[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
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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
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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]