[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]


                           COVID-19 VARIANTS
                      AND EVOLVING RESEARCH NEEDS

=======================================================================

                                HEARING

                               BEFORE THE

                     SUBCOMMITTEE ON INVESTIGATIONS
                             AND OVERSIGHT

                                 OF THE

                      COMMITTEE ON SCIENCE, SPACE,
                             AND TECHNOLOGY
                        HOUSE OF REPRESENTATIVES

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             FIRST SESSION

                               __________

                              MAY 12, 2021

                               __________

                           Serial No. 117-14

                               __________

 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                    
44-466PDF                 WASHINGTON : 2022                     
          
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              COMMITTEE ON SCIENCE, SPACE, AND TECHNOLOGY

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

              Subcommittee on Investigations and Oversight

                  HON. BILL FOSTER, Illinois, Chairman
ED PERLMUTTER, Colorado              JAY OBERNOLTE, California,
AMI BERA, California                   Ranking Member
GWEN MOORE, Wisconsin                PETE SESSIONS, Texas
SEAN CASTEN, Illinois                VACANCY
                         
                         C  O  N  T  E  N  T  S

                              May 12, 2021

                                                                   Page

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

                           Opening Statements

Statement by Representative Bill Foster, Chairman, Subcommittee 
  on Investigations and Oversight, Committee on Science, Space, 
  and Technology, U.S. House of Representatives..................     8
    Written Statement............................................     9

Statement by Representative Jay Obernolte, Ranking Member, 
  Subcommittee on Investigations and Oversight, Committee on 
  Science, Space, and Technology, U.S. House of Representatives..    10
    Written Statement............................................    11

Statement by Representative Eddie Bernice Johnson, Chairwoman, 
  Committee on Science, Space, and Technology, U.S. House of 
  Representatives................................................    12
    Written Statement............................................    13

                               Witnesses:

Dr. Salim Abdool Karim, Director of CAPRISA
    Oral Statement...............................................    14
    Written Statement............................................    31

Dr. Nathan Grubaugh, Assistant Professor of Epidemiology
    Oral Statement...............................................    47
    Written Statement............................................    49

Dr. Stephen Streiffer, Deputy Laboratory Director for Science and 
  Technology, Argonne National Laboratory
    Oral Statement...............................................    56
    Written Statement............................................    58

Dr. Caitlin Rivers, Senior Scholar, Johns Hopkins Center for 
  Health Security
    Oral Statement...............................................    71
    Written Statement............................................    73

Discussion.......................................................    79

              Appendix: Answers to Post-Hearing Questions

Dr. Stephen Streiffer, Deputy Laboratory Director for Science and 
  Technology, Argonne National Laboratory........................   100

 
                           COVID-19 VARIANTS
                      AND EVOLVING RESEARCH NEEDS

                              ----------                              


                        WEDNESDAY, MAY 12, 2021

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

     The Subcommittee met, pursuant to notice, at 10:03 a.m., 
via Zoom, Hon. Bill Foster [Chairman of the Subcommittee] 
presiding.
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

     Chairman Foster. This hearing will now come to order. 
Without objection, the Chair is authorized to declare a recess 
at any time.
     Before I deliver my opening remarks, I wanted to note the 
circumstances under which we're meeting today. Pursuant to 
House Resolution 8, the Subcommittee is meeting virtually, and 
a couple of reminders for the Members about the conduct of this 
remote hearing. First, Members should keep their video feed on 
as long as they are present in the hearing. Members are 
responsible for their own microphones. Please also keep your 
microphones muted unless you're speaking. Finally, if Members 
have documents they wish to submit for the record, please email 
them to the Committee Clerk, whose email address was circulated 
prior to the hearing.
     Well, good morning, and welcome to our Members and our 
panelists. Thank you for joining us for this hearing on COVID-
19 variants. Over a year into the pandemic, we're all 
accustomed to a new normal: social distancing, mask wearing, 
and, of course, the virtual proceedings we're conducting today. 
Almost 60 percent of Americans have received at least one 
vaccination dose, and our ability to detect and monitor the 
spread of the virus puts us in a much better position than we 
were just one year ago.
     But just as we've adapted to life in the pandemic, the 
virus has mutated as it continues to spread around the globe. 
Each new variant brings the potential for increased 
contagiousness, disease severity, and evasion of safety 
measures and vaccine-induced natural immunity. Today, most of 
the new variants seem to have evolved from national--natural 
evolutionary pressure, natural selection for infectiousness. 
One of the commonly expressed worries is about an escape 
variant of the virus, a superbug that is resistant to our 
vaccines and may--might evolve in a partially vaccinated 
population. In a worst-case scenario, such a variant would 
require us to start over from zero in our vaccine 
manufacturing, tests, and deployment.
     One important policy decision that the United States faces 
is whether to hold in reserve vaccine manufacturing capacity 
for such a contingency or perhaps simply to reserve vaccine 
manufacturing capacity for possible booster shots, which may be 
required due to the waning of our immune response. This 
decision will be especially fraught if we conclude that we must 
use our manufacturing capacity to make booster shots for the 
U.S. at a time when the rest of the world may not be fully 
vaccinated.
     To make those decisions, and many others, we need to 
evaluate the probability that new variants or escape variants, 
as well as what is known about the waning of our immune 
response from the vaccines, to the standard variants of the 
virus.
     And, more broadly, we must ensure that the tools we use to 
detect, treat, and forecast the virus are keeping up with the 
emerging variants. Researchers, medical practitioners, and 
public health authorities have spent the last year standing up 
an unbelievably impressive network of testing, surveillance, 
treatment, and prevention tools. Thinking back to March 2020, 
it was unimaginable to many that by May 2021, more than half of 
Americans would be vaccinated against a virus that had just 
reached our shores. Disease monitoring tools require an 
unprecedented scale of data sharing and aggregation on an 
international level.
     And, as the death rate in our country has been dropping 
for months, thanks to a better awareness of how to treat this 
disease, we must not lose any of the gains as this virus 
mutates, potentially increasing in contagiousness, severity, or 
its ability to escape our vaccines. It's important that we in 
the Federal Government support the efforts of researchers and 
public health agencies in conducting top-of-the-line research 
to inform health-protective policies.
     Our witnesses here today will tell us about some of the 
amazing science that has come out of the work on the pandemic, 
and how we can best support their work now and into the future. 
The U.S. scientific enterprise has historically been equipped 
to answer those questions, and the Federal Government must 
continue to support and amplify this support.
     In this fight, we must not lose sight of our Nation's 
place as a world leader and the importance of international 
collaboration. We have all seen the recent devastating news 
coming out of India, making this hearing all the more timely. 
Stories of overloaded hospitals, insufficient vaccine supplies, 
and mounting deaths. The more the virus spreads, the more 
mutations will occur, meaning more strains of virus will 
develop. No country is out of the woods until every country has 
the ability to reach herd immunity, or to paraphrase Dr. Rev. 
Martin Luther King, coronavirus anywhere is a threat to health 
everywhere.
     The Biden Administration has committed to this global 
fight by rejoining the World Health Organization and the COVAX 
(COVID-19 Vaccines Global Access) program, pledging $2 billion 
to support vaccine access in low- and middle-income countries. 
The United States is also sending 60 million doses of the 
AstraZeneca (AZ) vaccine overseas, but we must do more. All 
approved vaccines have shown to be efficacious in preventing 
severe forms of known variants, a triumph worth celebrating and 
something that we cannot take for granted into the future. 
Bolstering worldwide vaccine access must go hand-in-hand with 
continuing monitoring of vaccine efficacy in the face of new 
variants.
     I look forward to hearing from our witnesses today about 
how we can best support the research that we need to end this 
pandemic and to prepare for the next.
     [The prepared statement of Chairman Foster follows:]

    Good morning, and welcome to our members and our panelists. 
Thank you for joining us for this hearing on COVID-19 variants. 
Over a year into the pandemic, we're all accustomed to a new 
normal--social distancing, mask wearing, hand sanitizing, and, 
of course, the virtual proceedings we're conducting today. 
Almost 60 percent of Americans have received at least one 
vaccination dose, and our ability to detect and monitor the 
spread of the virus puts us in a much better position than we 
were just one year ago. But just as we've adapted to life in a 
pandemic, the virus has mutated as it continues to spread 
around the globe. Each new variant brings the potential for 
increased contagiousness, disease severity, and evasion of 
safety measures and vaccine-induced and natural immunity. We 
must ensure that the tools we use to detect, treat, and 
forecast the virus are keeping up with emerging variants.
    Researchers, medical practitioners, and public health 
authorities have spent the last year standing up an 
unbelievably impressive network of testing, surveillance, 
treatment, and prevention tools. Thinking back to March 2020, 
it was unimaginable to many that by May 2021, more than half of 
Americans would be vaccinated against a virus that had just 
reached our shores. Disease monitoring tools require an 
unprecedented scale of data sharing and aggregation on an 
international level. And the death rate in our country has been 
dropping for months, thanks in part to a better awareness of 
how to treat this disease. We must not lose any of these gains 
as the virus mutates, potentially increasing its contagiousness 
and severity. It is imperative that we in the federal 
government support the efforts of researchers and public health 
agencies in conducting top-of-the-line research to inform 
health-protective policies.
    Our witnesses here today will tell us about some of the 
amazing science that has come out of the pandemic, and how we 
can best support their work. Each time a new variant pops up on 
the CDC website, I'm sure we all have the same questions. How 
effective are existing tests and vaccines? How will masking and 
distancing guidelines be adjusted based on the contagiousness 
of this new strain? Will the virus cause more severe illness 
that requires different treatments? The U.S. scientific 
enterprise is equipped to answer these questions, and the 
federal government must continue to support and amplify this 
work.
    In this fight, we must not lose sight of our nation's place 
as a world leader and the importance of international 
collaboration. We have all seen the recent devastating news 
coming out of India, making this hearing all the more timely. 
Stories of overloaded hospitals, insufficient vaccine supplies, 
and mounting deaths. The more the virus spreads, the more 
mutations will occur, meaning more strains of the virus will 
develop. No country is out of the woods until every country has 
the ability to reach herd immunity. The Biden Administration 
has committed to this global fight by rejoining the World 
Health Organization and the COVAX program, pledging $2 billion 
to support vaccine access in low- and middle-income countries. 
The United States is also sending 60 million doses of the 
AstraZeneca vaccine overseas. All approved vaccines have shown 
to be efficacious in preventing severe disease from known 
variants--a triumph worth celebrating, and something we cannot 
take for granted. Bolstering worldwide vaccine access must go 
hand-in-hand with continued monitoring of vaccine efficacy in 
the face of new variants.
    I look forward to hearing from our witnesses today about 
how we can best support the research we need to end this 
pandemic and prepare for the next.
    I now yield to Ranking Member Obernolte for his remarks.

     Chairman Foster. And I'll recognize my Ranking Member, Mr. 
Obernolte, for his--an opening statement.
     Mr. Obernolte. Thank you very much, Chairman Foster, and 
thank you for convening this very timely hearing on a very 
important topic. I am looking forward to hearing from our 
witnesses, and I'm particularly excited about this hearing 
because it gives us the opportunity to highlight the incredibly 
important role that our research community has had in fighting 
this epidemic. I believe that many of our Federal researchers 
are the unsung heroes of this epidemic, and I also believe that 
the development and deployment of the vaccines that have been 
accomplished in the last few months will go down as one of the 
greatest scientific achievements of mankind so far. So it can't 
be understated the incredible role that our research community 
has had in combatting this virus.
     Unfortunately, though, it's clear that much more work 
needs to be done. If we look at the emergence of the different 
variants of COVID-19, it's clear that we need to invest more in 
research and development so that we understand a lot of the 
questions that are still unanswered, for example, the way that 
these variants emerge, whether or not these variants cause more 
or less severe illnesses, whether or not they're more or less 
transmissible, and the way that those variants respond to the 
various vaccines that have been developed and the way that we 
can develop vaccines in the future that anticipate those 
variants. So it's very important that we continue this 
investment in research into not only human biology but 
epidemiology and the spread of these variants.
     I also want to highlight the important role that Congress 
has to play in stimulating this kind of research. The Federal 
Government is a natural--actually absolutely critical source of 
funding and of focusing attention on these efforts, and we need 
to continue that investment. I know that the Science, Space, 
and Technology Committee is considering a number of different 
bills that will continue that investment, and I fully support 
those efforts. I want to highlight one in particular, H.R. 
2153, the Securing American Leadership in Science and 
Technology Act, which authorizes Department of Energy (DOE) 
infectious disease research program. I think that that's 
incredibly important, and I hope that that's something that's 
going to get attention in this Committee.
     So, Mr. Chairman, thank you very much again for convening 
the hearing, and I'm looking forward to hearing from our 
witnesses.
     [The prepared statement of Mr. Obernolte follows:]

    Thank you, Chairman Foster, for holding today's important 
and timely hearing. I would also like to thank our expert 
witnesses for their participation today.
    I look forward to learning more about the important 
contributions the Department of Energy (DOE) Office of 
Science's National Laboratories are making to combat the COVID-
19 virus, and what role they can play moving forward to combat 
other infectious diseases. Thank you, Dr. Streiffer for being 
here today and for all the important work you do at Argonne 
National Laboratory.
    Our nation's research enterprise has demonstrated it has 
the expertise, resources, and talent to fight this pandemic. We 
have supercomputers, advanced manufacturing techniques, and 
even advanced photon sources being used to fight COVID-19.
    The DOE National Labs have a history of using technical 
solutions to respond to national and international emergencies, 
and when the COVID-19 pandemic hit, the labs were prepared, 
ready, and willing to serve on the front lines. DOE received 
$99.5M in the CARES Act to fund research at the National Labs 
to better understand COVID-19. This funding has since been 
fully expended.
    At the start of the pandemic, DOE pivoted and launched the 
National Virtual Biotechnical Laboratory (NVBL) to mobilize the 
resources of the Department of Energy's 17 National Labs to 
engage in critical COVID-19 research. Projects within NVBL are 
focused on molecular design for medical therapeutics, 
development and evaluation of COVID-19 testing, epidemiological 
and transpiration modeling, and advanced manufacturing.
    I would also like to highlight that decades of investment 
in basic scientific research involving the National Labs 
contributed to the unprecedented speed COVID-19 vaccines were 
developed and distributed. These investments have been truly 
lifesaving.
    The accomplishments made possible through the NVBL 
demonstrate the power of the U.S. innovation ecosystem, when 
you have DOE National labs, universities, and companies all 
working together to address a national and societal challenge.
    As the original COVID-19 virus and new variants continue to 
spread across the globe, it is imperative that the United 
States continues to make critical investments in basic research 
for the health and safety of our nation. To date, the Centers 
for Disease Control and Prevention (CDC) have identified five 
COVID-19 Variants of Concern (VOCs) in the United States. 
Researchers are paying close attention to these VOCs as 
according to the CDC, they appear to spread more easily and 
quickly than other identified Variants of Interest (VOIs).
    There remains a lot of information public health officials 
and researchers do not yet know about COVID-19 variants, and 
further studies are needed. For example, researchers still need 
to learn how easily emerging COVID-19 variants spread, if they 
cause milder or more severe illness, if they are detected by 
currently available viral tests, if they respond to medications 
currently being used to treat COVID-19, and whether existing 
authorized vaccines protect people from them. The DOE National 
Labs can build upon previous COVID-19 research work and get 
ahead in the race against COVID-19 mutations. The National Labs 
have existing infrastructure, resources, and experts ready to 
deploy, and can continue to play a leading role in addressing 
key concerns and challenges to confront the COVID-19 pandemic 
and beyond.
    Before I close, I would like to highlight H.R. 2153, the 
Securing American Leadership in Science and Technology Act 
(SALSTA), which was introduced by Full Committee Ranking Member 
Lucas in March, and which I am an original cosponsor of. This 
legislation includes an authorization for a DOE emerging 
infectious disease research program and high-performance 
computing research consortium.
    I hope that today's hearing will continue an important 
dialogue on the role of Federal science agencies in supporting 
R&D to combat the COVID-19 virus and propose new and innovative 
solutions for infectious disease responses in the future.
    Thank you, and I yield back.

     Chairman Foster. Thank you. And we are honored to have the 
Full Committee Chairwoman, Ms. Johnson, with us today, and the 
Chair now recognizes the Chairwoman for an opening statement.
     Chairwoman Johnson. Well, thank you very much, and good 
morning. Let me thank you for holding this hearing today and 
thank all of our witnesses for joining us this morning. Dr. 
Abdool Karim, I understand you are halfway around the world 
right now, so good evening to you.
     Today's hearing could not be more timely. The United 
States has already made incredible strides in making safe, 
accessible vaccines available to all adults. Just this week, 
the FDA (Food and Drug Administration) extended an 
authorization for 12- to 15-year-olds to receive the Pfizer 
vaccine. And I understand that some of our basic science 
research was performed at one of our national laboratories, the 
home of one of our witness's laboratory. These scientific 
achievements were a gift to the world, and they've already 
saved millions of lives, and they will save millions more.
     In the United States, every teenager and adult now has 
access to the tools they need to protect themselves and loved 
ones. We must not squander this gift. We have no time to waste 
because viral variants are threatening the progress the United 
States has made toward defeating COVID-19. In recent weeks, one 
variant has brought the entire nation of India to its knees. 
And the longer the COVID-19 persists around the globe, the more 
mutations will emerge. Pandemics know no borders. An emerging 
variant anywhere is a public health threat everywhere, as you 
have said, Mr. Chair.
     Our witnesses today will help us understand how emerging 
variants make it even more urgent to vaccinate fast, not just 
in the United States, but across the globe. I also look forward 
to hearing about the scientific tools we can use to spot a 
variant. The Federal Government supports an impressive range of 
infectious diseases--disease modeling, data sharing, and 
surveillance activities. We know now that these programs should 
have been coordinating more closely before the pandemic. A 2016 
White House report offered a roadmap for exactly that: 
stitching together science activities across a dozen different 
agencies to enable better models of how diseases spread and 
change. Unfortunately, we did not get far enough on 
implementing these recommendations before COVID-19 reached our 
shores.
     But it isn't too late to continue to improve the Federal 
approach to disease forecasting and surveillance for this 
present-day crisis. We can deploy our best Federal science 
capabilities to detect and understand variants as early as 
possible. This helps public officials and healthcare providers 
have the quality information they need to protect and save 
lives.
     Thank you, Subcommittee Chairman Foster and Ranking 
Member, for putting together this timely discussion, and I 
yield back.
     [The prepared statement of Chairwoman Johnson follows:]
    Good morning and thank you to our witnesses for joining us 
this morning. Dr. Abdool Karim, I understand you are halfway 
around the world right now, so good evening to you.
    Today's hearing could not be more timely. The United States 
has already made incredible strides in making safe, accessible 
vaccines available to all adults. Just this week, the FDA 
extended an authorization for 12- to 15-year-olds to receive 
the Pfizer vaccine. I understand that some of the basic science 
research performed at Argonne National Laboratory, home to one 
of our witnesses today, was a foundational part of creating 
mRNA vaccines. These scientific achievements were a gift to the 
world. They have already saved millions of lives, and they will 
save millions more. In the United States, every teenager and 
adult now has access to the tools they need to protect 
ourselves and our loved ones.
    But we must not squander this gift.
    We have no time to waste, because viral variants are 
threatening the progress the United States has made toward 
defeating COVID-19. In recent weeks, one variant has brought 
the entire nation of India to its knees. And the longer COVID-
19 persists around the globe, the more mutations will emerge. 
Pandemics know no borders; an emerging variant anywhere is a 
public health threat everywhere. Our witnesses today will help 
us understand how emerging variants make it even more urgent to 
vaccinate fast--not in just the United States, but across the 
globe.
    I also look forward to hearing about all the scientific 
tools we can use to spot a variant. The federal government 
supports an impressive range of infectious disease modeling, 
data sharing, and surveillance activities. We know now that 
these programs should have been coordinating more closely 
before the pandemic. A 2016 White House report offered a 
roadmap for exactly this: stitching together science activities 
across a dozen different agencies to enable better models of 
how diseases spread and change. Unfortunately, we did not get 
far enough on implementing those recommendations before COVID-
19 reached our shores.
    But it isn't too late to continue to improve the federal 
approach to disease forecasting and surveillance for this 
present-day crisis. We can deploy our best federal science 
capabilities to detect and understand variants as early as 
possible. This helps public officials and healthcare providers 
have the quality information they need to protect the public 
and save lives.
    Thank you Subcommittee Chairman Foster and Ranking Member 
Obernolte for putting together this timely discussion. I yield 
back.

     Chairman Foster. Thank you. And if there are any 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. Our 
first witness is Dr. Salim Abdool Karim. Dr. Abdool Karim is a 
clinical infectious disease epidemiologist who has played a 
leading role in the global COVID-19 pandemic response. He is 
Director for the Center for AIDS--the AIDS Programme of 
Research in South Africa, CAPRISA, and CAPRISA Professor of 
Global Health at Columbia University. Dr. Abdool Karim is also 
one of the nine members of the World Health Organization's 
Science Council. His contributions during the pandemic have 
focused on the epidemiology of SARS-CoV-2 variants, including 
their impact on vaccine and natural immunity.
     Next is Dr. Nathan Grubaugh, Associate Professor of 
Epidemiology at the Yale School of Public Health and head of 
the Grubaugh Lab where he studies virus emergence, 
transmission, and evolution. During disease outbreaks, his lab 
sequences viruses for epidemiological investigations, 
determines the disease phenotype and transmission fitness of 
novel virus mutations, and maps the evolutionary pathways that 
a virus may take to adapt.
     Our third witness is Dr. Stephen Streiffer. Dr. Streiffer 
hold several positions at Argonne National Laboratory in the 
Illinois 11th District I might add, including Deputy Laboratory 
Director for Science and Technology. He is one of the founding 
Co-Chairs of the National Virtual Biotechnology Laboratory, or 
NVBL, a consortium of DOE national labs founded to address the 
COVID-19 crisis. The NVBL has used their scientific and 
technical expertise to address medical supply shortages, 
discover potential drugs to fight the virus, develop and verify 
COVID-19 testing methods, model disease spread and impact 
across the Nation, and understand virus transport in buildings 
and in the environment.
     Our final witness is Dr. Caitlin Rivers, Senior Scholar at 
the Johns Hopkins Center for Health Security and an Assistant 
Professor in the Department of Environmental Health and 
Engineering at Johns Hopkins Bloomberg School of Public Health. 
She's an epidemiologist specializing in emerging infectious 
diseases and has anchored or contributed to several reports on 
COVID-19 variants and the national pandemic strategy. Her 
research focuses broadly on improving public health 
preparedness and the response to large-scale events.
     And, as our witnesses should know, you'll each have five 
minutes for your spoken testimony. Your written testimony will 
be included in the record for the hearing. And when you've all 
completed your spoken testimony, we will begin with questions 
and each Member will have five minutes to question the panel.
     If time allows, we may have a second round of questioning. 
In addition, if there is interest in--among the Members at the 
close of the hearing, may--we may turn off the livestream and 
have an informal discussion with the panelists, something we do 
under normal circumstances and is possible also here.
     We will now start with Dr. Abdool Karim, so you are now 
recognized for five minutes.

              TESTIMONY OF DR. SALIM ABDOOL KARIM,

                      DIRECTOR OF CAPRISA

     Dr. Abdool Karim. Thank you very much, Chairman Johnson. 
It's indeed an honor for me to be here and provide some 
testimony. I submitted a slide set. I'm going to ask for that 
to be projected.
     [Slide follows:]
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

     Dr. Abdool Karim. I speak to you from South Africa where I 
am based at--and the Nelson R. Mandela School of Medicine at an 
NIH- (National Institutes of Health-) funded research center. 
I'm actually at ground zero where one of the world's most 
concerning variants was first described. So I'm going to 
briefly touch on the variants. I want to talk about the 
implications for public health and the COVID-19 end game. Next 
slide.
     [Slide follows:]
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

     Dr. Abdool Karim. So briefly, we know that all viruses 
mutate. That's in the nature of evolution, the way in which 
their genetic changes occur. SARS-CoV-2 shows slow genetic 
drifts pretty much one to two mutations per month. I've been 
monitoring in South Africa the epidemic and the viruses, and we 
see just a handful of mutations each month. But in November 
last year we saw something different, not just the slow 
antigenic drift but a shift, a major new mutant with 23 
different mutations. And to give you some idea of its advantage 
and its functional advantage that it obtained, I point you to 
the graph on the left-hand side. Initially, in September, we 
had 34 pre-existing variants that were transmitted. The next 
month the new mutation referred to as B.1.351, constituted 11 
percent of all the viruses. A month later, November, it was 60 
percent, and by December, 87 percent of all the viruses 
transmitted were this new variant B.1.351.
     Next slide, please.
     [Slide follows:]
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

     Dr. Abdool Karim. And to give you some idea of what that 
has meant in comparing the first wave with pre-existing 
variants in the light yellow line you can see that the second 
wave, due to this new, more highly transmissible variant, the 
B.1.351 variant, is about 50 percent faster. If you just take 
one province in South Africa, Western Cape, it reached 100,000 
cases within a matter of 54 days compared to the first wave 
where it took 107 days.
     Next slide, please.
     [Slide follows:]
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

     Dr. Abdool Karim. And that translation of what we're 
seeing is if you take the three countries, India, Brazil, and 
South Africa, each of them in the first waves dealt with a 
pretty substantial wave, but what happened was as the epidemic 
settled, they all began to look at this epidemic in a different 
way.
     Next slide.
     [Slide follows:]
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

     Dr. Abdool Karim. And what we began to see was the--that 
each of these countries, they thought that they had conquered 
this virus. They had become immune, that they've developed some 
kind of protection from natural infection. We saw that in South 
Africa, we saw that in Brazil, we saw that in India.
     Next slide.
     [Slide follows:]
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

     Dr. Abdool Karim. And what happened was complacency that 
set in, and this is what happened. In each of those settings, a 
new variant. In India, the B.1.617; in Brazil, the P.1 and P.2 
variants; and in South Africa, the B.1.351 variant. And in 
South Africa the data we have shows quite clearly at this point 
that the B.1.351 variant was able to escape immunity that was 
acquired in the first wave. And so what we are seeing is 
reinfections occurring quite commonly in South Africa.
     Next slide, please.
     [Slide follows:]
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     Dr. Abdool Karim. So if we look at where we are in terms 
of vaccines, that is perhaps the most concerning of the things 
that we see and that if you take the AstraZeneca vaccine with 
70 percent efficacious in the U.K. but only 10 percent 
efficacious in South Africa. Novavax, 89 percent but only 43 
percent. And we are seeing breakthrough variants. Fortunately, 
vaccines like the Johnson & Johnson (J&J) and the Pfizer 
vaccine have maintained their efficacy.
     Next slide.
     [Slide follows:]
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     Dr. Abdool Karim. And this is my last slide where I'll 
just make some parting comments that we should expect more 
variants, that no country is safe, as Chairman Johnson has 
pointed out so eloquently, until every country is safe, and 
that we need maximal suppression and that no single action is 
likely to be sufficient to prevent the spread of the virus. 
We're going to need our public health measures in addition to 
our vaccination programs. We need to strengthen genomic 
surveillance. And even though we are expecting next-generation 
vaccines to produce more broadly neutralizing antibodies and we 
expect they will impact on the escape variants, I suspect that 
we will continually see this virus finding ways to escape 
immunity.
     Thank you very much, Chairman.
     [The prepared statement of Dr. Abdool Karim follows:]
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     Chairman Foster. Thank you. And next we will recognize Dr. 
Grubaugh for five minutes.

               TESTIMONY OF DR. NATHAN GRUBAUGH,

              ASSISTANT PROFESSOR OF EPIDEMIOLOGY

     Dr. Grubaugh. Thank you, Chairman Foster and Members of 
the Subcommittee, for the invitation to discuss SARS CoV-2 
variants. I am a virologist and molecular epidemiologist. That 
is, I use virus genome sequencing and molecular diagnostic 
assays to study the emergence and spread of infectious 
diseases. I helped to develop the SARS-CoV-2 genomic 
surveillance system for the State of Connecticut and I worked 
directly with the CDC (Centers for Disease Control and 
Prevention) and other regional and international partners to 
investigate the emergence of SARS-CoV-2 variants.
     Surveillance is one of our most important tools for public 
health. Almost all major policy decisions rely on data 
informing the spread and incidence of an infectious disease. 
And it's not just local surveillance. We need global 
surveillance to inform as to what may be coming next. For 
example, surveillance from South Africa, Brazil, India, and the 
U.K. have provided critical information about what variants may 
be introduced into the United States, which is in addition to 
the variants that may emerge within our own borders.
     While sequencing COVID-19 cases in the United States is 
increasing, there are still many regions in the world of which 
we have little or no SARS-CoV-2 genomic information. These gaps 
lead us into the dark what--as to what variants may be emerging 
in those locations and what could be a threat to the United 
States. Local surveillance systems detect variants by the 
pattern of specific mutation of each sequence virus, which we 
then use to assigned to a numbered lineage, such is B.1.1.7, 
B.1.351, P.1, et cetera. These data are then used to detect the 
introductions and track the frequencies of known or novel 
variants.
     Our national and international surveillance systems are 
then reliant on SARS-CoV-2 genomic sequencing data to be 
submitted to public repositories. GISAID (Global Initiative on 
Sharing All Influenza Data) is the most popular repository 
which currently contains about 1.5 million sequences from 
around the world. From there, bioinformaticists and public 
health agencies and independent groups routinely poll the data 
to provide global, national, and regional reports on variants. 
This allows all of us to keep up-to-date on what is happening.
     But there are some major challenges to variant 
surveillance. One is that it mostly requires the use of whole 
genome virus sequencing, a method that is far more expensive 
and technical than conventional clinical testing. There are 
some simpler tests, similar to what we use for clinical 
diagnostic testing, that are used to help us to track the 
frequency of variants. For example, a PCR (polymerase chain 
reaction) test has been used to track the rapid spread of 
B.1.1.7 in the United States. These simpler tests, however, are 
limited in what they can detect. It's hard for them to detect 
something that is novel. So while useful, they are not a 
replacement for sequencing.
     Another challenge is the need for individual labs to share 
their data on public repositories. While data sharing is 
critical to our surveillance efforts, there are several 
barriers, especially in low-resource settings. These include 
technical barriers to data transfers to online repositories, 
lack of important information connected to the sequences needed 
for public health, lack of incentives to make expensive-to-
generate genomic data available to the public versus keeping 
them for their own research, and international responses to 
publicly submitted data such as naming a variant after a 
location or the implementation of travel restrictions.
     Here provides an opportunity for the U.S. Government to 
help. We need policies around pathogen genomic data sharing and 
usage for public health surveillance. These should include 
incentives to share and also protections for data generators to 
have the first right to publish. These policies should also be 
accompanied by standards for data generation, standards for 
data processing, and standards for analysis to help minimize 
sampling biases and eliminate data processing errors.
     Finally, these policies should support the work of 
pathogen genomic surveillance of all types not just during a 
public health emergency. Without sustained support, the 
important work that we started here could fold. Rather, our 
genomic surveillance system should remain intact and only ramp 
up or ramp down depending on the need.
     Thank you for your time, and I hope that I can answer any 
questions that you may have.
     [The prepared statement of Dr. Grubaugh follows:]

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     Chairman Foster. Thank you. And the Chair will now 
recognize Dr. Streiffer for five minutes.

              TESTIMONY OF DR. STEPHEN STREIFFER,

                   DEPUTY LABORATORY DIRECTOR

                   FOR SCIENCE AND TECHNOLOGY,

                  ARGONNE NATIONAL LABORATORY

     Dr. Streiffer. Chairwoman Johnson, Chairman Foster, 
Ranking Member Obernolte, Members of the Subcommittee, thank 
you for the opportunity to testify today about the challenges 
presented by the COVID-19 variants and the important role the 
Department of Energy's national laboratories have played in 
combating COVID-19.
     My name is Dr.--as Congressman Foster said, I'm Stephen 
Streiffer. I serve as Argonne's--National Laboratory's Deputy 
Laboratory Director for Science and Technology, as well as the 
Director of the lab's Advanced Photon Source (APS). For the 
last 15 months it's been my privilege to serve as the Co-
Director of the DOE's National Virtual Biotechnology 
Laboratory.
     As, again, Congressman Foster pointed out, the NVBL came 
together as a consortium of all 17 DOE national laboratories at 
the onset of the pandemic, supported by CARES Act funding. It 
brought together leading scientists and researchers from across 
the lab complex and leverages the Department of Energy's world-
class experimental and computational facilities. Our state-of-
the-art user facilities such as the APS, our capabilities in 
advanced computing and AI (artificial intelligence), structural 
and molecular biology and biotechnology, epidemiological and 
transportation modeling and advanced manufacturing, among 
others, uniquely position us to take on this challenge and lead 
the world in finding therapies to combat the virus.
     If you'll allow me, I'll just go through several of the 
contributions that NVBL has made in the fight against COVID. 
I'll highlight just a few here, and there's more in my written 
testimony of course.
     As the Nation initially grappled with testing, the lab 
supported the FDA, CDC, and DOD (Department of Defense) to 
establish national guidelines, identify diagnostic targets, and 
develop and prove out sample collection methodologies that were 
used in the administration of hundreds of millions of COVID-19 
tests. We also worked to solve supply chain challenges that 
plagued the early days of the outbreak. Teams from the NVBL 
produced innovations in materials and advanced manufacturing 
that mitigated shortages and test kit components and personal 
protective equipment, leading to the creation of over 1,000 new 
jobs as we transferred development to the private sector. Our 
high-performance computing and AI capabilities have proven 
extremely effective in the molecular design of medical 
therapeutics and in epidemiological mobility modeling to 
support decisionmakers.
     As far as we've come in the fight against COVID-19, as 
we're here today to discuss, the biggest threat right now are 
the variants that are emerging around the globe. An integrated 
approach that tracks and responds to the variants is what we 
need at this stage of the pandemic.
     A four-step approach to this requires a whole-of-
government approach to succeed. First, we need to sequence the 
genome of the virus collected from as many test results as 
possible nationally and, very importantly, globally. Second, we 
must maintain centralized inventories of collected viral 
sequences and build family trees that represent how they relate 
to each other. Third, we must use computational modeling and 
experimental methods to identify troublesome variants that can 
escape detection through current tests of current vaccines or 
resist current therapeutics. Fourth, as we discover those 
troublesome variants, we need to design new tests, vaccines, 
and treatments that target and work against variants as they 
continue to emerge.
     Coupled with other strong public health measures, finding 
and rooting out the variants is what will get us to the finish 
line with the pandemic. However, a number of challenges remain. 
As you'll hear, we must improve upon the systematic sequencing 
of the viruses to identify and track new variants. The NIH is 
putting resources into this in the United States, but more is 
needed. And in fact, DOE has significant expertise that can 
support these efforts.
     The issue of disinformation and vaccine hesitancy are 
highly concerning. DOE and the labs are playing a role 
combating disinformation and building scientific literacy among 
the American public and are actively engaged in outreach 
activities across communities, including the most underserved.
     We need to speed the process of drug design by harnessing 
computational artificial intelligence tools that the DOE is 
very expert in to find potential therapeutics faster. DOE also 
has the capability to further develop, evaluate, and validate 
tools for less expensive, simpler testing and diagnostics. 
There is also a need for substantial work to incorporate the 
emergence of vaccine resistance variants into epidemiological 
modeling. DOE's expertise in AI is inspiring new ways of 
thinking about inputs into pandemic models, including data on 
mobility, health, behavior, and demographics.
     And finally, we do need to enhance real-time standards and 
data sharing. Metropolitan and State-level models of COVID-19 
variant penetration, immunity, transmission, and morbidity/
mortality, broken down by geography and demographics, will 
continue to enhance the Nation's ability to proactively plan 
and to respond to the evolving landscape. These efforts will 
provide web-based tools and actionable information for a whole-
of-government approach.
     Let me conclude by saying that we appreciate the support 
that Congress has given to all the national laboratories, in 
particular to the NVBL. Thank you to the Subcommittee for your 
time and happy to answer questions through the hearing. Thank 
you.
     [The prepared statement of Dr. Streiffer follows:]

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     Chairman Foster. Thank you. And we will now recognize Dr. 
Rivers for five minutes.

        TESTIMONY OF DR. CAITLIN RIVERS, SENIOR SCHOLAR,

            JOHNS HOPKINS CENTER FOR HEALTH SECURITY

     Dr. Rivers. Chairman Foster, Ranking Member Obernolte, 
Chairwoman Johnson, and Members of the Subcommittee, thank you 
for the opportunity to speak to you today about variants and 
evolving research needs.
     In the United States we have entered a new phase of the 
pandemic. Nearly 60 percent of American adults have begun 
vaccination, including more than 80 percent of adults over age 
65. However, in the last 14 months, over 575,000 Americans have 
died and 32 million cases have been reported. Beyond the direct 
impacts, we've endured severe economic consequences, disruption 
to education, and strain on our healthcare systems. We've 
collectively suffered an enormous loss, and that grief will not 
be easily overcome.
     The situation in some other countries is much worse, and 
the pandemic is far from over. Case counts globally are 
reaching new highs. India is in the midst of a terrible wave 
and reports suggest that in some communities the situation is 
dire. A variant of interest, B.1.617, may be contributing to 
the surge. As our own domestic outlook improves, we must turn 
our attention to helping the world.
     And as we continue the work of ending the pandemic both at 
home and abroad, we must also identify the changes necessary to 
ensure we are never caught in this position again. In doing so, 
we should recognize that we were caught unprepared more than 
once. We were unprepared to manage the emergence and swift 
global spread of the novel coronavirus, and we were late to 
recognize when it reached our shores. Those delays set us on a 
worse trajectory than we might have otherwise faced.
     But so, too, were we unprepared for variants. Although 
genomics experts had warned of the threat, it was not until the 
United Kingdom suffered a severe wave attributed to the B.1.1.7 
variant that public health officials worldwide sharpened their 
focus. B.1.1.7 is now understood to be perhaps 50 percent more 
transmissible than other variants, and it may also cause more 
severe illness. The U.K. was able to identify and track this 
variant over time because they invested heavily in genomic 
surveillance. That capability yielded important information 
they needed to guide their response, and they provided warning 
to the world about what was to come. We did not have that level 
of genomic surveillance in the United States, and that was a 
gap.
     The United States currently recognizes five variants of 
concern and several variants of interest. The most concerning 
possibility with some of these variants is that they may 
exhibit some degree of immune escape, meaning that vaccines and 
therapeutics may be somewhat less effective. Future variants 
may drift even further from the protection existing vaccines 
can provide, cause more severe illness, or impact diagnostic 
testing. If we do need to update our vaccines or diagnostics to 
be a better match, we must know that as early as possible so 
that we can begin the work--that work before the variant 
becomes widespread. We must not again be caught unprepared.
     The American Rescue Plan includes $1.7 billion for genomic 
surveillance, as well as additional funds for biological 
research, expansion of the public health workforce, and a suite 
of other important public health initiatives that will improve 
our preparedness, including for variants. Looking ahead, given 
that SARS CoV-2 is likely to continue to circulate and in 
anticipation of the next viral threat that we will almost 
certainly face, Congress should provide long-term, sustainable 
support for this expansion in our public health infrastructure 
so that we will be in a better position to respond next time.
     As we advance our genomic surveillance infrastructure, we 
should also further develop the modeling and analytics 
infrastructure that will allow us to make even better use of 
that data. With the exception of a few small groups within the 
Department of Health and Human Services, most modelers work in 
academia and volunteer to support the public health response 
when an urgent need arises. This arrangement is not well-suited 
to either party. The Federal Government would benefit from a 
permanent capability with infectious disease modelers working 
to advance the state of the science and support public health 
decisionmaking both between and during emergencies.
     The Biden Administration announced a National Security 
Directive 1, an intention to create a National Center for 
Epidemic Forecasting and Outbreak Analytics, and the American 
Rescue Plan appropriated $500 million to CDC for disease 
forecasting and data modernization. These are promising steps 
toward modernizing our response capabilities, and I believe 
they will serve the Nation well. Congress could help by 
appropriating annual funding and authorizing language so that 
the forecasting center can endure as a permanent capability.
     In conclusion, although the currently circulating variants 
complicated our course through the spring months, we are now on 
track to regain control of the pandemic in the United States. 
Continued vigilance to current and future variants is essential 
to ensuring that we maintain our current encouraging 
trajectory. We must expand our genomic surveillance efforts 
domestically and work with partners and allies abroad to ensure 
global coverage. The United States is a world leader in science 
and technology, and we have the opportunity using those 
capabilities to lead the world through the rest of the 
pandemic. Thank you.
     [The prepared statement of Dr. Rivers follows:]

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     Chairman Foster. Thank you. And at this point we will now 
begin our first round of questions. So the Chair will recognize 
himself for five minutes.
     The first question is what I hope is sort of a simple 
question on the public health significance of new viral 
strains. Dr. Rivers, you note in your testimony that B.1.1.7 
has gone on to become dominant in the United States, 
constituting perhaps 60 percent of our current cases. So my 
question is does that mean that if this variant had never 
existed that we would have 60 percent fewer cases in the United 
States today or is it more complicated than that? You know, 
should we think about these as, you know, each new strain is a 
whole new disease circulating in our population or are there 
things like, you know, cross-immunity that really muddy the 
picture here? And how should we think about this?
     Dr. Rivers. Yes, thank you for that question. It's not the 
case that we would have 60 percent fewer cases. What it means 
for a variant to be more transmissible is the tools we have, 
particularly around masking, distancing, ventilation, have to 
be adhered to even more closely in order to be effective 
because the virus passes more easily between people. The 
increased transmissibility is seen across a number of variants 
of concern and interest, and it makes it more difficult for the 
variants to be--the virus to be controlled and slowed.
     Chairman Foster. OK. And so in the modeling do you model 
it as just one virus with a range of infectiousness or do you 
independently model the frequency of each strain in the 
population? I guess maybe that gets at my question.
     Dr. Rivers. There are several different approaches 
depending on the question you would like to answer. When 
producing a forecast, you would increase the infectiousness or 
the transmissibility, and so you would have a better sense of 
the new trajectory given the variant. If you would like to know 
how competing variants might unfold over time, it would be a 
different approach, but that is also a question that can be 
answered using modeling approaches.
     Chairman Foster. Thank you. Dr. Abdool Karim, in your 
prepared testimony you gave a great overview of how the known 
variants have affected disease severity, transmissibility, and 
treatment efficacy, and as well as natural and vaccine-induced 
immunity. I think that addressed a lot of questions and 
concerns that I have as we see new variants pop up, but, you 
know, how--could you say a little bit about the difference 
between how variants will evolve before you have the population 
vaccinated or at least partially vaccinated versus after you've 
got a big part of the population vaccinated? You know, what 
fraction of the danger from a vaccine-induced mutation, what 
fraction of the woods are we out of in that--in regards to 
that?
     Dr. Abdool Karim. Thank you very much for that question. I 
think you're getting to one of the difficult areas that we 
don't have data, and so I what I'm going to tell you is 
speculation to some extent. What we understand now is 
immunocompromised individuals are playing an important role in 
the generation of variants, and so as the virus is spreading at 
a higher rate, we are enhancing the risk of seeing new 
variants.
     When we have a vaccinated population, if a vaccinated 
individual or an individual who has had past infection or an 
individual who is receiving monoclonal antibodies has a virus 
that's evolving to create a variant, then that variant has a 
higher likelihood of escaping that immunity, and so that's our 
concern that as we get to higher levels of vaccination, the 
individuals who are immunocompromised that may lead to the 
emergence of new variants would be those at risk of creating 
variants with vaccine escape--ability to escape vaccine 
immunity.
     Chairman Foster. And are we in a situation now at least in 
the United States that when we see what are called these 
breakthrough cases where you get vaccinated and nonetheless get 
COVID, are those of enough special interest that at least those 
are completely sequenced to see if we're seeing those as the 
source of new vaccine-resistant variants?
     Dr. Abdool Karim. So there are several programs underway, 
and many of the companies themselves as part of their clinical 
trials have been sequencing the viruses that constitute escape 
and also they want to measure the antibody levels at which 
escape is occurring. And the most recent published paper in the 
New England Journal of Medicine showed that two of the variants 
that had been sequenced and studied in detail that caused 
breakthrough infections, that they were variants with escaped 
mutations. So I think what we're going to see in breakthrough 
infections is a combination of normal viruses that are just 
escaping because immunity is low and others that have escaped 
mutations that enable them to bypass the immunity or at least 
partially bypass it.
     Chairman Foster. And beautiful timing on ending your 
remarks as the timer goes to zero, and I will now recognize our 
Ranking Member, Mr. Obernolte, for five minutes.
     Mr. Obernolte. Well, thank you, Mr. Chairman, and thank 
you to all of our panelists. It's been a fascinating hearing.
     I am very interested in what we can do as a Federal 
Government to change policy to make the process of identifying 
these variants and combating them more cost-effective and 
efficient. So, Dr. Grubaugh, I had a question for you because 
you talked about different policy changes that can be 
contemplated along those lines. And one of the things that you 
mentioned is giving data generators the first right to publish, 
which seems to me to be counterintuitive because, you know, 
wouldn't that slow the spread of information? We want to speed 
that up. So what could we do to help that?
     Dr. Grubaugh. Yes, thank you for that question. It's a 
really complex area in public health. I think if data being 
generated by a public health lab and for the sole purpose of 
public health, then it makes sense just to make that free and 
open. In the United States we have a lot of data that are not 
being generated by public health labs but by academic labs that 
cost somewhere between, you know, $100 and $200 to sequence a 
virus genome. And when you have an academic lab whose first 
order of business is to support students and postdocs that need 
to publish to go on with their careers, if they're spending a 
lot of that time then giving the data away for free, then that 
can become problematic for those who actually need it.
     Now, in my lab I am open data, open resource, open 
everything, and we're sort of in a privileged situation that we 
can make everything available. And if we get scooped on that, 
then we have other things to help make sure that our students 
get papers. But other people may not be in those privileged 
situations, especially in the low-resource countries where 
maybe they can't quite survive--a lab may not be able to 
survive having their data be poached by high-income countries. 
So it becomes a really complicated scenario, one that there's a 
national and global debate right now, and I hope that I 
answered your question.
     Mr. Obernolte. OK. Thank you. I would hope--we all would 
hope that at some point the greater good of sharing information 
to combat something which is an existential threat to humanity, 
you know, could prevail over parochial interests, and so 
anything that we can do as a government to stimulate that I 
think would be a good thing.
     Dr. Karim, I found your testimony particularly 
interesting, and I wonder, you've testified that some variants 
such as the recent B.1.351 variant have proven to be 
problematic for some vaccines. And so, for example, vaccine 
efficacy of vaccines like AstraZeneca has been much lower 
whereas vaccines like the Pfizer vaccine and the Johnson & 
Johnson have not been as effective. So could you tell us a 
little bit more about why that is, why some vaccines are 
affected more than others and what we can do to improve that?
     Dr. Abdool Karim. Yes, thank you for that. So we don't 
fully understand why some vaccines are differentially affected 
and others are not, but I'll give you one of the possible 
reasons that might explain that. The mutation that occurs in 
position 484 is a particularly important mutation. Naturally 
when--in the pre-existing variants the position 484 has an 
amino acid that is negatively charged. The human cell at that 
point is also negatively charged, so the pre-existing variants 
have a bit of propulsion because of negative versus negative. 
However, when the mutation occurs, the virus becomes positively 
charged, so that enhances the ability of the virus to attach to 
the cell so it becomes more difficult for antibodies to 
displace it. It's what we refer to as electrostatic charge is 
impacting on that.
     So the way in which the vaccine immunity can displace one 
that has more affinity is differential by the different 
vaccines, and that's probably the key explanation why the 
AstraZeneca vaccine is pretty much--has no efficacy against 
mild to moderate disease against B.1.351, whereas Pfizer at 
this point has 100 percent efficacy. And we only know this 
because both the trials were done in South Africa.
     Mr. Obernolte. Right. Well, thank you very much. I find 
that fascinating. One last question for Dr. Streiffer. A couple 
of our panelists have expressed the need for faster and less 
expensive whole-virus genome sequencing. What can we do as a 
Federal Government to make that faster and less expensive? 
Because it seems very central to our ability to fight these 
virus variants.
     Dr. Streiffer. You know, one example of that is really 
fascinating right now is actually wastewater testing. So a lot 
of the genetic information is actually coming from patient 
samples where you're tying that back to a specific patient. 
What's actually been very efficacious at least in high-income 
countries is the idea of actually doing pooled sampling from 
wastewater and then sequencing everything in that wastewater. 
And that gives you more of a shotgun approach to be able to 
understand everything that's coming out of the community and 
the ability to be able to detect variants well before they 
present through clinical patient testing. And it's got some 
limitations, but that's one way in which we could do something 
that's much cheaper.
     I think Dr. Grubaugh also indicated some ways where you 
can actually design diagnostic tests that are simpler than the 
full genome sequencing but still allow you to sample variants 
in a way that gives you more visibility than the standard 
clinical testing, and that's a very important area to pursue.
     Mr. Obernolte. Well, great. Well, thank you. I've got 
about a dozen other questions, but I see my time's expired, so 
thank you to all of our panelists. And, Mr. Chairman, I yield 
back.
     Chairman Foster. All right. It looks like we will have a 
shot at another--second set of questions if there--if interest 
is retained.
     And I'll now recognize the Chairwoman of the Full 
Committee, Ms. Johnson, for five minutes.
     Chairwoman Johnson. Thank you very much. Dr. Karim 
Abdool--Abdool Karim, the rollout of the vaccine to many and 
the much-needed light at the end of the tunnel of course we 
think after a year waiting and hoping that we've gotten there, 
the CDC has gradually upgraded its guidance on measures such as 
social distancing, mask wearing as vaccine uptake in the United 
States increases. However, we are still falling short of 
achieving herd immunity in this country and globally. How 
important are the behavioral measures in preventing the spread 
of the virus while we remain under the threshold for herd 
immunity? And what current state of science regarding the 
ability of the vaccinated individuals to asymptomatically 
infect nonvaccinated people?
     Dr. Abdool Karim. Thank you very much, Chairwoman Johnson. 
So let me try and answer the first question, which is that we 
vaccinate individuals for two reasons. The first is for 
individual benefit. I get a vaccine so I benefit in that I 
don't get severe disease or I don't get infected at all when 
I'm exposed. The second reason we vaccinate is we want 
population benefit. We want to slow the transmission of the 
virus. Now, we can only do that with vaccines if a person who's 
vaccinated does not transmit the virus because if a person who 
is vaccinated who gets infected then transmits the virus, then 
we undermine our ability to achieve herd immunity. So far, the 
preliminary data--and it's pretty--it's very preliminary--
suggests that transmission rates are dropped in individuals who 
are vaccinated, but we do not yet have definitive evidence 
because those studies are hard to do.
     The second issue--the second question you asked me is 
about how important it is that we maintain our 
nonpharmaceutical prevention measures while we are vaccinating. 
It is critical because vaccines on their own are not able to 
achieve herd immunity or to slow transmission on their own. We 
do need to maintain those.
     When we start nearing levels of herd immunity with vaccine 
coverage only, I think what we will then see is a change in the 
number of restrictions that will be required, and many of the 
individual restrictions will be replaced by broader 
restrictions such as avoiding mass gatherings where the risk is 
high, but for the individual restrictions, we can expect that 
some of those will be eased, and the CDC has been doing that in 
a systematic, slow way at the moment.
     Chairwoman Johnson. Thank you very much. Mr. Chairman, I 
yield back.
     Chairman Foster. Thank you, and I will now recognize our 
colleague from Florida, Mr. Posey, for five minutes.
     Mr. Posey. Thank you very much, Chairman Foster and 
Ranking Member Obernolte, for holding this hearing.
     Discussing the variants of COVID-19 is very important to 
our work of defeating this virus and understanding its dangers 
and history. Dr. Streiffer, in 2003 it appears the first SARS 
epidemic, SARS-CoV, was beginning to spread, and the virus was 
mutating rapidly as it adapted to humans. But it appears once 
it became more contagious, it became more stable and stopped 
mutating so quickly.
     COVID-19 or SARS-CoV-2, appears to have been remarkably 
stable since it first emerged in 2019 in Wuhan. It never 
appears to have had the same period of rapid mutation that was 
seen in the 2003 SARS outbreak. Each witness obviously is very 
interested in the variants, but I wonder if we are as curious 
about the missing links for earlier variants of COVID-19 that 
we would have expected to have seen just after the emergence of 
a new virus. Can staff bring my pictures up now?
     [Slide follows:]

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     Mr. Posey. This is from a preprint paper, and figure 1 
shows mutations in early stage SARS in blue and then the late-
stage SARS in yellow. Figure 2 shows the mutations in COVID-19. 
Bigger spaces between those dots would appear to this layperson 
to indicate greater mutations in the virus. And obviously, the 
two figures are very different from each other, and in fact the 
red COVID, COVID-19 looks a lot more like the yellow late-stage 
SARS. The original SARS is known to be a nationally emerging 
virus, and it mutated rapidly when it did emerge. COVID-19 on 
the other hand did not have the same rapid mutations. So my 
question, Dr. Streiffer, based on your expertise, how would you 
explain why figure 2 does not have the early mutations that we 
see in figure 1?
     Dr. Streiffer. So just to jump in--and sorry, I apologize, 
I moving screens around so I can actually see the figure. I'm 
actually paying attention. So I think virus evolution is always 
a careful balance between trying to infect the host, replicate, 
and do that in a way which is efficient but not actually kill 
the host. And one of the things that you'll find is that 
vaccine--viruses rather are actually too aggressive they cause 
too much fatality and will actually damp out very quickly, so 
you do see an enormous amount of difference in the rate at 
which viruses mutate and the patterns that you see in those 
mutations.
     And I think that's reflected here. I think these are both 
natural viruses. I think the difference in the mutation rates 
is a reflection of the different epidemiology, the way in which 
the initial pandemic's played out, and then just the natural 
differences in the virus.
     And Dr. Abdool Karim and Dr.--excuse me, I'm going to get 
my name wrong--Dr. Grubaugh could probably comment very 
eloquently on this if they'd like to follow up with that, 
although, of course, it's the Member's prerogative.
     Mr. Posey. I'd be delighted for the follow-up. Thank you. 
I yield.
     Chairman Foster. Thank you. The gentleman has yielded his 
time for----
     Mr. Posey. I was going to yield to the witness to answer 
that Dr. Streiffer recommended.
     Dr. Grubaugh. I can answer for a minute. So, one, each 
virus is a little bit different, and especially when we have 
viruses that emerge from animals and to people that they're at 
different stages of being able to adapt and spread within 
people. And so there's--it's always hard to compare apples to 
apples when you have different events that are happening.
     Also, evolution is not just dependent on adapting to the 
host. There's other things in play such as the re-transmission, 
some other inherent factors, the types of therapeutics that are 
used, so it's a really complicated factor.
     And I would say that with SARS CoV-2 we did see early 
adaptation to humans. We had the D614G mutation that rapidly 
spread around the world, and then now we are seeing the 
emergence of many new variants that are happening. And also 
just to say that the pandemic with SARS-CoV-2 is really 
unprecedented in terms of the number of infections. It's 
evolutionary patterns with the emergence of several variants 
that have many mutations that are acquired in a very short 
period that I would just say it's very difficult to compare 
this to really anything else because we haven't seen anything 
quite like this.
     Mr. Posey. Thank you very much. Mr. Chairman, thank you. I 
yield back.
     Chairman Foster. Thank you. And, yes, the--I believe the 
gentleman's line of questioning touched on a very important 
issue, which is trying to understand what we can about the 
origins of this virus. And, you know, this is a subject of very 
serious scientific debate among serious scientists about what 
constitutes evidence in various directions. This Subcommittee 
on Investigations and Oversight does intend to have a hearing 
on the origins of the SARS-CoV-2 virus in the near future.
     And I will now recognize our colleague from California, 
Dr. Bera, for five minutes.
     Mr. Bera. Thank you, Chairman Foster.
     I know that, you know, that tracking variants and making 
sure we're data sharing is something that we've been incredibly 
interested in--along with Senator Tammy Baldwin from Wisconsin, 
we introduced the Tracking COVID-19 Variants Act asking for $2 
billion to go to CDC. We were able to get $1.75 billion into 
the American Rescue Plan, so hopefully, that's a first step, as 
well as indicating to the CDC to talk about the issue that I 
know--I think we've talked to Dr. Rivers about data sharing and 
how we, you know, link public health and academia and data 
sharing.
     I'm going to put my doctor hat on and just, you know, when 
I think about the variants that we're seeing in India, you 
know, also some of the variants that we're seeing in Michigan 
or some of the cases that we're seeing, it does seem like, you 
know, younger people are now being infected more rapidly, as 
well as being hospitalized. And I don't know if that's just 
epidemiology that younger folks are less vaccinated and thus 
are susceptible, and maybe, Dr. Karim, you know, since you're 
on the frontline in South Africa, you could tell us what you're 
seeing on the ground in terms of hospitalizations of who is 
being infected right now.
     Dr. Abdool Karim. Thank you for the question. Yes, you're 
quite right. It's a matter of epidemiology. And we saw that 
certainly in the second wave in Brazil, South Africa, and in 
India, that in the second wave, because the virus has a higher 
transmissibility, it infects a lot more people quickly. The 
number of younger people in those populations is high, and so 
even though it's a smaller fraction that will actually get to a 
hospital, so many of them became infected that 
disproportionately there were larger numbers of young people in 
hospitals, so it's just a function of the way in which the 
rapid transmissibility infects such a high proportion of young 
people that we begin to see more young people in hospitals. And 
that's been described quite well in all three settings. And 
it's a similar issue with the B.1.1.7 variant, that it causes 
many young people to get infected, so that's why 
disproportionately we start seeing more young people in 
hospital. You're quite right.
     Mr. Bera. And, you know, for any of the panelists, as we 
think about that then, you know, I think many of us in the 
medical community were surprised that India, Sub-Saharan 
Africa, et cetera, weren't severely impacted in the first wave 
a year ago, and some of us thought that, well, it's a younger 
population so they had subclinical infections, et cetera. Now 
our concern is that we're seeing these variants spread more 
rapidly with younger population, what this may do in Sub-
Saharan Africa that also speaks to a younger population. Is 
that a legitimate concern? And, you know, obviously we're 
seeing the overwhelming infections in India. And how should 
we--outside of rapidly getting vaccinations to these 
populations, how else should we think about it? And, again, I'm 
happy to let--or Dr. Karim, if you want to answer that one as 
well.
     Dr. Abdool Karim. Sure, I'll start with an answer. I have 
spent the last several months trying to answer that question. 
That's because we all predicted that Africa would have a really 
severe epidemic, but it didn't come to pass, and so there was 
some hypotheses that were proposed. And I have looked at nine 
of the different hypotheses, including temperature, including 
age, and so on.
     I think in summary I have found that there is no specific 
protection that Africans have. There's nothing in their 
lifestyle, there's nothing that they've got genetically that 
gives them any protection that I have been able to find.
     What is most clear is that the young populations that we 
see in Africa, the very small fractions of the population that 
are above 60 means that a large number of people who are 
getting infected are getting infected asymptomatically, and so 
the reporting has been--you know, they don't report those cases 
because they don't know about those cases. In addition, most of 
the countries in Africa went into very severe lockdowns 
initially, so that's why the first waves weren't that bad. But 
now they're being caught in the second wave and the variants 
where many countries in Africa have much more severe epidemics. 
So variants, age, and implementing nonpharmaceutical 
interventions early played that role in why I think Africa did 
not see a severe epidemic. And I'm sure my colleagues may have 
something to add. Thank you.
     Mr. Bera. I see I'm out of time. Hopefully, we'll have 
that second round of questions.
     Chairman Foster. And we plan to. And now, despite the fact 
that he is not a doctor but merely holds a master's degree in 
biochemical engineering, the Chair will now recognize our 
colleague from Illinois, Mr. Casten, for five minutes.
     Mr. Casten. Oh, you're far too kind. It's nice to be one 
of the non-nerds in this group.
     I really want to thank you all for being here. Thank you 
to our Chairman for pulling this hearing together.
     The--Dr. Abdool Karim, I want to start with you and I 
think just give us a chance to have a little bit of a--just a 
few quick public service announcements. The--you know, we are 
fortunately going from a point in our country where we shifted 
from having more demand than supply for vaccine to, you know, 
starting to see the opposite and, you know, daily doses 
administered have fallen off in the last month or so and 
starting to sort of get to that harder more vaccine-hesitant 
community.
     I want to start with a public service announcement of my 
own. My 16-year-old daughter is getting her second dose in two 
weeks, and my 14-year-old daughter has just registered for her 
first dose tomorrow, so what's good for us is good for--and 
hopefully everyone will follow.
     But, Dr. Abdool Karim--and you mentioned this before, but 
just a couple quick yes or noes. To the best of your knowledge 
are the Moderna, Pfizer, and J&J vaccines currently available 
to Americans effective at preventing the worst aspects of 
COVID-19?
     Dr. Abdool Karim. Yes.
     Mr. Casten. To your knowledge are they all generally safe?
     Dr. Abdool Karim. Yes.
     Mr. Casten. To your knowledge are they broadly effective 
against all of the common variants of COVID-19 that are 
circulating in the United States?
     Dr. Abdool Karim. I can't answer that exactly, but they 
are effective against most of the common variants. They haven't 
been tested against, for example, the Indian variant yet, the 
variant in India.
     Mr. Casten. OK. Well, there's--is there any good reason 
for any American, unless their doctor tells them otherwise, not 
to go get a vaccine?
     Dr. Abdool Karim. No.
     Mr. Casten. OK. Well, that's an easy one.
     Let me then move on to something a little bit more deep in 
the weeds. And you alluded to some of this in your conversation 
with Chairwoman Johnson. Early on I think we were all concerned 
about what is the likelihood of asymptomatic spread and how do 
we know about that and how do we think through that. Have you 
seen anything in the data to suggest that the risk of 
asymptomatic thread is--excuse me--asymptomatic spread is 
substantially different between vaccinated and nonvaccinated 
populations?
     Dr. Abdool Karim. We don't have empiric data, so I'm going 
to speculate based on what we have been seeing in terms of the 
viral load that's in the swabs that are taken from the nose. 
When we look at the swab--the amount of virus that's in the 
swab, vaccinated individuals who do get infected have lower 
levels of the virus in those swabs. So we would think that that 
translates into lower transmission, but I don't have clinical 
evidence. That laboratory evidence is certainly suggestive that 
vaccination means lower levels of transmission.
     Mr. Casten. And what about for folks who have, you know, 
tested positive for COVID and may have developed some degree of 
natural immunity? How would you put that population in amongst 
the vaccinated versus nonvaccinated?
     Dr. Abdool Karim. So individuals who have had prior 
infection generally have some level of protection to new 
infections even if they are variants. And the level of 
protection that's provided is at this point most likely in 
terms of the severity of infection, so they may be able to 
transmit, but we think that they get less severe disease. The 
empiric data for that is still preliminary. Only--there's only 
one study I've seen it, and that's of a small number that 
suggests that.
     But in terms of transmission, an individual who's been 
infected gets reinfection, we don't know about their risk of 
transmission. I can't answer that question.
     Mr. Casten. So I--and I realize I may be getting into 
small subsets of data, but if--you talked about viral loading 
as being your sort of estimate of why this might change. If you 
have experienced COVID but not been vaccinated versus 
experienced COVID and have been vaccinated, is there a 
difference in the viral loading of those two populations? I 
mean, what I'm trying to get at is do we expand herd immunity 
more greatly by making sure that even if you've had a bad case 
of COVID and you still get vaccinated, do you reduce your risk 
of asymptomatic spread at least theoretically?
     Dr. Abdool Karim. There's a big difference. If we look at 
vaccinated individuals, especially when they've been vaccinated 
with an mRNA vaccine, the antibody levels are really high. They 
are extremely high. They are at the highest levels that we see 
with natural infection, as opposed to natural infection where 
the antibodies are much lower. And when you deal with variants, 
higher antibodies are really important, higher levels of these 
antibodies, so there's no question that vaccination is a big 
advantage compared to natural infection in terms of risk of 
reinfection.
     Also, that when you've had natural infection, if you've 
had asymptomatic natural infection, the antibodies disappear 
quite early, within three, to four, five months, and so we see 
lower levels of antibodies with asymptomatic infections in 
natural infections, but with vaccines, it's consistent. 
Everybody gets high levels of antibodies.
     Mr. Casten. It's fascinating. And I'm unfortunately out of 
time. I have more questions, but I really appreciate your time. 
I yield back.
     Chairman Foster. Thank you. And I will now recognize our 
colleague from Colorado, Mr. Perlmutter, for five minutes.
     Mr. Perlmutter. Thank you, Dr. Foster. And I guess I want 
to start with a question that was posed early on in this 
process, and that was sort of Sweden's approach toward herd 
immunity by, you know, just sort of going on with their lives 
compared to surrounding Scandinavian countries. And this is to 
the whole panel. You know, I haven't seen much in the news 
about Sweden and its herd immunity and whether or not it's 
facing any new challenges given these variations. So, Dr. 
Rivers, why don't I start with you if you have any--or anybody 
who wants to jump in on that one.
     Dr. Rivers. Sure. I can't speak to the latest situation in 
Sweden as I haven't followed up on their current status, but I 
will note that their early strategy of allowing the infection 
to spread in hopes of achieving naturally acquired herd 
immunity was changed over time, and they did go on to adapt 
more restrictive measures in order to slow the spread because 
they saw that their hospitals were becoming overwhelmed. And so 
I think that our early perception of how Sweden managed the 
pandemic was something that evolved to look more in line with 
the measures that many other countries took. But I'll see if 
any of my colleagues know the latest on Sweden.
     Mr. Perlmutter. Anybody else?
     Dr. Abdool Karim. I can perhaps just comment briefly. I 
just did a webinar with Anders Tegnell, who is the chief COVID 
scientist in Sweden, my equivalent there, and he went with this 
initial approach, which is--actually was promoted by a group of 
scientists in--across the oceans both in the United States and 
the U.K. under something called the Great Barrington 
Declaration. And their hypothesis was if you let the virus run 
wild in younger populations, natural infection will provide 
immunity and herd immunity. Well, it's been shown now that that 
simply is not true, that in fact what happens is when you end 
up with large numbers of infections like that, the older people 
do get infected and you get the situation of high numbers of 
death. And Sweden saw that and so had to make those changes. 
And Sweden, by the way, still doesn't promote mask wearing, but 
that's a separate discussion. It's not related to this.
     Mr. Perlmutter. All right, thank you. Yes, I mean, what--
you saw the initial, you know, reports was, you know, Norway 
had a much smaller incidence than Sweden as Sweden was trying 
to, you know, develop herd immunity. They were having a lot 
sicker people and deaths compared to their next-door neighbor. 
So--OK. Thank you.
     Now I'm going to ask more personal questions because, Dr. 
Rivers, I'm one of those 32 million who was infected. And, you 
know, my curiosity is more in these variations. You know, we've 
talked about two things, how transmissible it is and how severe 
the new variations may be. So, you know, one thing we haven't 
talked and I'd ask the Chair and the Ranking Member that we 
also take a look at sort of the long-term effects of this 
disease. And, you know, we do know that there are issues that 
linger. So in terms of the severity of some of these new, more 
transmissible viruses, what are we seeing in terms of the 
effect on people's health? Is there something that, say, in the 
South African variation is more dangerous in terms of health or 
is it just because it's more transmissible? So, Dr. Grubaugh, 
why don't you--I don't know if you want to jump in on that or 
if that's something you've been thinking about or anybody else.
     Dr. Grubaugh. I'll just quickly start, and I believe Dr. 
Rivers probably has some points to make here, too. There is 
some data from the U.K. that would indicate that the B.1.1.7 
variant can cause more severe disease. It's not just more 
transmissible. It's a really difficult thing to actually answer 
because when you're--there's--you know, what has the most 
impact on disease is actually host factors, age, comorbidities. 
These sorts of things impact whether or not you're going to 
be--you know, have more severe disease or not, much more than 
the virus. So the virus could have some small impacts on that, 
but we need really large studies to be able to measure these 
sort of small changes.
     Mr. Perlmutter. OK. Dr. Rivers?
     Dr. Rivers. Thank you. I'll just add that there are three 
levels of variant classification in the United States, variants 
of interest, variants of concern, and the third is a variant of 
high consequence. And the variant that causes more severe 
disease would be classified as a variant of high consequence. 
There are currently no variants that carry that designation, 
and so that's not something that is currently circulating or 
has been identified.
     Mr. Perlmutter. Thank you. My time is expired. I yield 
back.
     Chairman Foster. Well, thank you. And at this point we 
will now begin our second round of questions, and the Chair 
will recognize himself for five minutes.
     Dr. Streiffer, it was I guess about a year ago last week 
the Science Committee held its first roundtable about the 
Federal research enterprise and its response to COVID-19. And 
we talked about the natural--National Virtual Biotechnology 
Laboratory with Michelle Buchanan of Oak Ridge. And at the time 
NVBL was only a few weeks old, and now with a year of 
experience behind you, you know, there are serious efforts to 
consider a permanent reauthorization of the NVBL both by--on 
the part of our former colleague, now Senator Ben Ray Lujan, as 
well as efforts in the House. And so with that year of 
experience behind you, what are the observations that you might 
have about the best practices on how to coordinate all of the 
diverse Federal capabilities that were brought together in the 
NVBL?
     Dr. Streiffer. Thank you, Dr. Foster. It's a very good 
question. I think some of the lessons learned from that is that 
the coordination across the 17 laboratories through a central 
body was actually very effective. And coordinating that 
directly with the Department of Energy and then with each of 
the agencies that's been involved in the national response is 
crucially important. And I think one thing that's very 
gratifying is the increased level of coordination that we're 
seeing over the last several months in the Nation's response to 
COVID-19.
     I think also very importantly is that the National Virtual 
Biotechnology Laboratory created a model that was very 
flexible, very adaptive, and very fast to respond to the 
issues, much different than we often think of the national 
response framework, particularly when research and development 
is concerned where those timescales are quite long. And with 
that adaptability I think we're able to quickly pivot to the 
most important problems at hand, maintain a focus on issues 
that they--as they developed and move on from issues like 
designing new ventilators as it became apparent that those were 
not going to be as of a concern as they initially appeared to 
be.
     Chairman Foster. Thank you. And I guess my next question 
is for any of the witnesses that might want to get to it. Do we 
really have a complete picture of how this disease spreads? You 
know, is it--for example, if it's airborne, is it a few large 
droplets that someone sprays at you while we're talking and 
gets inhaled deeply into the lungs or is it the ambient 
concentration of very small viral particles when you walk into 
a bar that's just had people in it for hours? How important is 
direct ingestion of the virus compared to inhalation both 
through the nose and directly into lungs? You know, what's the 
model here? Is it every virus that gets into your respiratory 
tract has the same probability, or are there certain 
configurations that are dangerous? What's understood about 
that?
     Dr. Rivers. I can perhaps start. This is one of the areas 
of our understanding of the virus that has changed 
substantially over time. We--particularly because it's 
difficult when people are in close contact to determine which 
mode of transmission was actually the one that infected them, 
but there's a growing understanding that the virus can buildup 
in the air and that crowded environments, even if you are not 
within 6 feet of someone, can be particularly risky. On the 
other hand, our perception of fomite transmission or 
contaminated services has gone down in the list and it is no 
longer considered one of the primary modes of transmission. And 
I would put even below that ingestion. So airborne and 
respiratory are--excuse me, airborne and droplet transmission 
are at the top of the list.
     Chairman Foster. Any other comments? You know, one of the 
reasons I bring it up is that the British are now apparently 
going to go ahead and do experiments in controlled human 
infection where they're going to be testing the efficacy 
directly of several candidate vaccines, which is one of the 
applications to very quickly get accurate measurements of the 
efficacy, you know, months faster than you can with standard 
clinical trials but also to get a better understanding of the 
methods of spread. And this is one of the tools that, you know, 
many people wish were available. You know, had we understood 
the role--the small role of fomites compared to inhalations 
on--early in the pandemic, we would be in a position to save 
hundreds of thousands of lives. If you can have some questions 
answered through those sort of experiments of direct human 
infection, what are the questions you'd really like to have 
answered in that kind of thing, or do you think that they won't 
really in the end be that useful?
     Dr. Abdool Karim. Perhaps I'll just add a quick comment if 
I might. I think Dr. Rivers really captured the issues quite 
well. We were initially taken with the wide spread of infection 
on the cruise liners, and we thought that fomites were 
important, but now it's becoming clearer and certainly in mice 
experiments, mice in different cages are infecting each other, 
showing the importance of aerosol transmissions, the very small 
droplets that carry the virus. But I think the droplet spread I 
think still remains probably, you know, the most important or, 
together with aerosols, is the most important. So I think that 
still remains our main focus, that having direct infection is 
still quite important, and then aerosols and then fomites being 
much more less important.
     Chairman Foster. Well, thank you. And if there is some 
best state-of-the-knowledge document that you could forward to 
our offices, it would be very valuable for any of the witnesses 
because it's--it matters a lot for policy obviously.
     My time is up. I will now recognize the Ranking Member, 
Mr. Obernolte, for five minutes.
     Mr. Obernolte. Thank you, Mr. Chairman. This has been a 
fascinating discussion, and I want to continue the discussion 
along the lines of our ability to combat this kind of crisis in 
the future because I think that when the dust settles, we put 
this crisis behind us, and we do a postmortem, we're going to 
realize how extraordinarily fortunate we were that the level of 
antigenic drift of COVID-19 was not higher. So to prepare 
ourselves for the future I think we need to really focus on the 
lessons that we've learned here, on how the virus is 
transmitted, and, more importantly, how it mutates and how 
those mutations affect immune escape and the ability of the 
vaccines we develop to react to it.
     So to any of our panelists that want to comment on this, 
how can the U.S. Government catalyze that kind of spread of 
information? Because I think it's going to be vital to our 
future ability to respond to these kind of crises.
     Dr. Streiffer. So I'll jump in here. I'd also add in 
addition to that one of the things we need to do is a much 
better job of what you would refer to as international zoonotic 
surveillance. So by the best scientific knowledge available to 
us, this disease came to mankind originally from bats. What we 
need to do is a much better job of understanding the viruses 
that are out there that could cross the species barrier, sample 
those, understand their threat, and track them as they move 
through potentially the wildlife populations and into contact 
with humans. That's something we need to invest much more in 
globally.
     Dr. Grubaugh. I'll jump in here, too, with this question. 
So of course we--you know, the hope is that, you know, with 
continued evolution and, you know, some level of transmission 
of this virus likely for years to come, that we don't have 
significant antigenic drift where this would significantly 
impact our vaccines, but I think we need to be prepared for 
that worst-case scenario. And the goal here would then be to 
sequence, you know, first, you know, as many of the vaccine 
breakthroughs as possible. I think these are really important 
to do, and then maintaining this general surveillance that we 
have on a yearly basis similar to what has already been done 
for flu for a long time to help inform vaccines. I think this 
is going to be one of the most critical areas as we go forward 
and have some level where there's always going to be some 
pockets of transmission probably at least for the next several 
years and being able to stay on top of how the virus is 
evolving and not having to respond from behind like we did 
starting at the beginning of this year.
     Mr. Obernolte. Right. Well, thank you very much to 
everyone, and let me restate my opinion that more funding into 
this kind of research is vitally important for us. I mean, it 
might be a case of existential survival for us as a species to 
make sure that we understand the threat that's out there and 
the way that we as governments and as a world health community 
can respond to it. So thank you very much, Mr. Chairman, and 
thank you to our witnesses. I yield back.
     Chairman Foster. Thank you. And we'll now recognize Dr. 
Bera for five minutes.
     Mr. Bera. Great, thank you. You know, maybe this is a 
question for Dr. Karim. When we talk about the vaccines, 
obviously, we talk about the efficacy of the vaccines. But each 
of the vaccines, including AstraZeneca, seem to be efficacious 
at preventing severe illness, hospitalization, and death. Is 
that a correct statement?
     Dr. Abdool Karim. Yes, against the D614G variant, pretty 
much all the vaccines seem to be doing quite well in preventing 
severe disease both in the clinical trials but more importantly 
in the real world data that's now being collected.
     Mr. Bera. OK. So, you know, while the AstraZeneca vaccine 
is not as effective at preventing illness necessarily, it's 
still, you know, an important component of our arsenal as we 
try to vaccinate the entire world. Is that----
     Dr. Abdool Karim. So that's a little bit more difficult. 
So the studies that have been done with other variants, not the 
D614G variant, so if you take, for example--I'll just--to 
simplify just focus on the variant that was first described in 
South Africa by us, the B.1.351, that variant, the studies that 
have been done only included younger people in South Africa 
with the AstraZeneca vaccine, so we know it doesn't work for 
mild and moderate infections in the South African setting 
against the B.1.351. The problem is we don't know if it 
prevents and ameliorates severe disease because there were no 
severe infections in the study itself.
     And so there's only indirect evidence. There's only 
speculation and, you know, using laboratory evidence to suggest 
that maybe it will protect against severe disease, but there is 
no clinical evidence. And so on that basis----
     Mr. Bera. If I were to ask Dr. Rivers or any of the other 
panelists--because obviously there's real-world evidence. You 
know, many people have gotten the AstraZeneca vaccine. Are we 
seeing those that have been vaccinated with AZ, let's say, in 
the United Kingdom and Britain being hospitalized or dying? 
Again, I have not seen anecdotal evidence that folks that have 
been vaccinated with the AZ even in places where there's a high 
prevalence of variants ending up dying? Is that--again, you 
know, Dr. Rivers?
     Dr. Rivers. I'm not sure that there is data available 
describing what Dr. Abdool Karim is sharing about the clinical 
evidence, but there are many places in the world where the 
immune escape variants are not circulating. The B.1.351 to my 
knowledge is not prevalent in many countries, and so the AZ and 
similar platforms would still have value there.
     Mr. Bera. OK. Shifting--a question that's, you know, 
certainly--that I've been pondering since the beginning of the 
pandemic is, you know, when I think about how hard New York 
City was hit and then I think about Tokyo and how Japan, you 
know, approached the pandemic, you know, with the older 
population in Japan with mass transit systems, et cetera, you 
know, it was quite remarkable that they escaped, you know, at 
least in the first phase, you know, a similar impact that New 
York City potentially possessed. And I would just be curious, 
again, you know, this is the opinions of folks, obviously, mask 
wearing has a significant impact and culturally, you know, 
that's not taboo in Japan, and that was an issue--you know, the 
politics around mask wearing in the United States clearly had 
some impact. But is there a cross-immunity? You know, Japan, 
Korea, other places probably did get exposed to SARS and other 
coronaviruses in previous pandemics, and I would just be 
curious, you know, why Japan or, you know, or some of the Asian 
nations, you know, skirted the first phase of this, whereas we 
got hit quite hard? Maybe Dr. Rivers or any of the panelists.
     Dr. Rivers. The number of people infected by the SARS 
pandemic in 2003 was quite small, and so I don't expect it 
would contribute meaningfully to population immunity really 
anywhere in the world. Several of the Asian countries were much 
swifter and more aggressive in their response with--after the 
emergence of the novel coronavirus, and I think that 
contributed to their success. Japan focused very heavily on 
contact tracing, particularly backwards contact tracing, and I 
think that lent itself well to early containment. South Korea 
was also very successful, Singapore. They focused very heavily 
on diagnostic testing. They had a testing volume many times 
over what the United States was doing at the time, which 
allowed them to find cases. And so the overarching lesson for 
me is that we need to be prepared to respond very quickly even 
before we really can characterize and feel confident that the 
threat is severe. If you fall behind, it's very difficult to 
catch up.
     Mr. Bera. And the impact of wearing masks in Asia versus 
the United States?
     Dr. Rivers. Certainly in many countries in Asia after the 
2003 pandemic it became common to wear masks in the community, 
and I--and many countries not only did they have them 
stockpiled but people had them in their homes, and I think that 
was very helpful as well.
     Mr. Bera. Great. I'll yield back.
     Chairman Foster. Yes, thank you. And I should also say in 
my one experience on Tokyo subways, it was very crowded but 
people were not talking, and I have never been on a New York 
subway where there weren't multiple people mouthing off in 
various ways.
     And we will now recognize our colleague, Representative 
Posey, for five minutes.
     Mr. Posey. Thank you very much, Mr. Chairman.
     The thing that alarmed me the most about COVID-19 in the 
very beginning is when we got our first TV reports. They said 
the damage to your lungs from this virus is unlike any others 
that we've ever seen before, and it will not heal itself. It's 
irreversible damage like neurological damage. You might stop it 
from progressing, but you can never reverse all the damage it's 
done. Of course, we've heard an awful lot of people have fully 
recovered.
     I remember talking to NASA (National Aeronautics and Space 
Administration) Administrator Jim Bridenstine right after he 
got tested, and he was sick at the time he got tested. And he 
said the doctor called him and said what do you want first, the 
good news or the bad news? And he said, well, give me the good 
news. He said, well, you don't have COVID. He said, well, then 
what's the bad news? He said, well, you've got the other virus 
that's already killed 80,000 people. But I guess that other 
virus didn't kill anybody after COVID came out. I guess it was 
stopped in its tracks.
     I was wondering, Dr. Streiffer, if the answer to my 
question that I asked before, you mentioned that you would 
expect to see this natural evolution, yet no one has presented 
any evidence of the evolution of COVID in animals or humans 
prior to the December 2019 outbreak. What do you make of that?
     Dr. Streiffer. I think there's a general understanding 
about the time that COVID-19 emerged as a disease in China. You 
know, as we've discussed previously, I think there's still some 
details about its origin that we don't quite understand. But I 
think the path of the virus upon its initial detection and its 
propagation around the world has followed more or less what we 
would expect for a virus that at some level has hit that sweet 
spot of being just infectious enough to spread, dangerous 
enough that it's caught our attention, but not so dangerous to 
kill so many hosts that it tamps itself down.
     So, again, I would respectfully ask the Member to perhaps 
call on Dr. Rivers or Dr. Karim or Dr. Grubaugh to add some 
additional perspective on this. But I think we're seeing a 
progression in the genetic evolution of the virus under the 
pressures that we would expect from both nonpharmaceutical 
interventions and how the vaccines are taking hold that is 
within the spectrum that we would anticipate as scientists.
     Mr. Posey. You know, I've had a lot of--and I'll direct 
this to Dr. Karim. I've had a lot of constituents question 
about taking the vaccination. You know, you mentioned a blanket 
statement absolutely everybody should and there's no good 
reason for anybody not to, but I've had people, well, what if 
my sister has pneumonia? I mean, should she take it then? Well, 
I mean, common sense would dictate no, but I'm not a doctor, 
and there are people that have contacted my office, we've had 
bad outcomes from vaccines before, and I'm sure you're probably 
familiar with that. And I've just told people talk to your 
physician about it. Your physician knows best of all if you 
should get it, and I've had some sort of vaccine--hey, my 
physician said not to do it. Well, I'm not going to argue with 
your physician about that.
     You know, I'm aware of the vaccine injury trust fund. I 
don't know if you all are familiar with it or not, but when 
people make these statements that vaccines are 100 percent safe 
for everybody without exception, end of subject, you're an 
idiot if you don't get vaccinated, the public is in large part 
unaware of the vaccine injury trust fund, which is very hard to 
access, has a 2-year statute of limitations on it. Most 
pediatricians tell people they're crazy if they think their 
kids were injured or whatever. That vaccine injury trust fund 
has paid out $4.5 billion and hasn't paid for a lot of the 
common bad outcomes that people suffer. So, Dr. Karim, just 
your thoughts briefly on that?
     Dr. Abdool Karim. Yes, thank you for that question. So I 
think all vaccines carry some side effects, and so that's part 
and parcel of what we live with. It's a question of the 
benefits and risks. In my own clinic I have had two severe 
reactions, one of which was very severe. The patient 
hospitalized, demyelinating disease, and she happened to have 
lupus, systemic lupus erythematosus. So she has a history of 
this kind of problem, and she didn't do well with the vaccine. 
I'm not sure if she actually got COVID, you know, she would 
probably also have quite a severe form of COVID, but we can 
never say that vaccines are 100 percent safe. There will always 
be those effects, and we've seen with some of the vaccines, 
clotting disorders. We've seen a range of others--I see them in 
my clinic. But I also see all of the many patients with severe 
COVID in my clinic, and I've got, you know, several patients 
with long COVID, and I can't tell you how debilitating it is. 
I'd rather you put up with the side effects and, you know, the 
antigenicity of the vaccine than have to deal with long COVID. 
I watch it and I shudder.
     Mr. Posey. I see my time is up. Mr. Chairman, thank you 
very much. I yield back.
     Chairman Foster. Thank you. And we will--finally, we will 
now recognize our colleague from Colorado, Mr. Perlmutter, for 
five minutes.
     Mr. Perlmutter. Thanks. And what Dr. Karim was just 
talking about is--I think should be another panel on the long-
term effects of this and the potential costs associated with it 
because they do exist, and they are debilitating and--for some.
     So my question is--let's start with Dr. Karim. When you 
were talking about immunoescape, you also mentioned people who 
are immunocompromised were more likely to have the virus do an 
immunoescape. And so can you tell me what you mean by 
immunocompromised and then the immunoescape? I wasn't quite 
sure I got it.
     Dr. Abdool Karim. Sure. So when the person gets naturally 
infected, the body's immune system goes through three steps--
well, there's many steps but just to make it simple, an innate 
immunity and then you get the B cells and the T cells 
responding, so those are the three parts. In somebody who is 
immunocompromised, let's say, somebody who has got cancer and 
is on immunosuppressive treatment, they don't follow those 
three steps, and so they can't bring the virus under quick 
control. Their innate response is first and foremost your first 
line of defense, and it brings the virus under some control 
quickly. So if you don't do that, the virus continues to 
replicate for months and months and months. And it remains 
viable all those months. And as it's replicating in the 
presence of antibodies against the virus, the virus itself will 
start mutating. So these antibodies are not killing the virus, 
but they are exposing this virus to what it needs to bypass. 
And so that's what the problem is.
     And so when we see--there's a superb paper in the New 
England Journal of Medicine, and that paper shows in the cancer 
patient over a period of four months how the virus 
systematically evolves and changes itself to bypass the immune 
response. And so that's--those are the individuals seem to be 
an important group in creating these shifts where these new 
variants are emerging.
     Mr. Perlmutter. Thank you. Anybody else? Or I'm happy to 
yield back to the Chair. I appreciate that answer. Dr. 
Grubaugh?
     Dr. Grubaugh. Yes, I'll just add onto that. I think Dr. 
Abdool Karim's explanation was really fantastic. And from the 
evolutionary perspective when we see natural infections and 
transmission so acute infections and then you transmit to 
somebody else and you look at that over the course of four 
months or so, there's about one to two mutations that are 
incorporated into the virus per month. When we look at some of 
these long infections, either, you know, some level of 
immunocompromised, obviously, that's a huge sort of range of 
things, it could be somebody who had an organ transplant and 
they're on immunosuppressive drugs, it could get somebody who 
has AIDS, cancer, right, a lot of different ways. And when the 
immune system can't quickly just clear the virus and it's left 
in some sort of middle state, it provides a great selective 
advantage. And that's where we see these new mutations rising 
quicker than what we would have in just natural--you know, a 
person-to-person acute transmission.
     The other thing that happens that we see is the virus 
responds really quickly to some of our drugs and monoclonal 
antibodies. And if they're not completely suppressing the 
virus, it gives an opportunity again for the virus to adapt. So 
we end up with these--during these prolonged infections in 
immunocompromised individuals we see some of those exact same 
mutations that we find in variants of interest and variants of 
concern.
     And so one of the hypotheses is that some of these 
variants that all of a sudden acquire, you know, 10, 20 
different mutations and many of those occurring in the spike 
protein where we're really concerned with, that some period of 
time later in infection when you have the viremia that goes up, 
they might be transmitting to other people, and therefore, you 
have these sort of jumps then of viruses that are adapted to 
humans. I mean, that's one of the hypotheses here. And then, 
you know, these events are still probably pretty rare overall, 
but when you have millions and millions and millions of 
infections that have happened that--and these jump and then 
they're more transmissible, I think that's one of the 
explanations for what we're seeing for the rise of many of 
these variants.
     Mr. Perlmutter. Thank you to this panel. You guys really 
are--have been educating me, and I appreciate it. I yield back 
to the Chair.
     Chairman Foster. Thank you. And before we bring this 
hearing to a close, I want to myself thank our witnesses for 
testifying before the Committee today. And for those Members 
and witnesses with time, at the close of the hearing we can 
just hang around for some informal discussions as we often do 
following in-person hearings.
     The record will remain open for two weeks for additional 
statements from the Members and for any additional questions 
that the Committee may ask of the witnesses. And this hearing 
is now adjourned.
     [Whereupon, at 11:41 a.m., the Subcommittee was 
adjourned.]

                                Appendix

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                   Answers to Post-Hearing Questions

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