J. Stephen Morrison: Good morning, good afternoon, good evening, depending on wherever you are. I’m J. Stephen Morrison, senior vice president at the Center for Strategic and International Studies, where I direct our global health work. And we’re delighted to be joined today by Congressman Tom Cole. Congressman, thank you so much for joining us here today.
Representative Tom Cole (R-OK): Thank you. It’s good to be with you.
J. Stephen Morrison: Let me just say a few quick words of introduction and thanks, and then we’ll start the conversation. Congressman Cole’s in his 10th term in the House of Representatives, representing the 4th District in Oklahoma. He currently serves as the vice ranking member of the full Appropriations Committee. And he’s ranking member of the Subcommittee of Labor, Health and Human Services, Education and Related Agencies. Terribly important for all of these global health security matters we’re talking about. He’s also a senior member of the House Appropriations Subcommittee on Defense, which obviously also has a very important role when we’re talking about health security at home and abroad.
He’s the ranking member of the full House Rules Committee, where he’s served since 2013, and is a deputy whip of the Republican Conference. He’s also a member – an enrolled member of Chickasaw Nation, one of six members serving in the – in Congress who are Native Americans. Congressman Cole has kindly served for the past three years on the CSIS Commission on Strengthening America’s Health Security. It’s been terribly important and valuable for Tom, Congressman, to have you be with us in that commission. We’ll be continuing through 2022. Very grateful to you for that.
Also very grateful your staff – Sabrina Parker, Shane Hand, and Josh Grogis have been terribly helpful to us. Here on the CSIS side, Amith Mandavilli, John Monts is our producer today, and very grateful to them.
So let’s start our conversation. I want to – last week was the 100th anniversary of the terrible massacre of the Black Wall Street neighborhood – the Greenwood community in Tulsa, Oklahoma. You were active in that period, congressionally, in memorializing that. But also I just wanted to ask you for your reflections on that moment. It’s a – it was a big, historical moment of reflection.
Representative Tom Cole (R-OK): It was. And thank you for mentioning it. Obviously, a terrifically horrific incident in the history of Oklahoma, and one that for many, many decades, quite honestly, I think the state tried to hide from – they didn’t teach it in school, didn’t know anything about it. It’s amazing to me the number of people that are only learning about this, in Oklahoma, you know, really within the last couple years. And I’ve had any number of friends and colleagues say, gosh, why wasn’t that taught in school? Well, you know, there are a lot of things in our history that are not moments that we’re proud of, but they’re moments that we learn from.
And I really want to commend the people in Tulsa who came together really across racial lines, across partisan lines, have worked for a number of years at the state level. We had a commission at the state legislature over this event and, you know, to try and come to terms with it, what would be the appropriate way to memorialize it, to learn from it and to, you know, use it as a reminder of what can happen when we, you know, live to our worst instincts instead of up to our best ideals.
So I’m very proud of the delegation. We all worked together on a commemorative resolution about this. I think it’s an appropriate resolution. There’s also one by the Black Caucus in the House. I thought that was a very appropriate resolution as well.
So again, we’re learning, hoping to get better, and I think we will and I think we have. And I don’t say that with any pretense that we don’t still have racial issues in Oklahoma. We certainly do. But it’s just a much better place.
I remember – I reflect – I remember once when my son and I were talking about race. And he’s now a public-school teacher, and he was quite young at the time. And I mentioned to him that, you know, I was old enough to have ridden across parts of Oklahoma and the South when the signs were no colored allowed. And he looked at me like how old are you, dad? I mean, wasn’t that the Civil War? And I said, no, this is living memory. This is the 1950s and ‘60s; and not proud that that happened in the country, but I’m proud it doesn’t happen anymore. And you think of all the struggle that went into making sure that we began to live up and try and form a more perfect union, literally in our lifetime.
So these things are important. They’re important milestones. And thank you for mentioning it. And again, we’re going to learn from it and try to do better as a state, and we hope we do better as a country.
J. Stephen Morrison: Thank you very much. I mean, it was – from a distance here, it was very moving to observe these different memorial activities that surrounded that anniversary.
Representative Tom Cole (R-OK): Well, I thought it was really well done. And the mayor there is actually a very good friend of mine, and I’ve known his family. He has both an uncle and a grandfather that were also mayors in Tulsa history, so – not in the 1920s but in the period between the ’60s and ’70s. So he has a deep sense of history of his community, and he did a wonderful job pulling everybody together.
J. Stephen Morrison: Thank you.
Well, let’s turn our attention now to matters pertaining to health security. Let’s talk about here at home, the national vaccination campaign. And I’d like to talk to you also about how things are going in Oklahoma. There’s been remarkable progress across the country in the last 120 days. And we also are hitting a plateau of sorts and we’re beginning to come to terms – we’ve got over half of our adult population fully vaccinated right now. There’s been some dramatic shift of opinion in favor of winning – of getting the vaccine as quickly as possible. But we’re also struggling with hesitation, people having – continuing to have questions about this, some who are refusing to consider the vaccine.
And tell us your thoughts on the progress that we’ve achieved. How do we explain that? And looking forward, how do we carry the progress forward? What do you think we’re going to look like as we head into the fall?
Representative Tom Cole (R-OK): Well, I think you’re right to stress that it’s successful but it’s still a pretty mixed bag out there; mixed picture, if you will. I’m very pleased. I mean, I’m pleased with Operation Warp Speed. I thought that was a tremendous tribute to the public-private partnership that put us in a position in less than a year to have multiple vaccines – high, unbelievably high, efficacy, you know.
And I remember, when we were talking early on, a successful vaccine was defined as something that would give you 50 percent protection. You know, we had two in the 90s, another in the high 70s or low 80s; and again, the effort, previous efforts, you know, up to four years. This was done in about 10 months. I mean, I remember talking to an NIH scientist who said, do your constituents realize this is the biomedical equivalent of the Manhattan Project? I mean, this is an extraordinary commitment of resources and talent, and I’m really proud of everybody that was involved in that and what they achieved. And the rollout – you know, like all rollouts, this is a big continental nation, 330 million people, every race, ethnicity, point of view on the planet. But I think we did pretty well, you know, and, certainly, it’s available, easily available, essentially, anywhere in the United States.
Now we’re running into the problem – obviously, people that wanted it got it as quickly as possible. I know I, certainly, did and my family, certainly, did. But, you know, we do have resistance. We have some people that have an ingrained mistrust of the government. We have other people that just think this was so fast and it’s an emergency basis and maybe there’s some mysterious problem down the road.
We have others, honestly, who are just lazy. They think, well, I’m going to be protected because everybody else around me is getting the vaccine so I don’t have to. And that’s a pretty unenlightened attitude because, frankly, you’re at grave risk. I mean, you’re much less likely to get it now but the rates of hospitalization and death among people that have not had the vaccine are not markedly different than they were when we were having much wider distribution. If you get it, it’s deadly, and so you should take the measures that would keep you from getting it in the first place, even though your protection is going up because of other people.
So yeah, and I think there’s a lot to learn here. I think there’s also – to me, the big lesson is the ongoing – we’ve been having a problem with people not getting the vaccinations they need in a variety of areas for a number of years now. And, again, part of this is complacency, but we probably need to have a public education program comparable to what we do in tobacco and some other things and recognize this is something we’re going to have to work at over time, and we’re going to have to make our population more comfortable with availing themselves of the protections that are here.
And then, you know, and then I look globally. There, I’m less satisfied. I’m very happy for the United States but, you know, we live in a world where you can’t practice isolationism when it comes to vaccinations and disease. You know, it moves with incredible speed across borders, and so enlightened self-interest would dictate that we’d be heavily involved in helping the rest of the world. And so it, certainly, looks to me like the administration is trying to do that and we’ll be able to move in that direction.
So, again, some knotty issues ahead of us. But, overall, I think if you went back a year ago and said, this is where we will be in a year – in June of 2020 – you wouldn’t have believed it would be possible that we would have the vaccines, that we would have the distribution, that we would have the falling rates of infection, hospitalization, and death.
So I think you got to try – you got to chalk it up as a great success, a great bipartisan success, a great success between two administrations that don’t like one another, particularly, and aren’t very good at giving the other a pat on the back. I’ll give them both a pat on the back. I think they deserve it, and I think we’d be better off for the country if we recognize that.
This is an area there shouldn’t be any partisan division and this is an area that we can cooperate on, and we’ve demonstrated that and we need to keep it – keep that firmly in mind as we go forward because I hope we don’t see anything like this again or – but you, certainly, can’t count on it.
J. Stephen Morrison: Thank you.
You know, we’ve heard from Kaiser Family Foundation, Pew Research Center, other pollsters, as they’ve looked at the – those who are in the movable middle, those who are waiting to make a decision who have some outstanding concerns, plus those – the 13 (percent), 14 percent who are pretty dug in and opposed to taking vaccine that there’s a great concern at trying to connect to Evangelical and conservative voters, particularly those and rural males are a particular concern.
And I’ve been encouraged that the very well-known Republican pollster, Frank Luntz, has joined with Brian Castrucci doing a series of focus groups that have been very illuminating and have also enlisted those who are M.D.s within Congress, Republican M.D.s, to come together and they’ve begun doing public service announcements. I mean, it’s – we’re seeing leadership at the Republican level coming from various directions to try to get the message out and connect and understand what those concerns are in terms of what are the concerns of those who are on the fence.
Representative Tom Cole (R-OK): Yeah, I think that’s true. And again, Frank’s actually a very good friend of mine. I’m a recovering pollster myself, from my time before I was in Congress. So a buy that I’ve admired for a long time, and I’m pleased that you mention him. And our Doc Caucus has really been pretty spectacular on this all the way through. We have a very – I don’t know why we have more physicians that are Republican in Congress than Democrat. And they have been very active legislative force all the way through this, an informative force, very helpful. So I do think, again, you know, different elements of the population. People forget Evangelicals are not just Republicans. The African American community is heavily Evangelical as well. That’s been another area where we have not had the penetration we would want to have.
So you know, we have pockets of the population. If you actually looked at it honestly, it tends to be collectively, you know, a portion of the population that’s a little bit not as well off, not as well educated, lives in more isolated and sometimes even more homogeneous type communities. So, you know, there’s some things to think through here. But the bottom line is pretty simple to me. This works. It’s saving lives. It’s a remarkable achievement. And, you know, while I respect people that have a different opinion on these sorts of things and recognize that the United States is a free country and you have lots of freedom, I do think we need to have a pretty aggressive public advocacy here for, you know, using these vaccines. And hopefully that will continue. You find very few responsible political leaders on either side that don’t make the point: This is something you should do. And so I’ve been pleased with that, that in a divided time that on this we’ve been speaking pretty much with one voice.
J. Stephen Morrison: I’ve been impressed with the gains within the Native American populations in Oklahoma. What explains that outcome?
Representative Tom Cole (R-OK): You know, partly it’s the cultures there. We’ve got 39 recognized tribes, including the Cherokees, which they and the Navajo go back and forth between the – which one is actually the largest. COVID sort of helped the Navajos find more Navajos, because they were providing treatment. And so they edged out the Cherokees. But these are really big tribes with very substantial health care – Choctaws, Chickasaws fit in that, kind of Creeks. These were, again, tribes of 70,000 to over 300,000 members.
And they maintain very robust health care capabilities, not just – they don’t rely on the Indian Health Care Service. These are gaming tribes and tribes that have substantial economies. My own tribe has a 3 billion – 70,000-plus people, $3 billion budget, 14,000 jobs, you know, multiple business ventures. But it spends a lot of money on top of federal money on health care. And that’s not uncommon in Oklahoma.
Plus, in the first CARES Act last year we got something that was unprecedented. And I worked very hard on this with now Secretary Haaland, on a bipartisan basis. And she and I and other members were able to secure about $8 billion in the $150 billion set aside for state, local and tribal governments. Which that was actually the largest transfer of wealth to Indian tribes by the federal government in the history of the United States. And we topped that, again, with the most recent CARES Act actually did better. So these tribes were given, you know, some fairly substantial amounts of money to attack the problem.
And they – in Oklahoma, they not only helped their tribal members, but pretty much as soon as they knew they were getting sufficient supplies they opened up. And a lot of our tribes are located in rural, more remote parts of the state. And it was sort of – you know, anybody can come. Just make an appointment, come on down, or we’re going to do a mass vaccination sponsored by the Chickasaw Nation. I actually went by their site in Ada, Oklahoma, where they had cars lines up and, you know, there were people there. They didn’t care if you were native or non-native, Chickasaw or not. If you showed up, you were going to get vaccinated.
So it actually gave us an arm, you know, in a lot of the – of course, one of the problem – one of the challenges with the vaccine is, you know, the storage of it in extraordinarily low temperatures. A lot of places in rural America don’t have facilities that you can store the thing. Fortunately for us, our Indian hospitals did. And so we had a network out there where we could move into the rural part of the state a little bit better than places that, you know, you could have had the same population but didn’t have a tribal structure or a governmental structure, a set of resources, a set of trained people. And so that helped us initially.
Now, we’ve fallen back off this. We’ve run into typical sort of Oklahoma populist resistance to nobody can tell me what to do. But in the early days, we were actually one of the top five or 10 in the country in terms of initial vaccinations. And I would say the tribal entities, which did hundreds of thousands of vaccinations in the state, were probably the reason why we’re – our performance was better than we would have anticipated.
J. Stephen Morrison: Well, Oklahoma’s sort of keeping pace with the national figures, right?
Representative Tom Cole (R-OK): Yeah.
J. Stephen Morrison: You’re over 50 percent of adults vaccinated at this point in Oklahoma. Still a lot of work to do, but you’re at pace with the national – the national figures.
Representative Tom Cole (R-OK): Yeah. Well, we’re – you know, I would like to do better than at pace, so.
J. Stephen Morrison: Yeah.
Representative Tom Cole (R-OK): But again, our tribes have been incredible partners in all this, and that has given us, you know, tools that other people don’t have, and I’m very proud of them for stepping up. And again, I think our state effort has been well-led, and so we’re trying. But you know, if you looked at it demographically, we have a lot of the same groups that nationally are more resistant, and so we’re just going to have to work at it. But at the end of the day, you know, I’m proud of what we’re trying to do.
J. Stephen Morrison: Thank you.
You know, one of the discoveries during this pandemic has been how weak our local public-health authorities have been in terms of staffing, budgets, data systems, surveillance, quick-response capacities. And in the emergency measures that have been passed, which you’ve been deeply involved with those emergency measures, over $300 billion dedicated towards reform of and strengthening of the pandemic response. When you think about those numbers and you think about this opportunity for strengthening those 3,500 public-health jurisdictions across the country, do you have a sense of how well that money is being spent to improve staffing, data systems, surveillance capacities? This is a big moment in trying to correct something that we really didn’t understand until the pandemic hit us and we saw this suddenly very vividly.
Representative Tom Cole (R-OK): Yeah, I think that’s correct. I think it’s actually being spent quite well. You know, actually, the Labor-H Subcommittee on Approps has been focused on this for a while. We actually had some hearings before the pandemic on the need to update our diagnostics all across the country in terms of getting information more rapidly, being able to track disease, what it was going to take. You know, I wish we had had those hearings a couple of years ago. Maybe we would have been a little bit better prepared and provided information. But we do have an important opportunity here to capitalize the public health-care system.
I was pretty stunned years ago when I became the chairman of the subcommittee to find out in my own state over 60 percent of the public-health budget was coming from the CDC. You know, the state just simply wasn’t doing its part. And I think the national number is about 50 percent. We have some states – New York usually is a real leader in this area, you know, long tradition out of New York City really for many, many decades, over a century of excellence in public health. But you know, by and large, too many of our states have thought of this as primarily a federal responsibility. And it is in the sense that we need uniform standards across the country, but it doesn’t mean that at the state level you can’t do something too. And so I do think we’re going to have a problem there.
Longer term, though, I do think the case has been made for these investments. I was pleased – I have a lot of areas that I disagree with the president’s budget on and I’m sure we’ll talk about some of that a little bit later, but I don’t disagree on his topline number for the CDC, for the NIH, for the strategic stockpiles. And in fact, I went out of my way in our testimony when we had Secretary Becerra come in on the overall budget – it was actually before the budget was released, but we had sort of the topline – to say, look, this is an area where we’re going to be working with you. And we may have some questions about different parts of it or should we do this rather than that, but we’re not going to quibble with the overall numbers.
I like the substantial investment. I give the Biden administration – this is the first time in my time on that subcommittee that an administration has come in and asked for more money than we were going to give them – that we might have given them anyway. I mean, in other words, even the Obama administration, we always put more money in these areas than they asked for, and we certainly did than the Trump administration, which actually asked for cuts for NIH and CDC.
I remember lecturing Mick Mulvaney in my office about what a dumb idea this was and that, God forbid if something terrible happened, it’d be the equivalent of cutting defense on the eve of war. And, lo and behold, it did happen. And we’re very fortunate that they did not get the CDC and the NIH and the strategic stockpile budgets that they asked for. They got what Congress thought, on a bipartisan basis, under both Republicans and Democrats, was more appropriate. And we needed every bit of that and more.
So it’s nice to have an administration, as much as I disagree with it in a number of areas, in this area that I think is willing to take a leadership role and put some important ideas and suggestions on the table. But we need to not just use the event that we have. And we’re getting a lot of, again, money. The real challenge is always what are your baseline numbers over the years going forward?
You know, we can invest a lot in a short period of time, but if we don’t maintain it – I think particularly incentivizing public-health personnel. What are we doing to make sure we have an adequate number of professional public-health experts? What are we doing to make sure that the salaries there are competitive, that the opportunities are such that we attract bright people? We have plenty of – you know, we – I wouldn’t say plenty. We don’t have enough doctors as it is. But the public-health sector, as is often the case, you know, very much the tail on the dog. It’s the private health sector where most people go to make a living and do their work. And that’s fine. But you certainly need a robust public-health system in the country.
This open, this fluid, this many people, this exposed really to the planet – we’re probably the most exposed country in the world in some ways because we’re the most, you know, popular destination from all over the world for both visits and for long-term arrivals. So, you know, we need to have a very robust system because, believe me, if something happens in West Africa, it’d be here in 24 hours.
J. Stephen Morrison: Now, while you’re talking about the budget proposal from the Biden administration, I want to ask you about the proposal that they’ve come forward with to invest $6 ½ billion in a new agency, ARPA-H. It’s modeled after DARPA at the Defense Department. But it’s meant to accelerate through NIH, through the National Institutes of Health, accelerate public-private partnerships that’ll bring forward better solutions on cancer, Alzheimer’s, other chronic diseases. Your thoughts on that?
Representative Tom Cole (R-OK): Yeah, it’s early days. We haven’t, you know, come around a hundred percent on this. People still have questions. But I’m a big fan of DARPA, which I think has done great work. It’s high-risk, high-reward kind of investment, but no question that the reward has more than merited the investment in the defense area.
So the concept is an appealing concept. I think our big concern initially – and I’ve had extensive private discussions with Dr. Collins about this, other people at NIH. Number one, we didn’t want something new that was separate from. If this is, you know, a new part of NIH, a new mechanism within it, that’s good. We didn’t need competing agencies, so to speak, out here. And that looks like that’s the plan. And I think NIH initially had the same concerns.
I’ve been around, you know, particularly on this committee, on – education I’ll use as an example – where people tend to get attracted to whatever the shiny new object is. I remember a number of years ago when President Obama was there, and the education program was something called Race to the Top. Well, you know, Race to the Top sounded wonderful and it was great, but it was funded at the expense of programs like TRiO and GEAR UP that have a longer history and that are very successful, producing millions of college graduates for the United States from populations that – I mean, most of these kids are first-generation college students.
So, you know, we were cannibalizing proven programs to try and do something new that wasn’t likely to last past an administration. And Race to the Top is no longer around, so to speak. So I think you fund the basic programs.
So we want to make sure that HARPA fits that model, that it lets us utilize the institutes across the NIH in a creative way, form partnerships with private entities. We certainly saw that in COVID-19. I remember Dr. Collins, and we had multiple discussions over the course of this pandemic, telling me. He said: Tom, we’re doing things in weeks and months that we haven’t done – you know, would have taken years beforehand. So we really saw some – and if that’s what this is, then I’m for it.
The second concern – and I made a point in the hearing when I raised this with Secretary Becerra. I said, I want you to understand this does not change my commitment to your topline number. Six point five billion dollars is a lot of money. Now, it’s not a one-shot deal. It’s over a three-year period. But as I recall, the DARPA, you know, budget’s around $3.8 billion, something like that, if I remember from our hearings. And you know, let’s just make sure we don’t overfund this at the beginning. I would want to keep the topline budget that the administration is proposing. And if this is the right number, great.
If we could start a little bit lower, as we sort of build the protocols and make sure this works and it pans out, I don’t want something that doesn’t work, although I’m – again, I walk into it with the expectation that it would, and the hope that it would. But $6.5 billion is a bit bet. And I might want to start at the table with a little bit smaller – (laughs) – bet and put that money – I’ll give you an example. We’re only funding 11-12 percent of the proposals we’re getting at National Cancer Institute right now. And it’s not because we’re not doing more than we’ve ever done. I mean, we are. You know, but over the course of the entire, you know, NIH apparatus, we’re probably funding 20, 22, 23 percent of the proposals.
Our problem is the scientific breakthroughs in cancer right now are just coming at extraordinary speed. This is a real moment of cancer research. And so I want to make sure we’re funding enough there. And again, we’ve made progress over the last few years. We were down to as low as, I think, 8 percent funding of cancer. And that’s still our number-one killer. That’s over 600,000 Americans a year die of cancer. And that’s with a recovery rate of over 60 percent that we have now, which is an extraordinary achievement. But we’re losing as many people to cancer every year as we’ve lost in the pandemic over the last year, in a rough order of magnitude.
And so those are the type of questions. But, again, I don’t want to – I don’t want to be critical here. I want to laude the Biden administration for making a substantial commitment and a substantial and important proposal and introducing a new idea. Now it’s our job, as legislators, to ask tough questions and to make sure we use the resources. But we’re all on the same page. And in this area, you know, I really look forward to working with an administration that I know is committed to making substantial investments in biomedical research and public health preparedness.
J. Stephen Morrison: Thank you. Thank you very much.
You’ve been very vocal about the need to get to the bottom of the controversy surrounding the origins of SARS-CoV-2. We know that there’s kind of two broad hypotheses. One is that it emerged through zoonosis, through a natural process of mutation and migration from animal species to human. There’s also the proposition that gain of function research that is manipulation of the virus in laboratories, that gain of function research has spread around the world into many different institutional settings, often with very weak regulation and oversight. Some of that was going on at the Wuhan Institute of Virology.
So we’re lacking data on – to support either of those. But I do believe that what we’re seeing here is a kind of recognition that the gain of function is a threat, if not – that that type of research is disseminated globally into many different settings where the oversight and accountability is oftentimes quite weak. Tell us a little bit how do we crack the nut specifically on Wuhan, where the Chinese are pretty dug in here, but more broadly what are we going to need to do in terms of biosafety and biosecurity in this current era?
Representative Tom Cole (R-OK): Yeah, I think the first thing that’s important is that we recognize that we have two working theories here and that we not vilify people that are associated with either one of those. I mean, these are people that are trying to get to the truth. And what looked like, you know – it’s been interesting to me just following these how, you know, I think initially most people thought it was probably a natural spread, but I – you know, in the last few months I think the pendulum swung the other way and it certainly now looks more like it was a lab escape incident – not a deliberate design, but a really bad thing.
And I think that, you know, honestly, the Chinese have been very bad actors. They’ve contributed to this because they’ve not opened up everything. They’ve not revealed everything they know. They have stonewalled from the very beginning. And you know, if you’re not guilty, then don’t act like you’re guilty. And I think they’re, in this case, acting like they’re guilty. And they did measures early on, such as prohibiting travel from Wuhan to Beijing but not prohibiting it from Wuhan to San Francisco. You know, there was a lot of thing(s). And we know they manipulated the personal protection equipment to their advantage and bought up stuff all over the world. I mean, this – it looks terrible and they’ve not been a good actor in this.
And I think probably initially a lot of our people, you know, didn’t want to believe that. And I think they’re probably dealing with scientists who are very much like them. You know, they’re trying to get at the truth. They’re worried about public health. They’re not necessarily dedicated members of the regime. But we are dealing with a very dangerous regime here and one that has a very ruthless competitive attitude, in my view.
So we need to know this, number one, to just get at the truth and guard against this. As you point out, we may need to rethink gain-of-function kind of research protocols for the entire planet, not just for China, this – you know. And we need to be able to do this in a thoughtful way where we don’t have everybody trying to score political points on this one way or the other. But again, you know, my instinct right now is I’m very worried that the Chinese didn’t cooperate, a lot of people died, and trillions of dollars’ worth of damage were done because they were slow, clearly, in notifying.
I think they probably manipulated the World Health Organization. That’s a huge loss because that will undermine the credibility of an institution that we really need. There needs to be a World Health Organization, but it needs to be something that everybody believes is above being manipulated, whose only objective is the protection of human health and cooperation across international borders, sharing of information and resources in times of crisis in ways that save people.
So there’s been a lot of damage done here, I think, by the Chinese, quite frankly, and I’m sad to say I see it spill into domestic politics. I hear a lot of people – you know, whatever our financial commitment was to the Wuhan laboratory – and that’s serious; we should know what that was. And it was through a third party. We’re talking maybe $600,000 to –
J. Stephen Morrison: Correct.
Representative Tom Cole (R-OK): That’s not a lot of money in the operation of a lab. It sounds like – and that was spread over several years. So there is every reason for us to be looking at bat populations in China given SARS and MERS and that beforehand.
That’s the other thing that concerns me now about the natural thing. We have not really identified, you know, where this came from, and it’s now been well over a year that we’ve been looking into this. And we identified SARS and MERS a lot quicker. And again, that argues, again, for a lab accident as opposed to something else.
But again, we should also remember some of the information we got were some – from some very brave doctors and scientists in China, some of whom died, you know, as a result of the disease. And you know, sort of – it’s not the human beings I doubt here, but I do think there’s a regime that acted outside the norms and everybody paid a horrific price for it. And it looks to me much more like a coverup right now. If it’s not, open everything up, let’s have a real investigation. They haven’t done that from the very beginning. So I think there’s a lot to answer for here.
J. Stephen Morrison: Thank you.
One point I want to raise here. There is a – there is a risk in this current very overheated controversy that some of our folks, like Dr. Fauci and some of our scientists who were partners in what were legitimate research efforts – partnerships – in China, that they – that the environment’s becoming overly politicized. There’s been quite an increase in the attacks upon Dr. Fauci coming from former President Trump, from others recently, members of Congress and others. What are your – what’s your view on that? That seems to be a pretty dangerous phenomenon.
Representative Tom Cole (R-OK): I think it’s a very dangerous phenomenon. Look, Anthony Fauci has spent a lifetime, you know, as one of the premier experts in infectious diseases. He’s worked for multiple presidents of both parties. You know, is a man of outstanding personal character and distinguished academic and institutional achievement. That’s just true. And so whether he was right or wrong at the very beginning about lab versus not, I mean, he’s made the point more eloquently than I can probably his biggest role was in helping coordinate Operation Warp Speed.
Now, there’s a lot of – that’s been such a tremendous success – there’s a lot of people that deserve a lot of credit there, and I think Alex Azar deserves a lot of credit, our – the Trump era secretary for Health and Human Services, I think Dr. Fauci and Dr. Collins. I think a lot of people I don’t know in the private sector deserve a lot of credit here, too.
So but we should just remember that. The response has been extraordinary. It’s been uneven. You know, we were overtaken by something we didn’t understand, that nobody had any experience with in living memory. You know, we have not had a global pandemic like this since 1918, 1919, and probably there was a certain amount of complacency at every level that we can always fix things. We can always solve things. We can all – but, you know, this could have happened with the MERS or SARS, but we got on top of it fast enough. We worked together internationally well enough. This could always happen with something like an Ebola, but we’ve, again, gotten on top of it.
So but you just got to realize that it’s sort of like playing baseball. If they keep hitting fly balls at you, sooner or later you’re going to drop one. Sooner or later, you know, everything doesn’t work just right, and this is one of those instances and we have to deal with it. But vilifying people that are operating in good faith, that have careers that are distinguished, is not helpful.
And, again, most of the people I see doing this, quite frankly, are not people that voted to help us have the resources that we needed to deal with this in the first place. You know, if you didn’t vote for the Labor/H budget that funded a lot of this stuff, don’t lecture me on what we didn’t do right. I mean, you know, belly up to the bar and cast a vote, and spend some resources here on what’s an important national investment. And so, again, I think historians will sort all this out. You know, I guess we’re all, you know, looking at Dr. Fauci’s emails now. I don’t see anything very incriminating there. I see a person wrestling with a crisis. I can’t believe he had enough time to read that many emails and respond to them and try and be that helpful.
So, you know, count me as one that thinks – this is sort of like when we went after some of our own nuclear scientists in the early era of the nuclear age and we were worried about, you know, loyalty or worried about, you know, how are the Russians getting access to nuclear, you know, technology.
And yes, they were very capable in espionage, but they also had some pretty capable scientists of their own. They’re pretty smart people themselves, you know, and, you know, tearing ourselves apart internally isn’t going to help us prepare for another one of these things and it’s not going to encourage people to go into public health, to go into these positions, if, instead of working with them, we’re going to vilify them and try and score points at their expense. So, again, I don’t find this a fruitful or helpful debate.
J. Stephen Morrison: Thank you, and I’m very heartened by what you’ve said in defense of Dr. Fauci. That’s terribly important.
In the Biden administration’s budget proposal for FY ’22 – 2022 – they’re proposing 10 billion (dollars) for global health and within that envelope of 10 billion (dollars) there’s a billion (dollars) for global health security, which the understanding is that this is – this will be in the regular budget for several years going out. That’s an important step, it seems to me, in moving towards that type of budget measure. And within that 1 billion (dollars) is 250 million (dollars) that will go towards the early stages of a pandemic financing effort, still in the works in terms of negotiations and the like.
But let’s start out, first of all, your thoughts on this move to build into the normal budgeting process a billion a year for global health security.
Representative Tom Cole (R-OK): I’m very much supportive of that. But let me pull back one step on the budget process, because it’s something I’m really worried about right now. If you look at the overall Biden budget, it’s about a 10 percent increase, roughly, but it’s very focused on domestic spending. The domestic budget goes up about 18 percent, the defense budget about 1.7 (percent), which, inflation-adjusted, is actually a modest cut.
On the defense side, you know, we’ve had several years where we’ve had a succession of, I think, really fine secretaries of defense; you know, Secretary Mattis in particular, who reoriented our thinking toward great-power rivalry, and Secretary Esper. Both of them would tell you we made some really important investments in their tenures, but we – about 3 to 5 percent real growth to sustain where they think we need to go. I think that’s true.
And the Biden budget doesn’t do that. And so we’re going to – whereas the Department of Education, you know, has increased 41 percent. I say this as a guy who used to be an educator, and I’m for them having a robust budget too. But a 41 percent increase in one year is a little much.
So what I worry about is in the budget battles to come, that if that domestic spending number doesn’t come down and the defense number doesn’t go up, you won’t get a bipartisan agreement. So while we will agree on individual things like NIH, like this Global Health Initiative that you’re talking about, if we stumble into a continuing resolution because we can’t reach a broader agreement, none of those things happen. We’re just living with last year’s budget.
Now, I think that’s actually, as I tell my friends, the best guarantee the Democrats will come to the table is I promise you Senator Leahy and Congresswoman DeLauro did not become the chairpeople of Appropriations to live with a CR that is Donald Trump’s last negotiated budget with Congress. So we have a powerful weapon to bring people to the table. But there will be people that will argue that we will be better off with a CR because it won’t spend as much money. And most of those people are not very familiar with the damage that CRs do to the military, to every agency of government, when you can’t have an active adjustment in a budget in a real-time budget process.
The example I always use, if you have a CR and we needed a hundred Abrams tanks last year and we need 65 this year, you’re still buying a hundred Abrams tanks. You know, it’s just silly. And you can’t start a new project. If you need a new set of runways someplace and a new – and we’re bringing on the KC-46 at Tinker Air Force Base and we’re going to be the long-term – we can’t build those things under a CR. You know, we have to have a regular budget. So that’s problem number one.
Now, in terms of the health-security stuff, I agree with all this. I think these are modest investments that do a lot to protect the American people. And again, this is in a military sense. It’s even more true in a biomedical sense. You can’t defend the United States in isolation. You have to be forward-deployed. You have to deal with disease. And, you know, we actually have a long history of this. We’ve done better than we think.
I remember years ago visiting a naval medical-research station in Peru, and they were doing some really important work on Zika at the time. And I asked them, I said how did this get here? You know, and, oh, gosh, you know, in World War II we lost more soldiers to disease in the Pacific than we did to combat – in combat. So we decided we probably needed a network of research stations in tropical areas to study disease. And we have them, and they’re decades old, and they do really important work. It’s an important part of our defense establishment, because you never know where you’re going to have to fight. And we need, you know, our troops immunized and with the best therapies available. But that spills over into civilian research as well.
So, again, operating around the world, making sure that we make investments – because, again, we can do things that other people can’t do. We do have resources and infrastructure that nobody else in the world can rival. But it does take regular investment and take some new thinking now and then. As I said during the Ebola crisis, you remember we had one patient that actually got from Africa to Dallas on a flight. And fortunately, they were able to locate him, and isolate him, and we didn’t get a major outbreak in the United States. But where do you want to fight Ebola, West Africa or West Dallas? I know between the two where I’d rather fight it. And we did. We deployed considerable resources there. I think we did it in a good way. I think we left some health infrastructure there that will serve us and the people there long term. So those are the kind of smart investments we need to think about.
J. Stephen Morrison: Thank you.
You brought up the Department of Defense. I want to focus for just a moment around its role internationally. We’ve talked about DARPA as an institution that is experimental, new public-private partnerships, thinking out of the box around technology and applications. We have the overseas labs. We have the surveillance system GEIS. We have research that’s been going on for decades through the labs. And we – obviously, we’ve seen here in the domestic response the DOD support of civilian efforts in terms of logistics, planning, delivery, and the like. And I know there’s discussion now around the DOD role as we expand our engagement internationally.
There’s another issue which is around medical personnel, the career corps within the Department of Defense, and making sure that we protect that population. So it takes a good 10 years to train up those folks. You’re on the Defense Appropriations Subcommittee. Your thoughts on these matters around the significance over the overseas engagement by DOD in support of civilian health security?
Representative Tom Cole (R-OK): It’s very important. And I was kind of surprised in the Biden budget there’s actually a proposed cut. We have a particular agency in defense that thinks about pandemic disease and helps plan for it. And its budget was cut by, like, 40 percent. Now, I don’t think that’s because the Biden administration doesn’t think this is important. I think they do think it’s important. Every other investment, you know, on the civilian side shows that they think it’s important.
I think they just have cut the defense budgets – or, you know, clamped down enough that people are trying to – you know, the main mission of defense is, obviously, a military one. And we have to have a military capable of engaging and defeating near-peer opponents any place in the world. And I don’t think we’re funding that adequately in the president’s proposal, in my view. And I think some of these other areas then get squeezed. But they’re important areas.
And Defense Department does house some capabilities that nobody else has. And we see it – again, its main mission is always to fight and win wars. Nothing should take away from that. But having the ability, for instance, when we had the tsunamis in Indonesia to respond, having the ability to help our friends and allies, the Japanese, when they, you know, had their tsunami/nuclear problems – we deployed 19,000 U.S. military personnel to assist the Japanese government in the relief of its people. This is an advanced and capable country, and a country that is very important to our own defense, and a very firm ally of the United States.
Having the ability to do that, or having the ability to go to Haiti, you know, when we had earthquakes there and disasters, with hospital ships, and the ability to provide relief. That kind of capability obviously is necessary in a wartime situation, but it can be used in peacetime, you know, opportunities. And it’s an enormously attractive thing to the rest of the world, that the United States has these kind of resources and will deploy them in this kind of way, in a disinterested way. It’s a great diplomatic advantage for us.
I remember once talking to a very experienced combat commander. And I asked him what was important to him when he was deploying troops. And he said: I want to make sure when I’m deploying troops that when I send them someplace these aren’t the first Americans they’ve ever seen. I want there to have been diplomats ahead, and I want there to have been – I want them to have a favorable impression of the United States of America. I don’t want the first thing that they see to be combat troops. And he said, that makes a big difference in how we’re received and the cooperation we get from the local population when and if.
I thought it was a very astute answer. You know, it’s always interesting to talk to military leaders because they are almost always the biggest proponents of a robust diplomatic/foreign assistance. They see national power much more broadly than just a military focus. They see all these other elements of soft power that are advantageous to them.
So maintaining this ability – back to the point – of our military, which has unique logistical abilities, unique assets that it can deploy – maintaining, you know, the appropriate kind of health-care response there, as long as it doesn’t take away from the main mission, is important to us. And again, it’s an asset that very few other countries have and nobody has on anywhere like the scale of the United States. So if there’s something global going on, we can be an important player for good. And our service people, you know, are just amazing that they will do that. They take on risk in lots of ways beyond the traditional ways we think of in serving your country in uniform. We send you into a place that’s been ravaged by a natural disaster or you’re dealing with disease, you’re running a risk of a whole different sort and maybe a risk you didn’t even think about when you signed to serve the United States of America and put on a uniform. But you’re doing it.
And so I’m proud of them. I want to make sure they have the – whatever it is they need to succeed wherever we put them and whatever mission we ask them to undertake.
J. Stephen Morrison: Thank you.
We have a few more minutes remaining. I want to talk for a minute about the Coalition for Epidemic Preparedness Innovations, CEPI. This was a(n) entity that was created after Ebola in order to accelerate the development of vaccines against dangerous pathogens where the marketplace was weak in terms of bringing private sector in, and use CEPI as a – as an intermediary and a catalyst to get the private sector connected up. It’s been quite successful. It’s proven to be very important in the creation of the COVAX – the solidarity mechanism to try and get vaccines to low- and middle-income countries. It’s showed great progress in accelerating the development of a number of the vaccines that are now being used. It’s also getting into innovations in manufacturing capacities so that we can get expanded manufacturing capacity for vaccines. And it’s – and it’s now looking at the next five-year stint in its lifespan to start looking at therapies and diagnostics, accelerating the development of those. And it’s proposing to the U.S. government that the U.S. become a major technical and financial partner over many – over the next five-year period. Your thoughts on CEPI?
Representative Tom Cole (R-OK): Again, money well spent, you know, investments well made. And the dividends are obvious and, frankly, sometimes immediate.
So, again, in the context of the budget – and you know, when we see the damage that this pandemic has inflicted upon our own economy, this is like the most modest of insurance – (laughs) – investments to me, to have these capabilities and, again, to recognize we need not just national but multinational institutions and efforts to deal with it. And we’re going to always play a unique role there, and there’s going to be some controversy about that. But you know, how is this much different than, you know, the Marshall Plan or something, you know, when we thought enlightened self-interest means we need a strong Europe, you know, and we’re going to make some investments here beyond military investments to help get this done? Well, we need a strong, you know, biomedical defense system that operates globally, and we need, you know, to pay the resources. We will be the biggest beneficiary, in the end, of these kind of investments.
And you know, again, I remember years ago at the – when we were dealing with Ebola, and I think it was my first year as chairman of the Labor-H Subcommittee, so I had talked to Dr. Collins and I had never been to NIH. And I said, hey, I’d like to come out, see if some of my members would like to come out, and just, you know, have you show us on ground some of the things that you do and educate us. And we did, and now it’s an annual feature we do that, since it’s a quick trip. And I think we missed last year, obviously, because of COVID, but we’ve done it – my successor, now the chairwoman of the full committee, Rosa DeLauro, likes it and does it too. So it’s – and we get a lot of bipartisan participation.
But in the very first one – and we were talking about Ebola and what we were doing there. We were making substantial investments. The vaccine had just been developed. And I wish I could remember her name, but Dr. Collins introduced me to a woman whose work had laid the groundwork for the vaccine. And she said: Here, let me show you where I got my idea. She pulled out a notebook from the 1990s that she had – her original idea, and went to the page where, this is where this started. And because we – once we had the money we could pursue it and, boom, it worked. You know, that kind of preparation, having people with that kind of talent thinking about things that are unthinkable and that you hope never happen but you better be prepared for it if they do, it’s just priceless. So again, these are the – these are all kinds of investments we ought to be making. And in the end, we know they’ll save lives, and we know that they will save, you know, trillions of dollars.
J. Stephen Morrison: Congressman, you’ve been very generous with us this morning in sharing all of your thoughts over this hour with us on so many different topics. I just want to thank you for your leadership in Congress, your leadership on health security, your contributions to CSIS, which have been so valuable and so substantial over several years. We’re just really grateful to you and thank you for being with us today.
Representative Tome Cole (R-OK): Well, other way around. Thank you and thank the folks at CSIS. They’re an important part of our capabilities as a country to deal with the challenges that we have and have a lot of very gifted people there doing a lot of great work for the United States and contributing honestly to a much more secure planet. So thanks for all CSIS does. My privilege to get to work with you guys.
J. Stephen Morrison: Thank you.
(END)
