the pandemic act. we'll examine the impact of major weather events on the electric power system of veterans affairs secretary testifies on changes at the virginia. we start at the health education and pensions committee. earlier today doctor tom inglesby brief members on the severity of the flu season in public health funding. this is about two hours. >> will call the hearing to order. owner recognize the chairman of the committee for a statement. >> thank you. think senator burr for chairing

the hearing today. senator casey for serving as ranking member. they have both been leaders on the subject. senator burr was the author of the pandemic and all hazards preparedness act. i'll collect all hazards preparedness act. the law helps protect us from the full range of public health threats from national disasters to terror attacks. in 2013, senators burn casey by the bipartisan authorization of the pandemic and all hazards act. many contributed including senators and sam bennett. warren, hatch, roberts, and

others. now it's to be reauthorized for a second time. today's hearing is the second for this year. last week we heard from the administration including from the assistant secretary, the fda and the centers for disease control. in the middle of the flu season is critical we reauthorized the act before many of the provisions expire in september. i hope will do that in a bipartisan way. people are not as aware of the devastation of the flu, and i mentioned. the figures are between 12 and 50000 americans die of the flu every year.

they have talked about expediting the universal flu vaccine what she sees soon. tennessee has seen these earlier is that is spread across the state and country. already a pregnant woman and three children in tennessee have died at the flu. this provides a framework that enables us to be prepared and able to respond to health threats. to ensure we have enough medicine to protect americans into sure hospitals are prepared to respond. thanks for witnesses for coming here to today. thank you. >> this morning were holding a hearing entitled facing 21st century threats. we will hear from doctor tom

inglesby, tractor for the center john hopkins, doctor john dreiser, commissioner of tennessee department of public health. brett mcgregor, senior vice president of operations, and cochair of the alliance for bias security. in doctor stephen, head of pediatric medicine in chicago. senator casey and i will have an opening statement in the will hear from witnesses and witnesses will have up to five minutes for questions. i'm pleased to -- today, will hear from individuals with firsthand knowledge of what we face including public health threats and their ideas on how to move forward.

this framework has been tested by the emergence of pandemic flu, natural disasters and ebola breaker and ezekiel virus. the lessons learned come from individuals like those sitting before us today in their efforts to protect and save lives. last hurricane season resulted in major storms raising news questions to manage and withstand these times of response. emphasize the needs of improved data collection to inform and protect as many mothers and babies as possible. it highlighted the need for a -- that brings the knowledge to the potential damage that can be brought by the stats in a deep understanding for research and

development. i look forward to learning more about the barrier cc to leverage technology. whether the challenge in the development of a vaccine, the information crucial of the health department. improvements to the way these complement one another, your experience reminds us we cannot let up on these efforts really set on the search and see. we must not get distracted by making changes to the law outside of our focus. improving and strengthening our programs to make them more effective now and in the future. i look forward to what each witness can provide.

>> i want to thank you for your years of work on these issues. i think the chairman and ranking member for this opportunity. the thinker witnesses for bringing experience and work to these issues and joining us today. this is her second hearing on this topic. the focus is our nation's preparedness to combat public health threats as we look towards reauthorizing this pandemic. whether never we must continue to build our nation's resiliency. to help security threats, the threats that face our nation today are increasing in frequency and intensity. it's critical to foster and advance you, when we consider

the emerging infectious disease or an engineer by a weapon yet to be seen by man, for the response to natural disaster like a hurricane, we don't have a countermeasure to protect us. in addition to supporting these we must also strengthen our hospitals and public health professionals. our front line of defense against the self threats. we must ensure we give our communities the necessary support necessary when the next emergency strikes. i spoke at the last hearing about the success of the hospital preparedness program. another public health emergency preparedness program in the

context of restraint or ailment. one of many examples we could say. these grants also facilitate preparedness activity that help hospitals and public health system with more regular occurrences. . . the reachable health care coalition created through the funding who assisted in the response of that circumstance and get the funding for these preparedness programs has decreased from appropriations falling beyond levels only with the response to ebola.

the impact funding reductions means a decrease in the amount of time the hospitals and medical staff have to plan and train for an emergency. the loss of thousands of public jobs, the eduction and emergency managers and public health lab technicians is very dangerous to wait for threats to emerge to try to pass emergency funding bills. we must be proactive, not reactive. so how can we improve our health care system preparedness in our public-health capacities and thereby improve our situational awareness in an emergency? can we work towards a precision public-health using better data to more efficiently guide responses to help emergencies to benefit our communities? i think we can. for example as reported by the

publication, when domestic transmission was confirmed in the united states, the entire country was not declared at risk. instead, precise surveillance to find the at-risk areas of miami-dade county of neighborhoods measuring less than 2.5 square miles. this allowed for the targeting of resources to these regions. building on that experience, we can expand surveillance to eliminate the causes of disease and spark opportunities for prevention. all last week where h or i shouy after last week's hearing we also heard from the assistant secretary about the use of the empowerment program to identify and treat at-risk individuals requiring electricity dependent medical and assistive equipment. he also identified a weakness. the system only pulls in medicare data, not medicaid or

try care so how do we ensure that we are acting on the data appropriately to protect these vulnerable individuals. the tragic death of 12 seniors at a nursing home during the hurricane in september highlights that more needs to be done to protect the more formidable citizens and most of the citizens have additional characteristics that make them more vulnerable to any public health emergency and this includes our children, our parents, our rural communities and individuals with limited english proficiency from individuals with disabilities and of course individuals with chronic illnesses and more. we must do better to help communities prepare for potential health security threats. we must continue to invest in innovative biotechnologies and we must also improve our non-

pharmaceutical interventions. i'm looking forward to the hearing for the witness's testimony and for how we can continue to prepare our hospitals and health systems to ensure equal consideration of all of our constituents. >> i am pleased we have our four witnesses here today and i think each of you for taking the time to be here. i would like to introduce first the director of the center for health security at johns hopkins school of public health and he is internationally recognized for his work as a writer with numerous publications focusing on public health preparedness pandemic and emerging infectious disease as well as the prevention of and response to biological threats in taiwa ande now turn to senator alexander.

>> i would like to welcome surely the tallest commissioner of health an in history may be n the country. he served as becoming a sure tennessee department of health since 2011. he has significant experience responding to public health emergencies including infectious diseases like natural disasters such as the wildfires that devastated eastern tennessee in 2016. today he will provide important insights into the nation's preparedness response capabilities and states what's working and where we can improve and where we can protect and save more lives. a physician with more than 25 years of service and commissioner coffee helps to protect from public-health threats. we appreciate his leadership and we welcome him to the committee. >> i'm sure if you were a little

younger this a couple of tennessee basketball teams that would probably recruit you tomorrow. [inaudible] next i would like to introduce the senior vice president for commercial operations the second-largest flu vaccine company in the world. it's an example of the success that can be achieved through public-private partnerships to ensure that we are better prepared for the threats that face us. holly springs north carolina is one of the three in the country with the capable body to rapidly respond in the event of a pandemic flu outbreak. he's also the cochair of the alliance for bio security, the alliance works to promote the critical partnerships between the government industry and other stakeholders to advance and encourage the development of medical countermeasures. welcome. and finally, doctor stephen, the

head of pediatric emergency medicine at the children's hospital of chicago, also a professor of pediatrics at northwestern university, school of medicine and serves as the chair of the american academy of pediatric disaster preparedness advisory council. with that i will turn to you and you can leave for up to ten minutes. >> thank you for the chance to speak today about these important issues. i'm the director of the center of the johns hopkins school of public health fopublic health fe or of medicine and public health. the center's mission is to protect people's health from epidemics and disasters and build resilient communities. i will provide a brief overview of areas of my colleagues and i consider vital to the nation's preparedness and response capabilities. the opinions expressed are my own and don't necessarily

reflect the views of johns hopkins university. there's a range of major public health threat any of which could occur without much warning. these include natural disasters, technological accidents, nasa shootings and bombings, chemical spills, radiation and nuclear threats and biological threats. biological threats whether natural lake in china or accidental such as an epidemic or deliberate like smallpox or anthrax are a particular concern and big focus of my comments today. biological threats could range from modest and size that is capable of posing global catastrophic risks. risks. what more can be done to prepare for these threats? first, we need to strengthen the health care system prepared us. that is the capacity to care for high numbers of sick or injured in an emergency. while there's been substantial progress preparing for small disasters in the country, the nation isn't ready to provide

medical care in large catastrophes were big epidemics continuous disease. the hospital preparedness program is helping fund and build the capabilities of the state and local level, but significant resource constraints limit what we can do. the budget has decreased more than 50% since the start in the 2002. that trend should be reversed. new initiatives like establishing regional disaster resource hospitals could be a strong new additional component in improving medical prepared. second, we need to strengthen the ability of the public-health system tpublic healthsystem to o the threats to it since 2001, there've been serious efforts at the cdc, state and local levels to provide early warnings of outbreaks, provide diagnostics, investigate and contain outbreaks, communicate to the public and ensure greater safety and security and much more. there's been good movement but there's too much to do and not enough professionals to do the

work. public health relies on funding from cdc public health emergency preparedness grants. that funding has been introduced by nearly 30% since 2002. even th though public-health crs have declined. it should be strongly supported and in addition i believe a public health emergency continuance initiative while rapid public-health response funding and emergencies. third, we need to move ahead on the medical countermeasure development. there's been good progress but many priority is remain including sustained funding and research development manufacturing and acquisition of countermeasures, transitioning to the new flu vaccine technologies and setting morgan bush's targets for the products and emergencies so that they are ready in the course of a given pandemic were epidemic. fourth, the u.s. needs to recognize threats that could emerge from biological research. after the u.s. moratorium of the pandemic pathogen research was

lifted last month, researchers can now again applie apply for g to study for example ways of making the world's most lethal viruses respiratory transmissible like the seasonal flu. this could lead to the novel strain of the virus that could cause an epidemic or even a pandemic. i don't believe the benefits are worth the risk but if it's going to go ahead i would advise to be transparency in the program and serious dialogue among the concerned government internationally on how to proceed. finally, we should fund a global security agenda. in 2014 the u.s. health launched with a billion-dollar commitment to help countries prevent, detect and respond to infectious disease threats. since then the cpc and usaid have been working in 39 countries with programs to stop and improve resistance from increased lab surveillance capabilities, strengthe, strengd public-health workforces and much more. but at this point, u.s. funding

is in said. if we pull away from it, other countries will likely do the same. we should continue to support it. it'it's cost effective program e have to contain international outbreaks of the sources overseas. improving the nation's preparedness and response capacities is a daunting and complex endeavor but i'm confident it is an achievable goal if we focus our efforts on these initiatives. i appreciate the time and welcome your questions. >> good morning, chairman alexander, senator burr, senator casey and distinguished committee members. thank you for the opportunity to appear before the committee and to discuss an issue of significant in that instant the common defense of this country, the strong, agile and recently and public health and medical prepared this response system it is an honor to be here, senator alexander said in a positio i'mn of the commissioner of health and was a vocal health director for a decade before that.

the thoughts i will be sharing with you today are my own but i'm confident they are shared by my public-health colleagues across the country who strive everyday to repair and respond to threats of all kinds. these threats may be infectious disease outbreaks like measles, foodborne illnesfood borne illne annual epidemic of seasonal influenza that can m-mike this year and predictably test the nation's response readiness and capacity. they can also be large-scale, national or global events like an influenza pandemic, ebola, the opioid epidemic were acts of triggers on. public health also mobilizes has been ordering natural disasters like winter storms, hurricanes, tornadoes, floods, wildfires have senator alexander mentioned and other events that unfortunately seldom doebutunfoe public-health jurisdiction of any size will more than a few years without experiencing as well through mechanisms like the emergency management assistant

even affected jurisdictions are called upon to assist neighbors. public health and emergency preparedness response and recovery is the responsibility, discipline and service that we have to get right, as was the less physical and economic health depends on it and it's something that we do every day. it's a matter of local resiliency of disastrous playoff locally and it's also a matter of national security. in a few moments we had together i would like to share my perspective having been directly involved in the planning implementation, execution roles at all levels both in the military and capacity over 25 years. let me start with a simple question of what is the preparedness response and recovery isn't stuff or equipment or plans, it is people. shelters don't staff themselves, a fire truck can't put out a fire without firefighters and people can't be hired and trained after the alarm sounds.

they need to be there ready to go before the thread ever emerges if there is to be effective responding to it. preparedness is about the people involved in the interconnected networks. to be prepared we need three key things. one, to train people some of local knowledge and all connected by relationships built upon trust. never to come expertise and leadership at all levels local state and federal and communication and shared situational awareness among the responding, people on the ground and experts trying to create these after an event begins takes the one commodity that is the most precious in an emergency, time. we don't have time to create this network after the event starts. in a way, the response recovery network is like a safety net for a performer. it has to be in place before the show starts, inspected and in good shape to do the job. many people think that equipment or supplies are the net, but if

you remember nothing else from my testimony today, i would like you to remember this, people, not things. thinkers matter that it's the peoplbut it's thepeople that wee of the relationships to the knowledge of the trust. the more chords and notes that unravel the less capabilities for what we needed to do at our most vulnerable times causing but durable medical equipment, medical countermeasures and communications infrastructure are essential. without them, the network of people can't be effected people are the net. the accomplishment and success in the response recovery of the last 15 years have been frustrated in my written remarks can be directly attributed by belief to the pandemic and all hazards preparedness acts. both ibut then it's initially fe authorization form is transformative to the public health and healthcare

preparedness and has provided the requisite direction authorities for the authorization of resources and the accountability that have become a part of the cultural public-health and enable us to do our job in the best way possible. as you consider the property authorization, the priority is and resources must be lined up with the demand of the ever-expanding threat environment given the frontline of defense and safety net ability, the scale and speed it needs to protect the public health and safety are critical to the ability. we should be applauded for the continued work like the brutalities and tribes, resources and tools needed for the vigilance of this critical post and to get the job done. these funds are not not duplics of the emergency management and homeland security as you know, but complement reading essential. sometimes, depending on the public-health is the only responder. what we ultimately need is a a a nation to ensure a strong safety

net is consistent, reliable funding to keep the people, the knowledge, the networks, the trust impact. thank you again for the opportunity to speak about this fundamental issue and for caring about preserving the ability to respond to any hazard or threat for generations to come. appreciate the opportunity and happy to take questions. >> the floor is yours. >> good morning, senator byrd, senator casey, members of the committee. i am the senior vice president of commercial operations. i appreciate the opportunity to appear before you today as you prepare to consider the second reauthorization of the pandemic and all hazards preparedness act. i'd like to focus my remarks on the importance of the influenza and the critical role played by the biomedical research authority and its industry partners. there are three issues i would like to highlight from my written testimony.

first, the pandemic influenza is one of the most urgent public health threats we face as a nation and must be a priority at the bio defense enterprise. second, the pandemic influenza program must finally be authorized in this year's legislation and third of the congress must provide sustained predictable funding to strengthen partnerships with the private sector to ensure the nation's preparedness. re: mregarding my first point preparing against pandemic influenza this is critical to the national and economic security. it is proud of the partnership we have disappointed one third of the nation's vaccine needs when the next pandemic strikes. thanks to the leadership of senator burr, senato byrd, senad members of the committee and the dedicated team at our state-of-the-art vaccine facility in holly springs north carolina is one of the best examples of a successful private public partnership in bio

defense. second, regarding the pandemic influenza program despite representing the authorized funding for influenza has never been included in the legislati legislation. as a result, funding for the activity such as the vaccine and stockpiling advanced research and development has been largely episodic since 2009. emergency supplemental funds provided in the 2005 into the 2009 pandemic is now fully exhausted. having a program authorized by congress will provide a signal to the private sector but the u.s. government is committed to prepare against pandemic threats in the future. the most recent five-year budget of $1,630,000,000 in pandemic funding needs for fiscal year 2019 alone. we believe in the annual authorization level is at least to support the most critical activities. finally, regarding the sustained in a predictable funding, over

the last 12 years this enterprise has greatly improved the nation's security and wireless improved its communication with industry partners, better coordination from the government to provide more certainty in the development process. procurement funding provided by the project of i/o shield a special reserve fund of the strategic national stockpile and the pandemic influenza program provides manufacturers with certainty after investing for many years. because there is no commercial market, companies like this can only rely on the commitment provided to make investments in this research. unfortunately over the last several years the private sector has become more skeptical of the government's commitment to bio defense and the lack of a multiyear funding has created uncertainty in the long-term sustainability of the programs. public-private partnerships must be sustained over time through a demonstrated commitment by the federal government.

there are dozens of companies both large and small that have committed to the mission and made significant new investments in the development. reauthorization of the authorities and renewed commitment will ensure these investments yield even more approved medical countermeasures. secure the authorization priority is and identified by the alliance for bio security through which i'm privileged to be a cochair and by the biotechnology organization. i would like to thank the members of the committee and in particular senator burr for the commitment to reauthorizing in a timely manner. drummond is progress has been made to ensure americans are better protected against the threat of pandemic influenza and we are excited about the future of the partnership. we strongly encourage the committee to authorize the pandemic influenza program as a critical opportunity for congress to ensure they have the

resources it needs to prepare against one of the predictable threats we face as a nation. i look forward to serving as a resource for the committee during the reauthorization process and i am happy to answer any questions you may have and i thank you for inviting me here today. >> chair member comin member cae another case of distinguished members of the committee, i am the head of division of emergency medicine at the children's hospital of chicago and professor of pediatrics at the northwestern university school of medicine. i am the chair of the american academy of pediatrics disaster preparedness advisory council and on behalf of the 60 to 6,000 members thank you for holding today's hearing and inviting me. i've also been privileged to serve on federal advisory committeecommittees are pleasede presently in the chair of the national science board. my comments today as a private citizen and as a member for the

academy. i applaud the work of the committee for strengthening and improving the nation's public health and preparedness with the pandemic and all the optimizations of 2013 and in particular i must thank you for the first-ever provisions for children in the last three authorizations. this changes have helped to meet the needs of a much higher priority and emergency planning and response. as we heard last week each agency has a vital and distinct role to play to ensure the health care system is prepared to meet the needs of all americans including of course children dipping and after a disaster. the leader of the solutions he said countless hard-working debtor to be federal employees oversee the backbone of the nation's 24/maximum readiness response capacity. by most accounts the frequency, severity and cost of the disasters and emergencies are increasing meaning that they

will remain a significant threat to the health and safety of the community and the nation and as such maintaining and expanding the federal government strategic focus on all hazardous approaches that address both routine is critical. this will require continuing engagement of all stakeholders including public health, medical and mental health services, academia, industry and day-to-day trauma services. the foundational elements are declared to preparedness including the emergency medical services for children program and donations children's hospital. it is evident that health care and other systems that are regularly tested will be the most reliable and effective during a response. regular exercises and drills along with continuing education for the providers and first responders are necessary to be ready for all populations when a disaster strikes.

this will reduce the burden on the healthcare system during and after disasters. this means ensuring access to affordable healthcare and reducing health-care disparities in all populations. financial drivers in today's healthcare environment are not aligned with the need for facilities to be prepared for public health emergencies and cost reduction measures have resulted in lean stockpile supplies and medications in equipmen, medications andequipmy smaller workforce with daily operations particularly inpatient operations functioning much closer. the poor capacity during these epidemics and pandemics like the one we are going through right now. the capacity at this particular. current disaster planning doesn't adequately integrate primary care. these clinicians who largely

operate a small private sector business provide vital services before, during and after disasters. we provide assistance to deceptive practices many have been forced to leave. given this isn't hard to see why so many have responded and why some may fully never recovered after a disaster. community resilience relies heavily upon the recipient of the healthcare sector. children account for 25% of the population and the unique possibilities that preparedness response activities at all levels must account for their needs. children are not little adults. i concur with the comments of my esteemed colleagues that i would offer three additional thoughts in terms of recommendations. first, reauthorizing strength in the national advisory committee on children and disasters with the subject matters experts from the public and private sector has provided insightful reports

with recommendations to improve health-care preparedness for children. what you can authorize the cbc children's preparedness unit which is proven to be an invaluable resource to the pediatrician can become a schools and other child serving institutions during emergencies. this unit is a best practice example of an effective public and private sector partnership that has brought tremendous value to the preparedness. finally, to reiterate the comments that have already been named by the grant programs as distinct nationwide programs with strong pediatrics performance measures and with increased funding. it is essential that all jurisdictions have a baseline level of prepared us by each of these programs. i want to thank the committee for the opportunity to testify and i look forward to your questions. >> as evidenced by the fact i'm

not sure if in the past we had a pediatrician on the proper hearings that shows that it we understand the need and i might say it is one of the most challenging areas because it is hard to incorporate pediatrics and the cutting-edge technologies that on the one side we are pushing and that the will always be a challenge to us and we need more subject experts to navigate through that. i will recognize members starting with myself and move on the majority basis. we've worked for many years to make us better prepared than the outbreak of the flu but this is both a promise and a partnership between your company in the ande federal government that is

needed, we can flip a switch from the manufacturing of the vaccines for the seasonal flu to the manufacturing for the pandemic flu. what are the lessons learned from this partnership and how can we improve the partnership? >> i think the lessons we have learned thus far the partnership has been a very good one since the very beginning. what has happened in recent years is ththe recentyears was t has been made and for which the companies have delivered the funding hasn't kept up with what we believe the threat is going forward so if there was a period of time and the funding for the pandemic flu was not part of the bio shielbio shield or the propr legislation, there was emergency funds that were supplemental funds provided. i think the big lesson that we have learned since that time is as the funding has declined to

very low levels particularly since 2009, you start to question the commitment and while we put a commitment forward, a partnership forward, i think sometimes we feel the funding is dedicated toward earmarked for the pandemic flu and suggests that there is not a seriousness or interest taken to this particular threat going forward. i think that is one of the lessons being learned. the ongoing communication is another lesson we've learned and for the most part, the communication between our companies and others that are in partnership with the government has been good but there's always opportunity for improvement across the spectrum. there is still room for improvement and they are harmonizing how it works across the entire spectrum. >> the jurisdictional alliance

is a little difficult at the beginning but i hope that my colleagues on this committee will remember this year's flu season, the severity of that we don't know yet but as we get smarter at predicting what the threat is going to be, this is a great example of we are not smarter to get it more than 30% based on the current & we've got to book a technology that allows us to address the seasonal flu in a way that encompasses all of the above options that might happen. they've done work to advance new and innovative technologies to better combat public-health threats and have been extremely successful in advancing innovative approaches to development of medical countermeasures such as platform technology. what do you see is the greatest challenggreatestchallenges to bw

and innovative technologies through the medical countermeasure pipeline? >> i think one example is that this is a cell-based technology, not the more conventional but more people are aware and the interaction has been very strong not only in allowing us to continue to advance the effectiveness of the technology bold recently through the partnershithat can not only bene pandemic setting but also potentially benefit in the seasonal setting as well and the benefit ideally will be sooner to the market.

it is invested in by the government and it is a better match in the advance of a mismatch season as we are experiencing this year. it's to monitor, detect and identify the public-health threat in as timely a fashion as possible. how can we create a more cohesive capability for public-health threats and as an aside that to be using that open source of information outside of the mechanisms we have set up thdrastically and international?

people have been working on it for a long time. it would be very difficult to do and i know it's been a goal of the federal government to try to consolidate and bring those together. one of the things we could do better is to give more get more information out of the healthcare system to public health during emergencies. public-health during emergencies. we have a lot of advances in electronic health records but for the most part, public-health agencies don't have any resources or analytics to be able to see what's going on in healthealthcare records around e country. so if we could do more to bridge the divide between public health and medicine, that's where the signals are going to come in the outbreaks from doctors and nurses seeking unusual things, getting laboratory diagnostics, getting that information

together, so i think that closing the divide a little bit and bringing together unusual sources of information like what's going on an animal systems anin animalsystems and h human systems being able to trace back foods when big food outbreaks arise it is a very difficult challenge for us right now. >> we are better at it now than we were years ago. >> i feel confident that the mechanisms are in place for the transmission of information. all we need is one breakdown and it does make one wonder in the overall scheme of things why we are not on top of the review of the scripts written on a daily basis that gives us either confirmation of what we are hearing from the public health arena or potentially a sign of an outbreak of something that we pick up in prescriptions that were administered the day before and that gives us great clarity

as far as the geographical location of something all the way down to the nine digit zip code and it seems like it's all of the above but we've got to do. we are told more than 17,700 cases of the flu has been confirmed just in pennsylvania. 32 people including one child has passed away because of that. it's a particularly bad flu season but it doesn't come close to what we want t would see on h larger scale. infectious disease emergency order of course a pandemic flu scenario. health care sectors are already near capacity with this flu season so they are woefully unprepared to respond to a mass casualty biological event.

so, for both i would ask how can we begin to prepare hospitals, let's just focus on hospitals for a mass casualty biological event? i know that's a lot to bite off but as best as you can. >> thank you for the question, senator. i think as it has been said, fully funding to its prior levels would be hugely helpful. i think he made some important points in terms of the financial incentives of the current system just in time for supplies and staffing. there's limited search capacity and we are seeing that in tennessee right now at a call with the hospitals a couple of weeks ago in another call

tomorrow some of the challenges this is the flu season that is more severe. we don't know exactly what this will look like in compared to others. we are reporting more. and as people hear about those things there's a perception of greater severity. one of the things we've been doing is messaging around if you are ill you may need to call your healthcare provider that you may not need to go to an emergency room, so-called of

those kind of things are part of what we deal with in a flu season where there is a heightened awareness. in terms of assuring that we are prepared, the amount of funding available to the grant has been inadequate for some time and again as you pointed out in your comments there is the need to bolster. i don't think it takes a great deal more but certainly returning to earlier funding levels would be extremely helpful. >> i would agree with everything that was said, and i would add the more that we can develop the flu vaccine technologies, the universal flu vaccine would be the ultimate goal of the prophetic celebration of the process being the interim goal, the less we will have six people in hospitals. but in the meantime, we need a strong progress of the program in place that there can be other

facets of the program like having more regional centers that can shoulder more responsibility in the crisis and take care of more patients. we have a level one trauma center that works very well that we don't have anything like that for infectious disease that could be modeled. the containment units in response but most of those units can only take care of one or two or three patients at the most if we want to raise the level of prepared as we might think about creating some regional strength that most hospitals will need to be able to take care of patients in neeand need proficiency persl protective equipment and relationships with the other hospitals and public health agencies and the clinics where people are being cared for in the community. it's a network of care as opposed to only relying on the hospitals and to distribute that out when there are major epidemics or pandemics of the flu. >> i know i will be out of time in a moment that i will come

back to it after other questions. the level one trauma center model how do you think we incentivize that in the context of your testimony on page three you refer to it as specialized disaster resource hospitals. i'm out of time but i will come back later to get comments on it. >> the way you incentivize it is some kind of competition but you have to provide resources because as we've said there is no give in the system. hospitals are running small margins so not able to build large entities or programs outside of the usual unless the government says we want you to do this and here is how.

>> the national security agenda in your comments that was from 2014. where is it house today backs >> it is multiple agencies of government particularly the cdc and usaid. >> i think it is the usa and cdc directors. >> when the outbreak took place, and you refer to some of the places around the united states that have containment areas. from a modest standpoint, we were able to meet the threat at emory university and a couple of other places for the doctors who came back from the outbreak. that was enough at the time but how much do you think should be billed to anticipate something happening like that again, maybe

not evil abou of some other infectious disease. >> emery was the national leader in the program if you stick to the leaders in the program they would say that it would be difficult to take care of more than one or two patients in the current unit. i think we need to get a better cost information about how much those units cost. it would be difficult to scale those by orders of magnitude by ten or 100 but i think we can build more capacities to the systems that share the lessons learned in the units and see if we can spread it responsibility out of it further because right now it is a pretty small number of units that can care for any patients. >> the capitol and the money. >> and training. specialized people. >> you talk in th talking the tf a contingency fund or some sort of planning. do you have any recommendations on where it ought to be? >> the contingency fund? if you base the contingency fund in on what we have spent in

other emergencies we typically have spent 500 million to a billion dollars as a country in response to things like h. one and one, ebola, sometimes more. the fund was in that range and i think public-health agencies and others outside of our center called for a 2 billion-dollar fund closer to what they use for their disaster relief funding. i think that would provide a lot of acceleration in the public health and we stomped emergencies. >> and because biological threats and deceased friends don't recognize national boundaries is something that community has to participate in together. >> absolutely. >> the cdc is great at coordinating things like that and so is usaid. the international agenda ought to be a game plan and contingency fund. >> the way that it worked as a

brings in differenitbrings in df government including financing side of government, security side so in the u.s. is bigger than the cdc and his participation with finance and economics and that's the model they are trying to get other countries to represent as well. >> is the plan in north carolina [inaudible] >> yes. >> how are we doing on that and we still have enough? >> we've been constantly enhancing the capability and that plant plans for from a seal perspective looking at it from the seasonal perspective the more than tripled over capacity into the market this year on the seasonal perspective. at the plant is also responsible as i mentioned in delivering one third of the requirement in boundaries of the even to be tha pandemic and responding within a six-month pair for. it is so base. >> what is the shelf life?

>> the shelf life of a vaccine pandemic perspective is five years. unfortunately, we do have an antigen right now that is older than that but from the cell perspective that is the state of affairs right now as far as the cell-based vaccine is concerned. we also have the promise that as i said, it offers the potential of being a better match in the event of a mismatched strain so an alternative form of manufacturing, that is some of the problem our company is trying to deliver on behalf of the government. >> thank you for your leadership on this issue and panelists. good morning and thank you for being here. i wanted to start with a question for you.

as we all know, puerto rico was recently devastated by hurricane maria and the island is still trying to rebuild from the disaster. the effects of that disaster are obviously widespread. hospitals are dealing with among other effects medical product and equipment shortages because the storm devastated some of the manufacture is on the island. what is the case of future events or other types of emergencies where medical supplies cannot be easily replenished i and what can we he in congress do find the real is this? >> the other storms have revealed how formidable the supply systems are and one possibility to consider would be

whether there are some critical supplies if they are single source or some active products or pharmaceutical single source for what they should be included in the national pharmaceutical stockpile that is not how the stockpile is configured or resourced now so it would need to be additional resources but it has a great success in acquiring medicine and being able to deliver them to the localities so that is one possibility if there's an additional purpose i and funding for the stockpile. >> can i interject holly springs is a great example for the other facilities when faced with a pandemic we actually became visionary and thought what can we do to meet what we don't know and we went into a partnership with three different companies

where we funded three corners and at any point we could turn it into what is in the nations best interest. it may be a model that we look at as we identify other things that we have shown a degree of vision in the past. it really helps us focus on one of the next things we should be doing. i also wanted to ask all of you, and i think i start the question with you, i love what you said about preparedness and response being about people and time and we both demand resources. to support a single statewide coalition that works together

for public health and emergency management professionals for hospitals to home care and beyond. new hampshire like other states relies on the funding to prepare for all kinds of emergencies, mass casualty incidents is and unfortunately like many other states, new hampshire is seen as a significant decrease in hospital preparedness on them in recent years. we don't know when the next emergency will have been or what precisely is going to entail so we need to make sure that the coalition in new hampshire is not only collaborating regularly but training regularly. it's hard to do that when it is reduced so i will start with y you. do you think that it should continue to fund those efforts in all states? >> very good question. i would say absolutely yes if

you think about who responds he thought he could talk about the three tiers, we have people that do this every day and people that are highly trained and called upon if there's an actual emergency like the one you described but they typically have different duties on their day-to-day basis, for example one of our emergency coordinators direct the medical services but when we have an emergency, she is in the state operations center. the third tier that i this kindf everybody else and the people that you are talking about are the clinicians and hospitals, people that are called upon whenever there is a need and the training and exercising and actually responding, creating the relationships and the know-how, where do did i go, ik to, those are the critical things couples are relationships

built on trust that the funding helps solidify and unfortunately when you reduce the funding that's one of the first things that go. to go. you try to preserve the positions and some of the things you've invested in, but the more fungible assets are the very things you need more of it i think you spoke to those very eloquently. >> in the interest of time i will ask the other three panels anything else you do disagree with or add to what was just said about the fun in. >> just the point that it is about people. the earlier question about how we get the hospitals better prepared, they have to train and if you don't have trained people, you are responsible not to be effective, but is shown in many areas of just healthcare. with the focus evolving from hospitals to healt health care s which is i think an appropriate

move, it's not just the hospitals that need to be trained if the entire community that needs to be trained. as an emergency physician can i do a brief tidbit after oxygen the elixir in how we care for patients is salient so because of the high consequence of infectious disease or you've been in an explosion or bus crash if you don't have saline, you lose lives. so there could be nothing more fundamental to our emergency response after oxygen than saline. >> thank you. and i know i've gone over so i will just submit a question about behavioral health needs especially for children in disasters that they impose on our kids that concern me greatly and last, thank you for pointing out the need for the special needs populations. and the mother of a special

needs young man and thank you for raising that in your testimony. >> thank you very much, senator byrd and senator casey and other members of the committee for your work on this focus on emergency preparedness and also to the test fires here today. in 2015 when i was lieutenant governor of minnesota it was hit by an avian flu outbreak which ended up costing somewhere in the neighborhood of a billion dollars with the largest and most expensive animal disease response in the history of this country and of course it hit the tree growers incredibly hard so i was relating to what you were talking about health or safety nets that we have is about people and not stuff because certainly as we responded to this catastrophe, the needed stuff but we also really needed the people and relationships that made our response work and

function incredibly quickly which was such an important part of it. so i am quite interested in this idea of a one health approach and how we can build that kind of approach into our thinking about emergency preparedness and i know that senator jan from indiana has raised this question just last week that raised the question of whether we need additional approaches or resources to do this and so maybe i would just like to turn over can you talk a little bit about what you think they might neewe mightneed for the proper n to address this question, this one health approach and what we ought to be getting better.

>> first of all, i completely agree with the values and principles and i think you're absolutely right there are strong connections between the outbreaks and i do think that those principles you'll find in federal agencies people believe there's a lot of acceptance and belief that you're also right it isn't housed in a particular program. there are large efforts underway tunderway to trick to bring one together. i do think that there's a national bio defense strategy that is being completed by the white house and its this is to bring together animal health, plant health and human health for bio defense and this is the first time the strategy has been written in a way so i do think there was a lot of coming together in the agencies over the last year on this and i think it's improving animal surveillance systems. we don't have strong animal surveillance if you talk of

shortageshortages in the workfoe human health public health workforce is strapped and the workforce is even most. so, taking a look at those things i'm not sure if that would be in this scope or not, but we don't have a lot of information coming from our animal system and it doesn't cross over into human health very easily so to create bridges between the system is a good step. >> thank you very much. i think if i can make this point is public-health professionals we think about the prevention of the flu and stopping it in the first place. but i think we have to look at ourselves and think about how do you primarily prevent the flu from ever occurring in the human population or another disease for example people were occurring in the human population and while doing things around about animal sources are critical, so the example that you gave we also

have to make sure that the circle for workers and their families because of his primary prevention of a potential novel influenza strain, so one is an essential perspective and i think from my perspective i would say the association of the interesting that we would be happy to work with you on that kind of crafting and how to specifically bring public-health professionals together to a better job of keeping animal diseases and animal populations and not allow it to transfer to other human beings. if somebody to come to congress years ago and say we need some money to teach people how to

properly prepare bush meet in africa because we know they are going to eat it and how to properly [inaudible] i think that would have been a hard sell when you consider all the money that we spend on the ebola outbreak that emanated from those practices and lack of education around the frisket would have been a relatively small investment.

this is about two hours and 15 minutes. we will call this hearing to order. welcome, everyone this hearing is entitled the first power system [inaudible] including the cyclone. i would like to start by calling on the ranking member to get her opening statement. >> thank you, and good morning to everyone. i'm sure senator murkowski