▶ 0:16:25Chair Cassidy: We are waiting for our witness.
▶ 0:17:17Chair Cassidy: The senate committee on health, education, labor, and pension will come to order. Thank you for appearing before the committee. Cdc failed to communicate crucial information to the american people. When the public needed to know the most up-to-date information on the outbreak of covid-19, they relied on a johns hopkins data dashboard because the cdc did not have that information readily available.
▶ 0:17:46Chair Cassidy: The agency failed to detect and anticipate the spread of covid-19 even when the virus had already reached the united states, and under president biden, cdc coordinated with outside political groups like teachers unions allowing them to influence pandemic health guidance.
▶ 0:18:04Chair Cassidy: By the way, unions then used cdc guidance as justification to push for continued closure of schools nationwide when other public health officials were saying it was a great detriment to children's learning and mental health. So when americans needed cd americans needed cdc the most, it failed.
▶ 0:18:34Chair Cassidy: Earlier this year, senate republicans launched a working group to improve the cdc. As a public health official for nearly 20 years, Dr. monarez brings insight that can guide this process. I look forward to working together if she is confirmed. For the last four years, republicans have understood the deficiencies in the cdc and desired change but restoring americans's trust in the cdc requires more than policy. It requires a strong leader committed to achieving permanent culture change within the agency.
▶ 0:19:04Chair Cassidy: This is the time with president trump and republican congress to put someone in charge of the cdc who can institute systemic change and ensure the agency operates to benefit americans. Above all, the cdc director must ensure agency decisions are transparent and based on science. I want to acknowledge the advisory committee of a musician practices is meeting as we speak. The cdc director plays a vital role in this process, having the permit to choose whether to adopt recommendations.
▶ 0:19:35Chair Cassidy: I want president trump to be successful in his efforts to restore trust in our public health system. Given there is no confirm cdc director along with a pillow that has very few members, many of whom black broad vaccine and immunology expertise, there are concerns about the rushed nature of this process.
▶ 0:19:56Chair Cassidy: To be clear, there is a difference between review and recommendations about the appropriateness of a patient receiving an immunization and broadly declaring a vaccine to be dangerous or unsafe if received without the evidence to support such a declaration. If confirmed, Dr. monarez, you will be tasked with strengthening the public trust in the cdc, ensuring decisions on immunizations are rooted in the gold standard of science. This mission is crucial to your success and the success of the entire trump administration.
▶ 0:20:26Chair Cassidy: I want to work with you and secretary robert caro need to ensure the agency is successful in restoring its credibility and making america healthy again. The director also needs to ensure the agency is nimble and not caught flat-footed in response to public health threats while also addressing drivers of disease to make america healthy again. The cdc's unique capabilities and data analysis, laboratory science, and public health responses are key to achieving president trump's goal.
▶ 0:20:54Chair Cassidy: Continued data modernization while preserving privacy will be crucial to restoring faith in the cdc. Dr. monarez and I have talked about these issues at length. I look forward to continuing our discussion. With that, I recognize senator sanders.
▶ 0:21:07Sen. Sanders: Chairman, thanks very much. Dr. monarez, thanks for being here. Before I comment on your nomination to become cdc director, I want to say a few words about maybe the most important disastrous health care legislation to come before congress in a very long time. That is the so-called reconciliation bill, which the senate will be dealing with in a few days. So let's be clear. This legislation, Dr.
▶ 0:21:37Sen. Sanders: Monarez, if enacted, would make the largest cut to health care in our nations history destination's history -- nation's history in order to pay for the largest tax break for billionaires in our nation's history.
▶ 0:21:57Sen. Sanders: At a time when everybody understands, including I suspect every member of this committee, that our current health care system is broken, is dysfunctional, this bill would make it even worse. The congressional budget office has estimated this legislation would cut medicaid and the affordable care act by over $1 trillion.
▶ 0:22:21Sen. Sanders: Those cuts along with ending the enhanced premium credits will lead to 16 million americans losing their health insurance. In other words, right now we are the only major country on earth not to guarantee health care to all people. 85 million are uninsured or underinsured. In this bill makes an awful situation -- and this bill makes an awful situation even worse.
▶ 0:22:51Sen. Sanders: Researchers at the yale school of public health and health care economists at the university of pennsylvania have found these health care policies would cause over 50,000 americans to die unnecessarily every single year. That is what happens when you throw 16 million low income and working-class people off the health care they have. That is what we are dealing with here, folks.
▶ 0:23:18Sen. Sanders: In order to give tax breaks to billionaires, we are endangering the lives of 50,000 americans every year. Not only would millions lose their health insurance and tens of thousands of our constituents needlessly die, if this legislation is enacted, rural hospitals all over this country that are already struggling would be forced to shut down, lay off workers, or substantially reduce the vital health care services they provide.
▶ 0:23:49Sen. Sanders: In other words, this bill among many other things would be a disaster for rural america. That is why, Mr. chairman, I and every democratic number of this committee sent to a letter a couple of weeks ago urging you to schedule hearings with doctors, nurses, hospitals, community health centers, and patients on the impact this legislation will have on the health and well-being of the american people. I am very disappointed, Mr. chairman, that with an issue of such consequence that you refuse to hold those hearings.
▶ 0:24:23Sen. Sanders: Since this committee has refused to bring health care providers before us, I am releasing today a report on the impact this legislation would have on our nation's health care system. The committee did not do it. We did it. I did that by reaching out to health care providers all across this country. Let me thank the over 750 health care providers from 47 states, probably every state represented here, who responded to our request.
▶ 0:24:53Sen. Sanders: Here is just some. It is a report I hope every member here reads it. By the way, Mr. chairman, I would ask unanimous consent to have that report put into the record.
▶ 0:25:02Chair Cassidy: Without objection.
▶ 0:25:04Sen. Sanders: Thank you. What this report says is that it would substantially increase the uninsured rate in every state in america. For example, if this legislation was signed into law, the uninsured rate in my state of vermont would go up from 3.3% to 6%. In the louisiana, the chairman's state, it would go up from 6.7% to 12.4%.
▶ 0:25:33Sen. Sanders: In the state of washington, patty murray's estate, it would go up from 6.2% to 11%. In florida, the uninsured rate would go up from 10.4% to 18.8%. It impacts dramatically every state represented by us here and every state in this country. And I would hope my colleagues understand that as we go forward. Mr.
▶ 0:25:56Sen. Sanders: Chairman, instead of throwing 16 million people off of health care, we should do what every other major country does, guarantee health care to all as a human right. Mr. chairman, let me quote just a few. We reached out to 750 health care providers. 750 responded. I just want to court a few. A doctor from texas wrote, "these cuts will cause rural hospitals in texas to close entirely.
▶ 0:26:25Sen. Sanders: As a neurologist, I am terrified the closest hospital for many rural folks may then be hours away." that is texas. Dr. malika from florida where the uninsured rate will surge to almost 19%, "plainly said, children will die as a result of these cuts. Hospitals will cut back on icu doctors, doctors will leave because of salary cuts, etc." Dr. henderson, community health center Dr.
▶ 0:26:53Sen. Sanders: In missouri, wrote that the cuts to medicaid in this legislation means we may not be able to keep the doors open. The louisiana rural health association wrote, "louisiana's rural hospitals and health care providers are already operating on razor thin margins, struggling to keep their doors open while serving some of our most metrically vulnerable -- medically vulnerable.
▶ 0:27:24Sen. Sanders: Hospitals operate on negative margins and 27% are currently vulnerable to closure. Medicaid cuts would worsen these losses, putting more hospitals at risk of shutting down entirely. Louisiana. Vermont, my state. Vermont association of hospitals , this bill reduces coverage and access particularly in rural areas, such as vermont hospitals and other health care providers already financially vulnerable. And on and on it goes.
▶ 0:27:52Sen. Sanders: The health care community understands what a disaster this would be. A disaster for rural america. A disaster for low income and working-class people. We must not devastate an already broken health care system in order to give tax breaks to billionaires who have never ever had it so good. Thank you, Mr. chairman.
▶ 0:28:12Chair Cassidy: Thank you. Dr. monarez, your opening statement please.
▶ 0:28:24Dr. Monarez: Chairman cassidy, ranking member sanders, and members of this committee, I am humbled to be here today before you, and I am honored to be nominated by the president to be the director of the centers for disease control and prevention. I am joined by my friends and my family, including my children who are my inspiration in all things. I want to start by telling you about myself. I grew up in rural wisconsin.
▶ 0:28:55Dr. Monarez: The daughter of a dairy farmer. I learned the meaning of hard work very early in life. When illness struck our herd, my father had to sell the farm and became a police officer to support as. My mother also worked wherever she could, in factories, clerical jobs, and my favorite, as a librarian. Though we did not own a television, we always had the world at our fingertips through books.
▶ 0:29:24Dr. Monarez: Hard work, community resilience, fiscal responsibility, and the importance of education are the core values this upbringing instilled. We had little money. So through academic scholarships & jobs, I paid my own way through college. Attending the university of wisconsin. It was here during my first semester at the dawn of the genomics era that I discovered a passion for science and health innovation. And I have not stopped since.
▶ 0:29:55Dr. Monarez: I earned my phd in microbiology and immunology and conducted postdoctoral research at stanford. By academic work focused on two deadly diseases, african sleeping sickness, which in its most severe forms is 100% fatal without treatment, and toxoplasmosis, was a leading cause of death in hiv aids patients. I did this work for over a decade.
▶ 0:30:22Dr. Monarez: While treatments for african sleeping sickness and toxoplasmosis made limited, public health advancements like screening and prevention programs have drastically reduced both diseases. These experiences cemented my belief. Good public health saves lives. After academia, I shifted to shaping public health policy at the federal level.
▶ 0:30:50Dr. Monarez: I helped establish the biomedical advanced research and development authority, prioritizing investment in medical countermeasures. At the department of homeland security, I led efforts to prevent, detect, and respond to the world's deadliest pathogens. During the 2014 ebola outbreak in west africa, I served on the ebola task force. Here I saw the incredible work of public health. But I also saw the vulnerabilities in communication, outbreak modeling, and global health security. This.
▶ 0:31:21Dr. Monarez: Preparedness. When public health is neglected, it costs lives island. I led efforts in breakthroughs, technologies, cancer diagnosis, and help in rural areas. Health technology innovation is america's next frontier. By investing in innovators and entrepreneurs, we will save lives and drive economic growth.
▶ 0:31:48Dr. Monarez: But these advancements will only be effective if we invest in public health infrastructure that enables them to be utilized on a population scale. What good is a potentially life-saving discovery if there is no translation to make it useful? That is where cdc plays a vital role. Outbreaks are only getting more frequent.
▶ 0:32:08Dr. Monarez: There is ebola in africa, mers and the middle east, h5n1 across nearly every continent. These threats are in our backyard or always just a fight away. Cdc must be fully prepared to defend the american people from these nonbiological risks, and as importantly be prepared to defend against those we have not yet seen.
▶ 0:32:37Dr. Monarez: If confirmed, I will focus cdc on three top priorities. The first is restoring trust. I will rebuild credibility by making cdc leadership more public facing an accountable. I will improve data transparency with a focus on protecting patient privacy and security. I will ensure all recommendations are backed by publicly available gold standard science. Second, strengthening public health infrastructure.
▶ 0:33:05Dr. Monarez: We must invest in innovation to prevent, detect, and respond to threats. I will prioritize near real-time situational awareness to detect outbreaks early. I will prioritize bringing state-of-the-art technology to cdc including our labs and diagnostic development. I will work with state and local public health officials to help build a modernized public health infrastructure across the country. I will support a position preventive health operation model to offer strategy to meet the needs of all americans.
▶ 0:33:36Dr. Monarez: Third, evidence-based rapid decision-making. We know the next outbreak is not a matter of if but when. I have learned first-hand crises demand clear plans and precise -- and decisive action. I will redefine particles to avoid confusion and delays and strengthen risk to medications of the public receives timely consistent guidance based on fact, not fear. These priorities support the president's an secretary's vision of a healthier america.
▶ 0:34:08Dr. Monarez: To achieve them, I will lead with integrity, transparency, and focus and work with congress to maximize health outcomes and protect the american people. Thank you for your time and for considering my nomination. I am happy to answer any questions.
▶ 0:34:21Chair Cassidy: Thank you. I will actually defer to begin. Senator paul.
▶ 0:34:28Sen. Paul: Dr. monarez, congratulations on your nomination. Francis collins infamously emailed anthony fauci and told him to take down three prominent scientists. The petition was use whatever means, but damage their reputations. One of these scientists is now the head of nih. Do you think that was an appropriate use of his office?
▶ 0:34:57Dr. Monarez: I am not familiar with that particular encounter, but we need to make sure we are open.
▶ 0:35:03Sen. Paul: Is it an appropriate use of the officer francis collins to email the head of the nih and say take down scientists?
▶ 0:35:11Dr. Monarez: We need to make sure we are open.
▶ 0:35:13Sen. Paul: It is sort of a yes or no question. Is it an appropriate use of office? The question goes to you. Is it an appropriate use of the office to email other government scientists and say take them down, take down these people that are disagreeing with us and have a different opinion?
▶ 0:35:29Dr. Monarez: It is not something that would be. I welcome open and honest debate and scientific discourse.
▶ 0:35:34Sen. Paul: Disappointed we don't get a little better answer from that. You led ostp. Was any research subject to the pause on function during your time there?
▶ 0:35:54Dr. Monarez: I don't know the details of that but all research should have been paused under that gain of function clause.
▶ 0:36:01Sen. Paul: Several were granted exemptions. Are you aware of an exception that was granted to the wuhan research?
▶ 0:36:07Dr. Monarez: I am not aware of that.
▶ 0:36:09Sen. Paul: Do you believe the research that was being done over that period of time and subsequently was gain of function research?
▶ 0:36:16Dr. Monarez: I have not had an opportunity to look at that research, but I share your concerns.
▶ 0:36:21Sen. Paul: About 10 books written about it. We have been talking about it. 15 million people died. You will be in charge of infectious disease. You would think you might have an opinion on where this came from and what happened. Even eco-health, which was funding the research in wuhan, finally sends a letter back to nih, and they say thank you for releasing the pause on our gain of function research.
▶ 0:36:51Sen. Paul: With regard to royalties, recently secretary kennedy fired members of the cdc vaccine committee. One of the things we have been asking for for years is that they release and reveal if they get royalties from pharma. I thing this is a basic good government request. We passed it in a committee with democrat and republican support.
▶ 0:37:19Sen. Paul: Previous heads of the cdc in the biden administration were adamantly opposed to revealing or any transparency. Will you support members, all members in the decision-making processes, revealing their loyalties from pharmaceutical companies?
▶ 0:37:33Dr. Monarez: I believe that anyone who is serving in this type of a role that is critical to make independent conflict free decisions needs to be fully transparent on any funding they are getting from any product developer.
▶ 0:37:48Sen. Paul: That is all I have.
▶ 0:37:51Chair Cassidy: Senator sanders.
▶ 0:37:53Sen. Sanders: Thank you, Mr. chairman. Dr. monarez, today secretary kennedy announced that he will be ending U.S. funding for the global alliance for vaccines and immunizations. You just a moment ago said that you believe, as I do, that public health saves lives.
▶ 0:38:24Sen. Sanders: Ending U.S. funding will lead to 1.2 million preventable deaths. Do you agree with secretary kennedy that we should end our support for providing life-saving vaccines around the world?
▶ 0:38:36Dr. Monarez: I believe the global health security preparedness is a critical and vital activity for the united states. As I shared in my opening remarks, I saw firsthand what happens.
▶ 0:38:50Sen. Paul: And I -- Sen.
▶ 0:38:54Sanders: And I agree with you. The question is do you think we should support ending life-saving vaccines around the world?
▶ 0:39:00Dr. Monarez: I think vaccines save lives. We need to continue to support the promotion and utilization of vaccines. I was not involved in that decision-making. If I am confirmed as cdc director, I will certainly look into it.
▶ 0:39:12Sen. Sanders: Thank you. Dcotor dcodoctor, a disproven link between vaccines and autism.
▶ 0:39:33Sen. Sanders: The president of the american academy of pediatrics stated in an effort to undermine decorative research, finding no link between vaccines and autism poses a threat to the health of children in our nation. Do you agree with the american medical association that there is no scientific proven link between vaccines and autism?
▶ 0:39:53Dr. Monarez: I have not seen a causal link between vaccines and autism.
▶ 0:39:57Sen. Sanders: Dr. monarez, you come from rural america.
▶ 0:40:04Dr. Monarez: I do.
▶ 0:40:05Sen. Sanders: I represent one of the most rural states in america. What impact do you think we will be having on the american people if rural hospitals all over this country are forced to shut down because of massive cuts to medicaid?
▶ 0:40:21Dr. Monarez: I can't speak to the ongoing deliberations you are having on medicaid but I will say rural health is very important to me. And I have seen what happens when rural health clinics shut down or critical access hospitals have them in staffing.
▶ 0:40:35Sen. Sanders: Are you aware that all over the country small rural hospitals are struggling?
▶ 0:40:40Dr. Monarez: I am very aware that all over the country small rural hospitals are struggling, and we need to make sure we continue to provide care to our rural populations.
▶ 0:40:50Sen. Sanders: Dr. monarez, what do you think the impact on the health and well-being of the american people are if 16 million low income and working-class people are thrown off of health care they currently have?
▶ 0:41:04Dr. Monarez: My understanding is no one we lose access to health care and that the work --
▶ 0:41:13Sen. Sanders: No one will lose access to health care?
▶ 0:41:15Dr. Monarez: The work being done is to reduce waste, fraud, and abuse.
▶ 0:41:19Sen. Sanders: I don't think there is anyone else in the world at things when you throw 60 million people off the health care they have by making massive cuts to medicaid or the affordable care act that no one will lose access to health care. I understand you are in a difficult position. Thank you very much for being here.
▶ 0:41:35Dr. Monarez: Thank you.
▶ 0:41:37Sen. Marshall: Thank you, chairman. I have to stop for a second before I open my questions and respond with how important access to health care is and want to make sure both sides of the dais understand we want to make sure everybody has access to health care. I think you are going to find with our legislation we are going to preserve and protect medicaid. We are going to strengthen it for those who need it the most.
▶ 0:42:02Sen. Marshall: We are going to strengthen it to make sure seniors and nursing homes, that people with disabilities have medicaid, that children have medicaid. But having medicaid does not -- is not the same thing as access to care. At least a third of physicians do not accept medicaid, and many that do delay that care.
▶ 0:42:26Sen. Marshall: As a referring physician, if I had someone that needed to see a neurosurgeon or needed to see a cardiac surgeon, it would maybe take 3, 6, 9 months to get them into see a doctor because they are medicaid. Having medicaid does not guarantee access to care. If we don't do something to fix it, it is going to go broke. I am so proud that in our legislation we increased funding for medicaid more than inflation. That over the course of 10 years we will increase funding for $200 billion.
▶ 0:42:56Sen. Marshall: That is right. There is so much misinformation out there. We will increase funding by over $200 billion in a year with our plan. But what we really need to do to address rural hospitals and strengthen the local economy. But I think you are going to find us finding another solution as well to help the rural hospitals beyond medicaid. I talked about the importance of rural health clinics and community health centers. Those are access to care.
▶ 0:43:25Sen. Marshall: Right now, everybody has access to care. But medicaid is actually in the way. It is the most broken federal system we have up here right now. There are better ways to do it then medicaid, and I look forward to continuing to try to strengthen those community health centers, to strengthening the rural clinics, rural health clinics, and strengthening the rural hospitals as well. You are going to find that ever legislation lifts up rural america and helps grow those economies where many countries are half the size of what they once were.
▶ 0:43:56Sen. Marshall: So I am so proud of the work we are doing to strengthen health care for americans and to save medicaid, to strengthen it to make it better. Dr. monarez, again, welcome. I want to talk about chronic disease. 60% of americans have chronic disease. 90% of the health care dollars in this country I spent on chronic disease. 90% of $4.5 trillion. You have an incredible wealth of experience and I like your experience with ai and wearables.
▶ 0:44:27Sen. Marshall: We talk about these chronic diseases, hypertension, obesity, diabetes or disease, and depression. The cdc has done a great job addressing commendable diseases, but there are other diseases out there that I think are more of a pressing issue. How would you help address the cdc to address chronic disease?
▶ 0:44:45Dr. Monarez: Thank you. And thank you again for taking the time to meet with me the other week. So, part of the approach that organizational optimization will be to get cdc back to its functions to prevent or detect come and respond to infectious diseases and emerging threats, but you highlighted a very important public health concern, and what I will do it confirmed as cdc director is continue to support the secretary, to
▶ 0:45:17Dr. Monarez: Support these critical issues, and make sure that any of the activities that were supported under cdc in the previous models are successfully transitioned on the part of hhs. As you said, there is critical work to be done in preventing chronic diseases and addressing other issues like maternal mortality and addressing issues like neurodegenerative disorders.
▶ 0:45:41Dr. Monarez: Answer if I am confirmed as cdc director, I will make sure that I am laser focused on the mission at hand as cdc but also as supportive as I can be to the secretary's goals and making america healthier again and transitioning those other programs to other parts of the agency.
▶ 0:45:55Sen. Marshall: Let's turn the page and talk about antimicrobial resistance. As a phd in microbiology, I know some thing about this. It is important for agriculture and humans as well. What are the opportunities to address it? Certainly emphasized we need to save into bodies for those purposes and therefore there is no economic incentive to try to develop them, so any thoughts on antimicrobial resistance?
▶ 0:46:22Dr. Monarez: Yeah, I think it is a multilayered approach. It is a significant public health concern. We need to make sure we have accurate and timely surveillance and detection so if something is being transmitted in the population that we can detect it early, whether it is in the hospitals or in other places. I think we need to make sure we are investing in next-generation antibiotics because what we are seeing is this increase in into microbial resistance bacteria, and these threaten lives.
▶ 0:46:52Dr. Monarez: We have to make sure we have second and third order antibiotics to prevent catastrophic outcomes when somebody becomes infected with one of these drug-resistant pathogens.
▶ 0:47:02Sen. Marshall: Thank you so much. We look forward to supporting your nomination and getting you confirmed and getting you back to work. Thank you, Mr. chairman. I yield back.
▶ 0:47:13Chair Cassidy: Before I get to senator hickenlooper, I noticed for the first time you smiled when talking about antimicrobial resistance. A sweet spot for him. Senator hickenlooper.
▶ 0:47:27Sen. Hickenlooper: Dr. monarez, thank you so much for your public service. Obviously, your dedication and commitment is noteworthy. You obviously have a lot of experience in technology, research, and development, including how to identify and treat infectious diseases.
▶ 0:47:51Sen. Hickenlooper: How would you incorporate this experience if confirmed for this position?
▶ 0:48:00Dr. Monarez: Thank you. Again, thank you for taking the time to meet with me. I know you have a lot going on so I thank you for the time.
▶ 0:48:17Dr. Monarez: What I will do if confirmed as the cdc director I will want to make sure as I laid out in my priorities that first we are incorporating the latest and state-of-the-art technologies into the work we are doing in the cdc, that we are modernizing our laboratories, investing in diagnostics with the level of sensitivity and specificity that if there is an urgent outbreak that we are able to be able to support our state and local public health officials with accurate diagnostics so they can
▶ 0:48:50Dr. Monarez: Differentiate between individuals who are worried and those who are truly in need of medical intervention. It helps us prioritize resources and helps make sure we are keeping american people safe. I will also bring in ai technologies to help in a couple of different ways. When I think about ai, the first thing I say are the problems we are trying to solve.
▶ 0:49:17Dr. Monarez: It allows you to have a disciplined way to incorporate these technologies that are really transforming what we think about in health innovation. I will be using ai technologies to help support cdc to create a modernized and operationally efficient organization where we look at how we optimize our workforce. How do we make sure our I.t. Is supported with internal operations and partnerships with state and locals?
▶ 0:49:42Dr. Monarez: How do we make sure we achieve fiscal responsibility through accurate tracking of all of our resource expenditures. I will also be incorporating ai technologies as we continue to support public health outcomes. So the areas that aaii think will be transformative in the health ecosystem is where we can work internally and with our parties to say --
▶ 0:50:06Sen. Hickenlooper: That is good. I apologize. I hate cutting you off. I love talking technology.
▶ 0:50:11Dr. Monarez: I look forward to working with you if confirmed.
▶ 0:50:14Sen. Hickenlooper: Exactly. In contrast to some of my colleagues across the aisle, I am very concerned about the cuts to medicaid. Certainly aware there are always improvements. You can find examples of fraud, waste, and abuse in any -- we are always with that. It is a constant struggle. The same in any organization to be quite blunt. But I think that medicaid is essential.
▶ 0:50:42Sen. Hickenlooper: I have start community health centers. I discussed that back in 1972, 1973. It now has over 200 locations and is an essential part of providing access to health care in this case across the state of connecticut. For them, medicaid is essential to being able to provide that care and be compensated for it so they don't collapse financially.
▶ 0:51:08Sen. Hickenlooper: I think it is amazing that in colorado we are besieged by concern from rural health care providers from community health centers that if these cuts go forward, they will be in peril of going out of business. Do you see any solutions? Or how can we address this potential issue?
▶ 0:51:29Dr. Monarez: So that is a very critical issue. I have had an opportunity in a previous role to really come to appreciate the value that these federally qualified health centers and rural health clinics play. Sometimes, they are the only health that is accessible for some of our rural and vulnerable populations.
▶ 0:51:49Dr. Monarez: I think the viability of these has always been a challenge and although they operate on a very thin margin that they are able to continue to support and keep their doors open to help the population that they serve. As the cdc director, I don't know that I will have a great deal of influence or ability to shape policy when needed to the health centers and to rural health clinics, but they are a very important part of our health ecosystem.
▶ 0:52:18Sen. Hickenlooper: The center of disease control, we have to have access to health care. You will be surprised how much influence you will have. Just your range of experience, your approach to what you are doing is going to give you a voice that will carry it further than most. I yield back to the chair.
▶ 0:52:37Dr. Monarez: Thank you.
▶ 0:52:39Chair Cassidy: Before I go to senator murkowski,c I want to point out that senator murkowski -- senator murkowski, I want to point out a misconception that there must be a thorough background overview to indeed, one of the nominees for the panel has just dropped out because of apparent financial conflict of interest.
▶ 0:53:03Chair Cassidy: I will also point out when governor hickenlooper raised provider taxes, that is one of the things we are concerned about now. So anyway, senator murkowski.
▶ 0:53:14Sen. Murkowski: Thank you, Mr. chairman. Dr. monarez, welcome to the committee and thank you for the discussion we had last week. I wanted to continue on this discussion about the advisory committee on immunization practices. Throughout his confirmation process, secretary kennedy made commitments to not take action that would discourage or limit access to vaccines.
▶ 0:53:41Sen. Murkowski: So when he made that decision recently to call for the removal of all of those on the committee, on the acip, and kind of called into question that commitment. And certainly did for me. As you know, acip is kind of important.
▶ 0:54:01Sen. Murkowski: For those that are not as familiar, acip recommendations help states determine which vaccines pharmacists can administer, and insurance companies use these recommendations as a guidance to determine coverage. This is one of those committees that the general public is not really very familiar with but the outcomes from this committee are important. And so the makeup of who is on that committee is equally important. We had eight. Now we are down to seven.
▶ 0:54:29Sen. Murkowski: I understand those that have been named, we are looking at their backgrounds there. How in your role as cdc director, assuming you are confirmed, how are you going to push for involvement in and how will you approach filling the remaining slots on the committee with individuals that follow and support evidence-based medicines? My understanding is I think 17 members could be authorized.
▶ 0:55:00Sen. Murkowski: And does not necessarily require that many, but there is room to fill that out. Can you speak to me a little bit about how you would approach that?
▶ 0:55:08Dr. Monarez: First, I want to thank you again also for meeting with me in advance of this. I enjoyed our discussion. The acip as you point out is a very important role. I think many of us have had that conversation. They take very technical information that comes from fda safety and efficacy clinical trials. They take information from post market monitoring and surveillance that is captured in any of these vaccine adverse event reporting systems.
▶ 0:55:39Dr. Monarez: They take real-world evidence. And they have to do highly complicated evaluation of that science and evidence and statistical analysis to be able to consider the benefits and the risks posed by any of the products they are evaluating. If I am confirmed as the cdc director, I look forward to participating as an active member and active participant in those discussions at those acip meetings.
▶ 0:56:07Sen. Murkowski: More specific to my question though, there are seats that are still available on that committee. People will be looking to you for your guidance here to make sure that either there is no conflict of interest or that the individuals themselves and what they bring to the table, what they bring to these very important, very technical considerations are not going to cause further doubt about the
▶ 0:56:37Sen. Murkowski: Credibility of the committee. Because you and I talked about that. There is a lot of trust that needs to be rebuilt here. How do you do that?
▶ 0:56:45Dr. Monarez: First, I would welcome -- these are not easy positions to fill. It takes a lot of time and commitment from some of these highly trained technical experts to want to participate. And I would encourage them to participate. I would encourage them to raise their hand and offer their support to be considered for placement on the acip. They need to have a depth and a breadth of technical experience to be able to understand immunological processes, to understand statistical analysis.
▶ 0:57:19Dr. Monarez: And if someone feels they are a good fit to be able to understand this complex information and they want to volunteer and they want to be considered, I welcome that.
▶ 0:57:28Sen. Murkowski: I will interrupt because I have one more question that I wanted to ask. I would hope that one of all things you would be looking to is to making sure these individuals are going to be looking at the science in front of them, leave their political bias at home. Let's just leave it at that. Leave the political bias at home. You mentioned in your opening statements that went public health is neglected, it costs lives, and I absolutely agree with this.
▶ 0:58:00Sen. Murkowski: We were talking about global disease prevention. I think we recognize we would love to be able to say that is not our problem in this country, but in a very mobile society, that is just not the case. I am concerned. And you shared with me your concern about cuts to the global health center and the global health programs and your commitment to global surveillance.
▶ 0:58:25Sen. Murkowski: So how do you plan to ensure hhs and cdc continue using every tool in their global arsenal, particularly immunization programs and specialized technical expertise like within cdc to stop diseases like polio, malaria, and other parasitic threats? I have given you no time to respond but this is a key question. We have decisions coming up next week that are specific to global health.
▶ 0:58:50Chair Cassidy: You are very good at doing this. I give the witness a chance to respond.
▶ 0:58:55Dr. Monarez: As you and I discussed, global health security awareness is something I am very passionate about. This is an area that if I am confirmed as cdc director, I will follow up with you and we will make sure we are doing everything we can from cdc to be able to continue to prevent, detect, and respond to our emerging infectious disease threats both here and abroad.
▶ 0:59:18Sen. Murkowski: Thank you. I will have questions for the record.
▶ 0:59:24Chair Cassidy: Chair cassidy: I am sure you will.
▶ 0:59:25Sen. Baldwin: Dr. monarez, thank you so much for being here. Thank you for meeting with me in advance of this hearing. Congratulations on your nomination. As we discussed when we met, I have expressed serious concerns to the secretary of health and human services, secretary kennedy, multiple times but before this committee and before the appropriations committee when he appeared in multiple times in writing about the firing of the entire staff of
▶ 0:59:56Sen. Baldwin: The childhood lead poisoning prevention branch at cdc. This has left the city of milwaukee unable to get the help they need to address a lead exposure crisis and milwaukee public schools. Just to give you a sense of the scale, six schools needed to close for remediation. 1800 young schoolchildren were displaced.
▶ 1:00:21Sen. Baldwin: And when the city's health department reached out to the cdc, their application was denied because there was no staff left. The good news it sounds hopeful that employees are now being reinstated. In fact, the very day we met was the day there was an announcement that some 400 plus cdc employees that were previously fired or let go were going to return.
▶ 1:00:52Sen. Baldwin: But they should have never been recklessly fired in the first place. The president's budget proposes current funding levels for this program but you cannot operate a program without the staff. Right? So, Dr. monarez, if confirmed, will you immediately ensure adequate staffing within the childhood lead poisoning prevention program and then reevaluate milwaukee's request for assistance?
▶ 1:01:23Dr. Monarez: Thank you, senator, for taking the time to meet with me in advance. As I talked about, cdc is refocusing its activities towards preventing, detecting, and responding to infectious diseases and emerging threats.
▶ 1:01:44Dr. Monarez: If I am confirmed as cdc director, I will return to an amazing organization, and I will be interested in understanding how we can successfully --
▶ 1:01:55Sen. Murkowski: This is very
▶ 1:01:57Specific -- Sen. Baldwin: This is very specific. Will you ensure there is adequate staffing and look into this?
▶ 1:02:09Dr. Monarez: This is an important issue and I am glad we are talking about it. I will look at the workforce aligned with this and other public house issues.
▶ 1:02:20Sen. Baldwin: This is an easy yes or no question. It is fully funded in the president's budget request. They are trying to hire the staff back, I understand. This should be a priority. Are you willing to say yes that you will assure adequate staffing exists within the childhood lead poisoning vegan program, which just a couple weeks ago had zero staff, and look at milwaukee's application for assistance?
▶ 1:02:46Dr. Monarez: So I will.
▶ 1:02:50Sen. Baldwin: Ok. Can I hear that? Yes?
▶ 1:02:53Dr. Monarez: I will look at the staffing and ensure these public health priorities have the capacity necessary to deliver the critical services to the american people.
▶ 1:03:03Sen. Baldwin: So I had followed up with secretary kennedy, asking several very specific questions related to the operation of the childhood lead poisoning prevention program. The status of appropriated funding for the program and milwaukee's request for assistance. I asked for a response to very straightforward questions and I have heard nothing back from the secretary.
▶ 1:03:27Sen. Baldwin: If confirmed, will you provide me with any requested information related to the status of the childhood lead poisoning prevention program and ballack's request for assistance in a timely manner since it appears secretary kennedy will not?
▶ 1:03:41Dr. Monarez: If I am confirmed as cdc director I will look intimate and will follow up with you -- I will look into it and will follow up with you.
▶ 1:03:50Sen. Baldwin: Ok. Do you agree that women should have access to breast and cervical cancer screenings?
▶ 1:03:55Dr. Monarez: I think breast and cervical cancer screenings are critically important.
▶ 1:04:00Sen. Baldwin: Thank. In the president's budget proposal, it seems cdc is cancer prevention programs are entirely eliminated, not moved to the new administration for a healthy america. They are proposing, but god, just gone -- but gone, just gone. I have long championed this bipartisan program with senator collins.
▶ 1:04:28Sen. Baldwin: It provides cancer screenings to millions of women, including thousands of women in wisconsin. I have serious concerns with the prime minister should proposal to blueblood standing cdc programs out of cdc. If congress directs and provides funding to cdc to continue a program, that absolutely needs to happen.
▶ 1:04:48Sen. Baldwin: If the program is lost, combined with the attacks on access to cancer screenings, included cancer screenings, inc includedn the reconciliation bill, women will be left without options to good care. So do you believe cdc has a role to play to prevent breast and cervical cancer and provide screenings for women at risk?
▶ 1:05:09Dr. Monarez: Those areas are critically important, and if I am confirmed as cdc director, I will ensure those programs are successfully transitioned and continued in other parts of the agency that are prioritizing these quickly areas.
▶ 1:05:23Sen. Baldwin: Even if the president's budget proposes elimination?
▶ 1:05:27Dr. Monarez: I have not been involved in the deliberations. I will support making sure that other parts of the agency that will be taking other broader public of measures will have my support and continuity.
▶ 1:05:43Sen. Baldwin: Thank you.
▶ 1:05:45Sen. Hawley: Mr. chairman, I will be happy to yield. Doctor, it is good to see you again. I enjoyed our conversation yesterday. Let me ask you about the massive increase we have seen in recent years when it comes to children and what we are seeing with chronic diseases, autoimmune diseases, developmental disabilities.
▶ 1:06:16Sen. Hawley: This is something secretary kennedy talked extensively about. I know you shared your concerns on this. What can cdc do to reverse the kind of chronic conditions in this country?
▶ 1:06:25Dr. Monarez: This is a very important issue to me and to the secretary as well. As cdc refocuses its efforts specifically on communicable diseases to prevent, detect, and respond to diseases and emerging threats, we will be focused on the area but we will continue and I will continue to make sure we are supporting the secretary's vision on overall making america healthier again, making sure we are supporting his initiatives to improve food sources for our
▶ 1:06:56Dr. Monarez: Children, making sure we are supporting efforts to allow our children to enjoy physical activity by making sure we are supporting clean water that is available to them, to really reduce all of these conditions that are leading to exactly what you just talked about, chronic diseases in our children, which ultimately is a public health threat that we just cannot continue in this country.
▶ 1:07:27Sen. Hawley: In missouri, we have seen a significant increase , particularly on the eastern side of my state. One of the reasons for this is the presence of nuclear radiation, nuclear toxins in our soil, air, and water. Are you familiar with the landfill in missouri that I am talking about?
▶ 1:07:49Dr. Monarez: I am not familiar, but these are important issues to me and I am happy to work with you if confirmed.
▶ 1:07:55Sen. Hawley: This site dates back to the manhattan area uranium enrichment project. St. Louis was a uranium enrichment site during the manhattan project, which we are very proud, but after the uranian enrichment -- uranium enrichment was shut down, they dumped it into public landfill, they allowed him to sit out in barrels that were exposed to the elements for years, so it was dumped into a landfill from which it ran into the groundwater.
▶ 1:08:26Sen. Hawley: It set out in barrels at another site for years from which it then seeped into a nearby stream where there are no suburbs built -- now suburbs built, built since the 1950's, and if you look at a heat map of childhood diseases lead to nuclear toxins, breast cancer rates, and other forms of cancer particularly in women, we have some of the highest rates in the nation right there right around this area.
▶ 1:08:51Sen. Hawley: I am as you because as cdc director you have jurisdiction over the agency for toxic substances and disease registry. Back in 2015, this agency did a health study on this landfill, on the landfill, on the nuclear radiation that was in st. Louis. And what the atsdr concluded was there is not significant pollution, that there was no health risk.
▶ 1:09:20Sen. Hawley: "no health risk to the surrounding community." now, since that time, we have learned in fact the report relied on faulty data. It relied on faulty methods. And there have been multiple subsequent reports, including those done by the government and army corps of engineers that show there is extensive contamination. As we speak right now, the army corps of engineers is moving people out of their homes in the st. Louis area, those who live adjacent to this creek where the toxins are.
▶ 1:09:50Sen. Hawley: They're moving them out of their homes because of existing continuing nuclear radiation in their homes, in their yards. We have had schools that have been closed because of the presence of nuclear toxins in the air, dust, soil. Here is my question to you.will you work to ensure that atsdr, if confirmed, reviews its technology and is another thorough study that corrects its faulty methodology of the past and gets the facts to the people of misery that we deserve on this issue?
▶ 1:10:19Dr. Monarez: If I am confirmed as cdc director, we will definitely look into this and I am happy to follow up with you.
▶ 1:10:25Sen. Hawley: Good. I want to point out it is so significant, so bad a study that the reuters news agency did an entire report that we will make sure you see detailing the faulty data and frankly haphazard process used to ensure this report that has been relied on I might add by corporate bad actors and polluters to say there is nothing wrong even as other agencies of the government are telling people, no, you have to leave your home because you have been exposed to nuclear radiation.
▶ 1:10:56Sen. Hawley: We also have to get this fixed and cleaned up. I look forward to working with you on that. I will have other questions for the record. Thanks for being here.
▶ 1:11:03Chair Cassidy: Senator kim.
▶ 1:11:05Sen. Kim: Thank you, chairman. Thank you for coming today. I want to start by asking you, do you know what the world trade center health program is?
▶ 1:11:16Dr. Monarez: I do.
▶ 1:11:17Sen. Kim: What is it?
▶ 1:11:19Dr. Monarez: It is a program for individuals who are in the world trade center and in the vicinity that have many -- that may have been exposed to chemical compounds in the cleanup, the aftermath. They have the ability to get screening and care as appropriate.
▶ 1:11:34Sen. Kim: For those that were there as well as the heroes at ground zero afterwards. We saw it when he percent cut in their staff in february. I asked the secretary about this. He said he was unaware and did not realize that the funding because he was making was authorizing or cutting staff from programs such as this. I guess I just wanted to ask you, were you aware that programs like this would suffer, that this program would suffer from the staffing and budget cuts?
▶ 1:12:00Dr. Monarez: I was not involved in that decision-making and I'm not aware of what happened.
▶ 1:12:05Sen. Kim: Can you explain to me who was involved in the decision-making? You were the acting director at that time in february. Do you have any input into the budget process?
▶ 1:12:16Dr. Monarez: I am not aware of any of those staffing changes that transpired during that period of time with the budget processes. This is a critical vital function that the cdc performed.
▶ 1:12:30Sen. Kim: So in february you should have at work one day and they told you that these are the cuts that have been made to your staff? Is that how it happened? Who told you that? How did that unfold?
▶ 1:12:40Dr. Monarez: I am not familiar with the specific details you are talking about. I am happy to look into it and follow up with you.
▶ 1:12:53Sen. Kim: So in february when there are cuts to cdc staff, especially for the world trade center health program, do you recall how you were made aware of those cuts to the staff?
▶ 1:12:57Dr. Monarez: I am not aware of the specific details you are asking about. I am happy to look into it and follow up with you if I am confirmed as the cdc director.
▶ 1:13:06Sen. Kim: Yeah but look I guess I raise this because you said earlier a lot about you want to focus on is creating evidence-based rapid decision-making. You want to make sure your actions are being driven by the data, by the science. Yet some of the most important decisions while you were acting director seems like they were made without your knowledge, without your inputs. Did you agree with those cuts to the road trade center health program?
▶ 1:13:31Dr. Monarez: The world trade center health program is very important to this country. It is very important that we continue to support it.
▶ 1:13:40Sen. Kim: So you did not agree with the cuts?
▶ 1:13:43Dr. Monarez: Again, I am not aware of the specific details you are talking about. I am happy to look into it and follow up with you.
▶ 1:13:50Sen. Kim: It is a little odd because they cut the staff. Congress in many ways, bipartisan way, pushed back on this. The staff were reinstated. I don't understand what the decision-making process is. I guess that is something I wanted to get a sense of. What type of role would you play in terms of standing up against some of these cuts if you disagree with them? What voice would you have?
▶ 1:14:14Sen. Kim: I guess I will switch gears a little bit and ask you, what do you think of secretary kennedy's performance and record so far since he has come in as secretary? How has he done in his job?
▶ 1:14:23Dr. Monarez: I think the secretary has laid out a very clear vision for making america healthy again. I think he has prioritized key publicpreventing chronic diseas, reducing maternal morbidity and mortality and emphasized his support for indian health
▶ 1:14:40Services -- Sen. Kim: Is there a decision that he has made so far that you disagree with? I think he is doing the important work of leading a very complex agency through a number of different transitions. He is supporting key priorities and preventing chronic disease.
▶ 1:15:01Sen. Kim: Does anything come to mind you disagree with him on?
▶ 1:15:04Dr. Monarez: The secretary is doing the work of leading a complex agency. He is been supporting chronic disease --.
▶ 1:15:14Sen. Kim: A third of the stuff was cut. Do you agree with that staffing cut.
▶ 1:15:21Dr. Monarez: I have not been involved.
▶ 1:15:24Sen. Kim: I understand but you agree with that?
▶ 1:15:26Dr. Monarez: Look, the important work of public health is critical to all of the activities related to hhs. If I'm confirmed as the cdc director, I look forward to understanding what is happening within my own organization and look forward to continuing to support these critical --.
▶ 1:15:49Sen. Kim: Let me ask in a slightly different way. Do you know with the leading cause of death is for children in the united states?
▶ 1:15:54Dr. Monarez: There are number of areas we have to be concerned about for pediatric morbidity and mortality. If there within the purview of cdc in terms of preventing and detecting --.
▶ 1:16:08Sen. Kim: What are the leading causes of death for children?
▶ 1:16:10Dr. Monarez: Look, this is a complicated issue. I want to make sure we are covering --.
▶ 1:16:17Sen. Kim: A numerical issue. Unintended injuries, homicides, and suicides under the purview of -- I would ask you to keep that in mind if you're making further cuts.
▶ 1:16:31Chair Cassidy: Senator collins.
▶ 1:16:36Sen. Collins: Thank you. Good morning, doctor. I enjoyed our discussion in my office and what to follow-up with you on some of the issues that I have raised. The state of maine as we discussed has experienced a steady and alarming increase in the number of cases of lyme disease. Last year, maine set an unfortunate record of 3035 cases.
▶ 1:17:09Sen. Collins: Fortunately, there is a promising vaccine trial underway at maine health research institute. Can you assure me that this work will be allowed to proceed? There is a lot of concern given prior to her being in office, obviously, arbitrary cancellations of grants, halting of critical trials -- clinical trials, and slashing of research
▶ 1:17:39Sen. Collins: Funds. This vaccine is very promising. I want to make sure that it is allowed to continue to its conclusion.
▶ 1:17:52Dr. Monarez: I truly appreciated the time we had together before this meeting. I share your concerns with lyme disease and other tic borne illnesses we are starting to see develop across the country. It is very concerning and we want to make sure we have public health approaches to mitigate those risks.
▶ 1:18:13Dr. Monarez: To the extent if I am confirmed a cdc, I will prioritize and make clear we are very mission-focused on being able to prevent and respond to emerging threats and infectious diseases.
▶ 1:18:32Dr. Monarez: This is an area very important to me and I look forward to working with my colleagues at nih and fda to ensure we do have continued support to be able to address these tickborne diseases and lyme disease in particular.
▶ 1:18:45Sen. Collins: Thank you. It is ironic that our dogs can get a vaccine to protect them against tickborne illnesses like lyme disease but we humans can't. I hope we can remedy that.
▶ 1:19:03Sen. Collins: I mentioned also to you that in may 2024, the cdc issued a very problematic rule that was intended to reduce the spread of rabies. But it was really a rule that was in search of a problem because it applied to dogs being brought from canada into the united states.
▶ 1:19:34Sen. Collins: And canada has long been considered to be a canine rabies-free country. I worked with border senators on this issue since many of us have sled dog races in the winter where canadian teams come over and truck drivers often travel with their dogs for companionship.
▶ 1:20:02Sen. Collins: Cdc did revise the rules somewhat by delaying implementation of the most burdensome parts. I would encourage you to go back to square one and see if we really need a rule that affects the transport of dogs from canada into the united states. I would understand if they were coming from a country that has a real problem with canine rabies. But canada does not.
▶ 1:20:34Dr. Monarez: Absolutely. As I said when we met, I would be happy to look into this and work with you if I am confirmed as a cdc director.
▶ 1:20:44Sen. Collins: And finally, I am the author of what is known as the bold act. It is a bill that has to do with alzheimer's disease and taking more of a public health approach to encourage earlier diagnosis, to train caregivers to give some relief to caregivers, to assist primary care providers who may not have expertise in
▶ 1:21:15Sen. Collins: Neurological diseases. We are in the midst of finishing up year two and a five-year grant cycle for state grants for the whole program -- the bold programs. My understanding is that states submitted their applications at the beginning of may and awards are supposed to go out in august. So here's the problem.
▶ 1:21:44Sen. Collins: The cdc staff who work on these programs have all been repped, and the cdc is just sitting, it appears come on the applications. If you are confirmed, will you commit to getting out these awards in august on time?
▶ 1:22:04Dr. Monarez: As I mentioned, if I'm confirmed as the cdc director, I will look at the workforce and the staffing issues that may have taken place . While I have not been in the organization and I will commit to understanding any of the impediments associated with awarding these grants. I'm happy to follow-up with you.
▶ 1:22:29Sen. Collins: Thank you.
▶ 1:22:30Chair Cassidy: Senator murray.
▶ 1:22:33Sen. Murray: Thank you. Three weeks ago, secretary kennedy abruptly fired all 17 members of the a sip and provided cash presented eight new embedded members, many of whom are vaccine skeptics. The committee is starting to vote on vaccine recommendations. As of last night, there down to just seven members.
▶ 1:22:57Sen. Murray: I'm going to ask you, do you agree any new members should have to go through a thorough ethics review process before meeting?
▶ 1:23:07Dr. Monarez: The members do need to go through a thorough ethics review before they are allowed to dissipate in those critical meetings.
▶ 1:23:21Sen. Murray: F that review process was not complete before the committee met today, do you think any vaccine recommendations from this week's summoning should be valid?
▶ 1:23:33Dr. Monarez: My understanding is that you can vision -- convene the ascip meetings, there needs to be a quorum.
▶ 1:23:44Sen. Murray: You just said they should go to the ethics vetting before meeting her yet they are meeting today without that ethics review process. Should they make recommendations today? Should they be valid?
▶ 1:23:55Dr. Monarez: I'm not familiar whether or not the members that are participating in the meeting this week have or have not gone through the ethics review necessary to allow them to participate in the meetings.
▶ 1:24:10Sen. Murray: If it is down they have not gone to the ethics process and the issue recommendations, would you accept them as valid?
▶ 1:24:15Dr. Monarez: If they have not gone through an ethics approval process, they should not be participating in meetings.
▶ 1:24:23Sen. Murray: I would agree on a note chair cassidy has expressed concerns about that as well. These affect millions of people. It is not just the members I am concerned about.
▶ 1:24:36Sen. Murray: Secretary kennedy is bringing anti-vaccine conspiracy theorists from his former organization into that crucial vaccine meeting was to polin from the children's defense, is scheduled to give a presentation on a vaccine to further our of case claims that it causes autism. She cited a study that does not exist. After that was pointed out, the cdc uploaded a new presentation.
▶ 1:25:04Sen. Murray: Do you think it is acceptable for a known conspiracy theorist who sites made up sources to be presenting at cdc's ascip meeting and advising on vaccine recommendations?
▶ 1:25:18Dr. Monarez: I'm not familiar with the person you have identified. The ascip is a public meeting and members of the public are in position to be able to present what should be scientific and evidence-based information. And members of the ascip should listen to that information and be able to evaluate the veracity of the data that is being discussed.
▶ 1:25:43Sen. Murray: The cdc director makes the decision on whether vaccines should be recommended to the public and does not have to follow recommendations. What we do have the committee votes to remove vaccines from the vaccine schedule or not approve new ones in opposition to clear come established science?
▶ 1:26:00Dr. Monarez: If I'm confirmed as a cdc director, I will be an active listener and will be very interested in the discussions that take place at the asip meetings. I will look at how the members are able to evaluate this information and the statistical analysis that goes into the risk benefit. Sen.
▶ 1:26:31Sesen. Murray: Many of us are deeply concerned because they impact millions of people but they also translate directly into which vaccines get covered by insurance. And which vaccines are then accessible to patients. Secretary kennedy has spread really blatant disinformation about vaccines and undermined the established science by pretending that families need to do their own research on vaccine safety.
▶ 1:26:58Sesen. Murray: Secretary kennedy recently decided to revoke covid vaccine recommendations for children and pregnant women, meaning their insurance may now not cover the cost of their vaccines. Do you think leaving it up to the parents or the individual if the choice they are left with is to spend hundreds of thousands of dollars just to get one vaccine that was previously free is the right way to go here?
▶ 1:27:20Dr. Monarez: I think we need to make sure we are providing transparent and clear, effective communications about the benefits and the risks associated with vaccines so parents can make informed decision-making for themselves, their children.
▶ 1:27:36Sen. Murray: It is hard to know if you have asip members who are living -- listening to someone who is a vaccine is perceived theorist that has been debunked and I just want to make this clear when asip closes recommendation or doesn't recommend and evidence-based vaccine, a lot more kids and a lot more families will not get vaccinated. They will not be able to afford it. And that is the reality. Thank you.
▶ 1:28:02Chair Cassidy: Senator banks.
▶ 1:28:06Sen. Banks: Doctor, congratulations, thank you for being here today. The job after your confirmed is a very important one and I want to help you every way we can. Just a few quick questions. As you know every year the cdc releases a report on abortions in the states. In that report, you collect important public health data, the risk of abortions, and some of the health effects from abortions.
▶ 1:28:35Sen. Banks: You might know indiana rightfully submits detailed reports to the cdc, but a lot of bigger states do not submit those reports. How can you strengthen the data collection on abortion and the health risk, especially from the states that refused to provide that data?
▶ 1:28:51Dr. Monarez: As you may be aware, data is very important to me. We need to make evidence-based decision-making and we can't do that if we don't have the right data from the populations that we serve.
▶ 1:29:10Dr. Monarez: I am not familiar with this particular database, but I do want to strengthen data collection, analysis, and contribution to public health issues. So if I'm confirmed, I am happy to work with you.
▶ 1:29:27Sen. Banks: It is important data about abortions in the states? Is there anything you can do to incentivize states who are not currently participating in providing that type of data?
▶ 1:29:38Dr. Monarez: I'm not particularly familiar with this -- it is very important data. I'm not familiar with how the data is currently collected. It is something that I will work with you on and I am happy to follow-up.
▶ 1:29:53Sen. Banks: When a president trump's biggest goals and initiatives is to move bureaucracy outside of washington, D.C., to better serve the american people. The cdc is already headquartered in atlanta. Can you talk about that? Maybe a simple question, why is it in atlanta and what challenges does that pose or why is that more effective to deliver the importance you do to the american --.
▶ 1:30:18Dr. Monarez: It is a historical reason of why cdc is in atlanta. At a time we had malaria as important public health threat here in the united states, it was determined the cdc's placement in atlanta would be very supportive to making sure it was addressing this critical public health crisis. I think the cdc has an important role to play across the country. We have cdc representatives that are working across many, many states and around the world.
▶ 1:30:47Dr. Monarez: I think that is an important element that we want to continue for the agency because it does allow us to be able to understand the challenges and opportunities in public health at the state and local and community level. That is really where you have an interface between public health experts and the need within those communities. If I am confirmed as a cdc director, I will continue to support our staff being distributed across this country and around the world to help address some of these --.
▶ 1:31:19Sen. Banks: I think what you're saying is it works. You don't have to run where you do in washington, D.C.
▶ 1:31:24Dr. Monarez: There is always an important element to being in washington, D.C. it is where a lot of policymaking happens. But I do believe a distributed workforce that can meet people where they are to understand the critical needs at the state and local levels and to be able to contribute directly to the american people's needs is a very valuable element of how we in federal service should be making sure we are contributing to helping keep americans healthier.
▶ 1:31:54Sen. Banks: The cbc is often criticized for being too academic and slow to respond to emergencies. You agree?
▶ 1:32:00Dr. Monarez: As part of my three priority areas for cdc, making sure we have modernize public health infrastructure and making sure we are preparing for the next pandemic, I will be evaluating the process -- processes we currently use to be able to understand the threads that are posed in infectious diseases and other emerging threats, making sure we have timely and accurate data to be able to respond in an effective way.
▶ 1:32:30Dr. Monarez: These are areas I think are critically important and I will incorporate them into our priority areas if I am confirmed as a cdc director.
▶ 1:32:37Sen. Banks: Any other organizational challenges you want to fix?
▶ 1:32:41Dr. Monarez: Any large complex organization should always be looking at ways to optimize its function, to continue to be able to use resources effectively. In this case come the cdc deliver value to the american people to make sure they are preventing and responding to infectious diseases and helping americans stay safe and healthy.
▶ 1:33:04Sen. Banks: . Thank you.
▶ 1:33:06Chair Cassidy: Senator hassan.
▶ 1:33:09Sen. Hassan: Thank you. I want to thank you, doctor, for being here and congratulations on your nomination. I'm going to start with a straightforward question I ask every nominee, if directed by the president to take action that would break the law, you follow the law or the president's directive?
▶ 1:33:26Dr. Monarez: The present we never asked me to break the law.
▶ 1:33:31Sen. Hassan: And if a president did, would you follow the law or the directive?
▶ 1:33:34Dr. Monarez: The law and the president would never asked me to break the law.
▶ 1:33:39Sen. Hassan: I would ask you to review recent facts and perhaps reflect on that answer. A second question, doctor come the cdc supports critical local work in new hampshire to fight addiction and overdoses, including funding that helps addiction in youth as well as a grant that helps new hampshire track overdose deaths. If your confirmed, can you commit to continuing these lifesaving programs at the cdc?
▶ 1:34:04Dr. Monarez: The cdc is moving toward getting back to its core mission of preventing, detecting, responding to infectious diseases and emerging threats. If I'm confirmed as a cdc director, I will look into and make sure we have effective continuity of these key public health activities as a transition to other parts of the organization.
▶ 1:34:26Sen. Hassan: I want to make sure the services remain in place because they have been lifesaving and critical not only to individuals but to our communities and, frankly, our economy in terms of workforce. We will follow-up with you on that. One critical role of the cdc director is to help protect children from lethal infectious diseases. The cdc director cannot perform this critical role unless they are politically independent.
▶ 1:34:52Sen. Hassan: Which means you must be willing to disagree with political leaders based on scientific evidence. Is there anything you disagree with secretary kennedy about?
▶ 1:35:02Dr. Monarez: If I'm confirmed as a cdc director, I look forward to having technical discussions with the secretary. He has said he values and prioritizes independent thinking and using science to drive decision-making. I am an independent thinker and I am a scientist and I will welcome the opportunity to share my opinions based on science and evidence with him as he makes some of these very difficult decisions.
▶ 1:35:32Sen. Hassan: Is there anything you disagree with them about?
▶ 1:35:34Dr. Monarez: If I'm confirmed as a cdc director, I look forward to supporting secretary with signs and evidence and making sure I am giving him the best information possible to help support some of these critical decisions.
▶ 1:35:47Sen. Hassan: When you are acting director of the cdc, secretary kennedy stated "it is very, very difficult for measles to kill a healthy person." do you have any scientific concerns about secretary kennedy statement?
▶ 1:36:03Dr. Monarez: So measles is an important public health threat and we have to make sure we are doing everything we can to prevent and mitigate --.
▶ 1:36:14Sen. Hassan: Didn't a child die for measles while you are acting cdc director?
▶ 1:36:18Dr. Monarez: Measles can be lethal. We know from historical data that in populations, unvaccinated populations that one in 1000 --.
▶ 1:36:35Sen. Hassan: Excludes me for interrupting but have limited time. In the secretary says it is difficult for measles to kill a healthy person, no concerns from you about that?
▶ 1:36:43Dr. Monarez: Look, we know measles can be fatal in one in 1000 individuals. These are very critical issues that we need to be able --.
▶ 1:36:55Sen. Hassan: Which is why you're being able to independently state in public you differ with the secretary is a really important thing. Right now you're showing reluctance to do this. What about when secretary kennedy said come again while you are cdc acting director, that cod liver oil and vitamin a have "87% effectiveness" for preventing death for measles. You agree with that from a scientific perspective?
▶ 1:37:20Dr. Monarez: There are no fda-approved antivirals or aligned treatments for the measles. We do know vitamin a has been approved by the who and has been supported by the american academy of pediatrics as an effective supportive therapy.
▶ 1:37:43Sen. Hassan: Where is the science that says it is 87% effective?
▶ 1:37:47Dr. Monarez: I'm not familiar with that quote or the specific statistic. If I'm confirmed as a cdc director, I'm happy to look into it and follow up with you.
▶ 1:37:57Sen. Hassan: For the record and with a request for unanimous consent, Mr. chair, I have a copy of an article from "the new york times" entitled "I feel like I have been lied to call it when a measles outbreak hits home" from someone who followed secretary kennedy's return it if treatment theories in texas whose family got very, very, very ill, almost died, because of measles.
▶ 1:38:23Sen. Hassan: I am very concerned that a cdc nominee who says she wants to be independent and will apply science is so unwilling to speak publicly about scientific evidence that contradicts the secretary.
▶ 1:38:37Chair Cassidy: Senator husted.
▶ 1:38:41Sen. Husted: Thank you. Doctor, thank you for joining us today.
▶ 1:38:47Chair Cassidy: Can ask you to pause? Senator hassan come did you want to put something in the record?
▶ 1:38:56Sen. Hassan: I asked for unanimous consent to submit for the record an article from "the new york times."
▶ 1:39:01Chair Cassidy: Without objection, I think my staff. Senator husted.
▶ 1:39:07Sen. Husted: When we visited, we discussed the role of the cdc in restoring trust in the cdc post-pandemic and some of the very troubling recommendations that came out I think the public helped sow the seeds of distrust.
▶ 1:39:27Sen. Husted: We also talked about the cost of health care that in the 21st century is the sector of the economy that is post inflation are and how technology can drive down costs which in health care is largely driven up costs so far. This is in driving down the cost maintain nullity and wonderful health care system that we have. You were very involved in research projects related to technology and ai I believe.
▶ 1:39:57Sen. Husted: I have been visiting with some health care professionals recently. One of them discussed an ar chatbot that they said -- ai chatbot that they said would serve, if anyone talked to this ai chatbot, it would give them better advice than any doctor could on a variety of topics. Not on a specific topic, but a broad variety of topics because no one can know as much as this chatbot had available to it.
▶ 1:40:25Sen. Husted: So under the idea of technology, technology driven -- driving down costs but also trust, what thoughts do you have on these new technologies and how they can improve health care for people in america?
▶ 1:40:37Dr. Monarez: It is a super important question. I think as I have evaluated the development of these ai-enabled technologies, the first thing you have to be able to do before you acquire a technology or you put it into your workflow is understand the problems you're trying to solve. What is it that this ai technology is going to enable that has not been able to be completed before with other mechanisms in the workforce?
▶ 1:41:06Dr. Monarez: When you're able to clearly define the problem you're trying to solve, it allows you to evaluate these different technologies to make sure you are putting in the right technologies fit for purpose. Once you put it technology in place that you have evaluated and you want to incorporate into your health care workflow, it has to be monitored. It is not one of those issues where you put in an ai enabled technology and walk away.
▶ 1:41:33Dr. Monarez: It will need constant evaluation to make sure that the training data that was used in this ai technology stays consistent with the evolution of your organization, an evolution of the patients you are serving and the evolution of the potential therapeutic and interventions that you seek to provide.
▶ 1:41:55Dr. Monarez: Ai technologies can be incredibly valuable and they can incorporate routine information that well exceeds a single human's ability to interface with a particular challenge. But it needs to be done in a disciplined way because you can create better outcomes but you also have to make sure you mitigating any risks about having these technologies incorporated without the right safeguards.
▶ 1:42:18Sen. Husted: The safeguards seem incredibly important because while this can be an amazing enhancement to health care, it in the wrong hands can be used to manipulate people to unhealthy things. We will just have to continue to work.
▶ 1:42:31Dr. Monarez: I look forward to working with you on this. I have a lot of experience in evaluating these technologies and I'm happy to work with you.
▶ 1:42:39Sen. Husted: One roll of the cdc, looking around the corner, prevent the next pandemic, what are we going to do but also their health challenges that sit right there in front of us every day we don't address. As I talked to you, a lot of experts keep telling me, look, it is what we eat, what we are putting in our bodies causing much of our health care costs and health care problems.
▶ 1:43:02Sen. Husted: I continue I can't believe we have a snap program where we literally subsidize people to eat things we know are killing them. What role do you play in helping america get healthier what we do to ourselves?
▶ 1:43:16Dr. Monarez: Such an important question. The cdc is going to refocus its mission specifically on those workable diseases but if I am confirmed as a cdc director, look forward to supporting the secretary as he continues to prioritize these other urgent public health threats.
▶ 1:43:35Dr. Monarez: I also look forward to supporting the secretary in transitioning any of the critical programs the cdc has been overseeing to other parts of the agency because as you highlight, there are existing threads right in front of us in terms of making sure our food supply is adequate and is healthy and is available to our children, making sure children have enough value, exercise, physical activity and making sure they are staying healthy and they have access to healthy
▶ 1:44:09Dr. Monarez: Water and environments -- these are all very, very important issues and I look forward to continuing to support the secretary on it and if confirmed, I look forward to working with you.
▶ 1:44:17Sen. Husted: Thank you, Mr. chairman.
▶ 1:44:19Chair Cassidy: Senator blunt
▶ 1:44:24Rochester. Sen. Rochester: Thank you. Thank you for meeting with me and taking the time to discuss issues that are so vitally important to our country. I want to follow up on senator murkowski and senator murray's comments and questions about the importance of vaccinations. In a couple of months, parents and my state of delaware and across the nation will be checking their children's vaccination records before they go back to school.
▶ 1:44:55Rochester. Sen. Rochester: Kids will receive vaccines against polio, measles, mumps, rubella, and the chickenpox to protect them and others from diseases. But also to comply with the states vaccination requirements for public schools. In fact, it was said in all states require children to receive certain vaccines before attending school. Do you know how much routine childhood vaccine will cost without insurance coverage?
▶ 1:45:23Dr. Monarez: I do not but I'm happy to look into that and follow up with you.
▶ 1:45:27Sen. Blunt Rochester: Polio is $44. Mmr, $95. Chickenpox, $183. When you total up the cost of vaccines for a child to start school in delaware, it would be about $1200, which as you can imagine, it really is important to families right now, especially -- a question was
▶ 1:45:57Sen. Blunt Rochester: Asked by senator sanders even about this reconciliation bill and the impact it will have on families. The thought that it is estimated that through cuts in medicaid, snap, and other resources, some families could see an average of $1600 cut in their budget. At the same time, you put on top of that the potential for a $1200 increase in vaccinations. If we are not doing the right thing.
▶ 1:46:27Sen. Blunt Rochester: The good news is, today, before this bill passes, most children can get routine vaccinations for free because congress requires insurance coverage of vaccines recommended by experts. Members of the advisory committee on immunization practices, a cip. In the vaccines for children program as well makes it affordable for children across our country. However, these programs, their coverage is dependent on recommendations from acip.
▶ 1:47:02Sen. Blunt Rochester: You said earlier that vaccine save lives. Do you agree vaccines against deadly diseases has reduced childhood mortality?
▶ 1:47:09Dr. Monarez: Yes.
▶ 1:47:12Sen. Blunt Rochester: If they were to remove the recommendations for a vaccine, generally our insurance required to cover those vaccines?
▶ 1:47:22Dr. Monarez: Can you repeat the question?
▶ 1:47:25Sen. Blunt Rochester: If it is not recommended, would insurers be required to cover it?
▶ 1:47:32Dr. Monarez: Look, I am --
▶ 1:47:37Sen. Blunt Rochester: The answer is yes or no.
▶ 1:47:40Dr. Monarez: The question is, if a vaccine is removed from the childhood schedule --.
▶ 1:47:48Sen. Blunt Rochester: Right now there's a lot of confusion because of what is going on with the firing of the acip members. There is confusion. But we don't need, as kids are about to go to school, is confusion, concern about the cost. I think it is really important this be an area that you focus on and I'm really concerned we don't put parents on the hook for thousands of dollars.
▶ 1:48:14Sen. Blunt Rochester: Will you commit to not deviate from historical norms and keep routine vaccines free for america's children?
▶ 1:48:21Dr. Monarez: Vaccines come absolutely save lives. If I'm confirmed as a cdc director, I commit to making sure we continue to prioritize vaccine availability.
▶ 1:48:33Sen. Blunt Rochester: One minute -- I'm running out of time. When we met, you told me during our meeting that you did not believe that the acip members had conflict of interest. That was a justification for secretary kennedy firing all of them. Members asked, do you disagree with him on anything -- which he did not say you did or didn't.
▶ 1:48:59Sen. Blunt Rochester: Do you agree with secretary kennedy's decision to fire all 17 acip members on the basis of conflict of interest?
▶ 1:49:07Dr. Monarez: Look, the american restoring trust in public health is a critical priority for me.
▶ 1:49:15Sen. Blunt Rochester: I would love an answer. Do you agree with that?
▶ 1:49:19Dr. Monarez: I agree the secretary had to make a decision related to ensuring the acip could be supportive of restoring public trust in decision-making.
▶ 1:49:30Sen. Blunt Rochester: Thank you for that. I have legislation called the vaccine act. I think we need to make it clear , democrats and republicans, as a matter come this is about the health and safety of our kids. We should not be unilaterally firing experts who have been vetted and are -- create confidence and trust in them with people that just today we learned one of the secretary's nominees has now been really busted for conflict of interest.
▶ 1:50:01Sen. Blunt Rochester: I hope my colleagues will join me in the vaccine act. I yield back.
▶ 1:50:08Chair Cassidy: Thank you for being here. Normally the chair goes first but I wanted to wait and listen to what everyone else spoke of. Not everyone. I still have a couple of colleagues. I feel prepared to go forward now. I think we are united. We want president trump's initiative to make america healthy again to succeed.
▶ 1:50:31Chair Cassidy: And you have emphasized rebuilding trust, as I did in my opening statement, and that will be essential. Obviously, there are consequences for that lack of trust. People so to distrust to the measles vaccine. There are two children dead in west texas. There's a pregnant woman infected in canada who lost her baby. Because she was exposed to someone who had measles.
▶ 1:50:59Chair Cassidy: She was nonvaccinated nor the person obviously to whom she was exposed. I am pro-life most of the loss of that life is tragic. It is all avoidable. This credit come secretary kennedy has publicly said if you're not vaccinated, should be vaccinated. That is a good message to the people in my state because many of the folks who are influenced by this distrust voted for president trump they love president trump.
▶ 1:51:27Chair Cassidy: Having the strong, clear message coming from the white house, coming from you regarding the importance of immunization, rebuilding that trust is going to be really important. I am concerned and the acip directly relates to you of course, because the agenda will ultimately be approved by you. And you will help decide rebuilding trust or not.
▶ 1:51:50Chair Cassidy: I will note that there are people who are critics of a vaccine that have been asked to testify but no one is speaking of the substantial evidence that in the amounts used in vaccines, the drug is safe. You had nothing to do with that.
▶ 1:52:09Chair Cassidy: I will say going forward, if the acip hearing today is being used for so distrust, I would ask as you go forward that you would make sure there really was a balanced perspective. Yes, some a kiss because a critic but there should be someone who is reviewing the overwhelming evidence of the safety of vaccines.
▶ 1:52:32Dr. Monarez: Absolutely. This group, this acip has a very vital role to play. And it must make sure that it is using science and evidence to drive that decision-making.
▶ 1:52:46Chair Cassidy: I think part of the concern is the people on the panel, although scientifically credentialed, no one has experience with immunizations, the kind of already knowledge to say, wait a second, the evidence representing, there's a lot more evidence to say it is not true. Again, that responsibly will fall upon you. I trust you to help fulfill president trump's vision of making america healthy again, which immunizations is such an important part.
▶ 1:53:18Chair Cassidy: Let me as something else. There are some perception, certainly from folks who make vaccines, that there is a discouragement of mrna vaccinations and of that platform. I noticed that because secretary collins, and you agreed, we need a lyme disease vaccine. One of the platforms being used for that is an mrna vaccine. You spoke in your notes of the need to address hiv.
▶ 1:53:49Chair Cassidy: Wouldn't it be great if we had a vaccine? One of the projects being used for vaccine is an mrna. So if we turn our back on that platform, we are turning our back on solutions to lyme disease -- which is terribly debilitating -- to hiv -- which is a scourge. Any thoughts about the safety of mrna vaccine in general?
▶ 1:54:09Dr. Monarez: The fda has in the production of the covid-19 vaccine had approved the mrna vaccines as safe and demonstrated efficacy associated with them.
▶ 1:54:21Chair Cassidy: So you would not be prejudiced from the get go again such a platform for such a vaccine built upon a platform whether it is for covid, flu, I'm disease, or anything else?
▶ 1:54:30Dr. Monarez: I have no prejudices against mrna platform or any other approach that is being taken to develop vaccines. That is why we have safety and efficacy standards the fda puts in place for any of these medical trials, to ensure anything that is being developed we can have the confidence that we can put it in ourselves and our children and families.
▶ 1:54:55Chair Cassidy: So U.S. a cdc director, responsible for setting the acip agenda, would not shrink from there's -- the recommendation from such a vaccine. Would you also recommend the 17 members be constituted with those who actually have experience with mrna research and could know both sides of the safety discussion?
▶ 1:55:19Dr. Monarez: We absolutely need highly trained scientists and medical professionals to be able to participate in the acip meeting. If they don't have deep technical knowledge and the mrna, have to be able to understand complicated scientific information and they have to have the temerity to ask questions to make sure they have clarity of understanding information being presented to them. These are critical aspects.
▶ 1:55:45Dr. Monarez: The acip is such a vital part of the cdc. Such a vital process in how we ensure we have the understanding , benefit, risk associated with any of these vaccines.
▶ 1:56:00Chair Cassidy: I now go to senator markey.
▶ 1:56:04Sen. Markey: Zinke. You stated that the public health safe lives. Neglected health costs lives. Rural health is very important. Are you familiar with the cdc's rural public health strategic plan?
▶ 1:56:22Dr. Monarez: I'm not familiar with that.
▶ 1:56:27Sen. Markey: Is part of the plan from the cdc established a goal to close health care gaps in rural america. Rural hospitals and health centers play an important role in public health programs like making sure they can get screened for cancer. Republicans are looking to cut $1 trillion in health care. The largest health care cuts in U.S. history as part of their big ugly bill to pay for tax breaks for billionaires. Take money from the health care for ordinary families and give that money to billionaires.
▶ 1:56:58Sen. Markey: Rural hospitals alone stand to lose at least $70 billion under the house and senate budget bill. Two weeks ago, I really stated that showed if the republicans passed their bill, at least 338 rural hospitals, including 33 hospitals in louisiana, 35 in kentucky, 21 in oklahoma are at risk of closure or cutting services like emergency room care, labor and delivery, mental health care.
▶ 1:57:28Sen. Markey: It isn't just hospitals. Nursing homes, community health centers will lose funding because of these cuts. When rural health center closes, people have to pay more, travel further, wait longer for care. When a rural hospital closest to my people, especially people on medicaid, died. With unanimous consent, I am submitting this university of north carolina data into the record, Mr. chairman.
▶ 1:57:56Sen. Markey: Report on rural hospitals losing $70 billion in three studies about the impact of rural hospital closures on health costs and outcomes. Dr. monarez, do you agree it is bad for public health, including addressing chronic disease, epidemics, infectious disease outbreaks close hospitals, nursing homes, and community health centers, and to make it more difficult for people to get health care?
▶ 1:58:22Dr. Monarez: I believe rural health clinics and qualified health centers and critical access hospitals in the rural environment are incredibly important. I care deeply about our rural populations. I support making sure they continue to have access to high-quality health care and they have a workforce that is commensurate with the needs of that population.
▶ 1:58:44Sen. Markey: But a vision without funding is an hallucination. If you cut $70 billion on rural health care, you're going to have a problem. You can't provide the services. My expectation of you is you are going to speak fairly and honestly to the american people. About health care cuts come on access to care based on your public health experience. Again, let me lay out the numbers.
▶ 1:59:12Sen. Markey: 16 million people will lose coverage under the republican plan. Rural hospitals stand to lose $70 billion. Community health centers, loose $32 billion. This comes from providing care to the 16 million people who are going to lose their insurance due to the republican plan we had it will create health care catastrophe in our country. In 1963, the U.S.
▶ 1:59:37Sen. Markey: Surgeon general called the measles vaccine "one of the most significant advances to its decreasing or eliminating one of our most serious childhood diseases." after 40 years, we eliminated measles in the united states. This year, there have been 1214 cases of measles in just the first six months. We are on track to see the highest number of cases in the united states since we eliminated the disease. Dr.
▶ 2:00:04Sen. Markey: Monarez, do you believe it is the secretary of health and human services robert f. Kennedy , the secretary of health and human services job and responsibility to help stop the measles outbreak?
▶ 2:00:21Dr. Monarez: The secretary has been very clear in his priority to help stop the measles outbreak. He has been very clear the mmr vaccine is a critical component to stopping this outbreak.
▶ 2:00:32Sen. Markey: Robust robert f. Kennedy, jr. Fired 17 members of the advisory council on immunization practices and hired several vaccine skeptics in their place. Lynn redwood, the former president the children's health defense and anti-vaccine organization that kennedy founded, will present at the cdc advisory council immunization practices meeting today.
▶ 2:00:59Sen. Markey: Her presentation includes a study that does not even exist about vaccine risks. December 2019, redwood published an article falsely calling the measles vaccine inadequate. With unanimous consent, I will introduce that article into the record. This is dangerous. Children are getting sick and dying.
▶ 2:01:23Sen. Markey: Secretary kennedy is giving a platform that people who lie about vaccines to the american people but kennedy appeared I said -- when kennedy appeared I said I did not -- I hope you will be forceful in pushing back against secretary kennedy's wrong assessment and messaging on vaccines in our country.
▶ 2:01:45Chair Cassidy: Senator kaine.
▶ 2:01:48Sen. Kaine: Thank you. Doctor, it was good to visit about public health data, modernization, priority we share. Your written testimony interested me because when a witness prepares testimony, chooses to bold two lines. That tells me these are the really important lines in the testimony.
▶ 2:02:09Sen. Kaine: The two lines you bolded in your testimony were "good public health saves lives" and "when public health is neglected it costs lives." is smoking a public health issue?
▶ 2:02:22Dr. Monarez: It is.
▶ 2:02:25Sen. Kaine: Is ignoring smoking as a public health issue run risk a people's lives? Smoking prevention and mitigation is very important public health strategy to mitigate the risk associated with tobacco use and cancer.
▶ 2:02:41Sen. Kaine: Mr. chair, I would like to introduce in the record an article from stat news from april 14 "cdc cuts are being called the greatest gift to tobacco industry in the last half-century." the article points out on april 1, the cdc's office on smoking and health was eliminated. There were 120 full-time employees and they were all laid off. Contractors into the office had been all laid off in february.
▶ 2:03:11Sen. Kaine: If smoking is a public health issue and ignoring it is a public health challenge that could risk lives, how can we justify the complete elimination the cdc office on smoking and health?
▶ 2:03:22Dr. Monarez: As you know, I was not by law involved in any of the personnel decision-making.
▶ 2:03:31Sen. Markey: I actually don't know that so let's focus on that. You are at the cdc from january to march 24. All -- you are the deputy director and acting director. All of the contractors who do work with this really important office that have been around for decades were all laid off in february when you are in that position. And the employees were all laid off on april 1.
▶ 2:03:55Sen. Markey: Let me ask you, did you have anything to do with the decisions about eliminating all the contractors and then all of them placed in the office on smoking and health?
▶ 2:04:04Dr. Monarez: I'm not aware of the layoffs to the contract.
▶ 2:04:08Sen. Kaine: So the answer is you did not have anything to do with the last of the contractors. Did you have anything to do with the layoff of all of the employees in the office?
▶ 2:04:18Dr. Monarez: I had no participation in the personnel decision-making after I left.
▶ 2:04:23Sen. Kaine: So you are not involved in any discussions about laying off the entire office before you left on march 24?
▶ 2:04:31Dr. Monarez: I will tell you what I was involved in. We were given clear guidance from the secretary --.
▶ 2:04:37Sen. Kaine: Only want to know about the office of smoking and health so don't talk to me about anything else. Are you involved in any discussions about laying off the entire staff of the office of smoking and health before you left march 24?
▶ 2:04:49Dr. Monarez: So when we were given the task to return cdc to its core functions related to preventing, detecting, and responding to infectious diseases and emerging threats, I worked with the career staff to make sure we did both -- made sure are reinforcing this core mission --.
▶ 2:05:09Sen. Kaine: To the office on smoking and health discussions, was at office discussed?
▶ 2:05:14Dr. Monarez: I don't recall that specific office.
▶ 2:05:17Sen. Kaine: If you don't recall the specific office, I'm going to go to the next question. You are career public health professional. If public health saves lives and this is an office that is been going for decades that is shown real effectiveness in reducing smoking, isn't it a bad idea to completely shatter the office on smoking and health and lay off all the employees and contractors?
▶ 2:05:45Dr. Monarez: Look, these issues are still public health priorities.
▶ 2:05:50Sen. Kaine: For who?
▶ 2:05:52Dr. Monarez: For the secretary.
▶ 2:05:54Sen. Kaine: Public health authorities for the secretary post of the article I introduced also points out he has laid off almost all of the smoking expertise at the fda. So give me any evidence that this is a public a priority for the secretary.
▶ 2:06:10Dr. Monarez: This is a public a priority for the secretary.
▶ 2:06:13Sen. Kaine: Tell me one thing he has done. You have laid off the entire office at the cdc. All of the contractors. All of the employees. You have gutted the fda. Let me read really quickly come at the end of osh comes on dramatic changes at the fbi, including the elimination of the centers management in relation to and the ouster of top tobacco regulator and head scientist.
▶ 2:06:43Sen. Kaine: He did not have anything to do with the fbi. Yes you did not have anything to do with the fda, but give me one thing the secretary is and that would suggest he understands what you testify to that smoking is a public health issue.
▶ 2:06:54Dr. Monarez: Secretaries continue to support preventing kong disease --.
▶ 2:06:58Sen. Kaine: Is smoking related to chronic disease?
▶ 2:07:01Dr. Monarez: Cancer related to tobacco use can turn into --.
▶ 2:07:05Sen. Kaine: A senator husted said, things we put in our body, that is a chronic disease. It seems that would be a priority for the hhs secretary and yet the cdc, complete elimination of this office and the fda dramatic curtailment of its office. I really have questions about -- not about the statement you made in your testimony more about your qualifications, I have questions about your willingness to follow on your values.
▶ 2:07:36Sen. Kaine: I yield.
▶ 2:07:38Chair Cassidy: Senator alsobrooks.
▶ 2:07:41Sen. Alsobrooks: Good morning, Dr. monarez, thank you for being here. We have over the last six months watched this administration in horror, watched it dismantle our public health and research system all while touting that they have called "the effort to restore gold standard science." I don't know what focus group came up with that title. It is untruthful.
▶ 2:08:11Sen. Alsobrooks: Because the fact is, cutting 12 million-dollar's from nih research for critical cures is not gold standard science. Looking to cut $18 million more will not deliver for us gold standard science. Finally, 2400 scientists and public health workers from the cdc will not make americans safer from the threats of our breaking and emerging diseases.
▶ 2:08:35Sen. Alsobrooks: Firing experts they have fired that provide recommendations for vaccines and sowing doubt about the science behind vaccines I believe will be -- lead to more americans dying. Shutting down rural hospitals, throwing them off their insurance -- it is just one thing after the next, which I think will not only make us sicker but also cause us to die.
▶ 2:08:58Sen. Alsobrooks: This past week you expressed confidence in secretary kennedy's new picks for the advisory committee on immunization practices known as acip saying they were all credentialed scientists and medical doctors.
▶ 2:09:11Sen. Alsobrooks: That same day the committee's own chairman called for the delay of the committee's wednesday meeting saying the new appointees "do not have significant experience studying microbiology, epidemiology, or immunology." my first question for you is whether you believe that the 17 members this administration fired from the advisory committee on immunization practices in fact lacked modifications?
▶ 2:09:39Dr. Monarez: Look, part of the secretary's vision in restoring public trust is making sure the american people can be confident in the way the evidence and signs are driving decision-making.
▶ 2:09:57Dr. Monarez: The secretary made a decision that resetting the acip from the 17 previous members to a new cohort of members was going to be on the path of restoring the public trust.
▶ 2:10:11Sen. Alsobrooks: I respect your not able to say yes that they are qualified individuals, so I'm going to ask another question about it. Do you believe the 17 individuals who the secretary, bless his heart, pointed come have conflict of interest that undermine their independence?
▶ 2:10:29Dr. Monarez: I'm sorry, the eight members that he appointed?
▶ 2:10:35Sen. Alsobrooks: The 17. Do you believe they had conflicts of interest that undermine their independence?
▶ 2:10:40Dr. Monarez: Talk about their previous?
▶ 2:10:43Sen. Alsobrooks: The new.
▶ 2:10:45Dr. Monarez: Ok, just -- he has only appointed I believe eight but I understand it is seven members. To participate in the acip meeting, thus members will have needed to go through an ethics approval process and declare conflict of interest in the office of government will evaluate whether or not those conflict of interest are directly related to the information you're going to be
▶ 2:11:15Dr. Monarez: Receiving and evaluating as a conductor business at the -- as the acip members. If the office of ethics determines the conflict of interest are directly related --.
▶ 2:11:27Sen. Alsobrooks: Let me ask a specific question. Would you say an acip member that made money as an expert witness an example in litigation against a major vaccine company would be considered a conflict of interest?
▶ 2:11:41Dr. Monarez: So that individual will have had to declare that during the vetting process. The office of government at the will make an eval -- a judgment to determine whether or not that dissipation in that payment is directly in conflict with the ability of the acip members.
▶ 2:12:04Sen. Alsobrooks: I know it is not allow that generally these members are not allowed to serve as expert witnesses and vaccine litigation that Mr. cole dorf who was appointed -- he is a person who recently served as an expert witness for plaintiff sue accused merk of concealing the risk of an hpv vaccine. I believe that would be a conflict of interest. Let me ask you something else important. You are a scientist.
▶ 2:12:30Sen. Alsobrooks: I know -- I want to ask you whether you believe fluoride is a safe and effective when used appropriately?
▶ 2:12:37Dr. Monarez: Fluoride is an important component to oral health. There are various aspects of using fluoride to improve oral health. Direct application can be very valuable.
▶ 2:12:51Sen. Alsobrooks: I'm so glad to hear that because the secretary has directed the cdc to stop recommending fluoride in communities. I'm concerned about this. I know you're one of my constituents and happy about that -- and I'm happy about that. Her community has fluoridation. Do you believe the water in potomac, maryland, for example, safer families? Is it safer families, the water in potomac, maryland?
▶ 2:13:18Dr. Monarez: I believe it is safe.
▶ 2:13:20Sen. Alsobrooks: Thank you so much.
▶ 2:13:24Chair Cassidy: Thank you, Dr. monarez. For any senator wishing to ask additional questions, questions for the record will be due at 5:00 p.m. Tomorrow june 26. Thank you for being here. The committee stands adjourned. Which is responsible for its caption content and accuracy. Visit ncicap.org] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap.org]