Fauci Testimony — Senate HELP Committee (CHRG-117shrg46765) (Part 2 of 2)

because what you—so much of what you say is patently not true. I have to wear a mask when I am outside and the wind is blowing at 20 miles an hour. That has been changed, but it was only changed recently. They seek not to believe those things which are true. You have got to realize. You have got to be more real time.
Let me finish with this. I think—I do not know if it was the Stat
article or the New York Times that pointed on the HIV epidemic. The recommendations were much more kind of calibrated to real life. Listen, we know people are going to do this. If you are going to do it, please accept this recommendation.
This is a blanket. Walk outside and wear a mask. You are vac-
cinated and everybody else in the room is vaccinated, but you are wearing a mask.
The American people have just lost patience with us, with you
guys. I just ask you just kind of be aware of their frustration and get a little real time into updating these things.
49
I am sorry to be so frustrated. I respect you all and thank you
for your service. I yield back.
The C HAIR . Senator Baldwin.
Senator B ALDWIN . Thank you, Madam Chair.
Dr. Walensky, as I led the effort to ensure that the American
Rescue Plan included funding for CDC’s work to address variants
of the coronavirus, specifically through genomic sequencing. I am really encouraged to hear from your testimony that we are now se-quencing 10 percent of our Nation’s weekly cases, and this is up from about—well, less than half of 1 percent in February when I introduced my Tracking COVID–19 Variants Act.
A couple questions about what we are finding. Last month, the
White House announced that it would provide initial funding to ju-risdictions so that health departments could conduct, expand, and improve activities to sequence genomes and identify mutations of the coronavirus. I would like to have you describe how health de-partments are making use of this funding and how this investment will improve our response to future public health threats. But, also, any new variants that we should know about that—particularly anything troubling from the perspective of eluding the therapeutics and vaccinations that we have produced?
Dr. W
ALENSKY . Thank you so much, Senator. I am—we are so
grateful for those resources and our ability to scale up. As you note, we are now sequencing about 35,000 virus samples per week. That is a broad collaboration with commercial labs, with public health labs, with academic partners, and then with public health labs sending samples to CDC so we can address them more completely.
In terms of moving forward, I am looking forward to bolstering
the infrastructure to be able to do these sequences at the local level; to producing the infrastructure within CDC to be able to fol-low these in a pandemic-related way, not just for this pandemic, but for future public health threats; and then, further, to expand our ability and our workforce in genomic sequencing and analytics and bioinformatics to be able to not just address COVID–19, but these are longstanding things that we are going to need to address antimicrobial resistance and other infectious threats.
Thank you. Senator B
ALDWIN . Thank you. Last week, the Administration an-
nounced support for the waiver of intellectual property protections on COVID–19 vaccines to help end the pandemic. I believe that this news is the beginning of our work to restore America’s public health leadership on the world stage. But, there is more to be done when it comes to addressing COVID–19 worldwide.
Dr. Fauci, can you explain how increases in new cases of
COVID–19 worldwide threaten the progress that we have made here in the United States? And how can we avoid repeating history when it comes to combatting infectious diseases worldwide?
Dr. F
AUCI . Thank you for that question, Senator. Yes, indeed, as
we have said so often, and it is true, that a global pandemic re-quires a global response. And, even if we successfully vaccinate our population and get the level of infection down to a very low level, as long as there is a dynamic of infection spread throughout the world, any place in the world, there always is the danger that variants will be generated and ultimately will come to the United
50
States because of the travel that we know makes no place in the
world separate completely from any other place in the world.
That is something that we really need to pay attention to, and
it is for that reason that I keep saying, and many of my colleagues keep saying, we really do have a responsibility to the United States first. We do, for sure.
But, we also need to take part in an effort, whatever effort, and
it is going to be multifaceted effort, to make sure that the rest of the world contains the outbreak. And that could be from some of the things we are doing right now with India by giving them imme-diate help with oxygen and drugs and PPEs, but also to provide for the availability of doses of vaccine that we can make available to them. Not alone, not just the United States, but the rest of the de-veloped world.
Senator B
ALDWIN . Thank you. One quick last question to Dr.
Kessler. In its first few months, the Biden administration has sur-passed every goal and expectation it has set in terms of getting shots in arms. Because of this effort, we are moving into the next phase of our vaccination effort in which the focus is less on mass vaccination sites and more about meeting folks where they are to get shots to hesitant and hard-to-reach individuals.
As these vaccines come with certain logistical challenges and lim-
itations, including cold storage and use-by requirements, as well as specific numbers of doses in each vial.
As we shift to a more individualized effort, how will the Adminis-
tration work to ensure that we are using our existing vaccine sup-plies effectively and maximizing the potential—and minimizing the potential for wasted doses?
Dr. K
ESSLER . Senator, a very, very important question. Because,
as everyone on this Committee has recognized and has been part of this heroic effort, initially certain decisions were made on how to maximize the number of doses produced.
The decision—in order to get the hundreds of millions of doses
that we have already administered, we have had to make certain tradeoffs, and that is why you see the packaging the way it is, which is in a considerable number of doses, and we have to reduce that packaging.
But, every day, Senator, I am in awe of the contributions that
many of our local community health professionals, community lead-ers, ordinary citizens are taking to be able to bridge the barriers that people are having.
I would like to get this eventually down into very small indi-
vidual doses, but that is going to take time. And right now, we are going to do everything possible to speed that up.
The C
HAIR . Thank you.
Senator Murkowski. Senator M
URKOWSKI . Thank you, Madam Chair. Thank you all
for being here.
A lot of frustration this morning, and I think, as Senator Cassidy
mentioned, it kind of reflects the frustration that Americans have with where we are. We are all tired with COVID. We are done with COVID. But, as many have said, COVID is not yet done with us. But, how we are able to make sense of the guidance that comes out of CDC is critically important.
51
Alaska was very early on in making sure that the vaccine was
available to all very quickly, and, as a consequence, we are pretty
proud of the fact that our numbers of vaccination were strong and we were No. 1 in the Country. But, when you start out first, you also then are the forerunner in demonstrating what it means to really see this vaccine hesitancy, and we are seeing that play out in different ways and different shapes.
I appreciated your comments, Dr. Walensky, to Senator Smith
about the ways that we can address the concerns that have been raised, whether it is where can I get the vaccine, is it safe, who do I look to for guidance.
The State of Alaska did a survey that was released on Thursday
that indicated that people are not looking to you all for guidance. They are not looking to our chief medical officer in the State of Alaska. They are looking to see what their friends and their neigh-bors do. They do not care what their Senator or the folks from CDC do. So, we have a lot more work to be doing with regards to that.
I want to speak to my particular frustrations, which you have
had the benefit of multiple conversations with me, and that is how we can get our tourist sector back to work for even a small sliver of the season.
One point three million tourists come to the State of Alaska on
a cruise ship. There were 48 tourists that came to Alaska on a cruise ship last year. And, right now, it does not look much better.
We have been working back and forth with CDC, trying to deal
with these—this conditional sail order. After many months of re-quests, we finally get to a place where we think we have some guidance out there. I just, at 11:30, got new information that the CDC’s last traunch of guidance still requires additional guidance to be published. And, I say, yes, it is minor, but the fact of the matter is it is still yet one more gate that has to be gone through. Our reality is if you cannot get ships turned north now, there is no sea-son, whether it is for 1 week or 1 month.
I guess, Dr. Walensky, I am going to ask you one more time, can
you give Alaskans any guidance at all with regards to the ability to finally get this guidance fully resolved? You have cruise lines that are saying, we are going to require everybody be vaccinated. All of our crews will be 100 percent vaccinated. We will require that those who want to sail on our ships this summer be vac-cinated. Those in the communities who are welcoming them are also equally committed to the vaccine.
Should I just tell folks back home do not even bother ramping
up your seasonal operations because it is just not coming, we can-not get that guidance from the CDC?
Dr. W
ALENSKY . First of all, Senator, let me congratulate you and
Alaskans for getting vaccines into arms because you have been a role model in being able to do that.
With regard to sail, I was here in March. We were waiting on
2A guidance. That 2A guidance of working with ports has since
come. We have been now engaging, as I noted we do with schools, with our consumers, with our key stakeholders. We have had twice- weekly calls now with the cruise ship industry to understand what—how they are interpreting their guidance and what they
52
need in order to be able to get boats back in the water. That is our
goal for this season. Mid-summer was our goal.
2A has been released. 2B has been released. Our guidance on
how we get conditional—how we get trial voyages into the water, as well as Step 3 released, how you get conditional sail certificates. All three of those have been released.
They have—we have been in this dialog with the industry so that
we can understand what are the challenges in the current guidance that are hard to be met. And, we are actually having these con-versations and then going back and addressing those challenges. We had a dear colleague’s letter that went out after 2A, and we have others that are in the works.
We are working with those in the industry to do our best to get
ships back in the water this season, and we have actually agreed to a 5–day turnaround when those proposals come to us.
Senator M
URKOWSKI . Well, it was news to me to, again, just see
that there is yet another thing that has come up just this morning, so I would ask you to take a look at that.
My time is expired here, but I must raise this fishing mask man-
date. If you think about those mandates that really do not make sense, the fact that the Coast Guard is requiring, because they— it is Federal law out there that persons traveling on a conveyance or at a transportation hub wear a mask for the duration of their travel.
I have fishermen, commercial fishermen, that are out there in
the water. I have crabbers and salmon fishermen and cod fisher-men that are trying to deal with a mask because they are con-cerned about failure to comply. This is more of a safety hazard than anything else. You are out on a boat. The winds are howling. Your mask is soggy wet.
Tell me, tell me, how anybody thinks that this is a sane and a
sound policy to do. So, I—we have a situation right now where the fishermen are more concerned about the liability in failing to have the mask on rather than prudent marine safety protocols. This is absolutely, absolutely a crazy policy.
I just do not understand. I do not understand how we put our
Coast Guard men and women in a situation where they know that safety is at issue, a broader safety issue, than the fear of trans-mission when you are outdoors, in the elements, and you are now being required to wear a mask. So, I would hope that the CDC would reconsider this quickly, quickly, quickly.
Dr. W
ALENSKY . We are in the process of finalizing industry-spe-
cific guidance for exactly this reason. Thank you.
Senator M URKOWSKI . Thank you.
Thank you, Madam Chair. The C
HAIR . Thank you. We will turn to Senators Murphy, Mar-
shall, and Hassan. A vote has been called. I am going to go over to the floor and vote. Senator Burr will preside, and I will be back as quickly as possible. We will go to Senator Murphy.
Senator M
URPHY . Thank you, Chair Murray. Thank you all for
the fantastic work you do to protect the Country.
Just a quick word on this frustration you are hearing regarding
guidance from the CDC. I mean, listen, our witnesses today could sit here and claim that we have definitive information on risks or
53
means of transmission or asymptomatic transmission, but they
would not be telling the truth. We suffered through 4 years with a president who literally made things up about this virus; who sim-plified the story over and over and over again because he thought simplifying things and being definitive would make him look good, including giving free medical advice to Americans on what thera-pies they should take; making claims that the virus would dis-appear after a matter of weeks.
That was not good for the Country. It did not help us fight this
disease. We still have a lot to learn. And, so, I frankly appreciate the fact that we have leaders today who recognize that we still have gaps in information, who occasionally may err on the side of caution in order to save lives. And I share the frustration, but the frustration is rooted in the fact that we are still less than a year and a half into a virus that we are still beginning to understand.
To that end, Dr. Walensky, on this question of outdoor trans-
mission. So, Senator Collins was asking you about a paper you put out suggesting that it could be 10 percent of cases. There are other folks that say it could be 1 percent of cases. There are some epi-demiologists who say that it could be .1 percent of cases. That is a really important difference, and I assume the difference between 5 percent and .1 percent would likely educate decisions you would make about what recommendations you make to summer camps.
How do we, on this question, close the gap in information that
we have? Given that there are so many competing analyses out there of outdoor transmission, what do we do to try to make sure, especially heading into this summer, that we have the best infor-mation possible? How do we solve this problem?
Dr. W
ALENSKY . Thank you, Senator, for that question. I think it
is important for—to realize that we, at CDC, are responsible for putting out guidance for individuals, as well as for populations, for public health. We are responsible for putting out guidance for coun-ties that have less than five cases per 100,000 and for counties that have greater than 100 cases per 100,000, as well as for counties that have less than 10 percent of people vaccinated and counties that have more than 50 percent of people vaccinated. Our guidance has to be science-based for all of these situations.
In our last iteration of what vaccinated people can do, safely do,
we did update our guidance not only for not wearing masks out-doors, but also for not wearing masks outdoors in certain settings for people who are unvaccinated. In those situations, we also said if people are gathered with other unvaccinated people dining with their masks off and close by, there may be a risk to that if they are dining close by.
Certainly, this meta-analysis that was put forward that dem-
onstrated the top line result of less than 10 percent transmission occurring outdoors was helpful scientific evidence, and we are fol-lowing the science as it continues to emerge.
I think it is also really important to recognize that now, with
vaccination of 12 to 15 year olds, our summer camp guidance is
probably going to have to change in those settings, and we plan to do so.
Senator M
URPHY . Great.
54
Dr. Kessler, question for you on booster shots. You have got—you
included in your testimony an expectation that we may be in the
business of purchasing and distributing booster shots, maybe as soon as later this year.
I asked a question at the last hearing about the transparency of
contracts with the companies that are supplying vaccines. I still think that we could do better in terms of letting the American pub-lic know and policymakers know about the financial terms of these contracts.
But, what do we expect when it comes to contracting for booster
shots? Are we going to go back to the same companies that pro-vided the vaccine, or are we going to open that tender up to a broader set of companies? How do we expect the process of pro-curing booster shots to work, and how do we make sure that it ade-quately protects taxpayer dollars?
Dr. K
ESSLER . Senator, thanks for the question. Very important.
We are in that process now. In order to plan, because that is really what we are doing, if we want a vaccine, let’s say both the duration of immunity increasing age so there is less antibodies, and the variants, we have to take all of those things into consideration. And if we want vaccine end of the year, we have to do that now, and we are, in fact, in those negotiations.
The best science to date—I mean, the data we have, and I do not
want to get too technical, but the question is are we dealing with homologous boosts or heterologous boosts. Basically, are you going to boost with the same vaccine or are you going to—can you switch that out and do mix and match? And that requires data. We are collecting that data, and it is going to be the data that drives what we boost with.
But, for planning purposes, I think the simplest and safest as-
sumption—and I underline the word assumption—is that it may be for, at least the short term, the homologous boost with the same type of vaccine makes the most scientific sense. But, I need a cou-ple of more months in order to give you definitive answer, but I have to plan now.
Specifically to answer your question, we are dealing with the
same companies because we want to continue with the safety and efficacy that we have seen in those vaccines. Down the road, that may change as we get other, for example, protein-based vaccines available, Senator.
Senator M
URPHY . I was just going to say this. I hope that this
Committee is actively involved with the Administration on the con-struction of those contracts, to make sure that we are adequately protecting our taxpayers’ investment.
Thank you, Mr. Chairman. Senator B
URR. [Presiding] Senator Braun.
Senator B RAUN . Thank you, Senator Burr.
Dr. Walensky, I think from the get-go, there has been an uncer-
tainty of when we arrive at the moment when many of us feel that this is truly in the rearview mirror. And, from the early conversa-tions I have had being on this Committee, it has always been inter-esting to understand, I think, if and when that comes with clarity, that is the only way I think we get true comfort back into the Country.
55
Senator Murphy, others, have mentioned how things have
changed, goal posts have moved. I think that is inherently con-
fusing to people, especially ones that might have other reasons for not getting vaccinated, and I think that is so important that we get there, everyone vaccinated.
My question is, I think, on the education side of it, more empha-
sis and resources need to be put into rural America, I think along with the logistics, that have seen some effort made there to im-prove it. I think it is inherently more difficult to get vaccines in the arms when it is spread out in areas like that.
I would like you to zero in on it was 3 feet, or 6 feet and then
3 feet, indoors and outdoors. So many things have evolved. And I think with something as uncertain as this, it is natural to have that dynamic.
Where in time, and does natural infection go along with vaccina-
tion to have some weight in that point in time where cases really start to fall off the chart?
Dr. W
ALENSKY . Thank you so much for that—those questions,
Senator. Maybe I will start briefly with the rural and say in our efforts over this last several weeks, resources have gone broadly to rural communities. We are now funding federally qualified healthcare centers, getting vaccines into areas in those centers. Over five million vaccine doses have been given through federally— FQHCs. So, we know we need to do that outreach, and that is part of this next chapter.
In terms of the 6 versus 3 feet, I think from the school guid-
ance—I know from the school guidance, the first iteration that was put out in February, the biggest challenge to getting children back to school was the 6 foot guidance. What happened soon thereafter is science emerged. And because 6 feet proved to be such a chal-lenge, within a month, we had three studies that demonstrated that 3 feet and 6 feet were equivalent for younger children. And, so, it was based on the science. I would really like to say that we are in a static situation here and that the science is not changing, but we are changing our guidance with—as the science evolves and as the science emerges, and we have to remain humble to that science.
With regard to your question regarding natural immunity, we
have several challenges there. The CDC on its website has a map of presumed seroprevalence by state as to how much—how many people out there have antibodies. And, of course, we do not know all of the infection that has happened, right, because much of this infection has been asymptomatic.
As Dr. Fauci has said, that prior infection likely confers some im-
munity. It might confer full immunity for some period of time.
But, I will say that we are still learning and being humble here.
This past week, our genomic surveillance data demonstrated that 72 percent of our sequences are now the B117 variant. What do we know about how long prior infection will last with regard to new infection and a B117 variant if you are not vaccinated? We do not have all of those data yet. We are doing studies. We are evaluating it. But, I do think that we should continue to encourage vaccination of people who have had disease before.
Senator B
RAUN . Thank you.
56
Dr. Fauci, the J&J vaccine, which I think for many people was
a preference in terms of just being one shot and had a high efficacy
rate to boot. Do you think it was a mistake in that we pulled it when statistically the rate of an incident was so, so low—lower than I think on many other drugs out there that seemingly have much higher side effect consequences? Was that a setback that put us in a place that has really hurt us, or have we recovered from it?
Dr. F
AUCI . I do not believe it was a setback, Senator, and I think
if it was, we certainly have recovered from it because we now know. When you ask people, there is a lot of people who really want to get a one-dose vaccine, who are waiting for the availability of this.
What I do think it did that you do not fully appreciate is that
it really underscored how seriously we take safety. Because to call a pause on an adverse event that, as you mentioned correctly is really quite rare, because at the time, there were six cases in about seven million people, which is less than one per million, which is really a very, very low amount.
The FDA and the CDC looked at the data. They wanted to find
out if there were any more. They wanted to alert the physicians who might be out there seeing patients about what is the proper way to treat them, because there is one general way to treat that people might use that would actually be contraindicated, namely with heparin.
In the long run and the big picture, when all is said and done,
I do not believe it was a setback. I think it really underscored how seriously we all take safety.
Dr. B
RAUN . How many vaccinations do we need to get fully in the
arms to be at what the theoretical herd immunity would be and cases crash? Anybody?
Dr. F
AUCI . Yes. I think that is going to be a difficult number to
give because herd immunity as a concept means you get enough people vaccinated, enough people infected, so that you have a core of protected people that is a blanket of protection over even the vulnerables who cannot. The threshold of herd immunity is a num-ber we do not know yet for this particular virus. We know it for measles, but we do not know yet what that is. We can——
Senator B
RAUN . I think that——
Dr. F AUCI [continuing]. Guess it is somewhere between——
Senator B RAUN . That uncertainty is probably the thing that is
going to be the hardest thing to grapple with to get this fully in the rearview mirror. So, thank you.
Senator B
URR. Thank you, Senator Braun.
Senator Hassan. Senator H
ASSAN . Well, thank you, Ranking Member Burr, and I
thank the Chair for holding this hearing. And, really, thank you to all of our witnesses today for not only being here, but for your serv-ice.
Before I get to a question, Dr. Walensky, I just want to second
what Senator Murkowski said about getting the guidance to the fishing industry out as quickly as you can. I just met with my fish-ermen at the Yankee Fishermen’s Co-op in New Hampshire this week, and we have boats of fishermen who are fully vaccinated who
57
see the Coast Guard coming, telling them they have to keep their
masks on. Not only is a wet mask dangerous out on the open water, but because of the noise, both the wind and the equipment, these guys are used to relying on kind of sign language on the boat. And with the mask on, they really cannot, and it is a real safety issue. So, I hope you will take this under advisement and get the guidance out as quickly as you can.
Dr. Fauci, I wanted to follow-up a little bit. We have been talking
about the very good news of the Pfizer authorization for 12 through 15 year olds, and it looks like they may be seeking at least emer-gency authorization for 2 to 11 year olds in September. And that is really welcome news, but many families are still looking for guid-ance about how to protect children under the age of 12 from the virus until a vaccine is authorized for them, especially as public health restrictions are being lifted around the Country. And I am hearing some from parents that the schools are mostly reopened, or hybrid reopened, but they are kind of nervous about sending their children to school.
What advice do you have for families about what steps they can
take to protect their children from the virus while we await FDA authorization for use of the vaccine for kids?
Dr. F
AUCI . My recommendation, Senator, would be really to fol-
low the CDC guidelines. I mean, what both—when the children are in the home with vaccinated individuals, the guidelines are clear what needs to be done. When they are outside, many things you can do without a mask outside. But, if you are not vaccinated and you are interacting with people outside of the home from different locations, you want to be careful and have the children have masks.
I think a good following of the CDC guidelines, which, as Dr.
Walensky says, continue to evolve in real time as they get more data. The guidelines get updated and upgraded. So, that would be my recommendation.
One other thing that I think is important is that there is a lot
of work that we are doing now in clinical trials to get vaccinations for children younger than 12. So, a bunch of companies, several of them, are doing what is called age de-escalation studies where we are looking at children from 12 to 9, 9 to 6, 6 to 2, and then 6 months to 2 years. We think by the time we get to the end of this year that we will have enough information to vaccinate children of any age.
Senator H
ASSAN . Well, that would be very welcomed news to a
lot of parents.
Dr. F AUCI . Right.
Senator H ASSAN . Thank you.
Dr. Kessler, I want to follow-up on a line of questioning that Sen-
ator Murphy was following. We have heard encouraging news, cer-tainly, that the protections from the COVID–19 vaccines remain strong for at least 6 months and likely longer, but, also, that Amer-icans will need booster shots, as you all—may need booster shots, as you all just discussed. It is going to be really critical that these vaccines remain accessible and that their price reflects the large in-vestments that American taxpayers made in the research and de-velopment of the technology.
58
What steps should Congress take to ensure that COVID–19 vac-
cines, including booster shots if needed, remain available to Ameri-
cans even after the end of the public health emergency? And how can we ensure that pharmaceutical companies price these vaccines in a way that account for taxpayer investment?
Dr. K
ESSLER . Senator, a key question. Let me assure you that be-
cause of what this Committee has done and your colleagues on Ap-propriations, we do have the funds to purchase the next round, again, if, if they are necessary. So, we will be able to purchase the next round and to assure that if there are boosters, they are free, just as the last round. I think you raise a very good question.
Beyond that, beyond 2022, I mean, I look to your guidance and
your colleagues on at what point do you transition back to a com-mercial market. But, I think for this coming round, we are going to proceed as we have proceeded, and you have made those funds available.
Senator H
ASSAN . Well, I look forward to continuing the discus-
sion. I see that I am almost out of time here, but I did want to just ask Dr. Walensky quickly. Can you speak to the importance of con-tinued access to COVID–19 testing even as we work to distribute the vaccine and people are getting—we are building up our commu-nity and herd immunity?
Dr. W
ALENSKY . Yes. Thank you very much for that question.
First of all, we recognize that right now we have done an extraor-dinary job in getting vaccine to one-third of Americans, and yet two-thirds of Americans do not yet have vaccine. And, in fact, our young children will not have access to vaccine for the rest of this year. We have put out $10 billion toward states to be able to do testing programs within schools. Some higher ed have been able to successfully engage in this past semester through testing programs on their college campuses. We are going to need to continue testing through our long-term care facilities, as well as our correctional fa-cilities, our dense industries. And, so, yes, I think there has to be a huge corner of what we are doing that is related to testing.
Also, surveillance water testing, sewage testing, to look for out-
breaks. So, we are doing a lot in the testing area. We are really grateful for the resources to be able to do so.
Once we have vaccine in the majority of people, we are still going
to have disease out there and we are going to need to rapidly be able to detect it. Thank you.
Senator H
ASSAN . Thank you very much.
Thank you, Madam Chair. The C
HAIR . [Presiding] Senator Marshall.
Senator M ARSHALL . Thank you, Madam Chair.
Dr. Fauci, do you think it is possible that COVID–19 arose from
a lab accident at a lab in Wuhan, and should it be fully inves-tigated?
Dr. F
AUCI . That possibility certainly exists, and I am totally in
favor of a full investigation of whether that could have happened.
Senator M ARSHALL . Great. Is it possible COVID–19 is not natu-
rally occurring?
Dr. F AUCI . Again, that is a possibility. I do not know if we are
ever going to be able to prove that. But, you always need to open up and leave all possibilities, which is the reason why I and so
59
many of my colleagues are very much in favor of what the WHO
said, that they want to go back again and take another look in there and see what was going on in that lab.
Senator M
ARSHALL . Will you commit to get this Committee all
the records, anything to do with any type of viral experiments, say from 2013 to the present so we can review those?
Dr. F
AUCI . Certainly. I would comply with any request of the
Committee.
Senator M ARSHALL . Do you and others at NIH have a conflict of
interest when determining if the labs and lab work you help fund should be investigated and how it is investigated?
Dr. F
AUCI . No. I do not think it is a conflict of interest. We are
very open and wanting to make sure that everything that has any question is looked into, at all. I have no problem with that.
Senator M
ARSHALL . Okay. In 2013, President Obama placed a
moratorium on viral gain-of-function studies with some loopholes, which you were able to use at certain times. I know we disagree— I do not know if we disagree. We can discuss what is viral gain- of-function and what is not. But, in 2017, you had a long process, and I assume it was you that decided to lift this moratorium, and during this review—my question is this.
During the review, did you consider the risk of dual applications
by military, terrorists, or other foreign actors?
Dr. F
AUCI . I am not sure what you mean by that, Senator. Did
I consider applications from dual actors?
Senator M ARSHALL . Yes. I will say it again. Did you consider the
risk of dual application, that there might be other folks that would use some of the——
Dr. F
AUCI . Sure.
Senator M ARSHALL [continuing]. Function of discoveries, that
they might be used by a military——
Dr. F AUCI . Sure.
Senator M ARSHALL [continuing]. Terrorist, or other foreign ac-
tors?
Dr. F AUCI . Well, in any research that we do, we publish the re-
search. It is available for anyone to use it in any manner in which they can. That is the modus operandi of the NIH. We fund re-search. The research is——
Senator M
ARSHALL . Is there not a——
Dr. F AUCI [continuing]. Made public.
Senator M ARSHALL . Is there a national security consideration,
though, in that type of decision with—thinking the viral gain-of- function could be more powerful than the nuclear weapons to——
Dr. F
AUCI . No, but——
Senator M ARSHALL [continuing]. Share that information with a
government——
Dr. F AUCI . Right.
Senator M ARSHALL [continuing]. Foreign actor may be consid-
ered—been like trying to do the Manhattan Project in nuclear en-
ergy, nuclear weapons, doing it with, say, Hitler or the Soviet Union?
Dr. F
AUCI . I am not sure what you are getting at, Senator, but
we do not fund research. We have committees that look at that to
60
make sure that research that is of any potential danger is not fund-
ed. So, I am not exactly sure what your point is.
Senator M ARSHALL . My point is, is there national security impli-
cations with something as theoretically lethal as viral gain-of-func-tion?
Dr. F
AUCI . Sure, there is. That is why we have committees. We
have a P3CO committee, which is the Potential Pathogen—Pan-demic Pathogen Care and Observation—and Oversight, excuse me. And that is a committee separate from the NIH that looks at these types of grants to see if they need to be funded. So, there is a con-siderable amount of oversight to make sure grants that are doing research that would obviously be of danger is not performed.
Senator M
ARSHALL . When you make a decision to stop the mora-
torium on gain-of-function, was—were there national security advi-sors in the room? Was there State Department? Was there Defense Department? Who were those people that might have been part of that decision?
Dr. F
AUCI . First of all, I did not make the decision to stop, to
pause the gain-of-function. If one looks at what actually happened, we put a pause on, and I was the one that was very much in favor of that pause. In 2013——
Senator M
ARSHALL . You are talking the 2013 pause?
Dr. F AUCI . In 2014——
Senator M ARSHALL . Okay.
Dr. F AUCI [continuing]. To 2017, the pause was lifted because we
established a committee that looked at what we called P3CO.
Senator M ARSHALL . I am familiar with it.
Dr. F AUCI . Right. Exactly. And when that committee then was
able to make decisions about granting, apart from the NIH so that we would not have any decision and it would be a decision——
Senator M
ARSHALL . I have one last question I wanted to sneak
in. I still do not know that you answered was there national secu-rity people in the room when you—when that process—someone made the decision. I think you led that decision, but we will come back to that.
Here is my last question. If COVID–19 is indeed a product of lab
manipulation, can you sit here and unequivocally say the viral studies that NIH funded—helped fund, could not be indirectly or directly related to this final COVID–19 virus?
Dr. F
AUCI . Yes. Looking at the experiments that were done that
we funded, there would not be that possibility.
Senator M ARSHALL . Unequivocally?
Dr. F AUCI . Well they are talking about a hybrid virus of a mouse
virus that was adapted to a mouse that anyone that knows any-thing about virology would realize that is not something that would infect a human, much less be pathogenic and transmissible.
Senator M
ARSHALL . But we helped make the mouse that had the
HLA receptor that this COVID–19 was specific for, and you were— NIH was involved in the development of——
Dr. F
AUCI . Yes.
Senator M ARSHALL [continuing]. Humanized mouse?
Dr. F AUCI . Yes, but as I mentioned in response to Senator Paul,
the NIH and NIAID did not fund gain-of-function research to be conducted at the Wuhan Institute of Virology.
61
Senator M ARSHALL . But that is not my question. You know, the
question is, could some of the—some of the funding you did—you
can call it gain-of-function or not, developing the HLA receptor with the mouse. I am not sure if you are going to call that gain- of-function or not. Probably not.
But, could some of the funding indirectly ended up to the con-
tribution of this—of COVID–19?
Dr. F
AUCI . I am not sure exactly where that question is going.
You could do research on something as benign as looking at some-thing that has nothing to do with it and it could indirectly, some-day, somehow, be involved. So, if you want to trap me into saying yes or no, I am not going to play that game.
Senator M
ARSHALL . But we need to look at that very deeply and
consider exactly—that is why you committed earlier to make shar-ing all the viral——
Dr. F
AUCI . I would be happy to share any information you would
like with the Committee.
Senator M ARSHALL . Thank you so much. I yield back.
The C HAIR . Thank you.
Senator Rosen. [Brief silence.] The C
HAIR . Senator Rosen, I believe you are on mute.
[Brief silence.] The C
HAIR . We are going to hold 1 second for Senator Rosen’s
mute function to work.
[Brief silence.] The C
HAIR . I believe they are trying to undo Senator Rosen’s
mute function from the studio.
Senator Rosen, if you can just be patient with us for a minute
while we get that fixed.
I am going to go ahead and ask a question, and if—Senator
Rosen, if you can just hold for just a minute.
I wanted to ask Dr. Walensky. There are variant strains of
COVID–19 that threaten to disrupt progress made toward ending the pandemic, and the CDC reports that the B117 variant is now the predominant strain in the United States. We need to know which variants are out there and how they are spreading and why they—and who they are spreading to, which is why we approved $1.75 billion in the American Rescue Plan to help CDC shore up its genomic sequencing and surveillance activities.
Do you have enough data? Do you have the right data and the
right data systems to be able to track these variants as they spread?
Dr. W
ALENSKY . Thank you, Senator. We are—we have scaled up
our sequencing dramatically, as I have noted, and every 2 weeks or so, we get an update on data and we look at the—where these sequences are. Just yesterday, I believe, we had the most recent update that demonstrated 72 percent of our cases are now B117. Six percent are now P1. And, we are grateful for the resources to be able to do so.
Generally, our ballpark was to have 10 percent of viral sequences
able—10 percent of all circulating virus to be able to be sequenced. And, so, with cases coming down and our sequencing rising up, we have been able to reach about that 10 percent mark right now.
62
That has required a lot of collaboration across government, across
commercial labs, and whatnot.
The function is a—and the impact of these, whether they are
variants of concern, variants under investigation, how we under-stand these, is related to an interagency collaboration with BARDA, NIH, and CDC in terms of seeing how transmissible they are, as well as how well they function against monoclonal anti-bodies and our vaccines.
The C
HAIR . Thank you for that.
Senator Rosen, do we have you back? Senator R
OSEN . I think we are back. Can you hear me now?
The C HAIR . Yes, we do.
Senator R OSEN . Oh, very good. Sometimes that Zoom happens.
There you go.
Well, thank you, Chair Murray. I appreciate your patience. I ap-
preciate you calling this hearing. It is extremely important. And, so, for you, for all the scientists, the medical personnel, the front-line workers, I am so grateful for what everyone has been doing to be sure that we can keep the American people, really, people around the world, safe, healthy, and informed.
Dr. Fauci, when we last spoke in March, you shared that NIH
had just launched a billion-dollar initiative to study the long-term effects of COVID–19 and identify potential prevention and treat-ment measures for the long-haulers. Because COVID–19, of course, is a novel virus, there are so many gaps in our research and un-knowns for the people who have been affected and are still suf-fering. And that is why I introduced bipartisan legislation that will ensure that NIH will continue to be able to work with the CDC on comprehensive and longitudinal studies of a diverse group of COVID–19 patients. I know some of the research has already been done. It is going to go forward.
You shared earlier some updates on long COVID. Could you
speak to the research gaps that remain for learning more about the long-term effects, such as lung capacity, heart function, some of the things that people really seem to be struggling with once they have recovered from their initial symptoms?
Dr. F
AUCI . Well, thank you very much for that question. Yes, we
have initiated a series of studies, first of all, building up cohorts so that we can get enough individuals in the cohort to be able to do the kinds of studies that you are going to do.
As I mentioned in response to a prior question, it is a multi-insti-
tute endeavor involving multiple NIH institutes with differences— different interests in different organ systems, just as you said. The National Institute of Heart, Lung, and Blood is one that is looking at some of the issues that you raised in your question, the National Institute of Neurological Diseases and Stroke, the National Insti-tute of Mental Health, and my institute, the National Institute of Allergy and Infectious Diseases.
We have also just now started the request for applications to be
able to gather the cohorts and do those types of studies. So, there
is a considerable amount of interest in this and a major commit-ment on the part of the NIH to study this thoroughly to fill in some of the gaps that still remain as to what the pathogenesis of this
63
particular syndrome is because it is a real syndrome that is very
troubling to a large number of patients.
Senator R OSEN . Thank you. I would like to move to the other
part of this equation, which is the therapeutic research and devel-opment. Because even though people are getting vaccinated, of course, there are still people getting sick and there are people, like we said, still suffering chronic pain, chronic illness, as a result of COVID–19. And, so, we have to be sure that we have those tools to continue to treat any cases that come forward.
Could you give us any updates about what therapeutics might be
in the pipeline? And do you think is there a potential for any of these treatments to help some of the long haulers? You know, maybe it can treat acute and chronic illness as a result of this func-tion of COVID?
Dr. F
AUCI . Senator, it is an excellent question but it is almost
impossible to talk about treatment when you do not know what the underlying pathogenesis is. So, that is the reason why the studies are starting off by gathering the cohorts and trying to find out if there is a mechanism for some of the symptomatology—the pro-found fatigue, the muscle aches, the temperature dysregulation, the sleep disorder, the brain fog, as they call it.
We do not know exactly what the mechanism of this symptoma-
tology is and, for that reason, it becomes very difficult to do any-thing other than symptomatic treatment for these individuals. That is why it is so important to do the studies that we are planning to do, so that hopefully when we understand the mechanisms, we will be able to have some therapeutic intervention.
Senator R
OSEN . Well, thank you. I appreciate that because it is
really going to be important moving forward. It is going to be im-portant to our healthcare workers, to our surging of hospital capac-ities, and actually globally around the world.
I just thank you for that. I look forward to reconnecting with you
as we begin to see more results of this really important longitu-dinal research and the progress that it is making.
Thank you, Madam Chair. I yield back. Dr. F
AUCI . Thank you.
The C HAIR . Thank you very much.
I wanted to ask, the pandemic’s deadly impact on communities
of color shows we have a long way to go to address systemic racism and health inequities in this Country. Black and Latino people are receiving vaccinations at disproportionately low rates, and some of the systems that are designed to make vaccinations easier, like on-line registration for appointments, have actually made it harder for some, like our native Hawaiian and Pacific Islander elders. Addi-tionally, AAPI communities have experienced higher rates of dis-crimination and violence, as we know, since the start of this pan-demic.
Dr. Kessler, I wanted to ask you, how is the Federal Government
working to decrease COVID–19-related health inequities?
Dr. K
ESSLER . Senator, thank you for the question. Enormously
important. There is some at least initial good news. You know, we have seen that deaths are down dramatically since January, and we all know that they are down 80 percent among seniors. But, they also include—that drop includes a drop among Hispanics of 80
64
percent, and among African Americans of about 70 percent. And,
in the past 2 weeks, 55 percent of the people vaccinated were White, but 45 percent were non-White. That compares to the gen-eral population that is about 60 percent White and 40 percent non- White.
We have much more to do, especially in the area of confidence.
We do see that people’s confidence in the vaccine is increasing. Black Americans’ confidence increased by 24 points since January, and Latino Americans’ confidence increased by 22 points since Jan-uary.
But, outreach access is absolutely critical. These vaccines are
free. Every adult in America is eligible in about 80,000 locations. But, we have a lot more work to do, and we are keeping equity at the center of the response, and we will not leave anyone behind.
The C
HAIR . Okay. Thank you so much for that effort, and I ap-
preciate it.
Senator Burr, do you have any closing questions or comments? Senator B
URR. Madam Chair, thank you. Yes, I do. I have a little
bit of cleanup if I can.
What I have been able to piece together since we started—and
this is to you Dr. Marks and maybe Dr. Kessler. BARDA signed a contract for $1.2 billion for 300 million doses of AstraZeneca vac-cine. That is currently authorized in 70 countries around the world; its manufacturing capacity in 15 countries and 25 sites. In addition to the Baltimore Emergent facility, two sites in the U.S. manufac-turing, in Ohio and New Mexico, of AstraZeneca vaccine.
Here is my question. Of the stock that we currently have on
hand, which I estimate to be about 60 million doses, is all of that being held because it came from Emergent? Or, in that 60 million inventory that we have today, is some of that either foreign manu-factured and/or Ohio or New Mexico and would not have to be held up because of the current inspection concerns at Baltimore?
Dr. K
ESSLER . Senator, I have been talking to AstraZeneca, even
last night. I have been talking to them regularly over the last sev-eral weeks. I—to answer your question very specifically, the 60 mil-lion that you reference, all of that drug substance was made at Emergent.
There is another facility at Catalent that manufactures drug sub-
stance, but we are not—we have not contracted and we are not in-volved, and that is for global.
There are two other facilities, one in West Chester that you ref-
erenced, that is for drug product.
But, everything that we have involvement in is that 60 that has
been produced for that first initial hundred, and they stopped at 60 when—because of the problems at Emergent were—are all being reviewed by our colleagues at FDA because of issues at Emergent.
Senator B
URR. Follow-up question. Of the over two million doses
that went to Mexico, a million and a half doses that went to Can-ada, have there been any indications from those vaccines if they have—one, I assume they have been used. Is there any reason to believe that they are reporting any adverse effects?
Dr. M
ARKS . Senator Burr, no, and in—and those came from a
time when that facility was not being used for more than one vac-cine, to produce more than one vaccine, sir.
65
Senator B URR. The fact that they produce not only AZ, but J&J,
now makes them susceptible?
Dr. M ARKS . It is a matter of public record that the problem that
occurred at the facility involved a contamination event between two
vaccines.
Senator B URR. Okay.
Dr. M ARKS . That was the issue that we are dealing with. But,
I just should add that you have our commitment that we are going to work as quickly as we possibly can to get both clearance of the doses that are currently being held—because we do not have clear-ance of the safety of those doses yet—and also to get that plant back up and running in a manner that is fully consistent with what Americans expect from their pharmaceutical products.
Senator B
URR. Okay. This question, I am going to go to Dr.
Fauci, Dr. Marks, and Dr. Walensky.
What percentage of the employees in your institute, your center,
or your agency, of your employees, has been vaccinated?
Dr. F AUCI . I am not 100 percent sure, Senator, but I think it is
probably a little bit more than half. Probably around 60 percent.
Senator B URR. Dr. Marks.
Dr. M ARKS . I cannot tell you the exact number, but it—it is prob-
ably in the same range. Some people vaccinated at our facility and others outside of the facility.
Senator B
URR. Dr. Walensky.
Dr. W ALENSKY . We are encouraging our employees to get vac-
cinated. We have been doing town halls and education seminars. We have—our staff have the option to report their vaccination sta-tus. But, as you understand, the Federal Government is not requir-ing it, so we do not know.
Senator B
URR. Okay. And, listen, you are the face of why people
should get vaccinated, and no one—and promoting and confidently giving numbers, percentages, I think is really, really important as we go into this last part.
Now, if you tell me that there is some statute that says you can-
not require somebody to tell you, imagine being the parent of a school age kid who for generations has been required to have their kids vaccinated before they could start school. And, the fact that, even within our health organizations, we cannot require that of people, we are going to have tough decisions to make.
Employers are going to make those decisions. There have been
decisions already made by colleges around the Country that said if you are on faculty or you are a student, you are not coming next year if you are not vaccinated. Now, they have the ability to do that.
These are tough questions with even tougher answers. But, if we
are going to get that last mile coverage, we are going to have to start portraying that we are willing to do to ourselves what we are asking the American people to do.
Dr. Walensky, I think it is safe to say that the 21st Century is
something that the CDC has not totally entered, but I am confident
that you are going to take them there, and especially as it relates to science and technology.
66
My question is simple. Do you believe the CDC director should
meet with private industry and innovators who have new tech-
nologies that can help modernize the CDC?
Dr. W ALENSKY . Thank you. I think I have an extraordinary op-
portunity as being the director of the CDC during this period of time. I think that much of what we are going to need to do in pub-lic health is going to take collaboration with academia, with gov-ernment, with private sector, with non-profits. And I am looking forward to engaging in those in a transparent, open way so that we can have that dialog and create those collaborations.
Senator B
URR. Let me go back and ask you one more time. Do
you believe that the CDC director should meet with private indus-try and innovators that have new technologies?
Dr. W
ALENSKY . I believe that we should—I should be encour-
aging all of those collaborations, and I am relying on my senior leadership team, my subject matter experts, to engage in many of those conversations.
Senator B
URR. But not you?
Dr. W ALENSKY . If it is a subject matter where I am an expert,
I would be happy to, absolutely.
Senator B URR. I think in a question to your staff, they suggested
that you could not, but I will revisit that through my staff to yours.
I have to say that I am little bit confused on the issue of CDC
guidance after hearing my colleagues, Senator Collins and Senator Cassidy, about exactly who is involved in content and language. So, I sent to CDC an oversight letter, and I got your response to it on 22 April, and I will just highlight a few things.
CDC uses its emergency response clearance protocol to clear
items during emergency responses. This emergency response clear-ance is applicable to all CDC-authored, CDC-branded information products with content related to an active or ongoing response, such as COVID–19 response.
The clearance process consists of a series of formal reviews, ap-
provals, by relevant CDC subject matter experts, SMEs, and Agen-cy clearance officials. This typically consists of content, develop-ment, and review by CDC’s relevant COVID–19 Response Task Force or SMEs, followed by additional review coordinated by CDC’s Joint Information Center.
At no point, given the opportunity, did the letter mention any-
thing about people outside of government. It could be parents. It could be the National Education Association. It basically said this all happens within government.
Now, that is not what I heard my colleagues say as it related to
the guidance on schools, that there was input provided by outside entities. And, as a matter of fact, I went ahead and pulled all the email chains that I think was accessed by the media outlets that made them write this story.
I will just say that it is a little bit alarming because it is all done
on a timeline, and it suggests that AFT leadership—not sure what the issue was they raised, but they certainly changed the language of the guidance because there is actually email that thanked them for the language that they provided.
When you look at the timeline between that and White House
announcement, one would have a hard time believing that every-
67
thing went through a clearance process that was described in the
oversight response letter to me. So, I would ask you clear it up for me, if you would.
Dr. W
ALENSKY . Thank you. Thank you for that question. So, as
I mentioned to Senator Collins, prior to our putting our guidance through a formal clearance process, we do an enormous amount of stakeholder engagement to ensure that the guidance can actually address the questions asked. In fact, I can tell you, on the other side, when I was a healthcare provider at Massachusetts General Hospital, I would frequently call my colleagues at the CDC and say, we need guidance on X, it needs to address X, Y, and Z.
In the stakeholder engagement for the schools, we did outreach
with over 50 organizations. We spoke to teachers. We spoke to par-ents. We spoke to superintendents. We spoke to many different stakeholders to understand what it is that they needed from our guidance.
As I mentioned previously, in doing so, we recognized, in meeting
with the teachers, that we had actually failed to comment on what happened if teachers were immunosuppressed, if teachers were un-dergoing chemotherapy, if they had a family member with a trans-plant at home, how we were going to engage and provide guidance to those. It was the CDC scientists that provided the guidance, that provided the science around what we should do. It was the request from teachers to say, you did not address this issue, and we had not.
Senator B
URR. The first contact by AFT with your staff was on
February 1st, Monday, February 1st. And your staff person—we were able to review a copy of the draft guidance or—excuse me.
Troutner with the AFT. We were able to review draft guidance
documents over the weekend. We are able to provide some initial feedback to several staff this morning about possible ways to strengthen the document.
That is on February 1st in the morning. On February 2nd, your
staff emailed to you that they had followed-up with suggested lan-guage on accommodations per exchange.
On February 3rd at a White House press conference, you say
schools can open, reopen without teachers being vaccinated.
Would one reading this be concerned with this timeline and what
the oversight letter told me was the protocol that you went through to have guidance signed off on?
Dr. W
ALENSKY . In the February 3rd press—first of all, in the
February 3rd press conference, that was before our guidance was released. That was speaking to science and studies that dem-onstrated that schools had effectively reopened without teachers being vaccinated and keeping students and children safe. February 3rd pre-dated our guidance release, which I believe was February 12th, although I would have to confirm.
You may recall at the time that in the media I took quite a hit
for commenting on that from teachers themselves. They were not
happy with me at the time.
Senator B
URR. With the success of AFT, the NEA engages you,
and you actually committed to do an NEA town hall meeting. Is that right?
68
Dr. W ALENSKY . We were engaging at the time with over 50 orga-
nizations—teachers, superintendents, parents alike—at the time
when our school guidance came out as a matter of practice and in an unbiased fashion.
Senator B
URR. Well, Madam Chair, I am going to ask that the
letter and the emails be included as part of the record.
The C HAIR . Without objection.
[The information referred to follows:] Senator B
URR. I want to make this observation, that I hope you
can understand why Members express frustrations on guidance, that there is a chain of information that suggests people had a pre-ferred access to not only advice, but actual language that went into the guidance.
I know what your answer to my last question is going to be be-
cause I have stated it in one of the emails.
Should CDC guidance suggest that all states should require
teachers to be vaccinated?
Dr. W
ALENSKY . I would encourage all teachers to be vaccinated.
We spent the month of March providing vaccines through our Fed-eral pharmacy programs and we got over 80 percent of our teachers and educators vaccinated as a—through that process. So, I am cer-tainly encouraging that all teachers be vaccinated.
I think that the guidance with regard to mandatory vaccination
in schools is going to have to be done at the local level.
Senator B
URR. Would you provide guidance that suggested to
schools that they vaccinate teachers?
Dr. W ALENSKY . We have been encouraging vaccination of teach-
ers——
Senator B URR. All teachers.
Dr. W ALENSKY . We have been encouraging vaccination of all
teachers, of all educators, of all parents, of all students.
Senator B URR. Is that in guidance?
Dr. W ALENSKY . I would have to confirm because I do not know
whether our most recent updated guidance for schools actually had widespread availability of vaccine.
Senator B
URR. Okay. The Chair has been awfully kind to me,
and I am not trying to pick.
As I said when I started, the next several months are going to
be extremely tough at getting people vaccinated. I do not want any of us to lose focus on what the mission is out there. I know for all of you, I am stating the obvious, that we have to stay focused on vaccines.
But, the confidence the American people have in you is a lot of
what is going to make us successful. As Dr. Fauci and I have talked many times about, thank God we had in place an architec-ture that we perfected over the last 20 years that allowed things to happen organically, like EUAs and this type of thing.
It was not because we experienced anything. We went through
little red flags, H1N1, SARS, Ebola, where we looked at it and said, boy, if this had been the big one, what would we have changed, and collectively, we went through and changed them. We were much better prepared a year ago architecturally, and 80 percent of what we did was following the statute that is out there and the authori-ties that were given to many of your institutes or agencies. Or, in
69
Dr. Marks’ case, to the FDA. And, I have to tell you that I believe
what the FDA has accomplished, I never dreamed they could do.
My goal now is to make sure we do not roll back. Because as we
move into technology platforms, that is not something that is easy to go back and do clinical trials on again if you are just looking for a new indication. But, I have to tell you that I believe that schools going back in person in the fall is absolutely crucial to getting a majority of the parents who have yet to be vaccinated, vaccinated. And knowing that at least by the end of this month, if we are not already there, every adult that wants to be vaccinated can be vac-cinated.
It is time for us to start setting the stage and paint the picture
for what the fall looks like; that people can go on vacation this year and they can eat in a restaurant, in the Outer Banks of North Carolina, preferably; that they can plan their summer vacation; hopefully, in a few more weeks or days, maybe they can go to camp; that in the fall, we expect every school to be in person, short of some drastic change in the infection glidepath; and next Thanks-giving, you ought to plan to have Thanksgiving with your family and extended family; and Christmas, you ought to be able to enjoy.
If we paint that type of picture, I believe, David, we are going
to get people vaccinated. But, if we continue to fail at the trust that they have in us making the calls that are appropriate at the time, feeling like they are influenced in any way, feeling like we are not out there where we need to be interpreting the science, we are going to fail, and we are going to fail for the American people. But, more importantly, we are going to fail for the world because the world right now is relying on us getting to that number and us pro-viding the technology and the manufacturing capacity for them to be vaccinated. So, we have a big step ahead of us.
I am delighted that all four of you are here today. I thank you
for the work that you have done up to this point and, more impor-tantly, for the work you are going to do in the future.
I thank the Chair. The C
HAIR . Thank you. That will end our hearing today.
I want to thank all of our colleagues who are here. I especially
want to thank all of our witnesses today. Thank you all, Doctors Walensky, Fauci, Marks, and Kessler, for joining us to update on this fight against this pandemic, and to tell you thank you to all of those who work for you and have been diligent and trying to make tough decisions in a difficult time to help protect all Ameri-cans. So, thank you very much to you and to all the people that work with you.
For any Senators who wish to ask additional questions, questions
for the record will be due in 10 business days, on Tuesday, May 25th, at 5 p.m. The hearing record will remain open until then for Members who wish to submit additional remarks and materials for the record.
The Committee will next meet tomorrow, Wednesday, May 12th,
to mark up the nominations of Jocelyn Samuels to be a member of the Equal Employment Opportunity Commission, Jennifer Abruzzo to serve as General Counsel of the National Labor Relations Board, and Seema Nanda to serve as Solicitor for the Department of Labor.
70
With that, the Committee stands adjourned.
71
ADDITIONAL MATERIALS
A Misleading C.D.C. Number
By David Leonhardt
The New York Times
Published May 11, 2021 When the Centers for Disease Control and Prevention released new guidelines
last month for mask wearing, it announced that ‘‘less than 10 percent’’ of Covid–
19 transmission was occurring outdoors. Media organizations repeated the statistic, and it quickly became a standard description of the frequency of outdoor trans-mission.
But the number is almost certainly misleading.
It appears to be based partly on a misclassification of some Covid transmission
that actually took place in enclosed spaces (as I explain below). An even bigger issue
is the extreme caution of C.D.C. officials, who picked a benchmark—10 percent— so high that nobody could reasonably dispute it.
That benchmark ‘‘seems to be a huge exaggeration,’’ as Dr. Muge Cevik, a virol-
ogist at the University of St. Andrews, said. In truth, the share of transmission that has occurred outdoors seems to be below 1 percent and may be below 0.1 percent, multiple epidemiologists told me. The rare outdoor transmission that has happened almost all seems to have involved crowded places or close conversation.
Saying that less than 10 percent of Covid transmission occurs outdoors is akin
to saying that sharks attack fewer than 20,000 swimmers a year. (The actual world-wide number is around 150.) It’s both true and deceiving.
This isn’t just a gotcha math issue. It is an example of how the C.D.C. is strug-
gling to communicate effectively, and leaving many people confused about what’s truly risky. C.D.C. officials have placed such a high priority on caution that many Americans are bewildered by the agency’s long list of recommendations. Zeynep Tufekci of the University of North Carolina, writing in The Atlantic, called those recommendations ‘‘simultaneously too timid and too complicated.’’
They continue to treat outdoor transmission as a major risk. The C.D.C. says that
unvaccinated people should wear masks in most outdoor settings and vaccinated people should wear them at ‘‘large public venues’’; summer camps should require children to wear masks virtually ‘‘at all times.’’
These recommendations would be more grounded in science if anywhere close to
10 percent of Covid transmission were occurring outdoors. But it is not. There is not a single documented Covid infection anywhere in the world from casual outdoor interactions, such as walking past someone on a street or eating at a nearby table.
Today’s newsletter will be a bit longer than usual, so I can explain how the C.D.C.
ended up promoting a misleading number.
The Singapore Mystery
If you read the academic research that the C.D.C. has cited in defense of the 10
percent benchmark, you will notice something strange. A very large share of sup-
posed cases of outdoor transmission have occurred in a single setting: construction sites in Singapore.
In one study, 95 of 10,926 worldwide instances of transmission are classified as
outdoors; all 95 are from Singapore construction sites. In another study, four of 103
instances are classified as outdoors; again, all four are from Singapore construction sites.
This obviously doesn’t make much sense. It instead appears to be a misunder-
standing that resembles the childhood game of telephone, in which a message gets garbled as it passes from one person to the next.
The Singapore data originally comes from a government data base there. That
data base does not categorize the construction site cases as outdoor transmission, Yap Wei Qiang, a spokesman for the Ministry of Health, told my colleague Shashank Bengali. ‘‘We didn’t classify it according to outdoors or indoors,’’ Yap said. ‘‘It could have been workplace transmission where it happens outdoors at the site, or it could also have happened indoors within the construction site.’’
As Shashank did further reporting, he discovered reasons to think that many of
the infections may have occurred indoors. At some of the individual construction sites where Covid spread—like a complex for the financial firm UBS and a sky-
72
scraper project called Project Glory—the concrete shells for the buildings were large-
ly completed before the pandemic began. (This video of Project Glory was shot more than 4 months before Singapore’s first reported Covid case.)
Because Singapore is hot year-round, the workers would have sought out the
shade of enclosed spaces to hold meetings and eat lunch together, Alex Au of Tran-sient Workers Count Too, an advocacy group, told Shashank. Electricians and plumbers would have worked in particularly close contact.
Are schools outdoors?
How, then, did the Singapore cases get classified as they did?
When academic researchers began collecting Covid data from around the world,
many chose to define outdoors spaces very broadly. They deemed almost any setting
that was a mix of outdoors and indoors to be outdoors.
‘‘We had to settle on one classification for building sites,’’ Quentin Leclerc, a
French researcher and co-author of one of the papers analyzing Singapore, told me, ‘‘and ultimately decided on a conservative outdoor definition.’’ Another paper, pub-lished in the Journal of Infection and Public Health, counted only two settings as indoors: ‘‘mass accommodation and residential facilities.’’ It defined all of these set-tings as outdoors: ‘‘workplace, health care, education, social events, travel, catering, leisure and shopping.’’
I understand why the researchers preferred a broad definition. They wanted to
avoid missing instances of outdoor transmission and mistakenly suggesting that the outdoors was safer than it really was. But the approach had a big downside. It meant that the researchers counted many instances of indoors transmission as out-doors.
Yet even with this approach, they found a minuscule share of total transmission
to have occurred outdoors. In the paper with 95 supposedly outdoor cases from Singapore, those cases nonetheless made up less than 1 percent of the total. A study from Ireland, which seems to have been more precise about the definition of out-doors, put the share of such transmission at 0.1 percent. A study of 7,324 cases from China found a single instance of outdoor transmission, involving a conversation be-tween two people.
‘‘I’m sure it’s possible for transmission to occur outdoors in the right cir-
cumstances,’’ Dr. Aaron Richterman of the University of Pennsylvania told me, ‘‘but if we had to put a number on it, I would say much less than 1 percent.’’
Britain’s Scientific Approach
I asked the C.D.C. how it could justify the 10 percent benchmark, and an official
there sent this statement:
There are limited data on outdoor transmission. The data we do have sup-ports the hypothesis that the risk of outdoor transmission is low. 10 percent is a conservative estimate from a recent systematic review of peer-reviewed papers. CDC cannot provide the specific risk level for every activity in every community and errs on the side of protection when it comes to recom-mending steps to protect health. It is important for people and communities to consider their own situations and risks and to take appropriate steps to protect their health.
Erring on the side of protection—by exaggerating the risks of outdoor trans-
mission—may seem to have few downsides. But it has contributed to widespread
public confusion about what really matters. Some Americans are ignoring the C.D.C.’s elaborate guidelines and ditching their masks, even indoors, while others continue to harass people who walk around outdoors without a mask.
All the while, the scientific evidence points to a conclusion that is much simpler
than the C.D.C.’s message: Masks make a huge difference indoors and rarely matter outdoors.
The health authorities in Britain, notably, seem to have figured this out. They
have been more aggressive about restricting indoor behavior, locking down many businesses again late last year and requiring masks indoors even as most of the country is vaccinated. Outdoors, however, masks remain rare.
It certainly doesn’t seem to be causing problems. Since January, daily Covid
deaths in Britain have declined more than 99 percent.
73
[Whereupon, the hearing was adjourned at 12:42 p.m.]
Æ

Summary:
Official printed transcript of a Senate HELP Committee COVID-19 response hearing featuring Anthony Fauci's testimony.

Excerpt: because what you—so much of what you say is patently not true. I have to wear a mask when I am outside and the wind is blowing at 20 miles an hour. That has been changed, but it was only changed recently. They seek not to believe those things which are true. You have got to realize. You have got to be more real time.  Let me finish with this. I think—I do not know if it was the Stat  article or the New York Times that pointed on the HIV epidemic. The recommendations were much more kind of calibrated to real life. Listen, we know people are going to do this. If you are going to do it, please accept this recommendation.  This is a blanket. Walk outside and wear a mask. You are vac- cinated and everybody else in the room is vaccinated, but you are wearing a mask.  The American people have…