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tv   Surgeon General Nominee Dr. Vivek Murthy Asst. Health Secretary Nominee...  CSPAN  February 25, 2021 10:00am-12:38pm EST

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coronavirus pandemic, follow the latest at search cspan's coverage, as well as remarks from congress and use maps to follow the cases in the u.s. and worldwide. go to coverage here on c-span3 of confirmation hearing for dr. vivek murthy and dr. rachel levine to serve as assistant hhs secretary. if confirmed the first openly transgender official and dr. murthy served as surgeon general under president obama. live coverage here on cspan3. before we begin i want to walk through the covid-19 safety protocols in place. we'll follow the advice of the physician and sergeant in arms in conducting this hearing. we're all very grateful to
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everyone who has worked so hard to get this set up and help everyone stay safe and healthy. committee members are seated at least six feet apart and some senators, including myself, are participating by video conference. and while we are unable to have the hearing open to the public or media for in-person attendance, live video is available on our committee website at we received dr. murthy's formal nomination on january 20th and his committee paperwork and office of government ethics paperwork, including his public financial disclosures and ethics agreements on february 3rd. and we received dr. levine's formal nomination -- >> hey, patty, can you hold for one second. they're working on getting you
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unmuted and your video went away for just a second. so, if you will, let us make sure that we've got you back before you continue. >> can you hear me yet? >> we can hear you. >> okay, great. i'm not sure where you lost me. >> if you back up about two sentences, i think, you'll have us. >> well, let me just say we received dr. levine's formal
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nomination on february 3th and office of government ethics paperwork on february 17th. dr. murthy, dr. levine, thank you for joining us today. while i have not been able to meet either of you in person since your nomination, i was pleased to speak with you about the challenges our nation is facing and i look forward to continuing those conversations today and working with you both in the future. remotely for now. and in person when this pandemic is over. of course, in order to end this pandemic and rebuild our nation stronger and fairer, the biden administration needs an all hands on deck as soon as possible, which is why it is so important this committee move quickly to consider and confirm qualified nominees like dr. murthy and dr. levine. we have lost over a half a million people to this pandemic. to say nothing of the countless other ways it has upended the lives of families across our country. we desperately need trusted
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public health experts who can debunk misinformation and rumors, promote public health guidance on mask wearing, social distancing and more and encourage vaccinations and inform people about vaccine safety and efficacy. we desperately need leaders who understand what our communities are going through. and who will go above and beyond to help our states, cities and tribes get the support they need. in other words, we need people like dr. murthy and dr. levine. dr. murthy is a crisis tested leader who is uniquely qualified to help the american people navigate the health challenges ahead of us. i'll say more about his impressive record shortly. but one of the reasons i know dr. murthy is the right pick to serve as surgeon general is because he's already done the job and done it well. during his last tenure as america's doctor, he established himself as a trusted voice on public health issues, saw our nation through public health emergencies like the zika
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epidemic in 2016. he led the charge against the opioid crisis and shined a light on how stress, isolation and other mental health issues threaten america's well being an issue that is all the more urgent given the trauma of this pandemic. in short, he proved why he is exactly the kind of leader we need as surgeon general today. i was proud to vote to confirm him as surgeon general back in 2014. i'm proud to support his nomination to return to that role now and i hopeful my colleagues will join me in working to get him in place quickly. i'm also proud to support the nomination of dr. levine who is a highly qualified and historic choice to serve as assistant secretary for health. i've always said our government should represent the people it serves and the nomination of dr. levine who would make history as the highest ranking openly transgender official in the u.s. government brings us a step closer in making sure that happens. dr. levine is a public health
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expert who has a first-hand understanding of the challenges our states are facing and the support they need. as the highest ranking health official in pennsylvania, dr. levine led the state's covid-19 response and advocated for resources and support pennsylvanians needed. she focused on transparency and clear science-based communication throughout the response. and gave daily briefings on the status of the epidemic. but even before this crisis, dr. levine established herself as a trusted voice to the people of pennsylvania on matters of public health, opioids and life-saving treatment for opiod overdoses available and combat eating disorders, increase health equity and help the lgbtq community get health care. she served the state as
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physician general, a position the republican-led state senate confirmed her to unanimously and then as the state secretary of health, a position she was confirmed to by an overwhelmingly 49 margin. given her clear qualifications and the urgency of this crisis, i hope she will have similar bipartisan support here. because the pandemic isn't the time to focus on politics. we need to focus on getting people reliable information from expert voices that they trust. getting states, tribes and communities the resources and support that they need. getting testing and tracing and vaccinations up and bringing new cases down. we need to focus on providing mental health care as the nation grapples with the trauma of this pandemic. and on eliminating inequiies that existed long before this crisis have grown worse during it and have the pandemic so much more deadly for communities of color. we all know this pandemic is not going to be stopped by bipartisan politics.
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it's going to be stopped by swift action and by public health experts like dr. murthy and dr. levine. i hope we can come together to confirm them in quick, bipartisan fashion and work with them the way families across the country so desperately need us to. finally, i seek unanimous consent to put in the record 29 letters in support of dr. murthy's nomination, 51 letters in support of dr. levine's nomination and from hundreds of hospitals, public health groups and patient advocates and medical schools and universities and clinicians, faith-based and medical organizations, reproductive rights and family planning groups, civil rights groups and so much more. with that, i will recognize ranking member burr for his remarks. >> thank you for the remarks. as the committee reviews the qualifications for two critical public health positions at hhs, the assistant secretary for
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health and the surgeon general. dr. levine, welcome. dr. murthy, welcome, as well. i also want to reinforce the chairman's words that we all seek bipartisan votes on nominees. but that doesn't mean that answers to questions don't have to be sufficient. today is your opportunity for that. each of you have accepted a nomination at an important time and our country is facing one of the most challenging times in our history. i have no doubt that should you be confirmed to these important leadership roles, the majority of your time will be focused on responding to the novel coronavirus and its impact. as assistant secretary of health, dr. levine, you'll be in charge of health issues human research protections and research integrity. as surgeon general, dr. murthy, you'd be responsible for
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providing americans with the best scientific information and overseeing the public health service commission corps, both of which continue to be critical to our pandemic response. the question before us today is, are both of you prepared and qualified to take on the roles and responsibilities required? in addition to the challenges that face us today with the pandemic. this hearing will help answer those questions, but i'm very concerned about a nomination that's not before us today. in fact, it hasn't yet been made by the administration. the assistant secretary of emergency preparedness and response is the stop adviser of the secretary of hhs during public health emergencies. congress created it to serve in a dedicated role that coordinates among all the operating divisions within hhs
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including the assistant secretary of health and the surgeon general. we have been, we have before us nominees for both assistant secretary for health and surgeon general, but not the coordinator. while the words of this administration claim urgency in their response to covid-19 their actions or lack there of speaks otherwise. the law calls for strong leadership during pandemic health emergencies but the nominations before us while important do not fill the role the department charged with leading on emergency response. the administration claimed to be ready on day one and the fact that a nominee for the and about filling the position. quite frankly raises serious questions. across the department to the secretary bringing daily vigilance to the health care needs of the american people so that the secretary can make
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informed decisions both in the midst of public health crisis and in times of preparation for the next threat we will face. we have been grappling with the coronavirus public health emergency for over a year. the new administration has had ample time to choose an individual for this critical role. so it's difficult to understand why the nominee is not sitting here before you. i'll try to understand the roles you will each play at hhs during the covid-19 pandemic and the qualifications and experiences you have to do so. dr. levine, the position of assistant secretary of health evolved during the pandemic under the previous administration playing an
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integral role and dr. grioir worked with nih as they partnered with innovators to develop and scale up testing technologies, helped to address shortages of testing supplies and worked with states to meet its testing needs. dr. levine on the front line in your home state of pennsylvania which faced vaccine rollout to this day. the lab was only able to perform six tests per day in march of last year. six. the response on identifying where the state virus was spreading. along with testing challenges from last spring, your state failed to protect nursing home residents from the virus and making unacceptable mistakes in the vaccine distribution process. pennsylvania ranks as one of the
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most dangerous states for long-term care residents battling covid-19. 52% of pennsylvania covid-19 deaths came from nursing homes. and three in ten of the deadliest facilities in the country were in pennsylvania. your state came in 46 in the country in its effort to put safe guards in place that managed the spread of infections in these settings with only 16% of the state's nursing homes receiving infection control inspections that could have saved residents from the spread of covid-19. you stated you relied on guidance, the tragic high mortality rate in your state's nursing homes shows more was needed but wasn't provided. in my state of north carolina our health secretary relied. in north carolina our nursing home mortality rate while still high account for 36% of the deaths in our state.
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this discrepancy clearly shows that hiding behind federal guidance is no excuse for taking action to protect our most vulnerable. i look forward to understanding exactly why your decisions when relying on the same federal guidelines as my state resulted in a different outcome for pennsylvania seniors. in regards to vaccine rollout your state indicated tens of thousands of pennsylvania residents mistakenly received the second dose of moderna vaccine. meaning second dose that was reserved for those who had a first dose and the second dose went to newly vaccinated people. why you may not have been in office during the last few weeks of the challenges facing your state, you were serving as the state's health secretary during the development and submission of its covid-19 vaccine plan last october and i might note that yesterday in the health
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committee senator marshall put into the record i believe 50 state plans that have been submitted and i think it's important that we understand that you cannot separate your role from the performance of agency a matter of weeks after your departure. i hope you will take those questions on seriously. at each step testing treatment and now vaccination. your state's response has fallen short. as the state's health secretary this track record reflects on you meeting the challenges that would come across your desk immediately should you be confirmed. i'm sure we will find similar problems in all 50 states and similar blame could be leveled on congress. but you're the nominee and i hope you will address those questions as best you can.
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dr. murthy, earlier this week you and i had an opportunity to discuss a range of issues and i'm thankful for that time as i did with dr. levine but the surgeon general will face in this administration. starting with the response to covid. you already served once as the nation's doctor and my friend from kentucky often tells us in the conference not much education comes out of the second kick of a mule. so, i hope to learn more about why you want to do this again should you be confirmed the american people will be placing their trust in you to communicate without political preference or pressure the best ways to keep their families safe during the crisis. i worry about your ability to separate political influence from your ability to communicate health care decisions. in fact, you spoke at the democrat national convention a political event just a few months ago as a co-chair of the transition chair's coronavirus task force, you said the president's goal of 100 million
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vaccinations by 100 days was doable lowering expectations for an accomplishment well within our reach today. before president biden took office, our country was already vaccinating 900,000 people a day and had administered over 20 million shots. i'm in politics. so i know lots of people try to lower expectations in order to look like they're accomplishing something when they're simply showing up. but the surgeon general has to be trusted for the facts. 100 million people in 100 days isn't a stretch goal and you shouldn't be afraid to stand up to the political staff who want you to lower the expectation so the administration can easily reach them. the american people deserve a surgeon general who will separate fact from fiction and level with us on the science. chairman, in conclusion, dr. levine, dr. murthy, the actions
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they have taken prior to your nomination in the process leave me to have some concerns. i hope that you'll use today's hearing to address these concerns to earn my support. the position of assistant secretary of health and surgeon general are important and must be filled. but it is frustrating that the administration chose to prioritize the nomination of candidates for these positions as important as they are instead of the nomination of the leader for federal government's response to pandemics that is required by law. strong leadership will continue to be absolutely necessary throughout this phase of pandemic response and i'll use my time today to get an answer to the questions or the question, who's in charge? chairman murthy, dr. levine's challenges in pennsylvania to bring early adequate testing and keep nursing home residents safe and inability to separate politics from good public health policy is concerning when the
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role still stands vacant. i look forward to hearing their testimony today and plans to provide the direction these two offices need during a challenging time. i thank both of our nominees for being here today. i yield back to the chair. thank you, ranking member, burr. we will now introduce today's witnesses. dr. vivek murthy solidified his recommendation as a trusted health expert. he worked to improve the health of people across the country and across the world. and in doing so has shown beyond a doubt he is the right person to see us through this pandemic as surgeon general. before he was a doctor, before he was a public health expert, dr. murthy was a kid growing up in miami florida, the son of two immigrants from india. he attended harvard university,
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yale for both his m.d. and mba and completed his residency in internal medicine at harvard medical school. his passion for public health was evident even as a freshman in college. that was when he co-founded visions worldwide, an organization focused on hiv/aids education in the u.s. and india. and since then, he has only further demonstrated his ability to lead and his drive to help people stay healthy. he also co-founded the project which empowered women with training to become health care providers in rural india. trial networks, a company that works to improve medical research and collaboration and data sharing. and doctors for america, a group of over 18,000 doctors and medical students that advocate for quality, affordable health care. in 2011, president obama tapped dr. murthy to serve on the advisory group on prevention,
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health promotion and integrated and public health. in 2013 he nominated dr. murthy to be surgeon general. as america's doctor, he saw the nation through the zika epidemic in 2016 and released landmark reports on the opioid crisis and the danger of e-cigarettes and led important discussions about mental health, something the trauma of this pandemic made more urgent. and champion preventable health including a video he did with elmo to help promote vaccines. during this pandemic, he has been an important voice urging people to follow public health guidance and keep themselves and others safe as a key adviser to president biden. he was a critical member of biden's campaign's covid-19 team and served as co-chair of the transition's coronavirus task force. dr. murthy is also the proud father of two children and the husband of dr. alice chen who is
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a physician, as well, and watching with us today. dr. chen, welcome to you. dr. murthy, we are so glad to have you with us today. thank you for being here and now i will turn it over to senator casey to introduce dr. levine. >> thank you, chair murray, for your introduction of dr. murthy. i'm pleased to introduce dr. levine the former secretary of health for pennsylvania and also former professor of pediatrics and psychiatry at penn state university and the immediate past president of the association of state health officials and the nominee to serve, of course, as assistant secretary of health at the department of health and human services. i've known dr. levine for years. thanks to her previous service as both secretary of health, as well as the physician general of pennsylvania. a position that is comparable to that of our other distinguished
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nominee today, dr. murthy. in this terrible time of crisis for our country when we have tragically lost over half a million people to this terrible disease, the need for expert experience and fact-based, as well as compassionate leadership could not be more critical. this is the type of leadership that dr. levine has demonstrated in pennsylvania throughout the pandemic. dr. levine has strong roots in academics, clinical care and protecting the most vulnerable among us. she has a distinguished career practicing pediatric and adolescent medicine in both new york and pennsylvania. serving as director of pediatric ambulatory services and adolescent medicine at penn state hershey medical center and she was the founding director of the division of adolescent medicine and eating disorders.
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she is the author of numerous papers on opioid, adolescents, eating disorders and lgbtq medicine. when covid-19 came to our state, dr. levine's leadership was marked by clear science-based communication at her daily briefings. her early action, her collaborative style and her calm were recognized by the medical community as well as leaders on both sides of the aisle. the covid-19 pandemic response was not dr. levine's first experience with crisis management. she earned the praise of pennsylvanians and the public health community for her comprehensive and strategic approach to address the opioid addiction crisis in our state. she changed addiction medical education and prescribing
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practices and she made the life-saving rescue medicine needed at the time of an overdose, she made it widely available to law enforcement, schools and residents alike. she worked tirelessly to address health disparities, including black maternal mortality obstacles to care faced by the lgbtq community. dr. levine has dedicated her career to children and young adults addressing physical, mental and social care needs. as pennsylvania secretary of health, she brought that approach to all residents, including our seniors and long-term care residents. as further evidence of her effectiveness and style of leadership, i would note that dr. levine was confirmed three times, three times to her prior positions in state government by
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pennsylvania's republican majority state senate. i'm grateful for her willingness to continue her distinguished career in public service and i look forward to working with her in the role that i know she will be confirmed as assistant secretary of health at the department of health and human services. thank you, chair murray. >> thank you so much, senator casey. dr. murthy, dr. levine. we're looking forward to hearing from both of you now. dr. murthy, you will begin with your testimony. >> thank you so much, chair murray. chair murray, ranking member burr, distinguished members of the committee, i am deeply honored and incredibly grateful for the opportunity to appear before you today. i would like to first introduce my wife and my best friend, dr. alice chen who is sitting behind me. it is her love and support that has brightened each day of my
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life since we first met more than a decade ago. and while they weren't able to be here in person, i am thinking today about the rest of my family who is watching from afar. my children 4 and shanti who is 3 and my grandmother and my sister rashmi and especially my parents lakshmi and maithreya. they are few contacts or resources but they had high hopes that america would be a place where their children would find education and opportunity. they set up a small medical practice in miami and as a child i watched them make house calls in the middle of the night and wake up early to visit patients in the hospital before heading in to their office. they attended birthdays, weddings and funal are funerals patients always there in the moments that mattered because
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they saw their patients as family and that's what you do for family. i try to live by the lessons and we have an obligation to alleviate suffering wherever we find it and to give back to this country that made our lives, my life and the lives of my children possible. this is a moment of tremendous suffering for our nation. more than half a million people have lost their lives to covid-19, including beloved members of my own family. many more are facing long-term health consequences and stressful financial struggles. if confirmed as surgeon general, my highest priority will help end this pandemic. in the work i've done over the past year with government leaders and schools and businesses and health care providers, i've seen the importance of providing clear, science-based guidance to americans on how to protect themselves and others.
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and i know how urgent it is that we communicate clearly about the safety and effectiveness of vaccines and get them to people as quickly as possible. particularly those in underserved rural communities and communities of color. but as we address covid-19, we cannot neglect the other public health crises that have been exacerbated by this pandemic. the opioid epidemic and racial and health inequities. i have witnessed how they're destroying lives and devastating families all across america. during my prior service as surgeon general, i listened to and learned from people in rural communities in oklahoma and in alaska and in big cities, including indianapolis, new orleans and charlotte. their stories are what led me to issue the first surgeon general's report on alcohol, drugs and health and to launch a national education campaign on
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opioids and safe prescribing. we have so much more to do and if confirmed i will work tirelessly to address these crises. i will do so guided always by the very best science. and i will work with secretary designated bessra equally as important, though, i will always work closely with community partners for faith leaders and businesses to doctors, nurses and educators. i would also welcome, once again, the chance to work hand in hand with congressional leaders on both sides of the aisle as i was privileged to do in the past as we together addressed the opioid epidemic, zika virus and other public health challenges and would be honored, deeply honored to lead the united states commission corps which for more than a century has helped our nation respond to public health threats
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including covid-19. senators, i know that the challenges before us are daunting, but if confirmed, i will never forget that at its essence, the role of the surgeon general is that of a doctor. one charged with serving every single american. i learned as a doctor to approach each patient with both head and heart, with science and compassion recognizing that both have the power to heal. i learned to respect the uniqueness of each patient, recognizing that solutions must be tailored to each individual. and i learned to listen deeply to the patient in front of me. to look beyond any labels. and to see that person in their fullest humanity knowing they were someone's mother, father, grandparent, child, sibling and friend. the most important job of a doctor is to help patients heal. if confirmed, that will be my mission as surgeon general. to do whatever i can for as long as i can to help our communities
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and our nation heal. thank you so much for your consideration of my nomination and i'll look forward to your questions. >> thank you very much, dr. murthy. we will now turn to dr. levine for your testimony. >> chairwoman murray, ranking member burr, distinguished members of the committee, thank you for the opportunity to appear before you today. >> can we make sure her mic is on. thank you. >> i am honored to be president biden's nominee to serve as the assistant secretary for health at the department of health and human services. if i am fortunate enough to be confirmed, i look forward to working with dr. becerra, dr. murthy and with each of you in service to our country. my career has been helping people live healthy lives. as the assistant secretary for health, i would be committed
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each day to helping the people of our nation and improving our public health. i am both humbled by the opportunity and ready for the job. as you know well, we each come to public service in our own unique way. in my case, i was a physician for many years specializing in pediatric and adolescent medicine and managing educational and departmental responsibilities at a major academic hospital system. throughout my medical career, i have been particularly invested in health issues that are at behavior and physical health and i brought that expertise to public health in addressing substance use disorders. after receiving my education at harvard college and the tulane school of medicine, i trained that mt. sinai medical center in new york city. i practiced pediatric and adolescent in lennox hill hospitals. and then i moved to pennsylvania and worked at the penn state
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hershey medical center. at penn state, i initiated a division of adolescent medicine for the care of complex teens with medical and psychological problems and in addition i started the penn state hershey eating disorders program which offers multidisciplinary treatment for adolescents and adults with eating disorders. when i left penn state hershey in 2015 i was professor of pediatrics and psychiatry and the chief of the division of adolescent medicine and eating disorders. in 2015, i was named by governor tom wolf to be the physician general for the commonwealth of pennsylvania and confirmed unanimously to the post by the state senate. i was confirmed twice more on a bipartisan basis to be secretary of health. in both roles, i concentrated on addressing the opioid misuse and overdose crisis in our state. working in partnership with the federal department of health and human services on these efforts.
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we focused on opioid stewardship meaning the safe, appropriate and responsible prescribing of opioids and taught those practices to medical students and continuing medical education programs and we established prescribing guidelines, as well as a robust prescription drug monitoring program as part of our efforts. one of my most significant accomplishments as physician general was signing the first ever statewide standing order for the distribution of the life-saving medicine. this enabled emergency medical personnel to treat overdoses and the public to readily access the medication saving thousands of lives as a result. as secretary of health through the pennsylvania rural health model, we worked to save rural hospitals by transitioning them from fee for service to global budget payments. this model aligned incentives for providers to deliver
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value-based care and for rural hospitals to transform their care to better meet community health needs. in addition, we established a maternal mortality review committee to better understand and respond to the causes of maternal deaths and we worked to improve childhood immunization rates as well as other priorities. of course, our focus changed dramatically last year and covid-19 became my most urgent and primary focus. we concentrated on three priorities to combat covid-19. containment with expansion of testing and contact tracing. mitigation with masks and social distancing. and medical countermeasures such as the distribution of medications and, of course, authorized vaccines. as part of these efforts, we created a health equity task force which included many community stakeholders such as the pittsburgh-based against covid-19 and the latino connection. we also launched a faith-based testing strategy where people
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could get tested at their places of worship. there is still so much more to do. if confirmed, i will continue focusing on these issues at hhs to work to get the pandemic under control. i look forward to driving efforts and oversight within the office of the assistant secretary for health that will bolster the health of our nation. i look forward to your consideration and i humbly ask for your support. i look forward to your questions. >> thank you very much to both of you. we will begin a round of five-minute questions and i ask my colleagues to keep track of your clock and stay within those five minutes. i am happy to stay if any of you have additional questions for a second round. the united states is in the midst of the worst pandemic we have ever seen in over a century and the previous administration's response to this pandemic was marked by the rejection of science, dissemination of misinformation and the erosion of trust in our
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scientific agencies. as we mark over half a million people dead in this country, it goes without saying the toll has been profound. under president biden's leadership, we now have a science-led coordinated national response. in the past month, we've already seen in significant increases in testing and tracing and vaccination and we've seen downward trends in the number of new cases, hospitalizations and deaths. but there is a lot of work ahead to keep families safe, get everybody vaccinated and fight misinformation with reliable public health guidance. and we need to address troubling reports about people choosing not to get vaccinated by having trusted public health experts and trusted partners communicating with the american public about these issues. dr. murthy, one of the important roles of surgeon general is being a clear and prominent voice on the importance of science. if confirmed in this role, how
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will you promote confidence in our scientific agencies and in covid-19 vaccines? >> well, thank you, chair murray, for that question. i think it's absolutely for sure that the essential job of the surgeon general has to be to communicate in a way that is driven by science. and one of the great challenges during this past pandemic that is ongoing is that we responded to the virus while we also had to learn about the virus. as our knowledge has changed, it hasn't always been easy to communicate clearly with the public about those changes. my goal if i was confirmed to serve, senator, would be, number one, to first and foremost work with the cdc with the nih and other scientific inteties in government to make sure we're clear on what the science says to go out to where people are and communicate that information clearly, including communicating why we change our
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recommendations if we do make changes. but i think perhaps most importantly, senator, i think public education actually starts not with speaking, but with listening. and i think that as i can say this for myself and perhaps for all the roles that i've played that i have learned far more by by listening that i sought to serve by reading textbooks. understanding their needs and how they interpret information can help us do better as public servants and public educators and that would be the approach i would seek to take if i had that privilege of serving. >> thank you. dr. levine, in your role as pennsylvania secretary of health, you worked closely with experts throughout the state on your covid-19 response. how will that experience inform your efforts to work with state, local and tribal public health and community leaders if you are confirmed as assistant secretary? >> well, senator, thank you so much for that question. i certainly, if confirmed to this position, look forward to
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working with the administration, the cdc, health and human services on president biden's strategic response to the covid-19 pandemic. i feel that i have a unique perspective on the covid-19 pandemic working as a state health official in pennsylvania. in addition to my work as the president of the association of state and territory health officials, i know first hand the importance of the collaboration and coordination between federal public health officials, state public health officials and local public health officials. if confirmed, i look forward to working with the biden administration and others on coordinating our response. >> thank you. the covid-19 pandemic has really been a painful reminder that deep health inequities remain entrenched in our society, driven by structural racism, discrimination and bias. from the beginning this pandemic has taken a disproportionately
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deadly toll on people of color which is entirely unacceptable. in addition to centering equity in our covid-19 response, we have to commit our selves to the hard work of building a more equitable health care system. all people, including families of color, people from low-income backgrounds, underserved areas, lgbtq people, people with disabilities and others need to be able to get high-quality, affordable care. i am out of time, but dr. murthy and dr. levine, i know that is a priority we share. we talked about and i want you to know i look forward to working together to make sure health equity is incorporated in the covid-19 response and all of hhs' public health. thank you again for being here. i will have more questions in the second round but i'll turn it over to senator burr for his questions. >> thank you, madam chairwoman. dr. levine, your state continues to struggle with covid-19 response. how can you assure that the same
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challenges that pennsylvania experienced in testing nursing home care and now vaccinations will not occur when given the opportunity to serve in the public health policy area? >> well, senator, thank you for that question and the opportunity to respond. in pennsylvania, we did work to have a scientific, evidence-based response to covid-19. there were significant challenges, this is a novel coronavirus and especially in the spring, we had challenges with testing. we had challenges with contact tracing, et cetera. we had lack of personal protective equipment as most other states did that were impacted in the spring. i think that the nation's response has improved significantly and under president biden's leadership and his strategic plan and task force, if confirmed, i look forward to my role in the nation's response. i look forward as i mention to collaborating with local, state,
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as well as federal officials and working on that coordination and communication. >> over the past few years, the national institute of health has been investigating cases involving nih supported researchers who have failed to disclose support from foreign governments and other entities who have diverted intellectual property through grant applications and other nih-funded projects or who have sought to influence or undermine the peer review process. the office of assistant secretary for health oversees the office of research integ integrity. if confirmed, how will you seek foreign to influence u.s. research? >> thank you for that question. if i am fortunate enough to be confirmed and oversee the office of research integrity, i certainly commit to working with you, to working with congress, with other experts at health and human services and nih to make
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sure that research standards are of the highest quality and that there is no interference in research in the united states. >> dr. murthy, vaccine hesitancy is not limited to covid. the 2019 measles outbreak, there were 1,282 cases reported in 31 states. and it shows vaccine hesitancy is a growing problem for other conditions, as well. given your previous participation in politics and controversial policy debates, will you be able to effectively communicate the safety and efficacy of vaccines to those americans who may not agree with your policy or your political views? >> well, thank you, senator, for that question. senator, i approach issues like vaccines and all public health issues first and foremost as a doctor.
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i was taught in medical school that it doesn't matter what someone's background is, doesn't matter what their race and ethnicity is, doesn't matter certainly what their political affiliation is. each person is a human life that has unique value and we have to treat them with dignity and respect. and that's how i approached my job when i had the privilege of serving last time, senator. with regard to the measles outbreak, my approach then in talking about vaccines was to start by listening to what people's concerns were. not to demonize them for their stance but to understand what their concerns are. second, it's to bring the best of science so that people can understand what the data actually tells us about these vaccines. what we know and to be honest about what we don't know. lastly, sir, i believe it's important to also recognize that the surgeon general is an important messenger but not just directly in speaking to the american people but engaging with partners and faith leaders and doctors and nurses in local communities and that convening role is also important as
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surgeon general. it's what i used certainly when i was building a national opioid campaign to work on changing prescribing practices and that is what i would incorporate if i was working on a vaccine strategy today. >> throughout the last year the surgeon general frequently communicate would the american people the best ways to keep families safe and healthy during a difficult time. how do you think the role of surgeon general differs today from when you previously held that role? >> well, senator, it's a great question. and i think it's especially important because i think the country is evolving and it's changing and people's needs are evolving and the surgeon general's role has to evolve accordingly. you know, there are some things that are similar to when i served last time, some things that are different. i think, you know, we have ongoing concerns around vaccine hesitancy but i think that they
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are more complex and nuance now than they were pre-pandemic. i think that the fragmentation and how people get their information is even greater now than it was seven years ago. with people not just getting their information from a couple of sources or a couple social media platforms but a wide variety of sources. to me that increases the importance of us engaging with local partners who can speak to and access people where they are. as opposed to solely trying to as individuals in government get on a few platforms or news sources and assume that we're going to reach everyone. so, that partnership strategy, the convening role of the surgeon general is even more important now than it was when i served the last time. >> thank you for that. thank you, chairman murray. >> thank you, senator burr. senator casey. >> chair murray, thank you very much. i have a question for dr. levine and one for dr. murthy. i'll start with dr. levine. two issues relating to children. one is mental health and the
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other is child abuse. one in five children before the pandemic suffered from mental health issues and rates of anxiety and depression doubled since the pandemic. it's hard to comprehend the scale of to comprehend the scale of it. 30% of emergency room vats. that is mental health. then we go to the american scourge of child abuse. child abuse is on the rise, we know that, and without the cannot provided through in-person school, more cases are going undetected. with all of these terrible
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stressors that are burdening our children it's more important than ever to focus on children's health and behaviorial health needs. can we be assured that these issues will be priority for you if you're confirmed to this position at hhs. >> senator, thank you very much for this question and i would like to thank you so much, you and very staff, for all of your work on these very important issues. i am a pediatrician in my original field and i still have a love for children and adolescence and i will do everything i can to work for the betterment of children in the country. mental health has been really an intersection between medical issues and mental health issues as a basis for my career. i look forward to bringing that
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experience that i have in academic medicine and the pends dptt of health to my role if i'm confirmed. and i would like to look forward to working with you in your office and your staffs since i know that you have done a lot of work in this area. >> thank you, i have a question for you based on your work combatting vaccine he he has t si. you have worked with others on these goals and even partnered with elmo on sesame street. you collaborated with dr. smith
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who is now leading the covid-19 ek quit si task force to reduce disparities related to the pandemic and ensure allocations to the resources including the vaccine. we're now fortunate enough to see a light at the end of this terrible dark tunnel. if we have all of the information that we need and trust so that more of us will take the vaccine, if that happens in greater numbers we'll all be in better shame. how will you use your leadership on the full force of public health service to address the issue of vaccine he is ten si so the people of our country can establish the trust they need to take the vaccine? >> thank you for raising this
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issue. we have seen concerning rates of vaccine he is ten si and what i would seek to do is seek to understand grektly by listening to people, showing up where they are, what is driving their concerns, and i think it is different. we have to understand what people's concerns are, and we have to bring the best of science to address those questions the best that we can. i also think that but have to do this in past experiences. one has to approach the approach with humility and recognize there is a lot that we don't understand. people on the ground, doctors, nurses, they often know more about what their families need. we need to listen with them welcome work with them, and together i believe we can reduce
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rates of vaccine he is ten si. >> thank you, chairman. >> thank you, senator paul? >> genital mutilation has been universally condemned. the united nations children's fund and population fund, according to the who it is recognized internationally as a violation of human rights. it is considered particularly egregious because it is nearly always carried out on minors and children. it is typically not performed by force, but by social convention, social norm, the social pressure to conform and do what others do and have been doing. american culture is down
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normalizing the idea that minors can be given hormones. dr. levine, you have supported them being given hormone blockers and also surgical reconstruction of a child's genitalia. the american college of pediatricians reports that 80% to 95% of pre puberty children with gender disforya will experience resolution by late adolescence if not exposed to medical intervention and social affirmation. do you believe minors are capable of making such a life changing decision of changing one's sex. >> thank you for your interest in this question. transgender medicine is a very complex and nuanced field with
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robust research and standards of care that have been developed. if i'm fortunate enough to be confirmed i will look forward to working with you and your office and coming to your office to discuss the particulars of the standards of care for transgender medicine. >> the question was about minors. do you agree to giving minors hormone blockers and reconstruction of genitalia. you would just go through this and allow that to happen to a minor? i would hope that you would have compassion for kira bell, a 23-year-old girl who was confused with her identity. at 14 she ran something about
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transsexuals. but now ultimately this is what she says now. this is very insightful from someone that made a mistake. i made a brash decision as a teenager when a lot of teenagers do. trying to find confidence and happiness. now the rest of my life will be negatively affected adding that the medicalized gender transitioning was a temporary superficial. i'm alarmed that you're not saying they should be prevented from making decisions to amputate their breasts or genitalia. we have always said that minors do not have full rights.
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will you make a more firm decision on whether or not minors should be involved in these decisions? >> transgender medicine is a very complex and nuanced field and if confirmed to the position of assistant secretary of health i would certain i will be pleased to come to your office and talk with you and your staff about the standards of care and the complexity of the field. >> let it go into the record that the witness refused to answer the question. should minors make these decisions for most of the history of medicine we would not let a cut get sewn up in the er. you give a woman testosterone. none of these drugs have been approved for this. they're being used off label.
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the left that went crazy over drugs for malaria being used for covid. there is dozens of people that regret that this happened. if you have been around children 14-year-olds cannot make this decision. in england 10% of the kids are between 3 and 10. we should be outrage that someone is talking to a 3-year-old about changing their sex. >> thank you for answering the question. i will turn to senator baldwin. >> thank you chair murray. and i want to welcome the doctors to the committee.
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it's good to see both of you again. i want to turn our attention, perhaps not turn our attention, we have sort of been speaking about this already, but to the issue of health disparities that i know both of you have worked on, worked to address throughout your careers. back when i served on the energy and commerce committee we had a seize of hearings on health disparities. these hearings were shocking and perhaps part of the early stages of us as a congress trying to tackle healthispariies that exist. we would have a panel of expert witnesses talking about the health disparities that exist,
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talking about possible ways to diminish these disparities, and i would often ask this panel of government experts or academic experts what can you tell me about health disparities affecting the lbgtq community. the response that i would often get is stammering and muttering and we'll have to get back to you. the institute of medicine did a very profound study on gaps in knowledge and a set of recommendations for how to close the gaps in our knowledge about health december parties impacting the lbgtq community. based on your experience as a state health official, what should the federal government do to support state and other efforts to better prioritize and address the health needs of people in the lbgtq community?
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>> well senator baldwin, thank you for your question. really to all health issues. covid-19 has showns a challenge in health care disparities that we see in our nation. we have had an annual lbgtq assessment that gave us very important data. and i think this brings up the point of the importance of data. it is critically important that we include questions about this, that would include studies by health and human services and
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the cdc. it is a big issue for members on this committee. unfortunately the on going pandemic has exacerbated challenges. i'm deeply concerned about reports of data. as a surgeon general and assistant secretary for health,
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what would you prioritize in response to the substance use disorder to make up for lost time and ground of the last year. >> thank you for this question. it is very, very important. the crisis has been with us for a number of years and it has worsened during the covid-19 pandemic. in spenz i look forward to working with dr. murphy and other experts on making sure we fully address the opioid crisis. >> thank you.
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the issue is near and dear to my heart. i focussed on it a lot as surgeon general last time. we struggled with issues related to opioids. on the report that i issued i laid out a number of steps we could take with the larger crisis of addiction. but i still feel there is important work that we have to do given what you said. i think we still have more on what we can do to expand access to stream making it, and making is easier for them to prescribe
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when they feel it is needed we detailed in the report a number of programs they provide an extraordinary number of investment. i think a lot of those programs are still not well known, their under invested and it help save lives. >> thank you, doctor, we had a very good discussion prior to this hearing. it is a host to issues and the need to get children back to school and to the opioid crisis
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that senator just touched up on. i want to read to you a daytime that was made in an op-ed that appear recently by some public health experts. they said at some point we have to recognize the consequences of keeping millions out of school for a year and treat this like the national emergency that it is. and i could not agree more with that statement, about half of the k-12 students are out of school as we meat today. studs are showing that they're falling behind academically. we have seen an increase in
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suicides and mental health problems due to isolation. social development is being set back. there are very real consequences of children not being in schools not to mention the extraordinary stress it is places on many parents. in this op-ed public health experts suggested that three feet of distancing from student to student while keeping adults six feet from everyone else would be sufficient to allow many classrooms to reopen. similarly the american academy of pediatrics, and i know you're a fellow of the academy said that they should weigh the evidence of strict adherence to
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the six-foot spacing high school with the potential downside if we mote learning is the only alternative. i would like to ask you very specifically what you will do to help us get our children back to school and whether or not you think there are ways to safely accommodate, including looking at this recommendation for only three feet of spacing, which is a major obstacle now. >> senator, thank you very much for your question and i very much enjoyed our conversation the other day about this and other issues. i think everyone agrees that we need to do everything that we can to have children safely go back into the classroom and that it is very, very important. a number of weeks ago we put out united states -- guidance and
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this is a local issue. it was only the decision of the superintendents and schoolboards about whether or not their learning would be remote, hybrid, or in person. i have had the opportunity to read the articles that you mentioned and review the mention academy of pediatrics statements and i found them very interesting. if i'm fortunate enough to be confirmed to this position, i would very much like to work with others in health and human services at the cdc, and work really closely at this issue. >> thank you, there is a diversity of views of how we can safely open schools and we're really seeing the downside of not having them home. we also talked about covid and nursing homes. and you assured many that they
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accurately reported, but i'm told that in september of 2020, there was a report of issues about inadequate disclosure of cases and deaths in nursing homes. for instance, some were listed as having no data in the data. one provider that operates said they did respond with information. do you still stand behind your statement that the data was accurately reported. i do stand behind my statement. we were cleatly transparent as
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we were in other data that we reported. there is a lag time from the time that a tragic death would occur to the time that it hits our electronic death reporting system, and then we report that death and that lag time can be days or weeks. it would not have hit our system for several weeks later. and that lag time explains the spotlight pa report. >> thank you. >> thank you, and congratulations to the nominees. i think the u.s. we response to covid-19 will go down in history
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as the worst failure in governance in the history of the united states. i feel very emotional as i say those words. there have been some failures on foreign policy issues that have been notable ones, but in the sense of domestic governance i cannot think of a worse one. spanish flu, 675,000 americans died. civil war, 620,000 americans died over the course of the world, we're north of 500,000 and climbing, more deaths than entire world war ii, for example. so many of these deaths were unnecessary if you measure the united states against the experience of other nations. and set aside nations that are communist nations that have a command and control over citizens that a democracy doesn't. but just use democratic nations, our peers, the oecd, the g 7, and look at their experiences.
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if you want to just average them together and say if we had done what they had done, it's hundreds of thousands of fewer deaths. dr. fauci said no nation handled this worse than us. and we're a nation with the best health care institutions in the world, the best health care providers in the world, and an industrial base that when pressed did an amazing job of producing multiple vaccines that work. we had health care providers on the front lines that have been unbelievably heroic. you have virginia guards men and women and those from other banks doing testing, food banks, vaccinations, so many people to be proud of. how did a nation like this, like the united states, lead the world in deaths at such an
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untold scale. it perpetrated a lie. the president with the biggest microphone in the world. and the cdc deciding not to use the w.h.o. testing protocol, and developing their own faulty testing protocol. i'm very emotional about this. i know nine people who have died of covid. last time i checked the entire nation, across the water from china where the virus originated. i think if we're not willing to acknowledge that look in the
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mirror we won't be prepared for the next thing. one of the things that i'm excited about is you have a track record to help us prepare for the next one. i have colleagues interested in doing in 9/11 commission. we need a commission that will analyze why the u.s. got the pandemic wrong. senator collins, you had a bipartisan bill to do that and that should be a pressing need for us to analyze what went wrong in the pandemic because there will be another one. and when there is another one we have to show that we're wider and able to deal with it. i was worried at the beginning of the biden rollout of a covid response team that i didn't see enough people that i thought had state level experience. i love doctors, academics, but i
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really love the implementers. what happens is in a situation like this is everything that we do have to survive the reality and be implemented at a state level or in a city. talk about your state level and what to do so it doesn't fall down as badly as it did in the last year. >> thank you for your question. for your passion about this subject, and for health. it has been the biggest public health crisis that the country has seen in 102 years. it took an enormous toll on our country with over 500,000 deaths. each death is a tranl i did as you have within pointing out. i think that this pandemic has shown the importance of public health like nothing else possibly could.
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that includes local public health, state public health, and federal public health. and the collaboration and coordination between all of the different aspects of public health. you are correct as the secretary of health in pennsylvania under the government's leadership, the containment, the distribution of medical counter measures. medications, and more in the vaccine. if confirmed to this position i would like to take that experience in organizationalizing the strategy at the state and local level. and i hope to make my contribution that time. >> thank you for indulging me. >> thank you, we will turn it over to senator cassidy. >> thank you, i could ask either
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of you my questions, but i will start with you, dr. murthy. health equity is something that we must all be concerned about. i spent 25 years caring for patients in a hospital in the poor and uninsured. that said when i hear some people speak about it, it sounds like something to stoke resentment, as if any health inequity must reflect injustice. i just want to explore this because i think it is important. are there biologic reasons. the older someone is when they get it the more likely they die. up to, and over 85, you really
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have a high death rate. could you suggest some of the other core morbidities and medical conditions that if they're present could part of increased morbidity and covid infection? >> senator cassidy, thank you for that question and it is good to see you today. i enjoyed our conversation a few weeks ago. i think you're right that the origins of the disparities that we see in health are complicated. and with covid in particular why some communities are experiencing worse than others. some of that we understand but we're still learning about that. it's a complex product i believe of the environment, of biology, pre-existing structural equities -- >> but what are some, i have limited time. what are specifically some of the medical core morbidity.
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if we don't make the diagnosis we're doomed to fail for the treatment. so i'm exploring if you thought about this, which i'm sure you have, but could you be a little more pointed to answer my question. >> fortunately the cdc noted a number of conditions that do increase the risk of poor outcomes. cardiac disease is another. we know that some pre-existing lung conditions can do the same. >> thank you, again i'm sorry i have limited time. >> are these medical conditions generally distributed through the population or are they more likely to occur in some groups of americans as opposed to other groups? >> they're more likely -- >> socioeconomic or however? >> they are not evenly distributed, they are
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disproportionately distributed. >> so if a group with higher rates of core morbidity have different outcomes, it may not inequality, it may be just more instances of obesity. to the degree that it is not true would negatively affect our ability to effectively address. is that a fair statement? >> i think you're correct that we have to look clearly at the data and understand what it is telling us. i think that this is where i think science has to lead us as we make the diagnosis as you put it and as we formulate solutions for how to address the outcomes that we see. >> i agree with that. so if we are going to talk about health inequity it's important to not just stoke resentment,
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but to acknowledge that there is a buy logic basis for why some people do worse than others, like someone is older, and recognize that, frankly, as how we can address that. in order to have the appropriate treatment. so let me ask you both,ly ask this of dr. levine. if it is hyper tension, heart disease, is it fair to say that the federal government should be doing more to address the epidemic of obesity? >> thank you for that question and bringing up the issue of health equity and health disparities. in terms of your specific question we certainly need to concentrate on the prevention and treatment of obesity. i think that when looking at
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covid-19 health care dispariies we have to look at the social determinents of health. >> i agree with that. we do need to look at social determinents of health, but if they're obese, hypertension, diabetes, are you telling me the social determinents would overwhelm those medical risk factors, or are the risk factors more important. >> i think they're all important. >> that's not what i'm asking. i'm asking to rank them, please. i don't mean to be rude but i'm out of time. how do you rank them? >> i don't think it's possible to rank them, sir, i think they're all involved. >> thank you, dr. levine. >> thank you, senator cassidy. >> before i turn it over no senator murphy, i appreciated
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your thoughtful and medically informed response to senator paul's questions earlier in the hearing. it is very critical to me that our nominees be treated with expect and that we focus on on their qualifications. and i will focus on that as chairman of this committee. so thank you again for that response. >> thank you very much. madame chair. let me associate myself with your remarkets, thank you for your way in which you handled those questions. really looking forward to working with you dr. levine. i have two sets of questions for both of you, one for each, excuse me. doctor murthy, i wanted to talk once again about the issue of of vaccine distribution. i know there was conversation
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about hesitancy earlier. and i received a significant amount of push back from folks around the table when it came up about hesitancy. they thought it was an effort to blame communities of color for a problem that has potentially been created through the design of the system. you disadvantage that work two or three jobs with a first-come, first-serve system. i heard a lot about lack of information that when you don't listen to people about where they get information, that you end up with broad sectors of the population not having the basic
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information. i want to make sure that we're building systems that are meeting people where they are rather than just looking at these numbers where, in connecticut we have, you know, incredibly low rates of african-americans and latinos taking the vaccine saying that's because the populations don't want it, or we have to convince them why it is important. i think the design just makes it harder for communities of color, low income communities, to be able to access it. how do you respond to that critique? >> well, senator, it is good to see you. thank you for that question. look, i think that you're highlighting a critical issue here is that vaccine hesitancy is complex and not solely experienced by members of racial
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minority groups, but there are many that are concerned, but the distribution, the disparities that we have seen with vaccine distribution are related to pre-existing structural challenges. one of them is a lack of access to health care. and if we want to, not only with covid, but with future pandemics, have a system that can respond well we have to ensure that we have community health centers. and this is why they're such a powerful part of our health care apparatus. we have to be able to quickly stand up and we have to establish that we are having vaccine centers in location that's are hard for people to access vaccines. >> thank you, i appreciate that.
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i think so much of our conversation on this subject is around this question of he has hesitancies. we have been pushing hard to have specific money set aside in the covid package for summer programming. and summer programming for kids that is centered on their emotional well-being. i, as a parent of two school-aged
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back to normal in the fall. >> senator, thank you for this question. i particularly enjoyed our discussion about this a number of days ago. certainly the mental health needs of our children in the country right now are at the forefront. pediatric medicine has been part of my career. i think it has exacerbated those mental health issues and mental health needs. i was really quite taken by your idea in terms of summer programming and if i'm confirmed to this position i would very much look forward to meeting with you again and your staff and working on this issue and see what question do to actualize it. >> thank you very much to both of you for your willingness to continue your service to the
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country. thank you madame chair. >> thank you. i believe that senator marshall is next. >> thank you, i appreciate the time. good to meet you in personal as well. appreciate your time with the caucus fur years ago. i will let you both answer the question. we talk about the goal of the current administration is 100 million vaccinations in 100 days. we should be able to be doing two or three million vaccinations a day. we had the infrastructure, as you all know, to do three million flu vaccinations per day. you have goals and is it feasible, but i would think that we could do. get us up to 150 million people
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vaccinated by the end of march. i think that 25% or 50% of the people have had the virus already. and my theory is that we could have heard immunity by april or may. is that possible? is it feasible? what type of advice would you offer to the president and the team that is working on this. maybe like a 30 second answer, dr. murthy, what is your advice as the potential surgeon general. >> thank you, senator, good to see you again as well. i love the spirit of what you're asking which is how can we do better, be faster. what i would seek to do iswork work with the administration. one of the reasons we have the ability to distribute so much flu vaccine is to develop the vaccine providers.
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-- >> why are we reinventing the wheels. doctor's offices, vaccinations, why do we need to reinvent the wheel. let's get the vaccines in their hands. >> i think especially with the johnson and johnson vaccine potentially coming on it would be easier to store for patients arms. >>. >> senator, thank you for that question. certainly we need do everything we can to cramp up the vaccination program. i think the president has an excellent strategy and be able to accomplish that. they are having vaccines go to pharmacies and to fill qualified centers. also the issues that we were discussing before to make sure we target vulnerable populations
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like the african-american community. >> of course, with the new big news, the vaccines that we're using already, it is 75% or 85% effective. what type of advice would you offer. as opposed to getting that second shot. >> i think that because of the way the trials are done i think that is the foundation we should use, and it could be a delayed second dose model. if it holds up, you can sustain protection, and i think that is a model that we should examine. we have to collect the data, keep the knowledge -- >> i would agree, i think that we need to stick to the two dose
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model now. that's how the studies are done, but study other models to see if they'll be effective. >> you said we're going to follow the science and it says one shot is 80% effective. why wouldn't you try to get more shots into more people's arms, still prioritizing people age 65, but why wouldn't you follow that science? >> right now the fda approval recommends two doses. i think that we need to look at the study, but i also share everyone's enthusiasm about the johnson and johnson -- >> so you think following the fda guidelines is a good idea? last question on kids in school. i want to know about what your opinion is. you follow the science. kids can go back in school, what is your opinion? should kids be back in school now?
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i am interested in the american academy of pediatrics that you're referring to. i look forward to collaborating -- >> but you don't have a recommendation? is that your goal? you think kids should be in school now? is there not enough science to say they should be school yet? >> i think we all want children in school in a safe way. >> is there enough science to say they should be in school now? >> senator, i think we have a growing amount of data that tells us how to get kids back in school safely. if they're masked, distanced, then we can do a pretty good job of reducing transmission in school and on top of that if we can get teachers vaccinated and testing in schools, that can further reduce the risk. >> i want to thank all of the teachers that are in school that are out there. we're focusing on the ones that aren't, but i'm so grateful for
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the teachers out there on front line teaching, and we want to do what we can do to empower them to get our kids back in school. thank you, i yield back. >> thank you very much, we will go to senator smith. >> thank you, thank you so much to dr. levine and dr. murthy for being here and your willingness to engage in public service in this way which is so important to our country right now. as senator cain said so powerfully we're in the midst of a tragic loss of life and a pandemic that upended out of economic, health, and sense of well-being. i know that you both understand this so i'm just doubly grateful for your willingness to serve in this way. i'm always reminded that something a minnesota farmer said to me earlier next year. he said when it comes to covid-19 we're all in the same storm, but we're not all in the same boat. i think this gets at the ways in
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which covid magnified the inequities that existed in our society. so i'm so grateful for your willingness to serve. i also want to say that i appreciate the dignity and the professionalism in your response to senator paul. this is a moment when we should focus on the brave challenges before us and one of these channels is that lgbtq plus people long faced discrimination and barriers to health care, and they're much more likely to lack access to insurance and affordable medical care. we need advocates at all levels to make sure that we address that inequity and that we fight discrimination and ensure that everybody, all patients, have access to care.
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especially amid this crisis that revealed so many inequities. so i wanted to thank you. >> dr. murthy, when you and i spoke we had a great conversation about the listening tour that you did when you were surgeon general the first time. and you talked about how you went out and expected to hear people's health concerns and you discovered a theme of americans feeling lonely and isolated. we talked a little bit about a broad based social isolation that is happening right now amongst older adults, amongst kids that are not able to be in school. we know about the direct isolation that it can have on people's health. it's not just about being
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lonely, it's about the direct impact on people's long-term health outcomes. so dr. murthy, could you talk more about this and maybe say a bit about how you expect to continue to work on the issue of social isolation, and what we can do in congress to help and how we can incorporate some of these ideas into our thinking about health care? >> senator, thank you so much for that question and i really enjoyed our conversation on that topic of isolation and loneliness as well. this is one of the unexpected things for me that came up during my service. as surgeon general, i expected when i began my listening tour to understand what was on the minds of americans everywhere. that i would hear about things like obesity, substance abuse, sdpregs, depression, and anxiety.
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but i heard stories of loneliness and not just from elderly, but college students, teachers, doctors, nurses. they struggled with loneliness and it resonated with me because i saw loneliness in patients that would come in by themselves and even in moments of extraordinarily difficult hard decisions about treatment we would have to have that conversation alone with them because they had no one to come be part of the conversation. i also experienced a lot of loneliness as a child. it is raw and present in my mind. what was concerning to me with the health consequences is the fact that the increasing body of data showing loneliness is associated with premature death and heart disease and other conditions like depression and anxiety there is a lot that we can do.
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starting with communities. faith organizations, other community organizations have a powerful role they can play in helping to stitch together the fabric of a more connected society. clinicians can also surface issues like loneliness, and people struggle with them and they don't feel comfortable talking about them. and government has a helpful role to play, too. when government choses to name an issue as important, when it convenes people to come together and build an issue, it can have a powerful effect on moving the needle. we have seen that with opioids and other issues. this is an issue i would love to work on with you and other members of congress affecting people across the country having significant health impacts. >> thank you, we will turn to senator murkowski. >> thank you, madame chairman.
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dr. murthy, it was good to speak with you some weeks ago. i appreciated that, dr. it is a pressing issue for me. i just came from a gathering of arctic parliamentarians on zoom, and we were focusing on what we're seeing in the arctic nations not only during covid, but prior to covid. and it is issues of mental health. just general behavioral health
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issues. and we're seeing riding levels of substance abuse, suicide, and i raise this again to ask your commitment. your focus, to not only mental health in a pandemic at a time of global pandemic, but really moving forward and how we can address these mental health needs in areas where we already have disparities with access to call kinds of mental services. so if you can speak briefly to mental health as it relates to substance abuse, suicide, and some of the very troubling realities that we're facing right now. >> senator it is good to see you again as well and thank you for that question. the issue of metahealth broadly
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is concerning. i have dealt with it as a clinician, but the impact of rural communities in particular have been heartbreaking. i had a window into the disparities. my father grew up in a small village in india, but many of the stories he told me hold true in america. that rural americas have different access to medical care and education and opportunities. when i visited alaska, oklahoma, and other rural areas i saw the disparities were real and the access to mental health care through telehealth, the ability to have access to providers as well in person, was often far reduced in a environment where we didn't have access to resources. one of the things that i would love to do if i have the privilege of serving is to work
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with you on how we can close the gap by providing not only better telehealth and medmedicine, but also working to strengthen our workforce and i think we can do that in part by investing in community health centers which is a backbone in communities across the country. >> as you know the significance that they play in providing for care in alaska and throughout our state. i want to ask you about homelessness as a public health issue. we see growing homelessness my state and it's a pretty tough place to be homeless particularly this time of year when it is cold and it will be cold for some time forward, but we're seeing this in so many areas of the country. my view is that there has been little focus on our public
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health authorities to evidence and mental health strategies with regard to homelessness. i think we're going to see more homelessness as a result of this pandemic. in your role, if you are confirmed as surgeon general, what do we need to do to be raising the awareness to be not only becoming more aware, but actually working to address these significant health issues as it relates to homelessness. >> thank you, i'm glad you raised this. i saw this firsthand as a doctor. one of the first patients i cared for that was homeless, i was a medical student at the time and i was talking to them as they were being discharged
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about the medications they needed to pick up and the follow up appointments they needed to have and i realized how foolish i was because their primary concern was where they were going to sleep that night, and all of the other issues of when they would follow up were secondary and less likely to happen, unfortunately. i believe there is a powerful connection between housing and health. i think there is a growing body of data that shows us that. i think it is clear to public and policymakers. when i was surgeon general last time, i worked with hud on a program and in an approach to reduce exposure to second-hand smoemt. that was just one example how how it goes together, and i would love to engage with h.u.d. and policymakers to help put roofs over heads. >> i would love to work with you on that.
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i would recognize that through h.u.d., that is one avenue to address the issues of homelessness, but so many are these invisible homeless that are in our community, particularly our children, our families, and whether or not hud is best able to respond to these issues of kids who are couch surfing, who are technically homeless, what the structure is to best address them. i'm over my time, i appreciate that, but this is a conversation i would love to follow up with. >> thank you. >> thank you, senator murkowski. senator rosen. >> thank you, madam chair. i want to thank both the doctors here today for your willingness to serve your thoughtful responses. i know being a doctor takes both intelligence and empathy. and i believe that the two of
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you possess both those important characteristics. so i appreciate you being here today. i have a question for each one of you. mental health concerns, k-12, kids', mental health for seniors. tragically, nevada has seen an increase in youth suicides throughout the pandemic. in our county school district, 18 students have taken their lives in just nine months. sadly, we are the highest in the nation. the pandemic also has been particularly hard on seniors, our most vulnerable to virus. we talked about the social isolation, the tremendous toll it takes. in nevada we have roughly about 370,000 seniors and 25% of those estimated to live alone. so, to dr. levine, i'll go first. i want to build upon senator murphy's question, given what's happening in nevada, you have
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extensive experience addressing youth mental health needs. how would you address the disturbing trends in youth suicides, mental health problems. i know that you have programs and services in pennsylvania that help out with the students. so what would you do for our youth experiencing suicidal thoughts? >> well, senator, thank you so much for that question. i enjoyed our conversation a number of days ago very much about this and other issues. clearly, mental health issues among our youth remains a significant public health problem. as you had pointed out, in my career in academic medicine at the penn state college of medicine, i saw many troubled children and teenagers, some of whom were suicidal and required intensive treatment to treat some of their underlying mental health issues and other issues that were leading to those
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concerns and their suicidal ideation. i participated in a suicide task force, suicide prevention task force as part of my role as the secretary of health in pennsylvania. and if i am fortunate enough to be confirmed to the role of assistant secretary of health for the nation, i look forward to collaborating with samsa, collaborating with dr. murthy and other content experts and working with you to address this issue, which has just become exacerbated during the covid-19 pandemic. >> thank you. next, i'd like to address the senior issue. so, dr. murthy, you know, many seniors, they really continue to isolate in their homes. and as you suggest in your health needs, we really have to think about the connection they have, they're missing people, they're missing that important touch. now we have covid. we're not even allowed to hug people. we don't get to be close. and that isolation is so
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devastating. it causes a lot of depression and other kinds of health issues that follow that. so can you talk about the importance of the social things that we can do, investing in maybe meal programs, some kind of home visits, check-ins, those things that serve seniors particularly in our rural areas where it might even be hard to get people out there? >> well, senator, thank you for that question. and i think you've touched on an issue that is painful, frankly, for many families, which is the experience that seniors have of being lonely and isolated especially during this pandemic, which i think has worsened that isolation for many of them. i think, senator, i don't think it's often well appreciated in the general public just how profound an impact that isolation loneliness has on health. and i think that's one place where as surgeon general i would hope to bring some attention is
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just to the fact that social connection and loneliness is important not just so we can feel better but so we can do better in terms of our health. but i think second is a powerful role that community organizations can play. so often i find, and i found this was true when i was traveling the country as surgeon general as well. that many organizations because they don't have primary expertise in health, they think they can't do anything to improve health outcomes. but organizations that can connect young people with the elderly for visits, that can provide food or resources to the elderly, that can simply call to check in on people who may be living alone. they can play a powerful role in helping people feel more connected in difficult periods of their life. so, addressing isolation that seniors experience, this is an all-in challenge that, yes, does require government attention, but also it requires communities to be engaged and recognized that they have incredible power when it comes to helping their seniors. but this is an area where i would love to certainly focus on with you and with your
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colleagues. >> now, i appreciate that. i know in my home community, there's groups at our university, there's groups in our faith-based community that have just created these phone trees to call and check in on people. that was something everyone could do during the pandemic. so you're right, sometimes there's a grassroots solution help for some of the problems. thank you. i've gone over my time. i appreciate you both being here. >> thank you very much. senator braun? >> thank you, madam chair. during the whole covid challenge, my observation has been, especially coming from the business world so recently, in a place like indiana where i think we did a pretty good job with the navigation through the whole process, maybe didn't take so much of one-size-fits-all approach, differentiate it a little bit by counties within the state. i thought that was something we should've done. and i think it did unfurl that
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way. i got a few questions about what you were able to do in your home state. the idea that you'd treat all counties the same, both rural and urban, to me didn't quite make sense. and have you actually looked at the results of the approach that was taken in your state in terms of that trade-off between fighting the disease itself and the economic impact that would be commitment with it if you were going to take an approach that would be too draconian that didn't make sense. have you been able to get through the data to see, are you happy with the way you handled it in your home state? >> well, senator, thank you very much for that question. i appreciate our discussion about this and other issues a number of days ago. you know, with this novel coronavirus, covid-19, in the
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spring, there are basically three tools in the public health toolbox in order to address it. one is containment, which involves testing, contact tracing. the second is mitigation. at its heart, mask wearing and social distancing and washing hands. but also some of the closures that you're discussing. and then the third are medical countermeasures including medications and vaccines which of course were not available in the spring. testing was also not particularly available in the spring. we had lack of personal protective equipment. so it was quite a challenging situation in the northeast and in the mid-atlantic. so, mitigation was one of the biggest tools in the toolbox that we could use. pennsylvania actually did take under governor wolf's leadership a very sequential iterative approach in terms of the business closures that we did. we did go county by county in terms of whether the businesses would be closed or not.
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and eventually the entire state did get closed. but it did go in that itarea theive approach. we also took a sequential iterative approach in terms of re-opening with a red/yellow/green schema that did go county by county. >> and have you actually done any metrics or compared -- where's your unemployment rate currently in your state? >> well, sir, i actually don't know the current unemployment rate. >> i think you'll find if you look across the country that there's a direct correlation. you look at a place like florida that got a lot of heat early on, figuratively speaking, ends up having the most vulnerable population. and you did have an approach there where i thought it took a dual perspective of trying to keep the disease at bay and respect it for all the peculiarities it's shown us but also with the most susceptible population has done a good job when you look at doing both. what about, very quickly, how
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has your vaccination rollout gone? have you been pleased with the performance of getting vaccinations out in your state? >> um, you know, pennsylvania, like many states, initially had significant challenges in terms of the rollout of the vaccine over the holidays, and then into january, et cetera. of course i left the pennsylvania department of health in january, so i have no -- i've had no contact with the pennsylvania department of health and don't really know what exactly differently they're doing now. i think pennsylvania has had successes and has had challenges in terms of the vaccine rollout. but things are continuing to improve. >> thank you. dr. murthy, just a question to the point. do you think guns present a public health emergency? >> well, senator, i think that gun violence, like any other
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form of violence, is a concern to me as a doctor is taking care of many patients who have been the victims of violence. i'm grateful that congress is in a bipartisan basis put funds to study the origins of gun violence and how best to address it. but i'll tell you that my focus, senator, is not on this issue. it is -- and if i'm confirmed, it will be on covid, on mental health, and on substance use disorders. these are the issues which i think are front and center. in this moment it's where i would put my attention if confirmed. >> about out of time, but since we've gone through and it looks like the health care crisis is, thank goodness, ebbing with the results we're seeing, this is an issue that i'm sure will come to the forefront, and i'll get with you later on that subject. >> okay. i look forward to those. thank you. >> thank you. senator lujan? >> chair murray, thank you so
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very much to you and to our ranking member mr. burr. dr. levine, was a pleasure visiting with you recently. dr. murthy, i look forward to our conversation. dr. murthy, understandably, the federal government has focused the bulk of its resources on slowing the spread of the covid-19 pandemic. however, we have simultaneously addressed the secondary impacts. we have to get this done of the pandemic, including the reported increase in opioid overdoses. as surgeon general, you are considered the nation's doctor. how will you guide discussions and scientific investment so that individuals who live with acute or chronic pain can get appropriate treatment including nonpharmacological treatments such as physical therapy and also if they do need pharmacological treatments that they're nonaddictive? >> well, thank you, senator, for that question. i think you're raising a critical issue here, which is how do we treat pain
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appropriately, given how many americans are living with some form of chronic pain. i cared for many of these patients when i was practicing medicine. i know just how that pain can affect not only the quality of life of an individual but their family as well. and i think what we have an obligation to do is to take what research currently tells us, which is that there are multiple strategies for addressing pain that are effective. they include physical therapy, cognitive behavioral therapy, and, yes, in some cases pharmacological therapy with medicines. and we have to make these treatment strategies available to people. right now any people that don't have access to physical therapy or cognitive behavioral therapy at the level that they need to help address chronic pain and even when it comes to medications, these decisions have to be tailored based on a patient's individual situation. and there's not a cookie cutter one-size-fits-all approach that we have to take here. that's why we got to empower clinicians with the right knowledge and the best and latest data so that they can
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make good decisions with their patients to help ultimately address their pain. >> i appreciate that, dr. murthy. dr. levine, we had a chance to visit about mental behavioral health. and you've been asked that question by several of our colleagues today. it matters to all of us across the country especially in rural communities. i'm interested in what we can count on with your advocacy to increase access to mental behavioral health. and then also a project that you're familiar with, and that our chair has championed in project echo and telementoring what your thoughts are with how we can expand those programs and also ensure that there will be a reimbursement for both telehealth and telemodeling and mentoring services. >> well, thank you, senator, for that question. and i particularly enjoyed our discussion about this and other issues a number of days ago. clearly, mental health issues are going to be forefront. as we work through the pandemic and afterwards. and this would include mental health issues for children,
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adolescents as we have spoken about previously, but also adults and seniors as was talked about as well. this is a particularly difficult issue in rural areas where there is lack of access to mental health services. and so i think telehealth is going to be very, very important. and that includes telepsychiatry and telepsychology. of course, as we discussed, broadband is often critical. access to broadband is critical to that success. i did want to highlight the program we talked about which is called project echo, which was founded by dr. owara in new mexico. and i know that you actually know him. and i've had really the fortune of meeting him. there is a project echo program in pennsylvania which is spearheaded by the penn state college of medicine and penn state hershey health. they have been using that in particular for the opioid crisis and expansion of medication assisted treatment. but also other medical issues
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and mental health issues. and i think that telehealth and programs such as project echo need to be further expanded. and if confirmed i look forward to working with you and other content experts and dr. aurora on expanding it. >> i appreciate that. dr. murthy, populations that live in rural regions of the united states face unique challenges in accessing health care. these barriers contribute to the rural/urban divide phenomena that leads rural americans with lower life expectancies than their urban counterparts. i believe everyone should have high-access care no matter where they live. one thing we need to address is the current caps and limitations on rural residency programs that have put rural america at a disadvantage. dr. murthy, how can we work together to address the shortage of health providers in rural areas and increase federal support for rural residency programs? >> well, senator, thank you for
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that question. i do think that we do -- we have critical work for our shortages in rural areas. and those include primary care shortages but also specialists. and i think programs like project echo, which i had the privilege of visiting, you know, in new mexico when i was surgeon general, are programs that can actually help to close that gap to some extent. but we have to do more because virtual care, while critical, is only part of that solution. we need to train more clinicians and bring them to rural areas. and we can do that in part through expansion of the national health service corps. we can do that i believe also by better utilizing the u.s. public health service commission corps, which i was privileged to oversee as surgeon general and provides a lot of care in rural areas but certainly poised to step up and do more. so, i do think that there are ways we can do this. with residency programs as well, i think we can strategically work to train residents and place them ultimately in rural
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parts of our country that are in desperate need of medical providers. i would certainly love to work with you on this issue. i think health care providers get into health care wanting to relieve suffering and to serve. i think the areas that so often need service are rural areas but they're not getting the providers that they need. >> thank you for the time today, chair murray. >> thank you very much. we will now turn to senator romney, who i understand, gets the patience award today for sitting there. [ laughter ] >> the light doesn't go on but the mic goes on. that ichl for being here today. you've given me this opportunity. dr. levine, are there school districts that are open in pennsylvania and some that are closed? >> well, senator, thank you for your question. >> we're short on time. so are there school districts, some open, some closed? >> there are some school districts which are remote and some school districts which are in-person. >> okay. has there been a public health
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analysis to see those that have been open, has there been a massive spread of covid that's different than those that have stayed hybrid or all-remote? >> i'm not aware of that analysis. >> okay. that's my impression as well, which is across the country we've had some school districts open, meaning kids going to school, others absolutely closed, kids only going on remote. the evidence doesn't show so far that those that have been having kids in classrooms are seeing a spike in covid cases. there are also countries that kept their schools open. they haven't seen a spike in covid cases. i don't understand why our schools are still closed. there are some of us who feel it's a submission to the teachers' unions. and because they are such big donors to the democratic party that the administration is saying, oh, at state levels, at the federal level, we're not going to push to get our schools open. but, you know, grocery store workers are working, drug store
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workers, taxi drivers, ems workers, health care workers. but there's just as much a priority for our kids to be educated. and i just can't understand why given the fact that the data doesn't show that there's a problem for teachers or for families having kids going to school, we got to get our kids into school. the administration is proposing $170 billion going to education as part of the 1.9 covid program. but only 5% of that is getting spent in this year. 95% is for years down the road. it has nothing to do with getting our kids safe and our schools open again. i don't understand why the administration does not directly encourage all of our school districts to open again. and if we're going to send out 170 billion, which i don't support, it ought to be linked to them agreeing to get the doors open and get the kids back
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in the classroom. that's my chance to make a point, and hopefully you'll take that point to the administration in the responsibilities you have. let me ask a question of dr. murthy. and that is you've had concern as i have about kids vaping. the analysis shows that about one-quarter, i guess, of high school kids are vaping on a regular basis, tobacco products. and in many cases marijuana as well, particularly at the higher grades for marijuana. what can we do to get the flavored vaping products off the market? that's what kids are getting into. this has been slow rolled by the prior administration. i think the prior administration was so concerned about the vaping shops and the adults that wanted to use the flavored products that they slow-rolled this. but how are we going to get vaping products that are flavored off the marketplace so we don't addict our kids to
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nicotine? >> well, senator, thank you for that question. and it is good to see you. you were my governor in massachusetts when i first moved there for medical training. so it's nice to see you in person. >> i take full credit for that. [ laughter ] >> thank you. listen, i share your passion for this subject when i was surgeon general i issued the first federal report on ecigarettes and youth, and i still am deeply concerned that while we have seen some improvement in numbers, there are still millions of children who are exposed to nicotine through vaping. i think that while we've taken some steps, especially at a state level to restrict access to youth, and while we have laws saying that kids shouldn't be using this, that there are still a lot of loopholes through which kids are accessing ecigarettes. and i also worry about the advertising, senator, especially online advertising, which is an easy way for these companies to get their products to kids. so, if i have the privilege of
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being confirmed, i will look forward to working with you and the administration to make sure we are taking steps to protect our kids from advertising to enforce these types of rules. and even though the surgeon general doesn't have policymaking authority, i do think that there are parents that i encountered all across this country who are concerned about exactly what you said, about why are there kids using nicotine-based products. this would be an area i would love from a public education standpoint to work with you on. i think there's a lot of progress we've made but so much more progress we've got to do to protect our kids. >> and i know part of this process is typically throwaway lines such as "i look forward to working with you," but this is one i really do care about. and i hope you'll be able to work with the administration and the fda that obviously has regulatory authority in this regard to say, guys, you've got to push this faster. the analysis paralysis in government is something that the private sector could never
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abide. and we have to get this addressed because it is a public health emergency. i'm sorry, dr. levine, my time is up. i couldn't get you to respond to that as well. but, thank you, madam chairman, back to you. >> senator hassan. >> thank you very much. let's try that, better. thank you very much to our chair and to our ranking member and to our nominees thank you for your service, thank you for your continued willingness to serve. and thank your families for us, too, because it is a joint commitment, i understand. i want to start with a little bit of a follow-up senator lujan asked you about the opioid epidemic. and this is a question to both of you. the covid-19 pandemic has exacerbated what already was a
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devastating mental health and substance misuse crisis in our country. i'm encouraged that you both have knowledge and experience in combating the opioid crisis through expanding access to substance mistreatment and use and services and working to diminish the stigma that is associated too often with heroin. dr. levine, you led the state's effort to combat the opioid epidemic for several years. can you please speak to the importance of continued robust federal funding for states as we work to turn the tide of the opioid epidemic? >> well, senator, thank you so much for that question. i appreciate our discussion about this and other topics tremendously a number of days ago. you are entirely correct. the opioid epidemic, the opioid crisis and overdoses continues. it has been exacerbated during the covid-19 crisis, and we have to continue to address this robustly. in pennsylvania, we worked on prevention with concept i call
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opioid stewardship. we had opioid prescribing guidelines. rescue with the medicine naloxone and expansion with treatment, particularly medication-assisted treatment. and we do have to get past the stigma associated with that. all of those programs required funding. we needed funding for our prevention efforts. we needed funding for naloxone and for further distribution of naloxone. then we needed funding for treatment. one of the programs we founded was called pennsylvania coordinated medication assisted treatment funded by the sor funding. and so if confirmed, i look forward to working with you, with the rest of members of congress, and with samhsa on continuing the sustainable funding for the opioid crisis. >> thank you very much. and, dr. murthy, if confirmed, how would you use your role to combat the opioid crisis and address the challenges in that crisis that have been exacerbated by covid-19? >> well, thank you, senator,
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hassan, for that question. you know, i think the opioid epidemic continues unfortunately to be a dire crisis for our country. i think that there are few things if i was confirmed i would look to focus on building on the 2016 surgeon general report that we issued on alcohol, drugs and health. one would be to continue to focus on public education, recognizing that there is still an extraordinary amount of stigma around the opioid crisis, which prevents people from coming forward and getting help. the second thing that i would look to do is to take some of the core recommendations around treatment, particularly access to medications to treatment but also integration with primary care and work with policymakers to see how we could advance treatment. and, third, i would say, is to focus on prevention. senator, in that report in chapter 3 we actually laid out a number of prevention programs which have been proven to work to be cost-effective as well to return far more dollars in terms of reduce health care costs, criminal justice costs, and economic productivity losses
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than the initial investment in those programs. but those are still not well known. they don't always often receive the investment they need. so those would be a few areas that i would love to focus on regarding the opioid crisis. >> thank you for that. and i look forward to working with both of you on it. i want to turn to a different question, dr. murthy. even as we expand access to covid-19 vaccines, we face the continued risk of additional spread within communities and the emerging threat of new covid-19 variants. experts have been clear one of the best ways to bring an end to the pandemic is to continue to wear a mask in public, avoid gatherings and social distance. many people are understandably experiencing fatigue. how do you plan to use your platform to ensure that americans continue to adhere to public health guidelines even as vaccinations continue until we're really truly able to get the virus and its variants under control? >> senator, it's a great
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question. i think, to be honest, a lot of us are experiencing fatigue from the pandemic. i certainly am as well. i know a lot of us have been struggling for the last year, although many certainly much, much harder, have had much more difficult experiences than others. i think there are a couple things that i would seek to do, senator. number one, i think we do need to be consistent in our communication around the value and the importance of masks. and we have to lead by example in demonstrating that they work and they're important to wear. but the second thing i think is recognizing that that fatigue is real. and it's not i think a reason to judge people. it's real, we're human beings, we're tired. that means that the faster we can get people vaccinated, the more quickly we can return to a state where we can see each other and don't have to wear masks all the time. and i would also focus my efforts on the vaccine, getting it to people, making sure people understood what the benefits are so that they can make a decision for themself and their families. >> thank you to the chair and
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ranking member. i will also just add that i would love to work with you and senator romney and others on the vaping issue because i think people are not understanding the connection now we are seeing between teenage vaping and cigarette use later in life. and i very much look forward to working with both of you on that. >> senator tuberville. >> thank you,3g/■ mr. chairman. thank you for being here today. most of them have asked most of my questions. i'll try to make it short. i've been in education for 40 years. i've seen a lot of words put into protecting our kids from drugs, opioids, marijuana, all those. and we don't seem to do a lot about it. and i'm glad dr. murthy i heard you say something about education. and after 40 years of experience, that's what has got to be done. we've got to put money behind education. and it's getting worse and worse. now that we've opened our borders it's going to get even worse. and i feel for our kids.
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i really do. they're looking for something else, something different. again, dealing with 17 to 24-year-olds for 40 years, it's different every day, but we got to find an answer. we got to find a solution because it's not going to get any better by just saying it'll go away on its own. we're losing 50 to 60,000 kids a year down of overdose. we talk about covid, and it's our biggest problem now. but we have to do something. i live in alabama. we've lost 14 rural hospitals in the last ten years because we're losing nurses and doctors. we don't have enough hospitals to take care of our patients. dr. murthy, for you, other than telemedicine, which we're using, what can we do? the thing about -- the only thing we have now in our rural areas is our pharmacies. and now those are starting to go under because if you think about it that's really our hospital and our doctor and our
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consultant for health care in rural areas. but these pbms are absolutely putting our pharmacies under because there's a middleman between the drug companies and the pharmacies and they're taking all the profits. but what else can we do in the rural areas? >> well, senator, i think this is such an important point. i realize that the challenges that you're speaking to in alabama are likely being experienced in other rural areas in our country too that you're struggling without enough health care providers, and they're watching rural hospitals close down as well. there are a couple of things, senator, in addition to telehealth, which you mentioned. the couple other areas i think we need to focus on is on strengthening our rural health workforce where we see often clinicians get trained and then they relocate or stay in urban areas. and we don't have enough nurses and doctors in rural areas. but we can address that i believe through a combination of the national health service corps, using the united states
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public health service commission corps and expanding their role. i think we can do more there. but the other place we can do more is supporting the rural hospitals themselves. i think the cost structure in rural areas, as you know, is different for health care than in urban areas. and you have to sometimes put more into base infrastructure to serve a smaller population because that is the nature of rural areas. if we apply a one size fits all model to rural areas then they won't get the support that they need. i think we've got to recognize that and build that into our funding support models as well. >> dr. levine, you've worked in mental health. being a football coach and an educator, i worked in mental health for 40 years because i see a lot of it. you know what i'm talking about. and we seem to be over the last 10, 12 years more and more problems with mental health with our young people. what do you think's the answer to that? what's the first direction in your job would be to overcome some of that? >> well, senator, thank you for that question.
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we do share concern about young people and their mental health. and at penn state hershey medical center i ran the adolescent medical program where we saw many young people with medical issues as well as mental health issues. i think that we need to work on prevention and we need to work on access for treatment. i think we need prevention programs to prevent mental health problems in our schools. i think we need prevention programs in our communities and community health centers as well. and i think we need to increase access to treatment whether that's in urban areas, suburban areas, or rural areas. we need more mental health professionals. we certainly need more child and adolescent psychiatrists and really the whole spectrum of mental health workers to be able to treat our young people who are suffering from these mental health issues. >> basically what you're saying is we need a plan. >> yes, sir, we need funding.
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>> we need funding, we need a plan. i've never seen that in mental health in all my years in being around kids, we had to look for somebody to help with mental health problems. one other question, dr. murthy, you've been through this job one time. what's your number one priority that you feel like you can do better at this time? >> well, sir, i have had the privilege of serving once before, you're right. and the reason i'm back, senator, is because my priority first and foremost is to address covid, to turn this pandemic around. there are issues that have been worsened by covid, mental health and sub substance use disorders. those are my accompanying priorities as well. but we've got to turn this pandemic around first and foremost. sir, to me, this is very personal. i've lost seven family members to covid. most recently my uncle in dallas a few weeks ago. i look at my children, you know, my oldest son is doing remote learning as well.
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desperately wants to be back with other kids but can't. and there are many families i know that are struggling much more than we are. i want those families to be able to get back to their lives. i want our kids to be able to get back to school. i want people to be able to go to work and not worry every day that they're going to catch a virus and get sick. i want us to be able to come together as a community again, senator. that's what's brought me back to public service. it's why i hope to have the opportunity to serve our country once again. >> and both your jobs are very important. and covid is -- i've lost friends. it's sad what we've gone through. we can see the light at the end of the tunnel. but we've seen drugs and mental health problems just continue to soar. we have to put money in education. dr. levine, i think dr. levine i think will agree with me on that. we have to do something about it. we can't continue to say it'll go away. covid hopefully we'll get it to go away. these other two, they're not going anywhere. and it's all about educating our
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kids at a young age, at a very -- and not starting when they've already had a problem. thank you very much. thank you, mr. chairman. >> thank you very much. senator, burr, i'll turn it over to you for closing. >> thank you, chairman murray. and i want to thank you for your time, for your personal stories, and for the expertise that you bring to the nomination. senator murray, i would like to ask unanimous consent this time to put into the record even though i don't have it in my possession while i sit here. the latest high school data relative to marijuana use and to vape products. what i think that latest data showed was that in high school students, marijuana was used more than vape product. that vape product in that category my high school students that the least used flavor was
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menthol. today menthol is the only flavor on the marketplace. all the rest of them are gone. and the decision by the last administration to allow menthol to remain was in hopes that those that used combustible -- adults that used combustible products could make the transition off of combustible cigarettes to vape product as a way to fulfill harm reduction, which is the full intent of vape products and other cessation programs. senator murray, i would ask unanimous consent that when i can get that data today, i can put it into the record. >> if you have that information, so ordered. >> thank you, madam chairman. >> thank you so much. that'll end our hearing for today. dr. murthy, dr. levine, thank you both for joining us to talk about your experience and your thoughtful answers on how you will work with us to end this pandemic and improve health
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equity and make progress on so many other public health challenges. i'd like to thank all of my colleagues on the committee for participating in today's hearing as well. given the urgency of this moment, i will be pushing to give both of these nominees confirmed quickly so they can hit the ground running. and i hope colleagues across the aisle are with us to do that. for any senators who wish to ask additional questions of the nominee, questions for the record about be due by friday, february 26th at 5:00 p.m. the hearing record will remain open for ten days for member who's wish to submit additional material for the record. we'll have a hearing on the ongoing response to covid-19 pandemic soon. details will be announced in the coming days. with that, the committee stands adjourned.
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>> we'll take you live now here on c-span3 to a news conference with white house press secretary jen psaki. >> i just have a couple of items at the top. one of my last money earrings. all right. today the president will deliver remarks to mark the 50 -- mark 50 million shots that have been administered since he entered office. in his remarks, he will provide an update on the strong progress we've made


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