[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
CORONAVIRUSES: UNDERSTANDING
THE SPREAD OF INFECTIOUS DISEASES
AND MOBILIZING INNOVATIVE SOLUTIONS
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON SCIENCE, SPACE, AND TECHNOLOGY
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
__________
MARCH 5, 2020
__________
Serial No. 116-71
__________
Printed for the use of the Committee on Science, Space, and Technology
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://science.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
39-909 PDF WASHINGTON : 2020
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COMMITTEE ON SCIENCE, SPACE, AND TECHNOLOGY
HON. EDDIE BERNICE JOHNSON, Texas, Chairwoman
ZOE LOFGREN, California FRANK D. LUCAS, Oklahoma,
DANIEL LIPINSKI, Illinois Ranking Member
SUZANNE BONAMICI, Oregon MO BROOKS, Alabama
AMI BERA, California, BILL POSEY, Florida
Vice Chair RANDY WEBER, Texas
CONOR LAMB, Pennsylvania BRIAN BABIN, Texas
LIZZIE FLETCHER, Texas ANDY BIGGS, Arizona
HALEY STEVENS, Michigan ROGER MARSHALL, Kansas
KENDRA HORN, Oklahoma RALPH NORMAN, South Carolina
MIKIE SHERRILL, New Jersey MICHAEL CLOUD, Texas
BRAD SHERMAN, California TROY BALDERSON, Ohio
STEVE COHEN, Tennessee PETE OLSON, Texas
JERRY McNERNEY, California ANTHONY GONZALEZ, Ohio
ED PERLMUTTER, Colorado MICHAEL WALTZ, Florida
PAUL TONKO, New York JIM BAIRD, Indiana
BILL FOSTER, Illinois FRANCIS ROONEY, Florida
DON BEYER, Virginia GREGORY F. MURPHY, North Carolina
CHARLIE CRIST, Florida VACANCY
SEAN CASTEN, Illinois
BEN McADAMS, Utah
JENNIFER WEXTON, Virginia
CONOR LAMB, Pennsylvania
VACANCY
C O N T E N T S
March 5, 2020
Page
Hearing Charter.................................................. 2
Opening Statements
Statement by Representative Ami Bera, Vice Chairman, Committee on
Science, Space, and Technology, U.S. House of Representatives.. 10
Written statement............................................ 11
Statement by Representative Frank Lucas, Ranking Member,
Committee on Science, Space, and Technology, U.S. House of
Representatives................................................ 12
Written statement............................................ 13
Written statement by Representative Eddie Bernice Johnson,
Chairwoman, Committee on Science, Space, and Technology, U.S.
House of Representatives....................................... 47
Witnesses:
Dr. Suzan Murray, Program Director, Smithsonian Global Health
Program, Smithsonian's National Zoo & Conservation Biology
Institute
Oral Statement............................................... 15
Written Statement............................................ 17
Dr. John Brownstein, Chief Innovation Officer, Boston Children's
Hospital; Professor, Harvard Medical School
Oral Statement............................................... 20
Written Statement............................................ 22
Dr. Peter Hotez, Professor and Dean, National School of Tropical
Medicine, Baylor College of Medicine; Co-Director, Texas
Children's Hospital Center for Vaccine Development
Oral Statement............................................... 30
Written Statement............................................ 33
Dr. Tara Kirk Sell, Senior Scholar, Johns Hopkins Center for
Health Security; Assistant Professor, Johns Hopkins Bloomberg
School of Public Health
Oral Statement............................................... 38
Written Statement............................................ 40
Discussion....................................................... 47
Appendix I: Answers to Post-Hearing Questions
Dr. Suzan Murray, Program Director, Smithsonian Global Health
Program, Smithsonian's National Zoo & Conservation Biology
Institute...................................................... 72
Dr. John Brownstein, Chief Innovation Officer, Boston Children's
Hospital; Professor, Harvard Medical School.................... 76
Dr. Peter Hotez, Professor and Dean, National School of Tropical
Medicine, Baylor College of Medicine; Co-Director, Texas
Children's Hospital Center for Vaccine Development............. 82
Dr. Tara Kirk Sell, Senior Scholar, Johns Hopkins Center for
Health Security; Assistant Professor, Johns Hopkins Bloomberg
School of Public Health........................................ 86
Appendix II: Additional Material for the Record
Letter submitted by Representative Ami Bera, Vice Chairman,
Committee on Science, Space, and Technology, U.S. House of
Representatives................................................ 90
Articles submitted by Representative Ed Perlmutter, Committee on
Science, Space, and Technology, U.S. House of Representatives.. 91
Article submitted by Representative Bill Foster, Committee on
Science, Space, and Technology, U.S. House of Representatives.. 126
Letter submitted by Representative Don Beyer, Committee on
Science, Space, and Technology, U.S. House of Representatives.. 131
CORONAVIRUSES: UNDERSTANDING
THE SPREAD OF INFECTIOUS DISEASES
AND MOBILIZING INNOVATIVE SOLUTIONS
----------
THURSDAY, MARCH 5, 2020
House of Representatives,
Committee on Science, Space, and Technology,
Washington, D.C.
The Committee met, pursuant to notice, at 9:03 a.m., in
room 2318 of the Rayburn House Office Building, Hon. Ami Bera
[Chairman of the Committee] presiding.
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman Bera. This hearing will come to order. Without
objection, the Chair is authorized to declare recess at any
time. Good morning, and welcome today's hearing on
``Coronavirus: Understanding the Spread of the Infectious
Disease, and Mobilizing Innovative Solutions''. I'll recognize
myself for an opening statement, and then I'll recognize the
Ranking Member for his opening statement, then we'll introduce
the witnesses.
Again, thank you for being here. Obviously, this is an
incredibly timely topic. COVID-19 is not the first pandemic
we're going to ever deal with, and it certainly is not going to
be the last one, but it is incredibly important that we come
together as a nation, and as a planet, to get ahead of this,
address it, and, you know, come up with the treatment for it.
If we think about, you know, the basis of global health
security, it's a three-pronged approach, containment,
mitigation, and then treatment.
This is the third hearing that I'm chairing on this
subject, and the first hearing focused on the containment
strategy. That was actually the first hearing that Congress
held. Conclusion of that was the initial strategy of trying to
contain this disease with travel bans, et cetera, was likely
not going to be successful, very difficult. You know, I think
what China did was ambitious, it bought us some time but most
of us in the public health world--and I'm a physician by
background, and ran a large public health system--recognize
that we would likely see community cases. It would be very
difficult to stop the spread of this disease.
The second hearing we had, which was last Thursday, was on
mitigation, largely looking at testing. And this was last
Thursday, after the first community spread case hit my home
county of Sacramento, where a patient was hospitalized at the
University of California Davis Health System, where I used to
practice. What we discovered was, you know, the testing
criteria were probably too rigid, that we were missing a lot of
community tests, and we also started to discover the ability to
test folks, the availability of test kits, et cetera, was
largely not there. I'm pleased, you know, to hear the Vice
President yesterday. Things are ramping up, but we probably did
lose quite a bit of time, and we are likely going to see many
more community cases, probably in all of our congressional
districts. So we still, you know, there's a lot to be learned
from kind of the bureaucratic breakdown that prevented us from
rapidly getting those tests out there.
Today's hearing is focused on treatment based on science,
and what we can learn from how this virus initially developed,
what we can learn from looking at the Chinese response. We now
have a big data set. How did they manage folks? You know, China
is a communist country, so they were able to do things that we
can't do as a democratic nation. You know, we respect
individual rights and individual freedoms here, but there's
still a lot that we can learn from how they did surveillance,
et cetera, especially given the breadth of contact tracing that
we likely are going to have to do based on the community cases
that we're going to see all across the United States. We won't
have enough epidemiologists, the CDC (Centers for Disease
Control and Prevention) won't have enough personnel, so what
can we learn in how China and Korea--and if you're looking at
the data that's coming out of Korea now, their aggressive
approach to testing, and community-based testing. They were
doing 15,000 tests a day, may have actually mitigated and
reduced how bad the response could've been. So I think that's
going to be incredibly important.
We're also going to look at the science of, you know, how
is it spread? How efficiently is it spread? You know, how long
can this virus live as a fomite on inanimate objects? So, you
know, I think this is an incredibly timely hearing. I think
this is, you know, this is the Science Committee, so I'm glad
that we're looking at the science of this, and the science
basis of treatment, and, again, I appreciate the witnesses that
are here that are bringing their scientific expertise to help
us better understand this disease.
[The prepared statement of Chairman Bera follows:]
Good morning and welcome to today's hearing on
Coronaviruses: Understanding the Spread of Infectious Diseases
and Mobilizing Innovative Solutions. I want to thank Ranking
Member Lucas, the Members of this Committee, and our witnesses
for joining us today to discuss the scientific tools and
research investments we need to better detect, predict, and
understand the spread of emerging diseases. While the
Chairwoman is not able to join today, I'm proud to hold the
gavel and appreciate her strong commitment to public health.
As a doctor, the former Chief Medical Officer of Sacramento
County, and a member of the CSIS Commission on Strengthening
America's Health Security, I have been a strong advocate of
American leadership in global health. Congress' job is to
exercise oversight over the federal government's response to
COVID-19. That is precisely what I have been doing, both as the
Vice Chair of the Science, Space, and Technology Committee and
as the Chairman of the Foreign Affairs Subcommittee on Asia,
the Pacific, and Nonproliferation. In addition to this hearing,
I have chaired two other Congressional hearings on the
coronavirus outbreak, sounded the alarm when the White House
disbanded the office in charge of preparing for pandemics, and
sought to include funds to combat coronavirus over a month ago
through other legislation.
Viruses have caused some of the most dramatic and deadly
disease outbreaks in human history. Novel viruses of animal
origin-like SARS and MERS-have been emerging at an alarming
rate over the last two decades. People are traveling more
internationally and living in more densely populated areas. We
are expanding into new geographic areas through deforestation,
mining, and agricultural land use. Humans are coming into
closer contact with animal species that are the perfect hosts
of infectious agents, making it easier for viruses to jump from
animals to humans.
Disease outbreaks caused by new viral infections are a
growing public health concern for the global community, as
viruses show no respect for national boundaries. The effect of
COVID-19 on our communities will depend on how the virus
spreads, the severity with which people get sick, and the
measures we have available to control its impact. I'd like to
drive home the point that these questions can all be answered
by a rapid and robust research response.
Yet recent outbreaks have highlighted the strengths and
weaknesses of our research and development response, both
domestically and internationally. We need additional research
to expedite the development of diagnostic tests to quickly
identify those that are sick and push those testing
capabilities to every state. Not only will this protect our
public health personnel on the front lines, but it will also
give them the tools to combat the disease head on.
Thanks to my role with the Foreign Affairs Committee, I am
also aware of the importance of social science in guiding our
response and actively combating the spread of misinformation
around infectious disease outbreaks. Fear, anxiety, and stigma
can drive sick people to hide their symptoms to avoid
discrimination, prevent some individuals from seeking health
care immediately, and discourage others from adopting healthy
behaviors. Integrating social scientists into our outbreak
response helps communities accept and adhere to public health
measures aimed at limiting the spread of disease.
Research and development actions are an integral part of
the response to an outbreak. Scientists are using innovative
technologies like artificial intelligence to detect and predict
the spread of disease more effectively. Others are conducting
research to optimize the use of currently available treatments
and evaluate candidates for new drugs and vaccines. It is
apparent now more than ever that our best scientists should be
leading our response.
For the last 14 months, this Committee has worked
tirelessly to ensure that decision-making is driven by science.
Now is the time to listen and trust science and use it to react
calmly and smartly to COVID-19. It is critical that we are not
swayed by misinformation and avoid the stigmatization of
vulnerable groups.
This issue has hit close to home. The first reported death
from COVID-19 in California occurred in Roseville, California,
which borders my district. Sacramento County is now monitoring
several potential cases of COVID-19 transmission. The hospital
where I used to attend in and teach medical students is
treating a patient with the disease. My heart is with those who
are currently suffering.
I continue to believe that the risk to the American people
is low at this time. But this disease is global in scope and it
is impacting our communities and our economy. Tackling it will
require our communities, our government, and our international
partners working together. With American leadership, we can do
it. But it will require proper planning, coordination, and
resourcing. It's not too late.
I look forward to hearing from our witnesses today on how
we can best support our nation's scientists as they deploy new
health technologies and develop scientific information critical
to controlling and mitigating the effects of emerging
infectious diseases.
With that, I will turn it over to the ranking member, Mr.
Lucas.
Chairman Bera. With that, the Chair now recognizes the
Ranking Member, Mr. Lucas, for his opening statement.
Mr. Lucas. Good morning, and thank you, Dr. Bera, for
holding this important hearing as we deal with an emerging and
rapidly evolving situation with the spread of coronavirus,
COVID-19. According to the Centers for Disease Control at this
time, most people in the United States have little immediate
risk of exposure to the virus, however, public health experts
also advise us a pandemic is likely, so we must gather the
facts and be prepared. Today I hope our expert witnesses can
provide important information we can share with our
constituents. I also hope we can learn what tools are needed to
detect, predict, and prevent the next pandemic.
COVID-19 was first identified in Wuhan, China in December
of 2019. Since then the World Health Organization has reported
over 90,000 confirmed cases, and over 3,000 deaths spread
throughout 76 countries. In the United States, the CDC has
reported at least 152 confirmed cases and 11 deaths. We know
that for most individuals the illness is not serious, but we're
still getting information on the death rate. The impact on
vulnerable populations is particularly concerning, though, and
my thoughts are with the individuals and families that have
been affected.
This is not the first global pandemic in modern times, and
I'm quite certain it won't be the last. Just over 100 years ago
the world faced one of the deadliest pandemics in history, the
1918 avian flu pandemic, also known as the Spanish flu. It
killed an estimated 50 million people worldwide, including over
600,000 people in the United States. Since 1980, outbreaks of
emerging infectious diseases have been occurring with greater
frequency and have been causing higher numbers of human
infections than in the past. The vast majority of these
infections are initially caused by the spread of the disease
from animals to humans. A SARS (Severe Acute Respiratory
Syndrome) outbreak in 2003 and an avian flu outbreak in 2006
were wakeup calls for the American public health system, and
Congress made considerable investments in improving our
Nation's capacity to detect and respond to pandemics. We would
be in a much worse position today without those investments.
I'm confident that the U.S. Government has the tools
necessary to deal with this. We have the best scientists in the
world with NIH (National Institutes of Health), CDC, and in our
universities. Their work has yielded considerable advancements
in health technology, disease surveillance, and predictive
modeling, as well as medicine, drugs, and vaccine development.
With the integration of technology like artificial intelligence
(AI), and the greater availability of data, researchers are now
able to identify and track outbreaks faster. Last Congress, we
also modernized the Pandemic All-Hazards Preparedness Act to
set up a framework to deal with precisely this type of
outbreak. While significant progress has been made, gaps
remain, and a severe pandemic like the novel coronavirus could
be devastating to the global population.
As the human population has grown, so has the livestock,
swine, and poultry populations needed to feed us. This expanded
number of hosts provides increased opportunities for viruses
from birds, cattle, and pigs to spread, evolve, and infect
people. To better understand how zoonotic diseases like avian
flu, swine flu, Ebola, Zika, SARS, and now coronavirus spread
and operate, we must invest in basic research to learn more
about the interconnection between people, animals, and plants
in shared environments. Yesterday the House passed a
supplemental appropriations bill to address the response to
COVID-19 and the development of a vaccine. I supported the
bipartisan bill, and I hope my colleagues and I can work
together on a long-term strategy to prepare for any global
pandemic we may face in the future. Our top priority is the
health and welfare of the American people.
I'm pleased the President has created the Coronavirus Task
Force. This interagency group is working to monitor, contain,
and mitigate the spread of the novel coronavirus, while
ensuring the American people have access to accurate and up-to-
date health and travel information. The best thing Americans
can do right now is to follow the guidance of CDC. Many of
their recommendations are simple ones you learned from your
mother. Wash your hands, wash your hands, do it thoroughly and
frequently, cover your mouth to cough or sneeze, avoid touching
your face, stay home if you are sick.
I want to thank the witnesses for taking the time to come
here to share their expertise and insights with us during this
crucial time to help keep Americans safe, healthy, and secure.
And, with that, I yield back the balance of my time, Mr.
Chairman.
[The prepared statement of Mr. Lucas follows:]
Good morning and thank you Chairwoman Johnson for holding
this important hearing as we deal with an emerging and rapidly
evolving situation with the spread of the coronavirus COVID-19.
According to the Centers for Disease Control (CDC), at this
time most people in the United States have little immediate
risk of exposure to the virus. However, public health experts
also advise us a pandemic is likely, so we must gather the
facts and be prepared.
Today I hope our expert witnesses can provide important
information we can share with our constituents. I also hope we
can learn what tools are needed to detect, predict, and prevent
the next pandemic.
Covid-19 was first identified in Wuhan, China in December
2019. Since then the World Health Organization has reported
nearly 90,000 confirmed cases and over 3,000 deaths spread
throughout 76 countries. In the United States, the CDC has
reported 152 confirmed cases and 11 deaths. We know that for
most individuals the illness is not serious, but we are still
getting information on the death rate. The impact on vulnerable
populations is particularly concerning though, and my thoughts
are with the individuals and families that have been affected.
This is not the first global pandemic in modern times, and
I am certain it won't be the last. Just over a hundred years
ago the world faced one of the deadliest pandemics in history -
the 1918 avian flu pandemic, also known as the "Spanish flu."
It killed an estimated 50 million people worldwide, including
over 600,000 people in the United States.
Since 1980, outbreaks of emerging infectious diseases have
been occurring with greater frequency and have been causing
higher numbers of human infections that inthe past. The vast
majority of these infections are initially caused by the spread
of disease from animals to humans.
A SARS outbreak in 2003 and an Avian flu outbreak in 2006
were wake-up calls for the American public health system, and
Congress made considerable investments to improve our nation's
capabilities to detect and respond to pandemics. We would be in
a much worse position today without those investments.
I am confident the U.S. government has the tools necessary
to deal with this. We have the best scientists in the world at
NIH, CDC, and in our universities. Their work has yielded
considerable advancements in health technology, disease
surveillance and predictive modeling, as well as medicine,
drugs, and vaccine development.
With the integration of technology like artificial
intelligence and the greater availability of data, researchers
are now able to identify and track outbreaks faster. Last
Congress, we also modernized the Pandemic All-Hazards
Preparedness Act to set up a framework to deal precisely with
this type of an outbreak. But while significant progress has
been made, gaps remain, and a severe pandemic like the novel
coronavirus could be devastating to the global population.
As the human population has grown, so has the livestock,
swine and poultry populations needed to feed us. This expanded
number of hosts provides increased opportunities for viruses
from birds, cattle and pigs to spread, evolve, and infect
people.
To better understand how zoonotic diseases like avian and
swine flu, Ebola, Zika, SARS, and now COVID-19 spread and
operate, we must invest in basic research to learn more about
the interconnection between people, animals, and plants in
shared environments.
Yesterday the House passed a supplemental appropriations
bill to fund the response to COVID-19 and the development of a
vaccine. I supported the bipartisan bill. But I hope my
colleagues and I can work together on a long-term strategy to
prepare for any global pandemic we may face in the future.
Our top priority is the health and welfare of the American
people. I am pleased the President has created the Coronavirus
Task Force. This interagency group is working to monitor,
contain, and mitigate the spread of the novel coronavirus while
ensuring the American people have access to accurate and up-to-
date health and travel information. The best thing Americans
can do right now is follow the guidance of the CDC. Many of
their recommendations are simple ones you learned from your
mother, wash your hands thoroughly and frequently, cover your
cough or sneeze, avoid touching your face, and stay home if you
are sick. I want to thank the witnesses for taking the time to
be here to share your expertise and insights with us during
this crucial time to help keep Americans safe, healthy, and
secure. I yield back the balance of my time.
Chairman Bera. Thank you, Mr. Lucas. If there are members
who wish to submit additional opening statements, your
statements will be added to the record at this point.
At this time I'd like to introduce our witnesses. First we
have Dr. Suzan Murray. Dr. Murray is the Program Director of
the--for the Global Health Program at the Smithsonian's
National Zoo and Conservation Biology Institute. Next is Dr.
John Brownstein. Dr. Brownstein is the Chief Innovation Officer
at Boston Children's Hospital, and a Professor at Harvard
Medical School. Third I welcome Dr. Peter Hotez, who will be
introduced by the Chair for the Subcommittee on Energy, Lizzie
Fletcher of Texas.
Mrs. Fletcher. Thank you very much, Mr. Chairman. It's
truly a privilege and a pleasure to introduce an
internationally recognized physician/scientist in global
health, neglected tropical diseases, and vaccine development
who is also my neighbor, and a true leader in our community in
Houston, Dr. Peter Hotez.
Dr. Hotez is Professor and Dean at Baylor College of
Medicine, and Co-Director of Texas Children's Hospital Center
for Vaccine Development. As head of Texas Children's Center for
Vaccine Development, he leads a team of product development
partnership for developing new vaccines for a variety of
diseases, including other human coronaviruses, like SARS and
MERS (Middle East Respiratory Syndrome), diseases affecting
hundreds of millions of children and adults worldwide, while
championing access to vaccines globally and in the United
States. Dr. Hotez, welcome. We are glad to have you here today.
Chairman Bera. And lastly we have Dr. Tara Kirk Sell. Dr.
Sell is a Senior Scholar at Johns Hopkins Center of Health
Security, and is an Assistant Professor at Johns Hopkins
Bloomberg School of Public Health.
You will each have 5 minutes for your spoken testimony.
Your written testimony will be included in the record for the
hearing. When you have completed your spoken testimony, we'll
begin with questions. Each member will have 5 minutes for
questioning. Dr. Murray, you may proceed.
TESTIMONY OF SUZAN MURRAY, PROGRAM DIRECTOR,
SMITHSONIAN GLOBAL HEALTH PROGRAM,
SMITHSONIAN'S NATIONAL ZOO
AND CONSERVATION BIOLOGY INSTITUTE
Dr. Murray. Thank you very much. Congressman Bera, Ranking
Member Lucas, and all Members of the esteemed Committee, thank
you for calling this hearing, and inviting me to participate.
My name is Dr. Suzan Murray, and I'm the Director of
Smithsonian's Global Health Program, based out of the National
Zoological Park and Conservation Biology Institute. Our program
utilizes experts in wildlife medicine, human medicine, public
health, conservation, biology, and epidemiology to study and
respond to health issues at the human/animal interface. We
utilize a multidisciplinary approach to investigate emerging
infectious diseases that threaten both human and animal life,
and we build in-country capacity to train the next generations
of health specialists. In short, this is the reason right now
that our program was created.
Human health, wildlife, and environmental health are
inextricably linked, and closely depend upon each other. In
order to safeguard the survival of all species, it's critical
that we examine health across a continuum of species, and have
research and decisions firmly rooted in scientific knowledge.
Understanding the current viral threats, the patterns and
drivers of disease emergence, and the human behaviors that
contribute to such emergence, will best allow us to not only
respond to this outbreak, but the next one, and the one after
that, because we do know they're coming. Already we have
identified many of the drivers of disease emergence and spread,
including land use change, increased human/wildlife
interaction, and the globalization of travel and markets.
Time and history have repeatedly shown us that it is much
more humane, efficient, and economical to prevent disease
rather than to identify, respond, diagnose, treat, and attempt
to contain an outbreak. Through increased understanding of the
as-yet undiagnosed viruses, the drivers of emergence, and the
risk factors associated with various behaviors, we can develop
the early warning systems, prepare for--prepare rapid response
teams, and provide critical data and information to the vaccine
industry to better prepare for the next outbreak. Just as
critical, we must educate local medical professionals, and the
people living in the communities at the greatest risk of
outbreaks. By preventing the spread of pathogens at the source,
we can avoid the global consequences that we are experiencing
now.
For example, over the last 10 years, and working with
partner agencies, our team has collectively identified over
1,200 novel mammalian viruses. So that's, you know, 1,200 is a
lot of viruses. It's only a small amount of the ones that are
out there. One hundred sixty-one of these belong to the same
family as COVID-19. In this time we also strengthened the
capability for virus detection and characterization in 60 labs,
and--in which pandemics are most likely to originate. We've
also trained over 6,000 people in more than 30 countries at the
frontline of defense against emerging diseases. At this moment,
the world is focused on the novel coronavirus, COVID-19, as it
should be. While it's essential that we do everything we can to
respond to this global crisis, it's also the time we need to be
thinking of emerging viruses. The next global pandemic is not a
matter of if, but when and where. To quickly identify and
contain such infections, health and disease must be evaluated
across species, and on a global scale.
While he might not have imagined it in this context, Ben
Franklin was right when he said an ounce of prevention is worth
a pound of cure. When it comes to outbreaks, the costs of
responding to a crisis can dwarf the up front investment in
research and education. Beyond a clear moral obligation to
protect human life, there are staggering financial benefits
from focusing on preventative measures. For example, the human
and economic toll from the West African Ebola outbreak was
massive. More than 11,000 people lost their lives, and well
over $4 billion was spent globally. In case of the SARS
epidemic of 2004, the estimated global financial impact was
between $30 and $50 U.S. billion dollars, and the current COVID
impact, while still evolving, and a dynamic situation, is
expected to be on orders of magnitude higher.
Advancements in the detection of novel pathogens show that
the most efficient way to respond to and contain an outbreak is
through the coordinated wildlife and human surveillance. While
we estimate there are 1.7 as yet unknown viruses, about half of
which can affect human people, and some lead to new pandemics.
As of now, there are no coordinated programs to work in high
risk regions to identify these unknown viruses, get their
genetic sequences into labs, and identify ways to reduce risk
of them emerging. Our best defense against spreading diseases
that make their way into the human population is through
research and education. While we cannot stop every disease
outbreak, we can reduce their frequency, and build the capacity
for a rapid global response when they do occur.
Thank you once again for this hearing, and your interest
in this pressing and important topic. I look forward to
answering any questions you might have.
[The prepared statement of Dr. Murray follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
TESTIMONY OF JOHN BROWNSTEIN,
CHIEF INNOVATION OFFICER,
BOSTON CHILDREN'S HOSPITAL
AND PROFESSOR, HARVARD MEDICAL SCHOOL
Dr. Brownstein. Congressman Bera, Ranking Member Lucas,
and distinguished Members of the U.S.----
Chairman Bera. Dr. Brownstein, could you turn your mic on?
Dr. Brownstein. That would help. Congressman Bera, Ranking
Member Lucas, and distinguished Members of the U.S. House of
Representatives Committee on Science, Space, and Technology,
thank you for inviting me today to speak with you. Today I'll
describe ways that novel technologies like artificial
intelligence can help detect, monitor, and predict emerging
infectious diseases. I'll also discuss how non-traditional
sources can supplement existing epidemiological techniques. But
as I describe the good news about such advances, I don't want
to sugarcoat the bad, for the current Federal investments in
disease surveillance are inadequate and transient. We urgently
need Federal and local investment in new technologies for
public health surveillance and response. Such investment will
augment the capacity of public health to implement new ways to
monitor the health of populations. It will deepen our
understanding of community-based morbidity and mortality. It
will also save lives.
This is the goal of my team at Boston Children's Hospital,
where we develop innovative surveillance technology, where we
use freely online information to provide insights for both
public health agencies and the general public. We did this for
the H1N1 influenza pandemic, H7N9, avian influenza, Ebola in
West Africa, and now COVID-19. These platforms, and our
research, have ultimately played a critical role in that
innovative surveillance technologies can help detect, monitor,
and ultimately mitigate the impact of these diseases.
Our inaugural project, HealthMap, which is available to
the public, brings together disparate sources from a variety of
data streams to help provide a unified view of the world of
infectious diseases. To do that we use AI, machine learning,
natural language processing, all to organize that information
and make it available. Here's an example. On December 30, 2019
the platform alerted us to an unknown viral pneumonia. That
turned out to be one of the earliest signals of the current
COVID-19 outbreak.
Using AI in modeling of epidemics is one of the areas of
research offering vast insights into the potential burden of
disease, and where it spreads. Machine learning models can
predict where a given virus may arrive next. That lets us
inform public health organizations about how to respond.
Predictive modeling can also be used with data like prior
disease history, weather, travel patterns, laboratory data,
symptom surveillance. All, together through AI, help us
exchange information, conduct surveillance, and measure public
response to the events and response.
It is also critical to support sentinel surveillance of
disease. Sentinel surveillance allows public health officials
to identify signals early, impacts, and disease burden in the
community. One such example is Flu Near You, which is a
crowdsourcing platform for symptom surveillance in the U.S. It
offers two advantages. One, it identifies individuals who may
be ill, but not seeking medical attention, and it's in real
time. Our team has now augmented this tool to improve with
COVID-19 surveillance.
To date, there is no evidence supporting widespread
transmission of COVID-19 in the U.S., but does suggest that
sustained transmission in the community level will be
occurring. Current global situation suggests that this outbreak
will become a pandemic. It threatens the people--the health of
the people of the United States and globally. The COVID-19
outbreak also demonstrates some reasons for optimism. It
demonstrates what we can accomplish when the scientific and
humanitarian disciplines unite around a common goal. We
understand that each outbreak might require a slightly
different approach to monitoring response, but there are key
updates and metrics that we need in every single outbreak.
There are questions that we must ask, how many new cases are
there? What is the geographic spread? Are healthcare workers
infected? We can help answer these questions by using both
digital disease platforms, along with traditional surveillance.
We aggregate data from a variety of these sources in real time.
There's an epidemiological expression that expresses what
we want, prioritizing sensitivity over specificity. In English
this means that--risking some false positives to uncover more
of those who are sick. These platforms do that. They aggregate
everything available to provide stakeholders with a snapshot of
the current view of the situation. Those within the realm of
infectious diseases often say it is not a matter of if, it's a
matter of when. We continually need support for initiatives to
make an impact both domestically and globally through
infectious disease monitoring and surveillance. By investing in
our neighbors, and promoting health initiatives outside of our
borders, we help reduce the threat of an outbreak reaching the
United States.
There's another essential step to being prepared, long
term support of the Centers for Disease Control and Prevention,
and for local Departments of Public Health. The CDC's Influenza
Surveillance Systems are the backbone of flu surveillance for
this country. Augmenting this surveillance system with novel
programs like HealthMap provides us with additional
information. It allows the public health authorities,
clinicians, researchers, and the general public to stay alert
of what's happening. And this is why I urge this Committee to
make sure the United States provides sustained investment in
the fundamental needs of disease detection and surveillance.
That means investments domestically and around the world. Non-
traditional data sources and enhanced data processing through
AI and machine learning have proven their worth. They support
traditional surveillance, they aid in the developing of a clear
path, and a picture of an existing or potential infectious
disease threat to human health.
You have shown through your thoughtful leadership on these
issues in the past, and now we need your help again, for with
your continued support, we cannot only strengthen the public
health community, we will protect the lives that we serve.
Thank you again, and I look forward to your questions.
[The prepared statement of Dr. Brownstein follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman Bera. Dr. Hotez?
TESTIMONY OF PETER HOTEZ, PROFESSOR AND DEAN,
NATIONAL SCHOOL OF TROPICAL MEDICINE,
BAYLOR COLLEGE OF MEDICINE, AND CO-DIRECTOR,
TEXAS CHILDREN'S HOSPITAL CENTER
FOR VACCINE DEVELOPMENT
Dr. Hotez. Thank you very much. Dr. Bera, Congress--
Chairman Bera, Ranking Member Lucas, Congresswoman Lizzie
Fletcher, thank you for that very generous introduction. I'd
also like to acknowledge my fellow Texan, Congressman Pete
Olson. It's an honor to be here. I always get thrilled when I
have the opportunity--I've been doing this for 20 years--to
address Committees in Congress, and it's still a special thrill
for me.
I'm a vaccine scientist, and a pediatric scientist. I was
previously Chair of Microbiology at George Washington
University, just down the road, and then a decade ago we moved
to Texas to create a new--a unique school for emerging and
neglected tropical diseases, and also to create a unique center
for vaccine development, and the need was this. There is an
urgency to create vaccines for diseases which don't make money.
So we took this on in--with the idea of pioneering not only the
interesting science, but also a new business model, and the
business model part we haven't quite figured out yet, because
we're trying to make diseases--vaccines for diseases no one
else will make.
So we have a schistosomiasis vaccine now in clinical
trials, a leishmaniasis vaccine that we hope will advance to
the clinic soon, a hookworm vaccine in clinical trials, a new
Chagas disease vaccine that's moving into the clinic. I like to
say these are the most important diseases you've never heard
of. These are some of the most common afflictions of the
world's population, but they mostly occur among people who live
in extreme poverty, and so there's no model to figure out who's
going to pay for them, so, as a consequence, neither the
biotechs, nor the big pharmaceutical companies, make those
vaccines. And, for reasons that we'll explore this morning, we
also took on, a decade ago, the interesting problem of making
coronavirus vaccines, because we recognize these as enormous
public health threats, and yet we have not seen the Big Pharma
guys and the biotechs rushing into this space.
So we partnered with a group at the New York Blood Center
and the Galveston National Laboratory to take on the big
scientific challenge of coronavirus vaccines. And I say a
scientific challenge because one of the things that we're not
hearing a lot about is the unique potential safety problem of
coronavirus vaccines. This was first found in the early 1960s,
with the respiratory syncytial virus (RSV) vaccines that--and
it was done here in Washington with the NIH and Children's
National Medical Center, that some of those kids who got the
vaccine, actually did worse, and I believe there were two
deaths as--in the consequence of that study.
Because what happens with certain types of respiratory
virus vaccines, you get immunized, and then, when you get
actually exposed to the virus, you get this kind of paradoxical
immune enhancement phenomenon. And what--how--and we don't
entirely understand the basis of it, but we recognize that it's
a real problem for certain respiratory virus vaccines. That
killed the RSV program for decades. Now the Gates Foundation is
taking it up again, but when we started developing coronavirus
vaccines, and our colleagues, we noticed in laboratory animals
that they started to show some of the same immune pathology
that resembled what had happened 50 years earlier, so we said,
oh, my God, this is going to be problematic.
But we collaborated with a unique group that figured out
how to solve the problem, that if you narrow it down to the
smallest sub-unit, the piece that--of--what's called the
receptor binding domain, that docks with the receptor, you get
protection, and you don't get that immune enhancement
phenomena. So we were really excited about that, and we
proposed this to the National Institute of Allergy and
Infectious Diseases (NIAID). They funded it, and we wound up
actually making and manufacturing, in collaboration with Walter
Reed Army Institute of Research, a first generation SARS
vaccine. So SARS was the one that emerged in 2003, and then
this new one, of course, we call the SARS-2 coronavirus.
We had it manufactured, but then we could never get the
investment to take it beyond that. And then--so that was really
unfortunate, because we had the vaccine ready to go, but we
couldn't move it into the clinic because of lack of funding,
because by then nobody was interested in coronavirus vaccines.
When the Chinese started putting up the data on bioarchive in
January/February, we saw very close homology between the two,
and realized that we may be sitting on a very attractive
coronavirus vaccine. Now we're working with--again with NIH,
and we'll work with BARDA (Biomedical Advanced Research and
Development Authority) and others, to get the funding, but now
we'll have that lag. And these clinical trials are not going to
go quickly because of that immune enhancement. It's going to
take time.
And so, you know, all--unfortunately, some of my
colleagues in the biotech industry are making these inflated
claims, you know, you've seen this in the newspapers, we're
going to have this vaccine in weeks, or--in this and that. What
they're really saying is they could move a vaccine to clinical
trials, but this will not go quickly because, as we start
vaccinating human volunteers, especially in areas where we have
community transmission, we're going to have to proceed very
slowly, very cautiously. The FDA (Food and Drug Administration)
is on top of that. They have a great team in place at the
Center for Biologics Evaluation Research (CBER). They're aware
of the problem, but it's not going to go quickly. We are going
to have to follow this very slowly, cautiously, to make certain
we're not seeing that immune enhancement.
So, you know, now we're hearing projections, a year, 18
months, who knows? This is not going to go quickly. The bottom
line is, had we had those investments early on to carry this
all the way through clinical trials years ago, we could've had
a vaccine ready to go. So we've got to figure out what the
ecosystem is going to be to develop vaccines that are not going
to make money. The Big Pharma companies are still not going in,
some of the biotechs are starting to, because they're trying to
really accelerate their technology, and use it--and hopefully
to flip it around for something else that will make money. We
need a new system in place, and I'm happy to explore that with
you more during the questions and answers.
Chairman Bera. Right.
Dr. Hotez. Thank you.
[The prepared statement of Dr. Hotez follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman Bera. Thanks, Dr. Hotez. Dr. Sell?
TESTIMONY OF TARA KIRK SELL, SENIOR SCHOLAR,
JOHNS HOPKINS CENTER FOR HEALTH SECURITY,
AND ASSISTANT PROFESSOR,
JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH
Dr. Sell. Good morning, Vice Chairman Bera, Ranking Member
Lucas, and members of the Committee. Thank you for inviting me
to speak about my research on crowd forecasting and
misinformation, this research, in context of COVID-19, and ways
to support research that improve outbreak response.
Traditional disease surveillance is critical during
infectious disease outbreaks, however, this information can be
supported with tools to help support decisionmaking. One such
tool is crowd forecasting. Crowd forecasting consolidates the
diverse opinions of many into hard probabilities for future
outcomes. This is helpful in engaging the most likely outcome,
but also for understanding the uncertainty about that outcome.
Over the past year my research team, in partnership with a
group called Hypermind, developed a crowdsourced disease
prediction platform, and asked forecasters to make predictions
about outbreaks. For instance, we asked about the growth of
Ebola in the DRC (Democratic Republic of Congo), the spread of
measles in the United States, and how many U.S. counties might
see cases of Eastern Equine Encephalitis. On most occasions,
forecasters provided accurate predictions about 3 weeks ahead
of time. Recently we focused our forecasting platform on COVID-
19. We asked about the number of countries that would have
cases of COVID-19, and the number of cases that would be seen
around the world, and in the U.S. For global cases, forecasts
showed high confidence that there would be a rapid and
explosive spread.
On a few occasions our predictions were incorrect. We
think this is probably because forecasters didn't have enough
information to make accurate forecasts. Essentially, there's no
magic here. If disease surveillance information is lacking, or
is delayed, forecasters don't have any information to go on.
This underscores an essential research need for the current
COVID-19 outbreak, that surveillance, both within the U.S. and
globally, is essential.
Another area of my research, misinformation during disease
outbreaks has emerged as a challenge during the COVID-19
outbreak, and highlights the need to transparently and rapidly
share information. Health misinformation can be defined as
false health-related information, and can range from the
promotion of fake cures to rumors about the origin of the
outbreak. Misinformation can substantially impede the
effectiveness of public health response measures, increase
societal discord, reduce trust in governments, leaders, and
responders, and increase stigmatization.
My team and I analyzed misinformation during the 2014 West
African Ebola outbreak, one of the most recent examples of a
fear inducing disease event for the U.S. public. Our--in our
analysis, we found that about 10 percent of the Ebola related
tweets had false or half true information. We also saw that
more tweets with misinformation were political, and seemed
designed to promote discord. Another finding with parallels to
COVID-19 was the infection--or the identification of rumors,
often focused on government conspiracies. Although we have
been--not been able to do a systematic analysis of COVID-19
misinformation, we have seen the spread of rapid--of false
information, including recommendations for false cures that
could be harmful, like drinking chlorine dioxide, blaming
specific ethnic groups, and conspiracy theories about various
governments creating the virus as a bioweapon.
Response to misinformation requires a nuanced approach,
and further research to best determine the ways forward. While
the solutions will be complex, one thing that is critical is
the prevention of an information void that can be filled with
false information. Members of the public need accurate and
timely information to help them make sense of what is happening
in the outbreak. As I advocated for improved disease
surveillance earlier, this shows the need for a better
collection and communication of disease information in a
transparent and rapid manner.
From my experience in conducting research in response to
emergent disease outbreaks, I believe that we need to reduce
the impediments and disincentives to doing rapid and timely
research during these events. One hurdle to overcoming--to
overcome is the slow response--or slow process to establish
Federal funding streams for research during a response. My
research was funded by awards from private groups prior to the
outbreak, which provided the flexibility to shift gears toward
COVID-19. And while the development of vaccines and
countermeasures are critical, social, behavioral, and
epidemiological research are also important. The best treatment
cannot be effective without knowing where the disease is, and
who it is affecting. The best vaccine cannot change the course
of an outbreak if people refuse to take it. And the best public
health response cannot be implemented if members of the public
don't cooperate.
My bottom line message is this, we need to support the
systematic collection and rapid dissemination of information
about outbreaks. The--as the issue of misinformation grows, a
dedicated effort to understanding the best ways to combat it
will be needed. Even after the COVID-19 outbreak is over,
emerging outbreaks will still be a continuing concern. The
Federal research space needs to evolve toward a more rapid
approach to meet this threat. Thank you.
[The prepared statement of Dr. Sell follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman Bera. Thank you, Dr. Sell. Before we proceed, I'd
like to bring the Committee's attention to a letter that
Chairwoman Johnson received in preparation for today's hearing,
letters from Johnson & Johnson (J&J) that highlights their
global response to the COVID-19 virus. Without objection, I'm
placing this document, and Chairwoman Johnson's opening
statement, in the record.
[The prepared statement of Chairwoman Johnson follows:]
Good morning and welcome to today's hearing. We have an
excellent panel of witnesses today, all experts in their field.
I look forward to a robust discussion of how science can help
control and mitigate the effects of emerging infectious
diseases, especially in light of this recent coronavirus
outbreak.
Unfortunately, outbreaks of new infectious diseases are
happening more often and infecting more people. Changing
ecosystems, economic development and land use, climate and
weather, and international travel and commerce are all examples
of ecological, environmental, and social factors that are
increasing the emergence and spread of disease. The size of the
current COVID-19 outbreak has created a public health crisis
with significant international dimensions. A successful public
health response relies on science- not only through rapid and
robust research during an outbreak, but through sustained
investments in research and development between epidemics.
As more people interact with technology in their day-to-day
lives, we have new ways of harnessing data. Scientists are
developing modeling techniques that use artificial intelligence
to predict where viruses may emerge and how far they'll spread.
Policymakers use these programs to inform efforts that seek to
prevent and control the spread and impact of disease. We also
rely on scientists to develop diagnostic tests and treatment
options and evaluate new drugs and vaccines. It is clear how
our research and development investments directly impact our
ability to prepare and respond to global emergencies. Every
decision we make must be rooted in science.
The outbreak of global viruses is often followed by the
spread of misinformation, especially about how or where the
virus originated and the government's response to control it. A
whole country or group of people may be singled out as the
source of the problem-rather than the pathogen. This is hardly
a new phenomenon, but the spread of misinformation during this
current outbreak has been accelerated by social media. The
World Health Organization has even labeled this outbreak an
"infodemic," meaning there is so much information out there
that it is hard for people to find trustworthy sources and
reliable guidance when they need it.
Given that COVID-19 is a new disease, it is understandable
that its emergence and spread may cause confusion, anxiety, and
fear. But if we let these emotions guide us, instead of
science, we will see the rise of harmful stereotypes that will
prevent people from accessing the health care they need. We
have already seen reports of public stigmatization against
people from areas affected by the COVID-19 outbreak. Coupled
with the health impacts of the virus itself, this is of grave
concern.
According to the World Health Organization, recent disease
outbreaks like SARS, MERS, Ebola, and Zika have highlighted the
need to use social science to fight deadly disease outbreaks
and epidemics. Additional investments in social science
research on combatting misinformation during outbreaks could
improve prevention and control efforts and strengthen global
public health communication. We need a holistic research and
development response now more than ever.
As the first nurse elected to Congress, I have been
dedicated to public health my entire career. Our Committee may
not have jurisdiction over the Health and Human Services
agencies, but we have long had a role in amplifying the voices
of our nation's best scientists and bringing them to the
forefront on an issue. Thousands have been affected by COVID-
19. We do not know how many more will be. We must do everything
in our power to ensure that science guides our response to this
outbreak and prepares us for the future.
Thank you all for being here this morning. And I thank
Vice-Chair Bera for his leadership on this issue.
Chairman Bera. At this point we'll begin our first round
of questions. The Chair recognizes himself for 5 minutes.
Dr. Hotez, you touched on some of your research into
developing a coronavirus vaccine and, you know, a SARS vaccine.
I think it's incredibly important since, you know, Dr. Sell
just talked about information and misinformation, we've heard
quite a bit about how quick we're going to get a vaccine, how
quickly that'll be available to the public. And I think just,
you know, this morning I woke up to a news alert that said a
Cambridge, Massachusetts biotech company had come up with a
vaccine that they've sent to Dr. Fauci to start looking at
testing and so forth. But I think we've got to be honest with
the public so we don't give them false hope. And, you know,
perhaps--if you could just go through a timeline on what
vaccine development is going to look like in the best case
scenario, then to clinical trials, and then to potential public
availability?
Dr. Hotez. Sure. Thank you for that question. So I think
what we're going to see over the next few weeks to months is
several vaccines will enter into a pipeline of clinical trials.
Hopefully ours will be one of them. You mentioned the Moderna
vaccine out of MIT (Massachusetts Institute of Technology).
Theirs will--certainly will be in there. Probably Inovio's
another one. There's about five or six--J&J may have one as
well. About five or six, maybe a couple more. But then it's
going to go into a bottleneck, and that bottleneck are the
clinical trials, phase one, phase two, phase three trials.
You know, in spite of what the anti-vaccine lobby likes to
claim, that vaccines are not adequately tested for safety, in
fact, among the pharmaceuticals, vaccines are the single most
tested pharmaceuticals we have for safety, and it takes time.
And because you have to initially do an injection in normal
human volunteers, show that it's safe, and then you proceed,
step-wise, to show that it actually works. And now, because of
this immune enhancement phenomena, you have the added
complexity because you want to make certain that those
volunteers, when they're immunized in an area of community
transmission, don't actually get worse.
And so the FDA and CBER--which, again, you know, I can't
emphasize enough how lucky America is to have that group, some
of the best public health vaccine scientists in the world--are
going to follow this very closely, step-wise. And that----
Chairman Bera. The best case scenario----
Dr. Hotez [continuing]. And that's not quick, right?
That's going to take----
Chairman Bera. Best case scenario, Dr.--and Dr. Fauci said
at least 12 months.
Dr. Hotez. And he's definitely right, at least 12 months,
but whether that means another year after that, maybe 2 years,
it really depends on the safety signals that we're seeing with
these vaccines.
Chairman Bera. OK. And the ability of our commercial
pharmaceutical sector to quickly ramp up and develop that--the
vaccine, and make it commercially available, is that going to
be an issue, or do we have that----
Dr. Hotez. Yeah, I mean, there's a lot being--there's a
lot of press releases from the biotechs, and some of them I'm
not very happy about, frankly, because I think it's telling
only half the message. You know, there's--so it took us years
to develop our recombinant protein vaccines. It's an old
method, but we know it works, because we've had a Hepatitis B
vaccine licensed with this technology, the HPV (human
papillomavirus) vaccine licensed with this technology. Now
you're seeing next generation platform vaccines, like DNA
(deoxyribonucleic acid) and RNA (ribonucleic acid) vaccines.
It's a very exciting technology because you can move very
quickly into clinical trials. The problem is we don't have a
single licensed vaccine with that technology. So the idea that
all of a sudden this is going to work, you know, historically,
these have worked very well in mice and laboratory animals, but
they haven't been reproduceable in people. Organizations like
Moderna and Inovia say they've gotten around it now, they've
fixed the--they've fixed this----
Chairman Bera. Right.
Dr. Hotez [continuing]. So maybe they have, but, you know,
it's----
Chairman Bera. Right.
Dr. Hotez [continuing]. Still we don't have----
Chairman Bera. So we're----
Dr. Hotez [continuing]. A lot of experience.
Chairman Bera. We're moving at an incredibly rapid pace
right now, but the public needs to understand that, at best,
there may be a vaccine in 12 months, it'll be longer----
Dr. Hotez. Yeah. I mean----
Chairman Bera [continuing]. Potentially longer than that.
Dr. Hotez. I mean, look at what happened with----
Chairman Bera. Yeah.
Dr. Hotez. [continuing]. Ebola, right? We had, you know,
our first Ebola vaccines started being rolled out in 2015 in
the epidemic in West Africa. It's not really until 2019 that we
really got it rolling, which, by the way, is one of the most
extraordinary public health stories ever told.
Chairman Bera. It absolutely----
Dr. Hotez [continuing]. And, you know, thanks to BARDA,
and all these----
Chairman Bera. Exactly. Let me ask Dr. Sell a question.
You talked about information and misinformation. Based on your
research as you're observing this, what are some of the common
misinformation that is out there on COVID-19?
Dr. Sell. Yeah, so I think that there's a range of
different misinformation. So there's misinformation about false
cures, and there aren't any cures right now, so all that is
false. There's misinformation about sort of government
conspiracies, that someone else started the disease, and I
think there's also misinformation about the disease, you know,
what characteristics it has. I think there's a lot that we
don't know, and so there's that information void that people
are just filling with their ideas.
Chairman Bera. So it is--it behooves this institution, and
each--vested Members of Congress to make sure we're in tight
communication with our constituents back home. With that, let
me recognize the Ranking Member, Mr. Lucas, for 5 minutes.
Mr. Lucas. Thank you, Mr. Chairman. And, Dr. Hotez,
thinking about Dr. Sell's comments, let's begin from the
parochial perspective, being your neighbor up north in
Oklahoma. As of last night the State Department of Health
reports there are no confirmed positive cases of coronavirus in
Oklahoma, as of yesterday evening, although one Oklahoman
showing symptoms is waiting on the test results from CDC. Can
you discuss for a moment what we can share with our
constituents back home to not instill panic, and how to stress
the importance of reasonable steps, prevent spread? Yes,
doctor?
Dr. Hotez. Peter Hotez. Yeah, I--we--I know Oklahoma
pretty well. My son graduated from OU, so--just last year as a
petroleum engineer, so he's--it was a great place. We love
Norman.
Mr. Lucas. Absolutely.
Dr. Hotez. The issue is this, you know, I think, in an
attempt to calm public fears, you're hearing things like it's a
mild illness, this is like flu. It's not really the case,
because this is an unusual virus. For many young people
especially it is a mild illness, but we're seeing some
devastating things, and we got a heads up about this from the
Chinese. They actually informed us, and we knew it was coming.
Nursing homes, look what this virus did in that nursing home in
Kirkland, Washington. It rolled through it like a train, right?
It's at least seven deaths so far in a nursing home of about
100 people, so this is like the angel of death for older
individuals.
We need to go back and support all of our nursing homes--I
don't know what we're doing wrong, but clearly that nursing
home was not prepared for this, and I'm going to guess nursing
home in--across Oklahoma are not prepared as well. Also our
healthcare providers. We saw in Wuhan 1,000 healthcare
providers got sick, and we had at least 15 percent severely ill
and in ICUs (intensive care units), and that is very dangerous
because not only do you subtract those people out of the
healthcare workforce, but the demoralizing effect of colleagues
taking care of colleagues is going to be--I mean, the whole
thing can fall apart if that starts to happen.
We saw this with Dallas. So I was on Governor Perry's task
force for infectious disease, and those two ICU nurses, when
they got sick, it was really devastating. And finally the
Governor had to call the Health and Human Services Secretary,
CDC Director, and said, look, I--normal ICUs can't take care of
these patients, we've got to get them out of here. So you don't
want to see those kinds of situations. I'm worried about our
first responders. We're already seeing in Washington State how
they're already in quarantine. So does that mean we're going to
have to bring in the National Guard? I think that's going to be
another big issue as well. So those are the three
vulnerabilities that I see right now in a place like Oklahoma.
Mr. Lucas. And how should our constituents back home react
to that, the average J.Q. Public out there?
Dr. Hotez. Well, I think the average J.Q. Public needs to
hear from its elected leaders, from the Governor, from the
public health authorities, on what the plan is. I mean, don't
just get up there and say, this is a flu, this is a mild
illness. One, it's not true, and people in Oklahoma are pretty
smart, and they'll figure that out pretty quickly, and second,
explain what the risks are, these are the three vulnerable
populations that we have to worry about, and here are the steps
that we're doing to mitigate that. That's what people will
appreciate.
Mr. Lucas. Dr. Murray, as you mentioned in your opening
statement, approximately 75 percent of emerging infectious
diseases originate in zoonotic pathogens. You estimate that 1.7
million unknown viruses yet to be discovered, around half of
which are capable of infecting people. Could you elaborate on
the current state of research to improve surveillance in these
diseases, and where gaps may exist now as we look toward the
future, about addressing future challenges?
Dr. Murray. Yes, thank you very much, and I also
appreciate that, while we're trying our best to address the
topic at hand of a lot of ill people, we do need to be thinking
of the next virus, and the next virus. I also think that the
CDC has done a wonderful job of looking at and studying human
health, and, if we're going to do our best job to prevent
future viruses from jumping, I think one of the missing
components is indeed wildlife health. If 75 percent of the
viruses come from wildlife, it makes sense that we look at that
juncture of both wildlife and human health.
We also--this virus is termed a novel virus, it's new.
It's new to the people. I don't think it's new to the bats, and
that's--right? That's an important point. And then some of our
other colleagues here have been talking about modeling, and how
important that is. Modeling gives us greater information now as
to what COVID will be doing within the U.S. and within other
countries.
We also have groups of modelers who look at the forefront
stages, before emergence, and look at the data that we have to
try and determine where are the hot zones, what are the risk
factors, and, behaviorally, what are people doing to put
themselves in danger? Those are really, really important ways
for us to get ahead of the curve and catch the viruses before
they come out.
As part of the team that we've been on, which is a USAID
(United States Agency for International Development) program
called Predict, we have a team of modelers who look at viral
emergence, and they're able to determine for each different
virus how--as we collect more and more data, what percentage of
the viruses that we know are characterized, and how many more
are likely to be out there? Latest estimates are less than 1
percent--well, the viruses we know are less than 1 percent of
the viruses that are out there, meaning there's over 99 percent
viruses in wildlife waiting to jump into humans. That's
staggering, and that's really one of the things that we need to
look at.
Mr. Lucas. Thank you, Mr. Chairman. My time's expired.
Chairman Bera. The gentlelady from Oregon, Ms. Bonamici,
is recognized for----
Ms. Bonamici. Thank you----
Chairman Bera. [continuing]. 5 minutes.
Ms. Bonamici. [continuing]. Dr. Bera, and Ranking Member
Lucas. This emergent coronavirus epidemic is a top concern for
Oregonians, and I'm glad we're having this hearing today. In
Oregon we currently have three individuals who have tested
positive, two of whom are in the district I represent, plus I
have an additional couple of constituents still in Japan who
had been on the cruise ship there. We know further community
transmission is likely. It's clear, from the tragic deaths in
Washington, how this virus can spread quickly, and cause
serious harm, and so let's take a moment to reflect on those
who have lost their lives in our neighboring States of
Washington, and now we understand there's a reported death in
California as well, all the affected friends and family of
those people. We need to take this seriously.
I also want to recognize the tireless efforts of our
public health officials in Oregon, and the Pacific Northwest,
and across the country. I know they've been working around the
clock to coordinate a response. For the past several days I've
spoken with our Governor, Kate Brown, and many State and county
public health officials, and school superintendents--we had a
school closed in Oregon for a couple of days--healthcare
providers. And everyone has emphasized the need for robust
funding, and I'm glad we passed a bill with strong bipartisan
support in the House here yesterday. I hope they get it over
the finish line soon in the Senate.
But I've also heard numerous concerns about the
availability of protective equipment, particularly masks. Also
staffing challenges, and testing capability. And we know those
infected with COVID-19 can remain asymptomatic for several
weeks, so healthcare professionals, as Dr. Hotez was talking
about, are at even greater risk. There are furloughed
healthcare workers in my district.
The CDC just expanded its guidance for testing, but
there's still a significant amount of confusion about who
should get tested, and how those increasing testing
capabilities can best be used to inform and improve our
response efforts. And we heard this morning South Korea's
testing 15,000 people a day. Dr. Brownstein and Dr. Hotez, we
can't get an accurate picture of the infection if we're not
testing, but until recently, the testing was limited to those
who had recently traveled to places with high rates, or those
showing symptoms after close contact.
So I understand the process of getting the tests out into
the field is slow. We had the test sent to the CDC the--on
Friday, and then it didn't come back until Tuesday, and that's
really hard for a community that's wondering what's happening.
So can you explain whether the scope of the CDC's guidance--was
that based on best practices, or was it inappropriately limited
because--a lack of capacity to test, and who should be tested?
Dr. Brownstein and Dr. Hotez?
Dr. Brownstein. Of course, it's hard to delve too deep
into what was happening at the CDC at the time, but, of course,
increasing testing is incredibly important. We know that this
is a mild condition. Oftentimes people might be feeling
symptoms, they may not even be interacting with a healthcare
provider, and so we don't actually know the full scope of
numbers of cases that are out there. And I think you mentioned
a really great point about the impact on the health system. We
are really advocating for opportunities to bring concepts like
telemedicine, and tools that help at the front line, beyond the
point where someone actually has to come in and end up in an
emergency department. There's opportunities to think about
tools that actually provide symptom checkers that integrate
data from the CDC, but also have virtual visits with providers.
This is a real important component, because----
Ms. Bonamici. Absolutely.
Dr. Brownstein [continuing]. What we expect is an influx
of people coming into our health system. I work in a health
system. We are very nervous about the flooding of our emergency
departments with potential cases, so the opportunities to bring
digital tools and innovative solutions, along with the ability
to integrate with testing--so home based testing, other
opportunities--are really things that we advocate for because
of the fact that, again, mild illness, lack of opportunities
for someone to come and meet with someone live, and for the
fact that we can actually begin to understand the depth of
what's happening in the population, again, those kind of data
points are so critical now to understanding----
Ms. Bonamici. Absolutely.
Dr. Brownstein [continuing]. The features of this
epidemic, and to understand more broadly what's happening in
the community.
Ms. Bonamici. Thank you. Dr. Hotez, as I mentioned, the
test was presumptive on Friday, sent to the CDC, it didn't come
back until Tuesday. Can you elaborate on some ideas why we've
seen such delays in testing? Do you think this recent emergency
use authorization will expedite things, and what else can we do
to increase the availability and accelerate the testing?
Dr. Hotez. So four brief points are around that, and thank
you for that question. I think the first is testing for
respiratory viruses is not trivial, because you get a--
oftentimes, and we've been seeing this in China, and this is
actually not unusual, if you look at the literature on testing
for respiratory viruses, you get a negative result, a negative
result, a negative result, you put the person on a quarantine,
all of a sudden they're positive. What does that mean? Is it a
true false negative, or is it because the test isn't sensitive
enough? So it takes time to really fine tune these diagnostic
tests for respiratory viruses.
And, in fairness to the CDC, testing--developing a new
diagnostic test, just like developing a vaccine in the middle
of a public health crisis, developing new technologies for a
new agent in a public health crisis, one of the hardest things
that we do as a nation. So this--so--and it' s hard to make
that go quickly. I understand we could've--we should've done
better as a country of getting those kits out there.
I think we will get up to a million eventually, as I
believe the Vice President mentioned, but until we do that, I
think we've got to prioritize who gets tested, and my
recommendation would be that we focus the testing strategically
around our protecting our three most vulnerable populations
that I mentioned. Our older residents in nursing homes and
places of assisted living, they're highly vulnerable. The
mortality among them is----
Ms. Bonamici. Right.
Dr. Hotez. [continuing]. 10 to 15 percent. The healthcare
providers, those who interact with the healthcare providers,
and protecting our first responders, because if they go down,
then, again, everything collapses.
Ms. Bonamici. OK.
Dr. Hotez. But then, even after that, I think the other
thing that not a lot of people are talking about, even then,
this is not adequate, right? If we have to wait hours, or days,
for the test result, it's of limited use to us. What we need is
like what we have now for a rapid flu test. We need to get a
rapid test for that.
Ms. Bonamici. Thank you. My time's long expired. I yield
back.
Chairman Bera. Thank you. Let me recognize the gentleman
from Florida, Mr. Posey, for 5 minutes.
Mr. Posey. Thank you, Mr. Chair, for calling this
important hearing. I only regret that it conflicts with a
Member's only briefing on almost the exact same topic taking
place simultaneously. And thank you, witnesses, for the
important work that you do every day, thinking about ways to
combat public health threats. There's a common theme across
your testimony, and that's pretty much when there's a crisis
all eyes turn to you, but when the disease or the crisis moves
off the front pages, the public loses interest, then the
funding goes away.
And you didn't say this part, but I'll say this also, that
when Washington sees a problem, the habit is to throw billions
of dollars at it and say, look, now we've done our job, and
hope for a good result, and move on to the next issue. And, of
course, there's always the finger pointing and blaming, based
on, as you well pointed out earlier, much information and
disinformation. That's really regrettable, and I think the
American people are getting a little tired of that, but Dr.
Murray, working with partner agencies you state you've
successfully identified over 1,200 novel wild-born illnesses,
including 161 of which belong to the same family as COVID-19. I
think most of us in the room are wondering what the risk to
humans is from those viruses as well? I have four related
questions that I'll ask you after----
Dr. Murray. Thank you very much. I'll try to be quick in
my response. So in addition to identifying the viruses, we also
have a team of modelers who helps us identify where to look in
the world. We also have a team of phylogenists and virology
experts who then rank all these viruses. If we had enough money
to look at every country, every species, every animal, we
would, but we don't, so we really try and use funds
effectively, so we identify the countries in which--are most
likely to be a problem, the species that are most likely to
transmit lethal diseases to humans, primates, bats, and
rodents, and then, of those 1,200 viruses, they're ranked
according to the families that are most likely to cause a
problem for human health, and that's where we spend the
majority of our time and resources. Influenzas, coronaviruses,
filoviruses, and paramyxoviruses are some of the most important
families.
Just to add on to what my colleagues here have said, it is
the time from--funds are an issue, and the program that I'm
describing is just in the process of being closed down. We're
actually holding our closeout session on March 17 at the Museum
of American Indian, in case anybody would like to join us,
because we'll be reporting on a lot of what we've done over the
last 10 years. My suggestion would be this is not the time to
lean out, but it'd be the time that we need to be leaning in.
Mr. Posey. What percentage of the viruses have the
potential to jump to humans? Just swag it, I mean.
Dr. Murray. So of the 1.7 as yet unidentified viruses,
about 50 percent of those have the potential to jump to humans,
and that's based on the receptor sites, and where they can
attach to the trachea. Of those--but not all of those are going
to spread rapidly, and not all of those are going to cause
severe disease. So we look at--there's 50 percent that could
jump to humans, and probably only 10 percent or 15 that can
cause rapid disease and a pandemic. But until we identify those
viruses, the species in which they occur, the reservoir
species, and the mode of transmission to humans, we're really
still at a tremendous risk.
And then we--the research has shown that these outbreaks
are coming more and more frequently, so while everybody--a lot
of us have felt like, this is a surprise, the folks in the
health community have felt like this isn't a surprise. We've
been saying it collectively for the last several years, these
pandemics are coming. We can tell you in general the countries
or the areas, some of the risk factors, and some of the viral
families.
Mr. Posey. Well, you answered my next two questions about
the percentages already, so, for the final question, how do you
think we best prioritize research? You know, is there a good
process to set research priorities in place?
Dr. Murray. I think a lot of what we're doing right here--
and thank you for this hearing. It does bring everybody--a lot
of the same folks into the room to help identify some of the
issues. From my perspective, the more that we can look at
bringing experts from many different fields, from the
government, from NGOs (non-governmental organizations), and
universities together, then that--and the confluence of human
physicians--well, most physicians are human, right? So human
physicians, veterinarians, nurse--and nursing staff
researchers, I think that's really what we need to be doing,
and looking at not only in the U.S., but in countries--in other
countries as well, because--we look at the economy globally.
It's really time for us to look at health globally. So that's
how I would go about establishing research priorities.
Mr. Posey. Thank you. That beats crisis du jour.
Dr. Murray. Thank you for your questions.
Chairman Bera. Thank you, Mr. Posey. The gentlelady from
Texas, Mrs. Fletcher, is recognized for 5 minutes.
Mrs. Fletcher. Thank you, Chairman Bera. I want to get
right to the questions. I thank all of you for being here, for
your testimony. It's very important. I want to follow up with
you, Dr. Hotez, on your opening comments with a question, and
then open it up to the panel to weigh in with your thoughts.
But, kind of following up on what Mr. Posey asked as well, in
your opening comments, or your statement, you mentioned your
work developing a vaccine for SARS, and you asked the question
what will the ecosystem be for vaccines that don't make money?
And that seems to be an appropriate question for this
Committee, and for the Congress of the United States to be
tackling. So I would like to ask you what you think that
ecosystem should look like, and then get others on the panel to
weigh in on that question, and also touch a little bit on what
Dr. Murray said about kind of the global nature, and something
we have discussed before as well, where can we partner with
other countries in doing this work, and where can we have a
national response and a global response? I'd love to get your
thoughts, and then open it up to the panel.
Dr. Hotez. Well, thank you very much for that question. I
mean, there is some good news to this. You know, we--we're very
blessed to have the National Institute of Allergy and
Infectious Diseases, headed by Dr. Fauci, who's been very
committed to this problem. And, you know, if it wasn't for
NIAID and NIH, I wouldn't be--even be here, right? They've, you
know, really worked hard around trying to fix this problem. The
issue is it's not enough, and it doesn't--and the problem is,
you know, if you talk to Tony--if you talk to Dr. Fauci, he'll
say, look, Peter, I'm not a venture capitalist. I can't just
hand over money. It's got to go through study sections.
And the issue is the study sections--some--oftentimes will
get dinged and get turn down from an NIH grant because what
we're--they'll claim what we're doing is not innovative, and
they're often right. It's not innovative. We're trying to make
a recombinant protein vaccine. It's boring, but it's absolutely
essential. So we have to figure out a way to--for a funding
mechanism to be created that will provide steady funding for a
base of scientists who are ready and able to develop a vaccine,
because this--we're over-relying on the big pharmaceutical
companies. They're not coming into this space in a big way,
with a couple of exceptions. The biotechs, some of them are in
it. Most of them are in it not so much for the specific
vaccine, but it's a device to accelerate their technologies. So
we've got to figure out a mechanism to create a--fund a group
of scientists working in an area where they'll develop vaccines
in the non-profit sector.
We've had Walter Reed Army Institute of Research for
years. They've been hit very hard. We could restore that. That
would be one way. We have this great VRC, Vaccine Research
Center, at the NIH, and there's a couple of others, like ours,
the University of Maryland Center for Vaccine Development, our
Baylor College of Medicine, one at Texas Children's, but we
need--each one has to be bigger, and each one has to be--and we
need more of them as well.
Dr. Brownstein. I'll just add also my thanks to the NIH,
because I also wouldn't be here without support from
specifically the National Laboratory of Medicine, and their
efforts to really train the next generation of data scientists
in health.
Specifically around--your question around vaccines, I
think it's really important to think about the comments of Dr.
Murray and think about the next event, right? Of course we need
to be focused on the current coronavirus, but we're going to
see likely another event, another likely coronavirus event. We
saw SARS, MERS. It's likely that we should be thinking about
universal vaccines around coronaviruses, as opposed to maybe
something very specific around this event, that ultimately will
prepare us for the next pandemic that we'll see in the future.
I think the more that we can be thinking about those next
events, and they will occur, the better off we'll be for the
next one.
Mrs. Fletcher. Thank you, Dr. Brownstein----
Dr. Sell. One----
Mrs. Fletcher. Dr. Sell, you had a----
Dr. Sell. Yeah, I have one thing to add. So you'd asked
about the ecosystem for vaccines that don't make money, right?
We have the difficulties with developing those vaccines, and
then testing them, but we also--a project at our center led by
Nancy Connell, we also have a problem with manufacturing those
vaccines at scale, right? So we might be able to have a
vaccine, but we can't make, you know, half a billion doses, or
whatever we need, quickly, in enough time to make a difference.
And so I think that's another thing, you know, we can't just
swap over the products in a manufacturing plant. That's another
area that really needs a lot of attention.
Mrs. Fletcher. Thank you. Dr. Murray, I have a few--30
seconds left. I'd love to hear your thoughts.
Dr. Murray. I agree, again, with my colleagues, in
particular with Dr. Brownstein, who was saying about the
universal vaccine. I think it's very well--a very good idea to
invest in that. And, again, part of the information we would
collect in the field about what types of vaccines, or what type
of viruses are out there, will hopefully help inform that. I
also wanted to add on just--I thought a little bit more about
the question from Mr. Posey, and I do think that if we're going
to be looking at research, creating a one health program
somewhere that we're--because we don't currently have a program
that works in high risk areas that incorporates both human
expertise and wildlife expertise, and ideally has one foot in
the Federal Government, and one foot outside of the Federal
Government. It would be great if such an institution were here
somewhere in D.C., and perhaps a parastatal institution
that's--already exists.
Mrs. Fletcher. Thank you very much. I have gone over my
time, so I will yield back.
Chairman Bera. Thank you----
Mrs. Fletcher. Thank you all.
Chairman Bera. [continuing]. Mrs. Fletcher. The gentleman
from Texas, Mr. Cloud, is recognized for 5 minutes.
Mr. Cloud. Thank you, Chairman, and thank you all for
being here to help us address this very important topic. I
appreciate the healthy discussion over some of the
misinformation that's come out sometimes with, you know,
political goals in the dispersion of it. I also appreciate you
educating us just really on some of the real scientific
challenges in addressing a situation like this.
I wanted to see, Dr. Murray, in the effort of giving good
communication on this, if you can give us, kind of
backtracking, it was kind of an understanding of why are doing
this, where did this coronavirus come from, how is it unique,
how is it spreading?
Dr. Murray. Thank you very much. I'd be happy to do--and I
think I could probably share the answer to that question as
well. In terms of what we know, or--that bats, primates, and
rodents are the species that are most likely to carry these
viruses that transmit to humans, and--the coronas in
particular, and our team has already discovered a--several
other coronaviruses in China, with 98--97 and 98 percent
homology to this virus, meaning--so they're very closely
related. And we also developed these trees so you can determine
how closely this virus is related to the other coronas. We
found some in Myanmar that are not closely related, and not
likely to cause disease.
So--and we also have behaviorists looking at what are the
risks associated with bats? In a lot of countries bats provide
a lot of protein, and people do eat bats. But, if you think
through it, the risk might not be the person in a restaurant
eating a fully cooked bat. Perhaps the risk is the women in the
back who are preparing the bat without the gloves, and without
the masks, that are--along with children, and then take it
home. So trying to understand the cultural norms and human
behavior patterns that give--that contribute to these sorts of
things.
A quick shoutout to OSTP (Office of Science and Technology
Policy) from--because we also have a pandemic preparedness
forecasting science and technology panel that looks at these
sorts of things, and collectively this past year we--at
Smithsonian we housed a--or a we hosted a 2 day workshop
looking at the--bringing together the soft sciences and the
hard sciences, the modelers who look at human behavior, and
also the hard scientists that look at what the virus does.
So we believe that these--that markets--wildlife markets
and the wildlife trade are a really huge risk in general, and
the risks are different whether you're in Africa or Asia.
Africa, animals tend to come to the market. The risk is more in
bush meat trade for the folks who are there in the forests that
are killing the animals, and the meat tends to come to the
market already dead, whereas in Asia it's often live animals
that are at the market. So those are--to answer some of your
questions about the virus, we believe that it's a bat related
virus, and that it's--it came in close contact through this--
the markets.
We still have so much more to learn about this virus in
particular, and these--with epidemiologists, and our human
health folks as well, and so--there's still so much we don't
know, but that's what we know so far. I'd like to yield to any
of our M.D. colleagues to see if they have something to add.
Mr. Cloud. Well, if I may, I only have two minutes left.
Dr.----
Dr. Murray. Sorry.
Mr. Cloud. [continuing]. Hotez, if you can tell us what's
some of the challenges in addressing these treatments and
vaccine, also, I'm just going to get all the questions out
here. Based on your experience working with SARS, and Ebola,
and Zika, what are some of the challenges that you've seen
governments face in the past, what are some of the best
practices we've learned, and what's some of the things that we
can use toward addressing this? And then if you can answer
that, and if any of you want to jump in and finish the time
out?
Dr. Hotez. Yeah, two points. We need more vaccines, and
trying to do this in the middle of a crisis is very difficult,
right? I mean, we have one--N of one, the--what--the story with
Ebola, maybe cholera vaccines in Yemen, so we want to start
doing this now. And one of the other problems that I'm seeing
is, you know, through NIAID and BARDA, we have incredible
mechanism for supporting vaccines, so clearly the U.S. is the
global leader in this. We need some of the other countries to
start pitching in and help supporting global health
technologies.
If you look at the funding--public funding globally, you
know, the U.S. is by far the No. 1, UK maybe second, the
European Union, and then the bottom falls out, so we see a lot
of underachievement among the G20 countries. China's doing very
little. Japan, not much, a little bit. Korea's starting now.
I'm on a board called the Korean Right Fund with the Gates
Foundation. Brazil needs to step up. You know, all the BRICS
(Brazil, Russia, India, China and South Africa) countries need
to step up. So the--we really need to put this on the agenda of
a G20 summit to say, look, the U.S., you know, has, you know,
globally taken the lead on recognizing this is a huge problem
through NAID and BARDA, the other countries need to step up.
This needs to be on the topic of a G20 summit.
I have a book--I like to write books, so one of the books
I wrote is called Blue Marble Health, which actually finds this
quite interesting finding. Overwhelmingly, most of the world's
emerging and poverty-related neglected diseases are not
necessarily in the poorest, most devastated countries of
Africa. It's the G20 countries. It's the poor living among the
wealthy, including 12 million Americans that suffer from
neglected tropical diseases. So we need the other G20 to show
some leadership, and work with State Department and others on
this.
Chairman Bera. Thank you, Dr. Hotez. The gentleman from
California, Mr. McNerney, is recognized for 5 minutes.
Mr. McNerney. Well, I thank the Chairman, and I thank the
witnesses this morning. Very useful, informative. Dr. Sell, how
can social science aid us in understanding how to stop
misinformation during outbreaks?
Dr. Sell. So misinformation during outbreaks is a big
problem, and I think it's a very complex problem. So social
science could help us understand what the best messages are to
help people understand when the rumors they're seeing are
false. So, to improve our messaging, the type of ways we're
trying to communicate with people, how to convince them of, you
know, the facts, rather than to believe in these rumors.
But I also think that there's a--we need to actually
develop an entire strategy here. We need to think about all the
different stakeholders, right? We have tech companies, they
need to be doing work. We have the public. The public--we can't
just say the public--the public should--we think the public
should figure out how to determine truth from falsehoods. But
we also have government, we have news media, and we have public
health. We all need to think about those stakeholders, and
everything they can do to deal with this problem.
Mr. McNerney. Is there a specific area of research that
would help develop those tools?
Dr. Sell. I mean, I think that looking into seeing what
misinformation is out there, and then also the communications
research that I do. I think that it's looking at what kind of
ways we can solve that, and the messages that are necessary, so
that's social science research.
Mr. McNerney. OK. Thank you. Dr. Hotez, I'm going to
follow up on Ms. Fletcher's question. How do we incentivize
pharma and biotechs to prioritize vaccine development?
Dr. Hotez. Well, it's tough, and, you know, I know I've
been critical of the big pharmaceutical companies today, but I
also have some great--some support as well. I mean, you know,
what Merck did--Merck and Company did for the Ebola vaccine is
an extraordinary story, right? I mean, this--that vaccine
ultimately--giving it to 200,000 people in DR Congo in the
middle of a war and conflict prevented a catastrophic epidemic
that would've dwarfed the one in West Africa, and would've
destabilized the entire African continent. So we owe a real
debt of gratitude to Merck, and BARDA, and the supporters that
made that happen.
But if you talk to some of the people at Merck offline,
one of the things they'll tell me is, look we didn't make--
Peter, we didn't make money on this thing, we actually--in
some--depending on how you crunch the numbers, we actually
might have lost money because we had to pull people from
moneymaking projects in order to put them on this, so it's
really a problem. You know, vaccines are expensive, and they're
expensive because of all the quality control and quality
assurance that you have to put in, and all the belts and
suspenders you put in to ensure safety.
So I, you know, and I'm, you know, and that's maybe one of
the reasons why we're not seeing the big pharmaceutical
companies jump in this time around, because they saw, my God,
look what Merck had to do in order to make this happen. So I
think we have to look at creating a new type of organization,
and maybe working this out in the nonprofit sector here in the
United States.
Mr. McNerney. Thank you. Dr. Brownstein, I'm pretty
excited about the HealthMap platform that you discussed. How is
artificial intelligence used in public health preparedness----
Dr. Brownstein. Yeah. So----
Mr. McNerney [continuing]. To prevent spreads?
Dr. Brownstein. So AI is seeing a real explosion in use in
healthcare. Of course we've seen advancements in other domains,
financial services, entertainment, but of--what we see is
there's opportunities in leveraging AI with large datasets.
When we're dealing with an important event like a public health
crisis, there's a huge amount of data, a lot of information
about cases, a lot of misinformation, and being able to sort
through all that critical data to get important insights that
we can feed to our modelers, our policymakers, even the public,
that's where this kind of--these kind of methodologies come
into play.
So, if you think about the earliest signs of the COVID-19
event, they are actually through this epidemic intelligence
collecting tools, actually some that support the technologies
that Dr. Murray was talking about. Combing through the web,
looking for signs of mysterious illnesses that we could utilize
to then pinpoint, and then communicate those to the World
Health Organization, and CDC, and other organizations. But more
importantly, there's a vast amount of information globally now
being transmitted about cases confirmed, suspected, on trying
to understand the response, the recovery, the demographic data
of these patients. That is well more capacity than the existing
workforce of epidemiologists that exist on this planet, and so
what we're trying to do is augment the work of these public
health practitioners through the opportunities that AI brings.
So the opportunity to mine that information, organize it, and
bring the situational awareness data to the forefront so it can
be used effectively.
Mr. McNerney. OK. I'm running out of time, so I'm going to
ask you for the record, not a verbal response, what the
challenges are in expanding AI into this field. So I yield
back.
Chairman Bera. Thanks. The gentleman from Texas, Mr.
Olson, is recognized for 5 minutes.
Mr. Olson. I thank the Chair, and welcome to our four
expert witnesses. A special welcome to Dr. Peter Hotez. I'd
like to join my Texas colleague, Mrs. Fletcher, in bragging
about Dr. Hotez. My colleagues need to know this is not just a
man who's an expert in Texas. He's a recognized expert in all
of America, and globally on pandemic viruses. And that's why
you saw him all day yesterday on national cable, explaining the
challenges with the COVID-19 virus. You also saw him doing that
with the Ebola, with SARS, with H1N1, and also with Zika. H1N1
was very special back home. That broke out in 2009, and your
institution, Texas Children's Hospital, set up a drive-through
vaccine in a parking garage almost overnight to have those
vaccines deployed. So, again, thank you for being here. As Bum
Phillips would say, you may not be in a class by yourself, but
every class you're in, it don't take long to call the roll. I
want to talk about----
Dr. Hotez. Thank you, Congressman.
Mr. Olson [continuing]. Quality treatments and future
responses. First, quality treatments. Yesterday it was
announced that my home county of Fort Bend was the first site
in Texas to have a confirmed case of the COVID-19 virus. Don't
know too much. The man was 70 years old, he had traveled
overseas, no confirmation if he went to China, Iran, or Italy,
and he's now quarantined in the local hospital. As Dr. Sell
mentioned, a lot of people right now are living in fear that
this disease is among the people of my hometown, and those
fears may cause people to do something that's not very wise,
and sometimes very foolish.
We've seen photos all across this country of towns
reacting to this influenza. We've seen empty shelves of grocery
stores. We've seen empty shelves of bleach. As you said, Dr.
Sell, people think drinking bleach can somehow help control
this virus, which is just crazy. We've seen empty shelves of
canned foods. We see at the Home Depots, the Lowe's, all the
masks and stuff needed to protect people are getting swarmed up
by people who don't need them. And, Dr. Hotez, you brought this
up yesterday on national TV, how can we make sure the required
resources we have to fight back are given to the top
priorities, which I think as you mentioned, are probably, first
all, the families, the victim, their neighbors, the first
responders, the EMS (emergency medical services) vehicles, the
cops, the firefighters, and also the doctors and nurses--how
can we make sure those people have the first priority to get
these scarce resources?
Dr. Hotez. So you've hit on it, right? I mean, that's
exactly right, and thank you for those really generous
comments. We need to give our one, two, three, four top
priorities of the groups that we're going to insure, because if
they go down, then everything falls apart, and things go badly
very quickly. And I don't know that we've really done that yet,
so, I think, you know protecting our older individuals in
nursing homes, because if--because we're--we now know, from
Kirkland, anytime a virus hits a community, those are the ones
who are going to get hit the hardest, and the healthcare
providers, and others.
The other thing I've been saying is--regarding panic has
been, look, you will have time. It's not like you're going to
wake up tomorrow morning and find that the entire Eastern half
of the United States is infected. What we're going to see is
multiple communities being affected, and that will cause a lot
of concern, but you will have time in order to prepare and
figure out what's happening. And we don't exactly know. It may
stop there. You know, there are some who believe there may be
seasonality to this virus. We don't know that at all, because
it's a new agent. So I think it's--the key is to stay in--our
leaders need to stay in contact with the people, hold those
White House briefings on a pretty regular basis, but also try
not to sugarcoat, right? To be--it's a real art to be able to
give difficult information, but to do it in a way to say, we're
aware of it, here's what we're doing about it. And I think, you
know, we've been through this before.
You know, one of the things that I've noticed in the 20
years that I've been following pandemics, it started with
anthrax in 2001, and then SARS in 2003, H1N1 2009, as you
pointed out, Ebola 2014, and then we go to Zika, and now this,
the same thing happens every time. It takes us a little bit of
time to get our arms around it. There are always stumbles in
the beginning, and a lot of that has to do with the Federal
Government and the State governments have to figure out all
over again how to work together, so there always seems to be
that new relationship building that has to happen. And then
eventually we get it right, and this will happen again.
So--and that's, I think, the other thing that we want to
see is the press not piling on too much when these things
happen.
Mr. Olson. Good luck with that.
Dr. Hotez. Yeah, and--well, especially it's occurring
right during the Democratic--it's, you know, it's happening in
the worst time possible from that sense. And to have that
perspective of time, saying, look, this always happens, I mean,
it's the hardest----
Chairman Bera. Thank you, Doctor.
Dr. Hotez [continuing]. Thing our country does.
Chairman Bera. Thank you, Doctor.
Mr. Olson. Yeah, I hear the gavel banging. I have some
questions for the record on stockpiling vaccines. Thank you
very much.
Chairman Bera. Let me recognize the gentleman from
Illinois, Mr. Casten.
Mr. Casten. Thank you, and thank you all for coming. I
want to follow, if I could, a little bit on the questions Dr.
Bera asked at the start about vaccine development. Dr. Hotez,
thank you for clarifying that we're not going to have this
vaccine for a year or so. Can you just share a little bit some
of the risks of bringing the vaccine to market too early?
Dr. Hotez. Thank you for that. Yes, well, the risk is
compromising safety. This, you know, the--remember what we're
doing, we're going to be doing. We're going to be immunizing
healthy people, right, so vaccines always have a higher safety
bar because you're injecting well people. These are often not
individuals who are ill, and you're trying to accelerate some
technology for compassionate use. So--and our FDA, our CBER,
has one of the best track records in the world in ensuring
safety, and we have one of the best monitoring systems in the
world ensuring safety. I mean, we have these four systems in
place, the vaccine events, adverse reporting system, we have--
but--and many times people think that's the only thing we have.
We have a redundant system of four tracks that follow this. So
we know how to do this.
We know how to ensure that vaccines could be developed and
tested safely. Don't try to pressure FDA, CBER, into doing
something that breaks with that, because, you know, if we start
rolling out a vaccine too quickly, and it's shown that a number
of those individuals are getting worse because of this vaccine,
which we know can happen with certain respiratory virus
vaccines. We've seen it with RSV, we've seen it with--in
laboratory animals with other coronavirus vaccines, then people
will lose confidence, and not only confidence in coronavirus
vaccines, but our whole vaccines----
Mr. Casten. Sure.
Dr. Hotez [continuing]. And safety network----
Mr. Casten. So----
Dr. Hotez [continuing]. So----
Mr. Casten. So with a, you know, with an unvaccinated
population, given that some of the early data, you know, is--
seems to suggest that those who are most at risk are those--the
elderly, immunocompromised, we're not going to have a----
Dr. Hotez. And healthcare workers.
Mr. Casten. Yeah. So we're not going to have a vaccinated
population. Presumably other complications that people have may
be at risk. As you look through sort of our broader healthcare
ecosystem, do you see other medications that we may be where,
you know, where increasing focus on some of these non-
coronavirus drugs may be the thing that is ultimately going to
hurt people? Are there other places we should be looking in the
ecosystem right now?
Dr. Hotez. Well, remember, vaccines are the highest bar
there is, so even though that's going to take, you know,
whatever time it is, there are other technologies out there
that we could be--that'll get deployed more quickly. I think
we'll probably have antiviral----
Mr. Casten. Just----
Dr. Hotez [continuing]. Drugs a little----
Mr. Casten. Sorry, I don't--I'm asking a sort of different
question, and maybe it's my own lack of knowledge. If I
already--let's say, as an example, I'm taking
immunosuppressants because I just had a liver transplant----
Dr. Hotez. Um-hum.
Mr. Casten [continuing]. The--and all of a sudden I come
down with coronavirus, I may not--coronavirus may not be the
thing that does me in, but this other thing does. So if we look
at the populations that are most at risk from getting a bad
flu, are there other sort of drugs and pharmacologicals that
that community is disproportionately taking that we should be
concerned about, or maybe a little focus there might protect
some of these folks?
Dr. Hotez. I don't know--I'll have to think about that a
little bit more, but you're right. I mean, I think, you know,
we don't have--remember, this is a new virus agent, and there
are differences in the U.S. and the Chinese population. We
haven't seen a lot of data of people with immunosuppressive
drugs, so----
Mr. Casten. OK.
Dr. Hotez [continuing]. I don't think we really know what
that----
Mr. Casten. Yeah, I just used that as an example. I----
Dr. Hotez. So people on Humira, and--I don't----
Mr. Casten. Yeah. My concern is just all these people who
might be needing insulin, might be needing statins, other
things. Shifting with the little bit of time I have left, Dr.
Sell, I appreciate your comments on not spreading
misinformation, and just, with the little time we have left,
all of us going to be back in our districts next week. We all
have, you know, certain platforms that we can speak to. Given
what you researched on Ebola, and without, you know, making
this a political conversation, as you look at what's going on
right now, are there specific pieces of misinformation that
trouble you, and if you were in our shoes, what would you love
to see us saying to the country this weekend?
Dr. Sell. You bring up something that's very important,
because influencers, like you, have the--one of the biggest
roles in spreading the truth about the disease. That's actually
borne out by the research. So I think, when you go home to your
constituents this weekend, I think people might be afraid, and
I think this is a concerning disease. We can't sugarcoat it. We
have to say, this is serious, we need to think of it, and think
about the ways that we can prepare.
People--research has shown that people really want to know
more about the actions that they can take, rather than the
risks that they have to worry about. So, you know, the CDC has
a lot of advice out there, wash your hands, use respiratory
etiquette. I think people also want to think about how they can
be prepared, how they might take care of a loved one, if a
loved one is sick, but not serious enough to be in the
hospital, to--and we're limiting how many people we're trying
to take care of in hospitals, to how we might care for sick
people at home, and think about, you know, stockpiling
prescription meds, and things that you might need, and you
don't want to be at the store when there's, you know, a lot of
sick people or whatever. I think that actions are really what
people need to hear right now.
Mr. Casten. Thank you. I yield back.
Chairman Bera. The gentleman from Ohio, Mr. Gonzalez, is
recognized for 5 minutes.
Mr. Gonzalez. Thank you, Mr. Chairman, and thank you, for
our witnesses. Dr. Hotez, you have a great background. I'm
going to sing Dr. Sell's praises for a moment. It's not every
day that we get an Olympic athlete in our midst, especially one
that had a world record at one point. Do you still have it, by
the way?
Dr. Sell. No. Someone took it a----
Mr. Gonzalez. Someone--OK.
Dr. Sell [continuing]. Years ago.
Mr. Gonzalez. Still unbelievably impressive. I don't think
any of us have world records in our history. Could be wrong.
Certainly for nothing as impressive as what you did. But of all
the accomplishments and things I respect most about Dr. Sell,
it's the fact that she has my wife's unyielding admiration and
appreciation, that means the most to me, as a college teammate
of yours.
So I want to start by asking about the role that
diagnostics play in forecasting accuracy. I just left a
briefing, where it's very obvious that we did not, and still
probably do not, have the number of diagnostics available, with
respect to coronavirus today. So, when it comes to your
forecasting accuracy, what role does having robust diagnostics
play in the process?
Dr. Sell. Well, that's a great question--and thank you
very much for the introduction. Diagnostics have an incredible
role to play because the way that you look for information out
there about the disease determines what you'll find, right? So
if you're only looking for people who have a travel history,
you're never going to say, we have community transmission,
because every case you find will have a travel history. And so
I think that being able to use rapid diagnostics, like the flu
test, or these other things, is really important so that we can
note those more mild cases, and we know the range of disease,
and where it is.
Mr. Gonzalez. Great.
Dr. Brownstein. From a modeling perspective----
Mr. Gonzalez. Yeah.
Dr. Brownstein [continuing]. Having an accurate
understanding of what's happening in the community is
incredibly important, right? Because we're essentially seeing
some of the more severe cases. It might lead to overestimates
of case fatality. We don't actually know what's happening at
the community level because we don't have the testing. So we're
going to essentially be biased in our understanding of disease,
and not actually have a direct understanding of things like
household transmission, what we're seeing in terms of the level
of spread that's happening. So this is why having enough
diagnostic capacity to do it at a population scale is so
critical, and why we see incredible advances in Korea and other
places.
Mr. Gonzalez. Yeah. And I think that, you know, one of the
things that is troubling for a lot of folks, certainly for me,
is you see different case fatality rates depending on the
country, right? And my estimation of that is because we don't
know the N, and everybody's using a disparate, you know, South
Korea they're testing all the time. It seems almost like drive-
through test kits, whereas here it's unclear to me how many
people we've actually tested. I don't think it's north of
1,000. I could be wrong on that. So that's been a little
troubling.
I guess follow up question on the model piece, if we had
been testing on the order of, say, South Korea, how much
further along do you think we would be, and how much closer to
being able to more effectively prepare and prevent a major
outbreak would we be if we had the better testing capabilities?
I'll start with Dr. Sell.
Dr. Sell. I'll be quick, so the others can answer, but I
think if we had better testing capabilities, I think we would
have had the motivation to get moving a little bit quicker.
Mr. Gonzalez. Yeah.
Dr. Sell. And--especially in places where we might see
disease so that we could keep it out of those nursing homes and
hospitals. So I think that's--would've been helpful.
Mr. Gonzalez. Great. Dr. Brownstein.
Dr. Brownstein. Yeah, exactly the same thing. The more
detailed information we have on the ground, the better off we
are to respond. Models are only as good as the data that we
feed them, of course, and so, if we have richer information
about what's happening, we have that testing, we can understand
what is happening at the community level, and think about
things like social isolation, and other mitigation efforts that
could slow the spread of the coronavirus.
Mr. Gonzalez. Thank you. And then, with my final minute,
Dr. Sell, I want to go back to the question that Mr. Casten was
asking, with respect to false information. Obviously, since
2014 and Ebola, the platforms that we use, the way we
communicate, has changed quite a bit. Have you noticed a stark
difference of any kind between how misinformation was spread in
2014 versus how it's spread today? What sort of lessons can we
learn from that?
Dr. Sell. This is an opinion without an analysis behind
it, but I think that the spread of misinformation has been much
more rapid. We know that in some cases it's been coordinated,
and I think that it spreads across multiple platforms very
quickly. We have these echo chambers, and we had echo chambers
in 2014, but this information just bounces within people who
have the same belief systems, and so it's very hard to change
that.
Mr. Gonzalez. OK. Thank you, and I yield back.
Chairman Bera. The gentleman from Illinois, Mr. Foster, is
recognized for 5 minutes.
Mr. Foster. Thank you, Mr. Chairman, and to our witnesses.
I've been sitting here trying to synthesize from your testimony
what a coherent plan to actually, you know, do something over
the next decades that would really move the ball on this, and
so the first step, it seems to me, is to actually characterize
the up to 1.7 million potentially transmissionable viruses, and
I think there may be hope for developing technology so we can
see the sort of, you know, 1.7 million sounds like a big
number, but with technology development you might be able to
bring the cost down. And then to potentially do things to
mitigate transmission from the animal reservoirs. And, you
know, there are things like gene drives, and other things. They
just did--they're talking about releasing mosquitoes that can't
transmit certain--that sort of approach might be important.
And secondly, to simply identify the concerned sequences
across broad classes of these. There was an example of this,
actually, in my district, Argonne National Labs, where they
recently solved a protein called NSP-15, which is conservative
on coronaviruses. It is apparently involved in the replication
of the virus as a very attractive drug target that--actually do
something that would sort of persist over a time longer than
Congress's Attention Deficit Disorder to actually, you know,
stay focused on a handful of attractive targets, or a large
number of attractive targets, and develop these for drugs, you
know, both as treatments and vaccines.
And here I perceive there's a real difference, that you
can potentially do things quickly for treatments, but the
vaccine problem is much tougher because of the clinical trial
bottleneck. I don't know if there are any great breakthrough
ideas to--so that if you have thousands of potential viruses,
and everything about them understood, but you haven't done the
clinical trials on--and you identified targets, but you still
need clinical trials, are there any ways to accelerate that, or
any potential technologies out there? I--that seems like an
unsolved problem, from your testimonies.
And then, fourth, developing high volume, general purpose
manufacturing that's on standby, which is something Dr. Sell
mentioned. This seems like it's something where you can throw
money at the problem. You know, if there are really general
purpose technologies out there, and we, you know, there's a lot
of overlap with this--frankly, with money we're spending on
bioterror defense, and it may be that it's the exact same
equipment that you need.
And so I'd be interested in--well, first off, have I
missed any big parts of this? Are there significant things--I
think the rapid detection is something you mentioned that's
sort of a parallel track from this.
Dr. Brownstein. If I may add just one other component to
this, which is this idea of a national or international service
around disease forecasting, right? We've done this for the
weather, right, like a national service for weather, where we
collect data from NOAA and make predictions. That does not
exist today in disease forecasting, and if there was
investments to be made in addition to important pipelines
around manufacturing, it would be developing a way to predict
the--sort of the next coronavirus-like pandemic.
Mr. Foster. Yes, Dr. Hotez?
Dr. Hotez. Yeah. I think you pointed out a very good
bottleneck, that, you know, that clinical testing does take
time. There has been a lot of effort to apply innovation toward
streamlining clinical safety testing. Sometimes we call it
systems vaccinology. The idea is we can do more things in
parallel, rather than sequentially. And, in fact, that was
already started with the Ebola vaccine in DR Congo. We did a
lot of things in parallel, so it really went through and got--
we got information on its efficacy and its safety in record
time.
And I think, if it wasn't for this particular safety
signal around this immune enhancement problem, we may--we might
have broken a record, because there is an appetite to figure
out how to streamline vaccine safety testing, it's just that
there's just--unique, quirky feature about coronavirus
vaccines, and some other respiratory virus vaccines. So I think
you will see innovation and streamlining clinical trials, I'm
just not sure this is the one to do it with.
Dr. Sell. I had one other addition. I think that, you
know, we--when we come up with these tools, they're
interesting, and the exist out there, but we really need a way
to sort of integrate them into practice, and that--so I think
practice-focused research at public health agencies and the CDC
is really important to making sure that we actually move
research into actually making a difference on the ground.
Mr. Foster. And have there been, you know, big studies
that actually come up with, here's the holistic plan, here's
rough budgets? You know, are--is this something where it was
done 15 years ago by the National Academies, and ignored by
Congress, or is that--there actually the need for, OK, let's
just sit down and, in an international context, come up with a
plan that has those elements that I mentioned and others? Dr.
Murray?
Dr. Murray. Yes, if I can answer part of that? The--to
answer the first part of your question, there is a group that
is newly formed, the Global Virome Project, that is looking at
the 1.7 million as yet unknown viruses. Their goal is to
identify and characterize all of that in--much in the same way
as the Human Genome Project started out, and provided a wealth
of information. We have had, for the last 10 years, a global
program looking at human and animal health, as well as
syndromic surveillance in country, laboratory building. That's
the one I was describing that's just in the process of shutting
down now.
I would suggest that this is not the time for the U.S. to
be pulling out, but, if we have a program that's doing it, if
anything else, we need to continue and expand, and incorporate
more of the type of folks we have here. And part of that
program also had what Dr. Sell was working on----
Mr. Foster. I'm sorry, I guess I'm----
Chairman Bera. Yeah. We're----
Mr. Foster [continuing]. Exceeding time here.
Chairman Bera. We're going to try to get one last question
in, since they called votes on us. The gentleman from Virginia,
Mr. Beyer, is recognized for five----
Mr. Beyer. Mr. Chairman, thank you very much, and thank
you all so much for being here. This--incredibly important
topic. And, Dr. Hotez, it's nice to see you again, 30 years
after first coming across your incredible landmark work on the
hookworm vaccine, so, good luck. I want to start by submitting
a letter I--yesterday supported by 60 Members of Congress
sharing my concern about the ineffective White House response,
the lack of a chain of command, sharing conflicting
information, et cetera, so--and how we stand ready to improve
it. So, if there's no objection, Mr. Chairman?
And, Dr. Sell, first, with apologies, I hate asking yes or
no questions because they tend to be gotcha questions here, so
please know that, time allowing, there will be time for
paragraph questions later, but I'd like to make just some--a
quick point, so five yes or no questions would be helpful----
Dr. Sell. OK.
Mr. Beyer [continuing]. And then we'll move. First, the
World Health Organization says that the death rate from
coronavirus is over 3 percent of those infected. Do you have
any reason to believe that the actual figure is a fraction of 1
percent?
Dr. Sell. A fraction of 1 percent?
Mr. Beyer. Yeah.
Dr. Sell. Yes.
Mr. Beyer. OK. Thank you. Would you say that the World
Health Organization statistics on the spread of the novel
coronavirus are false?
Dr. Sell. No.
Mr. Beyer. Will we have a vaccine soon, or within a few
months?
Dr. Sell. No.
Mr. Beyer. Are we likely to get a quick cure?
Dr. Sell. By cure do you mean a treatment?
Mr. Beyer. Well----
Dr. Sell. I have to say possibly, because there's drug
trials.
Mr. Beyer. OK, great. And should Americans who have the
coronavirus symptoms, or believe themselves to be sick, go to
work and risk spreading the disease?
Dr. Sell. No.
Mr. Beyer. Would you generally agree that all those
statements are false? The panel. Let me go on--the--Dr. Sell,
one last question, would you say that it would endanger
American lives to spread disinformation that would cause people
to go to work, and potentially spread the coronavirus because
the public was misled about the dangers of this deadly disease?
Dr. Sell. Misleading the public about a disease is wrong.
Mr. Beyer. And so the sad part here is that these
statements, which most scientists--well, every scientist
testifying today, would agree endanger American lives were
actually made by our President to large audiences in the last 3
days. Scientists just told me that Trump's coronavirus
statements about a soon--quick vaccine, a quick cure, it's OK
to go to work, that all these things are endangering American
lives. And, to be clear, the CDC advises anyone exhibiting
symptoms of coronavirus, such as a fever, coughing, or
shortness of breath, stay home from work, avoid public areas as
much as possible, and seek medical attention.
The Tuesday briefing from Vice President--was not
televised. He came here and talked I think four different
times. On Monday we heard reports that the CDC stopped
disclosing the stats on how many Americans are being tested. At
a time of high uncertainty in the face of a likely pandemic,
should the American administration more transparent or less?
Maybe Dr. Hotez? Or Dr. Sell?
Dr. Sell. I'll just be quick. The administration should be
transparent. They should be clear about what they know. They
should tell the truth, be clear about what they don't know,
what they're doing to try to find out those missing pieces of
information, and be clear about what the course is, and what
information might change that course.
Mr. Beyer. Great. Thank you. Dr. Brownstein, we've heard a
claim that focusing on testing is no longer needed once the
disease has spread, you know, that it's in the community, that
testing is moot. We've also heard the test--sentiment from many
that they'd rather over-test folks than under-test folks. Do
you think that testing will still be valuable when it starts to
spread into a community?
Dr. Brownstein. Yeah. I think it's important to actually
have an accurate picture, because the dynamic of this virus is
going to change as it moves from community to community, and
understanding the impact that it's having at scale is going to
be critical. And so, just like we do this for the influenza on
a seasonal basis, where we test for flu to understand what the
underlying illness is, the idea of doing this at scale for
coronavirus makes a lot of sense.
Mr. Beyer. Dr. Hotez, you've done so much work on vaccines
over the decades, and you testified earlier quite well about
it. What's the best the American people can hope for, in terms
of a quick vaccine, or a soon vaccine, or----
Dr. Hotez. Well, you know, I think it's really important
to remember that vaccines are not quick, and that has a lot to
do with vaccine confidence in the United States, because, as
you know, we have a very aggressive anti-vaccine movement here
in this country, and, as of the last couple of years, it's
affecting public health, right? Measles came back in 2019
because of the anti-vaccine movement. Historically, when we've
had measles epidemics, it peaks now, late winter, early spring,
so we may be battling two epidemics. We still have 16,000
Americans who've died of flu, including 100 kids most who were
not vaccinated. So I think it's really important not to tell
the American public that we will have a quick vaccine, because
that's not how it works. We have to reassure the public that we
don't give out vaccines unless they're thoroughly tested, and
they are the most thoroughly tested pharmaceuticals we have for
safety.
Mr. Beyer. And, Mr. Chairman, as I yield back, I just want
to thank Dr. Hotez too for leading the fight against the anti-
vaxxers, and that misinformation.
Chairman Bera. Thank you, Mr. Beyer. Before we bring this
hearing to a close, I want to thank all of our witnesses for
testifying before the Committee today. The record will remain
open for 2 weeks for additional statements from Members, and
for any additional questions the Committee may ask of the
witnesses. With that, the witnesses are excused, and this
hearing is now adjourned.
[Whereupon, at 10:45 a.m., the Subcommittee was
adjourned.]
Appendix I
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Answers to Post-Hearing Questions
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Appendix II
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Additional Material for the Record
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