walter stark, and howard ednarsity professor medford on abraham lincoln's friends and enemies. edge american history tv this week in primetime on c-span3. medical professionals and bio security experts testified on response capabilities on health threats. public health funding, and workforce capacity issues, and we authorization of the pandemic and all hazards preparedness act of 2006. >> i want to thank the senator for the hearing today, and senator casey as serving as a ranking member. leaders both been real on the subject. the center is the first author of the pandemic, and on all

hazards preparedness act. i will collect all hazards preparedness act, that makes it better for me. fromaw helps protect us the full range of public health threats. then in 2013, senator burr and , senator casey led the authorization. many members of this committee some are still on the committee. now, the bill needs to be reauthorized for a second time. today's hearing is the second we have had this year. last week, we heard from the oninistration recommendations in advance of the reauthorization act, including the secretary from

preparedness response, the food and the administrator centers for disease control and prevention. the middle of the flu season, it is critical that we reauthorized the act before many of its provisions expire in september. i hope will do this in a bipartisan way, and i expect that. it has been tradition with the law and this committee with all of our major bills. people are not as aware of the devastation of, for example, flu, and they mentioned the flu season. i think the figures are between 12,000-50,000 americans die of flu every year. dr. collins has talked to us about expediting a universal flu vaccine which he sees soon. tennessee has seen heartbreaking stories already this winter as the flu spread across the state and country. in our state already this season, a pregnant woman and three children have died and

tennessee of the flu. the act provides a preparedness framework that enables us to be prepared and respond to public health threats by ensuring we have enough medicine to ensure americans and to ensure our health services can respond to public health emergencies. -- thanks to all of our witnesses were here today. thank you. >> this morning we are holding a hearing entitled "facing the 20th century threats". we will hear from the director of the center at john hopkins school for public health. commissioner of tennessee department of public health. president ande

cochair of the alliance for bio head of -- and the pediatric emergency medicine at children's hospital. senator casey and i will have an opening statement and then we will hear from witnesses. members will have up to five minutes for questions. i am pleased to chair the second hearing to inform our work. i'd like to thank the chairman for giving the opportunity to senator casey and i to lead that discussion. today we will hear from individuals with firsthand knowledge. since the last authorization, the emergency response framework has been tested by the emergence of pandemic flu, multiple natural disasters, and ebola breakout and the zika virus. the lessons learned from these events come from individuals like those sitting before us

today, and their efforts to protect and to save lives. the last hurricane season resulted in three major storms, devastating many communities and raising questions about our ability to withstand multiple periods of response. the instances of zika showed us the need for more protections for as many mothers and babies as possible. the ebola breakout in 2014 highlighted the need for knowledge of the potential damage that can be brought by these threats and a deep understanding of the effort undertaken for research, development, and procurement of medical countermeasures. i look forward to learning more about the opportunities and barriers each of you see to better leverage innovative technology to solve these problems. whether it is information crucial to the public health department and myths of a

crisis, the infrastructure of needs to rapidly care for patients are improvements in the way these policies complement one another, your experiences reminds us we cannot let up on these efforts or lose sight of the urgency this mission demands. we must not get distracted by making changes to the laws that are outside of our focus of protecting the public, improving and strengthening our policies and programs to make them more effective now and in the future. i look forward to the inside each witness can provide, and i will now turn it over to senator casey for any remarks would like to make. sen. casey: thank you for joining us today. the give for this opportunity. i also want to thank our witnesses for breaking their experience and work to these issues and for joining us today.

this is our second hearing on and the focus is our nation's preparedness to combat public health threats as we look towards reauthorizing the pandemic and all hazards impairment -- procurement act. now more than ever we must rebuild our nation's resiliency to help security threats. the threats that face our nation today are increasing in both frequency and intensity. it is critical to foster an advanced innovation and drugs devices. yet, when we are considering any merging infectious disease or in engineered bio weapon that is yet to be seen by man or the response to a natural disaster like a hurricane, we do not and will not have a vaccine or countermeasure to protect us from these scenarios.

so in addition to supporting biomedical innovations, we must also strengthen our hospitals and our public health professionals, our front line of defense against these health threats. we must ensure we get our communities the support to be ready when, not if, the next emergency strikes. while accounts, we have come a long way. i spoke at the last hearing about the success of hospital preparedness programs, hpp. the public health emergency preparedness program in the context of a train derailment in pennsylvania, and of many examples we can cite. programsnts for these also facilitate preparedness activity that help hospitals and public health systems with more regular occurrences.

when subzero temperatures cause bursting pipes in st. vincent pennsylvania,ie, and they got hit with worse than any place with snow. the hospital got in contact with emergency and the health care coalition created through hpp funding. responsested in the that circumstance, and yet, the funding for these preparedness --grams have decreased from appropriations falling behind authorized levels, spiking only in the response to ebola and zika. in the amount of time that hospitals and medical staffs have to plan and train for an emergency. the loss of thousands of public inlth jobs, the reduction

emergency managers, and public health lab technicians. it is very dangerous to wait for a threat to emerge to pass emergency funding bills. proactive, not reactive. so how can we improve our health care system preparedness and public health capacities and thereby improve our situational awareness in an emergency? can work towards a precision public health using baiter data -- better data to guide and help emergencies to benefit our communities? i think we can. as reported by the publication, "nature. " the entire country whence igo struck was not considered at risk. showed to atnce

miami county. this allowed for targeting of resources to these regions. building on that experience, we can expand surveillance to eliminate causes of disease and spark opportunities for prevention. week, at last week's hearing, we also heard from assistant secretary about the to of empower program identify at risk individuals requiring electricity dependent medical assistive equipment. yet, he also identified a weakness. this system only pulls in medicare data, not medicaid and try care data. so how do we ensure that we are acting on the data appropriately to protect these moldable individuals? seniorsic death of 12

in a nursing home during hurricane irma september highlights that more needs to be done to protect our most honorable citizens. in fact, most of our citizens have additional characteristics that make them more vulnerable during a public health emergency. this includes our children, our parents, our rural communities, individuals with limited jewish proficiency. individuals with disabilities, and individuals with chronic illnesses, and more. we must do better to help our communities about potential health security threats, and we must invest in innovative biotechnologies, and what must also improve our nonpharmaceutical interventions. i look forward to the hearing, the witnesses testimony, and how we can continue to prepare our hospitals and health systems to ensure equal consideration of all of our constituents.

senator, thank you very much. i am pleased we have our fort when this is here today, and i thank you for taking your time to be here today. i would like to introduce all four. the doctor is the director at -- john hopkins, and his recommended as his work as a writer with numerous publications focusing on public pandemic,paredness, and emerging infectious disease. as was the prevention of and response to biologic threats. i'm turn to senator alexander for an introduction. dr.ould like to welcome john dreiser who is the tallest commissioner of health in our history, maybe in the country. he served as the commissioner of tennessee department of health

yes men can't express responding to state and local health department agencies, including infectious diseases like cigar, and natural disasters just wildfires that devastated eastern tennessee in 2016. insightswill provide about fairness at a state and local level, what is working, where we can improve, where we can save more lives. the doctor is a professional with more than -- years of service coming he helps protect his community, and i appreciate his leadership in tennessee, and we welcome them to the committee. i am sure if you were a little younger, there are a couple of tennessee basketball teams will recruit you tomorrow, given their record this year. >> next, i would like to introduce mr. mcgregor. he is the senior vice president for commercial operations.

the second largest vaccine company in the world. darren example of the success that can be achieved through public-private partnerships to ensure we are better prepared for the threats that face us. they are based in north carolina, and are part of three advanced manufacturers in the country in the event of a pandemic, flu outbreak. he is also the culture for the alliance of bio security. promotes critical partnerships between the government industry and other stakeholders to advance and encourage the development of medical countermeasures. dr. steven krug is the head of pediatric emergency and the children's hospital in chicago. is also the professor of pediatrics at the lemberg school of medicine and serves as the chair of the american academy of idiot trick disaster advisory

council. dr. krug, welcome. advisory disaster council. >> think you for the chance to speak to the on these important issues. healthe director of security at john hopkins school of public health where i'm a professor of public health. our mission is to protect people from disasters and to rebuild communities. i'll provide key areas that might colleagues and i consider vital response capabilities. the opinions expressed are my own and don't reflect john hopkins university. there is a range of public health threats that can occur without much warning. these include natural disasters, bombings, shootings,

nuclear threats, and biological threats. whether theyreats, are viruses in china, were accidental, such as a viral strain released from a lab, or deliberate like smallpox and anthrax, and that is a big focus of my comments today. biological threats can reach from modest in size or could pose as global, catastrophic threats. first, we need to strengthen the health care system preparedness. that is the capacity to care for high numbers injured in emergency. progressstantial prepared for disasters in the country, the nation is not ready for medical care in large catastrophes. or age 50,l program, has been funded at state and local levels, but significant resource constraints limit wage

-- what hpv can do. that trend should be reversed. a new initiatives could be a strong additional component in improving medical preparedness. second, we need and the ability of our public health system detect and respond to threats. since thousand one, there have been serious efforts in state and local levels to provide early warning of outbreaks, provide that agnostics, make it to the public, and sure biosafety in bio security, and much more. there's too much to you and not enough professionals to do the work. public health relies on funding -- grant funding. by 30% been reduced since 2002, even though public crisis have not declined.

in addition, i believe a public health emergency fund should be established which allow rapid public health response funding and emergencies. to move ahead in medical countermeasure development. there has been good progress, but many parties remain, including sustained funding and manufacturing of countermeasures. flu vaccineg new technologies, and setting up more ambitious targets in emergency so that they are ready the course of a given pandemic or epidemic. fourth, the u.s. needs a recognized that that could emerge from biological research. research was lifted last month -- researchers can now apply for funding to study, for example, ways of making the world's most flu,l viruses like bird respiratory transmission oil like season flu. ofcould be accidental strain

a virus that could cause an epidemic or pandemic. i don't believe the benefits of this work are worth the risks, but if it is going to go ahead, i devised there's be high transparency in the program answer is dialogue concerning governments in how to proceed. finally, we should fund the -- in security agenda 2014, the u.s. launch the program with a billion-dollar commitment to help countries prevent, detect, and respond to infectious threats. dc has been the c working on programs to help forces,en public health and much more. at this point, the funding is ending soon. of a pullout, other countries will do the same. we should continue to support it, it is the most effective program we have to contain international operates at their sources overseas. improving our nation's

preparedness capacity is a complex and ever, but it is an achievable goal if we focus on these efforts. i welcome your questions. >> good morning. distinguished committee members, think rick -- thank you for this opportunity. a strong, agile, and resilient public health and medical preparedness response system, it is an honor to be here. i'm the commissioner of health in tennessee. the thoughts i will be sharing with you today are my own, but i am confident it will be shared by my colleagues across the

country who strive every day to prepare to respond to any threats of all kinds. these threats can be outbreaks just measles, foodbornecountry o illness, or seasonal influenza. readinessur responses , these threats can also be large-scale, international, or global events. the ebola, zika, epidemic, or act of terrorism area of ehealth during naturalis disasters, storms, tornadoes, floods, wildfires, and other extreme weather events that unfortunately seldom there is a jurisdiction of any size that experiencing. as well, through mechanisms like impact, even unaffected jurisdictions are called upon to assist neighbors. public health response and recovery is responsibility discipline, and service that we have to get right. economic health

the pen on it, it is something we do every day, it is a matter of local resiliency. all disasters play out locally, and it is also a matter of national security. i like to share my perspective with you and how i have been directly involved the planning, and the limitation over 25 years. i start with a simple question, what is health and emergency medical preparedness? at root, it is people. shelters don't staff themselves. a fire truck cannot put out a fire without firefighters. and people cannot be hired and trained after the alarm sounds. they need to be there and ready to go before the fed emerges in order to respond to it. preparedness is about people responding to interconnected networks. to truly be prepared, we need three things, one is to train

people. two, expertise and leadership in all levels. local, state, and federal. three, communication and situational awareness among leaders, people on the ground, and experts. try to create these three things after an event begins takes up a valuable commodity, time. we do not have time to create this network after the event starts. network, the recovery is a safety net for our performer. it has to be in place before the show starts, anchored and expected and in good shape to do the job. -- ifmmitment supplies you remember nothing else my testimony today, i would like you to remember this. , people, not things are the net. the anchors matter, but it is the people anchor the response.

they are what strengthen the courts, open together, and keep them adaptable and resilient. their unraveled, the less capable than the is in most vulnerable times. medicalike durable equipment, and communications infrastructure are essential anchors for the net. the people are the net. havelast 15 years -- i illustrated in my written remarks, they can be attributed to all hazards preparedness act. was transformative relative to public health and health care preparedness, and it has provided the authorities the authorization resources and the cadence of accountability to become a part of the culture of public health and enabled us to do our job as best as possible.

be lined upes must with the demands of everett extending threat environment given our front line of defense and safety net abilities. the scale and speed it needs to this.t is credible for they should be applauded for their efforts that gives states, territories, and localities, and tribes the resources and tools needed to stay vigilant at this critical post and get the job done. these funds are not duplicate the as you know, but it is essential. sometimes, depending on the hazard, public health is the only responder. we ultimately need is a nation to ensure a strong safety net is consistent, liable, and sufficient, to keep the people, their knowledge, their networks, their trust intact. thank you again for the opportunity to speak with you today on this issue, and for caring about preserving our ability to respond to any hazardous threat to generations

to come. thank you. happy to take questions. >> good morning centerburg, senator casey, members of the committee. my name is brent mcgregor and i'm the senior vice president of commercial obligate -- operations. i appreciate the opportunity to appear before you. i would like to focus my remarks on the importance of preparedness against pandemic influenza and the critical role played by the biomedical advanced research and development authority and its industry partners. there are three issues alike to highlight from my written testimony. first, the pandemic influenza is one of the most urgent public health threats we face in the nation and must be a priority of hhs' biomedical enterprise. >> second, it must be authorized

, and third congress must provide sustained and predictable funding to strengthen partnerships with the private sector and to ensure our nation's preparedness. regarding my first point, preparing against pandemic influenza, this is critical to our national and economic security. we are proud of the partnership we have with barda. thanks to the leadership of senator burr, senator casey and members of this committee and the dedicated team at barda, our vaccine production facility in north carolina is one of the examples of successful public partner -- public partner private -- public-private partnership in bio defense. despite representing the p in pahpa, authorized funding has not been included in the

legislation. funding for critical activities such as stockpiling, advanced research and development has been episodic since 2009. emergency supplemental funds provided during the 2005 and 2009 pandemics are now fully exhausted. having a program authorized by congress would provide a clear signal to the private sector that the u.s. is committed to preparing against pandemic threats in the future. the most recent five-year budget outline $630 million. we believe in annual authorization level of the least $535 million is needed to support hhs's most critical activities. regarding predictable mcm funding, over the last 12 years, this enterprise has improved our nation's security and while bar da has improved of its industry partners, government must provide more certainty in the process. procurement funding provided by the project special was her fund , the national stockpile and b

arda's program provides market certainty. because there is no commercial market, companies can only rely on the commitment provided by hhs to make investments in research. unfortunately over the last several years, the private sector has become more skeptical of the government commitment to bio defense. funding has created uncertainty in the long-term sustainability of the programs. public-private partnerships must be sustained over time to demonstrate a commitment by the federal government. there are dozens of companies both large and small that have committed to the mission and made significant investments in mcm development. re-authorization in a renewed commitment will ensure these investments yield even more fda approved medical countermeasures.

securis supports the reauthorization and by the biotechnology innovation organization. i would like to thank members of the committee and senator burr further commitment to the authorizing -- for reauthorizing pahpa in a timely manner. we believe -- we are excited about the future of our partnership with barda, we encourage the committee to reauthorize the program. this is a critical opportunity to make sure they have the resources they need to prepare for one of the most predictable threats we face as a nation. i look forward to be a resource for this committee and i'm happy to answer any questions you may have.

>> good morning. chairman burr, distinguished members and staff, i am dr. steve krug and -- krugen. krug. i am the head of the division of emergency medicine at robert h children's hospital in chicago. i am the chair of the american academy of pediatrics preparedness advisory council and bath of the 60's -- on behalf of the members, thank you for inviting me. i'm privileged to serve on federal advisory committees and chaired the hhs national bio defense science board. my comments today are as a private citizen and member death i applaud the work of this committee for strengthening and improving our nation's public health for medical preparedness with the pandemic reauthorization act. i will thank you for the first-ever provisions for children in the last reauthorization. those changes of help to make

the needs of children a much higher priority in emergency planning and response. as we heard last week from leadership, each agency has a distinct role to play in ensuring our health care system is better prepared to meet the needs of all americans, including children, during and after -- natural disaster. the leaders of these federal agencies and countless hard-working employees really are the backbone of our nations 24/7 federal emergency readiness response capacity. the frequency, severity and cost of disasters and emergencies are increasing meaning they will remain a significant threat to the health and safety of our community and nation. maintaining and expanding the federal government's strategic focus on all hazard approaches is critical. this will require continuing engagement of all stakeholders including public health, medical and mental health services,

academia, industry and state today of emergency and trauma services. our nations -- it is evident that health care in systems that are regularly tested will be the most reliable and effective. regular exercises and drills along with continuing education for care providers and first responders are necessary in order to be ready for all populations when a disaster strikes. this is important if we hope to be ready to meet the unique needs of children. at a population -- as a population we should strive for a healthier community. this will reduce the burden on the health care system during and after disasters. this means ensuring access to affordable health care and preventable services and reducing health care to spell it -- disparities.

financial drives in today's health care environment are not aligned with the need for facilities to be prepared for public health emergencies. cost-reduction measures have resulted in leaner stockpiles and is substantially smaller workforce. with the daily operations functioning closer to full capacity. this is promoted emergency department overcrowding and poor surge capacity during seasonal epidemics and pandemics like the one we are going through now. the surge capacity gap particularly carries within pediatrics. crisis funding does not adequately indicate primary care. they provide vital services before, during and after disasters. in the absence of mechanisms to provide assistance to impacted providers and disrupt practices, many have been forced to leave. it is not hard to see why so many communities have for that struggle to respond and why some may never fully recover after disaster. communities rely heavily on resilience of the health care

sector. children account for 25% of the population and their unique vulnerabilities mean preparedness response activities at all levels must account for their needs. children are different than adults. i would offer three additional thoughts. in terms of recommendations. first, reauthorize and strengthen the hhs national advisory committee on children and disasters with subject matter experts from the public and private sector. there provided code recommendations for health care prepared for children. two, authorized the cdc preparedness unit which has proved to be an invaluable resource to the pediatrician community and other child

serving institutions. this unit is a best practice example of an effect of public and private sector partnership that has brought tremendous value to preparedness. finally, to reiterate comments already made, let's maintain the grant programs, those are distinct programs with strong pediatric performance measures and with increased funding. as disasters and universal risks can occur anywhere in the nation , it is essential all jurisdictions have a baseline level of preparedness needed by each of these programs. i want to thank the committee for the opportunity to testify and a look forward to your questions. >> as evidenced by the fact that i'm not sure in the past had a pediatrician on the floor for these related hearings, it shows we understand the need to get it right. i might say it is probably one of the most challenging areas because it is hard to incorporate pediatrics on the cutting it -- and the cutting-edge technologies that on one side are pushing and that

that will always be a challenge to us, we need more subject matter experts to help us navigate through that. i will recognize members from 25 minutes starting with myself and move on a seniority basis. mr. mcgregor, securis has worked to make us better prepared, the facilities in holly springs, north carolina is a promise and partnership between your company and the federal government. that is needed, we could flip a switch from the manufacturing of vaccines for flues to the manufacturing for pandemic flues. what are the lessons learned from this partnership, and how can we improve? >> thank you.

the lessons we have learned thus far, the partnership has been a good one since the beginning. what has happened in recent years is the commitment made, for which its predecessor companies have delivered, the funding has not kept up though the spread is going forward. even though the funding for pandemic flu was not part of the original legislation there was emergency funds provided for flu. the lesson we have learned since that time is as the funding has declined to a low level since 2009, you start to question the commitment. is aimes we feel there funding dedicated or earmarked for pandemic flu and suggest

seriousness as -- a into this particular threat going forward. communication is another lesson we have taken. between bardaion has been goody, but there is also opportunity for improvement. s&s.he way to the it is not bad. there is still room for improvement, harmonizing how it works across that spectrum. >> the jurisdictional lines were difficult. i hope my colleagues on this committee will remember this year's flu season, the severity of it, we don't know yet. as we get smarter at predicting

what the threat is going to be wes is a great example of are not smart enough to get it lookight, and we've got to at technology that allows us to address seasonal flu any way that encompasses all of the above options that might happen. they are known for their work to and hastechnologies been extremely successful advancing innovative approaches to medical countermeasures such as platform technology. what do you see is the biggest challenge? >> one example of what you mentioned is new innovative platform technologies.

this is cell-based technology. it is not more conventional egg-based. strong,raction has been allowing us to continue to advance the effectiveness of the technology, through the partnership efforts to improve the yields, not only benefits in a pandemic but in a seasonal setting as well. not onlyit will come in vaccines coming sooner to market but the other promise of technology as a platform, invested in by the government, that offers the potential for providing a better match as we are experiencing this year. innovation, it drastically

improves surveillance and sensual awareness capabilities to identify public health threats. and as timely a fashion as possible. this potential exists. the federal government lies behind in its ability to leverage these technologies. how can we improve? and as a side to that, do you believe we use enough open source information outside of the mechanisms we have set up domestically and internationally? that is a very good question. people happen working on that for a long time. there are many surveillance systems aimed at that goal. they are not all brought together under one roof.

it has been a goal to consolidate and bring those systems together. get more information out of the health care system to public health during emergencies. we have a lot of advances in electronic health records but for the most part they don't have any resources or analytics to see what is going on in health care records. if we could do more to bridge that divide, that is where the signals are going to come in outbreaks, from doctors and information,g that getting laboratory diagnostics, getting that information together. closing that divide and bringing , beener unusual surfaces able to trace back foods when food outbreaks arise.

itwe are better at a lot of than we were. >> much better. confident mechanisms are in place for that transmission of information. all we need is one breakdown. it does make one wonder. -- administer the day before. that gives us great clarity as far as the geographical location of something, all the way down to a nine digit zip code. it is all the above that we have got to do. >> thank you. i will start with you.

senator byrd talked about the flu this year. than 17,700 cases of the flu have been confirmed just in pennsylvania. 32 people, including one child have passed away because of that. while this is a particularly bad flu season it doesn't come close to what we would see on a larger scale, infections disease emergency or a pandemic flu scenario. our health care sector is at capacity with this. we are woefully unprepared to casualtyo a mass biological event. we begin to how can prepare hospitals for a mass casualty biological event?

as best we can. >> thank you for the question. i think, as has been said, fully funding to its prior levels would be hugely helpful. he made some important points in terms of the financial incentives of the current system. just in time for supplies and staffing. there is limited search capacity. we are seeing that now. tomorrow,ther call some of the challenges that are isthis is a flu season that more severe than we typically see. we don't know exactly what this will look like in comparison to others.

we are reporting more. many states are reporting child and pregnancy deaths. we have had several tragic preventable deaths. about thosele hear ofngs there is a perception greater severity. people frequently visit places like emergency room's. we had been messaging around, if you are ill, you may need to call your health care provider but you may not need to go to an emergency room. those things are part of what we deal with in a flu season where there is heightened awareness. in terms of assuring we are prepared, the amount of funding available through the hpp grant has been inadequate for some

time. as you pointed out, there is a need to bolster that. i don't think it takes a great deal more but earlier funding levels would be helpful. >> i would agree with everything going back tot the beginning of the hearing, the more we can develop flu vaccine technologies, modernization and rapid acceleration of the process being the goal, the less we will have sick people in hospitals. we need a strong health care system. there could be other facets of that program, like having more regional centers that could .houlder more responsibility we have a level one trauma , butr that works very well we don't have anything like that for infectious disease. units inbiocontainment

response to ebola. most of those can only take care of one or two or three patients at most. --might think about treating at most hospitals they will need to be able to take care of patients, they will need personal protective equipment, and relationships with public health agencies and surgery clinics were people are getting cared for. it is a network of care as opposed only relying on major hospitals. >> you mentioned -- the level , how doma center model you think we incentivize that in the context of what you referred to as specialized disaster

resource hospitals? later.come back >> the way you incentivize, you could have a competition for it. would have to provide resources. there is no give in the system. hospitals are running small margins. they are not going to be able to build large programs unless the government says we want you to do this and here is how. >> thank you. the national security agenda, global health security agenda. that was established in 2014. where is it house today? >> it is multiple agencies of government.

>> who is the quarterback for it? >> i think you would say usaid. ebola outbreak took of places that had containment areas, from a modest standpoint we were able nih and ae threat at couple of other places for those doctors who came back from liberia. -- how much oft that should be built in preparation to anticipate something like that happening again? every national leader in that program, they would say it would be difficult to take care of more than one or two patients in the current units. we need to get better cost

information. it would be difficult to scale .hose we could build more capacity, share the lessons that have been learned, see if we can spread that responsibility out a bit further. a strong -- small number of units can be cared for. >> capital and money is the secret. >> and training. >> you talked about a contingency fund. do you have any recommendations how much that ought to be? >> if you base contingency funding on what we have spent another infectious disease emergencies we typically have a billionmillion to dollars in response to h1n1, ebola, zika. a fund in that range, public health agencies have called for

$2 billion contingency funds. be providingwould a lot of acceleration. threatsse biological don't recognize boundaries, it is something the world has got to participate in together. >> absolutely. >> cdc is great at coordinating things like that. they did a great job on the ebola. would that be where the international agenda ought to coalesce? that has worked. it brings in different parts of government, including finance sides, security sides. it is bigger than that. that is the model they are trying to get other countries to represent as well.

plan. mcgregor, there is a in north carolina? how are we doing on that? do we still have enough? constantlybeen enhancing the capability and that plan. seasonalt a perspective, we more than tripled our capacity into the market this year. that plan is responsible in delivering one third of the requirement in the event of a pandemic in responding within six months. it is cell-based. >> what is the shelf life? >> the shelf life, five years. antigenately we do have that is older than that. from an egg and sell perspective.

that is the state of affairs. we also have the promise that it offers the potential of being a better match in the event of a mitch matt -- mismatched strain. the promise our company is trying to deliver on behalf of the government. >> thank you. >> thank you for your leadership on this issue, and to our panelists. good morning. i wanted to start with a question for you. as we know, puerto rico was devastated by hurricane maria. the island is still trying to rebuild. the effects of that disaster are obviously widespread. hospitals in new hampshire and around the country are dealing

medical equipment shortages because the storm devastated the manufacturers >> what can we do here in congress with this issue? yes i agree with you completely that the puerto rico hurricane and other storms have revealed how minimal our supplies are. one possibility is to consider whether there are some critical supplies. --e active but it's over

products or are missing goals, -- pharmaceuticals, it would need to be additional resources for an additional vision. -- mission. that would be one possibility. greatly springs is a example. when faced with a hand them at, ic actually became -- pandem we actually became visionary. we funded three quarters of the facility with a condition written and that at any point we could turn it into what is in the nations best interest. all three owners knew that and

participated. it may be a model that we look at and identify other things. we have shown a degree of vision in the past. >> i think the example of what happened really helps us focus on the next things we should be doing. , also wanted to ask all of you new hampshire uses its hospital funding to support a single coalitionhealth care to ensure that the health care preparedness is there. states,shire like other relies on this funding.

unfortunately, like many other states, new hampshire has seen a significant decrease in funding. we do not know when the next emergency will happen or what precisely will entail. we need to ensure that the coalition and new hampshire is training regularly. it is hard to do that when funding is dramatically reduced. from all of you, do you agree that we need to invest in hospital preparedness and it should continue to fund those efforts in all states? >> i would say absolutely yes. written testimony i talk about three cheers. -- tiers. people who do this every day, ,eople who are highly trained

people who have different duties on a day-to-day basis. one of our emergency coordinators in tennessee, is on the board of emergency services. tier, which is everybody else. thepublic health nurses, clinicians in the hospitals, the hospital nurses, the people who are called upon whenever there is a need. and exercising and actually responding, creating the relationships and the know-how, those are the critical things. those are relationships built on trust. you reducely, when that funding, that is one of the first things that goes. you try to preserve some of the things you invested in but the

more fundable assets are the very things that you need more of. i think you spoke to those very eloquently. >> in the interest of time, i will allow the other three panels anything you would agree or disagree to. isjust the point that it about people. the earlier question about how do we get the hospitals better prepared, they have to train. if you do not have trained people, your response will not be effective. that has been shown in many other industries including health care. with the focus on health care it is not just the hospitals that need to be trained, it is the entire community. as an emergency physician, after oxygen, the elixir of life and how we care for patients is

ailing. ing.ailling nothing more fundamental to our emergency response after oxygen than sailing -- salene. >> i will just submit for the doctor. a question about behavioral health needs especially for children in disasters. lastly, thank you for pointing importanceus of -- of focusing on special needs. >> senator smith. senator smith: thank you very much. you for your work on the focus of emergency preparedness.

2015, minnesota was hit by a flu outbreak. it ended up costing somewhere in the neighborhood of $1 billion. it was the largest and most expensive animal disease response in the history of this country. of course it hit poultry farmers incredibly hard. i was really relating to what you are talking about how the safety net is about people and not stuff. certainly, as we responded to this catastrophe, we needed stuff. we also, really needed the people and relationships that made our response work. an important part of it. in thiste interested one health approach and how we can build that kind of approach

into our taking about emergency preparedness. i know that senator young from indiana has raised this question just last week and has only been here for two weeks. of whethers question we need additional approaches or resource -- resources to do this. i would like to turn to the doctor and asked that you talk legislation to address this question. this one health approach. we be doing better there? >> i think you are absolutely right. there are strong connections between animal and human disease outbreaks. i do think that those principles will be found in federal

agencies. people think there is a lot of acceptance and believe in one health. you're also right in that it does not particularly house one program. there is athat national bio defense strategy that is now being written or completed by the white house. its purpose is to bring together animal health, plant health, and human health for bio defense. this is the first time the strategy has been written in that way. i think there has been a lot of coming together from agencies on this and it is improving animal surveillance systems. if you talk about her -- thetages in the workforce, animal and public work force are strapped. taking a look at those things, i'm not sure if those are in the scope or not but we do not have a lot of information coming from

our animal systems. it is not cross over into human health very easily. >> thank you. >> think you for that great question. point, asake this public health prevention, we think about vaccines not being pharmaceutical. we have to look at ourselves and think about how to primarily regret the flu from ever occurring in the human population. we do not want ebola in the human population. doing things around the animal sources are critical. the example that you gave with the influenza, we had to make sure we circled the workers and families because that is primary for vegan -- prevention of a influenza strain in the human population.

perspectiveential and from my perspective and from the associations prospective, we would all be very interested in that and be happy to be working with you in crafting how to bringically professionals, veterinarians, and the health world together to do a better job in keeping animal diseases into animal populations and not allow transfer into human beings. someone came in to congress if you years ago and said, we need money to teach people to properly prepare push me in africa. africa.eat in i think that would have been a pretty hard sell. when you consider all of the money that we spent on the ebola

been ak, it would have relatively small investment. >> they give a much. i look for to working -- t hank you very much. i might also just submit later and say that i'm interested in this question of how to respond to another epidemic suzy -- seriously affecting children. senator smith: that will be for a later time but i would very much appreciate your thoughts. >> thank you mr. chairman. i want to thank you for this committee is both a ranking member and chairman. agriculturethe committee held a heating --

hearing on safeguarding agriculture in the globalized world. dr. inglesby really hit the head with your comments. one of our witnesses was general richard myers, from kansas state university, home of the national bio and agricultural defense facility. we call it "nbad" for short. you can see why. in his testimony, general myers notes that because there were two homeland security presidential directives in 2004, one for people and one for animals. there seems not to be a strong focus on the executive level on crops and livestock. he suggested reasons why this is surprising and i will enter his full testimony to the record at this point if that is all right, mr. chairman. thank you. his reasonings are essentially every country that ever developed an offensive bio weapons program, including the u.s., crated weapons targeting

agriculture as well as people. i would just like to insert at this time that we have a lot of interest in this by former senators sam nunn and the old program on pandemic threats and also by tom ridge and joe lieberman with regards to agri-terrorism. i myself was in charge and it was called the emerging threats subcommittee. it's north and west of moscow. thereby seeing one of the secret cities that we are not allowed in now, but we were then because they needed the money. we were focusing on security, but in touring the area, i was really stunned with regards to vast warehouses of pathogens

that they were making ready with regards to attacking a country's food supply. we ran an exercise at that particular time. it was called crimson sky. it was a misnomer because you don't want to burn carcasses or anything like that. it was foot-in-mouth disease. by the time texas put a stop order from shipping cattle to oklahoma or oklahoma to texas so they don't ship cattle in to kansas and nebraska and north dakota and south dakota, we had an epidemic on our hands. we had to terminate thousands if not millions of cattle. all of our exports stopped. there was a run on grocery stores all throughout the country. people finally discovered their food did not come from grocery stores. it took us years to get back to

a situation where we could literally feed not only this country but a very troubled and hungry world. that was quite an experience for me. that is when we started on nbats. the general said first as i've indicated that every country that ever developed up by weapons program also targeted agriculture. almost every pandemic today is a disease that can spread from animals to people. among the bioterror threats that the homeland security has issued a material threat determination, all except for smallpox are zoonotic. meaning they can reach humans from animals. they could really devastate public threats as well. until its operational in the next four to five years, i regret that it's taking that long.

there is no u.s. laboratory for livestock research to be conducted on ebola. swine being the host animal for both. i would like to work with you and all of our colleagues on this reauthorization to be sure that we are preparing for these threats. i have 20 seconds to ask dr. inglesby if you would like to respond. leading the countermeasure enterprise, this is supposed to be where all the coordinating agencies, the department of defense, v.a., homeland security, along with all the first responders involved, to update our strategy and to implement our plan annually. from your perspective, are we doing the job? dr. inglesby: i think we have a lot more work to do in the realm of agriculture, food, and crop safety.

i completely agree with what you said about the importance of animal vaccines could the shortage of animal vaccines to protect herds against threats to the planet. i agree with what you said to the threat to agriculture. both animals and plants have been relatively neglected the last few years. how to organize that in the government -- i don't have a strong sense of how that should be organized. it's complicated in that usda is responsible for the promotion of food and the business of food. it perhaps could be difficult to have that protection of food in the same exact place. i've seen signs of life in those programs that i've not seen in the last 10 years. so perhaps the program is becoming much stronger. sen. roberts: secretary perdue and the office would run that. the construction of that is homeland security and they are responsible for any attack on the united states.

it's been very difficult to focus on this. some years back on this committee for which might distinguish friend is the chairman, we were able to determine what keeps you up at night. in the top 10 was an attack on our food supply. that is not the case today. talking with our cia director, mike pompeo, who happens to be from kansas. we are trying to reassess that threat and i think it's a very real one. i thank you all for your service and i'm over time. i yield back. thank you for your time. sen. burr: you did not disappoint me. i knew there was going to be a question somewhere in that dissertation. senator baldwin. sen. baldwin: this discussion today is important and timely and brought into focus the sobering fact that if experienced one health emergency every year in the five years that i've since serving on this

committee, from ebola to zika to the hurricanes this year. i was serving previously in the house of representatives during the 2009 h1n1 pandemic and also in 2004 when we saw a dangerous shortage of influenza vaccines due in part to our insufficient domestic production capabilities. we are also in the middle of a particularly severe and deadly seasonal flu year. so i wanted to focus specifically on our readiness for a pandemic flu outbreak. i am concerned with a lack of sustained and predictable funding for the pandemic vaccine stockpile. i'm committed to working with my colleagues to advance a specific authorization for pandemic flu activities.

i am concerned with the lack of sustained and predictable funding for the pandemic vaccine stockpile in it and i am committed to working with my colleagues to advance a specific authorization for pandemic flu activities. mr. macgregor, in your testimony, i was troubled that our pandemic flu stockpile does not match the current strains of influenza and is full of expired vaccine components due to underfunding. and, it is especially concerning as we have the h7n9 bird flu circulating in china that continues to evolve in ways that has the potential to trigger a global pandemic. are we adequately prepared for an outbreak of pandemic flu that could strike in the near term? how would a pandemic in the middle of this severe seasonal flu season complicate our vaccine readiness? >> thank you for the question, senator. i think at the start of your statement, you immediately gave part of what would be my answer.

i think your question and your comment about the stockpile as it exists today is a result of the underfunding that has occurred particularly since 2009. with the funds that were provided, kind of supplemental or emergency balances that were provided up to 2009 from 2005 that is from 2005-2009, it allowed for the building up of a stockpile of various pandemic strains. it was allowing us to test and to understand how to manufacture. this was a good partnership with barta and was fundamental to our preparation at that time. since then, the funding has really dropped off as you commented. that is really what's behind the point that i was making. there's product that sits in the stockpile today that was manufactured quite some time ago.

in some cases, seven or eight years ago. our ability and the ability of the government to replenish the stockpile whether it be with antigen or what's also in the stockpile has been diminished by the lack of sustainable funding to support its efforts. in answer to your question, because of that, i don't believe we sit in a great state of readiness today. you mentioned the h7n9 and we are working with barta, but we need sustainable funding going forward to enhance our readiness. sen. baldwin: this question is for you mr. mcgregor and dr. inglesby. my home state of wisconsin has long been a leader in medical innovations that help grow our economy. not only are we home to a world renowned flu scientist working to develop a universal vaccine, but we are also the hub for biomedical companies producing new technologies. stratatech, a company in madison, wisconsin is producing a new regenerative skin technology to treat severe burns

through a contract with barta to develop tissue as a medical counter measure. instead of painful skin graphs, they are designing tissue designed to mimic skin. and promote tissue regeneration. dr. inglesby and mr. mcgregor, can you discuss why it is important to maintain our federal investment and medical countermeasure research and development to foster innovation the keeps pace with the evolving and increasing chemical and biological threats? why don't we start with you, dr. inglesby? dr. inglesby: sure. i think the reason it is so important to continue investment is to cut the problems like the one you described for patients with burns, for pandemic influenza, further cuts of outbreaks. there is not necessarily a commercial market for this kind of products. so companies face a great deal

of challenges planning. they face a very difficult challenge in planning and a lot of uncertainty. if the government can provide more clarity both in the early phases and the research and the developer face, particularly the acquisition phase, companies can decide to make investments in this space as opposed to other they face a very difficult commercially valuable opportunities they might pursue otherwise. i think it will continue to be a very important role for the government to play for products that we want that are otherwise not produced by the commercial markets. >> i would certainly echo that comment. it's a mechanism that needs to exist to have innovative companies like the one you mentioned and the alliance for bio security to be able to continue innovating in the space. there needs to be sustainable funding in the space. the last comment i would make is just to add that it's interesting to hear from a number of colleagues in the

space that when you look at institutional investors and the like, where there used to be more of an attraction for them, when the funding was more certain, that attraction has gone away at little to no value placed on mcm work on the current context because of the lack of sustainable funding. institutional investors and the sen. burr: sen. cassidy. sen. cassidy: i enjoyed your testimony, all of you. i enjoyed it so much because you agree with me. one of you spoke about the need to have professionals, health care professionals, be able to go across lines and have liability protection. i was a practicing physician when katrina hit. there was an orthopod at the airport. the fema would not allow people to set some of these broken bones because he was out of state and they were concerned about liability. i think we need a good

samaritan. if you are from out of state and you're in good standing with your state, you get blanket protection. i think we need that on a federal level as opposed to the patchwork. i will say that and i have introduced a bill with dr. king that would do so. secondly, you spoke to the need to have a public health emergency fund. senator schatz and i have for do something such as that. just as fema has dollars that does not need special appropriations but when emergency it's the dollars are appropriated and it cannot be encumbered and put in escrow by another effort. those dollars are there. still have accountability where you have to come back to congress and get approval. gao will make sure they do it. we also take care of contracting because the previous cdc director's said you had to get 10 sign offs on travel vouchers

for people to get over to africa and that slowed the response. he had to contract with ngos to contract to get transportation for people and goods. we are trying to circumvent that and we put something together in regards to that. let me hit on stuff that's perhaps more provocative. you speak about the need to maintain this international network. theoretically the world health is doing that. i'm not sure we are getting a bang for our buck with world health. if we are funding internationally world health and the cdc is doing it separately, that does not seem in a time of scarce resources a wise use of resources. thoughts? dr. inglesby: the world health organization has some of the best experts in the world on

diseases around the world and they are the normative agency for setting policy and guidance around the world. they are not a strong operational agency. they don't have resources for going to train the world or build labs around the world. they have some money for that, but their budget is constrained as well. sen. cassidy: if they have the money, would they be capable of doing it? dr. inglesby: not right now. sen. cassidy: we are having to supplant international organization with the centers of disease control. it almost seems like we're compensating for something which should have the responsible the already. dr. inglesby: the cdc and 65 other countries are all contributing in some way, some with a lot of money and somewhat their experts, but the global health security agenda was a way of getting a large consortium of countries to go out and help. sen. cassidy: it seems like world health should be doing that.

quirks it was a way of getting a large amount of countries. quirks >> you mentioned having regional areas of expertise. let me go back to my formative experience with hurricane katrina area when the fecal matter hit the fan, was overwhelmed with anything. when i went to haiti as a private citizen after the earthquake there, i was struck that the israelis came in and plopped down a hospital, and unfolded it in every capability they need was there in a field hospital. since a public health emergency could happen in baton rouge, shreveport, or topeka, or you name it, how does every region have that kind of expertise as opposed to a public health hospital that may set up at your local v.a., which is a government health facility? boom, we've commandeered, we're taking it over. it seems like a better way to respond because you truly have

expertise that is deployable in a moment. any thoughts about that? dr. inglesby: we should be able to rely on the local institutions. the v.a. is a great source of strength in some cities. the national demand -- disaster center the dmat teams, some of , the teams that responded to katrina -- let's go back to ebola. which was specialized. you have to take off your booties in the correct fashion or else you were exposed. as happened to the nurse in dallas. dr. inglesby: the u.s. was not prepared to send doctors and nurses to ebola. they did not take care of patients. sen. cassidy: would it be better to have that sort of expertise that truly could go to a community and boom, we are going to be the expeditionary force? the health care expeditionary force that is going to be able to manage this and we don't have to have a lot of an service people are hitting the door right now. we will give you in-service, but we will provide direct care, so

whether it's baton rouge or topeka or new york, we know we have expertise deployed. dr. inglesby: yeah, i do think that would be valuable. we do have something like that on a smaller scale called dmat teams. sen. cassidy: they are more generic. dr. inglesby: we do not have infectious disease oriented like the one you're talking about. it would be good for us to be able to build those teams. sen. cassidy: i yield back. sen. burr: i would like the record to show that north carolina tried to deliver to louisiana after katrina and affordable hospital. it was the governor who would not sign the liability agreement that put that hospital in mississippi. so we have this incredible surge capacity i'm learning about. it's just that we have hurdles in the way that stop it dead in its tracks if it never stops the motion of collectively addressing the problem. so these are things we can work

out. sen. cassidy: we in louisiana continue to be indebted to other dmats around the nation. they so generously deployed. i cannot tell you the gratitude that we feel. sen. burr: senator kaine. sen. kaine: want to ask each of you to address a workforce question. so, the observation is this. when we reached a deal yesterday so the government would open, there were really two components to the deal. one, a guarantee of a debate and vote on permanent protection for dreamers which is very important, but the second half of that was we have to get out of resolution continuance mania and get back to the role budgeting again to find that these priorities and others. one of the questions we are grappling with is the question of budgetary caps because of votes of earlier congresses that would impose such caps. when the caps were imposed, they were imposed equally on defense and nondefense. all of your testimony and the

testimony of the panel last week is about national security. this is national security. i just came from a closed hearing about america's nuclear posture in the armed services committee, but you are national security, too. one of the proposals floating around is that we would increase caps on defense accounts, but not on the nondefense accounts. you guys are nondefense so your national security, but you are not defense. the lynchburg, virginia, economy is based pretty heavily on companies that build nuclear reactors that go into carriers and subs. those are under the control of the department of energy not dod. that is a nondefense expenditure. point that i'm making is that as we grapple with these caps, it would be foolish to not raise caps. if we are not raising caps appropriately to fund emergency response or we are not raising caps appropriately to fund the dod programs to build the programs, we are not taking care

of our national security. that's my observation. second, workforce. the quote in your testimony written and verbal is about people. it is about people, and one of the things i love about this committee is that it is health, education, labor. in the education jurisdiction, we are approaching rewriting the higher education act with programs like loan forgiveness. this is on the education side. you all approach your jobs from different backgrounds and expertise, but share any concerns you have about the current public health workforce in this country as you look forward because we might be able to do something about that. we might be able to do some things about that as we grapple with the higher education act

rewrite. if you want to start, dr. krug? dr. krug: thank you for the great question. as has already been said, this is a lot about people. we do need more stuff, but we do need more people. the budget environment today constraints the number of people that you can employ, which is why there's this just-in-time thing going on in health care, which is why we don't have a lot of capacity. in the end, there are not enough nurses to staff all the hospitals or all the clinics. some of those limitations are greater in certain communities than others. i will defer to my public health colleague, but i believe there is a public health issue as well. what we need to do through education and some incentives is direct more of our future young people toward these important careers because these are careers where in addition to taking home a paycheck, you are making a difference. you are serving the community. you are serving the public. you may not be a special government employee, but you're

still making a difference. i think if we can redirect the flow, we will be better prepared to deal with a calamity. sen. kaine: others who would like to address it? mr. macgregor: i will go down the line quickly. my main response to this would be some of the strain that comes on public health is referenced by my colleagues up here is the need to respond to an emergency. i feel a big part of the reauthorization discussion -- the notion of sustainable funding really has as its core the avoidance to respond to an emergency that puts an undue strain on the public health system. it's a bit drifted from your question about workforce, but i wanted to make that particular point because it gets to the sustainability question. sen. kaine: thank you. dr. dreyzehner: thank you, senator. a very important question as mr. mcgregor said in his comments about medical countermeasures

and the uncertainty around having a market for those. dr. krug mentioned folks who are engaged in this area are highly committed, compassionate people, but they need certainty in the profession being there tomorrow. that has not been the case for the last 15 years. there's been a lot of questions raised about will the area that i devoted my life to, and really called upon after 9/11 and anthrax when we developed are more modern and responsive higher capacity public health and preparedness infrastructure, but those are festivals have evolved around that. many of them are now becoming senior. many are retiring and making decision as to whether they want to enter the field. will there be a profession for

me if i decide to enter the field or to stay in it? all those things are really important. sustaining and maintaining funding is a very important. not pulling at the last minute to redirect it to some other priority is really important. you referenced that briefly. i absolutely think your points are really important. i think the threat to the public health workforce is that they will decide to go do something else and possibly they will retrain and childcare where there's a little more stability. they have other options, but they like these jobs. these are good jobs, they are important jobs in areas where they exist, both rural and urban environments. i think the national security would be well served to recognize the passion of these professionals and the relationships they built in the lives and property they have saved in the last 15 years since this regime were reauthorized.

sen. kaine: might i ask dr. inglesby to respond briefly? dr. inglesby: the public health emergency preparedness program that supports so much of the public health workforce has come down pretty substantially since the start. thousands of jobs have been eliminated in public health since we began this effort back after 9/11. i think there's great excitement in the field. young people want to work on these issues in medicine, nursing, and public health. beliefs goes with substantial loans. they leave with substantial loans. there are some loan forgiveness programs that need to be attended to to draw people in to the field. people will come to these jobs if there is a field there. a lot of this money comes from the federal government and supports jobs directly. continuing these programs would help ensure that we have a workforce. sen. kaine: thank you for that. sen. burr: senator young. sen. young: thank you for a series of hearings on a very important topic, public health

threats. i would like to turn to the topic of insurance for pandemics. i will be asking a question of each of you related to this topic, but by way of background, and our last hearing, we heard from admiral red from the centers of disease control prevention. he said the strategy to prevent diseases that spread from animals to people such as ebola and avian influenza is a reactive strategy. are there any strategies that might take this from a reactive stance to use a modern term proactive one? i found that last year the world bank launched the first pandemic bond to quickly finance public health emergencies. you may be familiar with this. financing emergencies like pandemic influenza strains,

something called coronaviruses, viruses like ebola, and others. according to the world bank, their pandemic emergency financing facility would provide over $500 million in coverage of pandemics in the next five years. my question to you is do you think congress should experiment in the creation of similar financing structures like the pandemic emergency financing facility or some other type of insurance mechanism to protect against pandemics? regardless of your thoughts on that, if there are other proactive strategies, do you think we should turn to first? if you could volunteer that, i would appreciate it. we will start with dr. inglesby please. dr. inglesby: i've not studied enough whether that would be some value to do in the united states. i've not heard that before so i can get back to you with thoughts on that.

one alternative that is less complicated that we talked about already would be to establish a contingency fund that would only be used in the event of emergencies declared by other congress with the secretary of health. we would have a fund ready to go kind of like an insurance policy. it would be a fund available for rapid response. sen. young: i've done work like this, new financing mechanisms from health care to social policy, so i respectfully am of the opinion that this would not be all that complicated. it would be a way to capitalize a fund like those invoked earlier.

thank you very much, doctor. dr. krug: i'm not sure i know what insurance means anymore. funding back to the prior levels is insurance to make sure the people that need to be there when the balloon goes up are there and able to do what they do. i think the contingency funds could be a very important piece of ensuring that the unknown unknowns are insured against. dr. dreyzehner: and they will certainly occur. i will just echo what dr. inglesby said. our best insurance is making sure we have adequate people and relationships and networks and experts available at a moments notice to respond. sen. young: thank you. mr. macgregor? mr. macgregor: i would add as well that if mechanisms such as these in the event of protecting a pandemic wants it has hit, i might be inclined toward financing mechanisms that might allow us to be more prepared in advance and not having to deal with the tragic aftermath. and maybe just maybe what the

world bank is proposing is something that could be more of a global kind of effort that cannot only benefit the u.s. but benefit other countries as well. by benefiting other countries, it actually contributes to the preparedness we can have here. sen. young: thank you. dr. krug: it's good to be last. i agree with all the comments made by my colleagues. i would offer to hopefully help full perspectives. -- i would offer to hopefully helpful perspectives. if we can mitigate the problem and avoid the disease, that would solve a lot of problems. that gets back to a proactive vaccinations and help globally and other local level looking at those vectors and prevent early on those diseases before they spread.

in the end, it's pretty clear to me -- and i know you guys get this -- that there's not enough money to go around to make this all work. we have all told you we need to improve funding for the core elements of the process because if you want to do it for less, that's what you're going to get. your going to get less and that is what we are seeing -- you are going to get less and that is what we are seeing today. is long overdue for a discussion with the public about the threats that we face, the reality of our resources, and how we can collectively make a difference. i think most americans share some common values and i think our collective survival and making america stronger is something that most people would want to do. in the end, there's not enough resources when the cavalry arrives, whether it's the state, local, or federal government to meet the needs of everybody in a town or city or whatnot. if citizens were better prepared and we began a discussion about the values and the culture with personal readiness and with a

strong helping the week, helping your neighbor, make a show that's ok, then we would not have to sort of rescue everybody. maybe we would be rescuing fewer and in doing so -- because there will be citizens who can't do that for a variety of important reasons. if we get back to the culture that i think i grew up with in grade school where that seemed to be a value, i think that would help us both with this and probably with some other issues >> a public health emergency

hits, you do not get news alerts on your phone about the years of in to makingt went the response of the disaster actually work when everything was on the line. training,runs and the dry runs and the training, we have to be ready when i emergency strikes. -- at emergency strikes. that seems for anthrax and influenza products to protect us from radiation exposure, next generation antibiotics.

two senators referred to this earlier. i want to dig in a little bit about this program, to accelerate medical countermeasures by investing in biomedical research. you are an expert on bio security. funding is usually received from private investors. why did medical countermeasures -- needic investment public investment? >> the products we are trying to , they don'tdemics have a commercial market. even in the event of a pandemic, it is difficult for people to access those funds without the help of government.

we need those companies to get them to do this work. >> when this project was billion it got 5.6 dollars in guaranteed funding over 10 years. it was called an advance appropriation. congress said it was going to spend that every -- amount of money but didn't come back every tor during that 10-year time decide whether they would put the money in as promised. d had to get its funding sent -- set aside. you work in the bio security field at a company that makes flu that seems. -- vaccines. level for thison project has stayed exactly the same since 2013?

>> yes. >> authorization stays the same. ,ut appropriations levels didn't congress actually get that money out the door? about 1.5 did -- $1.5 billion was actually appropriated. what does that mean for areanies like yours that trying to make decisions about researching and developing these kind of countermeasures? thealled into question what commitment is. it is very difficult for companies to do long-term forecasts.d

during the initial era, there was a lot of private investment in companies that were in that space. i have heard from a number of that investment has dried up. there was little value the market puts in the space. it's aare telling me market that only works if the federal government makes the investment? and the appropriations process is not working in this field. that is what i am hearing. keeping our nation's safe from these kinds of threats is one of the most important investments we can make. you can't make up ground overnight on this.

we have to be in this for the long haul. that we can discuss the importance of providing robust, researchersng to working to help us avert the next public health emergency. >> thank you, senator warren. i have written more .etters to appropriators there was a lack of request -- as esenator casey and i have found -- as senator casey and i have found than what the

presidential budget request was and there was a steady decline. this committee has always said that we have to appropriate at the authorization levels. the toughest thing to recognize how to create something there is not a commercial market for. and i will say though hiding in the back of the room is one of the authors who now works as she has been feverishly writing notes so everything you said is going to find its way back.

when this was originally designed, trying to find somebody to be the spokesperson for disaster, we had to create a new position called emergency secretary of emergency preparedness because nobody wanted to raise their hand and be in charge. this is something this committee has got to be absolutely vigilant on from a standpoint of what the needs are because i would say mr. macgregor is a great example. if this dries up, who wants to be in the vaccine space? the same reason we have a shortage of antibiotics today. who wants to be in the antibiotics space? it's millions and millions of

dollars of development. dr. krug, identifying emergent public health threats is important to treat and mitigate its effects. one of these tools is the diagnostic test. in the midst of combating ebola and zika, determining individuals in need of treatment help to inform providers and those on the front lines of the outbreak.

how do rapid point of care diagnostics work to better inform for these public emergencies? dr. krug: they help immeasurably. imagine for a moment that you are in a scenario with multiple sick victims. as one of my colleagues pointed out, your ebola treatment center can take care of at most three patients. which of these three patients will you admit to the ebola treatment unit? with the older technology we we were not operating ating peak capacity. by treating someone who might not actually have the disease prevents someone out -- eosomeoe else from getting that icu bed. in the hospital setting and in

the field, these diagnostics are important. resources are more limited in the field. the fundamental decisions made in that setting are vital. mentioned ebola. enough in the ebola crisis to understand our limitations but have done nothing about our capacity to understand what happens tomorrow." is that correct? we haven't changed resources that are available for the mission. learned enough to know to look atpacity

infectious diseases of that magnitude. back to you from a pediatric standpoint. there have been a number of news reports i don't know the accuracy of suggesting young amaflu have had hallucinations. makehallenging does that the avenue to try and expand these new treatments to the pediatrics of population? that is,s to that -- you've hit the nail on the head. the bigger issue is with vaccinations. with the exception of maybe a glass of water, there will be

side effects associated with potentially anything you give to a patient. whether you use something or not and that by evidence, risk-benefit ratio of positive effects versus side effects. media,in part to social everything that occurs that maybe didn't occur the way it should have been reports of adults having hallucinations flu, they make their way to places so the average family i care for that has a smartphone already knows about this. when i tried to of eyes that their child -- advise that their something recommended by the american academy of pediatrics, they say, this will heads. child have four

the likelihood of that having the of disease, is more likely than the four heads. there are other specialty societies as well. with theof sparkling -- part three the cbc -- cdc, --ng witht he with the cdc, there is information out there that says tamaflu is probably a good idea. tothe challenging thing is increase pediatric indications. you have to have children willing to join clinical trials. --t means a peer at the link

parent willing to allow a child to do that. when you take someone is equally different -- physically >> my hope is that there is an and get your electric indications is a normal process in the future. >> it should be part of the process. there are ethical concerns when ,ou are going to enroll a child concerns you have to address, or substantially greater than adults, so again, we calling this other half that we have, a very interesting discussion about -- we don't know if it is more to work, should we try and test the anthrax vaccine in children before it can anthrax event occurs? this is when anthrax was high on the radar screen, and in the end, we deferred to the

presidential commission on bioethics, which came to the conclusion that it probably was not ethical to do that. dilemma, and again, it is an industry where to start convince where there is the market, the market is even smaller for kids and is a risk for the industry to do for kids, it is the especially greater. it is a study he'll -- hell to climb. i think countermeasures are different things to develop. studies are not in some countermeasures that the a finally in 2015 set the way forward. my question is this, what are the challenges and successfully bringing forward a medical countermeasure by relying on the animal world as the pathway?

is a different approach than we are accustomed to. you are reliant on the data that it is beneficial in the sense that it allows us to bring medical countermeasures forward. in that regard, it is good. forward, as and it is straight, we're doing it, so it is a good step forward. >> is a chairman, take you very much. i want to continue the topic of children. we're almost out of time here, but dr. krug, in your last reauthorization we put in place new national advisory committee on children and disasters. and we appreciate your work and

your testimony today. the only question i have for you is what are the areas of our preparedness planning that you see the greatest need for more attention to the needs of children? i know you answered different parts of this, but maybe at least trying to wrap up would be there. arguably, in all facets. progressade tremendous , and the advisory committee has contributed in that direction. from a health care perspective, and that is a narrow perspective, because the whole process is bigger than health care. the health care industry is primarily to together to take care of somebody like me. child,y who is not a someone with underlying medical problems towards the end of their life -- i hope not. the point is, with the exception of the facilities, and there is a smaller number that specialize in kids, the rest of the system

does not. there is nothing wrong with it, that is not how it works on a day-to-day basis. -- we can build specialty centers, but every community, every institution, every clinic, that is what carries be provided. need to take care of all comers, and that includes kids. current operations, if you have a sick child, you put him in an ambulance, and he sent him to a children's hospital, and that isn't going to work. it has been disabled by the event or the nature of the disaster does not permit transportation or everything is fine, but they fall -- they are full to the gills. so, the challenge we have is everybody -- the good thing is everybody has a liking for kids. we have got to get everybody better prepared to take care of kids. one of the most important ways to get there through training. drilling, training would make us better in caring for all populations and certainly for children.

sen. casey: thank you very much. sen. burr: thank you to our witnesses. i want to highlight once again, 24 years i've done a lot of hearings. i've found it almost impossible to have an agency witness at the table who testified and the private panel come up second and get an agency person to stay in the room and listen to the private sector. this might be the first time i have looked at whim not had a government witness, but we have had agency folks who have attended to hear what the members in the private sector say about the reauthorization of the program. that is unusual. i hope it is a trend that is going to become the norm and not the exception, and i said that as a message to go back as i think your testimony is not only valuable to us, it is valuable to the agencies that are affected by the issues that you are here to talk about so i want you to know today, they got heard not just by us but by the agency itself.

i thank all four of you for your willingness to be here for the insight you provided today. this hearing is adjourned. [gavel pound]

[captions copyright national cable satellite corp. 2017] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] >> a bipartisan group will talk about poor security and dakar,

the program that allows undocumented immigrants who came to the u.s. as children to remain in the country. senate majority told reporters that the meeting was put together by gop senators susan collins and lindsay gray ham. senator dick durbin come at number two senate in the democrat was also expected to take heart. tomorrow, former secretary of state henry kissinger and george george socha, and richard armitage testified before the senate arms committee on u.s. national security strategy. live coverage starting at 10 a.m. eastern on c-span. c-span's washington journal live every day with news and policy issues that impact you. coming up thursday morning, the associated press will discuss the latest on the molar and messages between senior fbi agents and an fbi attorney. and then a look at the trump administration plan to allow

offshore trolling on coastal waters. and we are live in columbia for the next stop on the capitals bryant willn discuss keep public policy issues in the state. be sure to watch washington journal live at 7:00 eastern thursday morning. join the discussion. >> where are you from? >> i would describe it as a bizarre moment. he is the president of the united states, and you are in the oval office, and he says, who are you? come over here. a,sunday night on two and former our te washington correspondent katrina perry talks about covering president trump and his supporters for the irish media during the 20

presidential election season. america"ook, "in this provocative, and you know immediately what he is talking about. that notion that d.c. was built on a swamp, and taking these horrible people and replacing them with better people, and that is something that voters believed him or not -- whether they believed him to fulfill that are not, they were prepared to take them to the test. governor delivered his final state of the state address at the stake up until -- state in boise, idaho. he called for investments in k-12 education as well as higher education is just under one hour.