Chair DeLauro Presses CDC Director Redfield for Answers on Coronavirus, President’s FY2021 Budget Request at Subcommittee Hearing
WASHINGTON, D.C. —(March 10, 2020) Today, Congresswoman Rosa DeLauro (CT-03), Chair of the House Appropriations Subcommittee on Labor, Health and Human Services, and Education, held a hearing with officials from the Centers for Disease Control and Prevention (CDC), including Director Dr. Robert Redfield, on the President's budget request for Fiscal Year 2021. DeLauro pressed Redfield and the panel for answers regarding ongoing challenges to availability of diagnostic test kits. They also discussed funding measures in response to the coronavirus, modernizing our nation's public health infrastructure, gun violence prevention research, and more.
A video and transcript of DeLauro's opening remarks, as prepared for delivery, can be found here and here, respectively. Links to full videos of their exchanges can be found below, along with transcripts of each exchange.
Rep. DeLauro: Thank you. Dr. Redfield, CDC has been working to respond to COVID-19 and including utilizing quarantine authority that hasn't been used in decades. Over the last couple of weeks, we've moved from a strategy of quarantine to a strategy of mitigation. People are following CDC's guidance of calling their health care provider to get evaluated. Health care providers are facing the reality that they can't get their patients tested. Other countries are testing—thousands. South Korea is testing 10,000 people a day. We are behind the curve. My understanding is testing kits continue to be distributed, commercial firms are involved, as well. I've got—I'm going to try to keep within five minutes for all of us. Why is the U.S. behind other countries when it comes to testing availability? Why was there such a delay in CDC's ability to replace the test kits sent to the public health labs and then I have a question after that, Dr. Redfield.
Dr. Redfield: Thank you very much Chairwoman. We obviously got first notification of this new disease on actually New Year's Eve, December 31st and it's occurring in China. The Chinese fairly rapidly published the genetic sequence, and at the end of the first week of January. We actually worked at CDC based on that and created a diagnostic test that really I think tested the first person in January 17th. So fairly quickly we had diagnostic test up and running at the CDC, which is our job, to get that technology available for the public health laboratories of the country and we let them know and they began sending in samples. I think we had out first diagnosis on January, I think it was the 21st, in the state of Washington. Obviously at that time, it took time to fly the samples to CDC and run them. Sometimes it was three-day turnaround, four-day turnaround, occasionally even a five-day turnaround.
Rep. DeLauro: Dr. Redfield, tell me why are we behind other countries? And why were there such a delay of the ability to replace the test kits sent to public health labs?
Dr. Redfield: Yeah, I think we very rapidly developed the test. Then we had to expand that test to go to the public health labs. When that was scaled up by the contractor, the public health labs that need to validate it to make sure the test works. When they did try to verify it in their hands it worked, some of the labs found that the one of the reagents wasn't working correctly. It's a part of our quality control procedure. We then had to tell them to hold off on using those tests for public health. They can still send the samples to CDC. We worked to correct it with the FD. That was corrected in a very short time and then that was replaced. I think the most important point about the availability of testing that I want to say is CDC's focus was to provide testing for the public health system. There's a whole other system we need testing for, for clinical medicine. I'm happy to say now with LabCorp and Quest both operational as of yesterday, there's really, laboratory testing availability to any doctor's office that can go through LabCorp and Quest. But CDC's primary job was to get it out to the public health system of this nation.
Rep. DeLauro: Nevertheless, you've got people who are asking for a test who cannot get a test. The overarching question is, did the CDC's delay in introducing functioning test kits and its insistence on maintaining a narrow clinical definition for testing lead to an increased transmission in our communities? Did the delay undermine CDC's traditional public health efforts of track and trace?
Dr. Redfield: I'm not willing to concede the second. I am willing to say that we had to go through a regulatory process here to get out test out and our test was approved for very specific clinical settings. So when the test EOA was approved by the FDA, it was approved for use in high-risk individuals that were coming at that time from China. And then later it was expanded to individuals with pneumonia and then later as you know, we've expanded now that any physician that feels there's a need or public health person can order that test, but it was a series of going through that regulatory process to get that test available.
Rep. DeLauro: But I think the conclusion is that we are behind the curve and testing when South Korea can test 10,000 people a day. If I can very, very quickly. If you can otherwise, I'll come back. You got $2.2 billion for CDC, we want your assurance that the funds will be allocated quickly. And we are also going to need you to outline CDC's plan for its share of the emergency supplemental and deal with what your top priorities are. What should the American public see in the next coming weeks?
Dr. Redfield: I can assure you we're going to get that money out very quickly and much of it to the state and local health departments to operationalize this. But I would like Ms. Berger comment more.
Rep. DeLauro: We have got a lot of folks here.
Ms. Berger: Thank you very much for the opportunity and thank you for moving so quickly to provide us with the funding. Our top priority is to get funding out to the state and local jurisdictions. Using the Congressional language that we received our top priority is to get 90% of the preparedness grant amount out to the 62 current grantees as quickly as we can, and we plan to be able to do that in the next two weeks.
Rep. DeLauro: Do you have enough resources? Do you have enough resources?
Dr. Redfield: I think the most important thing that all realize is to make sure that CDC is over prepared for a response, not under prepared.
Rep. DeLauro: Okay, that means resources. Thank you very much.
Rep. DeLauro: I've got a couple questions for you and then I want to get in a question to Dr. Houry as well. This is about public health data. And I think what we've heard here this morning is that the coronavirus outbreak further confirms the need for modernizing our public health data system. Dr. Arias, I understand you worked directly on the public health data initiative. So let me ask you a couple questions. If the data initiative had been implemented over the last five years and the CDC had a modernized public health data system how would the current public health response be different?
Dr. Arias: In the spirit of conjecture, it would have been different in two different ways possibly. One is that we would have detected it much sooner and been able to contain it further and more effectively. The other is even before detecting, depending on—relying on different sources of data which we do not now and we want to do more of, and analyzing that information along with health data, we could have started seeing that there might have been a problem even before getting scared about the number of cases that were being detected. So it's both detection and very quick prediction.
Rep. DeLauro: And are their examples of things you cannot do right now that you would be able to? What can't you do right now?
Dr. Arias: What we cannot do right now is two-fold and they're related. One is the delay in finding out what actually is happening and who it is happening to. And a lot of that has to do with unfortunate barriers that the current systems have with getting that information from healthcare providers, getting it from states that we can use then to engage in that response earlier.
Rep. DeLauro: In that regard what we did was to provide in the supplemental to improve surveillance and reporting. Are CDC's public health data systems up to the task of handling all of the data coming from state and local jurisdictions in such an emergency. And I make the reference to the 4,856 number that you gave us Dr. Redfield. Are we where you want?
Dr. Arias: We are not 100% not where we would like and not what we know is possible?
Rep. DeLauro: What percent?
Dr. Arias: Maybe 75%. And the initiative would then get us to 100%. And not only get us to 100% but allow us to maintain that overtime. And be able to keep up with, the difficult that we are running into, that you probably can appreciate is that methods are changing significantly faster than they ever have been, tools are showing up faster than they ever have been. And if we cant keep up with that then we are gong to fall back even more. So if we talk five years from now and don't make those changes it may be 50% instead of 75%.
Dr. Redfield: I just want to add one quick thing: it is fundamentally critical that every state and local territorial and tribal health department has that capacity too.
Rep. DeLauro: Yes, and folks had come, we heard from them, and we talked about electronic medical records. They were talking about fax machines, individual excel worksheets, you know data entry, etc., which holds up the process. We need to invest in this effort.
Dr. Houry, let me just move to you for a second. First time in 20 years, 2020 appropriation including funding for CDC firearm injury and mortality prevention research. There is enthusiasm from researchers everywhere to move forward. What steps has the CDC taken with the new funding? What areas do you see as promising opportunities to address this public health emergency?
Dr. Houry: CDC really appreciates the appropriation and we have moved very quickly on this funding. February 21st we issued our first funding announcement for our RO1 Grants. I am pleased to let you know we had an informational call for potential applicants yesterday. We had a record number for our injury center for interested applicants. Letters of intent are due next week, and then we hope to issue these grants by September to really look at areas like mass violence, how is some prevented, why are others not? Self-defense for use of firearms, you know when is it used against a person or when does it help thwart a crime? And then things like school programs are they effective at really preventing this firearm violence. And then safe storage, what are the best circumstances for it?
Rep. DeLauro: Are there any applicants looking at homicides versus suicides?
Dr. Houry: So we don't know yet. Our hope is that we get a wide variety of applicants. We have really greatly disseminated this information to a diverse group of stakeholders. And we do think it's important, we appreciate the suicide funding as well to look at primary prevention and community level interventions for that.
Rep. DeLauro: I have an additional question and I know the Ranking Member does and then we hear from the ranking member to close and then I will close up. This about global health security, Dr. Redfield. You just mentioned Africa and I just got an email from my dear friend who was the former health director—health commissioner in South Africa. The shadow commissioner just said that they now have the first cases in South Africa. So, these are my questions because the viruses don't have borders and Africa can easily be overrun. What is CDC and global partners doing to assess the risk for immune suppressed clients with HIV and other infectious diseases? What resources are available to support diagnosis and clinical care, and can this be scaled up with other partners? Is CDC able to send health specialists to support the Africa CDC and its regional collaborating centers? We provided $600 million in the past and the supplemental. We include $300 million for global health. If you could just answer those three questions.
Dr. Redfield: Thank you very much Chairwoman. Clearly hit on one of the real concerns in Sub-Saharan Africa in general, obviously, how immune compromised individuals are going to react to this virus. One would predict it will be more likely to cause more severe illness. And in Africa that obviously causes the other problem, because more severe illness means greater likelihood of dependency on oxygen and many of these nations don't have that capacity to the degree they may need it.
We have from the beginning and as you know, because of the PEPFAR program, CDC has country offices all through Sub-Saharan Africa. We have provided technical assistance to their counterparts in the countries they are. We have worked with actually the director of the CDC Africa, is actually a CDC colleague that has gone on loan to the-actually hired by the African Union. He's one of our best. We've helped him build testing capacity. So, there is testing capacity now in West Africa in the African CDC in South Africa. But Africa is a great vulnerability. It's been one of my big concerns on a global scale because if this virus gets into Africa, like it's in Italy, there's going to be a lot of casualties.
Rep. DeLauro: I thank the gentleman, and I'm fortunate. We have been able to produce I think quite remarkable Labor-HHS bills over the last several years. There's a compatibility here that I think at the outset some would say, "Well it's not going to work." But because of the competence and professionalism and deep compassion and caring and the values of the Ranking Member and our ability to work together— yes there are differences but those differences don't cloud the goals and the challenges that we see. And, you know, it's been in the past history of this country that Members on both sides of the aisle that crafted the responses to the serious challenges that we have had they were not naïve. But they understood the challenges were that great that from wherever you come from that our obligation and our responsibility is to see that we address this issue. And that's the kind of cooperative relationship that I find on this committee with my Ranking Member and I think it's true with the subcommittee as well.
So, I thank you for being here very very much to all of you. There are a couple of things, I did look up PEPFAR which has been so critical and that's been cut by half. We will address that issue as well. On the vaping issue, Dr. Arias, the fact of the matter is that e-cigarettes never had an FDA approval which is why I made my comment on ban until we know. I want to go on science, you know, stop it until we figure out whether or not and who where we go for.
I would just ask you Dr. Redfield because you talked about the mask and I say this to the Ranking Member, what I heard yesterday was that yes 3M, it's $35 million, it's $4 million in terms of the hospitals or public health workers. $31 million is for the commercial sector, but it's only $4 million because that's all the insurance that 3M has. And, without some notion of indemnification or so forth, we need the strength of the Administration to say, "Get more insurance and let's move forward with what we need for the public health." That's something that I'm asking to do. It's wrong to stop at $4 million because we can't there.
And then, there's no answer to this, but I don't know for the life of me who is monitoring the self-monitors, you know who are out there and what they are doing. That's a hard task to push. If you want to say something about that go ahead and then I'll wrap up.
Dr. Redfield: I only say one more because we did this with the Ebola outbreak a number of years ago. It's heartening to see the cooperation of the American public when they understand what we're asking them to do. I think about 97% of them basically did what they were asked to. Not everybody, but it's heartening to know the American public when they understand, that they will in fact abide to these clear instructions.
Rep. DeLauro: And again, I thank you very very much. You heard the concerns, you know there are serious concerns. We'll keep asking the questions. We want to make sure that the statement is accurate that anyone who needs a test gets a test immediately and we can allay fears.
The crisis is here, we know that. We are all dependent on the strength of our public health infrastructure. If we are not strong you said it, if we're not strong in all fifty states we are not strong. Let us help you with the core capabilities and I wrote those down: rapid response, predictive analysis and data modernization, global health security, and a public health workforce that is second to none. We want to do that. And please let us know, you know you have listening ears here, to what you need and we want to get you where the country needs to go during this crisis. Thank you all very very much for being here this morning.
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