h1n1 influenza. let me just start by saying the administration is taking these challenges very seriously. in fact, the night i was sworn in on april 28, i went immediately to the situation room because this virus was just breaking out. from day one, this has been very high on my á@@@@@ sn @ @ @ @ @' dv

declared, it's also presented itself as the dominant flu strain in the southern hemisphere during the winter flu season. here in the u.s., we continue to see h1n1 flu activity over the summer, which is unusual, and as a number of you have already noted, it has increased now that the fall is under way. we are anticipating further increases in flu cases as seasonal flu begins circulating among us. we have provided, mr. chairman, each of the members with an update that's at your seats with some more detalsz on the current situation, including a situational update that's on, i think, the third page of your handout. dr. ann shooket from the centers of disease control is with me today, and cdc gives us these situational updates on a daily

basis, and we wanted you to have the newest information. although evidence to date shows that the virus has fortunately not changed to become more deadly, what we know is influenza is unpredictable and we need to monitor both the impact of the 2009 h1n1 and season al flu throughout the next several months. the virus is affecting more people than we typically see, including children, young adults and pregnant women. and slowing the spread of the virus is a responsibility shared by all of us. chairman ameritus dingle already said there are some simple steps, washing hands, covering coughs and sneezes and staying home while you're sick is the

big step. www.f www.flu.gov has some steps to help prevent it. on that web site, flu.gov are widgets, if any member of congress want to put a widget on your own web site so your constituents can monitor on a daily basis, see the regular cdc guidance, we would strongly encourage you to do that. if i'm speaking in technospeak, a 12-year-old can be hired easily and tell you what to do with a widget. my recommendation -- oh, i apologize, ranking member barton, i should have started with a happy birthday. you'll find the 60s will treat you well. it's a good place to be. to date the cdc has issued recommendations on how individuals, skoolsz, child care

services, universities can guard against the flu as well as the appropriate use of anti-viral drugs. all of those are on the web site and can be downloaded and shared with constituents and groups if you're going to have some meetings at home. guidance on infection control and worker safety and health care settings is forthcoming in the next few days. as i announced, this weekend we plan to initiate our h1n1 vaccination program in october. mid-october is still the target for the large-scale campaign to get underway, but we anticipate having limited amounts of vaccine available a week or ten days earlier. i'm pleased to report that today the food and drug administration has approved applications for vaccines for the 2009 h1n1 virus from four of the manufacturers

of the u.s. licensed seasonal influenza vaccines. the vaccines for this virus are being produced under careful fda oversight using the same licensed manufacturing process used in facilities used for seasonal flu vaccines that are provided every year to protect millions against the flu. and in response, mr. chairman, to your point, seasonal flu vaccine is now available widely in sites around the country, and again, we are urging people strongly, particularly if they're in the target population for seasonal flu, to go ahead and get the seasonal flu vaccine right now. we recently just last week had good news from studies being done both by nih and manufacturers. a single dose of the vaccine rapidly introduces a strong immune response in healthy

adults. we think that age group could go down as low as age nine, but the clinical studies in children and pregnant women are still underway, so we don't have the full data about whether children will need two doses or not. they do in seasonal flu, younger children. we're still waiting for those results to be back. and, mr. chairman, originally we thought that it would take up to 21 days for the immune response to be robust and it's showing up in eight to ten days. that's very good news. so one dose, eight to ten days for most of the population above age nine, we think, is a very positive step forward. the trials in pregnant women are underway, as i said, and in children, and our expectation is that the vaccine will be a good match in protecting against these populations as well. once ready, the vaccine will be

shipped through a central distribution system and available in up to 90,000 sites around the country. every state was asked to develop a plan and identify the appropriate vaccination sites. our contractor is shipping directly to those sites so there is not a glitch along the way. two types of vaccine: a flu shot made from inactivated virus and a nasal spray made from live weakened virus will be available free of charge, though some providers may charge an administration fee. and again, congress did authorize funds at the time of the supplemental bill to cover some of the costs, and the department of health and human services has expended on top of

that about $1 billion in our funds to get that process started before the supplemental funding was available. cdc's advisory committee on immunization practices recommended that initial doses of the h1n1 vaccine go to people with the greatest risk of complications from the flu as well as those who have frequent contact with those at risk. we're working with states, territories, tribes, local communities as well as the private sector to help distribute and adminster the new h1n1 vaccine. thanks to congress, we've allocated $1.44 billion for states and hospitals for planning and preparation. the nation's current preparedness is a direct result of the investments in support of the congress and the hard work of the hhs agencies and state and local officials across the country both recently, but certainly over the last several

years. so we look forward to continuing to work with congress in the weeks and months ahead. again, mr. chairman, i thank you for the opportunity to participate in the conversation, and i look forward to taking your questions. >> thank you very much, madam secretary, for that update. there are many members here, because this is an important hearing, and i know you have to leave in a couple of hours, in order to accommodate the members, what i'm going to do with mr. barton's assent, is ask each member to ask one question. we will put the timer on three minutes, but we would appreciate it if members could ask just one question, but no more than three minutes. mr. barton, is that -- >> yes, and i want the minority members to know that i support this. in fact, it's my recommendation, there is a precedent for this. other cabinet secretaries that have been before the panel, we have adopted this practice. i think it's fair so that the junior members have an opportunity to ask a question as

well as the senior members. >> thank you, mr. barton. i'm going to start off the questions with a more junior member to me, mr. marsie. >> thank you, mr. chairman. one of the real questions that people have is the safety of this drug, and there was a real concern going back to 1976 and that swine flu epidemic and the diseases later associated with the distribution of that drug. so just so i can understand this, this drug has not yet been fda approved; is that correct? >> it just was licensed today. >> it was licensed today. that's great news. can you talk a little bit about what is different -- what the difference is between this drug

and the drug back in 1976 in terms of what the fda and the agency believe will be the impact on americans? >> well, mr. markey, one of the first steps the president took was to actually gather the experts from 1976 together and ask for advice about what went right and what went wrong. and we had an opportunity to meet with everybody from the then-secretary of health and environment to the surgeon general to some of the scientists who were involved, and they gave some very good advice. the principal difference may not have been in the manufacturing of the drug but the fact that the flu never spread, so that the outbreak that was initially identified among about 200 soldiers in fort dix never went anywhere. so a massive vaccination

campaign was launched. about 40 million americans were vaccinated, yet there was no flu, not in america, not anywhere. so we are in a very different situation today where we know this virus is spreading, and this vaccination -- vaccine is actually being manufactured exactly like the seasonal flu vaccine. it's showing up in the same way, and it's using the same processes and procedures, so in terms of the safety and efficacy, while there are clinical trials under way to determine the right dosage and, really, the efficacy of the vaccine, is it hitting the right target, there have been years of clinical trials and lots of data gathered on seasonal flu vaccines, so we are assured by the scientists that lots of steps have been taken along the way to make sure that this will be a safe procedure.

there has been more oversight than in '76. bett better, made somewhat differently, less oversight in testing and quality. we do not anticipate the same problem. if it was a different problem than seasonal flu, we would have more concerns, but it is similar. >> madam secretary, i may have questions for the record, but my one question is something you may not be aware of. i was briefed this morning by officials from texas a and m, which is not in my district but it is the school that i went to. they have developed a -- if i understood them correctly, a vaccine that is made from hydroponic tobacco that they can produce up to 100 million doses very quickly if necessary. are you familiar with that, by any chance?

>> mr. barton, i don't know about that vaccine. i do know that tobacco is one of the growing agents looked at as an alternative to the egg-based vaccines, but i don't -- >> if i were to get the researchers to touch base with your staff, would you all be willing to be briefed about that program? >> sure. absolutely. >> thank you, mr. barton. mr. dingle? mr. dingle had to leave. mr. palome? >> thank you. madam secretary, i'm concerned about emergency room hospital capacity, that kind of thing. there was a report issued last month by the president's council that advises on science and technology that said there could be as many as 1.8 million hospitalizations in the united states during the epidemic, and of this 1.8 million, up to 300,000 could require intensive care untsz and those patients

could occupy 50 to 100% of all icu beds at the peak of the epidem epidemic. even without the epidemic, the icu usually operate close to capacity in my district. so with regard to the nation's hospitals, do we have the capacity to meet this potential

washington, d.c. and get a sense of what they're doing. so there have been recent dollars put forward but also dollars over the years to have that planning go on for surge capacity. we are concerned that we also try to get information to the public as rapidly and as clearly as possible. the worst of all worlds is to have everybody show up at the hospital or come through an emergency room door. the vast majority of individuals who get h1n1 so far are not terribly ill, do not require additional treatment and certainly don't require testing to see what kind of flu they have. so that we're trying to assure people the flu is the flu is the flu right now. cdc will continue to test through hospitals and other areas, those who are getting

seriously ill so we can monitor the cases, but the testing isn't required. so we have resources to hospitals, we are helping with systems that will put in place additional medical capacity, everybody from the medical reserve corps to additional personnel who we can help with assistance. so we don't think at this point that the presidential advisor's scenario is the most likely scenario to happen. we watched the southern hemisphere very closely and what they have done with surge capacity, and we'll learn a lot from them, but they had no critical emergencies that weren't able to happen without shifting some space. so i think at this point we're doing everything we can to get people ready and provide for some alternative, but part of it

is to diminish, hopefully, the strain on hospitals by encouraging people to go to the web site, call their health care provider and urge them to take steps that they would with the regular flu. >> thank you, mr. palone. mr. deal? >> will the distribution of the vaccine be sent to the states and the states will determine where it will go to within their states, and will there be a determination of how much goes to each state and what will be the factors that will be looked at in determining how many doses a state would be allocated? >> the distribution is based on a per capita basis, and states absolutely develop their plans, working with their emergency personnel, local health departments and others to determine the vaccination sites. so again, the distribution contract is not going to go to

one central site in a state as the traditional vaccine. it's going directly to the sites that have already been predetermined. states were asked to send plans to the cdc. part of the resources by congress helped with that planning effort, and the contract will be up to 90,000 sites determined, so it will be some traditional, you know, providers' offices and health clinics and hospitals but also a number of nontraditional sites. >> could i ask one brief question on that? that per capita amount, is that determined by who the cdc thinks should be eligible for getting the vaccination or a general per capita? >> it's a general per capita amount in terms of how it rolls out. we will have enough vaccine available for everyone. there is enough on order. we're looking now at the reorders for the one dose versus two -- there will be enough vaccine. what we're concerned about is

getting it to the priority populations as quickly as possible. that's what we've asked the states to focus on, how to get, you know, pregnant women, children under the age of 24, care givers of infants, health care workers, how to make sure that those folks get to the front of the line, if you will. >> thank you, mr. deal. mr. greene? >> thank you, madame secretary and i've read several articles in the media indicating administration supports voluntary school-based vaccination to protect our children from, h 1 n 1. i'm a co-sponsor along with my colleague from pennsylvania mr. murphy with a pilot program. it would allow hhs to per terrible multistate demonstration process to test the feasibility of using schools as an influenza vaccination center in coordination with

school nurses, school health providers, insurance companies, private state insurance agencies and private insurance. i'm pleased bill is part of hr 3200. would the administration support a voluntary multistate school-based seasonal influenza and h1n1 vaccination program such as was created in hr 2596? let me say that that version, i know senator reid in the senate is looking to do a national version of that particular provision. >> mr. green, what we're going to have is a demonstration, national demonstration project of the bill you just suggested. going on in the next couple of months. certainly our leadership at the centers for disease control feel strongly if we're successful as using schools as partners in vaccination that that may be a great way to enhance the

vaccination takeup rate going forward for seasonal flu and other issues i'm old enough that i was part of the group with the early polio vaccine and we got that vaccine in school. that was always a partner. we have school districts eager to be vaccination sites and are standing by to do that. we'll know a lot about your voluntary program and we think it probably will be a very good idea. >> being part of the sugar cube generation, also, that i think this important, again, it needs to be voluntary. but we can't have a great deal of more coverage by dealing with our schoolers, our center and our community and we're talking about our children. >> given the age group this virus is targeting we thought schools and actually daycare centers and others are very appropriate outreach sites to reach the population who we need to reach, so working closely

with the secretary of education and his counterparts, superintendents and governors and i think most governors are very enthusiastic of having the schools be voluntary vaccination sites. >> thank you, mr. chairman. >> thank you, mr. green. mr. murphy, you'd be next. >> thank you, mr. chairman. a pleasure to have you here madame secretary. thank you for your work you're going on health care, too. as part of this i'm assuming part of the aal yis you did with this virus, the impact it would have overall on our america's health care system including the costs, one of the issues this committee is trying to grapple with, as you are s the cost of health care in america. we have an -- time getting information that has to do -- therefore, i'm wonder if your office has gathered some invest, analyzed that as this, for example, as these vaccinations

are advanced out there earlier, what we are saving and what is this overall that comes from, yes, the government is spending money to move these out there, but what is the impact on saving money? saving health care costs and i wonder if you have that information. if not, could you get it to us, because this committee really would like to have some of that, if i could say so, mr. chairman. >> mr. murphy, i will certainly look to see what kind of cost effectiveness or strategies we have put together. i'm not sure -- i think we can tell you probably and gather it for you, the cost of what happens with seasonal flu every year. the 200,000 hospitalizations, the 36,000 deaths, you know, what the impact is. i would suggest, though, what we don't have is then a huge sort of social cost. one of the projections absent a

vaccine of this virus spreading even in a relatively mild case which would be 200,000 hospitalizations, 36,000 deaths, that's what seasonal flu looks like every year. if you have a widespread part of the population who misses work, what the impact then is on businesses and trade. whether you can even do continuity of businesses if you have essential workers missing. part of the issue about schools is what happens if half the teachers are sick or how do people go to work if half the kids are sick? so i don't know that we have added those costs but we can try to put together some information for you. >> i would appreciate that. it is a type of modeling which we don't have. not only in terms of scenarios of analysis, now we have something very real we anticipate it could have an impact on workforce, education, as well as direct and indirect medical costs. i'd appreciate if you get that to us. thank you, mr. chairman.

>> thank you very much, mr. murphy. i want to call on miss harman. >> thank you, mr. chairman. thank row for holding this hearing and thanks to a very cape l former governor and very capable team for putting in place a plan to prepare, not scare the public. i want to commend you on the tone of this, that has overcome the original hysteria that met the early stories about the effect of this illness. so thank you very much. my question really is taking this to the next level or, perhaps, to the next problem. is this basic set of protocols we now have in place and the public pitch that we are making quite effectively about this strain of flu, will this be -- could this be applicable to, perhaps, a pandemic that's more

severe, a possible biological attack in our country, or other huge health challenges that might arise? and if -- if this set of procedures and protocols and tone that we're using is not applicable, what steps can you take now to be sure it does -- we are -- we are able to adapt it to future problems we don't presently anticipate? >> i think that's a great question, and no question about the fact that congress working with the prior administration put in place steps, really, that have been executed over the last six or seven years of not only resources that have amplified efforts within the deparent of health and human services including, you know, our own vaccine development operation, enhancements to nih and centers for disease control and fda, but certainly resources at the state

and local level and a lot of planning. as a former governor, we went through pandemic planning. i never dreamed i'd be sort of here with a pandemic, but we called together efforts over the years. so i think at a minimum what is happening over the next several months will enhance our entire public health infrastructure. having hospitals look at the spring where the gaps were, re-double efforts to get ready for the fall is enormously helpful, how they direct resources. looking at workforce issues, how to get, you know, vaccinations to people. a huge challenge and is an ongoing challenge is just information. how to make sure folks can access timely, accurate information in a very transparent fashion and walk that balance between complacency and panic but get people

prepared and ready. i don't think there's any question what we do over the next several months will significantly prepare us for whatever challenge is next. whether that's a natural disaster or manmade disaster, infrastructure strength, communications strategies, working with the partnership not only throughout government but in the private sector is enormously helpful and exactly what you go through region by region. we just haven't done it nationally, really in 40 years. >> thank you, mrs. harman. ms. blackburn? >> thank you, mr. chairman and madame secretary, thank you for taking the time to come and talk with us today. i am pleased that you are here and i don't envy the task in front of you. i know it's going to be a rough flu season from what we're seeing and hearing already, and i do think the free flow of information is going to be an imperative as we try to handle this with our districts, with schools, with public events that

are taking place. you've testified before our committee twice and the first time that you came, we were working on the health care reform bill and now we're looking at what could end up being one of the -- it's significant to our constituents as the impact of that health care reform bill. this is a public health situation that we know is going to be in front of us to deal with this event. now, when you were here before and we talked about the issues dealing with -- with health care, we talked a little bit about the ten-care situation. i asked you about some of the issues that were there. your responses took a while to get to me, they were a single sentence, and that prompted another question and i just received the response to those

today. so i do thank you for getting those. but i -- i do ask that as we move forward that knowing that this is going to be critical that we have timely and accurate information, that we do have that freeflow of exchange as this public health issue effects our districts and maybe a little bit more timely than the response to the questions which was a little bit kurt and inadequate and bordering on disrespectful. i do want to say thank you for the widgets. i appreciate that those are on your website and that we can link to those and i do want to ask you, as we're talking about the supplies and the supplies being let to the states and you mentioned those that are most vulnerable to the flu. are those, the physicians and the care givers that are going

to administer the flu shots, do they have a ranking or priority system or will the states work that out? are thaw going to take seniors and pregnant women first or can you give that guidance on that protocol is going to be for who gets to go at the front of the line? >> congresswoman, we have not tried to determine for states the most appropriate way to get to their target populations. we thought that was a local and regional decision. we have done a lot of work with the provider community, outreach directly to ob-gyns, outreach to primary care docs, health clinics with health infrastructure. states are submitting plans based on their own determination, region by region, area by area, how best to target their vulnerable populations and that's where the vaccine will be -- >> so our best response to those

populations when they call our office is consult your local physician? >> in terms of where to get the vaccine? >> and who gets priority. >> well, their local physician won't be determining who gets the priority. again, the state health department has determined that, and that information should be available right now. there will be vaccine for everyone. >> gentlewoman's time -- >> it will roll off the line simultaneously. the state redetermined where the priority areas are. what sites should get it. >> thank you. >> thank you, gentlewoman from wisconsin. ms. baldwin. >> thank you, mr. chairman. thank you, secretary sebelius, for your testimony. encouraging news in terms of the hope that one dose will be sufficient, that it will be getting the desired immune

impact within eight to ten days and that you think you'll have sufficient dosage for everyone starting with priority targets. i have a few questions, very short questions related to that vaccine, the vaccine issue, and then in follow-up we'll submit written questions on strengthening our public health system addressing work force shortage issues. but on the vaccine, three quick questions. of the 195 million doses ordered, is the hope that you can reach everyone through use of that that you've also ordered. tell me a little bit about the adjavant during this season. second, i know we had shortage of seasonal flu vaccine i think back in 2004 when there was closure of production facility in the uk. we did not have a lot of domestic manufacturing capacity

at that point. i believe that has changed. i wonder if you could tell me of the five manufacturers that we're working with for these doses, where their facilities are located domestically versus foreign. i believe you announced in your testimony that four out of the five manufacturers have been appro approved today by the fda. what's the status? is there any reason we should be worried? >> no adjavant is currently anticipated to be used in the united states at all. there are some backup plans if things took a terrible turn for the worst. we have never used in any widespread area an adjavent of vaccines. the scientists strongly recommended we not head down that path and this time. the current purchases are likely to be enhanced to get to the point, what you've reported is the initial purchases, but as we

see the takeup rate, as we get the rest of the clinical trials we will make the purchases based on what is anticipated the takeup rate is for 300 million potential users. as you know, 100% of the people will never get vaccinated for anything, unfortunately. we currently have five facilities in the year that we ran out of vaccine there was one. and -- i'm sorry, we were down to one. there were two bullet one wt on debilita debilitated. i can't tell you right off the top of my head where they are. what i was told yesterday by the vaccine committee, we fully anticipate all five will be licensed. there were final steps needed to be taken in the final contract. >> on the domestic production and vaccines being made in america, i remember particularly telling hearing during the last administration where if we were

having a particularly variant pandemic, the perception was if we were not manufacturing it here in the u.s. it wouldn't be valuable for us in the u.s. >> gentlelady's time. gentleman from georgia. mr. gingrey. >> madame chairman, thank you. madam secretary, thank you very much for being with us again, let me just say at the outset that your efforts along with those of secretary janet napolitano when, way back i guess in june/july when you were getting confirmed, i think you've done a great job. no question about it. i don't think anybody could ever accuse you about being katrinaed on this issue. you've got b a lot of money appropriated toward this effort. my only concern back then, a little bit lesser now, was the

issue of greating a pandemic of fear. i mentioned that to you and you have already addressed that in your testimony, but i want to ask you about particularly -- particularly about pregnant women because that was what i did in my previous life as an ob-gyn physician and i have three adult daughters and a daughter-in-law and nine grandchildren, daughter-in-law just had a baby three weeks ago. >> congratulations. >> thank you. thank you, madame secretary. very concerned was she, though, about this issue of the swine flu and what should she do and that sort of thing. questions about what if she got it, what would be the risk to her, especially in the third trimester as she was then. and what was the risk to the fetus? and i think that we need to get more information. i noticed on web md, a recent

printout from web md, july 29th, 2009, it says, pregnant women even if they are healthy are at high risk of hospitalization and death from h1n1 swine flu, the cdc reports. now, i would like for you to answer that question. are they -- i know they're increased risk over the general population and there are certain issues with decreased lung capacity and not as vigorous immune response because of their pregnancy. it does put them at higher risk than the general population of women, but are they at high risk of hospitalization and death? i think the answer to that is probably no, but comment on that if you will. >> congressman, what we saw in the spring is that pregnant women constitute about 1% of the population. they were 6% of the

hospitalizations and deaths that occurred. a significantly out of kilter population and previous -- with no underlying health condition other than the pregnancy. we're not talking about somebody who had diabetes going into pregnancy or someone with chronic lung condition. >> yeah, definitely at higher risk than the general population, maybe as much as a factor of five. >> six would be the -- so in terms of the outreach we have tried to be -- and that was not only the u.s. data that's showing up around the world, but, again, pregnancy seems to be in and of itself an underlying health condition that significantly enhances the risk, so i know that for a lot of pregnant women, i certainly did this myself, was reluctant to take anything during the term of the pregnancy, but on talking to a number of ob-gyns, looking at

the data, talking to the scientists, there's a great belief that the risk of any sort of event occurring because of the vaccine far is outweighed by the risk that occurs without being vaccinated. in your daughter's case, a new mom, baby's under 6 months old are not recommended for the vaccine. so another of the target population is care givers of infants six months and younger to try and protect the infants. >> madame chair, i realize my time -- can i do a real quickly question? maybe we can do a second round. i yield back. thank you, madame secretary. thank you. >> thank you madame chair and thank you madame secretary for being with us here today, again. in states and cities across our country, local public health

departments are getting decimated by budget cuts. in my hometown of sacramento, the public health department has had to cut 17% of its budget this year alone. these cuts mean in my district alone the public health department will be losing three communicable disease specialists and two microbiologists from a public health lab on top of losses in field nursing staff, bioterrorism preparedness workers and people who work behind the scenes every day testing samples for h1n1 virus and other communicable diseases. the one bright spot in the statistics is my local public health department will be able to retain some positions thanks to a one-time recovery dollars. what are their plans, do we have at cdc in the department at large to help public health departments cope with the huge responsibilities they're going to have soon and also, too, what

is the plan if the virus mutates sometime soon so we have a greater endemic emergency? >> well, congresswoman, part of the planning effort has certainly been to recognize that the situation you're describing in california is nationwide. that public health agencies have been severely hampered by the budget cuts so the resources, the $1.4 billion which was pushed out, hopefully will help enhance that. we've also reactivated the commission corps, the energy group of retired medical providers and volunteers who came together after 9/11. they're now about 200,000 strong tlouts the country, registered in every state and kind of put them on notice to help with the vaccination efforts and have

them call -- able to be called upon. we do have our commission corps of health workers who, again, can be brought in to supplement some of the state-based efforts, but every state as they submitted plans to the cdc recognizes part of the challenge in dealing with this is a restricted core of personnel, of trained personnel. again, we're not urging folks to continue with the testing protocol. that was important early on to determine. right now we're just moving more to the vaccination and mitigation phases to try to just diminish the circulation of the flu. some of the earlier activities hopefully will be shifted into the vaccination effort. >> gentleman from louisiana. >> thank you, madame chair. secretary sebelius, appreciate you coming before us. since all my colleagues asked the questions i had regarding

the h1n1 situation, concerning last week's testimony, the president's address to the joint session of congress, there were some things that it said regarding, i guess, the new developments on the health care debate. since the bill that passed out of this committee, the congressional budget office tested it would add to the debt. and 8 million illegal aliens would have access to the government's plan. the president said he wouldn't sign a bill that would add to the deficit and wouldn't allow illegals. would you support changes that would be necessary to make hr 3200 comply with those two initiatives that president obama stated before the joint session to make sure that the bill doesn't add to the deficit which right now it would add and to make sure illegal aliens wouldn't have access to the government plan? >> congressman, i'm pleased to have any number of discussions

on health reform and i know it's a top priority of the administration and i'd be pleased to come back and do -- the chairman ask this hearing be on h1n1 and i would like to defer to that. i don't know -- >> i mean, we've never had the opportunity to ask you. your only testimony it us was at a time you acknowledged you hadn't looked at the details of the bill. really we're not going to have another opportunity i know of to talk to you, personally, about the concerns we have that are in hr 3200. >> would the gentleman yield? would the gentleman yield to the chair? >> i would yield, yes. >> i would advise the gentleman on behalf of the chairman that he does intend to have further discussions and meetings and hearings and the chairman really has asked the secretary to come and be prepared today to talk about the h1n1 situation and i think it's, you know, obviously

members are allowed to ask any questions they'd like, but i think the secretary's really prepared on that topic today and i can communicate to the chairman that he should have the secretary back. i know she's willing to come. >> i mean, i appreciate that. the problem we have is that these substitutions are ongoing every day. there could be a bill on the house floor. we don't have any assurance we're going to have a hearing before a vote occurs. i would imagine the secretary's well-versed in these issues because i know you were in the joint session with us last week in the house chamber when the president made those firm commitments. would no sign a bill that added to the deficit by a dime. would not support illegals getting access to health care. in the cbo testimony, cbo sat here in the chair you're sitting in and said 8 million illegal alien yns would have access to the plan you supported and said it would add $239 billion to the deficit. i'm sure you understand those issues. you were there at the speech last week. i'm sure you have ideas of how we can fix that.

we've got ideas of how we can fix those problem problems. would you support the fixes that would be necessary for the bill the president said before congress? >> as a recovering legislator, i'm reluctant to sign off on legislative language. i would be maep to look at it to see if i could support it. i support what the president stated going forward that he will sign or not sign a bill. i think you can -- >> right, we presented -- you weren't here i know, but we presented some of those here to fix those two problems. >> if you'd send me that language, i'd be delighted to take by it. >> i'd like a commitment by the acting chair we could get the secretary back before a vote is taken on the house floor. >> gentleman's time is expired. i did give him extra time because of the come comequestion. i know we could work with the

secretary. with that i recognize the gentleman from michigan. mr. stupak. >> as far as the last gentleman, section 236 of the bill makes it very clear illegal aliens are not available to get health care under hr 3200. if you remember, the markup with us, the space amendment, schip and medicaid made it illegal, unanimously adopted by the committee, but so be it. let's move on to h1n1. states are expected to purchase a portion of the need needed to vaccine to protect our citizens. it includes a 25% subsidy from the federal government. a lot of our states are suffering right now because the economic downturn and may not be able to meet obligation because of limited resources. is there some kind of a plan available under dhs to help some of these states like michigan, california, others that are

struggling? i don't want anyone not to get it because of state budget concerns. >> congressman, through the resources that congress has provided and through the resources from the department of health and human services, the vaccine will be free. distributed to the states free. they are not expected to have a cost share. i think there has been a cost share associated with their purchase of anti-virals which are in the stock pile but not with the vaccine. the vaccine is free. there may be an administration fee by the provider but there is no fee to get the vaccine. >> what about the anti-viral then? >> states have purchased anti-virals over the years in a stock pile. those are being pushed out as we speak. the department is continuing to replenish that stock pile. >> no states smould have to worry about not being able to afford or acquire the anti-virals? >> that's right. >> it's traditional flu season

and people are getting their shots. is there some kind of waiting period they should have before getting the seasonal flu and h1n1 flu shot? >> well, again, since we don't anticipate the real supply of h1n1 until october 15th, we're saying people get it now. it's my understanding the clinical trials under way right now are looking at whether or not there is any harm to simultaneously getting the flu shot. as we get closer to october we'll have that data available. >> let me ask you this. i'm from northern michigan and we share border with canada. we go back and forth daily. we're doing a lot of preb ration on this side. is there special situations given to border communities? what are they doing with those countries? places they're moving back? we have a much more robust program in this country. i haven't seen the same in canada, especially canada. >> the department of homeland security looked calfly at that

issue and scientistic advice during the spring and it was determined since there was already a robust outbreaking of h1n1 already within our borders that border closings really would harm commerce potentially but not really help with the disease outbreak. so there is no anticipation at this point to do anything with our northern and southern -- >> i don't want to see a border closing. are you coordinating with other country, canada, in particular, to make sure we're doing the same things? education programs? >> there has been a lot of national and international discussions and particularly with canada and mexico. that has been under way since the early spring and we'll continue. >> very good. >> gentleman from oregon. >> thank you, madame chair. i appreciate the chair's commitment to have the secretary come back before the committee, before we have a vote on the health care overhaul bill in the house. >> i don't have that power but i'm going to talk to the chairman who does have that power.

>> if you had that power you'd give us that commitment i know. i appreciate that because a lot of us share that concern. i also want to draw attention to the secretary to a letter that -- bipartisan letter mr. rogers, mr. gonzalez eni sent to you recently regarding the 2010 fee schedule on medicare as it relates to cardiologists and oncologists and proposed cuts that could be as high as 40% in some codes. if you haven't gotten that, i don't expect you to be on top of every letter that comes your direction, but if you flag that one we'd appreciate your response 37 i was reading a story in one of the papers coming out here yesterday from oregon, problem in the southern hemisphere related to h1n1 as it related to folks in the hospital trying to deal with those who are sick. they raised the issue in the story, at least, that the hospital workers, nurses, doctors, others, did not have a sufficient and early supply of

ma masks and other protective equipment to prevent the spread within the hospital setting. are you and your folks confident that in these environments where all of us who get sick are going to rush, that there is adequate whatever we call it, the materials, the masks, the protective equipment, the whatever, so that those we rely upon for our health care will in and of themselves be healthy in the process and not at an unnecessary risk? >> congressman, that discussion is actively under way. as i said, the guidance from the cdc is about to be issued. we -- the scientists have not been in complete agreement about the right protocol, particularly with the use of res praters going forward. the request went to the institute of medicine to do a rapid response study. they came back with a protocol which i would suggest is the

ideal case scenario, a respirator per provider for every patient seen. there are no adequate supplies to follow that protocol. >> so one new respirator for every patient. every time you see a patient the doctor or nurse would have to put on a new respirator? >> that's what the iom suggested. the stock piles in the country, the manufacturing capacity would not allow us to follow that protocol so right now we are working actively with osha and cdc and the health care providers to develop a protocol that actually is more in fitting with what the supply looks like because iom was told not to take into account what's available or what could be available over the next six months. unfortunately the reality is we've got to look at what's available, so that discussion is actively under way. >> on that topic, the vice president said at one point, probably regretted it, he

probably wouldn't put his family on an airplane, et cetera, et cetera. i was on an airplane yesterday and the person behind me was coughing. i directed the air filter to flow backwards. what advance and counsel do you have for all of us -- i realize we have to cover our mouths and all. if you're on the other side of that, should we be wearing those kinds of protective face masks when the outbreak comes? is that going to be helpful or is that just overboard. >> what i've been told by the scientists is that probably not. masks are really not -- if you are in a caregiver capacity and in a home situation coming in close contact is may provide some protection. basically, no. and if you -- if this continues to present much like seasonal flu and, you know, a number of people get hospitalized with seasonal flu every year, we

don't have that kind of rigid, fitted mask protocol under way. so we're trying to balance safety and security. what's most alarming and i think all of you would be great to help with, health care workers right now don't get vaccinated. less than 50% of health care workers ever get vaccinated for seasonal flu, though there are priority groups for h1n1. we're afraid that rate may be the same. i would say that's step one, take advantage of the protection that's there with the vaccination. both with seasonal flu and then with, you know, the h1n1 vaccine. they're at the front of the line and we would hope that they do that. >> gentlelady from the virgin islands, miss christianson. >> thank you, madame chair and madame secretary for being with us again today. individuals 25 to 64 with underlying medical conditions

such as asthma, diabetes, groups, for the forth coming vaccine. racial and ethnic minorities are disproportionately affected by these. more, your clinical trial, are the people in the clinical trial, what outreach has been done that is culturally and linguistically appropriate to reach sometimes hard to reach populations often with poor public health infrastructure to ensure they get the adequate prevention, treatment and so forth? >> the clinical trials, it's my understanding, are diverse and we're aware of the concerns that have been raised in the past. again, a lot of the trials under way are specifically about dosage because the clinical trials have been done for years on seasonal flu which deal a lot

with outcomes. the challenge of communication and outreach strategies is one that we're taking very seriously, so tradition media's being used, nontraditional media, ethnic-specific media, translating everything on the website into spanish, into vietnamese automatically then other languages can be requested as needed. looking at a variety of media outreach that reach nontraditional community, working with the faith-based and community -- >> a lot of these communities are also not connected. >> right. so we're using the faith-based groups to connect. for the younger population, it's an equal challenge, so facebook and twitter and espn has agreed to become a partner for the scrolls they put across college dorms. we have