Conflict of interest concerns keep CDC's Fitzgerald away from yet another meeting with Congress

A Senate health committee held the first of two hearings Wednesday over the current state of the nation's readiness to address public health emergencies, which led to calls to improve the reliability of data collected during and after disasters.

But before senators could tackle some of those pressing issues, they first had to contend with the fact that Centers for Disease Control and Prevention Director Dr. Brenda Fitzgerald again canceled an appearance before Congress. Fitzgerald cited ongoing potential conflicts of interests related to her personal financial investments as the reason for recusing herself.

Appearing instead was Dr. Stephen Redd, director of the CDC's Office of Public Health Preparedness and Response, which runs the national command center responsible for the deployment of personnel and resources to disaster areas. Redd was joined by Dr. Robert Kadlec, HHS assistant secretary for preparedness and response; and FDA Commissioner Dr. Scott Gottlieb, who provided updates on the agency's efforts to address shortages of intravenous saline fluids experienced by many hospitals across the country since a major manufacturer in Puerto Rico was forced to stop production due to the loss of power caused by Hurricane Maria in September.

On Tuesday, Gottlieb said the FDA expected the shortage to be resolved in the coming weeks as the agency approved products imported from other countries and as new companies begin production.

"The dynamics of all shortages are challenging—this situation is no different," Gottlieb said in a statement. "We're actively monitoring the situation and taking actions to address this shortage."

This isn't the first time that Fitzgerald has declined to appear before the Senate Health, Education, Labor and Pensions Committee. Sen. Patty Murray (D-Wash.), the committee's ranking Democrat, said Fitzgerald has declined three other opportunities to testify since taking the helm at the CDC last July.

In a letter sent to Fitzgerald last month, Murray requested the former Georgia state health officer to make her ethics agreement publicly available and to "clarify" by Dec. 19 whether she would be able to resolve any ongoing conflicts of interest.

"I am frustrated that Director Fitzgerald is once again unable to join us here today," Murray said. "Due to conflicts of interests presented by investments, our CDC director still has to recuse herself on some of the most important health issues that we face."

Murray stated that in the ethics agreement Fitzgerald submitted to HHS last September, she stated she was unable to divest from certain investments. Those investments, Murray said, required her to recuse herself from fully engaging in matters involving such issues as cancer and prescription drug monitoring programs to reduce opioid misuse.

"I am concerned that she still can't give her full attention to all the pressing health threats we face, and I hope that these conflicts of interest will be resolved soon," Murray said at Wednesday's hearing.

In an emailed statement, the CDC countered Murray's claims, saying Fitzgerald was "ready and prepared" to testify, but chose to defer to the committee's request to have a single CDC expert testify at the hearing.

As far as the conflicts of interest, the agency wrote: "Dr. Fitzgerald is actively working to address recusal obligations as soon as possible related to two financial holdings that, as noted in her ethics agreement, have complex transfer restrictions."

The hearing itself could be viewed as a prelude to the impending legislative effort to reauthorize the Pandemic and All-Hazards Preparedness Act, which is scheduled to expire in September and provides funding support to emergency preparedness programs that help improve state and local public health security, enhance bio-surveillance, and ensure hospital preparedness and medical surge capacity.

But the response to a number of recent public health emergencies has brought into question the nation's overall readiness to handle large-scale events such as an influenza pandemic or a widespread bioterrorism attack.

Kadlec said the country's level of preparedness varies depending on the type of emergency and that we still have "a long way to go" before we are prepared for newer threats such as bioterrorism or a cyberattack.

"Those are the things that keep me up at night," Kadlec said to lawmakers. Kadlec praised the response to hurricanes Harvey in Texas and Irene in Florida.

Sen. Elizabeth Warren (D-Mass.) asked what lessons the department learned from the response to Hurricane Maria and the devastation it left behind on Puerto Rico. Roughly half of the island's population is still without electricity. Many advocacy groups have raised questions about the federal response to Puerto Rico, especially when compared to Texas following Hurricane Harvey.

Kadlec said greater effort needs to be made to deploy teams to areas just prior to the storm to quicken response times.

But Warren contended any lessons that may have been learned had to be backed up with the collection of good data, which she claimed has been lacking when it comes to the island's recovery efforts. She highlighted disparities she encountered during a recent trip to Puerto Rico, where officials said most if not all of the island had potable water at this point, a claim she and others have disputed.

"We need to know not just what we got right and what we got wrong but when we got it right and when we got it wrong, by how much, and what kind of difference it would make on the ground," Warren said.

The committee's second hearing on public health readiness is scheduled to be held Tuesday, and will feature testimony from non-governmental stakeholders, according to committee Chair Sen. Lamar Alexander (R-Tenn.).