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




   USING BUDGET PRINCIPLES TO PREPARE FOR FUTURE PANDEMICS AND OTHER 
                               DISASTERS

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

                                HEARING

                               BEFORE THE

                    SUBCOMMITTEE ON LEGISLATIVE AND
                             BUDGET PROCESS

                                 OF THE

                           COMMITTEE ON RULES
                        HOUSE OF REPRESENTATIVES

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             SECOND SESSION

                               __________

                      WEDNESDAY, JANUARY 19, 2022

                               __________

               [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
                               

                    Available via http://govinfo.gov
             Printed for the use of the Committee on Rules
             
             
                     U.S. GOVERNMENT PUBLISHING OFFICE             

49-381                     WASHINGTON : 2023




                           COMMITTEE ON RULES

               JAMES P. McGOVERN, Massachusetts, Chairman
NORMA J. TORRES, California          TOM COLE, Oklahoma,
ED PERLMUTTER, Colorado                Ranking Republican
JAMIE RASKIN, Maryland               MICHAEL C. BURGESS, Texas
MARY GAY SCANLON, Pennsylvania       GUY RESCHENTHALER, Pennsylvania
JOSEPH D. MORELLE, New York          MICHELLE FISCHBACH, Minnesota
MARK DeSAULNIER, California,
  Vice Chair
DEBORAH K. ROSS, North Carolina
JOE NEGUSE, Colorado
                       DON SISSON, Staff Director
             KELLY DIXON CHAMBERS, Minority Staff Director
                                 ------                                

             Subcommittee on Legislative and Budget Process

                        JOSEPH D. MORELLE, Chair
MARY GAY SCANLON, Pennsylvania       MICHAEL C. BURGESS, Texas,
DEBORAH K. ROSS, North Carolina        Ranking Republican
JOE NEGUSE, Colorado                 TOM COLE, Oklahoma
JAMES P. McGOVERN, Massachusetts
                                 ------                                

          Subcommittee on Rules and Organization of the House

                   NORMA J. TORRES, California, Chair
ED PERLMUTTER, Colorado,             GUY RESCHENTHALER, Pennsylvania,
  Vice Chair                           Ranking Republican
MARY GAY SCANLON, Pennsylvania       TOM COLE, Oklahoma
JOSEPH D. MORELLE, New York
JAMES P. McGOVERN, Massachusetts
                                 ------                                

                  Subcommittee on Expedited Procedures

                     JAMIE RASKIN, Maryland, Chair
DEBORAH K. ROSS, North Carolina,     MICHELLE FISCHBACH, Minnesota,
  Vice Chair                           Ranking Republican
NORMA J. TORRES, California          TOM COLE, Oklahoma
MARK DeSAULNIER, California
JAMES P. McGOVERN, Massachusetts
                                 ------                                




                            C O N T E N T S

                              ----------                              

                            January 19, 2022

                                                                   Page
Opening Statements:
    Hon. Joseph D. Morelle, a Representative in Congress from the 
      State of New York and Chairman of the Subcommittee on 
      Legislative and Budget Process.............................     1
    Hon. Michael C. Burgess, a Representative in Congress from 
      the State of Texas and Ranking Member of the Subcommittee 
      on Legislative and Budget Process..........................     2
Witness Testimony:
    Dr. Helene Gayle, MD, MPH, President and CEO, The Chicago 
      Community Trust............................................     7
        Prepared Statement.......................................    10
    Ms. Julia Tedesco, President, and CEO, Foodlink..............    16
        Prepared Statement.......................................    19
    Mr. Jeff Schlegelmilch, MPH, MBA, Director, Columbia Climate 
      School National Center for Disaster Preparedness...........    24
        Prepared Statement.......................................    27
    Dr. Robert Kadlec, MD, Former Assistant Secretary for 
      Preparedness and Response, U. S. Department of Health and 
      Human Services.............................................    33
        Prepared Statement.......................................    36
Questions and Additional Material Submitted for the Record:
    Hon. Michael C. Burgess, a Representative in Congress from 
      the State of Texas and Ranking Member of the Subcommittee 
      on Legislative and Budget Process..........................    63
    Letter from 13 organizations dated January 15, 2022..........    69
    Curriculum Vitae and Truth in Testimony Forms for Witnesses 
      Testifying Before the Committee............................    71



 
   USING BUDGET PRINCIPLES TO PREPARE FOR FUTURE PANDEMICS AND OTHER 
                               DISASTERS

                              ----------


                      WEDNESDAY, JANUARY 19, 2022

                  House of Representatives,
    Subcommittee on Legislative and Budget Process,
                                        Committee on Rules,
                                                    Washington, DC.
    The subcommittee met, pursuant to call, at 10:01 a.m., via 
Webex, Hon. Joseph Morelle [chairman of the subcommittee] 
presiding.
    Present: Representatives Morelle, Ross, McGovern, and 
Burgess.
    Mr. Morelle. The Subcommittee on Legislative and Budget 
Process of the Committee on Rules will come to order.
    I want to begin by welcoming our witnesses and thank them 
for being here today. And I would like to thank my colleagues 
Chairman McGovern of the Rules Committee and Mr. Burgess, our 
ranking member of the subcommittee and a member of the Rules 
Committee, for joining as well.
    Today's hearing will focus on the importance of making 
strategic investments across the Federal budget to build 
economic resiliency and ensure an efficient Federal response to 
future pandemics and other disasters.
    Disaster preparedness includes not only ensuring that 
existing programs are adequately funded but that systems are in 
place to efficiently distribute the funding as well. It is 
critical for the United States Government to make these 
investments before the next disaster occurs. And we have seen 
that underinvestment in key programs exacerbates inequities 
already present in our communities.
    And we inherently know the value of investing in 
preparedness. In fact, we do it all the time. We invest in 
public safety infrastructure to quickly respond to 911 calls 
and help mitigate dangerous situations. The National Weather 
Service routinely communicates storm warnings to allow local 
governments and State governments to begin preparations. These 
are critical efforts. Are we doing enough in these critical 
efforts, or are we budgeting enough for them?
    These types of investments should be prioritized as we 
think of investments in disaster preparedness as well. As we 
all know, investments in preparedness cost far less than 
investments in response measures. And a recent study by the 
National Institute of Building Sciences found that for every $1 
invested in disaster mitigation measures we ultimately save 
society $6.
    So, while this fundamental budget principle can be applied 
to the Federal response to many different types of disasters, 
an examination of the response to COVID-19 is an obvious place 
to begin.
    Almost 2 years since the beginning of the pandemic, this 
hearing attempts to provide an opportunity to look back and, 
more importantly, have a conversation about what lessons we 
have learned and how we can be better prepared for the next 
pandemic. This type of forward-looking thinking is desperately 
needed, as lessons learned from previous crises have clearly 
not been taken to heart.
    For example, even after recent public health crises ranging 
from SARS to Zika, public health agencies continue to be 
dramatically underfunded. A recent analysis shows that public 
health spending accounts for just 2.5 percent of all health 
spending in the United States, which comes to roughly $274 per 
person.
    This past fall, the Biden administration released a 
pandemic preparedness plan that focused on strengthening public 
health systems, improving surveillance and monitoring for early 
threats, increasing stockpiles of PPE, and investing in 
vaccines and therapeutics.
    While I applaud the administration for these efforts and 
these types of measures that must be enacted, the budget 
principles behind this plan should be applied to preparedness 
for other types of disasters as well. From the 2000 to the 2010 
decade, spending on FEMA's public assistance programming 
increased 23 percent. And as the frequency and cost of 
disasters continues to increase, Congress must consider how to 
better address disaster preparedness and assistance in the 
annual appropriations process.
    And, finally, coordination between government and private 
stakeholders can clearly be improved. Although FEMA is the 
primary agency for disaster assistance, it is important to note 
that at least 16 other Federal departments and agencies also 
contribute to disaster relief efforts. And I appreciate, in the 
testimony submitted by the witnesses, a number have touched on 
this point.
    This response structure becomes even more complex when 
including State and local government stakeholders, who, along 
with the private sector and not-for-profit organizations, are 
often most directly engaged in local communities.
    Ensuring that efficient systems are already in place 
beforehand will dramatically improve the quality of the 
response, particularly for services where planning and 
logistics play a significant role. Whether it be allowing food 
distribution networks and supply chains to operate more 
efficiently or ensuring that funding for government stimulus 
programs are able to quickly get to families in need, Congress 
must examine potential changes to this process.
    So I look forward to the discussion today, which I hope 
will develop policy recommendations on how to use the Federal 
budget process to build an economy more resilient to future 
disasters.
    And, with that, the Chair now recognizes the ranking member 
of the subcommittee, Dr. Burgess, for any remarks that he 
wishes to make.
    Dr. Burgess. I thank the Chair, and I am certainly glad 
that we are holding this hearing.
    I do want to thank our witnesses for being here to testify, 
and certainly looking forward to hearing from all of you and 
learning about how our Nation can more efficiently plan our 
budget to prepare for future pandemics.
    You know, I can't help but think I am sitting here in the 
Rules Committee by myself. This hearing is being done 
virtually. But it was just a little over 2 years ago that we 
had one of the first Rules hearings to regard what were the 
initial stages of this pandemic. And it is hard to believe that 
not only are we on the second anniversary of that, we are going 
into the third year of the pandemic. And, certainly, you can 
recognize a certain amount of pandemic fatigue around the 
country. And every congressional district is encountering that 
and recognizing that.
    I do hope today's hearing is productive, and I am anxious 
to see and learn how our budgetary process and our response can 
improve our pandemic preparedness.
    And, Chair Morelle, I just have to point out--and Chairman 
McGovern--that we are probably--you referenced an 
appropriations acknowledging that there is going to be future 
disaster mitigation necessary.
    We are actually about, what, 3 weeks away from the lapse 
of--an appropriation lapse in our governmental funding. 
Unfortunately, because of where we are in the process, we are 
very likely to see additional continuing resolutions.
    And, as you both know, it is impossible to plan for or to 
budget money for future disasters if you are only using a 
continuing resolution process, because, by its very nature, 
that is a process where you only look back and fund the 
activities of the previous year or years, not what is going to 
be happening in the future.
    So, I certainly hope that we--and I am sensitive to the 
fact that our ranking member of the full Rules Committee is an 
appropriator, so I want to be careful what I say. But, at the 
same time, we really do depend upon the appropriations process 
to do their work, and then, of course, we will do our work in 
the Rules Committee when they finish their product.
    But here we are. We are in the largest and most devastating 
pandemic in--certainly in my lifetime. In fact, I serve on 
another committee that has jurisdiction over pandemic 
preparedness; that is the Committee on Energy and Commerce. And 
I have been asking our committee, the Committee on Energy and 
Commerce, to hold just such a hearing for certainly longer than 
a year, probably almost 2 years.
    And recently I sent a letter to Chairman Pallone of the 
Committee on Energy and Commerce expressing my frustration and 
disappointment with the lack of response from the Energy and 
Commerce Committee, which is one of the primary committees that 
should deal with public health.
    I think we have much to learn from the experience that we 
have all been through the past 2 years. But our committee has 
been--the Energy and Commerce Committee has been eerily silent. 
And it is a point of personal frustration to me that the Energy 
and Commerce Committee, which has a responsibility in this 
area, really has not shouldered that responsibility.
    And this is not just a criticism of the majority Democrats. 
I think that criticism actually applies to both sides of the 
dais. I cannot believe how passive we have been on the 
Committee on Energy and Commerce as far as asking the hard 
questions and providing information as an authorizing committee 
to our appropriators and then ultimately to the Rules Committee 
before a process comes to the floor.
    It has been extremely frustrating to be in the minority 
during this pandemic, but it is also extremely frustrating to 
be part of a committee that should be in the vanguard, should 
be in the lead, and, in fact, has not even shown up.
    So, the Energy and Commerce Committee reauthorized a bill; 
it was called the Pandemic and All Hazards Preparedness Act of 
2018. And this very situation is what we were aiming to prevent 
and for which we were attempting to be prepared. And I believe 
we can all agree that we have had many successful 
accomplishments from the Pandemic and All Hazards Preparedness 
Act. The one thing that it should have done, which was prepare 
us for this pandemic, it did not do.
    And, again, going to my previous frustration, we had no 
real-time--no actual hearings, as an authorizing committee, on 
the Committee on Energy and Commerce looking at this in real-
time while the drama was unfolding around us. We had the 
Pandemic and All Hazards Preparedness Act signed into law in 
June of 2019, 6 months later to be visited by this pandemic. 
And we never asked a single question: Did we get it right? What 
could we have done better? What should we learn for next time?
    So, it is not often that we have a real, live case study to 
intricately examine the effectiveness of the policies that we 
just passed. And many of us, those of us who are witnesses 
today and those of us on the legislative side, we have had some 
experience with this over the years.
    One significant success that did occur during the first 
year of the pandemic--it was a significant milestone of the 
previous administration, the Trump administration--was that of 
Operation Warp Speed. Because of this program, we have access 
to vaccines, we have access to effective therapeutics. And the 
very existence of those vaccines and therapeutics begs the 
question, what made Operation Warp Speed so successful, and are 
there ways that we can apply these successes to our 
government's regular duties so that we don't just have to 
respond at the time of an emergency?
    It is critically important that we take the time to examine 
the program while we still have an opportunity to speak with 
those who developed and deployed it, those who were on the 
front lines, those who lived it. And so, for that reason, we 
are so very fortunate to have Dr. Kadlec at our witness table 
today.
    Additionally, it is an opportune time to compare our 
Nation's response to the novel coronavirus to other pandemics 
that we have encountered--for example, while on different 
scales, the Ebola outbreak that ravaged western Africa in 2014 
and 2015 and in fact, made its way to this country and ended up 
in my backyard in Dallas, Texas.
    It took 5\1/2\ years for an Ebola vaccine to be developed 
and produced and receive emergency use authorization. That is 
why the stunning success of Operation Warp Speed stands in 
stark contrast, where, over a 9-month period we had the 
streamlining of the process, the emergency use authorization 
process, at the FDA and got that vaccine in the hands of our 
constituents.
    Furthermore, I think it is pertinent to learn about what we 
are currently doing in the current administration to further 
the progress, the success, of the previous administration's 
pandemic response.
    We also must determine exactly where the almost $5.5 
trillion that Congress has appropriated for these efforts, 
where are those dollars today? Which have been spent, and what 
remains unspent?
    And when we talk about further activities, we really can't 
authorize new spending--we can't appropriate new spending until 
we know where the last dollars have gone. Effective oversight 
is going to be a key component of any successful pandemic 
preparedness and response effort. And, in fact, we really can't 
talk about how we budget for future problems if we don't 
understand where the dollars went, where the successes and the 
missteps were in the last effort.
    Plain and simple, we really can't plan for future pandemic 
preparedness unless we have a strong understanding of what has 
worked and what has not worked.
    We find ourselves in a unique and really a historic 
position. While these past 2 years have been exhausting for 
Americans, now is not the time to just sit back and hope that 
we won't find ourselves in a similar crisis in the future. This 
will be our best opportunity to create strategic and smart 
policy that will help ensure that, the next time this occurs, 
the country is properly prepared and that preparation can be 
properly executed.
    Thanks, Mr. Chairman, for holding the hearing. Thanks to 
our witnesses. And I will yield back.
    Mr. Morelle. Thank you, Mr. Burgess. I appreciate your 
comments about Energy and Commerce.
    I do want to note, though, that, while the pandemic is, you 
know, in the center here in terms of our thinking, that more 
broadly I also want to deal with the notion of other natural 
disasters which may be regional, whether it is wildfires, et 
cetera, and whether or not our budget process is prepared to 
deal with that.
    So I appreciate your comments.
    I also want to thank Chairman McGovern, who has been 
working with our subcommittee to host this hearing, and so, 
appreciate them.
    As for the appropriations process, I don't have the 
privilege of serving on the Appropriations Committee, but I 
would note that the House has, I think, done a great deal and 
we are waiting for our brothers and sisters across the Capitol, 
as we do on many issues.
    So, with that, I would like to introduce our witnesses.
    Let me begin with Dr. Helene Gayle, who has been president 
and CEO of the Chicago Community Trust, one of the Nation's 
oldest and largest community foundations, since October 2017. 
Under her leadership, the Trust has adopted a new strategic 
focus on closing the racial and ethnic wealth gap of the 
Chicago region.
    For almost a decade, Dr. Gayle was president and CEO of 
CARE, a leading international humanitarian organization. An 
expert on global development, humanitarian, and health issues, 
she spent 20 years with the Centers for Disease Control, 
working primarily on HIV/AIDS. She worked at the Bill and 
Melinda Gates Foundation, directing programs on HIV/AIDS and 
other global health issues.
    Dr. Gayle was born and raised in Buffalo, New York, which, 
as a upstate New Yorker, I have special pride in knowing that. 
She earned a B.A. in psychology at Barnard College, an M.D. at 
the University of Pennsylvania, and an MPH at Johns Hopkins 
University.
    We are also joined by Julia Tedesco, who is the president 
and CEO of Foodlink, a not-for-profit dedicated to ending 
hunger and building healthier communities in the greater 
Rochester/Finger Lakes region of New York.
    Over the past decade, she has led the organization's 
evolution from one of the country's oldest food banks to an 
innovative food resource center and public health organization 
focused on addressing the root causes of food insecurity, 
including chronic poverty and systemic racism. Ms. Tedesco 
began at Foodlink in 2008 and has served in numerous roles for 
the organization. She was named executive director in 2014.
    Ms. Tedesco holds a master's degree from Syracuse 
University's Maxwell School of Citizenship and Public Affairs 
and a bachelor's degree from Fairfield University. And I have 
had the privilege of working with her on a number of issues 
back in my hometown.
    Jeff Schlegelmilch is the director for the National Center 
for Disaster Preparedness at Columbia Climate School at 
Columbia University. In this role, he oversees the operations 
and strategic planning for the Center. He also oversees 
projects relating to the practice and policy of disaster 
preparedness. His areas of expertise include public health 
preparedness, community resiliency, and the integration of 
private- and public-sector capabilities.
    Prior to his role at Columbia, he was the manager for the 
International and Non-Healthcare Business Sector for the Yale 
New Haven Health System Center for Emergency Preparedness and 
Disaster Response. He was also previously an epidemiologist and 
emergency planner for the Boston Public Health Commission.
    And, finally, Dr. Robert Kadlec previously served as 
Assistant Secretary of Preparedness and Response at the U.S. 
Department of Health and Human Services from August of 2017 
through January of 2021. Dr. Kadlec spent more than 20 years as 
a career officer and physician in the United States Air Force 
before retiring as a colonel. Over the course of his career, he 
has held senior positions in the White House, the United States 
Senate, and the Department of Defense.
    So thank you all again for joining us today.
    And we will begin with Dr. Gayle. You are recognized to 
share your testimony with us.

STATEMENTS OF HELENE GAYLE, M.D., CEO, CHICAGO COMMUNITY TRUST; 
    JULIA TEDESCO, PRESIDENT AND CEO, FOODLINK, INC.; JEFF 
     SCHLEGELMILCH, DIRECTOR, NATIONAL CENTER FOR DISASTER 
PREPAREDNESS, COLUMBIA CLIMATE SCHOOL; AND THE HONORABLE ROBERT 
 KADLEC, M.D., FORMER ASSISTANT SECRETARY FOR PREPAREDNESS AND 
     RESPONSE, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

                STATEMENT OF HELENE GAYLE, M.D.

    Dr. Gayle. Great. Good morning, and thank you, Chairman and 
the other members of the committee and the subcommittee, for 
the opportunity to address you on this incredibly important 
issue.
    I won't go over a lot of the statistics around this COVID 
pandemic. I think we know them well. And while the health and 
economic consequences of COVID-19 are unlike any that any of us 
have seen in our recent memory, it is likely that this is not 
going to be a once-in-a-generation pandemic. We know that more 
than 40 new infectious diseases in humans have emerged in the 
past decades. You have mentioned some of them: SARS, MERS, 
Ebola, Zika, et cetera. So we know that we are at a time when 
we will continue to see new infections that can lead to global 
pandemics as we are seeing now.
    Clearly, we have to take the lessons that we have learned 
and think about how we apply those not only to this current 
crisis but in ways to make us better prepared. And while we 
know that we will continue to have these new infectious 
diseases emerging and pandemics, how we respond to them will 
really determine whether or not we see the kinds of severe 
health and economic consequences that we are seeing today.
    So let me just lead off with five points.
    First, pandemics do play on social fault lines and will 
always impact the most vulnerable in our societies. COVID-19 
has highlighted how the social determinants of health and 
underlying root causes that make one vulnerable to poor health 
also further amplify health and economic inequity. Pandemic 
preparedness means focusing on how we prepare for economic 
stability and resiliency not just in the face of a crisis but 
also in normal times.
    This requires us to think about how we address issues like 
affordable housing, the social supports we provide to 
individuals and family over the long term, like paid sick 
leave; family leave; living wages; affordable, accessible high-
speed internet; and comprehensive, affordable health insurance.
    Pandemic preparedness can and should help us to reimagine 
how we deliver social and economic support to make sure that we 
are all, as a society, resilient in times of crisis.
    Number two, we must work with communities that are most 
impacted, establishing links to organizations and people who 
are trusted.
    Another important lesson we learned during COVID, as we 
have during other crises, is that, to address the public health 
needs of people, we must work with the communities that are 
most impacted, who often have less access to services and less 
faith in medical systems that have failed them in the past.
    It is critical that public health institutions develop 
relationships with trusted messengers in order to deliver life-
saving measures like vaccines. These organizations and people 
who have been with communities and have stood the test of time 
are the ones who are going to be most effective, particularly 
when residents are grappling with the impacts of crises like 
this pandemic.
    Third, pandemics do not know geographic and political 
boundaries. A go-it-alone approach is ineffective and 
counterproductive to preventing and addressing a global 
pandemic. While, clearly, preparing for future pandemics at 
home and strengthening our own health safety network are 
immediate priorities, we cannot afford to ignore global health 
security vulnerabilities. There are no boundaries to global 
pandemics, and attempts to isolate populations, like closing 
boundaries, are not only ineffective but counterproductive as 
we work to look at a collaborative and cooperative way that is 
critical in addressing global pandemics.
    And we have seen time and time again in this pandemic that 
no one is safe unless we are all safe. As the richest nation in 
the world and the leader in global health and development 
assistance, we must provide international assistance to address 
pandemic prevention and control globally, especially for under-
resourced nations.
    This is not a matter of charity but of strategic investment 
in U.S. and global health security. We need to think about 
models like PEPFAR and global health security and control and 
prevention of diseases in the ways that we have in the past, 
because it is critical to our strategic health diplomacy, our 
investment in foreign policy, our national security, and our 
economic interests.
    Fourth, pandemic preparedness is as important but 
underfunded as compared to investments in other major threats--
as an example, our preparedness in military readiness. Knowing 
that future pandemics are a serious security and economic 
threat, the government must commit to investing in prevention, 
detection, and response to protect vulnerable populations from 
future infectious disease outbreaks.
    And if you compare our spending, our military spending, as 
an example, $750 billion--compare that to $447 million that we 
use for preparing for global health security threats like 
COVID. And while those aren't exact comparisons, if we think 
about the fact that our future threats are more likely to be in 
the cyber arena and the biologic arena, we need to think about 
the magnitude of spending that we commit to health and health 
security, and particularly thinking about making sure that the 
organizations like the CDC, the NIH, the FDA, State Department, 
and USAID are adequately funded in advance to be able to be 
ready and have systems in place when the next crisis does 
occur.
    And, finally, five, maintaining public health 
infrastructure, including a well-trained and robust workforce, 
surveillance systems, laboratory systems, information systems--
all of these things are key. And we should have learned this 
from the HIV pandemic, Ebola, SARS, et cetera.
    We know that the public health workforce has been shrinking 
and is estimated to shrink dramatically. Leading up to the 
pandemic, there were approximately only 56,000 public health 
workers due to funding issues. Access to the Public Health 
Workforce Interests and Needs Survey shows that a large 
proportion of workers are considering leaving their job in the 
next year due to inadequate pay.
    We must make sure that we don't continue to lose the 
critical infrastructure of people, surveillance system, and 
laboratory capacity that is necessary and needs to be in place 
in order to be prepared.
    The budget for the Hospital Preparedness Program, the major 
source of Federal funding to help regional healthcare systems 
prepare for emergency, was only $275 million in fiscal year 
2020. That is just half over what it was in 2004 of $515 
million. So, you know, we have almost halved the dollars that 
were available for hospital preparedness over the course of the 
last few years.
    These are just a few examples of how the decline in funding 
has led to us being caught off guard for this pandemic, not 
prepared and not having the infrastructure in place. And so, 
you know, my overall message is that we need to make sure that 
we have in place the important systems, people, relationships, 
and commitment to be able to be prepared the next time.
    We have learned these--we should have learned these 
lessons. We have a lot of blueprint to go on, lots of 
information and lots of lessons learned from the past couple of 
decades of fighting global pandemics. We need to learn these 
lessons. We need to keep the infrastructure in place. We need 
to be prepared so that we don't have to suffer the consequences 
that we have during this global pandemic.
    Thank you.
    [The statement of Dr. Gayle follows:]
    
    
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    
    Mr. Morelle. Thank you, Dr. Gayle. I appreciate your 
comments, and I am sure people will have a number of questions.
    And, with that, Ms. Tedesco, you are recognized for your 
testimony.

                   STATEMENT OF JULIA TEDESCO

    Ms. Tedesco. Thank you, Chairman Morelle, Ranking Member 
Dr. Burgess, and members of the Rules Committee. Good morning, 
and thank you for the opportunity to speak with you today.
    My name is Julia Tedesco, and I have the great privilege of 
serving as the president and CEO of Foodlink, a nonprofit 
organization in Rochester, New York, that serves as the 
regional food bank.
    Congressman Morelle likely recalls attending Foodlink's 
very first COVID emergency response food distribution on March 
20, 2020, in his hometown of Irondequoit. There was a lot we 
didn't know about COVID then, but, as an emergency response 
organization, we knew that families were already struggling 
with hunger and access to food, as they do in the face of any 
crisis.
    That day, a collaboration between the nonprofit and 
government sectors enabled us to safely get food to more than 
300 households. In the 2 years since, we have organized more 
than 900 similar drive-through emergency food distributions 
across our region.
    In the next few minutes, I would like to first share 
details about Foodlink's response during this pandemic. And, 
second, I would like to talk about the critical role that 
nonprofits play and why investment in this sector will help 
prepare us for any future emergency response. In doing so, I 
will do my best to represent the 200-plus Feeding America food 
banks across the Nation that have responded to COVID-19 and 
countless other disasters.
    Much attention has been given to the pandemic's devastating 
impact on the food security of millions of families and just 
how many Americans were one crisis away from not having enough 
food to eat. We saw this firsthand in the city of Rochester and 
in the suburban and rural communities throughout our service 
area.
    We saw that as many as 40 percent of the people seeking 
support from the emergency food system were doing so for the 
very first time. But we also saw firsthand how this pandemic 
disproportionately impacted the vulnerable--the elderly with 
limited incomes, low-income parents, people of color, and so 
on--individuals who were already facing difficult choices like 
paying for rent or paying for food, individuals for whom panic-
shopping in bulk for groceries was simply not an option.
    At the same time, schools closed indefinitely. The city of 
Rochester has one of the highest child poverty rates in the 
Nation. Every student in the district is categorically eligible 
for free school meals. With schools closed, parents were left 
wondering how to account for two extra meals per child per day, 
a looming financial and public health crisis of its own.
    Foodlink sprang into action on both fronts. In response to 
the need, we within a matter of weeks established a temporary 
alternate off-site warehouse to safely store and pack emergency 
provisions. When most of our network of direct-service 
partners--think of food pantries in community centers and meal 
programs in church basements--were forced to shut down, we 
designed and coordinated no-touch drive-through distributions 
in centralized locations across 7,000 square miles.
    When government and community partners had critical 
information or supplies they needed to get to the public, we 
utilized these distributions to disseminate them.
    We became a central hub for everything from suicide 
prevention and mental health resources to U. S. Census data 
collection.
    When a nurse from our regional healthcare system called us 
to frantically figure out how to get food to an elderly, 
quarantined, immunocompromised patient, we for the first time 
in our 40-plus-year history made a home delivery and continued 
doing so, thanks to partnerships with other nonprofits.
    We sat with leaders from our local city school district to 
brainstorm and coordinate the logistics of 17 grab-and-go meal 
sites for kids and their families. Understanding that barriers 
still existed for food access, we repurposed some of our 
smaller box trucks and, thanks to waivers issued by the USDA, 
we implemented ice-cream-truck-style neighborhood meal 
distributions to complement our Summer Meals program.
    Foodlink distributed more than 50 million pounds of food in 
the last 22 months, and our kitchen produced more than 1.5 
million healthy meals and snacks. Our fellow food banks in New 
York State and around the Nation all did similar work, 
distributing unprecedented amounts of nutritious food, 
leveraging our relationships in the communities we serve, our 
expertise in food distribution, and our infrastructure, 
including distribution centers, industrial freezers and 
coolers, commercial kitchens, and fleets of trucks.
    Significant government intervention, such as child tax 
credits and boosts in SNAP benefits, helped quell what surely 
would have been devastating poverty levels. Still, food 
insecurity remains approximately 10 percent higher than levels 
recorded in 2019. That is more than 7 million people across our 
Nation who are food-insecure. And in our region, that equates 
to about 152,000 people who have limited access to food, 
152,000 people who might not know when or from where their next 
meal will come.
    As a food bank, we are proud of our response to this 
pandemic, but it is important to emphasize that, for every one 
meal that a Feeding America food bank like Foodlink provides, 
SNAP provides nine. If we are to make a meaningful reduction to 
hunger in America and address a compounding factor in any 
disaster or crisis, the Federal Government must continue to 
increase investments in antipoverty programs like SNAP and to 
think of this, in its own way, as a form of disaster 
preparedness.
    In addition to investing in the social safety net, the 
Federal Government should more significantly invest in the 
nonprofit sector's ability to respond to crises. Nonprofits are 
not merely a group of small charities trying to do good; we are 
oftentimes the engine that generates innovative solutions to 
complex problems in our society. When the government needed to 
find ways to distribute food, PPE, vaccines, and information 
into underserved communities, it relied on the infrastructure 
expertise and flexibility of community-based nonprofit 
organizations.
    Far too often, though, nonprofits like Foodlink are asked 
to execute on programs that we did not have an opportunity to 
weigh in on. Issues with the Coronavirus Food Assistance 
Program have already been well-documented, and I won't go into 
all of them here in the interest of time. But I do hope a major 
lesson from CFAP is that, when the Federal Government needs to 
find ways to help feed people, it should include or perhaps 
begin with the nonprofit sector, and specifically the expertise 
of the Feeding America network, rather than to recreate the 
wheel.
    This Nation already has a centralized hub for emergency 
food assistance with spokes across every State, county, and 
local community in America that could have helped to ensure 
smoother logistics and more equitable access to these food 
boxes. If food banks were included from the start and leveraged 
for their expertise, we could have significantly reduced staff 
time spent on coordination, saved dollars, and fed millions 
more Americans.
    I hope that a critical lesson to come out of the pandemic 
is the importance of investing in nonprofit infrastructure and 
technical capacity. Over the last couple of years, we often 
found ourselves with a strong food supply but insufficient cold 
storage and refrigerated vehicles. Foodlink has rented tractor 
trailers stationed in our parking lot running 24/7 for 2 years 
to provide additional cold storage.
    Community-based nonprofits do not have the resources to do 
R&D and invest in innovation the way that the private sector 
does, and when we do, it rarely, if ever, is funded by the 
Federal Government. We are encouraged by the USDA's promised 
investments in strengthening our food system and hope these 
investments extend beyond farmers, producers, and for-profit 
distributors to include the nonprofit sector.
    To summarize, we first and foremost believe that our 
Nation's social safety net must be strengthened to better 
prepare us for the next disaster, but the pandemic has also 
shown us that the Federal Government has a real stake in the 
operational efficiency, infrastructure, capacity and innovation 
of the nonprofit sector, especially when responding to 
disasters. This sector should be invested in, and nonprofits 
should be counted on not only to receive support and deliver 
interventions or services decided on by government but to take 
part in the very design of those services.
    Thank you for your time today.
    [The statement of Ms. Tedesco follows:]
    
    
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    Mr. Morelle. Thank you very much for your testimony.
    And now, Mr. Schlegelmilch, you are recognized for your 
testimony, sir.

                STATEMENT OF JEFF SCHLEGELMILCH

    Mr. Schlegelmilch. Thank you. Thank you, Chairman, and 
thank you to all of the members of the committee for the 
opportunity to speak with you today.
    To complement my written testimony, I want to talk about a 
few experiences in the field that sort of illuminate what these 
larger challenges look like.
    So, to start, actually, after Hurricane Harvey, my 
colleague and then-director of the Center, Irwin Redlener, and 
I were in Texas assisting some celebrity donors to identify 
where their money could do the most good. And we saw a range of 
things, from really emergent community organizations that never 
envisioned themselves being part of disaster response and were 
meeting unmet needs--needs that weren't being met by larger, 
sort of, external groups or maybe that the funding couldn't 
reach.
    But, in particular, what stands out is a faith-based group 
that was doing what we would call ``disaster case management. 
''So there were a number of people who were being denied 
assistance through various programs. And, a lot of times, they 
were actually eligible but had filled out their paperwork wrong 
or misunderstood a definition or something like that. And so 
what most of them did, well, they gave up. And so they went to 
these nonprofits, and they actually helped them reapply and get 
access to those resources.
    In other cases, maybe they weren't eligible but they were 
eligible for another program they weren't aware of and wouldn't 
have though to look, like the Small Business Administration.
    You know, zooming out a little bit, I was talking to a 
State mitigation officer on some of the new mitigation funding 
that was coming in, and he was lamenting about how a lot of the 
smaller, more marginalized communities just had no way of 
accessing and putting together the application for these, that 
the opportunity to waive Federal cost-share was great for the 
communities that had capacity but not resources for cost-share, 
but a lot of the most marginalized groups really lacked the 
administrative capacity.
    And for folks like you and I that are mired in paperwork 
day in and day out, the idea of another grant may not seem too 
daunting, but a mitigation grant is quite a daunting task and 
requires a high level of administrative sophistication that 
many simply don't have.
    So we see a pattern here with the increased complexity, 
that it sort of pushes out those who are already the most 
marginalized. I tend to say, those who have access to the 
benefits of civil society before a disaster have access after. 
Those who don't have lawyers and accountants and access to 
high-quality administrative frameworks often don't have access 
to what are otherwise deemed fair and open accessibility. Fair 
and open in theory does not actually equate to fair and equal 
in practice with these barriers in place.
    So, thinking about root causes and something I talk about 
in my written testimony--so I had a call a couple of months ago 
with a congressional office. And it is the same call I get from 
various offices on all sides of the aisle from time to time 
after there is a major disaster. And they say, you know, ``We 
want to know how to do a better job with response. What are 
some things we can do?''
    So I start going down my list, which is suspiciously 
similar to my written testimony when talking about 
consolidating and simplifying and really looking at, sort of, 
larger, sort of, muscle movements in our whole-of-government 
disaster response.
    And I am typically met with, ``Yeah, we can't do that. 
Yeah, that is not going to fly. No, there is no way we can get 
that approved. In the current climate, we would love to but we 
can't.'' And it settles in on this comment: ``We are looking 
for a quick win.'' ``We are looking for a quick win.'' And then 
the comment kind of gets cleaned up with ``something that can 
lead to more, something that can be a starting point in all of 
these things.''
    In the opening comments from the chairman, I know we talked 
about the complexity of disaster response and the sheer number 
of programs and agencies. It is important to note, these quick 
wins are quite literally killing us. They are creating layers 
upon layers of complexity to the disaster response. And it 
requires more and more workarounds with emergency supplementals 
and budgetary workarounds, which creates a cacophony of data 
and assistance that leaves the survivors--the only ones who can 
access it are the ones with the highest capacity and are likely 
to be less vulnerable to begin with.
    So, to close, I want to reiterate a couple of the key 
recommendations I had in my written testimony.
    One is, I know it is pretty on-brand as an academic to say 
we need better data and more analysis, but we need better data 
and we need more analysis. We know enough to know in broad 
strokes that preparedness saves, and some of these specific 
programs we know. But to really look at this across whole of 
government and look at what is going into preparedness through 
the true definition and what is going in response, we actually 
don't have enough information to get from this concept and 
general direction to be pointed in to start answering 
questions: How much? What are the details? What are the 
investments, and what is the value of those investments? And 
what are the payoffs in terms of equity, social good, financial 
good? We have rough ideas but not necessarily to the level of 
granularity to integrate into a lot of decisionmaking.
    We need enhanced guardrails, quite frankly, to prevent 
electoral incentives that are contrary to the public interest 
from dominating legislative and budget processes. The political 
science points towards faster and very voluminous relief and 
recovery funding. Relief and recovery funding is necessary, but 
the signals for preparedness funding are virtually nonexistent. 
But in disaster science, of course, we know those are the most 
valuable, and that is how you prevent loss of life and 
livelihoods in the event of a disaster.
    We desperately need to simplify disaster funding and 
assistance and the bureaucratic landscape for all of this. It 
is a very unappealing and complicated topic, but I think it is 
probably the single most important thing that could be done to 
set a landscape that is more conducive towards disaster 
assistance benefit and equity.
    And, finally, I haven't mentioned this yet in my verbal 
comments, but we need to look hard at the public servants who 
are carrying out these policies and make sure we are making 
investments in their development. The world is changing. We 
know this. We know that our structures need to change. But 
these structures ultimately translate into institutions and 
people. The investment in professional and organizational 
development often gets thought of as overhead. It needs to be 
an essential part of the cost of doing business to ensure that 
those that are engaged in the design, development, and 
implementation of these strategies have the support that they 
need to accomplish that which they are already working so 
tirelessly and admirably at every day.
    So, with that, I want to thank you for your time, for the 
opportunity to speak, and I look forward to any questions and 
the opportunity to discuss further. Thank you.
    [The statement of Mr. Schlegelmilch follows:]
    
    
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    Mr. Morelle. Thank you so much for your testimony.
    And I would like to ask Dr. Kadlec to provide his testimony 
now, sir.

         STATEMENT OF THE HONORABLE ROBERT KADLEC, M.D.

    Dr. Kadlec. Thank you, Chairman Morelle and Ranking Member 
Burgess and other members on the line today. Thank you for the 
privilege and the opportunity to appear before you.
    Now as a private citizen, as the HHS Assistant Secretary 
for Preparedness and Response at the start of the pandemic, I 
lived, breathed, and bled the experience. I certainly want to 
acknowledge the incredible work, service, and sacrifice of the 
Federal, State, local, Tribal, and territorial civil servants 
and professionals from the private health sector that served as 
the first responders during this pandemic response. The whole-
of-Nation response has been vital to preserving our Nation, 
society and saving lives.
    I also want to commend you and your colleagues for your 
strategic vision and foresight in having this subcommittee 
consider budgetary approaches that Congress should take to 
prepare the country for the next pandemic or major public 
health emergency.
    I am convinced, by these collective commitments to learning 
from the COVID response and to future congressional action we 
can better prepare to mitigate unnecessary loss of life, 
negative economic impacts, and societal disruptions that 
another pandemic will bring.
    There are several historical and contemporary budget 
approaches that worked, did not work, and could work better. 
There are some prospective ideas that are innovative and I 
think would work to improve future pandemic preparedness. 
Whatever approach is taken must address a range of potential 
health security threats, to your point, Mr. Chairman, and 
ensure congressional accountability and sustainability of 
critical response capabilities.
    What worked? Project BioShield Act that was created by 
Congress in 2004 after the events of 9/11 was an effective 
tool. It created a 10-year advance appropriation to incentivize 
the development and procurement of chemical, biological, and 
radio-nuclear medical countermeasures that did not have a 
commercial market.
    The program was successful, but the special reserve fund 
created by legislation was not replenished when the original 
10-year appropriation ended.
    Advance appropriations could be useful in developing 
pandemic and antimicrobial medical countermeasures as well as 
CBRN ones. The dilemma becomes renewing such advance 
appropriations and the potential that Congress may later choose 
not to do so. The original BioShield concept called for 
obligatory, nondiscretionary funding.
    What didn't work? Funding preparedness with periodic 
disaster supplementals.
    Funding to sustain improvements in preparedness are not 
particularly useful tools. And, quite frankly, with the 
mainstay at ASPR, I have a chart of ASPR's budgetary history 
that indicate that the majority of funding that we received for 
our role was often times through supplemental Congressional 
funding from disasters.
    While they have been significant enablers for preparedness, 
when those funds basically expire, as they did with influenza 
and Ebola, our ability to sustain programmatic funding for 
pandemic preparedness and particularly countermeasure 
development and some of our practical capabilities, operational 
capabilities, such as NDMS, national disaster medical teams, 
were jeopardized.
    For example, when I arrived at ASPR, our NDMS teams had not 
received any sustainment or specialized training for several 
years. Now, fortunately, but unfortunately, because of the 
hurricane supplemental generated after Hurricane Harvey, Irma, 
and Maria, we were able to fund highly infectious disease 
training for our NDMS teams before the pandemic.
    Looking ahead, periodic pandemic or disaster supplemental 
funding will not support the desired long-term countermeasure 
development, medical response or hospital preparedness, or 
similar programmatic preparedness initiatives that the Nation 
needs.
    What worked but could work better? Well, the CARES Act 
worked fabulously. The Coronavirus Aid, Relief, and Economic 
Security Act worked. But the delay in securing the funding 
through the supplemental process slowed our ability to respond 
and, quite frankly, delayed our ability to procure personal 
protective equipment at a time when cash in hand was the only 
way to buy available limited PPE supplies. It also delayed our 
ability to contract with pharmaceutical companies for the 
development of COVID-related vaccines, therapeutics, and 
diagnostics.
    What could work with the right safeguards and provisions? 
Appropriating funds into the existing Public Health Emergency 
Fund found in 42 U.S. Code, section 247(d), that enumerate 
powers and authorities of the Secretary of Health and Human 
Services. This cannot be a generalized public health emergency 
slush fund. It would be used by the Secretary specifically to 
address the risks of a pandemic or catastrophic national public 
health emergency such as a large-scale cyber attack affecting 
public health or healthcare or a large-scale CBRN event.
    The last area that I would identify is things that have 
been identified as prospective ideas, and that is really the 
idea of somehow circumventing or exempting designated 
preparedness funding from budget caps, which I believe is an 
excellent idea and is an idea supported by the Bipartisan 
Policy Center.
    And I think that the idea of creating a permanent budget 
designation for programs deemed highest priority to prevent, 
detect, and address infectious disease threats outside the 
annual 302 allocations and outside the overall budget 
limitations would be something that would be extraordinarily 
beneficial.
    And, finally, with time running out, I would just say that 
there needs to be some kind of mechanism to support the 
Strategic National Stockpile, and that should be studied and 
evaluated. The SNS has consistently been tasked to meet more 
hazards than its funding has allowed. Congress should 
specifically identify which hazards the SNS should be prepared 
to encounter over the next 5 to 10 years and authorize an 
appropriate commensurate budget to meet those requirements; 
when it makes economic sense, to permit the SNS to rotate 
certain stock before expiry, possibly through vendor-managed 
inventory, to save the government and American taxpayers 
significant funds.
    And, ideally, Congress should identify a mechanism to 
enable better preparedness not only for the Federal level but 
the opportunity to procure personal protective equipment by our 
non-Federal partners at the State, local, Tribal, and 
territorial levels.
    With that, sir, I will end my comments and look forward to 
your questions.
    Thank you very much.
    [The statement of Dr. Kadlec follows:]
    
    
    
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    Mr. Morelle. Thank you, Doctor. And thank you for your 
service to our country in the number of different capacities 
you have held, and we appreciate that very, very much.
    I am going to just, if I can, ask just a handful of 
questions in the first round, and then I want to make sure my 
colleagues all have an opportunity to ask questions. And I may 
come back for a second round, if that is acceptable to folks.
    I want to start with Dr. Gayle and Ms. Tedesco, both of you 
representing the not-for-profit sector that did so much over 
the last 2 years and continues to do so much. And perhaps, Dr. 
Gayle, if you could respond, and then Ms. Tedesco.
    But I sort of think about three things. First of all, is 
there enough local planning and coordination being done in 
Chicago and Rochester? And I will take those two data points to 
sort of reflect on what it is like in the country.
    So, in Chicago, for instance, are you routinely going 
through with other community partners and local government a 
planning process, a coordination on what would happen if? And 
the same thing I would ask of Ms. Tedesco.
    Second, if not, if we are not doing enough, how could we 
help incentivize that local coordination--drills, planning 
process, et cetera?
    And, finally--and I think Ms. Gayle mentioned this in your 
testimony, the idea of not enough money for not-for-profits 
prior to--and maybe it was Ms. Tedesco, actually, who mentioned 
this.
    So, if there were additional dollars, what would not-for-
profits do with those dollars in pursuit of greater resiliency? 
How would those--would they be technical? How would you 
actually use those things?
    So those are sort of just initial questions. If perhaps Dr. 
Gayle first, and then Ms. Tedesco?
    Dr. Gayle. Great. Thanks so much.
    So your first question around the coordination, I mean, I 
think that, clearly, much more coordination needs to occur. 
And, you know, I think the link is from the Federal to the 
State to the local and then working at the local level with 
nonprofits that work directly with communities.
    And I would say, you know, if I look at the situation here 
in Chicago, Chicago local public health department had done a 
lot of preparedness and had, in fact, been, you know, doing 
drills and looking at tabletop exercises and other things, 
understanding that, you know, preparedness for the next 
pandemic was critical.
    That said, that isn't necessarily going on across the 
country. And the resources that need to flow from Federal to 
State to local have not been there historically for 
preparedness so that, when something occurs, those systems are 
in place.
    And I think we saw in the beginning of this pandemic a real 
disconnect between, for instance, our surveillance system, our 
ability to even know what was going on--because we weren't 
adequately funding it so that those dollars did flow from 
Federal to State to local.
    You know, at the local level, you know, I go back to a lot 
of the experience I had when we were focusing on the HIV/AIDS 
pandemic. We funded at the Federal level directly community-
based organizations that really built the kind of 
infrastructure to reach communities that were at greatest risk. 
But a lot of that funding dried up, and it didn't maintain some 
of the kinds of networks that were necessary at the community-
based level.
    So we have seen, through this pandemic, a rebuilding of a 
lot of that. You know, we are working here at Chicago--we are 
helping to coordinate a Chicago vaccine partnership that is 
really looking to--with the organizations that can reach the 
hardest-to-reach communities, particularly Black and Latinx 
here in Chicago, but that has all had to be rebuilt.
    And, you know, these are the kinds of things that could 
stay in place, because these are the same community 
organizations that are meeting people's needs in different 
ways. And they can be ready and ready to be mobilized, but we 
had to do a lot of rebuilding to put those community partners 
in place and to make sure that the health department and 
community-based organizations were working in tandem.
    And so, you know, I think the message over and over again 
is that we know how to do it and we know the organizations that 
can be incredibly effective at the grassroots and the community 
level but we don't continue to resource them so that, you know, 
we have this functioning, seamless system that flows from 
Federal to community-based level.
    Ms. Tedesco. Thank you----
    Mr. Morelle. Thanks for that.
    Ms. Tedesco [continuing]. For the question, Chairman. And I 
agree with Dr. Gayle's response. I think there is a disconnect 
between emergency planning and disaster preparedness at the 
government level and then at the local and community-based 
level.
    On, you know, Foodlink's part, we have been involved at 
various times with VOAD, Voluntary Organizations Active in 
Disaster, but what we have seen is that there has been fits and 
starts with that. And at the State level, when you look at who 
manages disaster preparedness and how that flows, it is 
incredibly complex, and it does not translate to how we work at 
the ground level and does not, sort of, honor the knowledge 
that we have and the relationships we have in the community.
    So I don't know if this is a recommendation per se, but I 
think what needs to happen is that we need to begin to speak 
the same language, that the government needs to come to the 
table with community-based organizations who end up delivering 
those disaster response services and come to the table as 
equals in terms of planning.
    Because what exists at the government level, what we have 
seen, is a series of flowcharts and complexities. And what 
exists, you know, at the local level is just an understanding 
of what people need and what our peer nonprofits can offer.
    And communications is key. We saw that in Rochester, is 
simply having the structure--we immediately, thanks in part to 
you, Chairman, were able to have these weekly emergency 
response calls with government entities and nonprofits and the 
for-profit sector. That made all of the difference. It made us 
nimble; it made us be able to respond quickly. So, more than 
anything, having the communications structure in place.
    But to answer the second part of your question, yeah, it is 
truly capacity-building. Someone else touched on this earlier, 
but--and I am sure you have all heard this before, but, far too 
often, nonprofits have the opportunity to apply for Federal 
grants for, you know, really prescriptive programs, or even 
from private funders. You know, they want to fund a feeding 
program for children over and over, and I certainly understand 
why, but what they don't want to fund is the technical 
capacity-building, the staffing.
    And, certainly, I think what is lacking is thinking about 
all of that in the context of planning for a disaster. Food 
banks know how to distribute food. Do they all have 
generators?Do they all have the cold storage that is 
required?Right now, we are facing supply-chain issues with 
trucks. We have a truck shortage; we have a truck driver 
shortage. So that type of investment is what could make a huge 
difference for us.
    Mr. Morelle. Thank you.
    I do want to--and I will just editorialize, because, in 
Rochester, as Ms. Tedesco is pointing out, at the beginning I 
think we organized twice-a-day phone calls with groups that 
included Foodlink and others, but we were really making it up 
as we went along.
    And I am just sort of thinking about how we might better 
incent local communities to do that on an ongoing basis so that 
they are basically--you know, I used to say there is no real 
manual, locally, on what we do in the middle of this, so we are 
just making it up, sort of building the airplane as we are 
flying it. But it would be interesting to me whether there is a 
way, in partnership with the Federal Government, to start 
incenting local communities to go through that process and that 
exercise in advance of having a real, live event.
    I just want to switch--you know, Mr. Schlegelmilch, you 
said something that has been the bane of my public existence, 
which is, whenever I am at a table and people say ``let's get 
some quick wins,'' to me, in my brain, what that says is 
``let's do the easiest thing so we can show everybody that we 
are doing things,'' but rarely have I ever seen quick wins turn 
into any lasting value. In fact, I think it almost undercuts.
    So I would ask it this way: What kinds of things should we 
do to develop some slow wins or some wins that are lasting?
    You started to touch on it a little bit, but--and maybe 
even use the frame of making this easier for people. I thought 
your comments also about how difficult it is--if you are 
already, in a sense, disenfranchised prior to a crisis, you are 
not going to be any better able or better equipped to deal with 
it during the crisis.
    So if you could just expand on that a little more. I 
thought that was very interesting. What should we be doing to 
think about that differently?
    Mr. Schlegelmilch. Absolutely. Thank you for the question. 
I think--so I will answer it two ways, sort of the from the 
bottom up, I think the first thing we have to think about is 
really, what are the transactions that we are asking people to 
engage within in order to access different kinds of assistance, 
if you are a survivor at the individual level, if you are an 
nonprofit within a community? And what are the strings attached 
to that? Now, obviously, it runs through filters at the State 
and local level that this committee might not necessarily have 
direct oversight of but certainly originating from the Federal 
level.
    And so that is where there is an obvious answer but not an 
easy one to implement, which is simplification, that is sort of 
these quick wins layering on top of each other I reference in 
my written comment, and there is a Federal colleague who calls 
it the Jenga of Federal assistance, topping one block on top of 
the other in random arrangements, and seeing how that really 
affects those and what capacities are required to access that 
and who has them and who doesn't.
    Honestly, in the meantime, a stopgap may be to provide 
technical assistance to communities to put grants in place or 
to increase funding for disaster case management until the 
larger paradigm can be simplified. And that leads to sort of 
broader topics, which is that really taking a step back 
holistically and looking at this--you know, I mentioned the 
data. So a couple years ago--the conversation is still going 
on, but it sort of broke through in my world where a number of 
former senior Federal officials were talking about how States 
need to do more to invest in preparedness, and rules should be 
changed to really--really putting a lot of the burden on this 
is because States aren't investing in preparedness, and they 
are--the Stafford Act incentivizes not investing because you 
are can get 70 percent, 75 percent of Federal cost share 
through a disaster declaration.
    There is probably a bit of truth to that, but I am bringing 
this up because the Pew Charitable Trusts, through their fiscal 
federalism initiative, did a survey of States on their 
investments in preparedness, and it turned out there was no 
standard metric for measuring preparedness. States didn't have 
a standard way of doing this, and so the self-reported data 
ranged from very little to a whole lot to nonrespondents 
because they were responding to active disasters.
    So I think, also, as a consequence of quick wins, we have 
information that is spread out across many different points 
that can be neatly pulled together to form a narrative for an 
argument but are really short of systemic analysis.
    With my colleagues at Georgetown, we put together some 
analyses on some very specific elements of emergency 
supplementals, and even there we have--admittedly, there are 
things that there are blind spots to with different changes in 
rules and things like that.
    So I hope that is somewhat helpful, but I guess, at the 
ground level, really be very sympathetic to the transactions we 
are asking people to engage in to access resources and 
recognizing that can be a critical barrier and, in the 
formulation of these, really looking at whether or not this 
complexity ultimately serves or hides a lot of actions that are 
ultimately detrimental to the broader goals of resilience 
building.
    Mr. Morelle. Well, and I won't bore you with my long 
seminar on how we should better integrate social, health, and 
educational, and governmental services just in general, absent 
a natural disaster, but--and Ms. Tedesco and I are part of an 
effort back in Rochester to integrate those services. But, at 
some point, I may come back and talk to you more about that 
subject.
    Just if I can, to Dr. Kadlec, so we are hearing from local 
community organizations about what they experience in terms of 
coordination. I am just curious, and this is--you know, I am 
not someone who is very interested in the past except what we 
can learn from it, but from your vantage point, the notion that 
there was so many different agencies involved in this, did you 
feel frustrations, and is there a way to better organize and 
coordinate at the high level, at the Federal level our response 
in times of either natural disaster or things like the 
pandemic?
    Dr. Kadlec. Sir, there is a mechanism that exists through 
FEMA with the use of the VOADs. I think Ms. Tedesco kind of 
raised that up as one thing, and that is through the FEMA 
regional offices where they collect them. Now, I think, 
practically speaking, in the nature of a pandemic, which really 
required a different set of players to work in different 
contexts, you know, that is, I think, one of the issues that I 
think that was brought up by Dr. Gayle that there is this need 
to really drill and exercise.
    In my testimony, I have a piece that says, whatever we do, 
we need to commit to that at a Federal level, and we did do 
that at Crimson Contagion. We actually did do a local/State--we 
worked with a number of different States--Illinois being one, 
Chicago being a city--where we looked at the ability for 
pandemic preparedness, but that was the first time it was ever 
done.
    And this is something that has to be drilled regularly, you 
know, in some kind of regular basis, ideally like every third 
year, so every administration gets a chance to go through that 
experience but, more importantly, to do it with different parts 
of the country and really get down to the community level and 
exercise it so that we can get people like Ms. Tedesco talking 
about the food bank; we can get other elements of the local 
community outreach programs to make sure that those who are not 
easily reachable or who have challenges in being reached or the 
equity issues can be identified and effectively addressed.
    We did do that in our efforts with Warp Speed working with 
the Warp Speed team, the logistical team and with CDC and State 
and locals, but that is something that has to be done, I think, 
drilled regularly to make sure that not only the muscle memory 
but the people who are actually holding those positions, which 
oftentimes changes every couple years, are refreshed and, 
again, trained and educated.
    Mr. Morelle. Thanks for those comments. I am going to 
reserve more of my questions, but I want to give my colleagues 
an opportunity, and they have very demanding schedules.
    So I am going to go first to you, Dr. Burgess, for any 
questions you might have, sir.
    Dr. Burgess. Great. Thank you, Chairman Morelle.
    And, like you, I will probably divide my questions up into 
two sections to give other colleagues an opportunity to talk to 
our excellent panel this morning.
    Dr. Kadlec, I do want to reference one thing. You mentioned 
in your written testimony in speaking with Crimson--about 
Crimson Contagion, the exercise that you did. You have a 
statement here, in fact: Barely a month later, we hosted 
several dozen congressional staff to relive the exercise and 
tour a Strategic National Stockpile facility.
    Chairman McGovern, Chairman Morelle, maybe the Rules 
Committee could visit a Strategic National Stockpile facility 
so that we could learn better for ourselves firsthand. I dare 
say, it is probably an exercise that most Members of Congress 
have not taken.
    And we speak about a Strategic National Stockpile, but we 
have never actually been to the warehouse and seen for 
ourselves what is involved. So I just simply offer that as an 
observation. If the Rules Committee would like to organize a 
visit to a Strategic National Stockpile, this member would be 
interested in attending.
    So, Dr. Kadlec, let me just ask you, on the Operation Warp 
Speed and on your team on Operation Warp Speed, you 
successfully were able to accelerate the advancement of some of 
the monoclonal antibiotic treatments and the antiviral agents. 
And your ASPR team led the allocations of distributions of 
these products in an unprecedented way.
    You know, my understanding is, with the change of 
administrations, there was at least the existence of the 
opportunity for procurement that your administration and ASPR 
had left for the incoming administration in February of 2021, 
that those could have been extended but, in fact, weren't. And 
I just ask you, is that understanding correct, and do you have 
a sense if--if it is correct, do you have a sense as to why it 
was not executed?
    Dr. Kadlec. Sir, it is correct, and we made deliberate 
efforts, particularly when we were setting up Warp Speed and 
not knowing the nature of the election but was trying to, if 
you will, make sure that whatever we did would be in doing at 
least through the first couple of months of either the second 
term of Trump or the first term of Biden's administration to 
give them some time to get their feet underneath them and 
recognize that they would need to make decisions as it would 
relate to the conditions on the ground that they encountered.
    So we had turned over, I think in the sense of the vaccine 
issues, vaccine procurement that was to the 300 million dose 
level and the antiviral immunoglobulins at least at that time 
to at least give them some cushion of time and opportunity to 
evaluate as well as knowing that there would be additional 
products coming through the pipeline.
    Now, two things happened, is--and so I can't speak for the 
other team, but one was they had the Delta variant surge, and 
then clearly there were some of the monoclonals, truly the 
monoclonals, the single cocktail, single monoclonal cocktail 
made by Lilly that had to be reconfigured into a cocktail to 
ensure that it could have the coverage.
    So there was some challenges that were encountered that 
were anticipated, some that were not. But we did try to put 
them in the best position so that they could figure out what to 
do going forward. And, frankly, I don't know why, maybe there 
were decisions not to make further procurements at that time, 
but clearly they have adjusted to the realities on the ground 
and have expanded their monoclonals.
    But here is the dilemma that we have, we have--not that we 
have a thinking enemy, but the virus is a wily adversary and 
has circumvented the two main stays of our monoclonal 
therapies, the Regeneron product and the Lilly product, and now 
we are left with GSK. So, you know, again, this is a very 
dynamic, fluid environment, and you just can't rest on your 
laurels, for sure.
    Dr. Burgess. Yeah, as we have learned. And, you know, one 
of the successful aspects of Operation Warp Speed was the 
suspension of the normal Federal procurement rules, that if you 
had a product in development that showed significant promise, 
there was an ability to prefund the purchase prior to approval 
so that the government would assume a significant amount of the 
risk and not the private sector.
    So do you have a sense that that continues today? I know 
when we had an opportunity to just have a general HHS call with 
the administration's COVID team, they talked about Operation 
Warp Speed and Operation Warp Speed being used to develop the 
Pfizer antiviral, but it didn't seem like they followed through 
with the advance procurement, which seems to me to be a 
critical part of Operation Warp Speed. Do you have any 
knowledge about that?
    Dr. Kadlec. No, not directly. But I think, to your point, 
there was a package of things that were done that were really 
trying to aggressively, you know, advance the development of 
these--a variety of different products, vaccines and 
therapeutics. And the kind of panoply of things that were done 
were we use the Defense Production Act, which were aggressively 
kind of assisted companies, either expand capacity or obtain a 
priority for supplies, needed supplies so they could 
manufacture or develop their potential product.
    We did do advance procurement activities, particularly with 
the vaccines and with the therapeutics with the idea that that 
would just give them some assurance that if the product worked, 
whether it worked or not, we bought it. And as we would joke a 
little bit--there was no joking a lot in that experience, but 
it would--that we would take a product that didn't work and 
just accept that that was a lost investment and move to the 
next product and move forward.
    So there was an element of what I would say risk-taking on 
the part of the government, risk mitigation on the benefit of 
the company, and then really very focused product and portfolio 
management. And we had an extraordinary team, the public/
private partnership that existed with Dr. Slaoui, Dr. Carlo De 
Notaristefani were an exceptional group of experts that would 
kind of help us stay on track.
    Dr. Burgess. Well, thank you. And, again, let me just echo 
Chairman Morelle in thanking you for your incredible service to 
our Nation.
    Dr. Gayle, I appreciate so much you mentioning PEPFAR in 
your discussion. That is a model that it seems like we perhaps 
have lost sight of recently, but was enormously effective in 
the early part of the 2000s, at a time where it seemed like all 
could be lost in the fight against HIV and AIDS in Africa, and 
that a generation would have to be--would face coming into 
adulthood without their parents because the disease was so 
devastating.
    And because of actions of then the Bush administration and, 
yes, the United States Congress to participate in PEPFAR, which 
was really an extraordinary effort, and I don't know that we 
talk about it enough, that there--I don't know that before or 
since if there has been that sort of effort that one nation has 
made on behalf of multiple other nations. So, when we think 
about the global investments that need to be made for future 
preparedness, learning some of the lessons from PEPFAR, I 
think, are going to be extremely important.
    Dr. Gayle. Yeah, I would wholeheartedly agree. You know, it 
has been an incredibly important program. It was comprehensive. 
It was global. It really built infrastructure. And, in fact, 
the infrastructure that PEPFAR built was in large part the 
reason why future pandemics were able to build on that 
infrastructure.
    And so, you know, I think being able to mount something 
similar to that, and as you noted, it was started by President 
Bush, but it was continued on for other--all the next 
administrations no matter what the political party was, and I 
think it is just one example of how global health is a 
bipartisan issue and one that I think people can rally behind.
    And in a pandemic like this, you know, again none of us is 
safe unless all of us are safe, and I would love to see the 
same sort of coordinated effort that really, you know, made 
sure that we were thinking about this in a very holistic way in 
the way that we did with PEPFAR and the AIDS pandemic. So I 
think there is a lot of lessons to be learned there, and I 
think it is a very important model.
    Dr. Burgess. So immediately prior to being distracted by 
the pandemic of the century, there was some discussion of 
utilizing the infrastructure that had been built during the--
during PEPFAR to provide a platform for improved maternal care, 
maternal mortality in other locations. And, unfortunately, that 
is going to, I guess, go down in history as one of the 
unintended consequences or victims of the pandemic. I haven't 
heard recently any discussion of that, because clearly everyone 
has been focused on the more immediate danger of the 
coronavirus.
    Ms. Tedesco, it is really not fair to ask you this, but I 
am going to. Was Mr. Morelle helpful to you in getting the 
school districts to reprogram their funding that they should 
have been using to provide free and reduced lunches, to get 
those funds to your nonprofit so that you could appropriately 
take care of the people who now weren't being fed in their 
school lunchrooms?
    Ms. Tedesco. I can honestly answer, Congressman Morelle was 
incredibly instrumental in, you know, maybe not precisely what 
you just said but exactly the spirit of that, which was 
coordination between the sectors.
    And Foodlink, you know, even prior to this disaster is the 
largest nonmunicipal provider of meals in our region, so we 
have a community kitchen. Prior to the pandemic, we were doing 
3,000 meals a day. We can came in--the first case in Rochester 
was on a Friday. We came in on a Sunday and started preparing 
meals and figuring out in conjunction with the city school 
district how we could get those meals to kids.
    And if I could connect this to the question I was asked 
prior, in just continuing to think about that, in any disaster 
preparedness that I have been involved with--and, Dr. Kadlec, 
you sort of said this as well--never did a global pandemic come 
up. You know, when we were talking with the Red Cross and State 
FEMA reps and whatever, we didn't talk about global pandemics, 
nor did we talk ever specifically about the crises of children 
being out of school. And that became the number one crisis that 
we addressed, not public health instantly but kids being out of 
school and what we instantly knew that meant for our community 
and for families.
    And so, yes--I hope I answered your question. Yes, 
Congressman Morelle was incredibly helpful, but it was truly a 
collaborative process and I think paves the way for what it 
needs to be for school districts, especially in impoverished 
areas like the city of Rochester, that they really need 
sustainable, collaborative models with the nonprofit sector in 
order to fully meet the needs of their student body during a 
pandemic and during, quote/unquote, normal times. I hope that 
answered your question.
    Dr. Burgess. It almost did. And you used the word 
``nimble'' earlier, and I think that is perhaps something we 
should all bear in mind when we are faced with the existential 
crisis that this was and the ability to be nimble in our 
funding. And just as the virus doesn't respect any political 
party, it also doesn't respect political jurisdictions. And 
whether it is school district, county funding, State funding or 
Federal funding, we need to be nimble in our response.
    Mr. Chairman, I am going to reserve the balance of my time 
and allow you to go to other members.
    Mr. Morelle. Thank you, Dr. Burgess.
    And I do note, as it related to the schools, that one of 
the first requests we got from one of the school districts was 
to allow them to receive funding even though they weren't 
providing lunches anymore. And we held a pretty robust 
discussion that included Foodlink because they wanted to step 
up and help and certainly did. But it did raise the question of 
how difficult it is to coordinate in the middle of an 
emergency, because there were existing rules, there were 
existing requirements you have to meet. So we went through a 
long process to try to work that out. But I appreciate your 
comments. I want to now call on----
    Ms. Tedesco. Chairman, may I add one thing to that?
    Mr. Morelle. Yes, of course.
    Ms. Tedesco. I just--I want to say that I think one of the 
most successful things that happened during this pandemic in 
terms of government response was the USDA waivers that were put 
into place fairly rapidly, and I would truly advocate for those 
being extended or put in permanently.
    But reducing barriers to access for kids by allowing grab-
and-go meals, by increasing reimbursement rates so we can get 
more nutritious and higher quality food out to folks, by doing 
away with what was formerly required congregate meal settings 
that enabled caretakers and children to eat together, to take 
food home to their families together, all of those things, and 
there is more to add to that, I believe, should always be in 
place.
    They honor the dignity of the individuals receiving those 
services. They meet people where they are. They enable us to 
get better food to more people. So I applaud the USDA, the 
government for those waivers. Thank you.
    Mr. Morelle. Well, I appreciate those comments. And I am 
sure Chairman McGovern, who is leading the national effort on a 
White House conference on hunger, is thinking about those 
things, and I appreciate your comments.
    I now want to turn to my colleague and friend, Ms. Ross, 
for questions.
    Ms. Ross. Thank you, Mr. Chair.
    And thank you to the folks who have testified today. I am 
juggling a Science, Space, and Technology markup, but I would 
argue that maybe we should get Science, Space, and Technology 
to take up this issue as well since so much of their 
jurisdiction has to do with things that might involve research 
and planning for the future.
    As we know, the COVID pandemic has exposed how unprepared 
the United States and the rest of the world are for large-scale 
public health emergencies. And it is critical that we learn 
from these experiences and use our knowledge and resources to 
prepare for and prevent similar disasters in the future.
    For years, before the onset of the current pandemic, 
academic, scientific, and policy institutions warned of the 
potentially devastating impacts of a global pandemic, so did 
Hollywood. And as recently as 2012, the Rand Corporation 
concluded that pandemics were capable of destroying the 
American way of life.
    In the years following, the U.S. intelligence community 
cautioned in their Annual Worldwide Threat Assessment that 
pandemics can cause political and economic upheaval, as we can 
attest.
    Our goal today should be to address the systemic gaps that 
left us vulnerable to this crisis in the first place and to 
ensure that science is not politicized, especially when it 
concerns the health of millions, not only in our Nation but 
around the world. We must ensure that we take basic steps to 
protect our own citizens first, and there are ways that we 
simply have not.
    For example, in my home State of North Carolina, the State 
has refused to expand Medicaid, leaving hundreds of thousands 
of North Carolinians without health insurance and more 
vulnerable to this pandemic. And I spoke with all the hospital 
CEOs in my district yesterday, and they continue to say that, 
had we expanded Medicaid, things would be much better in the 
State of North Carolina.
    In addition, our public health infrastructure has been 
affected by staffing shortages, which some of you have 
mentioned, among frontline healthcare professionals. And it is 
critical that we in Congress provide support to our healthcare 
institutions to continue serving our Nation as we deal with the 
resurgence of cases caused by Omicron and the variants that I 
am sure will come even on the heels of Omicron.
    I have also heard from educators in my district about the 
challenges of teaching when schools lack essential health 
resources. And I know we have talked about food issues, but 
right now what the schools are looking for are KN95 masks and 
COVID tests.
    And we know that the administration is sending them out, 
but, clearly, it would have been great if they had them all 
throughout the pandemic. And providing these tools should be a 
top priority to ensure that our children can continue to be 
educated and our teachers and school professionals can be 
protected as they serve our communities.
    This brings me to the importance, as Dr. Burgess raised, of 
continuing our effort to provide COVID resources around the 
world, from vaccine tests to personal protective equipment. We 
can't defeat the pandemic and expect to protect ourselves 
without coordination and support with the international 
community. And, without investments in global health, including 
vaccines, therapeutics, and more, we will continue to face new 
variants that develop in other countries with fewer health 
resources that we have.
    My question to all of the witnesses, and Dr. Burgess 
started this by bringing up the success of PEPFAR, is, what 
strategy should we use to ensure that our Federal budget 
accounts for the global nature of pandemics and other public 
health crises in a recurring fashion and not just as a 
reaction?
    Dr. Kadlec. Representative Ross, I will take a first swing 
at this, if you don't mind.
    Ms. Ross. Thank you.
    Dr. Kadlec. In specifically focusing on I think the medical 
aspects that I think were highlighted by PEPFAR, and that is, 
clearly it was a U.S. initiative, but in managing a pandemic--
and obviously we--there are things called CEPI, and I applaud 
what the current administration is trying to do to expand, if 
you will, the participation of other countries to donate 
vaccine--there really has to be an established mechanism that 
builds capacity here domestically that is likely excessive to 
our national needs but yet is contributable to the global needs 
in the event of a pandemic. And I think that is one thing that, 
quite frankly, that has to be kind of considered and sized.
    There was discussion late in the Trump administration about 
creating a Marshall Plan, the idea of doing something similar 
to what was done in Europe following World War II to basically 
enlist support of willing countries to donate vaccine globally. 
And then I think that, you know, transitions are disruptive, 
but I think now that you can see that our country is kind of 
moving into that role.
    But I think there has to be a dedicated effort to build 
that. There has been a discussion about an international treaty 
to deal with pandemics, and it would seem that that would be an 
appropriate, you know, consideration to be part of that, 
amongst other things. But, with that, I will stop and turn to 
the other witnesses for their comments.
    Mr. Schlegelmilch. I can add a few thoughts, and thank you. 
And I appreciate the--also the callout to the series of 
warnings that have come from the scientific community, from the 
policy community, from the government itself on the challenges 
of the pandemic. And it is something that I am sure will be the 
subject of many committees, commissions, blue-ribbon panels, 
whatever the case may be for years to come.
    Yeah, the data was there; the incentives were not. And so I 
think that there--you know, complexity--we are entering into a 
more complex world. This pandemic may very well not be the last 
one we see in our lifetime, and with the growing impacts of 
climate change, it is going to get worse before it gets better.
    And I think that one of the key components there is we have 
a very distributed set of responsibilities, both throughout 
Congress and through the various committees. I know a few other 
committees have been mentioned today as potentially ones to 
also take this up as well as across our government, which we 
have talked about.
    And so, in a sense, almost what we need to do is to 
decomplexify--I am not sure if that is a word, but to reduce 
the complexity of this to afford more flexibility towards a 
range of scenarios that we are facing that can be implemented 
as they are needed.
    I think it is also worth noting that the science provides a 
range of different options for managing different disaster 
threats, but we tend to focus on certain kinds of science over 
others. So, up until fairly recently, a lot of mitigation 
efforts were focused on the built environment and engineering 
options, when increasingly we are seeing from the social 
science how social determinants can be an even greater 
predictor of how a community does before, during, and after a 
disaster. The relationships of social programs to disaster 
resilience after the fact is becoming increasingly clear.
    And we have had sort of the politics, the behavioral 
science. You know, why is it easier to ask people to wear masks 
and get vaccinated in some parts of the world than the other? 
The behavioral science illuminates a lot in terms of the 
landscape you have to work with these policies. And more 
individualistic societies are going to require different 
approaches or different levels of investment than for certain 
approaches than we are seeing overseas.
    So we do need more data, we do need more research, but 
there is also a lot of research that isn't really being pulled 
together in part because of the distributed nature and 
ownership of all of this. So unifying, simplifying, I know 
these are overly simplistic answers, but ultimately to create 
capacities to harness the complexity of these situations and 
create vehicles that have the flexibility to meet needs that we 
know the outer boundaries of but won't know the details of 
until they are occurring.
    Dr. Gayle. Yeah, and I would just add, I was going to say 
something similar. I mean I think, you know, in situations like 
this, the knee-jerk response is to try to create something 
different and something new and a new infrastructure. And I 
think there is a lot of things that are already in place that 
we need to figure out how are they better connected, how are 
they better coordinated, and are we giving systems incentives 
to work together.
    And so, you know, there are agencies that already have 
mandates, but we didn't do a good job in the beginning of this 
pandemic to actually make sure that agencies were working 
together and that there was a coordinated approach to it, you 
know. And some of the structures that we had had in place for 
disaster preparedness, which really were coordinating 
structures to a large degree, had been dismantled.
    So I think we have to think about, you know, not looking at 
recreating the wheel, but really are we doing the best job we 
can. And I like the notion of simplification, but, you know, 
really looking at how we have the right systems for 
coordination.
    I think the other thing that, you know, has come out in 
many ways as we have talked about this today is that, you know, 
we were dealing with two different aspects of the crisis. We 
had a public health crisis that precipitated an economic 
crisis, and in both of those situations, we did not have in 
place the things to make us more resilient.
    And so we have talked about how could we make some of the 
social safety net issues in place and better so that, you know, 
populations don't get knocked so far down every time something 
happens. If communities that are financially insecure had 
greater security going into this, they wouldn't have been as 
harmed as they were.
    And so we need to think about--you know, a lot of the 
things that I think we did on an emergency basis showed what we 
could do on a longer term basis to put in place not only the 
health preparedness but also the social and economic 
preparedness, and how can we weave that together so that 
whenever this next occurs we are resilient, both from a public 
health standpoint but also from a social and economic 
standpoint.
    Ms. Ross. Thank you, all, for your responses. I am happy to 
take information from this hearing to the Science, Space, and 
Technology Committee.
    And, Mr. Chairman, I yield back.
    Mr. Morelle. Thank you, Ms. Ross.
    I am now going to call on Mr. McGovern, who has the 
distinction of being the chair of the entire Rules Committee. 
And we appreciate him being here and for all of his help to get 
to the hearing today.
    Mr. McGovern. Well, let me thank Chairman Morelle and Dr. 
Burgess and Ms. Ross for their comments and questions. This has 
been a really interesting conversation on a very, very 
important topic.
    And as I was listening to the testimony, listening to the 
questions, I kept on thinking about the reality that we are not 
particularly good at things like planning, which is essential, 
or coordination. We are not very good at coordination between 
the House and the Senate, never mind the Federal Government, 
the State and local governments, and others that need to be 
part of it.
    There is an issue here of funding in order to prepare for 
these disasters--potential disasters, and then there's the 
issue of leadership, which is important. You know, we have 
Members of Congress when it comes to natural disasters, whether 
it is wildfires or tornados or, you know, you name it, floods, 
that routinely balk at responding to them after they happen 
except if it happens in their own State. So there is this 
hypocrisy that exists. And I think part of it is that we have 
some people who just don't think government is part of any 
solution unless it affects them directly.
    We heard about all the incredible work that went in to 
combating HIV/AIDS and the response that Congress actually 
acted--by the way, after years of inaction, Congress actually 
began to act. And the response included things like the Ryan 
White Act, and then the PEPFAR program that Dr. Burgess 
referenced, which was a bipartisan effort and, you know, I 
think is something that we could be proud of. But this was kind 
of a healthcare-plus approach. And here Congress also 
recognized how much housing and food matter to potential 
healthcare outcomes. So I think that is an important point.
    On the COVID-19 issue and the response, international 
efforts to speed up pharmaceutical response and review process 
I think was very, very important. It led to the rapid creation 
of a lifesaving vaccine, which I think is a fantastic feat. But 
the bad news, of course, is that misinformation has limited our 
Nation's ability to get shots in the arms.
    So the issue now is we have the vaccine, and I think I 
speak for all of us on this panel: I go home; I am still trying 
to convince people to make sure they get the vaccine. And we 
have a political system here in which some go out and actively 
say, you know, don't do the vaccine.
    You know, Dr. Burgess wax nostalgic about the previous 
administration. I look back on the early days of this crisis 
with with a lot of shock that scientists were telling us that 
we had to take this pandemic seriously, and we had leaders, 
including the President of the United States, saying, you know, 
it is no big deal. It is not real. The first couple of months 
we were in denial.
    And Dr. Burgess, if you don't believe me, just go read the 
President's statements. But the bottom line is we were being 
told to wear masks, and we had people actively discouraging 
people from wearing masks. This was before the vaccine was 
developed. And so you look back on that, and you say--you know, 
I am hearing now from medical experts, maybe we could have 
saved a lot more lives if we had taken it more seriously at the 
beginning.
    You know, I am trying to get the White House to start 
focusing in on, you know, on the issue of hunger and food 
insecurity in this country, trying to get more to the White 
House Conference on food, nutrition, health, and hunger, one, 
to plan; two, to understand that we have to connect the dots, 
that when we talk about, you know, issues of hunger, it is also 
a healthcare issue. It is also an issue of kids being able to 
learn in school. It is a whole bunch of things. We need to look 
at need things more holistically.
    But we don't have a plan in this country. We haven't had a 
plan to end hunger. We have had a plan to try to manage it but 
not to end it. And we talk about resiliency and all those other 
important concepts; I mean, quite frankly, we just haven't--we 
don't coordinate very well up here because, if you are going to 
prepare and solve some of these problems, it is not just one 
committee; it is multiple committees. It is not one agency; it 
is multiple agencies. It is not just the Federal Government; it 
is the State and local government; it is the provider. I mean, 
everybody has a role in all of this.
    So, you know--look, so I think what we have heard here 
today is some things that have gone well and that we ought to, 
you know, replicate or we ought to use as a model, some things 
that haven't gone so well. So let me just ask this question for 
each of the witnesses, any thoughts that you may have as it 
relates to pandemic or disaster preparedness in general. What 
is something that we have done that we should consider 
continuing beyond the pandemic to ensure better preparedness, 
and what is something that you believe we could or should have 
done, again, as we think toward the future to ensure better 
community, State, and national preparedness? I will just open 
this up to whoever wants to respond.
    Mr. Schlegelmilch. I will go ahead and start. You know, I 
think one of the things that has been done well, as much as we 
lament, myself included, really quite extensively the lack of 
funding for preparedness and the ebbs and flows in the annual 
appropriations process, we were better for having those 
resources over the last 20 years than not having them.
    The relationships that were fostered that are frustratingly 
not as robust as they could be within communities are where 
they are because of the capacities that have been invested in 
into emergency management structures and into a whole-of-
community sort of paradigm of thinking of these things. So I 
think that as--at least coming from me, while I am critical of 
funding levels and lack of predictability across a lot of this, 
having what we have is better than not having it.
    Now, on the flip side, in terms of what we could do better 
with--you know, I think we really do have to look at the 
disaster science is increasingly going into the social services 
arena and illuminating where social services predict outcomes 
in disasters. And this is only going to grow stronger as there 
is more data and there is more evidence with all of this.
    And I think one of the most important things to consider 
going forward is that investments in resilience aren't 
necessarily the bills that say ``disaster'' in front of them. 
They may be investments in food security. They may be 
investments in healthcare to make sure more people are insured 
and we have a financed national health continuum of public and 
private deliveries that are used to serving the whole 
population and not just the insured population, that is built 
for the kind of demand, that we are financing public health and 
not just taking for granted the value of that.
    And the other, as I do want to point out, there has been a 
lot of talk about structures, of sort of wrangling these 
Federal processes that are distributed. One of the big 
criticisms of the past administration was dismantling the--or 
moving to a point of functionally dismantling the Global Health 
Security Team and the Pandemic Response Unit in the National 
Security Council.
    I think there is some merit to that argument, but I also 
want to add that it was created because there was not a 
legislated solution to this, so it was executive action that 
created a Band-Aid approach. And as the political wind shifted, 
that Band-Aid was removed, and the pandemic hit, and we were 
left bare from a coordinated mechanism for doing this, and now 
that is being rebuilt.
    But I would be careful to not--it is a bipartisan issue, 
and it is one that ultimately we need some stability in the 
legislated groundwork for these things so that we are not 
completely reliant on executive action, which can be undone as 
easily as it can be implemented. So I hope some of that is 
marginally useful to you----
    Mr. McGovern. It is helpful, very helpful.
    Mr. Schlegelmilch [continuing]. And appreciate the 
opportunity.
    Mr. McGovern. Anybody else want to----
    Dr. Gayle. Yeah, I would say, you know, I think a couple 
things that we did well, and this was mentioned earlier, I 
think the coordination with the private sector was critically 
important and the ability to develop vaccines in record time, 
you know, which built on a lot of important science that was 
being worked on already. So, you know, I think that our 
investments in new science and discovery and then the working 
with the private sector, you know, I think was really critical 
and a model that we need to think about how do we do that in 
the future.
    I do also think that the speed with which emergency support 
and the level of emergency support that was mobilized was 
incredible and the willingness to do some things that we had 
not ever, you know, done before, like give people cash who 
needed cash to pay their bills and, you know, some of the 
things that, you know, I think could be models for how we think 
about building resiliency in the future.
    You know, things that I think we didn't do as well, the 
coordination, which we have talked about multiple times and the 
communication. I think the fact that we had mixed messages, the 
fact that we sowed, you know, seeds of doubt and confusion is 
not what you need at a time like this. At a time like this, you 
need clear communication, you need strong leadership, and you 
need consistency. And so I think that was one of the things 
that, you know, was a real challenge.
    And I would say the other is that we were pulling out of 
global collaboration at a time when we most needed global 
collaboration, the idea that we were going to pull out of the 
World Health Organization at a time when we needed to come 
together as the world community more than ever. So, anyway, 
those are some of the things that I think we did right and some 
of the things that I think we could do differently next time.
    Mr. McGovern. Thank you.
    Anybody else?
    Ms. Tedesco. I would just add, you know, a lot has been 
said about strengthening the social safety net. So I would, you 
know, just in my final remarks here say that what we were--it 
is something we did well during the pandemic, and it is 
something that, if we were willing to do during that type of 
crisis, I think we need to consider why we are not willing to 
do it all the time.
    We had an unprecedented level of investment in food and 
recognition of the issue of hunger, partially because hunger is 
tangible but it really in our Nation is another word for 
poverty. It is not a matter of food; it is a matter of a 
tradeoff because of limited economic resources for families. So 
we need to continue to invest in antihunger and put the 
infrastructure behind it, and as I argued, invest in nonprofits 
as partners.
    But, in the broader sense, we now know and it was said 
multiple times on this call, that pandemics, disasters 
disproportionately affect those who are economically 
disadvantaged, Black and LatinX communities. And so, for the 
long term investing in the social safety net is, to me, the 
best preparation for any future disaster.
    Mr. McGovern. No, and I appreciate that. I always tell 
people that, you know, we had a hunger problem and a crisis 
before the pandemic; we just weren't coordinating an effort to 
respond to it appropriately. We had close to 38 million people 
in this country who didn't know where their next meal was going 
to come from, and the pandemic just highlighted the disparities 
that already existed. And so, I mean, you know, but it is more 
than just responding to an immediate crisis. We have got to 
solve the problem.
    I don't know whether, Mr. Kadlec, do you have anything you 
want to----
    Dr. Kadlec. Yes, so I do, Mr. Chairman. And that is, it was 
mentioned already about the public/private partnerships and 
particularly around medical countermeasures. You know, that 
model quite frankly can be used in a much broader context, 
whether it be about surveillance of diseases, whether it be 
about testing, whether it be about supply chain, whether it be 
about healthcare provision; it would seem that that is a model, 
and, quite frankly, to your point about how do you manage, you 
know, hunger in America, it really does require a whole-of-
nation approach. And, quite frankly, that model, to work 
against these very troubling problems, whether it be during a 
pandemic or not, I think is a model that can effectively be 
mobilized in a way that, quite frankly, is demonstrated by 
things like Warp Speed.
    The second area is--and this gets to more public health or 
not public health but healthcare provision, and that is, even 
right now during Omicron with the availability of vaccines and 
other things, we are finding not only are we having problems 
managing cases of COVID but non-COVID emergencies, non-COVID 
chronic cases, both in rural and urban environments, and it 
affects all access groups and particularly those who are have 
difficulty getting access to healthcare. And I think that is 
one area that has to take maybe some kind of priority view.
    Public health has been defined as one of the critical gaps 
in our pandemic preparedness, and I would argue that our 
ability to provide healthcare across the range of conditions 
that we need to in a pandemic or not was severely challenged 
during this crisis and could be similarly challenged through 
other crises that are not necessarily infectious disease 
related. And I think that that is one thing that has to be 
evaluated.
    Mr. McGovern. I think that is an excellent point.
    I just--again, I want to thank Chairman Morelle for putting 
this hearing together, but I think you challenge us to think 
bigger and more holistically, which is something that is always 
very difficult to do, you know. And I mentioned that we--I 
talked about hunger at the beginning, but I also sit on the 
Agriculture Committee. So, when we talk about combating hunger 
on the Agriculture Committee, we talk about SNAP. Well, that is 
not the whole answer, right. If you want to talk about school 
feeding, you have got to go to the Education and Labor 
Committee. You know, if you want to talk about food is 
medicine, you have to go to Ways and Means or Energy and 
Commerce, and, you know, the same within our agencies. And I 
think there needs to be a better coordinated effort to look at 
things more holistically.
    I think it would enable us to be better prepared for 
upcoming disasters, whether they are climate related or whether 
they are pandemic related, or, you know, who knows what 
related. But anyway, I really appreciate the expertise of this 
panel and, again, I thank you for your comments.
    Mr. Morelle. Thank you, Mr. Chairman, not only for being 
here but the incredible work you are doing on addressing hunger 
in America.
    Just a couple of quick followups, because I am mindful of 
the time and appreciate all of your--the time and expertise you 
shared with us this morning. And I want to give Dr. Burgess a 
chance to ask any additional questions he has as well.
    But, Mr. Schlegelmilch, you mentioned the value of 
investments in mitigation in comparison to funding for disaster 
response. And I wonder if you could--first of all, before you 
even talk about your research showing the benefits of 
proactively investing in disaster mitigation measures, could 
you describe for me what those disaster mitigation measures are 
in sort of a tangible way? I would be interested to hear that.
    Mr. Schlegelmilch. Yeah, yeah. And so it is--I appreciate 
that. So the research has been conducted by some other groups, 
so FEMA has commissioned from the National Institute of 
Building Sciences, a look at some of the more specific 
mitigation measures. So that is where you get this term $1 in 
preparedness saves $6, it comes from sort of specific kind of 
physical mitigation measures, but then you see benefits 
downstream.
    There was a group of political scientists that did some 
research that found that number anywhere from $1 saves $12 to 
$1 saves $15. They were looking at more catalog of Federal 
direct assistance numbers and sort of categorizations and 
things like that. So we definitely see this trend. There have 
been other analyses for pandemics by the World Bank and others. 
The number varies, but the message is always the same.
    So what we have seen primarily in these investments, 
decisions have been more on the physical and administrative 
side, putting in planning processes and things like that. The 
social science research is getting more and more into sort of 
the value of these things. And I think we are going to start 
seeing more of that in the valuations going forward as well 
too.
    Mr. Morelle. Gotcha. And you also--I think you talked about 
this, but in November of 2020, FEMA released a report finding 
recovery programs often provide an additional boost to wealthy 
homeowners and others with less needs while lower income 
individuals and others sink further into poverty after 
disasters.
    And a number of people have talked about this, but from 
your perspective, what accountability and transparency 
mechanisms are available to ensure any increases in disaster 
preparedness and assistance funding is spread equitably among 
low-income and minority communities? And do you have any 
specific recommendations for how Congress could improve those 
mechanisms, any suggestions or thoughts?
    Mr. Schlegelmilch. Yeah, absolutely. And there has also 
been some independent research looking at the various Federal 
assistance programs as well too and similarly disparities among 
socioeconomic status and racial categories. And so, in terms of 
that, I think first and foremost, is data transparency in 
reporting to have demographic breakdowns to know where the 
money is going, who is getting what, what these are. It sounds 
like a simple thing, but often it is not immediately available.
    The other would be, you know, we saw with some of the COVID 
funds a nod to using the Social Vulnerability Index from the 
CDC, and there are plenty of tools that are out there to help 
kind of identify and steer resources towards areas that are in 
higher need, in higher states of vulnerability and higher 
states of social vulnerability.
    We see this built in with FEMA's National Risk Index, and 
so we are increasingly seeing this. But there isn't much 
accountability, so there is a lot of lamenting of various 
officials on the inequity but not necessarily a mechanism for 
accountability.
    And then the final piece, actually a colleague had brought 
the idea to me, is to have a scoring mechanism much like the 
Congressional Budget Office will score financially different 
bills, is to have an equity score and to bring together a panel 
of experts who can actually look at the equity implications as 
well as broader resilience implications of various bills, 
various traps, and actually provide more specific guidance on a 
case-by-case basis.
    Mr. Morelle. Thank you. That is very helpful.
    Dr. Gayle, do you have any thoughts on that, how that 
impacts either your agency or Chicago writ large and any 
thoughts about that--or nationally, but I am just curious about 
your experience.
    Dr. Gayle. Yeah. I would just in some ways echo some of the 
previous comments because, you know, what we saw in the 
beginning of this pandemic is we didn't have data to even know 
who was being impacted, you know, by demographic groups and 
particularly race/ethnicity. Chicago was one of the first 
cities to actually look at COVID cases by race and ethnicity, 
and it was a critically important piece to then putting in 
place systems to address the disparities accordingly.
    You know, to have talked to and been in discussions with 
people about coming up with some of those scores, if equity 
really is--if we are going to be accountable for thinking about 
equity, are there ways that we can build those into just like 
we do environmental scores that are built in to new development 
projects, could we do the same sort of thing of building 
something that kind of built on the social vulnerabilities 
index or other things to allow us to be able to have that 
accountability in there. But I think, first and foremost, is we 
have got to collect the data.
    Mr. Morelle. Yeah. And actually, Ms. Tedesco, from your 
perspective, have you been tracking that data on who you serve? 
Could you report back or have demographic information on who 
you served in the last 2 years?
    Ms. Tedesco. It would be difficult. We have a number of 
households served, and we have some demographic information, 
and then obviously we have other data that we are pulling from 
census data. But because of how food banks operate, we rely on 
a network of providers. Many of those, you know, these are 
small, grassroots, community-based organizations who are 
required to track the number of households they are serving, 
required in some cases to get attestations of need from those 
families but not always required to do demographic information.
    So we know partially just by looking at our geographic 
region and understanding the demographics there and looking at 
need and service levels in those areas but don't have hard data 
associated with it.
    Mr. Morelle. Gotcha. No, that is certainly understandable. 
Last--I think this is----
    Dr. Gayle. Could I add just one thing to that?
    Mr. Morelle. Yes.
    Dr. Gayle. You know, earlier we talked about building 
community-based organizations capacity, and I do think that by 
building capacity at the local and community level that is 
helping to build an accountability mechanism as well. And I 
think that the more we have strength from our civil society 
sector, you know, it does build in an accountability, because I 
think when people are able and capable of looking at how 
dollars flow, able and capable of applying for those dollars, 
and also, you know, being able to ask for what is rightfully 
their community because of where their needs are, I think we do 
build in accountability. I mean, that is what democracy, after 
all, is all about.
    Mr. Morelle. No, I very much appreciate that. I was--I did 
want to get into the issue of long-term funding, stable funding 
that didn't rely on emergency appropriations. I wonder, Dr. 
Kadlec, if you could just comment on the advisability of that. 
There has been a lot of conversation about it, but from the 
point of view, again, of having worked in an administration, 
how important is that, and how should Congress be thinking 
about that in terms of long-term funding the appropriations 
process rather than supplemental or emergency appropriations?
    Dr. Kadlec. Well, first of all, I just want to acknowledge 
that the funding that you provided, Congress provided, during 
the course of the pandemic during my tenure was very generous.
    However--however--you know, there is this issue of an ounce 
of preparedness is worth a pound of response dollars and that 
the fact of being able to be a good steward of the taxpayer 
dollars in a response--and I will just give you one example, 
and it had to do with ventilators, for example, and the fact 
that we bought 243,000 ventilators that, quite frankly, we 
didn't need. In fact, we bought types of ventilators that, 
quite frankly, were problematic.
    Because, as we learned very early in the pandemic--I mean, 
this is how you have to learn and get back to the data issue 
and how vital it is to have quality data. We didn't have 
quality data early.
    And yet, based on, you know, a little bit of serendipity 
and focus, we were able to recognize that certain techniques to 
manage people with the severe cases of COVID that in some parts 
of the country were resulting in people being on mechanical 
ventilation and was the thing that scared everybody to buy 
243,000 ventilators at $3. 5 billion--it was recognized that 
that was actually resulting in higher mortality, upwards over 
80, close to 90 percent mortality.
    Whereas, in other parts of the country--and this is a great 
story. And a lot of credit goes to the State health officer in 
Louisiana and a pulmonologist that he worked with to create a 
State system where they used proning and high-flow nasal 
cannula, which is a noninterventional way of managing 
somebody's ventilation so you don't need all the specialized 
drugs and paralytics and paralyzed people and a lot of 
intensive-care nursing staffing.
    And so, by just that virtue thing alone, based on 
recognizing that, we were able to do a couple of critical 
things to, first of all, not need the ventilators. And that was 
just an example of where you had to make big purchases because 
it took a long lead time to get those devices in there.
    And so I only use that as an example of saying, you know, 
if we kind of fund the needs based on requirements, based on 
exercises and working with State and local localities on what 
the needs would be in the event of a crisis, we can be a better 
steward of the taxpayer money. So you pay $1 today or $100 
tomorrow during the response is, I think, the tradeoff.
    And it really is something that you can't just invest in, 
you know, buying stuff. You have to, you know, invest in 
training people and exercising capabilities, which is the 
combination of people and stuff, to make sure all this stuff 
works.
    To Chairman McGovern's comments about coordination and 
planning, those are all critical elements of the preparedness 
quotient that are, you know, low dollar value but high response 
impact.
    And so I will just stop there and just say, you know, it is 
really--you want to spend a little now or you want to spend a 
lot later, and knowing that, well, when you spend a lot later, 
you are going to be less efficient and likely wasteful in your 
efforts.
    Mr. Morelle. I think there was an old TV commercial, ``You 
can pay me now or pay me later.'' So I appreciate that.
    Dr. Burgess, let me turn to you for any additional 
questions you might have.
    Dr. Burgess. Thank you, Chairman Morelle.
    I am going to submit some additional questions for the 
record, but I have two unanimous consent requests, one from 
Research America, a letter that they submitted. I will ask that 
be made part of the record. And then, earlier in my testimony, 
I referenced a letter that I wrote to Chairman Pallone, and I 
would ask that that be made part of today's record for this 
hearing.
    And I will yield back.
    Mr. Morelle. Without objection.
    Let me just thank everyone.
    I do note that a lot of the conversation has been about 
planning and coordination, resiliency, communication--trusted 
communication--and funding. And I am thoughtful, back many 
years ago when I was in the State legislature, I was chairman 
of the insurance committee. And I remember, you know, people 
don't want to pay insurance premiums, let's face it. It is the 
last thing any of us really wants to do. But, in a moment of 
crisis, having prepared and thought about it in advance really 
takes that moment of crisis and makes it hopefully more 
manageable. And I think, in some ways, that is what we need to 
do, is provide those insurance premiums so that in a moment of 
crisis, such as we are facing now, we are really in a much 
better position.
    And, finally, I even think of--I serve on the House Armed 
Services Committee. You know, the amount of planning that the 
military does for potential threats is virtually unlimited. I 
mean, we are constantly training.
    Colonel, I know you would attest to that.
    And yet we do so little of it when it comes to domestic 
challenges like natural disasters or the pandemic which we are 
going through. And so we might want to take a page out of the 
military's book as it relates at least to training people, 
capabilities, threats, and really make that part of our 
national dialogue.
    So, with that, I want to thank all the witnesses. You have 
been incredibly helpful to us as we go through our 
deliberations about how to move forward. And I want to thank 
you all for the incredible work that you have done to keep safe 
and help protect people in your communities and across the 
country.
    And, with that, I will officially declare this hearing 
ended. Thanks so much.
    [Whereupon, at 12:06 p.m., the subcommittee was adjourned.]
    
    
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