    [House Hearing, 116 Congress]
    [From the U.S. Government Publishing Office]

                          CORONAVIRUSES: UNDERSTANDING
                       THE SPREAD OF INFECTIOUS DISEASES
                       AND MOBILIZING INNOVATIVE SOLUTIONS

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

                                    HEARING

                                   BEFORE THE

                  COMMITTEE ON SCIENCE, SPACE, AND TECHNOLOGY
                            HOUSE OF REPRESENTATIVES

                         ONE HUNDRED SIXTEENTH CONGRESS

                                 SECOND SESSION

                                   __________

                                 MARCH 5, 2020

                                   __________

                               Serial No. 116-71

                                   __________

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

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

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

                                   __________

                        U.S. GOVERNMENT PUBLISHING OFFICE
    39-909 PDF                  WASHINGTON : 2020

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

                  COMMITTEE ON SCIENCE, SPACE, AND TECHNOLOGY

                 HON. EDDIE BERNICE JOHNSON, Texas, Chairwoman
    ZOE LOFGREN, California              FRANK D. LUCAS, Oklahoma,
    DANIEL LIPINSKI, Illinois                Ranking Member
    SUZANNE BONAMICI, Oregon             MO BROOKS, Alabama
    AMI BERA, California,                BILL POSEY, Florida
        Vice Chair                       RANDY WEBER, Texas
    CONOR LAMB, Pennsylvania             BRIAN BABIN, Texas
    LIZZIE FLETCHER, Texas               ANDY BIGGS, Arizona
    HALEY STEVENS, Michigan              ROGER MARSHALL, Kansas
    KENDRA HORN, Oklahoma                RALPH NORMAN, South Carolina
    MIKIE SHERRILL, New Jersey           MICHAEL CLOUD, Texas
    BRAD SHERMAN, California             TROY BALDERSON, Ohio
    STEVE COHEN, Tennessee               PETE OLSON, Texas
    JERRY McNERNEY, California           ANTHONY GONZALEZ, Ohio
    ED PERLMUTTER, Colorado              MICHAEL WALTZ, Florida
    PAUL TONKO, New York                 JIM BAIRD, Indiana
    BILL FOSTER, Illinois                FRANCIS ROONEY, Florida
    DON BEYER, Virginia                  GREGORY F. MURPHY, North Carolina
    CHARLIE CRIST, Florida               VACANCY
    SEAN CASTEN, Illinois
    BEN McADAMS, Utah
    JENNIFER WEXTON, Virginia
    CONOR LAMB, Pennsylvania
    VACANCY
                             C  O  N  T  E  N  T  S

                                 March 5, 2020

                                                                       Page

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

                               Opening Statements

    Statement by Representative Ami Bera, Vice Chairman, Committee on
      Science, Space, and Technology, U.S. House of Representatives..    10
        Written statement............................................    11

    Statement by Representative Frank Lucas, Ranking Member,
      Committee on Science, Space, and Technology, U.S. House of
      Representatives................................................    12
        Written statement............................................    13

    Written statement by Representative Eddie Bernice Johnson,
      Chairwoman, Committee on Science, Space, and Technology, U.S.
      House of Representatives.......................................    47

                                   Witnesses:

    Dr. Suzan Murray, Program Director, Smithsonian Global Health
      Program, Smithsonian's National Zoo & Conservation Biology
      Institute
        Oral Statement...............................................    15
        Written Statement............................................    17

    Dr. John Brownstein, Chief Innovation Officer, Boston Children's
      Hospital; Professor, Harvard Medical School
        Oral Statement...............................................    20
        Written Statement............................................    22

    Dr. Peter Hotez, Professor and Dean, National School of Tropical
      Medicine, Baylor College of Medicine; Co-Director, Texas
      Children's Hospital Center for Vaccine Development
        Oral Statement...............................................    30
        Written Statement............................................    33

    Dr. Tara Kirk Sell, Senior Scholar, Johns Hopkins Center for
      Health Security; Assistant Professor, Johns Hopkins Bloomberg
      School of Public Health
        Oral Statement...............................................    38
        Written Statement............................................    40

    Discussion.......................................................    47

                 Appendix I: Answers to Post-Hearing Questions

    Dr. Suzan Murray, Program Director, Smithsonian Global Health
      Program, Smithsonian's National Zoo & Conservation Biology
      Institute......................................................    72

    Dr. John Brownstein, Chief Innovation Officer, Boston Children's
      Hospital; Professor, Harvard Medical School....................    76

    Dr. Peter Hotez, Professor and Dean, National School of Tropical
      Medicine, Baylor College of Medicine; Co-Director, Texas
      Children's Hospital Center for Vaccine Development.............    82

    Dr. Tara Kirk Sell, Senior Scholar, Johns Hopkins Center for
      Health Security; Assistant Professor, Johns Hopkins Bloomberg
      School of Public Health........................................    86

                Appendix II: Additional Material for the Record

    Letter submitted by Representative Ami Bera, Vice Chairman,
      Committee on Science, Space, and Technology, U.S. House of
      Representatives................................................    90

    Articles submitted by Representative Ed Perlmutter, Committee on
      Science, Space, and Technology, U.S. House of Representatives..    91

    Article submitted by Representative Bill Foster, Committee on
      Science, Space, and Technology, U.S. House of Representatives..   126

    Letter submitted by Representative Don Beyer, Committee on
      Science, Space, and Technology, U.S. House of Representatives..   131

                          CORONAVIRUSES: UNDERSTANDING
                       THE SPREAD OF INFECTIOUS DISEASES
                      AND MOBILIZING INNOVATIVE SOLUTIONS

                                  ----------

                            THURSDAY, MARCH 5, 2020

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

         The Committee met, pursuant to notice, at 9:03 a.m., in
    room 2318 of the Rayburn House Office Building, Hon. Ami Bera
    [Chairman of the Committee] presiding.
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

         Chairman Bera. This hearing will come to order. Without
    objection, the Chair is authorized to declare recess at any
    time. Good morning, and welcome today's hearing on
    ``Coronavirus: Understanding the Spread of the Infectious
    Disease, and Mobilizing Innovative Solutions''. I'll recognize
    myself for an opening statement, and then I'll recognize the
    Ranking Member for his opening statement, then we'll introduce
    the witnesses.
         Again, thank you for being here. Obviously, this is an
    incredibly timely topic. COVID-19 is not the first pandemic
    we're going to ever deal with, and it certainly is not going to
    be the last one, but it is incredibly important that we come
    together as a nation, and as a planet, to get ahead of this,
    address it, and, you know, come up with the treatment for it.
    If we think about, you know, the basis of global health
    security, it's a three-pronged approach, containment,
    mitigation, and then treatment.
         This is the third hearing that I'm chairing on this
    subject, and the first hearing focused on the containment
    strategy. That was actually the first hearing that Congress
    held. Conclusion of that was the initial strategy of trying to
    contain this disease with travel bans, et cetera, was likely
    not going to be successful, very difficult. You know, I think
    what China did was ambitious, it bought us some time but most
    of us in the public health world--and I'm a physician by
    background, and ran a large public health system--recognize
    that we would likely see community cases. It would be very
    difficult to stop the spread of this disease.
         The second hearing we had, which was last Thursday, was on
    mitigation, largely looking at testing. And this was last
    Thursday, after the first community spread case hit my home
    county of Sacramento, where a patient was hospitalized at the
    University of California Davis Health System, where I used to
    practice. What we discovered was, you know, the testing
    criteria were probably too rigid, that we were missing a lot of
    community tests, and we also started to discover the ability to
    test folks, the availability of test kits, et cetera, was
    largely not there. I'm pleased, you know, to hear the Vice
    President yesterday. Things are ramping up, but we probably did
    lose quite a bit of time, and we are likely going to see many
    more community cases, probably in all of our congressional
    districts. So we still, you know, there's a lot to be learned
    from kind of the bureaucratic breakdown that prevented us from
    rapidly getting those tests out there.
         Today's hearing is focused on treatment based on science,
    and what we can learn from how this virus initially developed,
    what we can learn from looking at the Chinese response. We now
    have a big data set. How did they manage folks? You know, China
    is a communist country, so they were able to do things that we
    can't do as a democratic nation. You know, we respect
    individual rights and individual freedoms here, but there's
    still a lot that we can learn from how they did surveillance,
    et cetera, especially given the breadth of contact tracing that
    we likely are going to have to do based on the community cases
    that we're going to see all across the United States. We won't
    have enough epidemiologists, the CDC (Centers for Disease
    Control and Prevention) won't have enough personnel, so what
    can we learn in how China and Korea--and if you're looking at
    the data that's coming out of Korea now, their aggressive
    approach to testing, and community-based testing. They were
    doing 15,000 tests a day, may have actually mitigated and
    reduced how bad the response could've been. So I think that's
    going to be incredibly important.
         We're also going to look at the science of, you know, how
    is it spread? How efficiently is it spread? You know, how long
    can this virus live as a fomite on inanimate objects? So, you
    know, I think this is an incredibly timely hearing. I think
    this is, you know, this is the Science Committee, so I'm glad
    that we're looking at the science of this, and the science
    basis of treatment, and, again, I appreciate the witnesses that
    are here that are bringing their scientific expertise to help
    us better understand this disease.
         [The prepared statement of Chairman Bera follows:]

        Good morning and welcome to today's hearing on
    Coronaviruses: Understanding the Spread of Infectious Diseases
    and Mobilizing Innovative Solutions. I want to thank Ranking
    Member Lucas, the Members of this Committee, and our witnesses
    for joining us today to discuss the scientific tools and
    research investments we need to better detect, predict, and
    understand the spread of emerging diseases. While the
    Chairwoman is not able to join today, I'm proud to hold the
    gavel and appreciate her strong commitment to public health.
        As a doctor, the former Chief Medical Officer of Sacramento
    County, and a member of the CSIS Commission on Strengthening
    America's Health Security, I have been a strong advocate of
    American leadership in global health. Congress' job is to
    exercise oversight over the federal government's response to
    COVID-19. That is precisely what I have been doing, both as the
    Vice Chair of the Science, Space, and Technology Committee and
    as the Chairman of the Foreign Affairs Subcommittee on Asia,
    the Pacific, and Nonproliferation. In addition to this hearing,
    I have chaired two other Congressional hearings on the
    coronavirus outbreak, sounded the alarm when the White House
    disbanded the office in charge of preparing for pandemics, and
    sought to include funds to combat coronavirus over a month ago
    through other legislation.
        Viruses have caused some of the most dramatic and deadly
    disease outbreaks in human history. Novel viruses of animal
    origin-like SARS and MERS-have been emerging at an alarming
    rate over the last two decades. People are traveling more
    internationally and living in more densely populated areas. We
    are expanding into new geographic areas through deforestation,
    mining, and agricultural land use. Humans are coming into
    closer contact with animal species that are the perfect hosts
    of infectious agents, making it easier for viruses to jump from
    animals to humans.
        Disease outbreaks caused by new viral infections are a
    growing public health concern for the global community, as
    viruses show no respect for national boundaries. The effect of
    COVID-19 on our communities will depend on how the virus
    spreads, the severity with which people get sick, and the
    measures we have available to control its impact. I'd like to
    drive home the point that these questions can all be answered
    by a rapid and robust research response.
        Yet recent outbreaks have highlighted the strengths and
    weaknesses of our research and development response, both
    domestically and internationally. We need additional research
    to expedite the development of diagnostic tests to quickly
    identify those that are sick and push those testing
    capabilities to every state. Not only will this protect our
    public health personnel on the front lines, but it will also
    give them the tools to combat the disease head on.
        Thanks to my role with the Foreign Affairs Committee, I am
    also aware of the importance of social science in guiding our
    response and actively combating the spread of misinformation
    around infectious disease outbreaks. Fear, anxiety, and stigma
    can drive sick people to hide their symptoms to avoid
    discrimination, prevent some individuals from seeking health
    care immediately, and discourage others from adopting healthy
    behaviors. Integrating social scientists into our outbreak
    response helps communities accept and adhere to public health
    measures aimed at limiting the spread of disease.
        Research and development actions are an integral part of
    the response to an outbreak. Scientists are using innovative
    technologies like artificial intelligence to detect and predict
    the spread of disease more effectively. Others are conducting
    research to optimize the use of currently available treatments
    and evaluate candidates for new drugs and vaccines. It is
    apparent now more than ever that our best scientists should be
    leading our response.
        For the last 14 months, this Committee has worked
    tirelessly to ensure that decision-making is driven by science.
    Now is the time to listen and trust science and use it to react
    calmly and smartly to COVID-19. It is critical that we are not
    swayed by misinformation and avoid the stigmatization of
    vulnerable groups.
        This issue has hit close to home. The first reported death
    from COVID-19 in California occurred in Roseville, California,
    which borders my district. Sacramento County is now monitoring
    several potential cases of COVID-19 transmission. The hospital
    where I used to attend in and teach medical students is
    treating a patient with the disease. My heart is with those who
    are currently suffering.
        I continue to believe that the risk to the American people
    is low at this time. But this disease is global in scope and it
    is impacting our communities and our economy. Tackling it will
    require our communities, our government, and our international
    partners working together. With American leadership, we can do
    it. But it will require proper planning, coordination, and
    resourcing. It's not too late.
        I look forward to hearing from our witnesses today on how
    we can best support our nation's scientists as they deploy new
    health technologies and develop scientific information critical
    to controlling and mitigating the effects of emerging
    infectious diseases.
        With that, I will turn it over to the ranking member, Mr.
    Lucas.

         Chairman Bera. With that, the Chair now recognizes the
    Ranking Member, Mr. Lucas, for his opening statement.
         Mr. Lucas. Good morning, and thank you, Dr. Bera, for
    holding this important hearing as we deal with an emerging and
    rapidly evolving situation with the spread of coronavirus,
    COVID-19. According to the Centers for Disease Control at this
    time, most people in the United States have little immediate
    risk of exposure to the virus, however, public health experts
    also advise us a pandemic is likely, so we must gather the
    facts and be prepared. Today I hope our expert witnesses can
    provide important information we can share with our
    constituents. I also hope we can learn what tools are needed to
    detect, predict, and prevent the next pandemic.
         COVID-19 was first identified in Wuhan, China in December
    of 2019. Since then the World Health Organization has reported
    over 90,000 confirmed cases, and over 3,000 deaths spread
    throughout 76 countries. In the United States, the CDC has
    reported at least 152 confirmed cases and 11 deaths. We know
    that for most individuals the illness is not serious, but we're
    still getting information on the death rate. The impact on
    vulnerable populations is particularly concerning, though, and
    my thoughts are with the individuals and families that have
    been affected.
         This is not the first global pandemic in modern times, and
    I'm quite certain it won't be the last. Just over 100 years ago
    the world faced one of the deadliest pandemics in history, the
    1918 avian flu pandemic, also known as the Spanish flu. It
    killed an estimated 50 million people worldwide, including over
    600,000 people in the United States. Since 1980, outbreaks of
    emerging infectious diseases have been occurring with greater
    frequency and have been causing higher numbers of human
    infections than in the past. The vast majority of these
    infections are initially caused by the spread of the disease
    from animals to humans. A SARS (Severe Acute Respiratory
    Syndrome) outbreak in 2003 and an avian flu outbreak in 2006
    were wakeup calls for the American public health system, and
    Congress made considerable investments in improving our
    Nation's capacity to detect and respond to pandemics. We would
    be in a much worse position today without those investments.
         I'm confident that the U.S. Government has the tools
    necessary to deal with this. We have the best scientists in the
    world with NIH (National Institutes of Health), CDC, and in our
    universities. Their work has yielded considerable advancements
    in health technology, disease surveillance, and predictive
    modeling, as well as medicine, drugs, and vaccine development.
    With the integration of technology like artificial intelligence
    (AI), and the greater availability of data, researchers are now
    able to identify and track outbreaks faster. Last Congress, we
    also modernized the Pandemic All-Hazards Preparedness Act to
    set up a framework to deal with precisely this type of
    outbreak. While significant progress has been made, gaps
    remain, and a severe pandemic like the novel coronavirus could
    be devastating to the global population.
         As the human population has grown, so has the livestock,
    swine, and poultry populations needed to feed us. This expanded
    number of hosts provides increased opportunities for viruses
    from birds, cattle, and pigs to spread, evolve, and infect
    people. To better understand how zoonotic diseases like avian
    flu, swine flu, Ebola, Zika, SARS, and now coronavirus spread
    and operate, we must invest in basic research to learn more
    about the interconnection between people, animals, and plants
    in shared environments. Yesterday the House passed a
    supplemental appropriations bill to address the response to
    COVID-19 and the development of a vaccine. I supported the
    bipartisan bill, and I hope my colleagues and I can work
    together on a long-term strategy to prepare for any global
    pandemic we may face in the future. Our top priority is the
    health and welfare of the American people.
         I'm pleased the President has created the Coronavirus Task
    Force. This interagency group is working to monitor, contain,
    and mitigate the spread of the novel coronavirus, while
    ensuring the American people have access to accurate and up-to-
    date health and travel information. The best thing Americans
    can do right now is to follow the guidance of CDC. Many of
    their recommendations are simple ones you learned from your
    mother. Wash your hands, wash your hands, do it thoroughly and
    frequently, cover your mouth to cough or sneeze, avoid touching
    your face, stay home if you are sick.
         I want to thank the witnesses for taking the time to come
    here to share their expertise and insights with us during this
    crucial time to help keep Americans safe, healthy, and secure.
    And, with that, I yield back the balance of my time, Mr.
    Chairman.
         [The prepared statement of Mr. Lucas follows:]

        Good morning and thank you Chairwoman Johnson for holding
    this important hearing as we deal with an emerging and rapidly
    evolving situation with the spread of the coronavirus COVID-19.
        According to the Centers for Disease Control (CDC), at this
    time most people in the United States have little immediate
    risk of exposure to the virus. However, public health experts
    also advise us a pandemic is likely, so we must gather the
    facts and be prepared.
        Today I hope our expert witnesses can provide important
    information we can share with our constituents. I also hope we
    can learn what tools are needed to detect, predict, and prevent
    the next pandemic.
        Covid-19 was first identified in Wuhan, China in December
    2019. Since then the World Health Organization has reported
    nearly 90,000 confirmed cases and over 3,000 deaths spread
    throughout 76 countries. In the United States, the CDC has
    reported 152 confirmed cases and 11 deaths. We know that for
    most individuals the illness is not serious, but we are still
    getting information on the death rate. The impact on vulnerable
    populations is particularly concerning though, and my thoughts
    are with the individuals and families that have been affected.
        This is not the first global pandemic in modern times, and
    I am certain it won't be the last. Just over a hundred years
    ago the world faced one of the deadliest pandemics in history -
    the 1918 avian flu pandemic, also known as the "Spanish flu."
    It killed an estimated 50 million people worldwide, including
    over 600,000 people in the United States.
        Since 1980, outbreaks of emerging infectious diseases have
    been occurring with greater frequency and have been causing
    higher numbers of human infections that inthe past. The vast
    majority of these infections are initially caused by the spread
    of disease from animals to humans.
        A SARS outbreak in 2003 and an Avian flu outbreak in 2006
    were wake-up calls for the American public health system, and
    Congress made considerable investments to improve our nation's
    capabilities to detect and respond to pandemics. We would be in
    a much worse position today without those investments.
        I am confident the U.S. government has the tools necessary
    to deal with this. We have the best scientists in the world at
    NIH, CDC, and in our universities. Their work has yielded
    considerable advancements in health technology, disease
    surveillance and predictive modeling, as well as medicine,
    drugs, and vaccine development.
        With the integration of technology like artificial
    intelligence and the greater availability of data, researchers
    are now able to identify and track outbreaks faster. Last
    Congress, we also modernized the Pandemic All-Hazards
    Preparedness Act to set up a framework to deal precisely with
    this type of an outbreak. But while significant progress has
    been made, gaps remain, and a severe pandemic like the novel
    coronavirus could be devastating to the global population.
        As the human population has grown, so has the livestock,
    swine and poultry populations needed to feed us. This expanded
    number of hosts provides increased opportunities for viruses
    from birds, cattle and pigs to spread, evolve, and infect
    people.
        To better understand how zoonotic diseases like avian and
    swine flu, Ebola, Zika, SARS, and now COVID-19 spread and
    operate, we must invest in basic research to learn more about
    the interconnection between people, animals, and plants in
    shared environments.
        Yesterday the House passed a supplemental appropriations
    bill to fund the response to COVID-19 and the development of a
    vaccine. I supported the bipartisan bill. But I hope my
    colleagues and I can work together on a long-term strategy to
    prepare for any global pandemic we may face in the future.
        Our top priority is the health and welfare of the American
    people. I am pleased the President has created the Coronavirus
    Task Force. This interagency group is working to monitor,
    contain, and mitigate the spread of the novel coronavirus while
    ensuring the American people have access to accurate and up-to-
    date health and travel information. The best thing Americans
    can do right now is follow the guidance of the CDC. Many of
    their recommendations are simple ones you learned from your
    mother, wash your hands thoroughly and frequently, cover your
    cough or sneeze, avoid touching your face, and stay home if you
    are sick. I want to thank the witnesses for taking the time to
    be here to share your expertise and insights with us during
    this crucial time to help keep Americans safe, healthy, and
    secure. I yield back the balance of my time.

         Chairman Bera. Thank you, Mr. Lucas. If there are members
    who wish to submit additional opening statements, your
    statements will be added to the record at this point.
         At this time I'd like to introduce our witnesses. First we
    have Dr. Suzan Murray. Dr. Murray is the Program Director of
    the--for the Global Health Program at the Smithsonian's
    National Zoo and Conservation Biology Institute. Next is Dr.
    John Brownstein. Dr. Brownstein is the Chief Innovation Officer
    at Boston Children's Hospital, and a Professor at Harvard
    Medical School. Third I welcome Dr. Peter Hotez, who will be
    introduced by the Chair for the Subcommittee on Energy, Lizzie
    Fletcher of Texas.
         Mrs. Fletcher. Thank you very much, Mr. Chairman. It's
    truly a privilege and a pleasure to introduce an
    internationally recognized physician/scientist in global
    health, neglected tropical diseases, and vaccine development
    who is also my neighbor, and a true leader in our community in
    Houston, Dr. Peter Hotez.
         Dr. Hotez is Professor and Dean at Baylor College of
    Medicine, and Co-Director of Texas Children's Hospital Center
    for Vaccine Development. As head of Texas Children's Center for
    Vaccine Development, he leads a team of product development
    partnership for developing new vaccines for a variety of
    diseases, including other human coronaviruses, like SARS and
    MERS (Middle East Respiratory Syndrome), diseases affecting
    hundreds of millions of children and adults worldwide, while
    championing access to vaccines globally and in the United
    States. Dr. Hotez, welcome. We are glad to have you here today.
         Chairman Bera. And lastly we have Dr. Tara Kirk Sell. Dr.
    Sell is a Senior Scholar at Johns Hopkins Center of Health
    Security, and is an Assistant Professor at Johns Hopkins
    Bloomberg School of Public Health.
         You will each have 5 minutes for your spoken testimony.
    Your written testimony will be included in the record for the
    hearing. When you have completed your spoken testimony, we'll
    begin with questions. Each member will have 5 minutes for
    questioning. Dr. Murray, you may proceed.

              TESTIMONY OF SUZAN MURRAY, PROGRAM DIRECTOR,

                   SMITHSONIAN GLOBAL HEALTH PROGRAM,

                       SMITHSONIAN'S NATIONAL ZOO

                   AND CONSERVATION BIOLOGY INSTITUTE

         Dr. Murray. Thank you very much. Congressman Bera, Ranking
    Member Lucas, and all Members of the esteemed Committee, thank
    you for calling this hearing, and inviting me to participate.
    My name is Dr. Suzan Murray, and I'm the Director of
    Smithsonian's Global Health Program, based out of the National
    Zoological Park and Conservation Biology Institute. Our program
    utilizes experts in wildlife medicine, human medicine, public
    health, conservation, biology, and epidemiology to study and
    respond to health issues at the human/animal interface. We
    utilize a multidisciplinary approach to investigate emerging
    infectious diseases that threaten both human and animal life,
    and we build in-country capacity to train the next generations
    of health specialists. In short, this is the reason right now
    that our program was created.
         Human health, wildlife, and environmental health are
    inextricably linked, and closely depend upon each other. In
    order to safeguard the survival of all species, it's critical
    that we examine health across a continuum of species, and have
    research and decisions firmly rooted in scientific knowledge.
    Understanding the current viral threats, the patterns and
    drivers of disease emergence, and the human behaviors that
    contribute to such emergence, will best allow us to not only
    respond to this outbreak, but the next one, and the one after
    that, because we do know they're coming. Already we have
    identified many of the drivers of disease emergence and spread,
    including land use change, increased human/wildlife
    interaction, and the globalization of travel and markets.
         Time and history have repeatedly shown us that it is much
    more humane, efficient, and economical to prevent disease
    rather than to identify, respond, diagnose, treat, and attempt
    to contain an outbreak. Through increased understanding of the
    as-yet undiagnosed viruses, the drivers of emergence, and the
    risk factors associated with various behaviors, we can develop
    the early warning systems, prepare for--prepare rapid response
    teams, and provide critical data and information to the vaccine
    industry to better prepare for the next outbreak. Just as
    critical, we must educate local medical professionals, and the
    people living in the communities at the greatest risk of
    outbreaks. By preventing the spread of pathogens at the source,
    we can avoid the global consequences that we are experiencing
    now.
         For example, over the last 10 years, and working with
    partner agencies, our team has collectively identified over
    1,200 novel mammalian viruses. So that's, you know, 1,200 is a
    lot of viruses. It's only a small amount of the ones that are
    out there. One hundred sixty-one of these belong to the same
    family as COVID-19. In this time we also strengthened the
    capability for virus detection and characterization in 60 labs,
    and--in which pandemics are most likely to originate. We've
    also trained over 6,000 people in more than 30 countries at the
    frontline of defense against emerging diseases. At this moment,
    the world is focused on the novel coronavirus, COVID-19, as it
    should be. While it's essential that we do everything we can to
    respond to this global crisis, it's also the time we need to be
    thinking of emerging viruses. The next global pandemic is not a
    matter of if, but when and where. To quickly identify and
    contain such infections, health and disease must be evaluated
    across species, and on a global scale.
         While he might not have imagined it in this context, Ben
    Franklin was right when he said an ounce of prevention is worth
    a pound of cure. When it comes to outbreaks, the costs of
    responding to a crisis can dwarf the up front investment in
    research and education. Beyond a clear moral obligation to
    protect human life, there are staggering financial benefits
    from focusing on preventative measures. For example, the human
    and economic toll from the West African Ebola outbreak was
    massive. More than 11,000 people lost their lives, and well
    over $4 billion was spent globally. In case of the SARS
    epidemic of 2004, the estimated global financial impact was
    between $30 and $50 U.S. billion dollars, and the current COVID
    impact, while still evolving, and a dynamic situation, is
    expected to be on orders of magnitude higher.
         Advancements in the detection of novel pathogens show that
    the most efficient way to respond to and contain an outbreak is
    through the coordinated wildlife and human surveillance. While
    we estimate there are 1.7 as yet unknown viruses, about half of
    which can affect human people, and some lead to new pandemics.
    As of now, there are no coordinated programs to work in high
    risk regions to identify these unknown viruses, get their
    genetic sequences into labs, and identify ways to reduce risk
    of them emerging. Our best defense against spreading diseases
    that make their way into the human population is through
    research and education. While we cannot stop every disease
    outbreak, we can reduce their frequency, and build the capacity
    for a rapid global response when they do occur.
         Thank you once again for this hearing, and your interest
    in this pressing and important topic. I look forward to
    answering any questions you might have.
         [The prepared statement of Dr. Murray follows:]
        [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

                      TESTIMONY OF JOHN BROWNSTEIN,

                       CHIEF INNOVATION OFFICER,

                       BOSTON CHILDREN'S HOSPITAL

                 AND PROFESSOR, HARVARD MEDICAL SCHOOL

         Dr. Brownstein. Congressman Bera, Ranking Member Lucas,
    and distinguished Members of the U.S.----
         Chairman Bera. Dr. Brownstein, could you turn your mic on?
         Dr. Brownstein. That would help. Congressman Bera, Ranking
    Member Lucas, and distinguished Members of the U.S. House of
    Representatives Committee on Science, Space, and Technology,
    thank you for inviting me today to speak with you. Today I'll
    describe ways that novel technologies like artificial
    intelligence can help detect, monitor, and predict emerging
    infectious diseases. I'll also discuss how non-traditional
    sources can supplement existing epidemiological techniques. But
    as I describe the good news about such advances, I don't want
    to sugarcoat the bad, for the current Federal investments in
    disease surveillance are inadequate and transient. We urgently
    need Federal and local investment in new technologies for
    public health surveillance and response. Such investment will
    augment the capacity of public health to implement new ways to
    monitor the health of populations. It will deepen our
    understanding of community-based morbidity and mortality. It
    will also save lives.
         This is the goal of my team at Boston Children's Hospital,
    where we develop innovative surveillance technology, where we
    use freely online information to provide insights for both
    public health agencies and the general public. We did this for
    the H1N1 influenza pandemic, H7N9, avian influenza, Ebola in
    West Africa, and now COVID-19. These platforms, and our
    research, have ultimately played a critical role in that
    innovative surveillance technologies can help detect, monitor,
    and ultimately mitigate the impact of these diseases.
         Our inaugural project, HealthMap, which is available to
    the public, brings together disparate sources from a variety of
    data streams to help provide a unified view of the world of
    infectious diseases. To do that we use AI, machine learning,
    natural language processing, all to organize that information
    and make it available. Here's an example. On December 30, 2019
    the platform alerted us to an unknown viral pneumonia. That
    turned out to be one of the earliest signals of the current
    COVID-19 outbreak.
         Using AI in modeling of epidemics is one of the areas of
    research offering vast insights into the potential burden of
    disease, and where it spreads. Machine learning models can
    predict where a given virus may arrive next. That lets us
    inform public health organizations about how to respond.
    Predictive modeling can also be used with data like prior
    disease history, weather, travel patterns, laboratory data,
    symptom surveillance. All, together through AI, help us
    exchange information, conduct surveillance, and measure public
    response to the events and response.
         It is also critical to support sentinel surveillance of
    disease. Sentinel surveillance allows public health officials
    to identify signals early, impacts, and disease burden in the
    community. One such example is Flu Near You, which is a
    crowdsourcing platform for symptom surveillance in the U.S. It
    offers two advantages. One, it identifies individuals who may
    be ill, but not seeking medical attention, and it's in real
    time. Our team has now augmented this tool to improve with
    COVID-19 surveillance.
         To date, there is no evidence supporting widespread
    transmission of COVID-19 in the U.S., but does suggest that
    sustained transmission in the community level will be
    occurring. Current global situation suggests that this outbreak
    will become a pandemic. It threatens the people--the health of
    the people of the United States and globally. The COVID-19
    outbreak also demonstrates some reasons for optimism. It
    demonstrates what we can accomplish when the scientific and
    humanitarian disciplines unite around a common goal. We
    understand that each outbreak might require a slightly
    different approach to monitoring response, but there are key
    updates and metrics that we need in every single outbreak.
    There are questions that we must ask, how many new cases are
    there? What is the geographic spread? Are healthcare workers
    infected? We can help answer these questions by using both
    digital disease platforms, along with traditional surveillance.
    We aggregate data from a variety of these sources in real time.
         There's an epidemiological expression that expresses what
    we want, prioritizing sensitivity over specificity. In English
    this means that--risking some false positives to uncover more
    of those who are sick. These platforms do that. They aggregate
    everything available to provide stakeholders with a snapshot of
    the current view of the situation. Those within the realm of
    infectious diseases often say it is not a matter of if, it's a
    matter of when. We continually need support for initiatives to
    make an impact both domestically and globally through
    infectious disease monitoring and surveillance. By investing in
    our neighbors, and promoting health initiatives outside of our
    borders, we help reduce the threat of an outbreak reaching the
    United States.
         There's another essential step to being prepared, long
    term support of the Centers for Disease Control and Prevention,
    and for local Departments of Public Health. The CDC's Influenza
    Surveillance Systems are the backbone of flu surveillance for
    this country. Augmenting this surveillance system with novel
    programs like HealthMap provides us with additional
    information. It allows the public health authorities,
    clinicians, researchers, and the general public to stay alert
    of what's happening. And this is why I urge this Committee to
    make sure the United States provides sustained investment in
    the fundamental needs of disease detection and surveillance.
    That means investments domestically and around the world. Non-
    traditional data sources and enhanced data processing through
    AI and machine learning have proven their worth. They support
    traditional surveillance, they aid in the developing of a clear
    path, and a picture of an existing or potential infectious
    disease threat to human health.
         You have shown through your thoughtful leadership on these
    issues in the past, and now we need your help again, for with
    your continued support, we cannot only strengthen the public
    health community, we will protect the lives that we serve.
    Thank you again, and I look forward to your questions.
         [The prepared statement of Dr. Brownstein follows:]
        [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

         Chairman Bera. Dr. Hotez?

              TESTIMONY OF PETER HOTEZ, PROFESSOR AND DEAN,

                 NATIONAL SCHOOL OF TROPICAL MEDICINE,

              BAYLOR COLLEGE OF MEDICINE, AND CO-DIRECTOR,

                    TEXAS CHILDREN'S HOSPITAL CENTER

                        FOR VACCINE DEVELOPMENT

         Dr. Hotez. Thank you very much. Dr. Bera, Congress--
    Chairman Bera, Ranking Member Lucas, Congresswoman Lizzie
    Fletcher, thank you for that very generous introduction. I'd
    also like to acknowledge my fellow Texan, Congressman Pete
    Olson. It's an honor to be here. I always get thrilled when I
    have the opportunity--I've been doing this for 20 years--to
    address Committees in Congress, and it's still a special thrill
    for me.
         I'm a vaccine scientist, and a pediatric scientist. I was
    previously Chair of Microbiology at George Washington
    University, just down the road, and then a decade ago we moved
    to Texas to create a new--a unique school for emerging and
    neglected tropical diseases, and also to create a unique center
    for vaccine development, and the need was this. There is an
    urgency to create vaccines for diseases which don't make money.
    So we took this on in--with the idea of pioneering not only the
    interesting science, but also a new business model, and the
    business model part we haven't quite figured out yet, because
    we're trying to make diseases--vaccines for diseases no one
    else will make.
         So we have a schistosomiasis vaccine now in clinical
    trials, a leishmaniasis vaccine that we hope will advance to
    the clinic soon, a hookworm vaccine in clinical trials, a new
    Chagas disease vaccine that's moving into the clinic. I like to
    say these are the most important diseases you've never heard
    of. These are some of the most common afflictions of the
    world's population, but they mostly occur among people who live
    in extreme poverty, and so there's no model to figure out who's
    going to pay for them, so, as a consequence, neither the
    biotechs, nor the big pharmaceutical companies, make those
    vaccines. And, for reasons that we'll explore this morning, we
    also took on, a decade ago, the interesting problem of making
    coronavirus vaccines, because we recognize these as enormous
    public health threats, and yet we have not seen the Big Pharma
    guys and the biotechs rushing into this space.
         So we partnered with a group at the New York Blood Center
    and the Galveston National Laboratory to take on the big
    scientific challenge of coronavirus vaccines. And I say a
    scientific challenge because one of the things that we're not
    hearing a lot about is the unique potential safety problem of
    coronavirus vaccines. This was first found in the early 1960s,
    with the respiratory syncytial virus (RSV) vaccines that--and
    it was done here in Washington with the NIH and Children's
    National Medical Center, that some of those kids who got the
    vaccine, actually did worse, and I believe there were two
    deaths as--in the consequence of that study.
         Because what happens with certain types of respiratory
    virus vaccines, you get immunized, and then, when you get
    actually exposed to the virus, you get this kind of paradoxical
    immune enhancement phenomenon. And what--how--and we don't
    entirely understand the basis of it, but we recognize that it's
    a real problem for certain respiratory virus vaccines. That
    killed the RSV program for decades. Now the Gates Foundation is
    taking it up again, but when we started developing coronavirus
    vaccines, and our colleagues, we noticed in laboratory animals
    that they started to show some of the same immune pathology
    that resembled what had happened 50 years earlier, so we said,
    oh, my God, this is going to be problematic.
         But we collaborated with a unique group that figured out
    how to solve the problem, that if you narrow it down to the
    smallest sub-unit, the piece that--of--what's called the
    receptor binding domain, that docks with the receptor, you get
    protection, and you don't get that immune enhancement
    phenomena. So we were really excited about that, and we
    proposed this to the National Institute of Allergy and
    Infectious Diseases (NIAID). They funded it, and we wound up
    actually making and manufacturing, in collaboration with Walter
    Reed Army Institute of Research, a first generation SARS
    vaccine. So SARS was the one that emerged in 2003, and then
    this new one, of course, we call the SARS-2 coronavirus.
         We had it manufactured, but then we could never get the
    investment to take it beyond that. And then--so that was really
    unfortunate, because we had the vaccine ready to go, but we
    couldn't move it into the clinic because of lack of funding,
    because by then nobody was interested in coronavirus vaccines.
    When the Chinese started putting up the data on bioarchive in
    January/February, we saw very close homology between the two,
    and realized that we may be sitting on a very attractive
    coronavirus vaccine. Now we're working with--again with NIH,
    and we'll work with BARDA (Biomedical Advanced Research and
    Development Authority) and others, to get the funding, but now
    we'll have that lag. And these clinical trials are not going to
    go quickly because of that immune enhancement. It's going to
    take time.
         And so, you know, all--unfortunately, some of my
    colleagues in the biotech industry are making these inflated
    claims, you know, you've seen this in the newspapers, we're
    going to have this vaccine in weeks, or--in this and that. What
    they're really saying is they could move a vaccine to clinical
    trials, but this will not go quickly because, as we start
    vaccinating human volunteers, especially in areas where we have
    community transmission, we're going to have to proceed very
    slowly, very cautiously. The FDA (Food and Drug Administration)
    is on top of that. They have a great team in place at the
    Center for Biologics Evaluation Research (CBER). They're aware
    of the problem, but it's not going to go quickly. We are going
    to have to follow this very slowly, cautiously, to make certain
    we're not seeing that immune enhancement.
         So, you know, now we're hearing projections, a year, 18
    months, who knows? This is not going to go quickly. The bottom
    line is, had we had those investments early on to carry this
    all the way through clinical trials years ago, we could've had
    a vaccine ready to go. So we've got to figure out what the
    ecosystem is going to be to develop vaccines that are not going
    to make money. The Big Pharma companies are still not going in,
    some of the biotechs are starting to, because they're trying to
    really accelerate their technology, and use it--and hopefully
    to flip it around for something else that will make money. We
    need a new system in place, and I'm happy to explore that with
    you more during the questions and answers.
         Chairman Bera. Right.
         Dr. Hotez. Thank you.
         [The prepared statement of Dr. Hotez follows:]
        [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

         Chairman Bera. Thanks, Dr. Hotez. Dr. Sell?

              TESTIMONY OF TARA KIRK SELL, SENIOR SCHOLAR,

               JOHNS HOPKINS CENTER FOR HEALTH SECURITY,

                        AND ASSISTANT PROFESSOR,

            JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH

         Dr. Sell. Good morning, Vice Chairman Bera, Ranking Member
    Lucas, and members of the Committee. Thank you for inviting me
    to speak about my research on crowd forecasting and
    misinformation, this research, in context of COVID-19, and ways
    to support research that improve outbreak response.
         Traditional disease surveillance is critical during
    infectious disease outbreaks, however, this information can be
    supported with tools to help support decisionmaking. One such
    tool is crowd forecasting. Crowd forecasting consolidates the
    diverse opinions of many into hard probabilities for future
    outcomes. This is helpful in engaging the most likely outcome,
    but also for understanding the uncertainty about that outcome.
         Over the past year my research team, in partnership with a
    group called Hypermind, developed a crowdsourced disease
    prediction platform, and asked forecasters to make predictions
    about outbreaks. For instance, we asked about the growth of
    Ebola in the DRC (Democratic Republic of Congo), the spread of
    measles in the United States, and how many U.S. counties might
    see cases of Eastern Equine Encephalitis. On most occasions,
    forecasters provided accurate predictions about 3 weeks ahead
    of time. Recently we focused our forecasting platform on COVID-
    19. We asked about the number of countries that would have
    cases of COVID-19, and the number of cases that would be seen
    around the world, and in the U.S. For global cases, forecasts
    showed high confidence that there would be a rapid and
    explosive spread.
         On a few occasions our predictions were incorrect. We
    think this is probably because forecasters didn't have enough
    information to make accurate forecasts. Essentially, there's no
    magic here. If disease surveillance information is lacking, or
    is delayed, forecasters don't have any information to go on.
    This underscores an essential research need for the current
    COVID-19 outbreak, that surveillance, both within the U.S. and
    globally, is essential.
         Another area of my research, misinformation during disease
    outbreaks has emerged as a challenge during the COVID-19
    outbreak, and highlights the need to transparently and rapidly
    share information. Health misinformation can be defined as
    false health-related information, and can range from the
    promotion of fake cures to rumors about the origin of the
    outbreak. Misinformation can substantially impede the
    effectiveness of public health response measures, increase
    societal discord, reduce trust in governments, leaders, and
    responders, and increase stigmatization.
         My team and I analyzed misinformation during the 2014 West
    African Ebola outbreak, one of the most recent examples of a
    fear inducing disease event for the U.S. public. Our--in our
    analysis, we found that about 10 percent of the Ebola related
    tweets had false or half true information. We also saw that
    more tweets with misinformation were political, and seemed
    designed to promote discord. Another finding with parallels to
    COVID-19 was the infection--or the identification of rumors,
    often focused on government conspiracies. Although we have
    been--not been able to do a systematic analysis of COVID-19
    misinformation, we have seen the spread of rapid--of false
    information, including recommendations for false cures that
    could be harmful, like drinking chlorine dioxide, blaming
    specific ethnic groups, and conspiracy theories about various
    governments creating the virus as a bioweapon.
         Response to misinformation requires a nuanced approach,
    and further research to best determine the ways forward. While
    the solutions will be complex, one thing that is critical is
    the prevention of an information void that can be filled with
    false information. Members of the public need accurate and
    timely information to help them make sense of what is happening
    in the outbreak. As I advocated for improved disease
    surveillance earlier, this shows the need for a better
    collection and communication of disease information in a
    transparent and rapid manner.
         From my experience in conducting research in response to
    emergent disease outbreaks, I believe that we need to reduce
    the impediments and disincentives to doing rapid and timely
    research during these events. One hurdle to overcoming--to
    overcome is the slow response--or slow process to establish
    Federal funding streams for research during a response. My
    research was funded by awards from private groups prior to the
    outbreak, which provided the flexibility to shift gears toward
    COVID-19. And while the development of vaccines and
    countermeasures are critical, social, behavioral, and
    epidemiological research are also important. The best treatment
    cannot be effective without knowing where the disease is, and
    who it is affecting. The best vaccine cannot change the course
    of an outbreak if people refuse to take it. And the best public
    health response cannot be implemented if members of the public
    don't cooperate.
         My bottom line message is this, we need to support the
    systematic collection and rapid dissemination of information
    about outbreaks. The--as the issue of misinformation grows, a
    dedicated effort to understanding the best ways to combat it
    will be needed. Even after the COVID-19 outbreak is over,
    emerging outbreaks will still be a continuing concern. The
    Federal research space needs to evolve toward a more rapid
    approach to meet this threat. Thank you.
         [The prepared statement of Dr. Sell follows:]
        [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

         Chairman Bera. Thank you, Dr. Sell. Before we proceed, I'd
    like to bring the Committee's attention to a letter that
    Chairwoman Johnson received in preparation for today's hearing,
    letters from Johnson & Johnson (J&J) that highlights their
    global response to the COVID-19 virus. Without objection, I'm
    placing this document, and Chairwoman Johnson's opening
    statement, in the record.
         [The prepared statement of Chairwoman Johnson follows:]

        Good morning and welcome to today's hearing. We have an
    excellent panel of witnesses today, all experts in their field.
    I look forward to a robust discussion of how science can help
    control and mitigate the effects of emerging infectious
    diseases, especially in light of this recent coronavirus
    outbreak.
        Unfortunately, outbreaks of new infectious diseases are
    happening more often and infecting more people. Changing
    ecosystems, economic development and land use, climate and
    weather, and international travel and commerce are all examples
    of ecological, environmental, and social factors that are
    increasing the emergence and spread of disease. The size of the
    current COVID-19 outbreak has created a public health crisis
    with significant international dimensions. A successful public
    health response relies on science- not only through rapid and
    robust research during an outbreak, but through sustained
    investments in research and development between epidemics.
        As more people interact with technology in their day-to-day
    lives, we have new ways of harnessing data. Scientists are
    developing modeling techniques that use artificial intelligence
    to predict where viruses may emerge and how far they'll spread.
    Policymakers use these programs to inform efforts that seek to
    prevent and control the spread and impact of disease. We also
    rely on scientists to develop diagnostic tests and treatment
    options and evaluate new drugs and vaccines. It is clear how
    our research and development investments directly impact our
    ability to prepare and respond to global emergencies. Every
    decision we make must be rooted in science.
        The outbreak of global viruses is often followed by the
    spread of misinformation, especially about how or where the
    virus originated and the government's response to control it. A
    whole country or group of people may be singled out as the
    source of the problem-rather than the pathogen. This is hardly
    a new phenomenon, but the spread of misinformation during this
    current outbreak has been accelerated by social media. The
    World Health Organization has even labeled this outbreak an
    "infodemic," meaning there is so much information out there
    that it is hard for people to find trustworthy sources and
    reliable guidance when they need it.
        Given that COVID-19 is a new disease, it is understandable
    that its emergence and spread may cause confusion, anxiety, and
    fear. But if we let these emotions guide us, instead of
    science, we will see the rise of harmful stereotypes that will
    prevent people from accessing the health care they need. We
    have already seen reports of public stigmatization against
    people from areas affected by the COVID-19 outbreak. Coupled
    with the health impacts of the virus itself, this is of grave
    concern.
        According to the World Health Organization, recent disease
    outbreaks like SARS, MERS, Ebola, and Zika have highlighted the
    need to use social science to fight deadly disease outbreaks
    and epidemics. Additional investments in social science
    research on combatting misinformation during outbreaks could
    improve prevention and control efforts and strengthen global
    public health communication. We need a holistic research and
    development response now more than ever.
        As the first nurse elected to Congress, I have been
    dedicated to public health my entire career. Our Committee may
    not have jurisdiction over the Health and Human Services
    agencies, but we have long had a role in amplifying the voices
    of our nation's best scientists and bringing them to the
    forefront on an issue. Thousands have been affected by COVID-
    19. We do not know how many more will be. We must do everything
    in our power to ensure that science guides our response to this
    outbreak and prepares us for the future.
        Thank you all for being here this morning. And I thank
    Vice-Chair Bera for his leadership on this issue.

         Chairman Bera. At this point we'll begin our first round
    of questions. The Chair recognizes himself for 5 minutes.
         Dr. Hotez, you touched on some of your research into
    developing a coronavirus vaccine and, you know, a SARS vaccine.
    I think it's incredibly important since, you know, Dr. Sell
    just talked about information and misinformation, we've heard
    quite a bit about how quick we're going to get a vaccine, how
    quickly that'll be available to the public. And I think just,
    you know, this morning I woke up to a news alert that said a
    Cambridge, Massachusetts biotech company had come up with a
    vaccine that they've sent to Dr. Fauci to start looking at
    testing and so forth. But I think we've got to be honest with
    the public so we don't give them false hope. And, you know,
    perhaps--if you could just go through a timeline on what
    vaccine development is going to look like in the best case
    scenario, then to clinical trials, and then to potential public
    availability?
         Dr. Hotez. Sure. Thank you for that question. So I think
    what we're going to see over the next few weeks to months is
    several vaccines will enter into a pipeline of clinical trials.
    Hopefully ours will be one of them. You mentioned the Moderna
    vaccine out of MIT (Massachusetts Institute of Technology).
    Theirs will--certainly will be in there. Probably Inovio's
    another one. There's about five or six--J&J may have one as
    well. About five or six, maybe a couple more. But then it's
    going to go into a bottleneck, and that bottleneck are the
    clinical trials, phase one, phase two, phase three trials.
         You know, in spite of what the anti-vaccine lobby likes to
    claim, that vaccines are not adequately tested for safety, in
    fact, among the pharmaceuticals, vaccines are the single most
    tested pharmaceuticals we have for safety, and it takes time.
    And because you have to initially do an injection in normal
    human volunteers, show that it's safe, and then you proceed,
    step-wise, to show that it actually works. And now, because of
    this immune enhancement phenomena, you have the added
    complexity because you want to make certain that those
    volunteers, when they're immunized in an area of community
    transmission, don't actually get worse.
         And so the FDA and CBER--which, again, you know, I can't
    emphasize enough how lucky America is to have that group, some
    of the best public health vaccine scientists in the world--are
    going to follow this very closely, step-wise. And that----
         Chairman Bera. The best case scenario----
         Dr. Hotez [continuing]. And that's not quick, right?
    That's going to take----
         Chairman Bera. Best case scenario, Dr.--and Dr. Fauci said
    at least 12 months.
         Dr. Hotez. And he's definitely right, at least 12 months,
    but whether that means another year after that, maybe 2 years,
    it really depends on the safety signals that we're seeing with
    these vaccines.
         Chairman Bera. OK. And the ability of our commercial
    pharmaceutical sector to quickly ramp up and develop that--the
    vaccine, and make it commercially available, is that going to
    be an issue, or do we have that----
         Dr. Hotez. Yeah, I mean, there's a lot being--there's a
    lot of press releases from the biotechs, and some of them I'm
    not very happy about, frankly, because I think it's telling
    only half the message. You know, there's--so it took us years
    to develop our recombinant protein vaccines. It's an old
    method, but we know it works, because we've had a Hepatitis B
    vaccine licensed with this technology, the HPV (human
    papillomavirus) vaccine licensed with this technology. Now
    you're seeing next generation platform vaccines, like DNA
    (deoxyribonucleic acid) and RNA (ribonucleic acid) vaccines.
    It's a very exciting technology because you can move very
    quickly into clinical trials. The problem is we don't have a
    single licensed vaccine with that technology. So the idea that
    all of a sudden this is going to work, you know, historically,
    these have worked very well in mice and laboratory animals, but
    they haven't been reproduceable in people. Organizations like
    Moderna and Inovia say they've gotten around it now, they've
    fixed the--they've fixed this----
         Chairman Bera. Right.
         Dr. Hotez [continuing]. So maybe they have, but, you know,
    it's----
         Chairman Bera. Right.
         Dr. Hotez [continuing]. Still we don't have----
         Chairman Bera. So we're----
         Dr. Hotez [continuing]. A lot of experience.
         Chairman Bera. We're moving at an incredibly rapid pace
    right now, but the public needs to understand that, at best,
    there may be a vaccine in 12 months, it'll be longer----
         Dr. Hotez. Yeah. I mean----
         Chairman Bera [continuing]. Potentially longer than that.
         Dr. Hotez. I mean, look at what happened with----
         Chairman Bera. Yeah.
         Dr. Hotez. [continuing]. Ebola, right? We had, you know,
    our first Ebola vaccines started being rolled out in 2015 in
    the epidemic in West Africa. It's not really until 2019 that we
    really got it rolling, which, by the way, is one of the most
    extraordinary public health stories ever told.
         Chairman Bera. It absolutely----
         Dr. Hotez [continuing]. And, you know, thanks to BARDA,
    and all these----
         Chairman Bera. Exactly. Let me ask Dr. Sell a question.
    You talked about information and misinformation. Based on your
    research as you're observing this, what are some of the common
    misinformation that is out there on COVID-19?
         Dr. Sell. Yeah, so I think that there's a range of
    different misinformation. So there's misinformation about false
    cures, and there aren't any cures right now, so all that is
    false. There's misinformation about sort of government
    conspiracies, that someone else started the disease, and I
    think there's also misinformation about the disease, you know,
    what characteristics it has. I think there's a lot that we
    don't know, and so there's that information void that people
    are just filling with their ideas.
         Chairman Bera. So it is--it behooves this institution, and
    each--vested Members of Congress to make sure we're in tight
    communication with our constituents back home. With that, let
    me recognize the Ranking Member, Mr. Lucas, for 5 minutes.
         Mr. Lucas. Thank you, Mr. Chairman. And, Dr. Hotez,
    thinking about Dr. Sell's comments, let's begin from the
    parochial perspective, being your neighbor up north in
    Oklahoma. As of last night the State Department of Health
    reports there are no confirmed positive cases of coronavirus in
    Oklahoma, as of yesterday evening, although one Oklahoman
    showing symptoms is waiting on the test results from CDC. Can
    you discuss for a moment what we can share with our
    constituents back home to not instill panic, and how to stress
    the importance of reasonable steps, prevent spread? Yes,
    doctor?
         Dr. Hotez. Peter Hotez. Yeah, I--we--I know Oklahoma
    pretty well. My son graduated from OU, so--just last year as a
    petroleum engineer, so he's--it was a great place. We love
    Norman.
         Mr. Lucas. Absolutely.
         Dr. Hotez. The issue is this, you know, I think, in an
    attempt to calm public fears, you're hearing things like it's a
    mild illness, this is like flu. It's not really the case,
    because this is an unusual virus. For many young people
    especially it is a mild illness, but we're seeing some
    devastating things, and we got a heads up about this from the
    Chinese. They actually informed us, and we knew it was coming.
    Nursing homes, look what this virus did in that nursing home in
    Kirkland, Washington. It rolled through it like a train, right?
    It's at least seven deaths so far in a nursing home of about
    100 people, so this is like the angel of death for older
    individuals.
         We need to go back and support all of our nursing homes--I
    don't know what we're doing wrong, but clearly that nursing
    home was not prepared for this, and I'm going to guess nursing
    home in--across Oklahoma are not prepared as well. Also our
    healthcare providers. We saw in Wuhan 1,000 healthcare
    providers got sick, and we had at least 15 percent severely ill
    and in ICUs (intensive care units), and that is very dangerous
    because not only do you subtract those people out of the
    healthcare workforce, but the demoralizing effect of colleagues
    taking care of colleagues is going to be--I mean, the whole
    thing can fall apart if that starts to happen.
         We saw this with Dallas. So I was on Governor Perry's task
    force for infectious disease, and those two ICU nurses, when
    they got sick, it was really devastating. And finally the
    Governor had to call the Health and Human Services Secretary,
    CDC Director, and said, look, I--normal ICUs can't take care of
    these patients, we've got to get them out of here. So you don't
    want to see those kinds of situations. I'm worried about our
    first responders. We're already seeing in Washington State how
    they're already in quarantine. So does that mean we're going to
    have to bring in the National Guard? I think that's going to be
    another big issue as well. So those are the three
    vulnerabilities that I see right now in a place like Oklahoma.
         Mr. Lucas. And how should our constituents back home react
    to that, the average J.Q. Public out there?
         Dr. Hotez. Well, I think the average J.Q. Public needs to
    hear from its elected leaders, from the Governor, from the
    public health authorities, on what the plan is. I mean, don't
    just get up there and say, this is a flu, this is a mild
    illness. One, it's not true, and people in Oklahoma are pretty
    smart, and they'll figure that out pretty quickly, and second,
    explain what the risks are, these are the three vulnerable
    populations that we have to worry about, and here are the steps
    that we're doing to mitigate that. That's what people will
    appreciate.
         Mr. Lucas. Dr. Murray, as you mentioned in your opening
    statement, approximately 75 percent of emerging infectious
    diseases originate in zoonotic pathogens. You estimate that 1.7
    million unknown viruses yet to be discovered, around half of
    which are capable of infecting people. Could you elaborate on
    the current state of research to improve surveillance in these
    diseases, and where gaps may exist now as we look toward the
    future, about addressing future challenges?
         Dr. Murray. Yes, thank you very much, and I also
    appreciate that, while we're trying our best to address the
    topic at hand of a lot of ill people, we do need to be thinking
    of the next virus, and the next virus. I also think that the
    CDC has done a wonderful job of looking at and studying human
    health, and, if we're going to do our best job to prevent
    future viruses from jumping, I think one of the missing
    components is indeed wildlife health. If 75 percent of the
    viruses come from wildlife, it makes sense that we look at that
    juncture of both wildlife and human health.
         We also--this virus is termed a novel virus, it's new.
    It's new to the people. I don't think it's new to the bats, and
    that's--right? That's an important point. And then some of our
    other colleagues here have been talking about modeling, and how
    important that is. Modeling gives us greater information now as
    to what COVID will be doing within the U.S. and within other
    countries.
         We also have groups of modelers who look at the forefront
    stages, before emergence, and look at the data that we have to
    try and determine where are the hot zones, what are the risk
    factors, and, behaviorally, what are people doing to put
    themselves in danger? Those are really, really important ways
    for us to get ahead of the curve and catch the viruses before
    they come out.
         As part of the team that we've been on, which is a USAID
    (United States Agency for International Development) program
    called Predict, we have a team of modelers who look at viral
    emergence, and they're able to determine for each different
    virus how--as we collect more and more data, what percentage of
    the viruses that we know are characterized, and how many more
    are likely to be out there? Latest estimates are less than 1
    percent--well, the viruses we know are less than 1 percent of
    the viruses that are out there, meaning there's over 99 percent
    viruses in wildlife waiting to jump into humans. That's
    staggering, and that's really one of the things that we need to
    look at.
         Mr. Lucas. Thank you, Mr. Chairman. My time's expired.
         Chairman Bera. The gentlelady from Oregon, Ms. Bonamici,
    is recognized for----
         Ms. Bonamici. Thank you----
         Chairman Bera. [continuing]. 5 minutes.
         Ms. Bonamici. [continuing]. Dr. Bera, and Ranking Member
    Lucas. This emergent coronavirus epidemic is a top concern for
    Oregonians, and I'm glad we're having this hearing today. In
    Oregon we currently have three individuals who have tested
    positive, two of whom are in the district I represent, plus I
    have an additional couple of constituents still in Japan who
    had been on the cruise ship there. We know further community
    transmission is likely. It's clear, from the tragic deaths in
    Washington, how this virus can spread quickly, and cause
    serious harm, and so let's take a moment to reflect on those
    who have lost their lives in our neighboring States of
    Washington, and now we understand there's a reported death in
    California as well, all the affected friends and family of
    those people. We need to take this seriously.
         I also want to recognize the tireless efforts of our
    public health officials in Oregon, and the Pacific Northwest,
    and across the country. I know they've been working around the
    clock to coordinate a response. For the past several days I've
    spoken with our Governor, Kate Brown, and many State and county
    public health officials, and school superintendents--we had a
    school closed in Oregon for a couple of days--healthcare
    providers. And everyone has emphasized the need for robust
    funding, and I'm glad we passed a bill with strong bipartisan
    support in the House here yesterday. I hope they get it over
    the finish line soon in the Senate.
         But I've also heard numerous concerns about the
    availability of protective equipment, particularly masks. Also
    staffing challenges, and testing capability. And we know those
    infected with COVID-19 can remain asymptomatic for several
    weeks, so healthcare professionals, as Dr. Hotez was talking
    about, are at even greater risk. There are furloughed
    healthcare workers in my district.
         The CDC just expanded its guidance for testing, but
    there's still a significant amount of confusion about who
    should get tested, and how those increasing testing
    capabilities can best be used to inform and improve our
    response efforts. And we heard this morning South Korea's
    testing 15,000 people a day. Dr. Brownstein and Dr. Hotez, we
    can't get an accurate picture of the infection if we're not
    testing, but until recently, the testing was limited to those
    who had recently traveled to places with high rates, or those
    showing symptoms after close contact.
         So I understand the process of getting the tests out into
    the field is slow. We had the test sent to the CDC the--on
    Friday, and then it didn't come back until Tuesday, and that's
    really hard for a community that's wondering what's happening.
    So can you explain whether the scope of the CDC's guidance--was
    that based on best practices, or was it inappropriately limited
    because--a lack of capacity to test, and who should be tested?
    Dr. Brownstein and Dr. Hotez?
         Dr. Brownstein. Of course, it's hard to delve too deep
    into what was happening at the CDC at the time, but, of course,
    increasing testing is incredibly important. We know that this
    is a mild condition. Oftentimes people might be feeling
    symptoms, they may not even be interacting with a healthcare
    provider, and so we don't actually know the full scope of
    numbers of cases that are out there. And I think you mentioned
    a really great point about the impact on the health system. We
    are really advocating for opportunities to bring concepts like
    telemedicine, and tools that help at the front line, beyond the
    point where someone actually has to come in and end up in an
    emergency department. There's opportunities to think about
    tools that actually provide symptom checkers that integrate
    data from the CDC, but also have virtual visits with providers.
    This is a real important component, because----
         Ms. Bonamici. Absolutely.
         Dr. Brownstein [continuing]. What we expect is an influx
    of people coming into our health system. I work in a health
    system. We are very nervous about the flooding of our emergency
    departments with potential cases, so the opportunities to bring
    digital tools and innovative solutions, along with the ability
    to integrate with testing--so home based testing, other
    opportunities--are really things that we advocate for because
    of the fact that, again, mild illness, lack of opportunities
    for someone to come and meet with someone live, and for the
    fact that we can actually begin to understand the depth of
    what's happening in the population, again, those kind of data
    points are so critical now to understanding----
         Ms. Bonamici. Absolutely.
         Dr. Brownstein [continuing]. The features of this
    epidemic, and to understand more broadly what's happening in
    the community.
         Ms. Bonamici. Thank you. Dr. Hotez, as I mentioned, the
    test was presumptive on Friday, sent to the CDC, it didn't come
    back until Tuesday. Can you elaborate on some ideas why we've
    seen such delays in testing? Do you think this recent emergency
    use authorization will expedite things, and what else can we do
    to increase the availability and accelerate the testing?
         Dr. Hotez. So four brief points are around that, and thank
    you for that question. I think the first is testing for
    respiratory viruses is not trivial, because you get a--
    oftentimes, and we've been seeing this in China, and this is
    actually not unusual, if you look at the literature on testing
    for respiratory viruses, you get a negative result, a negative
    result, a negative result, you put the person on a quarantine,
    all of a sudden they're positive. What does that mean? Is it a
    true false negative, or is it because the test isn't sensitive
    enough? So it takes time to really fine tune these diagnostic
    tests for respiratory viruses.
         And, in fairness to the CDC, testing--developing a new
    diagnostic test, just like developing a vaccine in the middle
    of a public health crisis, developing new technologies for a
    new agent in a public health crisis, one of the hardest things
    that we do as a nation. So this--so--and it' s hard to make
    that go quickly. I understand we could've--we should've done
    better as a country of getting those kits out there.
         I think we will get up to a million eventually, as I
    believe the Vice President mentioned, but until we do that, I
    think we've got to prioritize who gets tested, and my
    recommendation would be that we focus the testing strategically
    around our protecting our three most vulnerable populations
    that I mentioned. Our older residents in nursing homes and
    places of assisted living, they're highly vulnerable. The
    mortality among them is----
         Ms. Bonamici. Right.
         Dr. Hotez. [continuing]. 10 to 15 percent. The healthcare
    providers, those who interact with the healthcare providers,
    and protecting our first responders, because if they go down,
    then, again, everything collapses.
         Ms. Bonamici. OK.
         Dr. Hotez. But then, even after that, I think the other
    thing that not a lot of people are talking about, even then,
    this is not adequate, right? If we have to wait hours, or days,
    for the test result, it's of limited use to us. What we need is
    like what we have now for a rapid flu test. We need to get a
    rapid test for that.
         Ms. Bonamici. Thank you. My time's long expired. I yield
    back.
         Chairman Bera. Thank you. Let me recognize the gentleman
    from Florida, Mr. Posey, for 5 minutes.
         Mr. Posey. Thank you, Mr. Chair, for calling this
    important hearing. I only regret that it conflicts with a
    Member's only briefing on almost the exact same topic taking
    place simultaneously. And thank you, witnesses, for the
    important work that you do every day, thinking about ways to
    combat public health threats. There's a common theme across
    your testimony, and that's pretty much when there's a crisis
    all eyes turn to you, but when the disease or the crisis moves
    off the front pages, the public loses interest, then the
    funding goes away.
         And you didn't say this part, but I'll say this also, that
    when Washington sees a problem, the habit is to throw billions
    of dollars at it and say, look, now we've done our job, and
    hope for a good result, and move on to the next issue. And, of
    course, there's always the finger pointing and blaming, based
    on, as you well pointed out earlier, much information and
    disinformation. That's really regrettable, and I think the
    American people are getting a little tired of that, but Dr.
    Murray, working with partner agencies you state you've
    successfully identified over 1,200 novel wild-born illnesses,
    including 161 of which belong to the same family as COVID-19. I
    think most of us in the room are wondering what the risk to
    humans is from those viruses as well? I have four related
    questions that I'll ask you after----
         Dr. Murray. Thank you very much. I'll try to be quick in
    my response. So in addition to identifying the viruses, we also
    have a team of modelers who helps us identify where to look in
    the world. We also have a team of phylogenists and virology
    experts who then rank all these viruses. If we had enough money
    to look at every country, every species, every animal, we
    would, but we don't, so we really try and use funds
    effectively, so we identify the countries in which--are most
    likely to be a problem, the species that are most likely to
    transmit lethal diseases to humans, primates, bats, and
    rodents, and then, of those 1,200 viruses, they're ranked
    according to the families that are most likely to cause a
    problem for human health, and that's where we spend the
    majority of our time and resources. Influenzas, coronaviruses,
    filoviruses, and paramyxoviruses are some of the most important
    families.
         Just to add on to what my colleagues here have said, it is
    the time from--funds are an issue, and the program that I'm
    describing is just in the process of being closed down. We're
    actually holding our closeout session on March 17 at the Museum
    of American Indian, in case anybody would like to join us,
    because we'll be reporting on a lot of what we've done over the
    last 10 years. My suggestion would be this is not the time to
    lean out, but it'd be the time that we need to be leaning in.
         Mr. Posey. What percentage of the viruses have the
    potential to jump to humans? Just swag it, I mean.
         Dr. Murray. So of the 1.7 as yet unidentified viruses,
    about 50 percent of those have the potential to jump to humans,
    and that's based on the receptor sites, and where they can
    attach to the trachea. Of those--but not all of those are going
    to spread rapidly, and not all of those are going to cause
    severe disease. So we look at--there's 50 percent that could
    jump to humans, and probably only 10 percent or 15 that can
    cause rapid disease and a pandemic. But until we identify those
    viruses, the species in which they occur, the reservoir
    species, and the mode of transmission to humans, we're really
    still at a tremendous risk.
         And then we--the research has shown that these outbreaks
    are coming more and more frequently, so while everybody--a lot
    of us have felt like, this is a surprise, the folks in the
    health community have felt like this isn't a surprise. We've
    been saying it collectively for the last several years, these
    pandemics are coming. We can tell you in general the countries
    or the areas, some of the risk factors, and some of the viral
    families.
         Mr. Posey. Well, you answered my next two questions about
    the percentages already, so, for the final question, how do you
    think we best prioritize research? You know, is there a good
    process to set research priorities in place?
         Dr. Murray. I think a lot of what we're doing right here--
    and thank you for this hearing. It does bring everybody--a lot
    of the same folks into the room to help identify some of the
    issues. From my perspective, the more that we can look at
    bringing experts from many different fields, from the
    government, from NGOs (non-governmental organizations), and
    universities together, then that--and the confluence of human
    physicians--well, most physicians are human, right? So human
    physicians, veterinarians, nurse--and nursing staff
    researchers, I think that's really what we need to be doing,
    and looking at not only in the U.S., but in countries--in other
    countries as well, because--we look at the economy globally.
    It's really time for us to look at health globally. So that's
    how I would go about establishing research priorities.
         Mr. Posey. Thank you. That beats crisis du jour.
         Dr. Murray. Thank you for your questions.
         Chairman Bera. Thank you, Mr. Posey. The gentlelady from
    Texas, Mrs. Fletcher, is recognized for 5 minutes.
         Mrs. Fletcher. Thank you, Chairman Bera. I want to get
    right to the questions. I thank all of you for being here, for
    your testimony. It's very important. I want to follow up with
    you, Dr. Hotez, on your opening comments with a question, and
    then open it up to the panel to weigh in with your thoughts.
    But, kind of following up on what Mr. Posey asked as well, in
    your opening comments, or your statement, you mentioned your
    work developing a vaccine for SARS, and you asked the question
    what will the ecosystem be for vaccines that don't make money?
         And that seems to be an appropriate question for this
    Committee, and for the Congress of the United States to be
    tackling. So I would like to ask you what you think that
    ecosystem should look like, and then get others on the panel to
    weigh in on that question, and also touch a little bit on what
    Dr. Murray said about kind of the global nature, and something
    we have discussed before as well, where can we partner with
    other countries in doing this work, and where can we have a
    national response and a global response? I'd love to get your
    thoughts, and then open it up to the panel.
         Dr. Hotez. Well, thank you very much for that question. I
    mean, there is some good news to this. You know, we--we're very
    blessed to have the National Institute of Allergy and
    Infectious Diseases, headed by Dr. Fauci, who's been very
    committed to this problem. And, you know, if it wasn't for
    NIAID and NIH, I wouldn't be--even be here, right? They've, you
    know, really worked hard around trying to fix this problem. The
    issue is it's not enough, and it doesn't--and the problem is,
    you know, if you talk to Tony--if you talk to Dr. Fauci, he'll
    say, look, Peter, I'm not a venture capitalist. I can't just
    hand over money. It's got to go through study sections.
         And the issue is the study sections--some--oftentimes will
    get dinged and get turn down from an NIH grant because what
    we're--they'll claim what we're doing is not innovative, and
    they're often right. It's not innovative. We're trying to make
    a recombinant protein vaccine. It's boring, but it's absolutely
    essential. So we have to figure out a way to--for a funding
    mechanism to be created that will provide steady funding for a
    base of scientists who are ready and able to develop a vaccine,
    because this--we're over-relying on the big pharmaceutical
    companies. They're not coming into this space in a big way,
    with a couple of exceptions. The biotechs, some of them are in
    it. Most of them are in it not so much for the specific
    vaccine, but it's a device to accelerate their technologies. So
    we've got to figure out a mechanism to create a--fund a group
    of scientists working in an area where they'll develop vaccines
    in the non-profit sector.
         We've had Walter Reed Army Institute of Research for
    years. They've been hit very hard. We could restore that. That
    would be one way. We have this great VRC, Vaccine Research
    Center, at the NIH, and there's a couple of others, like ours,
    the University of Maryland Center for Vaccine Development, our
    Baylor College of Medicine, one at Texas Children's, but we
    need--each one has to be bigger, and each one has to be--and we
    need more of them as well.
         Dr. Brownstein. I'll just add also my thanks to the NIH,
    because I also wouldn't be here without support from
    specifically the National Laboratory of Medicine, and their
    efforts to really train the next generation of data scientists
    in health.
         Specifically around--your question around vaccines, I
    think it's really important to think about the comments of Dr.
    Murray and think about the next event, right? Of course we need
    to be focused on the current coronavirus, but we're going to
    see likely another event, another likely coronavirus event. We
    saw SARS, MERS. It's likely that we should be thinking about
    universal vaccines around coronaviruses, as opposed to maybe
    something very specific around this event, that ultimately will
    prepare us for the next pandemic that we'll see in the future.
    I think the more that we can be thinking about those next
    events, and they will occur, the better off we'll be for the
    next one.
         Mrs. Fletcher. Thank you, Dr. Brownstein----
         Dr. Sell. One----
         Mrs. Fletcher. Dr. Sell, you had a----
         Dr. Sell. Yeah, I have one thing to add. So you'd asked
    about the ecosystem for vaccines that don't make money, right?
    We have the difficulties with developing those vaccines, and
    then testing them, but we also--a project at our center led by
    Nancy Connell, we also have a problem with manufacturing those
    vaccines at scale, right? So we might be able to have a
    vaccine, but we can't make, you know, half a billion doses, or
    whatever we need, quickly, in enough time to make a difference.
    And so I think that's another thing, you know, we can't just
    swap over the products in a manufacturing plant. That's another
    area that really needs a lot of attention.
         Mrs. Fletcher. Thank you. Dr. Murray, I have a few--30
    seconds left. I'd love to hear your thoughts.
         Dr. Murray. I agree, again, with my colleagues, in
    particular with Dr. Brownstein, who was saying about the
    universal vaccine. I think it's very well--a very good idea to
    invest in that. And, again, part of the information we would
    collect in the field about what types of vaccines, or what type
    of viruses are out there, will hopefully help inform that. I
    also wanted to add on just--I thought a little bit more about
    the question from Mr. Posey, and I do think that if we're going
    to be looking at research, creating a one health program
    somewhere that we're--because we don't currently have a program
    that works in high risk areas that incorporates both human
    expertise and wildlife expertise, and ideally has one foot in
    the Federal Government, and one foot outside of the Federal
    Government. It would be great if such an institution were here
    somewhere in D.C., and perhaps a parastatal institution
    that's--already exists.
         Mrs. Fletcher. Thank you very much. I have gone over my
    time, so I will yield back.
         Chairman Bera. Thank you----
         Mrs. Fletcher. Thank you all.
         Chairman Bera. [continuing]. Mrs. Fletcher. The gentleman
    from Texas, Mr. Cloud, is recognized for 5 minutes.
         Mr. Cloud. Thank you, Chairman, and thank you all for
    being here to help us address this very important topic. I
    appreciate the healthy discussion over some of the
    misinformation that's come out sometimes with, you know,
    political goals in the dispersion of it. I also appreciate you
    educating us just really on some of the real scientific
    challenges in addressing a situation like this.
         I wanted to see, Dr. Murray, in the effort of giving good
    communication on this, if you can give us, kind of
    backtracking, it was kind of an understanding of why are doing
    this, where did this coronavirus come from, how is it unique,
    how is it spreading?
         Dr. Murray. Thank you very much. I'd be happy to do--and I
    think I could probably share the answer to that question as
    well. In terms of what we know, or--that bats, primates, and
    rodents are the species that are most likely to carry these
    viruses that transmit to humans, and--the coronas in
    particular, and our team has already discovered a--several
    other coronaviruses in China, with 98--97 and 98 percent
    homology to this virus, meaning--so they're very closely
    related. And we also developed these trees so you can determine
    how closely this virus is related to the other coronas. We
    found some in Myanmar that are not closely related, and not
    likely to cause disease.
         So--and we also have behaviorists looking at what are the
    risks associated with bats? In a lot of countries bats provide
    a lot of protein, and people do eat bats. But, if you think
    through it, the risk might not be the person in a restaurant
    eating a fully cooked bat. Perhaps the risk is the women in the
    back who are preparing the bat without the gloves, and without
    the masks, that are--along with children, and then take it
    home. So trying to understand the cultural norms and human
    behavior patterns that give--that contribute to these sorts of
    things.
         A quick shoutout to OSTP (Office of Science and Technology
    Policy) from--because we also have a pandemic preparedness
    forecasting science and technology panel that looks at these
    sorts of things, and collectively this past year we--at
    Smithsonian we housed a--or a we hosted a 2 day workshop
    looking at the--bringing together the soft sciences and the
    hard sciences, the modelers who look at human behavior, and
    also the hard scientists that look at what the virus does.
         So we believe that these--that markets--wildlife markets
    and the wildlife trade are a really huge risk in general, and
    the risks are different whether you're in Africa or Asia.
    Africa, animals tend to come to the market. The risk is more in
    bush meat trade for the folks who are there in the forests that
    are killing the animals, and the meat tends to come to the
    market already dead, whereas in Asia it's often live animals
    that are at the market. So those are--to answer some of your
    questions about the virus, we believe that it's a bat related
    virus, and that it's--it came in close contact through this--
    the markets.
         We still have so much more to learn about this virus in
    particular, and these--with epidemiologists, and our human
    health folks as well, and so--there's still so much we don't
    know, but that's what we know so far. I'd like to yield to any
    of our M.D. colleagues to see if they have something to add.
         Mr. Cloud. Well, if I may, I only have two minutes left.
    Dr.----
         Dr. Murray. Sorry.
         Mr. Cloud. [continuing]. Hotez, if you can tell us what's
    some of the challenges in addressing these treatments and
    vaccine, also, I'm just going to get all the questions out
    here. Based on your experience working with SARS, and Ebola,
    and Zika, what are some of the challenges that you've seen
    governments face in the past, what are some of the best
    practices we've learned, and what's some of the things that we
    can use toward addressing this? And then if you can answer
    that, and if any of you want to jump in and finish the time
    out?
         Dr. Hotez. Yeah, two points. We need more vaccines, and
    trying to do this in the middle of a crisis is very difficult,
    right? I mean, we have one--N of one, the--what--the story with
    Ebola, maybe cholera vaccines in Yemen, so we want to start
    doing this now. And one of the other problems that I'm seeing
    is, you know, through NIAID and BARDA, we have incredible
    mechanism for supporting vaccines, so clearly the U.S. is the
    global leader in this. We need some of the other countries to
    start pitching in and help supporting global health
    technologies.
         If you look at the funding--public funding globally, you
    know, the U.S. is by far the No. 1, UK maybe second, the
    European Union, and then the bottom falls out, so we see a lot
    of underachievement among the G20 countries. China's doing very
    little. Japan, not much, a little bit. Korea's starting now.
    I'm on a board called the Korean Right Fund with the Gates
    Foundation. Brazil needs to step up. You know, all the BRICS
    (Brazil, Russia, India, China and South Africa) countries need
    to step up. So the--we really need to put this on the agenda of
    a G20 summit to say, look, the U.S., you know, has, you know,
    globally taken the lead on recognizing this is a huge problem
    through NAID and BARDA, the other countries need to step up.
    This needs to be on the topic of a G20 summit.
         I have a book--I like to write books, so one of the books
    I wrote is called Blue Marble Health, which actually finds this
    quite interesting finding. Overwhelmingly, most of the world's
    emerging and poverty-related neglected diseases are not
    necessarily in the poorest, most devastated countries of
    Africa. It's the G20 countries. It's the poor living among the
    wealthy, including 12 million Americans that suffer from
    neglected tropical diseases. So we need the other G20 to show
    some leadership, and work with State Department and others on
    this.
         Chairman Bera. Thank you, Dr. Hotez. The gentleman from
    California, Mr. McNerney, is recognized for 5 minutes.
         Mr. McNerney. Well, I thank the Chairman, and I thank the
    witnesses this morning. Very useful, informative. Dr. Sell, how
    can social science aid us in understanding how to stop
    misinformation during outbreaks?
         Dr. Sell. So misinformation during outbreaks is a big
    problem, and I think it's a very complex problem. So social
    science could help us understand what the best messages are to
    help people understand when the rumors they're seeing are
    false. So, to improve our messaging, the type of ways we're
    trying to communicate with people, how to convince them of, you
    know, the facts, rather than to believe in these rumors.
         But I also think that there's a--we need to actually
    develop an entire strategy here. We need to think about all the
    different stakeholders, right? We have tech companies, they
    need to be doing work. We have the public. The public--we can't
    just say the public--the public should--we think the public
    should figure out how to determine truth from falsehoods. But
    we also have government, we have news media, and we have public
    health. We all need to think about those stakeholders, and
    everything they can do to deal with this problem.
         Mr. McNerney. Is there a specific area of research that
    would help develop those tools?
         Dr. Sell. I mean, I think that looking into seeing what
    misinformation is out there, and then also the communications
    research that I do. I think that it's looking at what kind of
    ways we can solve that, and the messages that are necessary, so
    that's social science research.
         Mr. McNerney. OK. Thank you. Dr. Hotez, I'm going to
    follow up on Ms. Fletcher's question. How do we incentivize
    pharma and biotechs to prioritize vaccine development?
         Dr. Hotez. Well, it's tough, and, you know, I know I've
    been critical of the big pharmaceutical companies today, but I
    also have some great--some support as well. I mean, you know,
    what Merck did--Merck and Company did for the Ebola vaccine is
    an extraordinary story, right? I mean, this--that vaccine
    ultimately--giving it to 200,000 people in DR Congo in the
    middle of a war and conflict prevented a catastrophic epidemic
    that would've dwarfed the one in West Africa, and would've
    destabilized the entire African continent. So we owe a real
    debt of gratitude to Merck, and BARDA, and the supporters that
    made that happen.
         But if you talk to some of the people at Merck offline,
    one of the things they'll tell me is, look we didn't make--
    Peter, we didn't make money on this thing, we actually--in
    some--depending on how you crunch the numbers, we actually
    might have lost money because we had to pull people from
    moneymaking projects in order to put them on this, so it's
    really a problem. You know, vaccines are expensive, and they're
    expensive because of all the quality control and quality
    assurance that you have to put in, and all the belts and
    suspenders you put in to ensure safety.
         So I, you know, and I'm, you know, and that's maybe one of
    the reasons why we're not seeing the big pharmaceutical
    companies jump in this time around, because they saw, my God,
    look what Merck had to do in order to make this happen. So I
    think we have to look at creating a new type of organization,
    and maybe working this out in the nonprofit sector here in the
    United States.
         Mr. McNerney. Thank you. Dr. Brownstein, I'm pretty
    excited about the HealthMap platform that you discussed. How is
    artificial intelligence used in public health preparedness----
         Dr. Brownstein. Yeah. So----
         Mr. McNerney [continuing]. To prevent spreads?
         Dr. Brownstein. So AI is seeing a real explosion in use in
    healthcare. Of course we've seen advancements in other domains,
    financial services, entertainment, but of--what we see is
    there's opportunities in leveraging AI with large datasets.
    When we're dealing with an important event like a public health
    crisis, there's a huge amount of data, a lot of information
    about cases, a lot of misinformation, and being able to sort
    through all that critical data to get important insights that
    we can feed to our modelers, our policymakers, even the public,
    that's where this kind of--these kind of methodologies come
    into play.
         So, if you think about the earliest signs of the COVID-19
    event, they are actually through this epidemic intelligence
    collecting tools, actually some that support the technologies
    that Dr. Murray was talking about. Combing through the web,
    looking for signs of mysterious illnesses that we could utilize
    to then pinpoint, and then communicate those to the World
    Health Organization, and CDC, and other organizations. But more
    importantly, there's a vast amount of information globally now
    being transmitted about cases confirmed, suspected, on trying
    to understand the response, the recovery, the demographic data
    of these patients. That is well more capacity than the existing
    workforce of epidemiologists that exist on this planet, and so
    what we're trying to do is augment the work of these public
    health practitioners through the opportunities that AI brings.
    So the opportunity to mine that information, organize it, and
    bring the situational awareness data to the forefront so it can
    be used effectively.
         Mr. McNerney. OK. I'm running out of time, so I'm going to
    ask you for the record, not a verbal response, what the
    challenges are in expanding AI into this field. So I yield
    back.
         Chairman Bera. Thanks. The gentleman from Texas, Mr.
    Olson, is recognized for 5 minutes.
         Mr. Olson. I thank the Chair, and welcome to our four
    expert witnesses. A special welcome to Dr. Peter Hotez. I'd
    like to join my Texas colleague, Mrs. Fletcher, in bragging
    about Dr. Hotez. My colleagues need to know this is not just a
    man who's an expert in Texas. He's a recognized expert in all
    of America, and globally on pandemic viruses. And that's why
    you saw him all day yesterday on national cable, explaining the
    challenges with the COVID-19 virus. You also saw him doing that
    with the Ebola, with SARS, with H1N1, and also with Zika. H1N1
    was very special back home. That broke out in 2009, and your
    institution, Texas Children's Hospital, set up a drive-through
    vaccine in a parking garage almost overnight to have those
    vaccines deployed. So, again, thank you for being here. As Bum
    Phillips would say, you may not be in a class by yourself, but
    every class you're in, it don't take long to call the roll. I
    want to talk about----
         Dr. Hotez. Thank you, Congressman.
         Mr. Olson [continuing]. Quality treatments and future
    responses. First, quality treatments. Yesterday it was
    announced that my home county of Fort Bend was the first site
    in Texas to have a confirmed case of the COVID-19 virus. Don't
    know too much. The man was 70 years old, he had traveled
    overseas, no confirmation if he went to China, Iran, or Italy,
    and he's now quarantined in the local hospital. As Dr. Sell
    mentioned, a lot of people right now are living in fear that
    this disease is among the people of my hometown, and those
    fears may cause people to do something that's not very wise,
    and sometimes very foolish.
         We've seen photos all across this country of towns
    reacting to this influenza. We've seen empty shelves of grocery
    stores. We've seen empty shelves of bleach. As you said, Dr.
    Sell, people think drinking bleach can somehow help control
    this virus, which is just crazy. We've seen empty shelves of
    canned foods. We see at the Home Depots, the Lowe's, all the
    masks and stuff needed to protect people are getting swarmed up
    by people who don't need them. And, Dr. Hotez, you brought this
    up yesterday on national TV, how can we make sure the required
    resources we have to fight back are given to the top
    priorities, which I think as you mentioned, are probably, first
    all, the families, the victim, their neighbors, the first
    responders, the EMS (emergency medical services) vehicles, the
    cops, the firefighters, and also the doctors and nurses--how
    can we make sure those people have the first priority to get
    these scarce resources?
         Dr. Hotez. So you've hit on it, right? I mean, that's
    exactly right, and thank you for those really generous
    comments. We need to give our one, two, three, four top
    priorities of the groups that we're going to insure, because if
    they go down, then everything falls apart, and things go badly
    very quickly. And I don't know that we've really done that yet,
    so, I think, you know protecting our older individuals in
    nursing homes, because if--because we're--we now know, from
    Kirkland, anytime a virus hits a community, those are the ones
    who are going to get hit the hardest, and the healthcare
    providers, and others.
         The other thing I've been saying is--regarding panic has
    been, look, you will have time. It's not like you're going to
    wake up tomorrow morning and find that the entire Eastern half
    of the United States is infected. What we're going to see is
    multiple communities being affected, and that will cause a lot
    of concern, but you will have time in order to prepare and
    figure out what's happening. And we don't exactly know. It may
    stop there. You know, there are some who believe there may be
    seasonality to this virus. We don't know that at all, because
    it's a new agent. So I think it's--the key is to stay in--our
    leaders need to stay in contact with the people, hold those
    White House briefings on a pretty regular basis, but also try
    not to sugarcoat, right? To be--it's a real art to be able to
    give difficult information, but to do it in a way to say, we're
    aware of it, here's what we're doing about it. And I think, you
    know, we've been through this before.
         You know, one of the things that I've noticed in the 20
    years that I've been following pandemics, it started with
    anthrax in 2001, and then SARS in 2003, H1N1 2009, as you
    pointed out, Ebola 2014, and then we go to Zika, and now this,
    the same thing happens every time. It takes us a little bit of
    time to get our arms around it. There are always stumbles in
    the beginning, and a lot of that has to do with the Federal
    Government and the State governments have to figure out all
    over again how to work together, so there always seems to be
    that new relationship building that has to happen. And then
    eventually we get it right, and this will happen again.
         So--and that's, I think, the other thing that we want to
    see is the press not piling on too much when these things
    happen.
         Mr. Olson. Good luck with that.
         Dr. Hotez. Yeah, and--well, especially it's occurring
    right during the Democratic--it's, you know, it's happening in
    the worst time possible from that sense. And to have that
    perspective of time, saying, look, this always happens, I mean,
    it's the hardest----
         Chairman Bera. Thank you, Doctor.
         Dr. Hotez [continuing]. Thing our country does.
         Chairman Bera. Thank you, Doctor.
         Mr. Olson. Yeah, I hear the gavel banging. I have some
    questions for the record on stockpiling vaccines. Thank you
    very much.
         Chairman Bera. Let me recognize the gentleman from
    Illinois, Mr. Casten.
         Mr. Casten. Thank you, and thank you all for coming. I
    want to follow, if I could, a little bit on the questions Dr.
    Bera asked at the start about vaccine development. Dr. Hotez,
    thank you for clarifying that we're not going to have this
    vaccine for a year or so. Can you just share a little bit some
    of the risks of bringing the vaccine to market too early?
         Dr. Hotez. Thank you for that. Yes, well, the risk is
    compromising safety. This, you know, the--remember what we're
    doing, we're going to be doing. We're going to be immunizing
    healthy people, right, so vaccines always have a higher safety
    bar because you're injecting well people. These are often not
    individuals who are ill, and you're trying to accelerate some
    technology for compassionate use. So--and our FDA, our CBER,
    has one of the best track records in the world in ensuring
    safety, and we have one of the best monitoring systems in the
    world ensuring safety. I mean, we have these four systems in
    place, the vaccine events, adverse reporting system, we have--
    but--and many times people think that's the only thing we have.
    We have a redundant system of four tracks that follow this. So
    we know how to do this.
         We know how to ensure that vaccines could be developed and
    tested safely. Don't try to pressure FDA, CBER, into doing
    something that breaks with that, because, you know, if we start
    rolling out a vaccine too quickly, and it's shown that a number
    of those individuals are getting worse because of this vaccine,
    which we know can happen with certain respiratory virus
    vaccines. We've seen it with RSV, we've seen it with--in
    laboratory animals with other coronavirus vaccines, then people
    will lose confidence, and not only confidence in coronavirus
    vaccines, but our whole vaccines----
         Mr. Casten. Sure.
         Dr. Hotez [continuing]. And safety network----
         Mr. Casten. So----
         Dr. Hotez [continuing]. So----
         Mr. Casten. So with a, you know, with an unvaccinated
    population, given that some of the early data, you know, is--
    seems to suggest that those who are most at risk are those--the
    elderly, immunocompromised, we're not going to have a----
         Dr. Hotez. And healthcare workers.
         Mr. Casten. Yeah. So we're not going to have a vaccinated
    population. Presumably other complications that people have may
    be at risk. As you look through sort of our broader healthcare
    ecosystem, do you see other medications that we may be where,
    you know, where increasing focus on some of these non-
    coronavirus drugs may be the thing that is ultimately going to
    hurt people? Are there other places we should be looking in the
    ecosystem right now?
         Dr. Hotez. Well, remember, vaccines are the highest bar
    there is, so even though that's going to take, you know,
    whatever time it is, there are other technologies out there
    that we could be--that'll get deployed more quickly. I think
    we'll probably have antiviral----
         Mr. Casten. Just----
         Dr. Hotez [continuing]. Drugs a little----
         Mr. Casten. Sorry, I don't--I'm asking a sort of different
    question, and maybe it's my own lack of knowledge. If I
    already--let's say, as an example, I'm taking
    immunosuppressants because I just had a liver transplant----
         Dr. Hotez. Um-hum.
         Mr. Casten [continuing]. The--and all of a sudden I come
    down with coronavirus, I may not--coronavirus may not be the
    thing that does me in, but this other thing does. So if we look
    at the populations that are most at risk from getting a bad
    flu, are there other sort of drugs and pharmacologicals that
    that community is disproportionately taking that we should be
    concerned about, or maybe a little focus there might protect
    some of these folks?
         Dr. Hotez. I don't know--I'll have to think about that a
    little bit more, but you're right. I mean, I think, you know,
    we don't have--remember, this is a new virus agent, and there
    are differences in the U.S. and the Chinese population. We
    haven't seen a lot of data of people with immunosuppressive
    drugs, so----
         Mr. Casten. OK.
         Dr. Hotez [continuing]. I don't think we really know what
    that----
         Mr. Casten. Yeah, I just used that as an example. I----
         Dr. Hotez. So people on Humira, and--I don't----
         Mr. Casten. Yeah. My concern is just all these people who
    might be needing insulin, might be needing statins, other
    things. Shifting with the little bit of time I have left, Dr.
    Sell, I appreciate your comments on not spreading
    misinformation, and just, with the little time we have left,
    all of us going to be back in our districts next week. We all
    have, you know, certain platforms that we can speak to. Given
    what you researched on Ebola, and without, you know, making
    this a political conversation, as you look at what's going on
    right now, are there specific pieces of misinformation that
    trouble you, and if you were in our shoes, what would you love
    to see us saying to the country this weekend?
         Dr. Sell. You bring up something that's very important,
    because influencers, like you, have the--one of the biggest
    roles in spreading the truth about the disease. That's actually
    borne out by the research. So I think, when you go home to your
    constituents this weekend, I think people might be afraid, and
    I think this is a concerning disease. We can't sugarcoat it. We
    have to say, this is serious, we need to think of it, and think
    about the ways that we can prepare.
         People--research has shown that people really want to know
    more about the actions that they can take, rather than the
    risks that they have to worry about. So, you know, the CDC has
    a lot of advice out there, wash your hands, use respiratory
    etiquette. I think people also want to think about how they can
    be prepared, how they might take care of a loved one, if a
    loved one is sick, but not serious enough to be in the
    hospital, to--and we're limiting how many people we're trying
    to take care of in hospitals, to how we might care for sick
    people at home, and think about, you know, stockpiling
    prescription meds, and things that you might need, and you
    don't want to be at the store when there's, you know, a lot of
    sick people or whatever. I think that actions are really what
    people need to hear right now.
         Mr. Casten. Thank you. I yield back.
         Chairman Bera. The gentleman from Ohio, Mr. Gonzalez, is
    recognized for 5 minutes.
         Mr. Gonzalez. Thank you, Mr. Chairman, and thank you, for
    our witnesses. Dr. Hotez, you have a great background. I'm
    going to sing Dr. Sell's praises for a moment. It's not every
    day that we get an Olympic athlete in our midst, especially one
    that had a world record at one point. Do you still have it, by
    the way?
         Dr. Sell. No. Someone took it a----
         Mr. Gonzalez. Someone--OK.
         Dr. Sell [continuing]. Years ago.
         Mr. Gonzalez. Still unbelievably impressive. I don't think
    any of us have world records in our history. Could be wrong.
    Certainly for nothing as impressive as what you did. But of all
    the accomplishments and things I respect most about Dr. Sell,
    it's the fact that she has my wife's unyielding admiration and
    appreciation, that means the most to me, as a college teammate
    of yours.
         So I want to start by asking about the role that
    diagnostics play in forecasting accuracy. I just left a
    briefing, where it's very obvious that we did not, and still
    probably do not, have the number of diagnostics available, with
    respect to coronavirus today. So, when it comes to your
    forecasting accuracy, what role does having robust diagnostics
    play in the process?
         Dr. Sell. Well, that's a great question--and thank you
    very much for the introduction. Diagnostics have an incredible
    role to play because the way that you look for information out
    there about the disease determines what you'll find, right? So
    if you're only looking for people who have a travel history,
    you're never going to say, we have community transmission,
    because every case you find will have a travel history. And so
    I think that being able to use rapid diagnostics, like the flu
    test, or these other things, is really important so that we can
    note those more mild cases, and we know the range of disease,
    and where it is.
         Mr. Gonzalez. Great.
         Dr. Brownstein. From a modeling perspective----
         Mr. Gonzalez. Yeah.
         Dr. Brownstein [continuing]. Having an accurate
    understanding of what's happening in the community is
    incredibly important, right? Because we're essentially seeing
    some of the more severe cases. It might lead to overestimates
    of case fatality. We don't actually know what's happening at
    the community level because we don't have the testing. So we're
    going to essentially be biased in our understanding of disease,
    and not actually have a direct understanding of things like
    household transmission, what we're seeing in terms of the level
    of spread that's happening. So this is why having enough
    diagnostic capacity to do it at a population scale is so
    critical, and why we see incredible advances in Korea and other
    places.
         Mr. Gonzalez. Yeah. And I think that, you know, one of the
    things that is troubling for a lot of folks, certainly for me,
    is you see different case fatality rates depending on the
    country, right? And my estimation of that is because we don't
    know the N, and everybody's using a disparate, you know, South
    Korea they're testing all the time. It seems almost like drive-
    through test kits, whereas here it's unclear to me how many
    people we've actually tested. I don't think it's north of
    1,000. I could be wrong on that. So that's been a little
    troubling.
         I guess follow up question on the model piece, if we had
    been testing on the order of, say, South Korea, how much
    further along do you think we would be, and how much closer to
    being able to more effectively prepare and prevent a major
    outbreak would we be if we had the better testing capabilities?
    I'll start with Dr. Sell.
         Dr. Sell. I'll be quick, so the others can answer, but I
    think if we had better testing capabilities, I think we would
    have had the motivation to get moving a little bit quicker.
         Mr. Gonzalez. Yeah.
         Dr. Sell. And--especially in places where we might see
    disease so that we could keep it out of those nursing homes and
    hospitals. So I think that's--would've been helpful.
         Mr. Gonzalez. Great. Dr. Brownstein.
         Dr. Brownstein. Yeah, exactly the same thing. The more
    detailed information we have on the ground, the better off we
    are to respond. Models are only as good as the data that we
    feed them, of course, and so, if we have richer information
    about what's happening, we have that testing, we can understand
    what is happening at the community level, and think about
    things like social isolation, and other mitigation efforts that
    could slow the spread of the coronavirus.
         Mr. Gonzalez. Thank you. And then, with my final minute,
    Dr. Sell, I want to go back to the question that Mr. Casten was
    asking, with respect to false information. Obviously, since
    2014 and Ebola, the platforms that we use, the way we
    communicate, has changed quite a bit. Have you noticed a stark
    difference of any kind between how misinformation was spread in
    2014 versus how it's spread today? What sort of lessons can we
    learn from that?
         Dr. Sell. This is an opinion without an analysis behind
    it, but I think that the spread of misinformation has been much
    more rapid. We know that in some cases it's been coordinated,
    and I think that it spreads across multiple platforms very
    quickly. We have these echo chambers, and we had echo chambers
    in 2014, but this information just bounces within people who
    have the same belief systems, and so it's very hard to change
    that.
         Mr. Gonzalez. OK. Thank you, and I yield back.
         Chairman Bera. The gentleman from Illinois, Mr. Foster, is
    recognized for 5 minutes.
         Mr. Foster. Thank you, Mr. Chairman, and to our witnesses.
    I've been sitting here trying to synthesize from your testimony
    what a coherent plan to actually, you know, do something over
    the next decades that would really move the ball on this, and
    so the first step, it seems to me, is to actually characterize
    the up to 1.7 million potentially transmissionable viruses, and
    I think there may be hope for developing technology so we can
    see the sort of, you know, 1.7 million sounds like a big
    number, but with technology development you might be able to
    bring the cost down. And then to potentially do things to
    mitigate transmission from the animal reservoirs. And, you
    know, there are things like gene drives, and other things. They
    just did--they're talking about releasing mosquitoes that can't
    transmit certain--that sort of approach might be important.
         And secondly, to simply identify the concerned sequences
    across broad classes of these. There was an example of this,
    actually, in my district, Argonne National Labs, where they
    recently solved a protein called NSP-15, which is conservative
    on coronaviruses. It is apparently involved in the replication
    of the virus as a very attractive drug target that--actually do
    something that would sort of persist over a time longer than
    Congress's Attention Deficit Disorder to actually, you know,
    stay focused on a handful of attractive targets, or a large
    number of attractive targets, and develop these for drugs, you
    know, both as treatments and vaccines.
         And here I perceive there's a real difference, that you
    can potentially do things quickly for treatments, but the
    vaccine problem is much tougher because of the clinical trial
    bottleneck. I don't know if there are any great breakthrough
    ideas to--so that if you have thousands of potential viruses,
    and everything about them understood, but you haven't done the
    clinical trials on--and you identified targets, but you still
    need clinical trials, are there any ways to accelerate that, or
    any potential technologies out there? I--that seems like an
    unsolved problem, from your testimonies.
         And then, fourth, developing high volume, general purpose
    manufacturing that's on standby, which is something Dr. Sell
    mentioned. This seems like it's something where you can throw
    money at the problem. You know, if there are really general
    purpose technologies out there, and we, you know, there's a lot
    of overlap with this--frankly, with money we're spending on
    bioterror defense, and it may be that it's the exact same
    equipment that you need.
         And so I'd be interested in--well, first off, have I
    missed any big parts of this? Are there significant things--I
    think the rapid detection is something you mentioned that's
    sort of a parallel track from this.
         Dr. Brownstein. If I may add just one other component to
    this, which is this idea of a national or international service
    around disease forecasting, right? We've done this for the
    weather, right, like a national service for weather, where we
    collect data from NOAA and make predictions. That does not
    exist today in disease forecasting, and if there was
    investments to be made in addition to important pipelines
    around manufacturing, it would be developing a way to predict
    the--sort of the next coronavirus-like pandemic.
         Mr. Foster. Yes, Dr. Hotez?
         Dr. Hotez. Yeah. I think you pointed out a very good
    bottleneck, that, you know, that clinical testing does take
    time. There has been a lot of effort to apply innovation toward
    streamlining clinical safety testing. Sometimes we call it
    systems vaccinology. The idea is we can do more things in
    parallel, rather than sequentially. And, in fact, that was
    already started with the Ebola vaccine in DR Congo. We did a
    lot of things in parallel, so it really went through and got--
    we got information on its efficacy and its safety in record
    time.
         And I think, if it wasn't for this particular safety
    signal around this immune enhancement problem, we may--we might
    have broken a record, because there is an appetite to figure
    out how to streamline vaccine safety testing, it's just that
    there's just--unique, quirky feature about coronavirus
    vaccines, and some other respiratory virus vaccines. So I think
    you will see innovation and streamlining clinical trials, I'm
    just not sure this is the one to do it with.
         Dr. Sell. I had one other addition. I think that, you
    know, we--when we come up with these tools, they're
    interesting, and the exist out there, but we really need a way
    to sort of integrate them into practice, and that--so I think
    practice-focused research at public health agencies and the CDC
    is really important to making sure that we actually move
    research into actually making a difference on the ground.
         Mr. Foster. And have there been, you know, big studies
    that actually come up with, here's the holistic plan, here's
    rough budgets? You know, are--is this something where it was
    done 15 years ago by the National Academies, and ignored by
    Congress, or is that--there actually the need for, OK, let's
    just sit down and, in an international context, come up with a
    plan that has those elements that I mentioned and others? Dr.
    Murray?
         Dr. Murray. Yes, if I can answer part of that? The--to
    answer the first part of your question, there is a group that
    is newly formed, the Global Virome Project, that is looking at
    the 1.7 million as yet unknown viruses. Their goal is to
    identify and characterize all of that in--much in the same way
    as the Human Genome Project started out, and provided a wealth
    of information. We have had, for the last 10 years, a global
    program looking at human and animal health, as well as
    syndromic surveillance in country, laboratory building. That's
    the one I was describing that's just in the process of shutting
    down now.
         I would suggest that this is not the time for the U.S. to
    be pulling out, but, if we have a program that's doing it, if
    anything else, we need to continue and expand, and incorporate
    more of the type of folks we have here. And part of that
    program also had what Dr. Sell was working on----
         Mr. Foster. I'm sorry, I guess I'm----
         Chairman Bera. Yeah. We're----
         Mr. Foster [continuing]. Exceeding time here.
         Chairman Bera. We're going to try to get one last question
    in, since they called votes on us. The gentleman from Virginia,
    Mr. Beyer, is recognized for five----
         Mr. Beyer. Mr. Chairman, thank you very much, and thank
    you all so much for being here. This--incredibly important
    topic. And, Dr. Hotez, it's nice to see you again, 30 years
    after first coming across your incredible landmark work on the
    hookworm vaccine, so, good luck. I want to start by submitting
    a letter I--yesterday supported by 60 Members of Congress
    sharing my concern about the ineffective White House response,
    the lack of a chain of command, sharing conflicting
    information, et cetera, so--and how we stand ready to improve
    it. So, if there's no objection, Mr. Chairman?
         And, Dr. Sell, first, with apologies, I hate asking yes or
    no questions because they tend to be gotcha questions here, so
    please know that, time allowing, there will be time for
    paragraph questions later, but I'd like to make just some--a
    quick point, so five yes or no questions would be helpful----
         Dr. Sell. OK.
         Mr. Beyer [continuing]. And then we'll move. First, the
    World Health Organization says that the death rate from
    coronavirus is over 3 percent of those infected. Do you have
    any reason to believe that the actual figure is a fraction of 1
    percent?
         Dr. Sell. A fraction of 1 percent?
         Mr. Beyer. Yeah.
         Dr. Sell. Yes.
         Mr. Beyer. OK. Thank you. Would you say that the World
    Health Organization statistics on the spread of the novel
    coronavirus are false?
         Dr. Sell. No.
         Mr. Beyer. Will we have a vaccine soon, or within a few
    months?
         Dr. Sell. No.
         Mr. Beyer. Are we likely to get a quick cure?
         Dr. Sell. By cure do you mean a treatment?
         Mr. Beyer. Well----
         Dr. Sell. I have to say possibly, because there's drug
    trials.
         Mr. Beyer. OK, great. And should Americans who have the
    coronavirus symptoms, or believe themselves to be sick, go to
    work and risk spreading the disease?
         Dr. Sell. No.
         Mr. Beyer. Would you generally agree that all those
    statements are false? The panel. Let me go on--the--Dr. Sell,
    one last question, would you say that it would endanger
    American lives to spread disinformation that would cause people
    to go to work, and potentially spread the coronavirus because
    the public was misled about the dangers of this deadly disease?
         Dr. Sell. Misleading the public about a disease is wrong.
         Mr. Beyer. And so the sad part here is that these
    statements, which most scientists--well, every scientist
    testifying today, would agree endanger American lives were
    actually made by our President to large audiences in the last 3
    days. Scientists just told me that Trump's coronavirus
    statements about a soon--quick vaccine, a quick cure, it's OK
    to go to work, that all these things are endangering American
    lives. And, to be clear, the CDC advises anyone exhibiting
    symptoms of coronavirus, such as a fever, coughing, or
    shortness of breath, stay home from work, avoid public areas as
    much as possible, and seek medical attention.
         The Tuesday briefing from Vice President--was not
    televised. He came here and talked I think four different
    times. On Monday we heard reports that the CDC stopped
    disclosing the stats on how many Americans are being tested. At
    a time of high uncertainty in the face of a likely pandemic,
    should the American administration more transparent or less?
    Maybe Dr. Hotez? Or Dr. Sell?
         Dr. Sell. I'll just be quick. The administration should be
    transparent. They should be clear about what they know. They
    should tell the truth, be clear about what they don't know,
    what they're doing to try to find out those missing pieces of
    information, and be clear about what the course is, and what
    information might change that course.
         Mr. Beyer. Great. Thank you. Dr. Brownstein, we've heard a
    claim that focusing on testing is no longer needed once the
    disease has spread, you know, that it's in the community, that
    testing is moot. We've also heard the test--sentiment from many
    that they'd rather over-test folks than under-test folks. Do
    you think that testing will still be valuable when it starts to
    spread into a community?
         Dr. Brownstein. Yeah. I think it's important to actually
    have an accurate picture, because the dynamic of this virus is
    going to change as it moves from community to community, and
    understanding the impact that it's having at scale is going to
    be critical. And so, just like we do this for the influenza on
    a seasonal basis, where we test for flu to understand what the
    underlying illness is, the idea of doing this at scale for
    coronavirus makes a lot of sense.
         Mr. Beyer. Dr. Hotez, you've done so much work on vaccines
    over the decades, and you testified earlier quite well about
    it. What's the best the American people can hope for, in terms
    of a quick vaccine, or a soon vaccine, or----
         Dr. Hotez. Well, you know, I think it's really important
    to remember that vaccines are not quick, and that has a lot to
    do with vaccine confidence in the United States, because, as
    you know, we have a very aggressive anti-vaccine movement here
    in this country, and, as of the last couple of years, it's
    affecting public health, right? Measles came back in 2019
    because of the anti-vaccine movement. Historically, when we've
    had measles epidemics, it peaks now, late winter, early spring,
    so we may be battling two epidemics. We still have 16,000
    Americans who've died of flu, including 100 kids most who were
    not vaccinated. So I think it's really important not to tell
    the American public that we will have a quick vaccine, because
    that's not how it works. We have to reassure the public that we
    don't give out vaccines unless they're thoroughly tested, and
    they are the most thoroughly tested pharmaceuticals we have for
    safety.
         Mr. Beyer. And, Mr. Chairman, as I yield back, I just want
    to thank Dr. Hotez too for leading the fight against the anti-
    vaxxers, and that misinformation.
         Chairman Bera. Thank you, Mr. Beyer. Before we bring this
    hearing to a close, I want to thank all of our witnesses for
    testifying before the Committee today. The record will remain
    open for 2 weeks for additional statements from Members, and
    for any additional questions the Committee may ask of the
    witnesses. With that, the witnesses are excused, and this
    hearing is now adjourned.
         [Whereupon, at 10:45 a.m., the Subcommittee was
    adjourned.]

                                   Appendix I

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                       Answers to Post-Hearing Questions
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                                  Appendix II

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                       Additional Material for the Record
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