comment, so that these dislocations of the work force, all be it, as you said,@@@@@@rrr the new rocket with the new technologies and the new money that you've laid out. so i hope that the president and

the congress will give the administrator just exactly what you said. the flexibility so that he could utilize that work force in different places with different missions. so as to minimize the economic devastation. and in this regard, i'll put on my parochial hat, because center that is going to get the hardest is the kennedy space center. because of the lessening launches of humans. now, if indeed, for example, that the president were to pick that option of a commercial, that can come in and make some ameal oration of that layoff. but it's not going to step in. so we need to give the administrator of nasa a lot of

flexibility. so thank you for that statement. i want to ask you, what if you had more time? you had 90 days. if you had more time, do you think the results would change? >> well, the first thing that would have happened would have been my wife would have divorced me. >> i understand. >> all ten of us, of course, have regular jobs, so to speak. and when we began, i questioned whether 90 days was adequate to take on a task of this type. we thoroughly could have done a more thorough analysis, given more time. but it's also my belief that if the differences are small, between the new options and the current program, we should stick with the current program. and so i think we're not

discussing small differences. there need to be significant differences. and those are the kind of things we tried to identify. and our conclusion was that it would have been easier for us, and it -- we would have been able to get the third significant figure much more accurately. but in terms of the basic thrust of the options we've offered and their assessment, i think we could stand behind them. >> you had had testified earlier that your panel's recommendations are don't rush the shuttle fly out, keep safety paramount, by the way, parenthetical parenthetically, i assume will be a theme that will run throughout your report once it is produced publicly, that all of these items that safety has

to be paramount, given the experience, the very tragic experience we've had in the past. but you indicated in your testimony that you thought that it's realistic to think that at least part, if not all of fiscal year 2011 would be consumed by the fly out of the shuttle on the remaining missions to supply and equip the space station. did you attach a dollar figure to 2011 in that fly out? since the president's budget right now, and i'll refer it to the omb budget, and i say that sarcastically, only provides for fiscal year '10 on the fly out

of the shuttle. did you attach a cost to it? >> we did. and we've spoken with omb about it. they're aware of the number. i can't speak for omb, obviously. my recollection is that number is like a billion and a half dollars. but, mr. chairman, you should check that to be exact. it's our view that that's very important to add that to the fy 2011 budget. and as you say,is not there today. the problem not being there, is it introduces pressure on getting the launch off by a given time. i referred to that as launch fever, something we always tried to fight at the company i used to serve. it's a subtle pressure. and the "challenger" spoke to that pressure as one of the causes, they thought, of the "challenger" accident. and having said this, i would hasten to add, we've spent a

good deal of time talking with the people who are responsible for launching the remaining shuttles, the six remaining ones. and they're very conscious of this. they're taking the attitude that they won't be hurried. i think they're doing everything right. the problem is, they're going to run off a budget cliff 12 months from now. and we need to fix that for them. and i think if we do, they'll manage things very properly. >> and i have been amazed, as i have watched this entire space team, knowing that the space shuttle is likely to come to an end. and they haven't missed a beat. with still high morale. i mean, to me, i am just -- i'm amazed and very appreciative. >> and i say to -- i never cease to be amazed. when having to close a plant,

terminate a program, of the commitment of the people to doing just what you said. and that's particularly true in the space arena, and the defense arena, where what they're doing is more than building widgets. >> that's correct. and i might say, thank you for putting that on the record. i think it's important that the white house and omb hear what you just said. the congress has provided, in its budget for the out year 2011 an additional budget authorization of $2.5 billion. in order to fly out the space shuttle in year 2011. but that's in a budget planning document. it has to be put into reality, and there's only -- only the white house can do that with the congress concurring. let me ask you, as you look to the future, do you think --

well, let me ask you. what is your opinion about a constant source of funding and an adherence to a defined plan once the option is chosen as a key success for nasa's future? >> that clearly would be a key factor to success. particularly if that number included a reserve to account for the unforeseen. reserve a time, reserve in funds, reserve in technology. it's almost impossible, as you know, to manage a program that goes out to the year 2030 when you don't know what the funding commitment is. and when you have to redesign the program each year. this is a program that probably involves tens of thousands of contracts. and subcontractor agreements. and when you change the budget,

you have to renegotiate those. and rarely do they go down when you renegotiate, so your total costs go up. the stability of funding would have an enormously positive impact. having said that, i also recognize the difficulties that you face in your chair, when you don't know that the economy is going to collapse on us a year ago. and that the government's receipts are going to drop. and so it's not clear to me how one can guarantee a program budget for the kind of time period it takes to undertake these major pursuits, but anything that can be done by the congress and the white house to put stability in the funding, and to let the nasa leadership know ahead of time what that funding is going to be, so that they don't have to guess, would be one of the greatest contributions you could make to the human space flight program,

or any space flight program. >> let's talk about these options in 4a through the bottom, where the crude to low earth orbit is by the commercial provider instead of a nasa vehicle. you know the history of developing space craft. you think that seven years that you really could have one of these commercial operators be able to get a human crew up to the space station? >> i think if you were to have several paths with several operators, several commercial firms, not necessarily only the smaller firms that are very quick on their feet, but also

some of the larger, more experienced firms that are probably less quick on their feet, but have more scar tissue, i think if you could have several firms involved through a competition, that the chances would be very good that one would have a success. i think back to earlier in my career when we had icbms, launch vehicles. you are familiar. and i speak to the tight and the atlas. icbms in those days when i was involved, were designed to reliabilities that don't even approach the reliabilities we talk about today for human-rated vehicles. and yet we did find a way to -- we called it man-rating in those days, incorrectly. we did find a way to man-rate those vehicles and use them, and jim and i at the mercury

program, and they performed very well. and so there is no fundamental physical reason why this shouldn't be possible. but i would say again, it's not without risk. there are back-ups that one can consider. that is, other launch vehicles, including foreign launch vehicles, during that period of time. >> and so when it comes to u.s. commercial cargo capability, your committee felt pretty confident of that capability. >> i think that's true. and nasa has, of course, embraced this idea, provided nasa technical oversight and nasa help, which gives me greater assurance. and these firms have some very talented people, and i think there is every reason to believe they can be successful. >> you want to talk to us about the differences between the aries 5 heavy capability and

your discussions as an alternative to an arrest aries 5 light. >> i would be glad today that. the aries 5 is part of the current program of record, unfortunately, it's not been able to be funded, because to keep the budget for the aries 1 and the orion unchanged, we've been delayed in starting the aries 5 and things that might go with it. the aries 5 lite is very similar to the aries 5. but it has less pay load capability, and the basic measure, as you know -- it's 150 metric tons, 140 metric tons, i guess, for the arrest reese 5, and 130, i think -- there's about a 20 metric ton difference. in this terms of payload throw

weight. the aries 4 -- aries 5 lite basically has one less engine, has half a segment less on the solids, and can be designed to have more margin. and that is important to us, because the aries 5, even today, many years from first launch, has very shallow margins. and if there's one thing we have learned, i think is that having margins is the blessing of this space program, to be able to de-rate things. the aries 5 would be used in companion with an arrest res 1. it's referred to by nasa as

aries 1 1/2. whereas aries 5 lite would be used with another aries 5 as its companion. that also has the advantage of you only have to have spares at launch facilities and so on for one launch vehicle of the type. so you would use two aries 5, which gives you -- my numbers for some reason are escaping me at the moment, but let me just @@@ )'))))git, but let me just of merit to the aries 5 lite

approach. the disadvantage, of course, is that the aries 1 is partly developed. and the aries 5 is not. >> and according to your much more complicated chart, you could have the aries 1 -- aries 5 lite ready to go in the early 2020s if you went the flexible path, if you went the moon first. so it would be the early 20s. of course, you remember that the president said in the campaign, he wanted to be on the moon by 2020. so that's pretty much out the window, according to your panel, isn't it? >> that's true. >> so you're talking early 20s, you could have aries 5 lite ready, and you would have a

scenario by which you could get aries 5 up with a crew as also with a lunar vehicle and do rendezvous perhaps in lunar orbit? >> we're speaking to the larger budget level, of course, and the answer would be yes. >> yes. you want to -- for the record, do you have any comments about the alternative on the eelvs? the expendable launch vehicles? >> yes. the expendable launch vehicle family, of course, is one that's been with us for many years, traces its history to the icbm programs, in fact. and has been extended by the department of defense.

and these vehicles have been used in various forms, some not yet in the form -- or carrying the full throw weight that would be needed for this mission. and the vehicles are proven. they're not human-rated. and they would require additional development. they offer a legitimate alternative, and they also offer the advantage that the department of defense and the intelligence community might find useful. and we could have some savings there that offers a disadvantage of having to coordinate vehicles coming down the line of who gets what. and who gets first priority. but it would be our committee's view that eelv family is a

viable option, worthy of consideration, and we have not attempted to make specific choices here, in part because -- which -- a great deal more analysis we have done, in addition to wanting to take a position. it's a choice that good engineering can make. >> i'm curious, one of the earlier years of accomplishment is under using an eelv, going the flexible path, and you're looking at the years 2015, 2016. can you comment on that? >> yes. the reason for that, of course, is that the goal has changed. the goal is much less demanding one. under this flexible path option.

>> so that would still get you out on things like aster oids or one of the martian moons using an eelv? >> upgraded, yes. >> and you could do that within the span of 2015, 2016? >> no. no. it would be well beyond that. i unfortunately don't have the numbers here with me. but it would be well beyond that. >> okay. i was looking from this complicated chart. >> yeah, i don't have that chart here. >> right. well, under that plan, on this same chart, you would be late 2020s and doing actually a landing on the moon. >> that sounds more correct. >> did your committee discuss an atlas or a delta on the eelvs? >> we did. they're both certainly plausible

candidates. oh, i do have it. thank you. >> how did your committee arrive at the cost estimates for the different options? >> the committee, as i mentioned, hired the aerospace corporation to assist us in this regard. and we also had a good deal of help from nasa. and we obtained the nasa estimates that they have and probabilities of confidence levels that go with them. the aerospace corporation has some models that are based on a large number of prior programs. i believe it's 77 prior programs. space programs. and those models show correction factors to account for real-world experiences, compared with estimates that were made at various points in those

programs. we took the work -- i shouldn't say we. the aerospace corporation took the break down structure line by line, and considered to what -- what was the maturity of the work under that line item. is this a component that exists in which case there is no -- the factor they would add is 1.0. if it was a component that was just beginning, depending on the kind of component on average, they used a factor of about 1.5. if you go through that whole set of items, the average is about 1.25, factor they have used. and estimating cost. the -- the factors, as i say, weigh in the maturity of the item in question. and so that tends to reduce the factor that was added somewhat

more. nasa has raised the point that they consider that some of these factors, or in fact, many of them were included in their original estimates, and that when aerospace has taken this step, they have double counted. the aerospace corporation believes that's not the case, and even if it is the case, it's unlikely that we have been too conservative, and i'll give you one reason. that if you look at the set of programs that the aerospace corporation uses to arrive at the factors, i think it's 77 programs, for the whole set of programs, they have a given factor. if you take only the human space flight programs from that set, up you have a factor that's almost twice as great. so even if we have double counted, the chances are we have double counted on the order of 10% or so.

and experience would suggest that that's probably not a bad thing to do. >> how do you answer this question. that we've spent $8 billion thus far on the present architecture, which includes aries 1. and now we're going to abandon that, having spent $8 billion. >> well, my answer is that we've offered a set of of five options. we have not suggested abandoning aries 1. some of the options do abandon it. we could continue with aries 1. no question about it. and at the same thing -- we continue with the space shuttle, we could have iss longer. it gets to be a question of if you do all those things, you just don't get to do some of the things in the future like build an arrest res 5 or heavy lift

vehicle, which is what we think this nation has badly needed, frankly, since the first of these studies i was involved in, and recommended at that time. so aries 1, in our mind, we haven't recommended it either be continued or it be abandoned. if it were to be abandoned, we think there ought to be compelling reasons to abandon it. one of the strong sentiments i've derived in my career is constantly changing programs is one of of the worst things you can do, and you should only make changes for very compelling reasons. we have offered the pros and cons, and it's up to the reader to judge what the definition of compelling is in their mind. there are liabilities to continuing with the aries 1. one of of those liabilities is under the current program planned, ace mentioned at the outset, we won't even get it until two years after the iss is in the bottom of the pacific

ocean, by our estimate. if we extend the iss, we will only be able to use the aries 1 for about three years to support it. then there won't be that much to do with it, frankly, until we get the after res 5, but we'll get the aries 5 later, because we spent the money on aries 1. on the other hand, the aries 1 is designed to be probably the most reliable vehicle that's ever been built. we think there is a good chance that will be the case. as you say, we have spent $8 billion on it. and although that's a sum cost issue, nonetheless, we have spent $8 billion. there are a lot of people working on it. we're getting ready to conduct a test of what one might call a prototype of that vehicle. and it too is a very viable vehicle. so i would like not to make a choice here, but just to point out the pros and cons. >> well, if the president were to pick the option of the aries 5 heavy lift or the aries 5

lite, you're certainly going to be able to utilize the technology that you have developed for the aries 1. so that you don't lose all the value of that $8 billion that's already been spent. is that what the committee concluded? is it. >> that's absolutely true. and similarly, if you pick another option, you can always complete the aries 1 by adding money, as i recall -- you know, again, i don't have my data, but i think it's a billion and a half dollars or so. but pretty soon, you add up these things -- we tried very hard to scratch for money so that our profile was $3 billion, and not 6 or 5. >> what was the committee's thinking on promoting the development of on-orbit refuelling? >> interesting question. as a matter of fact, von brunn, and some of his writings you may be familiar with, pointed to the enormous advantages of on-orbit

refuelling. and over the years, we've had some efforts begun to look at the subject, but have never really turned into any great fruition. for financial reasons, cost reasons. it's our belief that on-orbit refuelling will be a major factor in space exploration one day. we currently aren't ready to undertake it today. we just don't know enough. it would be too dangerous. but there's no reason that we know of from an engineering standpoint that one can't do it. we -- we would like to use some of the money that we proposed spending under these option 3, 4 and 5 to run tests first on the ground and then in the general vicinity of the iss refuelling on orbit.

and once that's been done, it could have a significant impact on some of the options. for example, some of the closely-derived shuttle options benefit substantially from on-orbit refuelling. so we think it's something that's ready for a major technology effort today. but not anything further. beyond it. >> did you have any -- in your discussions, any idea of the time in mind as to when we should try to target for on-orbit refuelling? >> i would like to provide that for the record, if i could. >> okay. does any of the staff have any additional questions, or do you want to keep the record open for -- that we will do. we will keep the record open for any of the members of the committee. i know senator prior was trying to get here, and he was with his father. the former senator prior. so i'm sure he'll have one.

can you give us an estimate of how much it will cost to continue flying the shuttle until aries 1 or a commercial solution is available in that range of 2016, 2017? >> well, that was the -- >> and let me just complete the station, because it's one of your options. and that would also support the iss until 2020, and maintain the development of a heavy lift capability by the early 2020s. >> if you were to continue the shuttle to support the iss through 2020 -- >> that's right. >> you would probably have to add -- i think that -- >> just until a new commercial human-rated vehicle would be developed. >> human-rated.

of course. >> that doesn't seem to be one of the options. yeah. what staff is pointing out, it would be the best of all worlds. you continue to fly the shuttle, and the question is, what is it going to cost. until you had a human-rated capability on commercial, you keep the station up there until 2020, so that we have the value of that, and at the same time, you do your technology development of a heavy lift capability by the early 2020s. >> the -- my estimate would be

that additional cost would be of the order of $10 billion, probably a little more. >> over that whole time period? >> yes. >> that's above the $30 billion over that ten-year period, which was the $3 billion per year. >> exactly. and so you would have to add that, or else take it out of the 30. and if you take it out of the 30, you slip the other thing we would like to be doing. if you did continue the shuttle, one benefit of that -- another benefit, other than closing the gap, is that it makes the closely derived shuttle vehicle options very much more interesting. because if you still have the shuttle operating and in production, for that period of time, then driving from the external tank and so on becomes a much more plausible option. the difficulty, of course, is

that we don't have three shuttles left, and launch rate will be very low. and when you go with low launch rates, you start worrying about safety. >> well, that would be then more like option 5c, flexible path, shuttle derived. >> it would be like that, except in -- >> except the shuttle life would continue to service the space station until a commercial human capability were ready. >> yeah. you've described a derivative of option 5c, where you would continue the shuttle operation. >> right. any further questions from the staff? >> okay. the record will stay open for a couple of days. and again, i want to -- i want to thank you for what you've

done. this was very unselfish work, and i think the president really has a major decision here. and there's -- there's nothing like a president making a bold decision to focus the nation on where we ought to be going technologically. and he's at that point. and you've laid out a lot of parameters for it. and i think it's going to be up0

going to make a bold stroke, not unlike president kennedy. and he set this nation on a course that was extraordinary and it is my p belief that president obama will do that. so, with that optimistic note.

>> we must avoid a situation in which the loss of even one aircraft by accident or combat results in the loss of a significant portion of the fleet, a national disaster akin to a capital ship. this scenario raises our costs of action and shrinks our strategic options. when we should be looking to the kind of strategic -- to the kinds of weapon systems that limit the cost of action and expand our options. whatever system is chosen it

meet this requirement, it manned, unmanned or some combination of the two, it should be one that can realistically be produced and deployed in the numbers originally envisioned. that is why it is so important that with aircraft as with all of our major weapon systems, schedules are met, costs are controlled and requirements are brought into line with reality. now, before closing, i'd like to turn to some areas that underpin america's strategic strength and global reach, areas of ongoing and future importance to the air force and to the united states. first, just about all of our military forces, land, sea, air now depend on digital communications on the satellites and data networks that support them. with cheap technology and minimal investment, adversaries operating in cyberspace can inflict serious damage on our command and control, isr and precision strike capabilities.

the recently activated 24th air force under the services space command working with other military and nonmilitary partners will make an important contribution to protecting this key domain. second the role of space and satellites has never been more crucial to military operations. from gps-guided munitions and navigation. we have continued the streak of national security space launches so 65. our forces around the globe could not succeed with the satellite-based capabilities provided the air force 365 that's a year. third, the air force's nuclear stewardship, the stand-up of the noble strike command and the 28th air force is in this command is a historic marker who will add clear lines of authority and accountability to the service's nuclear mission.

these institutional reforms will also help keep this critical expertise alive and valued within the service and its officer corps. the activation of another new b-52 squadron further illustrates our commitment to america's strategic teattorney. -- deterrent, hard work is starting to show some results. steps on the path to institutional excellence in a mission where there is no room for error. and finally, i'm pleased to announced that source selection authority is returning to the air force for the kcx refueling tanker. with a draft request proposals to follow. i don't need to belabor the importance -- [applause] . >> i don't need to delabor the importance of getting this done and done right and my office will continue to have a robust oversight role.

we are committed to the integrity of the selection process and cannot let down the squabbles and corporate food fights that have bedeviled this effort over the last number of years. i have confidence that the kcx selection authority is in good hands with the service's leadership team with secretary donnelly and general schwartz. indeed, the air force is fortunate to have a deep bench of senior flag officers including four combat and commanders as many as any other service including the first air force officer to lead southern command. i depend greatly on their expert advice and strategic vision. all told, the foundation of america's air power in the 21st century rests first on a broad and mixed capabilities, tactical and strategic, manned and unmanned from cyberspace to outer space. and second, on the quality and

commitment of our airmen without which all of the most advanced hardware in the world would be of little use. which brings me to a final thought. this organization properly reveres the memory of leaders like billy mitchell, who advocated for air power between the world wars in the face of cherished traditions and conventional wisdom. cavalry, for example, was against aircraft because they might scare the horses. one of my predecessors, the sent of the war at the time told general pershing won a war without looking at a plane much less riding one. another war secretary thought mitchell's idea of using airplanes to shrink a ship was nonsensical and impossible i'm willing to stand on that bridge while that nitwit must have hit me. it must have been a hell of a temptation. [laughter] >> it strikes me that the

significance of mitchell and his travails was not that he was always right. it is that he had the vision and the insight to see that the world and technology had changed. understood the implications of that change and then pressed ahead in the fierce institutional resistance. the transformative figures of american air power from mitchell to arnold, lame to boyd had this quality in varying degrees. it is one i look for in the next generation of air force leaders, junior and midlevel officers and ncos who have experienced the grim reality of war and the demands of persistent conflict. these are men and women we need to retain and empower to shape the service to which they have given so much. in this dangerous new century, our country faces a fiendish and complex array of threats. and our military confronts a bewildering array of tasks. to overcome these challenges

we'll call on all of the elements that make up america's defense establishment, military and civilian, congress, industry, retired flag officers, veterans groups and military service organizations. to step up and be part of the solution, to be willing to stretch their comfort zones and rethink long-standing assumptions for the wider and greater purpose of doing what is necessary to protect our country. i believe this is happening in the united states air force. the american people are grateful to airmen for having protected us for many decades. and we are counting on you to do what it takes in the years ahead. my thanks again to afa for the opportunity to speak with you today. and for everything you do on behalf of our country and our air force. thank you. [applause]

>> thank you for agreeing to take a few questions. your recent announcement needless to say i have quite a few -- but your announcement concerning the kcx takes care of 50% of these questions. [laughter] >> the first one concerns our nuclear forces. and you mentioned the stand-up of global strike command. and as we continue our efforts to reinvigorate the nuclear enterprise, what could you share with us on the status of the nuclear posture review and what impact that might have in terms of major changes for our air force? >> well, the nuclear posture review is well underway. i would say we're beginning to see what's some of the likely conclusions are.

i would say it is -- it is clear, at least to me, that it is important for us to continue to make investments, and i think larger investments in modernizing our nuclear infrastructure, the labs and so then, the expertise in these places, to have the resources for life-extension programs and in one or two cases, probability new designs that will be safer and more reliable. we have no desire for new capabilities. that's a red herring. this is about modernizing and keeping safe a capability that everyone acknowledges we will have to have for some considerable period into the future. before achieving some of the

objectives of -- of significant arms reduction and eventually no nuclear weapons at all. all recognize that is considerable distance in the future. and we have an obligation to keep this capability safe. i also believe that these capabilities are unablers of arms controls and reduce the size of our stockpile when we have more confidence in the long-term viability of our weapon systems, then our ability to reduce the number of weapons we must keep in the stockpile is enhanced. so i see this modernization effort, if you will, as a vehicle and an enabler of stockpile reduction. >> thank you, sir. this concerns our efforts to build partnerships with regard to air power. and do you see a continued expansion of efforts of building partnerships with air forces

like iraq and others? >> yeah, and i think that this is an area where the air force is really stepping out, both in iraq and afghanistan. and, frankly, their ambitions for air power in my opinion probably exceeds their capabilities in the near term and so i think the air force has taken a very smart approach to this in terms of helping them walk before they run or fly in simpler, easier to maintain aircraft rather than the high end aircraft right away. and this i referred to in my -- in my -- in my remarks about the need to develop some capabilities where we can actually more easily hand over to them an aircraft that they can use and one that is easier for them to fly and maintain at least as they're getting started

in building these capabilities. >> this one is sort of a follow-up to that concerning air power in afghanistan. and that our nato air force and our air force have experienced considerable success. what is your use of air power in afghanistan and what do you see coming down the road in the future. >> as i said in my remarks, it's even more important in afghanistan this it is than it has been in iraq. if only because the infrastructure is so much more primitive in afghanistan. the absence of paved roads, the absence of roads all together, the size of the country, the isolation of many of our forward operating bases, the operation of our units as they operate out in the field, valley by valley, mountain by valley, and so i think that the demand for air power in afghanistan will only

grow and, obviously, as we've nearly doubled the size of u.s. forces in afghanistan in the last about a year and clearly the demand for logistical support has increased dramatically. and let them just highlight something with respect to afghanistan where i think the air force has really stepped up to the plate and done a remarkable job, and that is since last january, moving our medevac capabilities in afghanistan from around two hours down to -- on average an hour and in many cases, much less. and given the size of the country, this is a remarkable achievement. and i think you can hardly imagine the impact that that has had, i think, on the morale of our ground troops in knowing that the air force is for them

like that. i was told when i was out there a few weeks ago and visited, as i mentioned, a couple of the units that are doing the rescue operations, we had not had a double amputee survive those wounds in afghanistan until this kind of additional air power came along. so that's the kind of difference it's making. now they are being saved. >> the next one concerns the area of cyber. and you commented on 24th air force. and would you also comment on the stand-up of u.s. cybercommand and your expectation of the service will organize and provide capabilities to this new command? >> i think all the services have really readily embraced the reality that this is -- this is important and vital to us for the future. each of the services is

establishing its own cyberorganization such as the 24th. all of the -- i've asked each of the service chiefs to consider as a first priority filling the billets in the cyberschools. we were not filling all those billets and clearly the demand for trained people in each of the services in this area is critically important. i think everybody understands this is a huge potential vulnerability for us because of our dependence on electronic world for communications, for everything we do. and i think cybercommand really is a recognition of the need -- the u.s. cybercommand as a subunified command under straticom -- i think the reason why it's important is the need to intergrate the different elements from exploitation to defense and so on so we have a,

you know,tive effort in this respect and working with the individual service components. i think we've made a lot of institutional and structural progress over the past year to 18 months in getting ourselves better organized to deal with a threat that is only going to grow in the future. >> and sir, this is a follow-up on that. you describe well what we're doing within the department. but9v how will operations in cyberspace be coordinated between the department of defense and other civil and national agencies? >> well, i'm sort of speaking a little out of turn here. because i can't speak for the administration as a whole so i'll just give you a personal opinion. i think the notion of being able to replicate nsa for the civilian side of the government is wholly unrealistic. we lack the human capital as well as the dollars to be able

to do it and frankly we lack the time to be able to do -- you just couldn't create another nsa in a year or two. this is a 10 or 20-year project. so i think we have to figure out a way -- i think that the concerns of people -- of all of us concerned about civil liberties and so on have to be taken into account. one way to do this would be to double-hat a deputy secretary or an undersecretary of the department of homeland security and have that person also be a civilian deputy at nsa, you know, and then figure out a way to put some firewalls in to make sure that the authorities that we have, that we can use for going after foreign threats do not spill over into the civilian world. but clearly the need to address this issue and the vulnerability of the dot com world in this arena, i think, has to be

addressed and better sooner than later. >> thank you, sir. the next question has to do with our growing reliance on space. and our services and certainly our nation and the world continue to rely heavily and even more so on our space capabilities. what are we doing to address the potential threat to our space assets that have been appearing over the past several years. >> well, this is a worry for me and a especially once the chinese demonstrated their antisatellite capabilities, they're working on them. clearly the russians have some capabilities in this area. others may have in the years ahead. and maybe in the not too distant future. so i think we have to look at it in a couple of ways. how can we make what we do put in space more survivorable. but also what kind of alternatives can we develop in the atmosphere to be able to provide us at least short-term substitutes for space assets

should they be denied to us. and i would tell you we're not -- we've made some good progress but we've got a long way to go in this area. >> the next question looks to the future. would you care to expand a little bit on what you see as the department of defense's top three or four challenges as we look to the next five to ten years? >> well, i think that the biggest challenge that the department will face is sustaining the programs that we have in a very straightened budget environment and in an environment where the government is facing gigantic deserts. -- deficits. i always use to see the u.s. budget if you graph it over the past 30 or 40 years would look like the ekg of a fibrillating heart. and the truth of the matter is, radical ups and downs are about as inefficient a way to do business as there is.

and so my pitch basically has been, give us whatever the rate of growth -- try and give us a steady rate of growth that we can plan on for years at a time. whether it's 2% real growth over inflation, whether it's 3%, whatever that number is, give us some predictability because i think everybody in the room who's managed programs knows you can do a lot if you've got some predictability and know what's coming next year and the year after that. so i think that's the biggest challenge that we're going to face. we obviously have the challenge in particular of the war in afghanistan. as i said, i think that's entering a decisive phase over the next year or so. i think trying to organize ourselves and our thinking and

our programs in a way that provides for the maximum possible flexibility or versatility across the widest possible spectrum of conflict is a challenge we need to face. we don't have the money to have a lot of single mission niche capabilities. we need to have platforms that have applicability in a number of different areas. there will be somewhere we have to have a niche capability. and we have to preserve those. the f-22 is a good example of that. but by and large, we need to look at procurement in the future to say, can this help us in a number of different forums, a number of different kinds of conflict, whether at the high end of conventional conflict or in irregular conflict. >> and this question also looks to the future. you described the challenges.

what do you see is the things that give you the greatest hope for our future? >> well, that's really the easiest question of all. it's the men and women in uniform. they are all amazing. they are principally the reason that i came to this job and principally the reason why i stayed in this job. thank you, mr. secretary. thank you for your leadership. thank you for those kind words for our airmen and thank you for being with us today. we'd like to present you a small token of our gratitude. a photo of our great air force memorial that was taken on the day that it was dedicated. [applause]

>> next month, take a rare visit inside the supreme court as we talk about the justices about the roles, traditions and the history of court. >> brandeis said he wouldn't come in here. and the reason justice brandeis said the building is so elaborate it would go to his head. maybe he's right. but it's become over time a symbol of the court system, a third branch of government and the need for stability, rule of law, which is what america stands for. >> supreme court week starting october 4th on c-span. and as a complement of this original production c-span offers teachers free teaching resources on our judicial system. go to c-spanclassroom.org. >> now, a house hearing with health and human services secretary kathleen sebelius. the topic is the h1n1 swine flu and the 2009 flu season. henry waxman of california chairs this two-hour hearing of the house energy and commerce committee.

>> the meeting will please come to order. today's hearing on the 2009 pandemic h1n1 flu is a continuation of this committee's ongoing interest in learning more about and staying on top of this developing and concerning situation. the hearing builds on the work of chairman pallone's health subcommittee which held an initial hearing on the issue earlier this year. from then until now one thing has become crystal clear even as events continue to evolve. as a nation we must be prepared for whatever the h1n1 virus brings in its path to fight it as best we can and to ensure adequate and appropriate resources to treat those who fall seriously ill. we're especially pleased to have as our witness the secretary of health and human services, kathleen sebelius, secretary sebelius will share the government's plan for addressing

this enormous challenge. when the health subcommittee first met six months ago, there was much we did not know about h1n1 virus. we didn't know how dangerous the virus was. we didn't know if there would be a vaccine available. we didn't even know if the virus would return in the fall. many of those questions have now been answered. we know this outbreak won't be the false alarm of 1976 when the surge of swine flu cases never materialized. indeed, we are already seeing a large increase in cases, a pattern that is likely to continue. the epidemic will undoubtedly lead to hospitalizations, schools may close, healthcare facilities may become overwhelmed and almost certainly there will be some who will die. but there's also good news. this administration has carried on the efforts begun several years ago to prepare the country for the very situation we must now tackle.

the plans developed appear to be appearing appropriately and experts tell us that so far the 2009 h1n1 epidemic will not be anything like that which occurred in 1918 when an unusually dangerous flu virus devastated our nation. more good news was reported just 11:00. we not only will have an effective vaccine in place. studies now indicate that the vaccine will probably require only a single dose rather than the two doses many had predicted. as a result i hope secretary sebelius will report today that across the country we'll have a good supply of vaccine. allowing us to avoid both the additional cost and the additional needle stick that a second dose would mean. i expect that we will hear more about this as well as other h1n1 flu activities from secretary sebelius. i know all of us are also particularly interested in getting the secretary's

perspective on not only the progress we are making in taking on this virus but also the difficulties we surely will face along the way. but as we make preparations and carry out detailed plans for dealing with this new virus, we must also take heed of the battle we confront annually against the seasonal flu. each and every year some 36,000 americans, mostly among the elderly, die from this preventible disease. we can and should do much better than that and i hope that secretary sebelius can also share with us the administration's thinking on addressing this concern and in particular how that approach relates to its h1n1 strategy. with that, on behalf of the entire committee, i want to thank the secretary for appearing before us today. we all look forward to hearing from you and learning about the h1n1 challenges that lie ahead but before the secretary will be recognized to make her statement, i want to call on several of the members of the committee to make opening

statements, and we'll start with mr. deal. >> thank you, mr. chairman. i want to thank you for holding this hearing on the examination of our nation's preparedness for the h1n1 flu virus as we approach the flu season. and i look forward to secretary sebelius's testimony and welcome her to the hearing today. as i mentioned during the subcommittee hearing last april, the threat of a global influenza pandemic is one of the greatest public health threats that we face today. when speaking to scientists, researchers, healthcare providers and other experts in the field, i truly believe that it's not a matter of if a flu pandemic hits but when. and i believe we have the responsibility to ensure the greatest public protection possible when the situation arises. we all recognize that's not a simple matter. since the first reports of this novel strain of the influenza virus began to surface earlier this year, u.s. and international authorities have taken aggressive steps to mitigate the spread of the illness. this has taken the dedication

and cooperation of all of those involved, both public and private sectors, particularly, as the infection rates have increased. as my home state of georgia and other areas in the south have witnessed the easily transmittable h1n1 strain as it continues to spread particularly as we have now begun school, somewhat earlier than other parts of the country, we all recognize that this is a real threat. now, i have been in contact with my state's agencies and they are also coordinating with your offices at the federal level and as you are coordinating with international groups during these months that will lie ahead as we try to deal with this problem. the current response to the h1n1 strain was coordinated in large parts with plans which were developed to respond to a similar situation, the h5n1 avian flu. in 2006, congress provided approximately $6 billion for pandemic planning and cross-agency collaboration. these earlier efforts and others focused on preparedness for

emergencies have stream lined this response. while our efforts to combat h1n1 have been aggressive we must continue to monitor the situation closely and be proactive as we hopefully will be able to avoid this but regrettably know it will probably increase in severity. again, thank you, secretary sebelius, for being with us today. i look forward to your testimony. i yield back, mr. chairman. >> thank you, mr. deal. mr. pallone. >> thank you, mr. chairman. and thank you, secretary, to give us an update on the h1n1 situation. when the virus first hit it was devastating. it caused sickness it, generated fear it, caused panic and it caused many deaths and there were many unknowns about the virus. we did not know how the disease would present itself over time, how well it would respond to the antiviral medications on the market today or how quickly it would develop resistance to those drugs and we didn't know if and how quickly we would be able to develop and manufacture a vaccine. while we've learned more about

the virus and we've made progress on a vaccine, it has spread worldwide across continents and hemispheres and now is a level 6 pandemic the highest warning level there is, it continued to spread in the summer months which is unusual to the influenza and re-enforces the fact that we still have to take it seriously. in my state 17 people have died since the outbreak and 570 have been hospitalized and we've yet to see the disease at its strongest. in addition, the peak of this flu coincides with the normal flu season which on its own can be extremely taxing on the healthcare delivery system. i'm curious to hear how the federal government is tackling the fact that this flu tends to affect individuals under 50 years of age. unlike the seasonal flu that hits the elderly the hardest. the younger population does not deal with disease often, and tends not to seek medical care as readily. there have been many questions about our nation's ability to respond to medical emergencies.

unfortunately, it's hard to justify spending money on programs that are in place in case something bad happens especially since so many programs that are needed on a daily basis have been chronically underfund. as history has taught us grand scale outdisease outbreaks have been happening, we must now more than ever be prepared for the situation and we don't to add to the health insurance crisis and we don't want to hinder the economic community. i want to commend you and your team for your excellent work on the virus. i know you and your staff have been working on test and test results to states to educate state and local governments and keep the public informed of the latest information and how best to protect themselves from being sick and so i want to thank you for that and i want to hear more on the federal government is prepared for the next wave of

h1n1. >> mr. barton? >> thank you, mr. chairman. thank you for holding this hearing and thank you, madam secretary, for being here. i want to say that this is a very important issue. obviously, america and the world is worried about the pandemic flu. we have begun to discuss this this year, back in april, we had a hearing on the h1n1 virus. i'd like to review some of the recent history. the department of hhs has responded by declaring a public health emergency which has allowed the food and drug administration to approve the use of approved antivirals and other measures. the centers for disease control has responded by releasing antiviral drugs from strategic national stockpile. to date all 50 states have received their portion of that stockpile, which has been replenished through purchases.

hhs is working with the department of homeland security in its coordinating response efforts. most of the work is successful because we aren't making new ground. this committee and the federal government has begun serious work back in 2004 so in 2009, while we're not totally prepared, we are better prepared than we ever have been. there's still some issues that should be addressed as outlined in the president's advisory council on science and technology. it's my understanding that the administration is actively working to address these concerns and i look forward to hearing from you, madam secretary, on those issues. i guess that is it, mr. chairman. i have another part of my statement but it's on the overall healthcare reform and i understand that you limited your statement to the pandemic flu. so in the spirit of this hearing, i'm going to do that. i want to take a point of personal privilege and say i appreciate all the good wishes that many of you have given me about my birthday. today is my 60th birthday. [applause]

>> 30 didn't bother me, 40 didn't bother me, 50 didn't bother me but 60 bothers me but i am glad to be having it and i'm blessed to have a great family, great friends and i think to be on the greatest committee in the house of representatives. so with that, mr. chairman, i yield back. >> thank you, mr. barton. i too want to wish you happy birthday and tell you you don't look a day over 59. [laughter] . >> mr. dingell? >> thank you, mr. chairman. the gentleman from texas has spoiled my opening remarks. it was my intention to congratulate him as a fine young man who has performed well in his responsibilities and to congratulate him on his 60th anniversary and hopes he reaches many more. i'm sure that at least i'm the first in this committee to have

the privilege and pleasure of doing that. so, mr. barton, all of us on the committee do wish you a very, very happy birthday. and many, many happy returns. now, mr. chairman, i want to thank you for holding this important hearing. and i want to welcome secretary sebelius and thank her for joining us this afternoon. you'll recall that your father was a member of this committee. a very distinguished one. and i'm sure that gives you good memories when you appear in this room. you have taken a proactive role in preparing our country for the upcoming h1n1 pandemic by implementing surveillance procedures to attract an outbreak, mitigation of measures to keep americans healthy, a proper vaccination plan and a strategy to disseminate information of importance. i want to commend you and look forward to hearing your update on the administration's progress

in planning for a potential outbreak. at the same time, i want to recall that on an earlier occasion, we made some fine mistakes in dealing with the health problem of this kind on a related virus which led to some splendid costs and some fine earnings for the legal profession. and i want to tell you, madam secretary, i'm pleased you've not fallen into any of the holes that your predecessors did on that one. in any event, we have held as all know a hearing earlier on h1n1 when there were only the first few people who were infected with the virus. it appears that the spread of the influenza virus that we're discussing did not let up during the summer as some had hoped. and experts predict an increased number of cases in the upcoming

months. as of september 5, 2009, my own state of michigan has already seen 34019 confirmed or cases of h1n1. or most with underlying health conditions have died after contracting the vir. they are reporting that there's cases within their borders and nationwide about 600 persons have died and 9,000 have been hospitalized. these figures highlight the need for the congress and the administration to work together to prepare for the months ahead. preventing the spread of h1n1 will require collective action not only from federal, state and local governments but also from individuals as well. to address this it is imperative that we prepare evidence-based programs for parents, children and businesses and also public health professionals on what to expect as the nation prepares

for more flu cases than seen in the past few years. i want to applaud the administration and the federal government for stock piling vaccines, masks, antiviral medications, ventilators and other things necessary to address the potential upcoming problems. influenza is unpredictable and we must indeed be prepared for a wide variety of surprises. today federal, state and local officers are planning and executing multimedia outreach campaigns to arm americans with the information they need to best keep themselves healthy or to address their problems once they become ill. this is imperative because while we wait for h1n1 vaccine to become available, we must each play a part in slowing or reducing the spread of the virus with simple steps like hand-washing and staying home when sick.

additionally, it's important for families and businesses to prepare their strategy for dealing with h1n1. i have created an h1n1 agenda for my own office and urge other businesses here and elsewhere to do the same. i look forward to working with you, mr. chairman, and the committee. and also with you, madam secretary, as we seek to mitigate the outbreak of h1n1. thank you, mr. chairman. >> mr. stupak. >> thank you for holding this important hearing on this pandemic flu prevention. i look forward to hearing your testimony on the department of health and human services efforts to ensure federal, state and local public health officials are ready to prevent or respond to the spread of the h1n1 flu. when the h1n1 outbreak began in late february, excuse me, late april, federal and state health officials acted quickly to deal with the outbreak. among other things antiviral

drugs were released from the national stockpile and efforts were immediately undertaken to develop manufacture, and test a vaccine. congress provided an emergency appropriation of $1.9 billion for full response and an additional $5.8 billion was authorized contingent upon a presidential request documenting the proposed use of additional funds. i'm interested in learning how much of this money is actually going to public health agencies. in our communities, particularly rural districts like the one i represent, our local public health agencies, hospitals and clinics who shouldered responsibility for responding to public crisis. it is vital that they receive support from the want for. h1n1 is unique from flu season. unlike the seasonal flu, h1n1 affects a different population and particularly young people with children, younger adults and pregnant women. from all indications i've read, the vaccines for h1n1 will not be ready until mid-october. i'm looking forward to hearing

from you on what types of infrastructure hhs and cdc will have to issue vaccines to pregnant women or people who care for young children, healthcare emergency personnel, persons between the ages of six months and 24 years of age and people between 25 and 64 who are at a higher risk from the h1n1 because of chronic health disorders like asthma. as chairman of the subcommittee on oversight and investigations, this is a issue i'll continue to monitor following today's hearing. i look forward to your testimony and learning how well the federal government is coordinating with state and particularly local officials as a nation we respond and hopefully preventing widespread widespread h1n1 outbreak. thank you, mr. chairman. i yield back the balance of my time. >> thank you, mr. stupak. we said that the only ones who would be recognized for opening statements would be the chairmen, the ranking member, mr. dingell, and then the chair

and the ranking member of the health and the oversight subcommittees. but without objection, the record will be held open for any opening statements from any member that wishes to include them. i want to do this, move on because secretary -- mr. walden, are you ready for your opening statement? >> you know what, mr. chairman. i'll submit it for the record because i don't want to take too much time away from the secretary. i appreciate the opportunity to do that. i look forward to your comments on this and i do hope you'll be able to come back at some point because i'm sure we'll have questions on the overarching healthcare bill but i would just say that the flu is something we're all concerned about. i have a son who's a sheriff's officer at wake forest university, which got swept pretty early on with the flu outbreak. he got it. i don't know if it was h1n1 and neither does he but he's recovered thankfully but it's an issue all families are dealing with. and i look forward to your

testimony. >> madam secretary, we're delighted to have you with us. your full testimony that's been submitted in advance will be made part of the record. and we want to recognize you for your oral presentation to us. >> well, thank you very much. >> there's a button on the base of the mic. be sure it's on. >> the green light is on. chairman waxman, chairman emeritus dingell, mr. stupak, mr. walden, it's good to be back, members of the committee. it's very good to be back before the energy and commerce committee, and i appreciate the opportunity to give you an update on the public health challenges of the h1n1 influenza. let them just start by saying the administration is taking these challenges very seriously. the night i was sworn in i went immediately in the situation room because this virus was just

breaking out. and from day one this has been very high on my radar screen. we're working in close partnership with virtually every part of the federal government but also with governors, mayors, tribal leaders, state and local health departments, emergency personnel, working with the medical community, the private sector to actively prepare for the virus outbreaks that may develop over the next few months and to have some mitigation strategies in place in the meantime. since the initial outbreak of the 2009 influenza, not only has a worldwide pandemic been declared, it's also presented itself as the dominant flu strain in the southern hemisphere during the winter flu season. here in the u.s., we continue to see h1n1 flu activity over the summer, which is unusual.

and as a number of you have already noted, it has increased now that the fall is underway. we're anticipating further increases in flu cases as seasonal flu begins circulating among us. we have provided, mr. chairman, each of the members with an update that's at your seats with some more details on the current situation including a situational update that's on, i think, the third page of your handout. the doctor from the centers for disease control is with me today and cdc give us these situational updates on a daily basis and we wanted you to have the newest information. although evidence to date shows that the virus has fortunately not changed to become more deadly, what we know is influenza is unpredictable. and we need to monitor both the

impact of the 2009 h1n1 and seasonal flu throughout the next several months. the virus is infecting more people than we typically see with seasonal flu including children, younger adults and pregnant women. and slowing the spread of the virus is a responsibility shared by all of us. chairman emeritus dingell already referenced there are some simple steps, hand-washing, covering coughs and sneezes and staying home when you're sick. it's our important steps. the government-wide website, www.flu.gov does have comprehensive information about what to do to avoid getting the flu. and i would suggest, mr. chairman, i know we have communicated this to the offices but on that website, flu.gov are widgets if any members of congress want to put a widget on

your own website so that your constituents can monitor on a regular basis, see the latest cdc guidance, get regular information, we would strongly encourage you to do that if i'm speaking in techno-speak a 12-year-old can be hired and tell you what to do with a widget. i apologize ranking member barton, i should have started with a happy birthday. and you'll find the 60s will treat you well, you know? it's a good place to be. to date the cdc has issued recommendations on how individuals, schools, child care settings, colleges and universities, large and small businesses can guard against the flu. as well as a recent guidance on the appropriate use of antiviral drugs. again, all of those are on the website and can be downloaded and shared with constituency groups if you're going to have some meetings at home.

guidance on infection control and worker safety in healthcare settings is forthcoming in the next few days. as i announce this weekend we plan to initiate our h1n1 vaccination program in october. mid-october is still the target for the large-scale campaign to get underway but we anticipate having limited amount of vaccine a week or 10 days earlier. i'm pleased to report that today the food and drug administration has approved applications for vaccines for the 2009 h1n1 virus from four of the manufacturers of the u.s. licensed seasonal influenza vaccines. the vaccines for this virus are being produced under careful fda oversight. using the same license manufacturing processes and facilities used for seasonal flu vaccines that are provided every year to protect millions against the flu.

and in response, mr. chairman, to your point, seasonal flu vaccine is now available widely in sites around the country and then we are urging people strongly, particularly, if they're in the target population for seasonal flu to go ahead and get the seasonal flu vaccine right now. we recently, just last week, had good news from studies being done both by nih and manufacturers that a single dose of the vaccine rapidly introduces a strong immune response in healthy adults. we think that age group could go down as low as age 9. but the clinical studies in children and pregnant women are still underway. so we don't have the full data about whether children will need two doses or not. they do in seasonal flu, younger

children. we're still waiting for those results to be back. and, mr. chairman, we originally thought that it would take up to 21 days for the immune response to be robust and it's showing up in 8 to 10 days. that's very good news. so one dose, 8 to 10 days for most of the population above age 9 we think is a very positive step forward. the trials in pregnant women are underway in children and our expectation is that the vaccine will be a good match in protecting against these populations as well. once ready, the vaccine will be shipped through a central distribution system and available in up to 90,000 sites around the country. every state was asked to develop a plan and identify the appropriate vaccination sites. our contractor is shipping directly to those sites so there

is not a glitch along the way. two types of vaccine. a flu shot made from inactive aided virus and a nasal spray made of live virus will be available free of charge though some providers may charge an administrative fee and then congress did authorize funds at the time of the supplemental bill to cover some of the costs and the department of health and human services has expended on top of that about a billion dollars in our funds to get that process started before the supplemental funding was available. cdc's advisory committee on immunization practices recommended that initial doses of the h1n1 vaccine go to people at greatest risk of

complications from the flu as well as those who have frequent contact with people at risk. and we're working with states, territories, tribes as well as the private sector to help distribute and administer the new h1n1 vaccine. thanks to congress, we've allocated $1.44 billion for states and hospitals for planning and preparation. the nation's current preparedness is a direct result of the investments and support of the congress and the hard work of the hhs agencies and state and local officials across the country, both recently but certainly over the last several years. so we looked to continuing to work with congress in the weeks and months ahead. again, mr. chairman, i thank you for the opportunity to participate in the conversation and i look forward to taking your questions. >> thank you very much, madam secretary, for that update. there are many members here, because this is an important

hearing, and i know you have to leave in a couple of hours, in order to accommodate the members, what i'm going to do with mr. barton's assent is ask each member to ask one question. we will put the timer on at 3 minutes but we'd appreciate it if members could ask one question but no more than 3 minutes. >> i want to let the minority members that i support this. there's a recommendation and there's a precedent for this. other cabinet secretary who have been before the panel we've adopted this practice. i think it's fair to the junior members have an opportunity to ask a question as well as the senior members. >> thank you, mr. barton. i'm going to start off the questions with a more junior member to me, mr. markey. >> i thank the chairman very much. we've been sitting next to each other for 33 years. and the 60s are great, madam secretary.

you know, one of the real questions that people have is the safety of this drug and there was a real concern going back to 1976 and that swine flu epidemic. and the diseases later associated with the distribution of that drug. so just so i can understand this. this drug has not yet been fda-approved; is that correct? >> it just was licensed today. >> it was licensed today. >> well, that's great news. and could you talk a little bit about what is different -- what the difference is between this drug and the drug back in 1976 in terms of what the fda and the agency believe will be the impact on americans? >> well, mr. markey, one of the first steps that the president took was to actually gather the

experts from 1976 together and ask for advice about what went right and what went wrong. and we had an opportunity to meet with the -- everybody from the then-secretary of health and environment to the surgeon general to some of the scientists who were involved. and they gave some very good advice. the principal difference may not have been in the manufacturing of the drug but the fact that the flu never spread so that the outbreak that was initially identified among about 200 soldiers in fort dix never went anywhere. so a massive vaccination campaign was launched. about 40 million americans were vaccinated and yet there was no flu, not in america, not anywhere. so we're in a very different situation today where we know this virus is spreading. this vaccination -- vaccine, is

actually being manufactured exactly like the seasonal flu vaccine. it's showing up in the same way and it's using the same processes and procedures. so in terms of the safety and efficacy, while there are clinical trials underway to determine the right dosage and really the efficacy of the vaccine, is it hitting the right target, there have been years of clinical trials and lots of data gathered on seasonal flu vaccines so we are assured by the scientists that lots of steps have been taken along the way to ensure that this will be a safe procedure. there's been more oversight than in '76. better -- made somewhat differently more oversight in testing and in quality so we do not anticipate the same problem and as i say, if it were a different process than seasonal flu, we'd have more concerns,

but it has been very similar. >> thank you, madam secretary. >> thank you, mr. markey. mr. barton? >> madam secretary, i may have questions for the record but my one question is something that you may not be aware of. i was briefed this morning by officials from texas a & m, which is not in my district, but it is the school that i went to. they have developed a -- if i understood them correctly, a vaccine that is made from hydrouponic tobacco that they can produce up to 100 million doses very quickly if necessary. are you familiar of that by any chance. >> mr. barton, i don't know about that vaccine. i do know tobacco is one of the growing agents looked at as an alternative to the egg-based vaccines but i don't -- >> if i were to get the researchers to touch base with your staff, would y'all be

willing to be briefed about that? >> absolutely. sure. >> program. >> absolutely. >> thank you, mr. chairman. >> mr. dingell? mr. dingell had to leave. mr. pallone. >> thank you, mr. chairman. i'm concerned about emergency room hospital capacity, that type of thing. there was this report that was issued last month by the president's council of advisors on science and technology that says there could be as many as 1.8 million hospitalizations in the united states during the epidemic and of this 1.8 million, up to 300,000 could require intensive care units and those patients could occupy 50 to 100% of all icu beds at the peak of the epidemic. and those icu operate close to capacity in my district. with regard to the nation's hospitals, i mean, do we have the surge capacity to meet this

potential demand and can you tell us what steps the department is taking to help hospitals prepare for the surge in cases? >> mr. pallone, i think it's a very important question. part of the planning effort that was launched well before this virus was identified was in building surge capacity for hospitals. billions of dollars have been invested over the last number of years. in fact, i had a chance here in d.c. to visit their five regional center sites that have been developed to get even increased capacity and one is here in washington, d.c. and get a sense of what they're doing. so there have been recent dollars put forward but also dollars over the years to have that planning go on for surge

capacity. we are concerned that we also try and get information to the public as rapidly and as clearly as possible. the worst of all worlds is have everybody show up at the hospital or come through the emergency room door. the vast majority of individuals who get h1n1 so far are not terribly ill, do not require additional treatment and certainly don't require testing to see what kind of flu they have. .. additional treatment and certainly don't require testing to see what kind of flu they have. so that we're trying to assure people the flu is the flu is the flu right now. cdc will continue to test through hospitals and other areas, those who are getting seriously ill so we can monitor the cases, but the testing isn't required. so we have resources to hospitals, we are helping with systems that will put in place

additional medical capacity, everybody from the medical reserve corps to additional personnel who we can help with assistance. so we don't think at this point that the presidential advisor's scenario is the most likely scenario to happen. we watched the southern hemisphere very closely and what they have done with surge capacity, and we'll learn a lot from them, but they had no critical emergencies that weren't able to happen without shifting some space. so i think at this point we're doing

states, and will there be a determination of how much goes to each state and what will be the factors that will be looked at in determining how many doses a state would be allocated? >> the distribution is based on a per capita basis, and states absolutely develop their plans, working with their emergency personnel, local health departments and others to determine the vaccination sites. so again, the distribution contract is not going to go to one central site in a state as the traditional vaccine. it's going directly to the sites that have already been predetermined. states were asked to send plans to the cdc. part of the resources by congress helped with that planning effort, and the contract will be up to 90,000

sites determined, so it will be some traditional, you know, providers' offices and health clinics and hospitals but also a number of nontraditional sites. >> could i ask one brief question on that? that per capita amount, is that determined by who the cdc thinks should be eligible for getting the vaccination or a general per capita? >> it's a general per capita amount in terms of how it rolls out. we will have enough vaccine available for everyone. there is enough on order. we're looking now at the reorders for the one dose versus two -- there will be enough vaccine. what we're concerned about is getting it to the priority populations as quickly as possible. that's what we've asked the states to focus on, how to get, you know, pregnant women, children under the age of 24, care givers of infants, health care workers, how to make sure that those f

once the new. school health providers, insurance companies, private state insurance agencies and private insurance. i'm pleased bill is part of hr 3200. would the administration support a voluntary multistate

school-based seasonal influenza and h1n1 vaccination program such as was created in hr 2596? let me say that that version, i know senator reid in the senate is looking to do a national version of that particular provision. >> mr. green, what we're going to have is a demonstration, national demonstration project of the bill you just suggested. going on in the next couple of months. certainly our leadership at the centers for disease control feel strongly if we're successful as using schools as partners in vaccination that that may be a great way to enhance the vaccination takeup rate going forward for seasonal flu and other issues i'm old enough that i was part of the group with the early polio vaccine and we got that vaccine in school.

that was always a partner. we have school districts eager to be vaccination sites and are standing by to do that. we'll know a lot about your voluntary program and we think it probably will be a very good idea. >> being part of the sugar cube generation, also, that i think this important, again, it needs to be voluntary. but we can't have a great deal of more coverage by dealing with our schoolers, our center and our community and we're talking about our children. >> given the age group this virus is targeting we thought schools and actually daycare centers and others are very appropriate outreach sites to reach the population who we need to reach, so working closely with the secretary of education and his counterparts, superintendents and governors and i think most governors are very enthusiastic of having the schools be voluntary vaccination sites. >> thank you, mr. chairman. >> thank you, mr. green.

mr. murphy, you'd be next. >> thank you, mr. chairman. a pleasure to have you here madame secretary. thank you for your work you're going on health care, too. as part of this i'm assuming part of the aal yis you did with this virus, the impact it would have overall on our america's health care system including the costs, one of the issues this committee is trying to grapple with, as you are s the cost of health care in america. we have an -- time getting information that has to do -- therefore, i'm wonder if your office has gathered some invest, analyzed that as this, for example, as these vaccinations are advanced out there earlier, what we are saving and what is this overall that comes from, yes, the government is spending money to move these out there, but what is the impact on saving money? saving health care costs and i

wonder if you have that information. if not, could you get it to us, because this committee really would like to have some of that, if i could say so, mr. chairman. >> mr. murphy, i will certainly look to see what kind of cost effectiveness or strategies we have put together. i'm not sure -- i think we can tell you probably and gather it for you, the cost of what happens with seasonal flu every year. the 200,000 hospitalizations, the 36,000 deaths, you know, what the impact is. i would suggest, though, what we don't have is then a huge sort of social cost. one of the projections absent a vaccine of this virus spreading even in a relatively mild case which would be 200,000 hospitalizations, 36,000 deaths, that's what seasonal flu looks like every year. if you have a widespread part of

the population who misses work, what the impact then is on businesses and trade. whether you can even do continuity of businesses if you have essential workers missing. part of the issue about schools is what happens if half the teachers are sick or how do people go to work if half the kids are sick? so i don't know that we have added those costs but we can try to put together some information for you. >> i would appreciate that. it is a type of modeling which we don't have. not only in terms of scenarios of analysis, now we have something very real we anticipate it could have an impact on workforce, education, as well as direct and indirect medical costs. i'd appreciate if you get that to us. thank you, mr. chairman. >> thank you very much, mr. murphy. i want to call on miss harman. >> thank you, mr. chairman. thank row for holding this hearing and thanks to a very cape l former governor and very capable team for putting in place a plan to prepare, not

scare the public. i want to commend you on the tone of this, that has overcome the original hysteria that met the early stories about the effect of this illness. so thank you very much. my question really is taking this to the next level or, perhaps, to the next problem. is this basic set of protocols we now have in place and the public pitch that we are making quite effectively about this strain of flu, will this be -- could this be applicable to, perhaps, a pandemic that's more severe, a possible biological attack in our country, or other huge health challenges that might arise? and if -- if this set of procedures and protocols and tone that we're using is not applicable, what steps can you

take now to be sure it does -- we are -- we are able to adapt it to future problems we don't presently anticipate? >> i think that's a great question, and no question about the fact that congress working with the prior administration put in place steps, really, that have been executed over the last six or seven years of not only resources that have amplified efforts within the deparent of health and human services including, you know, our own vaccine development operation, enhancements to nih and centers for disease control and fda, but certainly resources at the state and local level and a lot of planning. as a former governor, we went through pandemic planning. i never dreamed i'd be sort of here with a pandemic, but we called together efforts over the years. so i think at a minimum what is

happening over the next several months will enhance our entire public health infrastructure. having hospitals look at the spring where the gaps were, re-double efforts to get ready for the fall is enormously helpful, how they direct resources. looking at workforce issues, how to get, you know, vaccinations to people. a huge challenge and is an ongoing challenge is just information. how to make sure folks can access timely, accurate information in a very transparent fashion and walk that balance between complacency and panic but get people prepared and ready. i don't think there >> we know whether that's a natural disaster or a manmade disaster that that infrastructure strength, the communication strategies, working with the partnerships not only throughout government, but in the private sector is

enormously helpful and is exactly what you go through region by region, we just haven't done it nationally, really, in 40 years. >> thank you, ms. hard missouri ms. blackburn? >> thank you, mr. chairman. i am pleased that you are here, and i don't envy the task in front of you. i know it's going to be a rough flu season from what we're seeing and hearing already, and i do think the free flow of information is going to be an imperative as we try to handle this with your districts w schools, with public events that are taking place. you've testified before our committee twice, and the first time that you came we were working on the health care reform bill, and you we're looking at what could end up being one of them, incident to our -- significant to our

constituents as the impact of the health care reform bill. this is a public hels situation that we know -- health situation that we know is going to be in front of us to deal with this event. now, when you were here before and we talked about the issues dealing with, with health care, we talked a little bit about the ten care situation. i asked you about some of the issues that were there. your responses took a while to get to me, they were a single sentence, and that prompted another question, and i just received the response to those today. so i do thank you for getting those, but i, i do ask that as we move forward that knowing that this is going to be critical that we have timely and accurate information, that we do have that free flow of exchange as this public health issue

affects our districts and maybe a little bit more timely than the response to the questions which was a little bit curt and inadequate and be bordering on disrespectful. i do want to say thank you for the widgets, i appreciate that those are on your web site and that we can link to those, and i do want to ask you as we're talking about the supplies and the supplies being lent to the states and you mentioned those that are most vulnerable to the flu, are, are those that -- the physicians and the caregivers that are going to administer the flu shots, do they have a ranking or a priority system, or will the states work that out? are they going to take seniors and pregnant women first or do you have, can you give us any guidance on what that protocol is going to be for who gets to go at the front of the line? >> well, congresswoman, we have

not tried to determine for states the most appropriate way to get to their target populations. we thought that was a local and regional decision. >> okay. >> we have done a lot of work with the provider community, outreach directly to ob/gyns, primary care docs, health clinics with the infrastructure, but states are submitting plans based on their own determination region by region, area by area how best to target their vulnerable populations, and that's where the vaccine will be -- >> so our best response to those populations when they call our office is consult your local unless? >> -- physician. >> in terms of where to get the vaccine? >> and who gets priority. >> well, their local fls won't be determining who gets the priority. again, the state health

department has determined that, and that information should be available right now. there will be vaccine for everyone. >> jebt l woman's time -- >> so the state is really, has predetermined where the priority areas are. >> thank you, ma'am. yield back. >> thank you. gentlewoman from wisconsin, ms. baldwin. >> thank you, mr. chairman. thank you, secretary sebelius, for your testimony. there were several very encouraging items of news in terms of the hope that one dose will be sufficient, that it will be getting the desired immune impacts within 8-10 days days ad that you think you'll have sufficient dosage for everyone starting with priority targets. i have a few questions, very short questions related to that vaccine, the vaccine issue, and then in follow up i'll submit some written questions on

strengthening our public health system. but on the vaccine three quick questions. of the 195 million doses ordered, is the hope that you can reach everyone through use of thage vent that you have also ordered? and so tell me a little bit ant the use of agivent during this season. second, i know we had a shortage of seasonal flu vaccine i think back in 2004 when there was a closure of a production facility in the u.k.. we did not have a lot of domestic manufacturing capacity at that point. i believe that has changed, but i wonder if you could tell me of the five manufacturers we're working with for this dosage, where their facilities are located domestically versus foreign. and then i believe you announced in your testimony that four out of the five manufacturers have been approved today by the fda? what's the status of the fifth?

is there any reason we should be worried? >> no agivent is currently anticipated to be use inside the united states at all. there are some back-up plans if things took a terrible turn for the worse. we have never used in any wide spread area that type of vaccine, so the scientists strongly recommended that we not head down that path this time. the current purchases are likely to be enhanced to get to the point, what you've reported is the initial purchases, but as we get the rest of the clinical trials, we will make the purchases based on what is anticipated for 300 million potential users. 100 percent of the people will never get vaccinated for anything unfortunately. we currently have five

facilities. in the year we ran out of vaccine there was one. or i'm sorry, we were down to onement there were two, but one was -- >> correct. >> -- was debilitated. i can't tell you off the top of my head, unfortunately, where they are. i will get you that information back. what i was told yesterday by the vaccine committee is that we fully anticipate that all five will be licensed. there were some final steps needed to be taken in the final contract. >> just on the domestic production and vaccines being made in america, i remember a particularly telling hearing during the last administration where if we were having a particularly virulent pandemic, the presumption was we weren't manufacturing it here in the u.s., it would not be available to us in the u.s., and i certainly hope we are bolstering our -- >> gentle lady's time is up. >> most of it is domestic. >> gentleman from georgia, mr. gipg ri.

>> madam chairman, thank you. madam secretary, thank you very much for being with us again, and let me just say at the outset that your efforts along with those of secretary janet napolitano way back, i guess n june/july when you were getting confirmed, i think you've done a great job. no question about it. i don't think anybody could ever accuse you of being katrinaed on this issue. you have gotten a lot of money appropriated toward this effort, and my only concern back then, a little bit lesser now, was the issue of creating a pandemic of fear. and i mentioned that to you, and you have already addressed that in your testimony. but i want to ask you about, particularly about pregnant women because that was what i did in my previous life as an

ob/gyn physician, and i have three adult daughters and a daughter-in-law and nine grandchildren. the daughter-in-law just had a baby three weeks ago. >> congratulations. >> thank you. thank you, madam secretary. very concerned was she, though, about this issue of the swine flu and what should she do and that sort of thing, questions about what -- if she got it, what would be the risk to her especially in the third trimester as she was then? and what was the risk to the fetus? and i think that we need to get more information. i noticed on web m.d. a recent printout from web m.d., july 29, 2009, it says pregnant women even if they are healthy are at high risk of hospitalization and death from h1n1 swine flu, the cdc reports. now, i would like for you to answer that question, are they -- i mean, i know they're

at increased risk over the general population, and there are certain issues with decreased lung capacity and not as vigorous immune response because of their pregnancy. it does put them at higher risk than the general population of women, but are they at high risk of hospitalization and death? and i think the answer to that is probably, no, but comment on that, if you will. >> congressman, what we saw in the spring is that pregnant women constitute about 1 percent of the population. they were 6 percent of the hospitalizations and deaths that occurred. significantly out of kilter population and with no underlying health condition other than the pregnancy. >> yes. >> so we're not talking about somebody who had diabetes going into pregnancy or someone with chronic lung conditions -- >> yeah, definitely at high risk than the general population,

maybe as much as a factor of five. >> six would be the -- so in terms of the outreach, we have tried to be -- and that was not only the u.s. data that's showing up around the world that, again, pregnancy seems to be in and of itself an underlying health condition that significantly enhances the risk. so i know that for a lot of pregnant women i certainly did this myself, was reluctant to take anything during the term of the pregnancy but on talking to a number of ob/gyns, looking at the data, talking to the scientists, there's a great belief that the risk of any sort of event occurring because of the vaccine far is outweighed by the risk that occurs without being vaccinated. and in your daughter's case, a new mom, babies under six months old are not recommended for the

vaccine, so another of the target population is care gives of infants six months and younger to try and protect the infants. so you sort of -- >> madam chair, i realize that my time -- can i do a real quick question? maybe we can do a second round. okay, all right. i yield back. thank you, madam secretary. thank you. >> thank you, madam chair. thank you, mad sam sec -- madam secretary, for being here with us again. in states and cities across the our country, local public health departments are getting decimated by budget cuts. in my hometown of sacramento the office has had to cut 17 percent of its budget. we'll lose three communicable disease specialists and two microbiologists from the public

health lab. this is on top of other people who work behind the scenes every day testing samples for h1n1 virus and other communicable diseases. madam secretary, the one bright spot in these statistics i just mentioned is that my local public health department will be able to retain at least some positions thanks to a one-time infusion of recovery package dollars. what other plans do we have at cdc or in a department at large to help local public health departments cope with the huge responsibilities they're going to have soon, and also too, what is the plan if the virus hue tate sometime -- mutates sometime soon so we have a greater endemic emergency? >> well, congresswoman, part of the planning effort has certainly been to recognize that the situation you're describing in california is nationwide. that public health agencies have

been severely hampered by the budget cuts so that the resources, the 1.4 billion dollars which was pushed out, hopefully, will help enhance that. we've also reactivated the commission core, the emergency group of retired medical providers and volunteers who came together after 9/11. there are now about 200,000 strong throughout the country registered in every state and kind of put them on notice to help with the vaccination efforts and have them call, able to be called upon. we do have our commission core of health workers who, again, can be brought in to supplement some of the state-based efforts, but every state as they submitted plans to cdc recognizes that part of the challenge in dealing with this is a restricted core of

personnel, of trained personnel. again, we're not urging folks to continue with the testing protocol. that was important early on to determine, but right now we're just moving more to the vaccination and mitigation phases to try and just diminish the circulation of the flu. so some of the earlier activities, hopefully, will be shifted into is vaccination effort. >> gentleman from louisiana, mr. scalise. >> thank you, madam chair. secretary sebelius, appreciate you coming before us. since all my colleagues asked the questions that i had regarding the h1n1 situation, concerning last week's testimony or the president's address to the joint session of congress there were some things that he had said regarding the, i guess, the new developments on the health care debate. since the bill that passed out of this committee, the congressional budget office testified that it would add $239

billion to the debt and that 8 million illegal aliens would have access to the government plan. since the president in his statements last week said that he wouldn't sign a bill that would add to the deficit and wouldn't allow illegals, would you support changes that would be necessary to make hr-3200 which pass bed out of this committee comply with those two initiatives that president obama stated before the jownlt session to make sure that the bill doesn't add to the deficit which right now it would add and make sure that illegals wouldn't have says to the plan which cbo testified 8 million would. >> congressman, i'm pleased to have any number of discussion on health reform, and you know it's a top priority of the administration, and i'd be pleased to come back and do it. the chairman asked that this hearing be on h1n1, and i would like to defer to that. i don't know -- >> i mean, we've never had the opportunity to ask you because your only testimony to us was at a time when you had acknowledged

you hadn't looked at the details of the bill, so really we're not going to have another opportunity that i know of to talk to you personally about the concerns we have that are in hr-3200. >> would the gentleman yield? >> [inaudible] >> would the gentleman yield to the chair? >> i would, yes. >> i would advise the gentleman on behalf of the chairman that he does intend to have further discussions and meetings and hearings, and the chairman really has asked the secretary to come and be prepared today to talk about the h1n1 situation, and i think, you know, obviously members are allowed to ask any questions they like, but i think the secretary's really prepared on that topic today, and i can communicate to the chairman that he should have the secretary back, and i know that she's willing to come. >> i mean, i appreciate that. the problem that we have is that these discussions are ongoing every day. there could be a bill on the house floor. we don't have any assurance that

we're going to have a hearing before the vote occurs, and i would imagine the secretary's well versed in these issues because i know you were in the joint session last week in the house chamber when the president said he would not sign the bill that would add to the deficit by a dime, and yet in the cbo testimony, the cbo sat here in the chair you're sitting in and said 8 million illegal aliens would have access to the plan under the bill you supported, and he said it would add 239 billion to the deficit, so i'm sure you understand those issues. you were there at the speech last week. i'm sure you have some ideas of how we can fix that. we've got ideas of how we can fix those problems, but would you support the fixes that would be necessary to make the bill conform with what the president said before congress. >> congressman, as a recovering legislator, i'm reluctant to sign off on any legislative language. i'd be happy to take a look at it to see if i could support it. i certainly support what the

president stated going forward that he, i mean, he will sign or not sign a bill. i think you can -- >> right. and we presented, and you weren't here, i know -- >> i've heard the cbo testimony. >> -- fix those two problems. >> if you could send me that language, i'd be delighted. >> and i'd like to get a commitment from the acting chair that we would be able to get the secretary back before -- >> gentleman's time is expired, i did give him extra time because of the colloquy, and i know the chairman will work with the secretary to make sure we get her back here to answer any questions people may have, and with that i'll recognize the gentleman from michigan, mr. stupak. >> thanks, ms. degette. section 246 of the bill makes it very clear illegal aliens are not available to get health care under hr-3200, and if you'll remember the space amendment that schip also made it illegal.

that was unanimously adopted by the committee, but so be it. let's move on. hn1n. currently states are expected to purchase a portion of the need, needed vaccine to protect their citizens, but it includes a 25 percent subsidy from the federal government. my concern is a lot of our states are suffering right now because of the economic downturn and may not be able to meet their obligation because of limited resources or operation alcon straints is there some kind of plan to help states like michigan, california, others that are struggling? i don't want anyone not to get it because of state's budget concerns. >> congressman, through the resources that congress has provided and through the resources from the department of health & human services, the vaccine will be free. distribute today the states free, they are not expected to have a cost can share. i think there has been a cost

share associated with their purchase of antivirals which are in the stockpile, but not with the vaccine. >> okay. >> there may be an administration fee by the provider, but there is no fee to get -- >> what about the antiviral then? >> states have purchased antivirals over the years in a stockpile. those are being pushed out as we speak, and the department is continuing to remennish that stockpile and if needed, we'll supply those to states. >> okay. so no state should be worried about obtaining -- >> that's correct. >> is flu season now traditional flu season, and is there some kind of waiting period between the seasonal flu and the h1n1 flu shot? >> well, again since we don't anticipate the real supply of h1n1 until october 15th, we're saying to people get it now. it's my understanding that the clinical trials underway right now are looking at whether or

not there is any harm to simultaneously getting the flu shot, and as we get closer to october, we'll have that data available. >> okay. let me ask can you this: i'm from northern michigan and we share a border with canada, we two back and -- go back and forth daily s there any special considerations being given to border communities? it seems like we've got a much more robust program here in this country. i haven't seen the same in canada or -- especially canada. >> the department of homeland security looked carefully at that issue, and the scientific advice during the spring determined that since there was already a robust outbreaking of h1n1 already within our borders that border or closings really would harm commerce potentially but not really help with the disease outbreak. so there is no anticipation at this point to do anything with our northern and southern --

>> i don't want to see a border closing, but are you coordinating with other countries to make sure we're doing the same thing? >> there definitely has been a lot of national and international discussions and particularly with canada and mexico. that has been underway since the early spring and will continue. >> very good. >> gentleman from oregon, mr. walden. >> thank you, madam chair. i appreciate the commitment to have the secretary come back before the committee before we have a vote on the health care overhaul -- >> i don't have that power, but i'm going to talk to the chairman who does have that power. >> if you had that power, you'd give us that commitment, i know. [laughter] i appreciate that because a lot of us share that concern. i also want to draw attention to the secretary to a bipartisan letter mr. rogers, mr. gonzalez and i sent to you recently regarding the 2010 fee schedule on medicare as it relates to cardiologists and encologists and proposed cuts that could be

as high as 40 percent in some codes. if you haven't gotten that -- i don't expect you to be on top of every letter that comes your direction, but if you could flag that one, we'd appreciate your response. i was reading a story in onefh o are sick, and they raised the issue in the story at least that the hospital workers, the nurses, the doctors, others did not have a sufficient and early supply of masks and other protective equipment to prevent the spread within the hospital setting. are you and your folks confident that in these environments where all of us who get sick are going to rush that there is adequate whatever we call it, the materials, the masks, the protective equipment, whatever so that those we rely upon for our health care will in and of themselves be healthy in the process and not an unnecessary risk? >> congressman that discussion

is actively underway, and as i say, the guidance from the cdc is about to be issued. we, the scientists have not been in complete agreement about the right protocol particularly with the use of -- >> right, i've read that. >> -- going forward, so the request went to the institute of medicine to do a sort of rapid-response study. they came back with a protocol which i would suggest is the ideal case scenario, a respirator per provider for every patient seen. >> wow. >> there are not adequate supplies to follow that protocol. >> so one new respirator for -- every time you see a patient, the doctor or nurse would have to put on a respirator? wow. >> that's what the iom recommended. the stockpiles in the country would not allow us to follow that protocol, so right now we are working actively with osha

and cdc and the health care providers to develop a protocol that actually is more in fitting with what the supply looks like because iom was told not to take into account what's available or what could be available over the next six months. unfortunately, the reality is we've gotta look at what's available, so that discussion is actively underway. >> and on that topic, the vice president had said at one point that he wouldn't put his family on an airplane. i was on an airplane yesterday, and the person behind me was coughing and i'm convinced was taking no precautions about the emissions. i directed the air filter to flow backwards. [laughter] what advice and counsel do you have for all of us about -- i realize we ought to cover our mouths and all, but if you're on the other side of that, should we be be wearing those kinds of protective face masks when the outbreak comes? is it going to be helpful, or is that just overboard? >> what i've been told by the

scientist is the that -- scientists is that probably not -- masks are really not if you are in a caregiver capacity in a home situation coming in close contact it may provide some protection, but basically, no. that -- and if you, if this continues to present much like seasonal flu and, you know, a number of people get hospitalized with seasonal flu every year, we don't have that kind of rigid, fitted mask protocol underway. so we're trying to balance safety and security. what's most alarming and i think all of you would be great to help with, health care workers right now don't get vaccinated. less than 50 percent of health care workers ever get vaccinated for seasonal flu even though they're a priority group for h1n1, we're afraid that takeup rate may be the same. so i would say that's step one s

to take advantage of the protection that's there with vaccination both with seasonal flu and then with, you know, the h1n1 vaccine because their at the front of the -- they're at the front of the line, and we would hope that they do that. >> gentle lady from the virgin islands, ms. christianson. >> thank you, madam chair, and thank you, madam secretary, for being with us again today. individuals 25-64 with underlying medical conditions such as asthma, diabetes and compromised immune systems are one of the target groups for the forthcoming vaccine. as you know, racial and ethnic minorities are disproportionately affected by all of these chronic diseases and more. are your clinical trials, are the people in the clinical trials diverse, and what outreach is being, has been done that is culturally and linguistically appropriate to reach these sometimes

hard-to-reach populations often with poor public health infrastructure to ensure that they get the adequate treatment and so forth? >> the clinical trials, it's my understanding, are diverse, and we're aware of the concerns that have been raised in the past. again, a lot of the trials underway are specifically about dosage because the clinical trials have been done for years on seasonal flu which, which deal a lot with outcomes. the challenge of communication and outreach strategies is one that we're taking very seriously. so traditional media's being used, nontraditional media, ethnic, specific media. so translating everything on the web site into spanish, into vietnamese automatically and then other languages can be requested as needed. looking at a variety of media

outreach that reach nontraditional community, working with the faith-based and community -- >> okay, because a lot of these communities also are not connected. >> right. so we're using the faith-based groups to connect. for the younger population it's an equal challenge. so facebook and twitter and espn has agreed to become a partner for the scrolls they put across college dorms. we have a psa contest on youtube in terms of trying to get to people. so we're really trying to maximize and special outreach to minority providers and health clinics knowing that they are likely to see a lot of folks with underlying health conditions who need to understand how serious the risk is for this, for this virus where nobody has an immunity.

>> dr. burgess. >> thank you, madam chair. secretary sebelius, i guess i should point out for health care providers of my age we were most of us in the midst of our training during the last swine flu outbreak during the ford administration and remember very vividly some of the problems encountered, so as information is gathered as to the safety of this vaccine, i think it is extremely important to get that out and get it disseminated. we had a big problem in ft. worth, texas, with the first round of this in the spring. the school district closed, and i would say i think appropriately so, but they received a great deal of criticism. the school district across trinity river in dallas did not close and, obviously, there were a lot of comparisons made between the decisions of the two school districts.

still, i think superintendent johnson did exactly as she should have when she was confronted with a large number of suspected cases and could not get information back in a timely fashion from the cdc as far as recommendations. to prevent that type of difficulty from occurring again in the fall, i asked and your department was kind to respond, and we did a seminar on h1n1 in st. worth this -- ft. worth this past august, and we had representatives not just from hhs, but from cdc as well as the state and county health departments. the impression i got from that day's discussion was that the decisions about close your or -- closure or nonclosure of schools would be left up to the local authorities. but then seems like less than 48 hours later the guidelines were coming down that your department would decide when schools should

close. so i would just simply ask the question, who is going to be making these decisions? is it the local folks? is it you? is it secretary duncan from the education department? who is going to be making these decisions? because it, obviously, impacts not just the school year of the kids, the learning curricula of the children, but in texas, of course, we have like many other states we have a testing protocol under no child left behind, and we don't want to see our school districts unnecessarily penalized, but we don't want to see our districts take on unnecessary risks with the children's safety. >> school closure both in the spring and now moving forward are always a local decision. that's made at the local level. having said that, the centers for disease control has issued school guidance 1k it's just that, guidance. what they're seeing from the science and what they would recommend. at this point the guidance is different than what was being

discussed this spring in part because we didn't know how lethal the disease would be, and it was very unclear whether or not sending your child to school could, indeed, cause much more serious harm. now we've learned a lot over the spring and summer, learned a lot from the southern hemisphere, so the guidance issued by the centers for disease control and put forward by secretary duncan and others in outreach to schools across this country is really leaning toward keeping schools open, having protocols available in the school to deal with outbreak, isolating kids, sending them home, trying to make sure that teachers and students are vaccinated but keeping schools open. that could change. the flu could change. we're watching it very closely. but the school decision will continue to be made at the local level. >> gentle lady from florida, ms. castor. >> thank you, madam chair.

and thank you, madam secretary, for all of your efforts on h1n1. i'm not unlike the millions of parents across the country that have been, we've been teaching our kids, you know, wash your hands all the time, cover your cough. we haven't altered substantially the way we live our lives. so this saturday we had a dozen 9 and 10-year-olds over for my 10-year-old daughter's birthday party, and they did not protest when i had them wash their hands before snacks, wash their hands again before cake, wash their hands again towards the end of the evening. [laughter] but wouldn't you know it that one of my daughter's friends got sick. at the party. and her mother called me yesterday and, sure enough, it's

h1n1. now, of course, she's staying home from school, and there are a number of kids out this week.s after the fever is gone. so what is, what is the most consistent answer i can give to parents of a child that has, has just come down with the h1n1? >> i think the scientists are saying 24 hours after the fever is gone without any medication to lessen the fever. and the problem is that for the kind of average maybe 5-7 days, a lot of kids it may be 2-3 days and then 24 hours later they're ready to go. so it's hard to give you a date specific. i think it's a child-to-child situation. some have more serious cases, some have lesser cases. but 24 hours without any medication since the time you've had a fever they say it's safe to go back. >> even though they could still

infect? >> well -- >> -- other kids a few days after that? >> well, yeah, the doctor is telling me what they're seeing is that the vast majority can't infect at that point, and that's why they've arrived at this 24 hours after, after the fever. >> terrific. okay, thank you very much. >> gentleman from iowa, mr. braley. >> thank you, madam secretary, for joining us, and i think everyone is concerned about the public health implications, but there are some unintended consequences of the public health campaign that i think we also need to be conscious of. and one of the concerns that i expressed at an earlier hearing when we had representatives of the cdc here was the decision to refer to this virus generically as swine flu despite its origins and the enormous negative impact it's had on our pork industry because of a lot of myths and

misconceptions. and yet i know that public health officials have determined that it's easier to get college students' attention about the need for getting prepared and exercising precautions when you refer to it by the swine flu as opposed to h1n1. so we've got these conflicting things going on, and one of the things that i'm very concerned about is how we balance those interests given the enormous economic implications to states like mine when people have half-truths and misinformation, and yet the reports that i've seen as recently as this weekend in "the washington post," sebelius encouraging news regarding swine flu vaccine -- their choice, not yours. >> thank you. >> new york times, one vaccine shot seen as protective for swine flu.

so how, how can we address the enormous public health challenge that we're all legitimately concerned about and still address this enormous negative economic impact that it's had on our pork industry? >> congressman, it's a great question, and i can tell you it's one we're wrestling with a lot. i hope never out of my mouth have you ever heard that other term -- [laughter] or out of cdc or nih or the fda. and i have taken it on as a bit of a personal mission when i'm with media, reporters and being interviewed to correct them and ask that they, please, use the terminology that's accurate because there's a lot of misinformation. we have on several occasions, and i've joaned with secretary -- joined with secretary vilsack and, again, the other side of this in assuring people that nothing at all in this through is related

to pork. there's no crossover but you're absolutely -- i know there has been over a billion dollars, if i understand it, and that may be very underestimated at this point. and i, you know, we'd welcome any suggestions. i think it's easier to do, so they do it. but i would agree it's a huge -- and it has an enormous economic impact. i've even suggested and maybe you want to conduct your own media campaign that maybe we should challenge people to use the right terminology, and you could send them a pork chop every time they use the right term -- >> or they could come to the congressional pork session tomorrow -- [laughter] >> the chair now recognizes the gentle lady from california, ms. capps. >> thank you, madam chair. secretary sebelius, you've been very patient, and i hope this won't take the full five minutes, but i want to thank you

and want the record to note that you did hit the ground running after your confirmation. i've seen you everything where on -- everywhere on both health care reform and also on this topic, and i'm referring to a bicameral briefing that you and several secretaries presented to members of congress. it was midsummer, if i'm not mistaken, in between sort of like the swing outbreak. and my question then was to acknowledge the role that a school nurse played in the first case in the bronx that resulted in massive school closures. and as a foreman school nurse i sort of emphasized i know why districts close their schools, but it's chaotic when it happens. parents have to, parents don't have back-up plans a lot of times to -- and they miss work and all the things that ensue, and you find kids on the mall and all kinds of places when that happens. so now i'm pleased to follow the chain of questions that have been asked, and i'll -- since

this topic has come up, i'm interested in the nuances now that have occurred watching the epidemic as it has proceeded and now as this school season hit and many of the campuses -- a little older young adults and that captive environment which can be dealt with somewhat differently because they're not so dependent on parents and jobs and things. but still i'd like to have you address just for a minute for the record because the relationship between your department and cdc and the local communities is very specific, and i think unlike many other departments with very direct communication and outline for us a few of the ways that you have been working with local health departments as they then are partners with local school districts to form lathe and get the right kind of advice tailored to different parts of

the country so that we behave in the proper way as this comes out both in terms of immunizations, the vaccination plan, and also what to do like when my colleague kathy castor's own daughter's friend, you know, how do you respond? >> well, i think that's a great question. since the spring i would say the three cabinet secretaries who have been sort of at the forefront of this effort are secretary napolitano with the homeland security -- >> right. >> -- and government coordination work, but secretary duncan from the department of education because given the age group of the target population that has been a real effort. and he has regular calls, regular outreach with superintendents and principals and teachers all throughout. the cdc has specific guidance that's on the flu.governor web site -- flu.gov web site and what happened to really change

the school advice, the guidance that was out from leaning toward closing schools to leaning toward keeping them open. first, realizing that it would not present itself as a more lethal disease. secondly, recognizing that there are a whole series of other health impacts for children who are sent home. missing, often, school breakfast and lunch which has a nutritional impact, being in an unsafe environment if there's nobody home to take care of them. and on balance given the way the disease was presenting, it seemed wiser that the guidance be toward keeping schools open but trying to isolate and send home sick children, urging parents to keep them home in the first place. but if they show up at school, send them back home. isolate them until you can find a parent. i think that this may change as we go along, and what we know is that what we saw in the spring

there are going to be some areas of the country, some cities that have lots of cases like new york did in the spring. there are going to be others relatively close by that may have very few cases, so it's impossible to have a national protocol and school decisions will continue toe