please come toward today's hearing on the two thousand and nine pan demick h one n one flu is a continuation of this committee's ongoing interest in learning more about and staying on top of this developing and concerning situation the hearing builds on the work of chairman polonius house subcommittee which held an initial hearing on the issue earlier this year from then until now one thing has become crystal clear even as events continue to evolve as a nation we must be prepared for whatever the h one n one virus brings in its path to fight it as best we can and to ensure adequate and appropriate resources to treat those who fall seriously ill we are especially pleased to have as our witness today the secretary of health and human services kathleen sebelius secretary sebelius will share with us the government's plan for addressing this enormous challenge subcommittee first met six months ago there was much we did not know about h one n one virus we didn't know how dangerous the virus was we didn't know if there would be a vaccine available we didn't even know if the virus would return in the fall many of those questions have now been answered we know this outbreak won't be the false alarm of one thousand nine hundred seventy six when the surge of swine flu cases never materialized indeed we are already seeing a large increase in cases a pattern that is likely to continue the epidemic will undoubtedly lead to hospitalizations schools may close health care sillett ease may become overwhelmed and almost certainly there will be some who will die but there's also good news this is ministration has carried on the efforts begun several years ago to prepare the country for the very situation we must now tackle the plans developed appear to be unfolding appropriately and experts tell us that so far the two thousand and nine h one n one epidemic will not be anything like that which occurred in one thousand nine hundred eighteen when an unusually dangerous flu virus devastated our nation more good news was reported just last week we not only will have an effective vaccine in place studies tao indicate the vaccine will probably require only a single dose rather than the two do many had predicted as a result i hope secretary sebelius will report today that across the country will have a good supply of vaccine allowing us to avoid both the additional costs and the additional needle stick that a would mean i expect that we will hear more about this as well as other h one n one flu activities from secretary sebelius i know all of us are also particularly interested in getting the secretary's perspective on not only the progress we are making in taking on this virus but also the difficulties we surely will face along the way but as we make preparations and carry out detailed plans for dealing with this new virus we most must also take heed of the battle we confront annually against the seasonal flu each and every year some thirty six thousand americans mostly among the elderly die from this preventable disease we can issued should do much better than that and i hope that secretary can also share with us the administration's thinking on addressing this concern and in particular how that approach relates to its h one n one strategy with that on the half of the entire committee i want to thank the secretary for appearing before us today we all look forward to hearing from you and to learn more about the h one n one challenges that lies ahead but before the secretary will be recognized to make your statement i want to call on several of the members of the committee to make opening statements and sebelius is testimony and welcome her to the hearing today as i mentioned during the subcommittee hearing last april the threat of a global influenza pandemic is one of the greatest public health threats that we face today when speaking to scientists researchers health care providers and other experts in the field i truly believe that it's not a matter of of flu pandemic hits but when and i believe we have the responsibility to ensure the greatest public protection possible when the situation arises we all recognize it that's not a simple matter since the first reports of this novel strain of the influenza virus began to surface earlier this year u s and international authorities have taken aggressive steps to mitigate the spread of the illness this is taken the dedication and cooperation of all of those involved both public and private sectors particularly as the infection rates of increased as my home state of georgia and other areas in the south have witnessed the easily transmittable h one n one strain as it continues to spread particularly as we have now begun school somewhat earlier than other parts of the country we all recognize that this is a real threat i have been in contact with state agencies and they are also coordinating of course with your offices at the federal level and also as you are coordinating with international groups during these months that will lie ahead as we try to deal with this problem the current response to the h one n one strain was coordinated in a law part with plans which were developed to respond to a similar situation the eighty five and one avian flu in two thousand and six six congress provided approximately six billion dollars for pandemic planning and cross agency collaboration these earlier at their efforts and others focused on preparedness for emergencies have streamlined the response to this situation while our efforts to combat h one n one have been aggressive we must continue to monitor the situation closely and be proactive as we hopefully will be able to for being here today to give us an update on the h one n one situation when the virus first hit it was devastating because sickness it generated fear caused panic in the close many deaths and there were many unknowns about the virus we did not know how the disease would present itself over time how well it would respond to the into viral viral medications on the market today or how quickly it would develop resistance to those drugs and we didn't know if if and how quickly we would be able to develop and manufacture a vaccine while we've learned more about the virus and we've made progress on a vaccine it has spread worldwide across continents and hemispheres and now is a level six pandemic the highest warning level there is it is continued to spread in the u s during the summer months which is unusual for an influenza and that adds to the unknowns and reinforces the fact that we still have to take it seriously in my state alone seventeen people have died since the beginning of the outbreak and over five hundred seventy have been hospitalized and we've yet to see the disease that is strongest in addition the peak of this flu coincides with the normal flu season which on its own can be extremely taxing on the health care delivery system i'm curious to hear how the federal government is tackling the fact that this flu tends affect individuals under fifty years of age unlike the seasonal flu that hits the elderly the hardest the younger population does not deal with disease often intends to not seek medical care as readily there been many questions about our nation's ability to respond to medical emergencies unfortunately it's hard to justify spending money on programs that are in place in case something bad happens especially since so many programs that are needed on a daily basis have been chronically underfunded but as history has taught us grand scale disease outbreaks can be devastating at a time when our economy is just beginning to men and the number of uninsured is rising we must now more than ever be prepared for such a situation and we don't want to add to the health insurance crisis and we certainly don't hinder the economic recovery so i just want to commend you and your team secretary for the excellent work you've done on this issue during the first wave of the virus i know you and your staff are working around the clock to provide tests and test results to states to develop  vaccine to educate state and local governments and keep the public informed of the latest information on the virus and how best to protect themselves from becoming sick and so i want to thank you for that and look forward to hearing more today about how the federal government is prepared for this next wave of h one n one thank you thank you mr pillow mr barton thank you mr chairman thank you for holding this hearing thank you madam secretary for being here i want to say that this is a very important issue obviously america and the world is worried best and it makes we had begun to discuss this this year back in april when we had a hearing on the h one n one virus i'd like to review some of the recent history department of h h s has responded by declaring a public health emergency which has allowed the food and drug administration to approve the use of approved any viral and other measures the centers for disease control has responded by releasing an overall drugs from the strategic national stockpile today to all fifty states have received their portion of that stockpile which is been replenished through purchases h h s is working with the department of homeland security and is coordinating response efforts much of this work has been successful because we are breaking new ground this committee in the federal government has begun serious work back in two thousand and four so in two thousand and while we're not totally prepared we are better prepared than we ever have been there are still some issues that should be addressed as outlined in the president's advisory council in technology it's my understanding that the administration is actively working to address these concerns and i look forward to hearing from you madam secretary on those issues i guess that is mr chairman i have another part of my statement but it's on the overall health care reform and i understand that you limited your statement to the pandemic flu in the spirit of this hearing i'm going to do that i want to take a point of personal privilege and say i appreciate all the good wishes that many of you have given me about my birthday about thirty didn't bother me forty didn't bother me fifty didn't bother me but me but i am glad to be having it and i'm blessed to have a great family great friends and i think to be on the greatest committee in the in his responsibilities to congratulate him on his sixtieth anniversary and hope that he reaches many more i'm sure that as least i am the first in this committee to have the privilege the pleasure of doing  proactive role in for pregnant country for the upcoming h one n one pandemic by implementing surveillance procedures to track an outbreak mitigation members to keep measures to keep americans healthy a proper vaccination plan and a communication strategy to disseminate information of important i want to commend you and look forward to hearing your update on the administration's progress planning for a potential outbreak same h one n one when there were only the first few people who were infected with the virus it appears that the spread of the influenza virus that we're discussing did not let up during the summer as some had hoped and experts predict an increased number of cases in the coming months as of september five two thousand and nine my own state of michigan has already seen thirty four hundred nineteen confirmed or probable cases of h one n one further eleven people with underlying health conditions have died after contracting the virus all fifty states have reported cases of the virus within their borders and nationwide about six hundred persons have died and nine thousand have been hospitalized these figures highlight need for the congress and administration to work together to prepare for the months ahead preventing the spread of h one n one will require collective action not only from federal state and local governments but also from individuals as well past few years i want to applaud the administration and the federal government for stockpiling vaccines masks anti viral medications that are letters and other things necessary to address the potential and upcoming problems influential is predictable and we must indeed be prepared for a wide variety of surprises today federal state and local office officers are planning and  chairman for owning this important hearing on the pandemic flu preparedness secretary sebelius welcome to our committee and i look forward to hearing your testimony on the department of health and human services efforts to ensure federal state and local public health officials are ready to prevent  respond to the spread of the h one n one flu h one n one began in late february late april federal and state health officials acted quickly to deal with the break among other things anti viral drugs were released from the national stockpile and efforts were immediately undertaken to develop manufacture and test a vaccine congress provide an emergency appropriation of one point billion for the response in additional five point eight billion was authorized contin upon a presidential request documenting the need for an additional funds interest in learning how much of this money is actually going to public health agencies in our communities particularly rural districts like the one i represent our local public health agencies hospitals and clinics shoulder the responsibility for responding to a public health crisis it is vital they receive financial support from the federal government h one n one is unique for flu season unlike the seasonal flu h one n one affects a different population particularly young people with children younger adults and pregnant women from all indications i've read the vaccines for h one n one will not be ready until mid october i'm looking forward to hearing from what types of infrastructure h h s and c d c will have in place is tribute of vaccines in a timely fashion to pregnant women people who live with or care for young children health care and emergency services personnel persons between the ages of six months and twenty four years of age and people between twenty five and sixty four who are at a higher risk from the h one n one because of chronic health disorders like asthma as chairman of the subcommittee on oversight and investigations is the issue will continue to monitor following today's hearing i look forward to your testimony and learning how well the federal government is coordinating with state and particularly local officials as a nation we respond and hopefully preventing widespread h one n one you mr chairman i yield back down to my time thank you mr stupak by previous understanding with the minority we said that the only ones who would be recognized for opening statements would be the chairman the ranking member mr dingell and then the chair and the and the ranking member of the health and the oversight subcommittee but without objection the record will be held open for any opening statements from any member that wishes to include the i want to do this mr weldon are you ready for your opening statement you know what mr chairman i will submit it for the record because i don't want to take too much time away from the secretary i appreciate the opportunity do that i look forward to your comments on this and i hope you'll be able to come back at some point because i'm sure we have questions on the overarching health care bill but i would i would just say that the flu is something we're all and about i have a son is a sophomore at wake forest university which got swept pretty early on with the flu outbreak  got it i don't know if it was h one n one and neither does he but he's recovered thankfully but it's an issue all families are worried about so i look forward to your testimony thank you mr thank you madam secretary we're delighted to have you with us your full testimony that's been before the energy and commerce committee and i appreciate the opportunity to give you an update on the public health challenges of the h one n one influenza let me just start by saying the administration is taking these challenges very seriously the night i was sworn in on april twenty eighth went immediately to the situation room because this was just breaking out and from day one this has been very high on my radar screen we're working in close partnership with virtually every part of the federal government but also with governors mayors tribal leaders state local health departments emergency personnel working with the medical community the private sector to actively prepare for the virus outbreaks that develop over the next few months and to have some strategies in place in the meantime  since the initial outbreak of the two thousand and nine influenza not only has a worldwide pandemic undeclared is also presented itself as the dominant flu strain in the southern hemisphere during the winter flu season here in the u s we continue to see h one n one flu activity over the summer which is unusual and as a number of you have already noted  it has increased now that the fall is underway we're anticipating further increases in flu cases as seasonal flu begins circulating among us we have provided mr chairman age of the members with a an update that's at your seats with some more details on the current situation including a situational update that's on i think the third page of your handout dr anne schuchat from the centers for disease control is with me today and c d c gives us these situational updates on a daily basis and we want to do to have the the newest information  although evidence to date shows that the virus has fortunately not changed to become more deadly what we know is influenza is unpredictable and we need to monitor both the impact of the two thousand and nine h one  one and seasonal flu throughout the next several months the virus is infecting more people than we typically see with seasonal flu including children younger adults and pregnant women and slowing the spread of the virus is a responsibility shared by all of us chairman emeritus stingel already referenced there are some simple steps hand washing covering coughs and sneezes and staying home when you're sick is are important steps the government wide web site w w w flu dot gov does have comprehensive information about what to do to avoid getting the flu and i would suggest mr chairman i know we have communicated this to the offices but on that web site flu dot gov are widgets if any members of congress want to put a widget on your own website so that your constituents can monitor on a regular basis see the latest c d c guidance get regular information we would strongly encourage you to do that if i'm speaking in techno speak a twelve year old can be hired easily and tell you what to do with it which is my recommendation i apologize ranking member of our and i should have started with a happy birthday and you'll find the sixty's will treat you well you  know it's a good place to be today the c d c has issued recommendations on how individuals schools child care settings colleges and universities large and small businesses can guard against the flu as well as a recent guidance on the appropriate use of an a viral drugs again all of those are on the web site and can be downloaded and shared with constituency groups if you're going to have some meetings at home guidance on infection control and worker safety and health care settings is forthcoming in the next few days as i now know this weekend we plan to initiate our h one n one vaccination program and october mid october is still the target for the large scale campaign to get underway but we anticipate having limited amounts of vaccine available a week or ten days earlier i'm pleased to report that today the food and drug administration has approved applications for vaccines for the two thousand and nine h one n one virus from four the manufacturers of the u s licensed season all influenza vaccine the vaccines for this virus are being produced under careful f d a oversight using the same license manufacturing processes and facilities used for seasonal flu vaccines that are provided every year to protect millions against the flu and in response mr chairman to your point seasonal flu vaccine is now available widely in sites around the country and again we are urging people  strongly particularly if they're in the target population for seasonal flu to go ahead and get the seasonal flu vaccine right now we recently just last week had good news from studies being done both by end and i h and manufacturers that a single dose of the vaccine rapidly and introduces a strong immune response and healthy adults we think that age group could go down as low as age nine but the clinical studies in children and pregnant women are still underway so we don't have the full data about whether children will need two doses or not they do in seasonal flu younger  children we're still waiting for those results to be back and mr chairman originally we thought that it would take up to twenty one days for the immune response to be robust and it's showing up in eight to ten days that's  very good news so one dose to ten days for most of the population above age and we think is is very positive step forward the trials in pregnant women are underway as i said and  children and our expectation is that the vaccine will be a good match in protecting against these populations as well once ready the vaccine will be shipped through a center distribution  system available in up to ninety thousand sites around the country every state was asked to develop a plan and identify the appropriate vaccination sites our contractor is shipping directly to those sites so there is not a glitch along the way two types of vaccine a flu shot made from an activated virus and a nasal spray made from live we can virus will be available free of charge through those some providers may charge an administration fee and again congress did authorize funds at the time of the supplemental bill to cover some of the costs and the department of health and human services has expanded on top of that about a billion dollars in our funds to get that process started before the supplemental funding was available c d c s advisory committee on immunization practices a sip recommended that initial doses of the h one n one vaccine go to people at greatest risk of complications from the flu as well as those who have frequent contact with people at risk and we're working with states territories tribes local communities as well as the private sector to help distribute and then minister  the new h one n one vaccine thanks to congress we've allocated one point four four billion dollars for states and hospitals for planning and preparation the nation's current preparedness is a direct result of the investments and support of the congress and the hard work of the h h s agencies and state and local officials across the country both recently but certainly over the last several years so we look forward to continu work with congress in the weeks and months ahead again mr chairman i thank you for the opportunity to participate in the conversation and i look forward to taking your questions thank you very much madam secretary for that update there are many members here because this is an important hearing and i know you have to leave in a couple of hours in order to accommodate the members what i'm going to do with mr barton's assent is ask each member to ask one  recommendation there is a precedent for this other cabinet secretaries had been before the panel we have adopted this practice and i think it's fair so that the junior members have an opportunity to ask a question as well as the senior members y you know the one of the real questions that people have is the safety of this drug and there was a real concern going back to the one nine hundred seventy six and that swine flu epidemic and the diseases later associated with the distribution of that drug so just so i can understand this this took was to actually gather the experts from nine hundred seventy six together and asked for advice about what went right and what went wrong and we had an opportunity to meet with  the everybody from the then secretary of health and vironment to the surgeon general to some of the scientists who were involved and they gave some very good advice the principal difference may not have been in the manufacturing of the drug but the fact that the flu never spread so that the outbreak that was initially identified among about two hundred soldiers in fort dix never went anywhere so a massive vaccination campaign was launched about forty million americans were vaccinated and yet there was no flu not in america not anywhere so we are in a very different situation today where we know this virus is spreading and  this vaccination vaccine is actually being manufactured exactly like the seasonal flu vaccine is showing up in the same way and it's using the same processes and procedures  so in terms of the safety and efficacy while there are clinical trials underway to determine the right dosage and really the efficacy of the vaccine is it hitting the right target there have been years of clinical trials and lots of data gathered on seasonal flu vaccine so we are assured by the scientists that lots of steps have been taken along the way to make sure that this will be a  anticipate the same problem as i say if it were a different process than seasonal flu we do have more concern than very similar may have questions for the record my first one question is something that you may not be aware of i was briefed this morning by officials from texas a and m which is not in my district it is the school when i went to they have developed a if i understand them correctly a vaccination or a vaccine that is made from hydroponic tobacco that they can produce one hundred million doses very quickly if necessary how are you familiar with that by any chance mr barr and i don't know about that vaccine i do know that tobacco is one of the growing agents looked at as an alternative to the vaccines but i misting i had to leave mr polonca thank you madam secretary i'm concerned about emergency room hospital capacity that type of thing there was this report that was issued last month by the president's council of advisors on science and technology that says there could be as many as one point eight million hospitalizations in the united states during the epidemic and of this one point eight million up to three hundred thousand could require intensive care units and those patients could occupy fifty to one hundred percent of all i c u beds in affected areas the epidemic you know even without the epidemic those i see is normally operate close to capacity in my district so what w regard to the nation's hospitals i mean do we have the surge capacity to meet this potential demand and can you tell us what steps the department is taking to help possibles prepare for the for the surge in cases capacity for hospitals and billions of dollars have been invested over the last number of years in fact i had a chance here in d c to visit their five regional centers sites that have been  developed to get even increased capacity and one is here in washington d c and get a sense of what they're doing so there have been recent dollars put forward but also dollars over the years to have that planning go on for surge capacity we are concerned that we also try and get information to the public as rapidly and as clearly as possible the worst of all worlds is to have everybody show up at the hospital or come through an emergency room door the vast majority of individuals who get age one and one so far are  not terribly ill do not require additional treatment and certainly don't require testing to see what kind of flu they have so that we're trying to assure people the flu is the flu is the flu right now c d c will continue to test through hospitals and other areas those who are getting seriously ill so we can monitor the cases but the testing is it isn't required so we have resources to hospitals we are helping  with systems that will put in place additional medical capacity everybody from the medical reserve corps to additional personnel who we can help with assistance so we don't think at this point that the the p k s the presidential advisors scenario is the most likely scenario to happen we watch the southern hemisphere very closely and what they have done for surge capacity and again we'll learn a lot from them but they had no critical emergencies that weren't able to happen with shifting some space so i think at this point we're doing everything we can  people ready and provide for some alternative a part of it is to diminish hopefully the strain on hospitals by encouraging people to go to the web site to learn more to call a primary care provider and urge them to just take steps that they would with the regular flu thank you mr plonk mr deal thank you i'd like to ask about the distribution of the vaccine when it becomes available will the distribution be sent to the stage and the states determine where it will go to within their states and will there be a determination of how much goes to each state and what will be the factors that will be looked at in determining how many doses a state would be allocated the distribution is based on a per capita basis and states absolutely develop their plans working with their emergency personnel their local health departments and others to determine the vaccination site so again the distribution contract is not going to go to one central site in the state as the tradition vaccine it's going directly to the sites that have already been pre determined states were asked to send plans to the c d c part of the resources provided by congress helped with the planning effort and the contract will be up to ninety thousand sites that have already been determined so it'll be some traditional you know providers offices and health clinics  hospitals but also a number of nontraditional sides are going to have one brief question on it that per capita amount is that determined by who the c d c thinks should be eligible for getting the vaccination or just a general capital that is a general pro capital amount in terms of how it rolls out we will have enough vaccine available for everyone there is enough on order we're looking now at the three orders for the one dose versus two there will be enough vaccine what we're concerned about is getting it to the priority populations as quickly as possible and that's what we've asked the states to focus on how to get pregnant version i know senator reid in the senate is looking to do a national version of that particular provision what we're going to have is a demonstration national demonstration project of the bill  suggested going on in the next couple of months and certainly our leadership at the centers for disease control feels strongly that if we are successful in using schools as partners in vaccination then that may be a great way to enhance the vaccination take up rate going forward for seasonal flu and other issues i'm old enough that i was part of the group with the early polio vaccine and we got the vaccine at school you know that was always a partner and this effort we have school districts who are very eager to be vaccination sites and are standing by to do that so we'll know a lot about your more coverage by dealing with our schools our centers in our community we're talking about our children given the age group that this virus is targeting we thought schools and actually daycare centers and others are very appropriate outreach sites to reach the population who we need to reach and so working closely with the terry of education and his counterpart superintendents and governors and i think most governors are very enthusiastic of having the schools this i'm assuming that puerto analysis you did with regard to this virus if it was on check in unabated the impact it would have overall on america's health care system including the cost one of the issues this committee is trying to grapple with as you are is the cost of health care in america we have an impossible time getting information from the congressional budget office on anything that has to do with prevention therefore i'm wondering if you office has gathered some information analyzed that as this for example as these vaccinations are advanced out there earlier what we are saving and what is the overall same as it comes from yes the government is spending money to move these out there but what is the impact on saving money and saving health care costs and what if you have any information if not could you get it to us because this committee really would like to have some of that if i could say much i will certainly look to see what kind of cost effectiveness or strategies we have put together i'm not sure i think we can tell you probably and  have is then a huge sort of social cost one of the projections absent of scene of this virus spreading even even in a relatively mild case which would be two hundred thousand hospitalizations thirty six thousand deaths that's what seasonal flu looks like every year but if you have a widespread part of the population who misses work what the impact is then on business and trade whether you can even do continuity of businesses if you have essential workers missing part of the issue about schools is what happens if half the teachers are sick or you know how do people go to work if half the kids are sick so i don't know that we have added those costs but we can try to put together some information i would appreciate it if you can get it to trim because it is a type of modeling which we just don't have not only in terms of scenarios of analysis but now we have something very real that we anticipate could have an impact on workforce education as well as direct and indirect medical costs and i appreciate you get that to us thank you mr chairman thank you very much mr murphy i work on this harman thank you mr chairman thank you for holding this hearing and thanks to very capable former governor and a very capable team for putting in place a plan to prepare not scare the public i do want to commend you on the tone of this plan which as i think overcome a lot of the original hysteria is this basic set of protocols we now have in place and they public pitch that we are making quite effectively about this strain of  be could this be applicable to perhaps a pandemic that's more severe a possible a biological attack in our country or other huge health challenges that might arise and if if this set of procedures and protocols and tone that we're using is not applicable what steps can you take now to be sure it does we are we are able to adapt to future problems we don't presently anticipate i think that's a great question and no question about the fact that congress working with the prior administration put in place steps really that have been executed over the last six or seven years of not only resources that have amplified efforts within the department of health and human services including you know our own  development operation and handsome and sue and i h and centers for disease control and f d a but certainly resources at the state local level and a lot of planning as a former governor we went through pandemic planning i never dreamed i'd be sort of here with a pandemic but we called together efforts over the years so i think it's at a minimum what is happening over the next several months will enhance our entire public health infrastructure having hospitals look at the spring where the gaps were really double efforts to get ready for the fall is enormously helpful how they direct resources looking at workforce issues how to get you know vaccinations to people a huge challenge and it's an ongoing challenge is just information how to make sure folks can access timely accurate information in a very transparent fashion and walk that balance between complacency and panic but get people prepared and ready so i don't think there's any question that what we do over the next several months will significantly prepare us for whatever challenges next we know whether that's a natural disaster or a manmade disaster that the infrastructure strength the communication strategies working with the partnerships not only through government but in the private sector is enormous helpful and is exactly what you go through region by region we just haven't done it nationally really in forty years thank goodness harmon miss blackburne thank you mr chairman and madam secretary thank you for taking the time to come and talk with us today i am pleased that you are here and i don't envy the task in front of you and i know it's going to be a rough flu season from what we're seeing and hearing already and i do think the free flow of information is going to be an imperative as we try to handle this with our districts with schools with public events that are taking place you've testified before our committee twice and the first time you came we were working on the health care reform bill and nailed we're looking at what could end up being one of them is significant to our constituents as the impact of that health care reform bill this as a public health situation that we know is going to be in front of us to deal with this event now when you were here before  talked about the issues dealing with with with health care we talked a little bit about that in care or situation i ask you about some of the issues that were  there your responses took a while to get to me they were a single sentence and that prompted another question and i just received the response to those today so i do thank you for getting those but i do ask that as we move forward that knowing that this is going to be critical that we have timely and accurate information that we do have that free flow of exchange as this public health issue affects our districts and may be a little bit more timely than the response to the questions which was a little bit kirton in adequate in bordering on disrespectful i do want to say thank you for the widgets i appreciate that those are on your web site in that we can link to those and i do want to ask you as we're talking about the supplies in the supplies being lent to the state and you mentioned those that are most vulnerable to the flu are are the those that the physicians in the caregivers that are going to administer the flu shots do they have a ranking or a priority system or will the states work that out are they going to take seniors and pregnant women farce or do you have it can you give us any guidance on what that protocol is going to be for who gets to go with the front of the line well congresswoman we have not tried to determine for states the most appropriate way to get to their target populations we thought that was a local and regional decision we have done a lot of work with the provider community outreach directly to o b g y n is outreach to primary care docs to health clinics with the health infrastructure but states are submitting plans based on their own determination region by region area by area how best to target their vulnerable populations and that's where the vaccine will go our best response so those populations when they call our office consult your local physician in terms of where to get the vaccine and who gets priority well their local physician won't be determining who gets the priority again the state health department has determined that and that information should be available right now there will be that scene for everyone gentlewoman's time roll off the production line simultaneously so the state is really has pre encouraging items of of news in terms of the hope that one dose will be sufficient that it will be getting the desired impact within eight to ten days and that you think you'll have sufficient dosage for for everyone starting with priority targets i have a few questions very short questions related to that vaccine the vaccine issue and then in follow up wi submit some written questions on strengthening our public health system we're addressing workforce shortage issues and technology issues but on the vaccine three quick questions of the one hundred ninety five million doses ordered is the hope that you can reach everyone through use of the adjutant that you've also ordered and so tell me a little bit about the the use of adjutant during this season second i know that we had a shortage of seasonal flu vaccine i think back in two thousand and four when there was a closure of a production facility in the u k we did not have a lot of domestic manufacturing capacity at that point i below leave that is change but i wonder if you could tell me of the five manufacturers that were working with for these dosage where their facilities are located domestically versus foreign and then i believe you announced in your testimony that four out of the five  manufacturers have been approved today by the f d a what's the status of the fifth is there any reason we should be worried no edge of and is currently anticipated to be used in the united states at all there are some backup plans if things took a terrible turn for the worse we have never used in any widespread area an edge of an a vaccine so the scientists strongly recommended that we not head down that path and this time the current purchases are likely to be enhanced to get to the point what you've reported is the initial purchases but as we see the take up rate as we get the rest of the clinical trials we will make the purchases based on what is anticipated the take up rate is for three hundred million potential users as you know one hundred percent of the people will never get vaccinated for anything unfortunately we currently have five facilities in the year that we ran out of vaccine there was one and our i'm sorry we were down to one there were two book around was debilitated i can't tell you off the top of my head and forcing exactly where they are will get you that information back but there what i was told yesterday by the vaccine committee is that we fully anticipate that all five will be licensed there were some final steps needed to be taken in the final contract just on the domestically domestic production and vaccines being made in america i remember a particularly telling hearing during the last administration where if we were having particularly  ill and pandemic the presumption was that if we weren't manufacturing it here in the u s it would not be available to us in the u s and i certainly hope that we are bolstering our domestic production of that when i'm general of the time greatly enhanced and most of it is domestic gentleman from georgia madam chairman thank you madam secretary thank you very much for being with us again and let me just say at the outset that your efforts along with those of secretary janet that to you and you have already addressed that in your testimony but i want to ask you about particularly about pregnant women because that was what i did in my previous life as  pregnant women even if they are healthy are at high risk of hospitalization and death from h one n one swine flu the c d c reports now i will live you to answer that question or are they i know they're at increased risk over the general population and there are certainly issues with the decrease lung capacity and not is a big row so mune response because of their pregnancy it does put  we saw in the spring is that pregnant women constitute about one percent of the population they were six percent of the hospitalizations and deaths that occurred significant really out of kilter population and previous with no underlying health condition other than the pregnancy you know we're not talking about somebody who had diabetes going into pregnancy or someone with chronic lung condition definitely a higher risk than the general population maybe as much as five times a factor of five or six would be so in terms of the outreach we have tried to be and that that was not only the u s data that's showing up around the world  again pregnancy seems to be in and of itself an underlying health condition that significantly enhances the risk so i know that for a lot of pregnant women i certainly did this myself was reluctant to take anything during the term of the pregnancy but talking to a number of o b g y n looking at the data talking to scientists there is a great belief that the risk of any sort of event occurring because of the vaccine far is outweighed by the risk that occurs without being vaccinated and in your daughter's case and new mom  babies under six months old are not recommended for the vaccine so another of the target population is caregivers of infants six months and younger to try and protect the infants so i thank you madam chair and thank you madam secretary for being here with us today again in states and cities across the country local public health departments are really getting decimated by budget cuts in my hometown of sacramento the public health department has already had to cut seventeen percent of its budget this year alone these cuts mean that in my district alone the public health department will be losing three communicable disease specialists and two microbiologists for our public health lab this is on top of losses and field nursing staff bioterrorism preparedness workers and other people who work behind the scenes every day testing samples for h one n one virus and other communicable diseases man secretary the one b spot and the statistics i just mentioned is that my local public health department will be able to retain at least some positions thanks to a one time infusion of recovery package donna dollars what other plans  do we have at c d c or the department at large to help local public health departments cope with the huge responsibilities are going to have soon and also to it's a plant of the virus mutate sometime soon so we have a greater pandemic emergency congresswoman the part of the planning effort has certainly been to recognize that the situation you're describing in california is nationwide and that public health agencies have been severely hampered by the budget cuts so that the resources the one point four billion dollars which was pushed out hopefully will help enhance that we've also really activated the the commission corps the emergency group of retired medical providers and volunteers who came together after nine eleven there now about two hundred thousand strong throughout the country registered in every state and kind of put them on notice to help with the vaccination efforts and had them call able to be called upon we do have our commission corps of health workers who again can be brought in to supplement some of the state based efforts but every state as they submitted plans to c d c recognizes that part of the challenge in dealing with this is a restricted corps of personnel of trained personnel again we're not urging folks to continue with the testing protocol that was important early on to determine but right now we're just moving more to the vaccination and mitigation phase is to try and just diminish the the circulation of the flu so some of the earlier activities hopefully will be shifted into the vaccination effort gentleman from louisiana concerning last week's testimony of the president's address to the joint session of congress there were some things that he had said regarding the new developments on the health care debate since the bill that passed out of this committee  the congressional budget office testified that it would add two hundred thirty nine billion dollars to the debt and that eight million illegal aliens would have access to the government plan since the president's statements last week said that he wouldn't sign a bill that would add to the deficit and  wouldn't allow illegals would you support changes that would be necessary to make our thirty two hundred which passed out of this committee comply with those two initiatives that president obama stated before the joint session to make sure that the bill doesn't add to the deficit which right now it would add in to make sure illegal aliens wouldn't have access to the government plan which c d o testified eight million would congressman i'm pleased to have and a number of discussions on health reform and top priority of the administration and i'd be pleased to come back and do that the chairman asked that this hearing be on h one n one and i would like to defer that i don't know but i mean we've never had the opportunity to ask you because you're only testimony to us was at a time when you would acknowledge you had looked at the details of the bill so really we're not going to have another opportunity that i know of to talk to you personally about the discussions are ongoing every day there could be a bill on the house floor we don't have any assurance that we're going to have a hearing before a vote occurs and i would imagine that the secretary is well versed in these issues because i know you were in the joint session with us last week in the house chamber when the president made those firm commitments he said he would not sign a bill that added to the deficit by a dime he said that he would not support illegals getting access to health care and yet in the c b l testimony that c b l sat here in the in the chair you're sitting in it said eight million illegal aliens would have access to the government plan under the bill that you supported and he said that it would add two hundred thirty nine billion to the deficit so i'm sure you understand those issues you were there at the speech last week i'm sure you have some ideas of how we can fix that we've got ideas of how we can fix those problems but would you support the fixes that would be necessary to make the bill conform with the president said before congress and as a recovering legislator i am reluctant to sign off on any legislative language i'd be happy to take a look at it to see if i could support it i certainly support what the president stated going forward that he and he will sign or not sign a bill i think you can  is taken on the house floor i think that's very important that we get these questions answered tenements time is expired i did give him extra time because of the i know the chairman will work with the secretary to make sure we get her back here to answer any questions people  currently states are expected to purchase a portion of the need needed to protect their citizens but it includes a twenty five percent subsidy from the federal government my concern is a lot of our states are suffering right now because the economic downturn and may not be able to meet their obligations because of limited resources or operational constraints or some kind of a plan available to help some of these states like michigan california others that are struggling i don't want anyone not to get it because the state's budget concerns congressman the through the resources that congress has provided them through the resources from the department of health and human services the vaccine will be free distributed to the states free they are not expected to have a cost share i think there has been a cochere associated with their purchase of banning barrels which are in the stockpile but not with the vaccine vaccine is free going to be distributed there may be an administration fee by the provider but there is no fee to get the what about the any viral in the states have purchased and a viral over the years in a stockpile those are being pushed out as we speak and the department is continuing to replenish that stockpile and if needed will supply those to stay ok so no state should have to worry about not being able to afford or obtain any that will correct that's what we're trying to do with the resources let me ask you i know it's flu season traditional flu season and people are getting are shot is there some kind of waiting period they should have before they get their seasonal flu h one n one flu shot well again since we don't anticipate the real supply of h one n one until october fifteenth we're saying right now get it now it's my understanding that the clinical trials are underway right now are looking at whether or not there is any harm to simultaneously getting the flu shot and as we get we'll have that data available to let me ask you this i'm from northern michigan and we share a border with canada we go back and forth daily and we do a lot of preparation on this side is there any special considerations being given to border communities whether southern border northern border and what are they doing in those countries were moving back it seems like we got a much more robust program here in this country i am seeing the same in canada or especially the department of homeland security look carefully at that issue and the scientific advice during the spring and it was determined that since there was already a robust out breaking of h one n one already within our borders that border closings really would harm commerce potentially but not really help with the disease outbreak so there is no anticipation at this point to do anything with our northern and southern why we want to see a border but are you coordinating with other countries to make sure they can in particular make sure that we're doing basically the same well thank you madam chair and i appreciate chairs commitment to have the secretary come back before the committee before we have a vote on the health care overhaul bill and i hope i don't have that power but i'm going to talk to the chairman who does have that power and if you had that power you'd give us that commitment no i appreciate that because a lot of us share that concern i also want to draw attention to the secretary to a letter that a bipartisan letter mr rogers mr gonzalez and i and others sent to you recently regarding the two thousand and ten fee schedule on medicare as it relates to cardiologists non college just proposed cuts that could be as high as forty percent in some codes if you haven't gotten that i don't expect you to be on top every letter that comes your direction but if you could flag that one we appreciate your response i was reading a story in the in the paper one of the papers coming out here yesterday from oregon about a problem in the southern hemisphere related to h one n one as it related to folks in the hospital trying to it to deal with those who are sick and they raised the issue in the story at least at the hospital workers the nurses the doctors others did not have a sufficient and  early supply of mass and other protective equipment to prevent the spread within the hospital setting are you and your folks confident that in these environments where all of us who get sick are going to rush that there is adequate whatever we call it the materials the mass the protective equipment whatever so that those we rely upon for our health care will in and of themselves be helped in the protocol which i would suggest is the ideal case aereo a respirator per provider for every patient seen there are not adequate supplies to follow that protocol one new respirator protocol so right now we are working actively with osha and c d c and the health care providers to develop a protocol that actually is more in fitting with what the supply looks like because i o m was told not to take into account what's available or what could be available over the next six months unfortunately the reality is we got a look at what's available so that discussion is actively underway and on that backwards what what advice and counsel do you have for all of us about i realize we have to cover our miles and all but but if you're on the other side of that should we be wearing those kinds of protective face masks when the outbreak comes is it going to be helpful or is that just overboard what i've been told by the scientists is that probably not masks are really not if you that capacity in a home situation coming in close contact that may provide some protection but basically now that if you if this continues to present much like seasonal fl and you know number of people get hospitalized with seasonal flu every year we don't have that kind of rigid fitted mask protocol under way so we're trying to balance and security what's most alarming and i think all of you would be great to help with health care workers right now don't get vaccinated less than fifty percent of health care workers ever get vaccinated for seasonal flu even though they're a priority group for h one n one we're afraid that take up rate may be the same so i would say that step one is to take advantage of the protection that's there with the vaccination both with seasonal flu and then with you know the h one n one vaccine because they're at the front of the line and we would hope that they they do that generally from the virgin islands christianson thank you madam chair and thank you madam secretary for being here with us again today  bedroom twenty five to sixty four with underlying medical conditions such as asthma diabetes and compromised immune systems are one of the target groups for the force coming back seen as you know racial and ethnic minorities are disproportionately affected by all of these chronic diseases and more are your clinical trials the people in the clinical trials the birth and what outreach is being that has been done a culture that is culturally and linguistically appropriate to reach these some times hard to reach populations often with poor public health infrastructure to ensure that they get the adequate prevention treatment a so forth to clinical trials it's my understanding are diverse and work aware of the concerns that have been raised in the past again a lot of the trials underway are specifically about dosage because the clinical trials have been done for years on seasonal flu which deal a lot with outcomes the challenge of communication and outreach strategies is one that we're taking very seriously so traditional media is being used nontraditional media ethnic specific media so translating everything on the web site into spanish into vietnamese automatically and then other languages can be requested as needed looking at a variety of media outrage that reach nontraditional community working with the faith based and community out because a lot of these communities also are not connected so we're using the faith based groups to connect for the younger population it's an equal challenge so facebook and twitter and e s p n has agreed to become a partner for the squirrels they put across college dorms we have a p s a contest on you too in terms of trying to get to people so we're really trying to maximize and special outrage to minority providers and health clinics knowing that they are likely to see a lot of folks with underlying health conditions who need to understand how serious the risk is for this for this virus where nobody has an immunity midst of our training during the last swine flu outbreak during the ford administration and i remember very vividly some of the problems encountered so as information is gathered as to the safety of this vaccine i think it is really important to get that out and get it disseminated we had a big problem in fort worth texas with the first round of this in the spring the school district closed and i would say a i think appropriately so but but they received a great deal of criticism the school district across the trinity river in dallas did not close and and obviously there were a lot of comparisons made between the decisions of the two school districts still i think superintendent johnson did exactly as she should have when she was confronted with a large number of suspected cases and could not get information back in a timely fashion from the c d c as far as recommendations  to prevent that type of difficulty from occurring again in the fall i asked and your department was kind to respond and we did of a seminar on  v h one n one in fort worth this past august and we had representatives not just from h h s but from v h s and c d c as well as the state and county health departments the impression i got from that day discussion was that the decisions about closure and on closure of schools would be left up to local authorities but then it seems like less than forty eight hours later the guidelines were coming down that that your department would decide when schools should close so i would just simply asked the question who is going to be making these decisions is it the local folks is it you is it secretary duncan from the from the education department who is going to be making these decisions because it obviously impacts not just the school year of the kids the learning curve curricula of the children but in texas of course we have like many other states we have a testing protocol under no child left behind and we i want to see our school districts not necessarily penalized but we won't don't want to see our school districts take an unnecessary risk with the children's safety school closure both in the spring and now moving forward are always a local decision  that's made at the local level having said that the centers for disease control has issued school guidance and it's just that guidance what they're seeing from the science and what they would recommend and at this point the guidance is different than what was being discussed this spring in part because we didn't know how lethal the disease would be and it was very unclear whether or not sending your child to school could indeed cause much more serious harm now we've learned a lot over the spring and summer learned a lot from the southern hemisphere and so the guidance issued by the centers for disease control and put forward by secretary duncan and others an outrage to schools across this country is really leaning toward keeping schools open having protocols available in the school to deal with outbreak isolating kids sending them home trying to make sure that teachers and students are vaccinated but keeping schools open that could change the flu could change we're watching it very closely but the school decision will continue to be made at the local level generally from florida miss cast thank you madam chair and thank you madam secretary for all of your efforts and educating the country on h one n one i'm not unlike the millions of parents across the country that have been read been teaching our kids you know wash your hands all the time cover your call we haven't altered substantially the way we live our lives so this saturday we have a dozen nine and ten year olds over my ten year old daughter's birthday party and they did not protest when i had them wash their hands before snacks wash their hands again before cake wash your hands again at the towards the end of the evening kitchen of course she's staying home from school and there are a number of kids out this week but parents want to know when your guidance is very good the c d c guidance is very good but the question i hear a lot from from neighbors and other parents you know how long how long does a child have to stay out of school in this guidance says that that a person who has it can infect others up to five to seven days after getting sick but it also says that it's ok to go back to school twenty four hours after the fever is gone so what is what is the most consistent answer i can give to parents  child that has has just come down with h one n one i think the the scientists are saying twenty four hours after the fever is gone without any medication to lessen the fever and the problem is that for the kind of average maybe five to seven days a lot of kids it may be two to three days and then twenty four hours later they're ready to go so it's hard to give you a date specific i think it's a child a child situation some have more serious cases some have lesser cases but twenty four hours without any medication since the time you've had a fever they say is safe to go back even though they could still infect well other kids a few days after that the dr is telling me what they're seeing is that the vast majority can't infect at that point and that's why they've arrived at this twenty four hours after after the fever ok thank you very much gentlemen from iowa mr thank you madam secretary for joining us and i think everyone is concerned about the public health implications but there are some unintended consequences of the public health campaign that i think we also need to be conscious of and one of the concerns that i expressed at an earlier hearing when we had represented c d c here was the decision to refer to this virus generically as swine flu despite its origins and the enormous negative impact it's had on our pork industry because of a lot of missed and missed conceptions and yet i know that public health officials have determined that it's easier to get college students attention about the need for getting prepared and exercising precautions when you referred to it by the name swine flu as opposed to h one n one so we've got these conflicting things going on and one of the things that i'm very concerned about is how we balance those interests given the enormous economic implications to states like mine when people have half trues and misinformation and yet the reports that i've seen as recently as this weekend in the washington post sebelius encouraging news regarding swine flu vaccine their choice not yours thank you new york times one vaccine shot seen as protect swine flu so how how can we address the enormous public health challenge that we are all legitimately concerned about and still address this enormous negative economic impact that it's had on our pork industry congressman it's a great question and i can tell you it's one that we're wrestling with a lot i hope never out of my mouth have you ever heard that other term and or out of c d c or and i or the f d a and i have taken it on as a bit of a personal mission when i'm with media  reporters and being interviewed to correct them and and ask that they please use the terminology that's accurate because there's a lot of misinformation and we have on several occasions that i've joined with secretary vil again the other side of this is sharing people that nothing at all in this flu is related to eating pork you can't get it from for there's no crossover but you're absolutely right i know there has been over a billion dollars if i understand it and that may very underestimated at this point and i you know we'd welcome any suggestions i think it's easier to do so they do it but i would agree it's a huge and it has an enormous economic impact i've even suggested maybe you want to conduct your own media campaign that maybe we should challenge people to use the right terminology and you could send them a pork chop every time they use the chair now recognizes generally from california this caps thank you back here secretary sebelius you've been very patient this afternoon and i hope that this won't take the full five minutes but i want to thank you and i want the record to note that you really did hit the ground running after your confirmation you had a lot of issues on your plate i've seen you everywhere on both health care reform and very positive ways and also on this topic and i'm referring to a bi cameral briefing that you and several secretaries presented to members of congress it was mid summer if i'm not mistaken in between sort of like this ring outbreak and i my my question then was to acknowledge the role that a school nurse played in the first case in the bronx that resulted in massive school closures and as a former school nurse i sort of emphasized i know why districts closer schools but it's chaotic when it happens parents have to parents don't have backup plans a lot of times too and they miss work and all the things that ensue and you find kids on the mall and all kinds of places and when that happens so now i pleased to follow that the chain of questions have been and ask and  since this topic has come up i'm interested in the nuances now that have occurred watching this epidemic get as it has proceeded and now as this school season hit and many of the campuses a little older teenager adults and that captive environment which can be dealt with somewhat differently because they're not so dependent on parents and jobs and things but still i'd like to have you address just for a minute for the record because the relationship between your your department and c d c and the local communities is is very specific and i think unlike many other departments with very direct communication and this outline for us a few of the ways that you have been working with local health departments as they then are partners with local school districts to formulate and get the right kind of advice tailored to different parts of the country so that we  behave in the proper way as this comes out both in in terms of the immunizations the bax nation plan and also what to do when when like my colleague kathy castor out daughter's friend you know what to how do you respond well i think that's a great question since the spring i would say the three cabinet secretaries who have been sort of at the forefront of this effort are secretary and a politician with the homeland security and right arm and coordination but secretary duncan from the department of education because given the age group of the target population that has been a real effort and he has regular calls regular outr with superintendents and principals and teachers all throughout the c d c has specific guidance that's on the flu dot gov website which we've asked schools to download and take a look at and what happened to really change the school advice the guidance that was out from leaning toward closing schools stood leaning toward keeping them open with first realizing that it would not present itself as a more lethal  disease secondly recognising that there are a whole series of other health impacts for children who are sent home missing often school breakfast and lunch which has a nutritional impact the oven on a safe environment which has a significant impact if there's nobody home to take care of them and on balance given the way the disease was presenting it seemed wiser that the guidance be toward keeping schools open but trying to isolate and send home sick children urging parents who keep them home in the first place but if they show up at school send them back home isolate them until you can find a parent i think that this may change as we go along and what we know is that what we saw this spring there are going to be some areas of the country cities that have lots of cases like new york did in the spring they're going to be others relatively close by that may have very few cases so it's impossible to have a national program and school decisions will continue to be very local but that outreach we do in every two weeks we've had a big flu summit and asked governors to send in their education secretaries their homeland security their emergency plan or their health so the school folks have been part of this conversation in a very robust way from day one thank you very much gentleman from georgia mr barrow madam secretary thank you for your service and thank you for coming here today and sharing with us on this my name is john barrow i represent savannah georgia goes to georgia and all points in between our prior response to seasonal flu might not be the best but we should do is probably a pretty good guide as to what we will do unless we do something different and i'm given to understand that less than half the targeted populations we reach out to on a regular seasonal basis get the vaccine that is that is that is suited for that situation and so we got in to support unless we do something different we're going to have sort of some of the success rate in response to this this new threat i understand that one of the targeted populations we are trying to reach in response to the  one n one is the population of children and young adults six months to twenty four years of age kind of sets it apart a little bit perhaps from seasonal flu i'm having a telephone conference call this afternoon with a pretty influential bunch of folks with respect to that targeted population my public health expert ms betty dixon is with me today and she's going to be participating in this conference we're going to be talking with every superintendent every assistant super and the principals from every elementary middle and high school in the district and the deans of students and many of the eighteen institutions of higher learning that we have in my district so my question to you is sort of a general one but what can we do what can we say in the course of that conversation but captive in very influential audience to help them get a higher success rate in reaching the targeted population they have some influence over them we've been able to do so far with respect to seasonal flu what we tell them that we're not already telling them well i think that you can tell them that we know that they have the target population and that if it's nothing more than just lots of folks getting the flu that has a huge disruptive factor so having minimizing the spread right now and then vaccinating we know is the best defense against the flu spread we do have some great information on the web site i would i would suggest that maybe if you widget on your web site and urged him to come and download you know we've got parent tool kits and information for teachers this is how to tell them as to why this is how to do things what can we tell them to motivate them to make a greater effort than has been made in the past well they can keep people from being hospitalized and dying if thirty six thousand children in this country die from this flu i would suggest it will have a huge impact on communities around the country and that's the average death rate for seasonal flu so even if it's just like regular flu given the population that basically they are responsible for that's what it looks like and so i think you need to convince them that even the regular flu is particularly is different because it's kids and it's young adults they have no immunity to this whatsoever so anybody with underlying health conditions is really far higher risk and i think i think just getting them their hands around two hundred thousand hospitalizations year in year out with seasonal flu thirty six thousand deaths that's what the profile looks like but typically because of the age of the population who is typically affected and because of their frail condition i'm not sure it has that kind of societal impact community impact there is sugared tells me a new tool kit for school immunization that will be online well that went online on the thirteenth  lable at but i just think you know getting their attention about how even mild flu is very serious people do people get very sick and anything we can do to prevent  the spring during the outbreak there was no one region one area isolated we think that the rise in cases in the southeast which showed up first is because of the fact that they did start school earlier and kids came together really or we're starting to see cases though spread and you know oregon kansas i mean so it's beginning to spread out as people come back to school as college is reengaged so we don't have any any information that gives us kind of a regional or local look at what's likely to be more of an outbreak which is why it's so important that we keep watching it very closely and monitoring what's happening on the local level have all of the state implemented what you would consider adequate to state preparedness plans for this well congressman all states were required in order to access the funding available to help them implement they were all required to submit plans i think that the assessment was that many states are ready in a very robust way others were in ok shape and some really needed a lot of help we provided technical assistance support on the ground surveyor we also had teams that did site visits to try and verify that what was coming in in the written plan was actually accurate in terms of what was available so we're trying to provide help support and get states ready to go because a lot of this will have to be the shots in the arm are really going to be a state and local effort will there be enough vaccine for all of be widely available on the fifteenth of october which is the target date we anticipate having some early supplies as early as ten days before that and it will be distributed as soon as it comes off the off the production american people and i think that we all appreciate that there are what five companies that are making the responsible for the five men making the  injections what i'd like to know is is this something that would be better used for children are you going to make a choice relative to that does it really matter is it good for adults is it as good for children and how do you think that it might affect the voluntary compliance rate for those opting to get the h one n one vaccine and what i'm going to do since we only can have one question is to follow up on some funding questions relative to this whole thing but the to stick with that for now what dr schuchat tells me is that it isn't the nasal mist is not recommended for the youngest children oh it's not due to forty nine seems to be the target popular say as long as they don't have underlying health conditions though again some of the highest risk children would not be recommended to get the nasal mist instead but it it certainly is a viable alternative for a lot of the population could well thank you again for what i think is really special and highly needed leadership we're proud of you and thank rooms with people who are in essence just having the every day a flu like concerns and i know that we have to do a good job calming the public so that they they use the services when they're needed they don't over utilize when they're not and i don't know how i'm not i'm not a health practitioner so i don't know how you gauge yeah but i do think that  answers unlike the other rest of my time to a doctor burgess because i just had a follow up question that came up one of the questions down here was on the funding issue and there was a little over seven and a half billion dollars  for the h one n one flu in the stimulus bill is that correct that is correct so and have these funds been dispersed are they readily available to you or are they still being held somewhere in the stimulus pot or what do you have all of the money you need do you have the funding that you need at this point at this point congressman we do we are drawing that money down we've made a couple of  draw downs to buy vaccine in and get ready to distribute it now that we have a little more clinical data we're likely to have a more accurate picture of how much vaccine we're going to need where we've used some of it to replenish the stockpiles of an environment that we sent to the states to help as i say about a billion for so far as gone out to states and hospitals for surge capacity we're buying protective equipment so we're we're trying to do a step at a time at this point the funding provided is extraordinarily helpful and we you know at the present time you don't don't anticipate having an additional funding requirements that we'll be asked to  to deal with at this point i don't have of them again we are watching this very closely if this turns more lethal if it begins to present itself in a different way if  the avian flu but it's so important because in three months time cardiologists on colleges and indeed all all physicians who practice under the medicare system are going to receive a twenty one percent reduction if congress doesn't do something now we still have a vacancy at the head of the center for medicare medicaid services that not correct that is correct currently how how close are we to filling that position we hope very close this is a critically you and i would encourage you to to get that done again congress has an obligation to its provider community to step up and do the right thing as far as the sustainable growth rate formula but it's very very difficult to even get an answer out of center for medicare medicaid services right now without a without in what they feel we do have as you probably know congressman i knew leader for the medicare and a new leader for medicaid who are in place john blue and cindy man and they are doing a spectacular job but i share your concern about the leadership and we are very close thank you very grateful that you're in this position at this time because you've handled things so superbly and i think with a sense of calm that is contagious in a good way so just don't get the flu maybe i can walk but right exactly i think you answered the first question i was going to ask which is the least valid the judgment about how lethal this thing can be could change i know that initially there was concern that it might be more lethal than it's turned out to be but you just alluded to the fact that it could it could turn back in the other direction is that right that's correct and i was just curious i imagine you have ways of judging the success of our overall effort to contain this pandemic as we go forward which would include clearly looking at the number of lives lost in the process i would imagine how well we're doing addressing these high risk groups of the gate what's happening with particular communities in terms of the modeling that that that suggests i wonder if you could just point to any other sort of prime indicators you're going to be looking at and a comment on whether you anticipate that there will be kind of pivot points along the way where we may need to regroup and move in a kind of different direction and we're anticipating right now great questions i think that one of the lessons learned from seventy six experts was that there do need to be points along the way that you make sure we're still on track because as people keep telling me the  predictable fact about the flu is it's unpredictable it could change so monitoring very closely what we're seeing and part of the lethality is really watching what happens when h one  one begins to mix with the seasonal flu viruses what we saw in the southern hemisphere is still encouraging that it did not mutate into a significantly more dangerous virus that's good news but can that happen next month the following month you bet so there will be continued monitoring and testing particularly the more serious cases when they come to the hospital and making sure that we know that we're on target the vaccine seems to be exactly what it should be to target h one n one the robust response is great the limited time that it's taking is very good and the fact that one dose seems to actually produce a good immunity response all of that is very good news but i think watching the outbreak certainly monitoring very carefully hospital capacity how to deal with the more seriously ill folks we really worry about right now antiviral treatments we are unfortunately seeing many providers give antivirals prophylactic lee so suggesting that people would fill a prescription and take it to prevent the flu what our scientists tell us is exactly that's the wrong direction because it actually lowers people's immune response it could make them far sicker in the long run and it'll draw down our and a viral stockpile so that is a particular concern that we put out new and of our guidance we're doing some aggressive outreach to the provider communities trying to remind them that that really is a strategy which is very counterproductive in the long run so i don't know what's the next challenge like that but we'll have them thank you gentleman from washington mr  thank you do you have any issues as far as prioritize ation geographically or otherwise when we have a vaccine become available because your dental finals issues that the public may be interested in or we use interested in well there's certainly no geographic priority we've asked the states to present plans which they have and the community on immunizations i mean the committee on immunization has developed a priority list based on the science basically five categories of people who total about one hundred sixty million americans pregnant women caregivers of infants under the age of six months children six months to twenty four particularly those with underlying health conditions adults twenty four and up with underlying health conditions and health care workers and that's about one hundred sixty million people he said the states figure out how to get those folks to the front of the line what are the best outreach opportunities and that's where the vaccine will flow they'll be about ninety thousand sites that will receive based on the state plans that we have so we're not targeting we're not making we're just trying to use our bully pulpit in the communication to say to those target populations you really need to think about this and one of the challenges as you all now will be to get parents ready to sign consent forms for kids nation is going home in schools to say to parents this will be available we think by the middle of october but here's what the consent form is going to look like you know think about it get ready to sign it so if we have a vaccination effort at your school your child actually could be vaccinated i heard to me sort of surprising comment by doc last week when i was home suggesting that one of the problems may be over utilization of our services associated with this that they're concerned about people coming in the worried well the worried well and we understand worried we'd all like to be well you know just to the extent we disseminate information what would you tell us all you may have already talked about this but it bears repeating and then in that regard when should people really feel compelled to you know go into the or room as opposed to calling your physician first or nurse well i would even back it up a step that if if someone comes down with a flu or an adult or a child and there are no serious consequences more than a fever and you know aches and pains go to bed to consume stay away from other folks i'm not sure you need to take additional steps anyone with underlying health conditions asthma diabetes  muscular disorders should contact a physician on for the presentation of flu like symptoms that's the population for anti virals that's who needs to am a flu fairly relenza and then certainly anybody who then is more seriously ill or a child who becomes lethargic or you know there are a series of again tips on the web site you know you take the next step but it's really a treat people who just come down with the flu probably don't need to call a doctor or have an aunt of iraq or certainly not go to the hospital thank you thank you work thank you very  information asked and in tamping down panic i think i think that the the public health efforts going really well here i several times in your testimony you you referred to the concern that we have that that this virus could mutate we hope that it won't it didn't in the southern hemisphere but we've had a number of hearings in this committee over the years about about various flu strains and of course the avian flu has been a big concern of this committee over the years i'm wondering first of all how are we coming in developing an s l based vaccine rather than the traditional egg based sexting that we're still using for development of the h one n one vaccine my understanding congresswoman is we're still a couple of years away from the different technology cell based i think is the sort of high tech version actually tobacco growing is also regarded as people by folks as sort of promising but we are not close to i mean the last time i talked to folks is probably still a couple of years away are we but are we making a real effort towards these other other vaccines because part of the problem we haven't and part of our concern last last spring with h one n one was that we might not be able to identify the strength quickly enough to make a vaccination because we do have to produce the eggs well that boy the in investing in developing a faster  newer technology is still very much underway it's part of what we're doing on an ongoing basis so we're trying to accelerate the work but it's not imminent that we will have another methodology for developing a vaccine then the base about that i think i think you can expect more hearings on this topic and we're going to also ask of the experts from and i would imagine i would welcome the i mean we because because what could happen is if we right and i think this is a you know hopefully it won't be more than this but as a sort of wake up call that up till now it's been hypothetical it's now very real and we're watching a disease spread enormously quickly not only in this country but it's now presented in about one hundred twenty countries around the world so we know this is real right and with great rapidity what are we doing for people who are allergic to the egg based vaccines with the h one n one vaccine can they just not get it i was just told they cannot get it but backs and hating those around them is the best will help protect ok now what is the it's still there it's continuing to cause disease but it isn't being transmitted is not a transfer ok i have a last question for ms castor has the nine and ten year olds at home i have the college student and the college now this is like when our kids were little and we had the chicken pox parties the college students are now having flu parties where they're trying to purpose fully get i don't want to know exactly how they're trying to share the virus but they are using on it and she and and so she and her friends asked me to ask you what is your advice about this practice of these flu parties i would say it's a pretty bad idea that was my mother lea advice to so i just want to know from the and i'm sure they won't listen any more to me than to you but again this is a serious disease most people you know getting the flu is is a problem you miss work you miss but for a lot of people this is deadly and so doing anything to transmit the disease and particularly i would say to our young people who think they're invincible a number of the younger folks may have health conditions that they're not even aware of and they really could be in serious trouble by voluntarily getting the flu so i mean and all seriousness the advice of the c d c and everybody else is that for every what they should be taking hand washing protocols doing their best if they feel sick to isolate themselves there's an absence of this from spreading and six to twenty four year olds including the college age group are in the first priority to get vaccinated i mean that's the best way on a college campus in a dorm to keep kids safe we've done a lot of outreach to college presidents to say you know find a dorm or find an isolation room we can often send kids who are away from school home by isolating them from one another don't have them go to the school cafeteria to get meals figure out a way to get them meals keep them away from roommates because a really what we know is this this spreads very very rapid and and when the vaccine does come out the college students should go get correct thank you thank you so much we've ended and under time and we've very appreciative of your testimony today we'll look forward to seeing you again either before and during the hearing let me say that card will stay open for seven days for members to submit additional questions