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Preparedness: Responding to Biological Attacks, Pandemics, and Emerging Infec- Tious Disease Outbreaks

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Preparedness: Responding to Biological Attacks, Pandemics, and Emerging Infec- Tious Disease Outbreaks THE STATE OF U.S. PUBLIC HEALTH BIO- PREPAREDNESS: RESPONDING TO BIOLOGICAL ATTACKS, PANDEMICS, AND EMERGING INFEC- TIOUS DISEASE OUTBREAKS HEARING BEFORE THE SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS OF THE COMMITTEE ON ENERGY AND COMMERCE HOUSE OF REPRESENTATIVES ONE HUNDRED FIFTEENTH CONGRESS SECOND SESSION FRIDAY, JUNE 15, 2018 Serial No. 115–140 ( Printed for the use of the Committee on Energy and Commerce energycommerce.house.gov U.S. GOVERNMENT PUBLISHING OFFICE 35–127 WASHINGTON : 2019 VerDate Nov 24 2008 13:47 Feb 28, 2019 Jkt 037690 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 U:\MY DOCS\HEARINGS 115\HEARINGS\115-140 CHRIS COMMITTEE ON ENERGY AND COMMERCE GREG WALDEN, Oregon Chairman JOE BARTON, Texas FRANK PALLONE, JR., New Jersey Vice Chairman Ranking Member FRED UPTON, Michigan BOBBY L. RUSH, Illinois JOHN SHIMKUS, Illinois ANNA G. ESHOO, California MICHAEL C. BURGESS, Texas ELIOT L. ENGEL, New York MARSHA BLACKBURN, Tennessee GENE GREEN, Texas STEVE SCALISE, Louisiana DIANA DEGETTE, Colorado ROBERT E. LATTA, Ohio MICHAEL F. DOYLE, Pennsylvania CATHY MCMORRIS RODGERS, Washington JANICE D. SCHAKOWSKY, Illinois GREGG HARPER, Mississippi G.K. BUTTERFIELD, North Carolina LEONARD LANCE, New Jersey DORIS O. MATSUI, California BRETT GUTHRIE, Kentucky KATHY CASTOR, Florida PETE OLSON, Texas JOHN P. SARBANES, Maryland DAVID B. MCKINLEY, West Virginia JERRY MCNERNEY, California ADAM KINZINGER, Illinois PETER WELCH, Vermont H. MORGAN GRIFFITH, Virginia BEN RAY LUJA´ N, New Mexico GUS M. BILIRAKIS, Florida PAUL TONKO, New York BILL JOHNSON, Ohio YVETTE D. CLARKE, New York BILLY LONG, Missouri DAVID LOEBSACK, Iowa LARRY BUCSHON, Indiana KURT SCHRADER, Oregon BILL FLORES, Texas JOSEPH P. KENNEDY, III, Massachusetts SUSAN W. BROOKS, Indiana TONY CA´ RDENAS, California MARKWAYNE MULLIN, Oklahoma RAUL RUIZ, California RICHARD HUDSON, North Carolina SCOTT H. PETERS, California CHRIS COLLINS, New York DEBBIE DINGELL, Michigan KEVIN CRAMER, North Dakota TIM WALBERG, Michigan MIMI WALTERS, California RYAN A. COSTELLO, Pennsylvania EARL L. ‘‘BUDDY’’ CARTER, Georgia JEFF DUNCAN, South Carolina SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS GREGG HARPER, Mississippi Chairman H. MORGAN GRIFFITH, Virginia DIANA DEGETTE, Colorado Vice Chairman Ranking Member JOE BARTON, Texas JANICE D. SCHAKOWSKY, Illinois MICHAEL C. BURGESS, Texas KATHY CASTOR, Florida SUSAN W. BROOKS, Indiana PAUL TONKO, New York CHRIS COLLINS, New York YVETTE D. CLARKE, New York TIM WALBERG, Michigan RAUL RUIZ, California MIMI WALTERS, California SCOTT H. PETERS, California RYAN A. COSTELLO, Pennsylvania FRANK PALLONE, JR., New Jersey (ex EARL L. ‘‘BUDDY’’ CARTER, Georgia officio) GREG WALDEN, Oregon (ex officio) (II) VerDate Nov 24 2008 13:47 Feb 28, 2019 Jkt 037690 PO 00000 Frm 00002 Fmt 5904 Sfmt 5904 U:\MY DOCS\HEARINGS 115\HEARINGS\115-140 CHRIS C O N T E N T S Page Hon. Gregg Harper, a Representative in Congress from the State of Mis- sissippi, opening statement ................................................................................. 1 Prepared statement .......................................................................................... 3 Hon. Diana DeGette, a Representative in Congress from the state of Colorado, opening statement ................................................................................................ 4 Hon. Greg Walden, a Representative in Congress from the State of Oregon, opening statement ................................................................................................ 5 Prepared statement .......................................................................................... 7 Hon. Frank Pallone, Jr., a Representative in Congress from the State of New Jersey, opening statement .......................................................................... 9 WITNESSES Rick A. Bright, Ph.D., Director, Biomedical Advanced Research and Develop- ment Authority, Deputy Assistant Secretary, Office of the Assistant Sec- retary for Preparedness and Response, U.S. Department of Health and Human Services ................................................................................................... 11 Prepared statement .......................................................................................... 14 Answers to submitted questions ...................................................................... 102 Anne Schuchat, M.D. (RADM, USPHS), Principal Deputy Director, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services ................................................................................................................. 24 Prepared statement .......................................................................................... 26 Answers to submitted questions 1 ................................................................... 112 Anthony Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health ............................................................. 36 Prepared statement .......................................................................................... 38 Answers to submitted questions ...................................................................... 115 Denise Hinton (RADM, USPHS), Chief Scientist, U.S. Food and Drug Admin- istration ................................................................................................................. 43 Prepared statement .......................................................................................... 45 Answers to submitted questions 2 ................................................................... 124 SUBMITTED MATERIAL Subcommittee memorandum .................................................................................. 80 Report of the Independent Panel on the U.S. Department of Health and Human Services (HHS) Ebola Response 3 Strategic National Stockpile Estimated Spending Graph .................................... 95 Statement of the Blue Ribbon Study Panel on Biodefense .................................. 96 1 The committee did not receive a response to Ms. Schuchat’s submitted questions for the record by the time of printing. 2 The committee did not receive a response to Ms. Hinton’s submitted ques- tions for the record by the time of printing. 3 The information can be found at: https://docs.house.gov/meetings/IF/ IF02/20180615/108422/HHRG-115-IF02-20180615-SD003.pdf. (III) VerDate Nov 24 2008 13:47 Feb 28, 2019 Jkt 037690 PO 00000 Frm 00003 Fmt 5904 Sfmt 5904 U:\MY DOCS\HEARINGS 115\HEARINGS\115-140 CHRIS VerDate Nov 24 2008 13:47 Feb 28, 2019 Jkt 037690 PO 00000 Frm 00004 Fmt 5904 Sfmt 5904 U:\MY DOCS\HEARINGS 115\HEARINGS\115-140 CHRIS THE STATE OF U.S. PUBLIC HEALTH BIO- PREPAREDNESS: RESPONDING TO BIOLOGI- CAL ATTACKS, PANDEMICS, AND EMERGING INFECTIOUS DISEASE OUTBREAKS FRIDAY, JUNE 15, 2018 HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS, COMMITTEE ON ENERGY AND COMMERCE, Washington, DC. The subcommittee met, pursuant to call, at 9:01 a.m., in room 2123, Rayburn House Office Building, Hon. Gregg Harper (chair- man of the subcommittee) presiding. Present: Representatives Harper, Griffith, Burgess, Brooks, Col- lins, Walberg, Walters, Costello, Carter, Walden (ex officio), Degette, Schakowsky, Castor, Ruiz, and Pallone (ex officio). Also Present: Representative Eshoo. Staff Present: Jennifer Barblan, Chief Counsel, Oversight and In- vestigations; Adam Fromm, Director of Outreach and Coalitions; Ali Fulling, Legislative Clerk, Oversight and Investigations, Digital Commerce and Consumer Protection; Christopher Santini, Counsel, Oversight and Investigations; Jennifer Sherman, Press Secretary; Alan Slobodin, Chief Investigative Counsel, Oversight and Inves- tigations; Austin Stonebraker, Press Assistant; Christina Calce, Mi- nority Counsel; Jeff Carroll, Minority Staff Director; Chris Knauer, Minority Oversight Staff Director; Miles Lichtman, Minority Policy Analyst; C.J. Young, Minority Press Secretary; and Perry Lusk, Mi- nority GAO Detailee. OPENING STATEMENT OF HON. GREGG HARPER, A REP- RESENTATIVE IN CONGRESS FROM THE STATE OF MIS- SISSIPPI Mr. HARPER. Good morning. Today, the subcommittee continues its longstanding oversight of the U.S. public health system’s pre- paredness to respond to biological threats and emerging infectious diseases that endanger the public health. The purpose of today’s hearing is to hear from top public health experts on the good work being done at their agencies to protect the public and to explore where improvements need to be made. The biological threats facing the United States in today’s global society are varied, ever-evolving and, in some cases, intensifying. The CDC just reported that the seasonal influenza claimed the lives of 172 children during the most recent flu season, making it the deadliest seasonal flu season for children on record. (1) VerDate Nov 24 2008 13:47 Feb 28, 2019 Jkt 037690 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 U:\MY DOCS\HEARINGS 115\HEARINGS\115-140 CHRIS 2 In recent years, the U.S. has also seen an increase in the number of antibiotic-resistant bacteria. Around the world, viruses are emerging, adapting and, in some cases, reemerging. Currently, there is an Ebola outbreak in West Africa and a Nipah virus out- break in India that has killed at least 17. In recent years, we have also seen humans in China contract the H7N9 strain of influenza which has been confined to birds. The H7N9 influenza strain is rated by the CDC’s influenza
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