diff --git "a/data/CHRG-117/CHRG-117hhrg43412.txt" "b/data/CHRG-117/CHRG-117hhrg43412.txt"
new file mode 100644--- /dev/null
+++ "b/data/CHRG-117/CHRG-117hhrg43412.txt"
@@ -0,0 +1,3507 @@
+
+ - THE SCIENCE OF COVID-19 VACCINES AND ENCOURAGING VACCINE UPTAKE
+
+[House Hearing, 117 Congress]
+[From the U.S. Government Publishing Office]
+
+
+ THE SCIENCE OF COVID-19 VACCINES
+ AND ENCOURAGING VACCINE UPTAKE
+=======================================================================
+
+ HEARING
+
+ BEFORE THE
+
+ COMMITTEE ON SCIENCE, SPACE,
+ AND TECHNOLOGY
+ HOUSE OF REPRESENTATIVES
+
+ ONE HUNDRED SEVENTEENTH CONGRESS
+
+ FIRST SESSION
+
+ __________
+
+ FEBRUARY 19, 2021
+
+ __________
+
+ Serial No. 117-1
+
+ __________
+
+ Printed for the use of the Committee on Science, Space, and Technology
+
+[GRAPHC NOT AVAILABLE IN TIFF FORMAT]
+
+ Available via the World Wide Web: http://science.house.gov
+
+ __________
+
+ U.S. GOVERNMENT PUBLISHING OFFICE
+43-412PDF WASHINGTON : 2021
+
+-----------------------------------------------------------------------------------
+
+
+ COMMITTEE ON SCIENCE, SPACE, AND TECHNOLOGY
+
+ HON. EDDIE BERNICE JOHNSON, Texas, Chairwoman
+ZOE LOFGREN, California FRANK LUCAS, Oklahoma,
+SUZANNE BONAMICI, Oregon Ranking Member
+AMI BERA, California MO BROOKS, Alabama
+HALEY STEVENS, Michigan, BILL POSEY, Florida
+ Vice Chair RANDY WEBER, Texas
+MIKIE SHERRILL, New Jersey BRIAN BABIN, Texas
+JAMAAL BOWMAN, New York ANTHONY GONZALEZ, Ohio
+BRAD SHERMAN, California MICHAEL WALTZ, Florida
+ED PERLMUTTER, Colorado JAMES R. BAIRD, Indiana
+JERRY McNERNEY, California PETE SESSIONS, Texas
+PAUL TONKO, New York DANIEL WEBSTER, Florida
+BILL FOSTER, Illinois MIKE GARCIA, California
+DONALD NORCROSS, New Jersey STEPHANIE I. BICE, Oklahoma
+DON BEYER, Virginia YOUNG KIM, California
+CHARLIE CRIST, Florida RANDY FEENSTRA, Iowa
+SEAN CASTEN, Illinois JAKE LaTURNER, Kansas
+CONOR LAMB, Pennsylvania CARLOS A. GIMENEZ, Florida
+DEBORAH ROSS, North Carolina JAY OBERNOLTE, California
+GWEN MOORE, Wisconsin PETER MEIJER, Michigan
+DAN KILDEE, Michigan VACANCY
+SUSAN WILD, Pennsylvania
+LIZZIE FLETCHER, Texas
+VACANCY
+ C O N T E N T S
+
+ February 19, 2021
+
+ Page
+
+Hearing Charter.................................................. 2
+
+ Opening Statements
+
+Statement by Representative Eddie Bernice Johnson, Chairwoman,
+ Committee on Science, Space, and Technology, U.S. House of
+ Representatives................................................ 7
+ Written Statement............................................ 8
+
+Statement by Representative Frank Lucas, Ranking Member,
+ Committee on Science, Space, and Technology, U.S. House of
+ Representatives................................................ 9
+ Written Statement............................................ 10
+
+ Witnesses:
+
+Dr. Kathleen Neuzil, MD, MPH, Professor in Vaccinology and
+ Director, Center for Vaccine Development and Global Health,
+ University of Maryland School of Medicine
+ Oral Statement............................................... 12
+ Written Statement............................................ 14
+
+Dr. Philip Huang, MD, MPH, Director and Health Authority, Dallas
+ County Department of Health and Human Services
+ Oral Statement............................................... 22
+ Written Statement............................................ 25
+
+Mr. Keith Reed, MPH, CPH, Deputy Commissioner, Oklahoma State
+ Department of Health
+ Oral Statement............................................... 33
+ Written Statement............................................ 35
+
+Dr. Alison Buttenheim, PhD, MBA, Scientific Director, Center for
+ Health Incentives and Behavioral Economics and Associate
+ Professor of Nursing and Health Policy, University of
+ Pennsylvania School of Nursing
+ Oral Statement............................................... 39
+ Written Statement............................................ 41
+
+Discussion....................................................... 64
+
+ Appendix I: Answers to Post-Hearing Questions
+
+Dr. Kathleen Neuzil, MD, MPH, Professor in Vaccinology and
+ Director, Center for Vaccine Development and Global Health,
+ University of Maryland School of Medicine...................... 110
+
+Dr. Philip Huang, MD, MPH, Director and Health Authority, Dallas
+ County Department of Health and Human Services................. 112
+
+Mr. Keith Reed, MPH, CPH, Deputy Commissioner, Oklahoma State
+ Department of Health........................................... 114
+
+Dr. Alison Buttenheim, PhD, MBA, Scientific Director, Center for
+ Health Incentives and Behavioral Economics and Associate
+ Professor of Nursing and Health Policy, University of
+ Pennsylvania School of Nursing................................. 118
+
+ Appendix II: Additional Material for the Record
+
+Documents submitted by Representative Gwen Moore................. 292
+
+Documents submitted by Representative Bill Posey................. 316
+
+
+ THE SCIENCE OF COVID-19 VACCINES
+ AND ENCOURAGING VACCINE UPTAKE
+
+ ----------
+
+
+ FRIDAY, FEBRUARY 19, 2021
+
+ House of Representatives,
+ Committee on Science, Space, and Technology,
+ Washington, D.C.
+
+ The Committee met, pursuant to notice, at 11:25 a.m., via
+Webex, Hon. Eddie Bernice Johnson [Chairwoman of the Committee]
+presiding.
+[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
+
+ Chairwoman Johnson. So I'll call this meeting to order,
+and without objection, the Chair is authorized to declare
+recess at any time.
+ Pursuant to House Resolution 8, today, the Committee is
+meeting virtually, and I want to announce a couple of reminders
+to the Members about the conduct of this remote hearing. First,
+Members, they should keep their video feed on as long as they
+are present in the meeting. Members are responsible for their
+own microphones. And please also keep your microphones muted
+until you are speaking. And finally, if Members have documents
+they wish to submit to the record, please email them to the
+Committee Clerk, whose email address was circulated prior to
+this hearing.
+ And so, again, good morning and welcome to the Space--
+Science, Space, and Technology Committee for the 117th
+Congress. We have an accomplished set of Members on our
+Committee--I just listened to one--and we bring diverse
+backgrounds and perspectives to our oversight and legislative
+work, and I look forward to a productive and stimulating 117th
+Congress.
+ It is fitting that our first hearing focus on the COVID
+pandemic and the role of vaccination in fighting this virus and
+its devastating impacts. As the first nurse elected to
+Congress, I'm deeply committed to understanding how basic
+research supports healthcare solutions, and I'm also a firm
+believer in vaccines.
+ Many of you are too young to know anyone who suffered from
+polio, but it was a devastating viral disease. I was a student
+nurse during that time, and I helped administer the polio
+vaccine as a student nurse. And thanks to scientific
+breakthroughs by brilliant virologists in the 1950's, the
+tremendous vaccine administration campaign that followed, this
+country has been polio-free since 1979. And we didn't get there
+by accident. We took great care to educate the public, ensured
+vaccine access in marginalized communities, and to assist other
+nations in vaccinating their own populations.
+ Like polio, COVID-19 kills. The last 12 months have been
+of great suffering. But they have also seen astounding
+achievements in virology. Researchers at the National Institute
+for Allergy and Infectious Disease (NIAID) and their research
+partners laid the scientific foundation over the past decade
+for a new type of vaccine called mRNA. When the news of the
+viral outbreak in Wuhan reached the United States, NIAID
+quickly deployed partnerships with drug companies to develop
+safe, effective vaccines in record time.
+ I cannot overstate what an incredible achievement it is
+that we have two safe, effective vaccines that have reached our
+shores. A third vaccine is being evaluated by FDA (Food and
+Drug Administration) as we speak, and we may have an answer on
+whether it is authorized as soon as next week.
+ We have an opportunity to take the lessons learned from
+polio, from measles, and so on to make sure that these vaccines
+reach their potential. Here's one lesson: Vaccines don't save
+lives. Manufacturing billions of doses and distributing them
+are the supply part of the question, but in order to get
+needles into arms as quickly as possible, we also have to think
+about demand. There are a lot of factors that make up consumer
+demand for a vaccine, but perception of risk is a big one. We
+must build high public confidence in these vaccines. We simply
+cannot and will not bring this virus to an end unless we
+vaccinate a high percentage of the American population and, in
+fact, the globe.
+ I hope our hearing today will help illuminate the methods
+that allowed these vaccines to be developed and approved
+quickly with scientific rigor, and that we will learn more
+about how vaccine hesitancy might threaten the pace of our
+national recovery. The Science, Space, and Technology Committee
+may not have primary jurisdiction over Health and Human
+Services (HHS), but we absolutely have a role in supporting
+public health outcomes through good science.
+ I welcome our esteemed panel of witnesses and thank Dr.
+Huang in particular for joining us, as Dallas is facing
+unprecedented power outages and freezing temperatures this
+week, and I know the demands on his time are intense right now
+because we're also with much of an uptick with the virus.
+ [The prepared statement of Chairwoman Johnson follows:]
+
+ Good morning and welcome to the first hearing of the
+Science, Space & Technology Committee in the 117th Congress. We
+have an accomplished set of Members on our Committee who bring
+diverse backgrounds and perspectives to our oversight and
+legislative work. I look forward to a productive and
+stimulating 117th Congress.
+ It is fitting that our first hearing in the 117th Congress
+focus on the COVID pandemic and the role of vaccination in
+fighting this virus and its devastating impacts. As the first
+nurse elected to Congress, I am deeply committed to
+understanding how basic research supports healthcare solutions,
+and I'm also a firm believer in vaccines.
+ Many of you are too young to know anyone who suffered from
+polio, but it was a devastating disease. I helped administer
+the polio vaccine as a student nurse. Thanks to scientific
+breakthroughs by brilliant virologists in the 1950s and the
+tremendous vaccine administration campaign that followed, this
+country has been polio-free since 1979. And we didn't get there
+by accident. We took great care to educate the public, to
+ensure for vaccine access in marginalized communities, and to
+assist other nations in vaccinating their own populations.
+ Like polio, COVID-19 kills. The last 12 months have seen
+great suffering. But they have also seen astounding
+achievements in virology. Researchers at the National Institute
+for Allergy and Infectious Disease and their research partners
+laid the scientific foundation over the past decade for a new
+type of vaccine called m-R-N-A. When news of the viral outbreak
+in Wuhan reached the United States, NIAID quickly deployed
+partnerships with drug companies to develop safe, effective
+vaccines in record time. I cannot overstate what an incredible
+achievement it is that we have two safe, effective vaccine
+options less than a year after this horrible virus reached our
+shores. A third vaccine is being evaluated by FDA as we speak,
+and we may have an answer on whether it is authorized as soon
+as next Friday.
+ We have an opportunity to take the lessons learned from
+polio, from the measles, and so on to make sure these vaccines
+reach their potential. Here's one lesson: Vaccines don't save
+lives; vaccinations do. Designing the vaccine, manufacturing
+millions of doses and distributing them are the ``supply'' part
+of the equation. But in order to get needles into arms as
+quickly as possible, we also have to think about ``demand.''
+There are a lot of factors that make up consumer demand for a
+vaccine, but perception of risk is a big one. We must build
+high public confidence in these vaccines. We simply will not
+bring this virus to an end unless we vaccinate a high
+percentage of the American population and in fact, the globe.
+ I hope our hearing today will help illuminate the methods
+that allowed these vaccines to be developed and approved
+quickly with scientific rigor, and that we will learn more
+about how vaccine hesitancy might threaten the pace of our
+national recovery. The Science, Space, and Technology Committee
+may not have primary jurisdiction over Health and Human
+Services, but we absolutely have a role in supporting public
+health outcomes through good science.
+ I welcome our esteemed panel of witnesses and thank Dr.
+Huang in particular for joining us, as Dallas is facing
+unprecedented power outages and freezing temperatures this
+week, and I know the demands on his time are intense right now.
+ Thank you, and I now yield to Ranking Member Lucas.
+
+ Chairwoman Johnson. So the Chair will recognize Mr. Lucas.
+Did he get in?
+ Mr. Lucas. Yes, Madam Chair. And thank you----
+ Chairwoman Johnson. Well, thank you.
+ Mr. Lucas. You and I both had challenges getting on board
+this morning, but we're both here. Good morning----
+ Chairwoman Johnson. Yes, thank you.
+ Mr. Lucas. Chairwoman Johnson. Thank you for holding this
+important and timely hearing. And thank you to our expert
+witnesses for their participation today. I hope we can learn
+valuable information that we can share with our constituents as
+we continue to battle the COVID-19 pandemic.
+ Almost 1 year ago to date, the Science Committee held our
+first hearing on the COVID-19 pandemic. Since then, we've seen
+day-to-day life changes dramatically. Millions of people have
+suffered from this pandemic, and COVID-19 has claimed the lives
+of nearly 480,000 Americans.
+ In recent weeks, the United States reached a positive
+milestone, as more Americans have now received at least one
+dose of the vaccine than have tested positive for the virus
+since the pandemic began just over a year ago. According to CDC
+(Centers for Disease Control and Prevention) data, the United
+States has administered approximately 55 million doses of
+COVID-19 vaccines since the first shot was given on December
+14, 2020, and approximately 12 percent of the total U.S.
+population has received at least one dose.
+ But as the original COVID-19 virus and new variants
+continue to spread across the globe, it is imperative that the
+United States take a more aggressive and ambitious approach to
+ramping up vaccine manufacturing and distribution. We need to
+get as many shots in arms as quickly as is possible.
+ It is also critical that rural and underserved communities
+are not left behind during the vaccine rollout. For example,
+many rural residents lack broadband internet connection and are
+unable to secure appointments, which are largely scheduled
+online. Residents in more isolated parts of the country also
+experience difficulties finding somewhere to get the vaccine if
+they do not live near pharmacies or community health centers.
+Distributing vaccines that require ultracold storage also
+presents challenges for these communities, as doses will expire
+if they're not properly stored.
+ The American research enterprise, including government,
+academia, and industry, has the expertise, resources, and
+talent to continue to fight this pandemic. From vaccine
+development at record speed to PPE (personal protective
+equipment) manufacturing, America's scientific community has
+stepped up to the plate, as scientists and researchers
+immediately pivoted at the start of the pandemic to focus on
+combatting COVID-19. With the integration of technologies such
+as artificial intelligence and high-performance computing,
+researchers have identified promising vaccine candidates
+quicker. Advanced manufacturing techniques also offer promising
+methods to bolster supplies and rapidly modify vaccines to
+address new strains of the disease.
+ These factors allowed the United States to approve two
+safe and effective COVID-19 vaccines just 1 year after the
+pandemic began. Scientists were able to develop these vaccines
+in record time thanks to almost two decades of basic research
+on related viruses. These investments in basic research have
+truly been lifesaving. We must continue to make critical
+investments in American research for the health and safety of
+our Nation. As vaccine distribution ramps up and we continue to
+work to stop the spread of COVID-19, it is imperative that key
+decisions are grounded and backed by strong science and data.
+We simply cannot afford to ignore science during this critical
+time.
+ This morning, I sent a letter to the Chairwoman
+respectfully requesting a hearing regarding the science on
+safely reopening and maintaining the Nation's K-12 schools for
+in-person learning. Research has established that approved
+COVID-19 vaccines are safe, and the evidence shows it's also
+safe to open our Nation's schools with the appropriate
+precautions in place.
+ I look forward to hearing from our witnesses today about
+the current state of vaccine uptake, hesitancy, and access
+across the country. I'm also looking forward to hearing about
+Oklahoma's plan and learning more about the efforts taking
+place across the State to ensure that the underserved and rural
+communities are not forgotten. Thank you, Deputy Commissioner
+Reed, for your participation here today.
+ And I want to thank the witnesses for taking the time to
+be here to share your expertise and insights with us during
+this pivotal time to keep Americans healthy. I know we're all
+looking forward to the day all Americans can safely return to
+work, our children are back in school, and we can look our
+loved ones in the eye once again.
+ I yield back the balance of my time, Madam Chair.
+ [The prepared statement of Mr. Lucas follows:]
+
+ Good morning Chairwoman Johnson. Thank you for holding this
+important and timely hearing. And thank you to our expert
+witnesses for your participation today. I hope we can learn
+valuable information that we can share with our constituents as
+we continue to battle the COVID-19 pandemic.
+ Almost one year ago to date, the Science Committee held our
+first hearing on the COVID-19 pandemic. Since then we've seen
+day-to-day life change dramatically. Millions of people have
+suffered from this pandemic, and COVID-19 has claimed the lives
+of nearly 489,000 Americans.
+ In recent weeks, the United States reached a positive
+milestone, as more Americans have now received at least one
+dose of the vaccine than have tested positive for the virus
+since the pandemic began just over a year ago. According to CDC
+data, the United States has administered approximately 55
+million doses of COVID-19 vaccines since the first shot was
+given on December 14, 2020, and approximately 12 percent of the
+total U.S. population has received at least one dose.
+ But as the original COVID-19 virus and new variants
+continue to spread across the globe, it is imperative that the
+U.S. take a more aggressive and ambitious approach to ramping
+up vaccine manufacturing and distribution. We need to get as
+many shots in arms as quickly as possible.
+ It is also crucial that rural and underserved communities
+are not left behind during the vaccine rollout. For example,
+many rural residents lack broadband internet connection and are
+unable to secure appointments, which are largely scheduled
+online. Residents in more isolated parts of the country also
+experience difficulties finding somewhere to get the vaccine if
+they do not live near pharmacies or community health centers.
+ Distributing vaccines that require ultra-cold storage also
+presents challenges for these communities as doses will expire
+if they are not properly stored.
+ The American research enterprise, including government,
+academia, and industry, has the expertise, resources, and
+talent to continue to fight this pandemic. From vaccine
+development at record speed to PPE manufacturing, America's
+scientific community has stepped up to the plate, as scientists
+and researchers immediately pivoted at the start of the
+pandemic to focus on combatting COVID-19. With the integration
+of technologies such as artificial intelligence and high-
+performance computing, researchers can identify promising
+vaccine candidates quicker. Advanced manufacturing techniques
+also offer promising methods to bolster supplies and rapidly
+modify vaccines to address new strains of disease.
+ These factors allowed the U.S. to approve two safe and
+effective COVID-19 vaccines just one year after the pandemic
+began. Scientists were able to develop these vaccines in record
+time thanks to almost two decades of basic research on related
+viruses.
+ These investments in basic research have truly been
+lifesaving. We must continue to make critical investments in
+American research for the health and safety of our nation.
+ As vaccine distribution ramps up and we continue to work to
+stop the spread of COVID-19, it is imperative that key
+decisions are grounded and backed by strong science and data.
+We simply cannot afford to ignore science during this critical
+time.
+ This morning, I sent a letter to the Chairwoman
+respectfully requesting a hearing regarding the science on
+safely reopening or maintaining our nation's K-12 schools for
+in-person learning. Research has established that the approved
+COVID-19 vaccines are safe, and the evidence shows it's also
+safe to open our nation's schools with the appropriate
+precautions in place.
+ I look forward to hearing from our witnesses today about
+the current state of vaccine uptake, hesitancy, and access
+across the country. I am also looking forward to hearing about
+Oklahoma's plan and learning more about the efforts taking
+place across the state to ensure that underserved and rural
+communities are not forgotten. Thank you, Deputy Commissioner
+Reed, for your participation here today.
+ I want to thank the witnesses for taking the time to be
+here to share your expertise and insights with us during this
+pivotal time to help keep Americans healthy. I know we are all
+looking forward to the day all Americans can safely return to
+work, our children are back in school, and we can see our loved
+ones once again.
+ I yield back my time.
+
+ Chairwoman Johnson. Thank you very much.
+ At this time, we'd like to introduce our witnesses. Our
+first witness is Dr. Kathleen Neuzil. Dr. Neuzil is Professor
+of Vaccinology, Medicine and Pediatrics, as well as Director
+for the Center for Vaccine Development and Global Health at the
+University of Maryland. She was part of the leadership team
+which oversaw the evaluation strategy for COVID-19 clinical
+trials, and she has been a central figure throughout the COVID-
+19 vaccine development process. She has led a phase 1 trials of
+the--she led phase 1 trials of Pfizer vaccine and the co-author
+of a recent paper establishing the efficacy and safety of the
+Moderna vaccine.
+ And then after Dr. Neuzil, Dr. Philip Huang, Dr. Huang is
+the Director and Health Authority for the Dallas County Health
+and Human Services Department where he manages almost 500
+public health professionals. Prior to that, he spent 11 years
+as Medical Director and Health Authority for the Austin Public
+Health Department. He also served as an Epidemic Intelligence
+Service Officer with the CDC where he conducted infectious
+disease outbreak investigations.
+ Our third witness, Mr. Keith Reed, is the Deputy
+Commissioner for Community Health Services with the Oklahoma
+State Department of Health. His public health career with the
+Department has spanned 19 years and multiple positions. Mr.
+Reed also is a Colonel in the Oklahoma Air National Guard and
+served multiple tours in support of Operation Iraqi Freedom and
+Enduring Freedom. He is currently assigned as Commander of the
+137th Special Operations Medical Group at Will Rogers Air
+National Guard Base in Oklahoma City.
+ Our final witness is Dr. Alison Buttenheim. She is the
+Scientific Director of the Center for Health Incentives and
+Behavioral Economics at the University of Pennsylvania. Her
+research is focused on vaccine exemption policy and zoonotic
+disease prevention. Dr. Buttenheim is a member of the National
+Academies' Committee on the Equitable Allocation of the Novel
+Coronavirus Vaccine and a lead author of the new National
+Academies report on ``Strategies for Building Confidence in
+COVID-19 Vaccines.''
+ Our witnesses should know that we will--you will have 5
+minutes for your spoken testimony. Your written testimony will
+be included in the record of the hearing. And when all of you
+have completed your spoken testimony, we will begin with
+questions. Each Member will have 5 minutes to question the
+panel.
+ We will open our witnesses' testimony now with--starting
+with Dr. Neuzil.
+
+ TESTIMONY OF DR. KATHLEEN NEUZIL, MD, MPH,
+
+ PROFESSOR IN VACCINOLOGY AND DIRECTOR,
+
+ CENTER FOR VACCINE DEVELOPMENT AND GLOBAL HEALTH,
+
+ UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE
+
+ Dr. Neuzil. Chairwoman Johnson, Ranking Member Lucas, and
+distinguished Members of the Committee, I appreciate the
+opportunity to elaborate on my written statement to you and to
+elucidate how investments in science and technology, effective
+partnership, and resource allocation enable the vaccine
+achievements of the past year.
+ The consequences of the COVID-19 pandemic on our health,
+our economy, and our social well-being have been staggering.
+While the urgent need for a vaccine was clear, vaccine
+development is a lengthy, risky, and expensive process.
+Researchers first evaluate experimental vaccines in the
+laboratory and in animals. If a vaccine is safe and appears
+promising, it may go on to be carefully tested in people, but
+only if there is funding to do so. Many vaccines never move
+beyond early testing simply because there is no perceived
+market value and no funding.
+ As part of the team that designed and conducted the early
+studies of the vaccines, I witnessed firsthand how the pandemic
+urgency shortened the vaccine development timeframe.
+Investments in basic science and technology were the key.
+Decades of work on understanding coronaviruses and other
+respiratory viruses enabled scientists to identify the
+appropriate target for the vaccine and to have a genetic
+sequence ready within days.
+ Investments in the mRNA technology for other vaccines,
+influenza, Zika, and Ebola, and prior partnerships with vaccine
+manufacturers meant we understood how to deliver the mRNA and
+at what doses. Likewise, government-funded researchers brought
+sophisticated animal models and innovative laboratory methods
+to the vaccine efforts.
+ The investment by NIH (National Institutes of Health) and
+others in clinical trials, infrastructure, and networks allowed
+experienced clinical scientists like myself to help design,
+execute, and analyze the studies in partnership with government
+and industry. Given my involvement from the start, I can attest
+that safety was never compromised by the speed of this effort.
+All trial designs were reviewed by ethics boards and the FDA.
+Experts with no ties to the products served on boards to
+monitor vaccine safety.
+ The first participants to receive the vaccine were healthy
+adults who would be the least likely to suffer ill effects. The
+trials began with low doses and worked up to higher doses. The
+volunteers were followed carefully in the hours, days, and
+weeks after receiving the vaccine. We learned that the vaccine
+caused more side effects at the highest dose, but the immune
+response was not as good at the lowest dose, so a middle dose
+was chosen to move forward into trials.
+ The first results of the mRNA vaccines were remarkable,
+showing more than 90 percent efficacy against disease and,
+importantly, against severe COVID-19. As most vaccine adverse
+events occur shortly after vaccination, the FDA required a
+median of 2 months of follow-up before emergency use
+authorization (EUA) would be granted.
+ Safety assessment does not stop at approval, however. The
+trials will continue for at least 2 years. As with all vaccines
+in the United States, the CDC, the FDA, and the manufacturers
+will continue to follow vaccine safety. Through these systems,
+we are learning more, for example, about the rare allergic
+reactions occurring after administration of the mRNA vaccines.
+ In summary, U.S. Government investments in science and
+technology enabled the COVID-19 vaccine development
+achievements. We don't know what pathogen will cause the next
+pandemic. Coronaviruses and influenza viruses have proven their
+pandemic potential. We must likewise be prepared for outbreaks
+from less-studied diseases due to arenaviruses, filoviruses,
+and togaviruses, for example. Our vaccine development can be
+better and faster but only with continued investments in
+technology. We have critical vaccine supply shortages, and
+people are dying.
+ Finally, this outbreak has reminded us again that little-
+known viruses causing disease in distant parts of the world are
+relevant. Variants are emerging in the absence of vaccines. The
+United States must work in partnership with the World Health
+Organization (WHO) and other international agencies to ensure
+an integrated, global response and to ensure that COVID
+vaccines are available to everyone in the United States and
+around the world. Thank you.
+ [The prepared statement of Dr. Neuzil follows:]
+[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
+
+ Chairwoman Johnson. Thank you very much.
+ Dr. Huang? Unmute.
+ Dr. Huang. OK.
+ Chairwoman Johnson. One more click. That's it.
+ Dr. Huang. Is it clicked?
+ Chairwoman Johnson. Yes, you got it. Click one more time.
+It keeps going off.
+ Dr. Huang. Can you hear me?
+ Chairwoman Johnson. Yes.
+ Dr. Huang. OK. Well, good morning, and thank you,
+Chairwoman Johnson, Congressman Lucas, and Members of the
+Committee, and greetings from frozen Dallas, Texas.
+ Chairwoman Johnson. You're off again. OK. It keeps
+clicking off.
+ Staff. Sir, you seem to be hitting the mouse twice or
+hitting a button twice, and that's just unmuting you and then
+muting you again.
+ Dr. Huang. [inaudible] unmuted. Can you hear me?
+ Staff. Yes.
+ Chairwoman Johnson. Yes.
+ Dr. Huang. OK. [inaudible] muted. OK.
+ Chairwoman Johnson. You're--OK.
+ Dr. Huang. I'm not----
+ Chairwoman Johnson. We hear you now. But you just went off
+again.
+ Dr. Huang. OK. I am not touching anything.
+ Chairwoman Johnson. Keep going. It went off again. I don't
+know what it is.
+
+ TESTIMONY OF DR. PHILIP HUANG, MD, MPH,
+
+ DIRECTOR AND HEALTH AUTHORITY, DALLAS COUNTY
+
+ DEPARTMENT OF HEALTH AND HUMAN SERVICES
+
+ Dr. Huang. Can you hear me? Oh, there. There, that looks
+good. OK. Well, I apologize for technical difficulties. Again,
+my name is Dr. Phil Huang, and as you heard, I'm the Director
+and Health Authority for the Dallas County Health and Human
+Services Department where we serve over 2.6 million residents
+in Dallas County. I'm also a board member for the National
+Association of County and City Health Officials, NACCHO, which
+represent our Nation's nearly 3,000 local health departments.
+And I'm honored to be with you here today.
+ Over my career, I've worked at the Federal, State, and
+local governmental public health levels, and I've truly come to
+appreciate that not just politics but all things really happen
+locally. Local health departments know our communities block by
+block, including the assets and barriers to care, the
+industries and living situations that pose particular
+challenges, as well as the community-level partners that have
+to be included in order to be successful.
+ Even before a single case of the virus was detected on
+American soil, we at local health departments began to mobilize
+and engage our community and healthcare partners, as well as
+with our State and the Federal Government. This continues as we
+provide testing and contact tracing, and while standing up the
+largest mass vaccination campaign in our Nation's history.
+ To be successful, we have to have strong, predictable
+supply of vaccines, but supply, while absolutely necessary, is
+not enough. We must do more to build demand and facilitate
+equitable uptake of these vaccines. To do this, we must provide
+clear communication through trusted messengers and healthcare
+providers, allow for the opportunity for questions to be asked
+and an individual's concerns to be thoughtfully considered, as
+well as target outreach via the many unique formal and informal
+communication channels where people get their information. This
+takes a robust workforce, strong relationships, and time and
+resources so that individuals can get their questions answered
+and then access the vaccine within their community.
+ The challenge of vaccine hesitancy is not new to COVID-19,
+but with nearly half a million Americans who have lost their
+lives to this virus and more challenging variants emerging, it
+highlights the importance of a successful and efficient mass
+vaccination effort.
+ Addressing this is not a one-time event also. Instead, it
+requires engaging with hesitant populations on an ongoing basis
+to honestly address concerns, provide the information they
+need, and build the trust that is crucial to their confidence
+in COVID-19 vaccines and the systems that provide them.
+ In Dallas, we've seen vaccine hesitancy among communities
+of color, especially the African-American and Latino
+communities. The roots of vaccine hesitance, though, are
+varied. The mistrust from the African-American community seems
+to be deep-rooted history, including the horrific Tuskegee
+studies of untreated syphilis in rural Black men, while
+concerns in the Latino community might stem from mistrust of
+government and skepticism of the vaccine development process.
+Among the Hispanic community, we're also hearing questions
+around whether an undocumented person can receive the vaccine,
+as well as concerns about providing personal information to the
+government needed to receive the vaccine.
+ These challenges persist in healthcare workers as well. We
+saw that in some long-term care facilities, even though there
+was a Federal program with the pharmacies that guaranteed that
+delivery, the uptake of the vaccine from the staff could be
+very low with some facilities only having 42 percent of their
+healthcare staff taking the vaccine. Local health department's
+chief health strategists within their communities are actively
+working on these actions to support equitable COVID-19 vaccine
+administration and uptake across all communities, all races,
+ethnicities, and other demographics and geographies.
+ Currently in Dallas County we have over 650,000 people who
+have signed up on our vaccine registration list. However, our
+health department is only receiving 9,000 doses of vaccine per
+week. Vaccine hesitancy, combined with the digital and resource
+divide, has also meant that our registration list is skewed to
+the northern more affluent areas of Dallas County.
+ However, because we've focused on the data, we've been
+able to tailor our approach with an eye toward equity. We
+provided vaccine distribution based on our vulnerability index
+to ensure we equitably distribute the vaccine as opposed to
+first-come, first-serve approach. We've also set up a
+professional phone bank so individuals without internet access
+or a smartphone can call to register, and we've partnered with
+community leaders to host in-person registration events. We're
+also launching a paid media campaign to address vaccine
+hesitancy and get information out to the community about the
+registration process.
+ We've seen firsthand how leveraging people that are
+respected by the community can increase vaccine confidence, and
+at one of our community registration events heard a 65-year-old
+African-American woman lean over to her friend and say that she
+decided to come because she saw the actor Tyler Perry on TV
+that morning say how important it was to get the vaccine.
+ While today's hearing is specific to vaccine hesitancy
+around COVID-19, I can't understate that this is an issue that
+was a challenge for us long before the pandemic, and our effort
+to build confidence in vaccines are long-term and continuous,
+but every day we work on it bringing us one step closer to
+getting our population fully vaccinated.
+ Thank you again for inviting me to testify today, and I
+look forward to your questions.
+ [The prepared statement of Dr. Huang follows:]
+[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
+
+ Chairwoman Johnson. Thank you.
+ Staff. Excuse me for a moment, Ms. Johnson. Real quick
+technical--if you press and hold the spacebar on the computer,
+that only temporarily unmutes you, and when you release the
+spacebar, it mutes you back.
+ Chairwoman Johnson. Thank you very much. Now we'll have
+Mr. Reed.
+
+ TESTIMONY OF MR. KEITH REED,
+
+ MPH, CPH, DEPUTY COMMISSIONER,
+
+ OKLAHOMA STATE DEPARTMENT OF HEALTH
+
+ Mr. Reed. Madam Chair Johnson and Ranking Member Mr.
+Lucas, thank you for the opportunity to speak today. My name is
+Keith Reed, and I'm Deputy Commissioner of Health for the State
+of Oklahoma. I'm here today to discuss our State's efforts to
+efficiently distribute and administer the COVID-19 vaccine and
+how we have addressed issues with uptake, hesitancy, and
+equitable access, particularly for those in our rural and
+underserved communities.
+ To begin, we've been conducting surveys throughout the
+State to gauge vaccine hesitancy. As of our latest survey in
+January, we've determined that while most people are willing to
+receive the vaccine at some point, roughly 33 percent of
+Oklahomans do not plan to do so. Major reasons for hesitancy
+are lack of information on the vaccine and its development
+process and concerns about potential side effects.
+ In this initial stage of vaccine distribution where demand
+is greater than supply, we found success in hedging the initial
+uptake issues by taking an overlapping approach. In order to
+vaccinate as many Oklahomans as possible, we've opened
+eligibility to new priority groups before entirely vaccinating
+earlier groups. With this tactic, we hope to lengthen the
+window of opportunity for those that might be undecided about
+vaccination, providing an extended timeframe to build consumer
+confidence in our program,
+ To overcome hesitancy and access boundaries, and encourage
+high vaccine uptake, a few key conditions are needed. One,
+vaccine supply needs to improve. As we all are well aware, with
+increases in supply, we can provide more options for
+appointments, protect more of our vulnerable populations, and
+increase vaccine eligibility to more Oklahomans.
+ Two, vaccine access needs to increase. We are working to
+open up new access points to the vaccine. We currently have
+approximately 1,500 pandemic providers signed up to participate
+in vaccine distribution around the State but can only engage a
+limited number due to supply issues. Getting vaccine to these
+providers, which include local pharmacies and many primary care
+providers, enables us to engage the most trusted sources in
+rural Oklahoma, giving us our best chance for high vaccine
+uptake.
+ And three, communication about vaccine safety and
+availability needs to be clear, and it needs to be consistent.
+We've been using a diverse network of communication partners to
+make sure that communication with Oklahomans about the vaccine
+is consistent, transparent, and accessible to everyone. We hold
+virtual media events twice weekly to provide updates to the
+public and partner with our local health departments to keep
+the lines of communication open so Oklahomans are informed on a
+daily basis. We work closely with regional health directors,
+family health departments, and other local partners to reach
+communities across the State. These partnerships are critical
+in determining the best communications approach for their local
+constituents as they understand what will resonate in their
+respective areas. We use social media and our website to
+provide timely, regular updates on the vaccine. Information is
+shared online and with partners across the State. Above all,
+we're ensuring that our communications across the board are
+clear and factual. Our top priority is to give Oklahomans the
+tools to make the--an informed decision about the COVID-19
+vaccine. This requires regular, repeated, and reliable
+communication that is honest and direct in its approach.
+ Oklahoma's unique landscape poses a particular set of
+challenges. Many of our community members lack internet access,
+particularly in rural areas with limited reception, or they
+lack digital literacy, particularly in our 65-plus community,
+who are some of the most at risk for COVID-19.
+ People in underserved or rural communities have expressed
+higher rates of distrust in vaccines in general. Many people of
+color are wary of vaccines due to a history of medical
+mistreatment. There is a fear of being targeted due to
+immigration status or disclosure of race or ethnicity.
+ This is also, of course--there is also, of course, general
+misinformation about COVID-19, leading to skepticism of the
+actual risk posed by COVID-19 or even skepticism that the virus
+exists at all. This misinformation is perpetuated on social
+media where it can have an exaggerated and local influence.
+ Our goal with vaccine rollout is to address these concerns
+in a clear and compassionate way. We found that our
+partnerships with local entities have been invaluable in
+contributing to a much smoother rollout process and ensuring
+everyone's health and safety when they receive the vaccine.
+ In Oklahoma, our surveys and experiences on the ground
+have shown us that two things are sorely needed: clear,
+accurate information about vaccine safety and efficacy, and
+increase vaccine accessibility to ensure equity.
+ Thank you again to Chair Johnson and Ranking Member
+Representative Lucas for the opportunity to provide this
+testimony here in such a critical moment in our Nation's
+history. I hope you find this testimony helpful in your
+endeavors, and I'll be happy to address any further questions
+regarding Oklahoma's experience with the rollout of COVID-19
+vaccine.
+ [The prepared statement of Mr. Reed follows:]
+[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
+
+ Chairwoman Johnson. Thank you very much, Mr. Reed.
+ We will now hear from Dr. Buttenheim.
+
+ TESTIMONY OF DR. ALISON BUTTENHEIM, PHD, MBA,
+
+ SCIENTIFIC DIRECTOR, CENTER FOR HEALTH INCENTIVES
+
+ AND BEHAVIORAL ECONOMICS AND ASSOCIATE PROFESSOR
+
+ OF NURSING AND HEALTH POLICY,
+
+ UNIVERSITY OF PENNSYLVANIA SCHOOL OF NURSING
+
+ Dr. Buttenheim. Thank you. And good afternoon, Madam
+Chair, Ranking Member Lucas, and Members of the Committee. I am
+Alison Buttenheim. I'm an Associate Professor of Nursing and
+Health Policy at the University of Pennsylvania School of
+Nursing, and I'm a behavioral scientist who studies vaccine
+acceptance and vaccine hesitancy.
+ As Chairwoman Johnson mentioned, I had the honor of
+serving last year on the National Academies Committee on the
+Equitable Allocation of the COVID-19 Vaccine, and as part of
+that effort, recently co-authored another National Academies
+report entitled ``Strategies for Building Confidence in the
+COVID-19 Vaccines,'' on which my written testimony was based.
+That report is chockful of very specific communication and
+engagement strategies to address hesitancy and ensure demand
+for our truly amazing COVID vaccines. We hope it will be a
+helpful guide to public health agencies at all levels working
+on vaccine rollout.
+ In my very brief time with you today, I'd like to expand
+on that report and share some additional insights and evidence
+that can further guide us as we tackle the last-mile challenge
+of getting shots in arms. Here are five science-based solutions
+that I hope Congress can endorse, fund, and promote.
+ No. 1, embrace the dual goal of vaccinating efficiently
+and equitably. This recently has been framed as sort of a false
+choice or an either/or with people saying that we can either be
+fast or be fair with vaccine rollout. We have the science to do
+both, but we have to be deliberate, intentional, and innovative
+in our approach to both tracking and achieving those
+complementary goals.
+ No. 2, fix the easy stuff. Hesitancy is definitely a
+barrier to vaccination, and I look forward to talking about
+that, but so are hassle factors. Even people who are motivated
+and excited about the vaccine can be deterred by the smallest
+amount of friction in the system, whether that's complex
+logistics, inconvenience, or confusing instructions. Making and
+keeping a vaccination appointment should be easy and hassle-
+free, and frankly, fixing those hassle factors is often easier
+than changing someone's mind.
+ No. 3, keep doing the hard stuff even if it doesn't scale.
+There are a lot of people with very legitimate concerns about
+the speed of vaccine development, diversity of trial
+participants, or trust in the medical research establishment.
+What's emerging as the most effective way to help those folks
+is sustained, repeated, one-on-one conversations with trusted
+peers or vaccine validators. Now, you can't bake that kind of
+engagement into a chat bot or a website FAQ (frequently asked
+questions) or a message on the side of a bus or even a TikTok
+video. We have to stand up and support those time-intensive
+interventions and get them to the people who need them even if
+they don't scale.
+ No. 4, use fun and delight. As Cass Sunstein has said,
+there's a deep human need to smile and laugh, and we can
+leverage that need through evidence-based messaging and
+promotions that exceeds people's expectations about the vaccine
+and about getting vaccinated in surprising ways. One example
+that I hope you've all seen is the ``Sleeves Up, NOLA'' public
+service announcement from New Orleans. If you haven't seen it
+yet, watch it right after the hearing today. It's on YouTube.
+I'll send you a link. It's a truly fantastic example of that
+idea of leveraging fun and delight.
+ Last, No. 5, fail fast, learn fast. Behavioral science
+advances in much the same way that lab science does. We
+generate hypotheses about an effective intervention, and then
+we test those hypotheses via experiments. We need to bring the
+same speed and rigor to vaccine acceptance research that we
+brought to vaccine development research so we can get it right
+in real time and also learn for next time because this is not
+our last rodeo. Both immediate and long-term investments in
+behavioral science research are needed.
+ So to recap, we can be fast and fair. We should address
+hassle barriers to vaccination in addition to hesitancy
+barriers. Some of our most effective strategies won't scale,
+and that's OK. Fun is effective, and learning what works is
+critical.
+ I want to thank the Committee for your time today and for
+your commitment to a science-driven vaccine rollout.
+ [The prepared statement of Dr. Buttenheim follows:]
+[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
+
+ Chairwoman Johnson. Thank you so very much. That completes
+the formal testimony of our witnesses, and now we will start
+our question-and-answer period. The Chair will recognize
+herself now for 5 minutes. And I'll start with Dr. Huang.
+ Let me first thank you again for being here with us today,
+and I'm glad that your family is safe and I hope you have
+power.
+ I toured the vaccination hub at the Kay Bailey Hutchison
+Convention Center in Dallas a couple of weeks ago, and I really
+was pleased to see how smoothly the operations are going. I
+attended the other one, but it was after the vaccines had run
+out, so it was not operational at Fair Park, so I commend all
+of the health professionals who are working tirelessly to get
+people their shots and the volunteers who are assisting.
+ You said in your testimony that reducing logistical
+barriers for patients is a big factor in encouraging vaccine
+uptake. Making it easy to register for a vaccine is one
+example. If you could advise the rest of the vaccine
+administrators in the United States about two or three specific
+strategies to deploy in making things easier, what would they
+be?
+ Dr. Huang. So thank you, Chairwoman Johnson. We have
+certainly evolved as this has progressed and as mentioned by
+Alison Buttenheim, the--you know, this learning and learning
+fast has been sort of our experience. And so, you know,
+initially, we had to get large numbers through registering
+people online, getting these things, but we really want to be
+equitable and, you know, opening professional phone banks so
+people don't need to have those technical capacity to do the
+registration. We're trying to do that.
+ We're going out in the community with many of our
+community and political leaders to sign up people for that
+registration and to make the systems more easy for people to
+access this. You know, we're moving from in-person walk-up
+sites to drive-throughs are some of the ways especially for our
+older population with mobility challenges and with the cold and
+the weather, you know, again, it's trying to get that stood up.
+We have a partnership with FEMA (Federal Emergency Management
+Agency) that's going to be starting next week for some drive-
+throughs. I mean, those are some of the logistic and hassle
+factors that we're trying to address and make it more equitable
+and make it easier.
+ Chairwoman Johnson. Well, thank you very much. Mr. Reed,
+would you say the same, or do you have some other pointers
+you'd like to point out?
+ Mr. Reed. I certainly would agree with Dr. Huang's
+assessment there. I think it's important to have options. We
+experience challenges with a registration pool. We quickly
+realized that you can't have a single point of failure. Not one
+option works for everybody. We've engaged our pandemic
+providers and encouraged them to use their own types of systems
+to help register or provide appointments for patients so that
+we don't depend on one single system. We've also had to use and
+encourage the use of manual type of systems. We use our 2-1-1
+system for those that do not have good technology options, that
+they can call and provide name, address, and phone number, and
+we push that out to local health jurisdictions so that they can
+proactively reach out to them to get them registered for
+vaccine.
+ I think the biggest key is that we provide options. I
+think we need many options for the public because not one
+single thing works for everybody out there.
+ Chairwoman Johnson. Thank you very much. Dr. Buttenheim,
+in your testimony you acknowledged that there are high levels
+of--particular distressing levels with people of color, almost
+three times more likely to die. And as Dr. Huang and Mr. Reed
+have observed that--all of this firsthand in both Dallas and
+Oklahoma and you pointed out that the mistrust is real. And I
+enjoyed your testimony. I thought it was very good and right to
+the point.
+ But healthcare discrimination did not begin and end with
+the Tuskegee study, so we really need more than just P.R.
+campaign to overcome this distrust because it is deep and
+painful for many people. Can you help us a little as to why
+it's important to acknowledge some of the past but we've got to
+move on and see what we can do for the future? Because we still
+have minorities dying at a higher rate.
+ Dr. Buttenheim. I think it's important to address those
+disparities for three reasons. One, they're the reality, so if
+we ignore that there are disparities and structural racism in
+health and healthcare now, we're not dealing with correct data
+or accurate data. It's also the root of some of the vaccine
+hesitancy that we're seeing, so if we want to close the gap on
+coverage, we have to acknowledge that. And I think being frank
+and honest about those conversations will also point us to the
+best kinds of interventions to make sure we're meeting people
+where they are, making vaccination services accessible and
+respectful, and hopefully that will convince people that
+vaccinating is the right thing to do.
+ Chairwoman Johnson. Thank you very much. Any further
+comment? Well, thank you very much. Excuse me, go right ahead.
+ Dr. Neuzil. None from me.
+ Dr. Huang. This is Phil Huang. I mean, I'd really say that
+on the ground level, you know, building that trust. But as was
+mentioned, you know, acknowledging the--some of the issues that
+are out there, but trying to be as factual in providing that
+information and addressing, but we're hearing--I mean, you
+know, some of the types of things we're hearing, you know, I
+mean, just--we hear from some people the distrust of
+government, people think we're putting something in the vaccine
+to--the government is putting something in the vaccine to track
+people. They're--you know, they're injecting influenza virus
+into this. A lot of different types of, you know,
+misinformation is out there, again, that the government is
+trying to get more information for undocumented persons, things
+like that. And so we have to acknowledge these but then, you
+know, try to explain in truth.
+ And that trusted individual, community partner, healthcare
+worker, Tyler Perry, whoever, I mean, it was really, you know,
+great to hear that story of how the impact that his statements
+on TV made.
+ Chairwoman Johnson. Well, thank you very much. I've
+completed my questioning period, so I'll now recognize Mr.
+Lucas for 5 minutes.
+ Mr. Lucas. Thank you, Chair.
+ Mr. Reed, you know I represent a predominantly rural
+district, essentially the northwest half of the great State of
+Oklahoma, and you have experience in dealing with a unique set
+of challenges that that poses through the COVID-19 pandemic.
+Could you expand for a moment on the steps that are being taken
+to ensure in particular that rural communities are not left
+behind as we combat this virus?
+ Mr. Reed. Yes, sir. So for us in Oklahoma we have been
+very deliberate about ensuring that we are meeting the needs of
+rural Oklahoma. One of our initial goals was to make sure that
+during the first week of the vaccine rollout we had citizens
+from all 77 counties that received some level of vaccination,
+and we were able to achieve that.
+ We've done that by really leveraging our local public
+health systems. We use a hub-and-spoke method to allocate
+vaccine, to push it out to local health jurisdictions. We do a
+lot of centralized planning, but we're very big on a
+decentralized execution plan. So we ask those local health
+jurisdictions to work with their local partners, who they've
+actually been planning for pandemic-type of events for years.
+We've asked them to engage those partners, go into those
+communities, and provide access points for vaccination.
+ And in doing so we have seen points of dispensing sites
+set up in churches, in fairgrounds, community centers, in some
+cases it's the health departments, but we have tried to
+leverage what is actually available in rural Oklahoma to meet
+these needs.
+ From a centralized standpoint, we watch closely the
+percentage of the population in these rural areas that is being
+vaccinated so they would continue to monitor our success and
+ensure that we have a program that is equitable and we don't
+have any part of the State that is being left behind.
+ But overall, I would say the No. 1 thing we're doing is
+engaging our local public health system and their partners and
+allowing them to make local decisions because they know what
+needs to be done on the ground to serve the citizens that they
+are responsible for.
+ Mr. Lucas. Thank you, Mr. Reed.
+ Dr. Neuzil and Dr. Buttenheim, Mr. Reed referenced a
+recent survey in Oklahoma, that 33 percent of my fellow
+Oklahomans do not plan to get the COVID-19 vaccine, and they
+cite lack of information on the vaccine, concern about
+development, safety, all those sort of things. In the remaining
+time I have, what can we tell our constituents back home to
+emphasize the safety of the vaccines authorized for use? Yes,
+you're writing my town meeting speech for me here.
+ Dr. Buttenheim. I mean, I can say from a communications
+standpoint, luckily, we have the amazing data that Dr. Neuzil
+and her colleagues have generated from these trials. One thing
+that I think is important is that people need to hear it more
+than once, and they need to hear it from trusted communicators.
+That might be clergy, that might be local government
+leadership, that might be other family members who, you know,
+are doing the online research for them. But the main--you know,
+the survey data that says the main concerns are the speed of
+the vaccine development, Dr. Neuzil just walked through that in
+an amazing way, that, you know, it wasn't tested on people who
+look like me. We actually had quite robust diversity in the
+trials, and we don't know the long-term side effects. We're
+starting to accumulate that data, and we have incredible safety
+profiles. So I think it's sort of hitting those three again and
+again and again but making sure if people have another set of
+concerns, that we hear those and address them as well.
+ Dr. Neuzil. Yes, and from my perspective, at the end of
+every conversation, I want people walking away thinking disease
+bad, vaccine good. And it comes down to being that simple. And
+others who are professional in the area can come up with those
+communication messages. But sometimes we forget the disease bad
+part. This pandemic is killing people. It's killing minorities.
+It's killing people with poor access to healthcare. It's
+hurting our schoolchildren. It's hurting our economy. So we do
+have to remind people that there is a real reason that we're
+asking them to get vaccine.
+ And then on the vaccine side, again, I have tried to
+emphasize the points that you heard, that safety is always
+paramount because we're giving vaccines predominantly to
+healthy people to prevent a disease. We did include high
+percentages of minority populations, of different age groups so
+everybody can point to the trial and say somebody that looked
+like me received this vaccine. But I think the disease bad,
+vaccine is good, is something to always remember.
+ Mr. Lucas. And as we every 2 years as elected officials
+will note, you have to repeat it 17 times in a row to make an
+impression. I yield back the balance of my time, Madam Chair.
+Thank you for a wonderful hearing.
+ Chairwoman Johnson. Thank you very much. I'll depend on
+the staff now to call on the other Members.
+ Staff. Ms. Lofgren is next.
+ Ms. Lofgren. Thank you so much, and thank you, Madam
+Chairwoman and Ranking Member, for this hearing.
+ We have obviously a big challenge ahead of us in getting
+vaccine distributed in sufficient quantities that we are able
+to put this virus in the rearview mirror. And right now, we
+have the hesitancy problem, but we also have a supply problem
+where, you know, there are millions of people who are trying to
+get vaccinated but they can't because there's not enough
+vaccine available. So I'm looking ahead, I guess, to a few
+weeks from now when there will be more vaccine.
+ In Santa Clara County, for example, we have now managed to
+vaccinate more than half of the people who are 65 years or
+older, and we're moving into the next group, which is people
+with serious pre-existing health conditions, people who work in
+food, the grocery store workers, and other essential workers.
+ I'm wondering whether the construct of signing up and then
+having people come in is really the wrong approach for this
+pandemic. I remember when polio vaccine was first devised, I
+was in elementary school, and you had to have a permission slip
+from your parents, but the public health people came and they
+gave every kid in the school a vaccination. Why would we not go
+to every grocery store and offer the vaccine to every person
+there? Obviously, they have the right to decline, but I'm also
+mindful that peer pressure is a great educator, and if every
+other person around you is getting vaccinated, it may cause you
+to question why wouldn't you? So who can answer that question?
+ Dr. Huang. Well, this is Phil Huang. I would say, as you
+started out, the supply is the issue at this point. And as I
+think I mentioned, we have over 650,000 people who signed up to
+register who want to be on our waiting list to get vaccine and
+we're only getting--like the health department is getting 9,000
+doses a week. So, you know, the sign-up at this point does
+allow us to distribute more equitably, so we are applying a
+vulnerability index, a proximity index to these and getting
+those appointments out. We started out with 75 years and older
+and then went down to 65-plus with an underlying health
+condition.
+ So--but absolutely when there is adequate supply, we want
+to make it with that availability that you're talking about,
+but the big limitation is we just don't have enough vaccine, so
+we're trying to get it and get it out equitably through some of
+these processes.
+ Ms. Lofgren. But there's no medical constraint or ethical
+constraint to just going to the grocery store and saying now
+that we're in your tier, anyone who wants it can get it if we
+have supply?
+ Dr. Huang. Oh, if we have supply, absolutely. I mean, we
+want it to be like the flu vaccine, the annual flu vaccine and
+you go to your drugstore or retail store, something like that.
+ Ms. Lofgren. Here's a question that you may or may not be
+able to answer, any of you, because it has to do with
+distribution of vaccine, but all of us, each State has rural
+areas where the capacity for the very cold freezing is not as
+available. Is there a way to direct the J&J (Johnson & Johnson)
+vaccine to parts of the country where the freezing capacity is
+a real constraint to the program of vaccinations so that the
+J&J, which does not require that extreme measure, can be
+directed to the areas that might need it the most?
+ Dr. Neuzil. Yes, so I--this will likely occur at the State
+level, and I'll let some of my colleagues comment. Here in the
+State of Maryland, even the differences between the Pfizer
+vaccine and storing in a minus-80-degree freezer versus storing
+in a minus-20-degree freezer have led to a distribution system
+at major medical centers versus outlying pharmacies and
+outlying clinics, so it can absolutely be done. It has to be
+orchestrated at the State and local level.
+ Ms. Lofgren. And not at the Federal level you're saying? I
+mean, for example, the District of Columbia doesn't have any
+rural areas.
+ Dr. Neuzil. I'm not sure I know enough about the Federal
+distribution to comment.
+ Ms. Lofgren. OK. Fair enough.
+ Madam Chairwoman, I see my time is just about expired.
+Thank you again for this hearing, and I yield back.
+ Chairwoman Johnson. Thank you very much. Who's next?
+ Staff. Mr. Posey is next.
+ Chairwoman Johnson. Mr. Posey.
+ Mr. Posey. Thank you, Madam Chair, for holding this
+hearing on these important issues regarding the COVID-19
+vaccination campaign.
+ Vaccines are a monumental achievement and a product of a
+massive governmentwide effort to defeat this pandemic.
+ Dr. Neuzil, you were part of the development of the
+protocols for the two vaccines that we're using today, and I'm
+pleased to hear your testimony that Operation Warp Speed played
+an important role in getting these vaccines developed, tested,
+and in use in less than a year. You state that, quote, ``The
+closure of schools and lack of extracurricular activities is
+impacting the academic, social, and physical development of
+children with disproportionate impact on minorities. Persons of
+all ages are struggling with the effects of isolation, extreme
+lifestyle changes, and increased anxiety.''
+ Florida schools are open, yet it's surprising that while
+the CDC says it's safe for schools to open, we have States that
+are still locked down. Would you provide for the committee
+record studies documenting the harm to children resulting from
+school closures that you alluded to?
+ Dr. Neuzil. Yes. So thank you for your comment. And again,
+just to emphasize that the damages in terms of the pediatric
+population are disproportionate to minority communities, so
+we--as we're seeing in the adult population, the minority and
+disadvantaged communities are more likely to get COVID-19 and
+they're more likely to get severe disease from COVID-19.
+ Similarly, the disadvantaged communities are less likely
+to have the tools, whether it's the computers, the ThinkPads,
+the mechanisms, and the oversight for virtual learning. And so
+I can provide you references after the hearing, but they are
+following--falling more behind in their academics because of
+this disadvantage.
+ Mr. Posey. Thank you very much, Doctor. And each of the
+panelists can comment on this, I'd appreciate it. And it seems
+like there is so much to learn from our experience with this
+pandemic. We need to better understand everything from the
+origins of the viruses and the development of the therapies and
+vaccines to the pandemic preparedness and collaborations
+between Federal, State, and local governments and public health
+officials.
+ After 9/11, Congress supported a commission to cut through
+the politics and finger-pointing and focus on the facts. Last
+week, I introduced legislation to do the same thing for COVID.
+Do you think, each of you, that we could benefit from such a
+commission? Starting left to right.
+ Dr. Neuzil. Yes, thank you for the question. I think in
+science, as of others have suggested, you know, we have
+hypotheses, we test the hypotheses, and we look to move forward
+at every step. So I do believe that it's always helpful to
+evaluate what has happened, whether it's an experiment or
+whether it's a program, evaluate what went well, evaluate what
+we can do better in the future. So yes, I think--I don't know
+exactly what type of program or commission you're describing. I
+think it would be useful for lessons learned.
+ Mr. Posey. Thank you.
+ Dr. Huang. This is Phil Huang. I mean, certainly with most
+incidents we do after-actions and hot washes and find out
+lessons learned and what went right and what went wrong, so
+that's always a best practice for any event, I believe.
+ Mr. Posey. Thank you.
+ Mr. Reed. Yes, this is Keith Reed. I would say that we
+have learned a great deal and put into practice a lot of things
+we learned after--for years of practice in emergency response
+based off of what you initially referenced occurred after 9/11
+and such. Those partnerships we created have made a big
+difference in our ability to respond right now, but there were
+things that did not go as planned. There were things that we
+put into motion that certainly was not the way we expected it
+to roll out. So looking back on that and evaluating what worked
+and what did not would be incredibly valuable, and I think it
+would help us moving ahead to ensure that we are prepared for
+the next pandemic or other major emergency that comes down the
+pike.
+ Mr. Posey. Thank you.
+ Dr. Buttenheim. And I would just add, hopefully, we can
+also learn from some of the behavioral and policy
+interventions, how did we do at getting people to mask, how did
+different kinds of lockdowns and stay-at-home orders work and
+use the 50 States and local jurisdictions as sort of case
+studies to see what was effective.
+ Mr. Posey. I thank the witnesses and see my time is
+expired and yield back, Madam Chair.
+ Chairwoman Johnson. Thank you very much.
+ Staff. Ms. Bonamici next.
+ Ms. Bonamici. Thank you so much. Thanks to Chair Johnson
+and all the witnesses. I also want to thank all the witnesses
+for the work that you've done to so quickly respond to the
+pandemic, and I applaud all the heroic efforts of the broader
+scientific and public health communities. There have been so
+many achievements made thus far in surveillance and testing
+strategies and therapeutics and now multiple vaccines that are
+safe and effective.
+ But, as we know, we're still facing many challenges. We've
+spoken about some of those, distribution and equity. I'm
+particularly concerned about some of the new problems that are
+emerging, for example, the viral variants. And evidence
+suggests that some of these variants may actually be more
+contagious than the original virus. The CDC reported that the
+highly contagious strain that emerged in the U.K. could become
+dominant in the United States in the next few months. They've
+already reported cases in 42 States. And there's also the South
+African mutation, the viral variant initially detected in
+Brazil. We're seeing all of these happening. So we know that
+work is underway to determine how well our current vaccines
+protect against the variants and whether booster shots or other
+approaches may be necessary.
+ So, Dr. Neuzil, can you tell us what you know so far about
+how effective the existing vaccines are against the new
+variants and what our options might be if we need to adapt to
+how the vaccines are formulated or administered and
+distributed?
+ Dr. Neuzil. Sure. Thank you for the question. And you have
+absolutely articulated one of the biggest concerns right now
+with SARS-CoV-2, the emergence of these variants. The first
+point I would like to make is that these variants were emerging
+in a setting of no vaccination. And RNA vaccines make mistakes
+when they replicate. It's a feature of the virus. And so the
+more that they are replicating unmitigated and uncontrolled,
+the more variants and more mutations that we are going to see.
+ So the variants are yet another argument to get vaccine
+out, to get vaccine out fast, and to have a global response
+because variants that emerge anywhere are a threat everywhere.
+ In regard to the vaccines, we're just beginning to learn
+about their effectiveness against variants. Fortunately, these
+mRNA vaccines, for example, are highly effective vaccines. They
+have strong what we call neutralizing--which means you can stop
+the growth of the virus--antibody against the vaccine strain.
+It is diminished against some of these variants strains, but
+it's still effective. So when you're starting at 95 percent,
+you know, you can lose a little effectiveness and still be an
+extremely good vaccine.
+ Some of the variants emerging in other places, the variant
+first recognized in South Africa, for example, have some more
+dramatic effects, and yet we are still seeing this neutralizing
+ability. However----
+ Ms. Bonamici. Dr. Neuzil, thank you. I want to get to a
+couple more questions, but----
+ Dr. Neuzil. OK.
+ Ms. Bonamici [continuing]. Thank you so much, Doctor.
+ Dr. Buttenheim, Johnson & Johnson, as we know, has applied
+for their Emergency Use Authorization for its vaccine, and that
+application will be considered soon by the FDA's independent
+science advisory board. So having more vaccines is clearly a
+good thing, but people may be understandably hesitant if a
+different option that is found to be somewhat less effective
+than Moderna or Pfizer at preventing mild and severe infection.
+And so the difference in these efficacy results received a
+great deal of media attention, but it's my understanding there
+have been zero cases of hospitalization or death in clinical
+trials for all three of these vaccines, including Johnson &
+Johnson.
+ So with the questions that are arising about the
+differences between the vaccines, how can we most effectively
+address the concerns with the public and really communicate
+complete and accurate information? And this is, I think, going
+to be an issue because it's my understanding the Johnson &
+Johnson is a one dose, although I know you probably likely saw
+this morning the news that perhaps Pfizer and Moderna could be
+effective as a one dose. But if we're using Johnson & Johnson,
+for example, in rural areas or with transient, migrant
+populations, there's going to be equity issues there. Why are
+we giving those populations something that is less--or looks to
+be less effective? So could you discuss that please?
+ Dr. Buttenheim. Yes, this is going to be a challenge. And
+I think as we think about the sort of choice architecture, how
+we arrange environments for people make choices, one thing we
+don't want the average American doing is choosing their
+vaccine. This should be sort of your provider or this clinic
+is--or this State is using this vaccine in their program, and
+lucky you, you get it. Those sort of extra choices that cause
+kind of cognitive load are--do not have a place here. And yet
+we have the sort of wonderful problem that we've all anchored
+on the incredible effectiveness of Pfizer and Moderna, to
+something from J&J that looks maybe a tiny little bit less
+effective but is still a great vaccine is a sort of seen as
+second-best. So I think messaging, good risk communication, and
+sort of evidence communication but also strategic allocation of
+that vaccine to areas, you know, that can use the different
+vaccines appropriately will also be important.
+ Ms. Bonamici. Does anybody else want to weigh in on this
+issue, any more witnesses?
+ Dr. Buttenheim. Maybe the folks who are actually doing
+vaccinating should weigh in.
+ Ms. Bonamici. Exactly. Exactly. I'm going to ask Dr. Reed.
+You testified about vaccine availability in rural areas. I
+represent a district in northwest Oregon that has urban,
+suburban but also a lot of rural areas. So what are the sort of
+practical implications of Johnson & Johnson formulation that
+doesn't have the same cold chain requirements as other
+vaccines? How meaningful would it be to have that option in
+rural communities specifically?
+ Mr. Reed. Well, it absolutely gives us more options when
+we're looking at rural communities. We've kind of worked out a
+hub-and-spoke model in order to handle the storage restrictions
+of the Pfizer vaccine, for example. The big advantage that we
+look at when we talk about Johnson & Johnson is some of these
+populations that--homeless populations, for example, when the
+likelihood of getting somebody back for a second dose is
+extremely difficult.
+ Another area we're looking at where this would be a great
+advantage for us is potentially some high resource-intense
+groups, homebound groups, things like that to where trying to
+get enough resources mobilized to get two doses to these
+individuals, which would be very difficult, so Johnson &
+Johnson provides us an option for that.
+ For us, it's about the logistical options of matching the
+requirement of one dose with a population that can really
+benefit from that and maximize their protection based off that.
+ Ms. Bonamici. Thank you. And I see my time is expired. I
+yield back. Thank you, Madam Chair.
+ Dr. Neuzil. May I make one comment answering?
+ Chairwoman Johnson. Yes.
+ Dr. Neuzil. About the Johnson & Johnson, I just want to
+stress that the efficacy against severe disease for the Johnson
+& Johnson vaccine is very high. So while it's nice to prevent
+loss of taste and smell and cough and--what we really want to
+prevent are hospitalizations and death. And the Johnson &
+Johnson vaccine does that.
+ Chairwoman Johnson. Thank you. Thank you. The next
+witness?
+ Staff. Mr. Babin is next.
+ Mr. Babin. Can you hear me? I'm sorry.
+ Chairwoman Johnson. Yes, we can.
+ Mr. Babin. OK. Yes, thank you. Thank you, Madam Chair.
+Great to have your expert witnesses with us today at such an
+important [inaudible]. Ms. Bonamici [inaudible] out now, and
+there was an article in the Wall Street Journal about
+[inaudible].
+ Chairwoman Johnson. You might have to repeat your
+question.
+ Mr. Babin. Can you hear me, Madam Speaker--I mean, Madam
+Chair?
+ Chairwoman Johnson. Yes, we can hear you now.
+ Mr. Babin. OK, I'm sorry.
+ Chairwoman Johnson. We can hear you now.
+ Mr. Babin. OK, thank you. I was just trying to find out
+what the latest is on the Pfizer in order to get more
+distribution to more individuals on the first injection of
+Pfizer. Is that something in the works right now? Dr. Neuzil,
+are you----
+ Dr. Neuzil. Yes.
+ Mr. Babin [continuing]. Are you----
+ Dr. Neuzil. Yes. So I didn't hear you directing that to
+me. So thank you for that question. You know----
+ Mr. Babin. Sure.
+ Dr. Neuzil [continuing]. The Moderna and Pfizer vaccines
+have very high efficacy after the first dose. If you take away
+that first week before your immune system has had a chance to
+respond to the vaccine and when many people were likely already
+exposed to the virus and maybe even incubating the virus, you
+get to about a 90 percent efficacy after a single dose for both
+vaccines. The problem is we only know that for a very short
+period of time because 2 to 3 weeks later we gave that second
+dose.
+ Now, the efficacy isn't going to drop from 90 percent to 0
+overnight. It will take time to wane. But in order to change
+from a two-dose to one-dose regimen, you would really need to
+follow those people who got a single dose for a longer period
+of time. We believe that second dose is important for duration
+of protection and perhaps protection against these variant
+strains. But if somebody is a little late getting their second
+dose, they should not be worried. It starts to work very well
+after one dose.
+ Chairwoman Johnson. We can't hear you, Dr. Babin. Are we
+getting him some technical support?
+ Staff. Yes, Mr. Babin, you may be experiencing some
+bandwidth issues. If you'd like to just turn your camera off
+momentarily, that will allow the audio to clear up a little bit
+and stop using as much bandwidth.
+ Mr. Babin. Now can you hear me?
+ Chairwoman Johnson. Yes.
+ Mr. Babin. OK. Following up on that question, your answer
+there, Dr. Neuzil, is there an antibody titer associated with
+this particular protection, and if it is the same antibody
+titer seen in a post-COVID infection? And if so, that leads me
+to the question of whether we need to vaccinate those who were
+previously infected. Is there any change there? I know that's a
+question that's still ongoing, but what is your opinion there
+and what is your knowledge concerning that?
+ Dr. Neuzil. Yes, so that's a great question and a very
+active area of research is to be able to define exactly the
+amount of antibody that is protective because that will help us
+when we moved to other populations, as you've said, when we
+vaccinate people who have already been infected. So it's a very
+active area of research. You know, ironically, having vaccines
+that are so protective makes that hard to establish because all
+those----
+ Mr. Babin. That's right.
+ Dr. Neuzil [continuing]. Almost everybody in the vaccine
+group didn't get the disease.
+ However, we're pooling all of the information from all of
+the trials to try to understand that. Data indicate that if you
+have had the infection before, you likely do respond better to
+a single dose of vaccine, but we don't yet----
+ Mr. Babin. OK.
+ Dr. Neuzil [continuing]. Have enough information to
+translate that into policy right now.
+ Mr. Babin. I've got you. I don't know how much time I have
+left, but I was just wondering if there was evidence for like
+an anamnestic response like an antibody titer and T cell
+activity if they go below a certain point, is there evidence
+that re-exposure to the virus might trigger a rapid
+immunological activation or escalation, which would give you
+protection as well?
+ Dr. Neuzil. Yes, so another great question, and in fact
+this was asked earlier. The companies now are very actively
+working on booster doses of vaccine with the same strain and
+with variant strains. So I would say within weeks to months we
+will have the answer to your question.
+ Mr. Babin. I am so glad to hear. We are in the middle of a
+bad winter storm down here in Texas, and it's been very
+difficult. I have a large rural district as well. And getting
+vaccines out there and getting people--these questions that
+have already been asked, we have really a shortcoming when it
+comes to connectivity via getting information on the internet,
+so we certainly hope that some of you other panel members would
+be able to say how is this being addressed to get connectivity
+on the internet into these rural areas to get people this
+information. Can anybody answer that?
+ Mr. Reed. I would say in Oklahoma we are trying to tap
+into every communication source we can for rural areas, radio,
+through local organizations, connecting with churches. We're
+really trying to work through our community resources, our
+community partners to get messaging out. It's a challenge. It's
+a definite challenge when we're trying to vaccinate the entire
+population or make it available to the entire population. It's
+obvious the easy way is to default toward some kind of media
+that requires internet, but we have to fight that urge in some
+of these areas, and we've got to access these other resources
+to be able to reach them.
+ Dr. Huang. And I would add that in Dallas County we are
+trying to do paid media, we are trying to do phone--you know,
+making phone--a paid phone bank available, other community
+events in the community to sign people up and get them the
+direct connections.
+ Mr. Babin. All right, great. That's great answers. I want
+to say thank you very much. And, Madam Chair, I don't see how--
+my time is not coming up, so I may already be expired. Am I?
+ Chairwoman Johnson. I can't tell.
+ Mr. Babin. OK. I can't either.
+ Chairwoman Johnson. Staff people might be able to tell.
+ Mr. Perlmutter. You're way, way over time.
+ Staff. Your time is expired.
+ Mr. Babin. Way over time, OK, I'm sorry. So I'm going to
+yield back then. Thank you so very much.
+ Chairwoman Johnson. Well, thank you, though, good
+questions.
+ Mr. Babin. Yes, ma'am.
+ Staff. Mr. Bera is next.
+ Mr. Bera. Great. Thanks, Madam Chair. I want--I'm going to
+follow up on some of the questioning that Ms. Bonamici asked.
+And I'm a physician by training, come out of academics, and
+have done clinical trials. And I am extremely worried about how
+we're talking about the efficacy of the vaccines. And I even
+hear it in the discussion here today because in truth you have
+to design the clinical trial for a common event, which is
+catching the disease. But there are other outcomes that we're
+certainly trying to prevent with this vaccine, serious illness,
+hospitalization, and death.
+ And we talk about Moderna and Pfizer as being more
+efficacious than Johnson & Johnson. That may be accurate in
+prevention of disease, catching COVID, but each of these
+vaccines are super effective in preventing serious illness,
+super effective in preventing hospitalization, and super
+effective at preventing death, and that, you know, is the truth
+for AstraZeneca as well. That's the truth for Novavax on the
+data that we can see.
+ And we're extremely concerned that if we don't start with
+the positive message, it's remarkable that we have potentially
+five super effective vaccines that are going to prevent you
+from getting seriously ill, that absolutely are keeping people
+out of the hospital, and had--as far as I can tell, nobody's
+died who's received any of these vaccines.
+ And, you know, I see our best spokespeople from the
+administration on television, on cable news all the time, and
+we fall into this message. And the risk that we're going to run
+is someone's going to say, well, I heard someone say that
+Johnson & Johnson is not as effective, so I'm going to wait a
+while until I can get the Pfizer vaccine or the Moderna
+vaccine.
+ And maybe, Dr. Buttenheim, this is kind of your area of
+expertise, and I've seen you quoted in some articles, and I am
+extremely worried that we are setting ourselves up in a way
+that is going to slow down vaccinations. And again, those three
+other variables, serious illness, hospitalization, and death,
+all of these vaccines are incredibly effective. You know, would
+you give us--as Members of Congress and others, you know,
+again, because we fall into this trap--so what's the best way
+to message these vaccines?
+ Dr. Buttenheim. You know, I think there are a couple
+strategies we can draw on. One is analogy, right? So no one
+asks what kind of vaccine they get when they go for their flu
+shot, right? It's not even an issue. You may not even know who
+makes your flu vaccine, and so we need to transition our
+vaccine promotion programs to be more like that. You're getting
+a COVID vaccine.
+ I think we also need to--and this is unsettled science,
+but we need to think about how to, as you said, really hone in
+on the adverse events, the severe events that are not happening
+because of these vaccines. And this is always a challenge for
+health promotion, right? We're trying to get people to do stuff
+so that something else doesn't happen. That's really hard. And
+if the thing that's not happening is even more rare and
+probabilistic, that's additionally challenging. So I think we
+need to pull in our best, you know, social marketing, marketing
+advertisement people to help with these frames and these
+messages that make most salient for people as they're making a
+decision, but the--any vaccine is a good vaccine decision here.
+ Mr. Bera. Right. And so starting with the process, right,
+it's starting with the--that all these vaccines are super
+effective at, you know, preventing serious illness, keeping us
+out of the hospital, and certainly, you know, preventing death.
+And if you can get a vaccine, get that vaccine, whichever one--
+--
+ Dr. Buttenheim. Exactly.
+ Mr. Bera [continuing]. Of those vaccines that are
+available.
+ Dr. Buttenheim. The best vaccine is the one you can get
+tomorrow.
+ Mr. Bera. Exactly. And we probably ought to start with
+that message----
+ Dr. Buttenheim. Yes.
+ Mr. Bera [continuing]. Because, you know, what I'm very
+worried about is in many rural communities and harder-to-reach
+communities, just logistically the Johnson & Johnson vaccine
+may be the easiest vaccine to get out there----
+ Dr. Buttenheim. Yes.
+ Mr. Bera [continuing]. If you're [inaudible] homeless
+folks, you know, at a river bank, a single-dose vaccine is
+going to be a lot better. If you're vaccinating college
+students that may not come back for that second vaccine, a
+single-dose vaccine is going to be better.
+ I do worry, though, that, you know, there's that potential
+where folks might say, well, why are you using a less effective
+vaccine in some of these disadvantaged communities and you're
+using the--and again, I don't think that's--those aren't----
+ Dr. Buttenheim. And you're right to worry about that
+because that is going to happen. So I think with J&J we can
+promote it's like the convenient vaccine, you know, like one
+and done on this one, isn't that great? But yes, the more we
+can take that choice away from people and not fall into the
+like, oh, I'm going to wait, I'm going to wait for Pfizer, the
+better off we'll be.
+ Mr. Bera. Right. So, again, just to my colleagues, if we
+can start with the positive that we are so lucky that, you
+know, we have potentially five great vaccines that are going to
+do a remarkable job, get that shot in your arm. So I think my
+time is up, and I will yield back.
+ Chairwoman Johnson. Thank you very much, great questions.
+ Staff. Mr. Gonzalez is next.
+ Mr. Gonzalez. Thank you, Chairwoman Johnson and Ranking
+Member Lucas, for holding this hearing and to our great
+witnesses for joining us.
+ I think we're all in agreement the COVID-19 vaccine
+development is a marvel of modern medicine, and to take a
+process that under most circumstances could take up to 10
+years, have multiple successes in a matter of months is just
+incredible. We should all be incredibly grateful for the
+talented researchers and scientists.
+ And I want to especially thank Dr. Neuzil. I'd like to
+personally extend this thank you to you because I know you
+worked so hard on this as well.
+ At this stage in the pandemic it's important that we
+satisfy our strategies in the short-run and long-run
+categories. In the short run I think we need to increase
+vaccine supply. That's been evident, make efforts to rebuild
+trust, and lay the groundwork for building demand so that when
+vaccines are readily available, there is sufficient uptake in
+the community. In the long run we need to sustain outreach to
+vaccine-hesitant communities and invest in research that
+improves our ability to identify people's perceptions of safety
+and tailor communication specifically to each population.
+ Dr. Neuzil, I want to start with you and I had a question.
+As these variants have come into play, what role do you think
+the Federal Government will need to continue to play from an
+investment standpoint? So obviously, we frontloaded a lot of
+the investment on the initial development of vaccines, but as
+the variants take hold, will we need to continue providing that
+or can the companies handle that themselves in your opinion?
+ Dr. Neuzil. Yes, thank you for that question. I think on
+the variants it's going to have to be both. You know, for one,
+we need a better surveillance system to pick up these variants,
+and we're really not there yet. And so that is going to be
+critical, and that is going to have to be coordinated, and that
+will need to be government-funded.
+ Again, we have to think about where are the incentives.
+And if there is not a natural market value and a market-driven
+reason for the companies to do it, that's when the public-
+private partnerships thrive and the government needs to step in
+and help. You know, this is why we never had an mRNA influenza
+vaccine because who's going to take that to market when we have
+10 other vaccines already on the market? And so that's the way
+we're going to have to think here and be strategic in the
+investments that are going to pay off for public health and
+won't naturally occur in a market-driven decisionmaking world.
+ Mr. Gonzalez. Can I ask you a follow-up on the mRNA
+specific to the traditional flu? And you may have already
+answered this, but from your answer should I assume that if we
+did an mRNA vaccine for the traditional flu, that it would be
+more effective and we could potentially cut down drastically on
+flu-related deaths as well?
+ Dr. Neuzil. So I don't think we can make that assumption.
+The mRNA vaccines for influenza have been in phase 1. They're
+immunogenic. Because of our ability to stabilize the virus, get
+the right sequence, and get it faster, they may be better, but
+that has yet to be tested.
+ Mr. Gonzalez. Got it.
+ Dr. Neuzil. They certainly have a speed advantage.
+ Mr. Gonzalez. Thank you. And then the mRNA vaccine is
+easier to produce and manufacture, as you said. How easy will
+it be to alter the vaccine such as the J&J and AstraZeneca
+vaccines?
+ Dr. Neuzil. Yes, so the J&J and AstraZeneca vaccines are
+also genetic-based vaccines. We're just using an adenovirus to
+deliver them instead of a lipid code to deliver them, so they
+will also be amenable to rapid sequence changes.
+ Mr. Gonzalez. Great. And then with my last minute--I can't
+see the clock, but just quickly, I know we've talked a lot
+about increasing confidence in minority communities, which is
+obviously critically important. We've started to see some
+success in northeast Ohio in the Hispanic community with a
+program called Cover COVID, which is more of a national,
+international program. And the short and long of it is is it's
+not just about translating things into Spanish, right? And for
+our community what we found is it's the translation but it's
+also having the cultural awareness to know that, you know, we
+have to do more than just translate to make sure that what
+we're translating hits the community in a way that they can
+receive it. I just draw that to everybody's attention. I know
+everyone is working on this in different ways, but we have seen
+some success in the Cleveland area, and I just would submit
+that to everyone for consideration. And thank you for your
+responses. I yield back.
+ Dr. Buttenheim. If I can follow up for a moment on that,
+it's going to be so important to gather and collate those
+success stories and make them easily shareable across different
+populations so, again, we can learn fast what's working.
+ Dr. Huang. And I would just add one thing. You know, even
+the term Operation Warp Speed we heard in the Hispanic
+community sort of gives a sense that it's rushed--been rushed
+through and that distrust of the government and things, so----
+ Mr. Gonzalez. Thank you.
+ Chairwoman Johnson. Thank you.
+ Staff. Is Mr. Sherman available?
+ Chairwoman Johnson. Who's next?
+ Staff. Mr. McNerney is next.
+ Chairwoman Johnson. Mr. McNerney. I see him. He's here.
+Mr. McNerney, unmute.
+ Mr. McNerney. There we go. Well, thank you, Madam
+Chairwoman, for holding this hearing. It's very interesting and
+informative.
+ I recently hosted a townhall meeting on a range of issues
+regarding vaccination. Fortunately, I had the help of Dr. David
+Relman of Stanford who was able to address some of these
+questions, but it's good to have experts that can give more
+information on this.
+ Dr. Neuzil, in your written testimony you mentioned the
+collaboration necessary for vaccine development that includes
+the Department of Health and Human Services and other relevant
+government agencies and partners abroad. Did the decision by
+the previous administration to withdraw from the World Health
+Organization put our country at a disadvantage in terms of the
+coronavirus in the last--and did our isolation approach do more
+harm than good?
+ Dr. Neuzil. Yes, so thank you for that question. I've been
+involved with the World Health Organization for the past 15
+years or so and done work in countries around the world. You
+know, again, as I said in my testimony, it's quite clear that
+we have to consider any infectious disease, any new pathogen
+anywhere to be consequential, and we must have a global
+response.
+ In terms of--it's always difficult to go backwards and say
+what would have happened if, but certainly now we should be
+cooperating fully with the World Health Organization. We should
+be setting up these global surveillance networks, and the
+influenza surveillance network is a model. And we must work
+together and get vaccines to everyone in the world or we all
+will remain at risk of SARS-CoV-2 infection.
+ Mr. McNerney. Thank you. Well, in your testimony you said
+that the emergence of three severe coronaviruses in the last
+two decades should encourage us to work toward a pan-
+coronavirus vaccine. Can you elaborate on that a little more
+and what work is being done at this point?
+ Dr. Neuzil. Sure. I don't think a lot of work is being
+done yet. You know, we had the SARS virus, then we had the
+Middle Eastern Respiratory Syndrome virus, MERS, and now we
+have SARS-CoV-2. So in the same way we approach influenza as a
+class of viruses, in my view, we have to approach coronavirus
+as a class of viruses. For example, if we had antivirals the
+way we do for influenza, that can help bide some time, so
+medications, ideally, oral medications that people can take
+during this time while vaccines are being developed. So I think
+we are going to need to approach coronaviruses in that way
+rather than each one individually as it emerges, think of them
+as a class and what we can do either from the vaccine or the
+medication standpoint to develop countermeasures that would
+fight all coronaviruses.
+ Mr. McNerney. Well, thank you. Dr. Buttenheim, I want to
+ask you about the same issue. I think it's safe to assume that
+we may see more variants in the coming months. What does the
+emergence of these variants tell us about the international
+approach to vaccinations?
+ Dr. Buttenheim. Well, I mean, I think I'd go back to the,
+you know, none of us is protected until we're all protected. I
+think the--you know, it's a messaging challenge and a behavior-
+change challenge for folks in the United States because, of
+course, we're trying to think how can we get our population
+vaccinated as quickly as possible. We also need to motivate
+people for the United States to be a player globally in
+providing vaccines to other countries in order to do things
+that we like to do as Americans. Like we like to travel, we
+like to have people from other countries come travel here. And
+that will be impacted if the rest of the world can't vaccinate.
+ I look every evening on some of the amazing trackers that
+show how we're doing as a--you know, doses given per 100 people
+or per 100 million people compared to the rest of the world,
+and it's agonizing. I mean, we are doing great. We have a ways
+to go in the United States, and much of the world hasn't seen a
+single dose yet. That's tough. That's tough to swallow.
+ Mr. McNerney. Yes, sure. Dr. Huang, you've discussed the
+difficulties faced in reaching and connecting with a variety of
+communities in our cities and States. How do you--how are you
+combating vaccine hesitancy and disinformation with the
+homeless population?
+ Dr. Huang. So we have definitely been working with the
+homeless population on testing, dealing with some of the
+outbreak situations. We have a lot of partners. I think what
+has been discussed in particular with them, the Johnson &
+Johnson vaccine may be more amenable for that population. We
+have already been vaccinating those in Texas. It's been--the
+1b's are defined by either 65 years of age or older or 16 to 64
+with an underlying health condition, so we've been trying to do
+those populations within the homeless settings. And, again,
+it's that communication and partnering with the other groups
+that we have that long-standing relationship with them, and
+right now, it's more of a vaccine availability issue.
+ Mr. McNerney. OK. Well, I want to again thank the
+witnesses for sharing your expertise and your time, and I yield
+back.
+ Chairwoman Johnson. Thank you very much.
+ Staff. Mr. Baird.
+ Mr. Baird. Yes, I want to thank Chairwoman Johnson and
+Ranking Member Lucas for putting on such a timely [inaudible]
+we can share with our constituents. And, you know, I especially
+appreciated Madam Chair's mention of polio. One of the reasons
+I became involved in Rotary was because their efforts worldwide
+or internationally to help with polio, and so I think that
+really demonstrates the importance of the vaccination.
+ My question really deals with messenger RNA or mRNA as
+we've made reference to. That messenger RNA creates enough
+protein to stimulate our immune system or whatever we're
+dealing with's immune system, and that triggers the production
+of antibodies. And so I think that is a valuable asset in that
+we're not injecting modified live virus. If you go back in the
+animal industry over the years, we used different techniques to
+vaccinate animals, one of those being a modified live virus,
+but we altered it so that it did not cause the disease. We
+weakened it in some way. And so I really think the selling
+point for getting over this hesitancy is the fact that we're
+not really injecting people with a live organism. It's only
+partially there, and it's a protein that stimulates our immune
+system.
+ So, Dr. Neuzil, you mentioned [inaudible]----
+ Dr. Neuzil. I lost him a little bit. I don't know if other
+people did.
+ Chairwoman Johnson. Yes.
+ Dr. Neuzil. OK. So I didn't hear the question.
+ Chairwoman Johnson. We'll see if we can get him to repeat
+it. He's talking; we just can't hear him. But he is unmuted. We
+can't hear him.
+ Staff. Yes, ma'am, I'm sending a message to Cisco now. I
+believe there's some bandwidth issues going on, and it looks to
+be across Webex, not just with one individual.
+ Chairwoman Johnson. OK.
+ Mr. Baird. So I'm going to try one more time, and
+otherwise, I'll say goodbye. Can you hear me now?
+ Chairwoman Johnson. Yes.
+ Dr. Neuzil. We can.
+ Mr. Baird. OK. My question is to Dr. Neuzil. You mentioned
+animals, and I think that provides us a big data base, but I
+really want to address the mRNA and the fact that I think it
+provides some protection for these variants. So I would like to
+give you a chance to elaborate on that little more.
+ Dr. Neuzil. Sure. First of all, I agree with you, and it's
+a really important point that these mRNA vaccines are not
+weakened viruses. They absolutely cannot cause COVID-19
+infection, and that's a very important message. They do allow
+our own cells to make the protein, which stimulates a very
+effective immune response because our body does think, you
+know, it's the protein from the real virus.
+ And that broad response we have shown from people who have
+been vaccinated with these mRNA vaccines can neutralize even
+these new variant viruses. So we don't know what difference
+that will make with disease, but at least in what we can
+measure in the blood, people who get these vaccines do have
+antibody that works against the new variants.
+ Mr. Baird. So, Madam Chair, thank you very much. I really
+appreciate that. And with that, I'm so close on time and I need
+to excuse myself anyway, but I can't tell you how much I
+appreciate this meeting, and I think it's very timely. And so
+thank you. I yield back.
+ Chairwoman Johnson. Thank you very much. Thank you. Our
+next witness?
+ Staff. Mr. Tonko.
+ Mr. Tonko. Thank you, Madam Chair. Can you hear me?
+ Chairwoman Johnson. Yes.
+ Mr. Tonko. Oh, thank you for holding today's hearing on
+the critically important science and research behind COVID-19
+vaccines.
+ Obviously, vaccines are one of the greatest success
+stories of public health. With them, we have eradicated
+smallpox, nearly eliminated wild poliovirus, and driven the
+number of people who experienced the devastating effects of
+many other preventable infectious diseases to an all-time low.
+ While I'm encouraged to see that so many people are
+getting vaccinated, including in my home district in New York's
+capital region, I know that many still have questions about the
+safety and effectiveness of COVID-19 vaccines. And this
+hesitancy might begin to affect the pace and equitability of
+our national recovery.
+ So, Dr. Neuzil, I--do we have any scientific consensus on
+how many Americans will need to immune--to be immune to COVID-
+19 for us to achieve herd immunity?
+ Dr. Neuzil. Yes, so a very good question, a very popular
+question. You know, we have models that look at that. You
+probably know for a disease like measles we look for about 95
+percent immunity. We're hoping that somewhere, you know,
+upwards of 75 to 80 percent might get us there for this virus.
+Some of this will depend on these variants and transmissibility
+and duration of immunity.
+ Mr. Tonko. Thank you. And, Dr. Neuzil, is herd immunity
+achieved through widespread vaccination, the quickest way to
+return to a more ``normal'' way of life?
+ Dr. Neuzil. In my view, it is the quickest way to return
+to a normal way of life, and we have to remember with
+infectious diseases, we're talking a lot about relative
+efficacy numbers. But I am as protected by what the people
+around me do as what I do. So, again, the more people that get
+vaccinated, the closer we are to returning to normal.
+ Mr. Tonko. Thank you. And, Doctor, what do you know right
+now about the effect of vaccination on transmissibility? What
+advice would you give to the public as that research continues?
+ Dr. Neuzil. Yes, it's a great question, and right now, the
+data that we have are in the early phases. However, the data
+are trending in a positive direction. We have data from
+AstraZeneca. We have data from Moderna, again, small numbers.
+The people who get these vaccines are less likely to have virus
+detected by a swab, so they have less virus in their nose. So
+the implication is if you have less virus in your nose, you
+will spread virus less well. We will know a lot more about this
+in the next 3 to 6 weeks or more. And, again, we are very
+hopeful that these vaccines will also decrease transmission.
+ Mr. Tonko. Thank you. Well, we're all anxious to return to
+our lives, but there are several key measures we need to hit
+before that can happen obviously. In addition to vaccine
+availability, we also need to be moving as quickly as possible
+to produce good science-based research that we can share with
+the public and use to offer guidance in real-time. So, Dr.
+Buttenheim, do you believe that State and local public health
+departments have the information they need right now to engage
+with their communities and increase vaccine uptake?
+ Dr. Buttenheim. They have the information. They do not
+have sufficient resources. So we're here in Philadelphia where
+I--we're our own CDC vaccine jurisdiction, right, one of the 64
+jurisdictions. We have a fantastic Department of Public Health,
+huge shout out to PDPH, but there's a lot to do right now. You
+know, we need to set up vaccine providers in different kinds of
+clinics. We need to, you know, put messages on buses, as I said
+earlier, and we need to engage with, you know, community
+networks, community health workers to do all that reaching--
+outreach to folks who don't have--you know, aren't on the
+internet all day. That takes money, and if we're going to
+really rely on our local and State health departments to do
+vaccine rollout, which is appropriate, that's why we have
+jurisdictions, they need resources.
+ Mr. Tonko. And how can Congress best assist State and
+local public health departments in their effort to provide up-
+to-date information aimed at curbing COVID-19 vaccine
+hesitancy?
+ Dr. Buttenheim. I think--again, I'll go back to the money.
+In addition to those resources, what I mentioned earlier with
+making sure we have sort of clearinghouses and compilations of
+best practices and what's working in different areas. I think
+also we need really good dashboards, especially if we want to,
+you know, do the sort of double punch on the equity and the
+efficient rollout. Every jurisdiction should be able to pull up
+a dashboard that shows, you know, how we're doing, how many
+doses are out, how many doses are in jurisdiction, how are we
+doing on race, ethnicity, and age, and social vulnerability
+index. And those are intensive, you know, data resources.
+Support to get those stood up and keep them active and dynamic
+is also really crucial.
+ Mr. Tonko. Dr. Buttenheim, thank you. I've exhausted my
+time. Madam Chair, thank you for your patience. I yield back.
+ Chairwoman Johnson. Thank you.
+ Staff. Mr. Sessions is next.
+ Chairwoman Johnson. You might need to unmute.
+ Staff. Sir, you are unmuted, but no audio is coming
+through.
+ Mr. Sessions. I hope that's better. We put a new
+microphone----
+ Staff. Yes.
+ Mr. Sessions. Good, thank you very much. I'll start back
+over. Thank you.
+ Chairwoman Johnson, thank you very much for holding this
+hearing. Your leadership in this Committee for years has been
+very important to many people, not just your background as a
+nurse but representing a huge number of people by speaking
+about them, also Ranking Member Lucas.
+ My question that I would like to direct--I believe it goes
+to Dr. Neuzil, which would give her a heads up that I'm going
+to ask this question. The first is just a comment that may or
+may not require an answer, but the last two I am looking for
+one. And it is that for a number of years I've been a blood
+donor, given 15 gallons of blood over my life, and I've watched
+at how these organizations come and work with local community-
+based organizations, including churches. And I wonder if it's
+appropriate ethically for us to consider going to churches and
+actually, you know, making sure you hit not just the Baptist
+and Methodist and the Catholics but other evangelical churches
+perhaps in an area, perhaps it might be a synagogue, but
+working through the churches, which would bring people together
+where they are together on a Sunday morning or a Monday or a
+Wednesday night. It seems to me that that may be a way that you
+could take care of what might be a disparity in the other
+communities that we're having problems with.
+ Now to my questions. No. 1, I'm a father of a Down
+syndrome young man and trying to stay up with issues related to
+disabilities. My question is that do you believe it's important
+for disabilities to have their own trial or would you suggest
+that they be involved in these trials that go on? We have
+people, some who are in wheelchairs, some who and may have an
+intellectual or a physical disability.
+ And secondly, evidently, we do not have our young
+students. I don't know the age whether it's 25 or 35 and below
+that really were not part of the adult study, but is a study
+necessary before we can get to all of our college students? Or
+what is that status, Dr. Neuzil? Thank you very much.
+ Dr. Neuzil. Yes, so really great questions. And it's very
+difficult because when we do a clinical trial, even trials as
+large as were done for these vaccines, 30,000 or more, you're
+trying to represent the population in which the vaccine will be
+used, but at the same time, you're trying to be safe. So, as I
+said at the beginning, you want to start with people who are
+least likely to have the ill effects and then move to older
+people, move to younger people. So we've moved very fast in
+adults, in older adults, in adults with chronic conditions. We
+haven't moved as fast in children. We're down to about age 12
+with enrolling children in these trials.
+ For the examples you give, Down syndrome, many other
+developmental diseases, neurologic diseases, if the immune
+system is intact, we can extrapolate that these vaccines will
+work well in any of those populations as they have in these
+trials. It's really populations where the immune system might
+be compromised where we don't have the data yet. These vaccines
+are likely to be safe, but we don't yet know how well they
+work, and companies and governments and academics are moving
+into those populations.
+ Mr. Sessions. Good, thank you very much. And once again,
+just a suggestion you might want to do. Where we're having
+problems, I think that when you have the availability of the
+vaccine, that's the time to go in an area that either is rural,
+hard to get to, or where there is a reluctance, and move to
+large groups of people, and that way your numbers grow. I think
+I heard you say go away from failure and move to success, make
+friends with success is what I agree with.
+ And it still--I mean, I'm not saying anybody is more
+important than anybody else in any of those communities, but I
+think that it gets the word out that when you go to a church,
+that they communicate with other people and say I got mine, you
+ought to get yours, and that's, to me, success also. Thank you
+very much. Chairwoman Johnson, I yield back my time.
+ Chairwoman Johnson. Thank you very much.
+ Staff. Mr. Foster is next.
+ Mr. Foster. Thank you. Am I audible and visible here?
+ Chairwoman Johnson. Yes.
+ Staff. Yes, sir.
+ Mr. Foster. All right. Well, thank you, Madam Chair, and
+to our witnesses.
+ You know, one of the lessons that I take away from COVID-
+19 is that we have to--much to learn from the rest of the
+world. So, Dr. Neuzil, in Britain, the E.U., Singapore, and
+other countries, they're making three significant choices
+differently than in the United States, and I'd really be
+interested in your reaction to them and whether we might learn
+something from them.
+ First, they are--many countries are making the choice to
+use available doses to get the first shot of vaccine into as
+many people as possible on the grounds, that most of the
+protection comes from the first shot. And my understanding is
+that there is, as yet, no evidence that the efficacy of the
+second shot is reduced if it is delayed. The British scientific
+modeling at least indicates that this approach will save many
+thousands of lives, and yet the United States has not--has
+chosen not to pursue this approach.
+ So my question on this first item is if the data from the
+U.K. and also the E.U., Singapore, and other countries confirms
+that there is a net public health benefit from giving the first
+shot first, should we consider adopting their approach, and
+when might we consider making this switch?
+ Dr. Neuzil. Yes, so this is an excellent question. And, as
+I said, as with many of you, I wear different hats and I'm part
+of the WHO committees that's evaluated the U.K. vaccines and
+vaccines from other countries. And, you know, most vaccines do
+well with a longer interval. So what you're really weighing are
+the pros and cons of getting as many people vaccinated as
+quickly as you can with the possibility that some then may
+never get a second dose, may have a delayed second dose and
+have a period of vulnerability.
+ So some of these issues--you know, to me, the U.K.
+decisions are based on science and the U.S. decisions are based
+on science. Some of these have to do with your medical care
+system, your culture, your understanding of the populations,
+and your aversion of risk. And so----
+ Mr. Foster. OK. So, yes, those don't sound too scientific.
+You know, I'm just trying to understand. I think--but you
+concur that at least in terms of the modeling, getting the
+first shot first is a lifesaver? And then the question is you
+need to talk about the sociology of your country and your
+culture to decide if that nets out well. But from a scientific
+point of view, first shot first is a winner. Is that
+something----
+ Dr. Neuzil. I think the U.K. approach is based on solid
+science. The further out you go with the second dose, you're
+getting to less solid science.
+ Mr. Foster. OK. And the second choice they're making
+differently is that Britain and other countries are
+manufacturing and testing not only mRNA vaccines but so-called
+self-amplifying mRNA vaccines, which can be manufactured
+roughly 30 times faster since they're effective in roughly a 30
+times smaller dose. You know, for example, one--if the 1
+microgram effective dose means that 1 liter of self-amplifying
+mRNA is enough for 1 billion doses, and so the factor is small
+and can be turned around rapidly.
+ So if this plays out, self-amplifying mRNA vaccines may be
+the technology of choice not only for rapid turnaround to
+manufacture if new virulent strands are uncovered, but also for
+vaccinating the seven billion people from around the world.
+ So my question, you know, in the U.S. we are not pursuing
+Operation Warp Speed-style speculative investment in
+manufacturing self-amplifying mRNA, and is this something that
+we should consider?
+ Dr. Neuzil. So we should absolutely be considering second-
+generation vaccines. The self-amplifying mRNA vaccines are
+being supported through NIH, not through the----
+ Mr. Foster. Yes, but not at the manufacturing level,
+right? That's the--you know, what they are doing, you know,
+Shattock and these guys in I think Imperial College are
+actually, you know, producing nontrivial amounts of this even
+as they are being tested in clinical trials, which is something
+we're not doing, so that if it turns out that this is the
+killer technology, they'll be ahead of us and once again we'll
+be dependent on, you know, other countries. So that's--anyway,
+if you have a more--something more complete for me to read, I'd
+be interested in your letting me know about that.
+ The third thing that is that they're doing in England and
+elsewhere are human challenge trials. These are currently
+ongoing in the U.K. As you know, all vaccines are very rapidly
+tested on monkeys, and they get the answer in 1 to 2 months by
+vaccinating them and then deliberately exposing them to the
+virus. And we regularly use challenge trials--human challenge
+trials to test flu vaccines and other vaccines, but after a
+lengthy debate, we decided not to do that for COVID-19 and
+instead we're using much more lengthy, you know, conventional
+field trials, which have taken 6 months or longer.
+ And so the situation I'm worried that we're going to be in
+is that with a combination of self-amplifying mRNA and
+preapproved human challenge trials in England and other
+countries, the British are going to be able to respond much
+faster than we will to new strains or new pandemics, you know,
+perhaps in as much as 4 months, many months faster than the
+United States will be able to do it. And are we missing
+something? Are there opportunities here that we should be
+thinking about taking?
+ Dr. Neuzil. Yes, so I have published on the human
+challenge controversy, and I come down on the side of--and I've
+done human challenge studies for influenza virus. I come down
+on the side until we have an oral antiviral that works, I feel
+that there's too much risk. However, we should be developing
+the challenge models now, preparing the challenge strains so
+that when we feel it's safe enough, we can quickly move into
+those challenge studies. And truthfully, the large clinical
+trials gave us the answer on vaccine efficacy before the
+challenge studies gave us the answer on vaccine efficacy.
+ Mr. Foster. Yes, because of the approval process. If we
+had pre-existing approved facilities ready to go, then you
+would have seen the same turnaround for human challenge trials
+that we currently see for primate trials. And so the question
+is should, for the next pandemic, we have the approvals, the
+ethical considerations all set so that we'll be in a
+technically limited schedule for rapidly testing those
+vaccines? Had we had that in place and chosen to use it, we
+would have known many months ahead of time that the vaccines
+that we are currently deploying were very effective and would
+have been able to ramp up production even faster than we did.
+ So I think that, you know, whether--this is a debate I
+think that should continue even after this pandemic has ended
+because of its potential use in future pandemics.
+ Well, I just want to thank you for everything you've done
+here and so----
+ Dr. Neuzil. Thank you.
+ Chairwoman Johnson. Thank you very much. Our next----
+ Staff. Mr. Garcia is next.
+ Mr. Garcia. All right. Good afternoon, and hopefully you
+can hear me OK. I want to thank the Chairwoman for her
+leadership on this, Ranking Member Lucas as well, and the
+witnesses here. I really appreciate everything you've done for
+our Nation's security. It actually is an impressive feat to
+have gotten where we are with so many vendors so quickly.
+ I'd like to start with just a quick nuanced comment here
+before I ask my question. I think to Dr. Buttenheim, your
+comments earlier and I mean this in a very constructive manner,
+so please don't take this critically, but I think it's
+important when we're in an effort to try to get everyone to get
+vaccinated to the max extent possible, that we don't
+necessarily push to ask people to not ask questions. I think
+this is different than a normal flu vaccination. It's got much
+more publicity. The average American is much more aware and
+they're much more informed about what's going on.
+ So I think when we say we need to try to remove cognitive
+load from people's decisionmaking process or discourage them
+from having choices, I understand what you're saying, but we
+have to be eyes wide open that when we use language like that,
+some demographics will actually become either more paranoid
+about the vaccine or less trustful of the government. We talked
+about the Hispanic community with the use of Warp Speed,
+trusting the process less because of just the language.
+ So I completely understand what you're saying and I agree
+with everything at an academic and science level. I think
+rather than discouraging people from asking questions, we
+should make the answers to those questions more readily
+available and in the end state I completely agree with you
+they're all great products and you're going to be saving your
+life with any of these vaccinations. Just a nuance, but I think
+it's important, especially in public forums, which these all
+are, right?
+ So my question is to Mr. Reed, and we can follow up with
+Dr. Neuzil. In California here we're close to the bottom, you
+know, five States in terms of distribution and the supply chain
+failure [inaudible] not only dosages here but distributed. What
+are the three or four biggest barriers to getting the vaccine
+to a more widely distributed network at the CVS, the Walgreens,
+the Walmarts, wherever you would have normally gotten your flu
+shot or your birth control or your prescription refilled?
+Besides the cold storage, because if we get through that or if
+there's a vaccine that is sort of amenable to wider
+distribution, what are the follow-on barriers, I guess, to
+ensuring that wider distribution?
+ Mr. Reed. So for us we did not initially engage a lot of
+those--the pharmacies and some of the smaller providers around
+the State that could have direct access to Oklahomans. We did
+that because in the initial stages when we had loads of
+vaccine, we were trying to move toward mass vaccination to get
+the vaccine out there much quicker and start to try to have an
+impact on interrupting the transmission of COVID.
+ We did initially within the first probably 3 to 4 weeks
+start to send some vaccine to some federally qualified
+healthcare centers and some other smaller outlets if you will
+other than mass vaccination. And the challenge for them is
+systems in which they can run through that vaccine rapidly, so
+we started seeing obstacles of diluting the vaccine inventory
+in one area, and in doing so, vaccine would start to sit on the
+shelf.
+ So I think it's important for us to engage all these
+outlets, our pharmacy partners. We're pleased with the Federal
+pharmacy retail program that's coming on board. Right now, we
+have 76 pharmacies in Oklahoma that are participating in that,
+but it's smaller doses, 100 doses here, maybe 200 there. And I
+think it's important for us that we give them inventory and
+ensure they have inventory that they can run through in a
+week's time because they don't have the resources set up, large
+volume, mass vaccination, so we want to equip them with the
+vaccine inventory that they can run through within a week or so
+so that we can ensure that vaccine is continually moving from
+freezers into arms a rapid manner.
+ Now, when vaccine inventory comes up, we have more
+vaccine, I think we're in much better shape to push out more
+vaccine to those individuals so that we do have that access to
+that trusted source at the local level.
+ Dr. Huang. This is Phil Huang if I could add one thing to
+that just--you know, because initially that was what our plan
+in Texas was. Like we have 800--over 800 local providers signed
+up to be part of that distribution, and, you know, then the
+State published a map with all these--you know, and some of the
+pharmacies that had it, then they were getting overrun with
+calls, you know, but they only had about 100 or so doses to
+last a week. And that's where there was a big pivot to moving
+to these hubs and the mass vaccination site. But that was sort
+of given the current situation, the limited availability. I
+think we're trying to get toward that. I think it sounds like
+the Federal pharmacy program is to start to get that supply
+going and testing it out. And once there is much more
+availability, then that will be a big part of certainly our
+efforts also.
+ Mr. Garcia. Great, thank you. You guys, I have a bad
+connection here, so I apologize. Thank you, Madam Chair.
+ Chairwoman Johnson. Thank you. Our next Member?
+ Staff. Mr. Casten is next.
+ Mr. Casten. Thank you, Madam Chair, and I think I feel I
+speak for all of us that I'm going to keep my fingers crossed
+that I don't have any Wi-Fi issues. [inaudible].
+ I really appreciate you all having this meeting and the
+thoughts you've all done in this. I feel like there's our need
+to communicate vaccine safety in public forums, and then
+there's the reality that all of us have as Members that I think
+every time I fly back and forth, someone on the airplane or
+someone at TSA (Transportation Security Administration) says,
+you know, this vaccine was rolled out too quick and I'm a
+little bit nervous and we have all of these little, small
+conversations.
+ And I don't know if I do a good job of that. I feel proud
+that I think I convinced a police officer at O'Hare a couple
+weeks ago to go get his vaccine, but you never know how all
+that works.
+ Dr. Neuzil, I wonder if you could comment. I saw some
+analysis early on that I found compelling, but I don't--I'm not
+a doctor--that the--that a part of the reason these vaccines
+[inaudible] so quickly was because the spread of--the community
+spread of COVID was so much more widespread and so much faster
+than we thought it was going to be. Is that accurate? And if
+so, can you explain for the layman how that works?
+ Dr. Neuzil. Sure. That is accurate. So, as I've said, we
+have large numbers of people in these trials. The minimum was
+30,000 up to 45,000 or more. And the way we look at a trial is
+we do sample size and power calculations. So when do we feel
+confident that the answer we are getting is the right answer?
+And that depends on how many cases of a disease--in this case,
+COVID-19--we get.
+ So because--so we may do--I just finished a typhoid
+vaccine trial. It took 3 years because that's a much rarer
+disease. So because we had so many people in this trial and
+there was so much COVID, we had hundreds of cases of COVID-19
+in a short period of time that could tell us how well these
+vaccines worked.
+ Mr. Casten. How much--just--I mean, this is an estimate,
+but how much do you think that shortened the trial time from
+what people were--you know, because early on, you know,
+everybody was saying this is going to be 18 months. Did this--
+does that substantially explain the difference?
+ Dr. Neuzil. It does. I think there are two parts that
+explain the difference. We ended up enrolling more people, so
+initially, we were going to enroll 5 to 10,000 people, and we
+increased that to 30,000. And partly it was so we could get
+these subgroups, the older adults, the minority populations and
+have good numbers in every subgroup. So the size of the trials
+helped shorten it, and then the extent of the pandemic.
+ Mr. Casten. OK. So the second one--and I want to be a
+little bit careful on how I ask this because it's a politically
+charged question and I don't mean to get political, but this--I
+don't know how you have a public health conversation and not
+inject some politics into it because people--especially when it
+comes out of the mouths of people like us.
+ The--and this builds a little bit on the--on your exchange
+you had with Mr. Babin. With almost a half a million Americans
+dead from COVID, I hope we never, ever again talk about how
+herd immunity is a good strategy to protect the population. At
+the same time, I think the--there is some--there is a
+reasonable question that Dr. Babin was asking you of how
+protected are you if you got exposed and were either non-
+symptomatic or had, you know, minor symptoms?
+ And I take your point that we don't really know enough yet
+about COVID, but I wonder, if you're comfortable, can you
+speculate at all on, you know, the broader classes of
+coronaviruses or RNA viruses more general? Is there--can you
+say anything generally about the level of protection you get
+from a vaccine as opposed to the level of protection you get
+from community exposure? How durable is one versus the other?
+Is there a point where you're satisfied that one is going to be
+better? Can you say anything generically to help us answer that
+question when people who have been, I think, infected by a very
+dangerous political idea ask us what's on its face is a
+reasonable scientific question?
+ Dr. Neuzil. Yes, so I think there's two answers. One is
+just to clarify. When we talk about herd immunity, it could be
+through exposure to the disease. And as you've alluded to, that
+comes with the risk of people getting sick and dying from the
+disease to get that immunity. What we'd ideally like is herd
+immunity to come through the rapid rollout of vaccines. But in
+fact it will be both of those added together that give us that
+herd immunity.
+ There are certain examples where the vaccine is better
+than the natural infection. HPV, human papilloma virus
+vaccines, are actually better at protecting you longer than
+getting the infection. With coronavirus, I would say the jury
+is still out, but it appears that both infection--reinfection
+is rare before about 6 months and maybe longer. We just haven't
+had enough experience with the virus. And similarly, about 6
+months after these vaccines are given, we're still seeing
+relatively high levels of antibody. So time will tell how long
+that immunity lasts from a disease and from a vaccine.
+ Mr. Casten. Thank you. And I'm out of time, would love to
+talk longer, but I really appreciate it. I yield back.
+ Staff. Mr. Feenstra is next.
+ Mr. Feenstra. Well, thank you. Thank you, Madam Chair.
+Thank you, Ranking Member Chair, also.
+ First, I want to thank each of you, the witnesses and
+their testimony today. It's very important that we discuss how
+we can both expand access and reduce skepticism of the vaccine
+to get our communities back to a state of normalcy.
+ So, Dr. Neuzil, Iowa State hosts a Nanovaccine Institute
+which received CARES Act funding to pursue nanovaccine research
+and development (R&D). As you may know, this technology will
+allow patients to self-administer an inhaler to receive a
+vaccination, which is likely a preferable method as a lot of
+people hate needles. For healthcare providers, it reduces
+exposure to contagious patients and avoids cases where
+providers have to be forced to throw away vaccines because, you
+know, there's just not the storage to preserve them.
+ Your testimony mentioned the need to invest and prepare
+for future pandemics. Can you share if this is very critical or
+how we can further invest into this type of nanovaccine type of
+treatment?
+ Dr. Neuzil. Yes, so thank you for the question. And I
+stressed in my testimony both the basic science as well as the
+technology. You know, I think people thought that mRNAs as a
+formulation for vaccines, you know, a few decades ago just did
+not seem realistic. And you're alluding to delivery strategies,
+which is actually a top priority of the World Health
+Organization in terms of the next innovations for vaccines and
+vaccine delivery. So I can't comment on the specific of the
+technology that you are referring to, but I can wholly endorse
+again investments in technology, investments in vaccine
+delivery methods that are alternatives to injections.
+ Mr. Feenstra. Thank you, Doctor. And I just want to say I
+applaud Iowa State University and others for looking at
+nanovaccinations. But I just think that's the way of the future
+when we start vaccinating. Hopefully, we never have a pandemic
+like this again, but we always have to be very aware of our
+future and the research that's out there. And I think
+nanovaccines come to light as sort of the next way of giving
+vaccinations. So, again, Dr. Neuzil, thank you for those
+comments. I yield back the balance of my time. Thank you.
+ Staff. Representative Lamb is next.
+ Mr. Lamb. Thank you all for being here, and I'm going to
+proactively apologize if you hear a 2-month-old baby screaming
+while I'm talking to you. He's being quiet at the moment, but
+he's on the other side of this wall.
+ Ms. Neuzil, I just wanted to ask you quickly, you
+emphasized the importance of the NIH research leading up to the
+pandemic that put us in a position to develop the vaccine so
+quickly. Is it fair to say in layman's terms that if we had not
+made those specific NIH investments that it could've added
+years on to our vaccine development process, in other words,
+that the money that we spent in past years probably saved us
+years of time getting to the vaccine?
+ Dr. Neuzil. I would say it saved us perhaps a year of time
+because the protein vaccines are being tested now, and that's
+the other technology. But I think it would be fair to say, you
+know, it saved us 10 to 12 months certainly.
+ Mr. Lamb. Thank you. And, Professor Buttenheim, thank you
+for your work in our great Commonwealth of Pennsylvania. I
+wanted to ask you a little bit about the vaccine uptake so far
+in Pittsburgh and Philadelphia, sort of two opposite ends of
+our State. But the common thing that we have seen in both
+places and many people have [inaudible] is a higher rate of
+very serious infection, particularly in the African-American
+and Hispanic communities, but a lower rate of vaccine uptake.
+So, for example, the numbers I have here that in Philadelphia,
+only 12 percent of people vaccinated in the first weeks of the
+rollout were African-American while the city's population is 44
+percent African-American and a much higher share were going to
+hospitals. In Pittsburgh, we saw the exact same thing.
+ So what we are looking at is how to make these specific
+investments that will fix this problem. Obviously, beliefs
+related to vaccine are a big issue, but if we just kind of set
+that to the side, would you agree that the massive investments
+we're about to make in community health centers, federally
+qualified health centers, and the hiring of 100,000 people
+directly through local public health departments, do you think
+that those will help us make an impact on these disparities?
+ Dr. Buttenheim. That's a compound question with a lot of
+complexity.
+ Mr. Lamb. Yes, I want to--I'll give you the rest of my
+time to answer it. I just kind of wanted to set up that in the
+COVID rescue package that we're about to pass----
+ Dr. Buttenheim. Yes.
+ Mr. Lamb [continuing]. There are billions of dollars for
+these hiring people and sending them to these areas of need.
+ Dr. Buttenheim. Yes.
+ Mr. Lamb. And our goal is to, you know, start to correct
+this disparity and who gets the vaccine and who's at risk--most
+at risk for infection. Do you think that will work?
+ Dr. Buttenheim. I think it will work, and I think the
+other ingredient that's needed when--the implementation of
+those programs is that we are smart about what barriers
+different people are facing. So when you give us the statistics
+for Philly, let's say, 11 percent of the people who have been
+vaccinated are Black but our city is 40 percent Black, there's
+a lot of heterogeneity, there's a lot of variation underlying
+that. Some of those people don't want to be vaccinated, and the
+kinds of programs and outreach and support we need to get them
+to make a good decision for them look one way. Some of those
+people, you know, never got the email because they don't have
+email or, you know, have been confused by the portals or
+aren't, you know, easily able to hop on a bus and get to the
+vaccine site.
+ So back to my earlier testimony about making it as easy
+and hassle-free as possible, that's a different kind of
+intervention. So just like we want to, you know, accurately
+diagnose whether someone has COVID, we also want to accurately
+diagnose where people are in that journey let's call it to
+getting vaccinated and use those incredible Federal dollars
+that support to target and tailor interventions to help people
+along the journey.
+ A specific example----
+ Mr. Lamb. I think what I was trying to suggest is that
+the--by spending the money in this way directly to local public
+health departments and community health centers, we're going
+for a geographic distribution of manpower, you know, or person
+power rather than saying--you know, using all the money on FEMA
+setting up mass vaccination sites in every city that you have
+to transport to. So I just wanted to kind of get confirmation
+that you think that goes along with what you're calling it,
+making it easier, which could then help have kind of a snowball
+effect for people in those communities to get----
+ Dr. Buttenheim. It does. And, you know, FEMA might work
+great in some jurisdictions, and the stadium might work great
+in others, so, you know, figuring out what assets we have
+locally to leverage is really important because it's not one
+solution. You know, we know that pharmacies have worked
+differently in different areas.
+ Mr. Lamb. Great. Go Quakers, and thank you for
+participating, everybody. Madam Chairwoman, I yield back.
+ Chairwoman Johnson. Thank you.
+ Staff. Mr. Obernolte is next.
+ Mr. Obernolte. Well, thank you very much, and I want to
+thank our panelists for participating in the hearing. I think I
+speak for most of the Members of our Committee when I say that
+the development of human vaccines is probably one of the
+crowning scientific achievements of our human civilization, and
+that in the science of vaccination, that development of the
+coronavirus vaccines is probably going to rank as one of the
+crowning achievements in that field of science.
+ So, you know, having said that, I think it's really
+important for us to take a retrospective look at the
+development of the vaccine and our efforts to deploy it so that
+in the future the people that sit in our seats and make these
+decisions will have good information to rely on so that we can
+do it even better next time. And so I think that that's the
+line of questioning I like to pursue.
+ First of all, I have a question for Dr. Huang. I think
+many of us were encouraged by Pfizer's announcement yesterday
+that its vaccine might be stable at higher temperatures. Can
+you tell us what implications that has for our efforts in
+getting the vaccine distributed quickly?
+ Dr. Huang. Certainly, the requirements for the ultracold
+freezers is a challenge. It's one of the logistic challenges
+for getting it out there. You know, it is surmountable, but it
+would certainly make it easier for delivery. Thus far, our
+local health department has been primarily dealing with
+Moderna, but we have partners that we're working with for that
+ultracold storage, so I would think certainly in rural settings
+and other settings certainly would simplify the ability to get
+vaccine out. And as Dr. Buttenheim mentioned, you know, just
+getting--making it simpler, addressing these sort of things--
+the barriers that we can, that would be one of them.
+ Mr. Obernolte. Thank you very much.
+ And, Dr. Neuzil, I had a question for you. You know, it's
+very interesting that our States have kind of served as the
+laboratory of democracy during this epidemic because many
+different States took different approaches to economic
+shutdowns and efforts to reduce the spread and transmission of
+the virus. And, you know, it's kind of a scientist's dream,
+right, because we have lots of different settings that we can
+look at statistical evidence and figure out what worked and
+what didn't.
+ And I think a growing body of research is indicating that
+the virus followed similar trajectories in States with very
+different approaches to shutting down their economies. So can
+you tell us your view of what that means for future epidemics?
+Because we know that this is going to happen again. This won't
+be the last time. In the future, should we have pursued the
+policy that we did regarding economic shutdowns?
+ Dr. Neuzil. Yes, so thank you for the question. It's a
+complicated question, and my conclusion might be a little
+different than yours. I think that there are so many variables.
+We scientists like controlled experiments, so if I'm going to
+do a controlled experiment, I want everything to be the same
+except for one variable. You know, this group wears masks and
+this group doesn't. And as we know, a lot of the behaviors and
+actions that were taken tracked together. There is in fact
+evidence, and the CDC has provided evidence, that many of these
+mitigation measures did work. You know, certainly the masking,
+now the double masking, the social distancing, and the limiting
+large crowds has been shown to work. Again, it is hard to
+dissect what single variable might be contributing there.
+ So I think it's going to take a scientific approach, and
+we should have that scientific approach to how these
+differences--what's worked best, where did it work, et cetera.
+ Mr. Obernolte. OK, thank you. Yes, I was talking less
+about masks and social distancing where the science is more
+clear, as you say, and more about shutting down, for example,
+indoor dining, forcing employers to do remote only instead of
+having controlled office environments, you know, where we've
+got States with very different approaches like Florida and
+California that seem to have similar trajectories of the spread
+of the virus and recovery from the epidemic.
+ And last question for Dr. Buttenheim, I was fascinated by
+your testimony the vaccine hesitancy and distrust of
+government. And I completely agree with you that this is less a
+discussion about virology and more of a discussion about
+psychology when we're talking about overcoming vaccine
+hesitancy.
+ However, you know, I think that something Dr. Huang said
+about distrust of government really resonated also, which is
+that people don't want to feel like their government is forcing
+them to get the vaccine, and I think we have to be very
+cautious about that because, in a way, we've said we're not
+going to make it mandatory, but in other ways we're kind of
+telling them that they are if we're telling them that their
+children had to be vaccinated to return to school, if we're
+telling them that they have to be vaccinated to get on a
+commercial aircraft.
+ What are your thoughts? You know, how do we tread this
+path toward steering people in the right direction to get
+vaccines but not alarming them by requiring them to get it and
+enhancing this distrust of government?
+ Dr. Buttenheim. Yes, this is a question we are getting a
+lot, sort of where do mandates potentially fit in with this
+vaccine. And most of my research pre-COVID was on the childhood
+schedule and whether you had to vaccinate your kid to go to
+school--to have a kid go to school, so very relevant. You know,
+fortunately, just regulatorily, we're still in emergency use
+authorization and we don't actually have to contemplate
+mandates quite yet. We are very unlikely to mandate a vaccine
+that's under an EUA.
+ But it's going to be a fine line. I really think about
+this as not trying to get 100 percent or 80 percent of people
+vaccinating but trying to make sure that everyone's been
+reached with information and support to make the decision
+that's best for them. That's really different from how I talk
+about--think about sort of parents vaccinating their kids. I
+just like--I want you to get your kid to get the measles shot,
+sort of, you know, end of story.
+ But we are obviously going to have situations. We mandate
+flu vaccine for healthcare workers in some settings in some
+States. There are going to be airlines that are going to say,
+you know, just as you have to have your yellow fever
+vaccination to travel to certain areas, you have to have your
+COVID vaccination. What schools and colleges do about students
+coming back, especially, I think it's going to be more relevant
+for colleges with congregant living maybe than for elementary
+schools. But those--you know, luckily, we have sort of
+templates for those conversations.
+ But for the general public right now, this--there should
+not be even the feeling of mandate or must. You know, maybe
+there can be some language around should or it would be great
+or we're really gung ho about this and we hope you are, too,
+but we can absolutely steer clear of mandate language for now.
+ Mr. Obernolte. OK. Well, thank you. Well, my time is
+expired, but thank you for that testimony. I completely agree
+with you. You know, I know my constituents pretty well. If they
+get the idea that they're being mandated to do this by the
+government, it's just going to enhance distrust, and it's going
+to make vaccine hesitancy worse, which is the wrong direction
+to go.
+ Dr. Buttenheim. One hundred percent.
+ Mr. Obernolte. So thank you very much, and, Madam Chair, I
+yield back.
+ Staff. Ms. Stevens is next.
+ Chairwoman Johnson. Unmute.
+ Ms. Stevens. Can you hear me?
+ Chairwoman Johnson. Yes.
+ Ms. Stevens. Great, fabulous. Thank you, Madam Chair, for
+this phenomenal hearing, couldn't imagine a better way to kick
+off the Science Committee of the 117th Congress. And thank you
+to our expert witnesses.
+ I'm talking to all of you from snowy Michigan where the
+President is today. He's in Portage, Michigan, visiting Pfizer,
+the place where the first vaccine rolled out to our great
+expectations.
+ Dr. Neuzil, I want to thank you so much for your
+testimony, which was really thorough and historic in nature.
+And certainly today we've spoken a lot about the efficacy of
+the vaccine, and I know that's a topic on everyone's mind from
+my constituents in Michigan's 11th District who are working to
+get access to that vaccine.
+ But I would just love to talk to you a little bit more
+about the vaccine development of which Dr. Baird also touched
+on with his very specific questions around that mRNA but more
+so to just backup for a minute because one of the things that
+we focus on in this Committee are the scientific achievements.
+We focus on the milestones.
+ Many of us recall--and I say many because we've got some
+newbies in Congress on this Committee this time, freshmen, but
+those of us who were in the 116th Congress recall that the
+first thing that we voted on--and it was all of Congress,
+completely bipartisan, immediately signed into law, done at the
+beginning of March was the original money to go into the
+development of this vaccine, to go into the R&D of the vaccine.
+And here we have it where we got it within the year, you
+touched on Operation Warp Speed.
+ But for somebody who is in this State, have you taken any
+moments to just pause and, if you have, what has been the
+thought? Is this something that surprised you? Was this
+expected? Did you think we were going to be able to get this
+done before the end of the year?
+ Dr. Neuzil. Yes, that's a great question, and I've been
+involved in a lot of vaccine development, very large public-
+private partnerships in my career. And as you've said, this one
+is absolutely historic. I think last year at this time we were
+all saying, you know, best-case scenario we might have a
+vaccine by the end of the year. When you say stop and reflect
+on December 31st, I got my vaccine, and that was really a very
+powerful moment for me personally that within the same calendar
+year I actually received a vaccine when I was there at the
+beginning for development.
+ So I think without--certainly, without the resources but
+without the vision, you know, without the leadership of
+bringing a diverse community together, bringing partners
+together with different skill sets united to a common goal was
+absolutely key to this happening.
+ Ms. Stevens. Great. And I think one of the privileges of
+being on the Science Committee last term--and it's worth
+reflecting on--we in March voted for the funding of the
+vaccine, voted for a second package around increasing our SNAP
+(Supplemental Nutrition Assistance Program) benefits for food
+assistance, paid family leave provision, and more money for the
+testing, and then we voted for the CARES Act. And being on the
+Science Committee, we got additional dollars out to our
+Manufacturing Extension Partnership network, yay, and we also
+got money over to the National Institute for Innovation in
+Manufacturing Biopharmaceuticals known as NIIMBL. And this is
+part of the Manufacturing USA network.
+ And, again, we talked a lot today about the distribution.
+This has come up in previous questions around where the supply
+is, how long the supply can last. And I just remember that
+conversation with Mr. Kelvin Lee, their Director, and asking
+him about the ability to distribute this vaccine given what we
+were seeing in the early stages. We remember about 13 months
+ago testing wasn't available.
+ And so I don't know if you all want to rate, you know, in
+terms of how this vaccine has gotten distributed, but if
+there's anything else that you'd want to reflect on in terms of
+getting the shots in the arms of, you know, I would say with my
+residents, but the American public and in particular what we're
+seeing with those who have adopted the models of working and
+coordinating with the pharmacies directly, those States versus
+those who haven't it. And this is just if anyone has anything
+left to add. I know I'm--Madam Chair, I'm right at my time, so,
+we might have to do it for the record, which would be fine, so
+I'll yield back.
+ Staff. Ms. Kim, next.
+ Ms. Kim. Thank you. Thank you, Madam Chair and Ranking
+Member Lucas. I want to thank you for holding this very
+important hearing on the science of COVID-19 vaccines. I don't
+know if all of you are having technical difficulty like I have
+where you're in and out because of that. But I also want to
+thank our very patient and expert panelists for doing this and
+answering our questions. I look forward to working with the
+Members of the Committee on both sides of the aisle to ensure
+that the United States stays at the forefront of science,
+research, and development, and innovation.
+ This is really exciting for me as a freshman being able to
+serve on this Committee because COVID-19 is affecting
+communities in different ways. And this so-called [inaudible]
+and individuals [inaudible] to weather the economic crisis much
+better than the low-income and minority families.
+ Unfortunately, the COVID-19 pandemic has also had the
+biggest negative impact among minority [inaudible] that
+minorities and low-income students have suffered the most as
+schools have [inaudible] with virtual learning. And the January
+25th study by PACE (Policy Analysis for California Education),
+which is an independent, nonpartisan research center based on
+California found in a study of [inaudible] that, quote,
+[inaudible] students, especially low-income students
+[inaudible] language learners are falling behind more
+[inaudible] than others, end quote. Clearly, this study
+problematic because many of the students are falling way behind
+on math and reading skills, which are obviously critical skills
+if our country wants to have successful STEM (science,
+technology, engineering, and mathematics) students.
+ So, moving forward, we need to ensure that we have a
+seamless vaccine distribution so that we can get to that point
+where anyone who wishes to get a vaccine can have access to it.
+We must also ensure that our research and development of
+vaccines are keeping pace with the variants that have been
+recently found.
+ So I would like to pose a question to, first, Mr. Reed.
+Talking to my students in California's 39th District, it seems
+individuals often do not know which entity in the State is
+administering the vaccine distribution. And there's a lack of
+communication between the State and local government. And in
+your testimony you discuss how partnerships with regional
+health directors, family health departments, and other local
+partners are critical in determining the best communications
+approach for local constituencies as they understand what would
+work well within their respective communities. So could you
+elaborate further on these [inaudible] and provide examples of
+how different constituencies communicate with their residents?
+ Mr. Reed. Certainly. And I was having a little trouble
+hearing you, so hopefully I heard the question. But, yes, our
+local partnerships have absolutely been key in our vaccination
+rollout. We've been very clear having a centralized planning,
+but we depend completely on a decentralized execution of that
+plan.
+ I'll give you an example. We are rolling out to teachers
+starting next week, and from the State level we have just
+identified that those are the--that's part of the next group
+that is coming online for vaccinations, and then we allocate
+vaccine to our health districts around the State. We leave it
+to them to work with partners on to develop those plans. In
+some cases, they are setting up specific pods that are for
+school districts and their teachers. In some cases, they are
+using strike teams that will go to some of these districts in
+order to vaccinate the teachers. In some cases, they are
+pulling multiple districts together to come together for one
+pod. Some areas, they are using contractors that can go out and
+use strike teams. We've essentially left it up to them locally
+to determine what they can do best because they understand
+those resources. They understand the needs of their partners.
+They're in constant communication with those partners, and
+that's really what helps them to understand how best to move
+forward with vaccination efforts. I hope that answers your
+question.
+ Ms. Kim. I'm pretty sure you did. My apologies. As soon as
+I posed that question, my computer froze, and so I had to log
+back in. And sorry we're having this problem. But thank you for
+answering that. And I do have a follow-up question if I still
+have some time. Madam Chair, how much time do I have?
+ Staff. Time has expired.
+ Ms. Kim. Thank you, I yield back.
+ Staff. Mr. Sherman is next.
+ Mr. Sherman. Thank you. I want to thank [inaudible]
+distribution [inaudible] disadvantaged communities, communities
+of color, rural communities [inaudible]. There's one other
+group that has a very low level of acceptance of vaccine, and
+that is Trump voters. And I'm hoping that some of the Members
+of this Committee who have a better personal relationship with
+the former President than I do can prevail upon him to go
+public with his support of these vaccines and that [inaudible]
+when members of the Trump family get their vaccination
+[inaudible] wants to be vaccinated or thinks he shouldn't be
+because he's already had the disease if he were present where
+other members of the Trump family were getting the vaccine,
+that would go a long way.
+ I want to focus on the shortage of vaccine. Now, one
+concern I have--and this is the only thing I disagree with Dr.
+Fauci on--is he's been on the shows talking about how certain
+steps we could take that would conserve vaccine--studied how we
+could conserve vaccine [inaudible] because by the time we get
+the results from most Americans, all Americans will have access
+to the vaccine. It's not enough to vaccinate just the United
+States. We've got to vaccinate the world. That's a matter of
+world leadership. It's a moral issue. It's an international
+economics issue. But also, as Dr. Neuzil pointed out, it
+relates to our health. Every time anyone in the world gets this
+disease, [inaudible] a chance to replicate, mutate, and perhaps
+come back to the United States in a form that we can't deal
+with. So we do have an interest in the entire world being
+vaccinated as quickly as possible. It means not stopping our
+efforts to maximize the efficiency and production of the
+vaccine just when we all get vaccinated in the United States.
+ But one issue here, while we do want to vaccinate the
+whole world, we're most interested in vaccinating the United
+States, is that there's vaccine being manufactured in the
+United States that is being exported. And we have [inaudible]
+Trump Administration didn't, and so Pfizer and others signed
+contracts with other countries. We could legally interrupt that
+with the Defense Production Act [inaudible] we want to maintain
+our relationship with our friends [inaudible] being
+manufactured in the United States is being exported
+[inaudible]? Do any of our witnesses know?
+ [inaudible] another question. We can research to determine
+whether one Pfizer [inaudible] and one in the late summer is
+enough, whether 1/2 or 1/3 of the current dosages will be
+effective for people under 65. Those studies are going on now.
+They should've started a few months ago.
+ But I want to focus [inaudible] throw the bottle away
+after that. [inaudible]. God knows how much vaccine was wasted.
+Even now, I'm told that there's a half a dose available in this
+bottle, and then you get the next half a dose available in
+[inaudible], same manufacturing lot [inaudible] in that bottle
+for the full dosage, we throw it away. Is that the--does any
+[inaudible].
+ Staff. Mr. Sherman, much of your audio was cutting in and
+out, so I think the witnesses weren't quite able to hear the
+questions exactly.
+ Mr. Sherman. I'm going to turn off my video and hopefully
+my audio will improve. Is my audio better now?
+ Staff. It does sound a little better, sir, yes.
+ Mr. Sherman. OK. I don't know if I have the time to
+restate the question, but I'll ask any of our witnesses, are
+you familiar with the process by which if there's maybe 1/3 or
+2/3 of a dose left in a bottle after--that you throw that
+bottle away rather than using some of the serum in this bottle
+and some of the serum in the next bottle, that next bottle
+being with the same manufacturing lot in order to administer a
+full dose? Are we throwing away 1/3 or 2/3 of a dose every time
+we finish a bottle?
+ Dr. Huang. This is Phil Huang. I mean, I would say that,
+you know, we have certainly been very diligent in getting as
+much out of each vial as we can and have been getting more than
+what was on the [inaudible]----
+ Mr. Sherman. That was my second question. But let's say--
+--
+ Dr. Huang. But in terms--yes.
+ Mr. Sherman [continuing]. What you can get out of the
+bottle is half a dose, you can get half a dose out, you can't
+get a full dose out of the bottle. [inaudible] from the same
+manufacturing lot. Do you throw away that half dose in the
+bottle that has already been mostly used?
+ Dr. Huang. You know, I--yes, I haven't specifically heard
+regarding that availability. We have tried to get different
+syringes that make it----
+ Mr. Sherman. Right.
+ Dr. Huang [continuing]. Easier to----
+ Mr. Sherman. Not----
+ Dr. Huang [continuing]. Maximize the amount, but----
+ Mr. Sherman. We've got the better syringes. We've stopped
+wasting whole dosages, but we are still wasting, on average,
+half a dose per bottle. So that would mean 1/12 of the serum is
+being thrown away. And that's--thank you, FDA. I think they'll
+correct that months from now.
+ And I yield back.
+ Staff. Mr. Weber is next.
+ Mr. Weber. Thank you, sir. And, Madam Chair, thank you for
+having this great hearing. And you, too, Mr. Ranking Member. We
+appreciate it.
+ Gosh, I don't know where to start. Let me do it this way.
+I think Alison Buttenheim, in your exchange with Dr. Bera, you
+said the best vaccine is the one you can get tomorrow. And so
+people are concerned about the--we've got two different kinds
+of vaccines, right? We have Moderna and Pfizer. How close are
+we on Johnson & Johnson? Do we know?
+ Dr. Buttenheim. I think their EUA hearing is next week,
+but we also know that there will not be the amount of supply
+for that vaccine that we have for Pfizer and Moderna, so it's
+not like we'll suddenly have another 1/3 of, you know, supply
+that will be----
+ Mr. Weber. Right.
+ Dr. Buttenheim. We've been told in Philly we will have
+much more limited supply of J&J.
+ Mr. Weber. And this may be a question for you and Dr.
+Neuzil I guess do we have a comparative analysis? In other
+words, how successful is the Pfizer and how successful is the
+Moderna? What are the numbers there that have been vaccinated?
+What are the numbers of adverse reactions? Do we have that kind
+of information?
+ Dr. Buttenheim. I shouldn't speak to post-marketing
+surveillance. It's not my area of expertise, and unfortunately,
+I think Dr. Neuzil had to drop off. But in general, you know,
+the trials continue and that we still, through our different
+monitoring and surveillance systems, the local folks here who
+are vaccinating locally can attest to this, gather all sorts of
+adverse event data and we're starting to accumulate the longer-
+term safety and efficacy data. That's ongoing and will be for
+months.
+ Mr. Weber. OK. In her exchange with Mr. Tonko, I think she
+said herd immunity was around 75 to 80 percent. I guess that's
+the ideal, herd immunity, quote/unquote. So where are we now?
+Do we know that?
+ Dr. Buttenheim. Well, we know the number of doses that
+have been delivered, and we know the number of people who have
+had one dose versus two doses. The mystery number is how many
+people have actually had COVID and what--how much do they
+contribute to herd immunity meaning how long are they
+protected. I've seen ranges from about 20 to 40 percent--it's a
+big range--of residents in the United States have some form of
+protection now either through prior disease or through
+vaccination.
+ Mr. Weber. OK. And you talked about the need for local
+jurisdictions to be able to track that progress.
+ Dr. Buttenheim. Yes.
+ Mr. Weber. Are we finding different jurisdictions, Texas
+or others, do things better and are tracking this better? Is
+there a model jurisdiction out there that you would recommend?
+ Dr. Buttenheim. I should let Dr. Huang and Mr. Reed weigh
+in on what they're doing. North Carolina has a great dashboard.
+Many States have dashboards that are not being run by the
+government. They're stood up by, you know, talented citizens
+who want to be able to see this. But I think--again, we need to
+sort of rapidly share best practices and how to just collect
+and analyze and display that information to guide decisions.
+ Mr. Weber. OK. Well, thank you for that. And I do want to
+hear Dr. Reed and Dr. Huang. Dr. Reed, what say you?
+ Mr. Reed. So one thing I would say is that we're missing a
+key piece of information. We start to look at our vaccination
+rates in our different counties and try to put that out there
+so that we have an idea of the rates plus the amount of disease
+out there. Our Federal allocation that comes into the State, we
+don't have any visibility on what that data shows us, so that's
+been a source of frustration. We have a significant tribal
+population in Oklahoma. We have our Veterans Administration
+centers, so Federal allocation comes into the State, but it
+doesn't go into our immunization registry, so it's a blind spot
+for us. We don't know what those vaccination rates are
+contributing to in some of our counties.
+ So while we are putting out information about how we're
+doing at a county level and now we're looking at adding on to
+ZIP Code level to put that information, we really need
+additional data from the Federal allocation so we can better
+understand vaccination rates within our State because that data
+will help drive our decisions on future allocations and future
+efforts.
+ Mr. Weber. Well, thank you. Dr. Huang, I've got about 20
+seconds.
+ Dr. Huang. Sure. And we've actually been working with a
+local group Parkland Center for Clinical Innovation, have been
+processing both our testing positivity results, as well as our
+vaccination, and so we've actually--they've been doing some
+projections based on the number of confirmed and probable cases
+but then also projections of how many other cases
+geographically might be out there. And we've looked at it by
+ZIP Code and also by census tract. Some of the ZIP Codes and
+census tracts may be about 30 percent perhaps protection and
+even up to 60 percent in some of the areas, but that's still
+preliminary data that we've been working on.
+ Mr. Weber. OK, thank you, and I appreciate that. Madam
+Chair, I yield back. Thank you.
+ Chairwoman Johnson. Thank you.
+ Staff. Ms. Ross is next.
+ Ms. Ross. Great. Can you hear me? Great, thank you.
+ Well, perfect timing, Dr. Buttenheim, because I'm from
+North Carolina. I don't know if you saw me kind of doing my
+little happy dance about our dashboard. And I just this week
+had a roundtable with community health providers with our HHS,
+with NIH, and with our--all of the local hospitals here. And
+I'd like you to tell the folks why our dashboard is good and
+would be a model. We didn't have a fast start. We had some
+difficulties, but I believe we're catching up. And if you could
+talk a little bit about the dashboard. And then I have a couple
+of other questions that came out of that roundtable.
+ Dr. Buttenheim. Sure. And I should clarify. The dashboard
+I had in mind when I said that is one of these that was set up
+by academic team Dr. Paul Delamater at UNC (University of North
+Carolina), and I actually don't know how well it complements
+the State dashboard.
+ But what's important to see for me is, for example, in
+Philadelphia, it is less helpful for me to just see how many
+doses have been given to different sociodemographic groups. I
+want to see rates. So, you know, we talked earlier about, you
+know, 11 percent of the doses in Philadelphia have gone to
+African-Americans, but 40 percent of the population is African-
+American. Show me that in rates so I can very quickly see only
+3 percent, you know, of this group versus 15 percent of that
+group.
+ And then the granularity is really important, especially
+for jurisdictions that are going to be using something like the
+social vulnerability index that was mentioned earlier to do
+equity-based allocation. You need to see that at a pretty fine
+level of detail. ZIP Code is OK, census tract actually better.
+So right now, for example, the--you know, you can sometimes see
+maps that show sort of ZIP Code of doses given but by provider,
+not by patient. So, you know, we need to use those data. And
+then it needs to be dynamic. You know, lots of us are checking
+these dashboards every night, and, you know, numbers that are
+really bumpy because we don't report over the weekend or, you
+know, 3- to 7-day lags are hard. So it's real-time data,
+granular data, and data that are presented as rates so that we
+can do comparisons are what's most useful.
+ Dr. Huang. And this is Phil Huang. Could I add one thing
+in there? Just, I mean, it really highlights the need for
+investment in our data systems. You know, it was--it came out
+during our testing data and all of that, but then also, you
+know, as we've been going out with the vaccinations, the mass
+vaccination centers, you know, getting the reporting into our
+State ImmTrac systems. We were during the first weeks having to
+do it all paper-based, and so it really limited the timeliness,
+the amount of data we could get back. Now we've transitioned to
+a paperless system using QR codes. But all of these, you know,
+it shows how much there's been neglect of some of these basic
+data systems and infrastructure for public health that really
+are so key.
+ Ms. Ross. Thank you so much. One final question. In that
+same roundtable we heard, and somewhat sadly, that there was
+vaccine hesitancy among healthcare workers for them to get the
+vaccine. And that's concerning obviously because they are in
+contact with patients, but it's also concerning because they're
+supposed to be our Ambassadors to good health care. Could you
+tell us what you've been learning about convincing all of our
+healthcare workers to get the vaccine?
+ Dr. Buttenheim. So, you know, this was a really important
+area of focus because that was the first group that we
+vaccinated, so we had data quickly on sort of which groups were
+saying yes and were saying no. I will say the same race-,
+ethnicity-based disparities that we see in the general
+population, we got a signal about that in healthcare workers,
+also by occupational group, which is of course correlated in
+many cases with race, ethnic groups as well. And one area where
+we're particularly seeing gaps is in the long-term care or
+nursing home workforce.
+ So I think--the--there's nothing sort of different about
+how we're going to approach this. Some of this, again, is going
+to be these longer-term, more intensive face-to-face
+conversations, making sure people have repeated opportunities--
+it wasn't just like there was this one chance to get vaccinated
+and you missed it--and figuring out who are the sort of
+persuasive peers or the validators that can help bring people
+along.
+ Ms. Ross. And are there--finally, are there any incentives
+to getting vaccinated? How does that work? And I know that
+there have been some folks in North Carolina who have looked at
+that as well.
+ Dr. Buttenheim. It's hard to do justice to it in 20
+seconds. Incentives are very controversial. You know, does a
+$20 gift card work? Does a $1,500, you know, big investment
+that looks like relief money work? My personal opinion as a
+researcher is that this is not--this is not a great place to
+use incentives. And one reason I'll say about that is that one
+thing incentives can do is signal to someone that the behavior
+you're incentivizing is difficult or risky or hard or
+unpleasant for some reason, and I think that's not the message
+we want to get with this vaccine. But I know there are lots of
+interesting programs and experiments who have tried incentives.
+ Ms. Ross. Thank you. And I yield back.
+ Staff. Representative Moore is next.
+ Ms. Moore. Thank you so much, Madam Chair and Mr. Ranking
+Member. I have really, really enjoyed listening to this panel
+of experts. I have more questions than I do time, so let me
+just get right to it.
+ Madam Chair, I was--want to enter a couple of things into
+the record without objection? I would like to enter a Pew
+Center research report recommending quite frankly that pregnant
+women receive the COVID vaccine, the American College of
+Obstetricians and Gynecologists--I'm sorry, the--it's a--I want
+to--the American College of Obstetricians and Gynecologists has
+observed that pregnant women are more vulnerable to severe
+illness and death, and they recommended that they get the
+virus. Then I also want to put in the record a study from the
+Pew Research Foundation that talks about the--about the age gap
+between whites and other minorities. Without objection, Madam
+Chair?
+ Chairwoman Johnson. So ordered.
+ Ms. Moore. Thank you. Thank you, Madam Chair.
+ I put those things in the record to tee up questions, and
+I'm not sure who is best to answer, but I'll start with Dr.
+Zydema. You know, when we talk about vaccine hesitancy, let me
+flip the script a little bit and say maybe some of the
+hesitancy has got to do with some of our organizations, the
+World Health Organization, the CDC. They have not been very
+clear about it. And so if you're pregnant, you may be hesitant
+to take the vaccine. You might not even be eligible based on
+States' priorities. I was wondering if you could comment on
+that briefly.
+ Dr. Buttenheim. And, Representative Moore, to whom are you
+directing that question?
+ Ms. Moore. Yes, Dr. Neuzil. I'm sorry, Dr. Neuzil.
+ Dr. Buttenheim. Oh, she unfortunately had to--she had a
+hard stop at 2 o'clock p.m. so we are without her----
+ Ms. Moore. OK. Well, I don't care. Dr. Buttenheim, I'll
+take you.
+ Dr. Buttenheim. Not my area of expertise. I'm going to
+pitch it to a medical doctor.
+ Ms. Moore. All right.
+ Chairwoman Johnson. We can submit your question----
+ Ms. Moore. OK. I'm sorry. Dr. Huang, anybody. I'm running
+out of time.
+ Dr. Huang. Yes, you know, I guess what I was hearing, you
+know, some--that the mixed messages or the lack of clear
+messages perhaps causing some of that hesitancy. I mean, I
+think that goes back to the point we do want to, you know,
+address the facts, you know, get--share them in an honest way,
+build that trust. Sometimes things aren't always clear, but
+then there are the recommendations that are resulting from
+that, and I think that, you know, making that clear and
+building that trust is part of building that--addressing the
+vaccine hesitancy. But----
+ Ms. Moore. Thank you, Dr. Huang. I mean, because the
+reality is is that vaccines have been administered to pregnant
+women in the past, and there haven't been any bad outcomes that
+we know of.
+ The second thing I put in the record was just--I just want
+to point out that while we talk about all of the hesitancy
+among Blacks and other minority groups--I know we have our
+witness here from the Native American tribe. I just want to
+point out that the most common age among white people is 58,
+and that's double what the common age is for Black people,
+which is 27. And if you're just going to line up Hispanics and
+pick out a random Hispanic person, they're much more likely to
+be age 11. If you put that in more scientific terms like the
+median age, the median age of white people in the United States
+is about 44. It's about 34 for African-Americans, 10 years
+difference, and then 30 for Hispanics. So, you know, I don't--
+you know, so if a State rolls out a plan to vaccinate all the
+65-year-olds first, that's fine. Then we're going to move down
+to the 55-year-olds. You know, you could be inadvertently, I
+would say, agreeing to vaccinate white people first. White
+people or the baby boomers, I'm 69, but literally, you know, my
+son, who got off the respirator on December 31st and is age 43,
+is wondering is it ever going to be his turn? So I just want a
+comment on that in my seven seconds.
+ Mr. Reed. I would say for us----
+ Ms. Moore. OK. Go on.
+ Mr. Reed. Well, I would just say for us in Oklahoma, the--
+really the only age disparity that we created was we cutoff at
+65-plus, and that was based off of the morbidity data that we
+had in Oklahoma. And then at this point we're moving to any
+adult under 65 with comorbidities. And we want to make sure
+that we are reaching out to our underserved communities, our
+communities of color, and work with our partners to make sure
+that we are reaching out to these communities and ensuring that
+we do get a level of vaccine equity that may not be based off
+of just the broad statewide plan. Again, we want to push that
+locally when we know that our local partners recognize the
+needs in their communities, and they can reach out to those
+individuals and help us to reach that level of equity we need
+to reach.
+ Ms. Moore. And, Madam Chair, my time is expired. Thank you
+for your indulgence, and I yield back.
+ Chairwoman Johnson. Thank you.
+ Staff. Is Mr. Kildee available?
+ Mr. Kildee. Yes, I am.
+ Staff. OK, you're next, sir.
+ Mr. Kildee. OK. I got to start my video. There we go.
+ All right. Well, first of all, thank you to Chair Johnson
+for holding this meeting. I'm so happy to be a Member of this
+Committee. And this hearing, my first hearing as a Member of
+the Committee, completely affirms what I had hoped for, that we
+would have a meaningful and really fact-based conversation
+about this really important subject. So thank you, Chairwoman
+Johnson, for your leadership in holding this hearing.
+ I have been in and out of the hearing. I just had to jump
+off for a minute to wish my 15-year-old nephew in Ireland a
+happy birthday on Zoom, so I may have missed a bit. And some of
+this may be redundant, but the subject is so critical. I
+apologize for any redundancy here.
+ Two of the communities that I represent are Flint and
+Saginaw, Michigan, both majority minority communities. And, as
+we know, African-Americans are at significantly greater risk. I
+have lost several friends, four very close friends that were
+lifetime friends, to COVID, so this is obviously not just a big
+issue for us as a country but it's very personal for many of
+us.
+ For the people in my hometown of Flint, as you might
+expect, this trauma comes in addition to the ongoing trauma of
+the water crisis that many are still recovering from. And at
+the core of that crisis was a complete breach of trust between
+government and the people of the community. The lack of trust
+between the people of Flint and public institutions is even
+worse than it is in many other communities. And so many of you
+mentioned in your testimony the skepticism--natural skepticism
+of the--of communities of color for any institution but
+particularly medical--the medical system because of the legacy
+of exploitative research. So this is not going to be easy to
+overcome.
+ And I wonder, maybe starting with Dr. Buttenheim, if you
+could comment as if you're speaking to the people of Flint and
+Saginaw, what can you tell us, what can you tell them, what--
+especially for leaders in the community, what are the evidence-
+based actions that leaders should be taking to encourage
+vaccine uptake and to address the distrust in communities of
+color? I know you've addressed this, but if you could just
+reiterate that for the people I represent, it would be really
+helpful.
+ Dr. Buttenheim. Sure. And the thing I put at the top of
+the list is to listen. You actually don't have to do all the
+talking and all the information conveying up front. A lot of
+this is tell me what's going on, tell me where you are with
+this, tell me about past experiences that have made--you know,
+have given you concerns about this vaccine, what questions do
+you need answered. I do think listening can go a long way here.
+ And then the other piece which will not be a surprise to
+you with Flint is of course to find those trusted sources, you
+know, who will people listen to? And if those people can share
+their why, what's your why, you know, if they can talk about
+their decision to get the vaccine in--you know, in sort of
+dialog with people, they can go a long way, too.
+ Finally, to the extent local and State health authorities
+can be transparent about the conversation and acknowledge--you
+know, I think if you just kind of skip over the fact that we
+maybe don't have trust in public health authorities, like
+you're already just behind the 8-ball. I don't know if that's
+the right metaphor. I'm not a sports person. But incorporating
+the recognition and acknowledgement of those--of the history
+and the present of structural racism and institutional racism
+and making that part of this conversation can also be helpful.
+ Mr. Kildee. I wonder if you could also, Dr. Buttenheim,
+zero in a bit. I was really interested in your testimony. I
+thought it was well-presented, the five points, but the third
+point you made about keep doing the hard stuff, I mean, this
+sort of falls into the category of hard stuff.
+ Dr. Buttenheim. Yes.
+ Mr. Kildee. If you could talk about how this relates to
+that point, that would be helpful.
+ Dr. Buttenheim. Yes. Sure. And I will say this is, you
+know, science happening in real time. My guidance on this and
+my instinct is really coming from following some I will say
+mostly Black female physicians on social media and some I know
+here at Penn who are doing this work on top of everything else
+they're doing by having conversations every day with patients,
+with people they run into in their daily lives. I'm thinking of
+Dr. Kimberly Manning at Grady Hospital in Atlanta. I'm thinking
+of Dr. Gina South here at Penn Medicine. And in their--like
+literally in their Tweet threads about this they provide
+templates for how to have these conversations. And the first
+thing you realize is, wow, these women are very powerful and
+very effective at listening and reflecting and sharing their
+own stories, and, boy, this work is hard. And again, you
+couldn't turn this into something that, you know, you could
+suddenly reach 1,000 people with because it is these one-on-one
+conversations.
+ So that's sort of where that point No. 3 came from in my
+testimony as recognizing the power of that and also the
+limitations in that we--it's hard to scale and it's hard to
+keep asking of some of these people to keep doing this labor.
+ Mr. Kildee. Great. Well, I really appreciate the
+testimony. I appreciate, again, as I said, the Chairwoman for
+holding this hearing. I wish I had an hour to ask questions
+because we have so many, but this has really been helpful.
+Thank you. I yield back.
+ Staff. Ms. Wild is next.
+ Ms. Wild. Thank you so much. I really appreciate it. I
+would like to join in Mr. Kildee's comments regarding this
+Committee. I am new to the Committee. I am thrilled to be on
+it, and I think the very substantive nature of this hearing is
+exactly what I was looking for in terms of a committee, so
+thank you very much, Chairwoman.
+ My question--I'm rather late in the questioning order. My
+question was going to be for Dr. Neuzil. But I'm going to ask
+Dr. Buttenheim if she might be able to assist me with this
+question. In recent weeks we have seen news of viral variants
+reaching U.S. shores. Evidence suggests that some of these
+variants may be more contagious than the original SARS-CoV-2
+virus. And I've seen a number of anecdotal stories about some
+severe concerns with how quickly the--one of the variants in
+particular is spreading. Can you tell us a bit about how we
+should expect the existing vaccines to perform against the new
+variants, and what if anything do we know about the vaccines
+that are in the pipeline in terms of their effectiveness
+against the new variants?
+ Dr. Buttenheim. Thank you, Representative Wild. I wish Dr.
+Neuzil were here because that is well out of my area of
+expertise. I'm neither a virologist, nor an epidemiologist or
+immunologist, so I will----
+ Ms. Wild. I was concerned about that. I don't know whether
+any of the other witnesses have any response on that. If not,
+I'll move on, but if you do, please feel free to comment, Dr.
+Huang or----
+ Dr. Huang. That really would be a Dr. Neuzil question for
+expertise.
+ Ms. Wild. That's fine. That's fine. So I--let me move to a
+different question then. And I'll address this to anybody who
+might be able to answer it. A number of people have the sense
+that these vaccine processes have been rushed and that maybe
+safety took a backseat. Can you comment on the integrity and
+the vaccine trial data? And, you know, a follow-up to that
+would be that some people are queasy about the name Operation
+Warp Speed. I'm actually at a vaccination clinic today. I'm
+doing this from a hospital conference room where they just
+celebrated giving their 100,000th vaccination today. So that's
+obviously commendable, but there are still so many more people
+that we know are going to need to be vaccinated. Is there any
+indication that scientific integrity and the safety of patients
+ever took a backseat in the Federal Government's effort to
+support the vaccine development? Anybody----
+ Dr. Huang. Again, I would say that probably Dr. Neuzil
+testimony earlier addressed that. You know, I mean, I think
+that there has been--yes, I mean, I think she covered a lot of
+that pretty quickly.
+ Regarding the interpretation of Operation Warp Speed, you
+know, I did express in my testimony we have heard that from the
+front, you know, people in the community that just that term,
+because of the fear or the concern that it was rushed, that
+that term does seem to reinforce that in some circles. So--and
+I've heard specifically that, and that is one of the vaccine
+hesitancy sort of concerns out there.
+ Ms. Wild. I'm hearing that a lot, too. Any best practices
+in terms of--that you can share with us in terms of convincing
+people who are more reluctant than others?
+ Dr. Buttenheim. You know, where I've seen communications
+be persuasive, there are sort of two aspects. One is showing
+how parts of this vaccine have been worked on for a long time,
+right? Like we actually have decades of research that got us to
+this point, which is why we have a 1-year vaccine instead of a
+4-year or a 10-year vaccine.
+ And I think the other persuasive piece is the confidence
+from experts like Dr. Neuzil that the approval process was not
+compromised in any way. You know, the FDA and the CDC have
+traditionally been two institutions that Americans have a lot
+of trust in that, you know, has had a rocky road the last
+couple years. But, you know, experts saying, yes, all the
+right, you know, i's were dotted and t's were crossed that got
+us to these emergency use authorizations, and sort of saying
+that over and over again also seems to be persuasive.
+ Ms. Wild. Thank you so much. Madam Chairwoman, I yield
+back.
+ Chairwoman Johnson. Thank you.
+ Staff. No additional Members for questions, Ms. Johnson.
+ Chairwoman Johnson. Well, thank you very much. And let me
+thank our witnesses. I do have one more question before we
+close out. I apologize for it taking us so long to get through
+it, but it lets you know how interested we are in these
+questions.
+ And I know that some of these questions that I might have
+here might be more appropriate for Dr. Neuzil. If that is the
+case, we will send the questions to her.
+ But what are the side effects of the Pfizer and Moderna
+vaccines? Are they mild or severe? And how often do people
+experience the side effects?
+ Dr. Huang. I mean, there are certainly some localized side
+effects, localized pain, redness, some of the common aches and
+pains, joint pain, body aches, headache, sometimes fever,
+typically short-lived. Some of the severe side effects, you
+know, I mean, that we would be worried about would be the
+severe allergic reaction, anaphylaxis. The only real
+contraindication, you know, is to have a history of anaphylaxis
+to any of the actual components in the vaccine or also then,
+you know, there's a delay recommended just if you had another
+vaccine in 14 days. But, again, there are--you know, and
+there's protocols in place for monitoring these vaccines.
+There's the V-safe program where everyone is being--you know,
+if they sign up, get daily text messages to report these side
+effects.
+ Chairwoman Johnson. OK. Is it possible for a vaccine to
+mutate into an active form of the virus or infect someone who
+is healthy?
+ Dr. Huang. Again, it was addressed by Dr. Neuzil. It's not
+an actual live virus. These are--so it can't mutate into
+another virus that would infect persons.
+ Chairwoman Johnson. Thank you. What's going on with
+chemicals in vaccines in general, and do we need to be worried
+about them?
+ Dr. Huang. Yes, I don't know that--maybe that might be
+something to talk to Dr. Neuzil about.
+ Chairwoman Johnson. OK. We will submit some questions to
+her. One last question. Is it possible for a vaccine to cause
+autism?
+ Dr. Buttenheim. The great, great preponderance of data--
+and there's a lot of it and a lot of studies--you know, it's
+hard to prove a negative, but there has never--there has not
+been any credible research, sustained, replicated that gives
+any suggestion that there's a relationship between vaccines and
+autism.
+ Dr. Huang. And the original research was actually
+disproved----
+ Dr. Buttenheim. Exactly.
+ Dr. Huang [continuing]. And the author has been
+discredited and it's been retracted and so----
+ Dr. Buttenheim. It's an incredibly, incredibly sticky
+worry, very hard to unstick people from that worry, I will say,
+behaviorally, but no science to support it.
+ Chairwoman Johnson. Thank you very much. Does anyone else
+want to ask any questions before we close out?
+ Well, thanks to all of you. This has been incredibly
+important. And you--and I so apologize for the technology
+glitches at the beginning. We will try to make sure that we can
+try to clear those up. This is a technology committee, and I'm
+the first to admit that I'm a little old for the era, and so
+I'm just as guilty as anyone else for not knowing exactly how
+to clear it up when it happens.
+ But before I close, I want to really thank all of you who
+testified and all of what you're doing and to say that this
+Committee certainly had interest in your coming today, as you
+can tell. We're sorry it went so long, but the record will
+remain open for 2 weeks for any additional statements from
+Members or our witnesses for any additional questions.
+ So before I excuse the witnesses, let me say one more time
+how much we appreciate you being here and how helpful your
+information has been.
+ Our witnesses are now excused, and our hearing is
+adjourned. Thanks to all of you.
+ [Whereupon, at 2:40 p.m., the Committee was adjourned.]
+
+ Appendix I
+
+ ----------
+
+
+ Answers to Post-Hearing Questions
+
+Responses by Dr. Kathleen Neuzil
+[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
+
+Responses by Dr. Philip Huang
+[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
+
+Responses by Mr. Keith Reed
+[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
+
+Responses by Dr. Alison Buttenheim
+[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
+
+ Appendix II
+
+ ----------
+
+
+ Additional Material for the Record
+
+ Documents submitted by Representative Gwen Moore
+[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
+
+ Documents submitted by Representative Bill Posey
+[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
+
+ [all]
+