billion to our jurisdictional
01:22:10partners for data modernization.
01:22:12We've seen great and tremendous progress.
01:22:14We've seen examples of electronic case reporting, syndromic surveillance, vital statistics,
01:22:19cloud capabilities across our jurisdictions, and at the CDC that's allowing us to have
01:22:24the robust national situational awareness.
01:22:27To put it into context, over the last couple decades, $35 billion were provided to health
01:22:32care to modernize their health IT system.
01:22:35The amount of money that's gone to public health to modernize our system pals in comparison.
01:22:40Despite that, we've been able to make tremendous progress, and with continued and sustained
01:22:44funding, we will have the robust public health capabilities that our nation needs.
01:22:49To your question about the partnership with private partners, that is critical for the
01:22:53work that we do, and we have multiple examples.
01:22:56We're not just CDC, but our jurisdictional partners partner with private entities.
01:23:02For example, over the last year, as we stood up the Public Health Data Office, we've had
01:23:08numerous summits where we've brought in private partners, the local state jurisdictions, and
01:23:13CDC programs to all come together, talk about the needs that public health has, and create
01:23:18innovative solutions.
01:23:19Well, thank you.
01:23:21If you could provide a written, detailed account of how this funding is being used, again,
01:23:27to our office, we'd appreciate it very much, after the hearing, of course.
01:23:31Dr. Hacker, the joint testimony mentioned the diabetes prevention program, which has
01:23:38been proven successful in preventing or delaying the onset of type 2 diabetes.
01:23:44The DPP is currently running unauthorized, along with many other CDC programs, which
01:23:52causes us on the committee to be concerned about the agency's transparency and accountability
01:23:58for measures.
01:23:59With over 38 million Americans living with diabetes, including myself, and its complications
01:24:06being the eighth leading cause of death nationwide, it's clear there are significant needs amongst
01:24:13our constituencies.
01:24:15How is the CDC consolidating its efforts, and what metrics is it using to ensure the
01:24:22methods brought by the DPP are leveraged in state and local communities?
01:24:29Again, this is for Dr. Hacker.
01:24:31Thank you for that comment.
01:24:33So the DPP program is, I think, one of our finest examples of a program that CDC, where
01:24:40we used NIH data to develop a program that could be used at the state and local level.
01:24:45It is a national program, and we do fund all of the states to be able to implement the
01:24:49DPP program.
01:24:51Generally, we look to having community organizations that know folks within the community, they're
01:24:56well-connected to the clinical system.
01:24:58This is a program that has been highly affected, and it is really geared toward people who
01:25:04don't have diabetes yet, but may be at risk for developing diabetes.
01:25:09And what we know is that if you participate in this program, and we know that this year
01:25:13alone, there's something like 700,000 people who are actually participating in the program,
01:25:18that they can reduce their risk of diabetes, actually getting diabetes, by over 50%.
01:25:23And after we have followed up, because we do strong evaluation to determine whether
01:25:27or not these programs continue to work, with which populations, where, how to deliver them,
01:25:33what we've found is that even in looking back at these programs, people sustain those changes
01:25:38that they've made and don't get diabetes.
01:25:41So our space really is in the prevention of diabetes.
01:25:45Now, we are involved, to some extent, in the self-management of diabetes, and we do believe
01:25:50that there has not been enough focus on educating individuals with the disease on how best to
01:25:55manage themselves so that they don't end up with the terrible sequelae of the disease,
01:26:00such as kidney problems or eye problems, things like that.
01:26:05So while we look at our programs severely, we are really, really trying to make sure
01:26:10that what we are delivering, and we do this also with our colleagues at the Centers for
01:26:15Medicaid and Medicare, because this is a program which is reimbursable, and we are very intent
01:26:21on making sure that the folks who need this program, that they get the referrals from
01:26:26their clinical perspective, from their physicians, and that they actually engage in the program
01:26:30going forward.
01:26:31Thank you.
01:26:32My time has expired.
01:26:33The gentleman yields back.
01:26:34I recognize Dr. Joyce.
01:26:35Five minutes.
01:26:36Thank you, Mr. Chairman, for holding this hearing today, and to our panel for testifying.
01:26:44For the CDC to effectively execute its mission as a public health authority, the American
01:26:49people must trust that the information and the guidance coming from the agency is accurate,
01:26:56up to date, and based purely on the science of public health.
01:27:00As the directors, you must ensure that your center remains on mission and is transparent
01:27:07and responsive both to the American public as well as to Congress.
01:27:12As we examine the efforts of the CDC to rebuild their trust with the public, I want to delve
01:27:17into a few specific public health issues that fall within the scope of your centers.
01:27:22Dr. Arwoudi, recent studies by the CDC and NIH found that more than 50 million Americans
01:27:30suffer from chronic pain, back pain, shoulder pain, musculoskeletal disorders.
01:27:35The HHS Pain Management Best Practices Task Force has called for individualized, multimodal
01:27:42care, improved access to non-opioid therapies, and increased education on pain management
01:27:50best practices.
01:27:51Dr. Arwoudi, does the CDC support the task force recommendations, and did the CDC's updated
01:27:58opioid prescribing guidelines incorporate those recommendations?
01:28:03Thank you.
01:28:04So the experts who work on opioid prescribing at the CDC certainly work, again, across federal
01:28:10government, look at the data.
01:28:13And in the most recent update to the clinical guidelines for opioid prescribing, there was
01:28:18increased attention to making sure that folks' pain is being adequately addressed, including
01:28:24with alternate approaches.
01:28:27One in nine Americans is still being prescribed an opioid every year, so we have continued
01:28:32work to do there, but there has been and continues to need to be additional work to ensure that
01:28:37folks with chronic pain are getting the relief that they need at the same time.
01:28:41So the task force recommendations were included, incorporated with your recommendations as
01:28:47well?
01:28:48Is this interaction occurring?
01:28:50That's my question.
01:28:51So the experts who work on the clinical prescribing guidelines out from the CDC, again, are working
01:28:58across the federal government.
01:29:00I will be honest with you, this specific piece predates my start with the Injury Center.
01:29:05I can follow up on that.
01:29:07I would appreciate that follow-up.
01:29:08I think that we all recognize, particularly with your data, that one in nine Americans
01:29:12are still receiving opioids annually in the United States.
01:29:16I think this is an important issue that we can work together on.
01:29:19Continuing, Dr. Arwoudi, what educational tools has the CDC developed, and what are
01:29:25you doing to promote specifically non-opioid pain management options?
01:29:30So this has been a major area of focus.
01:29:34We host calls that are focused on clinician education across the U.S. that routinely
01:29:40bring in thousands of individuals.
01:29:43We have developed materials and multiple pieces of guidance, as well as ensuring that when
01:29:49prescribers, physicians, but others as well, professional societies are meeting, they have
01:29:55the updated guidance, which has continued to put an emphasis on ensuring that those
01:30:00with chronic pain are also getting the attention that's needed.
01:30:04So there's been a focus on education, and the most recent updated guidelines from 2022
01:30:08reflect more of that.
01:30:10And I appreciate that focus on education.
01:30:12Dr. Hacker, according to the CDC, approximately 2 million Americans have type 1 diabetes,
01:30:19which requires lifelong insulin.
01:30:21A simple blood test can detect a disease in its earliest stages.
01:30:26However, in those early stages, before insulin is required, those who test positive for associated
01:30:33autoantibodies can be monitored to help prevent diabetic ketoacidosis, and be referred to
01:30:38medical interventions early to delay that onset.
01:30:42I recently introduced HR 8698, the screen for Type 1 Diabetes Act, with my colleague,
01:30:49Dr. Kim Schrier.
01:30:51This bill would create a public awareness campaign through the CDC on the benefits of
01:30:57early detection.
01:30:58Dr. Hacker, how would this bill enhance the CDC's efforts to provide comprehensive information
01:31:04and support for early detection and management, especially for clinicians?
01:31:12I don't know if that's on.
01:31:14So while I cannot comment on pending legislation, I will say that I think the strategies around
01:31:20type 1 diabetes and early intervention really speaks to our center's focus, not only on
01:31:25preventing disease, but also on helping early intervention.
01:31:30Because as you said, diabetes type 1 is not known to be preventable at this point.
01:31:36But obviously, strong management with insulin and regularly monitored insulin levels can
01:31:43be extremely helpful in terms of preventing future problems.
01:31:46And those future problems, which you elicited earlier and talked about, the renal effects,
01:31:51the kidney effects, the ophthalmologic effect, the effect on the eye and early blindness,
01:31:57that is what this piece of legislation is working to do, to develop an ability to recognize
01:32:02type 1 diabetes early and to prevent those terrible sequelae that so many type 1 diabetics
01:32:08have to deal with.
01:32:09This is a piece of legislation, a bipartisan piece of legislation, that I think would answer
01:32:14some of the questions that you have raised to us.
01:32:16Mr. Chairman, my time has expired.
01:32:18I thank all of our witnesses for being present with us here today.
01:32:22And I yield back.
01:32:23The gentleman yields back to recognize Mr. Griffith.
01:32:25Five minutes.
01:32:26Is this microphone working?
01:32:27I don't understand.
01:32:28I'll shift.
01:32:29You'll have to shift, yeah.
01:32:30I don't know why you're...
01:32:39We do want to hear what you have to say.
01:32:42You're five minutes has expired.
01:33:08Recognize Mr. Griffith, five minutes.
01:33:09I am told we're working on redoing this committee and getting things fixed, or this committee
01:33:15room.
01:33:16Dr. Walke, during a recent COVID Select Committee hearing, Dr. Fauci attributed the six-foot
01:33:21social distancing rule entirely to the CDC.
01:33:24Four years later, it is still unclear who at the agency created that guidance.
01:33:29What process for development was like and how it was intended to evolve with new information?
01:33:35Did the CDC ever revisit and reassess the six-foot recommendation, and do you all still
01:33:39stand behind it?
01:33:40Yeah, thank you for the question.
01:33:42During COVID, we used a number of different strategies to try to prevent transmission,
01:33:46including testing, including ventilation, distancing, for example, and masking, of course,
01:33:54during that time.
01:33:55So we had some early flu data, for example, that showed the effectiveness of distancing,
01:34:04the actual scientific studies that would undermine that.
01:34:07But I'd have to get back to you with those scientific studies.
01:34:09All right, I would appreciate it if you would do that.
01:34:11Dr. Jernigan, I'm switching to bird flu.
01:34:13Does the CDC think that bird flu or avian flu is likely to become a human pandemic?
01:34:19You're going to defer?
01:34:22Well, that sits in Dr. Daskaloski's center.
01:34:25Thank you for that question.
01:34:26So CDC surveillance systems are key in being able to track seasonal influenza, as well
01:34:32as novel influenza strains that we watch closely for the potential for any change that would
01:34:37make us more concerned for human spread.
01:34:39We currently assess the risk to the general population to be low, but have ongoing concerns
01:34:44for people who have exposures, like those who are working with animals with known infection.
01:34:50We monitor infections, transmissions to humans, and the way the virus is evolving specifically
01:34:55to make sure that we don't see anything that makes us more concerned.
01:35:00Highly pathogenic avian influenza is a virus that we've been tracking, or H5N1, for 20
01:35:05years, and have had a high level of concern monitoring it very closely.
01:35:08And so our surveillance systems, the way they're overlapping, both our general surveillance
01:35:12system, as well as the specific work that's happening with farm workers, is really around
01:35:17the fact that we always have a level of concern that a novel flu could change, and that it
01:35:21could potentially result in more efficient human transmission.
01:35:25So translating that into English for the folks back home, maybe we don't think so, but we're
01:35:30keeping it out.
01:35:31We're watching it.
01:35:32There you go.
01:35:33That our main goal is to keep our fingers on the pulse.
01:35:36Now, let me go to my next line of questions, since I've got the expert now.
01:35:41A recent New York Times article reported that only about 60 people have been tested for
01:35:46avian flu, while over 157 herds in 13 states have been infected with this particular virus.
01:35:54Here's my concern.
01:35:57We're not testing asymptomatic people.
01:35:58I know that a lot of the farmers are concerned that people will think, oh my gosh, you know,
01:36:03this is a horrible thing.
01:36:05But I think if we get more information and more data points now, we may find that there's
01:36:11a lot of people who are getting the virus, they're asymptomatic, and studying the DNA
01:36:17of those people who are asymptomatic or have such mild cases that they aren't necessarily
01:36:22showing up in a doctor's office and getting tested would give us more data, should there
01:36:27be a mutation later that makes it more deadly or more contagious for humans, and we're not
01:36:32doing anything, as I understand it.
01:36:33Am I correct in that, that we're not looking for asymptomatic people who may work with
01:36:37the same herds that somebody who's gotten sick with, if they're not reporting symptoms,
01:36:41we're not testing them, right?
01:36:42Thanks for that question.
01:36:43Yeah.
01:36:44Actually, we have just released data around a study looking at individuals who are working
01:36:50closely with dairy cows in Michigan.
01:36:54So special thanks to Michigan Department of Health for the great collaboration.
01:36:58What we did there is we surveyed those individuals, learned what their exposures were on the farm,
01:37:04but then also drew blood to look for evidence of exposure to avian influenza in their blood.
01:37:09We tested 35 people in that situation, and none of them demonstrated evidence of avian
01:37:15influenza infection, really supporting the plan of testing individuals with symptoms.
01:37:21I'll also add our influenza systems that we have for seasonal flu have actually tested
01:37:2732,000 people since March using an algorithm that would detect H5N1 in the general population.
01:37:35So we have this targeted testing based on exposure, and then this sort of seasonal surveillance
01:37:39that also looks for these-
01:37:41In the seasonal surveillance, are you seeing any upticks in particular regions?
01:37:46Great question.
01:37:47So we have a lot of overlapping systems.
01:37:48We look at syndromic surveillance.
01:37:50So what's happening in the emergency departments, we look at percent positivity of testing,
01:37:54and looking across those, we see nothing that is a signal beyond what we would expect this
01:37:58time of year.
01:37:59And the reason that I ask is because I'm particularly focused on the avian flu.
01:38:04We had that one death, I believe, in Mexico, and I'm just trying to make sure that we're
01:38:07not seeing, like we did with COVID, that there's a regional variation that suddenly explodes,
01:38:13and the more we can do, the better.
01:38:14It sounds like you're working on it, and I appreciate that, and I yield back, Mr. Chairman.
01:38:17Thank you.
01:38:18The gentleman yields back.
01:38:19I recognize Mr. Crenshaw.
01:38:20Five minutes.
01:38:21Thank you, Mr. Chairman.
01:38:22So I want to focus on the CDC's role, and the notion that it's doing- trying to do too
01:38:48much.
01:38:49I brought this up with the CDC director at our last hearing on the subject, and if you
01:38:54try to do too much, you end up really doing nothing.
01:38:57I'm not the only one who thinks this.
01:38:59Former FDA Commissioner Scott Golley is calling for a smaller, targeted agency.
01:39:05President Obama's CDC director, Tom Friedman, calling for a culture focused less on publishing
01:39:10academic papers and more on nimble action.
01:39:12That makes a lot of sense to most Americans.
01:39:14I think they view the CDC as the people who go out and quickly address a communicable
01:39:22disease that is new and novel and dangerous.
01:39:25I think that's what Americans think, right?
01:39:28It's supposed to be an operational organization.
01:39:30That's certainly what I believe it should be.
01:39:34And yet, there's massive overlap.
01:39:37The GAO study continues- since 2010, they've been mandated by Congress to annually report
01:39:43on federal activity duplication.
01:39:46To name a few in the CDC, I mean, the substance abuse elements of the CDC mirror the Substance
01:39:51Abuse and Mental Health Services Administration, so there's a whole administration for that.
01:39:55We have to really ask, why is the CDC doing that?
01:39:59Chronic disease programs in the CDC parallel similar institutes at the Centers- National
01:40:04Institutes of Health.
01:40:06Why?
01:40:07What extra benefit is there?
01:40:10We have to be asking those questions and asking about resource allocation.
01:40:14I'd rather the CDC is really good at getting into the field and doing what needs to be
01:40:18done to stop a communicable disease.
01:40:22It gets worse than that, because then the CDC is also publishing things like the Health
01:40:27Equity Guideline Principles for Inclusive Communication, saying drug users shouldn't
01:40:31be called drug users.
01:40:33They should be called people who inject drugs.
01:40:36Person who relapsed shouldn't be called that.
01:40:37They should be a person who returns to use- can't call somebody a smoker, got to call
01:40:42them people who smoke.
01:40:46That's weird.
01:40:47Also, why is anyone spending time on this?
01:40:49Why is anyone at the CDC spending time on speech codes?
01:40:52That forces the public to lose trust in a very important organization.
01:40:59It keeps going.
01:41:00I mean, there's another document called, Racism is a Serious Threat to the Public's
01:41:07Health.
01:41:08I mean, nobody likes racism, but again, is it a communicable disease?
01:41:14And how so?
01:41:15And if there's structural racism, is there a specific structure that the CDC has targeted
01:41:22to stop racism?
01:41:25Anybody?
01:41:27I can't imagine there is.
01:41:29I'm not really sure it's your job.
01:41:30There's been a lot of calls for the CDC to investigate gun violence.
01:41:36I'll tell you what, there's already an agency that does that full-time.
01:41:39It's called the police.
01:41:41They investigate crimes.
01:41:43They stop gun violence.
01:41:45There's this really crazy data out there, and it goes like this, when there's more police
01:41:49doing their jobs, there's less crime.
01:41:52When there's less police, when they get defunded, there's more crime.
01:41:55I did all your research for you, it's done.
01:41:57It's that simple, because we have common sense.
01:42:00There are things the CDC needs to be doing, and so I want to end on a positive note.
01:42:05One thing I do like that the CDC has talked about is investigating fentanyl wastewater.
01:42:13Now that's the kind of thing we should be doing.
01:42:16That's in the field, and it's actually focusing on a problem that Americans have, and with
01:42:21that kind of data, you could focus on problem areas that are dealing with fentanyl.
01:42:26Love that.
01:42:28I'll end with that question.
01:42:30I suppose it's for Dr. Layden.
01:42:31Do you have any updates on CDC's inquiry into this area of research, and whether you can
01:42:36do a pilot project testing it in key areas?
01:42:39Thanks for the question.
01:42:40I'm going to actually yield to my colleagues, Alice, Dr. Arbody.
01:42:46The Injury Center, a lot of our work related to substance use is about field-driven response,
01:42:52and actually there have been more.
01:42:54They're called epi-aids.
01:42:55When states or locals are requesting need help on the ground for an urgent public health
01:43:00threat, there have actually been more from the Injury Center than from any of the rest
01:43:03of CDC in the first six months of the year.
01:43:06We've had seven of those responses.
01:43:08One of those was related to looking to understand more about using wastewater to better understand
01:43:15how to respond to the opioid crisis.
01:43:17I will tell you it is a space that we are still very much learning in.
01:43:21We don't have the ability at this point, for example, to differentiate between prescribed
01:43:26opioids or illicit opioids.
01:43:29It's really important, though, that the work of the data work related to substance use.
01:43:34That's interesting.
01:43:35But you can specifically detect fentanyl versus OxyContin.
01:43:39Is that accurate?
01:43:40Yes.
01:43:41Say fentanyl is used appropriately in a hospital situation, that can't be differentiated.
01:43:47Understood, yeah.
01:43:48So you can at least create hotspots of where there's higher use of fentanyl in the wastewater,
01:43:53right?
01:43:54Whether it's legal or illegal.
01:43:55So this is exactly what we're looking into, and we've sent teams in the last few months
01:43:59out into communities that are exploring this.
01:44:01It's early technology, but I appreciate your point of needing to make sure that we have
01:44:06the data to understand this problem, and it is the CDC and the Injury Center where the
01:44:12data work to understand the overdose problem lives, and that's part of why CDC is focused
01:44:18on this.
01:44:19I appreciate that.
01:44:20I bring it up as one of the things the CDC should be doing, unlike a lot of the other
01:44:25things I've mentioned.
01:44:26So I appreciate that, and I yield back.
01:44:28Gentleman yields back, recognized Dr. Schreier, five minutes.
01:44:40Thank you, Mr. Chairman.
01:44:43And thank you to all the witnesses for convening here and being squished at that table today
01:44:48to discuss all of the emerging issues facing your respective Centers of Disease and Control
01:44:55and Prevention Centers and specific offices.
01:44:58I wanted to start just by thanking Dr. Arwady for being here today.
01:45:02She's a fellow pediatrician, leads the CDC's National Center for Injury Prevention and
01:45:08Control, which collects data and funds research at nine injury control centers across the
01:45:13country, including the University of Washington in my state, close to my district at Harborview.
01:45:21Accidental injuries are the leading cause of death among children, including vehicle
01:45:25safety and drowning and gun injuries.
01:45:29And so ensuring fiscal year 25 funding continues for this particular research is critical.
01:45:38My question is going to go to Dr. Dimitri Daskalakis.
01:45:44Last week, CDC confirmed the first H5N1 influenza infections in poultry workers.
01:45:50It's in addition to the dairy farmers since 2022.
01:45:54This particularly or could be particularly important in my district where the Wilcox
01:45:58eggs that we all purchase at Costco come from if they were ever to be hit by avian
01:46:03flu.
01:46:05So my question to you is, while the CDC still believes that the risk to humans is low, what
01:46:15would prompt a change in that assessment?
01:46:19How would any change be communicated to the public?
01:46:24And then if there were human-to-human transmission, because I'm remembering this from when my
01:46:29child was a baby, how close are we to developing, scaling up production of, and distributing
01:46:38a new H5N1 vaccine that could prevent transmission of this variant?
01:46:43Thank you so much for that question.
01:46:45So I'll start by just highlighting how important our core capabilities at CDC are to allow
01:46:50me to actually answer that question.
01:46:52So the work that we do in the laboratory and the data analytics really allows us to
01:46:56have visibility into what's happening with this virus and how it's interacting with human
01:47:01health.
01:47:02So we work very closely with our USDA colleagues, but we have both systems through our local
01:47:07health departments to monitor individuals who have been exposed to this infection, and
01:47:12then also through our laboratories to identify any changes that we see in the virus.
01:47:17So that place where epidemiology touches the lab ends up being a critical piece of
01:47:22the core capabilities that we use.
01:47:25We have these overlapping systems so that we can monitor what's happening with that
01:47:29virus, but it's also the system that we use to look at seasonal flu and what actually
01:47:34leads to the second part of your question.
01:47:36So our seasonal influenza surveillance is what allows us to identify what's circulating
01:47:41in the community, and that also tells us how to better develop seasonal vaccines, but also
01:47:47how to develop vaccines for more urgent or emergent pathogens.
01:47:50So as an example, there are two candidate vaccine viruses that exist today because of
01:47:55this system that allow us to have them available in the event that we do need to scale up.
01:48:02This is also a great point of collaboration with agencies.
01:48:05So we work really closely with our ASPR colleagues who really are focused on the development
01:48:10and the next steps in preparedness to be able to have vaccine available in the event that
01:48:16we see any changes in the epidemiology or virology related to that flu.
01:48:22So again, all of those systems come together.
01:48:25We are in a preparedness stance and really moving toward, again, better understanding
01:48:30what's happening in that important view.
01:48:33I just have to interrupt you for a sec because I want to get to my next question, but just
01:48:36for the record, if you could submit in writing, first of all, how do you detect that if we
01:48:40only screen for flu during flu season, and this might not be seasonal, and second, whether
01:48:45you think the mRNA vaccine or the model vaccines we already have would be the jumping off point.
01:48:50That could be in writing.
01:48:51I want to just get in a quick question to Dr. Hacker about cigarette smoking and tobacco
01:48:57exposure.
01:48:58So cigarette smoking itself has trended down among our nation's teenagers, however, nearly
01:49:02one in four high schoolers still use tobacco products.
01:49:07As a pediatrician, I'm really concerned about the widespread use of e-cigarettes, which
01:49:12hook them and then later turn them into cigarette smokers, perhaps, and then vaping products
01:49:16because we don't know what is in that liquid and how that could hurt the lungs, and these
01:49:21have flooded our schools and, of course, gotten kids re-hooked on nicotine.
01:49:26I was wondering if you could comment about that in 10 seconds, the work you're doing
01:49:34and what we can expect, and you can do that in writing.
01:49:37Absolutely.
01:49:38I always share your concern, and we track this very carefully with our tobacco survey
01:49:45that we do annually, and we work very closely with FDA as well.
01:49:49We now have a campaign to empower youth to quit smoking or to stop from the beginning
01:49:56and never to start, to really give out the information that I think is so critical to
01:50:01being able to make sure people understand exactly the kinds of things that you raised.
01:50:05Thank you.
01:50:06I'm talking with my son about that.
01:50:07Thank you, Mike.
01:50:08General Lay yields back.
01:50:11I recognize the chair of the full committee, Ms. Rogers, five minutes.
01:50:20Thank you, Mr. Chairman.
01:50:24I wanted to change the topic to bird flu.
01:50:26I've been in touch with my local public health workers on the ground, and it's their impression
01:50:30that CDC is asking them to significantly expand their current operations in terms of testing,
01:50:35surveillance, and prevention programs, including wastewater surveillance work and seasonal
01:50:41worker vaccine programs.
01:50:43Dr. Daskaloskis, can you provide more details as to what exactly you're requesting of local
01:50:51partners in their response to the recent bird flu outbreaks and specify which of these requests
01:50:56are mandatory versus voluntary?
01:50:59Thank you so much for the question.
01:51:02Our relationship with our local health departments is critical in terms of the work that happens
01:51:07on the ground.
01:51:08A lot of the work that the health departments are doing are in line with the work that they
01:51:12do for seasonal influenza and preparedness for any events such as bird flu or H5N1.
01:51:20We've requested that they work closely with their agriculture colleagues, that we work
01:51:24closely with them in terms of the data that we receive from the jurisdiction, both on
01:51:28testing percent positivity as well as syndromic to be able to monitor any sort of changes
01:51:35in what we're seeing with human disease.
01:51:38We have also asked them to continue seasonal flu laboratory surveillance into the summer
01:51:45so that we can make sure that our surveillance system identifies any circulating H5N1 that
01:51:51may be seen in the population.
01:51:52Additionally, we are collaborating with them, and I'll defer to Dr. Jernigan on wastewater,
01:51:58but on work to expand wastewater so we have a better view of what's happening on the ground.
01:52:04We already are working with influenza A in the wastewater, which is the sort of more
01:52:08general virus family that H5N1 is a part of, and are really working to scale that up with
01:52:13them as well.
01:52:14Okay.
01:52:15Before you answer, would you just also speak to what authority CDC is relying on to mandate
01:52:21states and localities comply, and are you conditioning funding on compliance with CDC
01:52:26requests?
01:52:28Thank you for that question.
01:52:29We really work with our state and local health departments as close partners, and the majority
01:52:33of the work that we do with them are through cooperative agreements, so we really provide
01:52:37that as the subject matter expertise and then work with them to identify ways to implement
01:52:44programs on the ground that work best for them and their jurisdiction.
01:52:47Okay.
01:52:48Thank you.
01:52:49Did you want to add anything?
01:52:51Just briefly, I think wastewater surveillance is something that through the last four years
01:52:55we've really seen the incredible use of it.
01:52:57It is cross-cutting.
01:52:58It allows us to look at any pathogen.
01:53:00It makes us able to ready to respond.
01:53:04It is all supported with supplemental funding.
01:53:06Right now there is not a budget for it, and so although we've seen incredible gains, incredible
01:53:10use of it across different pathogens for different reasons, it will go away without any additional
01:53:15funding.
01:53:16Okay.
01:53:17Thank you.
01:53:18Dr. Awadi, I have some serious concerns with CDC guidances being used politically or politically
01:53:25influenced and motivated.
01:53:26I've read a bit about your experience as a Chicago Public Health Commissioner and was
01:53:31concerned to hear how you were treated.
01:53:33It's my understanding that you were fired from your role for trying to open schools
01:53:37for our kids, and I especially enjoyed the anecdote of you locking out virtual classrooms
01:53:42to try and force teachers back into in-person learning.
01:53:47So tell me, what prevented you from opening schools earlier?
01:53:50I know that it still took Chicago over 500 days to open schools.
01:53:54Not until August of 2021, and we're still seeing negative impacts these school closures
01:53:59had on kids.
01:54:00So were you pressured by the teachers union to keep schools closed?
01:54:04And without this influence, what have you recommended schools opening earlier?
01:54:08So I remain incredibly proud of my team in Chicago and the work that we did during the
01:54:14pandemic.
01:54:15I will note that school decisions, as you know, tend to be made at state and then supplemented
01:54:23at local levels.
01:54:24My role leading the Chicago Department of Public Health through the pandemic was to
01:54:28provide the evidence.
01:54:30And that is what we stuck to.
01:54:31We shared when we had, for example, in Chicago, we had the largest private school system in
01:54:38the country was operating with a lot of special protections in place.
01:54:45And our public school system had elected not to return yet in person.
01:54:49We worked closely.
01:54:51We heard concerns, for example, that Chicago teachers union members had not had the chance
01:54:55to be vaccinated.
01:54:57And so as soon as there was an opportunity to vaccinate, we prioritize teachers and others
01:55:02who worked in schools for vaccination, and then worked together to bring kids back into
01:55:08the learning environment.
01:55:09Okay.
01:55:10I have some more questions on that.
01:55:11But I also want to get one more question in for everyone, because we sit here as members
01:55:14of Congress in control of the purse strings.
01:55:17And yet I'll be the first to admit the disease and program specific directed funding through
01:55:21the appropriations process has, in my opinion, gotten completely out of control, especially
01:55:27for an agency that remains unauthorized, the CDC.
01:55:31For example, in fiscal year 1990, the appropriations report contains specific funding levels for
01:55:3618 CDC related programs.
01:55:38And FY 23, it included more than 140 line items.
01:55:43So it makes it very difficult to see where the funding is going.
01:55:46So I do want to follow up in writing with a question for each one of you.
01:55:50I want to know, how much funding does your center or office control?
01:55:54How much of this goes towards grant or support external activities versus supporting internal
01:55:59CDC research and work?
01:56:01How many staff does your center or office employ?
01:56:03And how many of your staff could be immediately deployed in a crisis?
01:56:07And I know we have limited time today.
01:56:08So you can get me those numbers in writing later.
01:56:11And I appreciate you all being here.
01:56:12I yield back.
01:56:13I yield back.
01:56:14I now recognize Ms. Berrigan for five minutes.
01:56:18Thank you, Mr. Chairman.
01:56:19Since we're talking about schools and COVID and money, I just want to remind the American
01:56:23people it was actually Democrats who provided more than $122 billion in funding to ensure
01:56:30K-12 schools could open safely after COVID, and not a single Republican voted for it.
01:56:38So I just wanted to put that on the record.
01:56:40I want to thank all our witnesses for being here today and for the work that your centers
01:56:44do.
01:56:45The Centers for Disease Control and Prevention, or the CDC, has played a critical role to
01:56:50protect our nation's health from both infectious and chronic diseases since the 1950s.
01:56:56Dr. Jernigan, I want to start with you.
01:57:01I want to ask you about a program at the CDC that's the Climate and Health Program.
01:57:09Republicans have proposed to eliminate funds for the Climate and Health Program.
01:57:14It's a $10 million cut below the 2024 level and a $20 million below the 2025 request.
01:57:23Now California has faced public health impacts from wildfire smoke and extreme heat driven
01:57:29by the climate crisis, and we've seen similar environmental hazards harms to communities
01:57:34across the country.
01:57:36Can you speak to how these environmental threats, whether it be wildfire smoke, extreme
01:57:41heat or floods, affect public health and worsen the spread of infectious diseases?
01:57:48Thanks very much.
01:57:49And with regard to the specific program, Dr. Bernstein in the National Center for Environmental
01:57:53Health, who's not with us today, would be the best to respond to that specific question.
01:57:59But, you know, CDC is a health protection agency.
01:58:03And for me, in addressing emerging zoonotic infectious diseases, I take into account multiple
01:58:09factors that contribute to the infectious disease threats that Americans face.
01:58:13The impact of weather is one of those factors.
01:58:17Flooding, loss of power from storms, elevated temperatures, these and other factors all
01:58:22contribute to infectious disease transmission, and we in our center are really looking at
01:58:26those consequences of climate.
01:58:29We're seeing that warmer and wetter conditions really support mosquito and tick breeding.
01:58:35That increases the chances for Americans to be infected with dengue, with West Nile virus,
01:58:41with Lyme disease and other things.
01:58:44We also see increases in harmful algal blooms in waters in multiple states in the United
01:58:50States, and then also problems with certain kinds of bacteria that grow in warmer waters
01:58:54as well that might affect shellfish.
01:58:57So all of those things are factors that we look into as the world really is more crowded,
01:59:02it's more connected, the animals and humans' worlds are converging, and climate is one
01:59:07of those components that's helping to see some of those infectious diseases increase.
01:59:11So you talked a little about some of these, what to look for and some of the things that
01:59:15are happening.
01:59:16Can you talk a little about some of the ways that the CDC supports states to combat the
01:59:20rise of infectious disease in unstable climates?
01:59:23Yes, so just to speak to what we in our center do, we have a longstanding support for vector
01:59:31control.
01:59:32Those dollars, about $26 million, go out through the Epidemiology and Laboratory Capacity Cooperative
01:59:38Agreement to state health departments where it helps them to be able to detect, to pick
01:59:43up insects, find out which ones they are and see if they're carrying these particular viruses
01:59:47like dengue and West Nile virus.
01:59:49That's how we're monitoring what's happening with the increasing numbers of dengue in the
01:59:53U.S. right now.
01:59:54Great.
01:59:55Thank you.
01:59:56Dr. Laden, I have a question for you.
01:59:57The Center for Forecasting and Analytics, or CFA, conducts advanced statistical modeling
02:00:02analysis for the CDC with a focus on infectious diseases such as COVID-19 and monkeypox.
02:00:10Republicans' budget proposes to eliminate funds for CFA.
02:00:15Can you tell us, if CFA was defunded, could you speak to how this would impact local health
02:00:20departments' ability to forecast and respond to disease outbreaks?
02:00:24I'm going to turn to my colleague, Dr. Wach, because the CFA actually reports to him.
02:00:30Thank you for the question.
02:00:31So CFA is the only U.S. government entity with the primary mission of providing infectious
02:00:35disease forecasts during a response.
02:00:38And since its establishment in 2022, it's been instrumental in advancing public health
02:00:42response forecasting and modeling capabilities for disease outbreaks, has contributed to
02:00:46multiple outbreak responses, including polio, acute hepatitis, mpox, measles, COVID-19,
02:00:52and actually launched InsightNet in September, which is a national network for states and
02:00:57locals to help them build the capacity for modeling and forecasting.
02:01:02CFA was very important for the Chicago response to outbreaks, and as well for wastewater surveillance,
02:01:08showed that integrating wastewater data yields more accurate forecasts of hospital admissions
02:01:12for COVID-19.
02:01:15Reducing funding for or eliminating funding for CFA means that state and locals and the
02:01:19federal agencies won't have this important capacity to forecast and model in the future.
02:01:24Great.
02:01:25It sounds like it's something we should continue to fund.
02:01:26I appreciate it.
02:01:27I yield back.
02:01:28The gentlelady yields.
02:01:29The chair recognizes himself for five minutes, how about that?
02:01:39Thank you all for being here.
02:01:40I appreciate it very much.
02:01:41I'm very proud to say that the CDC is located in my home state of Georgia, and very proud
02:01:47of the work that you do.
02:01:48However, I do have some what I consider serious questions here.
02:01:53The Communicable Disease Center, of which it was formerly known, the main function,
02:01:59as I understand it, was to predict and protect Americans from infectious disease threats,
02:02:05but it's over time evolved into much more than that.
02:02:08The core mission has been diluted by bureaucracy that's covering now everything from environmental
02:02:14justice to deforestation, firearm deaths, social detriments of health, and a lot more.
02:02:21For example, Mr. Daskalosis, the National Immunization Survey, the CDC is using taxpayers'
02:02:29dollars to call Americans over the phone, asking them for medical information about
02:02:34their vaccination status.
02:02:36In fact, several of my constituents have called me and asked me about this.
02:02:40They've recently received phone calls from the CDC asking them whether they had certain
02:02:45vaccinations or not, such as the COVID vaccine.
02:02:49I understand the importance, trust me, of making sure you've got the information that
02:02:54you need.
02:02:55I get it.
02:02:56But at the same time, it's critical for these agencies to respect the freedoms and the privacy
02:03:00of the Americans.
02:03:02So the first question I've got, Dr. Daskalosis, how do you get these phone numbers?
02:03:09Where do you get them from?
02:03:11Thank you so much for that question.
02:03:13So I think I cannot actually comment on the algorithm that's used to sort of identify
02:03:18the phone numbers, but the National Immunization Survey, as you've mentioned, is really important
02:03:23in us understanding what coverage is for vaccinations, so we can identify what parts of the country
02:03:28and in what populations we need to do more work.
02:03:31I understand.
02:03:33My question is, where do you get the phone numbers from?
02:03:35And you say you don't know?
02:03:36We'll have to get back to you.
02:03:37I was about to say, please get that information to me, okay?
02:03:41Thank you.
02:03:42How many people has the CDC contacted, do you know, under the National Immunization
02:03:47Survey?
02:03:48I don't have the numbers of how many people we've contacted, but we can get back to you.
02:03:53Please, please do.
02:03:55Do you happen to know how many surveyors that the CDC employs?
02:03:59Again, we'll have to get back to you on those specifics.
02:04:01Okay, sure do need to know this information.
02:04:06Does the CDC collect information on children's vaccinations?
02:04:11The CDC has several systems to monitor vaccination in the U.S.
02:04:16One of them that you've already mentioned is the National Immunization Survey.
02:04:19Right.
02:04:20Included in that is a survey that happens to parents specifically to learn more about
02:04:24childhood vaccines.
02:04:25Additionally, our immunization information.
02:04:27Does they contact children?
02:04:30The CDC, those surveys are actually for the parents.
02:04:33So they contact the parents of the children.
02:04:35Correct.
02:04:36And we also have immunization information systems that really focus on getting vaccination
02:04:42coverage information for parents and from children.
02:04:46Ends up being really critical in terms of the information that children have with their
02:04:52care providers, as well as for their schools.
02:04:56And again, can you get me the information about where the phone numbers for the parents
02:04:59of the children come from?
02:05:01We will follow up.
02:05:02Thank you.
02:05:03I appreciate that.
02:05:04Look, as I've said before, for better or worse, CDC recommendations and guidance, they carry
02:05:09a lot of weight.
02:05:10And I'll say that as a health care professional.
02:05:13They do carry a lot of weight and they are very important.
02:05:17So what is the collected information from the National Information Survey used for and
02:05:22where is this collected information stored?
02:05:26The National Immunization Survey data is used to report coverage for vaccination in the
02:05:32country.
02:05:34So as an example, during our respiratory virus season, we really brought all of this together
02:05:39in our respiratory vaccine view that shows what coverage is for vaccines such as COVID-19,
02:05:44RSV, all of the seasonal vaccines.
02:05:46But it's also the information that we use to identify coverage for routine childhood
02:05:51vaccinations such as measles, mumps, rubella, and all the other vaccines that are recommended.
02:05:57The information is de-identified.
02:05:58So we actually don't track down to an individual, but only track sort of population trends that
02:06:03we see.
02:06:04And where do you store it?
02:06:06Our information is stored at CDC, but again, it is de-identified information.
02:06:10Okay.
02:06:11So you feel like you're in compliance with HIPAA, so there's no problems there?
02:06:15Once the information is not identified, we don't have the information that includes identifiers
02:06:21that would require us to have any sort of HIPAA.
02:06:24Look, I have a fiscal responsibility to the taxpayers as a member of Congress, as we all
02:06:30do.
02:06:31Do you feel like this is a good use of taxpayers' money?
02:06:34Understanding vaccine coverage is critical for us to be able to better advise healthcare
02:06:39providers and physicians and others in terms of populations that they need to focus on.
02:06:44Being able to see where we have decreases in measles, mumps, rubella outbreak really
02:06:48allows us to use strategies to accelerate catch-up vaccination.
02:06:54We know, because of the increase in measles, mumps, or measles outbreaks in the U.S., that
02:06:59populations with lower coverage are the ones that are the most susceptible.
02:07:03So that information is critical for us to really maintain the health of children as
02:07:07well as adults.
02:07:08Fair enough.
02:07:09Please do follow up with those answers to those questions.
02:07:11Thank you.
02:07:12Thank you.
02:07:13At this time, the Chair recognizes Dr. Harshbarger for her five minutes of questions.
02:07:19Thank you, Mr. Chair.
02:07:20Thank you for the witnesses for being here today.
02:07:22I want to start with you, Dr. R. Woody.
02:07:26As you know, since 1997, some form of the Dickey Amendment has been included in annual
02:07:31appropriation bills enacted by Congress to ensure no funds are made available in funding
02:07:36bills to advocate or promote gun control.
02:07:39How do you ensure that the National Center for Injury Prevention and Control is abiding
02:07:43by this prohibition?
02:07:47So the CDC obviously does not advocate for or promote gun control policies, and we are
02:07:54in full alignment with that requirement.
02:07:57The work that the CDC does related to firearms is really to fund the research that helps
02:08:03us better understand deaths and injuries that result.
02:08:06The kind of research that we fund are things like working with the 4-H shooting clubs across
02:08:13the U.S. that work with kids to say, how can we have better firearm safety?
02:08:18Or to evaluate things like anonymous reporting lines in states where high schoolers can call
02:08:24if they have concerns about school violence.
02:08:27Do those sorts of programs work?
02:08:29It's really important that we understand how to help limit deaths and injuries related
02:08:35to firearms.
02:08:36But again, we are in full alignment with the Dickey.
02:08:39So I guess my question is, what does your center as a whole contribute to CDC's overarching
02:08:45goal and purpose of preventing infectious disease?
02:08:49So CDC's goal is to protect health and improve lives, and the leading causes of death, different
02:08:55than 100 years ago when it was infectious diseases, is related to non-infectious diseases.
02:09:02And so we are focused on preventing the leading causes of death using data, expertise, and
02:09:07resources.
02:09:08Thank you, ma'am.
02:09:09Dr. Layden, CDC operates over 100 surveillance systems that collect data on an ongoing basis,
02:09:16oftentimes pulling from state and local departments.
02:09:20I have a series of yes or no questions you can just answer.
02:09:23Does the CDC buy personal information from data brokers?
02:09:27Yes or no?
02:09:28We currently do not have contracts.
02:09:32Does CDC buy identifiable personal information from data brokers?
02:09:37To the best of my knowledge, no.
02:09:39Does CDC buy identifiable personal information from other sources?
02:09:43To the best of my knowledge, no.
02:09:46From any sources, does the CDC buy identifiable health information like vaccine status?
02:09:52To the best of my knowledge, no.
02:09:54From any sources, does the CDC buy identifiable geolocation information?
02:09:59We currently do not have contracts for that, no.
02:10:01From any sources, does the CDC buy identifiable internet search history information?
02:10:06To the best of my knowledge, no.
02:10:09Does the CDC buy identifiable genetic or biometric information?
02:10:13No.
02:10:15Does the CDC buy identifiable information about children?
02:10:19To the best of my knowledge, no.
02:10:21Will you commit to send me in writing who the CDC buys information from and any and
02:10:26all types of information the CDC buys and with each purpose the information is used
02:10:30for?
02:10:32Fantastic.
02:10:33Dr. Hacknett, can you explain to me in precise terms how the National Center for Chronic
02:10:38Disease Prevention and Health Promotions focus, mission, and programs differs from those centers
02:10:45like the NIH such as the National Cancer Institute with a budget of $7.3 billion, the National
02:10:52Heart, Lung, and Blood Institute with a budget of $4 billion, the National Institute of Neurological
02:10:57Disorders and Stroke with a budget of $2.8 billion.
02:11:00I guess my question to you is what's the CDC doing that is better than these institutions
02:11:06are doing and can you explain how your work is not duplicative to similar work being done
02:11:13at the NIH and across HHS?
02:11:16Thank you for that question.
02:11:18So the CDC and the Centers for Disease Control and Prevention, including obviously our Center
02:11:25for Chronic Disease Prevention, is really focused on prevention.
02:11:29And what we're also focused on is taking the information that our colleagues oftentimes
02:11:33at NIH identify through their research to the field.
02:11:3880% of our dollars go to state and local health authorities so that they can implement these
02:11:45practices, these evidence-based interventions in the field, and they're really the ones
02:11:49who are actually doing the work.
02:11:51We contribute enormous amounts of technical assistance and support for them, but that's
02:11:56really a lot more of what we do.
02:11:58We're much more focused on the population-based types of things, which is really the perspective
02:12:04on public health, whereas, for example, HRSA, which is much more clinical in nature.
02:12:10And it's very important to combine the public health approach with the clinical approach
02:12:14so that we get that entire spectrum.
02:12:17I think you've heard a lot from my colleagues today about how important it is to understand
02:12:20what's happening at a population level.
02:12:23And our data is also very critical for helping our jurisdictions understand where they have
02:12:29their challenges and where they have their opportunities.
02:12:31Yeah, it's very interesting.
02:12:32When I visited the CDC, I guess my question is, wouldn't it serve the overarching mission
02:12:39of combating chronic diseases to have everything under one agency, is just what I'm saying,
02:12:45you know, where we could compile the information and then assess that and use it in the proper
02:12:49ways.
02:12:50That's why I wanted to know what the difference was.
02:12:52Well, at this point, we work very closely with our sister agencies.
02:12:56But it's also extremely important that our work remains within CDC, where we focus on
02:13:01public health, where we work with the jurisdictions, where we work with our colleagues in infectious
02:13:06disease, because we know, for example, that people with chronic diseases are often the
02:13:10most vulnerable to situations related to epidemics, but also related to natural disasters.
02:13:17And our ability to bring our data to the fore, while there, these guys are focusing
02:13:23on the infectious nature of those conditions, I think actually makes us a more efficient
02:13:29and much more effective organization, as someone earlier said to me, we can chew gum and walk
02:13:34at the same time.
02:13:35Will?
02:13:36Thanks.
02:13:37Thank you.
02:13:38I'll yield back.
02:13:39Thank you.
02:13:40I appreciate the gentlelady for yielding back.
02:13:41And the chair recognizes Mr. Sarbanes from Maryland for five minutes.
02:13:46Thanks very much, Mr. Chairman.
02:13:48I want to thank all of you for walking and chewing gum every day, because you have tough
02:13:52jobs and you're mission-oriented, and we appreciate that tremendously.
02:13:59The work that CDC undertakes to prevent, detect, and respond to public health challenges, obviously,
02:14:04is indispensable.
02:14:07And the past few years, they've given us all a new appreciation for the importance of well-organized,
02:14:12data-driven collaboration between federal, state, and local public health agencies.
02:14:18And they've also given us the opportunity, thanks largely to resources that COVID relief
02:14:22legislation provided, to build out our public health infrastructures in ways that reflect
02:14:28both lessons learned and the dynamic needs of the future.
02:14:31And just on COVID for a moment, we know that the pandemic pushed us to a place of needing
02:14:37to have greater, broader, deeper, more connected understanding of public health data from
02:14:43around the country.
02:14:45We made some progress there.
02:14:47I think CDC at times lagged behind what some non-governmental entities were able to do
02:14:53in terms of building these data platforms to give us the kind of insight into the trajectory
02:15:01of the pandemic that we would have liked to have.
02:15:03But I know that you're working hard to address these data issues, modernization initiatives
02:15:10to improve data collection, sharing, and interoperability between public health departments at all levels.
02:15:17So Dr. Lading, could you briefly share the progress you've made on adopting e-reporting
02:15:23and explain how it is not only helping provide more real-time collection and sharing of public
02:15:27health data, but also helping to reduce burdens on our health care workforce?
02:15:33Thanks for that important question.
02:15:36I'm assuming you're talking about electronic case reporting.
02:15:40So electronic case reporting has been one of our great successes with the data modernization
02:15:44effort.
02:15:45Thanks to the funding from Congress, we've been able to invest in this technology across
02:15:49our nation.
02:15:50Prior to the pandemic, most of the case reports coming to public health were manually entered,
02:15:55typed in, faxed, sent by phone to our health departments.
02:16:00Today, we have over 38,000 health care facilities across the nation, across all states, that
02:16:05are able to send automated real-time data through electronic case reporting to our jurisdictions.
02:16:10This saves time, it saves burden on the clinicians and the hospitals, and it gets the data to
02:16:16our health departments faster.
02:16:18Take for example, in California, they are leveraging this, not just for California,
02:16:23but for a disease called silicosis, sometimes fatal severe lung disease.
02:16:29With the advent use of electronic case reporting, they've been able to identify more cases and
02:16:35getting more individuals with this potentially severe disease into treatment.
02:16:40So I'm familiar, when you're speaking about this, is this the same thing as the Trusted
02:16:45Exchange Framework and Common Agreement, or is that a component of this data collection,
02:16:50this TEFCA?
02:16:51And I know Maryland is a participant in that, they've adopted it, so we'd love to hear a
02:16:56little bit more about that, because I know that's data sharing between providers and
02:17:02public health offices and so forth, and curious what you've seen in terms of impact when states
02:17:08like Maryland adopt that.
02:17:10We are grateful for Maryland to be an early adopter of really a game changer for interoperability
02:17:16between health care and public health.
02:17:17I mentioned earlier that the federal government has invested over $35 billion into health
02:17:23care IT.
02:17:24That pales in comparison to what, that is so much greater than what we have provided
02:17:28to public health.
02:17:29TEFCA is a Trusted Exchange Framework and Common Agreement, which allows data to be
02:17:33exchanged across our national network among clinical and health care entities, but also
02:17:38with public health.
02:17:40Public health is at the forefront of leveraging this technology, Maryland, as well as eight
02:17:44other jurisdictions, are early adopters.
02:17:47Electronic case reporting is one of the first public health use cases to leverage this technology.
02:17:53Got it.
02:17:54And I certainly look forward to CDC's continued efforts towards implementing its 2024-2025
02:17:59goals, particularly those ones that are focused on including additional data sources.
02:18:07I've been on this committee for a long time.
02:18:11Bring a perspective that the U.S. still doesn't really have a broad, national, robustly interconnected
02:18:22public health system.
02:18:24You find public health systems at different levels of capacity in different jurisdictions,
02:18:33but this notion of knitting it all together in a way that gives us sort of surveillance
02:18:39and all the other kinds of things that we need is still something we're reaching for.
02:18:43I'm glad to hear these initiatives on the part of CDC are helping us in that direction,
02:18:48and I appreciate very much you all being here today.
02:18:51And I yield back, Mr. Chairman.
02:18:53Thank you.
02:18:54The gentleman yields back.
02:18:55The chair recognizes Mr. Balderson for five minutes for questions.
02:18:58Thank you, Mr. Chairman, and thank you all for being here today.
02:19:01My first question is for Dr. Walke.
02:19:03Thank you.
02:19:04And forgive me.
02:19:05I see you down at the very end, but my names tags are a little blocked there.
02:19:09But as we look at recent events, such as COVID-19 pandemic and monkeypox outbreak and the recent
02:19:17bird flu spread, we must take biosecurity and pandemic preparedness to top national
02:19:23security priority.
02:19:25Many experts have expressed concerns that future pandemics could be increasingly severe.
02:19:30As co-chair of the Pandemic Preparedness Caucus, I am committed to ensuring that we are ready
02:19:34for the future health threats.
02:19:37The CDC was created to be the nation's lead on infectious disease outbreaks.
02:19:41Dr. Walke, does your office hold regular staff-wide emergency operating drills, training, or exercises
02:19:48to prepare for future outbreaks or public health emergencies?
02:19:51Yes, we do.
02:19:54Thank you for the question.
02:19:55Not only for with moving forward with past the after the COVID epidemic, we noticed a
02:20:02number of issues that we needed to improve.
02:20:05And through the moving forward initiative, we've made some changes, actually, not only
02:20:09in the way we would respond with our workforce, but also the way internally we would push
02:20:14our guidance out faster and communicate faster as well.
02:20:17So we continue, as we improve, to continue to try to exercise those SOPs.
02:20:21Okay.
02:20:22Thank you.
02:20:23Are our states and localities included in these trainings?
02:20:26Yes, absolutely.
02:20:27All right.
02:20:28Perfect.
02:20:29Thank you very much.
02:20:30My next question is for Dr. Layden.
02:20:32Dr. Layden, thank you for being here.
02:20:35On February 3rd, 2023, a train derailed in East Palestine, Ohio.
02:20:42As an Ohioan and a representative for counties in the nearby areas, I do not represent the
02:20:46affected area.
02:20:47This incident is incredibly concerning to me, as it should be for all of us.
02:20:51The CDC arrived in East Palestine three weeks after the train derailment.
02:20:56There is no denying that the derailment spread toxic chemicals into the air, soil, and local
02:21:01waterways.
02:21:03While I understand the CDC has been assessing chemical exposures and health impacts after
02:21:07the derailment, I am concerned that not enough attention has been placed on this issue.
02:21:13I would like to know what else is being done to ensure that the health, safety, and potential
02:21:17long-term effects of the derailment are monitored.
02:21:21And we are also, I mean, it seems like every day or every week we're hearing something
02:21:25else coming out about this derailment.
02:21:27So thank you if you can answer that.
02:21:30So as someone who's worked at the state and local public health, I share your concerns.
02:21:34These events have a significant impact on our communities.
02:21:38I am not familiar with that investigation.
02:21:42I'm happy to defer some colleagues if they may, or we can get back to you with additional
02:21:45information.
02:21:46Would anybody else like to talk about that, or we can have that information submitted?
02:21:51Go ahead, Dr. Walker.
02:21:52Our lead agency, the head of our National Center for Environmental Health would be best
02:21:57positioned to answer that question, but we'll get back to you.
02:22:02Thank you all very much.
02:22:04My next question is for Dr. Juergen.
02:22:07It's no secret that the serious public distrust in the CDC.
02:22:13We also know that individuals in your position are often aware of illnesses that may lead
02:22:18to pandemics or outbreaks much sooner than the general public.
02:22:21This is something that comes with the job, but also requires adequate handling of such
02:22:25sensitive information.
02:22:27During the COVID-19 pandemic, there was a lack of transparency and honest communication
02:22:31with the public.
02:22:33I understand that communications with the public have been acknowledged through the
02:22:36Moving Forward initiative.
02:22:38However, I'm not convinced that this is enough.
02:22:41What are some lessons that we've learned about the importance of transparency and honest
02:22:46communications with the public during the COVID-19 pandemic, and that your center will
02:22:52prioritize?
02:22:54Thanks very much.
02:22:56In our center, it's the National Center for Emerging Zoonotic Infectious Diseases, but
02:22:59I've been at CDC for almost 30 years doing mostly infectious disease epidemiology and
02:23:04outbreak control, and COVID was a humbling event for all of us.
02:23:10I think coming out of that, we've really changed how we're doing business.
02:23:14In addressing the public's trust, we're focused on, like you mentioned already, transparency
02:23:20where people need to see both how and why we develop evidence-based public health recommendations.
02:23:27We also learned that we need to be listening, and we need to better understand where people
02:23:31are and how we can meet them where they are with public health recommendations.
02:23:36You mentioned also the clear communication.
02:23:39We absolutely have to communicate the uncertainty that's happening at that situation and work
02:23:44with the public to get the most understandable recommendations for protecting Americans from
02:23:49infectious threats.
02:23:51And then finally, I think a big lesson learned was that we have to work together, that we
02:23:57can't do this alone, that the community needs to have better participation in the process,
02:24:03and we need to work with clinicians, stakeholders, and others to fight infectious diseases together
02:24:07because we can't do this alone.
02:24:09Okay.
02:24:10Thank you very much, Mr. Chairman.
02:24:11I yell back.
02:24:12Thank you.
02:24:13The gentleman yells back, and the Chair recognizes Ms. Kelly from Illinois for five minutes.
02:24:16Thank you, Chair Guthrie and Ranking Member Eshoo, for holding today's important hearing.
02:24:21Before I start, I just wanted to say, Dr. Awardee, it is so great to see you, and thank
02:24:26you for your leadership and the leadership of Mayor Lightfoot for getting Chicago through
02:24:31COVID.
02:24:32So, thank you so much.
02:24:33CDC's mission is dedicated to improving public health as it focuses on our nation's gravest
02:24:39health threats, everything from tuberculosis and influenza to lung and heart disease to
02:24:44opioid overdoses and extreme heat.
02:24:46It is critically important that we ensure the CDC has the necessary resources and funds
02:24:52to address the root problems causing many of our nation's most serious health threats.
02:24:57We should not cut CDC funding.
02:24:59Instead, we should be making investments in the health of our nation.
02:25:03It pays dividends, resulting in lower health care costs, better national security and readiness,
02:25:09and a healthier nation.
02:25:11For example, eliminating funding for the Office on Smoking and Health puts our children at
02:25:15risk.
02:25:16I have been very vocal about supporting a menthol cigarette ban to save lives and prevent
02:25:21a new generation from becoming tobacco users.
02:25:25States rely on this funding to keep kids from starting to smoke and vape.
02:25:30This decision would increase health disparities and reverse decades of work done by Congress
02:25:35and the public health community to reduce the harm from tobacco products.
02:25:40Dr. Hacker, are there proven ways to reduce tobacco use in the United States?
02:25:45And if so, what does CDC do in that space?
02:25:50Thank you so much for that question.
02:25:52We've had enormous success in terms of both cessation and prevention from people who begin
02:25:58to start smoking with so much of what we've been doing over the last years.
02:26:01I think we've reduced it by 65 percent.
02:26:03But with that said, there is still a lot of work to be done.
02:26:06We are very concerned about youth vaping in particular, and about getting people the tools
02:26:12that they need to stop smoking if they would like to do so.
02:26:16Our current Tips from Former Smokers campaign has been really successful.
02:26:23We've seen over a million people actually quit smoking as a result of that campaign.
02:26:28But we also are doing enormous amounts of surveillance to identify what is going on,
02:26:32what are the current trends, what are the emerging trends, what are the new products
02:26:36that are coming out, and what's the uptake of that, particularly where youth is concerned.
02:26:41Because a new vaping implement, a new strategy, suddenly it just takes off like wildfire.
02:26:46And we need to be able to be ahead of that.
02:26:48We work so closely with our colleagues at FDA to understand what they're doing.
02:26:53And recently we have put out grants around education, around menthol as well.
02:26:58Thank you.
02:26:58And what would happen if this program was eliminated both nationally and on the state level?
02:27:05Well, all of those things would disappear.
02:27:07We would have no ability to really monitor what was going on in terms of tobacco use.
02:27:11We would not be able to be doing the activities we are doing with young people
02:27:14around vaping or tobacco use of any type.
02:27:18We'd end all of our activities related to the campaign that I mentioned earlier,
02:27:22all of the focus that we now are putting on cessation in particular, which is so critical.
02:27:27And the bottom line is we would be taking away an enormous amount of resources from our states,
02:27:32because all the states are funded, in fact, to participate and to do this type of work.
02:27:37Thank you.
02:27:38As the co-chair of the Bipartisan Maternity Care Caucus, I applauded when Dr.
02:27:42Mandy Cohen became CDC director, and she announced that one of her key priorities across the agency is how we can support families and children.
02:27:50As she's rightly pointed out, we are a nation that is only as strong to fight off public threats when given a healthy, equitable start to life.
02:27:59Our lifelong health patterns start when we are young.
02:28:02In fact, experts have shown that our lifelong health is set up in our first five to ten years.
02:28:08So Dr. Hacker, what is CDC and specifically your center doing to support young families,
02:28:13whether that's supporting a mom through her pregnancy and making sure she has healthy pregnancy and a healthy birth,
02:28:19or that we are making sure that our children have all the support they need to make it through their first year of life?
02:28:24In addition to the work that we're doing in the tobacco space for young people,
02:28:27we are putting a lot of our energies into the work around maternal mortality.
02:28:31And we've successfully created an infrastructure, which are called the Maternal Mortality Review Committees,
02:28:37where states can actually dig into what happened when there was a maternal death.
02:28:43And that's really significant information when we really try to understand what do we need to do differently.
02:28:47And I think you know in Illinois, particularly, you all were the first state to actually extend Medicaid postpartum for a year.
02:28:56And now we have 46 other states that have done so in turn.
02:29:00We also work in schools, and we talked a little bit about the mental health work that we're doing in schools.
02:29:07Plus we have the Youth Risk Behavior Surveillance System, which is the foremost surveillance system to
02:29:12understand what is happening in terms of youth behaviors related to health.
02:29:17Thank you so much.
02:29:17I want to thank all the directors for being here today.
02:29:19Thank you.
02:29:21Thank you. The gentlelady yields back, and the chair recognizes Dr. Miller-Meeks for five minutes for questions.
02:29:34Okay, I'm going to have to use my big girl voice.
02:29:36So thank you, Mr. Chairman, and thank you to the witnesses for testifying before this opportunity today.
02:29:42As both a physician and a former public health director, I take public health very seriously and
02:29:47recognize the important role that the CDC and state health departments play in keeping Americans safe,
02:29:53which is why I released a CDC RFI to hundreds of stakeholders requesting feedback on how to sensibly and
02:29:59effectively perform America's leading communicable disease agency.
02:30:03It is also why, in 2021, with the release of the ARRA funds, which were supposed to be related to COVID,
02:30:11I specifically asked for part of that money to go to local public health unrestricted funds to fund local public health,
02:30:19not to go into big CDC infrastructure or go to the myriad of other things.
02:30:23But as we know, the least amount of money for those COVID funds went to local public health or to public health in general.
02:30:32So it is rich to hear my colleagues talk about the funding of the CDC.
02:30:36And part of this is requesting money on how our funds go and how to reform the agency.
02:30:43Not surprisingly, public trust in the CDC isn't at an all-time low.
02:30:48And when I'm back in my state, visiting with my public health director, our local public health does not have the same bad reputation that CDC now has.
02:30:59During the pandemic, much of CDC's guidance did not appear to emanate from data and scientific evidence,
02:31:04but rather from political interest as the clear communication we saw between the CDC and the American Federation of Teachers on school re-opening guidance.
02:31:13And as we talk about the risk, and as we've talked about here and my colleagues have talked about, young people, suicide prevention, depression,
02:31:22it did not occur to anybody in the CDC that closing schools for a long period of time would have an effect on young people's mental health and the rate of suicide.
02:31:32However, to the CDC's credit, they recognized a declining public trust, which has led former Director Lomansky to launch the Moving Forward initiative.
02:31:41This effort included reorganization and requests for sweeping new data collection authority from Congress.
02:31:47While CDC hasn't been forthcoming to Congress about the reorganization, CDC at least acknowledges the agency faces significant structural and systemic operational challenges
02:31:58and indicates a simple goal to create new internal processes, systems, and governments to empower leaders, align incentives, and hold CDC accountable.
02:32:07I believe that one of the main reasons why the CDC has lost so much trust is because it believes that virtually everything in health is public health.
02:32:17Rather, and regardless of how connected the issue is to communicable diseases, which is how the CDC got started, it was the CDC, not the CDC, and he.
02:32:29For example, the Center for Chronic Disease Prevention and Health Promotion awarded roughly $30 million in grants in 2010 to 2020 to decrease the level of sodium used in government facilities.
02:32:40Now, it may be laudable to reduce the amount of sodium, but is that a function and purview of the CDC?
02:32:48The Center also has multiple programs, such as Addressing Conditions to Improve Health Actions, Getting Further, Faster, Healthier Accelerator Plans, and REACH,
02:32:59which fund virtually the same interest groups to examine social determinants of health and to the point, what have the outcomes been of those programs?
02:33:08According to the CDC's own data, health accelerator plans and REACH program recipients received roughly $46 million in fiscal year 2022.
02:33:18How does this improve actual public health against these determinants?
02:33:21How do we define public health?
02:33:23Are we now talking about the population or anything that affects an adult person and individuals within the realm of public health?
02:33:30And as a director of the Department of Public Health, people on our big board of public health, big board of health, actually ask that question.
02:33:40Even Democrats ask, why is the CDC, why is public health engaged in all of these areas rather than focused on what should be the main thing,
02:33:50which is communicable infectious diseases, and have we lost sight of that?
02:33:54And how to translate research that the CDC does into actual messaging and implementing programs.
02:34:02CDC also studies environmental health and operates the Environmental Public Health Tracking Network, which includes an environmental justice dashboard,
02:34:10a system that processes and publishes demographic factors, environmental burdens, socioeconomic conditions, and public health concerns directly related to environmental justice.
02:34:19As someone with two advanced degrees and decades of experience serving patients in clinical care settings, environmental justice is nebulous and all-encompassing.
02:34:29So, my question for each of the program directors, CDC does not, and you can answer this offline and written since I'm running out of time,
02:34:37CDC does not have a mission or purpose defined in statute.
02:34:42If Congress were to go down the path of authorizing the CDC overall, we would also want to authorize each of your centers and offices.
02:34:50So you can respond in writing.
02:34:52For each of you, what would your mission be?
02:34:56If you could supply that for us, because the mission would not be what we currently function as the CDC.
02:35:04We would be able to take real-world evidence, incorporate that into pandemic infectious disease outbreaks.
02:35:11We would be able to take research and develop a test, one of which had already been developed at the University of Washington,
02:35:18and we would be able to respond appropriately, effectively, efficiently, and rapidly with pivoting as the situation changes to pandemic, which is the main purpose of the CDC.
02:35:30With that, I yield back.
02:35:32General Edie yields back, and the chair recognizes General Edie from Massachusetts, Ms. Trahan for five minutes for questions.
02:35:37Well, thank you.
02:35:38Thank you to the chair and ranking member and to all of our CDC directors here today.
02:35:44I think my colleagues have already described extensively the mission of CDC and the health threats that you all combat day in and day out.
02:35:55I think the agency's comprehensive approach also focused on reducing health care costs, boosting economic productivity, and enhancing our readiness.
02:36:05These are critical functions that impact and improve the lives of all Americans,
02:36:11which is why I'm deeply concerned that my Republican colleagues have proposed slashing funding for a number of programs and centers at the CDC.
02:36:19My colleagues across the aisle have justified eliminating the Injury Prevention Center by arguing that opioid overdose prevention efforts are already being handled by SAMHSA.
02:36:30I would argue that CDC's overdose work is distinctive from SAMHSA's, but crucially, complementary.
02:36:38Dr. Arwady, I'd like to hear from you about what the CDC brings to the opioid discussion
02:36:43and how the proposed cuts would affect your involvement in the broader federal response to the addiction crisis that has claimed far too many lives.
02:36:51So if the Injury Prevention Center is eliminated,
02:36:55how will that impact the federal government's efforts to address the opioid and overdose crisis that we're in?
02:37:01Thank you for the question. As I mentioned at the outset, more than 80 percent of the Injury Center's funding goes back out to states and locals,
02:37:10and 84 percent of our opioid funding. Before moving into this role,
02:37:14I led the Chicago Department of Public Health and had the privilege over eight years of working to fight fentanyl and the changing epidemic there.
02:37:23And I will tell you that the Overdose Data to Action Grant that goes to every state and 40 localities,
02:37:29almost three hundred million dollars, when we received that in Chicago,
02:37:33it transformed the way our city was able to respond to this crisis.
02:37:39It let us hire epidemiologists, GIS specialists, really be able to understand not just how many overdoses there were broadly,
02:37:47but in a way that protected patient privacy, where in a block by block time of the day, where exactly was the threat?
02:37:55How was that threat changing? We worked with hospitals, the medical examiner,
02:37:59to make sure we had data systems for non-fatal and fatal overdose so we could really track that.
02:38:05And then importantly, we developed responses. So, for example,
02:38:09there had not been a coordinated way if someone had suffered a non-fatal overdose to ensure that they were getting connected to care.
02:38:17And so the health department, using Overdose Data to Action funding, was able to make sure that after an overdose,
02:38:23there is follow up with the person who has an opportunity to get connected to treatment and to the rest of their family.
02:38:30Part of that work is making sure that folks are seamlessly connected to the individual treatment facilities that SAMHSA, for example, funds in the city of Chicago.
02:38:41So it is critical that the SAMHSA work of making sure people can get treatment for substance use disorders continues.
02:38:47It really, I'll tell you from my experience, making sure that public health work is at the table with the data,
02:38:54with the expertise, with the ability to coordinate and with the ability of those resources.
02:38:59What we are doing finally is starting to show promise for fighting opioid overdose in this country.
02:39:05And it is so essential that we take an all of government approach and do not lose the critical work that this funds across the country.
02:39:13Well, thank you for clarifying that. It's absolutely work that we must continue.
02:39:18So during the most recent district work period, I had the opportunity to join WIP Clark's bipartisan CODEL to Africa.
02:39:25And there we witnessed the CDC's impactful work on HIV in Tanzania and their contributions to the global efforts to defeat AIDS.
02:39:35The FY 25 House Labor HHS appropriation bill completely eliminates funding for the CDC's global HIV AIDS program.
02:39:46Dr. Daskalakis, did I say that right? Daskalakis.
02:39:50OK, great. How would withdrawing funding at this critical juncture,
02:39:54which we're on the brink of eradicating AIDS on the African continent by 2030, how would that set us back?
02:40:02Additionally, as we aim to counter China's growing influence in the region,
02:40:06wouldn't it be both irresponsible and detrimental to the United States interest to pull support from programs that have made such a tangible difference in people's lives?
02:40:16Thank you for that question. I'll just start and then say we'll also connect you with the center director,
02:40:22that the center director is a focus on the global HIV program. But having had a long history of working in HIV myself,
02:40:28I think it's really critical to say that resources really do demonstrate return and investment not only for HIV itself,
02:40:35but also for the infrastructure that's necessary on the African continent to respond to other emerging infections.
02:40:43So, again, really, those resources are critical to be able to respond not only to HIV and remembering that, again,
02:40:50we live in a global village and what happens in Africa touches us and what happens in the U.S.
02:40:55and in all of our cities and not even in our cities, but in the rural parts of the U.S. as well.
02:41:00So really critical for us to sort of remember that.
02:41:03And again, I will make sure to follow up with the center that actually does sort of cover the global HIV work.
02:41:08Thank you. Thank you. I yield back.
02:41:10General Eddie yields back and the chair recognizes the gentleman from California for five minutes for questions.
02:41:15Thank you. I don't think our mics are working on this road.
02:41:19Dr. Locke, I was very encouraged to hear you mention mental health as one of the priorities of your center.
02:41:28I think you and I are in agreement that we have underinvested in mental health in this country
02:41:34and we are now unfortunately reaping the consequences of that in the forms of homelessness,
02:41:40substance abuse, and all of the different concomitant societal problems with that.
02:41:45I chair the House Artificial Intelligence Task Force and healthcare in general is one of the areas that we see AI having the biggest impact on.
02:41:54But there has been a lot of discussion about AI's impact on mental health
02:41:59and I actually think that in the future it could have a transformational effect on that.
02:42:03Has the CDC done any investigation or thinking about the impact that AI could have on mental health?
02:42:10Thank you for the question and CDC's doing a lot of work related to AI.
02:42:14I want to defer to my colleague first, Dr. Layden, to talk about AI
02:42:17and then potentially Dr. Hacker or Dr. Awadi to follow up on the mental health piece.
02:42:22Yeah, thanks for an important question and I'll speak to AI and then as mentioned I'll yield to my colleague.
02:42:27So AI, I agree with you, offers tremendous opportunity and potential.
02:42:31But we also need to ensure that we do this in a way that's coupled up with ways to do it in a trustworthy way and to eliminate biases.
02:42:38CDC has been working to build up AI capabilities, including the development of guidance, addressing security aspects related to it.
02:42:46With investment in AI funds to public health, we can start to see the actual use of this technology to support some of the public health mission as well as the operation aspect of it.
02:42:56But specifically to a problematic area, Dr. Awadi, is there anything that you wanted to chime in on?
02:43:03I'll just briefly add that we agree that making sure we're focusing on mental health and particularly as it relates to suicide crises, overdose crises is central.
02:43:11I'll also note that we have to think about prevention in this space, just like we do on the physical side.
02:43:17My center focuses on preventing adverse childhood experiences.
02:43:21Those are experiences that can be traumatic for kids under 18, things like experiencing or witnessing abuse or neglect.
02:43:28And if we were able to prevent adverse childhood experiences in this country, we would prevent 44% of adult depression diagnoses.
02:43:39We're never going to treat our way one at a time out of this crisis.
02:43:43And so I think the work of public health that's community-based and focuses on prevention and building those structures upstream is critical.
02:43:51And again, we've got to work across government.
02:43:53Well, you know, it's interesting that the conversation now has turned to prevention because I think that AI could be a huge tool for helping us prevent some of the childhood experiences that are so damaging that you're talking about.
02:44:07Online bullying, the negative impacts of social media, I think all of those are things that we could do a much better job at policing.
02:44:14So thank you.
02:44:15Dr. Walker, I'm going to take it back to you.
02:44:18The last year coming out of COVID, the CDC did some introspection about how to refocus the organization on your core mission.
02:44:30And in April, you started writing a report on what could be done to accomplish that, which the report came out in August last year.
02:44:39CDC Moving Forward was the title.
02:44:41I have seen a summary of the report, but I actually have not read the report, and it doesn't appear to me that the report is publicly available.
02:44:48Is that correct?
02:44:49Is there somewhere that we can go to see the contents of that report?
02:44:52On our website, we actually can.
02:44:55It goes through all the elements of the report, all the elements of Moving Forward and what we've been doing in terms of advancing those challenges that were identified and the progress that we've made.
02:45:07Okay, so I saw that.
02:45:10It didn't seem to me like that was anything more than a summary, but you're saying that that's all the detail of the report?
02:45:17We had a detailed report.
02:45:19I believe that's also available.
02:45:20I'll circle back and make sure that you're able to access that.
02:45:24Okay, I'd appreciate that.
02:45:26So my understanding from reading the summary is that one of the key findings was that organizational silos within the CDC needed to be broken down to refocus the CDC on its core mission.
02:45:42Have you made any progress with that?
02:45:44In the reorganization, we did create these offices, cross-cutting offices, including my own office of Readiness and Response,
02:45:53and we created the data office that Dr. Layden here is leading, and also a cross-cutting office and center related to laboratory quality and laboratory support.
02:46:07So, yes, at CDC and Moving Forward pointed out we did have a series of silos actually within the organization,
02:46:15and we saw with COVID we needed to bring the whole organization actually to the fight.
02:46:19And so after COVID and with Moving Forward, we identified where the issues were,
02:46:25saw that across multiple CIOs or centers and institutes there were opportunities really to standardize the way we were working,
02:46:33including on the workforce, which I've talked about as the CDC-related responders.
02:46:37So it's not just a small group of people responding to every outbreak,
02:46:42but actually all 12,000 strong at CDC can respond and fit into an emergency operations center as well as through an incident management system.
02:46:51I haven't asked questions yet, so I'm looking forward to following up on that.
02:46:54Thank you. The gentleman yields back, and I'll recognize myself for five minutes for a question.
02:46:58So thank you all for being here. It's been appreciative of what you guys do.
02:47:03And this first question is for Dr. Jernigan.
02:47:07Director Cohen has communicated and communicated well about the avian bird flu,
02:47:13but I would say it's a concern that we all have.
02:47:16And I want to ask Dr. Jernigan about a specific point in the HHS action plan to address avian flu.
02:47:23They wrote in May, and quote, address the manufacturer issued detective with current avian flu test kits, unquote.
02:47:32And boy, we don't want to hear that again. That rings true of 2020.
02:47:37Could you talk about what issues were detected with flu test kits?
02:47:43And has the issue been addressed?
02:47:46Was that Dr. Awada or Dr. Daskalakis?
02:47:49Daskalakis.
02:47:50Thank you for the question.
02:47:51I'll start by saying that it's the sort of quality systems that grew from the experiences in COVID that actually were able to detect an issue,
02:48:01a manufacturing issue with the test.
02:48:04Very importantly, the test with its manufacturing issue does not have any propensity towards false negatives or false positives.
02:48:13And in close collaboration with the FDA, we know that the tests that are out in the world are actually very usable to be able to detect avian influenza.
02:48:22So I'll just go back and say, really, the quality systems that grew from the experience in COVID identified the issue.
02:48:28And we are resolving the issue.
02:48:30And like I said, the kits that are out.
02:48:32Can you share what the issue is?
02:48:33Sure.
02:48:34There are three components to the assay.
02:48:37And two of the components work normally.
02:48:40And one of the components sometimes would result in an inconclusive test.
02:48:45Any inconclusive test or positive test on those kits then come back to CDC for confirmation.
02:48:52So this very rare issue was identified through the quality systems that we've developed.
02:48:58And all of the tests that happened in the field were ultimately, again, checked at CDC and confirmed.
02:49:05So that manufacturing issue is being resolved.
02:49:08We're replacing that component in the kit.
02:49:10And, again, those tests that are in the field are 100% usable and not prone to false negatives or false positives.
02:49:17So at worst case, you would get inconclusive and have to test again?
02:49:20At worst case, it would be inconclusive.
02:49:22And it comes to CDC.
02:49:23And then we test it again.
02:49:24So every inconclusive comes to us for confirmation.
02:49:27Okay.
02:49:28Thanks.
02:49:29So I have Dr. Jernigan down as the person asked.
02:49:31Maybe you, Dusty or Dusty Gillespie.
02:49:33So the infrastructure.
02:49:35Hopefully, we don't get to human-to-human contact with avian flu.
02:49:38Could you kind of give an update with avian flu where we are?
02:49:40Sure.
02:49:41And then is the testing structure in place to distribute quicker since we have tests?
02:49:47Great.
02:49:48Thank you.
02:49:49So this is where we are with avian flu from the human disease side to date.
02:49:52We've identified 10 confirmed infections since April when we first detected the infection.
02:49:59And they're not human-to-human?
02:50:00No.
02:50:01So we are not seeing any evidence of human-to-human transmission.
02:50:04All of the cases were individuals who had exposure to either infected cows or poultry.
02:50:10We are working in multiple domains to make sure that testing is available and adequate.
02:50:17So through our public health labs, testing is available at this point.
02:50:21Again, that capacity exists and it is really being flexed now as we are identifying individuals
02:50:27with symptoms.
02:50:28Additionally, we are working with commercial laboratories to be able to move this testing
02:50:33also into the commercial arena in time for when we hit our regular flu season so that
02:50:39clinicians and public health practitioners will be able to differentiate seasonal influenza
02:50:45from H5.
02:50:46So all of those are happening simultaneously.
02:50:48So what's your level?
02:50:50What's your threat level or level of concern?
02:50:53I'd take to say 1 to 10.
02:50:54Great question.
02:50:55But I don't want to do that because I don't think that's fair.
02:50:57But what's your level of concern?
02:50:59In terms of what we are concerned for the general population, we think that the risk
02:51:03for the general population is low.
02:51:05But we have increased vigilance around individuals who have exposure to infected animals, whether
02:51:10they be cows or poultry.
02:51:12OK, thanks.
02:51:13And Dr. Iwate, I guess getting back to the SAMHSA versus what's going on at CDC.
02:51:19So your work is additive.
02:51:21I mean, what's the difference in your work and why is your work additive and not duplicative?
02:51:26That's the question.
02:51:27Yeah, thanks.
02:51:28So we work very closely, of course, with SAMHSA.
02:51:31We actually fund different entities even.
02:51:34The CDC funds public health departments.
02:51:38SAMHSA primarily funds state behavioral health and mental health agencies that are ensuring
02:51:44that people can get that clinical care.
02:51:46The CDC is focused on the data piece, like I've said a few times, in terms of making
02:51:51sure that we have day-by-day information for how this threat is also changing, and it is.
02:51:58We also work to make sure that that data is then shared with our partners, whether it's
02:52:03at SAMHSA, whether it's at NIDA, across the agency.
02:52:06And finally, we work on things like making sure public health departments will work to
02:52:11connect individuals to the care that SAMHSA provides.
02:52:14And we'll work to make sure that we have the data to know that naloxone, for example,
02:52:18the reversal agent that SAMHSA is providing, is in the right places in communities.
02:52:23So those are just some examples, but these are not duplicative.
02:52:27I want to be really clear about that.
02:52:29They are complementary, and we work really closely together to be sure of that.
02:52:33Well, thank you.
02:52:34My time has expired, and I will yield back.
02:52:36Dr. Walensky, you were ready to grab the microphone to talk, but your time has expired, and I
02:52:41will yield back.
02:52:42And I believe that concludes all members who are present to ask questions.
02:52:46And so we'll conclude with questions.
02:52:48Thank you all very much.
02:52:49We're not done yet, but we'll conclude with questions in a few more seconds.
02:52:52And so I have a list for documents for the record, and I ask unanimous consent to insert
02:52:57in the record the documents included on the staff hearing documents list.
02:53:01Without objection, Mr. Chairman.
02:53:03That will be in order.
02:53:05And I'll remind members that they have 10 business days to submit questions for the
02:53:09record, and I ask the witnesses to respond to questions promptly.
02:53:14And members should submit their questions by the close of business on August the 6th.
02:53:19Again, thank you so much.
02:53:20Thank you so much for being here.
02:53:21Thank you for the information.
02:53:23It was a really good hearing, and we appreciate you being here.
02:53:25And without objection, the subcommittee will be adjourned.
02:53:28Excellent.
02:53:29Thank you, Mr. Chairman.
02:53:33Good job.

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