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


                    THE SCIENCE OF COVID-19 VACCINES
                    AND ENCOURAGING VACCINE UPTAKE
=======================================================================

                                HEARING

                               BEFORE THE

                      COMMITTEE ON SCIENCE, SPACE,
                             AND TECHNOLOGY
                        HOUSE OF REPRESENTATIVES

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             FIRST SESSION

                               __________

                           FEBRUARY 19, 2021

                               __________

                            Serial No. 117-1

                               __________

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

[GRAPHC NOT AVAILABLE IN TIFF FORMAT]

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

                    U.S. GOVERNMENT PUBLISHING OFFICE                    
43-412PDF                 WASHINGTON : 2021                     
          
-----------------------------------------------------------------------------------          
       

              COMMITTEE ON SCIENCE, SPACE, AND TECHNOLOGY

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

                           February 19, 2021

                                                                   Page

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

                           Opening Statements

Statement by Representative Eddie Bernice Johnson, Chairwoman, 
  Committee on Science, Space, and Technology, U.S. House of 
  Representatives................................................     7
    Written Statement............................................     8

Statement by Representative Frank Lucas, Ranking Member, 
  Committee on Science, Space, and Technology, U.S. House of 
  Representatives................................................     9
    Written Statement............................................    10

                               Witnesses:

Dr. Kathleen Neuzil, MD, MPH, Professor in Vaccinology and 
  Director, Center for Vaccine Development and Global Health, 
  University of Maryland School of Medicine
    Oral Statement...............................................    12
    Written Statement............................................    14

Dr. Philip Huang, MD, MPH, Director and Health Authority, Dallas 
  County Department of Health and Human Services
    Oral Statement...............................................    22
    Written Statement............................................    25

Mr. Keith Reed, MPH, CPH, Deputy Commissioner, Oklahoma State 
  Department of Health
    Oral Statement...............................................    33
    Written Statement............................................    35

Dr. Alison Buttenheim, PhD, MBA, Scientific Director, Center for 
  Health Incentives and Behavioral Economics and Associate 
  Professor of Nursing and Health Policy, University of 
  Pennsylvania School of Nursing
    Oral Statement...............................................    39
    Written Statement............................................    41

Discussion.......................................................    64

             Appendix I: Answers to Post-Hearing Questions

Dr. Kathleen Neuzil, MD, MPH, Professor in Vaccinology and 
  Director, Center for Vaccine Development and Global Health, 
  University of Maryland School of Medicine......................   110

Dr. Philip Huang, MD, MPH, Director and Health Authority, Dallas 
  County Department of Health and Human Services.................   112

Mr. Keith Reed, MPH, CPH, Deputy Commissioner, Oklahoma State 
  Department of Health...........................................   114

Dr. Alison Buttenheim, PhD, MBA, Scientific Director, Center for 
  Health Incentives and Behavioral Economics and Associate 
  Professor of Nursing and Health Policy, University of 
  Pennsylvania School of Nursing.................................   118

            Appendix II: Additional Material for the Record

Documents submitted by Representative Gwen Moore.................   292

Documents submitted by Representative Bill Posey.................   316

 
                    THE SCIENCE OF COVID-19 VACCINES
                     AND ENCOURAGING VACCINE UPTAKE

                              ----------                              


                       FRIDAY, FEBRUARY 19, 2021

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

     The Committee met, pursuant to notice, at 11:25 a.m., via 
Webex, Hon. Eddie Bernice Johnson [Chairwoman of the Committee] 
presiding.
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

     Chairwoman Johnson. So I'll call this meeting to order, 
and without objection, the Chair is authorized to declare 
recess at any time.
     Pursuant to House Resolution 8, today, the Committee is 
meeting virtually, and I want to announce a couple of reminders 
to the Members about the conduct of this remote hearing. First, 
Members, they should keep their video feed on as long as they 
are present in the meeting. Members are responsible for their 
own microphones. And please also keep your microphones muted 
until you are speaking. And finally, if Members have documents 
they wish to submit to the record, please email them to the 
Committee Clerk, whose email address was circulated prior to 
this hearing.
     And so, again, good morning and welcome to the Space--
Science, Space, and Technology Committee for the 117th 
Congress. We have an accomplished set of Members on our 
Committee--I just listened to one--and we bring diverse 
backgrounds and perspectives to our oversight and legislative 
work, and I look forward to a productive and stimulating 117th 
Congress.
     It is fitting that our first hearing focus on the COVID 
pandemic and the role of vaccination in fighting this virus and 
its devastating impacts. As the first nurse elected to 
Congress, I'm deeply committed to understanding how basic 
research supports healthcare solutions, and I'm also a firm 
believer in vaccines.
     Many of you are too young to know anyone who suffered from 
polio, but it was a devastating viral disease. I was a student 
nurse during that time, and I helped administer the polio 
vaccine as a student nurse. And thanks to scientific 
breakthroughs by brilliant virologists in the 1950's, the 
tremendous vaccine administration campaign that followed, this 
country has been polio-free since 1979. And we didn't get there 
by accident. We took great care to educate the public, ensured 
vaccine access in marginalized communities, and to assist other 
nations in vaccinating their own populations.
     Like polio, COVID-19 kills. The last 12 months have been 
of great suffering. But they have also seen astounding 
achievements in virology. Researchers at the National Institute 
for Allergy and Infectious Disease (NIAID) and their research 
partners laid the scientific foundation over the past decade 
for a new type of vaccine called mRNA. When the news of the 
viral outbreak in Wuhan reached the United States, NIAID 
quickly deployed partnerships with drug companies to develop 
safe, effective vaccines in record time.
     I cannot overstate what an incredible achievement it is 
that we have two safe, effective vaccines that have reached our 
shores. A third vaccine is being evaluated by FDA (Food and 
Drug Administration) as we speak, and we may have an answer on 
whether it is authorized as soon as next week.
     We have an opportunity to take the lessons learned from 
polio, from measles, and so on to make sure that these vaccines 
reach their potential. Here's one lesson: Vaccines don't save 
lives. Manufacturing billions of doses and distributing them 
are the supply part of the question, but in order to get 
needles into arms as quickly as possible, we also have to think 
about demand. There are a lot of factors that make up consumer 
demand for a vaccine, but perception of risk is a big one. We 
must build high public confidence in these vaccines. We simply 
cannot and will not bring this virus to an end unless we 
vaccinate a high percentage of the American population and, in 
fact, the globe.
     I hope our hearing today will help illuminate the methods 
that allowed these vaccines to be developed and approved 
quickly with scientific rigor, and that we will learn more 
about how vaccine hesitancy might threaten the pace of our 
national recovery. The Science, Space, and Technology Committee 
may not have primary jurisdiction over Health and Human 
Services (HHS), but we absolutely have a role in supporting 
public health outcomes through good science.
     I welcome our esteemed panel of witnesses and thank Dr. 
Huang in particular for joining us, as Dallas is facing 
unprecedented power outages and freezing temperatures this 
week, and I know the demands on his time are intense right now 
because we're also with much of an uptick with the virus.
     [The prepared statement of Chairwoman Johnson follows:]

    Good morning and welcome to the first hearing of the 
Science, Space & Technology Committee in the 117th Congress. We 
have an accomplished set of Members on our Committee who bring 
diverse backgrounds and perspectives to our oversight and 
legislative work. I look forward to a productive and 
stimulating 117th Congress.
    It is fitting that our first hearing in the 117th Congress 
focus on the COVID pandemic and the role of vaccination in 
fighting this virus and its devastating impacts. As the first 
nurse elected to Congress, I am deeply committed to 
understanding how basic research supports healthcare solutions, 
and I'm also a firm believer in vaccines.
    Many of you are too young to know anyone who suffered from 
polio, but it was a devastating disease. I helped administer 
the polio vaccine as a student nurse. Thanks to scientific 
breakthroughs by brilliant virologists in the 1950s and the 
tremendous vaccine administration campaign that followed, this 
country has been polio-free since 1979. And we didn't get there 
by accident. We took great care to educate the public, to 
ensure for vaccine access in marginalized communities, and to 
assist other nations in vaccinating their own populations.
    Like polio, COVID-19 kills. The last 12 months have seen 
great suffering. But they have also seen astounding 
achievements in virology. Researchers at the National Institute 
for Allergy and Infectious Disease and their research partners 
laid the scientific foundation over the past decade for a new 
type of vaccine called m-R-N-A. When news of the viral outbreak 
in Wuhan reached the United States, NIAID quickly deployed 
partnerships with drug companies to develop safe, effective 
vaccines in record time. I cannot overstate what an incredible 
achievement it is that we have two safe, effective vaccine 
options less than a year after this horrible virus reached our 
shores. A third vaccine is being evaluated by FDA as we speak, 
and we may have an answer on whether it is authorized as soon 
as next Friday.
    We have an opportunity to take the lessons learned from 
polio, from the measles, and so on to make sure these vaccines 
reach their potential. Here's one lesson: Vaccines don't save 
lives; vaccinations do. Designing the vaccine, manufacturing 
millions of doses and distributing them are the ``supply'' part 
of the equation. But in order to get needles into arms as 
quickly as possible, we also have to think about ``demand.'' 
There are a lot of factors that make up consumer demand for a 
vaccine, but perception of risk is a big one. We must build 
high public confidence in these vaccines. We simply will not 
bring this virus to an end unless we vaccinate a high 
percentage of the American population and in fact, the globe.
    I hope our hearing today will help illuminate the methods 
that allowed these vaccines to be developed and approved 
quickly with scientific rigor, and that we will learn more 
about how vaccine hesitancy might threaten the pace of our 
national recovery. The Science, Space, and Technology Committee 
may not have primary jurisdiction over Health and Human 
Services, but we absolutely have a role in supporting public 
health outcomes through good science.
    I welcome our esteemed panel of witnesses and thank Dr. 
Huang in particular for joining us, as Dallas is facing 
unprecedented power outages and freezing temperatures this 
week, and I know the demands on his time are intense right now.
    Thank you, and I now yield to Ranking Member Lucas.

     Chairwoman Johnson. So the Chair will recognize Mr. Lucas. 
Did he get in?
     Mr. Lucas. Yes, Madam Chair. And thank you----
     Chairwoman Johnson. Well, thank you.
     Mr. Lucas. You and I both had challenges getting on board 
this morning, but we're both here. Good morning----
     Chairwoman Johnson. Yes, thank you.
     Mr. Lucas. Chairwoman Johnson. Thank you for holding this 
important and timely hearing. And thank you to our expert 
witnesses for their participation today. I hope we can learn 
valuable information that we can share with our constituents as 
we continue to battle the COVID-19 pandemic.
     Almost 1 year ago to date, the Science Committee held our 
first hearing on the COVID-19 pandemic. Since then, we've seen 
day-to-day life changes dramatically. Millions of people have 
suffered from this pandemic, and COVID-19 has claimed the lives 
of nearly 480,000 Americans.
     In recent weeks, the United States reached a positive 
milestone, as more Americans have now received at least one 
dose of the vaccine than have tested positive for the virus 
since the pandemic began just over a year ago. According to CDC 
(Centers for Disease Control and Prevention) data, the United 
States has administered approximately 55 million doses of 
COVID-19 vaccines since the first shot was given on December 
14, 2020, and approximately 12 percent of the total U.S. 
population has received at least one dose.
     But as the original COVID-19 virus and new variants 
continue to spread across the globe, it is imperative that the 
United States take a more aggressive and ambitious approach to 
ramping up vaccine manufacturing and distribution. We need to 
get as many shots in arms as quickly as is possible.
     It is also critical that rural and underserved communities 
are not left behind during the vaccine rollout. For example, 
many rural residents lack broadband internet connection and are 
unable to secure appointments, which are largely scheduled 
online. Residents in more isolated parts of the country also 
experience difficulties finding somewhere to get the vaccine if 
they do not live near pharmacies or community health centers. 
Distributing vaccines that require ultracold storage also 
presents challenges for these communities, as doses will expire 
if they're not properly stored.
     The American research enterprise, including government, 
academia, and industry, has the expertise, resources, and 
talent to continue to fight this pandemic. From vaccine 
development at record speed to PPE (personal protective 
equipment) manufacturing, America's scientific community has 
stepped up to the plate, as scientists and researchers 
immediately pivoted at the start of the pandemic to focus on 
combatting COVID-19. With the integration of technologies such 
as artificial intelligence and high-performance computing, 
researchers have identified promising vaccine candidates 
quicker. Advanced manufacturing techniques also offer promising 
methods to bolster supplies and rapidly modify vaccines to 
address new strains of the disease.
     These factors allowed the United States to approve two 
safe and effective COVID-19 vaccines just 1 year after the 
pandemic began. Scientists were able to develop these vaccines 
in record time thanks to almost two decades of basic research 
on related viruses. These investments in basic research have 
truly been lifesaving. We must continue to make critical 
investments in American research for the health and safety of 
our Nation. As vaccine distribution ramps up and we continue to 
work to stop the spread of COVID-19, it is imperative that key 
decisions are grounded and backed by strong science and data. 
We simply cannot afford to ignore science during this critical 
time.
     This morning, I sent a letter to the Chairwoman 
respectfully requesting a hearing regarding the science on 
safely reopening and maintaining the Nation's K-12 schools for 
in-person learning. Research has established that approved 
COVID-19 vaccines are safe, and the evidence shows it's also 
safe to open our Nation's schools with the appropriate 
precautions in place.
     I look forward to hearing from our witnesses today about 
the current state of vaccine uptake, hesitancy, and access 
across the country. I'm also looking forward to hearing about 
Oklahoma's plan and learning more about the efforts taking 
place across the State to ensure that the underserved and rural 
communities are not forgotten. Thank you, Deputy Commissioner 
Reed, for your participation here today.
     And I want to thank the witnesses for taking the time to 
be here to share your expertise and insights with us during 
this pivotal time to keep Americans healthy. I know we're all 
looking forward to the day all Americans can safely return to 
work, our children are back in school, and we can look our 
loved ones in the eye once again.
     I yield back the balance of my time, Madam Chair.
     [The prepared statement of Mr. Lucas follows:]

    Good morning Chairwoman Johnson. Thank you for holding this 
important and timely hearing. And thank you to our expert 
witnesses for your participation today. I hope we can learn 
valuable information that we can share with our constituents as 
we continue to battle the COVID-19 pandemic.
    Almost one year ago to date, the Science Committee held our 
first hearing on the COVID-19 pandemic. Since then we've seen 
day-to-day life change dramatically. Millions of people have 
suffered from this pandemic, and COVID-19 has claimed the lives 
of nearly 489,000 Americans.
    In recent weeks, the United States reached a positive 
milestone, as more Americans have now received at least one 
dose of the vaccine than have tested positive for the virus 
since the pandemic began just over a year ago. According to CDC 
data, the United States has administered approximately 55 
million doses of COVID-19 vaccines since the first shot was 
given on December 14, 2020, and approximately 12 percent of the 
total U.S. population has received at least one dose.
    But as the original COVID-19 virus and new variants 
continue to spread across the globe, it is imperative that the 
U.S. take a more aggressive and ambitious approach to ramping 
up vaccine manufacturing and distribution. We need to get as 
many shots in arms as quickly as possible.
    It is also crucial that rural and underserved communities 
are not left behind during the vaccine rollout. For example, 
many rural residents lack broadband internet connection and are 
unable to secure appointments, which are largely scheduled 
online. Residents in more isolated parts of the country also 
experience difficulties finding somewhere to get the vaccine if 
they do not live near pharmacies or community health centers.
    Distributing vaccines that require ultra-cold storage also 
presents challenges for these communities as doses will expire 
if they are not properly stored.
    The American research enterprise, including government, 
academia, and industry, has the expertise, resources, and 
talent to continue to fight this pandemic. From vaccine 
development at record speed to PPE manufacturing, America's 
scientific community has stepped up to the plate, as scientists 
and researchers immediately pivoted at the start of the 
pandemic to focus on combatting COVID-19. With the integration 
of technologies such as artificial intelligence and high-
performance computing, researchers can identify promising 
vaccine candidates quicker. Advanced manufacturing techniques 
also offer promising methods to bolster supplies and rapidly 
modify vaccines to address new strains of disease.
    These factors allowed the U.S. to approve two safe and 
effective COVID-19 vaccines just one year after the pandemic 
began. Scientists were able to develop these vaccines in record 
time thanks to almost two decades of basic research on related 
viruses.
    These investments in basic research have truly been 
lifesaving. We must continue to make critical investments in 
American research for the health and safety of our nation.
    As vaccine distribution ramps up and we continue to work to 
stop the spread of COVID-19, it is imperative that key 
decisions are grounded and backed by strong science and data. 
We simply cannot afford to ignore science during this critical 
time.
    This morning, I sent a letter to the Chairwoman 
respectfully requesting a hearing regarding the science on 
safely reopening or maintaining our nation's K-12 schools for 
in-person learning. Research has established that the approved 
COVID-19 vaccines are safe, and the evidence shows it's also 
safe to open our nation's schools with the appropriate 
precautions in place.
    I look forward to hearing from our witnesses today about 
the current state of vaccine uptake, hesitancy, and access 
across the country. I am also looking forward to hearing about 
Oklahoma's plan and learning more about the efforts taking 
place across the state to ensure that underserved and rural 
communities are not forgotten. Thank you, Deputy Commissioner 
Reed, for your participation here today.
    I want to thank the witnesses for taking the time to be 
here to share your expertise and insights with us during this 
pivotal time to help keep Americans healthy. I know we are all 
looking forward to the day all Americans can safely return to 
work, our children are back in school, and we can see our loved 
ones once again.
    I yield back my time.

     Chairwoman Johnson. Thank you very much.
     At this time, we'd like to introduce our witnesses. Our 
first witness is Dr. Kathleen Neuzil. Dr. Neuzil is Professor 
of Vaccinology, Medicine and Pediatrics, as well as Director 
for the Center for Vaccine Development and Global Health at the 
University of Maryland. She was part of the leadership team 
which oversaw the evaluation strategy for COVID-19 clinical 
trials, and she has been a central figure throughout the COVID-
19 vaccine development process. She has led a phase 1 trials of 
the--she led phase 1 trials of Pfizer vaccine and the co-author 
of a recent paper establishing the efficacy and safety of the 
Moderna vaccine.
     And then after Dr. Neuzil, Dr. Philip Huang, Dr. Huang is 
the Director and Health Authority for the Dallas County Health 
and Human Services Department where he manages almost 500 
public health professionals. Prior to that, he spent 11 years 
as Medical Director and Health Authority for the Austin Public 
Health Department. He also served as an Epidemic Intelligence 
Service Officer with the CDC where he conducted infectious 
disease outbreak investigations.
     Our third witness, Mr. Keith Reed, is the Deputy 
Commissioner for Community Health Services with the Oklahoma 
State Department of Health. His public health career with the 
Department has spanned 19 years and multiple positions. Mr. 
Reed also is a Colonel in the Oklahoma Air National Guard and 
served multiple tours in support of Operation Iraqi Freedom and 
Enduring Freedom. He is currently assigned as Commander of the 
137th Special Operations Medical Group at Will Rogers Air 
National Guard Base in Oklahoma City.
     Our final witness is Dr. Alison Buttenheim. She is the 
Scientific Director of the Center for Health Incentives and 
Behavioral Economics at the University of Pennsylvania. Her 
research is focused on vaccine exemption policy and zoonotic 
disease prevention. Dr. Buttenheim is a member of the National 
Academies' Committee on the Equitable Allocation of the Novel 
Coronavirus Vaccine and a lead author of the new National 
Academies report on ``Strategies for Building Confidence in 
COVID-19 Vaccines.''
     Our witnesses should know that we will--you will have 5 
minutes for your spoken testimony. Your written testimony will 
be included in the record of the hearing. And when all of you 
have completed your spoken testimony, we will begin with 
questions. Each Member will have 5 minutes to question the 
panel.
     We will open our witnesses' testimony now with--starting 
with Dr. Neuzil.

           TESTIMONY OF DR. KATHLEEN NEUZIL, MD, MPH,

             PROFESSOR IN VACCINOLOGY AND DIRECTOR,

       CENTER FOR VACCINE DEVELOPMENT AND GLOBAL HEALTH,

           UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE

     Dr. Neuzil. Chairwoman Johnson, Ranking Member Lucas, and 
distinguished Members of the Committee, I appreciate the 
opportunity to elaborate on my written statement to you and to 
elucidate how investments in science and technology, effective 
partnership, and resource allocation enable the vaccine 
achievements of the past year.
     The consequences of the COVID-19 pandemic on our health, 
our economy, and our social well-being have been staggering. 
While the urgent need for a vaccine was clear, vaccine 
development is a lengthy, risky, and expensive process. 
Researchers first evaluate experimental vaccines in the 
laboratory and in animals. If a vaccine is safe and appears 
promising, it may go on to be carefully tested in people, but 
only if there is funding to do so. Many vaccines never move 
beyond early testing simply because there is no perceived 
market value and no funding.
     As part of the team that designed and conducted the early 
studies of the vaccines, I witnessed firsthand how the pandemic 
urgency shortened the vaccine development timeframe. 
Investments in basic science and technology were the key. 
Decades of work on understanding coronaviruses and other 
respiratory viruses enabled scientists to identify the 
appropriate target for the vaccine and to have a genetic 
sequence ready within days.
     Investments in the mRNA technology for other vaccines, 
influenza, Zika, and Ebola, and prior partnerships with vaccine 
manufacturers meant we understood how to deliver the mRNA and 
at what doses. Likewise, government-funded researchers brought 
sophisticated animal models and innovative laboratory methods 
to the vaccine efforts.
     The investment by NIH (National Institutes of Health) and 
others in clinical trials, infrastructure, and networks allowed 
experienced clinical scientists like myself to help design, 
execute, and analyze the studies in partnership with government 
and industry. Given my involvement from the start, I can attest 
that safety was never compromised by the speed of this effort. 
All trial designs were reviewed by ethics boards and the FDA. 
Experts with no ties to the products served on boards to 
monitor vaccine safety.
     The first participants to receive the vaccine were healthy 
adults who would be the least likely to suffer ill effects. The 
trials began with low doses and worked up to higher doses. The 
volunteers were followed carefully in the hours, days, and 
weeks after receiving the vaccine. We learned that the vaccine 
caused more side effects at the highest dose, but the immune 
response was not as good at the lowest dose, so a middle dose 
was chosen to move forward into trials.
     The first results of the mRNA vaccines were remarkable, 
showing more than 90 percent efficacy against disease and, 
importantly, against severe COVID-19. As most vaccine adverse 
events occur shortly after vaccination, the FDA required a 
median of 2 months of follow-up before emergency use 
authorization (EUA) would be granted.
     Safety assessment does not stop at approval, however. The 
trials will continue for at least 2 years. As with all vaccines 
in the United States, the CDC, the FDA, and the manufacturers 
will continue to follow vaccine safety. Through these systems, 
we are learning more, for example, about the rare allergic 
reactions occurring after administration of the mRNA vaccines.
     In summary, U.S. Government investments in science and 
technology enabled the COVID-19 vaccine development 
achievements. We don't know what pathogen will cause the next 
pandemic. Coronaviruses and influenza viruses have proven their 
pandemic potential. We must likewise be prepared for outbreaks 
from less-studied diseases due to arenaviruses, filoviruses, 
and togaviruses, for example. Our vaccine development can be 
better and faster but only with continued investments in 
technology. We have critical vaccine supply shortages, and 
people are dying.
     Finally, this outbreak has reminded us again that little-
known viruses causing disease in distant parts of the world are 
relevant. Variants are emerging in the absence of vaccines. The 
United States must work in partnership with the World Health 
Organization (WHO) and other international agencies to ensure 
an integrated, global response and to ensure that COVID 
vaccines are available to everyone in the United States and 
around the world. Thank you.
     [The prepared statement of Dr. Neuzil follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
     Chairwoman Johnson. Thank you very much.
     Dr. Huang? Unmute.
     Dr. Huang. OK.
     Chairwoman Johnson. One more click. That's it.
     Dr. Huang. Is it clicked?
     Chairwoman Johnson. Yes, you got it. Click one more time. 
It keeps going off.
     Dr. Huang. Can you hear me?
     Chairwoman Johnson. Yes.
     Dr. Huang. OK. Well, good morning, and thank you, 
Chairwoman Johnson, Congressman Lucas, and Members of the 
Committee, and greetings from frozen Dallas, Texas.
     Chairwoman Johnson. You're off again. OK. It keeps 
clicking off.
     Staff. Sir, you seem to be hitting the mouse twice or 
hitting a button twice, and that's just unmuting you and then 
muting you again.
     Dr. Huang. [inaudible] unmuted. Can you hear me?
     Staff. Yes.
     Chairwoman Johnson. Yes.
     Dr. Huang. OK. [inaudible] muted. OK.
     Chairwoman Johnson. You're--OK.
     Dr. Huang. I'm not----
     Chairwoman Johnson. We hear you now. But you just went off 
again.
     Dr. Huang. OK. I am not touching anything.
     Chairwoman Johnson. Keep going. It went off again. I don't 
know what it is.

            TESTIMONY OF DR. PHILIP HUANG, MD, MPH,

          DIRECTOR AND HEALTH AUTHORITY, DALLAS COUNTY

            DEPARTMENT OF HEALTH AND HUMAN SERVICES

     Dr. Huang. Can you hear me? Oh, there. There, that looks 
good. OK. Well, I apologize for technical difficulties. Again, 
my name is Dr. Phil Huang, and as you heard, I'm the Director 
and Health Authority for the Dallas County Health and Human 
Services Department where we serve over 2.6 million residents 
in Dallas County. I'm also a board member for the National 
Association of County and City Health Officials, NACCHO, which 
represent our Nation's nearly 3,000 local health departments. 
And I'm honored to be with you here today.
     Over my career, I've worked at the Federal, State, and 
local governmental public health levels, and I've truly come to 
appreciate that not just politics but all things really happen 
locally. Local health departments know our communities block by 
block, including the assets and barriers to care, the 
industries and living situations that pose particular 
challenges, as well as the community-level partners that have 
to be included in order to be successful.
     Even before a single case of the virus was detected on 
American soil, we at local health departments began to mobilize 
and engage our community and healthcare partners, as well as 
with our State and the Federal Government. This continues as we 
provide testing and contact tracing, and while standing up the 
largest mass vaccination campaign in our Nation's history.
     To be successful, we have to have strong, predictable 
supply of vaccines, but supply, while absolutely necessary, is 
not enough. We must do more to build demand and facilitate 
equitable uptake of these vaccines. To do this, we must provide 
clear communication through trusted messengers and healthcare 
providers, allow for the opportunity for questions to be asked 
and an individual's concerns to be thoughtfully considered, as 
well as target outreach via the many unique formal and informal 
communication channels where people get their information. This 
takes a robust workforce, strong relationships, and time and 
resources so that individuals can get their questions answered 
and then access the vaccine within their community.
     The challenge of vaccine hesitancy is not new to COVID-19, 
but with nearly half a million Americans who have lost their 
lives to this virus and more challenging variants emerging, it 
highlights the importance of a successful and efficient mass 
vaccination effort.
     Addressing this is not a one-time event also. Instead, it 
requires engaging with hesitant populations on an ongoing basis 
to honestly address concerns, provide the information they 
need, and build the trust that is crucial to their confidence 
in COVID-19 vaccines and the systems that provide them.
     In Dallas, we've seen vaccine hesitancy among communities 
of color, especially the African-American and Latino 
communities. The roots of vaccine hesitance, though, are 
varied. The mistrust from the African-American community seems 
to be deep-rooted history, including the horrific Tuskegee 
studies of untreated syphilis in rural Black men, while 
concerns in the Latino community might stem from mistrust of 
government and skepticism of the vaccine development process. 
Among the Hispanic community, we're also hearing questions 
around whether an undocumented person can receive the vaccine, 
as well as concerns about providing personal information to the 
government needed to receive the vaccine.
     These challenges persist in healthcare workers as well. We 
saw that in some long-term care facilities, even though there 
was a Federal program with the pharmacies that guaranteed that 
delivery, the uptake of the vaccine from the staff could be 
very low with some facilities only having 42 percent of their 
healthcare staff taking the vaccine. Local health department's 
chief health strategists within their communities are actively 
working on these actions to support equitable COVID-19 vaccine 
administration and uptake across all communities, all races, 
ethnicities, and other demographics and geographies.
     Currently in Dallas County we have over 650,000 people who 
have signed up on our vaccine registration list. However, our 
health department is only receiving 9,000 doses of vaccine per 
week. Vaccine hesitancy, combined with the digital and resource 
divide, has also meant that our registration list is skewed to 
the northern more affluent areas of Dallas County.
     However, because we've focused on the data, we've been 
able to tailor our approach with an eye toward equity. We 
provided vaccine distribution based on our vulnerability index 
to ensure we equitably distribute the vaccine as opposed to 
first-come, first-serve approach. We've also set up a 
professional phone bank so individuals without internet access 
or a smartphone can call to register, and we've partnered with 
community leaders to host in-person registration events. We're 
also launching a paid media campaign to address vaccine 
hesitancy and get information out to the community about the 
registration process.
     We've seen firsthand how leveraging people that are 
respected by the community can increase vaccine confidence, and 
at one of our community registration events heard a 65-year-old 
African-American woman lean over to her friend and say that she 
decided to come because she saw the actor Tyler Perry on TV 
that morning say how important it was to get the vaccine.
     While today's hearing is specific to vaccine hesitancy 
around COVID-19, I can't understate that this is an issue that 
was a challenge for us long before the pandemic, and our effort 
to build confidence in vaccines are long-term and continuous, 
but every day we work on it bringing us one step closer to 
getting our population fully vaccinated.
     Thank you again for inviting me to testify today, and I 
look forward to your questions.
     [The prepared statement of Dr. Huang follows:]
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     Chairwoman Johnson. Thank you.
     Staff. Excuse me for a moment, Ms. Johnson. Real quick 
technical--if you press and hold the spacebar on the computer, 
that only temporarily unmutes you, and when you release the 
spacebar, it mutes you back.
     Chairwoman Johnson. Thank you very much. Now we'll have 
Mr. Reed.

                  TESTIMONY OF MR. KEITH REED,

                 MPH, CPH, DEPUTY COMMISSIONER,

              OKLAHOMA STATE DEPARTMENT OF HEALTH

     Mr. Reed. Madam Chair Johnson and Ranking Member Mr. 
Lucas, thank you for the opportunity to speak today. My name is 
Keith Reed, and I'm Deputy Commissioner of Health for the State 
of Oklahoma. I'm here today to discuss our State's efforts to 
efficiently distribute and administer the COVID-19 vaccine and 
how we have addressed issues with uptake, hesitancy, and 
equitable access, particularly for those in our rural and 
underserved communities.
     To begin, we've been conducting surveys throughout the 
State to gauge vaccine hesitancy. As of our latest survey in 
January, we've determined that while most people are willing to 
receive the vaccine at some point, roughly 33 percent of 
Oklahomans do not plan to do so. Major reasons for hesitancy 
are lack of information on the vaccine and its development 
process and concerns about potential side effects.
     In this initial stage of vaccine distribution where demand 
is greater than supply, we found success in hedging the initial 
uptake issues by taking an overlapping approach. In order to 
vaccinate as many Oklahomans as possible, we've opened 
eligibility to new priority groups before entirely vaccinating 
earlier groups. With this tactic, we hope to lengthen the 
window of opportunity for those that might be undecided about 
vaccination, providing an extended timeframe to build consumer 
confidence in our program,
     To overcome hesitancy and access boundaries, and encourage 
high vaccine uptake, a few key conditions are needed. One, 
vaccine supply needs to improve. As we all are well aware, with 
increases in supply, we can provide more options for 
appointments, protect more of our vulnerable populations, and 
increase vaccine eligibility to more Oklahomans.
     Two, vaccine access needs to increase. We are working to 
open up new access points to the vaccine. We currently have 
approximately 1,500 pandemic providers signed up to participate 
in vaccine distribution around the State but can only engage a 
limited number due to supply issues. Getting vaccine to these 
providers, which include local pharmacies and many primary care 
providers, enables us to engage the most trusted sources in 
rural Oklahoma, giving us our best chance for high vaccine 
uptake.
     And three, communication about vaccine safety and 
availability needs to be clear, and it needs to be consistent. 
We've been using a diverse network of communication partners to 
make sure that communication with Oklahomans about the vaccine 
is consistent, transparent, and accessible to everyone. We hold 
virtual media events twice weekly to provide updates to the 
public and partner with our local health departments to keep 
the lines of communication open so Oklahomans are informed on a 
daily basis. We work closely with regional health directors, 
family health departments, and other local partners to reach 
communities across the State. These partnerships are critical 
in determining the best communications approach for their local 
constituents as they understand what will resonate in their 
respective areas. We use social media and our website to 
provide timely, regular updates on the vaccine. Information is 
shared online and with partners across the State. Above all, 
we're ensuring that our communications across the board are 
clear and factual. Our top priority is to give Oklahomans the 
tools to make the--an informed decision about the COVID-19 
vaccine. This requires regular, repeated, and reliable 
communication that is honest and direct in its approach.
     Oklahoma's unique landscape poses a particular set of 
challenges. Many of our community members lack internet access, 
particularly in rural areas with limited reception, or they 
lack digital literacy, particularly in our 65-plus community, 
who are some of the most at risk for COVID-19.
     People in underserved or rural communities have expressed 
higher rates of distrust in vaccines in general. Many people of 
color are wary of vaccines due to a history of medical 
mistreatment. There is a fear of being targeted due to 
immigration status or disclosure of race or ethnicity.
     This is also, of course--there is also, of course, general 
misinformation about COVID-19, leading to skepticism of the 
actual risk posed by COVID-19 or even skepticism that the virus 
exists at all. This misinformation is perpetuated on social 
media where it can have an exaggerated and local influence.
     Our goal with vaccine rollout is to address these concerns 
in a clear and compassionate way. We found that our 
partnerships with local entities have been invaluable in 
contributing to a much smoother rollout process and ensuring 
everyone's health and safety when they receive the vaccine.
     In Oklahoma, our surveys and experiences on the ground 
have shown us that two things are sorely needed: clear, 
accurate information about vaccine safety and efficacy, and 
increase vaccine accessibility to ensure equity.
     Thank you again to Chair Johnson and Ranking Member 
Representative Lucas for the opportunity to provide this 
testimony here in such a critical moment in our Nation's 
history. I hope you find this testimony helpful in your 
endeavors, and I'll be happy to address any further questions 
regarding Oklahoma's experience with the rollout of COVID-19 
vaccine.
     [The prepared statement of Mr. Reed follows:]
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     Chairwoman Johnson. Thank you very much, Mr. Reed.
     We will now hear from Dr. Buttenheim.

         TESTIMONY OF DR. ALISON BUTTENHEIM, PHD, MBA,

       SCIENTIFIC DIRECTOR, CENTER FOR HEALTH INCENTIVES

        AND BEHAVIORAL ECONOMICS AND ASSOCIATE PROFESSOR

                 OF NURSING AND HEALTH POLICY,

          UNIVERSITY OF PENNSYLVANIA SCHOOL OF NURSING

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

                               Appendix I

                              ----------                              


                   Answers to Post-Hearing Questions

Responses by Dr. Kathleen Neuzil
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

Responses by Dr. Philip Huang
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

Responses by Mr. Keith Reed
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

Responses by Dr. Alison Buttenheim
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

                              Appendix II

                              ----------                              


                   Additional Material for the Record

            Documents submitted by Representative Gwen Moore
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

            Documents submitted by Representative Bill Posey
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

                                 [all]