Mr. Speaker, I thank the chairwoman for her leadership and continued respect for the oversight of this body. And I particularly thank the gentleman from Illinois and his cosponsors for this very astute legislation. I join with my…
Mr. Speaker, I thank the chairwoman for her leadership and continued respect for the oversight of this body. And I particularly thank the gentleman from Illinois and his cosponsors for this very astute legislation.
I join with my bipartisan colleagues to indicate that the transparency of funding by way of the budget process is absolutely crucial to be able to be guided by what is right, as well, to ensure that we, the Congress, have a knowledge of the importance of the funding process, the importance of the programs that are used for taxpayer dollars.
Mr. Speaker, let me just take a microcosm of what I believe will be an important aspect of this. Why don't I take COVID-19 as an example?
Mr. Speaker, I believe that we have been hearing from all over the Nation that the Federal Government needs to be in charge. The agency that I think would be most effective as a national coordinator of vaccine transport and delivery is FEMA.
For safe and effective supply chain transport, delivery, and site use of vaccines, FEMA has the ability to tell other agencies what to do or to be able to be part of the success of the distribution of these vaccines. They have broad stakeholder engagement. FEMA has personnel all over the Nation, and they are not in the business of picking business winners or losers. And implementing CDC COVID-19 vaccine recommendations, they know how to do that.
Mr. Speaker, I say thank you to all the private-sector volunteers, all the pharmacies located in grocery stores and well-known chains, but that is not working. It is not going to work.
This particular legislation would let us know the budget plan of an agency, like FEMA, which really looms large in our lives because whether you have experienced a fire in California, or whether or not you have experienced Hurricane Harvey in Texas, or whether or not you have experienced tornadoes, FEMA has been on the ground. They know how to put large efforts together. They can lead the effort for vaccine delivery so that we don't have these kinds of episodes.
``One American dies from COVID-19 every 33 seconds.'' Mr. Speaker, I include in the Record an article.
[From CNN, Jan. 5, 2021]
One American Dies From Covid-19 Every 33 Seconds as the Vaccine Rollout
Hits Snags
(By Holly Yan and Madeline Holcombe)
While hopes of vaccinating 20 million people by New Year's
Day sputtered out, the US now faces staggering new challenges
in the fight against Covid-19.
Over the past week, the US has averaged 2,637 coronavirus
deaths every day, according to Johns Hopkins University.
That's an average of one Covid-19 death every 33 seconds.
December was the deadliest month yet of this pandemic, with
77,572 lives lost. And
deaths are likely to accelerate as new infections and
hospitalizations rise.
On Monday, more people were hospitalized with Covid-19 than
any other day in this pandemic--128,210, according to the
Covid Tracking Project.
The US averaged 213,437 new infections every day over the
past week, largely fueled by holiday gatherings, health
experts say.
But while daily new infections soared 16% over the past
week, testing has actually decreased 11.65% over the past
week, according to the Covid Tracking Project.
Doctors worry this rampant spread of Covid-19 will push
more hospitals beyond capacity and lead to more deaths as the
vaccine rollout staggers along.
The possibility of giving half-doses of a vaccine
About 15.4 million vaccine doses have been distributed in
the US, but only 4.5 million people have received their first
doses, the US Centers for Disease Control and Prevention said
Monday.
That's far behind what officials had hoped for by now. And
it means herd immunity is still many months away.
``We agree that there is a lag. We'll work with the
states,'' said Moncef Slaoui, chief scientific adviser of the
federal Operation Warp Speed vaccination effort.
To help expedite vaccinations, the US might start giving
half-doses of Moderna's Covid-19 vaccine to people age 18 to
55, which could make the vaccine available to twice as many
people in that age group, Slaoui said.
Slaoui said Sunday the US Food and Drug Administration
would meet this week to consider the idea.
But the FDA commissioner and its vaccine division chief
said in a joint statement that people need to get two full
doses instead of two half-doses.
``At this time, suggesting changes to the FDA-authorized
dosing or schedules of these vaccines is premature and not
rooted solidly in the available evidence,'' said FDA
Commissioner Dr. Stephen Hahn and Dr. Peter Marks, who heads
the agency's vaccine division. ``Without appropriate data
supporting such changes in vaccine administration, we run a
significant risk of placing public health at risk,
undermining the historic vaccination efforts to protect the
population from Covid-19.''
It's understandable that people may want to stretch the
vaccine supply, they said. But it's not advisable.
``If people do not truly know how protective a vaccine is,
there is the potential for harm because they may assume that
they are fully protected when they are not, and accordingly,
alter their behavior to take unnecessary risks,'' they said.
The two 100-microgram Moderna vaccine doses are intended to
be spaced 28 days apart.
CNN has reached out to Moderna for comment.
Dr. Jonathan Reiner, a professor of medicine at George
Washington University, said he does not agree with the idea
of half-doses.
``We have about 13 million doses that have been shipped out
to the states, and only barely 4 million doses that have gone
into arms. So the bottleneck is not the lack of availability
of vaccine. The bottleneck is actually the logistics of
vaccinating people in this country.''
It's difficult enough to get some patients on board with
getting a vaccine, he said. Going against the recommended
dosing could hurt patients' confidence.
``When I see people in clinic, I talk about the vaccine
every single day. I'm trying to reduce vaccine hesitancy,''
Reiner said Monday.
``And the strongest weapon I have is the data. I can tell
people that these two vaccines have been studied in 70,000
people--more than 70,000 people--in this two-dose strategy.
And when given that way, they're both 95% effective, and
basically no one gets critically ill if you get this vaccine.
. . . Once you break from the data, I can no longer say
that.''
Study says holding back fewer doses could cut cases by 29%
Right now, the federal government is allocating about half
of the vaccines being produced. The other half is held in
reserve to be used as a second dose or as replacements in
cases where doses are unusable.
But by reducing the amount withheld to 10% for the first
three weeks and supplying a steady dose of 6 million doses
per week, the US could avoid up to 29% more coronavirus cases
over eight weeks, a study published in the Annals of Internal
Medicine found.
``We find that under most plausible scenarios, a more
balanced approach that withholds fewer doses during early
distribution in order to vaccinate more people as soon as
possible could substantially increase the benefits of
vaccines, while enabling most recipients to receive second
doses on schedule,'' write the study's authors, who were
supported by the Canadian Institutes for Health Research and
the Centers for Disease Control and Prevention.
The researchers modeled several scenarios, with variables
including vaccine supply, protection provided by the first
dose, and waning efficacy of a first dose if a second dose is
delayed.
An emergency department employee dies of Covid-19
In California, health care workers are treating an
unprecedented number of Covid-19 patients. Sometimes, those
patients are colleagues.
At Kaiser Permanente San Jose Medical Center, 44 emergency
department employees tested positive for Covid-19 between
December 27 and January 1, said Irene Chavez, senior vice
president and area manager.
On Monday, the hospital said one employee who was working
on Christmas has died of Covid-19.
``Our thoughts and prayers are with those affected by this
terrible loss,'' the hospital said in a statement. ``We are
providing support to our employees during this difficult
time,'' according to a statement from the hospital.
Over the weekend, Chavez said the medical center is
investigating whether an inflatable, air-powered costume may
have played a role in the spread.
``A staff member did appear briefly in the emergency
department on December 25th wearing an air-powered costume,''
she said.
``Any exposure, if it occurred, would have been completely
innocent, and quite accidental, as the individual had no
Covid symptoms and only sought to lift the spirits of those
around them during what is a very stressful time.''
Chavez said air-powered costumes will no longer be allowed
at the facility.
``If anything, this should serve as a very real reminder
that the virus is widespread, and often without symptoms, and
we must all be vigilant,'' she said.
`A rough start to 2021'
On Sunday, five states reported their highest number of new
infections ever in one day--Arizona, New Hampshire, Oklahoma,
South Carolina and Washington.
And over the past week, at least five states have average
test positivity rates higher than 40%--meaning more than 40%
of people who take a Covid-19 test get a positive result.
Those states include Idaho (57%), Alabama (46.7%), Iowa
(44.6%), Pennsylvania (44%) and South Dakota (43.8%). For
perspective, the WHO has recommended governments not reopen
until the test positivity rates stays at or below 5% for 14
days.
In South Carolina, which had a 29.6% test positivity rate
Sunday, officials in four counties said their hospitals were
at 100% capacity, according to the South Carolina Department
of Health and Environmental Control.
``We're in for a bit of a rough start to 2021,'' said Maria
Van Kerkhove, the World Health Organization's technical lead
for Covid-19 response.
But it's possible daily life in the US could be closer to
normal by the summer or fall, she said. Other countries are
already well on their way--thanks to quarantining, testing,
isolation and contact tracing.
``We've seen countries bring this virus to its knees,
without vaccination,'' Van Kerkhove said. ``We have the tools
at hand right now to actually bring this virus under
control.''
The city of Houston has done a phenomenal job by trying to open up these centers, but guess what? They are looking for their next delivery. We should not be looking for the next delivery. The delivery should be organized, logistically. It should be stored on the ground.
``Houston, have you finished your utilization? Are you ready for your next?''
``L.A., have you finished your utilization? Are you ready for your next?''
That is not happening.
``COVID vaccine rollout is going about as well as you'd feared.'' Mr. Speaker, I include in the Record that article, along with an article regarding the opening of Houston's first public COVID-19 vaccine location.
COVID Vaccine Rollout Is Going About As Well As You'd Feared
Texans are beginning the new year the same way we spent
much of the last one: straggling through a devastating
pandemic with a patchy public health infrastructure, a
confusing mishmash of rules and procedures, and an ominous
absence of effective statewide leadership.
We have a COVID-19 vaccine now: that's the good news. Two
of them, actually, one by Pfizer and the other by Moderna,
both developed as part of the federal Operation Warp Speed
and approved by the Federal Drug Administration for emergency
use last month.
We knew that distributing hundreds of millions of vaccines
would be a challenge. Each requires two doses and careful
handling--including ultra-cold storage for the Pfizer
vaccine. Each is being distributed to a population that
includes potential recipients skeptical of vaccines in
general, and the COVID vaccine in particular.
But we had several months to figure this out. And it's
quickly become painfully clear that we didn't.
In Phase 1A of the plan put forward by the Texas Department
of State Health Services, the first doses of the vaccine were
distributed to front-line health care workers and residents
of long-term care facilities, beginning last month. On
Tuesday, the state announced that vaccine providers could
begin immunizing Texans in group 1B--those over age 65 and
those with pre-existing conditions.
The experiences of Texans in that group gives you the
impression that we've responded to an ongoing crisis with a
maddening, high-stakes scavenger hunt. In Harris County, for
example, there are dozens of providers that have partnered
with the state to distribute vaccines, but making an
appointment at any of them seems to require persistence,
endless phone calls, and a hefty dose of luck.
Overall, the distribution process has been inefficient and
confusing. As of Dec. 31, according to DSHS, some 283,000
people across Texas--roughly 45,000 in Harris County--had
received the first dose of the vaccine. That's of the 773,000
doses the state had shipped to various providers, up to that
point.
And it's a worrisomely low figure, according to public
health professionals, given that we'll need to vaccinate up
to 80 percent of the population to achieve the herd immunity
that will allow normal life to resume. Dr. Peter Hotez,
professor and dean of the National School of Tropical
Medicine at Baylor College of Medicine, has pointed to the
straightforward back-of-the-envelope math: with roughly 30
million people in Texas, we should be aiming for a million
immunizations a week to achieve herd immunity by mid-year.
Last week, as these difficulties began coming to light,
Gov. Greg Abbott pointed the finger at the state's hospitals
and other vaccine providers.
``A significant portion of vaccines distributed across
Texas might be sitting on hospital shelves as opposed to
being given to vulnerable Texans,'' Abbott said on Twitter.
``The state urges vaccine providers to quickly provide all
shots,'' he continued. ``We get plenty more each week.''
In the Houston area, at least, providers say they're doing
just that. And Texans are having unpleasant memories of the
early days of the pandemic, when state leaders such as Abbott
took a largely hands-off approach to the public health
response--intervening only when local leaders in cities such
as Houston and Austin crossed what he deemed to be a red
line.
``Here we are, once again, hoping that private companies
will figure out a decent vaccine distribution system since
the State of Texas sure hasn't,'' said state Rep. Erin
Zwiener, a Democrat, on Twitter. ``But that means it will be
disparate and confusing and hard for our constituents to
navigate.''
These issues aren't unique to Texas. Even states with
relatively robust public health systems have seen what
Massachusetts Gov. Charlie Baker described this week as a
``lumpy and bumpy'' rollout.
An exasperated U.S. Sen. Mitt Romney of Utah vented in a
statement on New Year's Day.
``That comprehensive vaccination plans have not been
developed at the federal level and sent to the states as
models is as incomprehensible as it is inexcusable,'' Romney
said.
``It was unrealistic to assume that the health care workers
already overburdened with COVID care could take on a massive
vaccination program,'' he continued. ``So too is the claim
that CVS and Walgreens will save the day: they don't have
excess personnel available to inoculate millions of
Americans. Nor are they equipped to deal with the rare but
serious reactions which may occur.''
The distribution of COVID vaccines is, without question, a
matter of urgency. We begin the new year with more than
12,000 Texans hospitalized due to the virus, and public
health experts fretting about the impact of holiday
gatherings and travel on those statistics--as well as reports
that cases of a more transmissible variant of the virus have
been confirmed in the United States.
The state's plan to rely on public/private partnerships to
distribute the vaccine may be sensible, given Texas's extant
public health infrastructure. But, at the minimum, we need
better communication from state leaders about how Texans who
are eligible for the vaccine can access it--not finger-
pointing and politics.
Mr. Speaker, FDA is considering to halve the amount of vaccines going to Americans. This haphazard way will not work. And the budget bill that is before us gives Congress the insight into how agencies plan their work.
So, is FEMA well-funded to take care of a pandemic? Were they funded the way they should have been in case a pandemic came and they were the right agency to do it?
Please remember, when we were flagging around and flustering around at the beginning of COVID-19, the PPE had to be taken over by FEMA.
That is what happened. We were struggling. People were fighting over PPE. Governors were out on the market. They were making negotiations individually with China while their health professionals were dying or reusing masks or reusing PPE. FEMA came in and did it.
Mr. Speaker, I will be discussing this even further, but I support this legislation because it gives Members of Congress the ability to know budget and appropriations so that if a pandemic comes, what agency can handle it? FEMA, because it has the funding.
Mr. Speaker, I ask my colleagues to support the underlying legislation, and I look forward to this further discussion.
Mr. Speaker, I rise to speak in support of H.R. 22, the Congressional Budget Justification Transparency Act, which requires congressional budget justifications to be posted online in a centralized, searchable database, as well as on a Federal agency's websites.
The bill also would require the Office of Management and Budget to maintain and regularly update a public list of agencies expected to submit congressional budget justifications, the date they are submitted to Congress, and when they are posted online.
This bill is identical to one that passed the House under suspension in the last Congress.
As a member of the Budget Committee, I applaud this progovernment budget transparency legislation because it will make sure that the people we represent know and understand how each agency is spending taxpayer dollars.
Budget transparency is important during ordinary time but is much more important during extraordinary times like a global pandemic.
I am particularly focused on federal pandemic response that FEMA is engaged in as it relates to the COVID-19 Pandemic.
Since the beginning of the pandemic, I have worked on community access to testing and through this effort have opened over 40 testing centers in and around Houston, Texas.
Now that there are vaccines it is time to pivot to vaccinations.
For this reason, I will be introducing a new bill that will address vaccine delivery to every community across the nation.
Making FEMA the lead agency is the first step, the next important is making sure the American people have access to information on how the agency is accomplishing the task and at what cost.
My bill would establish: FEMA as the National Coordinator of vaccine transport and delivery; Safe and effective supply chain transport, delivery, and site use of vaccines; Broad Stakeholder Engagement; No picking business winners or losers; and Implementing CDC COVID-19 Vaccine Recommendations.
FEMA will be empowered to:
Lead the effort for vaccine delivery from the receipt from manufacturing facilities to delivery to designated inoculation sites (hospital, clinic, doctors' offices, schools, places of worship, community centers, parks, or neighborhood gathering locations, etc.)
Develop and deploy a fully staffed and resourced 24-7 advanced real- time tracking system that allows FEMA to monitor shipments of vaccine units that can provide end-to-end transparency on the temperature, real-
time location, origin, and destination data, anticipated time of arrival, and update recipients on the progress of their delivery and report on changes that may impact expected delivery or the viability of the vaccine while in transit;
Provide an advanced communication system that allows public health departments to communicate their vaccine readiness, their capability of receiving vaccines, delivery locations, details of facility capability of storing, securing, personnel authorized to receive deliveries, logistics for delivering vaccines to patients, report on vaccine receipts, condition of vaccines, patient reactions, and feedback on how to improve the process;
Design custom Apps for use by public health agencies, doctors' offices, etc. to be provided to patients to communicate information on the vaccine being received and the date and location of a second dose if required. The App should generate a token that corresponds to their vaccination record to ensure that the right vaccine is administered should a second inoculation be required and to ensure that a person is not vaccinated with different vaccines, additional information such as vaccine effectiveness period may be addressed as more is learned about this;
Secure transportation for delivery or use of vaccines, and, when requested, security for the vaccine delivery sites or inoculation locations to ensure the life and safety of personnel and patients who seek to provide or receive vaccinations are free of interference or threat;
Provide public education and patient engagement through the provision of inoculations of persons in areas and locations where vulnerable populations are under performing in getting vaccinations;
Waive authority of the states to share vaccination data with HHS;
Provide HHS with the capacity to manage the inoculations data on persons and tracking the second vaccination to ensure full immunity and to determine when enough vaccinations have been administered to unique persons to achieve herd immunity. HHS shall protect Vaccination Data as HIPAA protected data, and under the Privacy Act, which shall not allow a waiver of any provision of that law; and the Freedom of Information Act shall not apply to the records maintained.
Provide civil fines of up to $10,000 per violation, per instance; and criminal penalties of 5 years in prison for violation of this section; or for the use of the information outside the specific purpose of the data collection, which is to assure full inoculation of individuals; and determination of local, state and national herd immunity goals being achieved. Include a data retention limitation--all records shall be destroyed after 5 years--Sunset this provision after 5 years.
Provide an ombudsman to support: public (tribal, territorial, state, and local government); stakeholder input on the work being done; provide advocacy and advice for those who elect not to be vaccinated; and champion the privacy, civil liberty rights on behalf of the American people.
Waive state laws regarding management of inoculation data;
Provide HHS with the capacity as evidenced by the agency's prior experience in managing healthcare.gov, to manage the inoculations data on persons; for the purpose of tracking the second vaccination to ensure full immunity and the management of national inoculation goals. The protection of inoculation medical information is provided by the: Federal HIPAA medical information privacy law; the Privacy Act and eliminate access to that information through the Freedom of Information Act; and providing for civil and criminal penalties for access or use of the information outside the specific purposes of the collection, which are to ensure inoculations; and determination of progress in herd immunity goals. Patient Inoculation Data retention limitation--all medical records on inoculation of persons under this title shall be destroyed after 5 years--Sunset this provision after 5 years.
Keep oversight Committees in the House and Senate, and the American people informed through daily and weekly reporting requirements comprising data the CDC determines to be relevant and have public benefit in measuring and reporting on inoculation statistics;
Establish a stakeholder advisory board to support the collaboration and cooperation of participants that shall include representatives from, federal, state, and local governments, businesses, colleges, universities, K-12 schools, hospitals, clinics, professional medical associations. Others as deemed essential to the success of a national vaccination program.
Lead government collaboration with Stakeholders in establishing vaccine inoculation centers in locations that shall include: Stadiums; Arenas; K-12 schools; Colleges and Universities; Places of Worship; and Other locations determined to be conducive to reaching the greatest number of person who are in need of inoculations.
Empowering FEMA
FEMA will be empowered to engage all stakeholders and marshals the resources of the federal government where needed to accomplish the objectives.
FEMA employs about 20,000 people nationwide who are stationed in 10 regional offices and the Washington DC headquarters.
FEMA has the authority during times of emergency to leverage its tremendous capacity to coordinate within the federal government, pull federal agency personnel from agencies throughout the federal government to make sure America is equipped and prepared to respond to disasters.
I ask that my Colleagues join me in support of H.R. 22, and greater accountability to the American public on what the federal government is doing and the budget justification that supports expenditures.