we thank those who serve our nation today. with that, thank you again, gentlemen. this concludes today's hearing. this subcommittee stands adjourned. [captions copyright national cable satellite corp. 2020] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] announcer: u.s. defense secretary lloyd austin, for shinning up his testimony on his department's budget request for next year. if you missed anything he had to say, we will show it to you again beginning at 8:00 p.m. eastern on our companion network, c-span2. announcer: the director of the centers for disease control and prevention, dr. walensky, outlined the president's 2022 budget request and the agency's response to the pandemic before a house appropriations subcommittee. the hearing also included testimony from the cdc principal to be director. this is 2.5 hours. >> this hearing will come to order. as this hearing is fully

virtual, we must address a few housekeeping matters. members are responsible for muting and on muting themselves. if i notice you have not unmuted yourself, i will ask you to. if you indicate approval by nodding, staff will unmute your microphone. the five-minute clock still applies. if there's a technology issue, we will move to the next member until the issue is resolved. if you will retain the balance of your time. you will notice the clock on your screen that will show how much time is remaining. at one minute remaining, the clock will turn yellow. at 30 seconds remaining, i will gently tap the gavel to remind members that their time is almost expired. when the time has expired, the clock will turn red and i will be ligon to recognize the next

member. in terms of the speaking order, we will begin with the chair and ranking member. then members present at the time the hearing is called to order. you will be recognized in order of seniority. finally, members not present at the time of the hearing is called to order. hospitals require me to remind you that -- house rules required -- house rules require me to remind you that we have an email for anything you wish to submit in writing. that email has been provided in advance to your staff. with that, i want to acknowledge the ranking member today. i also want to thank all of our colleagues for joining. i am pleased to have the cdc leadership back before this subcommittee to discuss the current state of the pandemic

and our nation's response and the president's budget request for fiscal year 2022 for the cdc. on february 23, this subcommittee held a roundtable session with cdc focus on the covid-19 response, and a day later, we held a hearing focused on public health infrastructure. since the roundtable and hearing in february, our nation's response to covid-19 has made significant advances. vaccines are now widely available. one vaccine is now approved for those aged 12 and above. nearly 300 million vaccine doses have been administered, including nearly 4 million in my home state of connecticut. last week we heard from the yale new haven health system that they are treating a staggeringly small number of covid patients. this is a tremendous accomplishment. our public health workers are

finally able to sleep again. our families are finally breathing a sigh of relief, and our workforce and economy are beginning to rebound. but the messages from the public health infrastructure hearing in february were clear. covid-19 exposed numerous realities in our nation, including that the public health infrastructure is fragile. many health departments are still using fax machines or doing data entry by hand. information about patients' names are not being shared across departments. health workers are leaving the field in droves while others need workforce development. research labs are struggling to find the equipment, capacity, and trained workforce they need. now communities are realizing public health partners are essential not only for infectious diseases, but for health promotion and protection to keep communities healthy and

functional. our public health system can no longer only get attention during a crisis. we must invest in the public health workforce, laboratories, and data modernization, not just as a response to the pandemic, but every year. after the pandemic, public health agencies cannot go back to where they work. we need to meet this moment and build public health architecture to move our public health partners and workforce forward. today's hearing is the next step turning those recommendations into action. while we will not receive the details of the president's budget until later this week, we know from the blueprint the administration is requesting $8.7 billion, an increase of $1.6 billion over 2021. the administration has described this request as the largest increase in budget authority for

the cdc in nearly two decades. while this is a welcome increase , in general we need to consider increasing investment for the cdc not just this year, but every year. one time investments do not insure the cdc and our public health departments are ready to address chronic challenges. we need to ensure our public health infrastructure is ready to address the challenges or pandemics of the future. this pandemic has only further underscored the need to view public health infrastructure as a fundamental service, not just something we fund when the need arises. the tide has turned. we need to provide funding to address core public health activities. i look forward to receiving detailed requests for cdc. the programs highlighted to receive increases in the summary are very welcome. maternal mortality prevention.

mortality prevention research. climate and health. social determinants of health. and the establishment of a community based violence intervention program. in terms of gun violence research, i am interested in getting a progress report. it may be too early, but i hope you can let us know more about the status of gun violence research. in terms of maternal mortality prevention, i am pleased to see increased investments and research on maternal health to address the crisis of maternal mortality in the u.s. we need to make this a nationwide effort. not one more mother should die just for participating in the miracle of birth. we need increased funding on research to reduce racial disparities in maternal health outcomes, and improving mental

health is crucial. two weeks ago the cdc made a significant update to its guidance that fully vaccinated people no longer need to wear a mask or physically distance in most situations. dr. walensky committed to leading the cdc with science and i know we will have a lot of questions about the current evidence that led to this updated guidance and the subsequent guidance we are waiting to be updated by cdc. many people i have spoken to are uncomfortable with this change and are not confident being around people who are unmasked as safe. there is uncertainty about the nuances that may be implied in such guidance. throughout this pandemic, cdc has been in the unenviable position of making black-and-white recommendations in a world of gray areas, so i think it will be helpful to drill down on what this guidance

means and how we can restore public confidence in such guidelines. that's why i look forward to today's discussion. let me turn to congressman harris for any opening remarks he may have. rep. harris: thank you and good morning. before i begin, i want to recognize the outstanding work and careers of doctors anne schuchat and -- i want to thank both of these remarkable scientists for their public service, dedication, and commitment to public health, especially during the pandemic. you will both be missed. just over 14 months since the pandemic began, it is finally winding down in america. it is worth recognizing the stunning success that rapidly bringing a vaccine to market has had on the trajectory of this

disease in america. the covid-19 vaccines were the most quickly developed in history, thanks to the skills of researchers at moderna and pfizer and operation warp speed under the previous administration. operation warp speed set our country up for the outstanding results of current vaccination efforts. it has been a pleasure for me to help get marylanders vaccinated and i continue to encourage everyone to get vaccinated as soon as they can. the vaccines are relatively safe and effective and are enabling us to resume our normal lives quickly. i was glad the cdc began to follow science and recognize vaccinated individuals can safely resume activities. studies have shown for months that vaccines are effective and outdoor transmission is almost nonexistent. i question why the cdc resisted making these statements for so long, why many schools continue to be closed, why the mask

mandate continues in the house of representatives, and why children at outdoor camps need to wear masks. one wonders whether pressure from teachers unions and the need to distract from other difficulties, such as inflation, gasoline prices, and conflict in the middle east, have influenced public health guidance on schools. i hope this is not the case, but the timing and information about the influence teachers unions have on cdc guidance are troubling. a key part of the transition to normalcy will rely on fully reopening schools. 50 million americans have children school age or younger. for many of these, schools are the primary form of childcare. it is imperative all schools fully reopen immediately, not only so parents are not forced to choose between working and caring for their children, but so the children can continue learning in the best environment. children with disabilities and

without as many resources at home have been robbed of a year of academic, social, and emotional growth. the science is clear. we need to bring children back into the classroom now. these are important issues to discuss and i'm sure there will be questions about them. let me touch on the fy 2022 budget request before i conclude. the request contains the largest budget authority increase for the cdc in nearly 20 years. you are asking for funding to enhance state and local public health infrastructure as well as build international capacity to detect and respond to global biological threats. i support many of these efforts. i especially support the focus on reducing maternal mortality and morbidity. i question the magnitude of these increases in a single year, especially overlaid on the billions of dollars provided in

emergency covid relief bills last year. i question whether some of the funding items highlighted are outside cdc's core mission. the budget real request double the amount of funding for firearm prevention research. you are asking for $110 million for cdc's climate and health program, a 1000% increase, to identify potential health effects associated with climate change and implement health adaptation plans. are these activities in the same priority as combating covid or other chronic diseases that threaten vulnerable populations, like reducing antibody resistance? i would argue they are not and we should focus resources on communicable and chronic diseases rather than controversial, politically charged activities. i look forward to the hearing and i yield back the balance of my time. rep. delauro: i would like to again welcome and introduce our

witnesses. dr. rochelle walensky, director, centers for disease control and prevention, good morning and welcome. many thanks for the outstanding work you have been doing using science as your guide, particularly with regard to covid and the manner in which we should proceed. we are grateful for that guidance and returning the cdc to its former path in being drivers of science and leading the cdc and not politics engage in the direction we take a pandemic or any other illness. dr. anjo cap, principal -- dr. and show chat -- dr. anne

schucat, principal deputy director of the centers for disease control and prevention. you recently announced plans to retire after 30 years. i thank you for your public service. many times, whether it was ebola or lead poisoning of children in michigan and other areas, you have a stellar career, and we are delighted to have you before this subcommittee. dr. walensky, you full written testimony will be included in the record. you are recognized for five minutes for your opening statement. dr. walensky: good morning. thank you for your support of cdc. i am here with dr. anne schuchat, the cdc's principal deputy director. i have enormous respect for her leadership over three decades as

well as during this challenging time for this country and for her rocksolid support of me and my transition into this role. anne embodies the epitome of scientific and intellectual standards and has given her heart to our agency and the public health community. i will be forever grateful i had the opportunity to work with anne. the covid-19 pandemic threw the united states and the world into an economic and humanitarian crisis. as the crisis unfolded, it put a spotlight on the fragility of our public health infrastructure. it eliminated disparities in -- it illuminated disparities in racial outcomes, revealing we have failed to eliminate the racism that results in poor health outcomes for people of color. i am committed to working with the administration and public health partners to ensure every

lesson from this crisis is used to build a better, stronger, healthier america. i also commit to using public health expertise and experience in partnership with the public health community to move the world into a safer, healthier future. cdc's fiscal 2022 year request is an increase of $1.6 billion oval fiscal year 2021, the largest increase cdc has received in nearly 20 years. the increases focus on four areas -- building public health infrastructure, reducing health disparities, using public health approaches to reduce violence, and defeating diseases and epidemics. these increases build on investments made in the covid-19 supplement and are an important first step. covid-19 not only exposed the vulnerability within the united

states public health infrastructure, but also how underlying chronic conditions and lack of access to health care put too many americans at risk. across the globe, we see billions of people without access to vaccines and medical care, which means sars-cov-2, its variants, and other infectious disease threats, will continue. experts have warned for years that a pandemic of this scale was calming and we must expect additional diseases to emerge. we need to ask ourselves, are we ready? we must have a strong infrastructure that can identify and detect outbreaks at their source and take action before they take hold. the united states has faced four significant emerging disease threats, the h1n1 influenza, ebola, z got -- zika, and now

covid-19. we are also confronting a drug overdose epidemic. the increased deaths continued in 2020 and appears to have accelerated during the pandemic. these experiences show public health emergencies are here to stay. each of these threats demanded a rapid and unique response, but none resulted in the sustained improvements we need. long-term investments in public health infrastructure, flexible infrastructure will save lives and avert economic losses caused by public health emergencies and chronic public health problems. the fiscal year 2022 request makes initial investments to continue public health modernization, build the public health workforce, enhance public

health security, and strengthen immunization infrastructure. we are requesting funds to help states and communities be climate ready and prepared to confront new health risks, such as those associated with vectorborne diseases. the request makes investments in programs that improve health equity, such as the maternal mortality review committee. with these resources, cdc will expand resources to address social determinants of health. increases will address public health problems exacerbated by the pandemic, such as opioids, injury and violence, hiv and sexually transmitted infections. we are grateful for your support and look forward to working together to build a sustainable, resilient public health system that can respond effectively to emerging threats and meet the public health needs of every american.

we will work tirelessly to ensure the health of this nation and the world. thank you. we look forward to your questions. rep. delauro: thank you very much. spoke about the work -- you spoke about the work done by cdc with the vaccine. yesterday -- it is remarkable the achievements you have made are possible with targeted investments in covid research. but also by annual and sustained investments in biomedical research made by this committee over the years.

$650 million on basic research in coronavirus that helped us to move as rapidly as we work able to. thank you for your outstanding work. i have a question for you. given that nation's public health agencies cannot go from crisis to complacency to crisis. what covid related efforts need to be sustained post-pandemic that public health agencies are better positioned every day to support the health of our communities? health partners testified about core needs, public health data, workforce, laboratories that are

not specific to one disease or activity. do you agree? dr. walensky: thank you. first let me say congratulations to you and connecticut for your extraordinary work on the vaccine. maybe i will jump off of where you started, the nih, and comment that what we are looking for in the budget is similar to what has occurred with nih, long-term, longitudinal, sustainable increases. once a scientific study has been top -- has been published, there is evidence that by the time it gets to the core community in the rural south, the urban settings, it can take 17 years before it gets from scientific data to guidance training doctors, reaching people in

hospitals, to reaching people in the core community. that is the work of what public health can do and that is why we need sustainable resources. the buckets you described are exactly where we need to be and where we have learned we are fragile during the pandemic. our workforce. we need a trained workforce that is versatile and disciplined and in backgrounds coming from the communities they are going to serve. we know from the last decade when we have had all these infectious threats that we lost over 60,000 public health jobs. about one quarter of our public health work orders is eligible -- workforce is eligible to retire. we need a data savvy, skilled workforce that works at state health departments, local health departments, and in communities. community health workers to reach the people that they serve.

we need to bolster our public health labs. when we started this administration, we were doing less than 3000 samples of genomic sequencing a week. we are up to 35,000 samples a week. we didn't have the infrastructure in the lab to bolster that. finally, as you note, the data modernization. you mentioned the personal data entry, the need to bolster our data across different health departments, states, and up to the cdc. rep. delauro: dr. schuchat, would you like to comment? dr. schuchat: thank you for your kind remarks. just to agree with dr. walensky about the priorities, i would just add that we live in a global world and covid has taught us a threat anywhere is a threat everywhere. we were not as prepared as we

thought we were here and we know every nation needs the capacity to respond adequately and we need systems that can search -- surge rapidly and we need to work together on that. i regret that i will be 33 years at cdc, leaving with a public health infrastructure that is not stronger than when i got here. when i look at the nih and improvements in biomedical research capacity, i wish we had seen the same strengthening of our public health capacity. i think we have all seen that, regardless of the scientific breakthroughs, if we don't have the frontline workforce and a nimble and resilient system, we don't have data systems that surged to face the threat we are facing, we are all vulnerable. i hope the incredible investments in covid will be

extended for the other threats. rep. delauro: we included an emergency supplement last year expediting the data modernization initiative. can you give us any progress update on the multi-year initiative? dr. -- go ahead, dr. walensky. dr. walensky: this has been something we knew we needed to address early on. for example, the electronic health records we were able to do. in covid we were able to bridge test results to gather more data in a hipaa compliant way. systems have been bolstered. we have had to move quickly through the pandemic. we need to work with health centers, the public health work orders, bioinformatics and information through the private

sector, and all that work is actively ongoing. rep. delauro: my time has expired. congressman harris? sorry i went over time. rep. harris: one thing that's important is the public has trust that scientist behind decisions made by cdc and public officials. the first question, dr. walensky, are you and dr. schuchat in the same room? you are? neither of you have masks on. if we were conducting this hearing in a house committee room, we would all have to wear masks, vaccinated or not, because that is the rule of the speaker. is the speaker or the attending -- did the speaker or attending physician in the house consult with anyone at cdc before coming up with that policy? there is a fine of up to $2500

for someone not wearing a mask who has been vaccinated. dr. walensky: we put our masks on about two weeks ago and spoke to the science about individual risks. those decisions have to be made locally. rep. harris: did they consult with you before coming up with the house policy? dr. walensky: we have been in contact with the house physician and speaker's office. rep. harris: so they consulted with you about this policy? dr. walensky: there has been a dialogue. rep. harris: it is a simple question. it is a new policy, now that 100% of people have to be vaccinated before anybody takes their mask off. dr. walensky: the science we put in our guidance is related to the science of individual risk. decisions have to be made at the local level. rep. harris: that is not responsive. i am puzzled.

it is a simple yes or no question. did they consult with you? this is why america doesn't trust public health officials, doesn't trust elected officials, because i can't get a straight answer about whether the speaker of the house and the attending physician consulted you about the policy, which is that 100% of members and staff have to be vaccinated before anyone takes their mask off. let me turn to the problem with schools. is it true teachers unions helped drive the cdc policy on reopening schools? dr. walensky: as a matter of practice within the cdc, we engage with partner organizations related to any guidance we put out. rep. harris: so it is just coincidence that the wording of the guidance closely mirrors some of the communications between the teachers union and cdc? dr. walensky: we engage with many partners. i spoke to teachers, parents,

many people before the guidance came out. it became clear there was a piece missing. teachers were asking what happens if we have a teacher who is immunosuppressed? or a family member of that teacher who is immunosuppressed? . with the feedback, we were able to include science-based recommendations. rep. harris: ok. i appreciate we discussed this yesterday on the telephone. the need for people who have had prior investigations to be vaccinated, with two vaccines if they are receiving pfizer or mature enough, despite the evidence that there is a good t cell response following natural infection, whether symptomatic or asymptomatic.

virology indicated there was a very robust response after only one additional vaccine. given that these are still experimental vaccines under emergency use authorization, would it be reasonable to begin saying that people who have had the disease should either have test for antibodies or t cells or should only get one vaccine? dr. walensky: you bring up one of the things that's going to be the holy grail. what are the qualities of protection both in the t cells as well as the infection in either of these? we can icily -- we can easily measure antibody response. we don't have a good measure of t cell response. rep. harris: the oxford immuno

test, which the fda has put on the back shelf, but is licensed in england, is not a good test? dr. walensky: it's not applicable that we can use now to make a decision about whether somebody sitting in front of us should get vaccinated were not. rep. harris: thank you, i yield back. rep. delauro: i am looking at the document from 2021, a major speech made by the american federation of teachers president. she says, there is no doubt schools must be opened in person five days a week. we know that's how kids learn best and that prolonged isolation is harmful. educators should be back to school with their students. they asked for two things, an

end to the pandemic and the resources students need to succeed. i am going to recognize congresswoman lee, but i am going to step away for a moment to pose a couple questions to secretary mayorkas of homeland security. i should be back in short order. congresswoman lee, you are recognized. rep. lee: thank you, madam chair , and thank you to dr. walensky for your testimony and leadership in declaring racism is a public health threat. also to dr. schuchat, thank you for your 30 years of service and commitment to public health. we are going to miss you, but you have really made your mark. let me ask dr. walensky, with regard to structural racism and public health -- it's

undeniable, so thank you for the declaration. we have to work together to ensure our health care system works to dismantle racist practices that perpetuate racial disparity. congresswoman ayana pressley, senator warren, and myself introduced the antiracism in public health act, which calls for the development of a national center for antiracism at the cdc, and also a law enforcement violence prevention within the national center for injury prevention, incoordination with the department of justice. the president has included $100 million for the cdc to start a community-based violence intervention initiative. in what other ways are you going to ensure interdepartmental collaborations and accountability to address and dismantle racism in public health? is this $100 million appropriate to begin to establish some of

these programs we have laid out in our legislation? dr. walensky: thank you, congresswoman lee, for your leadership in this area. i have history in my work in hiv, which is where this interest started and i know you share that interest. about a month ago, we declared racism as a serious public health threat. through covid-19, we very much saw that. 1.7 years of life lost for people who are hispanic and 2.7 for people who are black in this country due to covid 19. truly extraordinary years of life lost. that has opened the door for us to do that for everybody else to see what you and i have been seeing for years, that health is different for people of color in this country.

one of the things i charged the agency with when we made this declaration is that we have documented the problem in all sorts of different screening mechanisms. we want to do something about it. i asked each of my agency center directors to plan an intervention for the next year, immeasurable intervention that will -- a measurable intervention that will show impact on how we can improve health among people of color in this country. we are going to be using resources deep in these communities. we need community workers to understand how we can reach them and i look forward to seeing what our center directors are planning and what they find. rep. lee: one thing i am looking on is the issue of the lack of black men in medicine and behavioral health professionals.

antiracism strategies have to be integrated into all areas where we have seen shortages of people of color. as you move forward on this, how are you looking at putting these strategies together across the board everywhere within your authority? dr. walensky: one of the things i think that's so important is that our workforce be diverse in their expertise as well as their background and the communities they serve. they need to come from the communities they serve. i had the pleasure to be in rural georgia and i said, how are you doing in vaccinations? they said it didn't work when they sent in the national guard. they trust local firefighters, the people who have been in the communities. i have seen that in my own hiv work in boston. they trust people from the communities.

it has to be at every level of expertise. rep. lee: let me ask you about the most effective intervention to prevent the spread of diseases. how are syringe services working and how are we using entities to use this program? dr. walensky: the opioid crisis is a real challenge. it had been a challenge before the pandemic. it continues to be a challenge exacerbated by the pandemic both in terms of infectious threats transmitted through injection use. we are working closely to embrace the sterile syringes under the context of the law and what we are able to do. we are looking forward to moving forward with you. rep. lee: i will yield back to

you. you made it back. rep. delauro: congresswoman herrera butler. rep. herrera beutler: it is all based around how we are treating children in this pandemic. there is a large amount of discussion around school reopening, but i hear from parents whose children are being forced to quarantine for long periods of time beyond cdc guidance, which interrupts their learning. in some cases a medical professional is not allowed to clear a student to return to school. their opinions are being overlooked, which is disappointing. i want to make sure you are communicating -- and ask what

you are doing to communicate this guidance. the broader observation i have is i think we are getting so many mixed messages, it is difficult to have one source of information. i saw a story in the new york times that says the cdc benchmark for outdoor transmission is 10%. if you dig down on the science, doctors will say it is less than 1%. 10% isn't inaccurate, it is just really imprecise. when you have this model of information, it causes challenges on how we provide leadership in our communities. that brings me to the next point, masking in children. i think children have disproportionately borne the isolation burden throughout this pandemic, whether learning loss through school, interaction, especially children in younger

grades who are learning to talk, to interact, whose social/emotional interaction is at stake. i saw some remarks from a doctor from stanford. i am not going to say his last name. i can provide it, i just don't want to butcher it. citing studies from sweden and the who, who recommended we avoid masking kids up until at least age 11 because they are at low risk for infection and the real hazard is stunting their development. yet our only recommendation at this point is young kids, you have to continue to mask. we are lifting this burden on everyone else, but we are even going to make you do it outside where there is not a single documented infection anywhere in the world from casual outdoor interaction. science is our base, right?

that's what you said, that's why the chair said. i believe that, but the science doesn't show children are at high risk. cdc data from july shows they are not at high risk of spreading it, either, two to 7, 8, 9. why are we making kids bear this burden? dr. walensky: i want to acknowledge two important things. i have three kids myself. one has been home all year. i understand the challenge deeply. maybe the second is the complexity of managing guidance and information and providing it to the public when it is changing and evolving and when we are learning so much so quickly, and how we are able to evolve our guidance in the context of that. you are highlighting something

really important. this is complex. things that we knew a year ago are different now because we have much more information and they continue to evolve. i have always said schools should be the last place to close and the first to open, and i very much still agree. i want schools to be safe places. my kids were home from camp last summer and i want camps to be open this summer. guidance has highlighted it is better to be outside than inside. what i want in camp guidance -- and we are revising guidance in the context of vaccinations for 12 to 15-year-olds -- my goal is to make sure camps can remain open. rep. herrera-beutler: i appreciate that. based on the science, children zero to four are less than i think 1% or 1.3% of all infections.

i get it, 12 and up you can get the vaccination, but not the younger kids. they are at low risk for getting it, even lower risk for hospitalization, even lower risk for spreading it. why are we making them mask? the science doesn't support that. dr. walensky: there are transmissions associated with young children. they have been vectors of transmission for older people. rep. herrera-beutler: what studies? maybe you can provide that because my time is up. that's not readily available. dr. walensky: absolutely. >> thank you both for being with us. you have outlined many ways you are going to spend the money. my only regret is the pentagon's increased budget is more than 50% of your total budget. i think that's important for

people to understand, given the biggest threat to this nation last year was covid-19. let me ask a couple questions, first about contact tracing. is this a good time to be very specific in contact tracing efforts? i know it was hard last year to keep up. at one point we were doing one of every five people was the best we could do in wisconsin. now that we have fewer people, are we intensifying efforts to further eradicate the spread? dr. walensky: contact tracing has always been a strategy for containment. it is hard to do contact tracing when you are in a mitigation strategy with hundreds of cases, as you note. now is a good time with fewer cases. we are able to do so, able to isolate.

one of the bigger things to mention is, who are those contact tracers? they are the community health workers, the infrastructure we never had that we couldn't deploy to do contact tracing to begin with. that's what a sustainable public health infrastructure will be able to do, be in the community working on hypertension, diabetes control, then pivot when you have an emerging threat. contact tracers should not only be contact tracers, but acting navigators within the community. promoting the quarantine of people who are potential contacts, but also vaccination. rep. pocan: this would be a good time to make sure we are thoroughly doing contact tracing with the limited cases. dr. walensky: i would emphasize, contact tracing with vaccination. those who have to quarantine are

likely those who are not vaccinated. rep. pocan: i know when you put out the new guidelines, there were a lot of new guidelines at once for everybody. last night secretary walsh was in town, so i was doing a few things in the community. based on your guidelines, i have not been doing many things. it seems like the change -- a lot of people are doing behavior without masks, which is in many ways ok. are there things that if you are vaccinated, we should still not be doing? and if you are in a mixed crowd, that we should not be doing? dr. walensky: the guidance for fully vaccinated people was intended at the individual level. we need to understand policies have to be locally driven. there are counties that still have less than 20% of people vaccinated and greater than 100 per 100,000 cases of disease

every seven days. we needed people to recognize this was important, science-based information to make local policies, but the heterogeneity of vaccine rollout and cases needs to be taken into account. rep. pocan: for example, indoor situation but mixed, if one quarter of the people are not vaccinated and you are within two feet of people, should you be wearing a mask? dr. walensky: i would defer to the local policy, but i would say you need to make that decision yourself. it's not you that's at risk, it's the unvaccinated. rep. pocan: last question, about sending vaccines abroad. i personally am trying not to do international travel this year because i think the rest of the world is not as far as we are in vaccines. what should the u.s. be doing to be sure? we are never going to be in the

place we want to until we get people vaccinated across the world. dr. walensky: disease anywhere is a threat to us here. we have put $4 billion into covax, $2 billion already given and another $2 billion that's going to be. 80 million doses of vaccine we are hoping to get out by the end of june. the cdc is going to be providing global technical support, how we do mass immunization campaigns, vaccine safety. we will be providing that support. rep. pocan: thank you. i know you have all put a lot extra time in. it has been a tremendous time in our history. thank you. i yield back. rep. delauro: congressman kline -- cline. rep. cline: thank you, madam chair. i want to thank our witnesses

and ask dr. walensky, in encouraging vaccinations, you mentioned the local specific, that we need to be specific for each locality, each individual. suffice it to say that your recommendations include the idea that if you are vaccinated, not only do you run a reduced risk of contracting covid, but a reduced risk of transmitting covid. is that accurate? dr. walensky: that is what emerging science is telling us, yes. rep. cline: circling back to the ranking member's questioning, were you in contact with the attending physician, dr. monahan, as he developed this most recent policy announced by the speaker where 100% vaccination was encouraged? dr. walensky: we have been a

resource for the capital physician throughout this pandemic. our offices have been in contact with him. i can't tell you the timing and terms of when the last discussion was versus when the guidelines came forward. rep. cline: were you in contact with his office as he developed recommendations for the senate? the physician also provided a recommendation to the senators as well. dr. walensky: my reply to that would be the same. our office has been in contact but i couldn't tell you when and when his decisions for the house or senate occurred. rep. cline: would it surprise you to learn the attending physician issued a recommendation to the senate that was different than the recommendation to the house? the senate was encouraged to proceed with normal business without masks being required.

social distancing respected, but the 100% vaccination was not required to the senate, but in the house it is somehow being mandated. does that surprise you? dr. walensky: one of the things you mentioned is how complex these decisions are in the case of evolving science. the capitol physician has more information than ideal about vaccination rates in the house and senate, as well as medical records of people, as well as the average age and immunity durability. he would be best equipped to make those decisions. rep. cline: senators on average are older. the science of the virus is not different in the senate chamber and it is in the house, correct? dr. walensky: i don't know the immunization rates of each of the house and senate. he would be equipped with that information. rep. cline: is it your opinion that american society should be

100% vaccinated before we open back up? dr. walensky: as i mentioned, i think these have to be locally driven based on vaccination as well as background rate of disease. rep. cline: that's a pretty good softball for you. do you have to be 100% vaccinated to open up and stop wearing masks? dr. walensky: no, i don't believe so. rep. cline: let me ask you about the business community. the livelihoods of many businesses in my district have been threatened as they work to adjust to the changing environment during covid. as more has been discovered, guidance has changed. a federal reserve study found the pandemic resulted in the permanent closure of 200,000 u.s. businesses. what will you do to empower states to determine how best to govern so that overly burdensome regulations from the federal government do not cause further harm? dr. walensky: we have been putting forward -- first, we are

working to get people vaccinated. as we have seen, when people get vaccinated, disease rates in local areas come down, and that is the ticket out of this. we are working with all jurisdictions at the state and local level to get people vaccinated to ensure confidence to provide the best information so people feel empowered to make these decisions, that they are the right decisions coming from trusted messengers in those communities. we are working to do that at the public-health level and providing guidance that can lead to informed decisions in communities with local jurisdictions, with governors. i spoke to the governors yesterday to make sure our guidance is applied in a safe and are at the local level. rep. cline: i yield back. rep. delauro: i would like to recognize congresswoman clark,

but i am again going to hand the gavel to congresswoman lee. i will get to homeland security and get right back. congresswoman clark, you are recognized. rep. clark: thank you so much, chair women. thank you both for joining us and the deep gratitude of a nation for the work of the cdc and the response to this pandemic. dr. walensky, you and i have talked about the value of public service, the importance of treating public-health jobs as we would as a career at doj or defense. are there programs or incentives the cdc would like this community to prioritize that would address the needs of our public health workforce? and in particular, how can we work with the cdc at state and local level to build a more

diverse public health workforce? dr. walensky: thank you, congressman clark. one of the things that's important here is to make sure the competition is competitive with the private sector in public-health jobs. state public health officials tell me they can't hire an md. the compensation wasn't competitive. someone who came out of medical training and medical school with on average $200,000 worth of debt was not going to enter the public-health work was because they did not have salaries that are competitive. as we work on expanding our disease detective program, one of the things we are looking forward to is loan repayment programs. that would go a long way so that people could enter into public-health, which obviously pays less than the private sector.

many of the training programs we put forward would be tuition free to be accessible to people who have less resources. rep. clark: thank you. anything specific around your plans and strategies for increasing diversity in your work orders -- you are workforce? dr. walensky: we are reaching people where they are. we are going to historically black universities, working in communities to bolster people within the communities. we have the potential now as we are scaling up our work -- our workforce that we have had to do by necessity during this pandemic, to retain them. these are people interested in public-health. they volunteered to help. now is the time to skill them up, to retain them to make sure they can continue doing the

important work they have been doing. i think it is key for our next step forward. rep. clark: really quickly, if an employer made a decision around masks based on two different groups, one that had a 96% vaccination rate, one that had a 77% vaccination rate, would you think that was a fair way in line with the science to make a decision around masks in the workplace? dr. walensky: almost every morning i look at vaccination rates across the country by county. rep. clark: dr. schuchat, i was wondering if you could tell me a little about the gun violence research that was first funding in 20 years in the fy 2020 budget. i wonder if you can tell me what

you are learning in our research on firearm injury and mortality prevention. we so appreciate you treating this as the public-health crisis it is, and any updates and strategies and>> thank you so mt question, congresswoman clark. our call for proposals for firearm safety, opened a flood of applications and we were pleased to be able to fund it several that were focused on a gap that the national academy of medicine had identified. the scientific research we are supporting is helping us understand firearms related injury across different types of incidents, different types of populations and different settings.

we had 18 funded sites in that research. they're looking at fire -- among youth. they're looking at individual neighborhood level risk so that communities can design interventions in their setting a clinical screening tool to assess risk for firearm violence. these are really important projects that span the nation. so the ability to scale that up is going to be precious. the other aspect of it that we received helped strengthen the data gathering so we would know who is getting injured by firearms and where these events were occurring, when they were occurring, so we could understand trends so i think it is a very important, precious area. >> i see my time has expired.

i yield back. >> thank you very much. night -- now i will yield. >> thank you doctors for all your good work. i would respectfully suggest that colleagues who do not want to wear a mask, ask their colleagues, who have not got vaccinated to get the vaccine because i think i speak for most americans who are vaccinated, -- small areas with people -- who are refusing to get vaccinated. my next question what is

expected of the boosters for the vaccinations? >> thank you for that question and congratulations on your grandbaby who i think was pending. >> came out of the pandemic. [laughter] >> on the topic of boosters, i think it is important for us to understand the whole thing. if you received the two doses of the vaccine, you're completely vaccinated. right now, you do not need a booster. it implies that you do not need a booster right now. i think all of us recognize we do not want to be back to where we were again so we want to study when we might need a booster. that givebacks to what are the true correlations of protection?

we do know that antibody levels over time wayne so what the question is whether they wait, are these people still protected? we also know importantly that we vaccinated first our most vulnerable. we vaccinated our elderly, weak vaccinated people who might not have had the most robust immune response to start so we're looking at the timing of when boosters might be needed, will it be nine to 12 months or one to two years? we have seen data that demonstrates re-infections after two or three years. i think the most important thing is we want to be ready and so that is where we are right now. >> do expect the next shots, we would be able to get them like flu shots? not having to go to mass sites?

dr. walensky: i think one of the things that is important to recognize is that we do not have an adult immunization structure in this country. we have a childhood immunization structure but we do not have one for adults. among the reasons for the funding is to develop and bolster adult immunization structure in this country. that would be the vision. when we need tetanus updates, we do not have that mechanism right now. >> i think that is a good idea. it is like the hunger games here. it is frightening. a population that suffered were the elderly and i'm interested

in whether you are doing work to address how we handle these kinds of situations with our elderly populations that have so much isolation and depression. dr. walensky: i think you are noting the elderly specifically. it has been so challenging and and long-term care facilities, so devastating to watch but you're raising a larger issue which is mental health of this nation have suffered. we are doing a lot of work and cooperation to evaluate mental health related issues to look at issues related to suicide, and to do outreach with interventions that are data-driven, that have toolkits provided by the cdc for how we could do outreach in these communities with community

workers to do evidence-based science and mental health across the h spectrum. >> about terms of ideas for communities to increase vaccination rates? is there a price that will help the departments to get different ideas or strategies? dr. walensky: we have an extraordinary number of resources, you could call the cdc -- we have the we can do this campaign. 5000 community core so if you have a group, you could get your vaccine and take a rider around the talladega track. there are a lot of different what ways to engage with the community. i would encourage your state department to engage these community core organizations via

nascar, country music, faith-based organizations can really help do the outreach. >> thank you very much. i yield back madam chair. >> i want to thank my colleague. mission accomplished and with that, let me recognize congresswoman. >> dr. walensky, thank you so much for taking the time. i want to talk a little bit about what you just shared about new ways and innovated waves to reach out, specific in this case to rural america. i talked with dr. fauci about this yesterday. he was going to take the questions i was asking about reaching rural residents and try to come up with some new ideas

but i want to talk specifically about the disparity between -- with those who live in more urban counties. we know by the numbers that the cdc has released that less than 40% of residents and 40% -- compared to 46% in urban counties. i want to hear your thoughts about vaccine hesitancy, other issues that are specific to rural counties. if i may throughout an example in the congressional district that i serve here in northwestern illinois, we have one county. along the mississippi road, the entire county has 6700 residents and for people to center for the vaccine, they have couple phone

lines. broadband is spotty at best, their volunteer corps as far as getting people out there to help , our seniors themselves and are concerned about getting covid themselves so that was all brought to a halt. they were registering people, there was no online portal to register, it was all handwriting, paper, pencil. with the announcement that just came out earlier today where we had half of the adult population that is vaccinated, only 19% overall is vaccinated and so to get these great big disparities so i'm just wondering, on top of what you just talked about, can i get a chicago bears player to come to henderson county? what steps are the cdc taking it increase these vaccination rates

admiral areas and specifically also how we can address vaccine hesitancy? maybe even talk through the celebrities so that could be a way to have this work and get some folks in my neck of the woods to help out. dr. walensky: thank you for that question. another piece you did not raise his telehealth. rural counties would be so helpful to have telehealth. the telehealth what we had exactly the kind, broadband, telephone, decreased access. i think it speaks to the fact that we do not have community workers in communities that have had a long-term health care infrastructure in these communities to do the work of public health. we do not have a public health

department that is been well tended to that as competitive salaries respective positions and community workers in those communities to do the work that you are talking about and that is exactly what -- that are specifically line items for rural areas. we've had community-based organizations outlined rural areas through the context of covid and what we are asking for -- you are going to find these people who are devoted to the community work and we need to make sure that they are trained, we need to scale them up and we need to be able to interact with the data. we do not have data systems there. people are doing it by hand. that is not a way to do public health in this country in 2021. never mind for what we need to reach for in 2030.

i was enrolled georgia and was really incredible -- who are hearing -- we needed to be at the change of shift at 4:00 a.m. and have people take over for us and can you get your vaccine out? that is the kind of grassroots efforts. we have these confidence consult that people could call for the community. [laughter] might be something to facilitate. i do think when you call we can do this.gov -- >> thank you to you and your team for all you're doing to help our country to get passes pandemic. i yield back.

>> i do not think you need to apologize for being a patriots fan. [laughter] my hope is that you are yankees fan. >> i do not know if i want to get myself in the middle this. thank you so much. special thanks for your decades of service. one of the things i want to focus on is how the pandemic has highlighted some of the gaps in our public health system. one of the things that is become abundantly clear is just how critical a strong well-funded workforce across the country especially in rural districts like mine where health capacity

is also in. i've seen the beginning -- it is going to help fund some of the programs outlined in the american rescue plan specifically the $7 billion investment. could you describe the rollout of the funding? especially how the cdc will support these positions in an ongoing basis after the rescue fund expires? dr. walensky: thank you for that. we just put out the -- scale up where we are now to get us out of this pandemic and to do the hard work and continuing testing, continuing to be diagnostic, continuing to be workforce, to make sure that

vaccine distribution and committee workers for the vaccine distribution get a piece of that but it is investment in the future to be able to take that infrastructure and invest in a workforce that will be moving forward but i think the most important thing you highlight is that these are not one-time investments. one-time investments will not fix the problem that led to this pandemic of covid-19 and our inability to handled. they need to be sustainable, they need to be long-standing, they need to be keeping the pace with inflation, the need to be keeping the pace -- this is an investment now but it needs to be a sustained investment over time. >> how will it be a sustained investment over time? in the budget document, i would expect that to manifest itself in discussions? dr. walensky: i think this is going to be a continued conversation.

i think i will be here next time the same time next year to demonstrate all the hard work that we've been able to do with the resources that we had it and what we still need to do in the years ahead. >> i look forward to working with you i think making sure that rural areas that are strained. some of the opportunities to get some of these grants because it is very much needed. my second question is a little bit more broad, with a tendency to only invest in public health during times of crisis and i think we need to do a lot more to improve the capacity of state and local health departments to prevent others in the future. what else can we doing to sustainably equip health department for future health emergencies? dr. walensky: every aspect of an

emergency response is improved by the work that is been done before and the relationships that have been built, data systems that are in place, skill level of the fast -- staff. we were not ready for this pandemic, our data systems were very far behind in our public workforce -- they were no longer filled. looking back, what is happened over the past year and over the past few decades, we can see we need to do better going forward. i want to say few words because i think that left us at the beginning of the response without really knowing what was going on and not able to keep up. at talk to health care

executives who described investments of $700 million versus what our initial research for the entire public health data modernization efforts. i think we need to date data and the complexity and the full ecosystem seriously both with data scientists and our inoperable system. my our systems to the cloud, and also what the cdc, so that is a big complex job and it also relates to what dr. walensky is describing where it is tough for public health at any level to be competitive with the private sector switch to figure out how to address -- have strong public partnerships to go even further so i this see this data hand-in-hand with workforce and getting us out of that state that we were in. >> thank you so much and with

that i yield back. >> congresswoman. >> thank you. dr. walensky, thank you for all the work that is been done not only in the space that relates to getting alice through covid and having an active experience but also the other work that you're doing at the same time and thank you so much for your 37 years, god bless you. you have been enormously important to all of us -- dr. lenski, ives or we did not get a chance to talk beforehand because i have a lot of questions. i want to talk about the gun violence issue. i appreciate the fact that we funded research for the first time in a very long time.

i'm wondering what the president's issues talking about more local intervention, what that means, i do see that rolling out -- how do you see that rolling out? that kind of violence and death by guns that we see in our communities, particularly our inner-city and low income communities? dr. walensky: thank you so much for that question. we are looking forward to seeing how the investment of the initial funds from the fiscal year 2020 and 2021. looking forward and using the template of information that we need from the national academy of medicine to inform the kinds of research that is being done. the research has to be at the

local level. it has to be related to behavioral health and mental health but has to be the neighborhood level. not every neighborhood is going to be the same so the signs we are going to do is about who, the how, the white -- the why and we are going to move forward and i look forward to seeing how that sites ventures. -- matures. >> the imitation of -- the implication because we are in a very urgent crisis situation with gun violence in our community. dr. walensky: i would agree with you. i will say that we will need to see you what the science demonstrates.

we need to understand what the sign says before we can act -- the science says before we can act. we had that first investment of the $3 million in this work but the proposed expansion. the provost -- the proposed -- the idea is to take what we have shown to work through the technical packages that we have issued on violence. to scale is up to have communities take on the ability and to implement proven methods. strengthening connectedness between kids and schools and schools at adults in terms of the community. it will vary but we are hoping to find a large number of

communities to tip the scale. >> i'm really interested in hearing some of those specifics that are going to be employed under this effort. the president also said that he wants to end the hiv aids crisis and one of the things that i think is important is a bill that i sponsored. what i am wondering is two things. number one, what do you say about the trend in hiv/aids right now? it is going down or are we seeing an upshot? what do you think the resources will be applied to all races and communities? dr. walensky: thank you for that question. prior to my coming here, my

career was in hiv prevention. it has been investigated in 57 jurisdictions. as with many diseases, they have been exacerbated by isolation, and access to medical care and many things. we are looking at investments that were bait -- made. as i'm certain you are aware, it is not getting to the communities that needed for cost reasons for access reasons, for health reasons, for places that have the highest rate of hiv at the lowest rate of -- use. >> i know my time is up but i

think that is a crisis that needs to be addressed. that is what we saw with contact tracing, that is what we are seeing in respective vaccinations but not as much so that is a crisis in and of itself. as it relates to poor communities. i want to know specifically at some point how we are going to get to those communities. i think you and i yield back. thank you, dr. walensky. >> thank you. good morning. i represent michigan and am very involved with the crisis in flint. we know that lead exposure is unfortunately prevalent across michigan and that includes the lasting efforts of the flint water crisis is -- i'm proud to

work with my colleague to provide funding for the flint lead exposure registry. i'm incredibly concerned with our high levels of lead. especially in the schools. when i talk to my colleagues, plastic bag over the drinking fountain. the researcher on how long the children drink from the water fountain. can you speak to how the cdc will utilize the lead poisoning prevention program? to combat lead poisoning in our communities, especially the impact it has on children and their developing brain? dr. walensky: thank you very

much. one thing i think we learned from this pandemic is increase and lead poisoning surveillance that is happened because of the lack of access to care. i think one of the things we really understand as we in various and our public health infrastructure, excuse me, communities need different things. in other communities, we need investments in our committee workers and we are doing active surveillance. >> thank you for your leadership around the flint crisis in the registry has been incredibly valuable for the community as a community own deadlines response . the children affected could have

long-term consequences. we hope that some of that will be mitigated. we do not know how many other states are in the same position. that is part of the focus. there are other departments that are really engaged investments that could help reduce the exposures, the lead pipes and so forth that you mentioned but we think that data is the first thing. we have to know what is going on to be able to target effective responses and ideally they are community owned. do not just have a distant government trying to figure out what is going on but to help the families that are affected. i share your sorrow about what is happened. the ability for us to strengthen surveillance around the country. >> i will tell you that if we had a hearing on lead poisoning,

many members would step up and talk about the concerns they have in our communities urban and rural. the last thing i wanted to add this to add my points to gun violence. there was a refusal to establish or identify gun violence as a health crisis because we were, for whatever reason, the administration did not have the wherewithal or the desire to do the data. we could use the data from car crashes that implement safety belts and airbags but we have never had the courage to see through the research so that we can begin a federally led program to address gun violence. i just want to tell you why this is so critical.

in 2020, there were three to 27 homicides, -- 327 homicides. a 53% increase respectively. this problem is not getting less, it is increasing. this obsession we have in america with guns, i can only see it getting worse. i'm not a mayor, about four people in congress who are seeing these debts so frequently. this has to be a priority but i want to yield back and they cue so much for everything. -- thank you so much for everything. >> we are now going to move to round two and i think we have

the time to do a five minute round so thank you. i want to begin -- mortality research and i just wanted to say that i'm so proud of this subcommittee to all the first hearing in 20 years on gun violence. we began funding for the nih after the cdc, the ability to do this research which can take a look at suicide, take a look at gun storage and a whole variety of other areas that could help prevent this violence. if the two double the funding, my hope, i've a very quick

question. when you believe we will have an opportunity to share some results? >> the projects are in progress and i hope that within a year or two, there will be preliminary results from the initial investments. they're doing extraordinary work and it is going to take time. >> thank you. let me ask. about cardiovascular disease in women leading cause of death in women in the u.s. a lot of women died in the research shows that women experience different symptoms

and leads doctors to misdiagnose women. critical for the cdc to support and an awareness campaign in all 50 states and territories on heart disease so women can receive appropriate care. to both of you, given the update on cdc supported activity to educate women about heart disease and cardiovascular health and need to create an urgency of looking at this issue to impact the research that needs to get done. >> thank you so much for raising this issue. it is so important as the leading cause of death in women and as an underrecognized preventable problem.

we know women are less likely, they have atypical symptoms, i've told stories about my mom who had deck pain, playing tennis which we thought was arthritic. thankfully she got surgery in time but it is very common for women to have different symptoms, to be detected later because of clinicians as well as bias you have that outcome so i think there can be benefit from education and communication efforts. which is really trying to get hypertension to be well treated. which takes public and clinician and institutional effort and i think the communication at education call that you raised can be raised as part of that

system. we are working together with the center for -- and partnership on this and education communication campaigns are part of that. the wear red offenses that i've seen many congresswoman be part of it. that can be not a one day or one month. that needs to be here long. >> thank you. that is one of the issues i want to focus on. i want u.s. this question. this is about the global response to covid. we have made significant progress here but the pandemic will not be over until it is a mobile success. doctoral and seek -- to support the global response and has the agency planning to expand surveillance, prevention, and

response around the globe. --? dr. walensky: a threat anywhere is a threat everywhere so we have a responsibility to not just take care of ourselves but around the world. collaborations in 60 countries and the ability to have these collaborations that have been long-standing as serpas well so for example, we have a regional office in india that is 20 years old. we have tons of colleagues there that trust us and over the last year, we have been training in india, over 10,000. when it came time when india was having challenges, we were able to mobilize those collaborations. we are able to get oxygen canisters. our work in the cdc is our technical surveillance -- and scaling up capacity and it really is critical to have those

people on the ground so that we are able to tons of crisis like we have also done in the congress -- in the congo, getting a to be able to scale up in times of crisis as that is where we are looking at resources. >> i was pleased that the administration -- the abbasid or time was at the world health organization talk about lifting -- supplying india, south africa, other countries for the opportunity and a temporary way. the licensing, the patents -- 90% recovered and 20% to 30% in other countries because we are at risk if that is the case so i

look forward to working with you on that effort. i was muted there. congressman harris. rep. harris: thank you for coming before the submitting -- subcommittee. the job sometimes you have to take slings and arrows because if you recall, it was highly criticized for suggesting that the wuhan virus came from a lab. castigated in the public media now it seems we are 100 degrees around -- hundred 80 degrees if we are determined how this got started and where it came from. let me go ahead and ask -- to

clear something up by the way because it was suggested that somehow florida had a bad response to covid, i guess. i think that florida as among the lower rates of infection despite the possible description of a vaccine rollout, it seems that the public health bill should be -- i think governor desantis did. and by objective data which is what we should be talking about is objective data. so let me just ask a brief follow-up on gun violence because last year in the 20th largest city, there was ace -- a 36% increase in gun violence in june and october. any ideas what could have possibly resulted in a huge increase in gun violence in our cities?

dr. walensky: thank you for all of your public service and trying to get people vaccinated. we are actively doing research on firearm prevention as highlighted by the priorities of the national academy of medicine on the who what and how of gun violence. we look forward to those studies. rep. harris: we have to get to the root of the increase in gun violence and whether it is because policing activities have decreased in many police officers -- they have up to a third of their positions vacant vacant she cannot find someone who was to be a law enforcement officer anymore. the other thing that i want to ask about is the data as you

look at data collection, that you do it across the very top -- various parts of the cdc. the way we collect data in 2021. develop a robust system because it is necessary but part of that that you look at what went on with nursing home deaths in new york during the covid epidemic because we all went to our seniors to understand what appears to be data manipulation in new york and i think we need to get to the end of it. i will close out and asked to update us on -- which we have not heard about it for a while, thank goodness. we still know that it is simmering in africa. what is the threat of these two

diseases right now to americans? dr. walensky: i will pass that to the other doctor but just to comment and you state some of things that are critically important is the investment is the review of maternal, which i think helps us evaluate not only speak out but also covid-19. >> i think there a lot of lessons from the epidemic. virus that had been recognized any years earlier with a mild syndrome but the lab test was developed because of that. introduction into our hemisphere -- that reminded us how important it is to have -- in public health and to have.

we know there a lot of threats right now and mosquitoes, ticks, other factors that can be the carriers of new diseases to susceptible populations so the result of the z cap -- infrastructure that we have. that helps us track -- syphilis, other things that could affect mothers or babies and so it really gets back to the public health infrastructure and need for sustained focus. we get investments and then we lose them and then we are surprised when a new threat can access without preparation. i can tell you from meetings at the world health organization they were very concerned. to understand -- i think the

emerging threats are out there -- that protect all this. >> i yield back. >> one lesson that we learned during covid was the need for -- culturally appropriate data collection. to really determine how to address, which were dressed targeted research, this was a heavy lift. we put this in all of our legislations. to work with states, to give us information as it relates to language -- based on race, socioeconomic status. i do not think the cdc took us

seriously by wondering now where are we in terms of data collection because we have to know not only for covid but also for any health care initiative that disproportionately impacts people of color and then dr. walensky, let me follow-up and i want to ask you to follow up from -- on hiv and aids. we have an hiv-aids national strategy. we went around seeking input of communities to develop this plan and i'm wondering if we have an update on national hiv-aids strategy plan that we have a point person in the white house who is putting all of this. dr. schuchat: i really appreciate the attention that congress gave you race and ethnicity. it was a tragedy at the beginning of the epidemic how

behind we are -- we were. we are not done with improvements and this has been a high priority for the ministration. we have made it a priority for state and local health. there someone health strong. we've been try to take a systematic approach, hospitalizations, debts -- deaths. we've been using something called the social vulnerability index we try to get vaccine access and that has four results. on who is getting vaccinated, we deployed through partners with fema to get federally qualified health centers to get the pop-up in the local clinics. an hour argosy partnership we

have been reaching much greater percentages of individuals who reside in high folder ability index areas. we've been looking at the zip code level to get those researchers out and i love congress for saying this is important. rep. lee we only have -- as it relates to data collection. dr. schuchat: we have been providing a monthly update on the data systems but i think a markup rants one it we are happy to follow up on. rep. lee: we've known each other for many years, dr. walensky when it relates to getting a handle on how we achieve eight aids free generation by 2030.

all recorded in it now with the white house? dr. walensky: what i know -- this is where we need to study so i'm very familiar with it. i do not believe we had updated in the administration -- they've been really focused on making sure we could get out of covid so we can focus on other areas of health but i do know in the months ahead when covid is no longer what we're dealing with most of the time that this is a high priority for this administration and i look forward to that. >> thank you again. rep. herrera-butler: two of my counties are considered maternity care desert.

it is classified as having low access to maternity care. those struggling with mental health, substance abuse. a 2018 report found that the rate of infant mortality rate could be -- our rates are not good. i wanted to ask how the cdc is going to ask -- build our to collect data on mental health there investigating the deaths but i want to make sure to better understand that piece of substance abuse and mental health problems. dr. walensky: thank you for that

question. i rates of country this is something that we have to address. only our week interested in -- they're not covering every area. we are interested in resources to expand the breath and the deaths and mental health -- the companion -- the campaign to make sure that people understand the warning signs the pregnancy. those are all parts of the efforts. rep. herrera-beutler: most

of these focused unless years deep isolation to protect themselves from covid -- making them uniquely vulnerable covid backs -- in fact -- creating the bodies after receiving the vaccine. what is this easy planning to do for these communities who are following all the guy leads, getting vaccinated but who may not be protected? dr. walensky: i care for these patients last year so i'm deeply aware following these patients, their worst covid outcomes and now the challenge is associated with how we care for them moving forward giving the vaccine may not be protective.

it is true that -- and the transplant world as well which is able discipline of transplant infectious diseases. what you're raising -- is not just unique to transplant and they also demonstrated. did not have his robust of enemy response. the project along at last and i we can feel about it. we very much indicated and we will continue to beat -- until we understand the for their own health. rep. herrera-beutler: i also have small children so if i understand that tension between

public need for younger kids to have that access, social emotional development but also want to protect one of my other kids who a vaccine is not going to do it, i think the data has to lead us and that is a really easy thing to say considering i recognize the challenges, that is the name of the game but making sure that you as the director, it is all backed up with policy based on the data. i think it is going to give us the best path forward. the trust to me is the most important thing is making sure to know that i could trust the data. thank you for that. >> for those who cannot

vaccinated, the best protection we as a society to give them is to -- thank you. rep. clark: staying on children and the pandemic for a moment, we know the kids are at a lower risk for severe infection but my understanding is that covid-19 is also become one of their top 10 causes of death in this country which is of course a cause for alarm. what do you see is the best benefits of vaccinating our children and when do you expect to have enough safety data available to vaccinate a child of any age? dr. walensky: thank you for that

question because i do think that some of the data and uppers are hard and it is the case that a young person may be less likely to die of covid-19 that old person but a young person is less likely to die of anything that a old person. when you say it is one of the top 10 causes of death among young people, that i think highlights the importance of protecting our children so course i want to see what that clinical trials demonstrate and the data shows and to do these scaled-down trials down from age 12 to age 92 86 -- they're both safe and effective and there's an extraordinary role for vaccinated children to protect their own health, to protect

their families health and to protect their community's health. rep. clark: give a sense of a timeline? dr. walensky: they're looking for a timeline of late fall, early 2022, i do not whether that would be the entire spectrum. i hate to say it depends. when people in the placebo -- less infections in the placebo arms so does depend on where we are with the pandemic. rep. clark: i wanted to talk to about recently the world health organization urge that wealthy countries like the u.s. postponed vaccinations for children in order to donate more

doses -- the vaccine sharing initiative. your region sees -- is your agency concerned that that saving our children will detract from participating in being a partner in beating the global pandemic and how are you approaching this balancing act? dr. walensky: i think we have to do both. i think we were the country with the largest upper of debts across the world. this was a put on your own facemask so you are able to help others and that is what we are working to do right now. we are actively scaling up at our efforts not only to provide funds but to provide vaccine, 80 milli-doses, with cdc are now working -- as those doses get donated and implemented with countries so that we can help them and immunization programs,

help them with vaccine confidence, and to do all of the work that we've been doing. >> great thank you in evan in my brief minute left. i want to go back to talking about data collection. we know extensive evidence of showing communities of color are disproportionately impacted. i wonder if you could tell me how to cdc's data collection has changed and how are you working to make sure that we are collecting impact data on communities of color? sorry there is no time left basically. dr. schuchat: if we do not know where the problems are, we cannot address them. the need to reach every community with trust and skill

systems. we have made progress this past year with increased -- ethnicity data. we have much more timely mortality data, the laboratory reporting -- it is usually missing a lot of information we are interested in so some of our highest yields focused area relate to electronic health records and other data systems that can be linked to the public health information so that we can complete actionable timely data so a lot of progress and a lot more to do and we do think this needs to go beyond covid because the next thing is not going to be covid. we are not done with this but we cannot develop a beautiful perfect pristine system for one disease and i have everything else fall behind. just a couple thousand cases,

really exhausted our data capacity. we have learned that we have to scale, we have to have the systems in the workforce that can handle them. >> thank you, my time has expired. i want to thank you for your remarkable work. >> congressman klein. >> thank you, madam chair. i understand we need to ensure we vaccinate as many as possible . considering that commode want to make sure our children are kept safe. i am concerned in the effort to keep children safe by going beyondaccinations to continue to keep lockdowns in place, keep

mask requirements in place, my colleagues in washington that i spoke to earlier, we are doing just as much harm as good to these children. one thing we need to remember is when we are talking about covid deaths, the 500,000 deaths involving covid-19 reported by the cdc, 238 have been in children 17 or younger, that equals .04% of all covid deaths in the united states. we have to make sure as we consider protecting our children , we also consider the effects of locking down too much, keeping them out of harms way to excess. i would add, do you have specifics on the suicide rates of children over the past year,

and how much that has risen? >> thank you for that question. i do not have them off the top of my head. my understanding is there is an increase in health challenges with children. it is not yet clear, and the research will show in the months and years ahead how much those are related to lockdowns or other childhood events associated with the pandemic that food insecurity and parents losing jobs. one thing i want to make sure you understand, i very much believe all schools should be open in person full-time five days a week come the fall. we have put extraordinary resources and measures and outreach to make sure that can be the case. teacher vaccinations through the much of martha was able to vaccinate over 80% of teachers.

and through testing initiatives we cannot vaccinate younger children and we have routine screening in schools, extraordinary resources and efforts that are science driven so we can make sure our schools are not only open full-time in the fall but are safe to do so. rep. cline: i want to shift over to the study you will be undertaking. the last study you undertook was in 2013. i am concerned with some bias within the organization. underpinning this study will be a recognition of the right to bear arms as a basic human right established in our constitution. dir. walensky: congressman, i do not know the specifics of that study. i am not familiar with it.

i will be happy to have our staff get back in touch with you. rep. cline: that will be in underpinning of the study you will take. dir. walensky: i would like to know the study before i speak to it. rep. cline: you were appropriated funds to study gun safety. dr. schuchat: maybe i can clarify. in 2020 we received funds to reinitiate proposals for research on firearm safety, gun violence, etc. rep. cline: when was the last one? dr. schuchat: you are right that this is suspended. rep. cline: 2013 is the last that came out. the obama administration issued an executive order to study gun safety. dr. schuchat: i am not familiar with the details, but what i can

say is we do not do advocacy. the funds for research that we have put out have followed the research gaps identified by the national academy of sciences. rep. cline: let me urge you to speak to the benefits and risks associated with gun ownership. the defensive use of guns is a common occurrence. defensive gun use are at least as common as offensive use by criminals. estimates are over 5 million per year. there is a way to look at this issue from a balanced perspective, and i would urge you to do so. i yield back.

>> if i may comment to my colleague, because this has been on my watch, the first hearing. please understand gun violence prevention research. it is about the public health crisis, and the amount of research, there has been no research in the same way we have dealt with automobile accidents and crashes, etc. what that did in terms to help prevent the loss of life. this is research, our colleague talked about a public health crisis in this area. that is what the research is focused on. i am happy to provide you with

the transcript of that hearing. we are not looking into the dollars appropriated, we are not looking at gun ownership. the issue is homicides, why do we have suicides, and the suicides are the highest number with our veterans. why is that happening? if we can store guns in a better way, would that cut down on gun violence? that is the basis, and we can provide what is in the legislation of the language of the legislation, which lays out the scope and the mission of the resources for gun violence

prevention research. let me recognize congresswoman frankel. rep. frankel: sadly, as we speak today, there is a mass shooting happening now in california. in san jose. i want you to know i actually live in florida. there have been so many questions to our guests. thank you very much. this whole issue of vaccine passports is starting to become controversial especially in my state, florida. i would like to get your

feedback on the use of requiring vaccine passports to go into establishments, cruises, so forth. dir. walensky: the federal government has made the decision to not use -- to not be the leader in vaccine passports, but has said local communities, private sector may use it for their industry if they so choose. i can envision there are certain sectors where this would be incredibly helpful, for example cruise ships would be one of those where cruises would like to know the status of the people . the most important thing is people get vaccinated. if there are a lot of people getting vaccinated, the passport

-- the utility of the passports is nil. the reason we have to have a discussion about passports is because people are not getting vaccinated. if we can get people vaccinated, then the importance of these passports diminishes. rep. frankel: if you can get us that hotline number, that would be helpful. let's switch the subject for a moment. i want to talk about domestic violence, because i know you have a program, and that you manage the rate prevention formulation grant, and i would like to ask how that is going, how progress is being made.

dr. schuchat: these are such difficult issues for the individuals involved, and those who love them. the cdc has been developing technical packages, toolkits of what we know works, evidence-based, and facilitating that to be used around the country. and we have funded additional programs to scale up these efforts. things are different in one place or another, and sometimes whether it is rural or urban areas, the nature of the challenges are complex. the team working on this is incredibly dedicated in carrying out the programs to implement evidence-based strategies. rep. frankel: one softball

question. we have been talking a lot about covid and aids and other diseases. what in your opinion are the top health care issues for americans today? dir. walensky: i will take a swing. we need to bolster our public health infrastructure. our workforce, our data, our labs. we need to work on health equity in this country. everything we do has to be founded in health equity in this country. we need to get through this pandemic and get everyone vaccinated. we have a lot of work to do in opioids, we have a lot of work to do with hiv and in mental health. we have a lot of work to do in health losses we saw during the

pandemic, 11.7 million childhood vaccinations have now been given. i look forward in leading this agency through the pandemic, and to address the public health infrastructure of the country. rep. frankel: thank you so much, everybody. i'm going back to the beaches. [laughter] >> i do not know there are other questions. if not, what i want to do is yield to congressman harris, and recognize you for closing remarks. rep. harris: some of the hearings we have, some of the most fascinating and although congress. i want to thank again the doctors for being with us today.

i want to say the cdc obviously plays an incredibly important role in the interface between science and the american public to a large extent. the american public looks to leadership and the cdc to be grounded in science. i'm glad to hear government will not get involved in vaccine passports. there is no data that would contribute anything. there is no data. it might, and it might be temping to think it would, i used all the hand cleaner in the world. that is not as important as we thought. there is a difference between making someone carry a vaccine passport and making somebody use hand sanitizer. i think this is where the

difficult he lies in public health, and treading that fine line between what really will help people, and recognizing that there are civil liberties in this country. i'm more than happy to help staff vaccine clinics, and i have done it. but it is an individual choice to get the vaccine because it is not fda approved. i encourage the vast majority of people i speak to to get it, but it is their decision, and the cdc has taken a tremendous step in the mask mandate guidance rules for people with vaccines. i think that engenders a lot of confidence in americans. a lot of americans say, my common sense is, i got the vaccine, i should take my mask

off. and now our policies are aligned with that. i think that is why we are approaching the 70% mark of people being vaccinated, and that combined with natural immunity, we should be near herd immunity, and that is what the figures are showing now. thank you for the work you do, thankless work as you pointed out in your testimony. public health officials are underpaid look tipped to their skill and training. this leads to some problem, there is no easy solution. the budget will get us in a better path with what we need for the 21st century. thank you for a fascinating hearing. i yield back. >> i want to thank dr. harris for his comments, and i think i

agree, not in a self-serving way, but this subcommittee has the best hearings, and between yesterday and today there really is with what we learn at both the nih and cdc can do to save lives, keep people healthy in this country is quite remarkable. it is a hallmark of the united states in terms of our health care system. i will ask, what keeps you up at night? dr. schuchat: a concern that people will not get vaccinated, and we are not serving everyone in the country fully. dir. walensky: i think we have to or the world is getting

better. there are many at risk. until we are out of this, none of us are out of this. >> thank you very much. i think we covered some important topics today. historically the cdc has been the trusted voice in leading the response to public health crises. ebola, zika, lead poisoning and so many others. we saw a recent departure from that standard. i want to say a real thank you to both of you and the cdc for returning the cdc to be that trusted voice, relying on the science and the data that is necessary to create the confidence in this country that we have in the agency that they

can take a lead from. people want the truth and need to be given the truth. we can look to how we can direct them. i would add covid exposed a number of realities in this country. we cannot go back to where we were, and we have to go forward. we look forward to receiving the comprehensive budget later this week. then the subcommittee has the challenging task of addressing critical issues included in your bill. it is remarkable the range of issues you look at. we talked about some of them today. you do so many other things,

immunization, mental health, opioids, hiv -- and doing all of that work while at the same time dealing with the pandemic. we want to provide the resources that you need, and will continue to fight for that sustainability that i think has come through in this hearing today. for the cdc to do the job we want them to do, you need to have the continued resources, not just for this pandemic but for whatever else comes to pass for this >> sba administrator isabel guzman testifies friday. watch the committee at 10:00

eastern on c-span. online on c-span.org. go to c-span.org/coronavirus for the federal response to the pandemic. if you miss live coverage, it is easy to the latest things in the biden administration's response. >> senate republicans are negotiating with president biden on the cost of an infrastructure bill. they laid out their plans at a news conference.