USING BUDGET PRINCIPLES TO PREPARE FOR FUTURE PANDEMICS AND OTHER DISASTERS
Summary
The printed record of a January 19, 2022 hearing of the Subcommittee on Legislative and Budget Process of the Committee on Rules, House of Representatives, titled "Using Budget Principles to Prepare for Future Pandemics and Other Disasters," with Joseph Morelle presiding. The witnesses are Dr. Helene Gayle of The Chicago Community Trust, Ms. Julia Tedesco of Foodlink, Mr. Jeff Schlegelmilch of the Columbia Climate School National Center for Disaster Preparedness and Dr. Robert Kadlec, Former Assistant Secretary for Preparedness and Response. Mr. Morelle says the hearing focuses on strategic investments across the Federal budget to prepare for future pandemics and other disasters. Material submitted for the record includes a letter from 13 organizations dated January 15, 2022.
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“USING BUDGET PRINCIPLES TO PREPARE FOR FUTURE PANDEMICS AND OTHER DISASTERS.”
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[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]
USING BUDGET PRINCIPLES TO PREPARE FOR FUTURE PANDEMICS AND OTHER
DISASTERS
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON LEGISLATIVE AND
BUDGET PROCESS
OF THE
COMMITTEE ON RULES
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTEENTH CONGRESS
SECOND SESSION
__________
WEDNESDAY, JANUARY 19, 2022
__________
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via http://govinfo.gov
Printed for the use of the Committee on Rules
U.S. GOVERNMENT PUBLISHING OFFICE
49-381 WASHINGTON : 2023
COMMITTEE ON RULES
JAMES P. McGOVERN, Massachusetts, Chairman
NORMA J. TORRES, California TOM COLE, Oklahoma,
ED PERLMUTTER, Colorado Ranking Republican
JAMIE RASKIN, Maryland MICHAEL C. BURGESS, Texas
MARY GAY SCANLON, Pennsylvania GUY RESCHENTHALER, Pennsylvania
JOSEPH D. MORELLE, New York MICHELLE FISCHBACH, Minnesota
MARK DeSAULNIER, California,
Vice Chair
DEBORAH K. ROSS, North Carolina
JOE NEGUSE, Colorado
DON SISSON, Staff Director
KELLY DIXON CHAMBERS, Minority Staff Director
------
Subcommittee on Legislative and Budget Process
JOSEPH D. MORELLE, Chair
MARY GAY SCANLON, Pennsylvania MICHAEL C. BURGESS, Texas,
DEBORAH K. ROSS, North Carolina Ranking Republican
JOE NEGUSE, Colorado TOM COLE, Oklahoma
JAMES P. McGOVERN, Massachusetts
------
Subcommittee on Rules and Organization of the House
NORMA J. TORRES, California, Chair
ED PERLMUTTER, Colorado, GUY RESCHENTHALER, Pennsylvania,
Vice Chair Ranking Republican
MARY GAY SCANLON, Pennsylvania TOM COLE, Oklahoma
JOSEPH D. MORELLE, New York
JAMES P. McGOVERN, Massachusetts
------
Subcommittee on Expedited Procedures
JAMIE RASKIN, Maryland, Chair
DEBORAH K. ROSS, North Carolina, MICHELLE FISCHBACH, Minnesota,
Vice Chair Ranking Republican
NORMA J. TORRES, California TOM COLE, Oklahoma
MARK DeSAULNIER, California
JAMES P. McGOVERN, Massachusetts
------
C O N T E N T S
----------
January 19, 2022
Page
Opening Statements:
Hon. Joseph D. Morelle, a Representative in Congress from the
State of New York and Chairman of the Subcommittee on
Legislative and Budget Process............................. 1
Hon. Michael C. Burgess, a Representative in Congress from
the State of Texas and Ranking Member of the Subcommittee
on Legislative and Budget Process.......................... 2
Witness Testimony:
Dr. Helene Gayle, MD, MPH, President and CEO, The Chicago
Community Trust............................................ 7
Prepared Statement....................................... 10
Ms. Julia Tedesco, President, and CEO, Foodlink.............. 16
Prepared Statement....................................... 19
Mr. Jeff Schlegelmilch, MPH, MBA, Director, Columbia Climate
School National Center for Disaster Preparedness........... 24
Prepared Statement....................................... 27
Dr. Robert Kadlec, MD, Former Assistant Secretary for
Preparedness and Response, U. S. Department of Health and
Human Services............................................. 33
Prepared Statement....................................... 36
Questions and Additional Material Submitted for the Record:
Hon. Michael C. Burgess, a Representative in Congress from
the State of Texas and Ranking Member of the Subcommittee
on Legislative and Budget Process.......................... 63
Letter from 13 organizations dated January 15, 2022.......... 69
Curriculum Vitae and Truth in Testimony Forms for Witnesses
Testifying Before the Committee............................ 71
USING BUDGET PRINCIPLES TO PREPARE FOR FUTURE PANDEMICS AND OTHER
DISASTERS
----------
WEDNESDAY, JANUARY 19, 2022
House of Representatives,
Subcommittee on Legislative and Budget Process,
Committee on Rules,
Washington, DC.
The subcommittee met, pursuant to call, at 10:01 a.m., via
Webex, Hon. Joseph Morelle [chairman of the subcommittee]
presiding.
Present: Representatives Morelle, Ross, McGovern, and
Burgess.
Mr. Morelle. The Subcommittee on Legislative and Budget
Process of the Committee on Rules will come to order.
I want to begin by welcoming our witnesses and thank them
for being here today. And I would like to thank my colleagues
Chairman McGovern of the Rules Committee and Mr. Burgess, our
ranking member of the subcommittee and a member of the Rules
Committee, for joining as well.
Today's hearing will focus on the importance of making
strategic investments across the Federal budget to build
economic resiliency and ensure an efficient Federal response to
future pandemics and other disasters.
Disaster preparedness includes not only ensuring that
existing programs are adequately funded but that systems are in
place to efficiently distribute the funding as well. It is
critical for the United States Government to make these
investments before the next disaster occurs. And we have seen
that underinvestment in key programs exacerbates inequities
already present in our communities.
And we inherently know the value of investing in
preparedness. In fact, we do it all the time. We invest in
public safety infrastructure to quickly respond to 911 calls
and help mitigate dangerous situations. The National Weather
Service routinely communicates storm warnings to allow local
governments and State governments to begin preparations. These
are critical efforts. Are we doing enough in these critical
efforts, or are we budgeting enough for them?
These types of investments should be prioritized as we
think of investments in disaster preparedness as well. As we
all know, investments in preparedness cost far less than
investments in response measures. And a recent study by the
National Institute of Building Sciences found that for every $1
invested in disaster mitigation measures we ultimately save
society $6.
So, while this fundamental budget principle can be applied
to the Federal response to many different types of disasters,
an examination of the response to COVID-19 is an obvious place
to begin.
Almost 2 years since the beginning of the pandemic, this
hearing attempts to provide an opportunity to look back and,
more importantly, have a conversation about what lessons we
have learned and how we can be better prepared for the next
pandemic. This type of forward-looking thinking is desperately
needed, as lessons learned from previous crises have clearly
not been taken to heart.
For example, even after recent public health crises ranging
from SARS to Zika, public health agencies continue to be
dramatically underfunded. A recent analysis shows that public
health spending accounts for just 2.5 percent of all health
spending in the United States, which comes to roughly $274 per
person.
This past fall, the Biden administration released a
pandemic preparedness plan that focused on strengthening public
health systems, improving surveillance and monitoring for early
threats, increasing stockpiles of PPE, and investing in
vaccines and therapeutics.
While I applaud the administration for these efforts and
these types of measures that must be enacted, the budget
principles behind this plan should be applied to preparedness
for other types of disasters as well. From the 2000 to the 2010
decade, spending on FEMA's public assistance programming
increased 23 percent. And as the frequency and cost of
disasters continues to increase, Congress must consider how to
better address disaster preparedness and assistance in the
annual appropriations process.
And, finally, coordination between government and private
stakeholders can clearly be improved. Although FEMA is the
primary agency for disaster assistance, it is important to note
that at least 16 other Federal departments and agencies also
contribute to disaster relief efforts. And I appreciate, in the
testimony submitted by the witnesses, a number have touched on
this point.
This response structure becomes even more complex when
including State and local government stakeholders, who, along
with the private sector and not-for-profit organizations, are
often most directly engaged in local communities.
Ensuring that efficient systems are already in place
beforehand will dramatically improve the quality of the
response, particularly for services where planning and
logistics play a significant role. Whether it be allowing food
distribution networks and supply chains to operate more
efficiently or ensuring that funding for government stimulus
programs are able to quickly get to families in need, Congress
must examine potential changes to this process.
So I look forward to the discussion today, which I hope
will develop policy recommendations on how to use the Federal
budget process to build an economy more resilient to future
disasters.
And, with that, the Chair now recognizes the ranking member
of the subcommittee, Dr. Burgess, for any remarks that he
wishes to make.
Dr. Burgess. I thank the Chair, and I am certainly glad
that we are holding this hearing.
I do want to thank our witnesses for being here to testify,
and certainly looking forward to hearing from all of you and
learning about how our Nation can more efficiently plan our
budget to prepare for future pandemics.
You know, I can't help but think I am sitting here in the
Rules Committee by myself. This hearing is being done
virtually. But it was just a little over 2 years ago that we
had one of the first Rules hearings to regard what were the
initial stages of this pandemic. And it is hard to believe that
not only are we on the second anniversary of that, we are going
into the third year of the pandemic. And, certainly, you can
recognize a certain amount of pandemic fatigue around the
country. And every congressional district is encountering that
and recognizing that.
I do hope today's hearing is productive, and I am anxious
to see and learn how our budgetary process and our response can
improve our pandemic preparedness.
And, Chair Morelle, I just have to point out--and Chairman
McGovern--that we are probably--you referenced an
appropriations acknowledging that there is going to be future
disaster mitigation necessary.
We are actually about, what, 3 weeks away from the lapse
of--an appropriation lapse in our governmental funding.
Unfortunately, because of where we are in the process, we are
very likely to see additional continuing resolutions.
And, as you both know, it is impossible to plan for or to
budget money for future disasters if you are only using a
continuing resolution process, because, by its very nature,
that is a process where you only look back and fund the
activities of the previous year or years, not what is going to
be happening in the future.
So, I certainly hope that we--and I am sensitive to the
fact that our ranking member of the full Rules Committee is an
appropriator, so I want to be careful what I say. But, at the
same time, we really do depend upon the appropriations process
to do their work, and then, of course, we will do our work in
the Rules Committee when they finish their product.
But here we are. We are in the largest and most devastating
pandemic in--certainly in my lifetime. In fact, I serve on
another committee that has jurisdiction over pandemic
preparedness; that is the Committee on Energy and Commerce. And
I have been asking our committee, the Committee on Energy and
Commerce, to hold just such a hearing for certainly longer than
a year, probably almost 2 years.
And recently I sent a letter to Chairman Pallone of the
Committee on Energy and Commerce expressing my frustration and
disappointment with the lack of response from the Energy and
Commerce Committee, which is one of the primary committees that
should deal with public health.
I think we have much to learn from the experience that we
have all been through the past 2 years. But our committee has
been--the Energy and Commerce Committee has been eerily silent.
And it is a point of personal frustration to me that the Energy
and Commerce Committee, which has a responsibility in this
area, really has not shouldered that responsibility.
And this is not just a criticism of the majority Democrats.
I think that criticism actually applies to both sides of the
dais. I cannot believe how passive we have been on the
Committee on Energy and Commerce as far as asking the hard
questions and providing information as an authorizing committee
to our appropriators and then ultimately to the Rules Committee
before a process comes to the floor.
It has been extremely frustrating to be in the minority
during this pandemic, but it is also extremely frustrating to
be part of a committee that should be in the vanguard, should
be in the lead, and, in fact, has not even shown up.
So, the Energy and Commerce Committee reauthorized a bill;
it was called the Pandemic and All Hazards Preparedness Act of
2018. And this very situation is what we were aiming to prevent
and for which we were attempting to be prepared. And I believe
we can all agree that we have had many successful
accomplishments from the Pandemic and All Hazards Preparedness
Act. The one thing that it should have done, which was prepare
us for this pandemic, it did not do.
And, again, going to my previous frustration, we had no
real-time--no actual hearings, as an authorizing committee, on
the Committee on Energy and Commerce looking at this in real-
time while the drama was unfolding around us. We had the
Pandemic and All Hazards Preparedness Act signed into law in
June of 2019, 6 months later to be visited by this pandemic.
And we never asked a single question: Did we get it right? What
could we have done better? What should we learn for next time?
So, it is not often that we have a real, live case study to
intricately examine the effectiveness of the policies that we
just passed. And many of us, those of us who are witnesses
today and those of us on the legislative side, we have had some
experience with this over the years.
One significant success that did occur during the first
year of the pandemic--it was a significant milestone of the
previous administration, the Trump administration--was that of
Operation Warp Speed. Because of this program, we have access
to vaccines, we have access to effective therapeutics. And the
very existence of those vaccines and therapeutics begs the
question, what made Operation Warp Speed so successful, and are
there ways that we can apply these successes to our
government's regular duties so that we don't just have to
respond at the time of an emergency?
It is critically important that we take the time to examine
the program while we still have an opportunity to speak with
those who developed and deployed it, those who were on the
front lines, those who lived it. And so, for that reason, we
are so very fortunate to have Dr. Kadlec at our witness table
today.
Additionally, it is an opportune time to compare our
Nation's response to the novel coronavirus to other pandemics
that we have encountered--for example, while on different
scales, the Ebola outbreak that ravaged western Africa in 2014
and 2015 and in fact, made its way to this country and ended up
in my backyard in Dallas, Texas.
It took 5\1/2\ years for an Ebola vaccine to be developed
and produced and receive emergency use authorization. That is
why the stunning success of Operation Warp Speed stands in
stark contrast, where, over a 9-month period we had the
streamlining of the process, the emergency use authorization
process, at the FDA and got that vaccine in the hands of our
constituents.
Furthermore, I think it is pertinent to learn about what we
are currently doing in the current administration to further
the progress, the success, of the previous administration's
pandemic response.
We also must determine exactly where the almost $5.5
trillion that Congress has appropriated for these efforts,
where are those dollars today? Which have been spent, and what
remains unspent?
And when we talk about further activities, we really can't
authorize new spending--we can't appropriate new spending until
we know where the last dollars have gone. Effective oversight
is going to be a key component of any successful pandemic
preparedness and response effort. And, in fact, we really can't
talk about how we budget for future problems if we don't
understand where the dollars went, where the successes and the
missteps were in the last effort.
Plain and simple, we really can't plan for future pandemic
preparedness unless we have a strong understanding of what has
worked and what has not worked.
We find ourselves in a unique and really a historic
position. While these past 2 years have been exhausting for
Americans, now is not the time to just sit back and hope that
we won't find ourselves in a similar crisis in the future. This
will be our best opportunity to create strategic and smart
policy that will help ensure that, the next time this occurs,
the country is properly prepared and that preparation can be
properly executed.
Thanks, Mr. Chairman, for holding the hearing. Thanks to
our witnesses. And I will yield back.
Mr. Morelle. Thank you, Mr. Burgess. I appreciate your
comments about Energy and Commerce.
I do want to note, though, that, while the pandemic is, you
know, in the center here in terms of our thinking, that more
broadly I also want to deal with the notion of other natural
disasters which may be regional, whether it is wildfires, et
cetera, and whether or not our budget process is prepared to
deal with that.
So I appreciate your comments.
I also want to thank Chairman McGovern, who has been
working with our subcommittee to host this hearing, and so,
appreciate them.
As for the appropriations process, I don't have the
privilege of serving on the Appropriations Committee, but I
would note that the House has, I think, done a great deal and
we are waiting for our brothers and sisters across the Capitol,
as we do on many issues.
So, with that, I would like to introduce our witnesses.
Let me begin with Dr. Helene Gayle, who has been president
and CEO of the Chicago Community Trust, one of the Nation's
oldest and largest community foundations, since October 2017.
Under her leadership, the Trust has adopted a new strategic
focus on closing the racial and ethnic wealth gap of the
Chicago region.
For almost a decade, Dr. Gayle was president and CEO of
CARE, a leading international humanitarian organization. An
expert on global development, humanitarian, and health issues,
she spent 20 years with the Centers for Disease Control,
working primarily on HIV/AIDS. She worked at the Bill and
Melinda Gates Foundation, directing programs on HIV/AIDS and
other global health issues.
Dr. Gayle was born and raised in Buffalo, New York, which,
as a upstate New Yorker, I have special pride in knowing that.
She earned a B.A. in psychology at Barnard College, an M.D. at
the University of Pennsylvania, and an MPH at Johns Hopkins
University.
We are also joined by Julia Tedesco, who is the president
and CEO of Foodlink, a not-for-profit dedicated to ending
hunger and building healthier communities in the greater
Rochester/Finger Lakes region of New York.
Over the past decade, she has led the organization's
evolution from one of the country's oldest food banks to an
innovative food resource center and public health organization
focused on addressing the root causes of food insecurity,
including chronic poverty and systemic racism. Ms. Tedesco
began at Foodlink in 2008 and has served in numerous roles for
the organization. She was named executive director in 2014.
Ms. Tedesco holds a master's degree from Syracuse
University's Maxwell School of Citizenship and Public Affairs
and a bachelor's degree from Fairfield University. And I have
had the privilege of working with her on a number of issues
back in my hometown.
Jeff Schlegelmilch is the director for the National Center
for Disaster Preparedness at Columbia Climate School at
Columbia University. In this role, he oversees the operations
and strategic planning for the Center. He also oversees
projects relating to the practice and policy of disaster
preparedness. His areas of expertise include public health
preparedness, community resiliency, and the integration of
private- and public-sector capabilities.
Prior to his role at Columbia, he was the manager for the
International and Non-Healthcare Business Sector for the Yale
New Haven Health System Center for Emergency Preparedness and
Disaster Response. He was also previously an epidemiologist and
emergency planner for the Boston Public Health Commission.
And, finally, Dr. Robert Kadlec previously served as
Assistant Secretary of Preparedness and Response at the U.S.
Department of Health and Human Services from August of 2017
through January of 2021. Dr. Kadlec spent more than 20 years as
a career officer and physician in the United States Air Force
before retiring as a colonel. Over the course of his career, he
has held senior positions in the White House, the United States
Senate, and the Department of Defense.
So thank you all again for joining us today.
And we will begin with Dr. Gayle. You are recognized to
share your testimony with us.
STATEMENTS OF HELENE GAYLE, M.D., CEO, CHICAGO COMMUNITY TRUST;
JULIA TEDESCO, PRESIDENT AND CEO, FOODLINK, INC.; JEFF
SCHLEGELMILCH, DIRECTOR, NATIONAL CENTER FOR DISASTER
PREPAREDNESS, COLUMBIA CLIMATE SCHOOL; AND THE HONORABLE ROBERT
KADLEC, M.D., FORMER ASSISTANT SECRETARY FOR PREPAREDNESS AND
RESPONSE, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
STATEMENT OF HELENE GAYLE, M.D.
Dr. Gayle. Great. Good morning, and thank you, Chairman and
the other members of the committee and the subcommittee, for
the opportunity to address you on this incredibly important
issue.
I won't go over a lot of the statistics around this COVID
pandemic. I think we know them well. And while the health and
economic consequences of COVID-19 are unlike any that any of us
have seen in our recent memory, it is likely that this is not
going to be a once-in-a-generation pandemic. We know that more
than 40 new infectious diseases in humans have emerged in the
past decades. You have mentioned some of them: SARS, MERS,
Ebola, Zika, et cetera. So we know that we are at a time when
we will continue to see new infections that can lead to global
pandemics as we are seeing now.
Clearly, we have to take the lessons that we have learned
and think about how we apply those not only to this current
crisis but in ways to make us better prepared. And while we
know that we will continue to have these new infectious
diseases emerging and pandemics, how we respond to them will
really determine whether or not we see the kinds of severe
health and economic consequences that we are seeing today.
So let me just lead off with five points.
First, pandemics do play on social fault lines and will
always impact the most vulnerable in our societies. COVID-19
has highlighted how the social determinants of health and
underlying root causes that make one vulnerable to poor health
also further amplify health and economic inequity. Pandemic
preparedness means focusing on how we prepare for economic
stability and resiliency not just in the face of a crisis but
also in normal times.
This requires us to think about how we address issues like
affordable housing, the social supports we provide to
individuals and family over the long term, like paid sick
leave; family leave; living wages; affordable, accessible high-
speed internet; and comprehensive, affordable health insurance.
Pandemic preparedness can and should help us to reimagine
how we deliver social and economic support to make sure that we
are all, as a society, resilient in times of crisis.
Number two, we must work with communities that are most
impacted, establishing links to organizations and people who
are trusted.
Another important lesson we learned during COVID, as we
have during other crises, is that, to address the public health
needs of people, we must work with the communities that are
most impacted, who often have less access to services and less
faith in medical systems that have failed them in the past.
It is critical that public health institutions develop
relationships with trusted messengers in order to deliver life-
saving measures like vaccines. These organizations and people
who have been with communities and have stood the test of time
are the ones who are going to be most effective, particularly
when residents are grappling with the impacts of crises like
this pandemic.
Third, pandemics do not know geographic and political
boundaries. A go-it-alone approach is ineffective and
counterproductive to preventing and addressing a global
pandemic. While, clearly, preparing for future pandemics at
home and strengthening our own health safety network are
immediate priorities, we cannot afford to ignore global health
security vulnerabilities. There are no boundaries to global
pandemics, and attempts to isolate populations, like closing
boundaries, are not only ineffective but counterproductive as
we work to look at a collaborative and cooperative way that is
critical in addressing global pandemics.
And we have seen time and time again in this pandemic that
no one is safe unless we are all safe. As the richest nation in
the world and the leader in global health and development
assistance, we must provide international assistance to address
pandemic prevention and control globally, especially for under-
resourced nations.
This is not a matter of charity but of strategic investment
in U.S. and global health security. We need to think about
models like PEPFAR and global health security and control and
prevention of diseases in the ways that we have in the past,
because it is critical to our strategic health diplomacy, our
investment in foreign policy, our national security, and our
economic interests.
Fourth, pandemic preparedness is as important but
underfunded as compared to investments in other major threats--
as an example, our preparedness in military readiness. Knowing
that future pandemics are a serious security and economic
threat, the government must commit to investing in prevention,
detection, and response to protect vulnerable populations from
future infectious disease outbreaks.
And if you compare our spending, our military spending, as
an example, $750 billion--compare that to $447 million that we
use for preparing for global health security threats like
COVID. And while those aren't exact comparisons, if we think
about the fact that our future threats are more likely to be in
the cyber arena and the biologic arena, we need to think about
the magnitude of spending that we commit to health and health
security, and particularly thinking about making sure that the
organizations like the CDC, the NIH, the FDA, State Department,
and USAID are adequately funded in advance to be able to be
ready and have systems in place when the next crisis does
occur.
And, finally, five, maintaining public health
infrastructure, including a well-trained and robust workforce,
surveillance systems, laboratory systems, information systems--
all of these things are key. And we should have learned this
from the HIV pandemic, Ebola, SARS, et cetera.
We know that the public health workforce has been shrinking
and is estimated to shrink dramatically. Leading up to the
pandemic, there were approximately only 56,000 public health
workers due to funding issues. Access to the Public Health
Workforce Interests and Needs Survey shows that a large
proportion of workers are considering leaving their job in the
next year due to inadequate pay.
We must make sure that we don't continue to lose the
critical infrastructure of people, surveillance system, and
laboratory capacity that is necessary and needs to be in place
in order to be prepared.
The budget for the Hospital Preparedness Program, the major
source of Federal funding to help regional healthcare systems
prepare for emergency, was only $275 million in fiscal year
2020. That is just half over what it was in 2004 of $515
million. So, you know, we have almost halved the dollars that
were available for hospital preparedness over the course of the
last few years.
These are just a few examples of how the decline in funding
has led to us being caught off guard for this pandemic, not
prepared and not having the infrastructure in place. And so,
you know, my overall message is that we need to make sure that
we have in place the important systems, people, relationships,
and commitment to be able to be prepared the next time.
We have learned these--we should have learned these
lessons. We have a lot of blueprint to go on, lots of
information and lots of lessons learned from the past couple of
decades of fighting global pandemics. We need to learn these
lessons. We need to keep the infrastructure in place. We need
to be prepared so that we don't have to suffer the consequences
that we have during this global pandemic.
Thank you.
[The statement of Dr. Gayle follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Morelle. Thank you, Dr. Gayle. I appreciate your
comments, and I am sure people will have a number of questions.
And, with that, Ms. Tedesco, you are recognized for your
testimony.
STATEMENT OF JULIA TEDESCO
Ms. Tedesco. Thank you, Chairman Morelle, Ranking Member
Dr. Burgess, and members of the Rules Committee. Good morning,
and thank you for the opportunity to speak with you today.
My name is Julia Tedesco, and I have the great privilege of
serving as the president and CEO of Foodlink, a nonprofit
organization in Rochester, New York, that serves as the
regional food bank.
Congressman Morelle likely recalls attending Foodlink's
very first COVID emergency response food distribution on March
20, 2020, in his hometown of Irondequoit. There was a lot we
didn't know about COVID then, but, as an emergency response
organization, we knew that families were already struggling
with hunger and access to food, as they do in the face of any
crisis.
That day, a collaboration between the nonprofit and
government sectors enabled us to safely get food to more than
300 households. In the 2 years since, we have organized more
than 900 similar drive-through emergency food distributions
across our region.
In the next few minutes, I would like to first share
details about Foodlink's response during this pandemic. And,
second, I would like to talk about the critical role that
nonprofits play and why investment in this sector will help
prepare us for any future emergency response. In doing so, I
will do my best to represent the 200-plus Feeding America food
banks across the Nation that have responded to COVID-19 and
countless other disasters.
Much attention has been given to the pandemic's devastating
impact on the food security of millions of families and just
how many Americans were one crisis away from not having enough
food to eat. We saw this firsthand in the city of Rochester and
in the suburban and rural communities throughout our service
area.
We saw that as many as 40 percent of the people seeking
support from the emergency food system were doing so for the
very first time. But we also saw firsthand how this pandemic
disproportionately impacted the vulnerable--the elderly with
limited incomes, low-income parents, people of color, and so
on--individuals who were already facing difficult choices like
paying for rent or paying for food, individuals for whom panic-
shopping in bulk for groceries was simply not an option.
At the same time, schools closed indefinitely. The city of
Rochester has one of the highest child poverty rates in the
Nation. Every student in the district is categorically eligible
for free school meals. With schools closed, parents were left
wondering how to account for two extra meals per child per day,
a looming financial and public health crisis of its own.
Foodlink sprang into action on both fronts. In response to
the need, we within a matter of weeks established a temporary
alternate off-site warehouse to safely store and pack emergency
provisions. When most of our network of direct-service
partners--think of food pantries in community centers and meal
programs in church basements--were forced to shut down, we
designed and coordinated no-touch drive-through distributions
in centralized locations across 7,000 square miles.
When government and community partners had critical
information or supplies they needed to get to the public, we
utilized these distributions to disseminate them.
We became a central hub for everything from suicide
prevention and mental health resources to U. S. Census data
collection.
When a nurse from our regional healthcare system called us
to frantically figure out how to get food to an elderly,
quarantined, immunocompromised patient, we for the first time
in our 40-plus-year history made a home delivery and continued
doing so, thanks to partnerships with other nonprofits.
We sat with leaders from our local city school district to
brainstorm and coordinate the logistics of 17 grab-and-go meal
sites for kids and their families. Understanding that barriers
still existed for food access, we repurposed some of our
smaller box trucks and, thanks to waivers issued by the USDA,
we implemented ice-cream-truck-style neighborhood meal
distributions to complement our Summer Meals program.
Foodlink distributed more than 50 million pounds of food in
the last 22 months, and our kitchen produced more than 1.5
million healthy meals and snacks. Our fellow food banks in New
York State and around the Nation all did similar work,
distributing unprecedented amounts of nutritious food,
leveraging our relationships in the communities we serve, our
expertise in food distribution, and our infrastructure,
including distribution centers, industrial freezers and
coolers, commercial kitchens, and fleets of trucks.
Significant government intervention, such as child tax
credits and boosts in SNAP benefits, helped quell what surely
would have been devastating poverty levels. Still, food
insecurity remains approximately 10 percent higher than levels
recorded in 2019. That is more than 7 million people across our
Nation who are food-insecure. And in our region, that equates
to about 152,000 people who have limited access to food,
152,000 people who might not know when or from where their next
meal will come.
As a food bank, we are proud of our response to this
pandemic, but it is important to emphasize that, for every one
meal that a Feeding America food bank like Foodlink provides,
SNAP provides nine. If we are to make a meaningful reduction to
hunger in America and address a compounding factor in any
disaster or crisis, the Federal Government must continue to
increase investments in antipoverty programs like SNAP and to
think of this, in its own way, as a form of disaster
preparedness.
In addition to investing in the social safety net, the
Federal Government should more significantly invest in the
nonprofit sector's ability to respond to crises. Nonprofits are
not merely a group of small charities trying to do good; we are
oftentimes the engine that generates innovative solutions to
complex problems in our society. When the government needed to
find ways to distribute food, PPE, vaccines, and information
into underserved communities, it relied on the infrastructure
expertise and flexibility of community-based nonprofit
organizations.
Far too often, though, nonprofits like Foodlink are asked
to execute on programs that we did not have an opportunity to
weigh in on. Issues with the Coronavirus Food Assistance
Program have already been well-documented, and I won't go into
all of them here in the interest of time. But I do hope a major
lesson from CFAP is that, when the Federal Government needs to
find ways to help feed people, it should include or perhaps
begin with the nonprofit sector, and specifically the expertise
of the Feeding America network, rather than to recreate the
wheel.
This Nation already has a centralized hub for emergency
food assistance with spokes across every State, county, and
local community in America that could have helped to ensure
smoother logistics and more equitable access to these food
boxes. If food banks were included from the start and leveraged
for their expertise, we could have significantly reduced staff
time spent on coordination, saved dollars, and fed millions
more Americans.
I hope that a critical lesson to come out of the pandemic
is the importance of investing in nonprofit infrastructure and
technical capacity. Over the last couple of years, we often
found ourselves with a strong food supply but insufficient cold
storage and refrigerated vehicles. Foodlink has rented tractor
trailers stationed in our parking lot running 24/7 for 2 years
to provide additional cold storage.
Community-based nonprofits do not have the resources to do
R&D and invest in innovation the way that the private sector
does, and when we do, it rarely, if ever, is funded by the
Federal Government. We are encouraged by the USDA's promised
investments in strengthening our food system and hope these
investments extend beyond farmers, producers, and for-profit
distributors to include the nonprofit sector.
To summarize, we first and foremost believe that our
Nation's social safety net must be strengthened to better
prepare us for the next disaster, but the pandemic has also
shown us that the Federal Government has a real stake in the
operational efficiency, infrastructure, capacity and innovation
of the nonprofit sector, especially when responding to
disasters. This sector should be invested in, and nonprofits
should be counted on not only to receive support and deliver
interventions or services decided on by government but to take
part in the very design of those services.
Thank you for your time today.
[The statement of Ms. Tedesco follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Morelle. Thank you very much for your testimony.
And now, Mr. Schlegelmilch, you are recognized for your
testimony, sir.
STATEMENT OF JEFF SCHLEGELMILCH
Mr. Schlegelmilch. Thank you. Thank you, Chairman, and
thank you to all of the members of the committee for the
opportunity to speak with you today.
To complement my written testimony, I want to talk about a
few experiences in the field that sort of illuminate what these
larger challenges look like.
So, to start, actually, after Hurricane Harvey, my
colleague and then-director of the Center, Irwin Redlener, and
I were in Texas assisting some celebrity donors to identify
where their money could do the most good. And we saw a range of
things, from really emergent community organizations that never
envisioned themselves being part of disaster response and were
meeting unmet needs--needs that weren't being met by larger,
sort of, external groups or maybe that the funding couldn't
reach.
But, in particular, what stands out is a faith-based group
that was doing what we would call ``disaster case management.
''So there were a number of people who were being denied
assistance through various programs. And, a lot of times, they
were actually eligible but had filled out their paperwork wrong
or misunderstood a definition or something like that. And so
what most of them did, well, they gave up. And so they went to
these nonprofits, and they actually helped them reapply and get
access to those resources.
In other cases, maybe they weren't eligible but they were
eligible for another program they weren't aware of and wouldn't
have though to look, like the Small Business Administration.
You know, zooming out a little bit, I was talking to a
State mitigation officer on some of the new mitigation funding
that was coming in, and he was lamenting about how a lot of the
smaller, more marginalized communities just had no way of
accessing and putting together the application for these, that
the opportunity to waive Federal cost-share was great for the
communities that had capacity but not resources for cost-share,
but a lot of the most marginalized groups really lacked the
administrative capacity.
And for folks like you and I that are mired in paperwork
day in and day out, the idea of another grant may not seem too
daunting, but a mitigation grant is quite a daunting task and
requires a high level of administrative sophistication that
many simply don't have.
So we see a pattern here with the increased complexity,
that it sort of pushes out those who are already the most
marginalized. I tend to say, those who have access to the
benefits of civil society before a disaster have access after.
Those who don't have lawyers and accountants and access to
high-quality administrative frameworks often don't have access
to what are otherwise deemed fair and open accessibility. Fair
and open in theory does not actually equate to fair and equal
in practice with these barriers in place.
So, thinking about root causes and something I talk about
in my written testimony--so I had a call a couple of months ago
with a congressional office. And it is the same call I get from
various offices on all sides of the aisle from time to time
after there is a major disaster. And they say, you know, ``We
want to know how to do a better job with response. What are
some things we can do?''
So I start going down my list, which is suspiciously
similar to my written testimony when talking about
consolidating and simplifying and really looking at, sort of,
larger, sort of, muscle movements in our whole-of-government
disaster response.
And I am typically met with, ``Yeah, we can't do that.
Yeah, that is not going to fly. No, there is no way we can get
that approved. In the current climate, we would love to but we
can't.'' And it settles in on this comment: ``We are looking
for a quick win.'' ``We are looking for a quick win.'' And then
the comment kind of gets cleaned up with ``something that can
lead to more, something that can be a starting point in all of
these things.''
In the opening comments from the chairman, I know we talked
about the complexity of disaster response and the sheer number
of programs and agencies. It is important to note, these quick
wins are quite literally killing us. They are creating layers
upon layers of complexity to the disaster response. And it
requires more and more workarounds with emergency supplementals
and budgetary workarounds, which creates a cacophony of data
and assistance that leaves the survivors--the only ones who can
access it are the ones with the highest capacity and are likely
to be less vulnerable to begin with.
So, to close, I want to reiterate a couple of the key
recommendations I had in my written testimony.
One is, I know it is pretty on-brand as an academic to say
we need better data and more analysis, but we need better data
and we need more analysis. We know enough to know in broad
strokes that preparedness saves, and some of these specific
programs we know. But to really look at this across whole of
government and look at what is going into preparedness through
the true definition and what is going in response, we actually
don't have enough information to get from this concept and
general direction to be pointed in to start answering
questions: How much? What are the details? What are the
investments, and what is the value of those investments? And
what are the payoffs in terms of equity, social good, financial
good? We have rough ideas but not necessarily to the level of
granularity to integrate into a lot of decisionmaking.
We need enhanced guardrails, quite frankly, to prevent
electoral incentives that are contrary to the public interest
from dominating legislative and budget processes. The political
science points towards faster and very voluminous relief and
recovery funding. Relief and recovery funding is necessary, but
the signals for preparedness funding are virtually nonexistent.
But in disaster science, of course, we know those are the most
valuable, and that is how you prevent loss of life and
livelihoods in the event of a disaster.
We desperately need to simplify disaster funding and
assistance and the bureaucratic landscape for all of this. It
is a very unappealing and complicated topic, but I think it is
probably the single most important thing that could be done to
set a landscape that is more conducive towards disaster
assistance benefit and equity.
And, finally, I haven't mentioned this yet in my verbal
comments, but we need to look hard at the public servants who
are carrying out these policies and make sure we are making
investments in their development. The world is changing. We
know this. We know that our structures need to change. But
these structures ultimately translate into institutions and
people. The investment in professional and organizational
development often gets thought of as overhead. It needs to be
an essential part of the cost of doing business to ensure that
those that are engaged in the design, development, and
implementation of these strategies have the support that they
need to accomplish that which they are already working so
tirelessly and admirably at every day.
So, with that, I want to thank you for your time, for the
opportunity to speak, and I look forward to any questions and
the opportunity to discuss further. Thank you.
[The statement of Mr. Schlegelmilch follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Morelle. Thank you so much for your testimony.
And I would like to ask Dr. Kadlec to provide his testimony
now, sir.
STATEMENT OF THE HONORABLE ROBERT KADLEC, M.D.
Dr. Kadlec. Thank you, Chairman Morelle and Ranking Member
Burgess and other members on the line today. Thank you for the
privilege and the opportunity to appear before you.
Now as a private citizen, as the HHS Assistant Secretary
for Preparedness and Response at the start of the pandemic, I
lived, breathed, and bled the experience. I certainly want to
acknowledge the incredible work, service, and sacrifice of the
Federal, State, local, Tribal, and territorial civil servants
and professionals from the private health sector that served as
the first responders during this pandemic response. The whole-
of-Nation response has been vital to preserving our Nation,
society and saving lives.
I also want to commend you and your colleagues for your
strategic vision and foresight in having this subcommittee
consider budgetary approaches that Congress should take to
prepare the country for the next pandemic or major public
health emergency.
I am convinced, by these collective commitments to learning
from the COVID response and to future congressional action we
can better prepare to mitigate unnecessary loss of life,
negative economic impacts, and societal disruptions that
another pandemic will bring.
There are several historical and contemporary budget
approaches that worked, did not work, and could work better.
There are some prospective ideas that are innovative and I
think would work to improve future pandemic preparedness.
Whatever approach is taken must address a range of potential
health security threats, to your point, Mr. Chairman, and
ensure congressional accountability and sustainability of
critical response capabilities.
What worked? Project BioShield Act that was created by
Congress in 2004 after the events of 9/11 was an effective
tool. It created a 10-year advance appropriation to incentivize
the development and procurement of chemical, biological, and
radio-nuclear medical countermeasures that did not have a
commercial market.
The program was successful, but the special reserve fund
created by legislation was not replenished when the original
10-year appropriation ended.
Advance appropriations could be useful in developing
pandemic and antimicrobial medical countermeasures as well as
CBRN ones. The dilemma becomes renewing such advance
appropriations and the potential that Congress may later choose
not to do so. The original BioShield concept called for
obligatory, nondiscretionary funding.
What didn't work? Funding preparedness with periodic
disaster supplementals.
Funding to sustain improvements in preparedness are not
particularly useful tools. And, quite frankly, with the
mainstay at ASPR, I have a chart of ASPR's budgetary history
that indicate that the majority of funding that we received for
our role was often times through supplemental Congressional
funding from disasters.
While they have been significant enablers for preparedness,
when those funds basically expire, as they did with influenza
and Ebola, our ability to sustain programmatic funding for
pandemic preparedness and particularly countermeasure
development and some of our practical capabilities, operational
capabilities, such as NDMS, national disaster medical teams,
were jeopardized.
For example, when I arrived at ASPR, our NDMS teams had not
received any sustainment or specialized training for several
years. Now, fortunately, but unfortunately, because of the
hurricane supplemental generated after Hurricane Harvey, Irma,
and Maria, we were able to fund highly infectious disease
training for our NDMS teams before the pandemic.
Looking ahead, periodic pandemic or disaster supplemental
funding will not support the desired long-term countermeasure
development, medical response or hospital preparedness, or
similar programmatic preparedness initiatives that the Nation
needs.
What worked but could work better? Well, the CARES Act
worked fabulously. The Coronavirus Aid, Relief, and Economic
Security Act worked. But the delay in securing the funding
through the supplemental process slowed our ability to respond
and, quite frankly, delayed our ability to procure personal
protective equipment at a time when cash in hand was the only
way to buy available limited PPE supplies. It also delayed our
ability to contract with pharmaceutical companies for the
development of COVID-related vaccines, therapeutics, and
diagnostics.
What could work with the right safeguards and provisions?
Appropriating funds into the existing Public Health Emergency
Fund found in 42 U.S. Code, section 247(d), that enumerate
powers and authorities of the Secretary of Health and Human
Services. This cannot be a generalized public health emergency
slush fund. It would be used by the Secretary specifically to
address the risks of a pandemic or catastrophic national public
health emergency such as a large-scale cyber attack affecting
public health or healthcare or a large-scale CBRN event.
The last area that I would identify is things that have
been identified as prospective ideas, and that is really the
idea of somehow circumventing or exempting designated
preparedness funding from budget caps, which I believe is an
excellent idea and is an idea supported by the Bipartisan
Policy Center.
And I think that the idea of creating a permanent budget
designation for programs deemed highest priority to prevent,
detect, and address infectious disease threats outside the
annual 302 allocations and outside the overall budget
limitations would be something that would be extraordinarily
beneficial.
And, finally, with time running out, I would just say that
there needs to be some kind of mechanism to support the
Strategic National Stockpile, and that should be studied and
evaluated. The SNS has consistently been tasked to meet more
hazards than its funding has allowed. Congress should
specifically identify which hazards the SNS should be prepared
to encounter over the next 5 to 10 years and authorize an
appropriate commensurate budget to meet those requirements;
when it makes economic sense, to permit the SNS to rotate
certain stock before expiry, possibly through vendor-managed
inventory, to save the government and American taxpayers
significant funds.
And, ideally, Congress should identify a mechanism to
enable better preparedness not only for the Federal level but
the opportunity to procure personal protective equipment by our
non-Federal partners at the State, local, Tribal, and
territorial levels.
With that, sir, I will end my comments and look forward to
your questions.
Thank you very much.
[The statement of Dr. Kadlec follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Morelle. Thank you, Doctor. And thank you for your
service to our country in the number of different capacities
you have held, and we appreciate that very, very much.
I am going to just, if I can, ask just a handful of
questions in the first round, and then I want to make sure my
colleagues all have an opportunity to ask questions. And I may
come back for a second round, if that is acceptable to folks.
I want to start with Dr. Gayle and Ms. Tedesco, both of you
representing the not-for-profit sector that did so much over
the last 2 years and continues to do so much. And perhaps, Dr.
Gayle, if you could respond, and then Ms. Tedesco.
But I sort of think about three things. First of all, is
there enough local planning and coordination being done in
Chicago and Rochester? And I will take those two data points to
sort of reflect on what it is like in the country.
So, in Chicago, for instance, are you routinely going
through with other community partners and local government a
planning process, a coordination on what would happen if? And
the same thing I would ask of Ms. Tedesco.
Second, if not, if we are not doing enough, how could we
help incentivize that local coordination--drills, planning
process, et cetera?
And, finally--and I think Ms. Gayle mentioned this in your
testimony, the idea of not enough money for not-for-profits
prior to--and maybe it was Ms. Tedesco, actually, who mentioned
this.
So, if there were additional dollars, what would not-for-
profits do with those dollars in pursuit of greater resiliency?
How would those--would they be technical? How would you
actually use those things?
So those are sort of just initial questions. If perhaps Dr.
Gayle first, and then Ms. Tedesco?
Dr. Gayle. Great. Thanks so much.
So your first question around the coordination, I mean, I
think that, clearly, much more coordination needs to occur.
And, you know, I think the link is from the Federal to the
State to the local and then working at the local level with
nonprofits that work directly with communities.
And I would say, you know, if I look at the situation here
in Chicago, Chicago local public health department had done a
lot of preparedness and had, in fact, been, you know, doing
drills and looking at tabletop exercises and other things,
understanding that, you know, preparedness for the next
pandemic was critical.
That said, that isn't necessarily going on across the
country. And the resources that need to flow from Federal to
State to local have not been there historically for
preparedness so that, when something occurs, those systems are
in place.
And I think we saw in the beginning of this pandemic a real
disconnect between, for instance, our surveillance system, our
ability to even know what was going on--because we weren't
adequately funding it so that those dollars did flow from
Federal to State to local.
You know, at the local level, you know, I go back to a lot
of the experience I had when we were focusing on the HIV/AIDS
pandemic. We funded at the Federal level directly community-
based organizations that really built the kind of
infrastructure to reach communities that were at greatest risk.
But a lot of that funding dried up, and it didn't maintain some
of the kinds of networks that were necessary at the community-
based level.
So we have seen, through this pandemic, a rebuilding of a
lot of that. You know, we are working here at Chicago--we are
helping to coordinate a Chicago vaccine partnership that is
really looking to--with the organizations that can reach the
hardest-to-reach communities, particularly Black and Latinx
here in Chicago, but that has all had to be rebuilt.
And, you know, these are the kinds of things that could
stay in place, because these are the same community
organizations that are meeting people's needs in different
ways. And they can be ready and ready to be mobilized, but we
had to do a lot of rebuilding to put those community partners
in place and to make sure that the health department and
community-based organizations were working in tandem.
And so, you know, I think the message over and over again
is that we know how to do it and we know the organizations that
can be incredibly effective at the grassroots and the community
level but we don't continue to resource them so that, you know,
we have this functioning, seamless system that flows from
Federal to community-based level.
Ms. Tedesco. Thank you----
Mr. Morelle. Thanks for that.
Ms. Tedesco [continuing]. For the question, Chairman. And I
agree with Dr. Gayle's response. I think there is a disconnect
between emergency planning and disaster preparedness at the
government level and then at the local and community-based
level.
On, you know, Foodlink's part, we have been involved at
various times with VOAD, Voluntary Organizations Active in
Disaster, but what we have seen is that there has been fits and
starts with that. And at the State level, when you look at who
manages disaster preparedness and how that flows, it is
incredibly complex, and it does not translate to how we work at
the ground level and does not, sort of, honor the knowledge
that we have and the relationships we have in the community.
So I don't know if this is a recommendation per se, but I
think what needs to happen is that we need to begin to speak
the same language, that the government needs to come to the
table with community-based organizations who end up delivering
those disaster response services and come to the table as
equals in terms of planning.
Because what exists at the government level, what we have
seen, is a series of flowcharts and complexities. And what
exists, you know, at the local level is just an understanding
of what people need and what our peer nonprofits can offer.
And communications is key. We saw that in Rochester, is
simply having the structure--we immediately, thanks in part to
you, Chairman, were able to have these weekly emergency
response calls with government entities and nonprofits and the
for-profit sector. That made all of the difference. It made us
nimble; it made us be able to respond quickly. So, more than
anything, having the communications structure in place.
But to answer the second part of your question, yeah, it is
truly capacity-building. Someone else touched on this earlier,
but--and I am sure you have all heard this before, but, far too
often, nonprofits have the opportunity to apply for Federal
grants for, you know, really prescriptive programs, or even
from private funders. You know, they want to fund a feeding
program for children over and over, and I certainly understand
why, but what they don't want to fund is the technical
capacity-building, the staffing.
And, certainly, I think what is lacking is thinking about
all of that in the context of planning for a disaster. Food
banks know how to distribute food. Do they all have
generators?Do they all have the cold storage that is
required?Right now, we are facing supply-chain issues with
trucks. We have a truck shortage; we have a truck driver
shortage. So that type of investment is what could make a huge
difference for us.
Mr. Morelle. Thank you.
I do want to--and I will just editorialize, because, in
Rochester, as Ms. Tedesco is pointing out, at the beginning I
think we organized twice-a-day phone calls with groups that
included Foodlink and others, but we were really making it up
as we went along.
And I am just sort of thinking about how we might better
incent local communities to do that on an ongoing basis so that
they are basically--you know, I used to say there is no real
manual, locally, on what we do in the middle of this, so we are
just making it up, sort of building the airplane as we are
flying it. But it would be interesting to me whether there is a
way, in partnership with the Federal Government, to start
incenting local communities to go through that process and that
exercise in advance of having a real, live event.
I just want to switch--you know, Mr. Schlegelmilch, you
said something that has been the bane of my public existence,
which is, whenever I am at a table and people say ``let's get
some quick wins,'' to me, in my brain, what that says is
``let's do the easiest thing so we can show everybody that we
are doing things,'' but rarely have I ever seen quick wins turn
into any lasting value. In fact, I think it almost undercuts.
So I would ask it this way: What kinds of things should we
do to develop some slow wins or some wins that are lasting?
You started to touch on it a little bit, but--and maybe
even use the frame of making this easier for people. I thought
your comments also about how difficult it is--if you are
already, in a sense, disenfranchised prior to a crisis, you are
not going to be any better able or better equipped to deal with
it during the crisis.
So if you could just expand on that a little more. I
thought that was very interesting. What should we be doing to
think about that differently?
Mr. Schlegelmilch. Absolutely. Thank you for the question.
I think--so I will answer it two ways, sort of the from the
bottom up, I think the first thing we have to think about is
really, what are the transactions that we are asking people to
engage within in order to access different kinds of assistance,
if you are a survivor at the individual level, if you are an
nonprofit within a community? And what are the strings attached
to that? Now, obviously, it runs through filters at the State
and local level that this committee might not necessarily have
direct oversight of but certainly originating from the Federal
level.
And so that is where there is an obvious answer but not an
easy one to implement, which is simplification, that is sort of
these quick wins layering on top of each other I reference in
my written comment, and there is a Federal colleague who calls
it the Jenga of Federal assistance, topping one block on top of
the other in random arrangements, and seeing how that really
affects those and what capacities are required to access that
and who has them and who doesn't.
Honestly, in the meantime, a stopgap may be to provide
technical assistance to communities to put grants in place or
to increase funding for disaster case management until the
larger paradigm can be simplified. And that leads to sort of
broader topics, which is that really taking a step back
holistically and looking at this--you know, I mentioned the
data. So a couple years ago--the conversation is still going
on, but it sort of broke through in my world where a number of
former senior Federal officials were talking about how States
need to do more to invest in preparedness, and rules should be
changed to really--really putting a lot of the burden on this
is because States aren't investing in preparedness, and they
are--the Stafford Act incentivizes not investing because you
are can get 70 percent, 75 percent of Federal cost share
through a disaster declaration.
There is probably a bit of truth to that, but I am bringing
this up because the Pew Charitable Trusts, through their fiscal
federalism initiative, did a survey of States on their
investments in preparedness, and it turned out there was no
standard metric for measuring preparedness. States didn't have
a standard way of doing this, and so the self-reported data
ranged from very little to a whole lot to nonrespondents
because they were responding to active disasters.
So I think, also, as a consequence of quick wins, we have
information that is spread out across many different points
that can be neatly pulled together to form a narrative for an
argument but are really short of systemic analysis.
With my colleagues at Georgetown, we put together some
analyses on some very specific elements of emergency
supplementals, and even there we have--admittedly, there are
things that there are blind spots to with different changes in
rules and things like that.
So I hope that is somewhat helpful, but I guess, at the
ground level, really be very sympathetic to the transactions we
are asking people to engage in to access resources and
recognizing that can be a critical barrier and, in the
formulation of these, really looking at whether or not this
complexity ultimately serves or hides a lot of actions that are
ultimately detrimental to the broader goals of resilience
building.
Mr. Morelle. Well, and I won't bore you with my long
seminar on how we should better integrate social, health, and
educational, and governmental services just in general, absent
a natural disaster, but--and Ms. Tedesco and I are part of an
effort back in Rochester to integrate those services. But, at
some point, I may come back and talk to you more about that
subject.
Just if I can, to Dr. Kadlec, so we are hearing from local
community organizations about what they experience in terms of
coordination. I am just curious, and this is--you know, I am
not someone who is very interested in the past except what we
can learn from it, but from your vantage point, the notion that
there was so many different agencies involved in this, did you
feel frustrations, and is there a way to better organize and
coordinate at the high level, at the Federal level our response
in times of either natural disaster or things like the
pandemic?
Dr. Kadlec. Sir, there is a mechanism that exists through
FEMA with the use of the VOADs. I think Ms. Tedesco kind of
raised that up as one thing, and that is through the FEMA
regional offices where they collect them. Now, I think,
practically speaking, in the nature of a pandemic, which really
required a different set of players to work in different
contexts, you know, that is, I think, one of the issues that I
think that was brought up by Dr. Gayle that there is this need
to really drill and exercise.
In my testimony, I have a piece that says, whatever we do,
we need to commit to that at a Federal level, and we did do
that at Crimson Contagion. We actually did do a local/State--we
worked with a number of different States--Illinois being one,
Chicago being a city--where we looked at the ability for
pandemic preparedness, but that was the first time it was ever
done.
And this is something that has to be drilled regularly, you
know, in some kind of regular basis, ideally like every third
year, so every administration gets a chance to go through that
experience but, more importantly, to do it with different parts
of the country and really get down to the community level and
exercise it so that we can get people like Ms. Tedesco talking
about the food bank; we can get other elements of the local
community outreach programs to make sure that those who are not
easily reachable or who have challenges in being reached or the
equity issues can be identified and effectively addressed.
We did do that in our efforts with Warp Speed working with
the Warp Speed team, the logistical team and with CDC and State
and locals, but that is something that has to be done, I think,
drilled regularly to make sure that not only the muscle memory
but the people who are actually holding those positions, which
oftentimes changes every couple years, are refreshed and,
again, trained and educated.
Mr. Morelle. Thanks for those comments. I am going to
reserve more of my questions, but I want to give my colleagues
an opportunity, and they have very demanding schedules.
So I am going to go first to you, Dr. Burgess, for any
questions you might have, sir.
Dr. Burgess. Great. Thank you, Chairman Morelle.
And, like you, I will probably divide my questions up into
two sections to give other colleagues an opportunity to talk to
our excellent panel this morning.
Dr. Kadlec, I do want to reference one thing. You mentioned
in your written testimony in speaking with Crimson--about
Crimson Contagion, the exercise that you did. You have a
statement here, in fact: Barely a month later, we hosted
several dozen congressional staff to relive the exercise and
tour a Strategic National Stockpile facility.
Chairman McGovern, Chairman Morelle, maybe the Rules
Committee could visit a Strategic National Stockpile facility
so that we could learn better for ourselves firsthand. I dare
say, it is probably an exercise that most Members of Congress
have not taken.
And we speak about a Strategic National Stockpile, but we
have never actually been to the warehouse and seen for
ourselves what is involved. So I just simply offer that as an
observation. If the Rules Committee would like to organize a
visit to a Strategic National Stockpile, this member would be
interested in attending.
So, Dr. Kadlec, let me just ask you, on the Operation Warp
Speed and on your team on Operation Warp Speed, you
successfully were able to accelerate the advancement of some of
the monoclonal antibiotic treatments and the antiviral agents.
And your ASPR team led the allocations of distributions of
these products in an unprecedented way.
You know, my understanding is, with the change of
administrations, there was at least the existence of the
opportunity for procurement that your administration and ASPR
had left for the incoming administration in February of 2021,
that those could have been extended but, in fact, weren't. And
I just ask you, is that understanding correct, and do you have
a sense if--if it is correct, do you have a sense as to why it
was not executed?
Dr. Kadlec. Sir, it is correct, and we made deliberate
efforts, particularly when we were setting up Warp Speed and
not knowing the nature of the election but was trying to, if
you will, make sure that whatever we did would be in doing at
least through the first couple of months of either the second
term of Trump or the first term of Biden's administration to
give them some time to get their feet underneath them and
recognize that they would need to make decisions as it would
relate to the conditions on the ground that they encountered.
So we had turned over, I think in the sense of the vaccine
issues, vaccine procurement that was to the 300 million dose
level and the antiviral immunoglobulins at least at that time
to at least give them some cushion of time and opportunity to
evaluate as well as knowing that there would be additional
products coming through the pipeline.
Now, two things happened, is--and so I can't speak for the
other team, but one was they had the Delta variant surge, and
then clearly there were some of the monoclonals, truly the
monoclonals, the single cocktail, single monoclonal cocktail
made by Lilly that had to be reconfigured into a cocktail to
ensure that it could have the coverage.
So there was some challenges that were encountered that
were anticipated, some that were not. But we did try to put
them in the best position so that they could figure out what to
do going forward. And, frankly, I don't know why, maybe there
were decisions not to make further procurements at that time,
but clearly they have adjusted to the realities on the ground
and have expanded their monoclonals.
But here is the dilemma that we have, we have--not that we
have a thinking enemy, but the virus is a wily adversary and
has circumvented the two main stays of our monoclonal
therapies, the Regeneron product and the Lilly product, and now
we are left with GSK. So, you know, again, this is a very
dynamic, fluid environment, and you just can't rest on your
laurels, for sure.
Dr. Burgess. Yeah, as we have learned. And, you know, one
of the successful aspects of Operation Warp Speed was the
suspension of the normal Federal procurement rules, that if you
had a product in development that showed significant promise,
there was an ability to prefund the purchase prior to approval
so that the government would assume a significant amount of the
risk and not the private sector.
So do you have a sense that that continues today? I know
when we had an opportunity to just have a general HHS call with
the administration's COVID team, they talked about Operation
Warp Speed and Operation Warp Speed being used to develop the
Pfizer antiviral, but it didn't seem like they followed through
with the advance procurement, which seems to me to be a
critical part of Operation Warp Speed. Do you have any
knowledge about that?
Dr. Kadlec. No, not directly. But I think, to your point,
there was a package of things that were done that were really
trying to aggressively, you know, advance the development of
these--a variety of different products, vaccines and
therapeutics. And the kind of panoply of things that were done
were we use the Defense Production Act, which were aggressively
kind of assisted companies, either expand capacity or obtain a
priority for supplies, needed supplies so they could
manufacture or develop their potential product.
We did do advance procurement activities, particularly with
the vaccines and with the therapeutics with the idea that that
would just give them some assurance that if the product worked,
whether it worked or not, we bought it. And as we would joke a
little bit--there was no joking a lot in that experience, but
it would--that we would take a product that didn't work and
just accept that that was a lost investment and move to the
next product and move forward.
So there was an element of what I would say risk-taking on
the part of the government, risk mitigation on the benefit of
the company, and then really very focused product and portfolio
management. And we had an extraordinary team, the public/
private partnership that existed with Dr. Slaoui, Dr. Carlo De
Notaristefani were an exceptional group of experts that would
kind of help us stay on track.
Dr. Burgess. Well, thank you. And, again, let me just echo
Chairman Morelle in thanking you for your incredible service to
our Nation.
Dr. Gayle, I appreciate so much you mentioning PEPFAR in
your discussion. That is a model that it seems like we perhaps
have lost sight of recently, but was enormously effective in
the early part of the 2000s, at a time where it seemed like all
could be lost in the fight against HIV and AIDS in Africa, and
that a generation would have to be--would face coming into
adulthood without their parents because the disease was so
devastating.
And because of actions of then the Bush administration and,
yes, the United States Congress to participate in PEPFAR, which
was really an extraordinary effort, and I don't know that we
talk about it enough, that there--I don't know that before or
since if there has been that sort of effort that one nation has
made on behalf of multiple other nations. So, when we think
about the global investments that need to be made for future
preparedness, learning some of the lessons from PEPFAR, I
think, are going to be extremely important.
Dr. Gayle. Yeah, I would wholeheartedly agree. You know, it
has been an incredibly important program. It was comprehensive.
It was global. It really built infrastructure. And, in fact,
the infrastructure that PEPFAR built was in large part the
reason why future pandemics were able to build on that
infrastructure.
And so, you know, I think being able to mount something
similar to that, and as you noted, it was started by President
Bush, but it was continued on for other--all the next
administrations no matter what the political party was, and I
think it is just one example of how global health is a
bipartisan issue and one that I think people can rally behind.
And in a pandemic like this, you know, again none of us is
safe unless all of us are safe, and I would love to see the
same sort of coordinated effort that really, you know, made
sure that we were thinking about this in a very holistic way in
the way that we did with PEPFAR and the AIDS pandemic. So I
think there is a lot of lessons to be learned there, and I
think it is a very important model.
Dr. Burgess. So immediately prior to being distracted by
the pandemic of the century, there was some discussion of
utilizing the infrastructure that had been built during the--
during PEPFAR to provide a platform for improved maternal care,
maternal mortality in other locations. And, unfortunately, that
is going to, I guess, go down in history as one of the
unintended consequences or victims of the pandemic. I haven't
heard recently any discussion of that, because clearly everyone
has been focused on the more immediate danger of the
coronavirus.
Ms. Tedesco, it is really not fair to ask you this, but I
am going to. Was Mr. Morelle helpful to you in getting the
school districts to reprogram their funding that they should
have been using to provide free and reduced lunches, to get
those funds to your nonprofit so that you could appropriately
take care of the people who now weren't being fed in their
school lunchrooms?
Ms. Tedesco. I can honestly answer, Congressman Morelle was
incredibly instrumental in, you know, maybe not precisely what
you just said but exactly the spirit of that, which was
coordination between the sectors.
And Foodlink, you know, even prior to this disaster is the
largest nonmunicipal provider of meals in our region, so we
have a community kitchen. Prior to the pandemic, we were doing
3,000 meals a day. We can came in--the first case in Rochester
was on a Friday. We came in on a Sunday and started preparing
meals and figuring out in conjunction with the city school
district how we could get those meals to kids.
And if I could connect this to the question I was asked
prior, in just continuing to think about that, in any disaster
preparedness that I have been involved with--and, Dr. Kadlec,
you sort of said this as well--never did a global pandemic come
up. You know, when we were talking with the Red Cross and State
FEMA reps and whatever, we didn't talk about global pandemics,
nor did we talk ever specifically about the crises of children
being out of school. And that became the number one crisis that
we addressed, not public health instantly but kids being out of
school and what we instantly knew that meant for our community
and for families.
And so, yes--I hope I answered your question. Yes,
Congressman Morelle was incredibly helpful, but it was truly a
collaborative process and I think paves the way for what it
needs to be for school districts, especially in impoverished
areas like the city of Rochester, that they really need
sustainable, collaborative models with the nonprofit sector in
order to fully meet the needs of their student body during a
pandemic and during, quote/unquote, normal times. I hope that
answered your question.
Dr. Burgess. It almost did. And you used the word
``nimble'' earlier, and I think that is perhaps something we
should all bear in mind when we are faced with the existential
crisis that this was and the ability to be nimble in our
funding. And just as the virus doesn't respect any political
party, it also doesn't respect political jurisdictions. And
whether it is school district, county funding, State funding or
Federal funding, we need to be nimble in our response.
Mr. Chairman, I am going to reserve the balance of my time
and allow you to go to other members.
Mr. Morelle. Thank you, Dr. Burgess.
And I do note, as it related to the schools, that one of
the first requests we got from one of the school districts was
to allow them to receive funding even though they weren't
providing lunches anymore. And we held a pretty robust
discussion that included Foodlink because they wanted to step
up and help and certainly did. But it did raise the question of
how difficult it is to coordinate in the middle of an
emergency, because there were existing rules, there were
existing requirements you have to meet. So we went through a
long process to try to work that out. But I appreciate your
comments. I want to now call on----
Ms. Tedesco. Chairman, may I add one thing to that?
Mr. Morelle. Yes, of course.
Ms. Tedesco. I just--I want to say that I think one of the
most successful things that happened during this pandemic in
terms of government response was the USDA waivers that were put
into place fairly rapidly, and I would truly advocate for those
being extended or put in permanently.
But reducing barriers to access for kids by allowing grab-
and-go meals, by increasing reimbursement rates so we can get
more nutritious and higher quality food out to folks, by doing
away with what was formerly required congregate meal settings
that enabled caretakers and children to eat together, to take
food home to their families together, all of those things, and
there is more to add to that, I believe, should always be in
place.
They honor the dignity of the individuals receiving those
services. They meet people where they are. They enable us to
get better food to more people. So I applaud the USDA, the
government for those waivers. Thank you.
Mr. Morelle. Well, I appreciate those comments. And I am
sure Chairman McGovern, who is leading the national effort on a
White House conference on hunger, is thinking about those
things, and I appreciate your comments.
I now want to turn to my colleague and friend, Ms. Ross,
for questions.
Ms. Ross. Thank you, Mr. Chair.
And thank you to the folks who have testified today. I am
juggling a Science, Space, and Technology markup, but I would
argue that maybe we should get Science, Space, and Technology
to take up this issue as well since so much of their
jurisdiction has to do with things that might involve research
and planning for the future.
As we know, the COVID pandemic has exposed how unprepared
the United States and the rest of the world are for large-scale
public health emergencies. And it is critical that we learn
from these experiences and use our knowledge and resources to
prepare for and prevent similar disasters in the future.
For years, before the onset of the current pandemic,
academic, scientific, and policy institutions warned of the
potentially devastating impacts of a global pandemic, so did
Hollywood. And as recently as 2012, the Rand Corporation
concluded that pandemics were capable of destroying the
American way of life.
In the years following, the U.S. intelligence community
cautioned in their Annual Worldwide Threat Assessment that
pandemics can cause political and economic upheaval, as we can
attest.
Our goal today should be to address the systemic gaps that
left us vulnerable to this crisis in the first place and to
ensure that science is not politicized, especially when it
concerns the health of millions, not only in our Nation but
around the world. We must ensure that we take basic steps to
protect our own citizens first, and there are ways that we
simply have not.
For example, in my home State of North Carolina, the State
has refused to expand Medicaid, leaving hundreds of thousands
of North Carolinians without health insurance and more
vulnerable to this pandemic. And I spoke with all the hospital
CEOs in my district yesterday, and they continue to say that,
had we expanded Medicaid, things would be much better in the
State of North Carolina.
In addition, our public health infrastructure has been
affected by staffing shortages, which some of you have
mentioned, among frontline healthcare professionals. And it is
critical that we in Congress provide support to our healthcare
institutions to continue serving our Nation as we deal with the
resurgence of cases caused by Omicron and the variants that I
am sure will come even on the heels of Omicron.
I have also heard from educators in my district about the
challenges of teaching when schools lack essential health
resources. And I know we have talked about food issues, but
right now what the schools are looking for are KN95 masks and
COVID tests.
And we know that the administration is sending them out,
but, clearly, it would have been great if they had them all
throughout the pandemic. And providing these tools should be a
top priority to ensure that our children can continue to be
educated and our teachers and school professionals can be
protected as they serve our communities.
This brings me to the importance, as Dr. Burgess raised, of
continuing our effort to provide COVID resources around the
world, from vaccine tests to personal protective equipment. We
can't defeat the pandemic and expect to protect ourselves
without coordination and support with the international
community. And, without investments in global health, including
vaccines, therapeutics, and more, we will continue to face new
variants that develop in other countries with fewer health
resources that we have.
My question to all of the witnesses, and Dr. Burgess
started this by bringing up the success of PEPFAR, is, what
strategy should we use to ensure that our Federal budget
accounts for the global nature of pandemics and other public
health crises in a recurring fashion and not just as a
reaction?
Dr. Kadlec. Representative Ross, I will take a first swing
at this, if you don't mind.
Ms. Ross. Thank you.
Dr. Kadlec. In specifically focusing on I think the medical
aspects that I think were highlighted by PEPFAR, and that is,
clearly it was a U.S. initiative, but in managing a pandemic--
and obviously we--there are things called CEPI, and I applaud
what the current administration is trying to do to expand, if
you will, the participation of other countries to donate
vaccine--there really has to be an established mechanism that
builds capacity here domestically that is likely excessive to
our national needs but yet is contributable to the global needs
in the event of a pandemic. And I think that is one thing that,
quite frankly, that has to be kind of considered and sized.
There was discussion late in the Trump administration about
creating a Marshall Plan, the idea of doing something similar
to what was done in Europe following World War II to basically
enlist support of willing countries to donate vaccine globally.
And then I think that, you know, transitions are disruptive,
but I think now that you can see that our country is kind of
moving into that role.
But I think there has to be a dedicated effort to build
that. There has been a discussion about an international treaty
to deal with pandemics, and it would seem that that would be an
appropriate, you know, consideration to be part of that,
amongst other things. But, with that, I will stop and turn to
the other witnesses for their comments.
Mr. Schlegelmilch. I can add a few thoughts, and thank you.
And I appreciate the--also the callout to the series of
warnings that have come from the scientific community, from the
policy community, from the government itself on the challenges
of the pandemic. And it is something that I am sure will be the
subject of many committees, commissions, blue-ribbon panels,
whatever the case may be for years to come.
Yeah, the data was there; the incentives were not. And so I
think that there--you know, complexity--we are entering into a
more complex world. This pandemic may very well not be the last
one we see in our lifetime, and with the growing impacts of
climate change, it is going to get worse before it gets better.
And I think that one of the key components there is we have
a very distributed set of responsibilities, both throughout
Congress and through the various committees. I know a few other
committees have been mentioned today as potentially ones to
also take this up as well as across our government, which we
have talked about.
And so, in a sense, almost what we need to do is to
decomplexify--I am not sure if that is a word, but to reduce
the complexity of this to afford more flexibility towards a
range of scenarios that we are facing that can be implemented
as they are needed.
I think it is also worth noting that the science provides a
range of different options for managing different disaster
threats, but we tend to focus on certain kinds of science over
others. So, up until fairly recently, a lot of mitigation
efforts were focused on the built environment and engineering
options, when increasingly we are seeing from the social
science how social determinants can be an even greater
predictor of how a community does before, during, and after a
disaster. The relationships of social programs to disaster
resilience after the fact is becoming increasingly clear.
And we have had sort of the politics, the behavioral
science. You know, why is it easier to ask people to wear masks
and get vaccinated in some parts of the world than the other?
The behavioral science illuminates a lot in terms of the
landscape you have to work with these policies. And more
individualistic societies are going to require different
approaches or different levels of investment than for certain
approaches than we are seeing overseas.
So we do need more data, we do need more research, but
there is also a lot of research that isn't really being pulled
together in part because of the distributed nature and
ownership of all of this. So unifying, simplifying, I know
these are overly simplistic answers, but ultimately to create
capacities to harness the complexity of these situations and
create vehicles that have the flexibility to meet needs that we
know the outer boundaries of but won't know the details of
until they are occurring.
Dr. Gayle. Yeah, and I would just add, I was going to say
something similar. I mean I think, you know, in situations like
this, the knee-jerk response is to try to create something
different and something new and a new infrastructure. And I
think there is a lot of things that are already in place that
we need to figure out how are they better connected, how are
they better coordinated, and are we giving systems incentives
to work together.
And so, you know, there are agencies that already have
mandates, but we didn't do a good job in the beginning of this
pandemic to actually make sure that agencies were working
together and that there was a coordinated approach to it, you
know. And some of the structures that we had had in place for
disaster preparedness, which really were coordinating
structures to a large degree, had been dismantled.
So I think we have to think about, you know, not looking at
recreating the wheel, but really are we doing the best job we
can. And I like the notion of simplification, but, you know,
really looking at how we have the right systems for
coordination.
I think the other thing that, you know, has come out in
many ways as we have talked about this today is that, you know,
we were dealing with two different aspects of the crisis. We
had a public health crisis that precipitated an economic
crisis, and in both of those situations, we did not have in
place the things to make us more resilient.
And so we have talked about how could we make some of the
social safety net issues in place and better so that, you know,
populations don't get knocked so far down every time something
happens. If communities that are financially insecure had
greater security going into this, they wouldn't have been as
harmed as they were.
And so we need to think about--you know, a lot of the
things that I think we did on an emergency basis showed what we
could do on a longer term basis to put in place not only the
health preparedness but also the social and economic
preparedness, and how can we weave that together so that
whenever this next occurs we are resilient, both from a public
health standpoint but also from a social and economic
standpoint.
Ms. Ross. Thank you, all, for your responses. I am happy to
take information from this hearing to the Science, Space, and
Technology Committee.
And, Mr. Chairman, I yield back.
Mr. Morelle. Thank you, Ms. Ross.
I am now going to call on Mr. McGovern, who has the
distinction of being the chair of the entire Rules Committee.
And we appreciate him being here and for all of his help to get
to the hearing today.
Mr. McGovern. Well, let me thank Chairman Morelle and Dr.
Burgess and Ms. Ross for their comments and questions. This has
been a really interesting conversation on a very, very
important topic.
And as I was listening to the testimony, listening to the
questions, I kept on thinking about the reality that we are not
particularly good at things like planning, which is essential,
or coordination. We are not very good at coordination between
the House and the Senate, never mind the Federal Government,
the State and local governments, and others that need to be
part of it.
There is an issue here of funding in order to prepare for
these disasters--potential disasters, and then there's the
issue of leadership, which is important. You know, we have
Members of Congress when it comes to natural disasters, whether
it is wildfires or tornados or, you know, you name it, floods,
that routinely balk at responding to them after they happen
except if it happens in their own State. So there is this
hypocrisy that exists. And I think part of it is that we have
some people who just don't think government is part of any
solution unless it affects them directly.
We heard about all the incredible work that went in to
combating HIV/AIDS and the response that Congress actually
acted--by the way, after years of inaction, Congress actually
began to act. And the response included things like the Ryan
White Act, and then the PEPFAR program that Dr. Burgess
referenced, which was a bipartisan effort and, you know, I
think is something that we could be proud of. But this was kind
of a healthcare-plus approach. And here Congress also
recognized how much housing and food matter to potential
healthcare outcomes. So I think that is an important point.
On the COVID-19 issue and the response, international
efforts to speed up pharmaceutical response and review process
I think was very, very important. It led to the rapid creation
of a lifesaving vaccine, which I think is a fantastic feat. But
the bad news, of course, is that misinformation has limited our
Nation's ability to get shots in the arms.
So the issue now is we have the vaccine, and I think I
speak for all of us on this panel: I go home; I am still trying
to convince people to make sure they get the vaccine. And we
have a political system here in which some go out and actively
say, you know, don't do the vaccine.
You know, Dr. Burgess wax nostalgic about the previous
administration. I look back on the early days of this crisis
with with a lot of shock that scientists were telling us that
we had to take this pandemic seriously, and we had leaders,
including the President of the United States, saying, you know,
it is no big deal. It is not real. The first couple of months
we were in denial.
And Dr. Burgess, if you don't believe me, just go read the
President's statements. But the bottom line is we were being
told to wear masks, and we had people actively discouraging
people from wearing masks. This was before the vaccine was
developed. And so you look back on that, and you say--you know,
I am hearing now from medical experts, maybe we could have
saved a lot more lives if we had taken it more seriously at the
beginning.
You know, I am trying to get the White House to start
focusing in on, you know, on the issue of hunger and food
insecurity in this country, trying to get more to the White
House Conference on food, nutrition, health, and hunger, one,
to plan; two, to understand that we have to connect the dots,
that when we talk about, you know, issues of hunger, it is also
a healthcare issue. It is also an issue of kids being able to
learn in school. It is a whole bunch of things. We need to look
at need things more holistically.
But we don't have a plan in this country. We haven't had a
plan to end hunger. We have had a plan to try to manage it but
not to end it. And we talk about resiliency and all those other
important concepts; I mean, quite frankly, we just haven't--we
don't coordinate very well up here because, if you are going to
prepare and solve some of these problems, it is not just one
committee; it is multiple committees. It is not one agency; it
is multiple agencies. It is not just the Federal Government; it
is the State and local government; it is the provider. I mean,
everybody has a role in all of this.
So, you know--look, so I think what we have heard here
today is some things that have gone well and that we ought to,
you know, replicate or we ought to use as a model, some things
that haven't gone so well. So let me just ask this question for
each of the witnesses, any thoughts that you may have as it
relates to pandemic or disaster preparedness in general. What
is something that we have done that we should consider
continuing beyond the pandemic to ensure better preparedness,
and what is something that you believe we could or should have
done, again, as we think toward the future to ensure better
community, State, and national preparedness? I will just open
this up to whoever wants to respond.
Mr. Schlegelmilch. I will go ahead and start. You know, I
think one of the things that has been done well, as much as we
lament, myself included, really quite extensively the lack of
funding for preparedness and the ebbs and flows in the annual
appropriations process, we were better for having those
resources over the last 20 years than not having them.
The relationships that were fostered that are frustratingly
not as robust as they could be within communities are where
they are because of the capacities that have been invested in
into emergency management structures and into a whole-of-
community sort of paradigm of thinking of these things. So I
think that as--at least coming from me, while I am critical of
funding levels and lack of predictability across a lot of this,
having what we have is better than not having it.
Now, on the flip side, in terms of what we could do better
with--you know, I think we really do have to look at the
disaster science is increasingly going into the social services
arena and illuminating where social services predict outcomes
in disasters. And this is only going to grow stronger as there
is more data and there is more evidence with all of this.
And I think one of the most important things to consider
going forward is that investments in resilience aren't
necessarily the bills that say ``disaster'' in front of them.
They may be investments in food security. They may be
investments in healthcare to make sure more people are insured
and we have a financed national health continuum of public and
private deliveries that are used to serving the whole
population and not just the insured population, that is built
for the kind of demand, that we are financing public health and
not just taking for granted the value of that.
And the other, as I do want to point out, there has been a
lot of talk about structures, of sort of wrangling these
Federal processes that are distributed. One of the big
criticisms of the past administration was dismantling the--or
moving to a point of functionally dismantling the Global Health
Security Team and the Pandemic Response Unit in the National
Security Council.
I think there is some merit to that argument, but I also
want to add that it was created because there was not a
legislated solution to this, so it was executive action that
created a Band-Aid approach. And as the political wind shifted,
that Band-Aid was removed, and the pandemic hit, and we were
left bare from a coordinated mechanism for doing this, and now
that is being rebuilt.
But I would be careful to not--it is a bipartisan issue,
and it is one that ultimately we need some stability in the
legislated groundwork for these things so that we are not
completely reliant on executive action, which can be undone as
easily as it can be implemented. So I hope some of that is
marginally useful to you----
Mr. McGovern. It is helpful, very helpful.
Mr. Schlegelmilch [continuing]. And appreciate the
opportunity.
Mr. McGovern. Anybody else want to----
Dr. Gayle. Yeah, I would say, you know, I think a couple
things that we did well, and this was mentioned earlier, I
think the coordination with the private sector was critically
important and the ability to develop vaccines in record time,
you know, which built on a lot of important science that was
being worked on already. So, you know, I think that our
investments in new science and discovery and then the working
with the private sector, you know, I think was really critical
and a model that we need to think about how do we do that in
the future.
I do also think that the speed with which emergency support
and the level of emergency support that was mobilized was
incredible and the willingness to do some things that we had
not ever, you know, done before, like give people cash who
needed cash to pay their bills and, you know, some of the
things that, you know, I think could be models for how we think
about building resiliency in the future.
You know, things that I think we didn't do as well, the
coordination, which we have talked about multiple times and the
communication. I think the fact that we had mixed messages, the
fact that we sowed, you know, seeds of doubt and confusion is
not what you need at a time like this. At a time like this, you
need clear communication, you need strong leadership, and you
need consistency. And so I think that was one of the things
that, you know, was a real challenge.
And I would say the other is that we were pulling out of
global collaboration at a time when we most needed global
collaboration, the idea that we were going to pull out of the
World Health Organization at a time when we needed to come
together as the world community more than ever. So, anyway,
those are some of the things that I think we did right and some
of the things that I think we could do differently next time.
Mr. McGovern. Thank you.
Anybody else?
Ms. Tedesco. I would just add, you know, a lot has been
said about strengthening the social safety net. So I would, you
know, just in my final remarks here say that what we were--it
is something we did well during the pandemic, and it is
something that, if we were willing to do during that type of
crisis, I think we need to consider why we are not willing to
do it all the time.
We had an unprecedented level of investment in food and
recognition of the issue of hunger, partially because hunger is
tangible but it really in our Nation is another word for
poverty. It is not a matter of food; it is a matter of a
tradeoff because of limited economic resources for families. So
we need to continue to invest in antihunger and put the
infrastructure behind it, and as I argued, invest in nonprofits
as partners.
But, in the broader sense, we now know and it was said
multiple times on this call, that pandemics, disasters
disproportionately affect those who are economically
disadvantaged, Black and LatinX communities. And so, for the
long term investing in the social safety net is, to me, the
best preparation for any future disaster.
Mr. McGovern. No, and I appreciate that. I always tell
people that, you know, we had a hunger problem and a crisis
before the pandemic; we just weren't coordinating an effort to
respond to it appropriately. We had close to 38 million people
in this country who didn't know where their next meal was going
to come from, and the pandemic just highlighted the disparities
that already existed. And so, I mean, you know, but it is more
than just responding to an immediate crisis. We have got to
solve the problem.
I don't know whether, Mr. Kadlec, do you have anything you
want to----
Dr. Kadlec. Yes, so I do, Mr. Chairman. And that is, it was
mentioned already about the public/private partnerships and
particularly around medical countermeasures. You know, that
model quite frankly can be used in a much broader context,
whether it be about surveillance of diseases, whether it be
about testing, whether it be about supply chain, whether it be
about healthcare provision; it would seem that that is a model,
and, quite frankly, to your point about how do you manage, you
know, hunger in America, it really does require a whole-of-
nation approach. And, quite frankly, that model, to work
against these very troubling problems, whether it be during a
pandemic or not, I think is a model that can effectively be
mobilized in a way that, quite frankly, is demonstrated by
things like Warp Speed.
The second area is--and this gets to more public health or
not public health but healthcare provision, and that is, even
right now during Omicron with the availability of vaccines and
other things, we are finding not only are we having problems
managing cases of COVID but non-COVID emergencies, non-COVID
chronic cases, both in rural and urban environments, and it
affects all access groups and particularly those who are have
difficulty getting access to healthcare. And I think that is
one area that has to take maybe some kind of priority view.
Public health has been defined as one of the critical gaps
in our pandemic preparedness, and I would argue that our
ability to provide healthcare across the range of conditions
that we need to in a pandemic or not was severely challenged
during this crisis and could be similarly challenged through
other crises that are not necessarily infectious disease
related. And I think that that is one thing that has to be
evaluated.
Mr. McGovern. I think that is an excellent point.
I just--again, I want to thank Chairman Morelle for putting
this hearing together, but I think you challenge us to think
bigger and more holistically, which is something that is always
very difficult to do, you know. And I mentioned that we--I
talked about hunger at the beginning, but I also sit on the
Agriculture Committee. So, when we talk about combating hunger
on the Agriculture Committee, we talk about SNAP. Well, that is
not the whole answer, right. If you want to talk about school
feeding, you have got to go to the Education and Labor
Committee. You know, if you want to talk about food is
medicine, you have to go to Ways and Means or Energy and
Commerce, and, you know, the same within our agencies. And I
think there needs to be a better coordinated effort to look at
things more holistically.
I think it would enable us to be better prepared for
upcoming disasters, whether they are climate related or whether
they are pandemic related, or, you know, who knows what
related. But anyway, I really appreciate the expertise of this
panel and, again, I thank you for your comments.
Mr. Morelle. Thank you, Mr. Chairman, not only for being
here but the incredible work you are doing on addressing hunger
in America.
Just a couple of quick followups, because I am mindful of
the time and appreciate all of your--the time and expertise you
shared with us this morning. And I want to give Dr. Burgess a
chance to ask any additional questions he has as well.
But, Mr. Schlegelmilch, you mentioned the value of
investments in mitigation in comparison to funding for disaster
response. And I wonder if you could--first of all, before you
even talk about your research showing the benefits of
proactively investing in disaster mitigation measures, could
you describe for me what those disaster mitigation measures are
in sort of a tangible way? I would be interested to hear that.
Mr. Schlegelmilch. Yeah, yeah. And so it is--I appreciate
that. So the research has been conducted by some other groups,
so FEMA has commissioned from the National Institute of
Building Sciences, a look at some of the more specific
mitigation measures. So that is where you get this term $1 in
preparedness saves $6, it comes from sort of specific kind of
physical mitigation measures, but then you see benefits
downstream.
There was a group of political scientists that did some
research that found that number anywhere from $1 saves $12 to
$1 saves $15. They were looking at more catalog of Federal
direct assistance numbers and sort of categorizations and
things like that. So we definitely see this trend. There have
been other analyses for pandemics by the World Bank and others.
The number varies, but the message is always the same.
So what we have seen primarily in these investments,
decisions have been more on the physical and administrative
side, putting in planning processes and things like that. The
social science research is getting more and more into sort of
the value of these things. And I think we are going to start
seeing more of that in the valuations going forward as well
too.
Mr. Morelle. Gotcha. And you also--I think you talked about
this, but in November of 2020, FEMA released a report finding
recovery programs often provide an additional boost to wealthy
homeowners and others with less needs while lower income
individuals and others sink further into poverty after
disasters.
And a number of people have talked about this, but from
your perspective, what accountability and transparency
mechanisms are available to ensure any increases in disaster
preparedness and assistance funding is spread equitably among
low-income and minority communities? And do you have any
specific recommendations for how Congress could improve those
mechanisms, any suggestions or thoughts?
Mr. Schlegelmilch. Yeah, absolutely. And there has also
been some independent research looking at the various Federal
assistance programs as well too and similarly disparities among
socioeconomic status and racial categories. And so, in terms of
that, I think first and foremost, is data transparency in
reporting to have demographic breakdowns to know where the
money is going, who is getting what, what these are. It sounds
like a simple thing, but often it is not immediately available.
The other would be, you know, we saw with some of the COVID
funds a nod to using the Social Vulnerability Index from the
CDC, and there are plenty of tools that are out there to help
kind of identify and steer resources towards areas that are in
higher need, in higher states of vulnerability and higher
states of social vulnerability.
We see this built in with FEMA's National Risk Index, and
so we are increasingly seeing this. But there isn't much
accountability, so there is a lot of lamenting of various
officials on the inequity but not necessarily a mechanism for
accountability.
And then the final piece, actually a colleague had brought
the idea to me, is to have a scoring mechanism much like the
Congressional Budget Office will score financially different
bills, is to have an equity score and to bring together a panel
of experts who can actually look at the equity implications as
well as broader resilience implications of various bills,
various traps, and actually provide more specific guidance on a
case-by-case basis.
Mr. Morelle. Thank you. That is very helpful.
Dr. Gayle, do you have any thoughts on that, how that
impacts either your agency or Chicago writ large and any
thoughts about that--or nationally, but I am just curious about
your experience.
Dr. Gayle. Yeah. I would just in some ways echo some of the
previous comments because, you know, what we saw in the
beginning of this pandemic is we didn't have data to even know
who was being impacted, you know, by demographic groups and
particularly race/ethnicity. Chicago was one of the first
cities to actually look at COVID cases by race and ethnicity,
and it was a critically important piece to then putting in
place systems to address the disparities accordingly.
You know, to have talked to and been in discussions with
people about coming up with some of those scores, if equity
really is--if we are going to be accountable for thinking about
equity, are there ways that we can build those into just like
we do environmental scores that are built in to new development
projects, could we do the same sort of thing of building
something that kind of built on the social vulnerabilities
index or other things to allow us to be able to have that
accountability in there. But I think, first and foremost, is we
have got to collect the data.
Mr. Morelle. Yeah. And actually, Ms. Tedesco, from your
perspective, have you been tracking that data on who you serve?
Could you report back or have demographic information on who
you served in the last 2 years?
Ms. Tedesco. It would be difficult. We have a number of
households served, and we have some demographic information,
and then obviously we have other data that we are pulling from
census data. But because of how food banks operate, we rely on
a network of providers. Many of those, you know, these are
small, grassroots, community-based organizations who are
required to track the number of households they are serving,
required in some cases to get attestations of need from those
families but not always required to do demographic information.
So we know partially just by looking at our geographic
region and understanding the demographics there and looking at
need and service levels in those areas but don't have hard data
associated with it.
Mr. Morelle. Gotcha. No, that is certainly understandable.
Last--I think this is----
Dr. Gayle. Could I add just one thing to that?
Mr. Morelle. Yes.
Dr. Gayle. You know, earlier we talked about building
community-based organizations capacity, and I do think that by
building capacity at the local and community level that is
helping to build an accountability mechanism as well. And I
think that the more we have strength from our civil society
sector, you know, it does build in an accountability, because I
think when people are able and capable of looking at how
dollars flow, able and capable of applying for those dollars,
and also, you know, being able to ask for what is rightfully
their community because of where their needs are, I think we do
build in accountability. I mean, that is what democracy, after
all, is all about.
Mr. Morelle. No, I very much appreciate that. I was--I did
want to get into the issue of long-term funding, stable funding
that didn't rely on emergency appropriations. I wonder, Dr.
Kadlec, if you could just comment on the advisability of that.
There has been a lot of conversation about it, but from the
point of view, again, of having worked in an administration,
how important is that, and how should Congress be thinking
about that in terms of long-term funding the appropriations
process rather than supplemental or emergency appropriations?
Dr. Kadlec. Well, first of all, I just want to acknowledge
that the funding that you provided, Congress provided, during
the course of the pandemic during my tenure was very generous.
However--however--you know, there is this issue of an ounce
of preparedness is worth a pound of response dollars and that
the fact of being able to be a good steward of the taxpayer
dollars in a response--and I will just give you one example,
and it had to do with ventilators, for example, and the fact
that we bought 243,000 ventilators that, quite frankly, we
didn't need. In fact, we bought types of ventilators that,
quite frankly, were problematic.
Because, as we learned very early in the pandemic--I mean,
this is how you have to learn and get back to the data issue
and how vital it is to have quality data. We didn't have
quality data early.
And yet, based on, you know, a little bit of serendipity
and focus, we were able to recognize that certain techniques to
manage people with the severe cases of COVID that in some parts
of the country were resulting in people being on mechanical
ventilation and was the thing that scared everybody to buy
243,000 ventilators at $3. 5 billion--it was recognized that
that was actually resulting in higher mortality, upwards over
80, close to 90 percent mortality.
Whereas, in other parts of the country--and this is a great
story. And a lot of credit goes to the State health officer in
Louisiana and a pulmonologist that he worked with to create a
State system where they used proning and high-flow nasal
cannula, which is a noninterventional way of managing
somebody's ventilation so you don't need all the specialized
drugs and paralytics and paralyzed people and a lot of
intensive-care nursing staffing.
And so, by just that virtue thing alone, based on
recognizing that, we were able to do a couple of critical
things to, first of all, not need the ventilators. And that was
just an example of where you had to make big purchases because
it took a long lead time to get those devices in there.
And so I only use that as an example of saying, you know,
if we kind of fund the needs based on requirements, based on
exercises and working with State and local localities on what
the needs would be in the event of a crisis, we can be a better
steward of the taxpayer money. So you pay $1 today or $100
tomorrow during the response is, I think, the tradeoff.
And it really is something that you can't just invest in,
you know, buying stuff. You have to, you know, invest in
training people and exercising capabilities, which is the
combination of people and stuff, to make sure all this stuff
works.
To Chairman McGovern's comments about coordination and
planning, those are all critical elements of the preparedness
quotient that are, you know, low dollar value but high response
impact.
And so I will just stop there and just say, you know, it is
really--you want to spend a little now or you want to spend a
lot later, and knowing that, well, when you spend a lot later,
you are going to be less efficient and likely wasteful in your
efforts.
Mr. Morelle. I think there was an old TV commercial, ``You
can pay me now or pay me later.'' So I appreciate that.
Dr. Burgess, let me turn to you for any additional
questions you might have.
Dr. Burgess. Thank you, Chairman Morelle.
I am going to submit some additional questions for the
record, but I have two unanimous consent requests, one from
Research America, a letter that they submitted. I will ask that
be made part of the record. And then, earlier in my testimony,
I referenced a letter that I wrote to Chairman Pallone, and I
would ask that that be made part of today's record for this
hearing.
And I will yield back.
Mr. Morelle. Without objection.
Let me just thank everyone.
I do note that a lot of the conversation has been about
planning and coordination, resiliency, communication--trusted
communication--and funding. And I am thoughtful, back many
years ago when I was in the State legislature, I was chairman
of the insurance committee. And I remember, you know, people
don't want to pay insurance premiums, let's face it. It is the
last thing any of us really wants to do. But, in a moment of
crisis, having prepared and thought about it in advance really
takes that moment of crisis and makes it hopefully more
manageable. And I think, in some ways, that is what we need to
do, is provide those insurance premiums so that in a moment of
crisis, such as we are facing now, we are really in a much
better position.
And, finally, I even think of--I serve on the House Armed
Services Committee. You know, the amount of planning that the
military does for potential threats is virtually unlimited. I
mean, we are constantly training.
Colonel, I know you would attest to that.
And yet we do so little of it when it comes to domestic
challenges like natural disasters or the pandemic which we are
going through. And so we might want to take a page out of the
military's book as it relates at least to training people,
capabilities, threats, and really make that part of our
national dialogue.
So, with that, I want to thank all the witnesses. You have
been incredibly helpful to us as we go through our
deliberations about how to move forward. And I want to thank
you all for the incredible work that you have done to keep safe
and help protect people in your communities and across the
country.
And, with that, I will officially declare this hearing
ended. Thanks so much.
[Whereupon, at 12:06 p.m., the subcommittee was adjourned.]
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