welcome to atarc's webinar series my name is jonathan albaum and i am the federal cto for servicenow and today i have the pleasure of moderating today's panel i want to begin by welcoming all of our attendees today we're going to be addressing the american rescue plan the american rescue plan is president biden's signature signature achievement in his first few months in office it aligns with his top priority providing coveted relief to all americans 1.9 trillion dollar act was passed in march and create significant requirements for all agencies for agencies at all levels of government to speed up the us recovery from the economic and health effects of the pandemic the agencies that are most responsible for implementing the arp all rely heavily on technology which really isn't very surprising when you recognize that the president's plan requires all levels of government to be firing on on all cylinders to ensure that the 1.9 trillion is used effectively and efficiently in support of the american people so at servicenow we make government work better for federal employees and the people they serve and one of the most important ways we do this is by ensuring that public sector can engage with their customers in the best way possible and we're working across agencies to streamline citizen service delivery uh we're working with agencies to manage vaccine distribution and working with a variety of organizations to enable a safe return to offices and to schools so these are all key elements of the american rescue plan so i'm very interested to hear from our panelists today on how they're supporting these and other aspects of the arp so today we're going to have uh some back and forth between myself and our panelists we're going to have some poll questions and i want to also encourage our audience to submit your own questions at the end of today's presentation we'll have a chance to go through these so please send them in and also remember to answer the poll questions as we as we get to those because they will ensure that you get cpe credit for today's session i want to begin by introducing our panelists panelists and i want to ask each of them to share a little bit of their background and describe their current role and i'd like to begin with jonathan warsh who is a senior policy advisor at the department of health and human services part of the covid19 response team jonathan thanks jonathan uh good to be with all of you my name is jonathan worsh i'm the astronaut instead of a senior policy advisor on the hhs code response team i came to the federal government previously from state government where i was working on uh pandemic response in the state of michigan for the first year or so of the pandemic and in our current team we focus on uh the range of cross-cutting issues that affect hhs so we're sort of the organizational nerve center for issues that touch cdc fda cms um other components of hhs and and sort of perform that uh cross uh agency coordination role uh internally with the white house so we have been spending uh an enormous amount of time on the american rescue plan and um and implementing various elements uh of the spending associated with that plan and and very excited to talk to you about that today thanks johnson um next i'd like josh corman who's a chief strategist at the cyber security infrastructure security agency to introduce himself hi i'm josh corman i'm a emergency cares act hiring authority uh for a one-year renewable up for one year more uh term as part of the pandemic response that congress passed last spring um i'm what you get when you put a philosopher in the hacker community for a couple of decades but i've held roles as chief security officer in the private sector but i was recruited by director krebs last year at the pandemic to be the chief strategist and design and implement cisa's response to the pandemic both for the protection of health care delivery during a once in a hundred year uh pandemic and impact on hospitals a month amongst adversaries deliberately disrupting and degrading patient care when we need it most but also in support of the interagency effort known as operation warp speed so we could develop and distribute first of a kind cures to protect u.s interests and the public so i lead a massively multi-disciplinary team and bring to bear some experience i drew upon from serving on a congressional task force for a healthcare industry cyber security for a few years so we try to put some hacker and executive mindset into the excellent ranks of the federal government over the last year to try to keep things uh reduce the harm possible but there was so much harm that we're gonna get into that uh we'll talk about why some of this rescue plan is necessary thanks josh and uh last but certainly not least i want anthony uh orozos to introduce himself and anthony i'm sorry if i messed up your last name there it's okay it's all roast it's fine um good afternoon good morning everyone my name is anthony oroz i'm the assistant director for the pharmaceutical center of excellence and expertise in customs and border protection i know that's a mouthful but uh we've been working very closely as you know cbp where uh our main duties facilitation and legal entry of all the goods coming into the united states so i believe since march of of last year when the pandemic began we were we set up a team ccrt the cargo cove police team uh response team um to facilitate any any pandemic vaccines ppe everything you name it um into the united states without the lice so with the ppe back here and that was a big mess and everybody in there and mother was trying to get in some kind of mask or get into the united states and that slowed down and then we had the vaccines so basically our team facilitates and safely make sure everything related depend to the pandemic gets into the united states and we work very closely with the private industry the drug companies on the ppe producers uh to give us a heads up when they're having shipments in so to this day we were actually i remember working on thanksgiving night of last year um getting the first facilitating the first uh physical vaccine into the united states into a free trade zone so we've had haven't stopped since and every shipment of vaccine or vaccine material that comes into the united states we pretty much have our hands on uh one way or another so pretty much well uh thank you anthony you know the one of the common themes across all of your introductions was um the vaccine vaccinations and the need to uh ensure that people could get the vaccines whether it's be than being created as josh described or distributed that distribution um processes that hhs is involved in uh that jonathan talked about or or just getting them into the country like anthony talked about the the vaccine is obviously uh has changed a lot of the gain still complicated but obviously it's it's made a tremendous difference in all of our lives so far so um you know jonathan uh maybe we could just jump back to you and can you talk a little bit about the uh processes that hhs is involved in relative to american rescue plan for vaccine distribution and other activities with within the agency i think i read recently that there was you know more than three billion dollars of uh funding sent to state and local governments for vaccine distribution activities yeah so um you know if you look at the american rescue plan funding i believe there was about 150 billion that went to hhs uh and of that 150 billion a large amount 30 40 was just around vaccine distribution um some of that money uh we funneled to community health centers to pharmacies some that went to fema which was setting up mass vaccination sites and so you know for i would say the first quarter of this year um a a you know very large amount of our effort in our funding was just getting the vaccine out and available um in in as many distribution channels as possible i think it's um you know you hear these stories i think i heard from the nba finals that you could get a vaccine at you know the stadium where the bucks were playing and they were going around and saying hey you want to take a bathroom break go get your vaccine but in the early days it's easy to forget that it was not widely available um and and it took um our state partners um you know time to figure out how to get distribution channels right uh and so that included um the healthcare ecosystem it included um you know pharmacies it included local public health offices and so there was just a really huge amount of our time and effort on um on the logistics the operations of getting the vaccine out there and and fema played a really large role especially with a lot of these mass vaccination sites um as a you know sort of former state official i would say that um the states and local governments deserve a huge amount of the credit for a lot of this work it took them um time to figure out how to get this up and running um but the vast majority of these vaccines are being you know distributed and run by local operations and so i just want to make sure to call that out there was a bit of a shift um i would say once supply inflected with demand uh and so we in the last several months have spent a lot of our arp dollars and a lot of our time on vaccine outreach and education um and you know the amount of time it took to get to 50 of the country vaccinated i believe is less than the amount of time it took to get from 50 to 70 and so every incremental all the incremental progress that we are making now um takes time it takes effort um there's been a lot of you know we're sort of in early days of research and understanding on this i spent a lot of my time now on public health outreach and education and you know i think contrary to a lot of popular opinion people who are choosing not to get vaccinated now um are not monolithic um and so we are sort of really in the early stages of understanding why people don't want to get vaccinated what might convince them to do so uh and so that really has been the shift in hhs efforts um over the last i would say two to three months is is much more about um vaccine outreach vaccine education funding local community organizations funding um uh faith-based organizations that are doing this work on the ground um and and i guess the last thing i'll say about this is we are also planning for a future but a future that is unknown we don't know yet whether or not people will need boosters um uh our outreach strategy our delivery strategy you know we're building that in real time but we don't you know we don't know i think folks probably saw there's new cdc guidance on masking that's coming out right now you know that's a um that's another factor so um broad range of activities but the the nature of the work really has shifted as the uh you know as the situation on the ground has shifted with regard to the pandemic well um thank you jonathan i i think you know the the vaccine distribution of those early days was a tremendous workflow challenge you know that it it was very confusing but it was also uh quite a complicated effort behind the scenes and you know you're right the um state and local governments you know really uh stepped up and played a huge role in you know i think a lot of people have thought about is there a better way if we have to do this again instead of replicating this uh you know countless times across all these local governments but you know i haven't heard anybody describe something better you know a national approach seems uh somewhat out of reach at times so i think uh your your perspective is a is a really interesting one having served in in the in the states uh in state government and now from an adhs perspective um i want i want to i want to turn uh to um anthony uh just you know what are the complexities to make uh what jonathan was describing work you know how does it how does it work at a at the border in order to get vaccines into the right hands so they can get to that state of state health office or county health office certainly it's not simple no in the beginning it was it certainly got more simple uh over the past few months i think we take pride also in working uh directly with the private industry that would be the drug companies of pfizer modern and johnson johnson astrazeneca we always had a personal relationship with these large companies um we know we're in the enforcement business cbp obviously but we know these large legitimate businesses are the business of fraud so we work very closely with them and they were giving us a heads up on the possible vaccine importations from belgium and over in europe uh long before they ever came into the country so we were well aware that we were working with them um they had vaccines in the country before it was even approved so we would they were in the free trade zone ready to go millions of doses so as soon as that uh authorization was approved he got out to the states as quickly as possible after it gets in the country we kind of lose it there because cbp were a border agency mostly right but luckily now that's slowed down quite a bit now the vaccine makers actually they import vaccine materials almost every day and we have an eye on that um but a majority of the vaccine now is actually produced in the united states so cbp doesn't have much involvement with that just getting those vaccine materials into the country safely and securely and make sure they're expedited they come to different courts every day we reach out to those ports personally we have a relationship with over probably 20 ports of these vaccine materials have come in so they know us they know the companies now we have a great relationship everything pretty much is seamless at this point let's knock on wood on that one right because in the beginning the ppe was just a complete mess um but things have really settled down we're kind of in a routine now and and now we're also focusing on um counterfeits too so that's mainly going to be our focus moving forward i don't think counterfeits is a they're not a huge issue um is all the drugs are right now because you know the vaccine is free right so i don't know how if there's make any money if they're you know if we're giving them for free at this point right so they're not going to make too much money well for that but you know there's always that threat there in other countries we have seen counterfeit vaccines um we're having trouble getting these legitimate vaccines so they haven't made it a way over our border yet and hopefully like i said we don't see that anytime soon but we are we do keep our eye out for certain things like that um thank you i want to turn to to josh now and you know uh josh you you've uh talked about healthcare impact related to cobit and um you know i'm curious your thoughts there and you know also what was the role that um you know cesa had relative to operation works being the creation of the vaccine which you referenced in the beginning in your opening remarks sure i guess i'll go in reverse order um we really had two major elements to this is a support of the federal government in state local tribal territorial it was the keep hospitals the national critical function of provide medical care keep them as open and undisturbed as possible during peak needs to avoid excess deaths which were numerous and to provide cybersecurity and visual security uh support to the cyber assurance level of effort in operation warp speed so for the designated funded granted large organizations that we're trying to invent the world's first uh vaccines for this style of virus they had significant federal funding and assistance to make sure that we were doing threat intelligence and counterintelligence and marshaling taxpayer funded resources to keep them safe and running but one of sis's tasks as the nation's risk management advisor was to identify the smaller less obvious weak links in the supply chain that if disrupted uh could have a profound impact on public safety human life so whereas the large pharmaceuticals in the world have very robust global teams for risk management some of these other organizations that might make a key ingredient in dna or mrna we developed a ball bearing strategy stealing from world war ii doctrine for these less guarded organizations some of which had three it people zero security people on staff and would not withstand even the most basic of attacks that could introduce months of this delay after we knew we could invent these uh successfully and get them through approval and then scaled production and fill and finish um hopefully not disrupted by ransom attacks and the scourge of ransomware hitting all these organizations then the the last part of that shared responsibility between the federal government kind of operation warp speed stopped at the distribution points and then it became state local tribal and territorial and luckily cis's mission to include uh coordination with sltt um allowed us to maybe bridge that divide a bit for that last 1500 miles in a lot of cases on ultra cold storage minus 80 degrees celsius to keep cold things cold long enough to get into people's arms and now we're shifting that era where the key constraint is really hesitancy we have plenty of supply and we have plenty of um that we're exporting but we don't don't have yet enough people taking this for misinformation disinformation and other varied varied reasons the the net result of both the attacks let's shift to healthcare though because this is where i think it's going to take us years to recover um the net result of both the pandemic itself on our limited healthcare institutions and unprecedented levels of cyber attack in this elective sickness from people that aren't taking the available vaccine is really throttling our provided medical care we saw that when the u.s in february hit the 500 000 mark of lost americans to the to the disease what was talked about less is the cdc tracks excess deaths the difference between expected deaths and actual deaths and on that same day we had crossed 150 000 non-coveted deaths with the top demographic being aged 25 to 44 young people were passing away from otherwise treatable conditions from delayed integrated patient care things like heart attacks things like strokes things like diabetes that weren't getting timely care because there was no room in our finite hospital supply chains in hospital institutions so most of that delay in excess death came from people not wanting to go to the hospital or not being able to get in because of bed count but towards the fall some of that delay was exacerbated by record high attacks on hospital institutions for ransom crews if minutes or hours can be the difference between life and death for heart attacks and strokes respectively what do you think four weeks did uh to the state of vermont with 118 institutions down for a protracted period of time that would be um that would increase mortality during the best of times absolutely during a pandemic when we already have so little room so the long term of this is everyone keeps celebrating in a good way that our mortality rates are going down when people are vaccinated if they still get sick but these heavy loads on the national critical functions still put us in the danger zone for those excess deaths from non-coveted related conditions so it's not merely amount of how many people are dying that we are continuing to be concerned about it's what is the additional strains and stress on hospitals who have less revenue from no elective surgeries less hospital staff and doctors nurses who are retiring early from stress and strain and less capacity to treat the sick and wounded for long periods of time it will take easily five years to get to full fighting strength again even once the pandemic's over so uh it's not merely that we want people to get vaccinated uh for fear of mortality we also want to get people vaccinated to reduce the strain and stress on materially weakened healthcare delivery so so i think this is a place where you know i'd love to hear from jonathan um at an hhs perspective there's a you know a core part of the hhs mission which is around recovery you know in the arp recovery [Music]