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


                    A SHOT AT NORMALCY: BUILDING COVID-19 
                            VACCINE CONFIDENCE

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

                            VIRTUAL HEARING

                               BEFORE THE

              SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

                                 OF THE

                    COMMITTEE ON ENERGY AND COMMERCE
                        HOUSE OF REPRESENTATIVES

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             FIRST SESSION

                               __________

                              MAY 26, 2021

                               __________

                           Serial No. 117-35
                           
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]                           

     Published for the use of the Committee on Energy and Commerce
                   govinfo.gov/committee/house-energy
                        energycommerce.house.gov
                        
                              __________

                    U.S. GOVERNMENT PUBLISHING OFFICE                    
48-986 PDF                 WASHINGTON : 2022                     
          
-----------------------------------------------------------------------------------   
                       
                    COMMITTEE ON ENERGY AND COMMERCE

                     FRANK PALLONE, Jr., New Jersey
                                 Chairman
                                 
BOBBY L. RUSH, Illinois              CATHY McMORRIS RODGERS, Washington
ANNA G. ESHOO, California              Ranking Member
DIANA DeGETTE, Colorado              FRED UPTON, Michigan
MIKE DOYLE, Pennsylvania             MICHAEL C. BURGESS, Texas
JAN SCHAKOWSKY, Illinois             STEVE SCALISE, Louisiana
G. K. BUTTERFIELD, North Carolina    ROBERT E. LATTA, Ohio
DORIS O. MATSUI, California          BRETT GUTHRIE, Kentucky
KATHY CASTOR, Florida                DAVID B. McKINLEY, West Virginia
JOHN P. SARBANES, Maryland           ADAM KINZINGER, Illinois
JERRY McNERNEY, California           H. MORGAN GRIFFITH, Virginia
PETER WELCH, Vermont                 GUS M. BILIRAKIS, Florida
PAUL TONKO, New York                 BILL JOHNSON, Ohio
YVETTE D. CLARKE, New York           BILLY LONG, Missouri
KURT SCHRADER, Oregon                LARRY BUCSHON, Indiana
TONY CARDENAS, California            MARKWAYNE MULLIN, Oklahoma
RAUL RUIZ, California                RICHARD HUDSON, North Carolina
SCOTT H. PETERS, California          TIM WALBERG, Michigan
DEBBIE DINGELL, Michigan             EARL L. ``BUDDY'' CARTER, Georgia
MARC A. VEASEY, Texas                JEFF DUNCAN, South Carolina
ANN M. KUSTER, New Hampshire         GARY J. PALMER, Alabama
ROBIN L. KELLY, Illinois, Vice       NEAL P. DUNN, Florida
    Chair                            JOHN R. CURTIS, Utah
NANETTE DIAZ BARRAGAN, California    DEBBBIE LESKO, Arizona
A. DONALD McEACHIN, Virginia         GREG PENCE, Indiana
LISA BLUNT ROCHESTER, Delaware       DAN CRENSHAW, Texas
DARREN SOTO, Florida                 JOHN JOYCE, Pennsylvania
TOM O'HALLERAN, Arizona              KELLY ARMSTRONG, North Dakota
KATHLEEN M. RICE, New York
ANGIE CRAIG, Minnesota
KIM SCHRIER, Washington
LORI TRAHAN, Massachusetts
LIZZIE FLETCHER, Texas
                                 ------                                

                           Professional Staff

                   JEFFREY C. CARROLL, Staff Director
                TIFFANY GUARASCIO, Deputy Staff Director
                  NATE HODSON, Minority Staff Director
              Subcommittee on Oversight and Investigations

                        DIANA DeGETTE, Colorado
                                  Chair
ANN M. KUSTER, New Hampshire         H. MORGAN GRIFFITH, Virginia
KATHLEEN M. RICE, New York             Ranking Member
JAN SCHAKOWSKY, Illinois             MICHAEL C. BURGESS, Texas
PAUL TONKO, New York                 DAVID B. McKINLEY, West Virginia
RAUL RUIZ, California                BILLY LONG, Missouri
SCOTT H. PETERS, California, Vice    NEAL P. DUNN, Florida
    Chair                            JOHN JOYCE, Pennsylvania
KIM SCHRIER, Washington              GARY J. PALMER, Alabama
LORI TRAHAN, Massachusetts           CATHY McMORRIS RODGERS, Washington 
TOM O'HALLERAN, Arizona                  (ex officio)
FRANK PALLONE, Jr., New Jersey (ex 
    officio)
                            
                            C O N T E N T S

                              ----------                              
                                                                   Page
Hon. Diana DeGette, a Representative in Congress from the State 
  of Colorado, opening statement.................................     2
    Prepared statement...........................................     3
Hon. H. Morgan Griffith, a Representative in Congress from the 
  Commonwealth of Virginia, opening statement....................     5
    Prepared statement...........................................     6
Hon. Frank Pallone, Jr., a Representative in Congress from the 
  State of New Jersey, opening statement.........................     7
    Prepared statement...........................................     9
Hon. Cathy McMorris Rodgers, a Representative in Congress from 
  the State of Washington, opening statement.....................    10
    Prepared statement...........................................    10

                               Witnesses

Nick Offerman, Actor and Woodworker..............................    13
    Prepared statement...........................................    15
    Answers to submitted questions...............................    81
Saad B. Omer, Ph.D., Director, Yale Institute for Global Health, 
  Yale University................................................    17
    Prepared statement \1\
    Answers to submitted questions...............................    82
J. Nadine Gracia, M.D., Executive Vice President and Chief 
  Operatinig Officer, Trust for America's Health.................    18
    Prepared statement...........................................    21
    Answers to submitted questions...............................    85
Amy Pisani, Executive Director, Vaccinate Your Family............    29
    Prepared statement...........................................    32
    Answers to submitted questions...............................    89
Karen Shelton, M.D., Director, Mount Rogers Health District, 
  Virginia Department of Health..................................    37
    Prepared statement...........................................    39
    Answers to submitted questions...............................    96

----------

\1\ Dr. Omer's statement has been retained in committee files and is 
available at https://docs.house.gov/meetings/IF/IF02/20210526/112684/
HHRG-117-IF02-Wstate-OmerS-20210526-U1.pdf.

 
        A SHOT AT NORMALCY: BUILDING COVID-19 VACCINE CONFIDENCE

                              ----------                              


                        WEDNESDAY, MAY 26, 2021

                  House of Representatives,
      Subcommittee on Oversight and Investigations,
                          Committee on Energy and Commerce,
                                                    Washington, DC.
                                                    
    The subcommittee met, pursuant to call, at 11:00 a.m. via 
Cisco Webex online video conferencing, Hon. Diana DeGette 
(chair of the subcommittee) presiding.
    Members present: Representatives DeGette, Kuster, Rice, 
Schakowsky, Tonko, Ruiz, Peters, Schrier, Trahan, Pallone (ex 
officio), Griffith (subcommittee ranking member), Burgess, 
McKinley, Long, Joyce, Palmer, and Rodgers (ex officio).
    Also present: Representatives Bilirakis and Carter.
    Staff present: Kevin Barstow, Chief Oversight Counsel; 
Jesseca Boyer, Professional Staff Member; Jeffrey C. Carroll, 
Staff Director; Austin Flack, Policy Analyst; Waverly Gordon, 
General Counsel; Tiffany Guarascio, Deputy Staff Director; 
Perry Hamilton, Clerk; Rebekah Jones, Counsel; Chris Knauer, 
Oversight Staff Director; Mackenzie Kuhl, Digital Assistant; 
Kaitlyn Peel, Digital Director; Peter Rechter, Counsel; Tim 
Robinson, Chief Counsel; Chloe Rodriguez, Clerk; Caroline Wood, 
Staff Assistant; C.J. Young, Deputy Communications Director; 
Sarah Burke, Minority Deputy Staff Director; Diane Cutler, 
Minority Detailee, Oversight and Investigations; Theresa Gambo, 
Minority Financial and Office Administrator; Marissa Gervasi, 
Minority Counsel, Oversight and Investigations; Brittany 
Havens, Minority Professional Staff Member, Oversight and 
Investigations; Nate Hodson, Minority Staff Director; Peter 
Kielty, Minority General Counsel; Emily King, Minority Member 
Services Director; Bijan Koohmaraie, Minority Chief Counsel; 
Clare Paoletta, Minority Policy Analyst, Health; Olivia 
Shields, Minority Communications Director; Alan Slobodin, 
Minority Chief Investigative Counsel, Oversight and 
Investigations; Michael Taggart, Minority Policy Director; and 
Everett Winnick, Minority Director of Information Technology.
    Ms. DeGette. The Subcommittee on Oversight and 
Investigations hearing will now come to order.
    Today the hearing--the committee is holding a hearing 
entitled, ``A Shot at Normalcy: Building COVID-19 Vaccine 
Confidence.''
    Today's hearing will explore strategies for increasing 
confidence in and uptake of COVID-19 vaccines.
    Due to the health emergency, as I noted, today's hearing is 
being held remotely. All witnesses, Members, and staff will be 
participating via video conferencing.
    And, as is usual for our proceeding, microphones will be 
set on mute for the purposes of eliminating inadvertent 
background noise. Members and witnesses, don't forget you will 
need to unmute each time you wish to speak.
    Now, if at any time I am unable to continue as chair, which 
has happened because of technology, the vice chair of the 
subcommittee, Mr. Peters, will serve as chair until I am able 
to return.
    Documents for the record can be sent to Austin Flack at the 
email address that all of the staff has. And all of the 
documents will be entered into the record at the conclusion of 
the hearing.
    The Chair now recognizes herself for an opening statement.

 OPENING STATEMENT OF HON. DIANA DeGETTE, A REPRESENTATIVE IN 
              CONGRESS FROM THE STATE OF COLORADO

    Today we continue our oversight of the Nation's COVID-19 
response efforts.
    Throughout the pandemic, this subcommittee has conducted 
robust oversight over a range of critical issues, including 
vaccine development and distribution [audio malfunction] enter 
a new phase of the pandemic, today's hearing addresses one of 
the most consequential COVID-19 issues that this subcommittee 
has examined: the pressing need to increase COVID-19 vaccine 
confidence and uptake in the United States. And it is simple, 
why. If not enough people get vaccinated, the massive 
investments that we have made to develop the vaccines and the 
extraordinary efforts that we have made to make them widely 
available will never reach their full potential.
    Now, fortunately, we are making significant progress. In 
just 5 months, more than 160 million Americans have received at 
least 1 COVID-19 vaccine. And over 85 percent of seniors have 
received at least 1 dose. In the 2 weeks since the FDA 
authorized Pfizer's vaccine for children ages 12 to 15, more 
than 2 million children in this age group received their first 
dose.
    Thanks to the millions of Americans who have chosen to get 
a safe and effective COVID-19 vaccine, we do have a shot at 
returning to normalcy. So, if you want to take off your masks, 
if you want to get together with friends and family safely, if 
you want to go on vacation, then join the millions of Americans 
who have done it, and get vaccinated.
    Here is the bad news, though: We are not out of the woods 
yet. Although it is easier to get a vaccine, millions of 
Americans remain unvaccinated, and immunization rates in many 
places remain alarmingly low. In some States, less than 30 
percent of the population has received even--I am sorry, less 
than 40 percent of the population has received even a single 
dose. And since peaking in mid-April, we have seen a decline in 
the number of daily doses administered across the country.
    This is worrying. And, frankly, it is going to take a 
collective push to get to the Biden administration's goal of 70 
percent of American adults having at least 1 shot by the Fourth 
of July. That is why this subcommittee is working tirelessly to 
support vaccination efforts nationwide, including today's 
hearing, which explores why some people so far haven't gotten 
vaccinated.
    So that is the big question: Why haven't some people gotten 
vaccinated?
    Polling indicates that many unvaccinated Americans have 
safety concerns or unanswered questions about how the vaccines 
work. Compounding these problems, rampant misinformation and 
outright lies are spreading on social media platforms, in many 
cases igniting viral hoaxes and fueling vaccine hesitancy.
    But low vaccine confidence isn't the only reason for the 
slow uptake. Some unvaccinated Americans, especially in rural 
areas and communities of color, still confront access 
challenges, like the inability to take off of work or to get a 
vaccine from a trusted source.
    Additionally, far too many Americans--in particular, young 
adults--they just don't have the urgency or motivation to get 
vaccinated. They don't understand that, while they are likely 
to have a mild case, they could get a serious case or even 
die--and worse, infect others who are at risk.
    Clearly, this is not a one-size-fits-all solution. It often 
takes the right message, from the right source, delivered at 
the right time. We are going to need a variety of strategies 
and incentives to overcome the range of reasons keeping 
unvaccinated Americans on the fence.
    I believe that our witnesses today can shed light on these 
challenges, and I want to thank every single one of them for 
being with us. I look forward to discussing, at the end, what 
is working and what needs to be done.
    And so I just want to say a few things, in conclusion.
    If you are worried about the vaccine's safety, you should 
know millions of doses have been administered throughout the 
country and around the world. The data is in. The vaccines are 
safe.
    If you are unsure about the vaccine's efficacy, you should 
know extensive, real-world data is available, and it shows the 
vaccines are extremely effective. They prevent hospitalization 
and severe illness, and they save lives.
    And if you question the benefit of getting vaccinated, you 
should know that fully vaccinated Americans can resume their 
prevaccine lives and go around without wearing a mask or 
physical distancing. So you can get back to your normal life. I 
was at a press conference yesterday at the State legislature, 
and everybody had a vaccine, and nobody had a mask, and it was 
wonderful.
    The facts are not in dispute. The only question is, how can 
we help unvaccinated Americans get their shots? I know, if we 
work together in a bipartisan fashion, we can do just that, and 
that is why I am so pleased again to have our witnesses.
    [The prepared statement of Ms. DeGette follows:]

                Prepared Statement of Hon. Diana DeGette

    Today, we continue our oversight of the Nation's COVID-19 
response efforts.
    Throughout the pandemic, this subcommittee has conducted 
robust oversight over a range of critical issues, including 
vaccine development and distribution challenges.
    As we enter a new phase of the pandemic, today's hearing 
addresses one of the most consequential COVID-19 issues this 
subcommittee has examined: the pressing need to increase COVID-
19 vaccine confidence and uptake in the United States.
    Because if not enough people actually get vaccinated, the 
massive investments made to develop these vaccines, and the 
extraordinary efforts to make them widely available, will never 
reach their full potential.
    Fortunately, we are making significant progress. In just 
five months, more than 160 million Americans have received at 
least one dose of a COVID-19 vaccine. Over 85 percent of 
American seniors have received at least one dose.
    And, in the two weeks since FDA authorized Pfizer's vaccine 
for children ages 12 to 15 years old, more than 2 million 
children in this age group received their first dose.
    Thanks to the millions of Americans who have chosen to get 
a safe and effective COVID-19 vaccine, we now have a shot at 
returning to normalcy. So if you want to take off your masks, 
get together with friends and family safely, or go on vacation, 
then join these millions of Americans--and go get vaccinated.
    But here is the bad news: We are not out of the woods yet.
    Although it is easier than ever to get a vaccine, millions 
of Americans remain unvaccinated--and immunization rates in 
many places remain alarmingly low.
    In some States, fewer than 40 percent of the population has 
received even a single dose. And, since peaking in mid-April, 
we have seen a decline in the number of daily doses 
administered across the country.
    This is worrying, and it will take a collective push to 
reach the Biden administration's goal of 70 percent of American 
adults having at least one shot by the Fourth of July.
    That's why this subcommittee has been working tirelessly to 
support vaccination efforts nationwide--including by holding 
today's hearing exploring why some Americans have, so far, not 
gotten vaccinated.
    So why are some people still not getting vaccinated?
    Polling indicates that many unvaccinated Americans have 
safety concerns or unanswered questions about how the vaccines 
work.
    Compounding these problems, rampant misinformation and 
outright lies are spreading on social media platforms--in many 
cases, igniting viral hoaxes and fueling vaccine hesitancy.
    But low vaccine confidence is not the only reason for the 
slowing uptake.
    Some unvaccinated Americans--especially in rural areas and 
communities of color--still confront access challenges, such as 
the inability to take off work or obtain a vaccine from a 
trusted source.
    Additionally, far too many Americans--particularly younger 
adults--do not have the sense of urgency or motivation to go 
get vaccinated.
    Clearly, there is not a one-size-fits-all solution. It 
often takes the right message from the right source, delivered 
at the right time. We will need a variety of strategies and 
incentives to overcome the range of reasons keeping 
unvaccinated Americans on the fence.
    Thankfully, our witnesses here today can shed light on 
these challenges. I look forward to discussing what is working 
and what more needs to be done to increase vaccine confidence 
and uptake.
    At the end of the day, I hope that any American watching 
this hearing who is unsure whether to get vaccinated takes away 
these key facts:
    If you are worried about the vaccines' safety, you should 
know that hundreds of millions of doses have now been 
administered throughout the country. The data is in. The 
vaccines are safe.
    If you are unsure about the vaccines' effectiveness, you 
should know that extensive, realworld data is available and 
shows the vaccines are extraordinarily effective. They prevent 
hospitalization and severe illness, and they save lives.
    And, if you question the benefit of getting vaccinated, you 
should know that fully vaccinated Americans can resume their 
pre-pandemic lives without wearing a mask or physically 
distancing. So, if you get vaccinated, you can start getting 
back to normal life.
    These facts are not in dispute. The only question is how we 
can help unvaccinated Americans get their shots. I am confident 
that if we work together, in a bipartisan fashion, we can build 
trust and increase uptake-and make our shot at normalcy a 
reality.

    Ms. DeGette. And I am also pleased to now yield 5 minutes 
to the ranking member, Mr. Griffith, for an opening statement.
    We have got some background noise somewhere. Everybody 
needs to make sure they are muted.

OPENING STATEMENT OF HON. H. MORGAN GRIFFITH, A REPRESENTATIVE 
         IN CONGRESS FROM THE COMMONWEALTH OF VIRGINIA

    Mr. Griffith. Thank you, Madam Chair. I appreciate that. If 
I may take a brief moment of personal privilege, and just say 
that all of us in Virginia are mourning the passing of former 
Senator John Warner, who served Virginia ably and was a very 
nice man. And so we are mourning his passing overnight.
    That being said, I do appreciate you holding this hearing 
on building COVID-19 vaccine confidence.
    I also want to thank the witnesses for taking the time to 
join us today, especially Dr. Karen Shelton, who is from the 
9th District of Virginia and doing some great work to serve all 
of the people in southwestern Virginia.
    We have come a long way since the first confirmed case of 
COVID, as SARS-CoV-2, which causes COVID, and that was 
diagnosed in January of 2020. Today we have three safe and 
effective vaccines with enough supply for every American aged 
12 and up who wants one. So far, over 61 percent of the U.S. 
population have received at least 1 dose. While we are well on 
our way to returning to normalcy, we still have to work to 
reach the higher rates of vaccinations necessary to eliminate 
the virus. The virus is a significant threat to our public 
health.
    At the beginning of the national vaccination campaign, 
demand exceeded supply. Now the U.S. faces the opposite 
problem: the vaccine supply is plentiful and exceeds the number 
of people in line to be vaccinated. The current unvaccinated 
population varies in its demographics, intentions, and concerns 
about the COVID-19 vaccines.
    There are about 13 percent of individuals who say they will 
definitely not receive the COVID-19 vaccine, yet there is a 
slightly larger share of individuals, 15 percent, who are 
waiting to see how the COVID-19 vaccine is working on other 
people before they receive their shot. These individuals could 
be persuaded to get COVID-19 vaccines by receiving answers to 
their questions and concerns. The leading concerns that 
contribute to vaccine hesitancy are that COVID-19 vaccines are 
not safe as they are said to be and that individuals will 
experience side effects following vaccination.
    Individuals are also concerned about what is actually 
misinformation about infertility and other possible long-term 
effects from getting the COVID-19 vaccines. Trusted messengers 
need to meet these Americans where they are, by listening to 
their concerns and asking permission to share accurate 
information to help them reach the right decision for each 
individual, while reinforcing their safety, dignity, choice, 
and autonomy.
    My home district is a region of rural communities. The 
Centers for Disease Control and Prevention released a study 
last week that people in rural areas are receiving the COVID-19 
vaccines at a lower rate than those in urban areas. My district 
is actually doing fairly well, but this study demonstrates a 
need to identify the barriers in many rural communities and to 
find solutions to remove them.
    Additionally, I have heard from my district on reasons why 
there are lower rates of vaccination. Two common factors 
contributing to the lower rates are a lack of information on 
the technology of the COVID-19 vaccines as well as a lack of 
access to receive the vaccine. The good part about these 
barriers is that they can be removed. We can provide accurate 
information on the decades of development for the mRNA 
technology in two of the vaccines, and that there were no cuts 
in safety requirements, just cuts in red tape.
    We find innovative ways--we can find innovative ways to 
bring vaccines to the people through mobile vaccination 
clinics. Public health practitioners should continue 
collaborating with healthcare providers, pharmacies, employers, 
faith leaders, and other community partners to identify and 
address barriers to COVID-19 vaccination in rural areas and 
other communities.
    Another key group of individuals who benefit from receiving 
the vaccine are children. Yes, COVID-19 is usually milder in 
children as compared to adults, but some children can get very 
sick and suffer complications from COVID-19. It is crucial to 
target messaging and provide accurate information and resources 
to this population so parents can make the best decisions for 
their children.
    According to the CDC, more than a half-million children 
between ages 12 and 15 received a Pfizer vaccine just 1 week 
after it was approved for this age group. This is a great 
accomplishment, and I hope we can continue to work with 
advocacy groups to provide parents with the necessary 
information to make this decision so they are confident in 
getting their children vaccinated. I look forward to hearing 
from our witnesses today on what messages and strategies work 
best to remove barriers to a much higher level of COVID-19 
vaccination throughout the United States so that we can all 
return to normalcy.
    Thank you, Madam Chair, and I yield back.
    [The prepared statement of Mr. Griffith follows:]

             Prepared Statement of Hon. H. Morgan Griffith

    Thank you, Chair DeGette, for holding this hearing on 
building COVID-19 vaccine confidence. I also want to thank the 
witnesses for taking the time to join us today, especially Dr. 
Karen Shelton, who is from my district, and doing some great 
work to serve southwestern Virginia.
    We have come a long way since the first confirmed cases of 
SARS-CoV-2, the virus that caused COVID-19, were diagnosed in 
the U.S. in January 2020. Today, we have three safe and 
effective vaccines with enough supply for every American age 
twelve and up who wants one. So far, over 61 percent of the 
U.S. population has received at least one dose.\1\ While we are 
well on our way to returning to normalcy, we still have work to 
do to reach the higher rates of vaccinations necessary to 
eliminate the virus' significant threat to our public health.
---------------------------------------------------------------------------
    \1\  https://covid.cdc.gov/covid-data-tracker/#vaccinations.
---------------------------------------------------------------------------
    At the beginning of the national vaccination campaign, 
demand exceeded supply. Now, the U.S. faces the opposite 
problem--the vaccine supply is plentiful and exceeds the number 
of people in line to be vaccinated.
    The current unvaccinated population varies in its 
demographics, intentions, and concerns about the COVID-19 
vaccines. There are about 13 percent of individuals who say 
they will ``definitely not'' receive the COVID-19 vaccine.\2\ 
Yet, there is a slightly larger share of individuals, 15 
percent, who are waiting to see how the COVID-19 vaccine is 
working on other people before they receive their shot.\3\ 
These individuals could be persuaded to get COVID-19 vaccines 
by receiving answers to their questions and concerns.
---------------------------------------------------------------------------
    \2\  https://www.kff.org/coronavirus-covid-19/dashboard/kff-covid-
19-vaccine-monitor-dashboard/messages/messages/information.
    \3\  https://www.kff.org/coronavirus-covid-19/dashboard/kff-covid-
19-vaccine-monitor-dashboard/messages/messages/information.
---------------------------------------------------------------------------
    The leading concerns that contribute to vaccine hesitancy 
are that the COVID-19 vaccines are not as safe as they are said 
to be, and that individuals will experience side effects 
following vaccination. Individuals are also concerned about 
what is actually misinformation about infertility and other 
possible long-term effects from getting the COVID-19 vaccines. 
Trusted messengers need to meet these Americans where they are, 
by listening to their concerns and asking permission to share 
accurate information to help them reach the right decision for 
each individual while reinforcing their safety, dignity, 
choice, and autonomy.
    My home district is a region of rural communities. The 
Centers for Disease Control and Prevention (CDC) released a 
study last week that people in rural areas are receiving the 
COVID-19 vaccines at a lower rate than those in urban areas.\4\ 
My district is actually doing pretty well, but this study 
demonstrates a need to identify barriers many rural communities 
are facing and find solutions to remove them.
---------------------------------------------------------------------------
    \4\  https://www.cdc.gov/mmwr/volumes/70/wr/mm7020e3.htm?s--
cid=mm7020e3--x.
---------------------------------------------------------------------------
    Additionally, I have heard from my district on reasons why 
there are lower rates of vaccination. Two common factors 
contributing to the lower rates are a lack of information on 
the technology of the COVID-19 vaccines as well as a lack of 
access to receive the vaccine. The good part about these 
barriers is that they can be removed. We can provide accurate 
information on the decades of development for the mRNA 
technology in two of the vaccines and that there were no cuts 
in safety requirements, just cuts in red tape. We can find 
innovative ways to bring vaccines to the people through mobile 
vaccination clinics. Public health practitioners should 
continue collaborating with health care providers, pharmacies, 
employers, faith leaders, and other community partners to 
identify and address barriers to COVID-19 vaccination in rural 
areas or other communities.
    Another key group of individuals who benefit from receiving 
the vaccine are children. Yes, COVID-19 is usually milder in 
children as compared to adults, but some children can get very 
sick and suffer complications from COVID-19. It is crucial to 
target messaging and provide accurate information and resources 
to this population so parents can make the best decision for 
their children. According to the CDC, more than half a million 
children between ages 12 to 15 received a Pfizer vaccine just 
one week after it was approved for this age group. This is a 
great accomplishment, and I hope we can continue to work with 
advocacy groups to provide parents with the necessary 
information to make this decision so that they are confident in 
getting their children vaccinated.
    I look forward to hearing from our witnesses today on what 
messages and strategies work best to remove barriers to a much 
higher level of COVID-19 vaccination throughout the U.S. so 
that we can all return to normalcy.
    Thank you, Madam Chair, I yield back.

    Ms. DeGette. The gentleman yields back. The Chair now 
recognizes the chair of the full committee, Mr. Pallone, for an 
opening statement for 5 minutes.

OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE 
            IN CONGRESS FROM THE STATE OF NEW JERSEY

    Mr. Pallone. Thank you, Chairwoman DeGette, and thanks for 
this continued effort of the Oversight and Investigations 
Subcommittee to do critical oversight of the COVID-19 
vaccination campaign in our country.
    Through the collective efforts of the American people over 
the past year, we have overcome the initial challenges of 
developing, producing, and distributing safe and effective 
vaccine. But now we face the more difficult task of reaching 
those Americans who have yet to embrace this important tool.
    The fact is, vaccine doubts and fears are not new 
challenges. In fact, this committee has a history of addressing 
these issues in a bipartisan manner. In 2019, for example, we 
held a hearing on the measles outbreak and renewed our efforts 
to provide resources to support vaccine confidence and uptake 
throughout the Nation. And we followed that with bipartisan 
legislation led by Representative Schrier. It finally passed 
late last year. And that bill authorized a campaign to educate 
and inform Americans on the benefits of vaccine. Earlier this 
year we significantly expanded upon those activities in the 
American Rescue Plan, which invested $160 billion in COVID-19 
response efforts, and that included $20 million in dedicated 
resources for vaccine distribution clinics, mobile units, and 
an awareness campaign.
    So, while these issues of awareness and confidence are not 
new, the gravity of the challenges facing us today is 
unprecedented because of the pandemic. Millions are stricken 
ill, more than a half a million lives tragically lost, and the 
enormous toll on the mental and financial well-being of 
Americans.
    But in the face of all this, we have risen to the occasion. 
We have worked together at a Federal, State, and local level 
through public and private partnerships and across political 
lines to develop several safe and effective vaccines. And we 
have solved supply issues and continue our work to ensure 
equitable distribution. And the result of this collective 
effort, if you are 12 years or older and you want a COVID 
vaccine, there is one waiting for you now.
    So I just wanted to mention not only decisive action by 
Congress and the Biden administration's leadership, now we have 
more than 116 million Americans who have received at least 1 
dose of the vaccine, and more than 130 million of those are 
fully vaccinated.
    So the number of new daily cases and deaths have fallen 
significantly since the start of the year. This is, obviously, 
cause for celebration. But we can't stop until more Americans 
are protected from COVID-19, and that is what we are going to 
hear about today. What are the next steps?
    What we know so far is there is no single factor causing 
eligible unvaccinated Americans to sit on the sidelines. Some 
people are skeptical of the vaccine's safety or worry about 
long-term effects. Some have been misled by bogus and 
misleading information. Still others have a distrust of the 
medical system or the government's role in developing vaccines. 
And many Americans, particularly in rural communities and in 
communities of color, are open or even eager to be vaccinated, 
yet continue to face barriers to access. So this--there is not 
one reason, Madam Chair, why some Americans remain 
unvaccinated, and there is no single solution.
    But the encouraging news is that our efforts have been 
successful so far. Poll after poll shows increasing confidence 
in the COVID-19 vaccines. And that progress, though, did start 
to plateau relatively recently. So that is why we have to 
redouble our efforts to understand who could be reached and how 
best to reach them. We have to do a lot of hard work, really, 
to just go out and meet people where they are.
    As we enter this vaccine campaign and its new aspects of 
it, I am pleased to be working alongside our Republican 
colleagues to encourage Americans to roll up their sleeves. I 
think that if we really want to be--go back to normalcy, we 
need every eligible American to make the right choice, get a 
shot, protect themselves, their community, and the Nation.
    So, again, I am just looking forward to the witnesses. I 
want to say to everyone--they may already know--that Chairwoman 
DeGette has been outspoken in continuing this oversight of the 
vaccine campaign, and today is a manifestation of that.
    And I appreciate your prioritizing this in your 
subcommittee. It is very important.
    And thanks to Morgan Griffith, as well.
    I yield back.
    [The prepared statement of Mr. Pallone follows:]

             Prepared Statement of Hon. Frank Pallone, Jr.

    Today we continue our critical oversight of the COVID-19 
vaccination campaign in the United States--our best shot at 
containing the virus and beating this pandemic.
    Through the collective efforts of the American people over 
the past year, we have overcome the initial challenges of 
developing, producing, and distributing safe and effective 
COVID-19 vaccines. But we now face the difficult task of 
reaching those Americans who have yet to embrace this life-
saving tool.
    Vaccine doubts and fears are not new challenges. In fact, 
this committee has a history of addressing these issues in a 
bipartisan manner.
    In 2019, for instance, we held a hearing on the measles 
outbreaks and renewed our efforts to provide resources to 
support vaccine confidence and uptake throughout the Nation. We 
followed that with bipartisan legislation led by Representative 
Schrier, finally passed late last year. The legislation 
authorized a campaign to educate and inform Americans on the 
benefits of vaccines and increase our understanding of how best 
to reach unvaccinated individuals.
    Earlier this year, we significantly expanded upon those 
activities in the American Rescue Plan, which invested $160 
billion in COVID-19 response efforts. This included $20 billion 
in dedicated resources for vaccine distribution and 
administration, vaccination clinics, mobile vaccination units, 
and a vaccine awareness campaign.
    While issues surrounding vaccine confidence are not new, 
the gravity of the challenges facing us today is unprecedented 
as we continue to combat this pandemic. Millions stricken ill. 
More than half a million lives tragically lost. And enormous 
tolls taken on the mental and financial well-being of too many 
Americans.
    In the face of all this pain and hardship, this Nation has 
again risen to the occasion. We have worked together at the 
Federal, State, and local levels; through public and private 
partnerships; and across political lines to develop several 
safe and effective vaccines. We have also solved supply issues 
and continue our work to ensure equitable distribution 
throughout the country.
    As a result of this collective effort, if you are 12 years 
or older and you want a COVID-19 vaccine, there is one waiting 
for you.
    And, thanks to decisive action by Congress, combined with 
the Biden administration's bold leadership and determined 
commitment to science, more than 160 million Americans have 
received at least one dose of a vaccine, and more than 130 
million of those are fully vaccinated.
    Because of this, the number of new daily cases and deaths 
have fallen significantly since the start of the year.
    This is cause for celebration. Our efforts, however, must 
not stop until more Americans are protected from COVID-19. And, 
as we will hear today, more work is needed.
    Today, there is no single factor causing eligible, 
unvaccinated Americans to sit on the sidelines. Some people are 
skeptical of the vaccines' safety or worry about long-term side 
effects. Some have been misled by bogus and misleading 
information that pollutes social media. Still others have an 
understandable distrust of the medical system or the 
government's role in developing the vaccine. Many more 
Americans--particularly in our rural communities and in 
communities of color--are open, or even eager, to be 
vaccinated, yet continue to face barriers to access.
    Just as there is no one reason why some Americans remain 
unvaccinated, there is no single solution to building vaccine 
confidence to get more people vaccinated.
    The encouraging news is that our efforts have been 
successful so far: Poll after poll has shown increasing 
confidence in COVID-19 vaccines since the first one was 
authorized more than five months ago. But that progress has 
begun to plateau while millions of unvaccinated Americans still 
remain vulnerable to the virus.
    That's why we must redouble our efforts to understand who 
can be reached and how best to reach them. We must do the hard 
work of meeting people where they are.
    The importance of this work cannot be overstated. As we 
enter a critical juncture of our vaccination campaign, I am 
pleased to be working alongside our Republican colleagues to 
encourage Americans to roll up their sleeves.
    If we are to have a true shot at normalcy, we need every 
eligible American to make the right choice: Get a shot and 
protect themselves, their community, and the Nation.
    Thank you to our witnesses for being here today, I yield 
back.

    Ms. DeGette. Thank you so much, Mr. Chairman, and the Chair 
is now pleased to recognize the ranking member of the full 
committee, Mrs. McMorris Rodgers, for 5 minutes for an opening 
statement.

      OPENING STATEMENT OF HON. CATHY McMORRIS RODGERS, A 
    REPRESENTATIVE IN CONGRESS FROM THE STATE OF WASHINGTON

    Mrs. Rodgers. Thank you, Madam Chair and Republican Leader 
Griffith. Thanks to the innovative work of the private sector, 
the Trump administration, Operation Warp Speed, and the 
continued work of the Biden administration, America has led the 
way with safe and effective vaccines. It is a historic and 
remarkable example of American innovation that is giving people 
the courage to dream again.
    As we work to get a vaccine to every person who wants one, 
building trust and confidence is foundational. Our goal today 
is to equip people with the information they need to make the 
best decisions for themselves, their children, and their 
families. That is the American way: to lead with trust, not 
fear.
    So I want to thank our distinguished panel for being here 
to share their expertise and answer questions people may have 
about the COVID-19 vaccines.
    I would now like to yield the remainder of my time to Dr. 
John Joyce, who is leading, with other doctors in Congress, to 
encourage people to talk to their doctors about the safety of 
COVID-19 vaccines.
    [The prepared statement of Mrs. Rodgers follows:]

           Prepared Statement of Hon. Cathy McMorris Rodgers

    Thank you, Chair DeGette and Republican Leader Griffith.
    Thanks to the innovative work of the private sector, the 
Trump administration, and Operation Warp Speed...
    ... America has led the way with safe and effective 
vaccines.
    It's a historic and remarkable example of American 
innovation that is giving people the courage to dream again.
    As we work to get a vaccine to every person who wants 
one....
    ... building trust and confidence is foundational.
    Our goal today is to equip people with the information they 
need to make the best decisions for themselves, their children, 
and their families.
    That is the American way--to lead with trust, not fear.
    So I want to thank our distinguished panel for being here 
to share their expertise....
    ... and answer questions people may have about the COVID-19 
vaccines.
    I would now like to yield the remainder of my time to Dr. 
John Joyce, who is leading with other doctors in Congress to 
encourage people to talk to their doctors about the safety and 
efficacy of COVID-19 vaccines.

    Mr. Joyce. I would like to thank------
    Ms. DeGette. The gentleman is recognized.
    Mr. Joyce. I would like to thank Ranking Member McMorris 
Rodgers for yielding me time, and for Chair DeGette and Ranking 
Member Griffith for holding this hearing on such an important 
topic.
    Safe and effective vaccines are critical tools as our 
Nation seeks to eradicate the COVID-19 pandemic and restore our 
normal way of life as Americans. Thanks to the success of 
Operation Warp Speed under President Donald Trump's leadership, 
multiple safe vaccines were developed and produced in record 
time.
    As a physician, I believe that every American who wants a 
vaccine should be able to get one, and this choice must remain 
between an individual and their doctor and pharmacist. 
Alongside other doctors in Congress, I have encouraged every 
American to talk to their own doctor or healthcare provider or 
pharmacist. Discuss the vaccine. I chose to get the vaccine as 
soon as it was available to me. Doctors, nurses, and 
pharmacists nationwide recommend that the COVID-19 vaccine is 
received by their patients, and over 90 percent of doctors in 
the U.S. have already chosen to become vaccinated.
    There are many reasons that some people, even those who 
want to be vaccinated, still have not been vaccinated. This is 
a concern to all of us. These include those who do not have the 
time; those who do not have the ability to sign up to get a 
vaccine; and those who are concerned about taking time off from 
work, especially if they have side effects; those who still 
have questions about concerns of the safety and effectiveness 
of vaccines. These are all individuals who have yet to be 
vaccinated.
    We have also heard about access challenges, including for 
those who live in rural areas of the country. For instance, 
there are people who do not have internet, a computer, or a 
smartphone. They don't know how to sign up for an appointment 
without those resources. We have also heard instances of people 
who live far away from the closest place offering COVID-19 
vaccines. These are some of the hurdles that need to be 
overcome so that those who live in rural areas are not 
disproportionately impacted in their ability to get a COVID-19 
vaccine, simply because of where they live.
    Widespread vaccination is the key to restoring our freedom 
and getting our communities back to normal. I look forward to 
working with the members of this committee in achieving these 
goals.
    Thank you, and I yield back, Madam Chair.
    Ms. DeGette. I thank the gentleman. Does the gentlelady 
yield back, as well?
    Mrs. Rodgers. Yes, Madam Chair, I yield back the remainder 
of our time.
    Ms. DeGette. Thank you. OK, thank you.
    The Chair will ask unanimous consent that all Members' 
written opening statements be made part of the record.
    And without objection, so ordered.
    I am now going to introduce our witnesses for today's 
hearing. But before I do, I just want to note so often--just 
yesterday, for example, I was in a panel discussion where 
people were lamenting the lack of bipartisanship in Congress. 
This is the Oversight Subcommittee of Energy and Commerce, and 
I just want to say how anybody watching this should recognize 
that, in a strong bipartisan way, the leadership of this 
committee, which has oversight over healthcare policy in the 
U.S. Congress, is bipartisan in their strong urging of all 
Americans to get the vaccine. And I want to thank my colleagues 
for their strong commitment, and Dr. Joyce, and all the other 
doctors on the committee, for being so outspoken.
    With that, I want to introduce our witnesses.
    Our first witness is Nick Offerman, and my sheet here says 
``Actor and Woodworker.'' And I would like to say welcome. I am 
a big fan, and I know the other members of this committee are, 
as well.
    Dr. Saad Omer, who is the director of Yale Institute for 
Global Health at Yale University.
    Dr. J. Nadine Gracia, executive vice president and chief 
operating officer of the Trust for America's Health.
    Amy Pisani, executive director of Vaccinate Your Family.
    And now I am going to recognize Mr. Griffith to introduce 
our last witness.
    Mr. Griffith. Thank you, Madam Chair.
    Ms. DeGette. Mr. Griffith, you are muted.
    Mr. Griffith. Thank you, Madam Chair, I appreciate it.
    It is my pleasure to welcome Dr. Karen Shelton. A native of 
Bristol, Virginia, she received her bachelor of science in 
biology from Wake Forest and her doctor of medicine from the 
University of Virginia. She practiced for 19 years in OB/GYN, 
as an OB/GYN, before joining the public sector. Today she 
serves the Virginia Department of Health as director of the 
Mount Rogers Health District and acting director of Lenowisco 
and Cumberland Plateau Districts.
    And Dr. Shelton, we are glad to have you here today, and so 
proud of the work you are doing for southwestern Virginia. 
Thank you.
    Ms. DeGette. I thank the gentleman.
    To the witnesses, I know you are all aware that the 
committee is holding an investigative hearing. And when we do 
so, we have the practice of taking testimony under oath.
    Does any witness have an objection to taking--to testifying 
under oath today?
    Let the record reflect the witnesses have responded no.
    The Chair will then advise you that, under the rules of the 
House and under the rules of this committee, you are entitled 
to be accompanied by counsel. Does any witness request to be 
accompanied by counsel today?
    Let the record reflect the witnesses have responded no.
    And if you would, then, would you [audio malfunction] sworn 
in?
    [Witnesses sworn.]
    Ms. DeGette. Let the record reflect the witnesses responded 
affirmatively.
    And you are now under oath and subject to the penalties set 
forth in title 18, section 1001 of the U.S. Code.
    The now--the Chair will now recognize our witnesses for 5-
minute summaries of their written statements.
    As you can see, there is a timer on the screen that counts 
down your time, and it turns red when your 5 minutes has come 
to an end.
    And so now I would like to start with our first witness.
    Mr. Offerman, you are recognized for 5 minutes.

  STATEMENTS OF NICK OFFERMAN, ACTOR AND WOODWORKER; SAAD B. 
 OMER, Ph.D., DIRECTOR, YALE INSTITUTE FOR GLOBAL HEALTH, YALE 
 UNIVERSITY; J. NADINE GRACIA, M.D., EXECUTIVE VICE PRESIDENT 
 AND CHIEF OPERATING OFFICER, TRUST FOR AMERICA'S HEALTH; AMY 
 PISANI, EXECUTIVE DIRECTOR, VACCINATE YOUR FAMILY; AND KAREN 
SHELTON, M.D., DIRECTOR, MOUNT ROGERS HEALTH DISTRICT, VIRGINIA 
                      DEPARTMENT OF HEALTH

                   STATEMENT OF NICK OFFERMAN

    Mr. Offerman. Thank you, Subcommittee Chairwoman DeGette, 
Ranking Member Griffith, and members of the subcommittee. Thank 
you so much for this opportunity to discuss this issue of 
vaccines.
    As an actor, author, and woodworker, I will not be offering 
medical advice today. I will leave that to the scientists and 
medical experts on the panel, also known as the smart people. 
Instead, I would like to lead with my ignorance in these 
matters to represent the rest of the citizens who are not 
epidemiologists and doctors, but feet-on-the-ground, hands-in-
the-dirt people across our country whose lives and livelihoods 
have taken a pounding from this pandemic.
    Ignorance is an area in which I can claim some authority. 
And it is from that perch I would like to communicate that I am 
not only an actor and author and woodworker, but I am also a 
small business owner and a proud Midwesterner. It is from those 
personal perspectives I would like to communicate why it is so 
important we all get vaccinated.
    Now, I understand that some Americans with experiences and 
backgrounds similar to my own are hesitant to get the vaccine. 
So I wanted to jump on this opportunity to get a positive 
message out to them. There is nothing more positive than the 
vaccine itself. I even hear people refer to it as a miracle. 
Now, this makes sense, given the magnitude of death and 
destruction that the virus has caused and the speed with which 
the vaccine prevents that death and destruction once it is 
administered.
    But I don't think that ``miracle'' is quite accurate. A 
miracle is something inexplicable that appears from nowhere, 
sent by unseen forces. The vaccine is not a miracle. The 
vaccine is a gift from the world's greatest scientists and 
thinkers and activists. It is the product of human ingenuity, 
the absolute pinnacle of achievement created out of whole cloth 
by a bunch of dang geniuses who have saved us from endless 
death and destruction by solving a complex problem of 
microbiology in record time.
    Now, as we have heard, unfortunately, the very expedience 
with which the vaccine has arrived is also a source of 
confusion, causing people to fear that it was rushed. Well, you 
are damn right, folks. It was rushed. It is a pandemic. But you 
can rest assured the hustle was not applied to the safety of 
the vaccine. The science didn't arrive overnight. The science 
is based on 40 years of work. The hustle was just applied to 
getting that science to you and me by bypassing the usual 
bureaucratic hurdles, the red tape.
    So when the pandemic hit, all of my own acting work was 
canceled. But after a few months we were able to start up 
again, carefully shooting TV and film. And the reason for this 
is because, on each show, about 200-odd crew members looked 
each other in the eye, and we all agreed to behave like we 
loved each other. We were ignorant to the medical science, so 
we agreed to trust the world's smartest doctors and follow 
every strict protocol so that we could go back to making our 
livings and taking care of our families. Three different shows 
I completed because we listened to the doctors and we thought 
about each other.
    I also run a small custom furniture outfit in Los Angeles 
called Offerman Woodshop that was crippled by the pandemic. The 
vaccine is going to save our business. We at Offerman Woodshop 
also help run a nonprofit called Would Works that trains 
individuals experiencing homelessness to be wood workers. Now, 
because of the heightened medical vulnerability of the unhoused 
population we serve, that program has been officially closed 
since March of 2020, losing us a year of revenue and leaving 
our artisans out in the cold. But now, due to the ubiquity of 
vaccines in L.A. County, we are poised to relaunch all of our 
programs this summer.
    Finally, I am close with my family of 38 people in the 
village of Minooka, Illinois. Unfortunately, because of 
disinformation from social media platforms with no oversight, a 
few of them have refused masks from the get-go, and they now 
refuse the vaccine. We also have a couple of immunocompromised 
nephews, which means we all have to avoid the antivaxxers, whom 
we love, for the safety of the rest of the family. It breaks my 
heart, and we can't wait when we--so we can all be reunited.
    On January 5th of this year, Los Angeles County had 8,098 
people hospitalized with COVID-19. A few days ago that number 
was 319. That is more than 96 percent lower in just 4\1/2\ 
months. That is the gift of this vaccine.
    I urge anyone who has not yet been vaccinated to catch my 
enthusiasm and hear the smart people who are about to speak. 
Medicine doesn't care who you voted for. We amazing humans have 
created a vaccine that serves the common good. The vaccine 
doesn't take sides, unless you count alive versus dead.
    I am so sincerely grateful to the committee for hearing me 
today. Thank you very kindly.
    [The prepared statement of Mr. Offerman follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Ms. DeGette. Thank you so much. I don't think any of us 
could have said it better. But now it is time for the smart 
people to talk, and I am first going to recognize Dr. Omer for 
5 minutes.
    Doctor?

                STATEMENT OF SAAD B. OMER, Ph.D.

    Dr. Omer. Hi, my name is Saad Omer, I am the director of 
Yale Institute for Global Health, and it is my privilege to be 
here. Thank you.
    With the U.S. vaccine supply outpacing the number of doses 
being administered, there is no shortage of diagnosis for what 
ails the--or what are the barriers to increasing this coverage 
even further.
    However, 20 years of research on vaccine acceptance and 
data from this pandemic show that the reality is a bit nuanced. 
And a lot of these things were appropriately covered by the 
various Members who spoke before me. Here are a few 
observations based on this research.
    First of all, we must recognize that vaccine acceptance 
behavior is a spectrum. On the one end, we--of this spectrum--
are individuals who actively demand vaccines, and on the other 
hand are people who would refuse vaccines in all situations. 
Even if you put Mom and apple pie in a shot, some people would 
refuse it.
    Then, you know, in this pandemic, active vaccines--seekers 
were so vociferous that it created the impression that, as soon 
as the supply improves and major delivery bottlenecks are 
resolved, there will be persistent increases in immunization 
rates until herd immunity is reached. However, for several 
weeks there is more vaccine available in the U.S. than there 
are seekers.
    Fortunately, we must recognize that strict refusers are a 
relatively small group, estimated to be approximately 10 to 13 
percent of eligible adults. This is larger than other vaccines. 
But nevertheless, it is not 20, 30, 40 percent of the 
population.
    There is much larger--there is a much larger group of so-
called fence sitters, who have questions about the vaccine but 
can be persuaded with the right interventions.
    And then there are those who do not have a lot of concern 
about immunization but are not particularly enthusiastic about 
it, either. They don't wake up every morning and think about 
vaccines, unlike some of us, whose job is to think about 
vaccines when we wake up every morning. So--but they are still 
susceptible to--amenable to nudges, and that is good news.
    So, given the range of enthusiasm about vaccines, there is 
an interplay between vaccine demand and vaccine access. Those 
who actively demand vaccines go the extra mile of--for getting 
it, sometimes traveling long distances to be vaccinated. 
However, now that most of the vaccine enthusiasts have been 
immunized, practical issues such as how easy it is to get an 
appointment have become relatively prominent reasons for 
nonvaccination.
    So we know from data that ethnic and racial minority groups 
in the U.S. have been disproportionately harmed by the 
pandemic. African Americans, for example, had a COVID-19 
mortality rate twice that of White Americans. And many nascent 
efforts to bring vaccines directly to communities, including 
programs that work with local, civic, and religious leaders, 
are playing a role in addressing barriers for getting 
vaccinated. These programs need to be sustained and scaled up.
    Getting communities engaged with the vaccine will be easier 
with a scalable template. And I have proposed an approach that 
involves pairing a community validator--for example, a church 
leader--with an expert--for example, a physician--with roots in 
the same community, and replicating this model across the 
country.
    Another group that the data have identified are 
conservative men, who have emerged as another group 
particularly hesitant to vaccines against COVID-19. Trying to 
persuade this group through messages that don't speak to their 
values could be counter-productive. And we have done some 
research on how to speak to people who emphasize liberty, and 
there are ways to doing so.
    Overall, vaccines have traditionally enjoyed bipartisan 
support, and our data show that support is important in 
instilling and increasing confidence in COVID-19 vaccines, as 
well.
    One of the things that I would highlight that--irrespective 
of the reason for nonvaccination, healthcare providers are the 
most trusted source of vaccine information, even among those 
who are highly hesitant. A strong endorsement by a healthcare 
provider is a consistent predictor of vaccine acceptance. And 
so how do we make--enable our healthcare providers to do so?
    And one idea is to have a national continued medical 
education program that trains them in these up-to-date, 
evidence-based communication methods that have been developed 
and evaluated through Federal funding over the last 5, 10 
years, generally around vaccines, and then scale it up at the 
national level. Yale is developing such a program, and others 
are welcome to do so, as well.
    While physician and healthcare providers are best suited to 
persuade vaccine-hesitant individuals, having an effective 
vaccine conversation requires time. And currently, doctors can 
charge for administering a vaccine, but they--if the 
vaccination doesn't happen, there is no reimbursement. So, 
since they cannot predict the future, it would be useful to 
make this counseling itself reimbursable.
    So I will stop here and would be happy to answer questions 
as my turn comes.\1\
---------------------------------------------------------------------------
    \1\ The prepared statement of Dr. Omer has been retained in 
committee files and is available at https://docs.house.gov/meetings/IF/
IF02/20210526/112684/HHRG-117-IF02-Wstate-OmerS-20210526-U1.pdf.
---------------------------------------------------------------------------
    Ms. DeGette. Thank you so much, Doctor. I am now pleased to 
recognize Dr. Gracia for 5 minutes.
    Dr. Gracia. Thank you----
    Ms. DeGette. Doctor?

              STATEMENT OF J. NADINE GRACIA, M.D.

    Dr. Gracia. Thank you, good morning. My name is Nadine 
Gracia, and I am the executive vice president and chief 
operating officer at Trust for America's Health, which is also 
known as TFAH.
    TFAH is a nonprofit, nonpartisan public health policy, 
research, and advocacy organization which has focused attention 
on the importance of a strong and effective public health 
system as well as on making health equity foundational to 
policymaking at all levels.
    I am honored and very pleased to be before you today to 
discuss the issue of vaccine confidence during this critically 
important time in our Nation.
    By way of background, I previously served as the Deputy 
Assistant Secretary for Minority Health and the Director of the 
Office of Minority Health at the U.S. Department of Health and 
Human Services.
    The COVID-19 pandemic is an unprecedented and devastating 
pandemic for the U.S. and the world. While we have certainly 
seen disparities in public health emergencies in the past, the 
COVID-19 pandemic has greatly exposed our Nation's systemic 
inequities. Prior to the pandemic, communities of color already 
faced inequitable opportunities for health and well-being. And 
we urge policymakers not to lose sight of the need for 
continued outreach, education, and access for communities that 
are both at higher risk from COVID-19, and may have greater 
barriers to vaccination.
    In October of last year, TFAH, in partnership with the 
National Medical Association and UnidosUS, cohosted a national 
convening on building trust in and access to a COVID-19 vaccine 
in communities of color and Tribal nations. As an outcome of 
the convening, we published a brief in December with 
recommendations for policy action. Our recommendations 
addressed six key areas:
    First, ensuring the scientific fidelity of the vaccine 
development process.
    Second, meaningfully engaging and providing resources to 
trusted community organizations and networks in vaccination 
efforts.
    Third, providing communities the information they need to 
understand the vaccine, make informed decisions, and deliver 
messages from trusted messengers and pathways.
    Fourth, ensuring that it is as easy as possible for people 
to be vaccinated. And vaccines must be delivered in community 
settings that are trusted, safe, and accessible.
    Fifth, ensuring complete coverage of the cost associated 
with the vaccine.
    And sixth, funding and requiring disaggregated data 
collection and reporting.
    Now, while these recommendations are most immediately 
applicable to the COVID-19 vaccine, many will remain essential 
beyond this pandemic and will be important in earning vaccine 
trust in these communities into the future.
    While the focus of this hearing is on vaccine confidence, 
the data also show that access remains an issue for many 
populations. A recent Kaiser Family Foundation survey 
highlighted that Latinos are most eager to get the vaccine but 
continue to face barriers in access. In another example, 
vaccination sites may be inaccessible for people who are 
homebound, including many older adults and people with 
disabilities.
    TFAH released an issue brief in March on ensuring that this 
population and their caregivers are prioritized for 
vaccination. The report highlights innovative programs such as 
one in the chair's home State of Colorado, where the Health 
Department partnered with a service that provides primary care 
at home to administer thousands of doses of the vaccine to 
people who are homebound. Leveraging community partnerships and 
trusted services that engage with the population can provide 
important lessons for building community resilience before the 
next emergency.
    Some of the COVID-19 vaccination funding provided in the 
last Congress and through the American Rescue Plan Act has been 
targeted to increasing vaccine confidence and access in 
communities of color in rural and underserved communities. And 
it appears that this focus is paying off. Last week the White 
House announced that, after months of receiving a 
disproportionately smaller share of vaccinations, 51 percent of 
those vaccinated in the U.S. were people of color in the prior 
2 weeks. We urge Congress and policymakers to carry forward 
these lessons for funding and preparedness programs to ensure 
equity is central to the responses.
    In closing, we urge Congress to build upon the lessons of 
the pandemic. We must modernize public health infrastructure 
and workforce. We must invest in community organizations that 
work with underserved populations and maintain these 
partnerships long after the pandemic. And we must provide long-
term investments, both in the systems that develop and deliver 
the vaccines and those that build bridges to the communities 
that are most affected. Now certainly is the time.
    Thank you.
    [The prepared statement of Dr. Gracia follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Ms. DeGette. Thank you so much, Doctor.
    Ms. Pisani, now I am very pleased to recognize you for 5 
minutes for your opening statement.

                    STATEMENT OF AMY PISANI

    Ms. Pisani. Thank you, Chairwoman DeGette and Ranking 
Member Griffith and members of the subcommittee, including 
Congressman Burgess, who has hosted several Vaccinate Your 
Family briefings over the years on vaccines and disinformation, 
as well. My name again is Amy Pisani, and I have had the 
pleasure to serve as the executive director of Vaccinate Your 
Family for the past 25 years.
    Vaccinate Your Family was founded by former First Lady 
Rosalynn Carter and former First Lady of Arkansas Betty 
Bumpers, who was the wife of Senator Dale Bumpers. That was 30 
years ago this summer. And they founded our organization on the 
heels of a massive measles outbreak that took the lives of many 
children and hospitalized over 10,000 people. Our founders 
traveled to every State in the Nation, building statewide 
immunization coalitions which continue to thrive. And one thing 
was clear to them back then and remains true today: Vaccination 
efforts need Federal support and guidance for certain, but they 
are best implemented at the local level, where community 
members can work together to make the greatest impact on their 
neighbors.
    I want to take this moment to thank the Members of Congress 
and both administrations for the work that you have done to 
protect and promote public health and to really protect us and 
keep us from economic ruin while we awaited those lifesaving 
vaccines that Mr. Offerman so clearly, generously spoke about.
    As you know, everyone is now eligible at 12 years and 
older, and families are being tasked with making a monumental 
decision. So--whether to vaccinate their family members of all 
ages, and where to go to access those vaccines, which is not 
always a simple procedure in this country.
    Now, I know that having access to science-based information 
is really essential to building confidence, and that is what we 
are going to be talking about a lot today. I actually 
experienced hesitancy while I was pregnant with my first child 
20 years ago, in the year 2000. Just after a few years in my 
role as executive director, I attended the House Committee on 
Oversight and Government Reform hearings where Andrew 
Wakefield, who has since been stripped of his medical license, 
was given the opportunity to share his now-retracted Lancet 
study that proclaimed that MMR vaccines caused autism. And that 
became a spotlight of the Nation.
    As a pregnant person who was really learning the science of 
vaccines still, I became susceptible to the gravitas of 
Wakefield, and I became bewildered by the data he was 
presenting to members of the committee. But fortunately, I was 
able to reach out to Vaccinate Your Family's board members, 
including Dr. Walter Orenstein and Dr. Paul Offit, renowned 
vaccine experts, and they answered each one of my questions 
with patience and compassion. And they helped me to move from 
hesitancy to confidence by the time my child's vaccines were 
due.
    So my confidence was built on information provided by 
experts that I trusted, and from that experience I became even 
more committed to ensuring that our organization builds 
educational and social media efforts that bring the science to 
the public so that they, too, can make informed decisions on 
vaccines for their own families.
    Now, we have learned the two key tenets to building 
confidence are transparency and respect. Since the beginning of 
the pandemic, our organization has focused not on encouraging 
people to just blindly accept an eventual vaccine but to learn 
about the safety systems in place that ensure the ongoing 
safety of our vaccines.
    We called for companies developing vaccines to hit all the 
usual milestones in the development, keeping in mind that some 
steps could be conducted simultaneously, and that would speed 
up the process without compromising their safety or efficacy, 
as many of the Members have discussed this morning.
    We also called on the FDA to adhere to the normal review 
process, ensuring that each vaccine would be vetted in the 
public eye, as it would be for any other product.
    And to build trust in COVID-19 and routine vaccines, we are 
collaborating with who we consider--who we think are trusted 
stakeholders in their communities, one of which is the Good 
Health WINs program, Women's Immunization Networks. And we are 
doing so with the National Council of Negro Women to reach 
their 12 million members with vaccine resources for their 
family, friends, and neighbors.
    We have also begun working with Dia de la Mujer Latina, to 
not just translate materials into Spanish but to create 
culturally relevant resources that engage and motivate Spanish-
speaking people.
    We are also continuing to work with immunization coalitions 
to develop new programs to raise vaccination rates in both 
rural and conservative areas, enlisting new partners, such as 
agricultural extension workers and evangelical leaders.
    So, Congress, you can help us on the path to good 
confidence to--to confidence by supporting great public health 
policies.
    First, let's improve access. Plain and simple, poor 
children and those in rural areas are up to a third less likely 
to receive some vaccine. And among adults, we spend $27 billion 
preventing--on vaccine-preventable diseases that could have 
been prevented through vaccines.
    Public health officials need good, timely data to evaluate 
their efforts, and you can help us by supporting four bills, 
which--many of which are sponsored by E&C Committee members, 
actually: the Strengthening Vaccines for Children Act; the 
Black Maternal Health Momnibus Act; the Helping Adults Protect 
Immunity, or HAPI, Act, and that helps eliminate cost-sharing 
for vaccines for Medicaid beneficiaries; and the Immunization 
Infrastructure Modernization Act.
    Finally, it is important to remember that people need other 
lifesaving vaccines. And I do urge the public to come visit 
VaccinateYourFamily.org, learn about our Don't Skip Vaccines 
and our Good Health WINs collaborations, and for educational 
materials on all diseases.
    And for Congress, we have a special report that we write 
for you every year called the State of the ImmUnion, which is 
on our website.
    Thank you so much for the opportunity to testify. I look 
forward to answering questions.
    [The prepared statement of Ms. Pisani follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Ms. DeGette. Thank you so much. And I urge all the Members 
to read your report, because it is an excellent snapshot of 
where we are. And now the Chair is very pleased to recognize 
Dr. Shelton.
    You are recognized for 5 minutes for an opening statement.

                STATEMENT OF KAREN SHELTON, M.D.

    Dr. Shelton. Good morning, Chairwoman DeGette, Congressman 
Griffith, and members of the committee. My name is Dr. Karen 
Shelton, and since 2016 I have been the director of the Mount 
Rogers Health District with the Virginia Department of Health. 
I am also acting director for a Lenowisco and Cumberland 
Plateau Health Districts. I am honored to be with you today to 
discuss the importance of vaccines and vaccine education, as 
well as the role that local health departments like mine play 
in improving vaccines, access, and acceptance.
    We are very proud of our work in the far southwest region 
of Virginia, in Mr. Griffith's district. I serve a geographic 
area with 16 localities that is larger than Connecticut. End to 
end, it takes me about 4 hours to drive across our 
jurisdiction, with many communities that lack access to 
broadband internet or even cell service. Situated in the heart 
of Appalachia, practicing public health in southwest Virginia 
might look different from public health in other parts of the 
country. But what all local health departments have in common 
is the shared goal of protecting and promoting the health of 
our communities.
    The response to COVID-19 pandemic has been the epitome of 
what public health does for our community. We know our 
communities well, including the assets and barriers to care, 
distinct local culture, the industries and living situations 
that might pose challenges, as well as the community-level 
partners and organizations that must be included to be 
successful. We live in our community and serve our neighbors.
    In the fall of 2020, prior to the authorization of COVID-19 
vaccines, our region experienced a surge of cases, 
hospitalizations, and deaths. Our area already was experiencing 
disproportionately poor health outcomes and is at increased 
risk from COVID-19 due to chronic disease and elderly 
population and limited healthcare access. In the winter, 
district daily caseloads spiked, and we could no longer conduct 
full case investigation or contact tracing. We advised schools 
to go fully virtual, and our local hospital capacity teetered 
on the brink of being overrun.
    At the peak of our disease burden, vaccines became 
available, and the ability to vaccinate our healthcare workers 
and first responders, followed by our most vulnerable elderly 
population, brought inexpressible joy. When vaccines began to 
roll out late December 2020, the Far Southwest Health 
District--had the advantage of a long history of partnerships, 
providing vaccines in our communities, and being service-
oriented health departments with large staff, allowed us to 
begin giving vaccines rapidly.
    With these partnerships, we led the State in percentages of 
population vaccinated from the onset of the vaccine campaign 
through March. We vaccinated our high-risk essential workers 
and prioritized teachers, because they had been teaching in 
person since the fall. We watched as our case rates fell and 
healthcare capacity was restored.
    We realized early on that the vaccination rollout heavily 
favored the tech savvy, those with internet, cell service, 
smartphones, and computers. As vaccine supply increased and 
demand decreased, we transitioned to our mobile units in May to 
reach the areas of the community that were more remote and had 
less broadband access.
    We are working with county administrators, emergency 
coordinators, schools, faith communities, and local businesses 
to increase vaccine uptake. We are scheduling outreach and 
mobile clinics at farmers markets, festivals large and small, 
high traffic areas such as convenience stores, and places 
people are already gathering: restaurants, breweries, wineries, 
churches, hiking trails, sporting events, food banks, parks, 
music events. We are partnering to give tickets as incentives 
for vaccines and creating messaging with trusted local voices.
    Some of our challenges have been in data acquisition. 
Currently, vaccines given out of State do not show up in our 
counts. And as we border North Carolina, Tennessee, Kentucky, 
and West Virginia, this makes it challenging to discern our 
true vaccine numbers. Virginia is working to access this data.
    Another challenge is technology needs. Our existing network 
is so poor that we cannot reliably participate in Zoom or 
Google Meet.
    We know there is some vaccine hesitancy in our community. 
However, many labeled as hesitant have simply not had access to 
vaccine or opportunity to have their questions answered. We 
feel it is important not to label our population, in order to 
avoid creating resistance where it may not truly exist. We know 
there are multiple reasons why people choose not to be 
vaccinated: medical, religious, political. We feel our role is 
to provide education and opportunity for vaccination by meeting 
people where they are in their own community and being 
champions for the vaccine.
    We are grateful to Congress, emergency funding, and 
attention to the needs of public health response of COVID-19. 
This response would benefit from single-dose vaccine packaging, 
streamlined national vaccine data, coordinated messaging that 
speaks to many different populations, and continued resources 
for local public health outreach.
    We know that some of the most important components of a 
successful vaccination campaign are access, education, 
opportunity, and respect. We appreciate the support of the 
Federal Government to create access to vaccine, and we will 
continue to work respectfully with our communities for 
education and opportunity. We will continue to seek to learn 
from others' successful vaccination strategies.
    Thank you again for inviting me to testify today, and I 
look forward to your questions.
    [The prepared statement of Dr. Shelton follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Ms. DeGette. Thank you so much, and thanks to all of our 
witnesses for their testimony.
    It is now time for Members to ask questions, and the Chair 
will recognize herself for 5 minutes.
    We know that COVID-19 vaccines are safe, effective, and our 
shot at a return to normalcy. And, as the panel has been 
discussing today, the main issue is, are Americans choosing not 
to get vaccinated, or do they simply not have the opportunity, 
and how can we help them?
    Dr. Omer, you testified that there is a large group of 
``fence sitters'' who have questions about the vaccine, that--
but can be provided with the right interventions. Can you very 
briefly tell us what some of those interventions that the data 
shows us might work are?
    Dr. Omer. Yes--no, so this is a group that--which doesn't 
actively think about vaccine but can be persuaded, or--either 
their beliefs are----
    Ms. DeGette. Yes, can you tell us some of those methods 
that can work?
    Dr. Omer. Yes. So one of them, one of the approaches, is to 
provide basic information about the immunization process 
itself. So that is number one.
    The second thing is making--bringing the vaccines closest 
to them, but also informing them that it is there.
    The third is these community outreach efforts--sorry, can 
you hear me?
    Ms. DeGette. Yes.
    Dr. Omer. Yes, so I will----
    Ms. DeGette. We can hear you.
    Dr. Omer. I will continue, yes. So----
    Ms. DeGette. Yes, please.
    Dr. Omer [continuing]. Then community outreach efforts that 
are--so the administration has announced, in terms of investing 
in community health workers and individuals going door to door, 
there are existing programs there, as well, that are 
coordinated by community-based organizations. Empowering them 
with evidence-based messaging, but also the ability to schedule 
there and then.
    So these are some of these approaches----
    Ms. DeGette. Right.
    Dr. Omer [continuing]. That can bridge the gap between 
demand and supply.
    Ms. DeGette. Thank you very much.
    And Dr. Shelton, you talked about some of the unique needs 
of rural individuals. I am wondering if you could tell us some 
of the strategies that you think work with rural Americans.
    Dr. Shelton. Thank you. Yes, we have been working--like I 
said, one of our greatest problems is access, and--to the 
vaccine, as far as going out to populations where they have not 
been able to take advantage of registration and sign-ups 
online. So going out into the communities where there is not--
where they don't have the broadband access or cell service or 
computer service. So we have been taking our mobile units out 
into the community to try to reach them.
    We would benefit from greater education opportunities with 
these. We do have some community health workers beginning to 
come online. But again, training them, and getting them up and 
rolling to be able to actually answer those questions on the 
spot with people who were there to give vaccines would be very 
helpful in our ongoing strategy there.
    Again, taking opportunities also where there is----
    Ms. DeGette. Great, thanks. OK, thank you.
    Ms. Pisani, you have been working on these vaccine issues 
for years, as you said. And one of the greatest pockets of 
vaccine hesitancy is, obviously, with children, which you have 
been working on. My home State of Colorado has one of the 
largest groups of these parents.
    Very briefly, what would you say to the parent of a child 
who is eligible for a shot, who isn't sure about the benefits?
    Ms. Pisani. Congresswoman DeGette, were you calling on me? 
It broke up for a second.
    Ms. DeGette. Yes, I was calling on you. What would you say 
to the parent of a child who is reluctant to get a shot for 
that child about what the benefit would be?
    Ms. Pisani. Yes, and I think that that is a big decision 
that families need to make. And everyone should be asking about 
any medical product. And that is something that Vaccinate Your 
Family, we feel really strongly we want to be the sort of no-
judgment zone.
    So really, what you need to think about are, first of all, 
we know that millions and millions of children have now been 
vaccinated safely. But also, really thinking about what are the 
risk-benefit ratios, I don't think that some parents are really 
recognizing that. Even though we haven't had a huge number of 
children who have died from COVID, we know that they can have 
multisystem inflammatory disorder. We don't know what the long-
term consequences will be of COVID. We know that people who got 
polio decades ago are back in their wheelchairs today. We know 
that, if you get chickenpox, you can get shingles later in 
life, which I got last year and, let me tell you, it is no 
picnic.
    So we don't know what the future will be. And it is--you 
know, that is why I vaccinate my own kids. I want to make sure 
that they don't end up suffering something in the future.
    Ms. DeGette. Thank you so much.
    OK, I am going to finish with you, Mr. Offerman, because I 
think one of the reasons you have chosen to be a spokesperson 
urging people to get the vaccine is because you are well known 
for playing the TV character Ron Swanson, who has a [audio 
malfunction] government programs, even though he worked for the 
government. And so I want to ask you, what is your message to 
Americans out there who are wondering if they should get the 
vaccine, or if they should have their family members get the 
vaccine?
    Mr. Offerman. Sorry, can you repeat the--just the last part 
of your question?
    Ms. DeGette. Sure.
    Mr. Offerman. Wondering if they should get a vaccine, or--
--
    Ms. DeGette. What is your best--or tell their family 
members why they should get a vaccine.
    Mr. Offerman. Well, to me, it really just comes down to, as 
Ms. Pisani just pointed out, the risk-benefit ratio, the--what 
is likely to occur at the hands of COVID-19 is much more 
catastrophic than what has now been proven to be a harmless 
vaccine.
    And so it is not a sensibility of deciding for oneself and 
saying, ``Oh, my immune system will take care of me.'' Instead, 
act as a member of a community, or as a good neighbor or a good 
citizen and say, ``Ah, the experts have made it clear that, for 
the health of all, we absolutely have to achieve this herd 
immunity. So let's all get our shots.''
    Ms. DeGette. Thank you so much.
    And now, Mr. Griffith, I am very pleased to recognize you 
for 5 minutes.
    Mr. Griffith. Thank you, Madam Chair. I took my headset off 
because, apparently, I was the cause of the previous--my 
headset was causing the previous buzz. Hopefully this is 
better----
    Ms. DeGette. We are not judging, though. Don't worry.
    Mr. Griffith. All right, I appreciate it. And I do 
appreciate this hearing being held today.
    In recent months we have seen a variety of efforts by the 
State, local, and Federal Government to educate and inform the 
public about vaccines. We have also seen efforts by the private 
sector, such as public service announcements from our cable 
providers and other TV and radio providers, and website tools 
that seek to bring awareness. It is important that we continue 
to find creative ways to communicate this information, as there 
are still many pockets of unvaccinated individuals.
    And Dr. Shelton, I was wondering if I could speak with you 
about that. You mentioned the proximity of the States and--that 
are near us, and the committee has heard me talk about that 
many times, how you could actually be in five States in a 
single day down in our corner of southwest Virginia.
    That being said, you are getting the information from the 
States, but I read an article--or you are hoping to get that 
information from the States. You haven't yet. I also read an 
article last week that the Federal Government was starting to 
share that information with localities. And I was just 
wondering if the VA was sharing that information, because both 
Mountain Home there in Johnson City and the VA center in Salem 
have vaccinated a lot of 9th District constituents. And I am 
just wondering if that is showing up in your records of people 
in our district that have been vaccinated.
    Dr. Shelton. No, sir, not yet. We don't have the Federal 
doses calculated--in one instance, but we did talk with one of 
the local penitentiaries about the number of vaccines given. It 
actually raised our percentage points 3 points in that county, 
just--but that was--access to--at this time.
    Mr. Griffith. And that was the--was that the Grayson 
facility or the Lee facility? Was it Federal or State?
    Dr. Shelton. Federal facility.
    Mr. Griffith. A Federal facility, OK.
    Dr. Shelton. In Lee.
    Mr. Griffith. Yes, ma'am. And you have talked somewhat 
about it, but--I know you are learning about the pockets of 
unvaccinated people, and I am glad to hear you have mobile 
units out there. Do we need to do more to get the mobile units 
out, and maybe not just units that do the vaccinations but, as 
you have indicated, educate the public about the history of the 
vaccines and the safeness of them?
    Are there other things that we should be doing or 
encouraging Virginia to do in that regard?
    Dr. Shelton. Well, we have a messaging campaign, and we are 
looking to kind of adapt this messaging and work toward our 
localities in things that speak to them. As Dr. Omer said, 
message about liberty and freedom along a lot of our 
constituents who may not be wanting to get vaccinated, but also 
to answer their questions. A lot of people have concerns. 
Concerns about--is huge in our area, and there are other--some 
of these more distinct cultural, rural areas, messaging would 
be very helpful.
    Also, we do have health education that we are beginning to 
send out in advance--to answer these questions one on one. And 
so we are--and how to really--and to be the boots on the 
ground, and to answer those questions--and more people out 
doing this would be helpful.
    Mr. Griffith. And I appreciate that, and I also appreciated 
in your comments that you talked about not labeling people or 
pressuring them, because the people in our area are very proud 
people. And you want to turn folks off, come in and say, ``We 
are from Richmond'' or ``We are from Northern Virginia, and we 
are going to tell you how to do it.'' That doesn't work in our 
area, as you know, and I appreciated you making those comments. 
Do you want to amplify that at all?
    Dr. Shelton. Well, the health department in southwest 
Virginia provides a lot of--for our community, and we are a 
trusted source of information to them. So we do respect all the 
viewpoints that we do hear, and we try to work with people in 
their own community and to address their concerns, 
specifically--again [audio malfunction] people without a lot 
of--they ought to have all their questions answered.
    Mr. Griffith. Yes, I appreciate that, and I think it is 
very helpful that you are a native of the area and have long 
served both patients and the community, and I think that helps 
you get that message out. If there is anything that we can do 
to help get that message out, not only in our part of southwest 
Virginia but in east Tennessee or rural parts of North 
Carolina, West Virginia, all of which border our territory, 
and--we are more than happy to do it.
    And as you can see, as as the chairwoman pointed out, this 
is not a Democrat or Republican issue. This is about all of us 
working together. And we have had some counties that have been 
hit pretty hard, even over the border in West Virginia. I had a 
county over there, not in my district, but one that was really 
hit pretty hard. So we are trying to do it, and we appreciate 
what you are trying to do and what all the witnesses are doing 
here today. Thank you.
    I yield back----
    Ms. DeGette. I thank the gentleman. The Chair now 
recognizes the chair of the full committee, Mr. Pallone, for 5 
minutes.
    I don't see Mr. Pallone.
    Mr. Pallone?
    We may have lost him briefly. And so, Ms. Kuster, are you 
ready to go? Why don't I recognize you for 5 minutes?
    Ms. Kuster. Thank you, and I apologize, I am just trying to 
pull up my remarks. Thank you so much, Chairwoman DeGette----
    Ms. DeGette. Take your time.
    Ms. Kuster. Can you hear me? Chairwoman DeGette, can you 
hear me?
    Ms. DeGette. Yes, yes.
    Ms. Kuster. Great. Thank you for holding this important 
hearing today, and thanks so much for our witnesses, for your 
testimony and preparation.
    The progress we have seen these past few months in beating 
back COVID-19 has been nothing short of remarkable. In just 
over 1 year, we have undertaken an incredible effort to 
manufacture multiple highly effective and safe vaccines. And we 
have undertaken, literally, a warlike vaccination campaign to 
get shots into the arms of the American people.
    On January 20th, when President Biden took the oath of 
office, only 1 percent of adults were fully vaccinated. But 
today over 50 percent of American adults are fully vaccinated. 
And not to brag on New Hampshire, but over 70 percent of adults 
in my State have at least 1 dose.
    While these statistics are encouraging, more must be done 
as we begin to see the signs of vaccine hesitancy among certain 
populations. A key component to our continued vaccination 
efforts is ensuring that we have hard data collected to ensure 
that we can improve access in rural communities, including my 
district. And that is why earlier this year I introduced the 
Immunization Infrastructure Modernization Act, bipartisan 
legislation that would improve and expand information sharing 
between State and Federal governments, as well as public and 
private healthcare providers, to ensure that vaccines are being 
administered effectively, efficiently, and fairly across all 
States and territories.
    Immunization information systems, IIS, are secure, 
multifaceted systems that allow for the sharing of crucial 
information and the maintenance of records. My bipartisan 
legislation aims to bolster these systems and support real-time 
immunization record data exchange and reporting.
    Dr. Gracia, you identified in your testimony deficiencies 
in our immunization information systems, many of which could be 
improved by advancing my bipartisan legislation with 
Congressman Bucshon. Can you discuss why it is so important for 
immunization information systems to be consistent in the type 
of data collected and reported?
    Dr. Gracia. Yes, thank you for that question and for your 
leadership with regards to addressing the importance of a 
strong and robust immunization infrastructure. That is, indeed, 
really, a core part of what we need with regards to our public 
health system and our public health infrastructure.
    What we have seen, for example, has been--over the years 
that, actually, the immunization information systems have not 
kept up to pace with regards to the need for funding to ensure 
that we have really robust, comprehensive immunization systems 
that can do the type of surveillance, whether it is in the 
detection of outbreaks, being able to tailor interventions--
because you identify that there are certain populations in 
communities that, either for hesitancy or for access, have not 
been immunized--and then being able to ensure that there is 
interoperability of these systems, as well as ensuring that the 
programs themselves--and that the immunization program itself 
has the ability to do the type of vaccine education and 
outreach.
    And so, as we think about, certainly, within the context of 
the COVID-19 pandemic, how critical that is for the local 
communities, as well as States, to be able to tailor 
interventions to be able to get resources to those communities 
that are undervaccinated, it is also important in the longer 
term, as we think about shoring up our immunization 
infrastructure to be able to detect and assess and address the 
next emergency.
    Ms. Kuster. Great. And Mr. Offerman, thank you for joining 
us and using your platform to encourage Americans to get the 
COVID vaccine. You speak to the effects the pandemic has had on 
your work in the entertainment industry and how, by listening 
to doctors and trusting each other, you and your colleagues 
were able to safely get back to work last year.
    Since this was a successful strategy, how do you think this 
can help our national vaccination effort, particularly in rural 
areas like the one you grew up in?
    Mr. Offerman. Well, you know, I think it is just a matter 
of extending the leadership that the--our other witnesses are 
talking to, and getting this clear messaging to all of our 
citizens who are confused by the information they are getting. 
That comes from a variety of reasons: misinformation, 
conspiracy theories, mistrust, et cetera. And I think we just 
need to turn up the volume on the clear information that it is 
safe, everyone should do it.
    It is your duty, as a family member. You know, if you love 
yourself, your family, your community, it is beholden on all of 
us to step up and be a good neighbor and a good family member 
and just shout that to the hills.
    Ms. Kuster. Great. Well, thank you for helping us shout 
that to the hills. And with that, I yield back.
    Ms. DeGette. I thank the gentlelady. The Chair now 
recognizes the ranking member of the full committee, Mrs. 
McMorris Rodgers, for 5 minutes.
    Mrs. Rodgers. Thank you, Chair DeGette and Morgan Griffith. 
As ranking member, I really appreciate the approach of today's 
oversight hearing, and thank you to all our witnesses. I, too, 
just have some followup questions.
    Dr. Omer, I wanted to ask the simple question: Do you have 
confidence in the three COVID-19 vaccines that are available 
today in the United States and the ways in which they were 
developed, reviewed, and authorized?
    Dr. Omer. Absolutely. And as an independent academic, I 
would have said so if I did have any lack of confidence in 
them.
    Mrs. Rodgers. Thank you.
    Ms. Pisani, I wanted to ask, do you believe it is important 
for people to get the best and most accurate information?
    And you stated that, that you believe it is important. How 
do you believe that they can, and allow them to make the best 
decisions for that--themselves?
    Because right now, some of the most common questions we 
have from people are that they are concerned about getting--you 
know, they want to make sure that they have the best and most 
accurate information when it comes to getting the COVID-19 
vaccine, and just any insights you have, as far as addressing 
those concerns.
    Ms. Pisani. Well, I mean, I think there's a combination of 
issues, obviously. And maybe we'll talk a little bit more about 
social media disinformation, and that is a really important 
issue that we have to deal with.
    But we do know that people do trust their providers. And so 
they are the most important source of information right now, no 
matter where you live.
    But, you know, hearing from some folks in rural and urban, 
the challenges are so different, depending on where you live. 
And I literally traveled the Nation with Mrs. Carter and Mrs. 
Bumpers. And if you're in Wyoming, and you are an hour and a 
half away from your medical care, that type of message that you 
need to get is a little bit different than a person who could 
just go down the road and go to any clinic and get vaccinated.
    So that trusted messenger issue, I mean, we are getting a 
little tired of hearing it, but it is so essential. Like, if 
you trust your evangelical leader, that is the person who needs 
to encourage your vaccinations. If you trust your local 
football coach, if you are from Penn State, those are the folks 
that you want to encourage to talk about vaccines. So I think 
it is different, no matter--depending on where you live.
    Mrs. Rodgers. Thank you.
    Dr. Omer, I wanted to ask you to address the issue of 
people being concerned about side effects, because the fear of 
the fever, the fatigue, especially following the second 
vaccine, is one of the leading reasons why people are choosing 
not to get the COVID-19 vaccine. Would you just address what 
you think is the best way to approach someone who is concerned 
about the side effects and the potential of losing a day of 
work or two?
    Dr. Omer. Yes. I think that is a really good question. So 
there are two things that should be emphasized for the 
individual.
    First of all, that this is the transient side effect. We 
get fatigue, pain, sometimes fever. They are expected. They 
were seen in the trials, and they are not connected to the 
serious adverse events, et cetera. So if you are getting that, 
it is just that, it is inconvenience. It is hard, in its own 
right, to be down with fever or fatigue, but it is not a sign 
of something more--sort of ominous, it's not an ominous sign 
for a more severe and long-term side effect. That is number 
one.
    The reason why it is happening is that, when your body is 
trying to mount a strong immune response, for some people--not 
for everyone, I did not get these side effects. That did not 
mean that I did not mount an adequate immune response. But for 
some people, that means that that inflammation, that immune 
response, leads to these transient side effects. And so those 
are the things we need to communicate.
    Mrs. Rodgers. Thank you.
    And my final question, Dr. Shelton, in your written 
testimony you note that in the rural areas it is especially 
important to build the cross-sector partnerships in order to 
meet the needs of the community. And I just wanted to ask if 
you could share any examples of those partnerships and why you 
believe it is critical in the rural communities, in particular.
    Dr. Shelton. Yes, we have built these relationships over 
time. It is very important, the relationships we have with our 
hospitals, as well as our pharmacies and healthcare providers 
with the rollout of the vaccine. But we also have long-term 
partnerships with our county administrators, emergency 
coordinators, and schools. When it came time to go out and give 
the vaccine to the students, for those who were 16-plus and 
then 12-plus, we, you know--begin to provide vaccines within 
the schools.
    Also, working in our larger--emergency coordinators, just 
having the whole community pitch in and help with these efforts 
went a long way toward increasing--and the number of people we 
were able to vaccinate.
    Mrs. Rodgers. Super. Thanks for your work.
    Madam Chair, I yield back the remainder of my time. Thank 
you.
    Ms. DeGette. I thank the gentlelady. The Chair now is 
pleased to recognize the chairman of the full committee, Mr. 
Pallone, for 5 minutes.
    Mr. Pallone. Thank you, Chairwoman DeGette. My questions, a 
lot of them are the same ones that Ranking Member Rodgers 
asked, so I guess we think alike, Cathy. But let me try to ask 
those that maybe you didn't cover. I wanted to ask Dr. Omer 
about these, you know, misconceptions.
    You know, we hear fears from Americans about vaccine 
safety, that they were developed too quickly, or the process--
review process wasn't rigorous enough, and there is also this 
thing about the side effects with--that vaccines can cause 
fertility problems.
    Just, you know, set the record straight for us. Why should 
we not be worried about this type of misinformation that is 
swirling, particularly online?
    Dr. Omer. Yes. So this is a misconception that is out there 
that we--the corners were cut. The corners weren't--you know, 
nobody took a shortcut. It is just that we built a highway. And 
that is why the--streamlining the process, cutting the--some of 
the bureaucratic process but also increasing efficiency by how 
we recruited in trials.
    If I may take the liberty of giving you one example. So if 
you need 30,000 people in a trial, which were an average size, 
30 to 40,000 people, you can have 30 sites with 1,000 people, 
or you can have 60 sites with 500 people, or 120 sites for 
recruitment for 250 people. So that is why--that is one example 
of how efficiently we expanded the number of sites, because 
resources were available, et cetera, so that we did these 
trials quickly, rather than doing it--you know, waiting for 
each site to enroll, let's say, 1,000 people, or 3,000, if you 
were going with 10 sites. So that is important.
    The processes that were used to ensure safety and efficacy 
are time tested. This was--these were the processes, the data 
collection, the evaluation. And just to remind everyone that 
all--with all of these trials, by regulation they have to have 
an independent data and safety monitoring board. So, even 
beyond the outside committee independent review that FDA 
performed while these trials were going on, there was weekly, 
ongoing safety review and effectiveness review after the data 
became available was happening.
    And then now, the--there is an unprecedented effort to 
ensure that there is robust vaccine safety surveillance. And 
that is why you hear about certain signals. You know, if you 
look for--you do robust surveillance, you hear about these 
signals. And FDA and the CDC has done--taken a rational--
conservative, in a sense--to protect the safety--to protect the 
general public against any uncertainty, as well. That path, by 
leveraging those data and having a short timeframe from signal 
emergence to signal evaluation, and then a recommendation. So 
this has enabled us to trust the process, and to trust the 
outcome of this development and deployment process.
    Mr. Pallone. Well, thank you. Another [audio malfunction].
    Ms. DeGette. OK, Mr. Chairman, can you start your question 
again?
    Mr. Pallone. Yes. [Audio malfunction] come down today to 
meet with the vice president on broadband. So I had to get on 
the road.
    But this is about whether people who previously had COVID-
19 should still get vaccinated.
    Dr. Omer. So I don't know if----
    Mr. Pallone [continuing]. Understanding around that.
    Dr. Omer. Sorry, I----
    Ms. DeGette. Go ahead, Doctor.
    Dr. Omer. Yes, so--OK, I was unclear if the question was 
for me, but I would answer it.
    Mr. Pallone. Yes, it is OK. Well, I guess it--actually if 
Dr. Gracia wants to answer it, about whether people who 
previously had COVID-19 [audio malfunction].
    Dr. Gracia. Yes, the recommendation is that people who have 
had COVID-19 should still get the COVID-19 vaccine. You know, 
there is natural immunity and antibodies that are developed 
through infection with COVID-19. However, that is not as robust 
as what we know from--with regards to vaccination. And so--and 
we don't know how long that natural immunity can last. And so 
the recommendation is, indeed, for those who have COVID-19 to 
also get the COVID-19 vaccination.
    Mr. Pallone. All right, thank you so much.
    Thank you, Chairwoman DeGette, I appreciate it. I yield 
back.
    Ms. DeGette. Thank you. Thank you, Mr. Chairman.
    The Chair is now pleased to recognize Dr. Burgess for 5 
minutes.
    Mr. Burgess. I thank the chair, and I thank all of our 
witnesses for being here today. This is such an important panel 
that we have put together.
    And I--you know, the--one of the things that leads to 
hesitancy, of course, is not being consistent in the 
information that is delivered. And I think Mr. Offerman, 
actually, said it at the beginning of his testimony. He is--
``Here I am, just a regular guy, and we have to defer to all 
the scientists.''
    But let me just tell you, Mr. Offerman, this is a novel 
disease. And the scientists were sometimes embarrassed, because 
what they had said at the beginning wasn't what they ended up 
saying several weeks or months later. And I can think of no 
area where that has been less pronounced--or where it would be 
more pronounced--as where did this virus originate. And the 
stories that we were told early on are now not comporting with 
the stories that we are hearing now.
    And Chairwoman DeGette, I think it would be incumbent upon 
this committee, being the primarily investigative committee of 
the subcommittee of the Committee on Energy and Commerce, to 
ask those questions, and ask them thoroughly. I realize----
    Ms. DeGette. Will the gentleman yield?
    Mr. Burgess. Yes, I would be happy----
    Ms. DeGette. Will the gentleman yield?
    So I agree. I think it is very important that we find a--
that we investigate where--particularly, if the virus escaped 
from some lab, because that, of course, has implications for 
international health.
    Mr. Burgess. Yes----
    Ms. DeGette. And I have already spoken to the ranking 
member. Whatever we can do--I don't think China is going to 
produce any documents to this committee.
    Mr. Burgess. No----
    Ms. DeGette. But we are going to do whatever investigation 
is appropriate. And Mr. Griffith and I are on the same page.
    Mr. Burgess. So reclaiming my time, because it is----
    Ms. DeGette. I will give you a little extra time, too.
    Mr. Burgess. All right.
    Ms. DeGette. I will give you a little extra.
    Mr. Burgess. I have got more than I can get through, 
anyway, and I, obviously, will be submitting questions for the 
record, as is my habit.
    But that is--if we can reestablish some credibility, even 
after the fact, I think that is going to be so critically 
important, because not only do we have a once-in-a-lifetime 
pandemic, we had it on top of a once-in-a-lifetime political 
year, and it left people, in many cases, confused. And now the 
challenge for all of us is to--how do we get to people and help 
them understand what is--what I believe would be in their best 
interest.
    Chairman Pallone, I guess we have lost you to the ether 
somewhere, but I have asked for your help in interceding with 
the Speaker. All of us, or most of us, took the vaccine in 
December. The Speaker told us we were--it was necessary for the 
continuity of government, and so--fully vaccinated, to be sure.
    And yet we behave as if we are still frightened of the 
disease. And that does not send--in my opinion, that does not 
send the right message. So, in conjunction with other doctors 
in the Doctors Caucus, we have asked the Speaker for 
clarification. We have to vote in these odd ways. We are doing 
this hearing in a virtual format. This should be in our main 
hearing room.
    This should be--if we are, indeed, all vaccinated, and we--
or those of us who are vaccinated believe that we can no longer 
transmit the illness or contract the illness, we should behave 
that way. And if there is someone who says, well, for whatever 
reason, I don't feel comfortable being in that setting, sure, 
let's have special arrangements. But we shouldn't be doing 
hearings remotely. We shouldn't be doing voting on this 
intractable schedule that just seems to never end. It doesn't 
allow us the opportunity to amend bills and have the 
appropriate legislative input. So I just make that plea. It is 
time. It is time for us to get back to normal.
    Now, I do have to ask Mr. Offerman a question, because this 
is absolutely critical, and I need to know the answer to it. 
With your vast experience as a wood worker, do you find that 
English walnut has no sense of humor?
    Mr. Offerman. Thank you for your question. I want to hit 
one point you just mentioned, and that is I believe, once you 
are vaccinated, you can still transmit the virus. It doesn't 
eradicate that possibility. The vaccination is simply a 
protection. But the reason that we are--I believe we are still 
trying to be safe, is because you can still catch it and pass 
it to others.
    Mr. Burgess. Yes, well, the--reclaiming my time again, the 
CDC guidelines that came out a week ago Thursday seemed to 
have--seemed in a different place than that. And I recognize 
that there is new information coming all the time, and we 
have--many of us have been--have issued pronouncements that 
turned out then to be inoperative later on. That is part of 
dealing with an novel virus that is of this severity.
    But it does appear that those who have been vaccinated 
are--if the virus is recoverable from their nasopharynx, it is 
no longer infective. And we need to know the answer to that, to 
be sure. But you just look at the broad graphs of the 
prevalence of disease in the United States of America, and, 
clearly, something is different now than it was in January. And 
do we need to be behaving the same way we were in January?
    And if we believe that the vaccine is what has brought us 
to that point, why don't we model that behavior?
    Thank you, Madam Chair. I will yield back, and I have got a 
ton of questions I will submit for the record.
    Ms. DeGette. I thank the gentleman. The Chair now 
recognizes Miss Rice for 5 minutes.
    Miss Rice. Thank you, Madam Chair.
    And Dr. Burgess, I couldn't agree with you more. I would 
love to get--for all of us to get back to our prepandemic life. 
And I would encourage you to speak to your colleagues on your 
side of the aisle as to why they are preventing us from doing 
that, and because they are not getting vaccinated.
    Mr. Offerman, if I could ask you, if you had every 
unvaccinated Member of Congress before you, what would you say 
to them? How would you convince them? What would you say to 
convince them to get the vaccine?
    Mr. Offerman. Well, thank you for your question.
    And just to answer Dr. Burgess quickly, English walnut is 
indeed humorous.
    If I had the unvaccinated Members of Congress before me, I 
would simply try to appeal to their common sense and say, 
``Look, as our conversation just now pointed out, we are 
humans, which means we are always learning more information. 
Sometimes we think we have got it figured out, but then things 
continue to evolve. Even if we have a solution, the variants 
show up. We will always have to be vigilant. There will be 
more, you know, there will be more, ostensibly, SARS viruses 
coming in our future.''
    And so I would just say, ``Look, all we--with the 
information that we have, the decent thing to do to--is to 
pitch in for the common good, regardless of any other 
misinformation, and get the shot.''
    And if you guys--you know, if you need a cookie, or a 
lottery ticket, or I will take you down the street for a glass 
of single malt, if that is what it will take, then I will be 
happy to pick up that bar tab.
    Miss Rice. You might have some Members take you up on that, 
Mr. Offerman.
    The daily average vaccine administration in the U.S. 
reached a peak of 3.4 million doses in April of 2021. 
Unfortunately, that average has declined to approximately 1.8 
million daily doses in recent weeks. So this is the issue that 
we are talking about.
    Mr. Offerman, you mentioned you had some family members 
back home in Illinois who are told--look, we are not going to 
be able to get--I have someone in my own family who is --
knows--you know, has family members who knows the science of 
this, that were experts in infectious disease. Do you know--and 
I am not asking you to out any of your relatives by name, but 
is the reason--is it mis- and disinformation?
    Because there is so much of that on social media. We can't 
control where people are getting their information from, but we 
know that there are, you know, a handful of people, Robert 
Kennedy Jr. being one of whom, who posts mis- and 
disinformation regarding this vaccine every day on social 
media.
    So have you been able to figure out the source of the 
hesitancy in people in your family, and how do you address 
that, specifically?
    Mr. Offerman. Well, I mean, yes, the--one of the family 
members in question actually used to work as a phlebotomist. 
And so they feel they have, you know, a sense of authority. And 
their information streams are, you know, both news channels, or 
``news channels,'' and social media platforms that turn this 
issue somehow into a political football and say, you know, ``Is 
this administration telling you the truth? Should we listen 
more to this administration?''
    And this--you know, I understand that that is, you know, 
the state of affairs in modern-day America. But this--what we 
say to this family member is, ``Your children, two--arguably, 
the cutest children in the family--haven't gotten to see their 
grandparents for over a year because of the danger of''--you 
know, it is a perfect storm. We have a couple of 
immunocompromised kids, as well. So we have to be incredibly 
vigilant. ``Can't you just do this for the good of the 
family?''
    And, you know, because of their incredible will and their 
wonderful Midwestern stubbornness, they so far refused. So we 
just try not to pull our hair out, and keep taking a deep 
breath and say, ``Hopefully, we can all get together soon.''
    Miss Rice. Mr. Offerman, I just want to thank you so much, 
because, you know, you say that you are not one of the smart 
people here and not one of the scientists, but you--your 
ability to reach millions of people is unmet by anyone on this 
Zoom. And so I really appreciate you being--and willing to talk 
about this, and to do it in a way that, you know, can reach 
regular people. You are talking specifically to people who 
don't have medical backgrounds, and many of whom admire the 
work that you do. So thank you so much.
    And thank you to all of the other smart witnesses who 
testified here today, and I yield back.
    Thank you, Madam Chair.
    Ms. DeGette. I thank the gentlelady. The Chair now 
recognizes Mr. McKinley for 5 minutes.
    Mr. McKinley. And I thank you, Madam Chairman, and thank 
you for getting this panel together, because this is going to 
be an interesting discussion.
    But before I raise further questions, I would like to go to 
Dr. Omer because, based on his written testimony, there were 
some--he revealed he had quite a knowledge of the process of 
the vaccination.
    So I am asking you if--without Operation Warp Speed, would 
we have a vaccine today in just 8 months?
    Dr. Omer. I think it is correct to say that the efforts 
that happened over the last year have really helped develop and 
sort of evaluate these vaccines.
    But I also point out----
    Mr. McKinley. If I could, if--let me just--that is what I 
wanted to point--I think back on the other, as to why we are 
not getting--I think we are sending mixed signals. We elected 
officials, public statements, public--I think we are sending 
confusing and mixed signals out to the public. No wonder they 
are--look back on just last year, just--not even 7 months ago, 
8 months ago, we had the then-Senator Harris saying that she 
would not take a vaccine if it were approved by the Trump 
administration. Now, think about that.
    And then we have--for decades all of us were taught, once 
we get a vaccine, we are protected against a disease. But 
then--and then, on May 13th is a--a couple of weeks ago, the 
CDC announced that vaccinated people no longer need to wear 
masks. That sets the tone. But now, follow through with that.
    The next statement, just a few days later, a week later, 
the President was at the Ford Rouge plant in Michigan, wearing 
a mask after he had been vaccinated, after the CDC had already 
come out. Dr. Fauci was wearing a double mask, and he was asked 
about that, the issue, again, challenged on that.
    So, Dr. Omer, again, do you think the actions of our 
political officials and--their statements and their actions, 
are they impacting us on the vaccine hesitancy?
    Dr. Omer. So, unfortunately, I wouldn't be able to track 
back, you know, sort of--since I wasn't following exact 
specific day or time where everyone was--anyone was wearing a 
mask, but I can do--I can speak broadly, because we tested this 
in our messaging trials, as well, that bipartisan support and 
endorsement of vaccines are extremely important. And so I agree 
with a clear, bipartisan message on this issue is helpful.
    Mr. McKinley. OK. So let me say--build off a little bit 
what Dr. Burgess was saying, because I think we are all 
frustrated about this, because Speaker Pelosi has said she is 
not going to let us go back into session until all the Members 
are vaccinated. But unlike the Senate--they are back, and they 
are not wearing masks. They are back on the floor. They are 
working in committees. But we are still--like this hearing 
today--still being done virtually.
    Now, this is contradictory towards what the Attending 
Physician has said and what the CDC's guidelines are saying. 
So, Dr. Omer, do you think that Nancy Pelosi is following the 
science in continuing to keep the House shut down and extending 
proxy voting?
    What is the end game?
    Dr. Omer. So Congressman, unfortunately, I am not in the 
position of evaluating specific House policies because I 
haven't looked at it.
    But I will say that, when these trials were done, they did 
not include end points for transmission. So when the data came 
out, it was very appropriate to say that, to prevent 
transmission to others, we should wear masks even if you are 
vaccinated. Since then, the state of evidence has evolved. And 
for several weeks, or actually, you know, a couple of months, 
we had--we started seeing studies that say that even 
transmission is drastically reduced.
    But there is a nuance to this. The nuance is that if you 
know--if you can verify that everyone is vaccinated, then it is 
perfectly safe. And CDC has said that, for people to interact 
like, you know, pretty much normal, with the exception if you 
are in a healthcare facility, et cetera.
    Mr. McKinley. Then, if I could, just in----
    Dr. Omer. We could----
    Mr. McKinley [continuing]. Go back, if I could--reclaiming 
my time, but are we ever going to get--it is not realistic to 
get 435 Members of the House to get vaccinated before we go 
back into session again. Are we going to continue this 
nonsense?
    I think it--let me hear from you.
    Dr. Omer. So I would--again, without commenting on specific 
policies, because I am not sort of that knowledgeable about the 
details, but I would say that, even if you cannot verify, a lot 
of activities can happen indoors. CDC has said that, with 
masking and--but then it depends on what the compliance is for 
masking, et cetera, if you don't know who is vaccinated and who 
is not.
    So that--there is a nuance there. I do think that we have 
evidence of high protection and decreased transmission.
    Mr. McKinley. Thank you.
    Madam Chairman, I yield back the balance of my time.
    Ms. DeGette. Thank you.
    The Chair now recognizes Congresswoman Schakowsky, the 
birthday girl, for 5 minutes.
    Ms. Schakowsky. I thank the chair and all our witnesses. It 
is so great to celebrate with you today.
    In March the Center for Countering Digital Hate and Anti-
Vax Watch found that 65 percent of antivaccine social media 
content stemmed from just 12 individuals called the 
Disinformation Dozen. Despite being brought to the attention of 
the social media companies, a review one month later found that 
at least nine of those individuals still maintained active 
accounts on Facebook and Instagram and Twitter.
    More alarming, a sample review of Facebook posts over the 
last week showed that online--that only 19 posts had fact-
checking labels applied to them. The posts that are left say 
things like ``asymptomatic people can't spread the virus'' and 
that the ``COVID-19 vaccine is a genetic mutation.'' One post 
alone reached approximately 62,500 people.
    Ms. Pisani, although vaccine myths continue to be 
accessible on social media, we understand that your 
organization had a challenging time getting factual vaccine 
information posted on social media. Can you briefly tell us 
about your experience, and how long did it take to be resolved?
    Ms. Pisani. That is a really great question. It happened--
it has happened to us on several occasions. And so at Vaccinate 
Your Family we started Facebook--I believe it was almost the 
year it began. We jumped right into social media. We felt like 
it was a really important place to be.
    And what happened was, years ago, we ended up being drowned 
out by these larger organizations that have a lot of money. And 
they were sharing disinformation. And it was a--just a few 
people, but with the most amount of money. While the rest of us 
were starting to realize that we had to provide information in 
order to be allowed to post, we hadn't realized it yet. And so 
they had beat the algorithms. We didn't know about them yet, so 
we hadn't fixed our problem.
    Most recently, during the COVID year, we were no longer 
able to get comments on our Facebook page for almost 7 months. 
We never were able to speak to a single person at Facebook. 
That is a really big deal, because we are the largest social 
media group on vaccines in the nation, and we have people from 
around the world. So when we can't--when our posts don't get 
boosted because we don't have a lot of movement on our pages, 
that makes a really big difference.
    So the companies can fix our algorithms. They--there is a 
lot that they can do. They can stop feeding people 
disinformation based on their search terms, on the information 
that they are already reading. They could whitelist groups like 
Vaccinate Your Family, Voices for Vaccines, the Academy of 
Pediatrics, and other groups that share fact-based information. 
There is so much that could be done to fix the problem.
    Ms. Schakowsky. Well, thank you for that. That is very 
disturbing, and I want to work with you to see if we can make 
that better, so that factual information doesn't have barriers 
to getting out.
    Dr. Gracia, unfortunately, as you mentioned in your 
testimony, misinformation campaigns have targeted people of 
color and low-income communities, often without accessibility 
to antivaccine--to--without accountability. The antivaccine 
movement has been able to exploit justifiable, historic 
distrust, and the media companies have helped to further their 
antivaccine goals.
    Can you talk to us a little bit about that? I am almost out 
of time, but I would love to hear that.
    Dr. Gracia. Yes, thank you for that question. It is 
important, because when we talk about why certain communities 
may not be getting vaccinated, this issue of misinformation is 
so critically important, and it is important as it relates to 
communities of color.
    There are efforts underway. One of the efforts that we 
have, for example, at Trust for America's Health, is through 
our Public Health Communications Collaborative, in which--it is 
a collaborative between Trust for America's Health and a 
partnership with the CDC Foundation and the de Beaumont 
Foundation, where we actually do tracking on misinformation and 
provide guidance, in particular, for public health officials at 
the local and State levels to be able to address 
misinformation.
    And then there are also other efforts. For example, the 
campaigns Between Us, About Us, where you have, for example, a 
campaign specifically for the Latino community that was 
recently launched through UnidosUS and the Kaiser Family 
Foundation, creating PSAs and other tools featuring Latino 
healthcare providers and other Latino health workers that can 
be used in the community to be able to combat some of that 
misinformation that is happening.
    And there is, likewise, a campaign specifically featuring 
Black healthcare providers that the Black Coalition Against 
COVID and others are engaged in. And that way they have the 
tools and the resources to be able to address some of the many 
myths about the COVID-19 vaccine.
    Ms. Schakowsky. Thank you so much. And trusted messengers, 
I think, are so important. So thank you for your important 
work.
    I yield back, and I appreciate----
    Ms. DeGette. I thank the gentlelady. And the Chair now 
recognizes Mr. Palmer for 5 minutes.
    Mr. Palmer. Thank you, Madam Chair, and happy birthday, 
Jan. And following up on your last question, I think that there 
is a role for faith-based organizations in increasing the 
confidence in the vaccines and maybe even serving as a familiar 
distribution site.
    And what I would like to ask Dr. Gracia is, has anyone 
looked into reaching out and partnering with the faith-based 
organizations for vaccine distribution or for public service 
announcements as a communication vehicle to raise the 
confidence among people, particularly in minority communities, 
which we know have an aversion to certain vaccinations?
    Dr. Gracia. Yes, absolutely. The faith community, faith 
leaders are such important partners as it relates to being 
trusted messengers and trusted institutions, as far as places 
of worship in communities. And in certain communities of color, 
it is actually one of the entities we highlighted in our policy 
brief as a core and trusted messenger. There are, indeed, many 
messengers.
    The administration has certainly been engaging with the 
faith community but also seeing, you know, local health 
departments, State health departments that have worked with 
faith leaders, where it is either to be able to get messages 
out to communities or to serve as potential vaccination 
centers, utilizing, for example, a church parking lot, doing 
virtual town halls to be able to deliver messages that they 
trust from their faith leaders.
    Mr. Palmer. Dr. Shelton, along the same lines, there are 
certain--there are unique issues that rural communities face 
when it comes to vaccine distribution. And I think that working 
through the faith community in rural areas could be helpful. 
But can you comment on how State and local governments could 
increase access to and confidence in the vaccines in rural 
communities?
    Dr. Shelton. Yes, thank you. Certainly--has been a great 
asset to our vaccine distribution--we had----
    Mr. Palmer. Madam Chairman, I can't hear her answer. I--
suspend my time for a moment.
    Ms. DeGette. Yes, yes, we are having difficulty hearing 
you.
    Dr. Shelton. OK, can you hear me now?
    Ms. DeGette. Yes. Perfect, thank you.
    Mr. Palmer. OK.
    Dr. Shelton. OK, yes, certainly, our faith communities have 
been a huge asset--sites that we had----
    Mr. Palmer. Madam Chairman, suspend again, if I may.
    Ms. DeGette. Yes, yes. This is the other issue this 
committee needs to work on, is our broadband access in rural 
areas.
    Mr. Palmer. Yes.
    Ms. DeGette. So let's try it again.
    Mr. Palmer. If she can't--if we can't understand her, can 
she just answer the question in writing, submitted to the 
committee?
    We will try it one more time, but if we can't hear her, we 
will just ask for her to submit it in writing.
    Dr. Shelton. OK. Can you hear me now?
    Mr. Palmer. Oh, yes.
    Ms. DeGette. Yes.
    Dr. Shelton. OK. Certainly, our faith-based communities 
have been a very important part of--many of our large--that we 
have had over the last several months have been in faith--we do 
this for our--also for local outreach to our neighborhoods, 
actually some of our--communities, including our Black and 
Hispanic communities. So that's a very important thing.
    As far as our State and local governments, I think working 
with our faith communities--there.
    Mr. Palmer. OK. I couldn't understand all of it. So, if you 
don't mind, submit it in writing.
    I would also like you to respond to--I have had some people 
speak to me about people having excess to vaccine and not 
knowing what to do with it, and concerned about it expiring.
    So, if there are some things going on in your State and 
local governments in that regard, I would like to know about 
that.
    And I would also like to point out that we are all focused 
on injectable vaccines, and there is research being done right 
now--there are clinical trials being done on another internasal 
vaccine that not only has shown promise in mucosal immunity, 
but it will protect against infection, but it also protects 
against transmission. And I--Doctor, I just hope that we will 
continue to focus on the development of new vaccines that there 
might not be as much opposition to.
    And the last thing I would like to say, Madam Chairman, I 
don't know how many of you have had a chance to look at Mr. 
Offerman's website for his wood working, but the canoe that he 
made out of cedar is absolutely, stunningly beautiful. And I 
don't know if he built it, or someone in his shop built it. 
They built a dresser out of walnut, apparently, a solid piece 
of walnut. It is amazing. I don't know if any of us could 
afford a canoe or a dresser like that. But they are really 
beautiful pieces.
    And I want to commend you for your outreach to the 
homeless. I think one of the great tragedies of the welfare 
state and homelessness is the loss of incredible talent and 
ingenuity and imagination among those people. And the fact that 
you are bringing them in, giving them a chance to demonstrate 
their artistic ability is amazing. And I want to congratulate 
you on that.
    And I yield back.
    Ms. DeGette. The gentleman yields back. The Chair now 
recognizes the chairman of the Environment and Climate Change 
Subcommittee, Mr. Tonko, for 5 minutes.
    Mr. Tonko. Thank you, Chairwoman DeGette. Can you hear me?
    Ms. DeGette. Yes, we can hear you.
    Mr. Tonko. OK, thank you. And I thank you and Ranking 
Member Griffith for hosting this wonderful meeting.
    We have heard today that there is no one-size-fits-all 
solution to--for increasing COVID-19 vaccination rates. While 
we have made tremendous strides in just a few short months to 
increase vaccine supply, we know that availability does not 
equal access. And the reality is that many Americans remain 
unvaccinated due to access barriers to getting vaccinated.
    Dr. Gracia, you emphasized in your testimony, and I quote, 
``lack of culturally and linguistically appropriate information 
and services, less access to technology required to sign up, 
less access to transportation, and a lack of paid sick leave 
may be hindering vaccine access for some populations.'' So how 
are these barriers preventing unvaccinated Americans from 
accessing COVID-19 vaccines, especially those who make up the 
movable middle?
    What populations are most likely to face these challenges?
    Dr. Gracia. Certainly. Thank you for that question. So if 
we think about, for example, low-income communities, many 
communities of color, with regards to being disproportionately, 
actually, those that work in some of the frontline jobs, some 
of the jobs that were deemed as essential jobs in the COVID-19 
pandemic, that actually--many workers of color did not have 
access to paid sick leave.
    And so the challenge of, for example, being able to take 
time off or being worried about--and losing income, or losing 
their job, being able to get the vaccine, and worrying about 
the side--potential side effects and having to take time off 
can be a barrier. And so addressing those types of issues, such 
as sick leave, as well as access to child care that families 
may need in order to get the vaccination, are addressing some 
of the issues of equitable access.
    As it relates to providing information that is culturally 
and linguistically appropriate, that is ensuring that, for the 
diversity of communities that we are serving, that information 
is available, that it is respectful and responsive to the needs 
of the communities that are being served. And so that is where 
partnership with trusted community organizations is so 
critically important.
    It is one--certainly, if it is a community that has limited 
English proficiency, ensuring that communications materials are 
translated into the languages that the community speaks, to 
ensure that they have access to information to make those 
informed decisions. But it is also understanding what might be 
some of the concerns and how to message that most 
appropriately.
    So it is, as many have said, it is the message and the 
messenger, and that is where it gets to understanding the 
cultural appropriateness of the messages that are being shared, 
and not doing so in a judgmental way that is a concern of why 
people aren't being vaccinated, but really getting to the 
causes of understanding why there may be limits in vaccination.
    You also look at other barriers. For example, access with 
regards to the sites. Are the sites open and accessible during 
hours that they can actually go to, if they have to work one or 
more jobs?
    And so these are the types of things that we are seeing, 
certainly now with these investments, and the--or these 
strategies with regard to pop-up clinics and mobile clinics, 
and extending clinic hours or the vaccination site hours. These 
are critically important ways to ensure that access is not a 
barrier to actual vaccination.
    Mr. Tonko. Thank you.
    And Mr. Offerman, as an owner and operator of a small 
business, you have the opportunity to work with the nonprofit 
Would Works to provide training opportunities to people 
experiencing homelessness or living in poverty, individuals 
likely to face access barriers. Like many others, we understand 
that operations of both the woodshop and Would Works were 
affected by COVID-19. Has vaccine uptake allowed normal 
operations to resume for you?
    Mr. Offerman. At the woodshop we are just about, you know, 
back up on our feet. Everybody's vaccinated. And so we still 
are employing masks, just erring on the side of safety. I don't 
see why we wouldn't do that.
    And at Would Works we have just announced today, 
coincidentally, we are opening the program back up. That is a 
much more vulnerable population, so we are taking extra 
precautions. But it's a wonderful organization. We are very 
happy to support it. So many of the people who are without 
homes just need an opportunity. They all want to go to work. 
They just need a chance. So I love--I wish we would--Would 
Works nationwide.
    Mr. Tonko. Well, thank you. And alleviating access concerns 
among unvaccinated Americans is, clearly, just as important as 
addressing other reasons why some people have yet to get the 
COVID-19 vaccine. So I am encouraged by the strategies being 
deployed across the country and certainly hope we can amplify 
these efforts.
    And with that, Madam Chair, I yield back. And again, thank 
you.
    Ms. DeGette. Thank you. And I am now pleased to yield to 
Dr. Joyce 5 minutes.
    Mr. Joyce. Thank you for yielding, Madam Chair, and to this 
panel for testifying on this important subject today.
    Dr. Omer, some clinicians had concerns that the U.S. Food 
and Drug Administration's recommended pause on the Johnson & 
Johnson vaccine might increase vaccine hesitancy and reduce 
public confidence in the overall approval process for the other 
vaccines, as well. Dr. Omer, do you feel that the FDA's actions 
instill a higher degree of confidence in the safety of the 
COVID-19 vaccines that have received the emergency use 
authorizations from the FDA?
    Dr. Omer. Yes. I think that was the right thing to do. As 
they were evaluating they had a temporary pause, communicated 
the reason for that pause. They--you know, whenever you have an 
emerging event, there are several difficult options. But they 
chose the best--the most appropriate, in my perspective--of 
those difficult options. So, yes, in the long run, it will 
instill confidence in our vaccine safety and regulatory system.
    Mr. Joyce. Dr. Omer, can you comment on how common the 
severe blood clotting, combined with low levels of platelets, 
that resulted in the FDA's recommending a pause of the J&J 
vaccine--would you say this is a rare, a very rare event? Could 
you comment additionally, please?
    Dr. Omer. So, depending on the group, it is a rare to very 
rare event. And looking at the risk versus benefit, it heavily 
favors benefit.
    But then it was appropriate to evaluate that, take a pause, 
evaluate that risk-benefit ratio, and then resume that--the 
vaccination drive with this vaccine.
    Mr. Joyce. Dr. Omer, how does the rate of severe events for 
the J&J COVID-19 vaccine compare to other vaccines that we more 
commonly see people get, the chicken pox vaccine, the MMR that 
has been discussed previously in today's hearing, which have 
been proven to be safe and effective?
    So what is the rate of severe events comparing J&J's COVID-
19 vaccine with other, more commonly administered vaccines?
    Dr. Omer. Well, it depends on the event. But overall, it is 
at par or favorable compared to other commonly used vaccines. 
So, you know, I would be happy to provide specific details 
between--based on the risk group and age group, et cetera. But 
I think it is reasonable to say that, qualitatively speaking, 
or sort of broadly speaking, that this vaccine is--has similar 
safety profile or, in certain cases, certain groups, better 
safety profile than some of the--our other commonly used 
vaccines, as well.
    Mr. Joyce. Yes, I would like to see that additional data, 
if you could, please.
    And then finally, Dr. Omer, on another subject, how common 
is it for someone to have an allergic reaction after receiving 
one of the COVID-19 vaccines?
    And is the risk the same among the--all three vaccines that 
have received the emergency use authorizations from the FDA?
    Dr. Omer. So there are different databases that were used. 
It is also considered within the rare side effect range. And it 
is one of the ways this is mitigated, because right now we are 
in a situation where it is mitigated by having people wait an 
extra 30 minutes if--extra 15 minutes, a total of 30 minutes, 
who have, you know, a predisposing situation, have a history of 
allergy, et cetera. So it is more, in the context of mRNA 
vaccines, if you look at the the absolute numbers. But even for 
mRNA vaccines, it is in the territory of rare events.
    So it ranges from, you know--so there are a few ranges 
around that. But, you know, it is in the rare category for--
even for mRNA vaccines.
    Mr. Joyce. And Dr. Omer, could you please comment for us, 
Dr. Omer, on the safety, from your perch, for the use of these 
new vaccines in adolescents and children?
    Dr. Omer. That is a really good question. So, based on the 
current data and the data that the Advisory Committee on 
Immunization Practices has evaluated, in the groups for which 
it is currently recommended, 12 and up, the benefits 
substantially outweigh risks. We continue to monitor events.
    There was a--there is a signal that various public health 
agencies, as you know, you may have seen in the news that they 
are evaluating proactively, just to remind everyone it is a 
self-limiting event in certain teams. And so--and I have 
confidence that we will get clarity on this event, as well, in 
the coming weeks, fairly soon.
    Mr. Joyce. And I thank you for that answer. My colleague, 
Dr. Schrier, the pediatrician on this panel today, I am sure 
will also have questions regarding immunization and children.
    Thank you, Madam Chair, and I yield the remainder of my 
time.
    Ms. DeGette. I thank the gentleman. The Chair now is 
pleased to recognize the vice chair of the subcommittee, Mr. 
Peters, for 5 minutes.
    Mr. Peters. Thank you, Madam Chair. I just want to start by 
saying I certainly share the frustration of Dr. Burgess that we 
are not all together in person, unmasked, which I believe we 
could be, if we were all vaccinated. And I know that--I think 
the--every Democrat is vaccinated. I am sad to say that every 
Republican is not. So if there is anything we can do to 
encourage that, I would certainly jump in.
    And, as the daily--number of daily vaccinations has 
declined since April, State and local governments are thinking 
about that issue, too, with respect to incentive programs to 
motivate unvaccinated Americans to get shots. In New Jersey 
there is a shot-and-a-beer program. In Ohio there is a vaccine 
lottery that offers you a million bucks. I don't know if that 
indicates that there is higher self-regard among Ohioans than 
New Jerseyites--I say that as a former New Jerseyite. Major 
League Baseball teams are offering free tickets to those who 
get vaccinated at the ballpark.
    And the question I have, I guess, for Dr. Omer is whether 
these programs work. I mean, even before the pandemic hit, you 
have been researching ways to incentivize vaccine uptake. So do 
these vaccine incentive programs work?
    And what types of incentive programs would be most 
effective?
    Dr. Omer. So there are two things. We know, as a concept, 
incentives have a role in increasing vaccine coverage. So there 
has been evidence for several years. We have done some 
experiments, others have done some experiments, but incentives 
are useful.
    In this pandemic, although the uncertainty is that the--
what kind of incentives are better suited. So with our 50-State 
laboratory, people like us, like myself, are watching and 
learning from it. And I think it is--but then, you know, within 
certain limits, it is worth trying different models. So that is 
the short answer.
    Mr. Peters. And Dr. Gracia, what is your view on the 
effectiveness of these types of vaccine incentives, and 
particularly--do you have any evidence that they can increase 
vaccine uptake in communities of color or Tribal nations?
    Dr. Gracia. Thank you. I think, similarly to Dr. Omer's 
response, you know, we too, just at our organization, follow 
the evidence with regards to these policy recommendations.
    And with regards to incentives, you know, there can be a 
place for incentives, and there is just a great deal of 
innovation that is happening both in the public and private 
sector regarding that. So I think studying that to see how that 
is impacting the uptake for various communities, I think, will 
be important for us, not only now in the pandemic but certainly 
moving forward.
    Mr. Peters. OK, thank you.
    Dr. Shelton, your testimony indicates that you are 
partnering with stakeholders to give away tickets to 
incentivize vaccinations. How has the community responded to 
this incentive?
    And more broadly, what kinds of incentives or innovative 
approaches for encouraging uptake have you seen work in rural 
communities that can be replicated or expanded on?
    Dr. Shelton. Well, thus far in our mobile units and 
outreach, the numbers have been very low as we go out. So we 
are looking to see what incentives might be helpful. And I 
would love to have some of these incentives to offer to our 
community as ways to see whether or not these experiments truly 
do work.
    We are just at the beginning of these incentive programs. 
So, again, we don't have a lot of knowledge yet about what is 
working, but we look forward to trying these incentives, and 
seeing what will work, and reporting back on any successes that 
we do have.
    Mr. Peters. And Dr. Omer, any recommendations for employers 
who may want to incentivize COVID-19 vaccinations for their 
employees? Any recommendations you have for us?
    Dr. Omer. Yes. First of all, promote it as a social norm. 
And we know that--we have evidence that promoting even an 
emerging social norm is helpful.
    Ensure that there is safety of everyone involved. So we 
know that, even though these vaccines are highly effective, 
people who are immunocompromised, there are certain concerning 
data about them, et cetera. So have those, you know, 
precautions available for these people.
    And sort of look at things like time off for--you know, 
during vaccination. It is easy to vaccinate, and there will 
come a time where onsite vaccination will have--pretty soon, 
for at least some large entities, onsite vaccination may have a 
role in there.
    So I think companies and employers of various sizes have a 
huge role. Even small businesses. But Mr. Offerman very 
eloquently spoke on the--on small businesses.
    Mr. Peters. Right. Well, it looks like there is a lot of 
information to come in on this. And I would certainly invite 
any of the witnesses who see results from these incentives to 
reply to the committee and offer us information on that. We 
would love to get that information.
    And Madam Chair, I appreciate you holding this hearing. It 
is OK to do hearings, virtually. I think it may be in some ways 
pretty useful, but I really am anxious to get back to work with 
everybody in person without masks in the committee room. And if 
there is any way we can incentivize the rest of our colleagues 
to get vaccinated, maybe we have learned something from this 
testimony, as well.
    Thank you, I yield back.
    Ms. DeGette. Thank you, and I agree.
    The Chair is now pleased to recognize Mr. Long for 5 
minutes.
    Mr. Long. Thank you, Madam Chair, and I appreciate it, and 
thank all the witnesses for being here today. And I might 
suggest that, as a first move to get away from these Zoom and 
committee hearings and things, we might consider doing them 
over at the White House. Because if you will Google ``Pelosi,'' 
``White House,'' ``no social distancing,'' you will see that it 
is very safe to mingle, mix and mingle there, with people who 
have been and have not been vaccinated. So just a suggestion 
for a first move, so we can get back to more normal times.
    Dr. Gracia, according to a recent report issued by the 
Centers for Disease Control, residents in rural communities 
like I represent a lot of here in southwest Missouri are at 
increased risk for severe COVID-19-associated morbidity and 
mortality. Last September, COVID-19 incidents of cases per 
100,000 residents in rural communities surpassed those in urban 
counties. Further, the report found that COVID-19 vaccination 
coverage was lower in rural communities, at a little under 40 
percent, than in urban communities, a little over 45 percent.
    The implications of these findings are the disparities in 
COVID-19 vaccination access and coverage between urban and 
rural communities can hinder progress toward ending the 
pandemic. What are the unique challenges found in rural 
communities of getting available vaccine doses into patients' 
arms?
    Dr. Gracia. Thank you for that question, and critically 
important to address, certainly, these disparities that we are 
seeing in rural communities. And similarly, we can point to 
some of the longstanding, as you noted, health disparities that 
exist in rural communities.
    We know, certainly, access to healthcare has been one of 
the areas that--having access to a healthcare provider and 
routine, regular care, as far as preventive services, those are 
issues that can be challenging in rural communities, and that 
pre-dated the pandemic. But recognizing, certainly, that also, 
beyond the access to healthcare, are really what we think about 
the broader social determinants of health.
    So, in addition to access to healthcare, is ensuring you 
actually have transportation to be able to get to those 
services. Do you have, you know, income, the income to be able 
to maintain, you know, and have access to healthy, affordable 
foods and be able to engage in the types of physical activity, 
et cetera, that is needed for a healthy lifestyle?
    I think that we need to really address some of these 
longstanding issues as it relates to rural health disparities, 
certainly, as we move forward beyond the pandemic with regards 
to access to healthcare, whether it is through telehealth and 
the closure of rural hospitals. We have seen several rural 
hospitals that have closed during the context of the pandemic, 
and making access to care more difficult.
    But with regards to vaccination, I think some of the 
promising things that are now happening is the investments, 
certainly, because of the legislation that has been passed, to 
do more investments to getting mobile healthcare units out, to 
be able to fund and support rural health clinics, to be able to 
do vaccinations in rural communities, and also to be able to 
educate and do outreach to rural communities through community 
health workers and other types of health outreach to increase 
vaccination.
    Mr. Long. OK, thank you. And I, for one, would like to see 
everyone vaccinated. I appreciate that. And it is discouraging 
that the rural areas are not able to get the same access.
    My next question for Ms. Pisani: The Pfizer vaccine, which 
is the one that I took back in December, is now available to 
children 12 to 15. And the Moderna announced this week--or 
Moderna announced this week that their vaccine is safe and 
effective for children ages 12 through 17, and they plan to 
submit their findings to the FDA in early June.
    What are the most frequently asked questions that you get 
from parents that have children in this age range about the 
COVID vaccine?
    Ms. Pisani. We get pretty much the same questions we get 
with all vaccines, and they want to know what are the long-term 
side effects of getting a vaccine, which, of course, the 
answer, again, is what is the long-term side effect of getting 
the virus. You have to remember to answer it that way.
    Parents are hearing the same rumors that are just literally 
going through wildfire on social media. I have never seen 
anything like it in my life. You will hear a rumor one day 
about, you know, questions about infertility here, and then it 
will go all the way across the globe. And so my friends and my 
family who have, you know, kids my age and younger--my kids' 
age and younger--they are asking the same questions: Will they 
be safe, you know, why do they need them, if they--if the virus 
isn't as dangerous to the children? And of course, that is all 
just misinformation that we need to correct.
    Mr. Long. OK. As the father of a pediatrician, I appreciate 
that very much. And it is--I have said it before on here, but I 
will say it again, it is very disturbing to me to have someone 
of such notoriety as Robert Kennedy, Jr., of all people, 
leading the anti-vaxxer charge.
    With that, Madam Chair, I yield back.
    Ms. DeGette. I thank the gentleman. The Chair now 
recognizes an actual pediatrician, Dr. Schrier, for 5 minutes.
    Ms. Schrier. Well, thank you, Chairwoman DeGette, and thank 
you to our excellent witnesses today.
    Vaccine hesitancy is such an important topic. And, as a 
pediatrician, I spent 20 years reassuring anxious parents about 
routine childhood vaccinations. And most parents, like you 
said, that are considered vaccine hesitant have heard something 
from a friend, online, that gives them pause, and they just 
want to be sure that they are making the right decision for 
their child. And we know that conversations with a trusted 
primary care provider makes all the difference in the world.
    However, we are seeing a higher degree of reluctance when 
it comes to the COVID vaccine for all the reasons you pointed 
out. So at this point, most parents who definitely want the 
COVID vaccine for their kids over 12 have already done it or 
scheduled it. My 12-year-old got his 10 days ago. More hesitant 
families will visit their primary care provider to seek answers 
from their trusted doctor.
    So I want to start with Dr. Gracia. One of the main 
questions that I get from parents is about why they should 
vaccinate their child, when they have heard that the risk to 
children from COVID-19 is low, and they are making this risk-
benefit calculation. So, as a pediatrician yourself, can you 
briefly describe how you would answer that question to that 
hesitant parent?
    Dr. Gracia. Yes, thank you for that question, and thank 
you--it was a pleasure, certainly, also, to partner with you on 
the vaccines briefing that we did last year, just ongoing, 
highlighting the importance of vaccinations, and why this is so 
critical, not only in emergencies but beyond, in calm times, if 
you will.
    I think, you know, formerly, when I formerly practiced as a 
pediatrician, I think an important thing is, really, to hear 
and understand a parent's concerns about the vaccination and be 
able to articulate, certainly, the safety and effectiveness of 
the vaccine and to note that, yes, while, you know, children 
have a much lower risk with regards to severe illness and 
hospitalizations from COVID-19, that is still important to 
provide that protection and to also think about it from the 
standpoint of there may be others in the family, for example, 
if someone is immunocompromised or they interact with others, 
that it also can provide that protection with regards to 
decreasing the risk of transmission.
    But I think it is especially important, too, to think about 
the ability for children then to engage in the activities that 
they were engaging in prepandemic and recognizing some of the 
social and emotional needs of children to really be able to re-
engage in the things that they did prepandemic, and that 
vaccination is an important strategy for us to get there.
    Ms. Schrier. I agree. And the risk of COVID is not zero. 
Several hundred kids have died. We don't know about long COVID. 
There are many risks, like you said, and getting back to 
normalcy is so important.
    Now, specifically, can you address the concern that some 
parents now have about finding a handful of cases of mild 
myocarditis out of many million vaccinated teens, and perhaps 
how they should think about that risk compared to, say, the 
risk of getting myocarditis from any viral infection, or 
certainly at a much higher risk of getting it from COVID 
itself?
    Dr. Gracia. Right. And I think that it's important, really, 
one, to hear--again, hear those questions, to listen to their 
concerns as parents and to tell them what is known now and, as 
you noted, that, yes, myocarditis can be caused by other 
viruses, by other bacteria, for example, as well, and--but to 
assure them, for example, one, you know, the American Academy 
of Pediatrics continues to recommend that children 12 and above 
should be vaccinated and that what is being studied, actually 
showing that, of the cases that--right now there--that there is 
not conclusive evidence that there is an association with the 
vaccine and also that the cases and the numbers of cases that 
are being seen is what would also be seen at baseline.
    And so, you know, really, it is stressing, too, that, 
especially for organizations such as the American Academy of 
Pediatrics, the pediatricians who are themselves vaccine 
experts, and really take this very seriously, and reading the 
data, I continue to recommend it, as does the CDC.
    And then getting back to Dr. Omer about--that these----
    Ms. Schrier. And then----
    Dr. Gracia [continuing]. The systems, yes.
    Ms. Schrier. Right. We are looking for a blip above 
baseline, and we haven't hit that.
    Last quick question. I just wanted touch on the new 
guidance that the COVID vaccine can be coadministered with 
other childhood immunizations that have been--that have dropped 
by about 30 percent during the pandemic. And so can you tell me 
again, Dr. Gracia, your thoughts about coadministration?
    What do you say to a parent who is nervous about getting 
COVID with, like, HPD and Tdap, and our ability to then track 
potential rare adverse effects if they are given together.
    Dr. Gracia. So, again, I would emphasize, you know, when--I 
was going to say practice--so I would emphasize again the 
importance that--how our safety systems are working to be able 
to detect if there are any concerns with regards to, you know, 
something like a coadministration, to know that--you know, that 
these academies, whether it is the American Academy of 
Pediatrics and others, certainly are reviewing this, and 
feeling that there is--safety with regards to being able to do 
that coadministration, which can also then be a support for 
parents, especially in the need to be able to come back to the 
office, to be able to do other administration of vaccinations--
--
    Ms. Schrier. Thank you.
    Dr. Gracia [continuing]. And building on the existing 
infrastructure that----
    Ms. Schrier. Thank you.
    Dr. Gracia [continuing]. Offices----
    Ms. Schrier. I am out of time. It is so great to see you 
again. And then just--that path back to normalcy, to school, to 
summer camps, everything, is vaccinating our kids. Thank you so 
much.
    Ms. DeGette. I thank the gentlelady. And then I apologize 
to Mr. Long for somehow implying his daughter wasn't a 
pediatrician. What I meant was he is not a pediatrician, 
although he assures me he once played a doctor on the radio. So 
there you go.
    Mrs. Trahan, I am now pleased to recognize you for 5 
minutes.
    Mrs. Trahan. Thank you, Chairwoman DeGette. Like so many of 
my colleagues, I am so pleased that earlier this month FDA 
expanded the authorization of the Pfizer COVID-19 vaccine for 
adolescents 12 to 15 years old. And CDC quickly recommended its 
use among this age group.
    And I am also encouraged by yesterday's news that, 
according to Moderna studies, its COVID-19 vaccine appears to 
be safe and effective for children as young as 12, as well.
    However, just as misinformation is spread across social 
media about the COVID-19 vaccine for adults, I too am concerned 
that families are facing a barrage of myths and disinformation 
about their use among children. So I am glad to have such a 
robust panel of experts here today to help us get the facts 
straight.
    Ms. Pisani, according to your testimony, the Vaccinate Your 
Family campaign has grown over the years into ``one of the 
nation's largest social media programs aimed at educating the 
public on vaccines and their safety and to counter vaccine 
disinformation.'' Unfortunately, we know that this 
disinformation is rampant online, with parents and children 
exposed to a range of myths about the safety of the COVID-19 
vaccines.
    What lessons can we learn from Vaccinate Your Family's 
efforts to combat vaccine disinformation?
    Ms. Pisani. Thank you for asking that question. So we 
have--obviously, we have been around for 30 years, so we didn't 
start in social media. We began working directly with parents, 
and children were our focus for 25 years.
    So--but one thing we can learn is that--never repeat the 
negative, first of all. And also that there's efforts being 
made. And I have to say Google is doing an amazing job. They 
are giving out grants around the world to try to help stop 
disinformation. And Instagram is doing a great job. I don't 
know why Facebook is not following up with that.
    But we have to really think about the groups that are 
targeting people, and they have taken to targeting communities 
of color to sow doubt. And, you know, after all the work that 
has been done to help the disparities, and all the work we need 
to do, we have to really think about what is, you know, the 
line of freedom of speech. We all hold it sacred, but when 
there is a group of individuals or companies that are making a 
cottage industry about spreading disinformation and selling 
alternative products instead of vaccines, I think something 
needs to be done. That is endangering the United States and, 
frankly, the global citizens.
    Mrs. Trahan. Yes, I couldn't agree more. We have taken that 
up on another subcommittee--this one. But, you know, 
authorizing a vaccine for adolescents 12 years and older is one 
hurdle, but getting shots in arms of those adolescents is 
another challenge altogether.
    You know, Dr. Shelton, you mention in your testimony that 
your agency has been vaccinating middle and high school 
students in school clinics. Has this proven to be successful?
    You know, what other activities have you led or have 
planned to expand vaccination efforts to these younger teens 
and preteens?
    Dr. Shelton. Yes, we have been very grateful for the 
partnership with our schools to be able to go in and offer 
vaccines in the middle and high school levels. To be sure, the 
uptake has been small. It is a difficult time of year. There 
are a lot of end-of-year testings and sports events going on, 
and people are afraid to--of side effects and that they may 
miss work.
    So I think a lot of the messaging that we need to use with 
focusing in our schools is we know that our schools transmit 
disease, are kind of like the petri dish of the community, so 
to speak. In the winter time we routinely combat flu and 
norovirus in our schools.
    And so we know that one of the incentives for parents to 
talk with--for pediatricians and healthcare providers to 
discuss with their parents is, if you want your students to 
have all of the great benefits of being--in-person school, and 
all the social, mental, and physical well-being that they 
receive from the school, in addition to just the learning, 
vaccines really are our path to be able to have our schools go 
in person for longer amounts of time.
    We had with--recently, in April, an increase in our cases 
throughout the district, because we had five different 
outbreaks in schools, despite having gone in school since the 
fall. This is the first time. And so, being able to go in and 
take those vaccines to the schools, we have seen some successes 
there. But definitely, the importance of what people can 
achieve by in-person school and the importance of having those 
vaccines is very much what needs to be messaged.
    Mrs. Trahan. Yes, no question.
    Finally, Dr. Omer, with my remaining time, your testimony 
cites a survey experiment in which you found that ``a 
bipartisan endorsement of COVID-19 vaccines would help increase 
confidence in the vaccines.'' That is precisely the goal of 
this hearing today, to work together to debunk vaccine 
misinformation and send a clear message of support for the 
COVID 19 vaccines.
    Dr. Omer, if we were--if we are not able to dispel vaccine 
myths, boost confidence, and increase uptake, what potential 
consequences do we face?
    Dr. Omer. So I think we are at risk of entering a vicious 
cycle, because if we have--so one way of responding to an 
outbreak is to get ahead of it. And if we don't get ahead of it 
by having high vaccination rates, we increase the probability 
of variants emerging, and then it becomes a cycle of where we 
need, for example, boosters and other approaches and some 
nonpharmaceutical interventions, although not--certainly, not 
at the level as we saw last year, but other measures that 
hamper normalcy but are applied to prevent adverse outcomes in 
the public health, in the sense of public health.
    So we absolutely need to invest in our--redouble our 
efforts to vaccinate as high a proportion of our population as 
possible.
    Mrs. Trahan. Thank you, Dr. Omer.
    I yield back, Madam Chair.
    Ms. DeGette. I thank the gentlelady. The Chair now is 
pleased to recognize Dr. Ruiz for 5 minutes.
    Mr. Ruiz. Thank you for holding this very important 
hearing, Chairwoman.
    When vaccine distribution was ramping up, there was concern 
that Black and Hispanic individuals would have a greater amount 
of vaccine hesitancy than White individuals. And that narrative 
continues. But it just has not been my personal experience, as 
a physician, public health expert working in the community, 
inoculating some of the hardest-hit, hardest-to-reach 
constituents of mine, the Hispanic farm workers, which in my 
district face one of the highest rates of infections and 
deaths. And I have been going out there, administering the 
vaccine and educating communities about its importance.
    [Audio malfunction] for Blacks and Hispanics, they just 
don't want the vaccine because of mistrust, et cetera. That 
narrative is dangerous. It abdicates the responsibility of the 
healthcare system and us to make sure they have access. And it 
just blames those that have been left behind for generations. 
And the data is showing that my experience was actually a more 
accurate picture of what was occurring.
    As it is, the problem is not hesitancy, it is access. As 
with many aspects of our healthcare system, it is not about 
whether someone wants to get the vaccine, it is whether there 
are barriers preventing them from doing so. Despite months of 
headlines driving a narrative that Black Americans and other 
people of color would be the primary communities hesitant to 
get the COVID-19 vaccine due to discrimination and a history of 
medical experimentation in these communities, Kaiser Family 
Foundation polling shows Black Americans are just as likely to 
want to get the COVID-19 vaccine as White Americans. And, in 
fact, among unvaccinated people, Hispanic adults report being 
twice as likely as White adults to want to get the vaccine.
    So I am concerned that, despite being motivated to get the 
COVID-19 vaccine, access barriers are preventing people of 
color from getting vaccinated. And we know that Hispanics, for 
example, have the lowest vaccination rate, even though they 
have the highest infection rate and death rate than other 
communities. As a result, the vaccination rates in these 
communities are disproportionally--way disproportionately--
lower than their White counterparts in the United States.
    Dr. Gracia, in referencing the vaccination rate disparities 
among Hispanic adults compared to White adults, you cautioned 
that ``if we only look at the population as a whole, we may be 
missing significant barriers to access and information.''
    So you have touched on some of those barriers already 
today. Could you further detail what barriers may specifically 
be preventing Black and Hispanic adults from getting the COVID-
19, and what are some good, successful efforts that allow us to 
overcome those barriers?
    Dr. Gracia. Thank you, Congressman Ruiz. Yes, these are--it 
is important, as you noted, with regards to the narrative that 
is being shared, and understanding that inequitable access can 
also drive these disparities in vaccination rates.
    One of the things that we can see is that, when we 
prioritize and center equity with regards to the vaccine 
distribution and allocation and administration and ensuring 
that the sites and locations are accessible, whether it is from 
the standpoint of the hours--you know, that you have evening 
hours and weekend hours that are available, that the sites are 
trusted, community sites, where communities of color already 
seek their health services.
    And we have seen an impact of that, for example, with 
regards to the community health centers that receive Federal 
funding, that of the 10 million doses that they have given, 
over 60 percent of the vaccine administration has been to 
people of color. And knowing that----
    Mr. Ruiz. Yes. You know, the initial phase of this vaccine 
really got the low-hanging fruit, and they did a first-come, 
first-served basis. That puts--advantages those who have high-
speed internet, those that have the educational capacity to 
navigate a complex system, those that have the flexibility from 
leaving work and standing in line or waiting on the phone for 
hours at a time. And it disadvantages rural, underserved 
communities who don't have those factors to benefit them.
    So we need to shift now from that model to a grassroot, 
community-based model, working with community health promoters, 
taking the vaccines to the people where they are at, with 
trusted individuals from the community.
    And we also have to think how we can change our healthcare 
delivery system, because the status quo has resulted in these 
barriers and failures that have not focused on equity but has 
promoted health disparities. And because of that, we need to 
use this new form of outreach into our healthcare delivery 
model, so we can address health disparities in general, so we 
don't find ourselves in this situation in the next pandemic.
    And I ran out of time. And I appreciate you all being here.
    Ms. DeGette. Thank you so much. This completes the 
questioning from members of the subcommittee, but we are always 
happy to welcome members of the full committee to ask questions 
in these hearings. And we have two today. And so my first 
nonsubcommittee member, but a wonderful member of the full 
committee that I will recognize for 5 minutes, is Mr. 
Bilirakis, for 5 minutes.
    Mr. Bilirakis. Thank you very much, Madam Chair. I 
appreciate it very much. And I want to preface my comments by 
saying that I did get the vaccine, both doses. I had COVID in 
early January, but I chose to get the vaccine after the 90 
days. And I have had a very positive experience.
    However, this is for the panel, whoever would like to ask 
this question--answer this question. Dr. Jay Carpenter, an 
internist in my district, has encountered young patients who 
have been vaccinated, young patients in their early twenties, 
who have suffered from myocarditis--so, again, let me pronounce 
it again: myocarditis--and the inflammation of the heart.
    So has anyone experienced that, any of the experts? Have 
they seen this from, again, young adults in their twenties?
    So who would like to reply to that?
    Maybe we can get the--you know, if it is applicable, the 
whole panel can apply--reply, quickly.
    Has anyone seen this?
    Ms. Pisani. I would say that it is such a rare--it is such 
a rare reaction that there is still research taking place. And 
here in the U.S. we have amazing systems that oversee our 
safety, and so we have a vaccine-adverse-event reporting 
system, where everyone is encouraged, if they have any type of 
adverse event from a vaccine, they are to report it there. We 
have the Vaccine Safety Datalink. We have got the Clinical 
Immunization Safety Assessment System. I mean, there is just--
and there's new systems that were put in place just for COVID, 
V-safe and the FDA's BEST system is working.
    So there is a lot of different systems that are out there. 
And I do feel very confident that we will soon know if there is 
any type of need for any type of pause. And it makes me feel 
comfortable that there was a pause on J&J when it was 
requested.
    Mr. Bilirakis. OK, anyone else? Anyone else want to 
comment? Have they experienced this, or heard about this?
    I mean, it is very serious, and I would like to actually 
have Dr. Carpenter maybe contact you, and maybe elaborate more. 
Is--was that OK? Would--do you welcome that?
    [No response.]
    Mr. Bilirakis. OK, I----
    Dr. Gracia. Congressman, what I would just add to is, with 
regards to what we noted earlier, that what has been detected 
is not above the baseline of what we would detect with regards 
to cases of myocarditis.
    So as Ms. Pisani noted, we are continuing to review that 
and determine if there is actually any association, but there 
is----
    Mr. Bilirakis. Thank you----
    Dr. Gracia [continuing]. At this time.
    Mr. Bilirakis. No, I appreciate that very much. And I 
understand. My chief of staff has been in direct contact with 
this particular physician, an internist, and apparently he has 
experienced this, his patients have experienced this more than 
once. So it is definitely worth looking into.
    Dr. Shelton. I would say we have not seen that locally, in 
our area, but certainly, as has been mentioned, the V-safe 
programs and other monitoring systems, we will continue to look 
toward those for any--and report any side effects.
    Mr. Bilirakis. Thank you very much.
    Dr. Omer, again, on this topic, given how much information 
is available, it can be difficult to know which sources of 
information you can trust. That is for sure, particularly with 
the internet. How can one ensure that information they find 
about COVID-19 vaccines is accurate and comes from critical--
credible sources?
    Dr. Omer. That is a really good question. So the general 
public can go to several reliable sources and--such as, for the 
CDC, so the technical documentation from the CDC has been 
consistently reliable on this issue and others, as well.
    The second thing is professional associations. So we have 
20 years of research that shows that in this country there is a 
high level of trust in professional associations. For example, 
when it comes to pregnancy vaccination, American Congress--
American College of Obstetricians and Gynecologists. For 
pediatric vaccinations, American Academy of Pediatrics. They 
are highly--not just trusted but trustworthy entities, because 
they go through a very careful, deliberate process to evaluate 
the risk and benefit. So these are some of those sources that 
folks can go to.
    And the third thing is that--I have mentioned this national 
continued medical education program for physicians and 
providers, other providers. Just--that is one of the reasons 
why we are doing this, so that, you know, primary care 
providers, frontline providers feel empowered to talk about 
vaccine efficacy and safety, and in a way that is evidence-
based.
    Mr. Bilirakis. OK, let me make a statement. I know, Madam 
Chair, my time is finished, but I recommend that our Members 
communicate directly with their constituents. I have had a town 
hall meeting, it was very successful, with experts, CDC and 
NIH, and they directly answered their questions.
    I can't go any further, so I will submit the rest of my 
questions for the record. Thank you.
    Ms. DeGette. I thank the gentleman. And Mr. Carter, you are 
recognized for 5 minutes as our cleanup batter.
    Mr. Carter. Thank you, Madam Chair. I appreciate the 
opportunity to waive on, and I thank all of the witnesses. This 
is very important, very important for me.
    I have a large minority population in my district, and it 
is very important. And I am very concerned, as a pharmacist and 
member of the Doctors Caucus, a healthcare professional. I went 
through the clinical trials myself, with the vaccine, to try to 
set a good example. And I am very concerned about that.
    I want to start with you, Dr. Shelton, because I want to 
know--you have mentioned in your testimony about the many 
communities that lack access to broadband internet or even to 
cell service. And we all know that that is a problem. We all 
know that they can't get to know--or they don't know how to 
sign up for an appointment or get their COVID-19 vaccine. How 
can we address that?
    How can we address these challenges that--to make sure that 
these people that don't have access to Internet or cell 
service, or other kind of technologies, that it is not a 
barrier to them getting COVID-19 vaccines?
    Dr. Shelton. Well, certainly, providing broadband access is 
a long-term goal for many, and for our State, as well. 
Currently, though, it--this lack of access does hamper their 
ability to even ask their own questions, to find their own good 
information, and correct and true information.
    So we have addressed this by, you know, a lot of people 
just call the health department or call the pharmacy or the 
healthcare provider. We have encouraged people to help their 
families, friends, neighbors who may not have access to try to 
access and sign them up, especially our elderly population, not 
as computer savvy, by taking the vaccines out into the 
community and using our local radio stations or other media 
stations to allow people to know that there's, you know, 
vaccines coming, vaccines available.
    But this doesn't help as much to answer the questions one 
on one. So we value those opportunities to speak with them, and 
encouraging them. This new move that we have now, where we can 
redistribute the vaccine in smaller increments to many more 
local providers, will go a long way with helping people to 
access their local physicians and having their local healthcare 
providers give them that one-on-one information.
    Unfortunately, a lot of people who are not interested in 
the vaccine may not go to their healthcare provider regularly, 
anyway, or even have one. So we do have to continue to look at 
how we could best message in these areas.
    Mr. Carter. Thank you for mentioning the role of 
pharmacies, because 95 percent of all Americans live within 5 
miles of a pharmacist. They are the most accessible healthcare 
professionals in America. So thank you for mentioning that, 
because that is very important, and certainly a big part of 
what we are trying to do here.
    Dr. Omer, I wanted to ask you, according to the Kaiser 
Family Foundation, about 6 in 10 African-American adults and 
two-thirds of Hispanic and White adults now say they have 
either gotten the vaccine, or at least one shot of the vaccine, 
or they will get it as soon as they can.
    At the same time, African Americans and Hispanic adults 
remain somewhat more likely than White adults to wait and see, 
if you will, before getting vaccinated. What are--Dr. Omer, in 
your experiences, what are the main concerns, the top concerns 
or questions that you have heard from minority populations 
about COVID-19 vaccine?
    Dr. Omer. That is a really good question. So the concern, 
the specific concerns, overlap significantly with the rest of 
the population. But they do, you know, sit on a bed of not-so-
pleasant series of interactions with the health system overall, 
not having sort of a healthcare home in certain situations, and 
some of the other structural barriers that were described 
earlier.
    So the concerns overlap. For example, the concerns, 
questions about the process, the questions about--that arise 
from certain rumors, people talking about risk and benefit in 
certain subpopulation, et cetera. But that is--but they sit on 
this baseline of understandable mistrust in a lot of these 
situations.
    Mr. Carter. Well, thank you. And that is something--and I 
tell you, that, to me, is difficult to get your arms around and 
difficult for us to address that situation.
    You know, we in the Doctors Caucus, we have done everything 
we can and certainly done a lot to try to build up the 
confidence of people in the vaccine and let them know that it 
is safe and effective. And, you know, yes, it was done quickly, 
but that is because we cut red tape. We didn't cut corners. And 
they need to be assured of that.
    And I think that--and I am real proud to be a member of the 
Doctors Caucus and proud of what we have done in the way of 
trying to encourage everyone and bringing about, you know, the 
fact that it is safe and effective, and building up that 
confidence.
    One more question, Dr. Gracia, just really quickly, you 
mentioned in your testimony about the real barriers and 
perceived barriers. What are--what is the difference there, 
what are you talking about?
    Dr. Gracia. So, you know, real barriers, for example, if 
you simply don't have access, right, to a vaccination site, or 
if you, for example, don't have the internet technology to be 
able to sign up for vaccine appointments, versus what might be 
a perceived barrier, for example, believing that there is costs 
associated with the vaccine or that you might not--or not 
knowing what the eligibility terms are with regards to the 
vaccine. It is really helping to clarify what are the barriers 
that an individual experiences and helping them to address 
getting access to the vaccine.
    Mr. Carter. Great.
    Well, this has been a great panel, Madam Chair, and thank 
you again for allowing me to waive on. And I will yield back.
    Ms. DeGette. I thank the gentleman, and I thank all of the 
Members for an excellent hearing. Everybody's questions were 
very helpful. And I mostly want to thank our witnesses again, 
an extraordinarily informative and interesting hearing.
    We, this subcommittee, we intend to continue our oversight 
over the vaccine distribution process. And we stand at the 
ready for all of you, our witnesses, to help in any way we can. 
So, as you get data for our researchers and our physicians, if 
you can let us know. And, Mr. Offerman, if you can, please let 
us know what we can do to help you in your outreach efforts, as 
well.
    And with that, I remind the Members that, pursuant to 
committee rules, they have 10 business days to submit 
additional questions for the record. And I would ask the 
witnesses, if you do get these questions, to please respond 
promptly to any of them that you may have.
    Thank you again to all of you for appearing today.
    And with that, the subcommittee is adjourned.
    [Whereupon, at 1:38 p.m., the subcommittee was adjourned.]
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