Susan Monarez Confirmation Hearing

Bill Cassidy (00:35):

The Senate Committee on Health, Education, Labor and Pensions will please come to order. Thank you, Dr. Monarez, for appearing before the committee.

(00:42)
During the COVID-19 pandemic, the Centers for Disease Control and Prevention failed to communicate crucial information to the American people. When the public needed to know the most up-to-date information on the outbreak, they relied on a Johns Hopkins data dashboard, because the CDC did not have that information readily available. The agency failed to detect and anticipate the spread of COVID even when the virus had already reached the United States. And under President Biden, instead of acting impartially, CDC coordinated with outside political groups like teachers unions, allowing them to influence pandemic health guidance.

(01:21)
By the way, the teachers unions then used CDC guidance, which they helped write as justification to push for continued closure of schools nationwide when other public health officials were saying it was safe to open, a great detriment to American children's learning and mental health. When the American people needed the CDC the most, the agency failed. Bureaucratic decision-making impeded CDC's ability to improve American's health and continued reforms are needed to regain public trust.

(01:50)
Earlier this year, Senate Republicans launched a working group to develop legislative solutions 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.

(02:06)
For the last four years, Republicans have understood the deficiencies in the CDC and desire change, but restoring Americans trust in the CDC requires more than policy. It requires a strong leader committed to achieving permanent culture change within the agency. This is the time with President Trump and a Republican Congress to put someone in charge of the CDC who can institute systemic change and ensure the agency operates effectively to benefit Americans.

(02:32)
Above all, the CDC director must ensure agency decisions are transparent and based on science. I want to acknowledge that the Advisory Committee on Immunization Practices, the ACIP, is meeting as we speak. The CDC director plays a vital role in this process, having the power to choose whether to adopt ACIP recommendations. I want President Trump to be successful in his efforts to restore trust in our public health system. Given that there is no confirmed CDC director, along with an ACIP panel, which has very few members, many of whom lack broad vaccine and immunological expertise, there are concerns about the rushed nature of this process.

(03:13)
To be clear, there's a difference between reviewing 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. It confirmed, Dr. Monarez, you'll be tasked with strengthening public trust in 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. I want to work with you and with Secretary Robert Kennedy to ensure the agency is successful in restoring his credibility and in making America healthy again.

(03:52)
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. CDC's unique capabilities and data analysis, laboratory science, and public health responses are key to achieving President Trump's goal. 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.

Bernie Sanders (04:26):

Chairman, thanks very much. Dr. Monarez, thanks very much 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 and disastrous healthcare legislation to come before Congress in a very, very long time. That is the so-called Reconciliation Bill, which the Senate will be dealing with in a few days.

(04:54)
Let's be clear. This legislation, Dr. Monarez, if enacted would make the largest cut to healthcare in our nation's history in order to pay for the largest tax breaks for billionaires in our nation's history. At a time when everybody understands, including, I suspect, every member of this committee, that our current healthcare 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. Those cuts, along with ending the enhanced premium credits, will lead to 16 million Americans losing their health insurance.

(05:50)
In other words, right now we are the only major country on Earth not to guarantee healthcare to all people. 85 million are uninsured or underinsured, and this bill makes a awful situation even worse. Researchers at the Yale School of Public Health and healthcare economists at the University of Pennsylvania have found that these healthcare policies would cause over 50,000 Americans to die unnecessarily every single year. That's what happens when you throw 16 million low-income and working-class people off the healthcare they have. That's what we're dealing with here, folks.

(06:35)
In order to give tax breaks to billionaires, we're 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, and I come from one of the most rural states in America, rural hospitals all over this country that are already struggling would be forced to shut down, lay off workers, or substantially reduce the vital healthcare services they provide.

(07:07)
In other words, this bill among many other things will be a disaster for rural America. That is why, Mr. Chairman, I and every Democratic member of this committee sent you 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'm very disappointed, Mr. Chairman, that with an issue of such consequence that you refuse to hold those hearings or mock-ups.

(07:42)
Since this committee has refused to bring healthcare providers before us, I am releasing today a report on the impact that this legislation would have on our nation's healthcare system. The committee didn't do it. We did it. I did that by reaching out to healthcare providers all across this country. Let me thank the over 750 healthcare providers from 47 states, probably every state represented here, who responded to our request.

(08:12)
Here is just some. It's 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.

Bill Cassidy (08:22):

Without objection.

Bernie Sanders (08:23):

Thank you.

(08:24)
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%. Louisiana, the Chairman's state, it would go up from 6.7% to 12.4%. In the state of Washington, Patty Murray's state, it will go off from 6.2% to 11%. In Florida, the uninsured rate will go off 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. Chairman, instead of throwing 16 million people off of healthcare, we should do what every other major country does: guarantee healthcare to all as a human right.

(09:25)
Mr. Chairman, let me quote just a few. Again, we reached out to 750 healthcare providers who responded. I just want to quote a few. Dr. Audrey Nath from Texas wrote, "These cuts will cause rural hospitals in Texas to close entirely. As a neurologist, I'm terrified that the closest hospital for many rural [inaudible 00:09:49] they then be hours away." That's Texas. Dr. Farron Malik from Florida, where the uninsured rate will surge to almost 19%, wrote, "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, et cetera."

(10:09)
Dr. Mia Henderson, community health center doctor in Missouri wrote that the cuts to Medicaid containing this legislation would mean that "we may not be able to keep the doors open." The Louisiana Rural Health Association, Mr. Chairman, wrote and I quote, "Louisiana's rural hospitals and healthcare providers are already operating on razor-thin margins, struggling to keep their doors open, while serving some of our most medically vulnerable communities. In Louisiana, 38% of hospitals operate on negative margins and 27% are currently vulnerable to closure. Medicaid cuts would worsen these losses, putting more hospitals at risk or shutting down entirely." Louisiana.

(10:52)
Vermont, my state. Vermont Association of Hospitals and Health Systems wrote that this bill reduces coverage and access particularly in rural areas, such as Vermont, where hospitals and other healthcare providers are already financially vulnerable. On and on It goes. The healthcare 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 healthcare system in order to give tax breaks to billionaires who have never, ever had it. So good. Thank you, Mr. Chairman.

Bill Cassidy (11:33):

Thank you. Dr. Monarez, your opening statement please.

Susan Monarez (11:44):

Chairman Cassidy, Ranking Member Sanders, and members of this committee, I'm humbled to be here today before you and I'm honored to be nominated by the president to be the director of the Centers for Disease Control and Prevention. I'm joined by my friends and my family, including my children, Bill and AJ, who are my inspiration in all things.

(12:09)
I want to start by telling you about myself. I grew up in rural Wisconsin, 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 he became a police officer to support us. My mother also worked wherever she could: in factories, clerical jobs, and my favorite as a librarian. Though we didn't own a television, we always had the world at our fingertips through books.

(12:43)
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 and side 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. I earned my Ph.D. in microbiology and immunology and conducted post-doctoral research at Stanford.

(13:20)
My academic work focused on two deadly diseases: African sleeping sickness, which in its most severe forms, is 100% fatal without treatment; and toxoplasmosis, once a leading cause of death in HIV-AIDS patients. I did this work for over a decade. While treatments for African sleeping sickness and toxoplasmosis remain limited, public health advancements like screening and prevention programs have drastically reduced the burden of both diseases.

(13:54)
These experiences cemented my belief. Good public health saves lives. After academia, I shifted to shaping public health policy at the federal level. I helped establish the Biomedical Advanced Research and Development Authority, prioritizing investments in medical countermeasures. At the Department of Homeland Security, I led efforts to prevent, detect, and respond to the world's deadliest pathogens.

(14:20)
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 preparedness. When public health is neglected, it costs lives. Finally, during my time at ARPA-H, I led efforts to develop high-risk, high-reward breakthroughs in AI technologies, regenerative medicine, cancer diagnostics, and healthcare tools to support rural areas.

(14:57)
Health technology innovation is America's next frontier. By investing in innovators and entrepreneurs, we will save lives and drive economic growth, 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 usable? That's where CDC plays a vital role. Outbreaks are only getting more frequent. There's Ebola and Mpox in Africa, MERS in the Middle East, Zika and Oropouche in South America, and now H5N1 avian influenza across nearly every continent. These threats are in our backyard or always just a flight away. CDC must be fully prepared to defend the American people from these known biological risks and, as importantly, be prepared to defend against those we have not yet seen.

(15:56)
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 and accountable. I'll 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.

(16:19)
Second, strengthening public health infrastructure. We must invest in innovation to prevent, detect, and respond to threats. I'll prioritize near real-time situational awareness to detect outbreaks early. I will prioritize bringing state-of-the-art technologies to CDC, including our labs and diagnostic development. I'll work with state and local public health officials to help build a modernized public health infrastructure across the country. I will support a precision preventive health operational model to offer tailored health strategy to meet the needs of all Americans.

(16:55)
Third, evidence-based rapid decision-making. We know the next outbreak is not a matter of if but when. I have learned firsthand crises demand clear plans and decisive action. I'll implement tested, evidence-informed, predefined protocols to avoid confusion and delays and strengthen risk communication so the public receives timely, consistent guidance based on fact, not fear.

(17:20)
These priorities support the president's and the secretary's vision of a healthier America. To achieve them, I will lead with integrity, transparency, and purpose, and work with Congress to maximize health outcomes and protect the American people. Thank you for your time and for considering my nomination and I'm happy to answer any questions.

Bill Cassidy (17:40):

Thank you. I'll actually defer to my down dais to begin with. Senator Paul.

Rand Paul (17:46):

Dr. Monarez, congratulations on your nomination. Francis Collins infamously emailed Anthony Fauci and told him to take down three prominent scientists. The implication was use whatever means, use the media, use reporters to damage their reputations. One of the scientists is now the head of NIH, Jay Bhattacharya. Do you think that was an appropriate use of his office?

Susan Monarez (18:17):

I'm not familiar with that particular encounter, but we need to make sure that we are open to letting the science-

Rand Paul (18:23):

Is it an appropriate use of the office for Francis Collins to have emailed the head of NIH and say, "Take down scientists that he disagreed with"?

Susan Monarez (18:31):

We need to make sure that we are open to-

Rand Paul (18:33):

It's sort of a yes or no question. Is it an appropriate use of office? Because the question goes, 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"?

Susan Monarez (18:48):

It is not something I would do. I welcome an open and honest debate in scientific discourse.

Rand Paul (18:53):

Disappointed that we don't get a little better answer from that. You read OSTP 2015 to 2016. Was any of the research between Ralph Baric with the Wuhan Institute of Virology subject to the pause on gain of function during a period of time there?

Susan Monarez (19:10):

I don't know the specific details of that, but all federally-funded research that met the standards of gain of function should have been paused under that gain of function pause.

Rand Paul (19:20):

Right. But several were granted exemptions. Are you aware of an exemption that was granted to the Wuhan research?

Susan Monarez (19:26):

I am not aware of that.

Rand Paul (19:28):

Do you believe that the research that was being done over that period of time and subsequently was gain of function research?

Susan Monarez (19:39):

I haven't had an opportunity to look at research, but I share your concerns about gain-

Rand Paul (19:40):

It's about 10 books written about it. I mean, we've been talking about it. 15 million people died. You're going to be in charge of infectious disease. You'd think you might have an opinion on where this came from and what happened. Even EcoHealth, 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." With regard to royalties recently, Secretary Kennedy fired members of the CDC vaccine committee.

(20:19)
One of the things we've been asking for years is that they release and reveal if they get royalties from pharma. I think this is a basic good government request. We've passed it unanimously in another senate committee with Republican and Democrat support. Previous heads of the CDC and the Biden administration were adamantly opposed to revealing or any transparency. Will you support all members in decision-making processes, revealing their royalties that they get from pharmaceutical companies?

Susan Monarez (20:52):

I believe that anyone who is serving in this type of a role that is so critically important to make independent, conflict-free decisions needs to be fully transparent on any funding that they're getting from any product developer.

Rand Paul (21:09):

That's all I have.

Bill Cassidy (21:11):

Senator Sanders.

Bernie Sanders (21:14):

Thank you, Mr. Chairman. Dr. Monarez, today, Secretary Kennedy announced that he will be ending US funding for the Global Alliance for Vaccines and Immunization. You, just a moment ago, said that you believe, as I do, that public health saves lives. Ending US funding, according to the Global Alliance, 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?

Susan Monarez (21:57):

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 when you have-

Bernie Sanders (22:09):

You did and I agree with you. And my question, though, is do you think we should end our support for providing life-saving vaccines around the world?

Susan Monarez (22:18):

I think vaccines save lives. I think that we need to continue to support the promotion of utilization of vaccines. I wasn't involved in that decision-making. If I'm confirmed as a CDC director, I will certainly look into it and I'm happy to follow up with you.

Bernie Sanders (22:32):

Thank you. Doctor, the American Medical Association has adopted a policy that "recognizes the substantial body of scientific evidence that has disproven a link between vaccines and autism." The president of the American Academy of Pediatrics has stated that in the effort to undermine decades of research, finding no link between vaccines and autism "poses a threat to the health of children and our nation." Do you agree with the American Medical Association that there is no scientific proven link between vaccines and autism?

Susan Monarez (23:11):

I have not seen a causal link between vaccines and autism.

Bernie Sanders (23:17):

Dr. Monarez, you come from rural America?

Susan Monarez (23:22):

I do.

Bernie Sanders (23:24):

I represent one of the most rural states in America. What impact do you think we'll be having on the American people if rural hospitals all over this country are forced to shut down because of massive cuts to Medicaid?

Susan Monarez (23:41):

I can't speak to the ongoing deliberations that you're 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 limited staffing.

Bernie Sanders (23:55):

Are you aware that, in fact, all over the country now, small rural hospitals are struggling?

Susan Monarez (23:58):

I am very aware that, all over the country, small rural hospitals are struggling. We need to make sure that we continue to provide vital care to our rural populations.

Bernie Sanders (24:10):

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 the healthcare they currently have?

Susan Monarez (24:23):

My understanding is that no one will lose access to healthcare and that the work that is being done-

Bernie Sanders (24:32):

No one will lose access to healthcare?

Susan Monarez (24:33):

The work that is being done is to reduce waste, fraud, and abuse and make sure-

Bernie Sanders (24:38):

Dr. Monarez, I don't think there's anybody else in the world who thinks that when you throw 16 million people off the healthcare they have, by making massive cuts in Medicaid with the affordable character, no one is going to lose access to that. All right. I understand you're in a difficult position. Thank you very much for being here.

Susan Monarez (24:54):

Thank you

Bill Cassidy (24:55):

Senator Marshall.

Roger Marshall (24:57):

Well, thank you, Chairman. I have to just stop for a second before I open my questions and respond how important access to healthcare is and want to make sure that both sides of the dais understand. We want to make sure everybody has access to healthcare. I think that you're going to find with our legislation, we're going to preserve and protect Medicaid. We're going to strengthen it for those who need it the most. We're going to strengthen it, make sure that seniors and nursing homes, that people with disabilities have Medicaid, that children have Medicaid, but having Medicaid is not the same thing as access to care.

(25:36)
At least of a third of physicians don't accept Medicaid, and many that do, delay that care. 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 three, six, nine months to get them in to see a doctor because they're on Medicaid. Having Medicaid does not guarantee access to care. If we don't do something to fix it, it's going to go broke.

(26:03)
I'm so proud that in our legislation, we increased funding for Medicaid more than inflation. That over the course of 10 years, we're going to increase funding for $200 billion. That's right. There's so much misinformation out there. We're going to increase funding by over 200 billion in a year with our plan but what we really need to do to address rural hospitals is strengthen the local economy. But I think you're going to find us finding another solution as well to help the rural hospitals beyond Medicaid.

(26:36)
We've talked over and over, the importance of rural health clinics and community health centers. Those are access to care. Right now, everybody has access to care, but Medicaid is actually in the way. It's the most broken federal system we have up here right now. There's just better ways to do it than 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.

(27:05)
You're going to find that our legislation lifts up rural America and helps grow those economies, where many counties are half the size of what they once were. I'm so proud of the work we're doing to strengthen healthcare for America and to save Medicaid, to strengthen it, to make it better.

(27:23)
Dr. Monarez, again, welcome. I want to talk to you about chronic disease. 60% of Americans have chronic disease, 90% of the healthcare dollars in this country are spent on chronic disease, 90% of $4.5 trillion. You have an incredible wealth of experience and I like your experience with AI and ARPA and wearables. We talk about these chronic diseases, hypertension, obesity, diabetes, heart disease, and depression. The CDC's done a great job at addressing communicable diseases, but there's other diseases out there that I think are more of a pressing issue. How would you help address the CDC to address chronic disease?

Susan Monarez (28:07):

Thank you and thank you again for taking the time to meet with me the other week. Part of the approach to organizational optimization will be to get CDC back to its core mission functions, to prevent, detect, and respond to infectious diseases and emerging threats, but what you highlighted are very important public health concerns. What I will do if I'm confirmed as a CDC director is continue to support the secretary and to support these critical issues and make sure that any of the activities that were supported under CDC in the previous models are successfully transitioned to other part of HHS.

(28:46)
As you said, there's critical work to be done in preventing chronic diseases and addressing other issues like maternal mortality and addressing issues like neurodegenerative disorders. If I'm confirmed as CDC director, I will make sure that I'm laser-focused on the mission at hand at 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.

Roger Marshall (29:14):

Yeah. Let's turn the page and talk about antimicrobial resistance. As a PhD microbiology, you might know something about this. It's important for agriculture, it's important for human as well. What are the opportunities to address it? Certainly just emphasize that we need to save antibiotics for those purposes and, therefore, there's no economic incentive to try to develop them. Any thoughts on antimicrobial resistance that you would be leading?

Susan Monarez (29:40):

Yeah. I mean, I think it's a multi-layered approach. It is a significant public health concern. I think we need to make sure that we have accurate and timely surveillance and detection. If something is being transmitted in the population that we can detect it early, whether it's in the hospitals or in other places, I think that we need to make sure that we are investing in next generation antibiotics, because what we're seeing is this increase in antimicrobial resistance bacteria. These threaten lives and we have to make sure that we have second and third order antibiotics to prevent catastrophic outcomes when somebody becomes infected with one of these drug-resistant pathogens.

Roger Marshall (30:22):

Thank you so much. We look forward to supporting your nomination and getting you confirmed and getting you back to work. Thank you so much, Mr. Chairman. I yield back.

Bill Cassidy (30:31):

I thank for that. Before I go to Senator Hickenlooper, I'll notice for the first time in this hearing, you smiled when he asked about antimicrobial resistance. You know what I'm saying? It was just a sweet spot for you. Senator Hickenlooper.

John Hickenlooper (30:47):

Dr. Monarez, thank you so much for your public service. Obviously, your dedication and commitment to the work you're doing is noteworthy and I think laudable. You obviously have a

John Hickenlooper (31:00):

… a lot of experience in technology research and development including how to identify and treat infectious diseases. How would you incorporate this experience if you confirmed for this position?

Susan Monarez (31:19):

Thank you. And again, thank you for taking the time to meet with me. I know there's a lot going on in here, so I appreciate all of your time in meeting with me in advance. So I do have almost 30 years of experience in science, technology and innovation. And what I will do if I'm confirmed with this as the CDC director is I want to make sure, as I laid out in my priorities, that first that we are incorporating the latest in state-of-the-art technologies into the work that we're doing within CDC, that we're modernizing our laboratory capabilities, that we're 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 that they can differentiate between individuals who are worried and those who are truly in need of medical intervention. It helps us prioritize resources and it helps to make sure that we're keeping American people safe.

(32:20)
I'll also bring in AI technologies to help in a couple of different ways. When I think about AI, the first thing I say is what problems are we trying to solve? And when you can define accurately what the problems you are trying to solve, it allows you to have a disciplined way to incorporate these technologies that are really transforming what we think about in health innovation. I'll be using AI technologies to help support CDC to create a modernized and operationally efficient organization where we look at how do we optimize our workforce, how do we make sure that our IT is supportive of internal operations and partnerships with state and locals. How do we make sure that we achieve fiscal responsibility through accurate tracking of all of our expenditures?

(33:07)
I'll also be incorporating AI technology as we continue to support public health outcomes. So the areas that AI I think is going to be transformative in the health ecosystem is where we can work internally and with our partners to say-

John Hickenlooper (33:23):

That's good. I've got other question. I apologize. I hate cutting you off. I love talking technology.

Susan Monarez (33:29):

Well, I look forward to following up with you if I'm confirmed.

John Hickenlooper (33:30):

Exactly. In contrast to some of my colleagues across the aisle, I am very concerned about the cuts to Medicaid. Certainly aware that there are always improvements. And you can find examples of fraud, waste, and abuse in pretty much any… I've been a mayor. I've been a governor. We're always dealing with that. It's a constant struggle. It's the same in any corporation to be quite blunt.

(33:56)
But I think that Medicaid is essential to community health centers. I helped start a community health centers, we discussed a little bit way back in 1972, 1973 that now has over 200 locations, is an essential part of providing access to healthcare in the case all 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. And I think it's amazing that in Colorado, we're besieged by concern from rural healthcare 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?

Susan Monarez (34:48):

So that is a very critical issue. I had 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. And sometimes they're the only health that is accessible for some of our rural and vulnerable populations. And I do think fiscal viability of these has always been a challenge in making sure that although they operate on a very thin margin, that they're 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'll have a great deal of influence or ability to shape policy related to the health centers and to rural health clinics, but they are a very important part of our health ecosystem.

John Hickenlooper (35:37):

Right. Well, certainly disease control. You've got to be able to have access to healthcare as you've pointed out. And I think you'll be surprised how much influence you're going to have. Just your range of experience and your approach to what you're doing is going to give you… Your voice is going to carry it further than most. Anyway, I yield back to the Chair.

Susan Monarez (35:55):

Thank you, sir.

Bill Cassidy (35:57):

Before I go to Senator Murkowski, I will point out that just to clear up any misconception, currently a member of the Advisory Committee of the Immunization Practices must have a thorough financial background review including disclosure of any pharmaceutical royalties. Indeed, one of the nominees for the ACIP panel has just dropped out because of a parent financial conflict of interest. And so there are strict criteria on that. I'll also point out that Senator Hickenlooper, when Governor Hickenlooper raised provider taxes to the tune of about $1.5 billion. So that's one of the things we're kind of concerned about right now. So anyway, Senator Murkowski.

Sen. Murkowski (36:33):

Thank you, Mr. Chairman. Dr. Monarez, welcome to the committee and thank you for the discussion that we had last week. I want to continue on this discussion about the ACIP, the Advisory Committee on Immunization Practices.

(36:47)
Throughout his confirmation process, Secretary Kennedy made commitments to not take action that would discourage use or limit access to vaccines. And so when he made that decision recently to call for the removal of all those on the committee, on the ACIP, it called into question that commitment. It certainly did for me.

(37:15)
As you know, ACIP is kind of important. For those who are not as familiar, ACIP recommendations help the states determine which vaccines pharmacists can administer, and insurance companies use these recommendations as a guidance to determine coverage. So this is one of those committees that the general public isn't 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.

(37:44)
So we had eight, now we're down to seven. I understand that have been named. I think we're all looking at their backgrounds there. But how in your role as a CDC director, assuming you're 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 medicine? It's my understanding that I think it's like 17 members that could be authorized. It doesn't 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?

Susan Monarez (38:27):

Yeah. First, I want to thank you again for also 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 trial. They take information from post-market monitoring and surveillance that's captured in any of these vaccine adverse event reporting systems. 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 that they're evaluating.

(39:15)
If I'm confirmed as the CDC director, I look forward to participating as an active member or active participant in those discussions at those ACIP meetings. My expectation-

Sen. Murkowski (39:27):

More specific to my question though is, there are seats that are still available on that committee. I think people would 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 credibility of the committee because you and I talked about that.

Susan Monarez (39:58):

Yes. That's right.

Sen. Murkowski (39:58):

There's a lot of trust that needs to be rebuilt here. How do you do that?

Susan Monarez (40:03):

Well, first, I would welcome… These are not easy positions to fill. I mean, 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 to 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. And if someone feels that 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. And I will obviously-

Sen. Murkowski (40:48):

I would hope- I'm going to interrupt because I have one more question that I want to ask. I would hope that one of the things that you would all be looking to is to make sure that these individuals are going to be looking at the science in front of them, leave their political bias at home. If they have… Just, let's just leave it at that, leave the political bias at home.

(41:09)
You mentioned in your opening statements that when public health is neglected, it costs lives. And I absolutely agree with this. When we're talking about global disease prevention, I think we recognize, we would love to be able to say, "Well, that's not our problem in this country, but in a very mobile society that's just not the case."

(41:28)
So I am concerned. And you shared with me your concern about cuts to the Global Health Center and just the global health programs and your commitment to global surveillance. So how do you plan to ensure that 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 I think that this is a really key question for us. We've got rescissions coming up next week that are specific to global health.

Bill Cassidy (42:08):

I'll give the witness… You're very good at doing this, but I give the witness a chance to respond.

Sen. Murkowski (42:14):

Right.

Susan Monarez (42:15):

Yeah. As you and I discussed, global health security preparedness is something that I'm very passionate about. And this is an area that if I'm confirmed as a CDC director, I will follow up with you. And we will make sure that 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.

Sen. Murkowski (42:37):

Thank you, Mr. Chairman. I have additional questions for the record.

Bill Cassidy (42:39):

Sure you will.

Sen. Murkowski (42:41):

Yeah. Thank you.

Bill Cassidy (42:42):

Senator Baldwin?

Sen. Baldwin (42:43):

Thank you, Mr. Chairman. Dr. Monarez, thank you so much for being here. Thank you for meeting with me in advance of this hearing. And congratulations on your nomination.

(42:54)
As we discussed when we met, I have expressed serious concerns to the Secretary of Health and Human Services, Secretary Kennedy, multiple times, both before this committee and before the Appropriations Committee when he appeared and multiple times in writing about the firing of the entire staff of 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 in the Milwaukee public schools. Just to give you a sense of the scale, six schools needed to close for remediation. 1,800 young school children were displaced. And when the city's health department reached out to the CDC, their application was denied because there was no staff left.

(43:52)
Now, the good news is it sounds hopeful that these employees are now being reinstated. In fact, the very day we met was the day that there was an announcement that some 400 plus CDC employees that were previously fired or let go were going to return. But they should have never been recklessly fired in the first place. And the president's budget proposes current funding levels for this program, but you can't operate a program without the staff, right?

(44:27)
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?

Susan Monarez (44:43):

Thank you, Senator, for taking the time to meet with me in advance. As I've talked about is CDC is refocusing its activities towards preventing, detecting, and responding to infectious diseases and emerging threats. If I am confirmed as a CDC director, I will return to an amazing organization and I will be interested in understanding how we can successfully-

Sen. Baldwin (45:14):

This is very specific. Will you assure that there's adequate staffing within the Childhood Lead Poisoning Prevention program and reevaluate Milwaukee's application for assistance?

Susan Monarez (45:24):

Yeah. This is a very important issue, and I'm glad that we're talking about it. I will look at the workforce that is aligned with lead poisoning in children as well as other critical public health issues to make sure.

Sen. Baldwin (45:41):

All right. All right. This is an easy yes or no question. It's fully funded in the president's budget request. They're trying to hire the staff back, I understand. This should be a priority. Are you willing to say yes that you will assure that adequate staffing exists within the Childhood Lead Poisoning Prevention program, which just a couple weeks ago had zero staff, and look at Milwaukee's application for assistance?

Susan Monarez (46:07):

So I will look-

Sen. Baldwin (46:08):

Okay. Can I hear that? Yes?

Susan Monarez (46:12):

I will look at the staffing and I will ensure that these public health priorities have the capacity necessary to deliver the critical services to the American people.

Sen. Baldwin (46:23):

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.

(46:45)
If confirmed, will you provide me with any requested information related to the status of the Childhood Lead Poisoning Prevention program and Milwaukee's request for assistance in a timely manner since it appears that Secretary Kennedy will not?

Susan Monarez (47:01):

If I am confirmed as a CDC director, I will look into it and I will follow up with you.

Sen. Baldwin (47:06):

Okay. Do you agree that women should have access to breast and cervical cancer screenings?

Susan Monarez (47:13):

I think that breast and cervical cancer screenings are critically important. As I talked about-

Sen. Baldwin (47:19):

Thank you. In the president's budget proposal, it appears that CDC's cancer prevention programs are entirely eliminated. Not moved to the new administration for a Healthy America they are proposing, but gone. Just gone. So the Cancer Prevention and Control activities at CDC houses the National Breast and Cervical Cancer Early Detection Program, I have long championed this bipartisan program with Senator Collins. It provides cancer screenings to millions of women, including thousands of women in Wisconsin.

(47:51)
I have serious concerns with the administration proposal to move long-standing CDC programs out of CDC. But if Congress directs and provides funding to CDC to continue a program that absolutely needs to happen, if the program is lost, combined with the attacks on access to cancer screenings included in the Republican Reconciliation bill, women are going to be left without options to get care. So do you believe that CDC has a role to play in helping prevent breast and cervical cancer and provide screenings for women at risk?

Susan Monarez (48:28):

Those areas are critically important. And if I'm confirmed as a CDC director, I will ensure that those programs are successfully transitioned and continue in other parts of the agency that are prioritizing these critical areas for -

Sen. Baldwin (48:41):

Even if the president's budget proposes elimination?

Susan Monarez (48:44):

So I haven't been involved in the president's budget deliberations, but these are areas. And I will support making sure that the other parts of the agency that will be taking other broader public health measures up will have my support and continuity of action.

Sen. Baldwin (49:01):

Thank you for your indulgence. Mr. Chairman?

Bill Cassidy (49:03):

Senator Hawley?

Sen. Hawley (49:09):

Mr. Chairman, I'd be happy to yield to Senator Collins if she'd like to go. Are you sure? Okay. Absolutely.

(49:14)
Doctor, it's good to see you again. I enjoyed our conversation yesterday. Let me just ask you about the massive increase that we have seen in recent years when it comes to children and what we're seeing with chronic diseases, autoimmune diseases, developmental disabilities. This is something that Secretary Kennedy has talked extensively about. I know that you share his concerns on this.

(49:38)
What can CDC do to help reverse the spread of these kind of chronic conditions in our country?

Susan Monarez (49:43):

Yeah. This is a very important issue to me and it's a very important issue to the secretary as well. I think as CDC refocuses its efforts specifically on communicable diseases to prevent, detect, and respond to infectious diseases emerging threats, we'll be laser-focused on that area. But I think we will continue, and I will continue, to make sure that we're supporting the Secretary's vision on overall making America healthier again, making sure that we're supporting his initiatives to improve food sources for our children, making sure that we're supporting efforts to allow our children's staff to enjoy physical activity, making sure that we're 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 to promulgate in this country.

Sen. Hawley (50:47):

In Missouri, we've seen a significant increase in chronic health diseases in children, particularly in the St. Louis and St. Charles areas. That's on the eastern side of my state. One of the reasons for this is the presence of nuclear radiation and nuclear toxins in our soil, in our air, and in our water.

(51:02)
Are you familiar with the West Lake Landfill Superfund site in Bridgeton, Missouri? Do you know what I'm talking about?

Susan Monarez (51:07):

I'm not familiar, but this is something that… Again, these are very important issues to me, and I'm happy to work with you if I'm confirmed to the CDC.

Sen. Hawley (51:14):

This Superfund site dates back to the Manhattan-era Uranium Enrichment Project. St. Louis was a uranium enrichment site during the Manhattan Project, of which we're very proud,. But after the site, after the uranium enrichment was shut down, the federal government did not dispose of the nuclear waste. What they did instead is they dumped it into a public landfill. They allowed it 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. It sat out in barrels in another site for years from which it then seeped into a nearby stream where there's now suburbs built that started building in the 1950s. People have lived there ever since. And if you look at a heat map for childhood diseases linked to nuclear toxins, to 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.

(52:08)
And I'm asking you because as CDC director, you've got jurisdiction over the Agency for Toxic Substances and Disease Registry. Back in 2015, this agency did a health study on this landfill, on the [inaudible 00:52:22] landfill, on the nuclear radiation that was in St. Louis. And what the ATSDR concluded was that there was not significant pollution, that there was no health risk. I'm going to quote this, "no health risk to the surrounding community."

(52:41)
Now, since that time, we have learned that in fact, the ATSDR report relied on faulty data. It relied on faulty methods. And there have been multiple subsequent reports including those done by the government and the Army Corps of Engineers that have shown that there is in fact extensive contamination. And 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. They're moving them out of their homes because of existing continuing nuclear radiation in their homes, in their yards. We've had schools that have been closed because of the presence of nuclear toxins in the air, in the dust, in the soil.

(53:21)
Here's my question to you. Will you work to ensure that ATSDR, if you're confirmed, that ATSDR reviews its methodology and does another thorough study that corrects its faulty methodology from the past and gets the facts to the people of Missouri that we deserve on this issue?

Susan Monarez (53:38):

If I'm confirmed as CDC director, we will definitely look into this and I'm happy to follow up with you.

Sen. Hawley (53:43):

Good. I'll just point out that it's so significant. It's so bad, ATSDR study, that the Reuters News Agency did an entire report that we will make sure that you see detailing the faulty data and frankly haphazard process that ATSDR used to issue this report that has been relied on, I might add, by corporate bad actors and other polluters to say, "Oh, see, there's nothing wrong" even as other agencies of the government are telling people, "No, you have to leave your home because you've been exposed to nuclear radiation." We absolutely have to get this fixed and have to get it cleaned up. I look forward to working with you on that. I'll have other questions for you for the record. Thanks again for being here.

(54:21)
Thank you, Mr. Chairman.

Bill Cassidy (54:22):

Thank you, Senator Hawley. And Senator Kim?

Sen. Kim (54:25):

Yeah. Thank you, Chairman. Thank you for coming on out here today. I guess I just wanted to start by asking you, do you know what the World Health… Sorry, the World Trade Center Health Program is?

Susan Monarez (54:35):

I do.

Sen. Kim (54:36):

What is it?

Susan Monarez (54:37):

It is a program that for individuals who were in the World Trade Center in the vicinity that may have been exposed chemical compounds in the cleanup and the aftermath, they have the ability to get screening and care as appropriate.

Sen. Kim (54:51):

For those that were there as well as the heroes that were at ground zero afterwards, we saw a 20% cut in their staff in February. I asked the secretary about this. He said that he was unaware and did not realize that the funding cuts that he was making, that was authorizing, were cutting staff from programs such as this.

(55:12)
I guess I just wanted to ask you, were you aware that this program would suffer from the staffing and budget cuts?

Susan Monarez (55:20):

I was not involved in that decision-making and I am not aware of what has happened.

Sen. Kim (55:24):

So can you explain to me who was involved in that decision-making? So you were the acting director at that time in February. Did you have any input into the budget process?

Susan Monarez (55:36):

I'm not aware of any of those staffing changes that transpired during that period of time or the budget processes. This is a critical vital function that the CDC performed.

Sen. Kim (55:48):

So in February, you showed up at work one day and they told you that these are the cuts that are being made to your staff. Is that how it happened? Who told you that? How did that unfold?

Susan Monarez (55:58):

I'm not familiar with the specific details that you're talking about. I am happy to look into it and follow up with you.

Sen. Kim (56:05):

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?

Susan Monarez (56:17):

I am not aware of the specific details that you're asking about. I am happy to look into it and follow up with you if I am confirmed as the CDC director.

Sen. Kim (56:25):

Yeah, look, I mean, I guess I raised this because you said earlier that a lot of what you want to focus on is creating evidence-based, rapid decision-making. You want to make sure that 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 World Trade Center Health Program?

Susan Monarez (56:51):

The World Trade Center Health Program is very important to this country. It is very important that we continue to support it.

Sen. Kim (56:59):

So you did not agree with the cuts?

Susan Monarez (57:01):

Again, I'm not aware of the specific details of what you're asking about. I'm happy to look into it and follow up with you. If I'm confirmed-

Sen. Kim (57:07):

It's just a little odd because they cut the staff, Congress in many ways, bipartisan way, pushed back on this and the staff were reinstated. I don't understand what the decision-making process is. And I guess that's 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?

(57:31)
I guess I'll just switch gears a little bit here, just ask you, what do you think of Secretary Kennedy's performance and records so far since he has come in on secretary? How has he done in his job?

Susan Monarez (57:41):

I think the secretary has laid out very clear vision for making America healthier again. I think he has prioritized key public health activities for preventing chronic diseases, for reducing maternal morbidity and mortality. He has emphasized his support for the rural health areas, his support for Indian Health Services, his support-

Sen. Kim (58:00):

IS there anything that he has… Is there a decision that he's made so far that you disagree with?

Susan Monarez (58:06):

I think the secretary is doing the important work of leading a very complex agency through a number of different transitions. He is supporting key priorities in preventing chronic diseases.

Sen. Kim (58:20):

Does anything come to mind though that you disagree with him on?

Susan Monarez (58:23):

The secretary is doing the important work of leading a complex agency. He is supporting preventing chronic diseases.

Sen. Kim (58:31):

A-third of the staff was cut at the Injury Center. Incredibly important part of the CDC. Do you agree with that staffing cut?

Susan Monarez (58:39):

I have not been involved in the decision making.

Sen. Kim (58:42):

Well, I understand that, but do you agree with it?

Susan Monarez (58:45):

Look, the important work of public health is critical to all of the activities related to HHS. If I'm confirmed as a CDC director, I look forward to understanding what is happening within my own organization. I look forward to continuing to support these critical activities-

Sen. Kim (59:08):

If you don't mind me asking maybe a slightly different way, do you know what the leading cause of death is for children in the United States?

Susan Monarez (59:15):

There are a number of areas that we have to be concerned about for pediatric morbidity and mortality, if they're within the purview of CDC in terms of preventing and detecting-

Sen. Kim (59:26):

And what are the leading causes of death for children?

Susan Monarez (59:30):

The leading causes of death for children? Look, this is a complicated issue and we want to make sure that we're covering-

Sen. Kim (59:36):

It's just a numerical issue. I'm running out of time. Unintended injuries, homicides, and suicides under the purview of the Injury Center. And I would just ask you to keep that in mind if you are looking at further cuts.

(59:49)
I yield back.

Bill Cassidy (59:49):

Senator Collins?

Sen. Collins (59:52):

Thank you, Mr. Chairman. Good morning, Doctor. I enjoyed our discussion in my office and want to follow up with you on some of the issues that I raised.

(01:00:05)
The state of Maine, as we discussed, has experienced as steady and alarming increase in the number of cases of Lyme disease. In fact, last year, Maine set a record, an unfortunate record of 3,035 cases. Fortunately, there is a promising vaccine trial underway at Maine Health Research Institute.

(01:00:35)
Can you assure me that this work will be allowed to proceed? There is a lot of concern, given prior to your being in office obviously, arbitrary cancellations of grants, haltings of clinical trials, and slashing of research funds. This vaccine is very promising and I want to make sure that it is allowed to continue to its conclusion.

Susan Monarez (01:01:12):

I also truly appreciated the time that we had together before this meeting. And I share your concerns with Lyme disease and other tick-borne illnesses that we're starting to see develop across the countries. This is very concerning and we want to make sure that we have the right public health approaches to mitigate those risks.

(01:01:32)
To the extent, if I'm confirmed as CDC, I will prioritize and make clear that we are very mission-focused on being able to prevent and respond to emerging threats and infectious diseases. This is an area that's very important to me. And I look forward to working with my colleagues at NIH and FDA to ensure that we do have continued support to be able to address

Susan Monarez (01:02:00):

… these tick-borne diseases and Lyme disease in particular.

Sen. Collins (01:02:03):

Thank you. It's ironic that our dogs can get a vaccine to protect them against tick-borne illnesses like Lyme disease, but we humans can't and I hope that we can remedy that. I mentioned also to you that in May of 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 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… Drivers often travel with their dogs for companionship case. And 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'd understand if they were coming from a country that has a real problem with canine rabies, but Canada does not.

Susan Monarez (01:03:54):

Absolutely. And as I said when we met, I'm absolutely happy to look into this and work with you if I'm confirmed as a CDC director.

Sen. Collins (01:04:04):

Thank you. And finally, I am the author of what's 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 neurological diseases. And we are in the midst of finishing up year two in a five-year grant cycle for state grants for the BOLD programs. My understanding is that states all submitted their applications at the beginning of May and awards are supposed to go out in August. So here's the problem. The CDC staff who work on these programs have all been riffed and the CDC thus is just sitting, it appears on the applications. If you are confirmed, will you commit to getting out these awards in August on time?

Susan Monarez (01:05:24):

Yeah, as I mentioned to Senator Baldwin, if I'm confirmed as a 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 and I'm happy to follow up with you.

Sen. Collins (01:05:46):

Thank you so much. Thank you, Mr. Chair.

Mr. Chair (01:05:50):

Senator Murray.

Senator Murray (01:05:53):

Thank you, Mr. Chairman. Three weeks ago, Secretary Kennedy abruptly fired all 17 members of the ACIP, and then he appointed eight new unvetted members, many of whom are known vaccine skeptics. And as we all know, the committee's starting today to vote on vaccine recommendations. As of last night, they're down to just seven members. I wanted to ask you, do you agree that any new ACIP members should have to go through a thorough ethics review process before meeting?

Susan Monarez (01:06:30):

The members of the ACIP do need to go through a thorough ethics review before they are allowed to participate in those critical meetings.

Senator Murray (01:06:38):

So if that ethics review process was not complete before the committee met today, do you think any vaccine recommendations from this week's meetings should be valid?

Susan Monarez (01:06:50):

So my understanding is that to convene the ACIP meetings, there needs to be a quorum of participants in those.

Senator Murray (01:07:00):

No, I'm asking you about whether… You just said that they should go through the ethics vetting before meeting.

Susan Monarez (01:07:06):

Correct.

Senator Murray (01:07:06):

They're meeting today without that ethics review process. Should they make recommendations today? Should they be valid?

Susan Monarez (01:07:15):

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 those meetings.

Senator Murray (01:07:27):

If it is known that they've not gone through the ethics process and they issue recommendations, would you accept them as valid?

Susan Monarez (01:07:35):

If they have not gone through an ethics approval process, they shouldn't be participating in the meetings?

Senator Murray (01:07:41):

I would agree with that. And I know Chair Cassidy has expressed concerns about that as well. These affect millions of people and it's not just the members that I'm concerned about. Secretary Kennedy is bringing anti-vaccine conspiracy theorists from his former organization into that crucial vaccine meeting. Lyn Redwood, who's from the Children's Health Defense is scheduled to give a presentation on thimerosal in vaccines to further RFK's debunked claims that it causes autism. And she cited a study that does not exist. And after that was pointed out, CDC uploaded a new presentation. But let me ask you, do you think it is acceptable for a known conspiracy theorist who cites made up sources to be presenting at CDC's ACIP meeting and advising on vaccine recommendations?

Susan Monarez (01:08:37):

So I'm not familiar with the person you've identified. The ACIP is a public meeting and members of the public are in a position to be able to present what should be scientific and evidence-based and information, and members of the ACIP should listen to that information and be able to evaluate the veracity of the data that is being discussed.

Senator Murray (01:08:59):

Well, the CDC director makes the decision on whether a vaccine should be recommended to the public and does not have to follow recommendations passed by ACIP. What will you do if the committee votes to remove vaccines from the vaccine schedule or to not approve new ones in opposition to clear established science?

Susan Monarez (01:09:21):

So 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 ACIP meetings. I will be looking at how the ACIP members are able to evaluate this complex scientific information and the statistical analysis that goes into the risk-benefit associated.

Senator Murray (01:09:45):

I appreciate the long answer there, but I have to say that many of us are very deeply concerned about the recommendations because they impact millions of people, as I said, 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. Secretary Kennedy recently decided to revoke COVID vaccine recommendations for children and pregnant women, meaning that 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're left with is to spend hundreds of thousand dollars just to get one vaccine that was previously free is the right way to go here?

Susan Monarez (01:10:40):

I think we need to make sure that 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.

Senator Murray (01:10:54):

Well, it's hard to know if it's informed if you have ACIP members who are listening to somebody who's a vaccine conspiracy theorist that has been debunked. And I just want to make this clear, when ACIP pulls its recommendation or refuses to recommend an 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, Mr. Chairman.

Mr. Chair (01:11:22):

Thank you. Senator Banks.

Senator Banks (01:11:24):

Thank you, Mr. Chairman. Doctor, congratulations. Thank you for being here today. Happen to think that the job after you're confirmed is a very important one. We want to help you in every way that we can. Just a few quick questions for you. As you know, every year the CDC releases a report on abortions in the states and in that report, you collect important public health data about the risk of abortions and some of the health effects from abortions. You might know that Indiana rightfully submits detailed reports to the CDC, but a lot of bigger states don't submit those reports. How can you strengthen the data collection about abortion and the health risk, especially from those states that refuse to provide that data?

Susan Monarez (01:12:11):

Yeah. So 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. And I'm not familiar with this particular database, but I do want to strengthen data collection analysis and contribution to public health issues. And so if I am confirmed, I'm happy to work with you on this.

Senator Banks (01:12:45):

You would agree it's an important database, important data about abortions that come from the states. Is there anything that you can do to incentivize states who aren't currently participating and provide that type of data?

Susan Monarez (01:12:57):

So I'm not particularly familiar with this particular… It is very important data and I'm not familiar with how the data is currently collected, but it is something that I will work with you on and I'm happy to follow up.

Senator Banks (01:13:11):

One of President Trump's biggest goals and initiatives is to move bureaucracy outside of Washington D.C. to better serve the American people. And CDC is already headquartered in Atlanta. Can you talk about that? I mean, just maybe a simple question, why is it in Atlanta and what challenges does that pose or why is that more effective to deliver the important work that you do to the American people?

Susan Monarez (01:13:37):

So it's a very historical reason why CDC is in Atlanta. At a time where we had malaria as an important public health threat here in the United States, it was determined that CDC's placement in Atlanta would be very supportive to making sure that it was addressing this critical public health crisis. I think CDC has an important role to play across the country, and we have CDC representatives that are working across many, many states and around the world. And 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. And that's really where you have an interface between public health experts and the needs within those communities. I think it's a great model and if I'm 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-

Senator Banks (01:14:36):

I think what you're saying is it works.

Susan Monarez (01:14:39):

It works, it works. And I think-

Senator Banks (01:14:40):

You don't have to run what you do in Washington, D.C.

Susan Monarez (01:14:44):

Well, there's always an important element of being in Washington D.C. It's 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 that we're contributing to helping keep Americans healthier.

Senator Banks (01:15:12):

The CDC is often criticized for being too academic and slow to respond to emergencies. Do you agree with that?

Susan Monarez (01:15:19):

As part of my three priority areas for CDC, making sure that we have modernized public health infrastructure and making sure that we are preparing for the next pandemic, I will be evaluating the processes that we currently use to be able to understand the threats that are posed in infectious diseases and other emerging threats, making sure that we have timely and accurate data to be able to respond in an effective way. These are areas that I think are critically important and I'll incorporate them into our priority areas if I'm confirmed as a CDC director.

Senator Banks (01:15:56):

Any other organizational challenges that you want to fix?

Susan Monarez (01:16:01):

Any large complex organization should always be looking at ways to optimize its function, to continue to be able to use resources effectively. And in this case, the CDC deliver value to the American people to make sure that we're preventing, detecting and responding to infectious diseases and helping Americans stay safe and healthy.

Senator Banks (01:16:22):

Thank you. I yield back.

Mr. Chair (01:16:26):

Let's see. Senator Hassan.

Senator Hassan (01:16:29):

Thank you, Mr. Chairman. And I want to thank you, doctor for being here today and congratulations on your nomination. I'm going to start with a straightforward question that I ask every nominee if directed by the president to take action that would break the law, would you follow the law or follow the president's directive?

Susan Monarez (01:16:46):

The President would never ask me to break the law.

Senator Hassan (01:16:49):

And if a president did, would you follow the law or follow the directive?

Susan Monarez (01:16:54):

We'll always follow the law and the President would never ask me to break the law.

Senator Hassan (01:16:57):

Well, I'd ask you to review recent facts and perhaps reflect on that answer. Let me move to a second question. Doctor, the CDC supports critical local work in New Hampshire to fight addiction and overdoses, including funding that helps prevent addiction in youth as well as a grant that helps New Hampshire track overdose deaths. Doctor, if you're confirmed, can you commit to continuing these lifesaving programs at the CDC?

Susan Monarez (01:17:24):

So CDC is moving towards getting back to its core mission of preventing, detecting and responding to infectious diseases and emerging threats. If I'm confirmed as a CDC director, I will look into and make sure that we have effective continuity of these key public health activities as they transition to other parts of the organization.

Senator Hassan (01:17:44):

Well, I want to make sure that these services remain in place because they have been lifesaving and critical not only to individuals but to our communities and frankly to our economy in terms of workforce. So 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 can't perform this critical role unless they are politically independent, which means that you must be willing to disagree with political leaders based on scientific evidence. So is there anything that you disagree with Secretary Kennedy about?

Susan Monarez (01:18:23):

If I'm confirmed as 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.

Senator Hassan (01:18:50):

Is there anything you disagree with him about?

Susan Monarez (01:18:53):

So look, if I'm confirmed as a CDC director, I look forward to supporting the secretary with science and evidence and making sure that I am giving him the best information possible to help support some of these critical decisions that he's making.

Senator Hassan (01:19:06):

Well, let's go to some specifics then. When you were acting director of the CDC, Secretary Kennedy stated, "It's very, very difficult for measles to kill a healthy person." Do you have any scientific concerns about Secretary Kennedy's statement?

Susan Monarez (01:19:24):

So measles is an important public health threat and we have to make sure that we are doing everything that we can to prevent and mitigate the spread.

Senator Hassan (01:19:32):

Do you have any concerns about a statement? Didn't a child die from measles while you were acting CDC director?

Susan Monarez (01:19:39):

See, measles can be lethal. We know from historical data that in populations, unvaccinated populations, that one in a thousand-

Senator Hassan (01:19:52):

Right. So excuse me for interrupting, but I have limited time. So when the secretary said it's very, very difficult for measles to kill a healthy person, no concerns from you about that?

Susan Monarez (01:20:03):

So look, we know that measles can be fatal and one in a thousand individuals. And look, these are very critical issues that we need to be able to consider-

Senator Hassan (01:20:12):

Which is why you are being able to independently state in public that you differ with the secretary is a really, really important thing. And right now you're showing a real reluctance to do this. What about when Secretary Kennedy said again, while you were CDC acting director, that cod liver oil and vitamin A have, "87% effectiveness," for preventing death from measles, do you agree with that? From a scientific perspective?

Susan Monarez (01:20:41):

There are no FDA approved antivirals or aligned treatments for the measles. We do know that vitamin A has been approved by the WHO and has been supported by the American Academy of Pediatrics as an effective supportive therapy to some-

Senator Hassan (01:21:02):

And so where's the science that says it's 87% effective?

Susan Monarez (01:21:06):

So I'm not familiar with that quote. I'm not familiar with this specific statistic, but if I am confirmed as a CDC director, I'm happy to look into it and follow up with you.

Senator Hassan (01:21:16):

Well, 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've Been Lied To When a Measles Outbreak hits home," from somebody who followed Secretary Kennedy's kind of alternative treatment theories in Texas whose family got very, very, very ill, almost died because of measles. 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. Thank you, Mr. Chair.

Mr. Chair (01:21:58):

Senator Husted.

Senator Husted (01:22:00):

Thank you, Mr. Chairman. Dr., thank you for joining us today. I enjoyed our visit and conversation-

Mr. Chair (01:22:06):

Senator Husted, can I ask you to pause for a second and pause the time? Senator Hassan, did you want to put something in the record? I'm sorry.

Senator Hassan (01:22:15):

Yes. I asked for unanimous consent to submit for the record an article from The New York Times.

Mr. Chair (01:22:20):

Without Objection and thank my staff for picking up our-

Senator Hassan (01:22:23):

Thank you.

Mr. Chair (01:22:24):

Senator Husted.

Senator Husted (01:22:25):

Thank you, Mr. Chairman. So 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 that the public helped sow the seeds of distrust and we also talked about the costs of healthcare that in the 21st century, it's the sector of the economy that is most inflationary and how technology can drive down costs, which in healthcare it's largely driven up costs so far. But we also in driving down those costs, want to maintain the quality in a wonderful healthcare system we have in this country.

(01:23:08)
You, when you were deputy director, were very involved in research projects related to technology and AI, I believe. And I've been visiting with some healthcare professionals recently and one of them discussed an 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 on a broad variety of topics because nobody could know as much as this chatbot had available to it. So under the idea of technology improving quality, technology driving down cost, but also trust, just what thoughts do you have on these new technologies and how they can improve healthcare for people in America?

Susan Monarez (01:23:57):

Yeah, it's a super important question. I think as I've 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 workflows 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 of workforce? And 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 that you're putting in the right technologies fit for purpose. Once you put a technology in place that you have evaluated and you want to incorporate it into your healthcare workflows, it has to be monitored. It is not one of those issues where you put an AI-enabled technology and then you walk away.

(01:24:51)
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 that you're serving, and the evolution of the potential therapeutic interventions that you seek to provide. So these AI technologies can be incredibly valuable and they can incorporate and retain information that well exceeds the 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 that you're mitigating any risks about having these technologies incorporated without the right safeguards.

Senator Husted (01:25:37):

Yeah, the safeguards seem incredibly important because while this can be an amazing enhancement to healthcare, it could also in the wrong hands be used to manipulate people to do unhealthy things. And so we will just have to continue to work on-

Susan Monarez (01:25:50):

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.

Senator Husted (01:25:59):

So one role of the CDC is you're looking around the corner, what we're going [inaudible 01:26:03]… To prevent the next pandemic, what are we going to do? But also, there are health challenges that sit right there in front of us every day that we don't address. And as I talk to a lot of experts, they keep telling me, look, it's what we eat. It's what we're putting in our bodies that are causing much of our healthcare costs and healthcare problems. I continue to just can't believe that we have a SNAP program where we literally subsidize people to eat things we know are killing them. And so what role do you play in helping America get healthier by what we do to ourselves?

Susan Monarez (01:26:36):

Yeah, it's such an important question. So CDC is going to refocus its mission specifically on those communicable diseases. But if I'm confirmed as a CDC director, I look forward to supporting the secretary as he continues to prioritize these other urgent public health threats. And I also look forward to supporting the secretary in transitioning any of the critical programs that CDC has been overseeing to other parts of the agency. Because as you highlight, there are existing threats right in front of us in terms of making sure that our food supply is adequate and is healthy and is available to our children, making sure that children have value, the exercise and physical activity and making sure they're staying healthy and they have access to healthy water and environments. These are all very, very important issues and look forward to continuing to support Secretary on it. And if I'm confirmed, I look forward to working with you.

Senator Husted (01:27:36):

Great. Look forward to supporting you. Thank you, Mr. Chairman.

Mr. Chair (01:27:40):

Senator Blunt Rochester.

Senator Blunt Rochester (01:27:42):

Thank you, Mr. Chairman. Dr. Monarez, thank you so much 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 in my state of Delaware and across the nation will be checking their children's vaccination records before they go back to school. 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 state's vaccination requirements for public schools. In fact, it is said in all states require children to receive certain vaccines before attending school. Do you know how much a routine childhood vaccine costs without insurance coverage?

Susan Monarez (01:28:43):

I do not, but I'm happy to look into that and follow up with you.

Senator Blunt Rochester (01:28:47):

Polio is $44. MMR is $95. Chickenpox, $183. In fact, when you total up the cost of vaccines for a child to start school in Delaware, it would be about $1,200, which as you can imagine, really is important to families right now. Especially a question was asked by Senator Sanders even about this reconciliation bill and the impact that it will have on families. The thought that it is estimated that through cuts in Medicaid and SNAP and other resources, some families could see an average of a $1,600 cut in their budget. And at the same time, you put on top of that the potential for a $1,200 increase in vaccinations if we're not doing the right thing.

(01:29:44)
The good news is that today, before this bill passes, most children can get routine vaccines for free because Congress requires insurance coverage of vaccines recommended by experts, members of the Advisory Committee on Immunization Practices, ACIP. And the Vaccines for Children program as well makes it affordable for children across the country. However, these programs, their coverage is dependent on recommendations from ACIP. And so you said earlier that vaccines save lives. Doctor, do you agree that vaccinating against deadly diseases like the measles has reduced childhood mortality?

Susan Monarez (01:30:27):

Yes, it has.

Senator Blunt Rochester (01:30:28):

If ACIP were to be removed or removed their recommendations for a vaccine or fail to recommend a vaccine, generally are insurance required to cover those vaccines?

Susan Monarez (01:30:43):

I'm sorry, can you repeat the question?

Senator Blunt Rochester (01:30:45):

What I'm trying to get at is if it's not recommended, would insurers be required to cover it?

Susan Monarez (01:30:52):

So look, I don't… If I'm-

Senator Blunt Rochester (01:30:53):

It's kind of a yes or no, really. The answer is…

Susan Monarez (01:30:58):

I'm sorry. The question is, if a vaccine is removed from a childhood schedule, is-

Senator Blunt Rochester (01:31:07):

The bottom line is right now, there's a lot of confusion out here because of what's going on with the firing of the ACIP members. There's confusion. And what we don't need as kids are about to go to school is confusion, concern about the cost. And so I think it's really important that this be an area that you focused on. And I'm really concerned that we don't put parents on the hook for thousands of dollars. So will you commit to not deviate from historical norms and keep routine vaccines free for America's children?

Susan Monarez (01:31:42):

Vaccines absolutely save lives. And if I'm confirmed as CDC director, I commit to making sure that we continue to prioritize vaccine availability to help mitigate health risks-

Senator Blunt Rochester (01:31:54):

… one minute to… Because I'm running out of time. And when we met, you told me during our meeting that you didn't believe that the ACIP members had conflicts of interest. That was the justification for Secretary Kennedy firing all of them. And members asked, do you disagree with him on anything which you did not say you did or didn't. Do you agree with Secretary Kennedy's decision to fire all 17 ACIP members on the basis of conflicts of interest?

Susan Monarez (01:32:27):

So look, the American… Restoring trust in public health is a critical priority for me. It's a critical-

Senator Blunt Rochester (01:32:35):

Doctor, I would really just love an answer. Do you agree with that?

Susan Monarez (01:32:39):

I agree that the secretary had to make a decision related to ensuring that the ACIP could be supportive of restoring public trust in decision-making.

Senator Blunt Rochester (01:32:51):

I thank you for that. I have legislation called the Vaccine Act. I think we need to make it clear, Democrats, Republicans, it doesn't matter. This is about

Senator Blunt Rochester (01:33:00):

… about the health and safety of our kids. We should not be unilaterally firing experts who have been vetted and who create confidence. And trust and then replacing them with people that just today we learned one of the secretary's nominees has now been really busted for our conflicts of interest. So again, I hope my colleagues will join me in the Vaccine Act. And with that, I yield back.

Bill Cassidy (01:33:28):

Now, thank you for being here. Normally the chair goes first, but I wanted to wait and listen to what everyone else spoke of. Now, not everyone, I still have a couple colleagues, but 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. And you've emphasized rebuilding trust as I did in my opening statement, and that will be essential. And obviously there's consequences for that lack of trust. People sowed distrust of the measles vaccine. There's 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. She was not vaccinated, nor the person obviously to whom she was exposed. I'm pro-life. The loss of that life is tragic. It's all avoidable.

(01:34:26)
To his credit Secretary Kennedy has publicly said that if you're not vaccinated, you should be vaccinated. And that's 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. And so having a strong, clear message coming from the White House and coming from you regarding the importance of immunization, rebuilding that trust is going to be really important. And the ACIP directly relates to you, of course, because the agenda will ultimately be approved by you. And you will help decide are we building trust or not.

(01:35:10)
I will note that there are people who are critics of thimerosal who've been asked to testify. But no one speaking of the substantial evidence that in the amounts used in vaccines, thimerosal is safe. You had nothing to do with that. But I will say going forward, if the ACIP hearing today is being used to sow distrust, I would ask as you go forward that you would make sure that there really was a balanced perspective. And yes, someone can speak as a critic, but there should be someone who's reviewing the overwhelming evidence of the safety of vaccines.

Susan Monarez (01:35:52):

Absolutely. This group, 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.

Bill Cassidy (01:36:06):

And I think part of the concern is that the people on the panel, although scientifically credentialed, no one has the experience with immunizations, the kind of already knowledge to say, "Wait a second. The evidence that you're presenting, there's a lot more evidence to say it's not true." And so again, that responsibility will fall upon you, and I trust you to help fulfill President Trump's vision of making America Healthy Again, which immunization is such an important part of.

(01:36:35)
Let me ask something else. There is 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. Wouldn't it be great if we had a vaccine? One of the projects being used for a vaccine is an mRNA. So if we turn our back on that platform, we're 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?

Susan Monarez (01:37:28):

The FDA has in the production of the COVID-19 vaccine, had approved the mRNA vaccines as safe, and had demonstrated efficacy associated with them.

Bill Cassidy (01:37:40):

So you would not be prejudiced from the get-go against such a platform, such a vaccine built upon a platform, whether it's for COVID, flu, for Lyme disease or anything else?

Susan Monarez (01:37:50):

That is why I have no a priori prejudice against mRNA platform or any other approach that is being taken to develop vaccines. And that is why we have safety and efficacy standards that the FDA puts in place for any of these medical product trials, to ensure that anything that is being developed, we can have the confidence that we can put it in ourselves and our children, our family members.

Bill Cassidy (01:38:14):

So then you as the CDC director responsible for setting the ACIP agenda, would not shrink from the recommendation of such a vaccine? Would you also recommend that the 17 members be constituted with those who actually have experience with mRNA research and could know both sides of the safety discussion?

Susan Monarez (01:38:39):

Yeah. 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 in mRNA, they have to be able to understand complicated scientific information and they have to have the temerity to ask questions to make sure that they have clarity of understanding of information that is being presented to them. These are critical aspects. The ACIP, as you and I agree, is such a vital part of the CDC. It's such a vital process in how we ensure that we have the understanding of benefit and a risk associated with any of these vaccines.

Bill Cassidy (01:39:19):

Thank you. I now go to Senator Markey.

Senator Markey (01:39:23):

Thank you, Mr. Chairman. Dr. Monarez, in your testimony you stated that good public health saves lives, neglected public health costs lives. And you've said here today that rural health is very important to you. Are you familiar with the CDC's Rural Public Health Strategic Plan?

Susan Monarez (01:39:42):

I am not familiar with that.

Senator Markey (01:39:44):

Well, as part of that plan, CDC established a goal to close healthcare gaps in rural America. Rural hospitals and health centers play an important role in public health programs like making sure that they can get screened for cancer. Dr. Monarez, Republicans are looking to cut over $1 trillion in healthcare, the largest healthcare cuts in US history as part of their Big Ugly Bill to pay for tax breaks for billionaires. Take money from the healthcare for ordinary families and give that money then to billionaires. Rural hospitals alone stand to lose at least $70 billion under the House and Senate budget bills.

(01:40:25)
Two weeks ago, I released data that showed that if the Republicans passed their bill at least 338 rural hospitals, including 33 hospitals in Louisiana, 35 hospitals in Kentucky, 21 hospitals in Oklahoma are at risk of closure, or cutting services like emergency room care, labor and delivery, or mental health care. And it isn't just hospitals. Nursing homes, community health centers will lose funding, because of these cuts. When a rural health center closes, people have to pay more, travel further, wait longer for care. And when a rural hospital closes people, especially people on Medicaid. Die with unanimous consent time submitting this University of North Carolina data into the record, Mr. Chairman-

Speaker 1 (01:41:14):

Objection.

Senator Markey (01:41:15):

The report on rural hospitals losing $70 billion, and three studies about the impact of rural hospital closures on health costs and outcomes. Dr. Monarez, do you agree that it is bad for public health, including addressing chronic disease, epidemics and infectious disease outbreaks to close hospitals, nursing homes and community health centers? And to make it more difficult for people to get healthcare?

Susan Monarez (01:41:42):

I believe that rural health clinics and federally qualified health centers and critical access hospitals in the rural environment are incredibly important. I care deeply about our rural populations, and I support making sure that they continue to have access to high-quality healthcare and that they have a workforce that's commensurate with the needs for that population.

Senator Markey (01:42:03):

I appreciate that. But a vision without funding is an hallucination. If you cut a trillion out of the funding, if you cut 70 billion for rural healthcare, you're going to have a problem. You can't provide those services. My expectation of you is that you're going to speak fairly and honestly to the American people about healthcare cuts on access to care, based on your public health experience. And again, let me just lay out the numbers again. 16 million people will lose coverage under the Republican plan. 16 million. Rural hospitals stand to lose $70 billion. Community health centers stand to lose 32 billion. This comes from providing care to the 16 million people who are going to lose their insurance under the Republican plan. And it's going to create a healthcare catastrophe in our country.

(01:42:54)
Ms. Monarez, in 1963, the US Surgeon General Luther Terry called the measles vaccine, quote, "one of the most significant advances towards 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 1,214 cases of measles in just the first six months, and we are on track to see the highest number of cases in the United States since we eliminated the disease. Dr. Monarez, do you believe that 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?

Susan Monarez (01:43:41):

The secretary has been very clear if his priority to help stop this measles' outbreak. And he has been very clear that the MMR vaccine is a critical component to stopping this outbreak.

Senator Markey (01:43:52):

Well, your boss Robert F. Kennedy Jr. fired 17 members of the CDC Advisory Council on immunization practices and hired several vaccine skeptics in their place. Lyn Redwood, the former President of the Children's Health Defense and anti-vaccine organization that Kennedy founded, will present at the CDC Advisory Council on immunization practices meeting today. Redwood's presentation includes a study that doesn't even exist about vaccine risk. And in December 2019, Redwood published an article falsely calling the measles vaccine "inadequate." With unanimous consent, I will introduce that article, Mr. Chairman, into the record. This is dangerous. Children are getting sick and dying. Secretary Kennedy is giving a platform to people who lie about vaccines to the American people.

Speaker 2 (01:44:46):

Objection.

Senator Markey (01:44:47):

When Kennedy appeared before this committee, I said I did not want any more tiny coffins in our country. I meant it. And I hope you will be forceful in pushing back against Secretary Kennedy's wrong assessment and messaging on vaccines in our country. Thank you, Mr. Chairman.

Bill Cassidy (01:45:05):

Senator Kaine.

Senator Kaine (01:45:08):

Thank you, Mr. Chair. Dr. Monarez, it was good to visit in the office about public health data modernization, a priority we share. Your written testimony interested me, because when a witness prepares testimony and chooses to bold two lines, that tells me that these are the really important lines in the testimony. And the two lines that you bolded in your testimony were, "good public health saves lives, and when public health is neglected, it costs lives." Those are the two bolded lines. Is smoking a public health issue?

Susan Monarez (01:45:42):

It is.

Senator Kaine (01:45:43):

And is ignoring smoking as a public health issue run risk to people's lives?

Susan Monarez (01:45:50):

Smoking, prevention and mitigation is a very important public health strategy to mitigate the risks associated with tobacco use in cancer.

Senator Kaine (01:45:57):

Thank you for that. Mr. Chair, I'd like to introduce in the record an article from Stat News from April 14, quote, "Why CDC cuts are being called the greatest gift to tobacco industry in the last half century."

Bill Cassidy (01:46:12):

Without objection.

Senator Kaine (01:46:13):

The article points out that on April 1st, the CDC's Office on Smoking and Health was eliminated. There were 120 full-time employees. They were all laid off. Contractors into the office, had been all laid off in February. 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 of the CDC Office on Smoking and Health?

Susan Monarez (01:46:43):

So as you know, I was not, by law, involved in any of the personnel decision-making-

Senator Kaine (01:46:51):

I actually don't know that. Let's focus on that. You were at the CDC from January till March 24th? And you were the deputy director and the acting director. All of the contractors who do work with this really important office that had been around for decades, were all laid off in February when you were in that position. And the employees were all laid off on April one. So let me just ask you, did you have anything to do with the decisions about eliminating all the contractors and then all the employees in the Office on Smoking and Health?

Susan Monarez (01:47:24):

I'm not aware of the layoffs to the contractors-

Senator Kaine (01:47:26):

Okay. But now let me just … So the answer is you did not have anything to do with the layoffs to the contractors, if you're not aware-

Susan Monarez (01:47:34):

I am not aware of that.

Senator Kaine (01:47:34):

Did you have anything to do with the layoff of all the employees of the office?

Susan Monarez (01:47:38):

I had no participation in the personnel decision-making after I left.

Senator Kaine (01:47:43):

Right. But, so you were not involved in any discussions about laying off the entire office, before you left on March 24th?

Susan Monarez (01:47:51):

So I'll tell you what I was involved in. So we were given clear guidance from the secretary-

Senator Kaine (01:47:56):

But I only want to know about the Office on Smoking and Health, so don't talk to me about anything else. Were you involved in any discussions about laying off the entire staff of the Office of Smoking and Health before you left on March 24th?

Susan Monarez (01:48:11):

So when we were given the tasking 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 there to make sure that we did, both made sure that we were reinforcing those core mission areas-

Senator Kaine (01:48:29):

And in those discussions, did the Office on Smoking and Health, was that office discussed?

Susan Monarez (01:48:34):

I don't recall that specific office, but-

Senator Kaine (01:48:37):

Okay. Well, if you don't recall the specific office, then I'm going to go to a next question. You're a career public health professional. If public health saves lives, and this is an office that's been going for decades, that's shown real effectiveness in reducing smoking, isn't it a bad idea to completely shutter the Office on Smoking and Health and lay off all the employees and contractors?

Susan Monarez (01:49:05):

Look, these issues are still public health priorities.

Senator Kaine (01:49:10):

For who?

Susan Monarez (01:49:11):

They're public health priorities for the secretary. They're public health-

Senator Kaine (01:49:14):

Okay. Public health priorities for the secretary. The article that I introduced in the record also points out that he's laid off almost all the smoking expertise at the FDA. So, give me any evidence that this is a public health priority for the secretary.

Susan Monarez (01:49:30):

So this is a public health priority for the secretary-

Senator Kaine (01:49:33):

Tell me one thing he's done. You have laid off the entire office at the CDC. All of the contractors, all of the employees. You've gutted the FDA. Let me read really quickly. "The end of OSH comes along dramatic changes at the FDA, including the elimination of the center's management and regulation divisions, and the ouster of top tobacco regulator, Brian King and head scientist Matthew Farrelly. You didn't have anything to do with the FDA, you're not there. But give me one thing that this secretary has done that would suggest he understands what you testified to, that smoking's a public health issue.

Susan Monarez (01:50:13):

So the secretary has continued to support preventing chronic diseases.

Senator Kaine (01:50:17):

Okay. Is smoking-related disease a chronic disease?

Susan Monarez (01:50:20):

Cancer related to tobacco use can turn into a chronic disease.

Senator Kaine (01:50:24):

Yeah, because it's what Senator [inaudible 01:50:26] said, the things we put in our bodies, that's a chronic disease. It would seem like that would be something that would be a priority for 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 that you made in your testimony, nor about your qualifications. I've got questions about your willingness to follow through on your values. I yield.

Speaker 1 (01:50:55):

Senator.

Bill Cassidy (01:50:58):

Senator Alsobrooks.

Senator Alsobrooks (01:51:00):

Thank you so much, Mr. Chair. Good morning Dr. Monarez and thank you so much for being here this morning. I have to tell you, we have over the last six months watched this administration in horror. Watched it dismantle our public health and research system, all while touting what they have called, quote, "their effort to restore gold standard science." And I don't know what focus group came up with that title. It's untruthful, because the fact is cutting $12 billion from NIH research for critical cures is not gold standard science. Looking to cut $18 billion more will not deliver for US gold standard science, and firing 2,400 scientists and public health workers from the CDC will not make Americans safer from the threats of out-breaking and emerging diseases. Firing experts, they have fired, that provide recommendations for vaccines and sowing doubt about the science behind vaccines, I believe will lead to more Americans dying. Shutting down rural hospitals, throwing them off their insurance, it's just one thing after the next, which I think will not only make us sicker, but also cause us to die.

(01:52:16)
This past week you expressed confidence in Secretary Kennedy's new picks for the advisory committee on immunization practices known as ACIP, saying that they were all credentialed scientists and medical doctors. And that same day the committee's own chairman called for the delay of the committee's [inaudible 01:52:35] meeting, saying that the new appointees, quote, "do not have significant experience studying microbiology, epidemiology or immunology." And so my first question for you is whether you believe that the 17 members that this administration fired from the advisory committee on immunization practices, in fact, lacked qualifications?

Susan Monarez (01:53:00):

So look, part of the secretary's vision in restoring public trust is making sure that the American people can be confident in the way that the evidence and science are driving decision making. 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 that public trust.

Senator Alsobrooks (01:53:31):

So I respect that you're not able to say yes, that they are qualified individuals. So I'm going to ask you just another question about it. Do you believe that the 17 individuals who the secretary, bless his heart, appointed, have conflicts of interest that undermine their independence?

Susan Monarez (01:53:50):

I'm sorry. The eight members that he appointed-

Senator Alsobrooks (01:53:54):

The 17. Yep. Do you believe that they had conflicts of interest that undermine their independence?

Susan Monarez (01:54:00):

You're talking about the previous 17?

Senator Alsobrooks (01:54:02):

The new.

Susan Monarez (01:54:03):

The new? The new?

Senator Alsobrooks (01:54:03):

Yes.

Susan Monarez (01:54:04):

Okay. So he's only appointed, I believe, eight. But now I understand that it's seven members to participate in the ACIP meeting. Those members will have needed to go through an ethics approval process and declare conflict of interest. And those Office of Government Ethics will evaluate whether or not those conflicts of interest are directly related to the information that they're going to be receiving and evaluating as they conduct their business at the ACIP members. If the Office of Government Ethics makes a determination that the conflict of interest are in fact directly related to-

Senator Alsobrooks (01:54:47):

And Doctor, let me just ask you a specific question. I see the time tolling. Would you say that an ACIP member that made money as an expert witness, for example, in litigation against a major vaccine company, would be considered a conflict of interest?

Susan Monarez (01:55:01):

So that individual will have had to declare that during the vetting process by the Office of Government Ethics. And the Office of Government Ethics will make an evaluative judgment to determine whether or not that participation and that payment is directly in conflict with the ability of that ACIP member's-

Senator Alsobrooks (01:55:22):

Let me just say this. So I know that it is not allowed, that generally these members are not allowed to serve as expert witnesses in vaccine litigation, yet Mr. Kulldorf who was appointed, he's a person who recently served as an expert witness for plaintiffs who accused Merck of concealing the risks of an HPV vaccine. So that would be, I believe, a conflict. Let me just ask you something else really important. You're a scientist and I know that you believe … I want to just ask you whether you believe that fluoride is safe and effective when used appropriately?

Susan Monarez (01:55:58):

Fluoride is an important component to oral health and there are various aspects of using fluoride to improve oral health. The direct application can be very valuable.

Senator Alsobrooks (01:56:10):

Valuable? So let me just say this. So I'm so glad to hear that, because the secretary has directed the CDC to stop recommending fluoridation in communities. I'm very concerned about this. I know you are one of my constituents. I'm very happy about that. And your community has fluoridation. And so I just want to ask you last question. Do you believe that the water in Potomac, Maryland, for example, is safe for families? They have fluoridation there. Is it safe for families, the water in Potomac, Maryland?

Susan Monarez (01:56:37):

I believe the water in Potomac, Maryland is safe.

Senator Alsobrooks (01:56:40):

Thank you so much, Doctor.

Bill Cassidy (01:56:44):

Thank you Dr. Monarez. For any senator wishing to ask additional questions, questions for the record will be due at 5:00 PM tomorrow, June 26th. Thank you again for being here and the committee stands adjourned.

Susan Monarez (01:57:00):

Thank you, sir.