[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]




 
      A RACE AGAINST TIME: DEPLOYING VACCINES AND ADDRESSING THE 
      
                            DISPROPORTIONATE
                            
         IMPACTS OF COVID-19 IN LATIN AMERICA AND THE CARIBBEAN

=======================================================================

                                HEARING

                               BEFORE THE

                            SUBCOMMITTEE ON
                 WESTERN HEMISPHERE, CIVILIAN SECURITY,
              MIGRATION AND INTERNATIONAL ECONOMIC POLICY

                                 OF THE

                      COMMITTEE ON FOREIGN AFFAIRS
                        HOUSE OF REPRESENTATIVES

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             FIRST SESSION

                               __________

                              MAY 13, 2021

                               __________

                           Serial No. 117-37

                               __________

        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 
 44-474PDF             WASHINGTON : 2022 
                       
                       
                       
                       
                      COMMITTEE ON FOREIGN AFFAIRS

                  GREGORY W. MEEKS, New York, Chairman

BRAD SHERMAN, California             MICHAEL T. McCAUL, Texas, Ranking 
ALBIO SIRES, New Jersey                  Member
GERALD E. CONNOLLY, Virginia         CHRISTOPHER H. SMITH, New Jersey
THEODORE E. DEUTCH, Florida          STEVE CHABOT, Ohio
KAREN BASS, California               SCOTT PERRY, Pennsylvania
WILLIAM KEATING, Massachusetts       DARRELL ISSA, California
DAVID CICILLINE, Rhode Island        ADAM KINZINGER, Illinois
AMI BERA, California                 LEE ZELDIN, New York
JOAQUIN CASTRO, Texas                ANN WAGNER, Missouri
DINA TITUS, Nevada                   BRIAN MAST, Florida
TED LIEU, California                 BRIAN FITZPATRICK, Pennsylvania
SUSAN WILD, Pennsylvania             KEN BUCK, Colorado
DEAN PHILLIPS, Minnesota             TIM BURCHETT, Tennessee
ILHAN OMAR, Minnesota                MARK GREEN, Tennessee
COLIN ALLRED, Texas                  ANDY BARR, Kentucky
ANDY LEVIN, Michigan                 GREG STEUBE, Florida
ABIGAIL SPANBERGER, Virginia         DAN MEUSER, Pennsylvania
CHRISSY HOULAHAN, Pennsylvania       AUGUST PFLUGER, Texas
TOM MALINOWSKI, New Jersey           PETER MEIJER, Michigan
ANDY KIM, New Jersey                 NICOLE MALLIOTAKIS, New York
SARA JACOBS, California              RONNY JACKSON, Texas
KATHY MANNING, North Carolina        YOUNG KIM, California
JIM COSTA, California                MARIA ELVIRA SALAZAR, Florida
JUAN VARGAS, California              JOE WILSON, South Carolina
VICENTE GONZALEZ, Texas              RON WRIGHT, Texas
BRAD SCHNEIDER, Illinois

             
                                    
                                     

                    Sophia Lafargue, Staff Director

               Brendan Shields, Republican Staff Director
                                 ------                                

 Subcommittee on Western Hemisphere, Civilian Security, Migration and 
                     International Economic Policy

                   ALBIO SIRES, New Jersey, Chairman

JOAQUIN CASTRO, Texas                MARK GREEN, Tennessee, Ranking 
ANDY LEVIN, Michigan                     Member
VICENTE GONZALEZ, Texas
JUAN VARGAS, California

                                     AUGUST PFLUGER, Texas
                                     MARIA ELVIRA SALAZAR, Florida

                  Alexander Brockwehl, Staff Director
                  
                  
                            C O N T E N T S

                              ----------                              
                                                                   Page

                               WITNESSES

Castro, Dr. Arachu, MPH, Samuel Z. Stone Endowed Chair of Public 
  Health in Latin America, Department of Global Community Health 
  and Behavioral Sciences, Tulane University School of Public 
  Health and Tropical Medicine...................................     7
Bertolucci, Tatiana, Regional Director for Latin America and the 
  Caribbean, Care International..................................    17
Ellis, Dr. R. Evan, Latin America Research Professor, Strategic 
  Studies Institute, US Army War College.........................    27

                                APPENDIX

Hearing Notice...................................................    47
Hearing Minutes..................................................    49
Hearing Attendance...............................................    50

                    OPENING STATEMENT CHAIRMAN SIRES

Opening statement submitted for the record from Chairman Sires...    51

                  INFORMATION SUBMITTED FOR THE RECORD

Information submitted for the record from Chairman Sires on 
  behalf of Dr. Arachu Castro....................................    54
Information submitted for the record from Representative Salazar.    56

             RESPONSE TO QUESTIONS SUBMITTED FOR THE RECORD

Response to questions submitted for the record...................    79


      A RACE AGAINST TIME: DEPLOYING VACCINES AND ADDRESSING THE 
DISPROPORTIONATE IMPACTS OF COVID-19 IN LATIN AMERICA AND THE CARIBBEAN

                         Thursday, May 13, 2021

                          House of Representatives,
            Subcommittee on the Western Hemisphere,
   Civilian Security, Migration, and International 
                                   Economic Policy,
                      Committee on Foreign Affairs,
                                                    Washington, DC.

    The subcommittee met, pursuant to notice, at 10:04 a.m., in 
room 2172, Rayburn House Office Building, Hon. Albio Sires 
(chairman of the subcommittee) presiding.
    Mr. Sires. Good morning, everyone. Thank you to all 
witnesses for being here today. This hearing, entitled ``A Race 
Against Time: Deploying Vaccines and Addressing the 
Disproportionate Impacts of COVID-19 in Latin America and the 
Caribbean,'' will come to order.
    Without objection, the chair is authorized to declare a 
recess of the committee at any point, and all members will have 
5 days to submit statements, extraneous material, and questions 
for the record, subject to the length limitation in the rules. 
To insert something into the record, please have your staff 
email the previously mentioned address or contact subcommittee 
staff.
    As a reminder to members joining remotely, please keep your 
video function on at all times, even when you are not 
recognized by the chair. Members are responsible for muting and 
unmuting themselves, and please remember to mute yourself after 
you finish speaking.
    Consistent with H. Res. 8 and the accompanying regulations, 
staff will only mute members and witnesses as appropriate when 
they are not under recognition, to eliminate background noise.
    I see that we have a quorum, and I now recognize myself for 
opening remarks.
    I have dedicated much of my 15 years in Congress to 
deepening the United States' engagement in the Western 
Hemisphere. So, it has been deeply painful to see the 
devastating impact of the COVID-19 pandemic in Latin America 
and in the Caribbean.
    The region has less than 10 percent of the world's 
population, but has accounted for almost 30 percent of the 
world's deaths. An estimated 22 million people in this region 
were pushed back into poverty last year, effectively eroding 
many of the region's gains in economic development over the 
last two decades.
    The pandemic's impacts have been especially severe for 
women in the region, who have been 44 percent more likely than 
men to lose their jobs. The pandemic has also created nightmare 
scenarios for many women who have been forced to shelter with 
their abusers. In Mexico, Argentina, Colombia, calls to 
domestic violence hotlines have skyrocketed.
    As we think about the lessons we should learn from this 
pandemic, I believe one of them is that the epidemic of 
domestic violence must be addressed with the urgency it 
deserves. The U.S. Government should incorporate efforts to 
combat and prosecute domestic violence into our foreign 
assistance programming throughout the regions.
    We have also seen how this pandemic is undermining 
democratic governance, reducing citizens' trust in government, 
and leading to greater political instability.
    The current situation in Colombia, the United States' 
strongest ally in Latin America, provides a grave foreshadowing 
of the kinds of unrest we may see throughout the region if we 
cannot work quickly and effectively to get this pandemic under 
control.
    Last Congress, we held two hearings to examine the impact 
of the pandemic in Latin America and the Caribbean and the U.S. 
Government's response. In July 2020, when we hosted the Acting 
Assistant Secretary, Ambassador Kozak, we discussed with him 
the urgent need in the region for more personal protective 
equipment and masks. Today, that urgent need is vaccines. I ask 
President Biden, Vice President Harris, and their 
administration to answer the call.
    The U.S. is expected to have over 400 million excess 
vaccines, even if we vaccinated every adult in the United 
States--even if we vaccinated every adult in the United States. 
In New Jersey, more than 7.7 million doses have been 
administered already, and I am working hard to ensure everyone 
in my district can easily get access to a vaccine. But the 
truth is that none of us will be fully safe from this virus 
until we all are. Time is of the essence, and we cannot afford 
any further delays.
    The P.1 and other variants are making it even more 
difficult to contain this virus. That is why I have joined with 
my colleagues, including Congressman Castro and Chairman Meeks, 
in calling for Latin America and the Caribbean to be 
prioritized for vaccine distribution. The Caribbean in 
particular cannot be forgotten. I am glad we have started to 
send some vaccines to Mexico, but our neighbors in the 
Caribbean and in Central America should also be at the top of 
the list.
    In the coming months, we must go beyond shipping excess 
vaccines or working with countries to pay for them to also 
supporting vaccine distribution and delivery. It should be U.S. 
policy to promote vaccine equity and ensure that the indigenous 
groups, women, and people of African descent, who have been hit 
especially hard by the virus, are prioritized in vaccination 
outreach efforts.
    Looking ahead, we should be assessing how we can leverage 
the United States' expertise in the private sector and in our 
government-funded research institutions to help strengthen 
health systems throughout the region.
    My hope is that, in the wake of the pandemic, the United 
States bonds with this region will help emerge stronger than 
ever before. I look forward to working with my colleagues, on a 
bipartisan basis, to advance that goal.
    Thank you. And I now turn to the ranking member, 
Congressman Green, for his opening statement.
    Mr. Green. Thank you, Mr. Chairman. And I want to thank our 
witnesses for being here today. As the United States begins to 
reopen and once all Americans have had a chance to receive the 
COVID-19 vaccine, we must prioritize vaccine assistance to our 
neighbors in the Western Hemisphere.
    China and Russia are advancing powerful disinformation 
campaigns in Latin America against American vaccine efforts 
and, of course, the pandemic's origins. In particular, the CCP 
is exploiting the region's health and economic vulnerability to 
promote its foreign policy priorities. They are leveraging the 
public health crisis for investment opportunities and pressing 
Taiwan's allies to sever diplomatic relations.
    Unfortunately, it seems to be working. Just this week, 
President Juan Orlando Hernandez of Honduras, an enduring ally 
of Taiwan, announced that his country may open a commercial 
office in China. He said that the CCP wanted a, quote, 
``diplomatic bridge,'' end quote, before Honduras could buy 
their vaccines.
    According to an article in Financial Times titled, quote, 
``Chinese jabs dominant Latin American vaccination campaigns,'' 
end quote, China has shipped more than half of the 143.5 
million doses of vaccines delivered to the region's 10 most 
populous nations.
    Yet, worldwide, the United States is by far the largest 
donor. However, because we are funding this through the 
multilateral initiative COVAX, the Chinese Communist Party can 
make it seem like they are the most generous.
    As China and Russia fill the vacuum in Latin America and 
the Caribbean with their suspect vaccines, many are resorting 
to a new trend called COVID shot tourism. Travel agencies are 
advertising trips to the United States to get the shot. One ad 
in Mexico says, quote: ``Want the COVID-19 vaccine? Have a U.S. 
Visa? Contact us,'' end quote.
    Demand has soared and prices have increased by as much as 
40 percent for flights from Mexico to the United States, as 
thousands from across the Americas try to get their shot here. 
States and cities are responding. On May 6th, New York City's 
government tweeted a quote: ``Welcome to New York, your vaccine 
is waiting for you. We will administer the Johnson & Johnson 
vaccine at iconic sites across our city,'' end quote.
    Our friends in Latin America are right to distrust the 
Chinese vaccines. As a physician, I know that the safety of the 
CCP vaccines, such as Sinovac and Sinopharm, is questionable at 
best and their efficacy is extremely poor.
    Even the director of the Chinese Centers for Disease 
Control and Prevention admitted that their vaccines do not have 
high protection rates. Additionally, according to liberal human 
rights watch, the CCP has detained vaccine safety advocates, 
censored information critical of the Chinese vaccines, and 
spread propaganda and disinformation regarding Western 
vaccines. Does this sound like a regime that is confident about 
the safety and efficacy of its vaccines? Of course not.
    Why should the United States--or what should the United 
States do to help our neighbors to the south and counter 
China's malign vaccine diplomacy? For starters, vaccines 
distributed using U.S. taxpayer money must be branded as U.S. 
assistance to counter CCP and Russian disinformation.
    The people of the world must know that it is not communism 
but freedom that is bringing these vaccines, reliable vaccines 
to the world. We also should be prioritizing aid to Latin 
American andCaribbean Nations, many of whom are struggling with 
COVID outbreaks and have historically been forgotten.
    Finally, we need to protect American intellectual property. 
America's IP laws have helped foster life-saving innovation, 
including the miraculous success of former President Trump's 
Operation Warp Speed. Waiving our IP protections would endanger 
American jobs and enable the CCP to profit from America's hard 
work and investment.
    I urge the Biden administration to incorporate these 
critical points in any strategy of COVID foreign aid. We cannot 
let Russia, China, or any of our adversaries benefit from a 
global health crisis. The world is crying out for America's 
help, and America must answer, America must lead.
    Thank you, Mr. Chairman, and I yield.
    Mr. Sires. Thank you very much, Ranking Member Green.
    I will now introduce Dr. Arachu Castro. She is the Samuel 
Z. Stone Chair of Public Health in Latin America and the 
director of the collaborative group for health equity in Latin 
America at Tulane School for Public Health and Tropical 
Medicine. Her research focuses on health equity, women's 
health, and early childhood development.
    Prior to joining Tulane in 2013, she was associate 
professor of global health and social medicine at Harvard 
Medical School. She holds a Ph.D. In social sciences and health 
from the University of Barcelona, and Ph.D. In ethnology and 
social anthropology from the School of Advanced Studies in the 
Social Sciences in Paris, and a master's of public health 
degree from Harvard School of Health.
    Dr. Castro, we welcome you to our hearing.
    We will then hear from Ms. Tatiana Bertolucci. She serves 
as the regional director for CARE USA's Latin America and the 
Caribbean program. Ms. Bertolucci has been working with CARE 
since 2012, and her expertise include issues----
    Ms. Bertolucci has been working with CARE since 2012, and 
her expertise include issues of governance, gender justice, and 
participatory budgeting. She holds a master's degree in Latin 
American studies from the Universidad Autonoma de Madrid and 
has a specialization in communications and culture from Sao 
Paulo University.
    Ms. Bertolucci, thank you for joining us today.
    Finally, we will hear from Dr. Evan Ellis. He is a research 
professor of Latin American studies at the U.S. Army War 
College Strategic Studies Institute, where he focuses on the 
region's relationship with China and other non-Western 
Hemisphere actors. He previously served on the Secretary of 
State's policy planning staff, with responsibility for Latin 
America and the Caribbean and international narcotics and law 
enforcement issues. Dr. Ellis holds a Ph.D. In comparative 
politics from Purdue University.
    Dr. Ellis, thank you for joining us today.
    I ask that the witnesses to please limit your testimony to 
5 minutes and, without objection, your prepared written 
statements will be made part of the record.
    Dr. Castro, you are recognized for your testimony.

 STATEMENT OF ARACHU CASTRO, PHD, MPH, SAMUEL Z. STONE ENDOWED 
 CHAIR OF PUBLIC HEALTH IN LATIN AMERICA, DEPARTMENT OF GLOBAL 
  COMMUNITY HEALTH AND BEHAVIORAL SCIENCES, TULANE UNIVERSITY 
         SCHOOL OF PUBLIC HEALTH AND TROPICAL MEDICINE

    Dr. Castro. Thank you, Mr. Chairman Sires, for inviting me 
to testify today. My comments complement the written statement 
that I submitted earlier this week. As you mentioned, the 
pandemic is creating great human suffering in Latin America and 
the Caribbean. Almost one million people have died of COVID-19.
    Latin America has also suffered the largest economic 
contraction among low-and middle-income regions, and thousands, 
millions of people have gone back to extreme poverty. According 
to the Economic Commission of Latin America and the Caribbean, 
it is expected that people living in extreme poverty are going 
to increase from 7 million to 8 million.
    As in the United States, the social determinants of health 
have come to the fore. Indigenous and African descendant 
communities and those in the lowest income groups are the most 
affected, both by the coronavirus itself and by the economic 
consequences of the pandemic.
    This pandemic has also brought to light the fragility and 
underinvestment of health systems and of essential public 
health functions, such as epidemiological surveillance. There 
is a shortage of ICU beds, personal protective equipment, 
oxygen and health workers. If that were not enough, around 
9,000 health workers have died of COVID-19 in the region, most 
of them female nurses.
    Most health systems have not been able to both respond to 
COVID-19 cases and maintain essential health services for 
events that happen every single day, such as complicated 
childbirth, diarrhea and pneumonia among children, and sexual 
violence. As a result of the disruption of essential health 
services, maternal and child deaths are increasing by the 
thousands.
    In 2021, hospitalizations and mortality rates due to COVID-
19 have increased among all age groups, and particularly among 
those under the age of 60. New coronavirus variants have 
greater transmissibility and greater mortality. Millions of 
vaccines are needed as soon as possible, and they need to be 
distributed with ethical and epidemiological principles.
    Most countries in the region have procured vaccines through 
COVAX, an international solidarity mechanism, and also through 
bilateral agreements with vaccine developers from the United 
States, the European Union, the United Kingdom, Russia and 
China. However, as of last Friday, less than 5 percent of the 
population in the region is fully vaccinated. At this slow 
vaccination rate, it is going to take a very long time to bring 
the pandemic to an end.
    There are different mechanisms to increase the delivery of 
vaccines in the region: One, donating vaccines to COVAX 
immediately; two, financing the logistics of vaccine rollout 
immediately; three, engaging other countries to support the 
intellectual property waiver of the upcoming World Trade 
Organization meeting and to redesign obsolete IP laws.
    The successful precedent with antiretroviral therapies to 
treat AIDS is proof that collaboration can help boost drug and 
vaccine discovery and manufacturing in the near and long terms 
and pharmaceutical companies are doing very well despite the 
collaboration.
    No. 4, collaborating with Latin American and Caribbean 
countries through technology transfer agreements to increase 
the development and manufacturing of messenger RNA vaccines to 
respond to the current and future pandemics.
    And number 5, reengaging with the region to help improve 
epidemiological surveillance and help strengthen health systems 
through the Centers for Disease Control and Prevention and 
through the Pan American Health Organization.
    Thank you for your attention.
    [The prepared statement of Dr. Castro follows:]
    
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    Mr. Sires. Thank you very much. I now turn to you, Ms. 
Bertolucci, for your remarks.

 STATEMENT OF TATIANA BERTOLUCCI, REGIONAL DIRECTOR FOR LATIN 
         AMERICA AND THE CARIBBEAN, CARE INTERNATIONAL

    Ms. Bertolucci. Chairman Sires and Ranking Member Green and 
distinguished members of the committee, thank you for the 
opportunity to testify today as you examine the challenges and 
impacts of the COVID-19 pandemic in Latin America and the 
Caribbean.
    These are critical issues, and I am really thankful for the 
committee's attention to them. CARE has provided the 
development, assistance and humanitarian relief in the region 
for over 65 years. We are currently responding directly or 
through partners in 12 countries, focusing on fighting the 
structural causes of inequality, supporting the most vulnerable 
populations, especially indigenous and afro-descendant women 
and girls and migrants and refugees.
    When the COVID-19 pandemic hit, Latin America was facing a 
major humanitarian crisis. More than 5 million people had fled 
Venezuela. In Central America, people exposed to violence, 
hunger, and the effects of climate change were forced to leave 
their countries. And in Haiti, millions were facing food 
insecurity.
    The impacts of the pandemic were deepened by the region's 
structural challenges and at the same time exacerbated the 
region's inequalities, making the humanitarian needs even more 
severe.
    CARE is witnessing them firsthand, as in the story of 
Maria, a 29-year-old owner of a food post in Honduras that told 
us, in her words, we have been locked up and I have not been 
able to sell my products, because I have to go to the market 
and right now I am not able to do so. We had help these past 
days, but I am afraid we will not die of COVID, we will starve.
    Or Mercedes, a 36-year-old Venezuelan woman living in 
Colombia, that told us, the hostel we were sleeping at was shut 
down by the government because of social distancing. Now myself 
and my two kids are on the street with no place to sleep, with 
no chance to have any income because everything is closed, and 
with no way of protecting ourselves from this disease or from 
people.
    It is for the many stories like those that my testimony 
today focuses on the secondary and long-term impacts of the 
crisis. The International Monetary Fund predicts that the 
region will face a contraction in its economy of 7 percent. 
Then unemployment rates are rising and reached 10.7 percent at 
the end of 2020.
    Lack of employment, together with the impacts of climate 
change, political instability, and income inequalities drive 
the tremendous poverty growth. Twenty-two million people moved 
into poverty just last year.
    We are also seeing food insecurity and malnutrition 
growing. According to the World Food Programme, the region is 
expected to see a 269 percent rise in the number of people 
facing severe food insecurity. Sixty million already do not 
have--sorry, 60 million people do not know where they are going 
to find their next meal, and women are already eating fewer 
meals to leave more food for their children.
    Access to health and education has also worsened. With 
fragmented and unequal health systems, the region is ill-
prepared to handle a health crisis of the scale of COVID-19. 
Also, 95 percent of the children are out of school because of 
COVID. The majority of them do not have access to internet, so 
they do not benefit from online learning. The caregiving burden 
is higher for women that are often responsible for the 
childcare, and for girls that are tasked with taking care of 
their younger siblings and have less time for their own 
education.
    As the secondary impacts of COVID take their toll, 
thousands of people have been forced to flee their homes and 
face higher risks with the closure of borders. Informal 
migration routes expose women to higher rates of sexual 
exploitation, abuse, and human trafficking.
    Finally, the rise in gender-based violence and the 
disproportionate rise in unpaid care work for women are two 
trends that are putting women's lives and futures at 
significant risk.
    To address these challenges, CARE urges the U.S. Government 
to prioritize five key areas in its policy and assistance 
strategy for the region: One, ensure fast and fair delivery of 
COVID-19 vaccines to the last mile and sustainable health 
system strengthened by prioritizing investment in frontline and 
community health workers.
    Two, elevate humanitarian diplomacy and funding within the 
U.S. strategy in the region, including facilitating durable 
solutions to displacement.
    Three, ensure U.S. humanitarian and development investments 
have a clear gender focus and support women and girls, 
including through continued support for sexual and reproductive 
health and for gender-based violence prevention and response.
    Four, engage with and support regional governments to 
ensure safety nets are accessible to the most vulnerable 
populations now and to improve their resilience throughout the 
years.
    And five, direct resources to strengthen the capacity of 
locally led and especially women-led organizations, and 
prioritize economic empowerment for women and vulnerable groups 
to bolster resilience and capacity to respond to the current 
and future crises.
    Thank you very much.
    [The prepared statement of Ms. Bertolucci follows:]
    
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    Mr. Sires. Thank you very much.
    We now recognize Dr. Ellis. You are recognized for your 
testimony.

    STATEMENT OF R. EVAN ELLIS, PHD, LATIN AMERICA RESEARCH 
  PROFESSOR, STRATEGIC STUDIES INSTITUTE, US ARMY WAR COLLEGE

    Dr. Ellis. Chairman Sires, Ranking Member Green, 
distinguished committee members, thank you for this 
opportunity. I will summarize my written testimony.
    No region in the world is more directly connected to U.S. 
security and prosperity than is Latin America. The region has 
recorded approximately the same number of COVID-19 cases as the 
United States, yet have 50 percent more deaths, over 960,000 as 
of May 11.
    The region's large informal sector and often marginal small 
businesses have made its population particularly vulnerable to 
both contagion and the adverse economic effects of fighting the 
spread of the virus. The region's GDP declined by 7.7% in 2020. 
Many small businesses bankrupted by the pandemic are gone 
permanently.
    This past week's violent protests in Colombia, the burning 
of Guatemala's Parliament last November, and other unrest 
across the region highlight that both Latin America's people 
and their governments are at their limits.
    Indeed, as a result of COVID-related spending, government 
debt in the region went from 68 percent to 77 percent of GDP 
since last year alone.
    The region's governments have been unable to obtain and 
distribute adequate quantities of vaccines, either directly 
through contractors or through COVAX. Only two countries in 
Latin America, Chile and Uruguay, have vaccinated more than 20 
percent of their populations.
    China, Russia, and even Cuba, as Ranking Member Green 
noted, have stepped into the breach. The PRC is currently 
supplying vaccines to at least 12 Latin American countries. 
This represents 85 percent, I repeat, 85 percent, of vaccines 
received by Chile to date, 82 percent of vaccines received by 
El Salvador to date, and 75 percent of vaccines received by 
both Brazil and Uruguay.
    At least 10 Latin American and Caribbean countries are 
using Russia's Sputnik V vaccine, including Venezuela, 
Nicaragua, Bolivia, Argentina and Mexico.
    The PRC is using access to its vaccines to promote its 
interests in other areas, as Ranking Member Green noted. 
Following PRC vaccine promises, both Brazil and our ally the 
Dominican Republic reversed their prior public commitments to 
exclude Huawei from their 5G networks, and in Paraguay the PRC 
tried unsuccessfully to use vaccines to get the Abdo Benitez 
government to abandon diplomatic relations with Taiwan. And 
their maneuvering with Honduras has also been noted by Ranking 
Member Green.
    Nonetheless, China's vaccines have had efficacy problems. 
Chile's government bet on Sinovac to get shots to more of its 
population than any other country, but Sinovac turned out to 
have only 3 percent efficacy after the first dose, allowing the 
virus to continue spreading.
    China's marketing of its vaccine contributions masks a less 
positive reality. The PRC sells, rather than donates most 
vaccines.
    Indeed, the PRC set up a $1 billion loan fund to help Latin 
American countries buy its vaccines, just like the PRC, loans 
money to the region to hire Chinese companies in other areas.
    The Chinese have, however, aggressively marketed their 
vaccine rollouts. They have turned just about every vaccine 
delivery into a photo op on the airport tarmac. Such marketing 
creates the false impression that, in the face of U.S. 
indifference, the PRC is generously saving our neglected 
neighbors.
    The Russians, for their part, have had production problems, 
resulting in only limited deliveries of Sputnik V. Even Cuba 
has gotten into the vaccine game now with its ``Sovereign 2'' 
and ``Abdala'' vaccines.
    It is in our strategic interests to help our neighbors to 
more rapidly and effectively vaccinate their populations. 
First, the United States will have vaccine to distribute. As of 
May 12th, 58.7 percent of the U.S. population, according to the 
CDC, have received at least one dose, with more vaccine in the 
pipeline.
    Second, controlling the virus in Latin America is important 
to minimize the risk of mutations or variants, such as the 
previously noted P.1 variant in Brazil, and their transmission 
to the United States, especially given the high level of U.S. 
personnel interchange with the region.
    Third, helping control COVID in the region is arguably a 
necessary precondition to ease migratory pressures and 
alleviate socioeconomic stresses that could help bring 
antidemocratic populist governments to power, further opening 
the door to worrisome forms of engagement by China, Russia, and 
Iran.
    Fourth, U.S. vaccine leadership strengthens our neighbors' 
goodwill to work with us in other areas that we value, while 
fighting China and Russia's false and self-promoting 
narratives.
    I, thus, respectfully recommend the following: First, that 
we donate, not sell, significant quantities of vaccines from 
proven Western manufacturers, highlighting U.S. generosity in 
contrast to Chinese profit-seeking.
    Two, in addition to COVAX, we should work directly with 
trusted Western manufacturers to obtain additional vaccines for 
the region.
    Three, where accepted by partner governments, we should 
provide logistic support for the transport, storage, and 
distribution of the vaccines, possibly even using the U.S. 
military, where appropriate, complemented by international 
observers and NGO's, thus reducing the risk that vaccines will 
be diverted or used by local elites to support their own 
interests or enrichments.
    Thank you for your time and interest. I welcome the 
committee's questions.
    [The prepared statement of Dr. Ellis follows:]
    
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    Mr. Sires. Thank you, Dr. Ellis.
    We will now go to questions.
    I have been advocating for a number of months for the U.S. 
to donate excess vaccines to the region. I was happy to hear 
the White House's announcement that the U.S. will share 60 
million doses of the AstraZeneca vaccine with the world.
    Dr. Castro, how should the United States prioritize where 
vaccine doses are sent within Latin America and the Caribbean?
    Dr. Castro. Throughout the region, there is an uneven 
distribution of vaccines. And we should follow epidemiological 
priorities to start to deploy vaccines.
    One mechanism is through COVAX, which already--so the 
Revolving Fund is distributing vaccines, and there could be an 
agreement to make sure that those vaccines are first 
distributed where they are needed the most.
    Usually, that entails the cities that are highly dense with 
populations where transmissibility occurs more rapidly. But, 
first of all, I would start with healthcare workers, who are 
the most exposed to the virus, following people who are the 
elderly and those with chronic conditions.
    Mr. Sires. Thank you. The COVID-19 pandemic has worsened a 
humanitarian crisis in Latin America and the Caribbean due to 
pervasive inequality, fragile health systems, and corruption.
    Ms. Bertolucci, where is the U.S. assistance most needed 
right now?
    Ms. Bertolucci. Thank you for the question. We do need to 
focus the U.S. assistance, both the humanitarian response but 
also the support, to fighting the root causes that are making 
people more vulnerable to this crisis that I mentioned in my 
testimony.
    That support is needed especially in Central America, 
responding to many of the crises that I mentioned, but also in 
South America, supporting the countries receiving the 
Venezuelan refugees and migrants and even Israelites south.
    Finally, as you mentioned, Representative, the Caribbean 
must not be forgotten, as they are facing already food 
insecurity, especially in Haiti. And also, we are expecting a 
very difficult hurricane season that is starting right now, 
which will increase the humanitarian needs in the region.
    Mr. Sires. Thank you.
    Dr. Ellis, I have said for a long time that if we do not 
pay attention to our own hemisphere, countries like Russia and 
China will fill the void the U.S. is leaving. They have taken 
advantage of this during the pandemic, offering almost every 
country in the region vaccines.
    How do we combat that, Dr. Ellis?
    Dr. Ellis. That is an excellent question, and I fully 
support your observation, Mr. Chairman, regarding the 
importance of the hemisphere. I think, No. 1, it is important. 
The United States has been very generous. This administration, 
as you know, has committed $4 billion to COVAX.
    Unfortunately, the Chinese play, as Ranking Member Green 
noted, a much better game, in terms of claiming credit for the 
vaccine. I think it is important that we take advantage of 
private sector mechanisms and existing contract mechanisms to 
get more vaccine directly, both the surplus vaccine that we 
have and others.
    We also need to do a better job in engaging with the region 
to emphasize the efforts that we are doing. And, frankly, 
beyond that, I believe that we need to sustain the investment 
in the region to continue to push back against the grave 
socioeconomic and other conditions that have been unleashed by 
the virus, not only the economic conditions, but there are also 
pressures for public insecurity and other things that will 
continue to push regimes to open the door for the expansion of 
new populist governments that traditionally have further 
created opportunities for China and Russia to advance in the 
region.
    There are a lot of pressures, both fiscal pressures and 
other pressures for that Chinese advance. And so we need to be 
a better friend and ally, supporting, strengthening 
governments' initiatives as well as the vaccine rollout 
themselves, Mr. Chairman.
    Mr. Sires. Thank you. I now recognize Congressman Green.
    Mr. Green. Thank you, Mr. Chairman, and really appreciate 
your leadership here on this. I also want to cite that I 
appreciate your continuing to advocate that we share our 
vaccines with our friends in Latin America.
    We have seen actors like the Chinese Communist Party, 
Russia, and Iran wage very intentional campaigns to undermine 
the Western vaccine effort. They are raising questions about 
the origins of the pandemic, shaping the narrative there.
    Dr. Ellis, how do these disinformation campaigns affect 
public health response efforts in Latin America?
    Dr. Ellis. Thank you. It is an excellent question.
    First of all, it creates the impression that the rollout of 
the Chinese vaccine is adequate. This was a problem in Chile. 
Again, due to the limited efficacy of those vaccines, despite 
Chile leading the campaign in vaccinating its country in the 
region, it discovered that the virus was continuing to spread.
    In addition, the impression of China and Russia, as I 
noted, coming to the supposed rescue of the region creates the 
narrative that the United States is not there, the United 
States does not care, and that undermines our efforts to engage 
with our allies in other ways, whether it is promoting our 
agendas of democracy and human rights or free markets and open 
governments.
    And finally, it opens the door for cooperation with the 
Chinese in other areas. Some of those areas, as you noted, sir, 
include, for example, the pressure, in order to obtain more 
vaccine, to open up the market for, for example, Huawei and 5G, 
which creates a very serious intelligence and opportunities for 
the Chinese that can even put the autonomy of member 
governments and their leaders at risk.
    It also puts our ally Taiwan in a very precarious position, 
as you noted, sir, with respect to both what is happening in 
Honduras and Paraguay and pressures elsewhere.
    And traditionally, as we have seen already with El 
Salvador, which is launching a major new program with the 
Chinese this week, as well as Chinese advances in the Dominican 
Republic and Panama, those open doors for the Chinese that lead 
to dramatic expansion of Chinese commercial presence, which has 
a silencing effect and often an antidemocratic effect, in 
addition to, again, helping open the door for further populist 
governments that, again, has a mutually reinforcing effect of 
creating even more opportunities for the Chinese in other 
areas.
    Mr. Green. So how do we push back on this, and how do we 
recruit some international partners to help us in fighting this 
disinformation campaign?
    Dr. Ellis. If that is for me, sir, an excellent question. 
First of all, I believe that we need to be very careful in not 
trying to tell the region that they are not allowed to 
economically engage with the Chinese. We believe in the 
principles of free market and, obviously, you know, principles 
of autonomy of states.
    But there is a lot more that we can do with respect to 
promoting principles of good governance, pushing for 
transparency, which makes it more difficult for countries, for 
elites in the region to engage with Chinese in under-the-table 
deals which ultimately benefit those elites and the Chinese 
without benefiting the populations.
    We need to help our countries in the region fight 
corruption and also strengthen their ability to implement 
solutions that involve level playing fields, rule of law, 
objective public planning, to prevent situations like what 
happened in Panama, where the previous government of Juan 
Carlos Varela signed up for a $4 billion bullet train, spending 
the Panamanian people's money, for something that wasn't even 
in the government's long-range plan.
    We need to help our governments in the region to enforce 
their own laws under their own sovereignty, so that Chinese 
companies can operate on a more level playing field.
    And, frankly, we need to bring to bear more resources with 
respect to studying performance of the Chinese, in terms of 
looking at the long, long record of where the Chinese companies 
have not lived up to promises, where they have had problems 
with local communities, where they have had environmental 
issues and other things.
    Because, at the end of the day, we need to give data-driven 
reasons why our partners should not accept those false promises 
and why democratic, free market solutions are the most viable 
path for their prosperity and development and, of course, to 
ours, because we are deeply connected to the region.
    Mr. Green. I only have a few seconds left, but I would love 
to get a response in writing back from all of our witnesses 
today on the following question: You know, Congress passed $15 
billion in aid through supplemental appropriations.
    I would like to know how State, USAID, and the NGO's are 
responding to that. Are they doing a good job with that aid? Is 
it being appropriately administered? And since my time is now 
up, if I could get those answers in writing, that would be 
helpful.
    And thank you, Mr. Chairman. I yield.
    Mr. Sires. We now recognize Congressman Castro.
    Mr. Castro of Texas. Thank you, Chairman.
    Ms. Bertolucci, thank you for your testimony today. As you 
have stated, the COVID-19 pandemic has exposed existing 
structural challenges and exacerbated inequalities affecting 
vulnerable populations across Latin America. This is certainly 
true for migrants and refugees, who have been displaced across 
the region and may lack access to healthcare and recourses to 
obtain a COVID-19 vaccine.
    So I wanted to ask you, how can the United States work with 
Latin American countries and civil society organizations to 
make sure migrants and refugees receive the COVID-19 vaccine?
    Ms. Bertolucci. Thank you so much for this question. I 
believe there are several things that the U.S. can do to 
support the governments. The first one has been very much 
discussed right now, which is ensuring a fast and fair 
distribution of vaccines, augmenting the capacity of the 
several States in Latin America to have availability of 
vaccines and, therefore, not having to choose who are they 
vaccinating and who are they excluding from this process.
    We need to also advocate and guarantee that not only the 
vaccines reach the countries, but also that the health systems 
are strengthened and the frontline workers and community health 
assistants are strengthened so that the vaccine can be 
distributed to the most remote communities, to the communities 
that are on the borders or walking through Latin America, which 
is a reality for the Venezuelans, for instance, and also make 
sure that we are looking at the most vulnerable populations as 
part of the targeting and strategy for the vaccines.
    Finally, focusing only on vaccines will not solve the huge 
displacement and needs that the migrants and refugees have at 
this moment in Latin America. So we do need to step up on our 
humanitarian response and humanitarian funding, to make sure 
that they have not only access to health but access to food 
security, access to education, and access to the basic 
protection, especially for women and girls.
    So those are some of the areas that I believe the U.S. 
could invest to support migrants and refuges in the region.
    Mr. Castro of Texas. Thank you.
    I have a question for Dr. Castro. Thank you for being here 
today as well. And I agree with your statements on the 
importance of donating excess vaccines to Latin America and of 
supporting the intellectual property waiver at the upcoming 
World Trade Organization meeting.
    During your testimony, you also mentioned the possibility 
of having the U.S. Government work with the governments of 
Mexico and Brazil to expedite their manufacture and development 
of COVID-19 vaccines. I think that this is a great idea, and it 
could be a long-term plan for generating sufficient COVID-19 
vaccines for the entire region's population.
    So I wanted to ask you, can you explain how assisting 
Mexico and Brazil in the manufacturing of COVID-19 vaccines 
could help the region in their long-term recovery from the 
coronavirus pandemic, and what are some of the steps the U.S. 
Government needs to take to make this a reality?
    Dr. Castro. Thank you, Representative Castro, for your 
question. Indeed, Brazil and Mexico have the largest 
populations in the region, and they also have plants where they 
are producing vaccines. However, they do not yet have the 
technology needed to produce vaccines such as those that have 
Messenger RNA.
    And that is where the United States can be very helpful, 
given that two of the most efficacious vaccines are based in 
the United States, and those are Moderna and Pfizer. And 
Moderna has been produced mostly with taxes from the taxpayers 
in the United States, and it would be a great idea if the 
National Institutes of Health, which has contributed vastly to 
the production of the Moderna vaccine, could come to agreement 
with researchers in Brazil and in Mexico to transfer that 
technology.
    And that technology can help produce vaccines for the 
current vaccine; but because the mRNA is a new technology, it 
could also be very useful to treat future diseases--I mean, to 
treat diseases in the future and also to produce vaccines for 
upcoming pandemics.
    So I believe that collaboration between the United States 
with the NIH and through vaccine developers such as Moderna and 
Pfizer working in collaboration with, for example, the Fiocruz 
in Brazil, which has a very long tradition of producing 
medicine and vaccines. There is also the Institute Butantan in 
Brazil.
    And there is an agreement between Argentina and Mexico, 
where part of the initial product for the vaccine are produced 
in Argentina and then they are finished in Mexico. And that is 
also an agreement that could be potentiated so that more 
vaccines are being able to be produced. Again----
    Mr. Castro of Texas. Well, thank you. Thank you.
    Ms. Bertolucci. You are welcome.
    Mr. Castro of Texas. My time is expired, but I appreciate 
it.
    Mr. Sires. Thank you.
    We now recognize Congressman Pfluger.
    Mr. Pfluger. Thank you, Mr. Chairman, for this important 
hearing. And I appreciate your comments, especially on the rise 
of the influence of the Chinese Communist Party and of Russia.
    And so I would like to focus my questions first, Dr. Ellis, 
with you. We have seen how actors like the Chinese Communist 
Party, Russia, and Iran are waging campaigns to undermine 
Western vaccine efforts and legitimate questions about the 
origin of the pandemic.
    So how do these disinformation campaigns affect public 
health response efforts, and what other efforts, disinformation 
efforts exist in Latin America?
    Dr. Ellis. Thank you very much, Congressman, for the very 
important question.
    With respect to the efforts, obviously, they undermine the 
United States' position in a number of different ways. No. 1 is 
it contributes to the undermining of goodwill toward the United 
States and, thus, the sense that the United States is a key 
partner and what the United States stands for is the right way 
to go in the region.
    In many ways, it contributes to a form of moral 
equivalence, the desire in the region to take the Chinese money 
in various other commercial endeavors. And if one can think 
there is somehow a moral equivalence or U.S. neglect then why 
not take the Chinese money, thus taking the elites down a very 
troubling path that leads them into dependence on the Chinese 
companies, because at the end of the day the Chinese are 
seeking to get their value-added out of their commercial 
endeavors.
    In my judgment, the Chinese and the Russians and others are 
playing a slightly different game here. The Russians have been 
more actively involved in trying to spread false rumors and sow 
discontent and play up stories on, you know, the internet to 
undermine our best allies.
    The Chinese have been particularly pressing, doing 
everything that they can to suppress information about the 
Wuhan origins of the coronavirus and the investigations into 
the origins, obviously, in the Wuhan virology lab. And so it 
has become very clear that anyone who raises that question, 
even our allies outside of the region, the Australians, when 
they dared to raise those questions were, you know, subject to 
very harsh economic reprisals.
    And so I think not only is it undermining the U.S. position 
and delivering the region more rapidly into an economic 
dependence on the Chinese, but it also shows the way in which 
it is not just about economics. Overall, it is about things 
that both Republicans and Democrats, I think, hold dear. There 
is a self-censorship effect. There is a silencing effect, 
anything that is objectionable to the Chinese. And the more 
that we see Chinese power and dependence grow, I think we will 
see an undercutting of the U.S. position and our values, that 
we fight for in the region.
    And, frankly, you know, a region in which its leaders, its 
political leaders, its elites do not feel free to speak out or 
question the Chinese is not the type of region that we stand 
for nor that I think that many in Latin America want to live 
in.
    So I think there is a lot more at stake than just the 
economics, but we certainly need to get the virus under control 
through vaccine leadership as well, sir.
    Mr. Pfluger. Thank you, Dr. Ellis.
    Dr. Castro, I would like to just kind of ask you, through 
the lens that you are looking at, do you see, you know, some of 
the similar lines of effort through disinformation or vaccine 
diplomacy, and do you see them negatively affecting the various 
countries?
    Dr. Castro. Thank you for the question.
    The efficacy of the vaccines varies a lot, and my concern 
is that Sinovac has only 51 percent efficacy, and it is being 
distributed throughout the region. And the problem is that it 
is going to be more difficult to reach herd immunity with 
vaccines that do not confer a greater protection.
    So there could be a disinformation in the fact that some 
people may think that all vaccines are equal, and that is not 
correct. So definitely, we need to make sure that the vaccines 
that are the most efficacious are the ones that are most widely 
distributed and to reach herd immunity, which would mean that 
about two-thirds of the population is vaccinated with 
efficacious vaccines. Thank you.
    Mr. Pfluger. Thank you very much.
    And I appreciate all three witnesses and their testimoneys 
for this important subject.
    I yield back.
    Mr. Sires. I now recognize Congressman Levin.
    Mr. Levin. Thank you so much, Mr. Chairman, for holding 
this really important hearing. It is my understanding that ten 
countries in Latin America and the Caribbean are eligible for 
vaccines through COVAX-AMC and, of those 10 eligible countries, 
only Haiti is waiting still on any doses.
    The Miami Herald reported last week that Haiti is supposed 
to get 756,000 doses of the AstraZeneca vaccine. According to 
the Pan American Health Organization--I am quoting--``Haiti is 
still in the process to finalize the arrangements that all the 
other countries have made to be able to receive these vaccines. 
Haiti is not paying for these vaccines, but the country needs 
to make some legal and administrative arrangements,'' end 
quote.
    The same Miami Herald report noted that in order to get the 
doses, Haiti's Health Ministry must make sure personnel are 
trained, that there is a plan for storage, and that other 
logistical details are in order.
    I am worried that this delay will be compounded by the 
COVID crisis in India, which had planned to send roughly 1 
billion doses of AstraZeneca to COVAX before halting their 
exports. I know Haiti was slated to receive a portion of those 
doses too.
    So, Dr. Castro, let me start with you. Are you able to 
share any additional details on why Haiti has not received any 
vaccine doses through COVAX yet?
    Dr. Castro. Thank you for the question. The information 
that I have is through NPR. Last week, it was published that 
actually the Minister of Health of Haiti had told the Revolving 
Fund that they did not need the vaccines because the pandemic 
is not having such a large impact.
    Of course, it is difficult to understand why there would 
not be more transmission of the coronavirus in Haiti, given all 
the very dire conditions in which most of the population live 
and given that it shares the island with the Dominican 
Republic, where thousands of people have died of COVID-19.
    So I do not have additional information, but I can find 
out, I can find out and provide you with a written answer about 
this topic.
    Mr. Levin. I would appreciate that. I have also heard 
reports that, you know, last month Haiti's Ministry of Health 
voiced concerns about the AstraZeneca vaccine's safety and 
asked Gavi to consider making a one-shot vaccine.
    And so, I mean, do you have a sense that Haiti' Ministry of 
Health is rejecting the AstraZeneca vaccine? Do you have that 
sense?
    Dr. Castro. Well, what I read in the NPR reporting was that 
they did not want to receive the vaccines that COVAX, that the 
Revolving Fund was about to ship to Haiti. But, again, I will 
find out and provide you with a better answer.
    Mr. Levin. All right. Well, thank you. I appreciate that.
    You know, in recent months, many countries in the region 
have experienced setbacks to democracy and authoritarian 
efforts to undermine democratic institutions and significant 
social and political unrest.
    On May 1, President Bukele's allies in El Salvador's 
Congress removed constitutional court judges and the attorney 
general and then proceeded a few days later to provide 
themselves blanket immunity for virtually any act of official 
corruption related to the pandemic.
    President Bolsonaro in Brazil is being investigated for his 
government's severe mishandling of the pandemic, and Colombia 
is experiencing massive social unrest with human rights 
organizations having documented excessive use of force by 
police.
    Dr. Ellis, how should the U.S. respond to democratic 
backsliding in the region made worse by the pandemic? What 
tools can we in Congress use to push back against these 
antidemocratic tendencies?
    Dr. Ellis. Congressman, you raise a very important point. 
And there are some very complex strategic tradeoffs that we 
have to obviously work with, remaining consistent, because at 
the end of the day it is really the fight to strengthen 
institutions and ensure democratic practices that is at the 
heart of what we stand for in pushing back against China.
    And yet we need to be careful at critical moments that we 
do not inadvertently push allies into conditions in which we 
actually increase their risk of populist revolutions, or push 
them into the hands of China, thus liberating them from their 
constraints and dependence on the United States and, frankly, 
making things worse for their people.
    But I think one of the key things you also brought up is 
with respect to the pressures and corruption that are really 
threatening not just public health but undermining the 
stability, the political and socioeconomic stability of the 
region, that creates very serious challenges for us.
    Mr. Levin. All right. Well, I see my time is expired, Mr. 
Chairman, so thanks and I yield back.
    Mr. Sires. Thank you.
    I now recognize Ms. Salazar.
    Ms. Salazar. Thank you, Mr. Chairman, for holding this very 
important hearing. And, unfortunately, what we are hearing is 
very troubling. There is something called a race for vaccine 
diplomacy, and we are getting outplayed by China and Russia, 
from what we are hearing.
    We invented the best vaccines in the world, but very few 
people know about it. We gave $4 billion to the global COVID-19 
relief through COVAX. We have given more than any other 
country, but most people do not have a clue that is happening.
    While the American companies, Pfizer and Moderna, have 
saved millions and millions of lives, Russia and China are 
pumping questionable vaccines in Latin America and demanding 
political loyalty in return.
    So we have worked miracles, literally miracles, yet China 
and Russia are taking the credit for it. So, in other words, we 
are getting outmaneuvered by communist propaganda that trades 
on power and destroys countries.
    So they are eating our lunch, and we have no apparent 
strategy to counter this new form of aggression from China and 
Russia. China wants to own the Panama Canal. Russia is 
supporting Venezuela and Nicaragua dictators. And the vaccines 
are their new tool.
    Look what they have done. We have just discussed it in this 
hearing. China is providing vaccines to Chile, Uruguay, and 
Brazil; Russia to Argentina, Bolivia, Mexico and Venezuela. And 
where are we, the United States?
    The good news is that by this July this country will reach 
a vaccine surplus. We will have more doses than people who need 
them in this country. In the meantime, we know that Latin 
America can't make the vaccine, but they desperately need one.
    So there is a vacuum. If we do not fill that vacuum, China 
and Russia will. It will be us versus them and, obviously, we 
always bet on America. So that is what I am proposing. I am 
proposing to protect American intelligence property so we can 
make sure China does not get its hands on our most valuable 
technology of this hour.
    We should deliver surplus vaccines directly to Latin 
America and put the American flag on every single vaccine dose 
we give out so everyone knows who is giving it to them, who is 
saving their lives, once again, like we have done for 
centuries, in exchange of nothing, just because we love the 
common good.
    So I just wanted to ask you a couple of questions, Dr. 
Ellis. And thank you very much for coming and spending your 
time and giving us your knowledge. I just wanted to ask you, do 
you know that within the State Department there is a group 
called the Bureau for Crisis and Contingency Response, the CCR, 
who was able to fly dozens of planes across the globe carrying 
almost 200,000 vaccines to our diplomats so we could protect 
our diplomatic personnel. Are you aware of this group within 
the State Department?
    Dr. Ellis. Yes, ma'am. You raised a number of excellent 
points. I had the honor of spending an unforgettable year with 
my life on the Policy Planning Staff, and the State Department 
has capabilities across a range of different areas.
    In addition to the things that we have for our own 
personnel to support U.S. Nationals, there are also a number of 
other tools, for example, through the Global Engagement Center, 
and others to more effectively push back against Chinese 
propaganda. We certainly need as much----
    Ms. Salazar. Do you know that these people are there, and 
we could use them to fly millions of vaccines to Latin America 
after we have this surplus that everything indicates that we 
are going to have it by July?
    Dr. Ellis. I would have to do a more detailed look at the 
scalability of those current efforts. You know, there are 
probably a range of different tools that can be used including 
with the Department of Defense and some of those logistics 
capabilities that it has as well.
    But, certainly, the State does have short turnaround, in-
house tools to deliver limited quantities of vaccines and other 
logistics supplies of the region. I would have to look into the 
scalability of that effort.
    Ms. Salazar. So that means that if the Biden administration 
has the willingness to help Latin America, we could fly and 
provide those extra vials, starting July when we have a surplus 
in this country? So it is just political willingness?
    Dr. Ellis. I think we can certainly, ma'am--I agree with 
you. We have the vaccine, and across our whole of government 
capabilities, we have a number of different instruments, as we 
found out responding to the Ebola crisis in Africa not too many 
years ago, as well as professional capabilities to move things 
quickly.
    I saw State when they were moving personnel and rescuing 
them, getting out of harm's way as the virus took off in the 
region last year. So whatever that particular capability is 
appropriate to this, we absolutely have the capability and we 
increasingly have the surplus in vaccines.
    Ms. Salazar. But do not you think it will be a good use to 
those----
    Mr. Sires. Thank you, Congresswoman Salazar.
    Ms. Salazar [continuing]. I'm sorry. Thank you. I just want 
to put on the record, there is this article by Vanity Fair that 
says that we have the vials and we have the capability of 
distributing them. It is just willingness.
    Thank you, Mr. Chairman.
    Mr. Sires. Thank you. Congressman Vargas is recognized.
    Mr. Vargas. Thank you very much, Mr. Chairman. I appreciate 
you very much having this hearing and, of course, the 
witnesses. I want to continue on with this line of questions 
because I think numbers matter here, though.
    So how many extra vials do we have right now, and how many 
people are in Latin America? I mean, I was just looking up the 
numbers of some of these countries. So Brazil has over 211 
million people, Mexico 127 million, Colombia 50 million. I 
mean, these numbers are huge compared to the vials that we 
have. Let's be frank. I mean, if we took all the extra vials 
right now and we sent them to Latin America that we have, how 
many would that be? Who can answer that?
    Evan? Dr. Evan.
    Dr. Ellis. Congressman you make a good point with respect 
to the number that we may have in stores at this moment versus 
the question of what is in the pipeline and what will also be 
freed up for the pipeline based on certain decisions that we 
make. I do not have the specific number what we have in 
inventory right now, but my understanding----
    Mr. Vargas. Is it 400 million? We have 400 million vials 
ready to go?
    Dr. Ellis. What I believe, sir, is that if we make 
commitments through existing or justable commercial 
relationships with our existing Western-based manufacturers 
that we can keep that pipeline ramped up as our own demand in 
the United States ramps down so that in the coming----
    Mr. Vargas. You do not want to give me a number, though? 
Does anyone want to give me a number?
    See, that is what I think the problem is we are talking 
about numbers that are small that we have and we are talking 
about gigantic numbers that they need. That is the problem. So 
even if we gave them all the extra vials--there is not that 
many extra vials, let's be frank. I mean, we do not have it 
right now. That is the problem.
    I mean, you have, you know, 19 percent of the COVID-19 
virus in the region, you have 8 percent of the population, but 
8 percent of the population is huge. So at the moment we do not 
have enough. I mean, that is the reality.
    The Chinese have been good, I think, about saying, hey, we 
will give this to you even though their vaccine is pretty 
crappy, but it is something so they will take it. We have to 
have the ability to give them some vaccines. I mean, that is 
the issue. And how do we do that? Dr. Castro, how do we do 
that?
    Dr. Castro. Well, some numbers is through COVAX. The 
current goal is to provide 280 million doses by the end of the 
year. And if you take into account that most people because of 
the type of vaccines are going to need two doses, that means 
140 million and for a population of 660 million. Of course, 
that 660 million includes children. And right now we are still 
going to--if they can, if it is safe to provide the vaccine. 
But it is true that we still need millions of doses to be 
delivered.
    Mr. Vargas. Now, I do have a concern that some of my 
colleagues on the other side of the aisle do is that COVAX-AMG 
is great, but the reality is that we do not--we should have on 
there, you know, provided by the United States of America. I do 
agree with that. That is something that we should insist on.
    I mean, if we are providing the money to do this, we should 
get credit for it. And not because we want to get credit for 
it, but I think it is good for democracy. I think it is good 
for the people there to understand we are doing this because 
this is what free countries do, this is what democracy does, as 
opposed to the Chinese who do it for self-interest. They are 
doing it because they want something out of it. They want us to 
take their canals. They want to take their raw materials.
    So I do think it is important when we provide these 
vaccines that they know that it is coming the United States of 
America. But at the same time we have to be realistic about it 
and understand that, you know, yes, we can fly down what we 
have right now, and you can, you know, get a very few people 
vaccinated, but the reality is it does not really cover the 
great majority of people there. We need a better plan. And that 
is what we have to come up with a better plan to figure out how 
do we help vaccinate everyone in Latin America that wants it? 
And hopefully everyone would want it, because we will not be 
safe until they are. Am I wrong about that?
    Dr. Castro. You are right. We need to immunize even if 
everybody in the United States wanted to be vaccinated, and we 
achieved herd immunity, we would not be safe in the United 
States until at least two-thirds of the population in every 
single country in the world is vaccinated.
    Mr. Vargas. And that is why I think we do need this plan to 
try to figure out how he are we going to help Latin America and 
the Caribbean get fully vaccinated? I mean, it is interested to 
talk about these little things to send them a few vials here, a 
few times there. That is not the scale that we need. We need a 
plan that is really going to do the job.
    I see my time is up, so I will yield back. Thank you.
    Mr. Sires. Thank you, Congressman. And I certainly agree 
with you to say on it, Made in the USA.
    Well, thank you, again, for joining us today, to all the 
witnesses. I want to close today's hearing by once again urging 
the Biden administration to take immediate steps to support 
vaccine distribution in Latin America and in the Caribbean. I 
look forward to working with Ranking Member Green and our 
colleagues to deepen U.S. engagement with our allies as we work 
to get this pandemic under control throughout the Western 
Hemisphere.
    With that, this committee is adjourned.
    [Whereupon, at 11:12 a.m., the subcommittee was adjourned.]

                                APPENDIX
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                    OPENING STATEMENT CHAIRMAN SIRES
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     INFORMATION FOR THE RECORD FROM SIRES ON BEHALF OF DR. CASTRO
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         INFORMATION FOR THE RECORD FROM REPRESENTATIVE SALAZAR
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            RESPONSES TO QUESTIONS SUBMITTED FOR THE RECRORD
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