[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]
COVID-19 VARIANTS
AND EVOLVING RESEARCH NEEDS
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON INVESTIGATIONS
AND OVERSIGHT
OF THE
COMMITTEE ON SCIENCE, SPACE,
AND TECHNOLOGY
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
__________
MAY 12, 2021
__________
Serial No. 117-14
__________
Printed for the use of the Committee on Science, Space, and Technology
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://science.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
44-466PDF WASHINGTON : 2022
-----------------------------------------------------------------------------------
COMMITTEE ON SCIENCE, SPACE, AND TECHNOLOGY
HON. EDDIE BERNICE JOHNSON, Texas, Chairwoman
ZOE LOFGREN, California FRANK LUCAS, Oklahoma,
SUZANNE BONAMICI, Oregon Ranking Member
AMI BERA, California MO BROOKS, Alabama
HALEY STEVENS, Michigan, BILL POSEY, Florida
Vice Chair RANDY WEBER, Texas
MIKIE SHERRILL, New Jersey BRIAN BABIN, Texas
JAMAAL BOWMAN, New York ANTHONY GONZALEZ, Ohio
BRAD SHERMAN, California MICHAEL WALTZ, Florida
ED PERLMUTTER, Colorado JAMES R. BAIRD, Indiana
JERRY McNERNEY, California PETE SESSIONS, Texas
PAUL TONKO, New York DANIEL WEBSTER, Florida
BILL FOSTER, Illinois MIKE GARCIA, California
DONALD NORCROSS, New Jersey STEPHANIE I. BICE, Oklahoma
DON BEYER, Virginia YOUNG KIM, California
CHARLIE CRIST, Florida RANDY FEENSTRA, Iowa
SEAN CASTEN, Illinois JAKE LaTURNER, Kansas
CONOR LAMB, Pennsylvania CARLOS A. GIMENEZ, Florida
DEBORAH ROSS, North Carolina JAY OBERNOLTE, California
GWEN MOORE, Wisconsin PETER MEIJER, Michigan
DAN KILDEE, Michigan VACANCY
SUSAN WILD, Pennsylvania
LIZZIE FLETCHER, Texas
VACANCY
------
Subcommittee on Investigations and Oversight
HON. BILL FOSTER, Illinois, Chairman
ED PERLMUTTER, Colorado JAY OBERNOLTE, California,
AMI BERA, California Ranking Member
GWEN MOORE, Wisconsin PETE SESSIONS, Texas
SEAN CASTEN, Illinois VACANCY
C O N T E N T S
May 12, 2021
Page
Hearing Charter.................................................. 2
Opening Statements
Statement by Representative Bill Foster, Chairman, Subcommittee
on Investigations and Oversight, Committee on Science, Space,
and Technology, U.S. House of Representatives.................. 8
Written Statement............................................ 9
Statement by Representative Jay Obernolte, Ranking Member,
Subcommittee on Investigations and Oversight, Committee on
Science, Space, and Technology, U.S. House of Representatives.. 10
Written Statement............................................ 11
Statement by Representative Eddie Bernice Johnson, Chairwoman,
Committee on Science, Space, and Technology, U.S. House of
Representatives................................................ 12
Written Statement............................................ 13
Witnesses:
Dr. Salim Abdool Karim, Director of CAPRISA
Oral Statement............................................... 14
Written Statement............................................ 31
Dr. Nathan Grubaugh, Assistant Professor of Epidemiology
Oral Statement............................................... 47
Written Statement............................................ 49
Dr. Stephen Streiffer, Deputy Laboratory Director for Science and
Technology, Argonne National Laboratory
Oral Statement............................................... 56
Written Statement............................................ 58
Dr. Caitlin Rivers, Senior Scholar, Johns Hopkins Center for
Health Security
Oral Statement............................................... 71
Written Statement............................................ 73
Discussion....................................................... 79
Appendix: Answers to Post-Hearing Questions
Dr. Stephen Streiffer, Deputy Laboratory Director for Science and
Technology, Argonne National Laboratory........................ 100
COVID-19 VARIANTS
AND EVOLVING RESEARCH NEEDS
----------
WEDNESDAY, MAY 12, 2021
House of Representatives,
Subcommittee on Investigations and Oversight,
Committee on Science, Space, and Technology,
Washington, D.C.
The Subcommittee met, pursuant to notice, at 10:03 a.m.,
via Zoom, Hon. Bill Foster [Chairman of the Subcommittee]
presiding.
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman Foster. This hearing will now come to order.
Without objection, the Chair is authorized to declare a recess
at any time.
Before I deliver my opening remarks, I wanted to note the
circumstances under which we're meeting today. Pursuant to
House Resolution 8, the Subcommittee is meeting virtually, and
a couple of reminders for the Members about the conduct of this
remote hearing. First, Members should keep their video feed on
as long as they are present in the hearing. Members are
responsible for their own microphones. Please also keep your
microphones muted unless you're speaking. Finally, if Members
have documents they wish to submit for the record, please email
them to the Committee Clerk, whose email address was circulated
prior to the hearing.
Well, good morning, and welcome to our Members and our
panelists. Thank you for joining us for this hearing on COVID-
19 variants. Over a year into the pandemic, we're all
accustomed to a new normal: social distancing, mask wearing,
and, of course, the virtual proceedings we're conducting today.
Almost 60 percent of Americans have received at least one
vaccination dose, and our ability to detect and monitor the
spread of the virus puts us in a much better position than we
were just one year ago.
But just as we've adapted to life in the pandemic, the
virus has mutated as it continues to spread around the globe.
Each new variant brings the potential for increased
contagiousness, disease severity, and evasion of safety
measures and vaccine-induced natural immunity. Today, most of
the new variants seem to have evolved from national--natural
evolutionary pressure, natural selection for infectiousness.
One of the commonly expressed worries is about an escape
variant of the virus, a superbug that is resistant to our
vaccines and may--might evolve in a partially vaccinated
population. In a worst-case scenario, such a variant would
require us to start over from zero in our vaccine
manufacturing, tests, and deployment.
One important policy decision that the United States faces
is whether to hold in reserve vaccine manufacturing capacity
for such a contingency or perhaps simply to reserve vaccine
manufacturing capacity for possible booster shots, which may be
required due to the waning of our immune response. This
decision will be especially fraught if we conclude that we must
use our manufacturing capacity to make booster shots for the
U.S. at a time when the rest of the world may not be fully
vaccinated.
To make those decisions, and many others, we need to
evaluate the probability that new variants or escape variants,
as well as what is known about the waning of our immune
response from the vaccines, to the standard variants of the
virus.
And, more broadly, we must ensure that the tools we use to
detect, treat, and forecast the virus are keeping up with the
emerging variants. Researchers, medical practitioners, and
public health authorities have spent the last year standing up
an unbelievably impressive network of testing, surveillance,
treatment, and prevention tools. Thinking back to March 2020,
it was unimaginable to many that by May 2021, more than half of
Americans would be vaccinated against a virus that had just
reached our shores. Disease monitoring tools require an
unprecedented scale of data sharing and aggregation on an
international level.
And, as the death rate in our country has been dropping
for months, thanks to a better awareness of how to treat this
disease, we must not lose any of the gains as this virus
mutates, potentially increasing in contagiousness, severity, or
its ability to escape our vaccines. It's important that we in
the Federal Government support the efforts of researchers and
public health agencies in conducting top-of-the-line research
to inform health-protective policies.
Our witnesses here today will tell us about some of the
amazing science that has come out of the work on the pandemic,
and how we can best support their work now and into the future.
The U.S. scientific enterprise has historically been equipped
to answer those questions, and the Federal Government must
continue to support and amplify this support.
In this fight, we must not lose sight of our Nation's
place as a world leader and the importance of international
collaboration. We have all seen the recent devastating news
coming out of India, making this hearing all the more timely.
Stories of overloaded hospitals, insufficient vaccine supplies,
and mounting deaths. The more the virus spreads, the more
mutations will occur, meaning more strains of virus will
develop. No country is out of the woods until every country has
the ability to reach herd immunity, or to paraphrase Dr. Rev.
Martin Luther King, coronavirus anywhere is a threat to health
everywhere.
The Biden Administration has committed to this global
fight by rejoining the World Health Organization and the COVAX
(COVID-19 Vaccines Global Access) program, pledging $2 billion
to support vaccine access in low- and middle-income countries.
The United States is also sending 60 million doses of the
AstraZeneca (AZ) vaccine overseas, but we must do more. All
approved vaccines have shown to be efficacious in preventing
severe forms of known variants, a triumph worth celebrating and
something that we cannot take for granted into the future.
Bolstering worldwide vaccine access must go hand-in-hand with
continuing monitoring of vaccine efficacy in the face of new
variants.
I look forward to hearing from our witnesses today about
how we can best support the research that we need to end this
pandemic and to prepare for the next.
[The prepared statement of Chairman Foster follows:]
Good morning, and welcome to our members and our panelists.
Thank you for joining us for this hearing on COVID-19 variants.
Over a year into the pandemic, we're all accustomed to a new
normal--social distancing, mask wearing, hand sanitizing, and,
of course, the virtual proceedings we're conducting today.
Almost 60 percent of Americans have received at least one
vaccination dose, and our ability to detect and monitor the
spread of the virus puts us in a much better position than we
were just one year ago. But just as we've adapted to life in a
pandemic, the virus has mutated as it continues to spread
around the globe. Each new variant brings the potential for
increased contagiousness, disease severity, and evasion of
safety measures and vaccine-induced and natural immunity. We
must ensure that the tools we use to detect, treat, and
forecast the virus are keeping up with emerging variants.
Researchers, medical practitioners, and public health
authorities have spent the last year standing up an
unbelievably impressive network of testing, surveillance,
treatment, and prevention tools. Thinking back to March 2020,
it was unimaginable to many that by May 2021, more than half of
Americans would be vaccinated against a virus that had just
reached our shores. Disease monitoring tools require an
unprecedented scale of data sharing and aggregation on an
international level. And the death rate in our country has been
dropping for months, thanks in part to a better awareness of
how to treat this disease. We must not lose any of these gains
as the virus mutates, potentially increasing its contagiousness
and severity. It is imperative that we in the federal
government support the efforts of researchers and public health
agencies in conducting top-of-the-line research to inform
health-protective policies.
Our witnesses here today will tell us about some of the
amazing science that has come out of the pandemic, and how we
can best support their work. Each time a new variant pops up on
the CDC website, I'm sure we all have the same questions. How
effective are existing tests and vaccines? How will masking and
distancing guidelines be adjusted based on the contagiousness
of this new strain? Will the virus cause more severe illness
that requires different treatments? The U.S. scientific
enterprise is equipped to answer these questions, and the
federal government must continue to support and amplify this
work.
In this fight, we must not lose sight of our nation's place
as a world leader and the importance of international
collaboration. We have all seen the recent devastating news
coming out of India, making this hearing all the more timely.
Stories of overloaded hospitals, insufficient vaccine supplies,
and mounting deaths. The more the virus spreads, the more
mutations will occur, meaning more strains of the virus will
develop. No country is out of the woods until every country has
the ability to reach herd immunity. The Biden Administration
has committed to this global fight by rejoining the World
Health Organization and the COVAX program, pledging $2 billion
to support vaccine access in low- and middle-income countries.
The United States is also sending 60 million doses of the
AstraZeneca vaccine overseas. All approved vaccines have shown
to be efficacious in preventing severe disease from known
variants--a triumph worth celebrating, and something we cannot
take for granted. Bolstering worldwide vaccine access must go
hand-in-hand with continued monitoring of vaccine efficacy in
the face of new variants.
I look forward to hearing from our witnesses today about
how we can best support the research we need to end this
pandemic and prepare for the next.
I now yield to Ranking Member Obernolte for his remarks.
Chairman Foster. And I'll recognize my Ranking Member, Mr.
Obernolte, for his--an opening statement.
Mr. Obernolte. Thank you very much, Chairman Foster, and
thank you for convening this very timely hearing on a very
important topic. I am looking forward to hearing from our
witnesses, and I'm particularly excited about this hearing
because it gives us the opportunity to highlight the incredibly
important role that our research community has had in fighting
this epidemic. I believe that many of our Federal researchers
are the unsung heroes of this epidemic, and I also believe that
the development and deployment of the vaccines that have been
accomplished in the last few months will go down as one of the
greatest scientific achievements of mankind so far. So it can't
be understated the incredible role that our research community
has had in combatting this virus.
Unfortunately, though, it's clear that much more work
needs to be done. If we look at the emergence of the different
variants of COVID-19, it's clear that we need to invest more in
research and development so that we understand a lot of the
questions that are still unanswered, for example, the way that
these variants emerge, whether or not these variants cause more
or less severe illnesses, whether or not they're more or less
transmissible, and the way that those variants respond to the
various vaccines that have been developed and the way that we
can develop vaccines in the future that anticipate those
variants. So it's very important that we continue this
investment in research into not only human biology but
epidemiology and the spread of these variants.
I also want to highlight the important role that Congress
has to play in stimulating this kind of research. The Federal
Government is a natural--actually absolutely critical source of
funding and of focusing attention on these efforts, and we need
to continue that investment. I know that the Science, Space,
and Technology Committee is considering a number of different
bills that will continue that investment, and I fully support
those efforts. I want to highlight one in particular, H.R.
2153, the Securing American Leadership in Science and
Technology Act, which authorizes Department of Energy (DOE)
infectious disease research program. I think that that's
incredibly important, and I hope that that's something that's
going to get attention in this Committee.
So, Mr. Chairman, thank you very much again for convening
the hearing, and I'm looking forward to hearing from our
witnesses.
[The prepared statement of Mr. Obernolte follows:]
Thank you, Chairman Foster, for holding today's important
and timely hearing. I would also like to thank our expert
witnesses for their participation today.
I look forward to learning more about the important
contributions the Department of Energy (DOE) Office of
Science's National Laboratories are making to combat the COVID-
19 virus, and what role they can play moving forward to combat
other infectious diseases. Thank you, Dr. Streiffer for being
here today and for all the important work you do at Argonne
National Laboratory.
Our nation's research enterprise has demonstrated it has
the expertise, resources, and talent to fight this pandemic. We
have supercomputers, advanced manufacturing techniques, and
even advanced photon sources being used to fight COVID-19.
The DOE National Labs have a history of using technical
solutions to respond to national and international emergencies,
and when the COVID-19 pandemic hit, the labs were prepared,
ready, and willing to serve on the front lines. DOE received
$99.5M in the CARES Act to fund research at the National Labs
to better understand COVID-19. This funding has since been
fully expended.
At the start of the pandemic, DOE pivoted and launched the
National Virtual Biotechnical Laboratory (NVBL) to mobilize the
resources of the Department of Energy's 17 National Labs to
engage in critical COVID-19 research. Projects within NVBL are
focused on molecular design for medical therapeutics,
development and evaluation of COVID-19 testing, epidemiological
and transpiration modeling, and advanced manufacturing.
I would also like to highlight that decades of investment
in basic scientific research involving the National Labs
contributed to the unprecedented speed COVID-19 vaccines were
developed and distributed. These investments have been truly
lifesaving.
The accomplishments made possible through the NVBL
demonstrate the power of the U.S. innovation ecosystem, when
you have DOE National labs, universities, and companies all
working together to address a national and societal challenge.
As the original COVID-19 virus and new variants continue to
spread across the globe, it is imperative that the United
States continues to make critical investments in basic research
for the health and safety of our nation. To date, the Centers
for Disease Control and Prevention (CDC) have identified five
COVID-19 Variants of Concern (VOCs) in the United States.
Researchers are paying close attention to these VOCs as
according to the CDC, they appear to spread more easily and
quickly than other identified Variants of Interest (VOIs).
There remains a lot of information public health officials
and researchers do not yet know about COVID-19 variants, and
further studies are needed. For example, researchers still need
to learn how easily emerging COVID-19 variants spread, if they
cause milder or more severe illness, if they are detected by
currently available viral tests, if they respond to medications
currently being used to treat COVID-19, and whether existing
authorized vaccines protect people from them. The DOE National
Labs can build upon previous COVID-19 research work and get
ahead in the race against COVID-19 mutations. The National Labs
have existing infrastructure, resources, and experts ready to
deploy, and can continue to play a leading role in addressing
key concerns and challenges to confront the COVID-19 pandemic
and beyond.
Before I close, I would like to highlight H.R. 2153, the
Securing American Leadership in Science and Technology Act
(SALSTA), which was introduced by Full Committee Ranking Member
Lucas in March, and which I am an original cosponsor of. This
legislation includes an authorization for a DOE emerging
infectious disease research program and high-performance
computing research consortium.
I hope that today's hearing will continue an important
dialogue on the role of Federal science agencies in supporting
R&D to combat the COVID-19 virus and propose new and innovative
solutions for infectious disease responses in the future.
Thank you, and I yield back.
Chairman Foster. Thank you. And we are honored to have the
Full Committee Chairwoman, Ms. Johnson, with us today, and the
Chair now recognizes the Chairwoman for an opening statement.
Chairwoman Johnson. Well, thank you very much, and good
morning. Let me thank you for holding this hearing today and
thank all of our witnesses for joining us this morning. Dr.
Abdool Karim, I understand you are halfway around the world
right now, so good evening to you.
Today's hearing could not be more timely. The United
States has already made incredible strides in making safe,
accessible vaccines available to all adults. Just this week,
the FDA (Food and Drug Administration) extended an
authorization for 12- to 15-year-olds to receive the Pfizer
vaccine. And I understand that some of our basic science
research was performed at one of our national laboratories, the
home of one of our witness's laboratory. These scientific
achievements were a gift to the world, and they've already
saved millions of lives, and they will save millions more.
In the United States, every teenager and adult now has
access to the tools they need to protect themselves and loved
ones. We must not squander this gift. We have no time to waste
because viral variants are threatening the progress the United
States has made toward defeating COVID-19. In recent weeks, one
variant has brought the entire nation of India to its knees.
And the longer the COVID-19 persists around the globe, the more
mutations will emerge. Pandemics know no borders. An emerging
variant anywhere is a public health threat everywhere, as you
have said, Mr. Chair.
Our witnesses today will help us understand how emerging
variants make it even more urgent to vaccinate fast, not just
in the United States, but across the globe. I also look forward
to hearing about the scientific tools we can use to spot a
variant. The Federal Government supports an impressive range of
infectious diseases--disease modeling, data sharing, and
surveillance activities. We know now that these programs should
have been coordinating more closely before the pandemic. A 2016
White House report offered a roadmap for exactly that:
stitching together science activities across a dozen different
agencies to enable better models of how diseases spread and
change. Unfortunately, we did not get far enough on
implementing these recommendations before COVID-19 reached our
shores.
But it isn't too late to continue to improve the Federal
approach to disease forecasting and surveillance for this
present-day crisis. We can deploy our best Federal science
capabilities to detect and understand variants as early as
possible. This helps public officials and healthcare providers
have the quality information they need to protect and save
lives.
Thank you, Subcommittee Chairman Foster and Ranking
Member, for putting together this timely discussion, and I
yield back.
[The prepared statement of Chairwoman Johnson follows:]
Good morning and thank you to our witnesses for joining us
this morning. Dr. Abdool Karim, I understand you are halfway
around the world right now, so good evening to you.
Today's hearing could not be more timely. The United States
has already made incredible strides in making safe, accessible
vaccines available to all adults. Just this week, the FDA
extended an authorization for 12- to 15-year-olds to receive
the Pfizer vaccine. I understand that some of the basic science
research performed at Argonne National Laboratory, home to one
of our witnesses today, was a foundational part of creating
mRNA vaccines. These scientific achievements were a gift to the
world. They have already saved millions of lives, and they will
save millions more. In the United States, every teenager and
adult now has access to the tools they need to protect
ourselves and our loved ones.
But we must not squander this gift.
We have no time to waste, because viral variants are
threatening the progress the United States has made toward
defeating COVID-19. In recent weeks, one variant has brought
the entire nation of India to its knees. And the longer COVID-
19 persists around the globe, the more mutations will emerge.
Pandemics know no borders; an emerging variant anywhere is a
public health threat everywhere. Our witnesses today will help
us understand how emerging variants make it even more urgent to
vaccinate fast--not in just the United States, but across the
globe.
I also look forward to hearing about all the scientific
tools we can use to spot a variant. The federal government
supports an impressive range of infectious disease modeling,
data sharing, and surveillance activities. We know now that
these programs should have been coordinating more closely
before the pandemic. A 2016 White House report offered a
roadmap for exactly this: stitching together science activities
across a dozen different agencies to enable better models of
how diseases spread and change. Unfortunately, we did not get
far enough on implementing those recommendations before COVID-
19 reached our shores.
But it isn't too late to continue to improve the federal
approach to disease forecasting and surveillance for this
present-day crisis. We can deploy our best federal science
capabilities to detect and understand variants as early as
possible. This helps public officials and healthcare providers
have the quality information they need to protect the public
and save lives.
Thank you Subcommittee Chairman Foster and Ranking Member
Obernolte for putting together this timely discussion. I yield
back.
Chairman Foster. Thank you. And if there are any Members
who wish to submit additional opening statements, your
statements will be added to the record at this point.
At this time, I'd like to introduce our witnesses. Our
first witness is Dr. Salim Abdool Karim. Dr. Abdool Karim is a
clinical infectious disease epidemiologist who has played a
leading role in the global COVID-19 pandemic response. He is
Director for the Center for AIDS--the AIDS Programme of
Research in South Africa, CAPRISA, and CAPRISA Professor of
Global Health at Columbia University. Dr. Abdool Karim is also
one of the nine members of the World Health Organization's
Science Council. His contributions during the pandemic have
focused on the epidemiology of SARS-CoV-2 variants, including
their impact on vaccine and natural immunity.
Next is Dr. Nathan Grubaugh, Associate Professor of
Epidemiology at the Yale School of Public Health and head of
the Grubaugh Lab where he studies virus emergence,
transmission, and evolution. During disease outbreaks, his lab
sequences viruses for epidemiological investigations,
determines the disease phenotype and transmission fitness of
novel virus mutations, and maps the evolutionary pathways that
a virus may take to adapt.
Our third witness is Dr. Stephen Streiffer. Dr. Streiffer
hold several positions at Argonne National Laboratory in the
Illinois 11th District I might add, including Deputy Laboratory
Director for Science and Technology. He is one of the founding
Co-Chairs of the National Virtual Biotechnology Laboratory, or
NVBL, a consortium of DOE national labs founded to address the
COVID-19 crisis. The NVBL has used their scientific and
technical expertise to address medical supply shortages,
discover potential drugs to fight the virus, develop and verify
COVID-19 testing methods, model disease spread and impact
across the Nation, and understand virus transport in buildings
and in the environment.
Our final witness is Dr. Caitlin Rivers, Senior Scholar at
the Johns Hopkins Center for Health Security and an Assistant
Professor in the Department of Environmental Health and
Engineering at Johns Hopkins Bloomberg School of Public Health.
She's an epidemiologist specializing in emerging infectious
diseases and has anchored or contributed to several reports on
COVID-19 variants and the national pandemic strategy. Her
research focuses broadly on improving public health
preparedness and the response to large-scale events.
And, as our witnesses should know, you'll each have five
minutes for your spoken testimony. Your written testimony will
be included in the record for the hearing. And when you've all
completed your spoken testimony, we will begin with questions
and each Member will have five minutes to question the panel.
If time allows, we may have a second round of questioning.
In addition, if there is interest in--among the Members at the
close of the hearing, may--we may turn off the livestream and
have an informal discussion with the panelists, something we do
under normal circumstances and is possible also here.
We will now start with Dr. Abdool Karim, so you are now
recognized for five minutes.
TESTIMONY OF DR. SALIM ABDOOL KARIM,
DIRECTOR OF CAPRISA
Dr. Abdool Karim. Thank you very much, Chairman Johnson.
It's indeed an honor for me to be here and provide some
testimony. I submitted a slide set. I'm going to ask for that
to be projected.
[Slide follows:]
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Dr. Abdool Karim. I speak to you from South Africa where I
am based at--and the Nelson R. Mandela School of Medicine at an
NIH- (National Institutes of Health-) funded research center.
I'm actually at ground zero where one of the world's most
concerning variants was first described. So I'm going to
briefly touch on the variants. I want to talk about the
implications for public health and the COVID-19 end game. Next
slide.
[Slide follows:]
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Dr. Abdool Karim. So briefly, we know that all viruses
mutate. That's in the nature of evolution, the way in which
their genetic changes occur. SARS-CoV-2 shows slow genetic
drifts pretty much one to two mutations per month. I've been
monitoring in South Africa the epidemic and the viruses, and we
see just a handful of mutations each month. But in November
last year we saw something different, not just the slow
antigenic drift but a shift, a major new mutant with 23
different mutations. And to give you some idea of its advantage
and its functional advantage that it obtained, I point you to
the graph on the left-hand side. Initially, in September, we
had 34 pre-existing variants that were transmitted. The next
month the new mutation referred to as B.1.351, constituted 11
percent of all the viruses. A month later, November, it was 60
percent, and by December, 87 percent of all the viruses
transmitted were this new variant B.1.351.
Next slide, please.
[Slide follows:]
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Dr. Abdool Karim. And to give you some idea of what that
has meant in comparing the first wave with pre-existing
variants in the light yellow line you can see that the second
wave, due to this new, more highly transmissible variant, the
B.1.351 variant, is about 50 percent faster. If you just take
one province in South Africa, Western Cape, it reached 100,000
cases within a matter of 54 days compared to the first wave
where it took 107 days.
Next slide, please.
[Slide follows:]
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Dr. Abdool Karim. And that translation of what we're
seeing is if you take the three countries, India, Brazil, and
South Africa, each of them in the first waves dealt with a
pretty substantial wave, but what happened was as the epidemic
settled, they all began to look at this epidemic in a different
way.
Next slide.
[Slide follows:]
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Dr. Abdool Karim. And what we began to see was the--that
each of these countries, they thought that they had conquered
this virus. They had become immune, that they've developed some
kind of protection from natural infection. We saw that in South
Africa, we saw that in Brazil, we saw that in India.
Next slide.
[Slide follows:]
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Dr. Abdool Karim. And what happened was complacency that
set in, and this is what happened. In each of those settings, a
new variant. In India, the B.1.617; in Brazil, the P.1 and P.2
variants; and in South Africa, the B.1.351 variant. And in
South Africa the data we have shows quite clearly at this point
that the B.1.351 variant was able to escape immunity that was
acquired in the first wave. And so what we are seeing is
reinfections occurring quite commonly in South Africa.
Next slide, please.
[Slide follows:]
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Dr. Abdool Karim. So if we look at where we are in terms
of vaccines, that is perhaps the most concerning of the things
that we see and that if you take the AstraZeneca vaccine with
70 percent efficacious in the U.K. but only 10 percent
efficacious in South Africa. Novavax, 89 percent but only 43
percent. And we are seeing breakthrough variants. Fortunately,
vaccines like the Johnson & Johnson (J&J) and the Pfizer
vaccine have maintained their efficacy.
Next slide.
[Slide follows:]
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Dr. Abdool Karim. And this is my last slide where I'll
just make some parting comments that we should expect more
variants, that no country is safe, as Chairman Johnson has
pointed out so eloquently, until every country is safe, and
that we need maximal suppression and that no single action is
likely to be sufficient to prevent the spread of the virus.
We're going to need our public health measures in addition to
our vaccination programs. We need to strengthen genomic
surveillance. And even though we are expecting next-generation
vaccines to produce more broadly neutralizing antibodies and we
expect they will impact on the escape variants, I suspect that
we will continually see this virus finding ways to escape
immunity.
Thank you very much, Chairman.
[The prepared statement of Dr. Abdool Karim follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman Foster. Thank you. And next we will recognize Dr.
Grubaugh for five minutes.
TESTIMONY OF DR. NATHAN GRUBAUGH,
ASSISTANT PROFESSOR OF EPIDEMIOLOGY
Dr. Grubaugh. Thank you, Chairman Foster and Members of
the Subcommittee, for the invitation to discuss SARS CoV-2
variants. I am a virologist and molecular epidemiologist. That
is, I use virus genome sequencing and molecular diagnostic
assays to study the emergence and spread of infectious
diseases. I helped to develop the SARS-CoV-2 genomic
surveillance system for the State of Connecticut and I worked
directly with the CDC (Centers for Disease Control and
Prevention) and other regional and international partners to
investigate the emergence of SARS-CoV-2 variants.
Surveillance is one of our most important tools for public
health. Almost all major policy decisions rely on data
informing the spread and incidence of an infectious disease.
And it's not just local surveillance. We need global
surveillance to inform as to what may be coming next. For
example, surveillance from South Africa, Brazil, India, and the
U.K. have provided critical information about what variants may
be introduced into the United States, which is in addition to
the variants that may emerge within our own borders.
While sequencing COVID-19 cases in the United States is
increasing, there are still many regions in the world of which
we have little or no SARS-CoV-2 genomic information. These gaps
lead us into the dark what--as to what variants may be emerging
in those locations and what could be a threat to the United
States. Local surveillance systems detect variants by the
pattern of specific mutation of each sequence virus, which we
then use to assigned to a numbered lineage, such is B.1.1.7,
B.1.351, P.1, et cetera. These data are then used to detect the
introductions and track the frequencies of known or novel
variants.
Our national and international surveillance systems are
then reliant on SARS-CoV-2 genomic sequencing data to be
submitted to public repositories. GISAID (Global Initiative on
Sharing All Influenza Data) is the most popular repository
which currently contains about 1.5 million sequences from
around the world. From there, bioinformaticists and public
health agencies and independent groups routinely poll the data
to provide global, national, and regional reports on variants.
This allows all of us to keep up-to-date on what is happening.
But there are some major challenges to variant
surveillance. One is that it mostly requires the use of whole
genome virus sequencing, a method that is far more expensive
and technical than conventional clinical testing. There are
some simpler tests, similar to what we use for clinical
diagnostic testing, that are used to help us to track the
frequency of variants. For example, a PCR (polymerase chain
reaction) test has been used to track the rapid spread of
B.1.1.7 in the United States. These simpler tests, however, are
limited in what they can detect. It's hard for them to detect
something that is novel. So while useful, they are not a
replacement for sequencing.
Another challenge is the need for individual labs to share
their data on public repositories. While data sharing is
critical to our surveillance efforts, there are several
barriers, especially in low-resource settings. These include
technical barriers to data transfers to online repositories,
lack of important information connected to the sequences needed
for public health, lack of incentives to make expensive-to-
generate genomic data available to the public versus keeping
them for their own research, and international responses to
publicly submitted data such as naming a variant after a
location or the implementation of travel restrictions.
Here provides an opportunity for the U.S. Government to
help. We need policies around pathogen genomic data sharing and
usage for public health surveillance. These should include
incentives to share and also protections for data generators to
have the first right to publish. These policies should also be
accompanied by standards for data generation, standards for
data processing, and standards for analysis to help minimize
sampling biases and eliminate data processing errors.
Finally, these policies should support the work of
pathogen genomic surveillance of all types not just during a
public health emergency. Without sustained support, the
important work that we started here could fold. Rather, our
genomic surveillance system should remain intact and only ramp
up or ramp down depending on the need.
Thank you for your time, and I hope that I can answer any
questions that you may have.
[The prepared statement of Dr. Grubaugh follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman Foster. Thank you. And the Chair will now
recognize Dr. Streiffer for five minutes.
TESTIMONY OF DR. STEPHEN STREIFFER,
DEPUTY LABORATORY DIRECTOR
FOR SCIENCE AND TECHNOLOGY,
ARGONNE NATIONAL LABORATORY
Dr. Streiffer. Chairwoman Johnson, Chairman Foster,
Ranking Member Obernolte, Members of the Subcommittee, thank
you for the opportunity to testify today about the challenges
presented by the COVID-19 variants and the important role the
Department of Energy's national laboratories have played in
combating COVID-19.
My name is Dr.--as Congressman Foster said, I'm Stephen
Streiffer. I serve as Argonne's--National Laboratory's Deputy
Laboratory Director for Science and Technology, as well as the
Director of the lab's Advanced Photon Source (APS). For the
last 15 months it's been my privilege to serve as the Co-
Director of the DOE's National Virtual Biotechnology
Laboratory.
As, again, Congressman Foster pointed out, the NVBL came
together as a consortium of all 17 DOE national laboratories at
the onset of the pandemic, supported by CARES Act funding. It
brought together leading scientists and researchers from across
the lab complex and leverages the Department of Energy's world-
class experimental and computational facilities. Our state-of-
the-art user facilities such as the APS, our capabilities in
advanced computing and AI (artificial intelligence), structural
and molecular biology and biotechnology, epidemiological and
transportation modeling and advanced manufacturing, among
others, uniquely position us to take on this challenge and lead
the world in finding therapies to combat the virus.
If you'll allow me, I'll just go through several of the
contributions that NVBL has made in the fight against COVID.
I'll highlight just a few here, and there's more in my written
testimony of course.
As the Nation initially grappled with testing, the lab
supported the FDA, CDC, and DOD (Department of Defense) to
establish national guidelines, identify diagnostic targets, and
develop and prove out sample collection methodologies that were
used in the administration of hundreds of millions of COVID-19
tests. We also worked to solve supply chain challenges that
plagued the early days of the outbreak. Teams from the NVBL
produced innovations in materials and advanced manufacturing
that mitigated shortages and test kit components and personal
protective equipment, leading to the creation of over 1,000 new
jobs as we transferred development to the private sector. Our
high-performance computing and AI capabilities have proven
extremely effective in the molecular design of medical
therapeutics and in epidemiological mobility modeling to
support decisionmakers.
As far as we've come in the fight against COVID-19, as
we're here today to discuss, the biggest threat right now are
the variants that are emerging around the globe. An integrated
approach that tracks and responds to the variants is what we
need at this stage of the pandemic.
A four-step approach to this requires a whole-of-
government approach to succeed. First, we need to sequence the
genome of the virus collected from as many test results as
possible nationally and, very importantly, globally. Second, we
must maintain centralized inventories of collected viral
sequences and build family trees that represent how they relate
to each other. Third, we must use computational modeling and
experimental methods to identify troublesome variants that can
escape detection through current tests of current vaccines or
resist current therapeutics. Fourth, as we discover those
troublesome variants, we need to design new tests, vaccines,
and treatments that target and work against variants as they
continue to emerge.
Coupled with other strong public health measures, finding
and rooting out the variants is what will get us to the finish
line with the pandemic. However, a number of challenges remain.
As you'll hear, we must improve upon the systematic sequencing
of the viruses to identify and track new variants. The NIH is
putting resources into this in the United States, but more is
needed. And in fact, DOE has significant expertise that can
support these efforts.
The issue of disinformation and vaccine hesitancy are
highly concerning. DOE and the labs are playing a role
combating disinformation and building scientific literacy among
the American public and are actively engaged in outreach
activities across communities, including the most underserved.
We need to speed the process of drug design by harnessing
computational artificial intelligence tools that the DOE is
very expert in to find potential therapeutics faster. DOE also
has the capability to further develop, evaluate, and validate
tools for less expensive, simpler testing and diagnostics.
There is also a need for substantial work to incorporate the
emergence of vaccine resistance variants into epidemiological
modeling. DOE's expertise in AI is inspiring new ways of
thinking about inputs into pandemic models, including data on
mobility, health, behavior, and demographics.
And finally, we do need to enhance real-time standards and
data sharing. Metropolitan and State-level models of COVID-19
variant penetration, immunity, transmission, and morbidity/
mortality, broken down by geography and demographics, will
continue to enhance the Nation's ability to proactively plan
and to respond to the evolving landscape. These efforts will
provide web-based tools and actionable information for a whole-
of-government approach.
Let me conclude by saying that we appreciate the support
that Congress has given to all the national laboratories, in
particular to the NVBL. Thank you to the Subcommittee for your
time and happy to answer questions through the hearing. Thank
you.
[The prepared statement of Dr. Streiffer follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman Foster. Thank you. And we will now recognize Dr.
Rivers for five minutes.
TESTIMONY OF DR. CAITLIN RIVERS, SENIOR SCHOLAR,
JOHNS HOPKINS CENTER FOR HEALTH SECURITY
Dr. Rivers. Chairman Foster, Ranking Member Obernolte,
Chairwoman Johnson, and Members of the Subcommittee, thank you
for the opportunity to speak to you today about variants and
evolving research needs.
In the United States we have entered a new phase of the
pandemic. Nearly 60 percent of American adults have begun
vaccination, including more than 80 percent of adults over age
65. However, in the last 14 months, over 575,000 Americans have
died and 32 million cases have been reported. Beyond the direct
impacts, we've endured severe economic consequences, disruption
to education, and strain on our healthcare systems. We've
collectively suffered an enormous loss, and that grief will not
be easily overcome.
The situation in some other countries is much worse, and
the pandemic is far from over. Case counts globally are
reaching new highs. India is in the midst of a terrible wave
and reports suggest that in some communities the situation is
dire. A variant of interest, B.1.617, may be contributing to
the surge. As our own domestic outlook improves, we must turn
our attention to helping the world.
And as we continue the work of ending the pandemic both at
home and abroad, we must also identify the changes necessary to
ensure we are never caught in this position again. In doing so,
we should recognize that we were caught unprepared more than
once. We were unprepared to manage the emergence and swift
global spread of the novel coronavirus, and we were late to
recognize when it reached our shores. Those delays set us on a
worse trajectory than we might have otherwise faced.
But so, too, were we unprepared for variants. Although
genomics experts had warned of the threat, it was not until the
United Kingdom suffered a severe wave attributed to the B.1.1.7
variant that public health officials worldwide sharpened their
focus. B.1.1.7 is now understood to be perhaps 50 percent more
transmissible than other variants, and it may also cause more
severe illness. The U.K. was able to identify and track this
variant over time because they invested heavily in genomic
surveillance. That capability yielded important information
they needed to guide their response, and they provided warning
to the world about what was to come. We did not have that level
of genomic surveillance in the United States, and that was a
gap.
The United States currently recognizes five variants of
concern and several variants of interest. The most concerning
possibility with some of these variants is that they may
exhibit some degree of immune escape, meaning that vaccines and
therapeutics may be somewhat less effective. Future variants
may drift even further from the protection existing vaccines
can provide, cause more severe illness, or impact diagnostic
testing. If we do need to update our vaccines or diagnostics to
be a better match, we must know that as early as possible so
that we can begin the work--that work before the variant
becomes widespread. We must not again be caught unprepared.
The American Rescue Plan includes $1.7 billion for genomic
surveillance, as well as additional funds for biological
research, expansion of the public health workforce, and a suite
of other important public health initiatives that will improve
our preparedness, including for variants. Looking ahead, given
that SARS CoV-2 is likely to continue to circulate and in
anticipation of the next viral threat that we will almost
certainly face, Congress should provide long-term, sustainable
support for this expansion in our public health infrastructure
so that we will be in a better position to respond next time.
As we advance our genomic surveillance infrastructure, we
should also further develop the modeling and analytics
infrastructure that will allow us to make even better use of
that data. With the exception of a few small groups within the
Department of Health and Human Services, most modelers work in
academia and volunteer to support the public health response
when an urgent need arises. This arrangement is not well-suited
to either party. The Federal Government would benefit from a
permanent capability with infectious disease modelers working
to advance the state of the science and support public health
decisionmaking both between and during emergencies.
The Biden Administration announced a National Security
Directive 1, an intention to create a National Center for
Epidemic Forecasting and Outbreak Analytics, and the American
Rescue Plan appropriated $500 million to CDC for disease
forecasting and data modernization. These are promising steps
toward modernizing our response capabilities, and I believe
they will serve the Nation well. Congress could help by
appropriating annual funding and authorizing language so that
the forecasting center can endure as a permanent capability.
In conclusion, although the currently circulating variants
complicated our course through the spring months, we are now on
track to regain control of the pandemic in the United States.
Continued vigilance to current and future variants is essential
to ensuring that we maintain our current encouraging
trajectory. We must expand our genomic surveillance efforts
domestically and work with partners and allies abroad to ensure
global coverage. The United States is a world leader in science
and technology, and we have the opportunity using those
capabilities to lead the world through the rest of the
pandemic. Thank you.
[The prepared statement of Dr. Rivers follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairman Foster. Thank you. And at this point we will now
begin our first round of questions. So the Chair will recognize
himself for five minutes.
The first question is what I hope is sort of a simple
question on the public health significance of new viral
strains. Dr. Rivers, you note in your testimony that B.1.1.7
has gone on to become dominant in the United States,
constituting perhaps 60 percent of our current cases. So my
question is does that mean that if this variant had never
existed that we would have 60 percent fewer cases in the United
States today or is it more complicated than that? You know,
should we think about these as, you know, each new strain is a
whole new disease circulating in our population or are there
things like, you know, cross-immunity that really muddy the
picture here? And how should we think about this?
Dr. Rivers. Yes, thank you for that question. It's not the
case that we would have 60 percent fewer cases. What it means
for a variant to be more transmissible is the tools we have,
particularly around masking, distancing, ventilation, have to
be adhered to even more closely in order to be effective
because the virus passes more easily between people. The
increased transmissibility is seen across a number of variants
of concern and interest, and it makes it more difficult for the
variants to be--the virus to be controlled and slowed.
Chairman Foster. OK. And so in the modeling do you model
it as just one virus with a range of infectiousness or do you
independently model the frequency of each strain in the
population? I guess maybe that gets at my question.
Dr. Rivers. There are several different approaches
depending on the question you would like to answer. When
producing a forecast, you would increase the infectiousness or
the transmissibility, and so you would have a better sense of
the new trajectory given the variant. If you would like to know
how competing variants might unfold over time, it would be a
different approach, but that is also a question that can be
answered using modeling approaches.
Chairman Foster. Thank you. Dr. Abdool Karim, in your
prepared testimony you gave a great overview of how the known
variants have affected disease severity, transmissibility, and
treatment efficacy, and as well as natural and vaccine-induced
immunity. I think that addressed a lot of questions and
concerns that I have as we see new variants pop up, but, you
know, how--could you say a little bit about the difference
between how variants will evolve before you have the population
vaccinated or at least partially vaccinated versus after you've
got a big part of the population vaccinated? You know, what
fraction of the danger from a vaccine-induced mutation, what
fraction of the woods are we out of in that--in regards to
that?
Dr. Abdool Karim. Thank you very much for that question. I
think you're getting to one of the difficult areas that we
don't have data, and so I what I'm going to tell you is
speculation to some extent. What we understand now is
immunocompromised individuals are playing an important role in
the generation of variants, and so as the virus is spreading at
a higher rate, we are enhancing the risk of seeing new
variants.
When we have a vaccinated population, if a vaccinated
individual or an individual who has had past infection or an
individual who is receiving monoclonal antibodies has a virus
that's evolving to create a variant, then that variant has a
higher likelihood of escaping that immunity, and so that's our
concern that as we get to higher levels of vaccination, the
individuals who are immunocompromised that may lead to the
emergence of new variants would be those at risk of creating
variants with vaccine escape--ability to escape vaccine
immunity.
Chairman Foster. And are we in a situation now at least in
the United States that when we see what are called these
breakthrough cases where you get vaccinated and nonetheless get
COVID, are those of enough special interest that at least those
are completely sequenced to see if we're seeing those as the
source of new vaccine-resistant variants?
Dr. Abdool Karim. So there are several programs underway,
and many of the companies themselves as part of their clinical
trials have been sequencing the viruses that constitute escape
and also they want to measure the antibody levels at which
escape is occurring. And the most recent published paper in the
New England Journal of Medicine showed that two of the variants
that had been sequenced and studied in detail that caused
breakthrough infections, that they were variants with escaped
mutations. So I think what we're going to see in breakthrough
infections is a combination of normal viruses that are just
escaping because immunity is low and others that have escaped
mutations that enable them to bypass the immunity or at least
partially bypass it.
Chairman Foster. And beautiful timing on ending your
remarks as the timer goes to zero, and I will now recognize our
Ranking Member, Mr. Obernolte, for five minutes.
Mr. Obernolte. Well, thank you, Mr. Chairman, and thank
you to all of our panelists. It's been a fascinating hearing.
I am very interested in what we can do as a Federal
Government to change policy to make the process of identifying
these variants and combating them more cost-effective and
efficient. So, Dr. Grubaugh, I had a question for you because
you talked about different policy changes that can be
contemplated along those lines. And one of the things that you
mentioned is giving data generators the first right to publish,
which seems to me to be counterintuitive because, you know,
wouldn't that slow the spread of information? We want to speed
that up. So what could we do to help that?
Dr. Grubaugh. Yes, thank you for that question. It's a
really complex area in public health. I think if data being
generated by a public health lab and for the sole purpose of
public health, then it makes sense just to make that free and
open. In the United States we have a lot of data that are not
being generated by public health labs but by academic labs that
cost somewhere between, you know, $100 and $200 to sequence a
virus genome. And when you have an academic lab whose first
order of business is to support students and postdocs that need
to publish to go on with their careers, if they're spending a
lot of that time then giving the data away for free, then that
can become problematic for those who actually need it.
Now, in my lab I am open data, open resource, open
everything, and we're sort of in a privileged situation that we
can make everything available. And if we get scooped on that,
then we have other things to help make sure that our students
get papers. But other people may not be in those privileged
situations, especially in the low-resource countries where
maybe they can't quite survive--a lab may not be able to
survive having their data be poached by high-income countries.
So it becomes a really complicated scenario, one that there's a
national and global debate right now, and I hope that I
answered your question.
Mr. Obernolte. OK. Thank you. I would hope--we all would
hope that at some point the greater good of sharing information
to combat something which is an existential threat to humanity,
you know, could prevail over parochial interests, and so
anything that we can do as a government to stimulate that I
think would be a good thing.
Dr. Karim, I found your testimony particularly
interesting, and I wonder, you've testified that some variants
such as the recent B.1.351 variant have proven to be
problematic for some vaccines. And so, for example, vaccine
efficacy of vaccines like AstraZeneca has been much lower
whereas vaccines like the Pfizer vaccine and the Johnson &
Johnson have not been as effective. So could you tell us a
little bit more about why that is, why some vaccines are
affected more than others and what we can do to improve that?
Dr. Abdool Karim. Yes, thank you for that. So we don't
fully understand why some vaccines are differentially affected
and others are not, but I'll give you one of the possible
reasons that might explain that. The mutation that occurs in
position 484 is a particularly important mutation. Naturally
when--in the pre-existing variants the position 484 has an
amino acid that is negatively charged. The human cell at that
point is also negatively charged, so the pre-existing variants
have a bit of propulsion because of negative versus negative.
However, when the mutation occurs, the virus becomes positively
charged, so that enhances the ability of the virus to attach to
the cell so it becomes more difficult for antibodies to
displace it. It's what we refer to as electrostatic charge is
impacting on that.
So the way in which the vaccine immunity can displace one
that has more affinity is differential by the different
vaccines, and that's probably the key explanation why the
AstraZeneca vaccine is pretty much--has no efficacy against
mild to moderate disease against B.1.351, whereas Pfizer at
this point has 100 percent efficacy. And we only know this
because both the trials were done in South Africa.
Mr. Obernolte. Right. Well, thank you very much. I find
that fascinating. One last question for Dr. Streiffer. A couple
of our panelists have expressed the need for faster and less
expensive whole-virus genome sequencing. What can we do as a
Federal Government to make that faster and less expensive?
Because it seems very central to our ability to fight these
virus variants.
Dr. Streiffer. You know, one example of that is really
fascinating right now is actually wastewater testing. So a lot
of the genetic information is actually coming from patient
samples where you're tying that back to a specific patient.
What's actually been very efficacious at least in high-income
countries is the idea of actually doing pooled sampling from
wastewater and then sequencing everything in that wastewater.
And that gives you more of a shotgun approach to be able to
understand everything that's coming out of the community and
the ability to be able to detect variants well before they
present through clinical patient testing. And it's got some
limitations, but that's one way in which we could do something
that's much cheaper.
I think Dr. Grubaugh also indicated some ways where you
can actually design diagnostic tests that are simpler than the
full genome sequencing but still allow you to sample variants
in a way that gives you more visibility than the standard
clinical testing, and that's a very important area to pursue.
Mr. Obernolte. Well, great. Well, thank you. I've got
about a dozen other questions, but I see my time's expired, so
thank you to all of our panelists. And, Mr. Chairman, I yield
back.
Chairman Foster. All right. It looks like we will have a
shot at another--second set of questions if there--if interest
is retained.
And I'll now recognize the Chairwoman of the Full
Committee, Ms. Johnson, for five minutes.
Chairwoman Johnson. Thank you very much. Dr. Karim
Abdool--Abdool Karim, the rollout of the vaccine to many and
the much-needed light at the end of the tunnel of course we
think after a year waiting and hoping that we've gotten there,
the CDC has gradually upgraded its guidance on measures such as
social distancing, mask wearing as vaccine uptake in the United
States increases. However, we are still falling short of
achieving herd immunity in this country and globally. How
important are the behavioral measures in preventing the spread
of the virus while we remain under the threshold for herd
immunity? And what current state of science regarding the
ability of the vaccinated individuals to asymptomatically
infect nonvaccinated people?
Dr. Abdool Karim. Thank you very much, Chairwoman Johnson.
So let me try and answer the first question, which is that we
vaccinate individuals for two reasons. The first is for
individual benefit. I get a vaccine so I benefit in that I
don't get severe disease or I don't get infected at all when
I'm exposed. The second reason we vaccinate is we want
population benefit. We want to slow the transmission of the
virus. Now, we can only do that with vaccines if a person who's
vaccinated does not transmit the virus because if a person who
is vaccinated who gets infected then transmits the virus, then
we undermine our ability to achieve herd immunity. So far, the
preliminary data--and it's pretty--it's very preliminary--
suggests that transmission rates are dropped in individuals who
are vaccinated, but we do not yet have definitive evidence
because those studies are hard to do.
The second issue--the second question you asked me is
about how important it is that we maintain our
nonpharmaceutical prevention measures while we are vaccinating.
It is critical because vaccines on their own are not able to
achieve herd immunity or to slow transmission on their own. We
do need to maintain those.
When we start nearing levels of herd immunity with vaccine
coverage only, I think what we will then see is a change in the
number of restrictions that will be required, and many of the
individual restrictions will be replaced by broader
restrictions such as avoiding mass gatherings where the risk is
high, but for the individual restrictions, we can expect that
some of those will be eased, and the CDC has been doing that in
a systematic, slow way at the moment.
Chairwoman Johnson. Thank you very much. Mr. Chairman, I
yield back.
Chairman Foster. Thank you, and I will now recognize our
colleague from Florida, Mr. Posey, for five minutes.
Mr. Posey. Thank you very much, Chairman Foster and
Ranking Member Obernolte, for holding this hearing.
Discussing the variants of COVID-19 is very important to
our work of defeating this virus and understanding its dangers
and history. Dr. Streiffer, in 2003 it appears the first SARS
epidemic, SARS-CoV, was beginning to spread, and the virus was
mutating rapidly as it adapted to humans. But it appears once
it became more contagious, it became more stable and stopped
mutating so quickly.
COVID-19 or SARS-CoV-2, appears to have been remarkably
stable since it first emerged in 2019 in Wuhan. It never
appears to have had the same period of rapid mutation that was
seen in the 2003 SARS outbreak. Each witness obviously is very
interested in the variants, but I wonder if we are as curious
about the missing links for earlier variants of COVID-19 that
we would have expected to have seen just after the emergence of
a new virus. Can staff bring my pictures up now?
[Slide follows:]
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Mr. Posey. This is from a preprint paper, and figure 1
shows mutations in early stage SARS in blue and then the late-
stage SARS in yellow. Figure 2 shows the mutations in COVID-19.
Bigger spaces between those dots would appear to this layperson
to indicate greater mutations in the virus. And obviously, the
two figures are very different from each other, and in fact the
red COVID, COVID-19 looks a lot more like the yellow late-stage
SARS. The original SARS is known to be a nationally emerging
virus, and it mutated rapidly when it did emerge. COVID-19 on
the other hand did not have the same rapid mutations. So my
question, Dr. Streiffer, based on your expertise, how would you
explain why figure 2 does not have the early mutations that we
see in figure 1?
Dr. Streiffer. So just to jump in--and sorry, I apologize,
I moving screens around so I can actually see the figure. I'm
actually paying attention. So I think virus evolution is always
a careful balance between trying to infect the host, replicate,
and do that in a way which is efficient but not actually kill
the host. And one of the things that you'll find is that
vaccine--viruses rather are actually too aggressive they cause
too much fatality and will actually damp out very quickly, so
you do see an enormous amount of difference in the rate at
which viruses mutate and the patterns that you see in those
mutations.
And I think that's reflected here. I think these are both
natural viruses. I think the difference in the mutation rates
is a reflection of the different epidemiology, the way in which
the initial pandemic's played out, and then just the natural
differences in the virus.
And Dr. Abdool Karim and Dr.--excuse me, I'm going to get
my name wrong--Dr. Grubaugh could probably comment very
eloquently on this if they'd like to follow up with that,
although, of course, it's the Member's prerogative.
Mr. Posey. I'd be delighted for the follow-up. Thank you.
I yield.
Chairman Foster. Thank you. The gentleman has yielded his
time for----
Mr. Posey. I was going to yield to the witness to answer
that Dr. Streiffer recommended.
Dr. Grubaugh. I can answer for a minute. So, one, each
virus is a little bit different, and especially when we have
viruses that emerge from animals and to people that they're at
different stages of being able to adapt and spread within
people. And so there's--it's always hard to compare apples to
apples when you have different events that are happening.
Also, evolution is not just dependent on adapting to the
host. There's other things in play such as the re-transmission,
some other inherent factors, the types of therapeutics that are
used, so it's a really complicated factor.
And I would say that with SARS CoV-2 we did see early
adaptation to humans. We had the D614G mutation that rapidly
spread around the world, and then now we are seeing the
emergence of many new variants that are happening. And also
just to say that the pandemic with SARS-CoV-2 is really
unprecedented in terms of the number of infections. It's
evolutionary patterns with the emergence of several variants
that have many mutations that are acquired in a very short
period that I would just say it's very difficult to compare
this to really anything else because we haven't seen anything
quite like this.
Mr. Posey. Thank you very much. Mr. Chairman, thank you. I
yield back.
Chairman Foster. Thank you. And, yes, the--I believe the
gentleman's line of questioning touched on a very important
issue, which is trying to understand what we can about the
origins of this virus. And, you know, this is a subject of very
serious scientific debate among serious scientists about what
constitutes evidence in various directions. This Subcommittee
on Investigations and Oversight does intend to have a hearing
on the origins of the SARS-CoV-2 virus in the near future.
And I will now recognize our colleague from California,
Dr. Bera, for five minutes.
Mr. Bera. Thank you, Chairman Foster.
I know that, you know, that tracking variants and making
sure we're data sharing is something that we've been incredibly
interested in--along with Senator Tammy Baldwin from Wisconsin,
we introduced the Tracking COVID-19 Variants Act asking for $2
billion to go to CDC. We were able to get $1.75 billion into
the American Rescue Plan, so hopefully, that's a first step, as
well as indicating to the CDC to talk about the issue that I
know--I think we've talked to Dr. Rivers about data sharing and
how we, you know, link public health and academia and data
sharing.
I'm going to put my doctor hat on and just, you know, when
I think about the variants that we're seeing in India, you
know, also some of the variants that we're seeing in Michigan
or some of the cases that we're seeing, it does seem like, you
know, younger people are now being infected more rapidly, as
well as being hospitalized. And I don't know if that's just
epidemiology that younger folks are less vaccinated and thus
are susceptible, and maybe, Dr. Karim, you know, since you're
on the frontline in South Africa, you could tell us what you're
seeing on the ground in terms of hospitalizations of who is
being infected right now.
Dr. Abdool Karim. Thank you for the question. Yes, you're
quite right. It's a matter of epidemiology. And we saw that
certainly in the second wave in Brazil, South Africa, and in
India, that in the second wave, because the virus has a higher
transmissibility, it infects a lot more people quickly. The
number of younger people in those populations is high, and so
even though it's a smaller fraction that will actually get to a
hospital, so many of them became infected that
disproportionately there were larger numbers of young people in
hospitals, so it's just a function of the way in which the
rapid transmissibility infects such a high proportion of young
people that we begin to see more young people in hospitals. And
that's been described quite well in all three settings. And
it's a similar issue with the B.1.1.7 variant, that it causes
many young people to get infected, so that's why
disproportionately we start seeing more young people in
hospital. You're quite right.
Mr. Bera. And, you know, for any of the panelists, as we
think about that then, you know, I think many of us in the
medical community were surprised that India, Sub-Saharan
Africa, et cetera, weren't severely impacted in the first wave
a year ago, and some of us thought that, well, it's a younger
population so they had subclinical infections, et cetera. Now
our concern is that we're seeing these variants spread more
rapidly with younger population, what this may do in Sub-
Saharan Africa that also speaks to a younger population. Is
that a legitimate concern? And, you know, obviously we're
seeing the overwhelming infections in India. And how should
we--outside of rapidly getting vaccinations to these
populations, how else should we think about it? And, again, I'm
happy to let--or Dr. Karim, if you want to answer that one as
well.
Dr. Abdool Karim. Sure, I'll start with an answer. I have
spent the last several months trying to answer that question.
That's because we all predicted that Africa would have a really
severe epidemic, but it didn't come to pass, and so there was
some hypotheses that were proposed. And I have looked at nine
of the different hypotheses, including temperature, including
age, and so on.
I think in summary I have found that there is no specific
protection that Africans have. There's nothing in their
lifestyle, there's nothing that they've got genetically that
gives them any protection that I have been able to find.
What is most clear is that the young populations that we
see in Africa, the very small fractions of the population that
are above 60 means that a large number of people who are
getting infected are getting infected asymptomatically, and so
the reporting has been--you know, they don't report those cases
because they don't know about those cases. In addition, most of
the countries in Africa went into very severe lockdowns
initially, so that's why the first waves weren't that bad. But
now they're being caught in the second wave and the variants
where many countries in Africa have much more severe epidemics.
So variants, age, and implementing nonpharmaceutical
interventions early played that role in why I think Africa did
not see a severe epidemic. And I'm sure my colleagues may have
something to add. Thank you.
Mr. Bera. I see I'm out of time. Hopefully, we'll have
that second round of questions.
Chairman Foster. And we plan to. And now, despite the fact
that he is not a doctor but merely holds a master's degree in
biochemical engineering, the Chair will now recognize our
colleague from Illinois, Mr. Casten, for five minutes.
Mr. Casten. Oh, you're far too kind. It's nice to be one
of the non-nerds in this group.
I really want to thank you all for being here. Thank you
to our Chairman for pulling this hearing together.
The--Dr. Abdool Karim, I want to start with you and I
think just give us a chance to have a little bit of a--just a
few quick public service announcements. The--you know, we are
fortunately going from a point in our country where we shifted
from having more demand than supply for vaccine to, you know,
starting to see the opposite and, you know, daily doses
administered have fallen off in the last month or so and
starting to sort of get to that harder more vaccine-hesitant
community.
I want to start with a public service announcement of my
own. My 16-year-old daughter is getting her second dose in two
weeks, and my 14-year-old daughter has just registered for her
first dose tomorrow, so what's good for us is good for--and
hopefully everyone will follow.
But, Dr. Abdool Karim--and you mentioned this before, but
just a couple quick yes or noes. To the best of your knowledge
are the Moderna, Pfizer, and J&J vaccines currently available
to Americans effective at preventing the worst aspects of
COVID-19?
Dr. Abdool Karim. Yes.
Mr. Casten. To your knowledge are they all generally safe?
Dr. Abdool Karim. Yes.
Mr. Casten. To your knowledge are they broadly effective
against all of the common variants of COVID-19 that are
circulating in the United States?
Dr. Abdool Karim. I can't answer that exactly, but they
are effective against most of the common variants. They haven't
been tested against, for example, the Indian variant yet, the
variant in India.
Mr. Casten. OK. Well, there's--is there any good reason
for any American, unless their doctor tells them otherwise, not
to go get a vaccine?
Dr. Abdool Karim. No.
Mr. Casten. OK. Well, that's an easy one.
Let me then move on to something a little bit more deep in
the weeds. And you alluded to some of this in your conversation
with Chairwoman Johnson. Early on I think we were all concerned
about what is the likelihood of asymptomatic spread and how do
we know about that and how do we think through that. Have you
seen anything in the data to suggest that the risk of
asymptomatic thread is--excuse me--asymptomatic spread is
substantially different between vaccinated and nonvaccinated
populations?
Dr. Abdool Karim. We don't have empiric data, so I'm going
to speculate based on what we have been seeing in terms of the
viral load that's in the swabs that are taken from the nose.
When we look at the swab--the amount of virus that's in the
swab, vaccinated individuals who do get infected have lower
levels of the virus in those swabs. So we would think that that
translates into lower transmission, but I don't have clinical
evidence. That laboratory evidence is certainly suggestive that
vaccination means lower levels of transmission.
Mr. Casten. And what about for folks who have, you know,
tested positive for COVID and may have developed some degree of
natural immunity? How would you put that population in amongst
the vaccinated versus nonvaccinated?
Dr. Abdool Karim. So individuals who have had prior
infection generally have some level of protection to new
infections even if they are variants. And the level of
protection that's provided is at this point most likely in
terms of the severity of infection, so they may be able to
transmit, but we think that they get less severe disease. The
empiric data for that is still preliminary. Only--there's only
one study I've seen it, and that's of a small number that
suggests that.
But in terms of transmission, an individual who's been
infected gets reinfection, we don't know about their risk of
transmission. I can't answer that question.
Mr. Casten. So I--and I realize I may be getting into
small subsets of data, but if--you talked about viral loading
as being your sort of estimate of why this might change. If you
have experienced COVID but not been vaccinated versus
experienced COVID and have been vaccinated, is there a
difference in the viral loading of those two populations? I
mean, what I'm trying to get at is do we expand herd immunity
more greatly by making sure that even if you've had a bad case
of COVID and you still get vaccinated, do you reduce your risk
of asymptomatic spread at least theoretically?
Dr. Abdool Karim. There's a big difference. If we look at
vaccinated individuals, especially when they've been vaccinated
with an mRNA vaccine, the antibody levels are really high. They
are extremely high. They are at the highest levels that we see
with natural infection, as opposed to natural infection where
the antibodies are much lower. And when you deal with variants,
higher antibodies are really important, higher levels of these
antibodies, so there's no question that vaccination is a big
advantage compared to natural infection in terms of risk of
reinfection.
Also, that when you've had natural infection, if you've
had asymptomatic natural infection, the antibodies disappear
quite early, within three, to four, five months, and so we see
lower levels of antibodies with asymptomatic infections in
natural infections, but with vaccines, it's consistent.
Everybody gets high levels of antibodies.
Mr. Casten. It's fascinating. And I'm unfortunately out of
time. I have more questions, but I really appreciate your time.
I yield back.
Chairman Foster. Thank you. And I will now recognize our
colleague from Colorado, Mr. Perlmutter, for five minutes.
Mr. Perlmutter. Thank you, Dr. Foster. And I guess I want
to start with a question that was posed early on in this
process, and that was sort of Sweden's approach toward herd
immunity by, you know, just sort of going on with their lives
compared to surrounding Scandinavian countries. And this is to
the whole panel. You know, I haven't seen much in the news
about Sweden and its herd immunity and whether or not it's
facing any new challenges given these variations. So, Dr.
Rivers, why don't I start with you if you have any--or anybody
who wants to jump in on that one.
Dr. Rivers. Sure. I can't speak to the latest situation in
Sweden as I haven't followed up on their current status, but I
will note that their early strategy of allowing the infection
to spread in hopes of achieving naturally acquired herd
immunity was changed over time, and they did go on to adapt
more restrictive measures in order to slow the spread because
they saw that their hospitals were becoming overwhelmed. And so
I think that our early perception of how Sweden managed the
pandemic was something that evolved to look more in line with
the measures that many other countries took. But I'll see if
any of my colleagues know the latest on Sweden.
Mr. Perlmutter. Anybody else?
Dr. Abdool Karim. I can perhaps just comment briefly. I
just did a webinar with Anders Tegnell, who is the chief COVID
scientist in Sweden, my equivalent there, and he went with this
initial approach, which is--actually was promoted by a group of
scientists in--across the oceans both in the United States and
the U.K. under something called the Great Barrington
Declaration. And their hypothesis was if you let the virus run
wild in younger populations, natural infection will provide
immunity and herd immunity. Well, it's been shown now that that
simply is not true, that in fact what happens is when you end
up with large numbers of infections like that, the older people
do get infected and you get the situation of high numbers of
death. And Sweden saw that and so had to make those changes.
And Sweden, by the way, still doesn't promote mask wearing, but
that's a separate discussion. It's not related to this.
Mr. Perlmutter. All right, thank you. Yes, I mean, what--
you saw the initial, you know, reports was, you know, Norway
had a much smaller incidence than Sweden as Sweden was trying
to, you know, develop herd immunity. They were having a lot
sicker people and deaths compared to their next-door neighbor.
So--OK. Thank you.
Now I'm going to ask more personal questions because, Dr.
Rivers, I'm one of those 32 million who was infected. And, you
know, my curiosity is more in these variations. You know, we've
talked about two things, how transmissible it is and how severe
the new variations may be. So, you know, one thing we haven't
talked and I'd ask the Chair and the Ranking Member that we
also take a look at sort of the long-term effects of this
disease. And, you know, we do know that there are issues that
linger. So in terms of the severity of some of these new, more
transmissible viruses, what are we seeing in terms of the
effect on people's health? Is there something that, say, in the
South African variation is more dangerous in terms of health or
is it just because it's more transmissible? So, Dr. Grubaugh,
why don't you--I don't know if you want to jump in on that or
if that's something you've been thinking about or anybody else.
Dr. Grubaugh. I'll just quickly start, and I believe Dr.
Rivers probably has some points to make here, too. There is
some data from the U.K. that would indicate that the B.1.1.7
variant can cause more severe disease. It's not just more
transmissible. It's a really difficult thing to actually answer
because when you're--there's--you know, what has the most
impact on disease is actually host factors, age, comorbidities.
These sorts of things impact whether or not you're going to
be--you know, have more severe disease or not, much more than
the virus. So the virus could have some small impacts on that,
but we need really large studies to be able to measure these
sort of small changes.
Mr. Perlmutter. OK. Dr. Rivers?
Dr. Rivers. Thank you. I'll just add that there are three
levels of variant classification in the United States, variants
of interest, variants of concern, and the third is a variant of
high consequence. And the variant that causes more severe
disease would be classified as a variant of high consequence.
There are currently no variants that carry that designation,
and so that's not something that is currently circulating or
has been identified.
Mr. Perlmutter. Thank you. My time is expired. I yield
back.
Chairman Foster. Well, thank you. And at this point we
will now begin our second round of questions, and the Chair
will recognize himself for five minutes.
Dr. Streiffer, it was I guess about a year ago last week
the Science Committee held its first roundtable about the
Federal research enterprise and its response to COVID-19. And
we talked about the natural--National Virtual Biotechnology
Laboratory with Michelle Buchanan of Oak Ridge. And at the time
NVBL was only a few weeks old, and now with a year of
experience behind you, you know, there are serious efforts to
consider a permanent reauthorization of the NVBL both by--on
the part of our former colleague, now Senator Ben Ray Lujan, as
well as efforts in the House. And so with that year of
experience behind you, what are the observations that you might
have about the best practices on how to coordinate all of the
diverse Federal capabilities that were brought together in the
NVBL?
Dr. Streiffer. Thank you, Dr. Foster. It's a very good
question. I think some of the lessons learned from that is that
the coordination across the 17 laboratories through a central
body was actually very effective. And coordinating that
directly with the Department of Energy and then with each of
the agencies that's been involved in the national response is
crucially important. And I think one thing that's very
gratifying is the increased level of coordination that we're
seeing over the last several months in the Nation's response to
COVID-19.
I think also very importantly is that the National Virtual
Biotechnology Laboratory created a model that was very
flexible, very adaptive, and very fast to respond to the
issues, much different than we often think of the national
response framework, particularly when research and development
is concerned where those timescales are quite long. And with
that adaptability I think we're able to quickly pivot to the
most important problems at hand, maintain a focus on issues
that they--as they developed and move on from issues like
designing new ventilators as it became apparent that those were
not going to be as of a concern as they initially appeared to
be.
Chairman Foster. Thank you. And I guess my next question
is for any of the witnesses that might want to get to it. Do we
really have a complete picture of how this disease spreads? You
know, is it--for example, if it's airborne, is it a few large
droplets that someone sprays at you while we're talking and
gets inhaled deeply into the lungs or is it the ambient
concentration of very small viral particles when you walk into
a bar that's just had people in it for hours? How important is
direct ingestion of the virus compared to inhalation both
through the nose and directly into lungs? You know, what's the
model here? Is it every virus that gets into your respiratory
tract has the same probability, or are there certain
configurations that are dangerous? What's understood about
that?
Dr. Rivers. I can perhaps start. This is one of the areas
of our understanding of the virus that has changed
substantially over time. We--particularly because it's
difficult when people are in close contact to determine which
mode of transmission was actually the one that infected them,
but there's a growing understanding that the virus can buildup
in the air and that crowded environments, even if you are not
within 6 feet of someone, can be particularly risky. On the
other hand, our perception of fomite transmission or
contaminated services has gone down in the list and it is no
longer considered one of the primary modes of transmission. And
I would put even below that ingestion. So airborne and
respiratory are--excuse me, airborne and droplet transmission
are at the top of the list.
Chairman Foster. Any other comments? You know, one of the
reasons I bring it up is that the British are now apparently
going to go ahead and do experiments in controlled human
infection where they're going to be testing the efficacy
directly of several candidate vaccines, which is one of the
applications to very quickly get accurate measurements of the
efficacy, you know, months faster than you can with standard
clinical trials but also to get a better understanding of the
methods of spread. And this is one of the tools that, you know,
many people wish were available. You know, had we understood
the role--the small role of fomites compared to inhalations
on--early in the pandemic, we would be in a position to save
hundreds of thousands of lives. If you can have some questions
answered through those sort of experiments of direct human
infection, what are the questions you'd really like to have
answered in that kind of thing, or do you think that they won't
really in the end be that useful?
Dr. Abdool Karim. Perhaps I'll just add a quick comment if
I might. I think Dr. Rivers really captured the issues quite
well. We were initially taken with the wide spread of infection
on the cruise liners, and we thought that fomites were
important, but now it's becoming clearer and certainly in mice
experiments, mice in different cages are infecting each other,
showing the importance of aerosol transmissions, the very small
droplets that carry the virus. But I think the droplet spread I
think still remains probably, you know, the most important or,
together with aerosols, is the most important. So I think that
still remains our main focus, that having direct infection is
still quite important, and then aerosols and then fomites being
much more less important.
Chairman Foster. Well, thank you. And if there is some
best state-of-the-knowledge document that you could forward to
our offices, it would be very valuable for any of the witnesses
because it's--it matters a lot for policy obviously.
My time is up. I will now recognize the Ranking Member,
Mr. Obernolte, for five minutes.
Mr. Obernolte. Thank you, Mr. Chairman. This has been a
fascinating discussion, and I want to continue the discussion
along the lines of our ability to combat this kind of crisis in
the future because I think that when the dust settles, we put
this crisis behind us, and we do a postmortem, we're going to
realize how extraordinarily fortunate we were that the level of
antigenic drift of COVID-19 was not higher. So to prepare
ourselves for the future I think we need to really focus on the
lessons that we've learned here, on how the virus is
transmitted, and, more importantly, how it mutates and how
those mutations affect immune escape and the ability of the
vaccines we develop to react to it.
So to any of our panelists that want to comment on this,
how can the U.S. Government catalyze that kind of spread of
information? Because I think it's going to be vital to our
future ability to respond to these kind of crises.
Dr. Streiffer. So I'll jump in here. I'd also add in
addition to that one of the things we need to do is a much
better job of what you would refer to as international zoonotic
surveillance. So by the best scientific knowledge available to
us, this disease came to mankind originally from bats. What we
need to do is a much better job of understanding the viruses
that are out there that could cross the species barrier, sample
those, understand their threat, and track them as they move
through potentially the wildlife populations and into contact
with humans. That's something we need to invest much more in
globally.
Dr. Grubaugh. I'll jump in here, too, with this question.
So of course we--you know, the hope is that, you know, with
continued evolution and, you know, some level of transmission
of this virus likely for years to come, that we don't have
significant antigenic drift where this would significantly
impact our vaccines, but I think we need to be prepared for
that worst-case scenario. And the goal here would then be to
sequence, you know, first, you know, as many of the vaccine
breakthroughs as possible. I think these are really important
to do, and then maintaining this general surveillance that we
have on a yearly basis similar to what has already been done
for flu for a long time to help inform vaccines. I think this
is going to be one of the most critical areas as we go forward
and have some level where there's always going to be some
pockets of transmission probably at least for the next several
years and being able to stay on top of how the virus is
evolving and not having to respond from behind like we did
starting at the beginning of this year.
Mr. Obernolte. Right. Well, thank you very much to
everyone, and let me restate my opinion that more funding into
this kind of research is vitally important for us. I mean, it
might be a case of existential survival for us as a species to
make sure that we understand the threat that's out there and
the way that we as governments and as a world health community
can respond to it. So thank you very much, Mr. Chairman, and
thank you to our witnesses. I yield back.
Chairman Foster. Thank you. And we'll now recognize Dr.
Bera for five minutes.
Mr. Bera. Great, thank you. You know, maybe this is a
question for Dr. Karim. When we talk about the vaccines,
obviously, we talk about the efficacy of the vaccines. But each
of the vaccines, including AstraZeneca, seem to be efficacious
at preventing severe illness, hospitalization, and death. Is
that a correct statement?
Dr. Abdool Karim. Yes, against the D614G variant, pretty
much all the vaccines seem to be doing quite well in preventing
severe disease both in the clinical trials but more importantly
in the real world data that's now being collected.
Mr. Bera. OK. So, you know, while the AstraZeneca vaccine
is not as effective at preventing illness necessarily, it's
still, you know, an important component of our arsenal as we
try to vaccinate the entire world. Is that----
Dr. Abdool Karim. So that's a little bit more difficult.
So the studies that have been done with other variants, not the
D614G variant, so if you take, for example--I'll just--to
simplify just focus on the variant that was first described in
South Africa by us, the B.1.351, that variant, the studies that
have been done only included younger people in South Africa
with the AstraZeneca vaccine, so we know it doesn't work for
mild and moderate infections in the South African setting
against the B.1.351. The problem is we don't know if it
prevents and ameliorates severe disease because there were no
severe infections in the study itself.
And so there's only indirect evidence. There's only
speculation and, you know, using laboratory evidence to suggest
that maybe it will protect against severe disease, but there is
no clinical evidence. And so on that basis----
Mr. Bera. If I were to ask Dr. Rivers or any of the other
panelists--because obviously there's real-world evidence. You
know, many people have gotten the AstraZeneca vaccine. Are we
seeing those that have been vaccinated with AZ, let's say, in
the United Kingdom and Britain being hospitalized or dying?
Again, I have not seen anecdotal evidence that folks that have
been vaccinated with the AZ even in places where there's a high
prevalence of variants ending up dying? Is that--again, you
know, Dr. Rivers?
Dr. Rivers. I'm not sure that there is data available
describing what Dr. Abdool Karim is sharing about the clinical
evidence, but there are many places in the world where the
immune escape variants are not circulating. The B.1.351 to my
knowledge is not prevalent in many countries, and so the AZ and
similar platforms would still have value there.
Mr. Bera. OK. Shifting--a question that's, you know,
certainly--that I've been pondering since the beginning of the
pandemic is, you know, when I think about how hard New York
City was hit and then I think about Tokyo and how Japan, you
know, approached the pandemic, you know, with the older
population in Japan with mass transit systems, et cetera, you
know, it was quite remarkable that they escaped, you know, at
least in the first phase, you know, a similar impact that New
York City potentially possessed. And I would just be curious,
again, you know, this is the opinions of folks, obviously, mask
wearing has a significant impact and culturally, you know,
that's not taboo in Japan, and that was an issue--you know, the
politics around mask wearing in the United States clearly had
some impact. But is there a cross-immunity? You know, Japan,
Korea, other places probably did get exposed to SARS and other
coronaviruses in previous pandemics, and I would just be
curious, you know, why Japan or, you know, or some of the Asian
nations, you know, skirted the first phase of this, whereas we
got hit quite hard? Maybe Dr. Rivers or any of the panelists.
Dr. Rivers. The number of people infected by the SARS
pandemic in 2003 was quite small, and so I don't expect it
would contribute meaningfully to population immunity really
anywhere in the world. Several of the Asian countries were much
swifter and more aggressive in their response with--after the
emergence of the novel coronavirus, and I think that
contributed to their success. Japan focused very heavily on
contact tracing, particularly backwards contact tracing, and I
think that lent itself well to early containment. South Korea
was also very successful, Singapore. They focused very heavily
on diagnostic testing. They had a testing volume many times
over what the United States was doing at the time, which
allowed them to find cases. And so the overarching lesson for
me is that we need to be prepared to respond very quickly even
before we really can characterize and feel confident that the
threat is severe. If you fall behind, it's very difficult to
catch up.
Mr. Bera. And the impact of wearing masks in Asia versus
the United States?
Dr. Rivers. Certainly in many countries in Asia after the
2003 pandemic it became common to wear masks in the community,
and I--and many countries not only did they have them
stockpiled but people had them in their homes, and I think that
was very helpful as well.
Mr. Bera. Great. I'll yield back.
Chairman Foster. Yes, thank you. And I should also say in
my one experience on Tokyo subways, it was very crowded but
people were not talking, and I have never been on a New York
subway where there weren't multiple people mouthing off in
various ways.
And we will now recognize our colleague, Representative
Posey, for five minutes.
Mr. Posey. Thank you very much, Mr. Chairman.
The thing that alarmed me the most about COVID-19 in the
very beginning is when we got our first TV reports. They said
the damage to your lungs from this virus is unlike any others
that we've ever seen before, and it will not heal itself. It's
irreversible damage like neurological damage. You might stop it
from progressing, but you can never reverse all the damage it's
done. Of course, we've heard an awful lot of people have fully
recovered.
I remember talking to NASA (National Aeronautics and Space
Administration) Administrator Jim Bridenstine right after he
got tested, and he was sick at the time he got tested. And he
said the doctor called him and said what do you want first, the
good news or the bad news? And he said, well, give me the good
news. He said, well, you don't have COVID. He said, well, then
what's the bad news? He said, well, you've got the other virus
that's already killed 80,000 people. But I guess that other
virus didn't kill anybody after COVID came out. I guess it was
stopped in its tracks.
I was wondering, Dr. Streiffer, if the answer to my
question that I asked before, you mentioned that you would
expect to see this natural evolution, yet no one has presented
any evidence of the evolution of COVID in animals or humans
prior to the December 2019 outbreak. What do you make of that?
Dr. Streiffer. I think there's a general understanding
about the time that COVID-19 emerged as a disease in China. You
know, as we've discussed previously, I think there's still some
details about its origin that we don't quite understand. But I
think the path of the virus upon its initial detection and its
propagation around the world has followed more or less what we
would expect for a virus that at some level has hit that sweet
spot of being just infectious enough to spread, dangerous
enough that it's caught our attention, but not so dangerous to
kill so many hosts that it tamps itself down.
So, again, I would respectfully ask the Member to perhaps
call on Dr. Rivers or Dr. Karim or Dr. Grubaugh to add some
additional perspective on this. But I think we're seeing a
progression in the genetic evolution of the virus under the
pressures that we would expect from both nonpharmaceutical
interventions and how the vaccines are taking hold that is
within the spectrum that we would anticipate as scientists.
Mr. Posey. You know, I've had a lot of--and I'll direct
this to Dr. Karim. I've had a lot of constituents question
about taking the vaccination. You know, you mentioned a blanket
statement absolutely everybody should and there's no good
reason for anybody not to, but I've had people, well, what if
my sister has pneumonia? I mean, should she take it then? Well,
I mean, common sense would dictate no, but I'm not a doctor,
and there are people that have contacted my office, we've had
bad outcomes from vaccines before, and I'm sure you're probably
familiar with that. And I've just told people talk to your
physician about it. Your physician knows best of all if you
should get it, and I've had some sort of vaccine--hey, my
physician said not to do it. Well, I'm not going to argue with
your physician about that.
You know, I'm aware of the vaccine injury trust fund. I
don't know if you all are familiar with it or not, but when
people make these statements that vaccines are 100 percent safe
for everybody without exception, end of subject, you're an
idiot if you don't get vaccinated, the public is in large part
unaware of the vaccine injury trust fund, which is very hard to
access, has a 2-year statute of limitations on it. Most
pediatricians tell people they're crazy if they think their
kids were injured or whatever. That vaccine injury trust fund
has paid out $4.5 billion and hasn't paid for a lot of the
common bad outcomes that people suffer. So, Dr. Karim, just
your thoughts briefly on that?
Dr. Abdool Karim. Yes, thank you for that question. So I
think all vaccines carry some side effects, and so that's part
and parcel of what we live with. It's a question of the
benefits and risks. In my own clinic I have had two severe
reactions, one of which was very severe. The patient
hospitalized, demyelinating disease, and she happened to have
lupus, systemic lupus erythematosus. So she has a history of
this kind of problem, and she didn't do well with the vaccine.
I'm not sure if she actually got COVID, you know, she would
probably also have quite a severe form of COVID, but we can
never say that vaccines are 100 percent safe. There will always
be those effects, and we've seen with some of the vaccines,
clotting disorders. We've seen a range of others--I see them in
my clinic. But I also see all of the many patients with severe
COVID in my clinic, and I've got, you know, several patients
with long COVID, and I can't tell you how debilitating it is.
I'd rather you put up with the side effects and, you know, the
antigenicity of the vaccine than have to deal with long COVID.
I watch it and I shudder.
Mr. Posey. I see my time is up. Mr. Chairman, thank you
very much. I yield back.
Chairman Foster. Thank you. And we will--finally, we will
now recognize our colleague from Colorado, Mr. Perlmutter, for
five minutes.
Mr. Perlmutter. Thanks. And what Dr. Karim was just
talking about is--I think should be another panel on the long-
term effects of this and the potential costs associated with it
because they do exist, and they are debilitating and--for some.
So my question is--let's start with Dr. Karim. When you
were talking about immunoescape, you also mentioned people who
are immunocompromised were more likely to have the virus do an
immunoescape. And so can you tell me what you mean by
immunocompromised and then the immunoescape? I wasn't quite
sure I got it.
Dr. Abdool Karim. Sure. So when the person gets naturally
infected, the body's immune system goes through three steps--
well, there's many steps but just to make it simple, an innate
immunity and then you get the B cells and the T cells
responding, so those are the three parts. In somebody who is
immunocompromised, let's say, somebody who has got cancer and
is on immunosuppressive treatment, they don't follow those
three steps, and so they can't bring the virus under quick
control. Their innate response is first and foremost your first
line of defense, and it brings the virus under some control
quickly. So if you don't do that, the virus continues to
replicate for months and months and months. And it remains
viable all those months. And as it's replicating in the
presence of antibodies against the virus, the virus itself will
start mutating. So these antibodies are not killing the virus,
but they are exposing this virus to what it needs to bypass.
And so that's what the problem is.
And so when we see--there's a superb paper in the New
England Journal of Medicine, and that paper shows in the cancer
patient over a period of four months how the virus
systematically evolves and changes itself to bypass the immune
response. And so that's--those are the individuals seem to be
an important group in creating these shifts where these new
variants are emerging.
Mr. Perlmutter. Thank you. Anybody else? Or I'm happy to
yield back to the Chair. I appreciate that answer. Dr.
Grubaugh?
Dr. Grubaugh. Yes, I'll just add onto that. I think Dr.
Abdool Karim's explanation was really fantastic. And from the
evolutionary perspective when we see natural infections and
transmission so acute infections and then you transmit to
somebody else and you look at that over the course of four
months or so, there's about one to two mutations that are
incorporated into the virus per month. When we look at some of
these long infections, either, you know, some level of
immunocompromised, obviously, that's a huge sort of range of
things, it could be somebody who had an organ transplant and
they're on immunosuppressive drugs, it could get somebody who
has AIDS, cancer, right, a lot of different ways. And when the
immune system can't quickly just clear the virus and it's left
in some sort of middle state, it provides a great selective
advantage. And that's where we see these new mutations rising
quicker than what we would have in just natural--you know, a
person-to-person acute transmission.
The other thing that happens that we see is the virus
responds really quickly to some of our drugs and monoclonal
antibodies. And if they're not completely suppressing the
virus, it gives an opportunity again for the virus to adapt. So
we end up with these--during these prolonged infections in
immunocompromised individuals we see some of those exact same
mutations that we find in variants of interest and variants of
concern.
And so one of the hypotheses is that some of these
variants that all of a sudden acquire, you know, 10, 20
different mutations and many of those occurring in the spike
protein where we're really concerned with, that some period of
time later in infection when you have the viremia that goes up,
they might be transmitting to other people, and therefore, you
have these sort of jumps then of viruses that are adapted to
humans. I mean, that's one of the hypotheses here. And then,
you know, these events are still probably pretty rare overall,
but when you have millions and millions and millions of
infections that have happened that--and these jump and then
they're more transmissible, I think that's one of the
explanations for what we're seeing for the rise of many of
these variants.
Mr. Perlmutter. Thank you to this panel. You guys really
are--have been educating me, and I appreciate it. I yield back
to the Chair.
Chairman Foster. Thank you. And before we bring this
hearing to a close, I want to myself thank our witnesses for
testifying before the Committee today. And for those Members
and witnesses with time, at the close of the hearing we can
just hang around for some informal discussions as we often do
following in-person hearings.
The record will remain open for two weeks for additional
statements from the Members and for any additional questions
that the Committee may ask of the witnesses. And this hearing
is now adjourned.
[Whereupon, at 11:41 a.m., the Subcommittee was
adjourned.]
Appendix
----------
Answers to Post-Hearing Questions
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
[all]