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	<title> - THE SCIENCE OF COVID-19 VACCINES AND ENCOURAGING VACCINE UPTAKE</title>
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	[House Hearing, 117 Congress]
	[From the U.S. Government Publishing Office]


	THE SCIENCE OF COVID-19 VACCINES
	AND ENCOURAGING VACCINE UPTAKE
	=======================================================================

	HEARING

	BEFORE THE

	COMMITTEE ON SCIENCE, SPACE,
	AND TECHNOLOGY
	HOUSE OF REPRESENTATIVES

	ONE HUNDRED SEVENTEENTH CONGRESS

	FIRST SESSION

	__________

	FEBRUARY 19, 2021

	__________

	Serial No. 117-1

	__________

	Printed for the use of the Committee on Science, Space, and Technology

	[GRAPHC NOT AVAILABLE IN TIFF FORMAT]

	Available via the World Wide Web: http://science.house.gov

	__________

	U.S. GOVERNMENT PUBLISHING OFFICE
	43-412PDF WASHINGTON : 2021

	-----------------------------------------------------------------------------------


	COMMITTEE ON SCIENCE, SPACE, AND TECHNOLOGY

	HON. EDDIE BERNICE JOHNSON, Texas, Chairwoman
	ZOE LOFGREN, California FRANK LUCAS, Oklahoma,
	SUZANNE BONAMICI, Oregon Ranking Member
	AMI BERA, California MO BROOKS, Alabama
	HALEY STEVENS, Michigan, BILL POSEY, Florida
	Vice Chair RANDY WEBER, Texas
	MIKIE SHERRILL, New Jersey BRIAN BABIN, Texas
	JAMAAL BOWMAN, New York ANTHONY GONZALEZ, Ohio
	BRAD SHERMAN, California MICHAEL WALTZ, Florida
	ED PERLMUTTER, Colorado JAMES R. BAIRD, Indiana
	JERRY McNERNEY, California PETE SESSIONS, Texas
	PAUL TONKO, New York DANIEL WEBSTER, Florida
	BILL FOSTER, Illinois MIKE GARCIA, California
	DONALD NORCROSS, New Jersey STEPHANIE I. BICE, Oklahoma
	DON BEYER, Virginia YOUNG KIM, California
	CHARLIE CRIST, Florida RANDY FEENSTRA, Iowa
	SEAN CASTEN, Illinois JAKE LaTURNER, Kansas
	CONOR LAMB, Pennsylvania CARLOS A. GIMENEZ, Florida
	DEBORAH ROSS, North Carolina JAY OBERNOLTE, California
	GWEN MOORE, Wisconsin PETER MEIJER, Michigan
	DAN KILDEE, Michigan VACANCY
	SUSAN WILD, Pennsylvania
	LIZZIE FLETCHER, Texas
	VACANCY
	C O N T E N T S

	February 19, 2021

	Page

	Hearing Charter.................................................. 2

	Opening Statements

	Statement by Representative Eddie Bernice Johnson, Chairwoman,
	Committee on Science, Space, and Technology, U.S. House of
	Representatives................................................ 7
	Written Statement............................................ 8

	Statement by Representative Frank Lucas, Ranking Member,
	Committee on Science, Space, and Technology, U.S. House of
	Representatives................................................ 9
	Written Statement............................................ 10

	Witnesses:

	Dr. Kathleen Neuzil, MD, MPH, Professor in Vaccinology and
	Director, Center for Vaccine Development and Global Health,
	University of Maryland School of Medicine
	Oral Statement............................................... 12
	Written Statement............................................ 14

	Dr. Philip Huang, MD, MPH, Director and Health Authority, Dallas
	County Department of Health and Human Services
	Oral Statement............................................... 22
	Written Statement............................................ 25

	Mr. Keith Reed, MPH, CPH, Deputy Commissioner, Oklahoma State
	Department of Health
	Oral Statement............................................... 33
	Written Statement............................................ 35

	Dr. Alison Buttenheim, PhD, MBA, Scientific Director, Center for
	Health Incentives and Behavioral Economics and Associate
	Professor of Nursing and Health Policy, University of
	Pennsylvania School of Nursing
	Oral Statement............................................... 39
	Written Statement............................................ 41

	Discussion....................................................... 64

	Appendix I: Answers to Post-Hearing Questions

	Dr. Kathleen Neuzil, MD, MPH, Professor in Vaccinology and
	Director, Center for Vaccine Development and Global Health,
	University of Maryland School of Medicine...................... 110

	Dr. Philip Huang, MD, MPH, Director and Health Authority, Dallas
	County Department of Health and Human Services................. 112

	Mr. Keith Reed, MPH, CPH, Deputy Commissioner, Oklahoma State
	Department of Health........................................... 114

	Dr. Alison Buttenheim, PhD, MBA, Scientific Director, Center for
	Health Incentives and Behavioral Economics and Associate
	Professor of Nursing and Health Policy, University of
	Pennsylvania School of Nursing................................. 118

	Appendix II: Additional Material for the Record

	Documents submitted by Representative Gwen Moore................. 292

	Documents submitted by Representative Bill Posey................. 316


	THE SCIENCE OF COVID-19 VACCINES
	AND ENCOURAGING VACCINE UPTAKE

	----------


	FRIDAY, FEBRUARY 19, 2021

	House of Representatives,
	Committee on Science, Space, and Technology,
	Washington, D.C.

	The Committee met, pursuant to notice, at 11:25 a.m., via
	Webex, Hon. Eddie Bernice Johnson [Chairwoman of the Committee]
	presiding.
	[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

	Chairwoman Johnson. So I'll call this meeting to order,
	and without objection, the Chair is authorized to declare
	recess at any time.
	Pursuant to House Resolution 8, today, the Committee is
	meeting virtually, and I want to announce a couple of reminders
	to the Members about the conduct of this remote hearing. First,
	Members, they should keep their video feed on as long as they
	are present in the meeting. Members are responsible for their
	own microphones. And please also keep your microphones muted
	until you are speaking. And finally, if Members have documents
	they wish to submit to the record, please email them to the
	Committee Clerk, whose email address was circulated prior to
	this hearing.
	And so, again, good morning and welcome to the Space--
	Science, Space, and Technology Committee for the 117th
	Congress. We have an accomplished set of Members on our
	Committee--I just listened to one--and we bring diverse
	backgrounds and perspectives to our oversight and legislative
	work, and I look forward to a productive and stimulating 117th
	Congress.
	It is fitting that our first hearing focus on the COVID
	pandemic and the role of vaccination in fighting this virus and
	its devastating impacts. As the first nurse elected to
	Congress, I'm deeply committed to understanding how basic
	research supports healthcare solutions, and I'm also a firm
	believer in vaccines.
	Many of you are too young to know anyone who suffered from
	polio, but it was a devastating viral disease. I was a student
	nurse during that time, and I helped administer the polio
	vaccine as a student nurse. And thanks to scientific
	breakthroughs by brilliant virologists in the 1950's, the
	tremendous vaccine administration campaign that followed, this
	country has been polio-free since 1979. And we didn't get there
	by accident. We took great care to educate the public, ensured
	vaccine access in marginalized communities, and to assist other
	nations in vaccinating their own populations.
	Like polio, COVID-19 kills. The last 12 months have been
	of great suffering. But they have also seen astounding
	achievements in virology. Researchers at the National Institute
	for Allergy and Infectious Disease (NIAID) and their research
	partners laid the scientific foundation over the past decade
	for a new type of vaccine called mRNA. When the news of the
	viral outbreak in Wuhan reached the United States, NIAID
	quickly deployed partnerships with drug companies to develop
	safe, effective vaccines in record time.
	I cannot overstate what an incredible achievement it is
	that we have two safe, effective vaccines that have reached our
	shores. A third vaccine is being evaluated by FDA (Food and
	Drug Administration) as we speak, and we may have an answer on
	whether it is authorized as soon as next week.
	We have an opportunity to take the lessons learned from
	polio, from measles, and so on to make sure that these vaccines
	reach their potential. Here's one lesson: Vaccines don't save
	lives. Manufacturing billions of doses and distributing them
	are the supply part of the question, but in order to get
	needles into arms as quickly as possible, we also have to think
	about demand. There are a lot of factors that make up consumer
	demand for a vaccine, but perception of risk is a big one. We
	must build high public confidence in these vaccines. We simply
	cannot and will not bring this virus to an end unless we
	vaccinate a high percentage of the American population and, in
	fact, the globe.
	I hope our hearing today will help illuminate the methods
	that allowed these vaccines to be developed and approved
	quickly with scientific rigor, and that we will learn more
	about how vaccine hesitancy might threaten the pace of our
	national recovery. The Science, Space, and Technology Committee
	may not have primary jurisdiction over Health and Human
	Services (HHS), but we absolutely have a role in supporting
	public health outcomes through good science.
	I welcome our esteemed panel of witnesses and thank Dr.
	Huang in particular for joining us, as Dallas is facing
	unprecedented power outages and freezing temperatures this
	week, and I know the demands on his time are intense right now
	because we're also with much of an uptick with the virus.
	[The prepared statement of Chairwoman Johnson follows:]

	Good morning and welcome to the first hearing of the
	Science, Space & Technology Committee in the 117th Congress. We
	have an accomplished set of Members on our Committee who bring
	diverse backgrounds and perspectives to our oversight and
	legislative work. I look forward to a productive and
	stimulating 117th Congress.
	It is fitting that our first hearing in the 117th Congress
	focus on the COVID pandemic and the role of vaccination in
	fighting this virus and its devastating impacts. As the first
	nurse elected to Congress, I am deeply committed to
	understanding how basic research supports healthcare solutions,
	and I'm also a firm believer in vaccines.
	Many of you are too young to know anyone who suffered from
	polio, but it was a devastating disease. I helped administer
	the polio vaccine as a student nurse. Thanks to scientific
	breakthroughs by brilliant virologists in the 1950s and the
	tremendous vaccine administration campaign that followed, this
	country has been polio-free since 1979. And we didn't get there
	by accident. We took great care to educate the public, to
	ensure for vaccine access in marginalized communities, and to
	assist other nations in vaccinating their own populations.
	Like polio, COVID-19 kills. The last 12 months have seen
	great suffering. But they have also seen astounding
	achievements in virology. Researchers at the National Institute
	for Allergy and Infectious Disease and their research partners
	laid the scientific foundation over the past decade for a new
	type of vaccine called m-R-N-A. When news of the viral outbreak
	in Wuhan reached the United States, NIAID quickly deployed
	partnerships with drug companies to develop safe, effective
	vaccines in record time. I cannot overstate what an incredible
	achievement it is that we have two safe, effective vaccine
	options less than a year after this horrible virus reached our
	shores. A third vaccine is being evaluated by FDA as we speak,
	and we may have an answer on whether it is authorized as soon
	as next Friday.
	We have an opportunity to take the lessons learned from
	polio, from the measles, and so on to make sure these vaccines
	reach their potential. Here's one lesson: Vaccines don't save
	lives; vaccinations do. Designing the vaccine, manufacturing
	millions of doses and distributing them are the ``supply'' part
	of the equation. But in order to get needles into arms as
	quickly as possible, we also have to think about ``demand.''
	There are a lot of factors that make up consumer demand for a
	vaccine, but perception of risk is a big one. We must build
	high public confidence in these vaccines. We simply will not
	bring this virus to an end unless we vaccinate a high
	percentage of the American population and in fact, the globe.
	I hope our hearing today will help illuminate the methods
	that allowed these vaccines to be developed and approved
	quickly with scientific rigor, and that we will learn more
	about how vaccine hesitancy might threaten the pace of our
	national recovery. The Science, Space, and Technology Committee
	may not have primary jurisdiction over Health and Human
	Services, but we absolutely have a role in supporting public
	health outcomes through good science.
	I welcome our esteemed panel of witnesses and thank Dr.
	Huang in particular for joining us, as Dallas is facing
	unprecedented power outages and freezing temperatures this
	week, and I know the demands on his time are intense right now.
	Thank you, and I now yield to Ranking Member Lucas.

	Chairwoman Johnson. So the Chair will recognize Mr. Lucas.
	Did he get in?
	Mr. Lucas. Yes, Madam Chair. And thank you----
	Chairwoman Johnson. Well, thank you.
	Mr. Lucas. You and I both had challenges getting on board
	this morning, but we're both here. Good morning----
	Chairwoman Johnson. Yes, thank you.
	Mr. Lucas. Chairwoman Johnson. Thank you for holding this
	important and timely hearing. And thank you to our expert
	witnesses for their participation today. I hope we can learn
	valuable information that we can share with our constituents as
	we continue to battle the COVID-19 pandemic.
	Almost 1 year ago to date, the Science Committee held our
	first hearing on the COVID-19 pandemic. Since then, we've seen
	day-to-day life changes dramatically. Millions of people have
	suffered from this pandemic, and COVID-19 has claimed the lives
	of nearly 480,000 Americans.
	In recent weeks, the United States reached a positive
	milestone, as more Americans have now received at least one
	dose of the vaccine than have tested positive for the virus
	since the pandemic began just over a year ago. According to CDC
	(Centers for Disease Control and Prevention) data, the United
	States has administered approximately 55 million doses of
	COVID-19 vaccines since the first shot was given on December
	14, 2020, and approximately 12 percent of the total U.S.
	population has received at least one dose.
	But as the original COVID-19 virus and new variants
	continue to spread across the globe, it is imperative that the
	United States take a more aggressive and ambitious approach to
	ramping up vaccine manufacturing and distribution. We need to
	get as many shots in arms as quickly as is possible.
	It is also critical that rural and underserved communities
	are not left behind during the vaccine rollout. For example,
	many rural residents lack broadband internet connection and are
	unable to secure appointments, which are largely scheduled
	online. Residents in more isolated parts of the country also
	experience difficulties finding somewhere to get the vaccine if
	they do not live near pharmacies or community health centers.
	Distributing vaccines that require ultracold storage also
	presents challenges for these communities, as doses will expire
	if they're not properly stored.
	The American research enterprise, including government,
	academia, and industry, has the expertise, resources, and
	talent to continue to fight this pandemic. From vaccine
	development at record speed to PPE (personal protective
	equipment) manufacturing, America's scientific community has
	stepped up to the plate, as scientists and researchers
	immediately pivoted at the start of the pandemic to focus on
	combatting COVID-19. With the integration of technologies such
	as artificial intelligence and high-performance computing,
	researchers have identified promising vaccine candidates
	quicker. Advanced manufacturing techniques also offer promising
	methods to bolster supplies and rapidly modify vaccines to
	address new strains of the disease.
	These factors allowed the United States to approve two
	safe and effective COVID-19 vaccines just 1 year after the
	pandemic began. Scientists were able to develop these vaccines
	in record time thanks to almost two decades of basic research
	on related viruses. These investments in basic research have
	truly been lifesaving. We must continue to make critical
	investments in American research for the health and safety of
	our Nation. As vaccine distribution ramps up and we continue to
	work to stop the spread of COVID-19, it is imperative that key
	decisions are grounded and backed by strong science and data.
	We simply cannot afford to ignore science during this critical
	time.
	This morning, I sent a letter to the Chairwoman
	respectfully requesting a hearing regarding the science on
	safely reopening and maintaining the Nation's K-12 schools for
	in-person learning. Research has established that approved
	COVID-19 vaccines are safe, and the evidence shows it's also
	safe to open our Nation's schools with the appropriate
	precautions in place.
	I look forward to hearing from our witnesses today about
	the current state of vaccine uptake, hesitancy, and access
	across the country. I'm also looking forward to hearing about
	Oklahoma's plan and learning more about the efforts taking
	place across the State to ensure that the underserved and rural
	communities are not forgotten. Thank you, Deputy Commissioner
	Reed, for your participation here today.
	And I want to thank the witnesses for taking the time to
	be here to share your expertise and insights with us during
	this pivotal time to keep Americans healthy. I know we're all
	looking forward to the day all Americans can safely return to
	work, our children are back in school, and we can look our
	loved ones in the eye once again.
	I yield back the balance of my time, Madam Chair.
	[The prepared statement of Mr. Lucas follows:]

	Good morning Chairwoman Johnson. Thank you for holding this
	important and timely hearing. And thank you to our expert
	witnesses for your participation today. I hope we can learn
	valuable information that we can share with our constituents as
	we continue to battle the COVID-19 pandemic.
	Almost one year ago to date, the Science Committee held our
	first hearing on the COVID-19 pandemic. Since then we've seen
	day-to-day life change dramatically. Millions of people have
	suffered from this pandemic, and COVID-19 has claimed the lives
	of nearly 489,000 Americans.
	In recent weeks, the United States reached a positive
	milestone, as more Americans have now received at least one
	dose of the vaccine than have tested positive for the virus
	since the pandemic began just over a year ago. According to CDC
	data, the United States has administered approximately 55
	million doses of COVID-19 vaccines since the first shot was
	given on December 14, 2020, and approximately 12 percent of the
	total U.S. population has received at least one dose.
	But as the original COVID-19 virus and new variants
	continue to spread across the globe, it is imperative that the
	U.S. take a more aggressive and ambitious approach to ramping
	up vaccine manufacturing and distribution. We need to get as
	many shots in arms as quickly as possible.
	It is also crucial that rural and underserved communities
	are not left behind during the vaccine rollout. For example,
	many rural residents lack broadband internet connection and are
	unable to secure appointments, which are largely scheduled
	online. Residents in more isolated parts of the country also
	experience difficulties finding somewhere to get the vaccine if
	they do not live near pharmacies or community health centers.
	Distributing vaccines that require ultra-cold storage also
	presents challenges for these communities as doses will expire
	if they are not properly stored.
	The American research enterprise, including government,
	academia, and industry, has the expertise, resources, and
	talent to continue to fight this pandemic. From vaccine
	development at record speed to PPE manufacturing, America's
	scientific community has stepped up to the plate, as scientists
	and researchers immediately pivoted at the start of the
	pandemic to focus on combatting COVID-19. With the integration
	of technologies such as artificial intelligence and high-
	performance computing, researchers can identify promising
	vaccine candidates quicker. Advanced manufacturing techniques
	also offer promising methods to bolster supplies and rapidly
	modify vaccines to address new strains of disease.
	These factors allowed the U.S. to approve two safe and
	effective COVID-19 vaccines just one year after the pandemic
	began. Scientists were able to develop these vaccines in record
	time thanks to almost two decades of basic research on related
	viruses.
	These investments in basic research have truly been
	lifesaving. We must continue to make critical investments in
	American research for the health and safety of our nation.
	As vaccine distribution ramps up and we continue to work to
	stop the spread of COVID-19, it is imperative that key
	decisions are grounded and backed by strong science and data.
	We simply cannot afford to ignore science during this critical
	time.
	This morning, I sent a letter to the Chairwoman
	respectfully requesting a hearing regarding the science on
	safely reopening or maintaining our nation's K-12 schools for
	in-person learning. Research has established that the approved
	COVID-19 vaccines are safe, and the evidence shows it's also
	safe to open our nation's schools with the appropriate
	precautions in place.
	I look forward to hearing from our witnesses today about
	the current state of vaccine uptake, hesitancy, and access
	across the country. I am also looking forward to hearing about
	Oklahoma's plan and learning more about the efforts taking
	place across the state to ensure that underserved and rural
	communities are not forgotten. Thank you, Deputy Commissioner
	Reed, for your participation here today.
	I want to thank the witnesses for taking the time to be
	here to share your expertise and insights with us during this
	pivotal time to help keep Americans healthy. I know we are all
	looking forward to the day all Americans can safely return to
	work, our children are back in school, and we can see our loved
	ones once again.
	I yield back my time.

	Chairwoman Johnson. Thank you very much.
	At this time, we'd like to introduce our witnesses. Our
	first witness is Dr. Kathleen Neuzil. Dr. Neuzil is Professor
	of Vaccinology, Medicine and Pediatrics, as well as Director
	for the Center for Vaccine Development and Global Health at the
	University of Maryland. She was part of the leadership team
	which oversaw the evaluation strategy for COVID-19 clinical
	trials, and she has been a central figure throughout the COVID-
	19 vaccine development process. She has led a phase 1 trials of
	the--she led phase 1 trials of Pfizer vaccine and the co-author
	of a recent paper establishing the efficacy and safety of the
	Moderna vaccine.
	And then after Dr. Neuzil, Dr. Philip Huang, Dr. Huang is
	the Director and Health Authority for the Dallas County Health
	and Human Services Department where he manages almost 500
	public health professionals. Prior to that, he spent 11 years
	as Medical Director and Health Authority for the Austin Public
	Health Department. He also served as an Epidemic Intelligence
	Service Officer with the CDC where he conducted infectious
	disease outbreak investigations.
	Our third witness, Mr. Keith Reed, is the Deputy
	Commissioner for Community Health Services with the Oklahoma
	State Department of Health. His public health career with the
	Department has spanned 19 years and multiple positions. Mr.
	Reed also is a Colonel in the Oklahoma Air National Guard and
	served multiple tours in support of Operation Iraqi Freedom and
	Enduring Freedom. He is currently assigned as Commander of the
	137th Special Operations Medical Group at Will Rogers Air
	National Guard Base in Oklahoma City.
	Our final witness is Dr. Alison Buttenheim. She is the
	Scientific Director of the Center for Health Incentives and
	Behavioral Economics at the University of Pennsylvania. Her
	research is focused on vaccine exemption policy and zoonotic
	disease prevention. Dr. Buttenheim is a member of the National
	Academies' Committee on the Equitable Allocation of the Novel
	Coronavirus Vaccine and a lead author of the new National
	Academies report on ``Strategies for Building Confidence in
	COVID-19 Vaccines.''
	Our witnesses should know that we will--you will have 5
	minutes for your spoken testimony. Your written testimony will
	be included in the record of the hearing. And when all of you
	have completed your spoken testimony, we will begin with
	questions. Each Member will have 5 minutes to question the
	panel.
	We will open our witnesses' testimony now with--starting
	with Dr. Neuzil.

	TESTIMONY OF DR. KATHLEEN NEUZIL, MD, MPH,

	PROFESSOR IN VACCINOLOGY AND DIRECTOR,

	CENTER FOR VACCINE DEVELOPMENT AND GLOBAL HEALTH,

	UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE

	Dr. Neuzil. Chairwoman Johnson, Ranking Member Lucas, and
	distinguished Members of the Committee, I appreciate the
	opportunity to elaborate on my written statement to you and to
	elucidate how investments in science and technology, effective
	partnership, and resource allocation enable the vaccine
	achievements of the past year.
	The consequences of the COVID-19 pandemic on our health,
	our economy, and our social well-being have been staggering.
	While the urgent need for a vaccine was clear, vaccine
	development is a lengthy, risky, and expensive process.
	Researchers first evaluate experimental vaccines in the
	laboratory and in animals. If a vaccine is safe and appears
	promising, it may go on to be carefully tested in people, but
	only if there is funding to do so. Many vaccines never move
	beyond early testing simply because there is no perceived
	market value and no funding.
	As part of the team that designed and conducted the early
	studies of the vaccines, I witnessed firsthand how the pandemic
	urgency shortened the vaccine development timeframe.
	Investments in basic science and technology were the key.
	Decades of work on understanding coronaviruses and other
	respiratory viruses enabled scientists to identify the
	appropriate target for the vaccine and to have a genetic
	sequence ready within days.
	Investments in the mRNA technology for other vaccines,
	influenza, Zika, and Ebola, and prior partnerships with vaccine
	manufacturers meant we understood how to deliver the mRNA and
	at what doses. Likewise, government-funded researchers brought
	sophisticated animal models and innovative laboratory methods
	to the vaccine efforts.
	The investment by NIH (National Institutes of Health) and
	others in clinical trials, infrastructure, and networks allowed
	experienced clinical scientists like myself to help design,
	execute, and analyze the studies in partnership with government
	and industry. Given my involvement from the start, I can attest
	that safety was never compromised by the speed of this effort.
	All trial designs were reviewed by ethics boards and the FDA.
	Experts with no ties to the products served on boards to
	monitor vaccine safety.
	The first participants to receive the vaccine were healthy
	adults who would be the least likely to suffer ill effects. The
	trials began with low doses and worked up to higher doses. The
	volunteers were followed carefully in the hours, days, and
	weeks after receiving the vaccine. We learned that the vaccine
	caused more side effects at the highest dose, but the immune
	response was not as good at the lowest dose, so a middle dose
	was chosen to move forward into trials.
	The first results of the mRNA vaccines were remarkable,
	showing more than 90 percent efficacy against disease and,
	importantly, against severe COVID-19. As most vaccine adverse
	events occur shortly after vaccination, the FDA required a
	median of 2 months of follow-up before emergency use
	authorization (EUA) would be granted.
	Safety assessment does not stop at approval, however. The
	trials will continue for at least 2 years. As with all vaccines
	in the United States, the CDC, the FDA, and the manufacturers
	will continue to follow vaccine safety. Through these systems,
	we are learning more, for example, about the rare allergic
	reactions occurring after administration of the mRNA vaccines.
	In summary, U.S. Government investments in science and
	technology enabled the COVID-19 vaccine development
	achievements. We don't know what pathogen will cause the next
	pandemic. Coronaviruses and influenza viruses have proven their
	pandemic potential. We must likewise be prepared for outbreaks
	from less-studied diseases due to arenaviruses, filoviruses,
	and togaviruses, for example. Our vaccine development can be
	better and faster but only with continued investments in
	technology. We have critical vaccine supply shortages, and
	people are dying.
	Finally, this outbreak has reminded us again that little-
	known viruses causing disease in distant parts of the world are
	relevant. Variants are emerging in the absence of vaccines. The
	United States must work in partnership with the World Health
	Organization (WHO) and other international agencies to ensure
	an integrated, global response and to ensure that COVID
	vaccines are available to everyone in the United States and
	around the world. Thank you.
	[The prepared statement of Dr. Neuzil follows:]
	[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

	Chairwoman Johnson. Thank you very much.
	Dr. Huang? Unmute.
	Dr. Huang. OK.
	Chairwoman Johnson. One more click. That's it.
	Dr. Huang. Is it clicked?
	Chairwoman Johnson. Yes, you got it. Click one more time.
	It keeps going off.
	Dr. Huang. Can you hear me?
	Chairwoman Johnson. Yes.
	Dr. Huang. OK. Well, good morning, and thank you,
	Chairwoman Johnson, Congressman Lucas, and Members of the
	Committee, and greetings from frozen Dallas, Texas.
	Chairwoman Johnson. You're off again. OK. It keeps
	clicking off.
	Staff. Sir, you seem to be hitting the mouse twice or
	hitting a button twice, and that's just unmuting you and then
	muting you again.
	Dr. Huang. [inaudible] unmuted. Can you hear me?
	Staff. Yes.
	Chairwoman Johnson. Yes.
	Dr. Huang. OK. [inaudible] muted. OK.
	Chairwoman Johnson. You're--OK.
	Dr. Huang. I'm not----
	Chairwoman Johnson. We hear you now. But you just went off
	again.
	Dr. Huang. OK. I am not touching anything.
	Chairwoman Johnson. Keep going. It went off again. I don't
	know what it is.

	TESTIMONY OF DR. PHILIP HUANG, MD, MPH,

	DIRECTOR AND HEALTH AUTHORITY, DALLAS COUNTY

	DEPARTMENT OF HEALTH AND HUMAN SERVICES

	Dr. Huang. Can you hear me? Oh, there. There, that looks
	good. OK. Well, I apologize for technical difficulties. Again,
	my name is Dr. Phil Huang, and as you heard, I'm the Director
	and Health Authority for the Dallas County Health and Human
	Services Department where we serve over 2.6 million residents
	in Dallas County. I'm also a board member for the National
	Association of County and City Health Officials, NACCHO, which
	represent our Nation's nearly 3,000 local health departments.
	And I'm honored to be with you here today.
	Over my career, I've worked at the Federal, State, and
	local governmental public health levels, and I've truly come to
	appreciate that not just politics but all things really happen
	locally. Local health departments know our communities block by
	block, including the assets and barriers to care, the
	industries and living situations that pose particular
	challenges, as well as the community-level partners that have
	to be included in order to be successful.
	Even before a single case of the virus was detected on
	American soil, we at local health departments began to mobilize
	and engage our community and healthcare partners, as well as
	with our State and the Federal Government. This continues as we
	provide testing and contact tracing, and while standing up the
	largest mass vaccination campaign in our Nation's history.
	To be successful, we have to have strong, predictable
	supply of vaccines, but supply, while absolutely necessary, is
	not enough. We must do more to build demand and facilitate
	equitable uptake of these vaccines. To do this, we must provide
	clear communication through trusted messengers and healthcare
	providers, allow for the opportunity for questions to be asked
	and an individual's concerns to be thoughtfully considered, as
	well as target outreach via the many unique formal and informal
	communication channels where people get their information. This
	takes a robust workforce, strong relationships, and time and
	resources so that individuals can get their questions answered
	and then access the vaccine within their community.
	The challenge of vaccine hesitancy is not new to COVID-19,
	but with nearly half a million Americans who have lost their
	lives to this virus and more challenging variants emerging, it
	highlights the importance of a successful and efficient mass
	vaccination effort.
	Addressing this is not a one-time event also. Instead, it
	requires engaging with hesitant populations on an ongoing basis
	to honestly address concerns, provide the information they
	need, and build the trust that is crucial to their confidence
	in COVID-19 vaccines and the systems that provide them.
	In Dallas, we've seen vaccine hesitancy among communities
	of color, especially the African-American and Latino
	communities. The roots of vaccine hesitance, though, are
	varied. The mistrust from the African-American community seems
	to be deep-rooted history, including the horrific Tuskegee
	studies of untreated syphilis in rural Black men, while
	concerns in the Latino community might stem from mistrust of
	government and skepticism of the vaccine development process.
	Among the Hispanic community, we're also hearing questions
	around whether an undocumented person can receive the vaccine,
	as well as concerns about providing personal information to the
	government needed to receive the vaccine.
	These challenges persist in healthcare workers as well. We
	saw that in some long-term care facilities, even though there
	was a Federal program with the pharmacies that guaranteed that
	delivery, the uptake of the vaccine from the staff could be
	very low with some facilities only having 42 percent of their
	healthcare staff taking the vaccine. Local health department's
	chief health strategists within their communities are actively
	working on these actions to support equitable COVID-19 vaccine
	administration and uptake across all communities, all races,
	ethnicities, and other demographics and geographies.
	Currently in Dallas County we have over 650,000 people who
	have signed up on our vaccine registration list. However, our
	health department is only receiving 9,000 doses of vaccine per
	week. Vaccine hesitancy, combined with the digital and resource
	divide, has also meant that our registration list is skewed to
	the northern more affluent areas of Dallas County.
	However, because we've focused on the data, we've been
	able to tailor our approach with an eye toward equity. We
	provided vaccine distribution based on our vulnerability index
	to ensure we equitably distribute the vaccine as opposed to
	first-come, first-serve approach. We've also set up a
	professional phone bank so individuals without internet access
	or a smartphone can call to register, and we've partnered with
	community leaders to host in-person registration events. We're
	also launching a paid media campaign to address vaccine
	hesitancy and get information out to the community about the
	registration process.
	We've seen firsthand how leveraging people that are
	respected by the community can increase vaccine confidence, and
	at one of our community registration events heard a 65-year-old
	African-American woman lean over to her friend and say that she
	decided to come because she saw the actor Tyler Perry on TV
	that morning say how important it was to get the vaccine.
	While today's hearing is specific to vaccine hesitancy
	around COVID-19, I can't understate that this is an issue that
	was a challenge for us long before the pandemic, and our effort
	to build confidence in vaccines are long-term and continuous,
	but every day we work on it bringing us one step closer to
	getting our population fully vaccinated.
	Thank you again for inviting me to testify today, and I
	look forward to your questions.
	[The prepared statement of Dr. Huang follows:]
	[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

	Chairwoman Johnson. Thank you.
	Staff. Excuse me for a moment, Ms. Johnson. Real quick
	technical--if you press and hold the spacebar on the computer,
	that only temporarily unmutes you, and when you release the
	spacebar, it mutes you back.
	Chairwoman Johnson. Thank you very much. Now we'll have
	Mr. Reed.

	TESTIMONY OF MR. KEITH REED,

	MPH, CPH, DEPUTY COMMISSIONER,

	OKLAHOMA STATE DEPARTMENT OF HEALTH

	Mr. Reed. Madam Chair Johnson and Ranking Member Mr.
	Lucas, thank you for the opportunity to speak today. My name is
	Keith Reed, and I'm Deputy Commissioner of Health for the State
	of Oklahoma. I'm here today to discuss our State's efforts to
	efficiently distribute and administer the COVID-19 vaccine and
	how we have addressed issues with uptake, hesitancy, and
	equitable access, particularly for those in our rural and
	underserved communities.
	To begin, we've been conducting surveys throughout the
	State to gauge vaccine hesitancy. As of our latest survey in
	January, we've determined that while most people are willing to
	receive the vaccine at some point, roughly 33 percent of
	Oklahomans do not plan to do so. Major reasons for hesitancy
	are lack of information on the vaccine and its development
	process and concerns about potential side effects.
	In this initial stage of vaccine distribution where demand
	is greater than supply, we found success in hedging the initial
	uptake issues by taking an overlapping approach. In order to
	vaccinate as many Oklahomans as possible, we've opened
	eligibility to new priority groups before entirely vaccinating
	earlier groups. With this tactic, we hope to lengthen the
	window of opportunity for those that might be undecided about
	vaccination, providing an extended timeframe to build consumer
	confidence in our program,
	To overcome hesitancy and access boundaries, and encourage
	high vaccine uptake, a few key conditions are needed. One,
	vaccine supply needs to improve. As we all are well aware, with
	increases in supply, we can provide more options for
	appointments, protect more of our vulnerable populations, and
	increase vaccine eligibility to more Oklahomans.
	Two, vaccine access needs to increase. We are working to
	open up new access points to the vaccine. We currently have
	approximately 1,500 pandemic providers signed up to participate
	in vaccine distribution around the State but can only engage a
	limited number due to supply issues. Getting vaccine to these
	providers, which include local pharmacies and many primary care
	providers, enables us to engage the most trusted sources in
	rural Oklahoma, giving us our best chance for high vaccine
	uptake.
	And three, communication about vaccine safety and
	availability needs to be clear, and it needs to be consistent.
	We've been using a diverse network of communication partners to
	make sure that communication with Oklahomans about the vaccine
	is consistent, transparent, and accessible to everyone. We hold
	virtual media events twice weekly to provide updates to the
	public and partner with our local health departments to keep
	the lines of communication open so Oklahomans are informed on a
	daily basis. We work closely with regional health directors,
	family health departments, and other local partners to reach
	communities across the State. These partnerships are critical
	in determining the best communications approach for their local
	constituents as they understand what will resonate in their
	respective areas. We use social media and our website to
	provide timely, regular updates on the vaccine. Information is
	shared online and with partners across the State. Above all,
	we're ensuring that our communications across the board are
	clear and factual. Our top priority is to give Oklahomans the
	tools to make the--an informed decision about the COVID-19
	vaccine. This requires regular, repeated, and reliable
	communication that is honest and direct in its approach.
	Oklahoma's unique landscape poses a particular set of
	challenges. Many of our community members lack internet access,
	particularly in rural areas with limited reception, or they
	lack digital literacy, particularly in our 65-plus community,
	who are some of the most at risk for COVID-19.
	People in underserved or rural communities have expressed
	higher rates of distrust in vaccines in general. Many people of
	color are wary of vaccines due to a history of medical
	mistreatment. There is a fear of being targeted due to
	immigration status or disclosure of race or ethnicity.
	This is also, of course--there is also, of course, general
	misinformation about COVID-19, leading to skepticism of the
	actual risk posed by COVID-19 or even skepticism that the virus
	exists at all. This misinformation is perpetuated on social
	media where it can have an exaggerated and local influence.
	Our goal with vaccine rollout is to address these concerns
	in a clear and compassionate way. We found that our
	partnerships with local entities have been invaluable in
	contributing to a much smoother rollout process and ensuring
	everyone's health and safety when they receive the vaccine.
	In Oklahoma, our surveys and experiences on the ground
	have shown us that two things are sorely needed: clear,
	accurate information about vaccine safety and efficacy, and
	increase vaccine accessibility to ensure equity.
	Thank you again to Chair Johnson and Ranking Member
	Representative Lucas for the opportunity to provide this
	testimony here in such a critical moment in our Nation's
	history. I hope you find this testimony helpful in your
	endeavors, and I'll be happy to address any further questions
	regarding Oklahoma's experience with the rollout of COVID-19
	vaccine.
	[The prepared statement of Mr. Reed follows:]
	[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

	Chairwoman Johnson. Thank you very much, Mr. Reed.
	We will now hear from Dr. Buttenheim.

	TESTIMONY OF DR. ALISON BUTTENHEIM, PHD, MBA,

	SCIENTIFIC DIRECTOR, CENTER FOR HEALTH INCENTIVES

	AND BEHAVIORAL ECONOMICS AND ASSOCIATE PROFESSOR

	OF NURSING AND HEALTH POLICY,

	UNIVERSITY OF PENNSYLVANIA SCHOOL OF NURSING

	Dr. Buttenheim. Thank you. And good afternoon, Madam
	Chair, Ranking Member Lucas, and Members of the Committee. I am
	Alison Buttenheim. I'm an Associate Professor of Nursing and
	Health Policy at the University of Pennsylvania School of
	Nursing, and I'm a behavioral scientist who studies vaccine
	acceptance and vaccine hesitancy.
	As Chairwoman Johnson mentioned, I had the honor of
	serving last year on the National Academies Committee on the
	Equitable Allocation of the COVID-19 Vaccine, and as part of
	that effort, recently co-authored another National Academies
	report entitled ``Strategies for Building Confidence in the
	COVID-19 Vaccines,'' on which my written testimony was based.
	That report is chockful of very specific communication and
	engagement strategies to address hesitancy and ensure demand
	for our truly amazing COVID vaccines. We hope it will be a
	helpful guide to public health agencies at all levels working
	on vaccine rollout.
	In my very brief time with you today, I'd like to expand
	on that report and share some additional insights and evidence
	that can further guide us as we tackle the last-mile challenge
	of getting shots in arms. Here are five science-based solutions
	that I hope Congress can endorse, fund, and promote.
	No. 1, embrace the dual goal of vaccinating efficiently
	and equitably. This recently has been framed as sort of a false
	choice or an either/or with people saying that we can either be
	fast or be fair with vaccine rollout. We have the science to do
	both, but we have to be deliberate, intentional, and innovative
	in our approach to both tracking and achieving those
	complementary goals.
	No. 2, fix the easy stuff. Hesitancy is definitely a
	barrier to vaccination, and I look forward to talking about
	that, but so are hassle factors. Even people who are motivated
	and excited about the vaccine can be deterred by the smallest
	amount of friction in the system, whether that's complex
	logistics, inconvenience, or confusing instructions. Making and
	keeping a vaccination appointment should be easy and hassle-
	free, and frankly, fixing those hassle factors is often easier
	than changing someone's mind.
	No. 3, keep doing the hard stuff even if it doesn't scale.
	There are a lot of people with very legitimate concerns about
	the speed of vaccine development, diversity of trial
	participants, or trust in the medical research establishment.
	What's emerging as the most effective way to help those folks
	is sustained, repeated, one-on-one conversations with trusted
	peers or vaccine validators. Now, you can't bake that kind of
	engagement into a chat bot or a website FAQ (frequently asked
	questions) or a message on the side of a bus or even a TikTok
	video. We have to stand up and support those time-intensive
	interventions and get them to the people who need them even if
	they don't scale.
	No. 4, use fun and delight. As Cass Sunstein has said,
	there's a deep human need to smile and laugh, and we can
	leverage that need through evidence-based messaging and
	promotions that exceeds people's expectations about the vaccine
	and about getting vaccinated in surprising ways. One example
	that I hope you've all seen is the ``Sleeves Up, NOLA'' public
	service announcement from New Orleans. If you haven't seen it
	yet, watch it right after the hearing today. It's on YouTube.
	I'll send you a link. It's a truly fantastic example of that
	idea of leveraging fun and delight.
	Last, No. 5, fail fast, learn fast. Behavioral science
	advances in much the same way that lab science does. We
	generate hypotheses about an effective intervention, and then
	we test those hypotheses via experiments. We need to bring the
	same speed and rigor to vaccine acceptance research that we
	brought to vaccine development research so we can get it right
	in real time and also learn for next time because this is not
	our last rodeo. Both immediate and long-term investments in
	behavioral science research are needed.
	So to recap, we can be fast and fair. We should address
	hassle barriers to vaccination in addition to hesitancy
	barriers. Some of our most effective strategies won't scale,
	and that's OK. Fun is effective, and learning what works is
	critical.
	I want to thank the Committee for your time today and for
	your commitment to a science-driven vaccine rollout.
	[The prepared statement of Dr. Buttenheim follows:]
	[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

	Chairwoman Johnson. Thank you so very much. That completes
	the formal testimony of our witnesses, and now we will start
	our question-and-answer period. The Chair will recognize
	herself now for 5 minutes. And I'll start with Dr. Huang.
	Let me first thank you again for being here with us today,
	and I'm glad that your family is safe and I hope you have
	power.
	I toured the vaccination hub at the Kay Bailey Hutchison
	Convention Center in Dallas a couple of weeks ago, and I really
	was pleased to see how smoothly the operations are going. I
	attended the other one, but it was after the vaccines had run
	out, so it was not operational at Fair Park, so I commend all
	of the health professionals who are working tirelessly to get
	people their shots and the volunteers who are assisting.
	You said in your testimony that reducing logistical
	barriers for patients is a big factor in encouraging vaccine
	uptake. Making it easy to register for a vaccine is one
	example. If you could advise the rest of the vaccine
	administrators in the United States about two or three specific
	strategies to deploy in making things easier, what would they
	be?
	Dr. Huang. So thank you, Chairwoman Johnson. We have
	certainly evolved as this has progressed and as mentioned by
	Alison Buttenheim, the--you know, this learning and learning
	fast has been sort of our experience. And so, you know,
	initially, we had to get large numbers through registering
	people online, getting these things, but we really want to be
	equitable and, you know, opening professional phone banks so
	people don't need to have those technical capacity to do the
	registration. We're trying to do that.
	We're going out in the community with many of our
	community and political leaders to sign up people for that
	registration and to make the systems more easy for people to
	access this. You know, we're moving from in-person walk-up
	sites to drive-throughs are some of the ways especially for our
	older population with mobility challenges and with the cold and
	the weather, you know, again, it's trying to get that stood up.
	We have a partnership with FEMA (Federal Emergency Management
	Agency) that's going to be starting next week for some drive-
	throughs. I mean, those are some of the logistic and hassle
	factors that we're trying to address and make it more equitable
	and make it easier.
	Chairwoman Johnson. Well, thank you very much. Mr. Reed,
	would you say the same, or do you have some other pointers
	you'd like to point out?
	Mr. Reed. I certainly would agree with Dr. Huang's
	assessment there. I think it's important to have options. We
	experience challenges with a registration pool. We quickly
	realized that you can't have a single point of failure. Not one
	option works for everybody. We've engaged our pandemic
	providers and encouraged them to use their own types of systems
	to help register or provide appointments for patients so that
	we don't depend on one single system. We've also had to use and
	encourage the use of manual type of systems. We use our 2-1-1
	system for those that do not have good technology options, that
	they can call and provide name, address, and phone number, and
	we push that out to local health jurisdictions so that they can
	proactively reach out to them to get them registered for
	vaccine.
	I think the biggest key is that we provide options. I
	think we need many options for the public because not one
	single thing works for everybody out there.
	Chairwoman Johnson. Thank you very much. Dr. Buttenheim,
	in your testimony you acknowledged that there are high levels
	of--particular distressing levels with people of color, almost
	three times more likely to die. And as Dr. Huang and Mr. Reed
	have observed that--all of this firsthand in both Dallas and
	Oklahoma and you pointed out that the mistrust is real. And I
	enjoyed your testimony. I thought it was very good and right to
	the point.
	But healthcare discrimination did not begin and end with
	the Tuskegee study, so we really need more than just P.R.
	campaign to overcome this distrust because it is deep and
	painful for many people. Can you help us a little as to why
	it's important to acknowledge some of the past but we've got to
	move on and see what we can do for the future? Because we still
	have minorities dying at a higher rate.
	Dr. Buttenheim. I think it's important to address those
	disparities for three reasons. One, they're the reality, so if
	we ignore that there are disparities and structural racism in
	health and healthcare now, we're not dealing with correct data
	or accurate data. It's also the root of some of the vaccine
	hesitancy that we're seeing, so if we want to close the gap on
	coverage, we have to acknowledge that. And I think being frank
	and honest about those conversations will also point us to the
	best kinds of interventions to make sure we're meeting people
	where they are, making vaccination services accessible and
	respectful, and hopefully that will convince people that
	vaccinating is the right thing to do.
	Chairwoman Johnson. Thank you very much. Any further
	comment? Well, thank you very much. Excuse me, go right ahead.
	Dr. Neuzil. None from me.
	Dr. Huang. This is Phil Huang. I mean, I'd really say that
	on the ground level, you know, building that trust. But as was
	mentioned, you know, acknowledging the--some of the issues that
	are out there, but trying to be as factual in providing that
	information and addressing, but we're hearing--I mean, you
	know, some of the types of things we're hearing, you know, I
	mean, just--we hear from some people the distrust of
	government, people think we're putting something in the vaccine
	to--the government is putting something in the vaccine to track
	people. They're--you know, they're injecting influenza virus
	into this. A lot of different types of, you know,
	misinformation is out there, again, that the government is
	trying to get more information for undocumented persons, things
	like that. And so we have to acknowledge these but then, you
	know, try to explain in truth.
	And that trusted individual, community partner, healthcare
	worker, Tyler Perry, whoever, I mean, it was really, you know,
	great to hear that story of how the impact that his statements
	on TV made.
	Chairwoman Johnson. Well, thank you very much. I've
	completed my questioning period, so I'll now recognize Mr.
	Lucas for 5 minutes.
	Mr. Lucas. Thank you, Chair.
	Mr. Reed, you know I represent a predominantly rural
	district, essentially the northwest half of the great State of
	Oklahoma, and you have experience in dealing with a unique set
	of challenges that that poses through the COVID-19 pandemic.
	Could you expand for a moment on the steps that are being taken
	to ensure in particular that rural communities are not left
	behind as we combat this virus?
	Mr. Reed. Yes, sir. So for us in Oklahoma we have been
	very deliberate about ensuring that we are meeting the needs of
	rural Oklahoma. One of our initial goals was to make sure that
	during the first week of the vaccine rollout we had citizens
	from all 77 counties that received some level of vaccination,
	and we were able to achieve that.
	We've done that by really leveraging our local public
	health systems. We use a hub-and-spoke method to allocate
	vaccine, to push it out to local health jurisdictions. We do a
	lot of centralized planning, but we're very big on a
	decentralized execution plan. So we ask those local health
	jurisdictions to work with their local partners, who they've
	actually been planning for pandemic-type of events for years.
	We've asked them to engage those partners, go into those
	communities, and provide access points for vaccination.
	And in doing so we have seen points of dispensing sites
	set up in churches, in fairgrounds, community centers, in some
	cases it's the health departments, but we have tried to
	leverage what is actually available in rural Oklahoma to meet
	these needs.
	From a centralized standpoint, we watch closely the
	percentage of the population in these rural areas that is being
	vaccinated so they would continue to monitor our success and
	ensure that we have a program that is equitable and we don't
	have any part of the State that is being left behind.
	But overall, I would say the No. 1 thing we're doing is
	engaging our local public health system and their partners and
	allowing them to make local decisions because they know what
	needs to be done on the ground to serve the citizens that they
	are responsible for.
	Mr. Lucas. Thank you, Mr. Reed.
	Dr. Neuzil and Dr. Buttenheim, Mr. Reed referenced a
	recent survey in Oklahoma, that 33 percent of my fellow
	Oklahomans do not plan to get the COVID-19 vaccine, and they
	cite lack of information on the vaccine, concern about
	development, safety, all those sort of things. In the remaining
	time I have, what can we tell our constituents back home to
	emphasize the safety of the vaccines authorized for use? Yes,
	you're writing my town meeting speech for me here.
	Dr. Buttenheim. I mean, I can say from a communications
	standpoint, luckily, we have the amazing data that Dr. Neuzil
	and her colleagues have generated from these trials. One thing
	that I think is important is that people need to hear it more
	than once, and they need to hear it from trusted communicators.
	That might be clergy, that might be local government
	leadership, that might be other family members who, you know,
	are doing the online research for them. But the main--you know,
	the survey data that says the main concerns are the speed of
	the vaccine development, Dr. Neuzil just walked through that in
	an amazing way, that, you know, it wasn't tested on people who
	look like me. We actually had quite robust diversity in the
	trials, and we don't know the long-term side effects. We're
	starting to accumulate that data, and we have incredible safety
	profiles. So I think it's sort of hitting those three again and
	again and again but making sure if people have another set of
	concerns, that we hear those and address them as well.
	Dr. Neuzil. Yes, and from my perspective, at the end of
	every conversation, I want people walking away thinking disease
	bad, vaccine good. And it comes down to being that simple. And
	others who are professional in the area can come up with those
	communication messages. But sometimes we forget the disease bad
	part. This pandemic is killing people. It's killing minorities.
	It's killing people with poor access to healthcare. It's
	hurting our schoolchildren. It's hurting our economy. So we do
	have to remind people that there is a real reason that we're
	asking them to get vaccine.
	And then on the vaccine side, again, I have tried to
	emphasize the points that you heard, that safety is always
	paramount because we're giving vaccines predominantly to
	healthy people to prevent a disease. We did include high
	percentages of minority populations, of different age groups so
	everybody can point to the trial and say somebody that looked
	like me received this vaccine. But I think the disease bad,
	vaccine is good, is something to always remember.
	Mr. Lucas. And as we every 2 years as elected officials
	will note, you have to repeat it 17 times in a row to make an
	impression. I yield back the balance of my time, Madam Chair.
	Thank you for a wonderful hearing.
	Chairwoman Johnson. Thank you very much. I'll depend on
	the staff now to call on the other Members.
	Staff. Ms. Lofgren is next.
	Ms. Lofgren. Thank you so much, and thank you, Madam
	Chairwoman and Ranking Member, for this hearing.
	We have obviously a big challenge ahead of us in getting
	vaccine distributed in sufficient quantities that we are able
	to put this virus in the rearview mirror. And right now, we
	have the hesitancy problem, but we also have a supply problem
	where, you know, there are millions of people who are trying to
	get vaccinated but they can't because there's not enough
	vaccine available. So I'm looking ahead, I guess, to a few
	weeks from now when there will be more vaccine.
	In Santa Clara County, for example, we have now managed to
	vaccinate more than half of the people who are 65 years or
	older, and we're moving into the next group, which is people
	with serious pre-existing health conditions, people who work in
	food, the grocery store workers, and other essential workers.
	I'm wondering whether the construct of signing up and then
	having people come in is really the wrong approach for this
	pandemic. I remember when polio vaccine was first devised, I
	was in elementary school, and you had to have a permission slip
	from your parents, but the public health people came and they
	gave every kid in the school a vaccination. Why would we not go
	to every grocery store and offer the vaccine to every person
	there? Obviously, they have the right to decline, but I'm also
	mindful that peer pressure is a great educator, and if every
	other person around you is getting vaccinated, it may cause you
	to question why wouldn't you? So who can answer that question?
	Dr. Huang. Well, this is Phil Huang. I would say, as you
	started out, the supply is the issue at this point. And as I
	think I mentioned, we have over 650,000 people who signed up to
	register who want to be on our waiting list to get vaccine and
	we're only getting--like the health department is getting 9,000
	doses a week. So, you know, the sign-up at this point does
	allow us to distribute more equitably, so we are applying a
	vulnerability index, a proximity index to these and getting
	those appointments out. We started out with 75 years and older
	and then went down to 65-plus with an underlying health
	condition.
	So--but absolutely when there is adequate supply, we want
	to make it with that availability that you're talking about,
	but the big limitation is we just don't have enough vaccine, so
	we're trying to get it and get it out equitably through some of
	these processes.
	Ms. Lofgren. But there's no medical constraint or ethical
	constraint to just going to the grocery store and saying now
	that we're in your tier, anyone who wants it can get it if we
	have supply?
	Dr. Huang. Oh, if we have supply, absolutely. I mean, we
	want it to be like the flu vaccine, the annual flu vaccine and
	you go to your drugstore or retail store, something like that.
	Ms. Lofgren. Here's a question that you may or may not be
	able to answer, any of you, because it has to do with
	distribution of vaccine, but all of us, each State has rural
	areas where the capacity for the very cold freezing is not as
	available. Is there a way to direct the J&J (Johnson & Johnson)
	vaccine to parts of the country where the freezing capacity is
	a real constraint to the program of vaccinations so that the
	J&J, which does not require that extreme measure, can be
	directed to the areas that might need it the most?
	Dr. Neuzil. Yes, so I--this will likely occur at the State
	level, and I'll let some of my colleagues comment. Here in the
	State of Maryland, even the differences between the Pfizer
	vaccine and storing in a minus-80-degree freezer versus storing
	in a minus-20-degree freezer have led to a distribution system
	at major medical centers versus outlying pharmacies and
	outlying clinics, so it can absolutely be done. It has to be
	orchestrated at the State and local level.
	Ms. Lofgren. And not at the Federal level you're saying? I
	mean, for example, the District of Columbia doesn't have any
	rural areas.
	Dr. Neuzil. I'm not sure I know enough about the Federal
	distribution to comment.
	Ms. Lofgren. OK. Fair enough.
	Madam Chairwoman, I see my time is just about expired.
	Thank you again for this hearing, and I yield back.
	Chairwoman Johnson. Thank you very much. Who's next?
	Staff. Mr. Posey is next.
	Chairwoman Johnson. Mr. Posey.
	Mr. Posey. Thank you, Madam Chair, for holding this
	hearing on these important issues regarding the COVID-19
	vaccination campaign.
	Vaccines are a monumental achievement and a product of a
	massive governmentwide effort to defeat this pandemic.
	Dr. Neuzil, you were part of the development of the
	protocols for the two vaccines that we're using today, and I'm
	pleased to hear your testimony that Operation Warp Speed played
	an important role in getting these vaccines developed, tested,
	and in use in less than a year. You state that, quote, ``The
	closure of schools and lack of extracurricular activities is
	impacting the academic, social, and physical development of
	children with disproportionate impact on minorities. Persons of
	all ages are struggling with the effects of isolation, extreme
	lifestyle changes, and increased anxiety.''
	Florida schools are open, yet it's surprising that while
	the CDC says it's safe for schools to open, we have States that
	are still locked down. Would you provide for the committee
	record studies documenting the harm to children resulting from
	school closures that you alluded to?
	Dr. Neuzil. Yes. So thank you for your comment. And again,
	just to emphasize that the damages in terms of the pediatric
	population are disproportionate to minority communities, so
	we--as we're seeing in the adult population, the minority and
	disadvantaged communities are more likely to get COVID-19 and
	they're more likely to get severe disease from COVID-19.
	Similarly, the disadvantaged communities are less likely
	to have the tools, whether it's the computers, the ThinkPads,
	the mechanisms, and the oversight for virtual learning. And so
	I can provide you references after the hearing, but they are
	following--falling more behind in their academics because of
	this disadvantage.
	Mr. Posey. Thank you very much, Doctor. And each of the
	panelists can comment on this, I'd appreciate it. And it seems
	like there is so much to learn from our experience with this
	pandemic. We need to better understand everything from the
	origins of the viruses and the development of the therapies and
	vaccines to the pandemic preparedness and collaborations
	between Federal, State, and local governments and public health
	officials.
	After 9/11, Congress supported a commission to cut through
	the politics and finger-pointing and focus on the facts. Last
	week, I introduced legislation to do the same thing for COVID.
	Do you think, each of you, that we could benefit from such a
	commission? Starting left to right.
	Dr. Neuzil. Yes, thank you for the question. I think in
	science, as of others have suggested, you know, we have
	hypotheses, we test the hypotheses, and we look to move forward
	at every step. So I do believe that it's always helpful to
	evaluate what has happened, whether it's an experiment or
	whether it's a program, evaluate what went well, evaluate what
	we can do better in the future. So yes, I think--I don't know
	exactly what type of program or commission you're describing. I
	think it would be useful for lessons learned.
	Mr. Posey. Thank you.
	Dr. Huang. This is Phil Huang. I mean, certainly with most
	incidents we do after-actions and hot washes and find out
	lessons learned and what went right and what went wrong, so
	that's always a best practice for any event, I believe.
	Mr. Posey. Thank you.
	Mr. Reed. Yes, this is Keith Reed. I would say that we
	have learned a great deal and put into practice a lot of things
	we learned after--for years of practice in emergency response
	based off of what you initially referenced occurred after 9/11
	and such. Those partnerships we created have made a big
	difference in our ability to respond right now, but there were
	things that did not go as planned. There were things that we
	put into motion that certainly was not the way we expected it
	to roll out. So looking back on that and evaluating what worked
	and what did not would be incredibly valuable, and I think it
	would help us moving ahead to ensure that we are prepared for
	the next pandemic or other major emergency that comes down the
	pike.
	Mr. Posey. Thank you.
	Dr. Buttenheim. And I would just add, hopefully, we can
	also learn from some of the behavioral and policy
	interventions, how did we do at getting people to mask, how did
	different kinds of lockdowns and stay-at-home orders work and
	use the 50 States and local jurisdictions as sort of case
	studies to see what was effective.
	Mr. Posey. I thank the witnesses and see my time is
	expired and yield back, Madam Chair.
	Chairwoman Johnson. Thank you very much.
	Staff. Ms. Bonamici next.
	Ms. Bonamici. Thank you so much. Thanks to Chair Johnson
	and all the witnesses. I also want to thank all the witnesses
	for the work that you've done to so quickly respond to the
	pandemic, and I applaud all the heroic efforts of the broader
	scientific and public health communities. There have been so
	many achievements made thus far in surveillance and testing
	strategies and therapeutics and now multiple vaccines that are
	safe and effective.
	But, as we know, we're still facing many challenges. We've
	spoken about some of those, distribution and equity. I'm
	particularly concerned about some of the new problems that are
	emerging, for example, the viral variants. And evidence
	suggests that some of these variants may actually be more
	contagious than the original virus. The CDC reported that the
	highly contagious strain that emerged in the U.K. could become
	dominant in the United States in the next few months. They've
	already reported cases in 42 States. And there's also the South
	African mutation, the viral variant initially detected in
	Brazil. We're seeing all of these happening. So we know that
	work is underway to determine how well our current vaccines
	protect against the variants and whether booster shots or other
	approaches may be necessary.
	So, Dr. Neuzil, can you tell us what you know so far about
	how effective the existing vaccines are against the new
	variants and what our options might be if we need to adapt to
	how the vaccines are formulated or administered and
	distributed?
	Dr. Neuzil. Sure. Thank you for the question. And you have
	absolutely articulated one of the biggest concerns right now
	with SARS-CoV-2, the emergence of these variants. The first
	point I would like to make is that these variants were emerging
	in a setting of no vaccination. And RNA vaccines make mistakes
	when they replicate. It's a feature of the virus. And so the
	more that they are replicating unmitigated and uncontrolled,
	the more variants and more mutations that we are going to see.
	So the variants are yet another argument to get vaccine
	out, to get vaccine out fast, and to have a global response
	because variants that emerge anywhere are a threat everywhere.
	In regard to the vaccines, we're just beginning to learn
	about their effectiveness against variants. Fortunately, these
	mRNA vaccines, for example, are highly effective vaccines. They
	have strong what we call neutralizing--which means you can stop
	the growth of the virus--antibody against the vaccine strain.
	It is diminished against some of these variants strains, but
	it's still effective. So when you're starting at 95 percent,
	you know, you can lose a little effectiveness and still be an
	extremely good vaccine.
	Some of the variants emerging in other places, the variant
	first recognized in South Africa, for example, have some more
	dramatic effects, and yet we are still seeing this neutralizing
	ability. However----
	Ms. Bonamici. Dr. Neuzil, thank you. I want to get to a
	couple more questions, but----
	Dr. Neuzil. OK.
	Ms. Bonamici [continuing]. Thank you so much, Doctor.
	Dr. Buttenheim, Johnson & Johnson, as we know, has applied
	for their Emergency Use Authorization for its vaccine, and that
	application will be considered soon by the FDA's independent
	science advisory board. So having more vaccines is clearly a
	good thing, but people may be understandably hesitant if a
	different option that is found to be somewhat less effective
	than Moderna or Pfizer at preventing mild and severe infection.
	And so the difference in these efficacy results received a
	great deal of media attention, but it's my understanding there
	have been zero cases of hospitalization or death in clinical
	trials for all three of these vaccines, including Johnson &
	Johnson.
	So with the questions that are arising about the
	differences between the vaccines, how can we most effectively
	address the concerns with the public and really communicate
	complete and accurate information? And this is, I think, going
	to be an issue because it's my understanding the Johnson &
	Johnson is a one dose, although I know you probably likely saw
	this morning the news that perhaps Pfizer and Moderna could be
	effective as a one dose. But if we're using Johnson & Johnson,
	for example, in rural areas or with transient, migrant
	populations, there's going to be equity issues there. Why are
	we giving those populations something that is less--or looks to
	be less effective? So could you discuss that please?
	Dr. Buttenheim. Yes, this is going to be a challenge. And
	I think as we think about the sort of choice architecture, how
	we arrange environments for people make choices, one thing we
	don't want the average American doing is choosing their
	vaccine. This should be sort of your provider or this clinic
	is--or this State is using this vaccine in their program, and
	lucky you, you get it. Those sort of extra choices that cause
	kind of cognitive load are--do not have a place here. And yet
	we have the sort of wonderful problem that we've all anchored
	on the incredible effectiveness of Pfizer and Moderna, to
	something from J&J that looks maybe a tiny little bit less
	effective but is still a great vaccine is a sort of seen as
	second-best. So I think messaging, good risk communication, and
	sort of evidence communication but also strategic allocation of
	that vaccine to areas, you know, that can use the different
	vaccines appropriately will also be important.
	Ms. Bonamici. Does anybody else want to weigh in on this
	issue, any more witnesses?
	Dr. Buttenheim. Maybe the folks who are actually doing
	vaccinating should weigh in.
	Ms. Bonamici. Exactly. Exactly. I'm going to ask Dr. Reed.
	You testified about vaccine availability in rural areas. I
	represent a district in northwest Oregon that has urban,
	suburban but also a lot of rural areas. So what are the sort of
	practical implications of Johnson & Johnson formulation that
	doesn't have the same cold chain requirements as other
	vaccines? How meaningful would it be to have that option in
	rural communities specifically?
	Mr. Reed. Well, it absolutely gives us more options when
	we're looking at rural communities. We've kind of worked out a
	hub-and-spoke model in order to handle the storage restrictions
	of the Pfizer vaccine, for example. The big advantage that we
	look at when we talk about Johnson & Johnson is some of these
	populations that--homeless populations, for example, when the
	likelihood of getting somebody back for a second dose is
	extremely difficult.
	Another area we're looking at where this would be a great
	advantage for us is potentially some high resource-intense
	groups, homebound groups, things like that to where trying to
	get enough resources mobilized to get two doses to these
	individuals, which would be very difficult, so Johnson &
	Johnson provides us an option for that.
	For us, it's about the logistical options of matching the
	requirement of one dose with a population that can really
	benefit from that and maximize their protection based off that.
	Ms. Bonamici. Thank you. And I see my time is expired. I
	yield back. Thank you, Madam Chair.
	Dr. Neuzil. May I make one comment answering?
	Chairwoman Johnson. Yes.
	Dr. Neuzil. About the Johnson & Johnson, I just want to
	stress that the efficacy against severe disease for the Johnson
	& Johnson vaccine is very high. So while it's nice to prevent
	loss of taste and smell and cough and--what we really want to
	prevent are hospitalizations and death. And the Johnson &
	Johnson vaccine does that.
	Chairwoman Johnson. Thank you. Thank you. The next
	witness?
	Staff. Mr. Babin is next.
	Mr. Babin. Can you hear me? I'm sorry.
	Chairwoman Johnson. Yes, we can.
	Mr. Babin. OK. Yes, thank you. Thank you, Madam Chair.
	Great to have your expert witnesses with us today at such an
	important [inaudible]. Ms. Bonamici [inaudible] out now, and
	there was an article in the Wall Street Journal about
	[inaudible].
	Chairwoman Johnson. You might have to repeat your
	question.
	Mr. Babin. Can you hear me, Madam Speaker--I mean, Madam
	Chair?
	Chairwoman Johnson. Yes, we can hear you now.
	Mr. Babin. OK, I'm sorry.
	Chairwoman Johnson. We can hear you now.
	Mr. Babin. OK, thank you. I was just trying to find out
	what the latest is on the Pfizer in order to get more
	distribution to more individuals on the first injection of
	Pfizer. Is that something in the works right now? Dr. Neuzil,
	are you----
	Dr. Neuzil. Yes.
	Mr. Babin [continuing]. Are you----
	Dr. Neuzil. Yes. So I didn't hear you directing that to
	me. So thank you for that question. You know----
	Mr. Babin. Sure.
	Dr. Neuzil [continuing]. The Moderna and Pfizer vaccines
	have very high efficacy after the first dose. If you take away
	that first week before your immune system has had a chance to
	respond to the vaccine and when many people were likely already
	exposed to the virus and maybe even incubating the virus, you
	get to about a 90 percent efficacy after a single dose for both
	vaccines. The problem is we only know that for a very short
	period of time because 2 to 3 weeks later we gave that second
	dose.
	Now, the efficacy isn't going to drop from 90 percent to 0
	overnight. It will take time to wane. But in order to change
	from a two-dose to one-dose regimen, you would really need to
	follow those people who got a single dose for a longer period
	of time. We believe that second dose is important for duration
	of protection and perhaps protection against these variant
	strains. But if somebody is a little late getting their second
	dose, they should not be worried. It starts to work very well
	after one dose.
	Chairwoman Johnson. We can't hear you, Dr. Babin. Are we
	getting him some technical support?
	Staff. Yes, Mr. Babin, you may be experiencing some
	bandwidth issues. If you'd like to just turn your camera off
	momentarily, that will allow the audio to clear up a little bit
	and stop using as much bandwidth.
	Mr. Babin. Now can you hear me?
	Chairwoman Johnson. Yes.
	Mr. Babin. OK. Following up on that question, your answer
	there, Dr. Neuzil, is there an antibody titer associated with
	this particular protection, and if it is the same antibody
	titer seen in a post-COVID infection? And if so, that leads me
	to the question of whether we need to vaccinate those who were
	previously infected. Is there any change there? I know that's a
	question that's still ongoing, but what is your opinion there
	and what is your knowledge concerning that?
	Dr. Neuzil. Yes, so that's a great question and a very
	active area of research is to be able to define exactly the
	amount of antibody that is protective because that will help us
	when we moved to other populations, as you've said, when we
	vaccinate people who have already been infected. So it's a very
	active area of research. You know, ironically, having vaccines
	that are so protective makes that hard to establish because all
	those----
	Mr. Babin. That's right.
	Dr. Neuzil [continuing]. Almost everybody in the vaccine
	group didn't get the disease.
	However, we're pooling all of the information from all of
	the trials to try to understand that. Data indicate that if you
	have had the infection before, you likely do respond better to
	a single dose of vaccine, but we don't yet----
	Mr. Babin. OK.
	Dr. Neuzil [continuing]. Have enough information to
	translate that into policy right now.
	Mr. Babin. I've got you. I don't know how much time I have
	left, but I was just wondering if there was evidence for like
	an anamnestic response like an antibody titer and T cell
	activity if they go below a certain point, is there evidence
	that re-exposure to the virus might trigger a rapid
	immunological activation or escalation, which would give you
	protection as well?
	Dr. Neuzil. Yes, so another great question, and in fact
	this was asked earlier. The companies now are very actively
	working on booster doses of vaccine with the same strain and
	with variant strains. So I would say within weeks to months we
	will have the answer to your question.
	Mr. Babin. I am so glad to hear. We are in the middle of a
	bad winter storm down here in Texas, and it's been very
	difficult. I have a large rural district as well. And getting
	vaccines out there and getting people--these questions that
	have already been asked, we have really a shortcoming when it
	comes to connectivity via getting information on the internet,
	so we certainly hope that some of you other panel members would
	be able to say how is this being addressed to get connectivity
	on the internet into these rural areas to get people this
	information. Can anybody answer that?
	Mr. Reed. I would say in Oklahoma we are trying to tap
	into every communication source we can for rural areas, radio,
	through local organizations, connecting with churches. We're
	really trying to work through our community resources, our
	community partners to get messaging out. It's a challenge. It's
	a definite challenge when we're trying to vaccinate the entire
	population or make it available to the entire population. It's
	obvious the easy way is to default toward some kind of media
	that requires internet, but we have to fight that urge in some
	of these areas, and we've got to access these other resources
	to be able to reach them.
	Dr. Huang. And I would add that in Dallas County we are
	trying to do paid media, we are trying to do phone--you know,
	making phone--a paid phone bank available, other community
	events in the community to sign people up and get them the
	direct connections.
	Mr. Babin. All right, great. That's great answers. I want
	to say thank you very much. And, Madam Chair, I don't see how--
	my time is not coming up, so I may already be expired. Am I?
	Chairwoman Johnson. I can't tell.
	Mr. Babin. OK. I can't either.
	Chairwoman Johnson. Staff people might be able to tell.
	Mr. Perlmutter. You're way, way over time.
	Staff. Your time is expired.
	Mr. Babin. Way over time, OK, I'm sorry. So I'm going to
	yield back then. Thank you so very much.
	Chairwoman Johnson. Well, thank you, though, good
	questions.
	Mr. Babin. Yes, ma'am.
	Staff. Mr. Bera is next.
	Mr. Bera. Great. Thanks, Madam Chair. I want--I'm going to
	follow up on some of the questioning that Ms. Bonamici asked.
	And I'm a physician by training, come out of academics, and
	have done clinical trials. And I am extremely worried about how
	we're talking about the efficacy of the vaccines. And I even
	hear it in the discussion here today because in truth you have
	to design the clinical trial for a common event, which is
	catching the disease. But there are other outcomes that we're
	certainly trying to prevent with this vaccine, serious illness,
	hospitalization, and death.
	And we talk about Moderna and Pfizer as being more
	efficacious than Johnson & Johnson. That may be accurate in
	prevention of disease, catching COVID, but each of these
	vaccines are super effective in preventing serious illness,
	super effective in preventing hospitalization, and super
	effective at preventing death, and that, you know, is the truth
	for AstraZeneca as well. That's the truth for Novavax on the
	data that we can see.
	And we're extremely concerned that if we don't start with
	the positive message, it's remarkable that we have potentially
	five super effective vaccines that are going to prevent you
	from getting seriously ill, that absolutely are keeping people
	out of the hospital, and had--as far as I can tell, nobody's
	died who's received any of these vaccines.
	And, you know, I see our best spokespeople from the
	administration on television, on cable news all the time, and
	we fall into this message. And the risk that we're going to run
	is someone's going to say, well, I heard someone say that
	Johnson & Johnson is not as effective, so I'm going to wait a
	while until I can get the Pfizer vaccine or the Moderna
	vaccine.
	And maybe, Dr. Buttenheim, this is kind of your area of
	expertise, and I've seen you quoted in some articles, and I am
	extremely worried that we are setting ourselves up in a way
	that is going to slow down vaccinations. And again, those three
	other variables, serious illness, hospitalization, and death,
	all of these vaccines are incredibly effective. You know, would
	you give us--as Members of Congress and others, you know,
	again, because we fall into this trap--so what's the best way
	to message these vaccines?
	Dr. Buttenheim. You know, I think there are a couple
	strategies we can draw on. One is analogy, right? So no one
	asks what kind of vaccine they get when they go for their flu
	shot, right? It's not even an issue. You may not even know who
	makes your flu vaccine, and so we need to transition our
	vaccine promotion programs to be more like that. You're getting
	a COVID vaccine.
	I think we also need to--and this is unsettled science,
	but we need to think about how to, as you said, really hone in
	on the adverse events, the severe events that are not happening
	because of these vaccines. And this is always a challenge for
	health promotion, right? We're trying to get people to do stuff
	so that something else doesn't happen. That's really hard. And
	if the thing that's not happening is even more rare and
	probabilistic, that's additionally challenging. So I think we
	need to pull in our best, you know, social marketing, marketing
	advertisement people to help with these frames and these
	messages that make most salient for people as they're making a
	decision, but the--any vaccine is a good vaccine decision here.
	Mr. Bera. Right. And so starting with the process, right,
	it's starting with the--that all these vaccines are super
	effective at, you know, preventing serious illness, keeping us
	out of the hospital, and certainly, you know, preventing death.
	And if you can get a vaccine, get that vaccine, whichever one--
	--
	Dr. Buttenheim. Exactly.
	Mr. Bera [continuing]. Of those vaccines that are
	available.
	Dr. Buttenheim. The best vaccine is the one you can get
	tomorrow.
	Mr. Bera. Exactly. And we probably ought to start with
	that message----
	Dr. Buttenheim. Yes.
	Mr. Bera [continuing]. Because, you know, what I'm very
	worried about is in many rural communities and harder-to-reach
	communities, just logistically the Johnson & Johnson vaccine
	may be the easiest vaccine to get out there----
	Dr. Buttenheim. Yes.
	Mr. Bera [continuing]. If you're [inaudible] homeless
	folks, you know, at a river bank, a single-dose vaccine is
	going to be a lot better. If you're vaccinating college
	students that may not come back for that second vaccine, a
	single-dose vaccine is going to be better.
	I do worry, though, that, you know, there's that potential
	where folks might say, well, why are you using a less effective
	vaccine in some of these disadvantaged communities and you're
	using the--and again, I don't think that's--those aren't----
	Dr. Buttenheim. And you're right to worry about that
	because that is going to happen. So I think with J&J we can
	promote it's like the convenient vaccine, you know, like one
	and done on this one, isn't that great? But yes, the more we
	can take that choice away from people and not fall into the
	like, oh, I'm going to wait, I'm going to wait for Pfizer, the
	better off we'll be.
	Mr. Bera. Right. So, again, just to my colleagues, if we
	can start with the positive that we are so lucky that, you
	know, we have potentially five great vaccines that are going to
	do a remarkable job, get that shot in your arm. So I think my
	time is up, and I will yield back.
	Chairwoman Johnson. Thank you very much, great questions.
	Staff. Mr. Gonzalez is next.
	Mr. Gonzalez. Thank you, Chairwoman Johnson and Ranking
	Member Lucas, for holding this hearing and to our great
	witnesses for joining us.
	I think we're all in agreement the COVID-19 vaccine
	development is a marvel of modern medicine, and to take a
	process that under most circumstances could take up to 10
	years, have multiple successes in a matter of months is just
	incredible. We should all be incredibly grateful for the
	talented researchers and scientists.
	And I want to especially thank Dr. Neuzil. I'd like to
	personally extend this thank you to you because I know you
	worked so hard on this as well.
	At this stage in the pandemic it's important that we
	satisfy our strategies in the short-run and long-run
	categories. In the short run I think we need to increase
	vaccine supply. That's been evident, make efforts to rebuild
	trust, and lay the groundwork for building demand so that when
	vaccines are readily available, there is sufficient uptake in
	the community. In the long run we need to sustain outreach to
	vaccine-hesitant communities and invest in research that
	improves our ability to identify people's perceptions of safety
	and tailor communication specifically to each population.
	Dr. Neuzil, I want to start with you and I had a question.
	As these variants have come into play, what role do you think
	the Federal Government will need to continue to play from an
	investment standpoint? So obviously, we frontloaded a lot of
	the investment on the initial development of vaccines, but as
	the variants take hold, will we need to continue providing that
	or can the companies handle that themselves in your opinion?
	Dr. Neuzil. Yes, thank you for that question. I think on
	the variants it's going to have to be both. You know, for one,
	we need a better surveillance system to pick up these variants,
	and we're really not there yet. And so that is going to be
	critical, and that is going to have to be coordinated, and that
	will need to be government-funded.
	Again, we have to think about where are the incentives.
	And if there is not a natural market value and a market-driven
	reason for the companies to do it, that's when the public-
	private partnerships thrive and the government needs to step in
	and help. You know, this is why we never had an mRNA influenza
	vaccine because who's going to take that to market when we have
	10 other vaccines already on the market? And so that's the way
	we're going to have to think here and be strategic in the
	investments that are going to pay off for public health and
	won't naturally occur in a market-driven decisionmaking world.
	Mr. Gonzalez. Can I ask you a follow-up on the mRNA
	specific to the traditional flu? And you may have already
	answered this, but from your answer should I assume that if we
	did an mRNA vaccine for the traditional flu, that it would be
	more effective and we could potentially cut down drastically on
	flu-related deaths as well?
	Dr. Neuzil. So I don't think we can make that assumption.
	The mRNA vaccines for influenza have been in phase 1. They're
	immunogenic. Because of our ability to stabilize the virus, get
	the right sequence, and get it faster, they may be better, but
	that has yet to be tested.
	Mr. Gonzalez. Got it.
	Dr. Neuzil. They certainly have a speed advantage.
	Mr. Gonzalez. Thank you. And then the mRNA vaccine is
	easier to produce and manufacture, as you said. How easy will
	it be to alter the vaccine such as the J&J and AstraZeneca
	vaccines?
	Dr. Neuzil. Yes, so the J&J and AstraZeneca vaccines are
	also genetic-based vaccines. We're just using an adenovirus to
	deliver them instead of a lipid code to deliver them, so they
	will also be amenable to rapid sequence changes.
	Mr. Gonzalez. Great. And then with my last minute--I can't
	see the clock, but just quickly, I know we've talked a lot
	about increasing confidence in minority communities, which is
	obviously critically important. We've started to see some
	success in northeast Ohio in the Hispanic community with a
	program called Cover COVID, which is more of a national,
	international program. And the short and long of it is is it's
	not just about translating things into Spanish, right? And for
	our community what we found is it's the translation but it's
	also having the cultural awareness to know that, you know, we
	have to do more than just translate to make sure that what
	we're translating hits the community in a way that they can
	receive it. I just draw that to everybody's attention. I know
	everyone is working on this in different ways, but we have seen
	some success in the Cleveland area, and I just would submit
	that to everyone for consideration. And thank you for your
	responses. I yield back.
	Dr. Buttenheim. If I can follow up for a moment on that,
	it's going to be so important to gather and collate those
	success stories and make them easily shareable across different
	populations so, again, we can learn fast what's working.
	Dr. Huang. And I would just add one thing. You know, even
	the term Operation Warp Speed we heard in the Hispanic
	community sort of gives a sense that it's rushed--been rushed
	through and that distrust of the government and things, so----
	Mr. Gonzalez. Thank you.
	Chairwoman Johnson. Thank you.
	Staff. Is Mr. Sherman available?
	Chairwoman Johnson. Who's next?
	Staff. Mr. McNerney is next.
	Chairwoman Johnson. Mr. McNerney. I see him. He's here.
	Mr. McNerney, unmute.
	Mr. McNerney. There we go. Well, thank you, Madam
	Chairwoman, for holding this hearing. It's very interesting and
	informative.
	I recently hosted a townhall meeting on a range of issues
	regarding vaccination. Fortunately, I had the help of Dr. David
	Relman of Stanford who was able to address some of these
	questions, but it's good to have experts that can give more
	information on this.
	Dr. Neuzil, in your written testimony you mentioned the
	collaboration necessary for vaccine development that includes
	the Department of Health and Human Services and other relevant
	government agencies and partners abroad. Did the decision by
	the previous administration to withdraw from the World Health
	Organization put our country at a disadvantage in terms of the
	coronavirus in the last--and did our isolation approach do more
	harm than good?
	Dr. Neuzil. Yes, so thank you for that question. I've been
	involved with the World Health Organization for the past 15
	years or so and done work in countries around the world. You
	know, again, as I said in my testimony, it's quite clear that
	we have to consider any infectious disease, any new pathogen
	anywhere to be consequential, and we must have a global
	response.
	In terms of--it's always difficult to go backwards and say
	what would have happened if, but certainly now we should be
	cooperating fully with the World Health Organization. We should
	be setting up these global surveillance networks, and the
	influenza surveillance network is a model. And we must work
	together and get vaccines to everyone in the world or we all
	will remain at risk of SARS-CoV-2 infection.
	Mr. McNerney. Thank you. Well, in your testimony you said
	that the emergence of three severe coronaviruses in the last
	two decades should encourage us to work toward a pan-
	coronavirus vaccine. Can you elaborate on that a little more
	and what work is being done at this point?
	Dr. Neuzil. Sure. I don't think a lot of work is being
	done yet. You know, we had the SARS virus, then we had the
	Middle Eastern Respiratory Syndrome virus, MERS, and now we
	have SARS-CoV-2. So in the same way we approach influenza as a
	class of viruses, in my view, we have to approach coronavirus
	as a class of viruses. For example, if we had antivirals the
	way we do for influenza, that can help bide some time, so
	medications, ideally, oral medications that people can take
	during this time while vaccines are being developed. So I think
	we are going to need to approach coronaviruses in that way
	rather than each one individually as it emerges, think of them
	as a class and what we can do either from the vaccine or the
	medication standpoint to develop countermeasures that would
	fight all coronaviruses.
	Mr. McNerney. Well, thank you. Dr. Buttenheim, I want to
	ask you about the same issue. I think it's safe to assume that
	we may see more variants in the coming months. What does the
	emergence of these variants tell us about the international
	approach to vaccinations?
	Dr. Buttenheim. Well, I mean, I think I'd go back to the,
	you know, none of us is protected until we're all protected. I
	think the--you know, it's a messaging challenge and a behavior-
	change challenge for folks in the United States because, of
	course, we're trying to think how can we get our population
	vaccinated as quickly as possible. We also need to motivate
	people for the United States to be a player globally in
	providing vaccines to other countries in order to do things
	that we like to do as Americans. Like we like to travel, we
	like to have people from other countries come travel here. And
	that will be impacted if the rest of the world can't vaccinate.
	I look every evening on some of the amazing trackers that
	show how we're doing as a--you know, doses given per 100 people
	or per 100 million people compared to the rest of the world,
	and it's agonizing. I mean, we are doing great. We have a ways
	to go in the United States, and much of the world hasn't seen a
	single dose yet. That's tough. That's tough to swallow.
	Mr. McNerney. Yes, sure. Dr. Huang, you've discussed the
	difficulties faced in reaching and connecting with a variety of
	communities in our cities and States. How do you--how are you
	combating vaccine hesitancy and disinformation with the
	homeless population?
	Dr. Huang. So we have definitely been working with the
	homeless population on testing, dealing with some of the
	outbreak situations. We have a lot of partners. I think what
	has been discussed in particular with them, the Johnson &
	Johnson vaccine may be more amenable for that population. We
	have already been vaccinating those in Texas. It's been--the
	1b's are defined by either 65 years of age or older or 16 to 64
	with an underlying health condition, so we've been trying to do
	those populations within the homeless settings. And, again,
	it's that communication and partnering with the other groups
	that we have that long-standing relationship with them, and
	right now, it's more of a vaccine availability issue.
	Mr. McNerney. OK. Well, I want to again thank the
	witnesses for sharing your expertise and your time, and I yield
	back.
	Chairwoman Johnson. Thank you very much.
	Staff. Mr. Baird.
	Mr. Baird. Yes, I want to thank Chairwoman Johnson and
	Ranking Member Lucas for putting on such a timely [inaudible]
	we can share with our constituents. And, you know, I especially
	appreciated Madam Chair's mention of polio. One of the reasons
	I became involved in Rotary was because their efforts worldwide
	or internationally to help with polio, and so I think that
	really demonstrates the importance of the vaccination.
	My question really deals with messenger RNA or mRNA as
	we've made reference to. That messenger RNA creates enough
	protein to stimulate our immune system or whatever we're
	dealing with's immune system, and that triggers the production
	of antibodies. And so I think that is a valuable asset in that
	we're not injecting modified live virus. If you go back in the
	animal industry over the years, we used different techniques to
	vaccinate animals, one of those being a modified live virus,
	but we altered it so that it did not cause the disease. We
	weakened it in some way. And so I really think the selling
	point for getting over this hesitancy is the fact that we're
	not really injecting people with a live organism. It's only
	partially there, and it's a protein that stimulates our immune
	system.
	So, Dr. Neuzil, you mentioned [inaudible]----
	Dr. Neuzil. I lost him a little bit. I don't know if other
	people did.
	Chairwoman Johnson. Yes.
	Dr. Neuzil. OK. So I didn't hear the question.
	Chairwoman Johnson. We'll see if we can get him to repeat
	it. He's talking; we just can't hear him. But he is unmuted. We
	can't hear him.
	Staff. Yes, ma'am, I'm sending a message to Cisco now. I
	believe there's some bandwidth issues going on, and it looks to
	be across Webex, not just with one individual.
	Chairwoman Johnson. OK.
	Mr. Baird. So I'm going to try one more time, and
	otherwise, I'll say goodbye. Can you hear me now?
	Chairwoman Johnson. Yes.
	Dr. Neuzil. We can.
	Mr. Baird. OK. My question is to Dr. Neuzil. You mentioned
	animals, and I think that provides us a big data base, but I
	really want to address the mRNA and the fact that I think it
	provides some protection for these variants. So I would like to
	give you a chance to elaborate on that little more.
	Dr. Neuzil. Sure. First of all, I agree with you, and it's
	a really important point that these mRNA vaccines are not
	weakened viruses. They absolutely cannot cause COVID-19
	infection, and that's a very important message. They do allow
	our own cells to make the protein, which stimulates a very
	effective immune response because our body does think, you
	know, it's the protein from the real virus.
	And that broad response we have shown from people who have
	been vaccinated with these mRNA vaccines can neutralize even
	these new variant viruses. So we don't know what difference
	that will make with disease, but at least in what we can
	measure in the blood, people who get these vaccines do have
	antibody that works against the new variants.
	Mr. Baird. So, Madam Chair, thank you very much. I really
	appreciate that. And with that, I'm so close on time and I need
	to excuse myself anyway, but I can't tell you how much I
	appreciate this meeting, and I think it's very timely. And so
	thank you. I yield back.
	Chairwoman Johnson. Thank you very much. Thank you. Our
	next witness?
	Staff. Mr. Tonko.
	Mr. Tonko. Thank you, Madam Chair. Can you hear me?
	Chairwoman Johnson. Yes.
	Mr. Tonko. Oh, thank you for holding today's hearing on
	the critically important science and research behind COVID-19
	vaccines.
	Obviously, vaccines are one of the greatest success
	stories of public health. With them, we have eradicated
	smallpox, nearly eliminated wild poliovirus, and driven the
	number of people who experienced the devastating effects of
	many other preventable infectious diseases to an all-time low.
	While I'm encouraged to see that so many people are
	getting vaccinated, including in my home district in New York's
	capital region, I know that many still have questions about the
	safety and effectiveness of COVID-19 vaccines. And this
	hesitancy might begin to affect the pace and equitability of
	our national recovery.
	So, Dr. Neuzil, I--do we have any scientific consensus on
	how many Americans will need to immune--to be immune to COVID-
	19 for us to achieve herd immunity?
	Dr. Neuzil. Yes, so a very good question, a very popular
	question. You know, we have models that look at that. You
	probably know for a disease like measles we look for about 95
	percent immunity. We're hoping that somewhere, you know,
	upwards of 75 to 80 percent might get us there for this virus.
	Some of this will depend on these variants and transmissibility
	and duration of immunity.
	Mr. Tonko. Thank you. And, Dr. Neuzil, is herd immunity
	achieved through widespread vaccination, the quickest way to
	return to a more ``normal'' way of life?
	Dr. Neuzil. In my view, it is the quickest way to return
	to a normal way of life, and we have to remember with
	infectious diseases, we're talking a lot about relative
	efficacy numbers. But I am as protected by what the people
	around me do as what I do. So, again, the more people that get
	vaccinated, the closer we are to returning to normal.
	Mr. Tonko. Thank you. And, Doctor, what do you know right
	now about the effect of vaccination on transmissibility? What
	advice would you give to the public as that research continues?
	Dr. Neuzil. Yes, it's a great question, and right now, the
	data that we have are in the early phases. However, the data
	are trending in a positive direction. We have data from
	AstraZeneca. We have data from Moderna, again, small numbers.
	The people who get these vaccines are less likely to have virus
	detected by a swab, so they have less virus in their nose. So
	the implication is if you have less virus in your nose, you
	will spread virus less well. We will know a lot more about this
	in the next 3 to 6 weeks or more. And, again, we are very
	hopeful that these vaccines will also decrease transmission.
	Mr. Tonko. Thank you. Well, we're all anxious to return to
	our lives, but there are several key measures we need to hit
	before that can happen obviously. In addition to vaccine
	availability, we also need to be moving as quickly as possible
	to produce good science-based research that we can share with
	the public and use to offer guidance in real-time. So, Dr.
	Buttenheim, do you believe that State and local public health
	departments have the information they need right now to engage
	with their communities and increase vaccine uptake?
	Dr. Buttenheim. They have the information. They do not
	have sufficient resources. So we're here in Philadelphia where
	I--we're our own CDC vaccine jurisdiction, right, one of the 64
	jurisdictions. We have a fantastic Department of Public Health,
	huge shout out to PDPH, but there's a lot to do right now. You
	know, we need to set up vaccine providers in different kinds of
	clinics. We need to, you know, put messages on buses, as I said
	earlier, and we need to engage with, you know, community
	networks, community health workers to do all that reaching--
	outreach to folks who don't have--you know, aren't on the
	internet all day. That takes money, and if we're going to
	really rely on our local and State health departments to do
	vaccine rollout, which is appropriate, that's why we have
	jurisdictions, they need resources.
	Mr. Tonko. And how can Congress best assist State and
	local public health departments in their effort to provide up-
	to-date information aimed at curbing COVID-19 vaccine
	hesitancy?
	Dr. Buttenheim. I think--again, I'll go back to the money.
	In addition to those resources, what I mentioned earlier with
	making sure we have sort of clearinghouses and compilations of
	best practices and what's working in different areas. I think
	also we need really good dashboards, especially if we want to,
	you know, do the sort of double punch on the equity and the
	efficient rollout. Every jurisdiction should be able to pull up
	a dashboard that shows, you know, how we're doing, how many
	doses are out, how many doses are in jurisdiction, how are we
	doing on race, ethnicity, and age, and social vulnerability
	index. And those are intensive, you know, data resources.
	Support to get those stood up and keep them active and dynamic
	is also really crucial.
	Mr. Tonko. Dr. Buttenheim, thank you. I've exhausted my
	time. Madam Chair, thank you for your patience. I yield back.
	Chairwoman Johnson. Thank you.
	Staff. Mr. Sessions is next.
	Chairwoman Johnson. You might need to unmute.
	Staff. Sir, you are unmuted, but no audio is coming
	through.
	Mr. Sessions. I hope that's better. We put a new
	microphone----
	Staff. Yes.
	Mr. Sessions. Good, thank you very much. I'll start back
	over. Thank you.
	Chairwoman Johnson, thank you very much for holding this
	hearing. Your leadership in this Committee for years has been
	very important to many people, not just your background as a
	nurse but representing a huge number of people by speaking
	about them, also Ranking Member Lucas.
	My question that I would like to direct--I believe it goes
	to Dr. Neuzil, which would give her a heads up that I'm going
	to ask this question. The first is just a comment that may or
	may not require an answer, but the last two I am looking for
	one. And it is that for a number of years I've been a blood
	donor, given 15 gallons of blood over my life, and I've watched
	at how these organizations come and work with local community-
	based organizations, including churches. And I wonder if it's
	appropriate ethically for us to consider going to churches and
	actually, you know, making sure you hit not just the Baptist
	and Methodist and the Catholics but other evangelical churches
	perhaps in an area, perhaps it might be a synagogue, but
	working through the churches, which would bring people together
	where they are together on a Sunday morning or a Monday or a
	Wednesday night. It seems to me that that may be a way that you
	could take care of what might be a disparity in the other
	communities that we're having problems with.
	Now to my questions. No. 1, I'm a father of a Down
	syndrome young man and trying to stay up with issues related to
	disabilities. My question is that do you believe it's important
	for disabilities to have their own trial or would you suggest
	that they be involved in these trials that go on? We have
	people, some who are in wheelchairs, some who and may have an
	intellectual or a physical disability.
	And secondly, evidently, we do not have our young
	students. I don't know the age whether it's 25 or 35 and below
	that really were not part of the adult study, but is a study
	necessary before we can get to all of our college students? Or
	what is that status, Dr. Neuzil? Thank you very much.
	Dr. Neuzil. Yes, so really great questions. And it's very
	difficult because when we do a clinical trial, even trials as
	large as were done for these vaccines, 30,000 or more, you're
	trying to represent the population in which the vaccine will be
	used, but at the same time, you're trying to be safe. So, as I
	said at the beginning, you want to start with people who are
	least likely to have the ill effects and then move to older
	people, move to younger people. So we've moved very fast in
	adults, in older adults, in adults with chronic conditions. We
	haven't moved as fast in children. We're down to about age 12
	with enrolling children in these trials.
	For the examples you give, Down syndrome, many other
	developmental diseases, neurologic diseases, if the immune
	system is intact, we can extrapolate that these vaccines will
	work well in any of those populations as they have in these
	trials. It's really populations where the immune system might
	be compromised where we don't have the data yet. These vaccines
	are likely to be safe, but we don't yet know how well they
	work, and companies and governments and academics are moving
	into those populations.
	Mr. Sessions. Good, thank you very much. And once again,
	just a suggestion you might want to do. Where we're having
	problems, I think that when you have the availability of the
	vaccine, that's the time to go in an area that either is rural,
	hard to get to, or where there is a reluctance, and move to
	large groups of people, and that way your numbers grow. I think
	I heard you say go away from failure and move to success, make
	friends with success is what I agree with.
	And it still--I mean, I'm not saying anybody is more
	important than anybody else in any of those communities, but I
	think that it gets the word out that when you go to a church,
	that they communicate with other people and say I got mine, you
	ought to get yours, and that's, to me, success also. Thank you
	very much. Chairwoman Johnson, I yield back my time.
	Chairwoman Johnson. Thank you very much.
	Staff. Mr. Foster is next.
	Mr. Foster. Thank you. Am I audible and visible here?
	Chairwoman Johnson. Yes.
	Staff. Yes, sir.
	Mr. Foster. All right. Well, thank you, Madam Chair, and
	to our witnesses.
	You know, one of the lessons that I take away from COVID-
	19 is that we have to--much to learn from the rest of the
	world. So, Dr. Neuzil, in Britain, the E.U., Singapore, and
	other countries, they're making three significant choices
	differently than in the United States, and I'd really be
	interested in your reaction to them and whether we might learn
	something from them.
	First, they are--many countries are making the choice to
	use available doses to get the first shot of vaccine into as
	many people as possible on the grounds, that most of the
	protection comes from the first shot. And my understanding is
	that there is, as yet, no evidence that the efficacy of the
	second shot is reduced if it is delayed. The British scientific
	modeling at least indicates that this approach will save many
	thousands of lives, and yet the United States has not--has
	chosen not to pursue this approach.
	So my question on this first item is if the data from the
	U.K. and also the E.U., Singapore, and other countries confirms
	that there is a net public health benefit from giving the first
	shot first, should we consider adopting their approach, and
	when might we consider making this switch?
	Dr. Neuzil. Yes, so this is an excellent question. And, as
	I said, as with many of you, I wear different hats and I'm part
	of the WHO committees that's evaluated the U.K. vaccines and
	vaccines from other countries. And, you know, most vaccines do
	well with a longer interval. So what you're really weighing are
	the pros and cons of getting as many people vaccinated as
	quickly as you can with the possibility that some then may
	never get a second dose, may have a delayed second dose and
	have a period of vulnerability.
	So some of these issues--you know, to me, the U.K.
	decisions are based on science and the U.S. decisions are based
	on science. Some of these have to do with your medical care
	system, your culture, your understanding of the populations,
	and your aversion of risk. And so----
	Mr. Foster. OK. So, yes, those don't sound too scientific.
	You know, I'm just trying to understand. I think--but you
	concur that at least in terms of the modeling, getting the
	first shot first is a lifesaver? And then the question is you
	need to talk about the sociology of your country and your
	culture to decide if that nets out well. But from a scientific
	point of view, first shot first is a winner. Is that
	something----
	Dr. Neuzil. I think the U.K. approach is based on solid
	science. The further out you go with the second dose, you're
	getting to less solid science.
	Mr. Foster. OK. And the second choice they're making
	differently is that Britain and other countries are
	manufacturing and testing not only mRNA vaccines but so-called
	self-amplifying mRNA vaccines, which can be manufactured
	roughly 30 times faster since they're effective in roughly a 30
	times smaller dose. You know, for example, one--if the 1
	microgram effective dose means that 1 liter of self-amplifying
	mRNA is enough for 1 billion doses, and so the factor is small
	and can be turned around rapidly.
	So if this plays out, self-amplifying mRNA vaccines may be
	the technology of choice not only for rapid turnaround to
	manufacture if new virulent strands are uncovered, but also for
	vaccinating the seven billion people from around the world.
	So my question, you know, in the U.S. we are not pursuing
	Operation Warp Speed-style speculative investment in
	manufacturing self-amplifying mRNA, and is this something that
	we should consider?
	Dr. Neuzil. So we should absolutely be considering second-
	generation vaccines. The self-amplifying mRNA vaccines are
	being supported through NIH, not through the----
	Mr. Foster. Yes, but not at the manufacturing level,
	right? That's the--you know, what they are doing, you know,
	Shattock and these guys in I think Imperial College are
	actually, you know, producing nontrivial amounts of this even
	as they are being tested in clinical trials, which is something
	we're not doing, so that if it turns out that this is the
	killer technology, they'll be ahead of us and once again we'll
	be dependent on, you know, other countries. So that's--anyway,
	if you have a more--something more complete for me to read, I'd
	be interested in your letting me know about that.
	The third thing that is that they're doing in England and
	elsewhere are human challenge trials. These are currently
	ongoing in the U.K. As you know, all vaccines are very rapidly
	tested on monkeys, and they get the answer in 1 to 2 months by
	vaccinating them and then deliberately exposing them to the
	virus. And we regularly use challenge trials--human challenge
	trials to test flu vaccines and other vaccines, but after a
	lengthy debate, we decided not to do that for COVID-19 and
	instead we're using much more lengthy, you know, conventional
	field trials, which have taken 6 months or longer.
	And so the situation I'm worried that we're going to be in
	is that with a combination of self-amplifying mRNA and
	preapproved human challenge trials in England and other
	countries, the British are going to be able to respond much
	faster than we will to new strains or new pandemics, you know,
	perhaps in as much as 4 months, many months faster than the
	United States will be able to do it. And are we missing
	something? Are there opportunities here that we should be
	thinking about taking?
	Dr. Neuzil. Yes, so I have published on the human
	challenge controversy, and I come down on the side of--and I've
	done human challenge studies for influenza virus. I come down
	on the side until we have an oral antiviral that works, I feel
	that there's too much risk. However, we should be developing
	the challenge models now, preparing the challenge strains so
	that when we feel it's safe enough, we can quickly move into
	those challenge studies. And truthfully, the large clinical
	trials gave us the answer on vaccine efficacy before the
	challenge studies gave us the answer on vaccine efficacy.
	Mr. Foster. Yes, because of the approval process. If we
	had pre-existing approved facilities ready to go, then you
	would have seen the same turnaround for human challenge trials
	that we currently see for primate trials. And so the question
	is should, for the next pandemic, we have the approvals, the
	ethical considerations all set so that we'll be in a
	technically limited schedule for rapidly testing those
	vaccines? Had we had that in place and chosen to use it, we
	would have known many months ahead of time that the vaccines
	that we are currently deploying were very effective and would
	have been able to ramp up production even faster than we did.
	So I think that, you know, whether--this is a debate I
	think that should continue even after this pandemic has ended
	because of its potential use in future pandemics.
	Well, I just want to thank you for everything you've done
	here and so----
	Dr. Neuzil. Thank you.
	Chairwoman Johnson. Thank you very much. Our next----
	Staff. Mr. Garcia is next.
	Mr. Garcia. All right. Good afternoon, and hopefully you
	can hear me OK. I want to thank the Chairwoman for her
	leadership on this, Ranking Member Lucas as well, and the
	witnesses here. I really appreciate everything you've done for
	our Nation's security. It actually is an impressive feat to
	have gotten where we are with so many vendors so quickly.
	I'd like to start with just a quick nuanced comment here
	before I ask my question. I think to Dr. Buttenheim, your
	comments earlier and I mean this in a very constructive manner,
	so please don't take this critically, but I think it's
	important when we're in an effort to try to get everyone to get
	vaccinated to the max extent possible, that we don't
	necessarily push to ask people to not ask questions. I think
	this is different than a normal flu vaccination. It's got much
	more publicity. The average American is much more aware and
	they're much more informed about what's going on.
	So I think when we say we need to try to remove cognitive
	load from people's decisionmaking process or discourage them
	from having choices, I understand what you're saying, but we
	have to be eyes wide open that when we use language like that,
	some demographics will actually become either more paranoid
	about the vaccine or less trustful of the government. We talked
	about the Hispanic community with the use of Warp Speed,
	trusting the process less because of just the language.
	So I completely understand what you're saying and I agree
	with everything at an academic and science level. I think
	rather than discouraging people from asking questions, we
	should make the answers to those questions more readily
	available and in the end state I completely agree with you
	they're all great products and you're going to be saving your
	life with any of these vaccinations. Just a nuance, but I think
	it's important, especially in public forums, which these all
	are, right?
	So my question is to Mr. Reed, and we can follow up with
	Dr. Neuzil. In California here we're close to the bottom, you
	know, five States in terms of distribution and the supply chain
	failure [inaudible] not only dosages here but distributed. What
	are the three or four biggest barriers to getting the vaccine
	to a more widely distributed network at the CVS, the Walgreens,
	the Walmarts, wherever you would have normally gotten your flu
	shot or your birth control or your prescription refilled?
	Besides the cold storage, because if we get through that or if
	there's a vaccine that is sort of amenable to wider
	distribution, what are the follow-on barriers, I guess, to
	ensuring that wider distribution?
	Mr. Reed. So for us we did not initially engage a lot of
	those--the pharmacies and some of the smaller providers around
	the State that could have direct access to Oklahomans. We did
	that because in the initial stages when we had loads of
	vaccine, we were trying to move toward mass vaccination to get
	the vaccine out there much quicker and start to try to have an
	impact on interrupting the transmission of COVID.
	We did initially within the first probably 3 to 4 weeks
	start to send some vaccine to some federally qualified
	healthcare centers and some other smaller outlets if you will
	other than mass vaccination. And the challenge for them is
	systems in which they can run through that vaccine rapidly, so
	we started seeing obstacles of diluting the vaccine inventory
	in one area, and in doing so, vaccine would start to sit on the
	shelf.
	So I think it's important for us to engage all these
	outlets, our pharmacy partners. We're pleased with the Federal
	pharmacy retail program that's coming on board. Right now, we
	have 76 pharmacies in Oklahoma that are participating in that,
	but it's smaller doses, 100 doses here, maybe 200 there. And I
	think it's important for us that we give them inventory and
	ensure they have inventory that they can run through in a
	week's time because they don't have the resources set up, large
	volume, mass vaccination, so we want to equip them with the
	vaccine inventory that they can run through within a week or so
	so that we can ensure that vaccine is continually moving from
	freezers into arms a rapid manner.
	Now, when vaccine inventory comes up, we have more
	vaccine, I think we're in much better shape to push out more
	vaccine to those individuals so that we do have that access to
	that trusted source at the local level.
	Dr. Huang. This is Phil Huang if I could add one thing to
	that just--you know, because initially that was what our plan
	in Texas was. Like we have 800--over 800 local providers signed
	up to be part of that distribution, and, you know, then the
	State published a map with all these--you know, and some of the
	pharmacies that had it, then they were getting overrun with
	calls, you know, but they only had about 100 or so doses to
	last a week. And that's where there was a big pivot to moving
	to these hubs and the mass vaccination site. But that was sort
	of given the current situation, the limited availability. I
	think we're trying to get toward that. I think it sounds like
	the Federal pharmacy program is to start to get that supply
	going and testing it out. And once there is much more
	availability, then that will be a big part of certainly our
	efforts also.
	Mr. Garcia. Great, thank you. You guys, I have a bad
	connection here, so I apologize. Thank you, Madam Chair.
	Chairwoman Johnson. Thank you. Our next Member?
	Staff. Mr. Casten is next.
	Mr. Casten. Thank you, Madam Chair, and I think I feel I
	speak for all of us that I'm going to keep my fingers crossed
	that I don't have any Wi-Fi issues. [inaudible].
	I really appreciate you all having this meeting and the
	thoughts you've all done in this. I feel like there's our need
	to communicate vaccine safety in public forums, and then
	there's the reality that all of us have as Members that I think
	every time I fly back and forth, someone on the airplane or
	someone at TSA (Transportation Security Administration) says,
	you know, this vaccine was rolled out too quick and I'm a
	little bit nervous and we have all of these little, small
	conversations.
	And I don't know if I do a good job of that. I feel proud
	that I think I convinced a police officer at O'Hare a couple
	weeks ago to go get his vaccine, but you never know how all
	that works.
	Dr. Neuzil, I wonder if you could comment. I saw some
	analysis early on that I found compelling, but I don't--I'm not
	a doctor--that the--that a part of the reason these vaccines
	[inaudible] so quickly was because the spread of--the community
	spread of COVID was so much more widespread and so much faster
	than we thought it was going to be. Is that accurate? And if
	so, can you explain for the layman how that works?
	Dr. Neuzil. Sure. That is accurate. So, as I've said, we
	have large numbers of people in these trials. The minimum was
	30,000 up to 45,000 or more. And the way we look at a trial is
	we do sample size and power calculations. So when do we feel
	confident that the answer we are getting is the right answer?
	And that depends on how many cases of a disease--in this case,
	COVID-19--we get.
	So because--so we may do--I just finished a typhoid
	vaccine trial. It took 3 years because that's a much rarer
	disease. So because we had so many people in this trial and
	there was so much COVID, we had hundreds of cases of COVID-19
	in a short period of time that could tell us how well these
	vaccines worked.
	Mr. Casten. How much--just--I mean, this is an estimate,
	but how much do you think that shortened the trial time from
	what people were--you know, because early on, you know,
	everybody was saying this is going to be 18 months. Did this--
	does that substantially explain the difference?
	Dr. Neuzil. It does. I think there are two parts that
	explain the difference. We ended up enrolling more people, so
	initially, we were going to enroll 5 to 10,000 people, and we
	increased that to 30,000. And partly it was so we could get
	these subgroups, the older adults, the minority populations and
	have good numbers in every subgroup. So the size of the trials
	helped shorten it, and then the extent of the pandemic.
	Mr. Casten. OK. So the second one--and I want to be a
	little bit careful on how I ask this because it's a politically
	charged question and I don't mean to get political, but this--I
	don't know how you have a public health conversation and not
	inject some politics into it because people--especially when it
	comes out of the mouths of people like us.
	The--and this builds a little bit on the--on your exchange
	you had with Mr. Babin. With almost a half a million Americans
	dead from COVID, I hope we never, ever again talk about how
	herd immunity is a good strategy to protect the population. At
	the same time, I think the--there is some--there is a
	reasonable question that Dr. Babin was asking you of how
	protected are you if you got exposed and were either non-
	symptomatic or had, you know, minor symptoms?
	And I take your point that we don't really know enough yet
	about COVID, but I wonder, if you're comfortable, can you
	speculate at all on, you know, the broader classes of
	coronaviruses or RNA viruses more general? Is there--can you
	say anything generally about the level of protection you get
	from a vaccine as opposed to the level of protection you get
	from community exposure? How durable is one versus the other?
	Is there a point where you're satisfied that one is going to be
	better? Can you say anything generically to help us answer that
	question when people who have been, I think, infected by a very
	dangerous political idea ask us what's on its face is a
	reasonable scientific question?
	Dr. Neuzil. Yes, so I think there's two answers. One is
	just to clarify. When we talk about herd immunity, it could be
	through exposure to the disease. And as you've alluded to, that
	comes with the risk of people getting sick and dying from the
	disease to get that immunity. What we'd ideally like is herd
	immunity to come through the rapid rollout of vaccines. But in
	fact it will be both of those added together that give us that
	herd immunity.
	There are certain examples where the vaccine is better
	than the natural infection. HPV, human papilloma virus
	vaccines, are actually better at protecting you longer than
	getting the infection. With coronavirus, I would say the jury
	is still out, but it appears that both infection--reinfection
	is rare before about 6 months and maybe longer. We just haven't
	had enough experience with the virus. And similarly, about 6
	months after these vaccines are given, we're still seeing
	relatively high levels of antibody. So time will tell how long
	that immunity lasts from a disease and from a vaccine.
	Mr. Casten. Thank you. And I'm out of time, would love to
	talk longer, but I really appreciate it. I yield back.
	Staff. Mr. Feenstra is next.
	Mr. Feenstra. Well, thank you. Thank you, Madam Chair.
	Thank you, Ranking Member Chair, also.
	First, I want to thank each of you, the witnesses and
	their testimony today. It's very important that we discuss how
	we can both expand access and reduce skepticism of the vaccine
	to get our communities back to a state of normalcy.
	So, Dr. Neuzil, Iowa State hosts a Nanovaccine Institute
	which received CARES Act funding to pursue nanovaccine research
	and development (R&D). As you may know, this technology will
	allow patients to self-administer an inhaler to receive a
	vaccination, which is likely a preferable method as a lot of
	people hate needles. For healthcare providers, it reduces
	exposure to contagious patients and avoids cases where
	providers have to be forced to throw away vaccines because, you
	know, there's just not the storage to preserve them.
	Your testimony mentioned the need to invest and prepare
	for future pandemics. Can you share if this is very critical or
	how we can further invest into this type of nanovaccine type of
	treatment?
	Dr. Neuzil. Yes, so thank you for the question. And I
	stressed in my testimony both the basic science as well as the
	technology. You know, I think people thought that mRNAs as a
	formulation for vaccines, you know, a few decades ago just did
	not seem realistic. And you're alluding to delivery strategies,
	which is actually a top priority of the World Health
	Organization in terms of the next innovations for vaccines and
	vaccine delivery. So I can't comment on the specific of the
	technology that you are referring to, but I can wholly endorse
	again investments in technology, investments in vaccine
	delivery methods that are alternatives to injections.
	Mr. Feenstra. Thank you, Doctor. And I just want to say I
	applaud Iowa State University and others for looking at
	nanovaccinations. But I just think that's the way of the future
	when we start vaccinating. Hopefully, we never have a pandemic
	like this again, but we always have to be very aware of our
	future and the research that's out there. And I think
	nanovaccines come to light as sort of the next way of giving
	vaccinations. So, again, Dr. Neuzil, thank you for those
	comments. I yield back the balance of my time. Thank you.
	Staff. Representative Lamb is next.
	Mr. Lamb. Thank you all for being here, and I'm going to
	proactively apologize if you hear a 2-month-old baby screaming
	while I'm talking to you. He's being quiet at the moment, but
	he's on the other side of this wall.
	Ms. Neuzil, I just wanted to ask you quickly, you
	emphasized the importance of the NIH research leading up to the
	pandemic that put us in a position to develop the vaccine so
	quickly. Is it fair to say in layman's terms that if we had not
	made those specific NIH investments that it could've added
	years on to our vaccine development process, in other words,
	that the money that we spent in past years probably saved us
	years of time getting to the vaccine?
	Dr. Neuzil. I would say it saved us perhaps a year of time
	because the protein vaccines are being tested now, and that's
	the other technology. But I think it would be fair to say, you
	know, it saved us 10 to 12 months certainly.
	Mr. Lamb. Thank you. And, Professor Buttenheim, thank you
	for your work in our great Commonwealth of Pennsylvania. I
	wanted to ask you a little bit about the vaccine uptake so far
	in Pittsburgh and Philadelphia, sort of two opposite ends of
	our State. But the common thing that we have seen in both
	places and many people have [inaudible] is a higher rate of
	very serious infection, particularly in the African-American
	and Hispanic communities, but a lower rate of vaccine uptake.
	So, for example, the numbers I have here that in Philadelphia,
	only 12 percent of people vaccinated in the first weeks of the
	rollout were African-American while the city's population is 44
	percent African-American and a much higher share were going to
	hospitals. In Pittsburgh, we saw the exact same thing.
	So what we are looking at is how to make these specific
	investments that will fix this problem. Obviously, beliefs
	related to vaccine are a big issue, but if we just kind of set
	that to the side, would you agree that the massive investments
	we're about to make in community health centers, federally
	qualified health centers, and the hiring of 100,000 people
	directly through local public health departments, do you think
	that those will help us make an impact on these disparities?
	Dr. Buttenheim. That's a compound question with a lot of
	complexity.
	Mr. Lamb. Yes, I want to--I'll give you the rest of my
	time to answer it. I just kind of wanted to set up that in the
	COVID rescue package that we're about to pass----
	Dr. Buttenheim. Yes.
	Mr. Lamb [continuing]. There are billions of dollars for
	these hiring people and sending them to these areas of need.
	Dr. Buttenheim. Yes.
	Mr. Lamb. And our goal is to, you know, start to correct
	this disparity and who gets the vaccine and who's at risk--most
	at risk for infection. Do you think that will work?
	Dr. Buttenheim. I think it will work, and I think the
	other ingredient that's needed when--the implementation of
	those programs is that we are smart about what barriers
	different people are facing. So when you give us the statistics
	for Philly, let's say, 11 percent of the people who have been
	vaccinated are Black but our city is 40 percent Black, there's
	a lot of heterogeneity, there's a lot of variation underlying
	that. Some of those people don't want to be vaccinated, and the
	kinds of programs and outreach and support we need to get them
	to make a good decision for them look one way. Some of those
	people, you know, never got the email because they don't have
	email or, you know, have been confused by the portals or
	aren't, you know, easily able to hop on a bus and get to the
	vaccine site.
	So back to my earlier testimony about making it as easy
	and hassle-free as possible, that's a different kind of
	intervention. So just like we want to, you know, accurately
	diagnose whether someone has COVID, we also want to accurately
	diagnose where people are in that journey let's call it to
	getting vaccinated and use those incredible Federal dollars
	that support to target and tailor interventions to help people
	along the journey.
	A specific example----
	Mr. Lamb. I think what I was trying to suggest is that
	the--by spending the money in this way directly to local public
	health departments and community health centers, we're going
	for a geographic distribution of manpower, you know, or person
	power rather than saying--you know, using all the money on FEMA
	setting up mass vaccination sites in every city that you have
	to transport to. So I just wanted to kind of get confirmation
	that you think that goes along with what you're calling it,
	making it easier, which could then help have kind of a snowball
	effect for people in those communities to get----
	Dr. Buttenheim. It does. And, you know, FEMA might work
	great in some jurisdictions, and the stadium might work great
	in others, so, you know, figuring out what assets we have
	locally to leverage is really important because it's not one
	solution. You know, we know that pharmacies have worked
	differently in different areas.
	Mr. Lamb. Great. Go Quakers, and thank you for
	participating, everybody. Madam Chairwoman, I yield back.
	Chairwoman Johnson. Thank you.
	Staff. Mr. Obernolte is next.
	Mr. Obernolte. Well, thank you very much, and I want to
	thank our panelists for participating in the hearing. I think I
	speak for most of the Members of our Committee when I say that
	the development of human vaccines is probably one of the
	crowning scientific achievements of our human civilization, and
	that in the science of vaccination, that development of the
	coronavirus vaccines is probably going to rank as one of the
	crowning achievements in that field of science.
	So, you know, having said that, I think it's really
	important for us to take a retrospective look at the
	development of the vaccine and our efforts to deploy it so that
	in the future the people that sit in our seats and make these
	decisions will have good information to rely on so that we can
	do it even better next time. And so I think that that's the
	line of questioning I like to pursue.
	First of all, I have a question for Dr. Huang. I think
	many of us were encouraged by Pfizer's announcement yesterday
	that its vaccine might be stable at higher temperatures. Can
	you tell us what implications that has for our efforts in
	getting the vaccine distributed quickly?
	Dr. Huang. Certainly, the requirements for the ultracold
	freezers is a challenge. It's one of the logistic challenges
	for getting it out there. You know, it is surmountable, but it
	would certainly make it easier for delivery. Thus far, our
	local health department has been primarily dealing with
	Moderna, but we have partners that we're working with for that
	ultracold storage, so I would think certainly in rural settings
	and other settings certainly would simplify the ability to get
	vaccine out. And as Dr. Buttenheim mentioned, you know, just
	getting--making it simpler, addressing these sort of things--
	the barriers that we can, that would be one of them.
	Mr. Obernolte. Thank you very much.
	And, Dr. Neuzil, I had a question for you. You know, it's
	very interesting that our States have kind of served as the
	laboratory of democracy during this epidemic because many
	different States took different approaches to economic
	shutdowns and efforts to reduce the spread and transmission of
	the virus. And, you know, it's kind of a scientist's dream,
	right, because we have lots of different settings that we can
	look at statistical evidence and figure out what worked and
	what didn't.
	And I think a growing body of research is indicating that
	the virus followed similar trajectories in States with very
	different approaches to shutting down their economies. So can
	you tell us your view of what that means for future epidemics?
	Because we know that this is going to happen again. This won't
	be the last time. In the future, should we have pursued the
	policy that we did regarding economic shutdowns?
	Dr. Neuzil. Yes, so thank you for the question. It's a
	complicated question, and my conclusion might be a little
	different than yours. I think that there are so many variables.
	We scientists like controlled experiments, so if I'm going to
	do a controlled experiment, I want everything to be the same
	except for one variable. You know, this group wears masks and
	this group doesn't. And as we know, a lot of the behaviors and
	actions that were taken tracked together. There is in fact
	evidence, and the CDC has provided evidence, that many of these
	mitigation measures did work. You know, certainly the masking,
	now the double masking, the social distancing, and the limiting
	large crowds has been shown to work. Again, it is hard to
	dissect what single variable might be contributing there.
	So I think it's going to take a scientific approach, and
	we should have that scientific approach to how these
	differences--what's worked best, where did it work, et cetera.
	Mr. Obernolte. OK, thank you. Yes, I was talking less
	about masks and social distancing where the science is more
	clear, as you say, and more about shutting down, for example,
	indoor dining, forcing employers to do remote only instead of
	having controlled office environments, you know, where we've
	got States with very different approaches like Florida and
	California that seem to have similar trajectories of the spread
	of the virus and recovery from the epidemic.
	And last question for Dr. Buttenheim, I was fascinated by
	your testimony the vaccine hesitancy and distrust of
	government. And I completely agree with you that this is less a
	discussion about virology and more of a discussion about
	psychology when we're talking about overcoming vaccine
	hesitancy.
	However, you know, I think that something Dr. Huang said
	about distrust of government really resonated also, which is
	that people don't want to feel like their government is forcing
	them to get the vaccine, and I think we have to be very
	cautious about that because, in a way, we've said we're not
	going to make it mandatory, but in other ways we're kind of
	telling them that they are if we're telling them that their
	children had to be vaccinated to return to school, if we're
	telling them that they have to be vaccinated to get on a
	commercial aircraft.
	What are your thoughts? You know, how do we tread this
	path toward steering people in the right direction to get
	vaccines but not alarming them by requiring them to get it and
	enhancing this distrust of government?
	Dr. Buttenheim. Yes, this is a question we are getting a
	lot, sort of where do mandates potentially fit in with this
	vaccine. And most of my research pre-COVID was on the childhood
	schedule and whether you had to vaccinate your kid to go to
	school--to have a kid go to school, so very relevant. You know,
	fortunately, just regulatorily, we're still in emergency use
	authorization and we don't actually have to contemplate
	mandates quite yet. We are very unlikely to mandate a vaccine
	that's under an EUA.
	But it's going to be a fine line. I really think about
	this as not trying to get 100 percent or 80 percent of people
	vaccinating but trying to make sure that everyone's been
	reached with information and support to make the decision
	that's best for them. That's really different from how I talk
	about--think about sort of parents vaccinating their kids. I
	just like--I want you to get your kid to get the measles shot,
	sort of, you know, end of story.
	But we are obviously going to have situations. We mandate
	flu vaccine for healthcare workers in some settings in some
	States. There are going to be airlines that are going to say,
	you know, just as you have to have your yellow fever
	vaccination to travel to certain areas, you have to have your
	COVID vaccination. What schools and colleges do about students
	coming back, especially, I think it's going to be more relevant
	for colleges with congregant living maybe than for elementary
	schools. But those--you know, luckily, we have sort of
	templates for those conversations.
	But for the general public right now, this--there should
	not be even the feeling of mandate or must. You know, maybe
	there can be some language around should or it would be great
	or we're really gung ho about this and we hope you are, too,
	but we can absolutely steer clear of mandate language for now.
	Mr. Obernolte. OK. Well, thank you. Well, my time is
	expired, but thank you for that testimony. I completely agree
	with you. You know, I know my constituents pretty well. If they
	get the idea that they're being mandated to do this by the
	government, it's just going to enhance distrust, and it's going
	to make vaccine hesitancy worse, which is the wrong direction
	to go.
	Dr. Buttenheim. One hundred percent.
	Mr. Obernolte. So thank you very much, and, Madam Chair, I
	yield back.
	Staff. Ms. Stevens is next.
	Chairwoman Johnson. Unmute.
	Ms. Stevens. Can you hear me?
	Chairwoman Johnson. Yes.
	Ms. Stevens. Great, fabulous. Thank you, Madam Chair, for
	this phenomenal hearing, couldn't imagine a better way to kick
	off the Science Committee of the 117th Congress. And thank you
	to our expert witnesses.
	I'm talking to all of you from snowy Michigan where the
	President is today. He's in Portage, Michigan, visiting Pfizer,
	the place where the first vaccine rolled out to our great
	expectations.
	Dr. Neuzil, I want to thank you so much for your
	testimony, which was really thorough and historic in nature.
	And certainly today we've spoken a lot about the efficacy of
	the vaccine, and I know that's a topic on everyone's mind from
	my constituents in Michigan's 11th District who are working to
	get access to that vaccine.
	But I would just love to talk to you a little bit more
	about the vaccine development of which Dr. Baird also touched
	on with his very specific questions around that mRNA but more
	so to just backup for a minute because one of the things that
	we focus on in this Committee are the scientific achievements.
	We focus on the milestones.
	Many of us recall--and I say many because we've got some
	newbies in Congress on this Committee this time, freshmen, but
	those of us who were in the 116th Congress recall that the
	first thing that we voted on--and it was all of Congress,
	completely bipartisan, immediately signed into law, done at the
	beginning of March was the original money to go into the
	development of this vaccine, to go into the R&D of the vaccine.
	And here we have it where we got it within the year, you
	touched on Operation Warp Speed.
	But for somebody who is in this State, have you taken any
	moments to just pause and, if you have, what has been the
	thought? Is this something that surprised you? Was this
	expected? Did you think we were going to be able to get this
	done before the end of the year?
	Dr. Neuzil. Yes, that's a great question, and I've been
	involved in a lot of vaccine development, very large public-
	private partnerships in my career. And as you've said, this one
	is absolutely historic. I think last year at this time we were
	all saying, you know, best-case scenario we might have a
	vaccine by the end of the year. When you say stop and reflect
	on December 31st, I got my vaccine, and that was really a very
	powerful moment for me personally that within the same calendar
	year I actually received a vaccine when I was there at the
	beginning for development.
	So I think without--certainly, without the resources but
	without the vision, you know, without the leadership of
	bringing a diverse community together, bringing partners
	together with different skill sets united to a common goal was
	absolutely key to this happening.
	Ms. Stevens. Great. And I think one of the privileges of
	being on the Science Committee last term--and it's worth
	reflecting on--we in March voted for the funding of the
	vaccine, voted for a second package around increasing our SNAP
	(Supplemental Nutrition Assistance Program) benefits for food
	assistance, paid family leave provision, and more money for the
	testing, and then we voted for the CARES Act. And being on the
	Science Committee, we got additional dollars out to our
	Manufacturing Extension Partnership network, yay, and we also
	got money over to the National Institute for Innovation in
	Manufacturing Biopharmaceuticals known as NIIMBL. And this is
	part of the Manufacturing USA network.
	And, again, we talked a lot today about the distribution.
	This has come up in previous questions around where the supply
	is, how long the supply can last. And I just remember that
	conversation with Mr. Kelvin Lee, their Director, and asking
	him about the ability to distribute this vaccine given what we
	were seeing in the early stages. We remember about 13 months
	ago testing wasn't available.
	And so I don't know if you all want to rate, you know, in
	terms of how this vaccine has gotten distributed, but if
	there's anything else that you'd want to reflect on in terms of
	getting the shots in the arms of, you know, I would say with my
	residents, but the American public and in particular what we're
	seeing with those who have adopted the models of working and
	coordinating with the pharmacies directly, those States versus
	those who haven't it. And this is just if anyone has anything
	left to add. I know I'm--Madam Chair, I'm right at my time, so,
	we might have to do it for the record, which would be fine, so
	I'll yield back.
	Staff. Ms. Kim, next.
	Ms. Kim. Thank you. Thank you, Madam Chair and Ranking
	Member Lucas. I want to thank you for holding this very
	important hearing on the science of COVID-19 vaccines. I don't
	know if all of you are having technical difficulty like I have
	where you're in and out because of that. But I also want to
	thank our very patient and expert panelists for doing this and
	answering our questions. I look forward to working with the
	Members of the Committee on both sides of the aisle to ensure
	that the United States stays at the forefront of science,
	research, and development, and innovation.
	This is really exciting for me as a freshman being able to
	serve on this Committee because COVID-19 is affecting
	communities in different ways. And this so-called [inaudible]
	and individuals [inaudible] to weather the economic crisis much
	better than the low-income and minority families.
	Unfortunately, the COVID-19 pandemic has also had the
	biggest negative impact among minority [inaudible] that
	minorities and low-income students have suffered the most as
	schools have [inaudible] with virtual learning. And the January
	25th study by PACE (Policy Analysis for California Education),
	which is an independent, nonpartisan research center based on
	California found in a study of [inaudible] that, quote,
	[inaudible] students, especially low-income students
	[inaudible] language learners are falling behind more
	[inaudible] than others, end quote. Clearly, this study
	problematic because many of the students are falling way behind
	on math and reading skills, which are obviously critical skills
	if our country wants to have successful STEM (science,
	technology, engineering, and mathematics) students.
	So, moving forward, we need to ensure that we have a
	seamless vaccine distribution so that we can get to that point
	where anyone who wishes to get a vaccine can have access to it.
	We must also ensure that our research and development of
	vaccines are keeping pace with the variants that have been
	recently found.
	So I would like to pose a question to, first, Mr. Reed.
	Talking to my students in California's 39th District, it seems
	individuals often do not know which entity in the State is
	administering the vaccine distribution. And there's a lack of
	communication between the State and local government. And in
	your testimony you discuss how partnerships with regional
	health directors, family health departments, and other local
	partners are critical in determining the best communications
	approach for local constituencies as they understand what would
	work well within their respective communities. So could you
	elaborate further on these [inaudible] and provide examples of
	how different constituencies communicate with their residents?
	Mr. Reed. Certainly. And I was having a little trouble
	hearing you, so hopefully I heard the question. But, yes, our
	local partnerships have absolutely been key in our vaccination
	rollout. We've been very clear having a centralized planning,
	but we depend completely on a decentralized execution of that
	plan.
	I'll give you an example. We are rolling out to teachers
	starting next week, and from the State level we have just
	identified that those are the--that's part of the next group
	that is coming online for vaccinations, and then we allocate
	vaccine to our health districts around the State. We leave it
	to them to work with partners on to develop those plans. In
	some cases, they are setting up specific pods that are for
	school districts and their teachers. In some cases, they are
	using strike teams that will go to some of these districts in
	order to vaccinate the teachers. In some cases, they are
	pulling multiple districts together to come together for one
	pod. Some areas, they are using contractors that can go out and
	use strike teams. We've essentially left it up to them locally
	to determine what they can do best because they understand
	those resources. They understand the needs of their partners.
	They're in constant communication with those partners, and
	that's really what helps them to understand how best to move
	forward with vaccination efforts. I hope that answers your
	question.
	Ms. Kim. I'm pretty sure you did. My apologies. As soon as
	I posed that question, my computer froze, and so I had to log
	back in. And sorry we're having this problem. But thank you for
	answering that. And I do have a follow-up question if I still
	have some time. Madam Chair, how much time do I have?
	Staff. Time has expired.
	Ms. Kim. Thank you, I yield back.
	Staff. Mr. Sherman is next.
	Mr. Sherman. Thank you. I want to thank [inaudible]
	distribution [inaudible] disadvantaged communities, communities
	of color, rural communities [inaudible]. There's one other
	group that has a very low level of acceptance of vaccine, and
	that is Trump voters. And I'm hoping that some of the Members
	of this Committee who have a better personal relationship with
	the former President than I do can prevail upon him to go
	public with his support of these vaccines and that [inaudible]
	when members of the Trump family get their vaccination
	[inaudible] wants to be vaccinated or thinks he shouldn't be
	because he's already had the disease if he were present where
	other members of the Trump family were getting the vaccine,
	that would go a long way.
	I want to focus on the shortage of vaccine. Now, one
	concern I have--and this is the only thing I disagree with Dr.
	Fauci on--is he's been on the shows talking about how certain
	steps we could take that would conserve vaccine--studied how we
	could conserve vaccine [inaudible] because by the time we get
	the results from most Americans, all Americans will have access
	to the vaccine. It's not enough to vaccinate just the United
	States. We've got to vaccinate the world. That's a matter of
	world leadership. It's a moral issue. It's an international
	economics issue. But also, as Dr. Neuzil pointed out, it
	relates to our health. Every time anyone in the world gets this
	disease, [inaudible] a chance to replicate, mutate, and perhaps
	come back to the United States in a form that we can't deal
	with. So we do have an interest in the entire world being
	vaccinated as quickly as possible. It means not stopping our
	efforts to maximize the efficiency and production of the
	vaccine just when we all get vaccinated in the United States.
	But one issue here, while we do want to vaccinate the
	whole world, we're most interested in vaccinating the United
	States, is that there's vaccine being manufactured in the
	United States that is being exported. And we have [inaudible]
	Trump Administration didn't, and so Pfizer and others signed
	contracts with other countries. We could legally interrupt that
	with the Defense Production Act [inaudible] we want to maintain
	our relationship with our friends [inaudible] being
	manufactured in the United States is being exported
	[inaudible]? Do any of our witnesses know?
	[inaudible] another question. We can research to determine
	whether one Pfizer [inaudible] and one in the late summer is
	enough, whether 1/2 or 1/3 of the current dosages will be
	effective for people under 65. Those studies are going on now.
	They should've started a few months ago.
	But I want to focus [inaudible] throw the bottle away
	after that. [inaudible]. God knows how much vaccine was wasted.
	Even now, I'm told that there's a half a dose available in this
	bottle, and then you get the next half a dose available in
	[inaudible], same manufacturing lot [inaudible] in that bottle
	for the full dosage, we throw it away. Is that the--does any
	[inaudible].
	Staff. Mr. Sherman, much of your audio was cutting in and
	out, so I think the witnesses weren't quite able to hear the
	questions exactly.
	Mr. Sherman. I'm going to turn off my video and hopefully
	my audio will improve. Is my audio better now?
	Staff. It does sound a little better, sir, yes.
	Mr. Sherman. OK. I don't know if I have the time to
	restate the question, but I'll ask any of our witnesses, are
	you familiar with the process by which if there's maybe 1/3 or
	2/3 of a dose left in a bottle after--that you throw that
	bottle away rather than using some of the serum in this bottle
	and some of the serum in the next bottle, that next bottle
	being with the same manufacturing lot in order to administer a
	full dose? Are we throwing away 1/3 or 2/3 of a dose every time
	we finish a bottle?
	Dr. Huang. This is Phil Huang. I mean, I would say that,
	you know, we have certainly been very diligent in getting as
	much out of each vial as we can and have been getting more than
	what was on the [inaudible]----
	Mr. Sherman. That was my second question. But let's say--
	--
	Dr. Huang. But in terms--yes.
	Mr. Sherman [continuing]. What you can get out of the
	bottle is half a dose, you can get half a dose out, you can't
	get a full dose out of the bottle. [inaudible] from the same
	manufacturing lot. Do you throw away that half dose in the
	bottle that has already been mostly used?
	Dr. Huang. You know, I--yes, I haven't specifically heard
	regarding that availability. We have tried to get different
	syringes that make it----
	Mr. Sherman. Right.
	Dr. Huang [continuing]. Easier to----
	Mr. Sherman. Not----
	Dr. Huang [continuing]. Maximize the amount, but----
	Mr. Sherman. We've got the better syringes. We've stopped
	wasting whole dosages, but we are still wasting, on average,
	half a dose per bottle. So that would mean 1/12 of the serum is
	being thrown away. And that's--thank you, FDA. I think they'll
	correct that months from now.
	And I yield back.
	Staff. Mr. Weber is next.
	Mr. Weber. Thank you, sir. And, Madam Chair, thank you for
	having this great hearing. And you, too, Mr. Ranking Member. We
	appreciate it.
	Gosh, I don't know where to start. Let me do it this way.
	I think Alison Buttenheim, in your exchange with Dr. Bera, you
	said the best vaccine is the one you can get tomorrow. And so
	people are concerned about the--we've got two different kinds
	of vaccines, right? We have Moderna and Pfizer. How close are
	we on Johnson & Johnson? Do we know?
	Dr. Buttenheim. I think their EUA hearing is next week,
	but we also know that there will not be the amount of supply
	for that vaccine that we have for Pfizer and Moderna, so it's
	not like we'll suddenly have another 1/3 of, you know, supply
	that will be----
	Mr. Weber. Right.
	Dr. Buttenheim. We've been told in Philly we will have
	much more limited supply of J&J.
	Mr. Weber. And this may be a question for you and Dr.
	Neuzil I guess do we have a comparative analysis? In other
	words, how successful is the Pfizer and how successful is the
	Moderna? What are the numbers there that have been vaccinated?
	What are the numbers of adverse reactions? Do we have that kind
	of information?
	Dr. Buttenheim. I shouldn't speak to post-marketing
	surveillance. It's not my area of expertise, and unfortunately,
	I think Dr. Neuzil had to drop off. But in general, you know,
	the trials continue and that we still, through our different
	monitoring and surveillance systems, the local folks here who
	are vaccinating locally can attest to this, gather all sorts of
	adverse event data and we're starting to accumulate the longer-
	term safety and efficacy data. That's ongoing and will be for
	months.
	Mr. Weber. OK. In her exchange with Mr. Tonko, I think she
	said herd immunity was around 75 to 80 percent. I guess that's
	the ideal, herd immunity, quote/unquote. So where are we now?
	Do we know that?
	Dr. Buttenheim. Well, we know the number of doses that
	have been delivered, and we know the number of people who have
	had one dose versus two doses. The mystery number is how many
	people have actually had COVID and what--how much do they
	contribute to herd immunity meaning how long are they
	protected. I've seen ranges from about 20 to 40 percent--it's a
	big range--of residents in the United States have some form of
	protection now either through prior disease or through
	vaccination.
	Mr. Weber. OK. And you talked about the need for local
	jurisdictions to be able to track that progress.
	Dr. Buttenheim. Yes.
	Mr. Weber. Are we finding different jurisdictions, Texas
	or others, do things better and are tracking this better? Is
	there a model jurisdiction out there that you would recommend?
	Dr. Buttenheim. I should let Dr. Huang and Mr. Reed weigh
	in on what they're doing. North Carolina has a great dashboard.
	Many States have dashboards that are not being run by the
	government. They're stood up by, you know, talented citizens
	who want to be able to see this. But I think--again, we need to
	sort of rapidly share best practices and how to just collect
	and analyze and display that information to guide decisions.
	Mr. Weber. OK. Well, thank you for that. And I do want to
	hear Dr. Reed and Dr. Huang. Dr. Reed, what say you?
	Mr. Reed. So one thing I would say is that we're missing a
	key piece of information. We start to look at our vaccination
	rates in our different counties and try to put that out there
	so that we have an idea of the rates plus the amount of disease
	out there. Our Federal allocation that comes into the State, we
	don't have any visibility on what that data shows us, so that's
	been a source of frustration. We have a significant tribal
	population in Oklahoma. We have our Veterans Administration
	centers, so Federal allocation comes into the State, but it
	doesn't go into our immunization registry, so it's a blind spot
	for us. We don't know what those vaccination rates are
	contributing to in some of our counties.
	So while we are putting out information about how we're
	doing at a county level and now we're looking at adding on to
	ZIP Code level to put that information, we really need
	additional data from the Federal allocation so we can better
	understand vaccination rates within our State because that data
	will help drive our decisions on future allocations and future
	efforts.
	Mr. Weber. Well, thank you. Dr. Huang, I've got about 20
	seconds.
	Dr. Huang. Sure. And we've actually been working with a
	local group Parkland Center for Clinical Innovation, have been
	processing both our testing positivity results, as well as our
	vaccination, and so we've actually--they've been doing some
	projections based on the number of confirmed and probable cases
	but then also projections of how many other cases
	geographically might be out there. And we've looked at it by
	ZIP Code and also by census tract. Some of the ZIP Codes and
	census tracts may be about 30 percent perhaps protection and
	even up to 60 percent in some of the areas, but that's still
	preliminary data that we've been working on.
	Mr. Weber. OK, thank you, and I appreciate that. Madam
	Chair, I yield back. Thank you.
	Chairwoman Johnson. Thank you.
	Staff. Ms. Ross is next.
	Ms. Ross. Great. Can you hear me? Great, thank you.
	Well, perfect timing, Dr. Buttenheim, because I'm from
	North Carolina. I don't know if you saw me kind of doing my
	little happy dance about our dashboard. And I just this week
	had a roundtable with community health providers with our HHS,
	with NIH, and with our--all of the local hospitals here. And
	I'd like you to tell the folks why our dashboard is good and
	would be a model. We didn't have a fast start. We had some
	difficulties, but I believe we're catching up. And if you could
	talk a little bit about the dashboard. And then I have a couple
	of other questions that came out of that roundtable.
	Dr. Buttenheim. Sure. And I should clarify. The dashboard
	I had in mind when I said that is one of these that was set up
	by academic team Dr. Paul Delamater at UNC (University of North
	Carolina), and I actually don't know how well it complements
	the State dashboard.
	But what's important to see for me is, for example, in
	Philadelphia, it is less helpful for me to just see how many
	doses have been given to different sociodemographic groups. I
	want to see rates. So, you know, we talked earlier about, you
	know, 11 percent of the doses in Philadelphia have gone to
	African-Americans, but 40 percent of the population is African-
	American. Show me that in rates so I can very quickly see only
	3 percent, you know, of this group versus 15 percent of that
	group.
	And then the granularity is really important, especially
	for jurisdictions that are going to be using something like the
	social vulnerability index that was mentioned earlier to do
	equity-based allocation. You need to see that at a pretty fine
	level of detail. ZIP Code is OK, census tract actually better.
	So right now, for example, the--you know, you can sometimes see
	maps that show sort of ZIP Code of doses given but by provider,
	not by patient. So, you know, we need to use those data. And
	then it needs to be dynamic. You know, lots of us are checking
	these dashboards every night, and, you know, numbers that are
	really bumpy because we don't report over the weekend or, you
	know, 3- to 7-day lags are hard. So it's real-time data,
	granular data, and data that are presented as rates so that we
	can do comparisons are what's most useful.
	Dr. Huang. And this is Phil Huang. Could I add one thing
	in there? Just, I mean, it really highlights the need for
	investment in our data systems. You know, it was--it came out
	during our testing data and all of that, but then also, you
	know, as we've been going out with the vaccinations, the mass
	vaccination centers, you know, getting the reporting into our
	State ImmTrac systems. We were during the first weeks having to
	do it all paper-based, and so it really limited the timeliness,
	the amount of data we could get back. Now we've transitioned to
	a paperless system using QR codes. But all of these, you know,
	it shows how much there's been neglect of some of these basic
	data systems and infrastructure for public health that really
	are so key.
	Ms. Ross. Thank you so much. One final question. In that
	same roundtable we heard, and somewhat sadly, that there was
	vaccine hesitancy among healthcare workers for them to get the
	vaccine. And that's concerning obviously because they are in
	contact with patients, but it's also concerning because they're
	supposed to be our Ambassadors to good health care. Could you
	tell us what you've been learning about convincing all of our
	healthcare workers to get the vaccine?
	Dr. Buttenheim. So, you know, this was a really important
	area of focus because that was the first group that we
	vaccinated, so we had data quickly on sort of which groups were
	saying yes and were saying no. I will say the same race-,
	ethnicity-based disparities that we see in the general
	population, we got a signal about that in healthcare workers,
	also by occupational group, which is of course correlated in
	many cases with race, ethnic groups as well. And one area where
	we're particularly seeing gaps is in the long-term care or
	nursing home workforce.
	So I think--the--there's nothing sort of different about
	how we're going to approach this. Some of this, again, is going
	to be these longer-term, more intensive face-to-face
	conversations, making sure people have repeated opportunities--
	it wasn't just like there was this one chance to get vaccinated
	and you missed it--and figuring out who are the sort of
	persuasive peers or the validators that can help bring people
	along.
	Ms. Ross. And are there--finally, are there any incentives
	to getting vaccinated? How does that work? And I know that
	there have been some folks in North Carolina who have looked at
	that as well.
	Dr. Buttenheim. It's hard to do justice to it in 20
	seconds. Incentives are very controversial. You know, does a
	$20 gift card work? Does a $1,500, you know, big investment
	that looks like relief money work? My personal opinion as a
	researcher is that this is not--this is not a great place to
	use incentives. And one reason I'll say about that is that one
	thing incentives can do is signal to someone that the behavior
	you're incentivizing is difficult or risky or hard or
	unpleasant for some reason, and I think that's not the message
	we want to get with this vaccine. But I know there are lots of
	interesting programs and experiments who have tried incentives.
	Ms. Ross. Thank you. And I yield back.
	Staff. Representative Moore is next.
	Ms. Moore. Thank you so much, Madam Chair and Mr. Ranking
	Member. I have really, really enjoyed listening to this panel
	of experts. I have more questions than I do time, so let me
	just get right to it.
	Madam Chair, I was--want to enter a couple of things into
	the record without objection? I would like to enter a Pew
	Center research report recommending quite frankly that pregnant
	women receive the COVID vaccine, the American College of
	Obstetricians and Gynecologists--I'm sorry, the--it's a--I want
	to--the American College of Obstetricians and Gynecologists has
	observed that pregnant women are more vulnerable to severe
	illness and death, and they recommended that they get the
	virus. Then I also want to put in the record a study from the
	Pew Research Foundation that talks about the--about the age gap
	between whites and other minorities. Without objection, Madam
	Chair?
	Chairwoman Johnson. So ordered.
	Ms. Moore. Thank you. Thank you, Madam Chair.
	I put those things in the record to tee up questions, and
	I'm not sure who is best to answer, but I'll start with Dr.
	Zydema. You know, when we talk about vaccine hesitancy, let me
	flip the script a little bit and say maybe some of the
	hesitancy has got to do with some of our organizations, the
	World Health Organization, the CDC. They have not been very
	clear about it. And so if you're pregnant, you may be hesitant
	to take the vaccine. You might not even be eligible based on
	States' priorities. I was wondering if you could comment on
	that briefly.
	Dr. Buttenheim. And, Representative Moore, to whom are you
	directing that question?
	Ms. Moore. Yes, Dr. Neuzil. I'm sorry, Dr. Neuzil.
	Dr. Buttenheim. Oh, she unfortunately had to--she had a
	hard stop at 2 o'clock p.m. so we are without her----
	Ms. Moore. OK. Well, I don't care. Dr. Buttenheim, I'll
	take you.
	Dr. Buttenheim. Not my area of expertise. I'm going to
	pitch it to a medical doctor.
	Ms. Moore. All right.
	Chairwoman Johnson. We can submit your question----
	Ms. Moore. OK. I'm sorry. Dr. Huang, anybody. I'm running
	out of time.
	Dr. Huang. Yes, you know, I guess what I was hearing, you
	know, some--that the mixed messages or the lack of clear
	messages perhaps causing some of that hesitancy. I mean, I
	think that goes back to the point we do want to, you know,
	address the facts, you know, get--share them in an honest way,
	build that trust. Sometimes things aren't always clear, but
	then there are the recommendations that are resulting from
	that, and I think that, you know, making that clear and
	building that trust is part of building that--addressing the
	vaccine hesitancy. But----
	Ms. Moore. Thank you, Dr. Huang. I mean, because the
	reality is is that vaccines have been administered to pregnant
	women in the past, and there haven't been any bad outcomes that
	we know of.
	The second thing I put in the record was just--I just want
	to point out that while we talk about all of the hesitancy
	among Blacks and other minority groups--I know we have our
	witness here from the Native American tribe. I just want to
	point out that the most common age among white people is 58,
	and that's double what the common age is for Black people,
	which is 27. And if you're just going to line up Hispanics and
	pick out a random Hispanic person, they're much more likely to
	be age 11. If you put that in more scientific terms like the
	median age, the median age of white people in the United States
	is about 44. It's about 34 for African-Americans, 10 years
	difference, and then 30 for Hispanics. So, you know, I don't--
	you know, so if a State rolls out a plan to vaccinate all the
	65-year-olds first, that's fine. Then we're going to move down
	to the 55-year-olds. You know, you could be inadvertently, I
	would say, agreeing to vaccinate white people first. White
	people or the baby boomers, I'm 69, but literally, you know, my
	son, who got off the respirator on December 31st and is age 43,
	is wondering is it ever going to be his turn? So I just want a
	comment on that in my seven seconds.
	Mr. Reed. I would say for us----
	Ms. Moore. OK. Go on.
	Mr. Reed. Well, I would just say for us in Oklahoma, the--
	really the only age disparity that we created was we cutoff at
	65-plus, and that was based off of the morbidity data that we
	had in Oklahoma. And then at this point we're moving to any
	adult under 65 with comorbidities. And we want to make sure
	that we are reaching out to our underserved communities, our
	communities of color, and work with our partners to make sure
	that we are reaching out to these communities and ensuring that
	we do get a level of vaccine equity that may not be based off
	of just the broad statewide plan. Again, we want to push that
	locally when we know that our local partners recognize the
	needs in their communities, and they can reach out to those
	individuals and help us to reach that level of equity we need
	to reach.
	Ms. Moore. And, Madam Chair, my time is expired. Thank you
	for your indulgence, and I yield back.
	Chairwoman Johnson. Thank you.
	Staff. Is Mr. Kildee available?
	Mr. Kildee. Yes, I am.
	Staff. OK, you're next, sir.
	Mr. Kildee. OK. I got to start my video. There we go.
	All right. Well, first of all, thank you to Chair Johnson
	for holding this meeting. I'm so happy to be a Member of this
	Committee. And this hearing, my first hearing as a Member of
	the Committee, completely affirms what I had hoped for, that we
	would have a meaningful and really fact-based conversation
	about this really important subject. So thank you, Chairwoman
	Johnson, for your leadership in holding this hearing.
	I have been in and out of the hearing. I just had to jump
	off for a minute to wish my 15-year-old nephew in Ireland a
	happy birthday on Zoom, so I may have missed a bit. And some of
	this may be redundant, but the subject is so critical. I
	apologize for any redundancy here.
	Two of the communities that I represent are Flint and
	Saginaw, Michigan, both majority minority communities. And, as
	we know, African-Americans are at significantly greater risk. I
	have lost several friends, four very close friends that were
	lifetime friends, to COVID, so this is obviously not just a big
	issue for us as a country but it's very personal for many of
	us.
	For the people in my hometown of Flint, as you might
	expect, this trauma comes in addition to the ongoing trauma of
	the water crisis that many are still recovering from. And at
	the core of that crisis was a complete breach of trust between
	government and the people of the community. The lack of trust
	between the people of Flint and public institutions is even
	worse than it is in many other communities. And so many of you
	mentioned in your testimony the skepticism--natural skepticism
	of the--of communities of color for any institution but
	particularly medical--the medical system because of the legacy
	of exploitative research. So this is not going to be easy to
	overcome.
	And I wonder, maybe starting with Dr. Buttenheim, if you
	could comment as if you're speaking to the people of Flint and
	Saginaw, what can you tell us, what can you tell them, what--
	especially for leaders in the community, what are the evidence-
	based actions that leaders should be taking to encourage
	vaccine uptake and to address the distrust in communities of
	color? I know you've addressed this, but if you could just
	reiterate that for the people I represent, it would be really
	helpful.
	Dr. Buttenheim. Sure. And the thing I put at the top of
	the list is to listen. You actually don't have to do all the
	talking and all the information conveying up front. A lot of
	this is tell me what's going on, tell me where you are with
	this, tell me about past experiences that have made--you know,
	have given you concerns about this vaccine, what questions do
	you need answered. I do think listening can go a long way here.
	And then the other piece which will not be a surprise to
	you with Flint is of course to find those trusted sources, you
	know, who will people listen to? And if those people can share
	their why, what's your why, you know, if they can talk about
	their decision to get the vaccine in--you know, in sort of
	dialog with people, they can go a long way, too.
	Finally, to the extent local and State health authorities
	can be transparent about the conversation and acknowledge--you
	know, I think if you just kind of skip over the fact that we
	maybe don't have trust in public health authorities, like
	you're already just behind the 8-ball. I don't know if that's
	the right metaphor. I'm not a sports person. But incorporating
	the recognition and acknowledgement of those--of the history
	and the present of structural racism and institutional racism
	and making that part of this conversation can also be helpful.
	Mr. Kildee. I wonder if you could also, Dr. Buttenheim,
	zero in a bit. I was really interested in your testimony. I
	thought it was well-presented, the five points, but the third
	point you made about keep doing the hard stuff, I mean, this
	sort of falls into the category of hard stuff.
	Dr. Buttenheim. Yes.
	Mr. Kildee. If you could talk about how this relates to
	that point, that would be helpful.
	Dr. Buttenheim. Yes. Sure. And I will say this is, you
	know, science happening in real time. My guidance on this and
	my instinct is really coming from following some I will say
	mostly Black female physicians on social media and some I know
	here at Penn who are doing this work on top of everything else
	they're doing by having conversations every day with patients,
	with people they run into in their daily lives. I'm thinking of
	Dr. Kimberly Manning at Grady Hospital in Atlanta. I'm thinking
	of Dr. Gina South here at Penn Medicine. And in their--like
	literally in their Tweet threads about this they provide
	templates for how to have these conversations. And the first
	thing you realize is, wow, these women are very powerful and
	very effective at listening and reflecting and sharing their
	own stories, and, boy, this work is hard. And again, you
	couldn't turn this into something that, you know, you could
	suddenly reach 1,000 people with because it is these one-on-one
	conversations.
	So that's sort of where that point No. 3 came from in my
	testimony as recognizing the power of that and also the
	limitations in that we--it's hard to scale and it's hard to
	keep asking of some of these people to keep doing this labor.
	Mr. Kildee. Great. Well, I really appreciate the
	testimony. I appreciate, again, as I said, the Chairwoman for
	holding this hearing. I wish I had an hour to ask questions
	because we have so many, but this has really been helpful.
	Thank you. I yield back.
	Staff. Ms. Wild is next.
	Ms. Wild. Thank you so much. I really appreciate it. I
	would like to join in Mr. Kildee's comments regarding this
	Committee. I am new to the Committee. I am thrilled to be on
	it, and I think the very substantive nature of this hearing is
	exactly what I was looking for in terms of a committee, so
	thank you very much, Chairwoman.
	My question--I'm rather late in the questioning order. My
	question was going to be for Dr. Neuzil. But I'm going to ask
	Dr. Buttenheim if she might be able to assist me with this
	question. In recent weeks we have seen news of viral variants
	reaching U.S. shores. Evidence suggests that some of these
	variants may be more contagious than the original SARS-CoV-2
	virus. And I've seen a number of anecdotal stories about some
	severe concerns with how quickly the--one of the variants in
	particular is spreading. Can you tell us a bit about how we
	should expect the existing vaccines to perform against the new
	variants, and what if anything do we know about the vaccines
	that are in the pipeline in terms of their effectiveness
	against the new variants?
	Dr. Buttenheim. Thank you, Representative Wild. I wish Dr.
	Neuzil were here because that is well out of my area of
	expertise. I'm neither a virologist, nor an epidemiologist or
	immunologist, so I will----
	Ms. Wild. I was concerned about that. I don't know whether
	any of the other witnesses have any response on that. If not,
	I'll move on, but if you do, please feel free to comment, Dr.
	Huang or----
	Dr. Huang. That really would be a Dr. Neuzil question for
	expertise.
	Ms. Wild. That's fine. That's fine. So I--let me move to a
	different question then. And I'll address this to anybody who
	might be able to answer it. A number of people have the sense
	that these vaccine processes have been rushed and that maybe
	safety took a backseat. Can you comment on the integrity and
	the vaccine trial data? And, you know, a follow-up to that
	would be that some people are queasy about the name Operation
	Warp Speed. I'm actually at a vaccination clinic today. I'm
	doing this from a hospital conference room where they just
	celebrated giving their 100,000th vaccination today. So that's
	obviously commendable, but there are still so many more people
	that we know are going to need to be vaccinated. Is there any
	indication that scientific integrity and the safety of patients
	ever took a backseat in the Federal Government's effort to
	support the vaccine development? Anybody----
	Dr. Huang. Again, I would say that probably Dr. Neuzil
	testimony earlier addressed that. You know, I mean, I think
	that there has been--yes, I mean, I think she covered a lot of
	that pretty quickly.
	Regarding the interpretation of Operation Warp Speed, you
	know, I did express in my testimony we have heard that from the
	front, you know, people in the community that just that term,
	because of the fear or the concern that it was rushed, that
	that term does seem to reinforce that in some circles. So--and
	I've heard specifically that, and that is one of the vaccine
	hesitancy sort of concerns out there.
	Ms. Wild. I'm hearing that a lot, too. Any best practices
	in terms of--that you can share with us in terms of convincing
	people who are more reluctant than others?
	Dr. Buttenheim. You know, where I've seen communications
	be persuasive, there are sort of two aspects. One is showing
	how parts of this vaccine have been worked on for a long time,
	right? Like we actually have decades of research that got us to
	this point, which is why we have a 1-year vaccine instead of a
	4-year or a 10-year vaccine.
	And I think the other persuasive piece is the confidence
	from experts like Dr. Neuzil that the approval process was not
	compromised in any way. You know, the FDA and the CDC have
	traditionally been two institutions that Americans have a lot
	of trust in that, you know, has had a rocky road the last
	couple years. But, you know, experts saying, yes, all the
	right, you know, i's were dotted and t's were crossed that got
	us to these emergency use authorizations, and sort of saying
	that over and over again also seems to be persuasive.
	Ms. Wild. Thank you so much. Madam Chairwoman, I yield
	back.
	Chairwoman Johnson. Thank you.
	Staff. No additional Members for questions, Ms. Johnson.
	Chairwoman Johnson. Well, thank you very much. And let me
	thank our witnesses. I do have one more question before we
	close out. I apologize for it taking us so long to get through
	it, but it lets you know how interested we are in these
	questions.
	And I know that some of these questions that I might have
	here might be more appropriate for Dr. Neuzil. If that is the
	case, we will send the questions to her.
	But what are the side effects of the Pfizer and Moderna
	vaccines? Are they mild or severe? And how often do people
	experience the side effects?
	Dr. Huang. I mean, there are certainly some localized side
	effects, localized pain, redness, some of the common aches and
	pains, joint pain, body aches, headache, sometimes fever,
	typically short-lived. Some of the severe side effects, you
	know, I mean, that we would be worried about would be the
	severe allergic reaction, anaphylaxis. The only real
	contraindication, you know, is to have a history of anaphylaxis
	to any of the actual components in the vaccine or also then,
	you know, there's a delay recommended just if you had another
	vaccine in 14 days. But, again, there are--you know, and
	there's protocols in place for monitoring these vaccines.
	There's the V-safe program where everyone is being--you know,
	if they sign up, get daily text messages to report these side
	effects.
	Chairwoman Johnson. OK. Is it possible for a vaccine to
	mutate into an active form of the virus or infect someone who
	is healthy?
	Dr. Huang. Again, it was addressed by Dr. Neuzil. It's not
	an actual live virus. These are--so it can't mutate into
	another virus that would infect persons.
	Chairwoman Johnson. Thank you. What's going on with
	chemicals in vaccines in general, and do we need to be worried
	about them?
	Dr. Huang. Yes, I don't know that--maybe that might be
	something to talk to Dr. Neuzil about.
	Chairwoman Johnson. OK. We will submit some questions to
	her. One last question. Is it possible for a vaccine to cause
	autism?
	Dr. Buttenheim. The great, great preponderance of data--
	and there's a lot of it and a lot of studies--you know, it's
	hard to prove a negative, but there has never--there has not
	been any credible research, sustained, replicated that gives
	any suggestion that there's a relationship between vaccines and
	autism.
	Dr. Huang. And the original research was actually
	disproved----
	Dr. Buttenheim. Exactly.
	Dr. Huang [continuing]. And the author has been
	discredited and it's been retracted and so----
	Dr. Buttenheim. It's an incredibly, incredibly sticky
	worry, very hard to unstick people from that worry, I will say,
	behaviorally, but no science to support it.
	Chairwoman Johnson. Thank you very much. Does anyone else
	want to ask any questions before we close out?
	Well, thanks to all of you. This has been incredibly
	important. And you--and I so apologize for the technology
	glitches at the beginning. We will try to make sure that we can
	try to clear those up. This is a technology committee, and I'm
	the first to admit that I'm a little old for the era, and so
	I'm just as guilty as anyone else for not knowing exactly how
	to clear it up when it happens.
	But before I close, I want to really thank all of you who
	testified and all of what you're doing and to say that this
	Committee certainly had interest in your coming today, as you
	can tell. We're sorry it went so long, but the record will
	remain open for 2 weeks for any additional statements from
	Members or our witnesses for any additional questions.
	So before I excuse the witnesses, let me say one more time
	how much we appreciate you being here and how helpful your
	information has been.
	Our witnesses are now excused, and our hearing is
	adjourned. Thanks to all of you.
	[Whereupon, at 2:40 p.m., the Committee was adjourned.]

	Appendix I

	----------


	Answers to Post-Hearing Questions

	Responses by Dr. Kathleen Neuzil
	[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

	Responses by Dr. Philip Huang
	[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

	Responses by Mr. Keith Reed
	[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

	Responses by Dr. Alison Buttenheim
	[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

	Appendix II

	----------


	Additional Material for the Record

	Documents submitted by Representative Gwen Moore
	[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

	Documents submitted by Representative Bill Posey
	[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

	[all]
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