to report energy sources. what percentage right now are the best volume uses any imported source, whether it be outside -- >> i don't have a precise number for you, we can get you a number. it is small. >> but there are some things that are foreign sources that are actually being permitted right now? >> yes. the statute doesn't distinguish between imported and domestic. it really varies a lot depending on all different factors that have nothing to do with domestic policy. it is small. >> you had mentioned as well about the obligated parties. i'm not going to try to work you into a corner, help us to understand the decision for the point to say, no, we're going to deny this and help us understand what brought you to that point. as you know both sides of the argument have expressed this to you clearly, obviously, some of

the ones i know of, have told me point blank, the second most expensive part of their operation are rents. it's crude oil and after that, the energy for the facility and personnel and health care, but the second most expensive thing to have is something that's paper, that doesn't really exist anywhere except in the world of government. so help us understand the process that you went through to make this decision? >> let me talk about the process, first. so when we get petitions, it's up to the agency to grant or deny them, we often d we're not required to go through a proposal process to do that. in this case, we felt it was important enough and one reason because people across the board asked for a public to be able to put information for it and have that in conversation.

but, also, because we felt that it was an opportunity for to put forward our best thinking at this moment of the infrastructure and you have ak nolged, people are in very different places. they're not clear and they also wait for it. i sat in many meetings, we've had many conversations where people will come in with the same exact data and say one thing to us, one day, and then another group will look at the same data and say exactly the opposite to us. and so we're trying to sort all of this through and one of the questions that i was getting from people, as i was having this meeting, tell us what you think about what you're saying. so we thought it was fair to do that. and so to put our thinking out in, you know, proposal, rather than just say, to open it up nor, you know, we don't know whether we're going to grant it tonight but give us your

thoughts. we thought it would be moren rg we tried to lay it out very very clearly, our analysis of the objections the points that people were making to us. nobody is denying that they're significant cost for businesses that buy them. there's a complicated interplay whether the value of that is recovered through the products that they sell and gerks again, they passed it own to the consumer. that's complicated, too and i think bears a lot of discussion by people who are much smarter on the -- economics of this than i am. i would not presume to be an expert on that i think there's a range of views on whether the consumer doesn't see or whether it's past back and fourth. so people have different views

on this and we wanted to try to lay that as best we can. so i know we'll get lots and lots of am all for an open proc on it. it's a complicated, difficult issue. i'm exceptionally skeptical that any industry could have a $200 million cost, for instance, for a small manufacturer, for a small refiner, and that that would not be passed on to the consumer in some ways. if your second highest cost of your business is an item, you don't swallow that, and the other folks don't swallow that. the consumer does at the end. that's parts of that ten cent increase that we see in cost that's sitting out there, if we can agree on a simple number, because that ongoing cost has to go somewhere. that would be part of it. by the way, i don't think that goes away if you shift the obligation. i'm not saying it does. i'm not arguing one way or the other. i'm telling people, the more open the process can be is

better. i have integrated retail folks that have as a part of their business mold the rins that they produce and accept. i have other groups that are refiners that struggle exceptionally under this. so i get that part of the business. the hard part is just the consistency and trying to guess how to predict an rins price. it is very hard to predict an rins price. when it's such a large part of your business, everyone wants to know how to plan for the next year and it's tough to do that when you have to move the rins so much. >> we made a clear point that if we're looking for certainty in the system, changing the point of obligation now will completely undermine that. it would take multiple years to get that fixed. people will be arguing about how we should do it. so that is a consideration. >> so much simpler if we do away with the mandate entirely, that fixes that entirely.

>> i want to make a point about transparency and the rin market. i think epa has long recognized the potential for fraud, and the concern about lack of transparency and volatility. you've implemented the quality assurance program. i don't think we should leave this subject without acknowledging that and at least getting some feedback from you on whether that quality assurance project has worked. you've also been working with cfts on a memorandum of understanding related to transparency and oversight. and so i don't know that we need to comment given our port period of time, but i did want to acknowledge the work you're doing outside of this debate about, you know, who has the obligation to try and make the program more transparent, to try and work cooperatively with the cfts to guarantee minimization of speculation and fraud. >> thank you, senator.

we are looking at those opportunities every day, to try to provide more transparency. >> the only thing worse than rin is a fake rin. last question that i have, unless you all had other comments as well, mrs. mccabe, when you and i spoke last you were in the process of dealing with ozone and air quality, at the same time that you're dealing with the rfs. and we talked about the conflict between the two. >> mm-hmm. >> help me catch up on where that conversation is going right now. because as you produce more ethanol, it produces more ozone in those areas, in the production part of it, at the same time we're dealing with reducing ozone nationwide as well. >> so back in 2010, when we did our analysis, when we put the rule in place, we did note there were places and times where ozone air quality could be increased. it's not uniform, it's not across the board. it's not necessarily in places

where the ozone standard is not met already. so those are all complicating factors. and senator, i think we're about where we were last time, which is that states and cities are working to meet the ozone standard. most of those areas that are ozone nonattainment areas are large metropolitan areas. and so the contributors to ozone are overwhelmingly motor vehicles generally, industry power plants, and large emitters. but i'm not -- certainly not denying that we have found that there could be some increases in ozone as a result of ethanol. >> i did notice as well that you and others had very different -- the dia had a number for what is e zero at quite a bit higher,

than what y'all have estimated what the e zero. >> it was order of magnitude. that's the kind of discrepancy that gets people sitting down and talking to one another, which we did, and worked out that we were looking at different points in the process. so we were looking at the retail level. their numbers were reflecting a point higher up in the supply chain. so we feel we've resolved that discrepancy between the two agencies. >> but i would assume then the higher number still is used in the united states, or the lower number is what's used in the united states? >> we were looking at what's used at retail, what's expected to be needed at retail. in terms of people buying e zero, as opposed to e zero somewhere else in the supply chain then being blended later. >> okay. >> if that makes sense. >> it does make sense, then. any other final comments the two of you need to make that we did

not cover? >> no. >> mr. ruscoe, the report is very thorough, hopefully we can get consistency on numbers and costs, that's one area that's missing, to figure out this number, what does it cost the consumer. we have not been able to get an independent estimate, and we're all kind of guessing what that would be at this point based on numbers that are several years old. it would be extremely helpful for us to get a good snapshot even if it was literally grabbing one day a month for a year and snapshoting those days, this is what the estimated cost would be with or without the mandate and with or without ethanol. i would assume some days it is less expensive, it depends on the price of oil at that time. but i would also assume many days it's more expensive, especially with a lower oil price right now, with what we have. so hopefully in the days ahead we can get that kind of number. any final comments? >> thank you. >> thank you both.

let me see if i've got a very formal closing statement for you to be able to make. that concludes today's hearing. there's my formal statement. i would like to thank the witnesses for their testimony. the hearing record will remain open for 15 days until the close of business on december 16th for submission of statements for the record. with that, this hearing is adjourned. [ room noise ]

friday, former white house staffers and presidential transition teams on how the incoming president governs through the first 100 days. and how the first family prepares for moving into the white house. we are live with the national council for the social studies, starting at 11:15 a.m. eastern here on c-span3. the israeli defense minister and egyptian foreign minister speak friday on u.s. foreign policy in the middle east. we're live from the brookings institution at 6:30 p.m. eastern on c-span2. listen to c-span radio this saturday for historic audio about japan's bombing of pearl harbor, the attack that prompted the u.s. entry into world war ii. you'll hear president roosevelt's declaration of war address to congress. >> a date which will live in

infamy. >> as well as british prime minister winston churchill's remarks to congress. >> the british and american people will for their own safety and for the good of all walk together. >> and interviews with veterans who were at pearl harbor on the day of the attack. the 75th anniversary of pearl harbor is featured on c-span radio, saturday at 7:00 p.m. eastern. listen to c-span radio at c-span.org or with the free c-span radio app. december 1st marks world aids day. next, dr. deborah birx, u.s. global aids coordinator, on funding the fight against hiv/aids. from "washington journal," this is 40 minutes. at our table this morning, ambassador and doctor deborah birx, who is the u.s. global aids coordinator and u.s. special representative for global health diplomacy.

it is world aids day. tell our viewers why it's important to have this day. >> it allows all of us a moment in time to reflect on the epidemic, where we are, where we've been, who we've served, who we haven't served. really look at our progress. also, real time to remember those who we've lost, because that's what motivates us everyday. we know many of the people we've lost. we have to prevent losing them. >> let's talk about we're at with combating hiv/aids. if you look at it in the united states, almost 1.2 million people are living with aids infection. in 2015, 39,000 were diagnosed with the infection. from 2005 to 2014, the number of people who were diagnosed with aids declined by 14%. gay and by sexual men accounted for 82% of diagnoses.

heterosexual diagnoses accounted for 24%. talk about where we are in this fight against hiv/aids. >> that is a critical question. epidemics evolve and move, and change their dynamics, who is being infected, who is infecting who. unless you're on top of that and follow the data, you're behind the epidemic and new infections expa expand. the focus is ensuring we're putting resources where the epidemic needs to be controlled. when you look at the history of two cities, you look at the history of san francisco and oakland, you can see amazing progress in san francisco where they're talking about and counting new infections being less than 100, less than 90, less than 75, with the intent to get to zero. then you look across the bay and you see oakland with expanding epidemic, young gay men of

color, do you have the right messages. it causes us to evaluate how we reach everyone. >> what's the difference between those two programs, those two cities? >> i think the difference is very stark, when you look at where everyone has focused. i know the mayor of oakland is very dedicated. congresswoman lee, very dedicated to the issue there. but the epidemic started to expand in a group where we didn't have focused activities. watching that, finding that, now they're having a huge impact and will continue to have a great impact. san francisco, new york, a few cities, were ground zero a few years ago. so they had a head start really getting the data and the informs from oakland has been key. and many people have participated in that. and now they're matching programs. when you look at washington, dc, ten years ago some of the incidents here and prevalence here was higher than many countries where i worked in africa. but the community, the

government, the mayor, and all the resources together, nih, came together with georgetown university and really said, where inne nexfections are occu where do we get people diagnosed, where do we get them on treatment. and incidence has plummeted in the city. it's taking the parameters frro paper to action. >> is this a federal initiative? is most of this work done on the state level? >> it's done at both, it's also done at the community level. we have to remember how important the local community groups that continue to work tirelessly against this epidemic, ensuring that people in their community are served with health services that meet their needs, in a way that's representati receptive to them, nonstigmatizing, nondiscriminating. i think it helps that the churches are taking this on once again as a real issue to ensure that everybody who is in their pews on sunday is aware of their risk of hiv and their need to be

tested. so community plays a really critical role. yes, there are federal dollars. yes, there are state dollars. yes, we recently had ryan white reauthorized. yes, we do have programs for the poorest of the poor and safety nets. but it takes everybody together. and i think we never want to lose track, that no federal or state program is going to be impactful without community engagement. >> how much money are we talking about? >> billions in the u.s. it's somewhere between 15 and $20 billion a year of really investments both in prevention as well as treatment programs to ensure that we're decreasing the epidemic. that number continues to depending on the cost of medication and access. but it's really been from the beginning a comprehensive response that really had said we need to have prevention, you need to have treatment, you need to have community, the state, the federal government, and science. and what nih has done to provide us the tools over the last 30

years is extraordinary. >> where are you seeing increases in infections in the united states? >> when you look across the entire united states and you look across the south, that's where you see many what we call hotspots. we look for hotspots domestically and we look for hotspots globally. it's areas where there's more transmission. over tho often those are areas where people know their status. no one is intentionally transmitting the virus. when you first get infected, you're healthy, and you stay healthy for a long period of time. when you talk about motivating a 16 or 17-year-old to interact with the health system, that's not one of their top three things to do in their daily life. so really finding a message that resonates with them and personally with them, that motivates them to want to know their status and want to know what it takes to protect them against hiv, that's really key.

but those messages have to evolve from talking to a 30-year-old down to talk to a 16-year-old. very different, and very different message. >> what is the president's emergency plan for aids relief, pepfar? >> it is an amazing program that grew out of the durbin conference in 2000, where president mandela got up and talked about the unrelenting playing in africa that was killing 20 to 30% of their teachers, their mothers, their doctors, their nurses, and really saying something needs to be done globally. the congress took this up between barbara lee, senator frisk, senator kerry. president bush, historically, for the first time ever in the history of the world, stood up to say we're going to invest to save people's lives around the globe, we're going to translate the compassion and empathy of the american people and their tax dollars into a program that prevents, cares, and treats

those who have less. and that has now, fast forward 13 years, we're so excited on this world aids day, because for the first time we have data to show that we're beginning to control the epidemic in three of the high burden countries. when you say in 13 years you've gone from -- and we continue to save lives and prevent new infections, but now we have the impact data that said those investments brought us to a place where we're actually changing the very trajectory of this pandemic and dramatically decreasing incidences. if you look at how incidences have decreased since pepfar has started, over 50% in countries where we've invested. >> what countries are you talking about? >> we're highly invested in sub-saharan africa. we have programs in the caribbean. we have programs throughout southeast asia, central asia, the ukraine, and programs, a few

programs of support in south america. >> and we're showing our viewers a map, a 2015 map of those so-called hotspots that you were referring to, sub-saharan africa. there's a goal of an aids-free generation by 2030. i want to show our viewers what the map looks like by 2020 comparing to what they're seeing now in 2015. those red spots become more orange. is it realistic, is it possible to have an aids-free generation by 2030? >> that's what these three surveys in the field were about. these were three comprehensive, done at the community level, so everybody in the community, not biased in any way, going door to door, 25,000 people in each of these three countries, zambia, zimbab zimbabwe, and malawi, and looking at the community level, what services are being provided and are those services having an impact. the fact that we have community viral load suppression of over

60%, that means you're disrupting the sexual networks. that means we do have the evidence base. we had the scientific evidence base, all the clinical trials that nih supported that said if you do this, you can have an aids-free generation. going from there to implementing these programs in a full community country, county way, is quite extraordinary. but we have amazing government and implementing partners on the ground who have taken that science and they've taken that science to the people we serve in their communities, where they lived, and now we're showing for the first time that that's changing the course of the pandemic. so yes, we can. we need to continue to focus our resources. every single day we get up and say, are we spending the dollars where we need to to change the course of the epidemic and save lives? you have to be attentive to the money, the people, the locations, every single day.

otherwise, you can get behind the epidemic. this epidemic doesn't respect borders or gender or race or any kind of sexual orientation. this is a virus that spreads quietly. and that really takes programs that are comprehensive. >> if our viewers have questions about the virus, about the science, and about this effort to combat it across the world, we invite you to call in, republicans and democrats and independents. we have the ambassador and dr. deborah birx who has been working for a long time, who will take your questions. a democrat from chase city, hi there. >> hi. we should send some aid to indiana, since mike pence defunded planned parenthood, which they take care of all the aids medicine and everything.

and he cut that off. so -- >> yes, let's talk about what happened in diana and the role planned parenthood plays. >> there are clinics everywhere in these states and counties. these programs are more effective the more local they are to the communities. i don't know of the specific case so i can't comment. but we know through our advocacy and our community work that if people weren't being served, we would know it immediately. >> do you see infections then go up? >> people don't stop their medication. that's the other piece that these impact surveys show, that when you had 86 to 91% viral suppression, that means that that patient is every day

staying on his medication, he or she is staying on their medication. that's extraordinary, that people have that level of dedication, both so they can thrive but also so they don't transmit of virus. >> what is the medication? >> a combination of different drugs that work at different sites of action to inhibit the virus and keep the virus from replicating in your cells or keep the virus from binding to your cells, going what we call inside your cells. these all work in a complementary way. we have a combination of three drugs that we've been using in sub-saharan africa that cost less than $100 a year. those have been extraordinarily durable and extraordinarily accepted by the individuals that are hiv-positive. in the u.s., because we started with what we call one drug and then two drugs and then three drugs, because every time we had a new drug, we wanted to make sure that every one of our

clients had access because it was such a devastating time to have people in their 20s and 30s dying of this plague and not having the medication. so in the u.s., we've had to use more sophisticated drugs, more technically difficult to make drugs, because we have more resistance in the united states because of that, people being on one drug, then two drugs, then three drugs, which in africa, clients, because they couldn't access any drugs until pepfar, less than 50,000 people were on treatment before pepfar, now we have 11.5 million people. that's in 12 years. so they have much more durability to what we call the first line drugs than in many developed world who had access to the drugs. >> let's go to york, grand junction, colorado, independent. york, you're next. >> hello, dr. birx. i've been in the hiv/std

prevention business for you for 30 years. i manufacture condom vending machines. i have them in over 80 countries around the world. i ship 600 just to moscow. but we have noticed, even my competition here, we have noticed a definite decline in condom machines for around the u.s. and i've noticed a definite decline in the offshore. i haven't heard from the u.n. or planned parenthood for quite a while. but anyway, i'm on the web, if you would like to -- i sure would like to work with you. and i'm on the web. you can go there and go to condommachines.com. >> let's have dr. birx respond about prevention. >> thank you for talking about condoms, because they are a critical, critical component in our prevention armentarium. we launched two years ago what we call d.r.e.a.m.s., providing

a program of prevention meeting the needs of the young woman where the young woman is and responding to her specific issues. condoms are part of that. and pepfar continues to procure probably more condoms than any other program in the world. and we continue to do that at a very high level. we have not decreased, in fact we've increased the number of condoms we continue to procure. condoms are part of that. but we have to make sure that we just talked about -- we have know that people understand that they have a risk of hiv. and sometimes, particularly 15 to 24-year-olds, don't believe that they have a risk. so as the epidemic, and you raise an important point with your knowledge about condom availability, when a disease moves into 15 to 24-year-olds and they're not aware that hiv is a risk, they wouldn't be particularly motivated to utilize a condom machine because they wouldn't think that they are exposed or others that they're with are exposed to hiv.

so that's our job, to make sure people understand how this epidemic is moving and how in the united states, it's moved very much into young men of color, 15, 16, 17, and 18-year-olds becoming infected. throughout the world, particularly sub-saharan africa, it's moved into 15 to 24-year-old women who didn't even perceive themselves at risk. you have to constantly pay attention. >> ambassador birx is responsible for implementing the u.s. president's aids relief, pepfar, started under george w. bush, and as you told our viewers, the results that you've seen in the last 13 years to reduce the infection across the world. but the goal is an aids-free generation by 2030. >> and that's not just the united states' goal. that's the goal of the world, because when the world signed onto what we call the sustainable development goals, they said that we will absolutely end hiv, tb, and

malaria as pandemics and they'll be controlled by 2030. that's extraordinarily an ambitious goal. we've shown through pepfar that it's achievable. >> why do you think it has been successful so far? what has led to the reduction in numbers? >> i think there's three components to that. one of them is really utilizing data and information at the very most granular level. in pepfar, if your viewers would go to pepfar.gov today, they would find all our results down to the district level. we have results down to the site level. and we have all of those results age and sex aggregated. we have to know immediately, are young men not being tested, and are there certain areas where they're successfully being tested? we go to those clinics and find incredibly innovative solutions

in the field. but every time i go and say, this is amazing what you're doing, they say, doesn't everyone do it this way? people in general are so humble in their new ideas. but what we've been able to do by utilizing data in a very clear and disaggregated way is to find the areas of success and then find the areas that are lacking in success and improve those. we talk about the starbucks model. it's a little bit like a starbucks store being open and never selling a cappuccino. is that because that community doesn't like cappuccino or is that because no one knows about the cappuccino? so what we do is we look at data to really see, why aren't young men accessing treatment, why aren't they being tested, what age groups are we missing, what genders are we missing? that's how you stay ahead of an epidemic. more importantly, that's how you make programs effective, so that every dollar goes to a highly impactful program. >> what are your questions about

the epidemic? start calling in now. republicans, 202-748-8001. independents, 202-748-8002. we've got several callers lined up. david in gatson, alabama, a democrat, you're next. >> yes. i would like to give a big shout out to c-span and dr. birx, i think her work is great. i'm a 54-year-old white male, i have a modest income. what would be the best way for somebody like me to give to this foundation and to get involved in it? because i have kids and grandkids coming up, and i'm going to try to really educate them on it. but i would really like to help, you know, support the cause. what's the best way of doing that? and thank you for your work. >> david, thank you, because

that's what pepfar really is, says the translation, and you're doing something every day, because you're paying taxes that make this program successful, and we're deeply grateful to you, we're deeply grateful to the american congress, and we're deeply grateful to two administrations, a republican and democratic administration, who continue to support this program. i think that represents the best of all of us. what you just said represents the best of all of us. the best thing that you can do is what you talked about, educating your grandchildren and your children about hiv/aids. and then looking in your community, because i'm sure there's a community service organization within your community that is doing outreach into the communities that really are most affected by hiv/aids. thank you for your compassion, and thank you for being an american that has made this program successful. >> here is a tweet from a viewer, urban dweller. the difference is color of one's skin.

nonwhites were marginalized during the early days of the hiv/aids epidemic. would you agree with that? >> i think that's a very interesting perception, and i think the fact that someone feels that way means that we have to look at how we're working. we hear this all the time in sub-saharan africa from young women who said, i went to a clinic to try and find out how to protect myself and they turned me away and said, you don't belong here because you shouldn't even be thinking about having sex. this is a 17-year-old. until we really look at ourselves and we look at ourselves at the communities where we're providing services and saying, are our services open to everyone. i think the other piece behind that tweet that has worried me both here and around the world is, are the churches helping and are they part of the solution now. are the black churches talking about hiv/aids? i think they are, and i think they're part of that critical

community that can outreach. we talk about the churches in africa and we say are the churches in africa reaching out to the individuals in the churches every sunday morning and really ensuring that they have awareness of hiv/aids, how to protect themselves, how to keep from getting infected, and how to get tested to find out if they are infected. >> stan in broad brook, connecticut, independent. thanks for holding, it's your turn. >> yes, deborah, i would like to know why you and the government help spread the aids by allowing men to have sex with each other, by having this -- making it legal for same-sex marriage and all this stuff, you spread it -- you give aids a chance to spread across the country doing that. >> let's get a response, stan. dr. birx? >> i think we have to really be aware of the data. that's why data is so important. so when you start to look at the data, and as we opened the segment, we talked about -- greta talked about how 25% of

hiv/aids in the united states is heterosexually spread. we also know hiv/aids is spread among people who inject drugs. we also know hiv/aids is spread in prison. if you look around the globe, the primary, the absolutely primary mode of risk of spreading hiv/aids is in hetero sexual couples. so that's what's putting young women at risk, that's what's putting people at risk around the world. we don't have to be very careful that we don't use language that further drives people away from services and keeps them out of the health care system when we need them to access services and become tested. >> here is a question from jim buck on twitter. given the difficulty creating a vaccine to a retro virus, what is the current status of an hiv vaccine? >> well, thank you for mentioning vaccines, because there's two things that nih and the scientific community around the world are working on right now. one of them is a cure.

and that's extraordinarily exciting and they're making progress every day. the other one is hiv vaccines. i think that was the world i came out of about ten, 15 years ago. there's a really critical trial that just opened in south africa and really shows how vaccine development can work in partnership between the south african government, nih, and the community. and that is just being launched. that will be a critical trial. and i believe that we will have a vaccine. i hope we have a vaccine in the mid-20s, hopefully critically by 2030, because we will be able to control this epidemic with the tools that we have now. but we will not be able to end aids. i want to make that very clear. we're talking about 37 million people thriving and living with hiv/aids because they're on medication. they stop that medication, they once again can transmit the virus. so we have to ensure that those individuals stay on treatment.

and we have to ensure that we have a vaccine that's protective of all the rest of the individuals, while we work on our prevention activity. we're excited about the progress nih is making, and dr. fauci. >> let me give our viewers your background. dr. birx, military trained clinician in immunology, focusing on aids vac even research in the department of defense in 1985. assistant chief of the hospital immunology service at walter reed from 1985 to 1989. director of the u.s. military hiv research program from walter reed from '96 to 2005, rose to rank of colonel during that time and helped lead one of the most influential hiv vaccine trials in history. and then the director of cdc's division of global hiv/aids from 2005 to 2014, led the implementation of pepfar programs there, around the world, and managed the annual budget there of more than $1.5 io