[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
THE WUHAN CORONAVIRUS:
ASSESSING THE OUTBREAK,
THE RESPONSE, AND REGIONAL
IMPLICATIONS
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HEARING
BEFORE THE
SUBCOMMITTEE ON ASIA, THE PACIFIC AND NONPROLIFERATION
OF THE
COMMITTEE ON FOREIGN AFFAIRS
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
__________
FEBRUARY 5, 2020
__________
Serial No. 116-100
__________
Printed for the use of the Committee on Foreign Affairs
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available: http://www.foreignaffairs.house.gov/, http://
docs.house.gov,
or http://www.govinfo.gov
______
U.S. GOVERNMENT PUBLISHING OFFICE
39-674PDF WASHINGTON : 2022
COMMITTEE ON FOREIGN AFFAIRS
ELIOT L. ENGEL, New York, Chairman
BRAD SHERMAN, California MICHAEL T. McCAUL, Texas, Ranking
GREGORY W. MEEKS, New York Member
ALBIO SIRES, New Jersey CHRISTOPHER H. SMITH, New Jersey
GERALD E. CONNOLLY, Virginia STEVE CHABOT, Ohio
THEODORE E. DEUTCH, Florida JOE WILSON, South Carolina
KAREN BASS, California SCOTT PERRY, Pennsylvania
WILLIAM KEATING, Massachusetts TED S. YOHO, Florida
DAVID CICILLINE, Rhode Island ADAM KINZINGER, Illinois
AMI BERA, California LEE ZELDIN, New York
JOAQUIN CASTRO, Texas JIM SENSENBRENNER, Wisconsin
DINA TITUS, Nevada ANN WAGNER, Missouri
ADRIANO ESPAILLAT, New York BRIAN MAST, Florida
TED LIEU, California FRANCIS ROONEY, Florida
SUSAN WILD, Pennsylvania BRIAN FITZPATRICK, Pennsylvania
DEAN PHILLIPS, Minnesota JOHN CURTIS, Utah
ILHAN OMAR, Minnesota KEN BUCK, Colorado
COLIN ALLRED, Texas RON WRIGHT, Texas
ANDY LEVIN, Michigan GUY RESCHENTHALER, Pennsylvania
ABIGAIL SPANBERGER, Virginia TIM BURCHETT, Tennessee
CHRISSY HOULAHAN, Pennsylvania GREG PENCE, Indiana
TOM MALINOWSKI, New Jersey STEVE WATKINS, Kansas
DAVID TRONE, Maryland MIKE GUEST, Mississippi
JIM COSTA, California
JUAN VARGAS, California
VICENTE GONZALEZ, Texas
Jason Steinbaum, Staff Director
Brendan Shields, Republican Staff Director
------
Subcommittee on Asia, the Pacific and Nonproliferation
BRAD SHERMAN, California, Chairman,
DINA TITUS, Nevada TED YOHO, Florida, Ranking Member
CHRISSY HOULAHAN, Pennsylvania SCOTT PERRY, Pennsylvania
GERALD CONNOLLY, Virginia ANN WAGNER, Missouri
AMI BERA, California BRIAN MAST, Florida
ANDY LEVIN. Michigan JOHN CURTIS, Utah
ABIGAIL SPANBERGER, Virginia
Don MacDonald, Staff Director
C O N T E N T S
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Page
WITNESSES
Nuzzo, Dr. Jennifer, Associate Professor and Senior Scholar,
Center For Health Security, Johns Hopkins University........... 8
Bouey, Dr. Jennifer, Senior Policy Researcher and Tang Chair in
China Policy Studies, Rand Corporation......................... 21
Klain, Mr. Ron, Former White House Ebola Response Coordinator,
2014-2015...................................................... 39
APPENDIX
Hearing Notice................................................... 76
Hearing Minutes.................................................. 77
Hearing Attendance............................................... 78
OPENING STATEMENT FROM CHAIRMAN BERA
Opening statement from Chairman Bera............................. 79
THE WUHAN CORONAVIRUS: ASSESSING THE OUTBREAK, THE RESPONSE, AND
REGIONAL IMPLICATIONS
Wednesday, February 5, 2020
House of Representatives
Subcommittee on Asia, the Pacific and
Nonproliferation
Committee on Foreign Affairs
Washington, DC
The subcommittee met, pursuant to notice, at 2:02 p.m., in
room 2172 Rayburn House Office Building, Hon. Ami Bera
(chairman of the subcommittee) presiding.
Mr. Bera. The subcommittee will come to order.
We meet today for Congress' first hearing on the 2019 novel
coronavirus. Without objection, all members will have 5 days to
submit statements, questions, extraneous materials for the
record, subject to the length limitations in the rules.
I will now make my opening statement and then turn it over
to the ranking member for his opening statement.
First-off, I want to thank the witnesses for joining us
today. This is the first hearing on coronavirus, and for many
Americans as well as Members of Congress, this is on our mind
right now. Before kind of diving into things, I do want to make
note that we did ask the Administration to come up and brief
us. And, unfortunately, they did not send folks.
This is not a partisan issue, this is an issue of how we
work together as Democrats and Republicans, Congress along with
the Administration, to get ahead of a public health emergency.
I would note that they did give Members of Congress a
bipartisan unclassified hearing earlier today with Acting Chief
of Staff Mick Mulvaney, Secretary of HHS Alex Azar, Deputy
Secretary of State Steve Biegun, Acting Deputy Secretary of
Homeland Security Ken Cucinelli, the Director of the CDC Robert
Redfield, the Director of National Institutes of Allergy and
Infectious Disease Dr. Tony Fauci, and Assistant Secretary for
Preparedness and Response, Dr. Robert Kadlec.
That was not televised. That was not open to the public but
it was unclassified. And I would make the request of the
Administration to provide their opening statements to this
committee so we can add that to the public record because we do
believe the public's concerns here. The more the Administration
can speak directly to the public and answer those questions,
the better off we would all be.
Again, the Administration has an open door to come before
this committee or the full committee to show what they are
learning in the rapidly fluid situation. We look to work with
the Administration to support the response.
You know, I look at this as a physician and someone who has
worked in public health, was Chief Medical Officer for
Sacramento County, and who has worked overseas internationally.
This is quite concerning right now. We have many questions.
When I think about the three objectives of this hearing, but
also of how we respond as a nation but also a globe, how is the
U.S. Government coordinating the response both domestically and
internationally?
Do we have the right tools and resources in place to help
get ahead of this outbreak?
And what I mean by that is if we think about one of the
most urgent things we could do, CDC has the best
epidemiologists in the world. We have some of the best
personnel. I know we have been getting conflicting reports. We
have had some folks in country that now would be a time for us
to collaborate with the Chinese to get our best epidemiologists
to the epicenter so we could actually answer some of the health
questions that are there.
How easily is this transmitted human to human?
How are people infectious when they are asymptomatic?
Are people infectious when they do not exhibit symptoms, or
is it only when they are symptomatic?
We have had conflicting reports of what the incubation
period is. At times we are told it is up to 14 days. Then we
were told it was 5 to 7 days. Then we were told it is 3 to 5
days. All of these are incredibly important questions for our
staff. So, we cannot just help the Chinese as well as the rest
of the world internationally, but we can also plan our response
here.
A second important point that we learned post-Ebola and
post-other pandemics is the importance of having an individual
or small group of individuals who can coordinate across the
interagency process. To date we do not have that single
individual that has sole responsibility of that coordination.
We have Secretary Azar, extremely capable individual, but
he runs Health and Human Services. If this broadens here
locally, Health and Human Services are going to have their
hands full responding and supporting our public health efforts
here.
We have a great CDC director, but they have a specific
role.
The DoD can do logistics, and they have a specific role.
Homeland Security, you know, has a specific role.
One of the recommendations was at the national security
level we really do need to have a single individual who can
coordinate the whole interagency process. Mr. Klain, I know you
were instrumental in that role, and certainly look forward to
hearing your thoughts about why that is such an important role.
No. 3, in the era that we live in the misinformation that
is out there is going to be really important as the public, you
know, should this spread in the United States. What is the
right information that should get out to the public? And how do
we combat disinformation? That is a very difficult scenario,
but it is incredibly important, not just here but also, you
know, internationally.
I look forward to hearing from the witnesses on their
thoughts and ideas.
Out of an abundance of caution, we did see the
Administration institute a travel ban and increase screening of
folks that are returning from China and the region.
You know, there are discussions taking place backward and
forwards as to whether that actually will help us get a handle
on this or if the travel ban will actually potentially make
things worse. And, again, I would be curious for the
perspective of some of the witnesses on how that is being
implemented and the impact of that.
Lastly, part of the reason why I really did want the
Administration here is we do not see this as an adversarial
role. A lot of things in Washington, DC. are partisan. This is
not partisan. We, as Congress, understand how rapidly this is
moving. We also understand that we want to make sure the
Administration has all the tools and resources that they need.
Right now, we are guessing at what they might need in the
emergency supplemental. I would invite the Administration to
work with us. Tell us what you need and then we will work to
try to get that available to you as quickly as possible. We are
on the same team here. This, you know, novel coronavirus does
not see Republicans or Democrats, it sees human beings. And
let's get ahead of this. Let's learn from this.
And then let's also plan so we are not constantly
responding to the latest outbreak but we are actually thinking
about how to prevent the next pandemic.
Those are a few things that I have on my mind. And, again,
I want to thank the witnesses for being here. And we really do
have great personnel at CDC, HHS, State Department. And they
are working overtime. And, again, I commend those men and women
that are spending quite a bit of time working on this just to
keep us safe. We look forward to working with them.
This is an open door if they ever want to come to this
subcommittee. And I think any of the members here, we are here
to help support the Administration.
With that, let me turn it over to the ranking member for
his opening statement.
Mr. Yoho. Well, thank you, Mr. Chairman, and good morning.
I would like to thank Chairman Bera for holding this hearing on
global spread of novel coronavirus from China.
And I want to comment on what you said, the hysteria and
misinformation. We saw that when Zika happened. And it was--it
turned into a political fight, it was politicized. And we do
not want to do this. And I commend everybody that is working on
this to this point; it hasn't happened. And I hope we go
forward.
And then you have an M.D. and a veterinarian, and so we are
both used to having quarantines and dealing with outbreaks.
I would like to welcome Dr. Jennifer Nuzzo from the Johns
Hopkins University, Dr. Jennifer Bouey from RAND, and Mr. Ron
Klain. I look forward to hearing from each of you about recent
developments and paths forward to coronavirus and related
global diseases.
As of today, 20,630 people in 24 countries around the world
have been infected with coronavirus that we know of. The virus
has killed 425 people so far, as we know, or that is all we
know of, the vast majority of which have occurred within China.
I extend my sympathies to the people in China who have lost
family members or remain quarantined by the Chinese authorities
in an unprecedented look-down of millions of people. I do not
think we have ever seen this before.
However, despite the severity and infectiousness of this
virus, the Chinese Government has so far refused to fully
cooperate with the global community. And, again, this is
something we hope does not become politicized. Viruses know no
borders and they do not really care what your politics are.
Although Chinese scientists were able to share the sequence
of the strain with international partners, they were only able
to do so after bypassing government censors. So far, China has
spurned the help of CDC and refused to provide biological
samples to the United States. And to date, if we look back,
whether it was the MERS or SARS epidemic, that was a worldwide
collaboration. And other countries, even Taiwan, needs to be
involved in this because they were the ones that helped solve
the SARS epidemic.
The slow-walking of information and assessments not only
hurts the credibility of China, but also hinders our ability as
an international community to prevent the further loss of life
and spread of the disease. Further, in the middle of the
unprecedented crisis the CCP continues to endanger people
through Asia by using the World Health Organization to advance
its political agenda through the exclusion of Taiwan.
Taiwan has also forbidden the evacuation of Taiwanese
citizens from the mainland, directly threatening the safety and
sovereignty of their citizens. This cannot stand. And, again,
viruses really do not care what your politics are.
The United States should be better prepared to face future
threats as well, which is why I supported multiple efforts in
Congress to promote the One Health framework which we are going
to talk a little it about, because this coordinates
departments, activities, and programs that will prepare to
protect the U.S. food and feed supplies in the event of a
zoonotic disease outbreak. So, this is a cooperation between
USDA and HHS.
As we know, six to seven out of ten diseases that we get
originate in the animal world. And the coronavirus is a perfect
example.
The recent outbreak of coronavirus stemming from Wuhan,
China, is a perfect example why managing the spread of the
animal-to-person spread to prevent person-to-person spread is
so important. Thankfully, the CDC has repeatedly assured the
American people that the risk to our residents remains low.
This, thanks in large part to the actions taken by the
Administration in organizing targeted quarantines, travel
advisories, research into treatments and vaccines, in addition
to the daily calls our staffs get and Members of Congress get
on this issue.
However, questions remain regarding potential paths
forward. What can we do in the future to prevent not just
China, but China, any country from hiding the spread of a
deadly virus, of which they are repeat offenders?
How can we balance long-term pandemic preparedness with the
billions of dollars our government spends in short-term
responses to emerging threats?
Congress must continue to enable our agencies to respond
effectively to infectious diseases and encourage our Government
to collaborate with all of our international partners in global
health.
I look forward to hearing from the panel on response to the
spread of the coronavirus in the U.S., and what we can do
better to prepare ourselves for the arrival of not just this
one but future pandemics from foreign countries.
Thank you, and I yield back.
Mr. Bera. Thank you to the ranking member.
And my staff was just updating numbers. It is now 492
deaths. So, obviously, rapidly flowing and constantly being
updated.
I should have noted that it is my pleasure to have had the
gavel passed over toward me from the former chair of this
committee. And I would like to recognize you for a 1-minute
opening statement, Mr. Sherman.
Mr. Sherman. Thank you, Mr. Chairman. You are to be
commended for having the first public hearing on this disease
outbreak of either house of Congress.
We did get a private briefing from the Administration. And
let me say that I was impressed by the team that made that
presentation to us. That is, I hope, particularly noteworthy
because I am not a leader when it comes to complimenting the
Trump administration. I am also not a leader in complimenting
the government in Beijing.
But, I think the entire world is impressed when they build
a new hospital and put it in service in 8 days. Which is why I
am surprised that the Chinese Government has taken offense that
we have chosen to limit travel, because the Chinese Government
has limited travel internally in China. And, of course, Hong
Kong has limited travel from the Chinese mainland. What we do
to protect our own citizens should not be regarded by the
Chinese as an insult but, rather, as part of a collective
effort to control this disease.
We need Chinese cooperation to start clinical trials. There
are a variety of possible medicines that might be helpful, but
we will not know. One of the good things about this disease is
that it looks like the mortality rate is 1 to 2 percent. That
is much lower than other outbreaks. I realize some people may
have slightly different definitions, but it is a lower
mortality rate than, say, Ebola, that Mr. Klain is familiar
with.
And so it means that without a clinical trial you do not
know whether a particular medicine is successful. Because if
you take 20 people with Ebola and you try something out and
they all live, that is a good treatment. If you take 20 people
with this disease and give them a treatment and they all live,
that may have proved nothing at all.
So, we need double-blind clinical trials, we need
cooperation with China. And I look forward to getting there.
I yield back.
Mr. Bera. Thank you, Mr. Sherman.
Now I am very pleased to welcome our witnesses to today's
hearing. We are joined by Dr. Jennifer Nuzzo, a Senior Scholar
at the Johns Hopkins Center for Health Security.
She will be followed by Dr. Jennifer Bouey, the Tang Chair
in China Policy Studies at the RAND Corporation. Both are
trained epidemiologists.
And, finally, we are joined by Mr. Ron Klain, who
coordinated the response to West African Ebola epidemic in 2014
and 2015.
Please summarize your written statements to 5 minutes. And
without objection, your prepared written statements will be
made a part of the record.
Dr. Nuzzo, if you could begin.
STATEMENT OF DR. JENNIFER NUZZO, ASSOCIATE PROFESSOR AND SENIOR
SCHOLAR, CENTER FOR HEALTH SECURITY, JOHNS HOPKINS UNIVERSITY
Dr. Nuzzo. Good afternoon. Chairman Bera, Ranking Member
Yoho, and members of the committee, thank you for allowing me
to appear before you today to discuss the emerging global
spread of the 2019 novel coronavirus.
In the last 2 months since this virus was first identified
we have learned several important things, such as its potential
to spread between people, and its capacity to cause a spectrum
of disease ranging from mild to severe. These discoveries have
changed our perceptions of the global risks the virus poses,
but there are still critical unknowns for which we urgently
need more information.
Though more and more cases are reported each day, we do not
yet know the true size and geographic scope of this epidemic.
And many countries are not capable of actively searching for
cases. And most countries that have implemented surveillance
are likely missing cases, perhaps large numbers of them.
Severity of this disease is another key unknown. Because of
biases in the way we look for cases, it is difficult for us to
estimate from the case numbers how much severe illness and
death we may expect to see as this epidemic grows. That said,
even though we cannot get a precise estimate, there are some
emerging signs that this virus may be less severe than we
initially feared. If these trends continue we will ultimately--
we may ultimately downgrade our concerns about this virus. But,
for now these uncertainties leave important gaps in our
response planning.
Though the ultimate trajectory of this epidemic is hard to
predict with certainty, evidence is mounting each day that it
may not be possible to contain this virus. What this means is
that if it is not possible to completely stop disease
transmission, we must plan for how we will mitigate the impact
of the virus as it spreads.
To do this, I recommend three priority actions:
First, we need to seriously reexamine the current policy of
banning travel from China and quarantining returning travelers.
All of the evidence we have indicates that travel restrictions
and quarantines directed at individual countries are unlikely
to keep the virus out of our borders. These measures may
exacerbate the epidemic's social and economic tolls and can
make us less safe.
Simply put, this virus is spreading too quickly and too
silently, and our surveillance is too limited for us to truly
know which countries have active transmission and which do not.
The virus could enter the U.S. from other parts of the world
not on our restricted list, and it may already be circulating
here.
The U.S. was a target of travel bans and quarantines during
the 2009 flu pandemic. It did not work to stop the spread and
it hurt our country. I am concerned that by our singling out
China for travel bans we are effectively penalizing it for
reporting cases. This may diminish its willingness to further
share data and chill other countries' willingness to be
transparent about their own outbreaks.
Travel bans and quarantines will make us less safe if they
divert attention and resources from higher-priority disease
mitigation approaches that we know are needed to respond to
cases within the United States. Caring for and monitoring even
a small number of quarantined individuals will be highly
challenging for health departments and may siphon attention
from other more important response work.
And we are already hearing stories about chaos in the
States as they are trying to implement these recent policies.
Second, rather than penalize China, we should try to assist
it in responding to the epidemic. Helping China is in our best
interests. It is a risk of the drastic actions that China is
taking to control the epidemic could lead to disruptions in
U.S. supplies of essential medical resources such as personal
protective equipment and critical medicines. We need to examine
this possibility and identify ways to ensure that the epidemic
or the U.S. response to it does not interrupt medical supply
chains.
Third, we should focus on health response efforts that we
know will help to lessen the impacts of the virus within U.S.
communities. We need to ensure that Federal, State, and local
health agencies, and hospitals and health clinics have the
resources they need to diagnose, isolate, and safely treat
cases, and to promote feasible approaches to disease mitigation
that are most likely to reduce disease spread, minimize
disruption, and protect those most likely to experience severe
illness and death.
For this, we need leadership and additional investment,
possibly in the form of emergency funding such as was
appropriated during the 2009 pandemic.
Government leadership is also needed to facilitate the
development of medical countermeasures, including infectious
disease diagnostics.
The points I have raised today hopefully paint a picture of
a epidemic that is in many ways complex and evolving, but for
which we are increasingly gaining clarity. One thing is
certain, international collaboration will be essential for us
to monitor, for continued monitoring and learning about the
virus and to inform our own response plans. That we know
anything about this virus is due in large part to information
contributed by China, Thailand, Vietnam, the other countries
that have worked hard to improve their surveillance, in part
with U.S. help. And we will likely need their help going
forward.
We should recognize these successes as they demonstrate the
value of our investments and the need for continued
international engagement. Though our instincts may be to
isolate ourselves to try to keep the virus out of our borders,
this approach may only weaken our preparedness.
Thank you.
[The prepared statement of Dr. Nuzzo follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Bera. Thank you, Dr. Nuzzo.
Dr. Bouey.
STATEMENT OF DR. JENNIFER BOUEY, SENIOR POLICY RESEARCHER AND
TANG CHAIR IN CHINA POLICY STUDIES, RAND CORPORATION
Dr. Bouey. Thank you. Chairman Bera, Ranking Member Yoho,
and members of subcommittee, thank you for inviting me to
testify for this coronavirus outbreak. My testimony will start
with laying out the context of this outbreak by looking at
China's public health development after SARS. Then I will
examine China's current response to this outbreak. And I will
end with some recommendations.
Seventeen years ago SARS emerged from southern China and
caused a global outbreak and infecting over 8,000 people, and
killing more than 700. SARS prompted China to radically rethink
its public health system. The country invested heavily in the
Centers for Disease Control, surveillance networks, and a
National Influenza Center. SARS also spurred China to
strengthen its relationship with United States and the wider
international community around public health concerns.
The U.S. helped China in both public health infrastructure
and capacity building. Public health professionals from both
countries collaborated on HIV/AIDS, avian flu, swine flu, H7N9,
and Ebola. In the last couple years, however, this relationship
has faltered due to tensions between the U.S.-China
relationship.
Compared to SARS, the time taken for the Chinese Government
and global health communities to respond to the first cases of
coronavirus are much shorter. So, there were about 4 weeks from
the first noticed case to the public announcement of the
outbreak, and then 12 days to the time when virus was
identified, and then 9 more days until the national case report
system was triggered.
The credit for this progress can be tied to the
availability of the latest genomic sequencing technology and
the global data networks. Because of the rapid identification
of the virus, many countries, including U.S. and China, can now
quickly develop a testing kit, monitor the genetic mutation,
and have better understanding of the transmission. All
countries can link their cases to the current outbreaks now.
Further, the wide use of social media and China's progress
on globalization has pushed the government to be more
transparent. However, there are remaining similarities to the
SARS response. Given the Chinese Government values stability
most, an outbreak by its nature is disruptive. The government's
hesitation to announce the public health threat was reflected
in the long review process and the regulations that prohibited
local officials and the members of the public to discuss the
outbreak before the approval from the central government.
The downplay of the severity of the outbreak also has
happened again. From January 3d to the 20th, the expert
investigation team assured the public that there was limited
person-to-person transmission. And after closing the animal
markets associated with the first group of cases, the epidemic
was under control.
It was not until cases outside China appeared and the
second team was sent and they confirmed the communal
transmission, then the government announced a public health
emergency and triggered the national case reporting system.
Finally, as with SARS, the government uses mass quarantine
as the primary intervention. Resources have been mobilized
nationally to support a health care system in the crisis areas,
and even new hospitals were built for the outbreak. The
quarantine and the health care system strengthening are
important strategies, but we do not know, do not know yet if
such intervention can contain this epidemic, nor do we know
about the social, cultural, economic, and the political
implication and impacts.
I will highlight three recommendations here:
First, USG should consider having a concerted and
comprehensive plan to contain the domestic outbreak. In
addition to the social distancing action we just mentioned, we
should consider the strategies to reduce the spread of rumors
and the stigma associated with the outbreak.
Second, public health and humanitarian assistance should be
sent at a time when China is bearing the principal burden of
the outbreak. Currently, 99 percent of the cases are in China,
and 97 percent of the deaths in Hubei province. Public health
expertise, medical supplies, and even supporting language can
help the people who are suffering there.
And, last, given the continued spread of the outbreak, USG
should consider working with WHO and China CDC to provide
strategic and capacity building for other countries that are in
danger of the epidemic.
Thank you.
[The prepared statement of Dr. Bouey follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Bera. Thank you, Dr. Bouey.
Mr. Klain.
STATEMENT OF MR. RON KLAIN, FORMER WHITE HOUSE EBOLA RESPONSE
COORDINATOR, 2014-2015
Mr. Klain. Chairman Bera, Ranking Member Yoho, other
members of the subcommittee, thanks for having me. I move you--
I commend you for moving quickly to hold this hearing.
At the outset I want to make two preliminary points:
First, while scientists are working at unprecedented speed
to learn more about this virus, we still know less about the
coronavirus today than we did about Ebola in 2014. There are
many important gaps to be filled in.
Second, I want to say a word about partisanship. I am a
political partisan, that is well known, but I testify today the
same way I approached serving as Ebola Response Coordinator,
putting politics aside. Epidemic response should not be a
partisan issue. The coronavirus will certainly not ask anyone's
political affiliation before infecting them.
With that introduction, I want to turn to the lessons from
the Ebola response. That response was not without problems, and
particularly early on. But, ultimately, President Obama
launched a whole-of-government effort, he appointed me to lead
a team at the White House to coordinate it. The president
ordered the first ever deployment of U.S. troops to combat an
epidemic. He implemented innovative policies and travel
screening and monitoring, and worked with this body to pass a
$5.4 billion bipartisan emergency response package.
This response improved preparedness at home, and put over
10,000 people, civilians and soldiers, government employees,
contractors, and NGO members on the ground in Africa to help; a
gargantuan effort. The epidemic was tragic, a loss of 11,000
lives or more, but experts had forecast a death toll of more
than 1 million. Thus, as part of a global response, with
Africans playing the largest part, America helped save hundreds
of thousand of lives.
Here at home, after some initial missteps in Dallas, no one
contracted Ebola on U.S. soil. And the evacuation of Americans
from Africa with Ebola saved lives and resulted in no spread of
the disease here.
And the benefits of this response continues to this day.
With Congress' support we stood up a national network of
medical facilities that remain prepared now to respond to cases
of dangerous infectious disease. Nothing like that existed
before. The response helped develop an effective Ebola vaccine
being used now in Central Africa. And new therapeutics have
dramatically reduced the mortality rate of Ebola.
Tom Friedman recently wrote that the Ebola response was
``President Obama's most significant foreign policy achievement
for which he got little credit precisely because it worked,
demonstrating that without America as quarterback, important
things that save lives and advance freedom often do not
happen.''
Now, the challenges we face now from the novel coronavirus
have many differences from those that Ebola posed, but also
some key similarities. And I want to try to quickly run through
seven lessons from the Ebola response that should be applied
today.
First, in a scenario like this one there is no substitute
for White House leadership. There should be a single high-level
official inside the National Security Counsel overseeing the
response. At the end of my tenure as Ebola Response
Coordinator, President Obama accepted my recommendation to
create a permanent pandemic preparedness and response
directorate inside the NSC.
President Trump initially continued this structure. But,
unfortunately, in July 2018 he disbanded this unit. The gap
that created for this response is significant.
Now, last week's decision to create a task force to oversee
the coronavirus response is a valuable step, but I think it is
insufficient. That is not a criticism of its chair, Secretary
Azar, for whom I have a great respect, but reflects the
fundamentals of bureaucratic behavior, the realities of the
competing demands on a cabinet secretary's time, and the need
to ensure foreign engagement at a high level. This response
should be lead by a full-time senior appointee at the White
House.
Second, the U.S. must lean forward to fight this epidemic
overseas. Unlike West Africa in 2014, China said they would not
accept thousands of U.S. responders on the ground. But that
does not mean our focus is limited to the homeland. Nations
poorer than China may see outbreaks and need direct help. Our
diplomats should be engaged around the globe.
The best way to keep Americans safe is to eschew
isolationism and help other nations combat the virus.
Third, this Administration must ensure that science and
expertise guide our actions. There are going to be many hard
decisions in the days ahead. The American people are fortunate
to have the world's leading experts on infectious disease
working in this government, experts who have served Democratic
and Republican presidents alike. This expertise should be
paramount in decisionmaking.
Fourth, the Administration should quickly transmit to
Congress an emergency funding package to respond to the
coronavirus challenge. Federal agencies, State and local
governments, hospitals testing and treating patients will need
assistance. Research and deployment of new therapeutics and
vaccine need government support.
While the response has benefited from the new emergency
fund that Congress created on a bipartisan basis last year,
that probably will not suffice. The Trump administration should
send an appropriate funding request to this body.
Fifth, the Congress must do its job in dealing with the
coronavirus. It needs to act on any such request quickly and
should, perhaps, work now to be ready for it.
In addition, hearings like today's are very important. The
emergency fund needs to be increased and paired with a fund to
support the development of therapeutics and vaccines on public/
private partnerships.
And, finally, Congress must renew funding for the full
network of Ebola and special pathogen hospitals created in 2014
that is set to expire in May.
Six, this should be a wake-up call to finish the work we
need on pandemic preparedness. Recently we marked the 100th
anniversary of the single largest mortality event in American
history, the Spanish flu epidemic. At present it seems very
unlikely that the coronavirus poses a similar threat. But even
if this epidemic is not the big one, as Representative Yoho
said, it is a reminder that the danger lurks and it will come.
The global health security agenda, bipartisan commissions
and reports, and my own writing have set forth detailed agendas
of what we need to do to prepare for this event that have
largely been ignored. The time to act is now.
And seventh, finally, all of us need to be on the watch for
discrimination against Chinese Americans and speak out strongly
against it. The coronavirus strikes humans, not people of any
particular race or ethnicity. Chinese Americans and Chinese
immigrants in America are no more likely to get this disease or
transmit it than anyone else. It is critical to speak out
against discrimination. Americans need to pull together to
fight the disease, not pull apart to fight one another.
Thank you again for having. And I am ready to answer your
questions.
[The prepared statement of Mr. Klain follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Bera. Thank you, Mr. Klain. And thank you to all the
witnesses.
I will now recognize myself for opening questions, and then
I will recognize the ranking member and other members for 5
minutes for the purpose of questioning our witnesses.
Let's touch on a couple areas that I think each of you
touched on in your opening statement. I understand the initial
reaction to say, you know, let's try to contain this virus at
the epicenter in China. That, you know, just given the
worldwide spread of these cases how little we know about the
transmission at this juncture.
It seems as though, you know, we are beyond the point of,
you know, trying to contain this at the epicenter.
Maybe starting with you, Dr. Nuzzo, and, you know, just
going down the line, how effective is this travel ban? And you
touched on it that it actually may worsen, worsen things right
now in concentrate.
Dr. Nuzzo. Thank you, Chairman Bera.
I, as I mentioned, am worried about the implications of the
travel ban. We often see when we have emerging disease
outbreaks out first instinct is to try to lock down travel to
prevent the introduction of virus to our country. And that is a
completely understandable instinct.
I have never seen instances in which that has worked when
we are talking about a virus at this scale. Respiratory viruses
like this one, and like others, they just move quickly. They
are hard to spot because they look like many other diseases. It
is very difficult to interrupt them at borders. You would need
to have complete surveillance in order to do that, and we
simply do not have that.
In China we are looking for largely sick people. I mean,
other countries we are only looking for people from China. So,
we are going to miss transmission elsewhere.
So, for that and other reasons I do not believe that it
will be able to keep the virus out of our border.
I am, though, very worried about the potential diversion of
resources because this was apparently, it was a decision that
caught many public health folks off guard. And they are now
trying to figure out what to do. And so, I talked to one health
department who has 31 staff working around the clock supporting
two quarantined individuals. And I just think, as this epidemic
grows that is not likely to scale.
So, I am worried about that. And then I am also worried
about the chilling effect that attends the potential to erode,
well, our relationship with China that we are critically
dependent on right now for the supplies of the things that we
need to be able to manage our own cases. But, also, we just
need more information.
And as you mentioned in your opening remarks, China will be
the source for that information in large part.
Mr. Bera. Right.
You know, maybe, Mr. Klain, Dr. Nuzzo touched on the supply
chains and the interconnectedness of it. How concerned should
we be about those supply chains? And, you know, obviously they
are global supply chains as well, and the medical supply
potentially needed here but also in China?
Mr. Klain. Yes, Congressman. We do not have a travel ban,
we have a travel band-aid right now.
First, before it was imposed, 300,000 people came here from
China in the previous month. So, that horse is out of the barn.
Second, what we have restricted is not travel to or from
China but passports to and from China. There is no restriction
on Americans going back and forth. There are warnings. People
should abide by those warnings. But today 30 planes will land
in Los Angeles that either originated in Beijing or came here
on one stops. Thirty in San Francisco, 25 in New York City. OK?
So, unless we think that the color of the passport someone
carries is a meaningful public health restriction we have not
placed a meaningful public health restriction.
And then to get to your question, exempt from the
President's travel restriction, of course, is the import of
goods from China and, of course, the people who fly the planes
and drive the boats that bring those goods from China. We
couldn't ban that activity. We vitally need that. 90 percent of
the antibiotics in this country come from China. All kinds of
vital medical supplies. Dr. Nuzzo mentioned the PPP--PPE we
will use to treat people.
So, travel bans, even putting aside Dr. Nuzzo's concerns,
that is not what we are imposing, that is not what exists. What
we should be focused on is monitoring the people who are here
who have been in China in the past 14 days. That is
complicated. That is hard. We built a path-breaking system to
do that in the Ebola response. This is much larger and more
complicated.
And I do not think we have heard answers--I hope Congress
will get them--but what the Administration is doing on that,
which really should be our public health priority.
Mr. Bera. And maybe in the limited time I have left, Dr.
Bouey, you have a unique perspective having trained in China.
And, you know, from your perspective, how best can we assist
the Chinese? And, again, from the congressional perspective we
are not looking at this as adversarially, we are looking at
this as collaboratively.
Dr. Bouey. Thank you. I agree wholeheartedly with Dr. Nuzzo
and Mr. Klain that the travel ban does not cause--does not help
that much in this, the current situation.
I want everyone to understand that China, Chinese
scientists look up to the American scientists highly. The
United States has helped China to build a public health system,
and has helped with capacity building after SARS.
So, they are always looking at the U.S. as a leader in this
field and for U.S. to make this decision. So, I think that is
why China is a little bit surprised and also feel hurt.
And I also, my own feeling is that with the travel ban that
should come with other policies. It should not be the only
policy that U.S. announced to China. Humanitarian aid, the
public health assistance should, and the other support should
be in place at the same time as the travel ban.
Mr. Bera. Great. I am out of time.
Let me go and recognize Ranking Member Mr. Yoho from
Florida.
Mr. Yoho. Thank you, Mr. Chairman.
Great testimony. I really, really appreciate it. I have a
ton of questions let me go through.
Dr. Nuzzo, you said we should look to help China versus
blocking them out. What kind of help would you recommend other
than what we have done?
Keep in mind if China will not accept our offer to help
with the CDC, what else can we do? I would like to hear from
you.
Dr. Nuzzo. Yes, thank you, Ranking Member Yoho, for that
question.
First of all, I want to make clear that I think one of the
concerns that I have about our----
Mr. Bera. Dr. Nuzzo, could you speak into the microphone,
please.
Dr. Nuzzo. Excuse me. Sorry.
I want to make clear one of the concerns that I have
pertains to not just our response to this virus but also how
China is responding. And the disruptions that I spoke to
earlier I believe will be exacerbated by the lock-downs that
China is taking in an attempt to control the virus.
Since those lock-downs have been announced, every single
province in China is reporting cases. So, I am increasingly not
convinced that those measures are helping. And I am really
worried that they are going to cause disruptions.
And so, I think it is essential that we encourage China,
pressure China, whatever the negotiations that we do, to pursue
strategies for controlling the virus that are not going to be
disruptive, that will not suspend the production of critical
medical supplies because people cannot get to their jobs.
Mr. Yoho. Let me interrupt you right there because that is
something I want to talk about.
Dr. Nuzzo. Right.
Mr. Yoho. You know, does the fact that China did a massive
quarantine--our reports are 50 to 58 million people have been
quarantined--does that concern you in addition to the rapid
construction of the 1,000-bed hospital, which was a monumental
feat, and they have another 1,500 going in--so China is putting
a stellar effort into this--that alone would be a concern for
all of us if they are that concerned about it, yet the
information coming out is, well, we have it kind of under
control. And then the furloughing of workers, I have heard up
to some, they are told not to come back till sometime in March.
I think this is a big concern that we need to look at. And
I am all for quarantine if it is done properly but, as Dr.
Bouey said, it cannot be the only thing. You have to have a
systematic way of doing it. I mean, we do that with equines
with influenza outbreaks in shows.
And it is not--somebody asked me, well, do you care more
about horses than people, or do you want to treat people like
horses? I am, like, no. But do we put more emphasis on our
animals than we do our people?
This is a national security thing and we cannot afford it.
And if the economic impact that China is going to feel I think
that is something that we need to look at very seriously that
this has the potential.
And I want to bring up, does anybody know the duplication
rate of this virus compared to the influenza or SARS?
Dr. Nuzzo. I completely agree with your concerns about the
internal response. I do not believe that the massive lock-downs
in China will lead to a cessation of transmission of the virus.
I think that it is already causing a tremendous amount of
disruption.
When you hear stories about people having to walk to the
hospital, sick people having to walk to the hospital because
transportation has been shut down, that is really what raises
warning flags in terms of the public health benefits of these
measures.
Mr. Yoho. But does not that also show you the severe threat
that the Chinese see themselves?
Dr. Nuzzo. I think that everybody is viewing this severely.
I will tell you that many of these tendencies we saw during
SARS as well, and we often see when there is an emerging
infectious disease outbreak like this.
Mr. Yoho. All right. I want to go to Mr. Klain because he
is jumping over there.
Mr. Klain. Yes. Thank you. I appreciate that, Congressman.
Look, I think that there are two points, or three. One, I
agree that there are a lot of signs that this has been more
severe in China than has been reported. And I have no doubt
that the actionable cases is significantly higher.
Mr. Yoho. Well, let me tell you what I heard yesterday from
reliable sources. It is over 100,000 people have been exposed.
Mr. Klain. Yes. Yes, I----
Mr. Yoho. What we have heard. And the duplication rate with
influenza was about 1.3 percent. That means one person can
affect about 1.3 people. And that was the same with SARS, a
little bit higher for SARS.
This one they are estimating right now between 2.5 to 3.
So, that means one person is affecting 2.5 to 3 people. And
that is not being reported. And if that is true and the Chinese
know that, they need to let that--us know because that shows
you the virulence of that and the rapid spread.
Mr. Klain. Yes, I agree. We do not really know what the R-
nought is, we do not know a lot of these facts. We need to get
this information, I agree.
The last thing I want to say is about this Chinese internal
quarantine. Just to put a finer point on what Dr. Nuzzo said, I
am highly skeptical that this is effective.
You know, I think we all saw that picture of all the
bridges out of Wuhan with no one leaving. But if you look at
that picture, on the other side were literally thousands of
trucks on their way into Wuhan.
Who drove those trucks? And what happened after they
unloaded them?
Think about trying to quarantine a city the size of New
York City in the United States, and imagine that no one would
come in and no one would go out. How would you feed those
people? Who would run the power plants and all these things.
Mr. Yoho. That is going to be found out in the future.
Mr. Klain. Yes. And so what I am willing to bet right now
is that people are coming and going from Wuhan every day. And
it is just a practical reality of the size and the scope of
what we are talking about.
Mr. Yoho. I am out of time. Thank you.
Mr. Bera. Thank you, Mr. Yoho.
Mr. Sherman from California.
Mr. Sherman. First, this outbreak shows the
wrongheadedness, almost immorality of the Chinese Government
excluding Taiwan from the World Health Organization. We have to
be on Team Human, not on Team Disease.
You know, whenever something new like this happens we
react. Almost always it is an overreaction until there is that
one case where the reaction is not an overreaction. We are in a
race to develop vaccines and cures. And that can happen only
with cooperation between the United States and China.
We look back at November 2002 when it took months for the
scale of Chinese SARS crisis to be exposed. This time, as the
New York Times reported, at critical moments in the first 7
weeks between the appearance of the first symptoms in early
December and today, the government's decision--between when the
first appearance and the government's decision to lock down the
city officials chose to put secrecy and order ahead of openly
confronting the growing crisis.
So, I will ask each of our witnesses, are the Chinese being
honest as to the extent of the epidemic?
Does the World Health organization have sufficient access
to facilities and to patients? Doctor?
Dr. Nuzzo. I cannot speak to intention. I think there have
been critical information gaps.
Mr. Sherman. Uh-huh.
Dr. Nuzzo. The one that I am particularly interested in
learning more about and think we should have more information
about is about the severity of cases.
You know, to the point about how--is the situation more
severe than they are letting us know? Are there more deaths or
dying that we are not hearing about?
Mr. Sherman. OK.
Dr. Nuzzo. One puzzling feature so far is that the cases
that we have seen outside of China have been far more mild than
what is going on in China. So, we need to understand why that
is. And for that we need access to more data.
I have been encouraged that there have been a number of
scientific publications that have come out already about this
with Chinese and others, scientists from elsewhere on those
publications. But I, as an academic, cannot even justify
waiting for a publication to learn about these things.
So, I absolutely believe that more information is critical.
Mr. Sherman. OK. I do have limited time.
The Chinese have reported 24,000 cases and 490 deaths. Dr.
Bouey, what----
Dr. Bouey. My observations----
Mr. Sherman [continuing]. What do you think the number is?
Dr. Bouey. Right. My observation is that there was delay of
case reporting for sure before January 19th. After January
19th, the government triggered a public health emergency. And
that triggers the national case reporting system.
That case system was implemented after SARS. And as we know
SARS better, well, then you know that at the end of the SARS
when they set up this system they said, they put in a law that
if anyone cannot report accurate numbers then they will be
punished.
Mr. Sherman. I have to go to the other----
Dr. Bouey. I think that is very well. But the problem is--
--
Mr. Sherman. Excuse me. I have limited time.
The Chinese have not involved the United States' experts to
the degree they should. Are they, do we have sufficient numbers
of people from Europe, Japan, and the World Health Organization
on the ground to get us the information and to see that we are
doing all we can to look for cures and vaccines? Mr. Klain.
Mr. Klain. I do not think so, Congressman. And, again, this
is one reason why I think we need a high-level coordinator at
the White House who can be in touch with foreign governments at
other high levels. Again, Secretary Azar is competent and
skilled, but this is an active diplomacy, not just health
diplomacy but high-level diplomacy.
Our President should be on the phone with President Xi. You
know, we should be engaging these other countries at a very
high level. That is what we did during the Ebola response, very
high level from the White House. And I think we need to do that
here to get more American eyes on the ground there.
Mr. Sherman. And, again, I was asking not just about the
U.S. Do any of our witnesses know the level of WHO, European,
and Japanese experts on the ground in China? And is that
sufficient?
Is China cooperating with any of the other advanced health
organizations in the world?
Dr. Bouey. My source is the news. And I know that the WHO
has announced that they will--they have a team on ground. And I
thought----
Mr. Sherman. They have a what?
Dr. Bouey. They have an emergency team in Beijing.
Mr. Sherman. Uh-huh.
Dr. Bouey. And I think the Director of the WHO was in
Beijing I think since January 27th.
Mr. Sherman. My time has expired.
Mr. Bera. I recognize Mr. Perry for 5 minutes.
Mr. Perry. I thank the Chairman, thank the witnesses.
We have ample evidence that China has undue influence over
many U.N. organizations, including the WHO. The WHO continues
to exclude Taiwan, that is an important player in this and many
other things.
Do you, do all of you think that we can just unilaterally
trust the World Health Organization to give an impartial
assessment of China's response to the coronavirus?
Mr. Klain. I will start. I certainly do not think so,
Congressman Perry. I think the WHO is performing better now
than it was during the Ebola response 5 years ago. I think new
leadership has helped.
But I think the delay in declaring a public health
emergency international concern reflected Chinese influence
there.
And think that, you know, the WHO is just one aspect of
this response. They aren't going to treat people. They aren't
doing research. They are important. The U.S. should support the
WHO. But we need to be involved directly on our own in China
and with our allies.
Mr. Perry. OK, so that is fair. They have been
complimentary of China's response but critical of other
nations. I mean, do you take pause when you hear that?
Or, Mr. Klain, just for example, you are I guess a self-
described expert having your involvement with Ebola, have you
been critical of China's response?
Mr. Klain. Yes, I have, sir. I have published. And
everything I have written about this so far that the Chinese
have failed the test of transparency and cooperation, and that
they, they definitely need to do better.
We should be very concerned about that. And we should be,
as I just said a moment ago, engaging the Chinese Government at
the highest levels to press the issue.
Mr. Perry. Do you know----
Mr. Klain. This should be at the top of our agenda----
Mr. Perry. Mr. Klain.
Mr. Perry [continuing]. In our relations with China, sir.
Mr. Perry. I understand.
Do you know if President Trump has or has not talked to the
President of China about this?
Mr. Klain. I do not, sir.
Mr. Perry. You do not know?
Mr. Klain. I do not.
Mr. Perry. I mean, you would admit it is a little unfair to
criticize it here when you just said you do not know if he--
maybe he has, maybe he hasn't, I do not know. But you are
making the claim here that he should have done it or should be
doing it.
Mr. Klain. My claim is that he should have done it or
should be doing it. I will say he hasn't said that he has done
it. And the officials reiterate that the Chinese aren't
cooperating yet.
Mr. Perry. Mr. Klain, you worked on the Ebola virus
outbreak in Sierra Leone, Guinea, and Liberia, is that, West
Africa; is that about right?
Mr. Klain. Yes, sir.
Mr. Perry. Yes. Are any of those nations communist nations?
Mr. Klain. Not to the best of my knowledge, sir.
Mr. Perry. No. Right.
Are any of those nations seeking worldwide dominance over
the United States of America, stealing somewhere between $300
and $600 billion in intellectual property annually, including
medical technology?
Mr. Klain. No, sir. As I said, I am not here to defend
China or its response to this virus. In fact, I have been
critical of China and its response to this virus in virtually
every answer I have given to the subcommittee today.
Mr. Perry. So, in your view, what is the first
responsibility of the U.S. Government regarding a pandemic, the
coronavirus, Ebola? What is the first responsibility of the
United States Government?
Mr. Klain. The first responsibility of this government is
to keep the American people safe. And the best way----
Mr. Perry. To keep the American people safe. That is right.
Mr. Klain. Yes, sir. And the best way to do that, as we did
with Ebola, as we do with other things, is be engaged globally
in helping nations fight these diseases overseas so they do not
come here, sir.
Mr. Perry. So, are you, are you advocating for a travel ban
outright to China or from China? I am trying to get that from
your initial testimony and I couldn't tell where you were. You
were critical of the current situation but you did not offer
your solution set as an expert, so to speak.
Mr. Klain. Sir, I did offer my solution set. It was that we
monitor carefully everyone who has come to this country from
China recently.
Mr. Perry. How many people travel from China to the United
States every single day, sir?
Mr. Klain. Well, before this outbreak it was about 8,000 a
day.
Mr. Perry. Eight thousand a day?
Mr. Klain. Yes, sir.
Mr. Perry. And it is your studied opinion that we should
let that happen unencumbered, unimpeded, under all
circumstances and monitor those 8,000 people a day's
whereabouts should this continue to progress and we found an
outbreak in the United States of America?
Mr. Klain. Congressman, it is my studied opinion that we
will never reduce that to zero due to trade and due to travel
of Americans and Americans' family members. In fact, the
President's order exempts 11 different categories of people
from going back and forth to China, as well as hundreds of
people a day bringing goods here.
Mr. Perry. So, it is----
Mr. Klain. And so given that hundreds----
Mr. Perry [continuing]. Zero or all?
Mr. Klain. No, sir. Given that hundreds of people,
thousands of people will come here every day, I take it, sir,
it is not your position that American citizens in China should
be stranded there and unable to come back. And, given that,
then the only practical thing we can do is to monitor those who
are coming here to this country, who are bringing medicines to
this country, who are bringing goods.
Mr. Perry. May I close with the time I have, Mr. Chairman.
Mr. Klain. That seems like the only practical solution.
Mr. Perry. Mr. Klain, we appreciate your experience, we do,
and your expertise because you have done this to a certain
extent, but I do not think that you have operated in the same
realm with the Chinese Communist Government and their actions
toward the United States. So, things are a little different.
And the other thing is, is that while you had a certain
experience, it might not be the only way of doing things. And
so while it is great to throw partisan shots, I mean, when you
talk about bringing--I read your piece in The Atlantic, sir--I
mean, you are talking about bringing countries and the United
States together and not being paranoid. All you did was offer
criticism and really no help. And that is not helpful at all.
And I yield back.
Mr. Klain. Well, Congressman, that piece included praise
for Secretary Azar for the other aspects of the response,
praise for the Administration's response, to a limited extent,
in Congo to Ebola we have seen there.
I opened by saying this isn't a partisan issue, and I
reiterate that this is not a partisan issue. What I do believe,
though, is that if we do not engage globally--and, again, I
have been very critical of the Chinese--we cannot keep America
safe, sir.
Mr. Perry. And I would agree with you. But instead of
blaming America, you ought to look more toward the Chinese.
And I yield.
Mr. Bera. Great. And, again, the goal here is we want to be
supportive of the Administration. Congress wants to be on the
same page with the Administration. And we want to work with the
Chinese to get ahead of this because this is a global issue.
With that, let me recognize Ms. Houlahan.
Ms. Houlahan. Thank you, Mr. Chair. Thank you all for
coming today.
I am actually really intrigued by, Dr. Nuzzo and Dr. Bouey,
your initial conversations about the fact that the travel bans
and quarantines weren't necessarily the solution. I guess I am
really struggling trying to understand, based on my limited
understanding of biology, and I am a mere engineer, why is
quarantining not appropriate? Why is it something that is not
useful to this case?
How do we know what cases it is useful?
And because my limited understanding of biology is
quarantining works, is there ever a situation where that would
be something that would be useful? And when do we know when it
is before it is too late?
Dr. Nuzzo. Thank you so much. I will start with answering
that question.
The challenge here is that we are talking about a
respiratory virus that potentially has--and I take the earlier
points, there are still some uncertainties about the incubation
period--but potentially can spread between people quite
quickly. So, it is very difficult to know where the disease is
spreading because we just simply cannot get a hold of it, ahead
of it in terms of your surveillance.
So, those sorts of circumstances makes quarantine
challenging because we do not know who we should be
quarantining fully. We may decide just based on the numbers of
cases in China that we should quarantine travelers from China.
But we do not actually know if travelers from other countries
have the virus.
We also do not know if it is already here because we are
only testing people who have a connection to China. So that
makes it challenging.
Quarantine is actually not something that we routinely use
in public health. Despite what you may have heard, it is
actually something that we only use in very rare circumstances.
We, in public health, when we talk about quarantine we mean
restricting the movement of people that are not yet sick. We
very frequently isolate people that we know are sick. It is a
very routine and well-studied process. But quarantine is not
something we routinely do. It is usually reserved for
circumstances in which you have a small group of people,
perhaps in a measles outbreak in a vaccine-hesitant community.
Ms. Houlahan. So, is this a situation where you will know
it when you see it? You will know that this is a quarantine
situation and an effective one, and this just does not happen
to be one? Or we are just speculating?
Dr. Nuzzo. In this situation this definitely does not
happen to be one.
Ms. Houlahan. And, Dr. Bouey?
Dr. Bouey. My sense of a quarantine it is a primary
prevention. So it is basically separating those who are sick
versus those who are not sick.
So, without the vaccine, without the treatment usually we
have to rely on quarantine on paper, on paperwork. But in
reality, it often only slows the transmission, not prevents.
Ms. Houlahan. So, I am sorry to interrupt, because I do
have very limited time I just want to talk about the vaccine or
treatment.
Is there anything that we can do in the short-term with
this particular situation with vaccinations or treatment from a
congressional standpoint? Is there anything that we should be
able to do for the forward-looking perspective because this may
not be as bad as it seems to have been, at least initially. But
at some point it will be, something will be.
I guess this is probably for Mr. Klain. Can you talk to
anything, you mentioned maybe emergency supplemental funding?
Can you identify what programs specifically or what
accounts would be useful, not just for this particular
situation but for future situations as well?
Mr. Klain. Yes, Congresswoman. I think it is very--I think
Congress last year expanded the public health emergency fund,
considered but did not adopt a proposal to create a special
fund to help seed public/private partnerships to accelerate the
development of vaccines and therapeutics. And I think while
that would probably be too late to really help with this
epidemic, it might not be. And certainly it will be very
helpful going forward.
I think, you know, that means putting more money also into
BARDA, which plays an important part in turning this research
and bringing it to the marketplace. We are always underfunded
and always a little bit behind. But I think, you know, whatever
Congress can do to supplement public/private partnerhips in
this regard would be very useful for keeping the American
people safe.
Ms. Houlahan. Thank you. And with the last minute of my
time, Dr. Bouey, I was wondering, you did comment on the fact
that there would be potential social, cultural, political, and
economic implications to our current strategy. But you kind of
left it at that.
Can you elaborate on what those--I know you said we do not
know what they are--but could you speculate?
Dr. Bouey. I was referring to the quarantine measures in
China. Certainly economic concern is huge. And I think even
China's government probably is considering, you know, how long
this quarantine can actuate without harming the economy too
much.
And of course it has social and cultural issues. People who
are being quarantined are worried. They are nervous. And
especially for the hospitals within Wuhan, they are
overwhelmed. Certainly the new hospital will help a little bit,
and the mobilization of resources help a little bit. But for
people under quarantine it is a tremendous stress.
Politically, of course, there are lots of distrust, a lot
of questions within China now. And, again, quarantine to lock
down a whole city usually is not the best practice.
Ms. Houlahan. Thank you. I have run out of time.
I yield back.
Mr. Bera. Great. Thank you.
Let me recognize Mr. Mast from Florida for 5 minutes.
Mr. Mast. Thank you, Mr. Chairman.
I want to take a step back and ask that we all recall we
have districts back home. And while we deal with national
policy, the questions that we ask on this matter to
individuals, individuals with children, individuals that go to
work, individuals that are exposed to people that travel. We
will all travel presumably Friday or Saturday back to our home
districts. We are in a very international city here.
And I think, I feel as though the sense that I am getting
from you all about quarantine not being the right path does not
pass the test of common sense. But I do not want to dwell on
that right at this moment.
What I want to ask first, No. 1, in the aim of speaking
about people that we represent back home, if you were in Wuhan
right now, any one of you, you all have experience with this,
what would be your first or second or third line of defense?
How would you protect your family? How would you protect
yourself? Would you wear a mask? Would you wash your hands?
Does that not work? Would you not touch your eyes or your nose?
Would you prevent your kids from going to school? What would
you do?
Dr. Bouey. Can I start with I think there are many other
primary prevention methods. Health education is one. I think if
people understand what is going on, and they understand the
severity of the issue, and you let them know that how can they
protect themselves and their families and their children----
Mr. Mast. That is the question I asked. If you could answer
that for me it would be fantastic.
Mr. Klain. That would be through social media, through any
channel we can have.
Mr. Mast. Social media is not protecting anybody in Wuhan.
Dr. Bouey. The knowledge. The knowledge they can.
Mr. Mast. What do they do to protect themselves?
So, if there are people that come to our country because
there is no quarantine on them because of this academic
approach instead of common sense approach, what do people do to
protect themselves when they are exposed to others?
Dr. Nuzzo. I think what confused me about your question
initially is the if you were in Wuhan. And I cannot speculate.
I do not know what the situation is happening in Wuhan.
As I mentioned before, one of the great unknowns about this
virus is the apparent discrepancy in what we are hearing about
in terms of severity and illness in China versus the more close
to 150 cases that have been reported outside of China. The
majority of the cases that have been reported outside of China
have largely been mild disease, like other respiratory
illnesses----
Mr. Mast. I apologize for cutting you off. But none of you
are answering a very straightforward question.
Mr. Klain, you are presumably the expert on this panel. If
you were there at ground zero, maybe you are not in a full-on
TAP suit, but what would you do if your family was going to be
in an area that was exposed to it? How would you protect your
family from this? What is defense one?
Mr. Klain. Yes. So, Congressman, I think this goes back to
your initial point, which is defense one would be get out. And
the problem I think for this issue of travel bans and
quarantines is that probably hundreds of thousands or millions
of people have.
Mr. Mast. OK. No. 1, get out.
Mr. Klain. Right.
Mr. Mast. No. 2?
Mr. Klain. No. 2 would be, would be----
Mr. Mast. If you cannot get out of there, No. 2, what would
you do?
Mr. Klain. Would be social distancing. Would be trying to
have fewer interactions with people, yes.
But keeping your children home from school? We found in the
past is when that happens, people's children leave the house
and go to shopping malls and other places where they have
contact with people.
So, you know, it is a tricky thing.
Mr. Mast. How would you physically protect yourself?
Mr. Klain. The only real way I think to physically protect
yourself is to try to stay away from other people. I think if
you are going to have exposure to other people, as we all do,
you know, washing your hands, doing things to minimize the
spread of the virus is good.
But, you know, get out of where the virus is, stay away
from other people, and then engage in standard, you know,
public health kind of practices, wash your hands, whatever.
Mr. Mast. I mean, we do not say whatever, this is a serious
question.
Mr. Klain. Yes.
Mr. Mast. I mean, washing your hands might be a simple act,
but it is a very serious thing when you are looking at a
pandemic like this.
Dr. Bouey, one of your last comments that you made was
about quarantine perhaps only slowing the transmission. Is
there at this point a vaccine?
Dr. Bouey. No.
Mr. Mast. So, would slowing the transmission be a victory?
Dr. Bouey. Well, it is a victory for other cities, other
countries.
Mr. Mast. Is it a victory for the United States of America?
Dr. Bouey. It is a victory for human beings.
Mr. Mast. So, it is a victory to slow that. That being
something that comes from----
Dr. Bouey. I think so.
Mr. Mast [continuing]. Some point.
Dr. Bouey. I am not all against the quarantine. I am just
saying the quarantine policy should be evaluated very often.
Now, every 7 days, every month, you know, it should be
evaluated.
Mr. Klain. Congressman, my concerns about the travel policy
is not an academic concern, it is that as a practical matter
people are coming here from China every day. Every day. And we
couldn't stop that unless your district does not want
antibiotics and protection, and all the things that come from
China every single day.
And so, we need to be honest about the American people,
with the American people about the fact that we cannot keep
people coming here from China. We are not going to keep
Americans from coming home, for goodness' sakes, and there is
no reason to think that a foreign national or an American
anymore is likely to transmit the disease. In fact, we think
they aren't.
So, I think reducing the number of amount of travel from
China here is a, is a good thing. But I also think we need to
be honest with people about the fact that we will always be at
risk for this disease coming here because we will never turn
off the supply of people, and planes, and ships altogether
coming here from China given the interconnectedness of our
world, interconnectedness of vital traffic back and forth.
Dr. Nuzzo. Can I----
Mr. Mast. My time has expired.
Dr. Nuzzo. I would just like to add that this has been
worked out in a number of circumstances, including the lead-up
prior to the 2009 influenza pandemic. And, essentially, the
best evidence suggests that a lock-down of travel will at most
prevent an introduction for perhaps weeks.
That is not meaningful in the context of developing a
vaccine. A vaccine could take a year or more. It is not like
flu where we have an exiting platform that we can use toe
create a new version of a flu vaccine for the use in a
pandemic.
So, I do not disagree that slowing is a good idea if it a
meaningful amount of time that it can be slowed, and if the
consequences do not, do not--aren't worse than the disease
itself.
Mr. Mast. Right.
Mr. Bera. I appreciate the point that my colleague from
Florida is making. I just want to emphasize one piece that, you
know, we certainly have emphasized to the Administration is the
best thing we can do right now is get the smartest people, our
smartest epidemiologists and everyone working side-by-side with
the Chinese and the global community to figure out as much as
we can about infectiousness, incubation, transmission, et
cetera.
And, again, the best thing we can do is get those folks
into China. And the President may be working on this every day
with phone calls, et cetera. But, again, we are here to help.
And I do think we can then better answer a lot of those
questions if we can get our folks into China to help answer
some of those questions.
I am going to go to the chairman of the full committee, Mr.
Engel. Mr. Engel, you are recognized for 5 minutes.
The Chairman. Thank you, Mr. Chairman. Thank you for
calling this important hearing on the coronavirus outbreak. It
is one of the reasons why I love this committee, we are really
right in the center of things, and quickly as well.
So, I want to start by expressing my sympathy and
condolences to everyone who has been impacted by the outbreak,
including the people of China, other affected countries, and
those here in the United States. It is hard to imagine how
painful and scary these past weeks have been for these
families.
Here on the Foreign Affairs Committee we know that global
health is critical to our national security. We held a hearing
on women's health this morning. The rapid spread of the
coronavirus over the past month shows this all too clearly. Our
country needs substantial resources to strengthen our ability
to prepare for and respond to public health crises like this.
But instead of building up that capacity, the Trump
administration has scaled down some of our most critical public
health institutions.
Over the past 3 years, the Administration has slashed the
budget for the Centers for Disease Control and Prevention,
known as CDC, National Center for Emerging and Zoonotic
Infections Diseases, and the CDC's Global Health Security
Agenda, making it much harder for the agency to respond to
outbreaks overseas.
And here in the U.S., our own response capabilities are
diminished. State and local health departments, our first line
of defense in public health emergencies, are short staffed,
down tens of thousands of health workers compared to where we
were just in 2008. This Fiscal Year President Trump is
proposing a nearly 20 percent cut to the CDC's budget--and you
heard that right. Just as we are confronting the coronavirus,
the President wants to cut the very agency on the front lines
of fighting the disease.
I think Americans from all corners of the Nation will find
that extremely unwise, if not crazy. And I hope all my
colleagues will join me in opposing this dangerous plan and
committing to support the CDC's important work.
Rather, building up our institutions is critical. So is
working hand-in-hand with other countries and investing in
international bodies like the World Health Organization, WHO.
In order for us to effectively fight this virus, we need to
respond with evidence-based practices, transparency,
collaboration, and communication.
To that end, I am glad that the Chinese authorities have
been more cooperative partners with the United States and
others in the international community in handling the
coronavirus than they were during 2003 SARS outbreak. Maybe we
learned something from that.
But the way the Chinese Communist Party has treated its
citizens in response to this outbreak is horrifying: crackdowns
on transparency and information, brave doctors and ordinary
citizens facing draconian punishments merely for speaking about
the outbreak. It is unacceptable and must come to an end.
And in our own country we need to approach this outbreak
with a scientific, fact-based approach. The United States and
other countries around the world have put in place
unprecedented travel restrictions in response to the virus.
These measures are not proven to improve public health
outcomes, rather, they tend to cause economic harm and to stoke
racist and discriminatory responses to this epidemic.
Now I will turn to ask questions of all witnesses. I must
note I am profoundly disappointed that the Trump Administration
would not agree to send any government officials to testify
today. I understand that there was some kind of briefing today,
but this hearing was set for a long time and we did not get any
cooperation from the Administration. I personally asked the
Administration to send a witness to the hearing. The American
people deserve to hear firsthand what the Government is doing
to protect them in this situation.
Nonetheless, I am pleased that we have such a distinguished
panel of experts before us today.
So, thank you, Mr. Chairman, for holding this important
hearing. And with that, I will move to my questions.
Over the past 3 years we have seen reductions in funding
for epidemic prevention efforts abroad, attempted cuts to
foreign assistance, including global health security funding,
as well as the elimination of the NSC Global Health Security
and Biothreats Directorate. How would you assess our Nation's
current capacity to address epidemics, both here in our own
country and in terms of offering our expertise to help other
countries around the world?
Anyone who would care to answer that I would be happy.
Dr. Nuzzo. Thank you. I would like to point out that this
is not the only emergency that our scientists at the Centers
for Disease Control are managing. They are also still trying to
end an Ebola epidemic in the DRC. There are other important
transmissions of polio in the world. This past year has been
unprecedented in terms of measles cases.
So, I think what this points to is the need for continued
support and increased support for the CDC and for their other
health partners.
The Chairman. Anybody else?
Dr. Bouey. Can I add?
The Chairman. Yes.
Dr. Bouey. In the last 17 years, U.S. CDC has been working
with China CDC hand-in-hand in every single pandemic or
epidemic in China. And the current difficulty I feel as relates
to your comments is the reduction of collaborations in the last
2, you know, 2 to 3 years.
The NSF, National Science Foundation office was closed in
Beijing last--in 2018. The GAP program, the Global AIDS Program
was closed last year. The NIH and CDC programs all reduced in
size in Beijing.
So, when we talk about the influence, U.S. had a huge
influence on Chinese public health a few years ago. But the
problem is the interruption in the last few years.
Mr. Klain. Congressman, I would just reiterate what I said
before you arrived. The best way to keep the American people
safe is to engage globally and to help fight diseases overseas.
President Obama made a big point of creating a, helping to
create a CDC in Africa so that we could help fight disease
there.
Global health security is American security, and we need to
continue to support and invest in that.
The Chairman. Let me--thank you very much--let me ask one
final question. And if it was asked and answered, please let me
know. And that is how would you rate the response to this
epidemic by the Chinese Government and by WHO and other U.N.
specialized agencies so far?
What has been the impact of Taiwan's exclusion from the WHO
and other U.N. specialized agencies given its proximity to the
Chinese mainland, its status as a transit and trade hub, and
the handful of cases reported there as well?
Dr. Nuzzo. I study outbreaks, and epidemics, and pandemics
in various different settings. And in every situation that we
have looked at there have always been challenges, there have
always been missteps, and there have always been mistakes.
I have not personally seen yet a mistake that I haven't
also seen in other places. And so, while I think that there is
an important gap in our knowledge and for which I think it is
incredibly urgent that we gain additional data in order to
answer some of these questions that we still have, I also have
to imagine that any country dealing with tens of thousands, or
essentially tens of thousands of cases now would be hard
pressed to handle all that it needs to do, including managing
the patients, standing up enhanced laboratory surveillance,
rolling it out to all of the hospital clinics, making sure the
hospitals have all the personal protective equipment that they
need.
So, I am very reluctant to criticize anybody at this point.
In terms of the World Health Organization, they are limited
by their member States. The international health regulations
were established to define the maximum efforts that countries
should take in the name of disease control. They are inherently
looking at international issues and not what individual
countries do within their own borders so long as it does not
spill across their borders.
What we have seen from the WHO is that they have been very
reluctant to call out countries, all countries, not just China.
And there was questions earlier about whether they were unduly
influenced by China.
Just looking at the Ebola outbreak in the DRC, there was a
long period for which many individuals thought that they should
have declared a public health emergency of international
concern, and they did not want to. And I believe, and the
director-general said, and I believe him at his word, that one
of his deep concerns was that in doing so it would encourage
countries to take non-evidence based actions like banning
travel and trade, et cetera. Very much mindful of what happened
in Ebola in 2014.
This was, again, reiterated as a concern about declaring a
public health emergency of international concerns with this
current outbreak. And what we saw was that countries even
before the declaration, but certainly after the declaration did
just that.
So, I believe that WHO is in a very difficult position of,
one, not having enough resources itself. It is still very much
on the ground in essentially a war zone in the DRC, trying to
stop the spread of Ebola, and now also managing this and many
other outbreaks in insecure settings in the world.
Mr. Bera. I want to be conscious of each of the member's
times. If you have anything to add to that otherwise, go ahead.
The Chairman. Thank you.
Mr. Bera. With that, let me recognize Ms. Wagner from
Missouri.
Mrs. Wagner. I thank the Chair very much, certainly for
organizing this timely hearing. I want to thank all of our
witnesses for being here today.
I represent the St. Louis area and greater metropolitan
region, and many, many of my constituents do business, they
study, and travel in China. And I appreciate the opportunity to
learn more about the rapidly changing coronavirus outbreak so I
can share best practices and up-to-date information with other
St. Louisians in Missouri's 2d congressional District
specifically.
And I would like to just say this, contrary to some of the
things that are being represented here today, I have had a
number of briefings. I probably attended at least three myself.
My staff has had daily briefings from the NIH, CDA--or CDC,
Health and Human Services, the Administration. So, I want to
applaud the Trump administration for an amazing amount of
information, transparency, and trying to keep us up to date on
things that are really very frightening I think globally, and
certainly here at home.
I also would like to thank Representatives Connolly and
Chabot for introducing the bipartisan Global Health Security
Act to establish a permanent official responsible for epidemic
and pandemic preparedness. I am proud to be an original co-
sponsor of the bill. And I urge my colleague to support it.
Health systems across the developing world lack the
capacity to control the spread of the novel coronavirus. Mr.
Klain, how is--I will ask the question and then I want to put a
context on it--I want to know how the U.S., and it sounds
broad, but how is the U.S. helping these partners to prepare?
I know for a fact that the CDC and the NIH here in the
United States of America have been begging in very early
January China to come in, help, be there on the ground. And it
took them 3 weeks, it wasn't until about the 28th or 29th of
January before they finally said, oh, please, rush on over. We
could use the help and the assistance.
And we are there on the ground in a very big presence and
way.
So, what else are we doing to help, help these partners
prepare? What more needs to be done?
Mr. Klain. Well, thank you, Congresswoman. And I was
waiting for either Mr. Connolly or Mr. Chabot to show up here
to praise their bill that you are the co-sponsor of.
Mrs. Wagner. Yes.
Mr. Klain. I think H.R. 2166----
Mrs. Wagner. Yes.
Mr. Klain [continuing]. Is vital legislation. I hope this
committee and the Congress will act on it, bipartisan as well,
as it should be.
What I would say is, and this is why I have been a little
perhaps more critical of the Chinese than Dr. Nuzzo, I think
this delay of a month of getting our people on the ground there
in China is hard to explain and hard to justify. And I think it
is good that we have some people there. We should have more
experts there.
We have the best experts in the world here working for our
government. Having them on the ground I think would be of use.
Mrs. Wagner. And we were trying for over a month to get----
Mr. Klain. Yes. Yes, ma'am.
Mrs. Wagner [continuing]. Get there. And we will come up
with a cure and the vaccine. Now, sadly, it will take months
and months to probably do that, but.
Mr. Klain. Yes, ma'am.
The other thing I would say is we also needed to work with
the nations around China; right? We are going to see spread of
this virus certainly through the region, probably globally, but
certainly first and foremost through the region. Other nations
in the neighborhood have less advanced health care systems than
China, less resources, less ability to manage this than even
the Chinese do. So, we ought to be reaching out to them to see
what we can do to help them. They may need more direct
assistance from us in terms of the response.
And, of course, we need to be beefing up our own
preparedness for cases here.
Mrs. Wagner. Well, I think we are doing that. I think we
are very much on top of that. That is certainly what the
briefings have been telling, telling me.
Dr. Nuzzo, what challenges does the U.S. face in deploying
testing services?
Dr. Nuzzo. Thank you. That is an area that I am
particularly concerned about. There seems to be a testing lag
right now for individuals here in the United States. That is in
part because the CDC has been doing all of the testing. And I
know that they plan to roll test kits out to the State
laboratories, which I think will be essentially important. And
it is essential that States think about how they are going to
be doing the testing and what the plan is for that.
But we do not just need it at public health labs, we also
need it at hospitals and health clinics so that doctors can use
it to guide treatment and isolate patients.
Mrs. Wagner. Well, and in addition, given that respirators
and other medical equipment are largely produced and shipped
from China, how can we best address supply chain issues--I keep
hearing this over and over again--supply chain issues that
could become critical if the coronavirus were to spread more
widely in the U.S.?
I mean, I talked about some of the medical equipment and
respirators that are mainly sourced, being produced in China.
But it is also masks, it is so many things. So, can you speak
to that, please?
Dr. Nuzzo. Yes. So, we need to assessing the medical supply
chain and see where there are potential vulnerabilities. That
is, I know, work that has been ongoing. And I have been
encouraged to hear that the agencies have been working on that.
But it also needs to be addressed at the political strategy
level in China because the decisions that they are making
internally could impact that beyond just our own assessment of
what country is producing where, and can we get it from
somewhere else.
This summer, the U.S. experienced critical shortages in the
drug Heparin, which is a blood thinner.
Mrs. Wagner. Right.
Dr. Nuzzo. This shortage was in part due to China's efforts
to control the spread of African swine fever, which is not a
human disease, it is a pig disease. They were culling pigs. You
need the pigs to make the Heparin.
So, we have already seen the impact of how decisions made
in the name of controlling a disease can affect health and
health care here in the U.S.
Mrs. Wagner. I have a lot of other questions. I will go
ahead and submit them.
I appreciate the chair's indulgence. And I will yield back.
Thank you, all, for being here.
Mr. Bera. Great. Thank you. I appreciate my colleagues.
And, again, a compliment to the Administration that the
briefings that they have been giving us, their experts, et
cetera, on a regular basis, as well as to our staff. That said,
we would love for those experts to come before our committee in
a public setting to answer those questions.
And what we are really asking for is how can we be of
assistance? You know, what do they need from Congress in terms
of appropriations, et cetera? And, again, these experts ought
to be talking to the public and not just Members of Congress.
With that, let me recognize Ms. Spanberger from Virginia.
Ms. Spanberger. Thank you very much, Mr. Chairman. And to
our witnesses today, thank you very much for what has been a
very interesting conversation focused on the epidemiology of
this disease and how it is spreading, and also a policy
discussion related to what we can do as Members of Congress.
And, Mr. Klain, I would also like to thank you for your
very specific 7-point plan and recommendations of things that
we should see from a Federal perspective out of Washington to
help with this and future, future viruses and future outbreaks.
And you have talked about the need for high-level diplomacy
to address threats on the ground. And so, I would like to
briefly just talk about that from this committee's perspective.
Looking long-term, I have deep concerns about the fact that we
have vacancies at State Department and other agencies, we have
individuals who continue to work in acting positions not fully
confirmed.
And reflecting back on your experiences working with other
outbreaks, looking forward toward what we are dealing with now,
could you just tell me briefly what your day to day experiences
were, how much you were interacting with diplomats and with
civil servants, and how some of these staffing challenges might
be impacting our ability to react currently?
Mr. Klain. Yes, thank you, Congresswoman.
My job in coordinating the Ebola response was really to
oversee the all-of-government response that President Obama
summoned. And that means daily interactions with key people at
the agencies at all levels, some at the cabinet level, some
below that.
I think the good news is many really high-quality people
remain in key posts. Tony Fauci is a national icon and hero.
Dr. Schuchat at the CDC, others throughout the government. We
have great people, Ambassador Green at USAID for example.
But I do worry about some of the gaps, particularly at DHS.
You know, Congressman Perry was saying how could you possibly
screen all these people coming here, and so on and so forth?
That is a DHS function. It will require great skill and
organization to do that. I worry about the vacancies there.
I worry about the loss of institutional capacity for
highest levels of the State Department, which has to manage so
much of the logistics of an international response.
So, there are gaps. We have some great people in our
government. We have some gaps in our government. And we are
going to need to manage all that.
And last, as I said, I think someone at the White House
really needs to be running this every day to help fill those
gaps, but also to be interacting with other countries. I had
daily calls with people in Liberia, Sierra Leone, Guinea,
weekly calls with my counterparts in the U.K. and France. These
are high-level interactions that really are needed to make a
global response like this effective.
Ms. Spanberger. Thank you very much.
And, Dr. Nuzzo, as we are looking at contagious outbreaks,
and in this case there is a contagious outbreak that is
happening on the other side of the world. And all of us
represent districts here in the United States. My question for
you is how could or how should the Federal Government work in
ensuring that medical providers across the United States can
deal with some of the concerns, have the information they need,
have the resources that they need? And that is one part of it.
And then the other part of it would be how can we help as
Members of Congress to ensure that the information is getting
out there and that these physicians and hospitals have what
they need?
And do you anticipate that there are specific resources
that will need to be mobilized to support clinicians across the
country if we do see increased spread here at home?
Dr. Nuzzo. Yes, thank you.
I had said earlier that although we have a perception of
this as an epidemic that is happening across the world, we
actually do not have enough information to say for sure where
it is happening. We are only testing around people's
connections with China.
Ms. Spanberger. Does that mean that are you asserting that
it could be elsewhere and we are not yet attuned to that?
Dr. Nuzzo. Yes.
Ms. Spanberger. OK. Thank you.
Dr. Nuzzo. And that is what other countries are doing as
well. I mean, it could very well already be here.
And I think an important thing for us to all consider in
thinking about this is it is not just about how many cases we
have in the world but our level of concern should be tiered to
what our perception of the severity is. And I continue to be
encouraged by the fact that we are seeing many, many more mild
cases than we initially thought were possible, particularly
outside of China.
As I said earlier, we need to understand what is going on
in China about those severe cases and deaths to know if they
are in the people that we would expect to have severe illness
and death regardless of what pathogen, what respiratory virus
they have.
It seems like some of the death reports that that is the
case, the elderly and people with underlying medical
conditions.
Ms. Spanberger. Uh-huh.
Dr. Nuzzo. And if you walk into any hospital in the United
States and just look for people suffering from respiratory
viruses you would see disturbing things.
I think the critical thing that we need here in the United
States is enhanced diagnostic capabilities. We are moving test
kits to the State labs, which will be important for
supplementing our understanding of the virus and where it is,
and potentially to think about expanding the categories of
people that we test. But we also need this in health care
clinics so that they do not have to wait a day or more to get a
test result for a patient to make a decision about whether or
not to isolate somebody, how they should treat them, et cetera.
And although we have heard a lot attention on medicines and
vaccines, there is less attention to diagnostics. And so, I
think that is where a funding opportunity as well as funding
for State health departments and hospitals who are going to be
on the front lines of this.
Ms. Spanberger. And just a followup point quickly on that.
So, in the absence of those diagnostic tools in clinics and
with health providers across the country, the alternative then
is what?
Dr. Nuzzo. The alternative is you do not get tested for
coronavirus. I mean, we are only at this point testing absent
the people who are traveling. But in the United States you have
to have a lower respiratory infection and have traveled to
Wuhan specifically.
Ms. Spanberger. Uh-huh.
Dr. Nuzzo. Or, if you have traveled to China, broader China
you have to be hospitalized for your infection.
So, we are only looking at a very small number of people.
And so your earlier point about people's level of concern, et
cetera, I think having diagnostic tools to help know what
people's illnesses are will be useful.
Ms. Spanberger. And in the absence of that testing, from
your perspective and your role, how does that contribute to the
spread of disease at a faster, slower?
Dr. Nuzzo. It absolutely contributes to the spread oft he
disease because we do not know where it is. We do not know who
to stop from coming, and we do not know who to isolate.
But I continue to be encouraged by the appearance of mild
symptoms because it is important to recognize that we live with
a whole lot of respiratory viruses that do not, we do not have
hearings about.
Ms. Spanberger. Thank you. I have gone well over time.
Thank you very much, Mr. Chairman. I yield back.
Mr. Bera. Thank you.
I recognize Ms. Titus from Nevada for 5 minutes.
Ms. Titus. Thank you, Mr. Chairman.
Dr. Bouey, do you need to finish that conversation?
Dr. Bouey. If I could. I would, because Dr. Nuzzo mentioned
several times that the cases outside China are milder, I, you
know, no one--I agree with her question, but some hypotheses
or, you know, potential answers are in China, especially in
Wuhan, within China there are different, we see different
percentage of fatality. Wuhan is the highest.
So, I wonder if Wuhan they, only hospitals have noticed
people who have the most symptoms. So there is a, it is a
reflection of a lack of resources medically.
Ms. Titus. Well, thank you.
Ms. Spanberger, you got that? OK, thank you.
Well, now I would like to ask you something. In your
remarks you said that in 2003 the industries hurt most by SARS
were tourism, retail, and entertainment. And at that point
those industries made up 43 percent of China's GDP. They now
account for 54 percent. And China contributes a much larger
share to the world's economy.
I serve as the co-chair of the Travel and Tourism Caucus,
and I recognize the huge impact of tourism on local economies.
Also, China has expressed concern about travel restrictions
that have been announced by the White House and noted correctly
that the World Health Organization advises against the
application of restrictions of international traffic, based on
the information that is currently available.
Could you address how we might balance U.S. security
precautions with the negative impact that these restrictions on
travel have had on travel and tourism here in the U.S., and on
international commercial activities? And then either one of you
could also weigh in.
Dr. Bouey. So, if I can say quickly, that I think both
quarantines and travel bans, all of these social distancing
measures can harm the economy. So, it is always a--so, often I
tell people, I am a public health researcher, a public health
worker, then I am all for social distancing. But usually it is
not just me talking, it is the economy is also talking.
So, as you mentioned that in my report I provided some
statistics that it is going to harm China's GDP. And how much,
it depends how long the quarantine will be on, how long the
travel ban will be on. So, I urge all the policymakers to think
about these measures as temporary measures and certainly
balance the economic loss versus health care concerns.
Ms. Titus. Mr. Klain?
Mr. Klain. Congresswoman, I would just add we live in a
global economy, interconnected economy. It is impossible,
impossible to cutoff the flow of people from China to the
United States. They are needed to bring vital goods to the
United States by boat and by plane.
We have Americans coming back, to and from, back from
China, family members, so on and so forth.
So, my point about travel bans is beyond the effectiveness
issue that Dr. Nuzzo has raised, as a practical matter we do
not have one, we will never have one. And, therefore, what we
need to do is to monitor the people who have been in China
recently who are here in the U.S. and pose public health
measures on a very large scale. This is a complicated, it is a
hard problem to detect if those people get sick, to isolate
them, and to treat them.
This isn't about academics, it is the only practical
solution on the facts we face here.
Ms. Titus. Dr. Nuzzo?
Dr. Nuzzo. I was just reacting to the notion of monitoring.
And I agree that it is a preferable approach than the
restriction of travel and the quarantine. I am less optimistic
about the impact of those measures. And just reflecting on
Ebola, that we monitored 30,000 individuals and found not a
single case of Ebola. And, yet, those programs that were
essentially necessarily set up overnight, in many respects
diverted resources from, I think, more important work.
So, I, I used to be a public health practitioner, so I am
thinking from the field and what it means for them. You know,
these measures are only as effective as people believe in their
utility. There was an important paper where a bunch of
clinicians were monitored for their symptoms for Ebola upon
returning. And a large, surprisingly large percentage of them
reported that they lied about their temperatures because they
did not believe that they should be monitored.
So, nothing is perfect. And if that is where we need to go
I, truthfully, from an epidemiological perspective think that
those approaches are more about politics than public health.
But if that is what is needed to be done to provide assurances
and to make people feel better, then I, in my view it is
potentially less resource intensive than some of what I have
also heard proposed.
Ms. Titus. Well, not only does a travel ban, or
restrictions, or monitoring impact the economy, does not it
also make it more difficult to share information so that we can
address the outbreaks quickly or get international cooperation
from others addressing the problem?
Dr. Nuzzo. So, I am deeply concerned about penalizing
countries that report cases. And when you implement travel bans
and trade restrictions, that is a penalty.
China may be able to handle it, but other countries around
the world are watching who haven't yet reported any cases. And
I can imagine they are seeing what is playing out and thinking
is it in their best interest to tell, to even look for cases
first of all. So, that is something that I am particularly
concerned about.
I also agree with all the statements that have been made
about the importance of gaining access to data in China. I
particularly think China understands that severity is a matter
of priority. And I do not truthfully understand what the rate-
limiting step is. I am not sure that they do not have the right
epidemiologists or scientists. I think China is actually quite
capable, the fact that they have pumped out many Lancet and New
England Journal of Medicine papers does not signal to me a lack
of expertise.
I wouldn't be surprised if we see a paper next week that
tells us more than we already know. But I think that this is
critically important, and we should do everything in our power
to make sure we continue to incentivize the flow of
information.
Ms. Titus. So, it affects, negatively affects the economy,
travel and tourism; negatively affects our ability to get
information; negatively affects our ability to cooperate with
other countries. And, finally, we have in the past sent health
care workers to other countries where these outbreaks occur,
like Ebola. But now with this new approach of bringing people
home, that cuts off that assistance as well, does not it?
Dr. Nuzzo. And just to add to that, what happened in Ebola,
even with threats of quarantine for health care workers,
actually put a chilling effect on the number of doctors and
nurses who were willing to go volunteer, essentially put their
lives on the line to fight a deadly virus. Just the prospect of
coming back and having to, in addition to the time away from
their families and their jobs, then we put into quarantine,
that is another concern that I have.
Mr. Klain. If I could just very quickly. I think it is
important that public health and scientific analysis drive
these decisions, not politics. So, the same day that we
quarantined a charter plane of Americans coming from Wuhan,
that same day planes landed at airports all over this country
bringing people from China to airports all over this country.
OK?
And so, you know, I just think that these policies on
travel restrictions and quarantines, which I understand why
they are politically compelling, I understand why one of the
members earlier said it kind of, like, passes the common sense
test. But policies that are kind of filled with Swiss cheese
and exceptions and unevenly applied do not keep us safe, and
raise the kinds of concerns about cooperation and effectiveness
that Dr. Nuzzo raised.
So, whatever we do, I think we need to be candid about what
we are doing and what we are not doing, and let science drive
those decisions.
Mr. Bera. Great. Let me take the chair's liberty here and
give each of the witnesses a minute or two, if there is
anything we did not ask that we should have been asking or
thinking about, or that would be in the public's interest of
asking. Maybe we will start with you, Mr. Klain. Again, a
minute or two just.
Mr. Klain. Yes. What I would say just very briefly is
Congressman Sherman said before he left that we have a tendency
to overreact to these things. And what I would say is it is
actually more complicated than that.
We have a tendency to overreact in the short term and then
underreact in the long term. After the 2001 anthrax attacks
this body appropriated billions of dollars to prepare for a
potential pandemic. And most of those investments were
frittered away because they weren't followed up. Most of that
was gone when I took over the Ebola response in 2014.
This body then put billions of dollars into responding to
Ebola very effectively. And, yet, before the coronavirus
outbreak we were set to see the national hospital network that
protects us from these infectious diseases expire in May
without being renewed.
So, what I would say is we should address this crisis or
this challenge immediately, but also make the consistent long-
term investments in pandemic preparedness and response that are
vital to keep this Nation safe over the long run. Again, I
think the Connolly Chabot bill is a good start on that. There
are many other proposals. But I think it is consistent focus
that really keeps this country safe.
Mr. Bera. Great.
Dr. Bouey, if there is anything that you would like to add
or we should have asked?
Dr. Bouey. I will focus, I will emphasize that it is a
battle between human and the virus. It is not between persons
to person, and it is not between party to party, it is not
between country to country.
I really hope that global health should be a area for
research for health care collaborations that is beyond all the
conflict. It think it needs a long-term investment, not only in
the infrastructure but also in collaboration, in capacity
building.
And I hope, no matter what happens between the two
countries, between the two parties, that this area can be
protected because this is critical for every country, for all
the human beings. So, this should be more than just pointing
fingers. But this is a time for collaboration.
Mr. Bera. Thank you, Dr. Bouey.
Dr. Nuzzo.
Dr. Nuzzo. As I mentioned in my remarks, I am increasingly
of the belief that this virus is not something that we can stop
at borders, that we cannot contain it, that we should be
probably shifting our focus to one more of trying to mitigate
its spread and mitigate the impacts. And as I look at th
situation it is, of course, evolving and complex, but it is
increasing to me--increasingly to me looking like what we saw
in 2009 with the influenza pandemic.
And we have a number of things that we learned during 2009.
So, we learned that the travel restrictions and the quarantines
did not stop the spread. Within months the virus was
everywhere. And that is because we had more capability to do
surveillance for flu than we have for novel coronavirus right
now. So, I wouldn't be surprised if we had those capabilities
if we saw a very similar map to what we saw in 2009.
So, I really think we should be thinking about it in the
context of that and asking, if this were flu would we be doing
these things?
Obviously, there are still questions about severity. But
increasingly, and my, my perspective is that we will find more
cases and our perception of severity will decline.
The other thing I want to point out is that I actually see
some optimism here. Just looking at what we have learned in the
amount of time that we have learned from countries who have
previously had difficulties, like for instance South Korea, in
2015 it had a very bad MERS outbreak that caught it off guard,
they really struggled with, and their information and their
ability to do surveillance. And an epi investigation of the
case, the novel coronavirus cases to me is the symbol of what
our goals are when we make investments and we work with
countries to improve their capacities. And we are the direct
benefits of that.
So, I just want to stress that it is we need more
information from other countries. The fact that they are able
to get this information is likely because of our help and
assistance in many places. We should continue those efforts,
not just as I mentioned in China, but in other countries that
we expect to struggle. And I think that we should continue to
assess our plans based on the information that we have coming
in and, crucially, in my mind not so much the number of cases
but the severity.
Mr. Bera. Great. Thank you.
Let me allow the ranking member to make a closing statement
and I will make one myself.
Mr. Yoho. Well, I appreciate everybody being here. And, Mr.
Klain, I have this article here and you are saying we need to
keep politics out of it and need to be factual based. But just
the title of this, ``Coronavirus Is Coming and Trump Isn't
Ready.`` And I read it, and there is a lot of politics in that
article. That is all I am going to say.
Dr. Nuzzo and Dr. Bouey, you are both epidemiologists. We
know that the epicenter is supposedly the Wuhan area, the fish
market and the wet market. Correct?
Dr. Bouey. Yes.
Mr. Yoho. Do you feel it was sufficiently studied to get
the possible original outbreak of where it came from? Do you
feel that? Do you have any indication?
Dr. Nuzzo. The answer is no. One of the concerns----
Mr. Yoho. You said no, you do not think it was?
Dr. Nuzzo. No, I do not think it was sufficiently studied.
Mr. Yoho. OK.
Dr. Nuzzo. And I know that I have heard not just WHO, but
also some of the major philanthropies are putting money toward
enhancing the study of that, trying----
Mr. Yoho. Yet the Chinese Government destroyed it
completely, the way I understand it. Is that correct?
Dr. Nuzzo. I do not, I do not have any information about
that.
Mr. Yoho. Dr. Bouey, do you know?
Dr. Bouey. I know they, after they announced the outbreak
they closed the animal, the wet market the next day. They
thought it was the sources. We do not know.
We do not know whether there is a person working there had
the first case and transmitted to other people or the animal
source was there. We do not know that.
Mr. Yoho. But that supposedly was where it was reported
where it came from. But then we have heard it was completely
demolished and destroyed. And that, there again that creates a
cloud of confusion. You know, what is their intent.
And if we are going to work on this collaboratively
together between countries, politics needs to go away and it
needs to be based on science because this is something that we
are all in threat of. And I think you brought up over and over
again how it does not seem to be as virulent in other
countries. And let's hope it maintains that way.
But I worry about countries like in Africa where there is
large Chinese population in the Belt Road Initiative, and their
inability to check with diagnostic equipment.
So, this is something that is going to be fluid, we are
going to watch, and we want to make----
Dr. Bouey. I think it is to everyone's advantage to know
where it comes from.
Mr. Yoho. Right.
Dr. Bouey. So, I do not think it is Americans or Chinese,
it is everyone wants to know that.
Mr. Yoho. Sure. We are all here together.
Thank you all. Appreciate it. Mr. Chairman, thank you.
Mr. Bera. Great. Thank you.
And just in close, first-off I want to thank each of you
for taking the time to come here as well as your service to
both science as well as to our country and the global
community.
You know, again, the message to the Administration here is
we are here to work as Congress. We are all on the same page
here. And to the global community and to the Chinese, you know,
let's get ahead of this. And it will take all of our resources
to learn as much as we can.
You know, I think I cannot speak for the CDC, but in my
conversations with the CDC, with Dr. Fauci and others, we want
to get there and work with you side by side. And if there is
one thing that we can do it is that second thing is really put
someone in control of this.
This isn't the last time we are going to see a pandemic.
This isn't the last time we are going to be dealing with a
viral outbreak. And as we get ahead of this let's not--Mr.
Klain, you talked about this as let's stop just responding to
crisis after crisis, let's actually make this part of our
national security agenda.
And I had the privilege of being a commission member for
CSIS. They just came out with a recommendation on what we could
be doing with regards to global health security. And in a
bipartisan way it was a great commission, great Members of
Congress on there, but also, you know, working closely with the
Administration and others to come up with recommendations.
And I would say let's deal with the situation that we have
in front of us right now, but then let's take some of those
recommendations and act on them.
So, you know, again I thank the witnesses and all the
members for being here today. And with that, the committee is
adjourned.
[Whereupon, at 3:54 p.m., the subcommittee was adjourned.]
APPENDIX
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OPENING STATEMENT FROM CHAIRMAN BERA
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