Transcripts For CSPAN Infectious Disease Experts Testify On Coronavirus 20240713

This hearing will come to order. Without objection the chair is authorized to declare recess at any time. Good morning and welcome to the hearing on coronavirus, understanding the spread of the Infectious Disease and mobilizing Innovative Solutions. I will recognize myself for an Opening Statement and then i will recognize the Ranking Member for his Opening Statement and i will introduce the witnesses. Again, thank you for being here. Obviously this is an incredibly timely process. Covid19 is not the first pandemic we are ever going to deal with and certainly not the last one but it is incredibly important that we come together as a nation and as a planet and get ahead of this and address it and come up with treatment for it. If we think about Global Health security to threepronged approach. Containment, mitigation, and treatment. This is the third hearing that im chairing on the subject and the hearing is focused on the containment. It was the first hearing the congress held. The conclusion of that was the initial strategy of trying to contain this disease with travel bans, etc. , was likely not going to be successful. Very difficult. What china did was ambitious and bought us some time but most of this in the Public Health world and im a physician by background in a large Public Health system recognize we have likely seen committee cases that would be difficult to stop the threat of this disease. The second hearing we had last thursday was on mitigation. Largely looking at testing, and this was last thursday after the First Community spread case hit my hometown of sacramento where a patient was hospitalized at the university of california davis Health System where i used to practice. What we discovered was the testing criteria were probably too rigid, that we were missing a lot of community tests, and we also started to discover the ability to test folks, the availability of test kits, etc. Was largely not there. I am pleased to share with the Vice President yesterday and things are ramping up. But we probably didnt lose quite a bit of time, and we are likely going to see many more did lose quite a bit of time, and we are likely going to see many more Community Cases probably in all of our congressional districts. So, there is a lot to be learned from the bureaucratic breakdown that prevented us from rapidly getting those tests out there. Todays hearing is focused on treatment based on science and what we can learn from how the virus initially developed, what we can learn from looking at the chinese response, we now have a big data set, how did they manage folks . China is a communist country so they were able to do things that we cannot do as a democratic nation. We respect individual rights and individual freedoms here, but there is still a lot we can learn from how they did surveillance, etc. Especially given the breadth of Contact Tracing we are likely going to do based on the community pieces that we are going see you cross the United States. We will not have enough epidemiologists, the cdc will not have enough personnel, so what can we learn and how china and korea if you are looking at the data coming out of korea now, their aggressive approach to testing and communitybased testing, they were doing 18,000 tests a day, may have actually mitigated and reduced how bad the response could have been. So i think that is going to be incredibly important. We are also going to look at the science of how is it spread and how efficiently is it spread. How long can this virus live on inanimate objects. I think this is an incredibly timely hearing. This is a Science Committee so i am glad we are looking at the science of this, the Science Basis of treatment, and i appreciate the witnesses here, bringing their scientific expertise to help us better understand this disease. With that, the chair recognizes Ranking Member mr. Lucas for his Opening Statements. Good morning and thank you for holding this important hearing as we deal with an emerging and rapidly evolving situation with the spread of coronavirus, covid19. According to the centers for Disease Control at this time most people in the United States have little immediate risk of exposure to the virus. However Public Health experts , advise us a pandemic is likely, so we must gather the facts and be prepared. Today i hope our expert witnesses can provide expert expert Important Information we can share with our constituents. I also hope we can learn what tools are needed to detect and predict and prevent the next pandemic. Covid19 was first identified in wuhan, china in december of 2019. Since then, the World Health Organization has reported over 90,000 confirmed cases and over 3000 deaths throughout 76 countries. In the United States, the cdc has reported at least 152 confirmed cases and 11 deaths. We know that for most individuals the illness is not serious, but we are getting information on the death rate. The impact on vulnerable populations is particularly concerning though, and my thoughts are with the individuals and families who have been affected. This is not the first Global Pandemic in modern times and im quite certain it wont be the last. Just over 100 years ago the world faced one of the deadliest pandemics in history. The avian flu pandemic, also known as the spanish flu. It killed an estimated 50 Million People worldwide including over 600,000 people in the United States. Since 1980, outbreaks from emerging Infectious Diseases have been occurring with greater frequency and have been causing higher numbers of human infections than in the past. The vast majority of these infections are initially caused by the spread of the disease from animals to humans. The sars in 2003 outbreak and the sars outbreak in 2003 and the avian outbreak in 2006 were wake up calls to the american Public Health system. And congress made considerable investments in improving our nations capacity to detect and respond to pandemics. We would be in a much worse position without those investments. Im confident that the u. S. Government has the tools necessary to deal with this. We have the best scientists in the world with nih, the cdc, and in our universities. Their work has yielded considerable advancements in health technology, disease surveillance, and predictive modeling, as well as medicine, drugs, and Vaccine Development. Technology like Artificial Intelligence and greater availability of data, researchers are able to identify and track outbreaks faster. We also modernize the pandemics preparedness act to set up a framework to deal with precisely this type of outbreak. While significant progress has been made, gaps remain, and the severe pandemic like the Novel Coronavirus could be devastating to the global population. As the human population has grown, so has the livestock, swine, and poultry populations needed to feed us. This expanded number of hosts provides increased opportunities for viruses and birds cattle and spread, evolve, and in fact people. Nfect people. To better understand how diseases like evian flu, swine flu, ebola, zika, and sars and now the Coronavirus Spreads and operates we must invest in the basic research to learn more about the interconnection between people and animals and plants in shared environments. Yesterday the house passed a supplemental appropriations bill to address the response and the development of a vaccine. I supported the bipartisan bill and i hope my colleagues and i can Work Together on a longterm strategy to prepare for any Global Pandemic we might face in the future. Our top priority is the health and welfare of the American People. I am pleased the president has created the corona task force. This Interagency Group is working to monitor, contain, and mitigate the spread of Novel Coronavirus while ensuring the American People have access to accurate and uptodate travel and health information. The best things americans can do is to follow the guidance of the cdc. Many of the recommendations are simple ones youll learn from your mother. Wash your hands, wash your hands, do it thoroughly and frequently. Cover your mouth when you cough or sneeze, avoid touching your face, and stay home if you are sick. I want to thank the witnesses for taking the time to share their expertise with us during this crucial time to help keep americans safe, healthy, and secure. With that i yield back the balance of my time, mr. Chairman. Thank you, mr. Lucas. If there are members who wish to submit additional Opening Statements, your statements will be added to the record at this point. At this time i would like to introduce our witnesses. First we have dr. Suzan murray. Dr. Murray is the Program Director for the Global Health program at the Smithsonians National disease and conservation biology group. Next is dr. John brownstein, the chief innovation officer at boston Childrens Hospital and professor at harvard medical school. Third, i welcome dr. Peter hotez, who will be introduced by the chair for the subcommittee on energy. Thank you very much mr. Chairman. Its truly a privilege and a pleasure to introduce an internationally recognized physician scientist in Global Health, tropical diseases, and Vaccine Development who is also my neighbor and a cheerleader in our community. Dr. Hotez is a professor at college of medicine and codirector of texas Childrens Hospital for Vaccine Development. As head of texas general vaccine forlopment he leads a Team Developing New vaccines for a variety of diseases including other human coronaviruses like sars and mers, diseases affecting hundreds of millions of children and adults worldwide, while championing access to vaccines globally and in the United States. Dr. Hotez, welcome. We are glad to have you here today. And lastly we have dr. Tara kirk sell. Sell is a senior scholar at Johns Hopkins center for Health Security and assistant professor at Johns Hopkins Bloomberg School of Public Health. You will each have five minutes for your spoken testimony and your written testimony will be included in the record. When they have completed your testimony we will begin with questions. Each member will have five minutes for questioning. Dr. Murray, you may proceed. Dr. Murray thank you very much. Congressman bera, Ranking Member lucas, and all members of the esteemed committee thank you for , calling this hearing and inviting me to participate. My name is dr. Suzan murray and i am director of the Global Health Program Based of the National Zoological park and conservation biology institute. Our program utilizes experts and wildlife medicine, human medicine, Public Health , conservation biology epidemiology to study , and respond to Health Issues the humananimal interface. We utilize a multidisciplinary approach to investigate emerging Infectious Diseases that threaten both human and animal life and we build capacity to train the next generation of health specialists. In short, this is the reason right now that our program was created. Human health, wildlife, and Environmental Health are inextricably linked and depend upon each other. In order to safeguard the survival of all species, its critical that we examine Health Across the continuum of species and have research and decisions firmly rooted in scientific knowledge. Understanding the current viral threats, the patterns and drivers of disease emergence, and that Human Behaviors that contribute to such emergence will best allow us to not only respond to this outbreak, but the next one and the one after that, because we do know they are coming. Already we have identified many of the drivers of disease emergence and spread including landuse change, increased human wildlife interaction, and the globalization of travel and markets. Time and history have repeatedly shown us that it is much more humane, efficient, and economical to prevent disease rather than to identify, respond, diagnose, treat, and attempt to contain an outbreak. To increase understanding of the as yet undiagnosed virus is the viruses, thed drivers of emergence, and the risk factors associated with variance behaviors, we can develop Early Warning systems, prepare Rapid Response teams, and provide Critical Data and information to the vaccine industry to better prepare for the next outbreak. Just as critical, we must educate local medical professionals and the People Living in the communities at the greatest risk of outbreak. By preventing the spread of pathogens at the source, we can avoid the global consequences we are experiencing now. For example, over the last 10 years and working with partner agencies, our team has collectively identified over 1200 novel mammalian viruses. 1200 is a lot of viruses. It is only a small amount of the ones that are out there. 161 of these belong to the same family as covid19. In this time, we strengthened the capability for virus detection and characterization 60 labs in which pandemics are most likely to originate. We have also trained over 6000 people in more than 30 countries at the front line of defense against emerging diseases. At this moment, the world is focused on the Novel Coronavirus, covid19, as it should be. While it is essential we do everything we can to respond to this global crisis, it is also the time we need to be thinking of emerging viruses. The next Global Pandemic is not a matter of if, but when and where. To quickly identify and contain such infections, health and disease must be evaluated across species and on a global scale. While he might not have imagined in this context, ben franklin was right when he said one ounce of prevention is worth a pound of cure. When it comes to outbreaks, the cost of responding to a crisis can do worth the upfront investment in research and education. Obligation toar protect human life, there are financial benefits from focusing on preventative measures. For example, the human and economic toll from the west african Ebola Outbreak was massive. More than 11,000 people lost their lives, and well over 4 billion was spent globally. In the case of the sars epidemic of 2004, the estimated Global Financial impact was between 30 billion and 50 u. S. Billion and id situation is expected to be on orders of magnitude higher. Advancements in the detection of novel pathogens show the most efficient way to respond to and contain an outbreak is through the coordinated wildlife and human surveillance. While we estimate there are 1. 7 as yet unknown viruses, about half of which can affect human people and some lead to new pandemics. As of now, there are no coordinated programs to work in highrisk regions to identify these unknown viruses, get their genetic sequences into labs, and identify ways to reduce risk of them emerging. Our best defense against spreading diseases that make their way into the human population is through research and education. While we cannot stop every disease outbreak, we can reduce their frequency and build the capacity for a rapid Global Response when they do occur. Thank you once again for this hearing and your interest in this pressing and important topic. I look forward to answering any questions you might have. Congressman bera, Ranking Member lucas, and distinguished members dr. Brownstein, could you turn your mic on . Dr. Brownstein that would help. Congressman bera, Ranking Member lucas, and distinguished members of the house of Representatives Committee on sciencebased technology, thank you for inviting me today to speak with you. Today i will describe ways the novel technologies like Artificial Intelligence can help detect monitor and predict emerging Infectious Diseases. I will also discuss how nontraditional sources can supplement existing epidemiological techniques. But as i described the good news, i do not want to sugarcoat the bad. We urgently need federal and local investment in new technologies for Public Health surveillance and response. Such investments will augment the capacity of Public Health to implement new ways to monitor the healthy population. It will deepen our understanding andommunitybased morbidity mortality. It will also save lives. This is the goal in boston Childrens Hospital where we develop technology and use freely online information to provide insights to agencies and the general public. We did this for the h1n1 influenza pandemic, avian influenza, ebola in west africa, and covid19. These platforms and our research has ultimately played a Critical Role in the Innovative Surveillance technology to help detect monitor and mitigate the impact of these diseases. Our project which is available to the public brings together sources from a variety of places to help provide a unified view of the world of Infectious Diseases. To do that we use ai Machine Learning, natural leg which processing to organize the information to make it available. Here is an example. 2019 platforms ordered system unknown viral outbreak. Using ai is one of years of research into the potential disease and word spreads. Machine learning models can predict where viruses may arrive next. That lets us inform Public Health organizations about how to respond. Predictive modeling can be used with data like prior disease history, the weather, laboratory data, symptom surveillance. Through ai it helps us Exchange Information and conduct surveillance and measure public response to the events and response. It is also critical to support sentinel surveillance which allows publichealth information impacting the community. One example is the cloud serving platform for symptom surveillance in the u. S. Whodentifies individuals may be ill but are not seeking medical attention in realtime. Our team has augmented this tool to improve covid19 surveillance. To date, there is no evidence supporting widespread transmission of covid19 in the u. S. , but suggests the same transition at the Community Level will be occurring. Current global situations make sure this outbreak will become a pandemic. It threatens the health of the people of the United States and globally. The covid19 outbreak also demonstrates some reason for optimism. It demonstrates what we can accomplish when the scientific and humanitarian disciplines unite around a common goal. Each outbreak may require a slightly different approach, but there are key updates in metrics we need in every single outbreak. There are questions we must ask. How many new cases are there . What is the geographic spread . Are Health Care Workers affected . We cant answer questions by using forms along with traditional surveillance could we agree data from a right of sources in realtime. There is a epidemiological expression that expresses what we want. In english this means risking some false positive to uncover more of those who are sick. These platforms do that. They aggregate everything available to provide stakeholders with a snapshot of the current view of the situation. Those within the realm of Infectious Diseases often say its not a matter of if but a matter of when. We continually need support for initiatives to make an impact domestically and globally Infectious Disease monitoring and surveillance. By investing in our neighbors and promoting Health Initiatives outside of our borders, we help reduce the threat of an outbreak reaching the United States. There is another essential step to being prepared. Longterm support from Disease Control and prevention at the local department of Public Health. The cdcs influenza Surveillance Systems are the backbone for flu surveillance in this country. Augmenting this Surveillance System with novel programs like health net provides Additional Information that allows the Public Health, authorities, clinicians, researchers, and the general public to stay alert of whats happening. This is why i urge this committee to make sure the United States provides the same investment in the fundamental leaps of this detection of surveillance. That means domestically and around the world. Nontraditional data sources and Machine Learning have proven their worth. They support traditional surveillance and aid in a clear path and picture of existing or potential Infectious Disease threat in human health. Youve shown for your thoughtful leadership in the past and now we need your help again. With your continued support we can not only strengthen the Public Health community, we will protect the lives of those we serve. Thank you again and i look forward to your questions. Dr. Hotez . Dr. Hotez thank you very much. Chairman bera, Ranking Member lucas, thank you for that very generous introduction. I would also like to acknowledge my fellow texan. It is an honor to be here. I always get thrilled when i have the opportunity. Ive been doing this for 20 years, to address committees in congress, and it is still a special thrill to me. Im a vaccine scientist and a pediatric scientist. I was previously chair of microbiology at George Washington university, just down the road, and a decade ago we moved to texas to create a unique school for emerging and neglected tropical diseases, and to create a unique center for Vaccine Development. And the need was this. There is an urgency to create vaccines for diseases which dont make money. So, we took this on with the idea of pioneering not only interesting science, but a new Business Model. And the Business Model part we have not figured out yet because we are trying to make vaccines for diseases that no one else can make. The vaccine that we hope will attend to the clinic soon and a hookworm vaccine in Clinical Trials, a new vaccine moving into the clinic. I would like to say these are the most important diseases you have never heard of, some of the most common afflictions of the worlds population, but mostly occur among people who live in extreme poverty. So there is no model to figure out who will pay for them. So there is a consequence in that neither the biotechs or pharmaceutical companies will make the vaccine. We also took on a decade ago of making coronavirus vaccines , because we recognized these as enormous publichealth threats , yet we have not seen the big pharma guys and biotechs rushing into this space. We partnered to take on the big scientific challenge of coronavirus vaccines. And i say a scientific scientific challenge, because one of the things we are not hearing a lot about is the unique potential safety problems of coronavirus vaccines. This was first found in the early 1960s with respiratory interstitial virus vaccines done here in washington with the nih and Childrens National medical center. That some of those kids who got the vaccine actually did worse, and i believe there were two deaths and the consequence of that study. Because what happens with certain types of respiratory virus vaccines, you get immunized and when you are exposed to the virus you get this paradoxical enhancement phenomenon. And we dont entirely understand the basis of it, but we recognize it as a real problem with certain respiratory virus vaccines. That killed the rsv program for decades, and now the Gates Foundation is taking it up again. But when we started developing coronavirus vaccines we noticed in Laboratory Animals that they started to show some of the same immune pathology that resembled what had happened 50 years earlier. We said oh my god, this is going to be problematic. But we collaborated with the group that figured out how to solve the problem. That if you narrow it down to the smallest subunit, the receptor that docs with the receptor, you get protection and you do not get that immune enhancement phenomenon. We posted it to the National Institute of allergy and texas andnstitute of allergy Infectious Diseases. They funded it and we wound up actually making and manufacturing in collaboration with Walter Reed Army research a first generation sars vaccine. Sars was the one that emerged in 2003. And then his new one of course we called the sars ii coronavirus. We had it manufactured but we could never get the investment to take it beyond that. That was really unfortunate because we had the vaccine ready to go but we could not move it into the clinic because of lack of funding because by then no one was interested in coronavirus vaccines. When the chinese started putting up the data on bio archive in january and february, we saw a very close symbology between the two and we might be sitting on a very attractive coronavirus vaccine. Now youre working again with nih and others to get the funding. Now we will have that lag. These Clinical Trials are not going to go quickly because of the immunity enhancement. Its going to take time. Unfortunately some of my colleagues in the biotech industry are making inflated claims, youve seen this in the newspapers. We will have this vaccine in weeks, but what they are really saying is they can move effects into Clinical Trials. But this will not go quickly. As we start vaccinating human volunteers especially in areas where we have Community Transmission we are going to have to proceed very cautiously. The fda is on top of this. They have a great team in place. They are aware of the problem but its not going to go quickly. We are going to have to follow this slowly and cautiously to make certain we arent creating we arent seeing that immune enhancement. Now we are hearing projections, one year, 18 months. Who knows. We are not going to go quickly. But the bottom line is that we have those investments early on to carry this all the way to Clinical Trial years ago we could have had a vaccine ready to go. We have got to figure out what the ecosystem is going to be to develop vaccines that are not going to make money. The Big Pharma Companies are not going in. Some of the biotechs are starting to because they are trying to accelerate their technology and hopefully flip it around for Something Else that will make money. We need a new system in place. I am happy to explore that more during the questions. Sell . Dr. Sell good morning. Thank you for inviting me to speak about my research on misinformation. This research in context of covid19 and ways to support research that improve outbreak response. Traditional disease surveillance is critical during an Infectious Disease outbreak. However disinformation can be supported with tools to support decisionmaking. One such tool is crowd forecasting. Crowd forecasting consolidates the diverse opinions of many to hard probabilities or future outcomes. This is helpful in gauging the most likely outcome, but also for understanding the uncertainty about the outcome. Over the past year my Research Team in partnership with a group called hyper mind developed the crowd source disease prediction platform and asked forecasters to make addictions about outbreaks. We asked about the growth of ebola, the spread of measles in the United States, and how many u. S. Counties might see cases of eastern equine encephalitis. Most forecasters had accurate predictions about three weeks ahead of time. Recently we focused our forecasting platform on covid19 and we asked about the number of countries that would have cases of covid19, and the number of cases that will be seen around the world and in the u. S. For global cases, forecasts showed high confidence in a rapid and explosive spread. On a few occasions are predictions were incorrect. We think this is probably because forecasters did not have enough information to make accurate forecasts. Essentially, there is no magic here. If information is lacking or is delayed, forecasters do not have information to go on. This underscores an essential Research Need for the current covid19 outbreak. That surveillance within the u. S. And globally is essential. Another area of my research, misinformation during disease outbreaks, has emerged as a challenge during the covid19 outbreak and highlights the need to transparently and rapidly share information. Health misinformation can be defined as falls false Health Related information and can range from the promotion of rumors about the origin of the outbreak. Misinformation can substantially impede the effectiveness of Public Health response measures, increase societal discord, reduce trust in government leaders and responders, and increase stigmatization. My team and i analyzed information the west african Ebola Outbreak. One of the most recent examples of a fear inducing disease event for the u. S. Public. In our analysis, we found about 10 of the ebolarelated tweets or half true information. We also saw more disinformation was political designed to promote discord. Another finding was parallel to covid19 was the infection identification of rumors, often focused on government conspiracies. Although we have not been able to use systematic analysis of covid19 misinformation we have seen the spread of false information of false cures that harmful, blaming specific ethnic groups, and conspiracy theories about various governments creating the virus as a bioweapon. Response to misinformation requires a nuanced approach and further research to best determine the way forward. While the solutions will be complex, one thing that is critical is the prevention of information void that can be filled with false information. Members of the public need accurate and timely information to help them make sense of the outbreak. As i advocated for improved surveillance earlier, this shows the need for better collection of disease information in a transparent and rapid manner. From my experience in conducting research in response to emerging disease outbreaks, i believe we need to reduce the impediment and disincentives to doing rapid and Timely Research during these events. One hurdle to overcome is the slow process to establish establish federal funding streams for research during a response. My research was funded by awards from private groups prior to the which provided the flexibility to shift gears toward covid19. And while the development of vaccines and countermeasures are critical, social, behavioral, and Epidemiological Research is also important. The best treatment cannot be effective without knowing where the disease is and who it is affecting. The best vaccine cannot change the course of an outbreak if people refuse to take it. And the above occult response and the best Public Health response cannot be implemented if members of the public do not cooperate. My bottomline message is this, we need to support the systematic collection and rapid dissemination of information about outbreaks. As the issue of misinformation grows, a dedicated effort to understanding the best way to combat it will be needed. Even after the covid19 a break outbreak is over, emerging outbreaks will still be a continuing concern. The federal Research Space needs to evolve towards a more rapid approach to meet this threat. Thank you. Thank you. I would like to bring the committees attention to a letter that chairwoman johnson received in preparation for todays hearing. Letters from johnson and johnson that highlights their Global Response to the covid19 virus. Without objection i am placing this document in the record. At this point well begin our first round of questions. The chair recognizes himself for five minutes. Dr. Hotez, you touched on some of your research into developing a coronavirus vaccine, a sars vaccine. I think its incredibly important. Dr. Sell just talked about information and misinformation. We have heard quite a bit about how quick we are going to get a vaccine, how quick that will be available to the public. This morning i woke up to a news alert that said cambridge, Massachusetts Biotech Company had come up with a vaccine that they sent to dr. Fauci to Start Testing and so forth, but i think we have to be honest with the public so as to not give them false hope. If you can go through a timeline on what Vaccine Development is going to look like, in the best case scenario, onto Clinical Trials, and potential public availability. Dr. Hotez thank you for that question. I think what we are going to see over the next few weeks to months is several vaccines will enter into a pipeline of Clinical Trials. Hopefully, ours will be one of them. You mentioned the vaccine out of m. I. T. Theirs certainly will be in there. There are five or six. About five or six and maybe a couple more. But then its going to go into a bottleneck, and that bottleneck are the Clinical Trials. Phase one, phase two, phase three trials. In spite of what the antivaccine lobby likes to claim that vaccines are not adequately tested for safety, in fact, among pharmaceuticals, vaccines are the single most tested pharmaceuticals we have for safety. It takes time. Because you have to initially do an injection in normal human volunteers to show it is safe, and show it actually works. Now because of the enhancement phenomena you have the added complexity, because you want to make certain the volunteers when they are immunized in transmission do not get worse. I cannot emphasize enough how lucky america is to have that best publicof the Health Vaccine scientists in the world will follow this very closely. And thats not quick. Best case scenario, dr. Fauci said at least 12 months. Dr. Hotez hes definitely right, at least 12 months. But whether that means another year after that, two years, it really depends on the safety signals we have seen with these vaccines. The ability of our commercial pharmaceutical sector to quickly ramp up and develop that vaccine and make it commercially available, is that going to be an issue . Do we have that . Dr. Hotez there is a lot of press releases from the biotechs. Some of them i am not very happy about, frankly. I think it is telling only half the message. It took us years to develop our vaccines. It is an old method, but we know it works because we have had the hepatitis b vaccine license with this technology, hpv vaccine license with this technology. Now you are seeing generation platform vaccines. Like dna and rna vaccines. It is a very Exciting Technology because you can use quickly into Clinical Trials. The problem is you do not have a single licensed vaccine with that technology. The idea all of a sudden that is going to work. Historically, these have worked very well in mice and Laboratory Animals, but they have not been reproducible in people. Organizations have gotten around it and they have fixed it, so maybe they have. But we dont have a lot of experience. We are moving at an incredibly rapid pace right now. The public needs to understand at best there may be a vaccine in 12 month or longer, potentially longer than that. Dr. Hotez look at ebola. The first ebola vaccine started being rolled out in 2015 in the epidemic in west africa. It was not until 2019 that we really got it rolling. Which, by the way, is one of the most Extraordinary Health stories ever told. Let me ask dr. Sell a question. You talked about information, misinformation. Based on your research, as you are observing this, what are some of the common misinformation that is out there on covid19 . Dr. Sell there is a range of different misinformation. There is misinformation about false tears. There are no cures out there right now, so all that is false. Theres disinformation about government conspiracies. That someone else started the disease. I think there is also misinformation about the disease, what characteristics it has. I think theres a lot that we dont know. So theres that information void that people are just filling with their ideas. It behooves this institution and each of us as members of congress to make sure we are in tight communication with our constituents back home. With that, let me recognize the Ranking Member mr. Lucas for five minutes. Thank you. Thinking about those comments, lets begin from the perspective being your neighbor of north and in oklahoma. As of last night, there are no confirmed positive cases of coronavirus in oklahoma as of yesterday evening. Although one oklahoman showing symptoms is awaiting on test results from the cdc. Can you discuss for a moment what we can share with our constituents back home to not instill panic and how to stress the importance of reasonable steps to prevent spread. Dr. Hotez i know oklahoma pretty well. My son graduated from ou just last year. He is a petroleum engineer. A great place. We love norman. The issue is this. I think an attempt to calm public fears, youre hearing things like it is a mild illness. This is like flu. It is not really the case. Because this is a really unusual virus. Especially for young people, it is a mild illness, but we are seeing some devastating things. We got a heads up about this from the chinese. They actually informed us, and we knew it was coming. Nursing homes. Look what this virus did in that nursing home in kirkland, washington. It rolled through it like a train. At least seven deaths so far in a nursing home with about 100 people. So this is like the angel of death for older individuals. We need to go back and support all of our Nursing Homes. I dont know what we are doing wrong. But clearly that nursing home was not prepared for this, and i am going to guess Nursing Homes across oklahoma are not prepared as well. Also, our Healthcare Providers. We saw in wuhan, 1000 Healthcare Providers got sick. And we had at least 15 severely ill and in icus. That is very dangerous. Because not only do have subtract those people out of the health care workforce, but the demoralizing effect of colleagues taking care of colleagues. The whole thing can fall apart if that starts to happen. We saw this in dallas. I was on governor perrys task force for Infectious Diseases. Those two icu nurses, when they got sick it was really devastating. Finally the governor, the cdc director said look, normal icu units cannot take care of these patients. We have to get them out of here. You do not want to see those kinds of situations. I am worried about our First Responders. We are seeing in Washington State they are already in quarantine. Does that mean we have to bring in the National Guard . That will be another big issue as well. Those are the three vulnerabilities that i see right now in a place like oklahoma. How should our constituents back home react to that . The average gq public . Dr. Hotez the average public needs to hear from its elected leaders, from the governor, the Public Health authorities, what plan is. Dont just get up there and say this is a flu, this is a mild illness. One, it is not true and people in oklahoma are smart and will figure that out quickly. Second, explain what the risks are. These are the three vulnerable populations that we have to worry about. And here are the steps that we are doing to mitigate that. That is what people will appreciate. Dr. Murray, as you mentioned in your Opening Statement, approximately 75 of diseases emerge as pathogens. You estimate unknown viruses yet 1. 7 million to be discovered around half of which we are capable of infecting people. Could you expand and elaborate on the current state of research to improve surveillance in these diseases and where gaps may exist now . As we look towards addressing future challenges . Dr. Murray thank you very much. I also appreciate that while we are trying our best to address the topic at hand, there are a lot of ill people. We need to be thinking about the next virus and the next virus. I also think the cdc has done a wonderful job of looking at and studying human health. And if we are going to do our best job, to prevent future viruses from jumping, i think one of the missing components is wildlife health. 75 of the viruses come from the wildlife, so it makes sense we look at that junction, both wildlife and human health. We also, this virus has turned a novel virus. It is new to the people. I dont think its new to the bats. Thats an important point. And some of our other colleagues here have been talking about modeling and how important that is. Modeling gives us greater information now as to what cuvee did we doing within the u. S. And within other countries. We also have groups of modelers who look at the forefront of the stages and look at the data we have to try to determine where are the hot zones, what are the risk factors, and behaviorally, what are people doing to put themselves in danger. Those are really important ways for us to get ahead of the curve and catch the viruses before they come out. As part of the team that we have been on, we have a team of modelers who look at viral emergence and they are able to determine for each different virus, as we collect more and more data, what percentage of the viruses that we know are characterized and how many more are likely to be out there. Latest estimates are less than 1 of the viruses that we know are less than 1 of the viruses that are out there. Meaning theres over 99 viruses in wildlife waiting to jump into humans. That is staggering. And its really one of the things that we need to look at. Thank you. My time has expired. The gentlelady from oregon is recognized. Thank you. This emergent coronavirus epidemic is a top concern for oregonians. And im glad we are having this hearing today. In oregon we currently have three individuals who tested two of whom are in the district i represent. Plus an additional couple of additional constituents in japan. We know the transmission is likely. It is clear from the tragic deaths in washington how this dous can spread quickly and serious harm. So lets take a moment to reflect on those who have lost their lives in our neighboring states of washington. And now we understand theres been reported death in california as well. Friends and family of those people, we need to take this seriously. I also want to recognize the tireless efforts of our Public Health officials in oregon and across the country. They have been working around the clock to coordinate a response. For the past several days i have been speaking with our governor and many state and county Public Health officials and school superintendents. We had a School Closed a couple days, Health Care Providers, and Everybody Knows theres a need for robust funding. I know we passed a bill in the house yesterday. I hope they get it finished in the senate soon. Ive also heard numerous concerns about the availability of protective equipment, particularly masks. Also staffing challenges and testing ability. Those who have covid19 can remain asymptomatic for several weeks. Talking about even greater risk, furloughed healthcare workers in my district. The cdc expanded its guidance for testing but there is still a significant amount of confusion about who should get tested and how those increasing testing capabilities can best be used to inform and improve our response efforts. We heard this morning south korea is testing 15,000 people a day. We cannot get an accurate picture of the infection if we are not testing. Until recently the testing was limited to those who had recently traveled to places with high rates are those showing symptoms after close contact. I understand the process of getting to test out into the field is slow. We had the test sent to the cdc on friday, and it did not come back until tuesday. Thats really hard for a community that is wondering what is happening. Can you explain the scope of the cdcs guidance, was that based on best practices or was it inappropriately limited because of a lack of capacity to test . Who should be tested . Dr. Brownstein it is hard to too deep into what was happening at the cdc at the time. Often times people might be showing symptoms and may not be even interacting with a healthcare provider, so we dont actually know the whole scope of the number of cases that are out there. You mentioned a great point about impact in the Health System. We are really advocating for opportunities to bring concepts like telemedicine and tools that help at the front line. Beyond the point where someone is actually helping to come in and end up in an emergency department. Theres opportunities to think about tools that can integrate data from the cdc but also have virtual visits with providers. This is a real important component. We suspect an influx of people coming into our Health System. I work in a Health System and were very nervous about the flooding of our Emergency Departments with potential cases. The opportunity is bring Digital Tools and Innovative Solutions along with the ability to integrate with testing. Homebased testing and other opportunities are really things that we advocate for because lack of opportunities for someone to come and meet with someone live. And also for the fact that we can actually begin to understand the depth of what is happening in the population and again those kind of data points are so critical now to understand more broadly what is happening in the community. As i mentioned, the test was presumptive on friday, and then sent to the cdc, did not come back into tuesday. Can you elaborate on the ideas of why we are seeing such delays in testing. Do you think this recent emergency authorizations will expedite things and what else can we do to increase the availability and accelerate the testing. Dr. Hotez four brief points around that. And thank you for the question. I think the first is, respiratory virus is not trivial because you often and we seen this in china, is actually not unusual, if you look at the literature on testing for respiratory viruses you get negative results several times and you put them in a quarantine and all of the sudden they are positive. Is it a true false negative or is it because the tents the test was not sensitive enough . It takes time to really fine tune these diagnostic tests for respiratory viruses. In fairness to the cdc, testing developing new diagnostic test just like developing it vaccine developing a vaccine in the middle of a crisis. To develop a new technology, for a new age of Public Health crisis is one of the hardest thing that we do as a nation. So its hard to make that go quickly. I understand we couldve done better. As a country we should have but getting those kits out there, i think we will get up to a million eventually. I believe the Vice President had mentioned that. But as we do that, i think we have to prioritize who gets the test. My recommendation would be that we focus testing strategically around protecting our three most vulnerable populations as i mentioned. Our older residents in the Nursing Homes, places of assisted living, they are highly vulnerable and their mortality is 10 to 15 , Health Care Providers and protecting our , First Responders. If they go down, everything collapses. But then even after that, the other thing that not a lot of people talk to about, this is not adequate. If we have to wait hours or days for the test results, thats a it is of limited use to us. We need to get it like a rapid flu test. Thank you. My time has long passed. Let me recognize it gentleman from florida for five minutes. Thank you for calling this very important meeting. I only regret the conflict with members only briefing taking place simultaneously, and thank you witnesses for the important work you do every day. Thinking about ways to combat Public Health threats. Theres a common theme in the testimony which is when there is a crisis, all eyes turned to you. But when the disease or moves off of the front pages, the public loses interest in the funding goes away. You didnt say this part but i will say this also that we see the problem, have is to throw billions of dollars at it is a look now we have done our job. We hope for a good result. Then we move onto the next issue. And of course theres always the fingerpointing and claiming based on as you well pointed out earlier, much information and disinformation. That is really regrettable. People are getting really tired of that. Doctor murray, working with you, you successfully identified over 1200 novel wild illnesses including 161 of which belongs to the same family as covid19. I think most of us in the room are wondering what the risk to humans is from those viruses as well. I have four related questions that i will ask you. I will try to be quick in my response. So in addition to identifying viruses, we also have this team of modelers to help self identify where to look in the world. Also a team of experts who then rank all of these viruses. If we had enough money to look at every country, species, and animal, we would, but we dont we really try and use the funds effectively. We identify the countries in which are most likely to be a problem, the species that are most likely to transmit the length of disease to humans, primates bats and rodents. Of those 1200 viruses, the rate according to the families that are most likely to cause a problem for health. And that is where we spend the majority of our time. Orluenza, corona viruses, some of the most important families. Just to add on what my colleagues here said, it is a time that the funds are an issue. The program i am describing, is in the process of being closed down. Holding ourlly closeout session on march 17th if anyone would like to join us, because we will be reporting a lot of what we have done over the last 10 years. My suggestion would be, this is not the time to lean out but the time we need to be leaning in. What percentage of the viruses have the potential to jump to humans . The 1. 7 as of yet unidentified viruses, about 50 of those have the potential to jump to humans, based on the receptor sites and where they can attach to the trachea. But not all of those are going to spread rapidly. Not all of those are going to cause severe disease. So we look at there is 50 that could jump to humans and probably only 10 or 15 that can cause rapid disease and pandemic. Until we identify those viruses, the species in which they occur, the reservoir in the transmission to humans, we are still at a tremendous risk. The research that has shown these outbreaks are coming more and more frequently. So a lot of us have felt like, this is a surprise, but folks in the Health Community felt like this is not a surprise. We have been saying collectively, these pandemics are coming. We can tell you in general, the countries are the areas and some of the risk factors and some of the viral families. You answered my next question about the percentages already. How can you best Prioritize Research . Is there a good process to set Research Priorities in place. Dr. Murray i think a lot of what we are doing, and i thank you for this hearing. It does say a lot of the same folks in the same room to help identify the issues. From my perspective, the more that we can look at bringing experts from many different fields, from the government, ngos, and universities together and the consulates of humans , physicians, well most of them are human. Humans physicians, veterinarians, nursing staff researchers, i think thats really what we need to be doing. Looking at not only in the u. S. , but in countries and other countries as well. We look at the economy globally. Its time for us to look at health globally. Thats how i would go about establishing Research Priorities. Thank you. Dr. Murray thank you for your questions. The gentle lady from texas. Thank you, chairman. I want to get right to the questions. I think all of you for being here for your testimony. I want to follow up with you on your opening comment and then opening up to the panel to weigh in on your thoughts. In your opening comment, you mentioned your work developing a vaccine for sars and the question, what will the ecosystem be for vaccines that dont make money. That seems to be an appropriate question for this committee for the congress of the United States to be tackling. I would like to ask you what you think that ecosystem should look like and get others on the panel to weigh in on that question and touch on what dr. Murray said, about the Global Nature where , can we partner with other countries in doing this work . Where can we have a National Response and a Global Response . I would love to get your thoughts. Dr. Hotez there is some good news to this. We are very blessed to have a national into suits National Institute of allergy and Infectious Diseases headed by dr. Fauci, who has been very committed to this problem. If it was not for nih, i would not be here. They have really worked hard around trying to fix this problem. The issue is, it is not enough. If you talk to dr. Fauci, he says, i am not a venture capitalist, i cannot just hand over money. It has to go through study sections. Study sections oftentimes will and turned off from an nih grant, because they will claim what we are doing is not innovative. They are often right. Boring, but it is absolutely essential. We have to figure out a way for a funding mechanism to be created that will provide steady funding for scientists who are ready and able to develop the because we are overreliance on the Big Pharmaceutical Companies. They are not coming in in a big way with a couple of exceptions. The biotechs, some of them are in it, not so much for the specific vaccine but the device to accelerate their technologies. So we have to figure out a mechanism to fund a group of scientists, working in an area where they will develop a vaccine Nonprofit Sectors. We have done research for years, reed, and they been hit very hard. We can restore that. We have this Great Research center at the nih. A couple of others like ours, university of maryland, college of medicine, texas childrens. Each one has to be bigger and we need more of them. Also, my thanks to the nih. I also would not be here if it was not for the support of the library of medicine and their efforts to really train the next generation in the data scientists and health. Specifically around your question around vaccines, thinking about the comments of dr. Murray and the next event. We need to be focused on the current coronavirus but we will likely see another coronavirus event. We saw sars, mers. Is it likely we should be developing something that will ultimately prepare us for the next pandemic in the future . I think the better we prepare for those events, the better off we will be. Thank you. You talked about the ecosystems for vaccines that dont make money. Developing those vaccines and then testing them, but we also project at our center, manufacturing those vaccines by scale. You might be able to have a vaccine, but we cannot make half a billion doses in enough time to make a difference. So i think that is another thing that we cant just swap over the products to manufacturing plant. This is another area that really needs a lot of attention. Thank you. Dr. Murray i agree with my colleagues in particular doctor brownstein about the universal vaccine. I think its a very good idea to invest in that. I think part of it is we would collect in the field, what types of vaccines or viruses are out there would inform that. I also wanted to add on, i found a little bit more about the question from mr. Posey, i do think that it we are looking at research, creating one Health Program somewhere, we dont currently have a program that works in high risk areas, incorporates both the Human Expertise and the wildlife expertise and ideally has one foot in the federal government in one foot outside of the federal government. It worse be great if some institution like were here and in d. C. Perhaps an institution that already exists. Thank you very much period have gone over my time. I will yield back. The gentleman from texas, recognized for five minutes. Thank you for being here. I appreciate the healthy discussion over some of this misinformation that has come out, sometimes with Political Goals in the dispersion of it. I also appreciate educating us on some of the real scientific challenges in addressing a situation like this. I wanted to see, in the effort of giving Good Communications on this, can you give us the back tracking of this and understanding of why are we dealing with this. Where does coronavirus come from and how is it spreading . Dr. Murray thank you. I would be happy to do that. I can abruptly share the answers i can probably share the answers to that question as well. In terms of what we know, primates and rodents are the species that are the most likely to carry these viruses and transmit them to humans. The coronas in particular, in a team is already discovered several other coronavirus is in china. There is 97 to 98 percent homology which means they are very closely related. And you can determine how closely this virus is related to the other coronas. We found some in myanmar that are not closely related. Have behavioral lists ists looking at the risk associated with that. In a lot of countries, bats provide a lot of protein. People do eat that. If you think the right on the risk might not be the person in a restaurant eating fully cooked bat. Perhaps the risk is the woman in the back preparing the bat without the gloves, and without the mask. And they along with children, will take it home. Trying to understand the cultural norms of Human Behavior patterns that contribute to these sorts of things. A quick shout out to o ftp because we also have a pandemic preparedness science and Technology Panel that looks at these things. Last year at smithsonian we hosted a twoday workshop looking at the soft scientists and the hard sciences. And modelers look to the Human Behavior and also the heart scientists look at what the virus does. We believe the wildlife markets and the trades are a really huge risk in general. The risks are different whether youre in africa or in asia. In africa animals tend to come , to the market, the risk is more for the folks in the forest killing the animals. The meat tends to come to the market already dead. In asia, they are live animals at the market. To answer some of your questions about virus, we believe it is a bat related virus and it came in close contact through the markets. We still have so much lot more to learn about this in particular. Epidemiologists and human health folks as well. Theres still so much we dont know. Thats what we know so far. I would like to yield to our colleagues if you have something to add. If you can tell us what some of the challenges in addressing the treatment and vaccine. I will just get all the questions out here. Based on your working with sars and ebola and zika, what are some of the challenges that you see governments have faced in the best practices we have learned . What are some of the things that we can use in addressing this . Dr. Hotez two points. We need more vaccines. And trying to do this in the middle of a crisis, is very difficult. The story with ebola, and yemen, so we want to start doing this now. So one of the other problems that i am seeing, through naid and barta, we have incredible mechanisms for supporting the vaccines. Clearly the u. S. Is the Global Leader in this. We need some of the other countries to start pitching in and helping with the Global Health technologies. If you look at the public funding globally, the u. S. Is by far the number one in the uk second and European Union and then the bottom falls out. So we see a lot of underachievement among the g20 countries. China is doing very little, japan, not much. A little bit in korea. I am on a board with the Gates Foundation brazil needs to step , up. So we really need to put this on the agenda of the g20 summit to say, look, the u. S. Has globally taken the lead on recognizing this is a huge problem. The other countries need to step up. This needs to be on the topic of a g20 summit. One of the books i wrote is called blue marble health. It finds that overwhelmingly most of the worlds emerging and poverty related and neglected diseases are not necessarily the most devastating countries in africa. It is in the g20 countries. It is the poor living among the wealthy including 12 million , americans have suffered from a neglected tropical diseases. So we need the others to show some leadership. And work of the state departments and others. Gentleman from california. Recognized for five minutes. I think the chairman and the witnesses. Very useful and informative. How can social sciences aid us in understanding how to stop misinformation during an outbreak . Dr. Sell misinformation during outbreaks is the big problem. I think it is a very complex problem. So social scientists can help us understand what the best messages are to help people understand when the rumors theyre seeing are false. So to improve our messaging, the type of ways we are trying to communicate with people, how to convince them the facts rather than believing in these rumors. I also think that there is an we need to develop an entire strategy here. We need to think about all of the different stakeholders. We have Tech Companies need to be doing work. We have the public, you cant just say to the public, we think the public to figure out how to determine truth from falsehoods. We also have governments, news media, and we have Public Health. We have to think about those stakeholders and everything they can do to deal with this problem. Is there a specific area of research that would help develop the tools . Dr. Sell i think that looking into see what misinformation is out there in the Communications Research i do is looking at what kind of ways we can solve that. Thank you. I am going to follow up on ms. Fletchers question. How do we incentivize from an biotechs to prioritize Vaccine Development . Dr. Hotez it is tough. Ive been critical of the Big Pharmaceutical Companies today but also have some great support as well. What merck and company did, with the ebola vaccine, is an extraordinary story. That vaccine, ultimately, given to 200,000 people in the middle of a war and conflict, prevented a catastrophic epidemic that would have dwarfed the one in west africa and destabilized the entire african continent. So we owe a debt of gratitude to them who made that happen. But if you talk to some of these people from merck, they say we did not make money on this thing. They say depending on how you crunch the numbers, we actually may have lost money. We had to pull people from moneymaking projects and put them on this. It is really a problem. Vaccines are expensive. They are expensive because of all of the Quality Control and assurance that you have to have. All of the belts and suspenders to assure the safety. Maybe thats one of the reasons we are not seeing the Big Pharmaceutical Companies jump in this time around. They saw, look what merck had to do in order to make this happen. I think we have to look at creating a new type of organization and maybe working this out in the Nonprofit Sector here in the United States. I am pretty excited excited about the health map platform you discussed. How is Artificial Intelligence used in Public Health preparedness . Dr. Brownstein ai is seeing an explosion in health care. There are opportunities leveraging ai with large data sets. When we are dealing with a Public Health crisis, there is a huge amount of data. A lot of information about cases a lot of disinformation. , and be able to sort through all that Critical Data, we can use our modelers, our policymakers and even the public, thats where these kind of methodologies come into play. So, if you think about the earliest signs of the covid19 event, they are actually through these collecting tools, the technologies that doctor murray was talking about. Combing through the web, looking for signs of these illnesses that we could neutralize in those this point and then communicate those to the World Health Organization and the cdc and other organizations. More importantly, theres a vast amount of information globally now being transmitted about cases. I am now trying to understand the response and recovery the Demographic Data and that is more that exists on this planet so what we are trying to do is , to augment the work of these Public Health practitioners through the opportunities that ai brings. The opportunity to mind that information, organize it, and bring that Situational Awareness data to the forefront so it could be used effectively. I am going to ask you for the record what the challenges are in expanding ai . I yield back. The gentleman from texas. Mr. Olson is recognized for five minutes. I think the chair and welcome our four witnesses. A special welcome to doctor peter hotez. I would like to join my texas colleague, misses fletcher, in bragging about dr. Hotez. My colleagues need to know this is not just man who is an expert in texas. He is recognized in all of america and globally on pandemic viruses. And thats why you saw him all day yesterday on National Cable explaining the challenges with the covid19 virus. You also saw him doing that with h1n1, and zika. That one broke out in 2009. Texas Childrens Hospital set of set up a drivethrough vaccine in the parking lot almost overnight have those vaccines. Thank you for being here. Maybe inuld say you the class youre in, but it dont take long to call the roll. I want to talk about the quality treatment and future responses. Quality treatments. Yesterday, it was announced that my home county of fort bend was the first site in texas to have a confirmed case of the covid19 virus. Dont know too much. The man was 70 years old, he traveled overseas. No confirmation he went to china, iran, or italy. He is now quarantined a local hospital. As dr. Sell mentioned, a lot of people right now are living in fear that this disease is amongst the people of my hometown. And those fears may cause people to do something that is not very wise and is sometimes very foolish. Weve seen photos, all across this country, of towns reacting to this. We have seen empty shelves in grocery stores, weve seen empty shelves of bleach. As you said, people think that drinking bleach can somehow help control this virus, which is just crazy. We see empty shelves of canned foods. We see at the home depots, the lowes, all of the things that needed to protect people are being swarmed up by people who do not need them. Hotez, you brought this up yesterday on national tv. We make sure that the required resources are given to the Top Priorities. Families, victims, neighbors, the First Responders the ems , vehicles, the cops and the firefighters and doctors and nurses. How do you make sure that those are the people who get the First Priority to these scarce resources . Dr. Hotez you have hit on it. Thats exactly right. Thank you for those really generous comments. We need to give our 1, 2, 3, 4 Top Priorities to the groups that were going to ensure that if they go down, things fall apart and things go badly quickly. I dont know that we have really done that yet. I think protecting our older individuals in the Nursing Homes. We now know from kirkland, anytime a virus its the community those are the ones who community,hits the those are the ones who are going to get hit the hardest. The other thing i have been saying is regarding panic. You will have time. Its not like you going to wake up tomorrow morning and find that the entire eastern half of the United States is infected. What we are going to see is multiple communities being affected. That will cause a lot of concern but you will have time in order , to prepare and figure out what is happening. We dont exactly know. It may stop there. There are some who believe there may be seasonality to this virus. We do know that it all. We dont know that at all because it is a new agent. So i think the key is to stay in contact with people, hold those white house briefings on a pretty regular basis. But also try not to sugarcoat. Its a real art to be able to give difficult information but do it in a way where we are aware of it, here is what we are doing about it. Weve been through this before. I think one of the things that i have noticed, in 20 years that ive been following pandemics. It started with anthrax in 2001 and sars in 2003. H191, 2009. Ebola, 2014. Then we go to zika and now this. The same thing happens every time. It takes us a little bit of time to get our arms around it. Theyre always stumbles in the beginning. A lot of it has to do with the federal and state governments have to figure out all over again how to Work Together. There always seems to be that new Relationship Building that has to happen. Eventually, we get it right. And this will happen again. And i think the other thing that we want to see is the press not piling on too much. Good luck with that. Dr. Hotez it is occurring during the democratic primary. Happening at the worst time possible from that sense. To have that perspective of time. Aying, this always happens it is the hardest thing our country does. We have some records about stockpiling. Recognize the gentleman from illinois. Thank you very much. Thank you for clarifying we will not have this vaccine for a year or so. Can you share some of the risks of bringing a vaccine to market to early. Dr. Hotez it is compromising safety. We are going to be immunizing healthy people. Vaccines always have a higher safety bar because you are not often these are individuals who are ill and tried to accelerate some technology for compassionate use. Our fda has one of the best track records in the world in ensuring safety and we have one of the best Monitoring Systems in the world ensuring safety. We have these systems in place. The reporting system, and many times people think thats only thing we have. We have a redundant system around four tracks that follow this. So we know how to do this. We know how to ensure that vaccines could be developed and safely. And tested safely. Dont try to pressure fda into doing something that breaks with that, because if we start rolling out a vaccine to quickly and it is shown that a number of those individuals are getting worse because of this vaccine, which we know can happen with certain respiratory vaccines. Inhave seen it with rsv, and Laboratory Animals with other coronavirus vaccines, then people will lose confidence and not only confidence in coronavirus vaccines but in the whole vaccine safety. Rep. Casten with the nonvaccinated population, given some of the early data, seems to suggest those that most of rest are the elderly and the immunocompromised. Dr. Hotez and healthcare workers. Rep. Casten yeah. So not going have a vaccinated population. Presumably other complications that people have maybe at risk may be at risk as you look at , the broader healthcare ecosystem, you see other medications that we may be, increasing focus on some of these noncoronavirus things. And maybe that will be ultimately what hurts people. Are there other places we should be looking in the ecosystem right now . Dr. Hotez maybe we should be looking at the ecosystem right now. Even though that is going to take, whatever time it is, there are other technologies out there that we could be using that will get deployed more quickly. We will probably have rep. Casten im sorry, im asking maybe a different question. If i already, lets say as an example, i am taking immunosuppressants because it , just a liver transplant. And all of a sudden i come down with coronavirus. Be the thingay not that does me in but this other thing does. So we look at the populations that are most at risk from getting a bad flu are there , other drugs and pharmacologicals that is disproportionately taken that we should be concerned about . Our little bit focus on the we can protect some of these folks. Dr. Hotez i will have to think about that a little bit more. But youre right, we dont have, remember this is a new virus. There are differences in the u. S. And chinese populations. Weve not seen a lot of data with people using suppressive with immunosuppressive drugs. I dont think we really know what that is. Rep. Casten im using that as an example. My concern is people might need insulin, statins other things. , i am shifting a little bit. Dr. Cell, i appreciate your comments are not spreading disinformation. We all have certain platforms we can speak to. Given what you researched on ebola, and without making this a political conversation as you look at what is going on right now, are there specific pieces of misinformation right now that trouble you, and if you were in their shoes, what would you like to see us thing to the country this weekend. Dr. Sell you bring up something that is a very important, because influencers like you have one of the biggest roles in spreading the truth about this disease. That is borne out by the research. When you go home to your constituents i think people , might be afraid. This is a concerning disease. You cannot sugarcoat it. This is serious. You need to think of it and think about the ways we can prepare. Research has shown the people really want to know more about the actions that they can take rather than the risks they have have to worry about. And so the cdc has a lot of advice out there. Wash your hands, use etiquette. Use respiratory etiquette. I think people also want to think about how they can be prepared and they might take care of their loved one. If a loved one is sick but not enough to be the hospital. They were limiting how many people we are trying to take care of at home. How we might care for sick people at home and think about stockpiling prescription meds that might need. You dont want to be at the store for theres a lot of sick people or whatever. I think actions are really what need to hear actions are really what people need to hear right now. Rep. Casten thank you. I yield back. Thank you. Dr. So, it is not everyday we get an olympic athlete in our midst, especially one that had world record at one point. Do you still have it . Dr. Sell no. Still unbelievably impressive. I dont think any of us have one of those in our history but i could be wrong. But nothing as impressive as you did. Out of all of the accomplishments of dr. Sell, i respect most about you is that you have my wifes unyielding admiration and appreciation that means mostly as a College Teammate of yours. I want to start by asking about the role that diagnostics play in forecasting. Forecasting accuracy. I just left a briefing. It is very obvious that we did not and so probably do not have the number of diagnostics available with respect to coronavirus today. So when it comes to your forecasting accuracy, what role does having robust diagnostics play in the process . Dr. Sell thats a great question. Diagnostics and thank you very much for the introduction diagnostics have an incredible role to play, because on the way that you look for information out there about the disease determines what you will find. So you are looking for people in people who have a travel history you never going to say, we have Community Transmissions. As i think that being able to use rapid to diagnostics, like the flu test and other things is really important so that we can note those more mild cases in the range of disease and where it is. Dr. Brownstein from the modeling perspective, having an accurate understanding in the community is incredibly important. We are essentially seeing some of the more severe cases. It might lead to overestimating in the kits for the tallies. We dont actually know whats happening the community leve, because we dont have the testing. We are going to be essentially biased in our understanding of the disease and not have a direct understanding such as household transmissions. What we are seeing in terms of the little level of spreads in what is happening. And this is what is having is incredible advances in other places. One of the things that is troubling for a lot of folks, certainly for me is you see different case fatality rates in my estimation of that is because we dont know the end. In south korea, the testing all of the time it seems like drivethrough testing. Here, its unclear to me how many people we have actually tested. I dont think is north of a thousand. I be wrong on that. So its been a little troubling. I guess a followup question on the model piece, if we have been testing on the order of south korea, how much further along to do you think we would be and how much closer to being able to more effectively prepare and prevent a major outbreak, if we had the better testing capabilities . Will start with dr. Sell. I think if we had better testing capabilities, i think we would have had the motivation to get moving a little bit quicker. And especially in places where we might see disease, so that we can keep it out of those Nursing Homes and hospital. Dr. Brownstein . Dr. Brownstein exactly the same thing. The more detailed information we have of the rounds, the better off we will be to respond. Models is only as good as the data we feed them of course. If we have richer information about what is happening and we had the testing we can , understand what is happening at a Community Level and think about things like social and social isolation and other mitigation efforts that could help with that spread of the coronavirus. Thank you. With my final minute, dr. Sell, i want to go back to what representative casten was asking with respect to false information. Obviously since 2014, ebola, the platforms that were used in the ways we communicate has changed quite a bit. Have you noticed a difference, a stark difference of any kind of how misinformation was spent in 2014 versus how it is spread today . What sort of lessons can we learn from that . Dr. Sell this is an opinion without an analysis behind it. I think the spread of misinformation has been much more rapid. We know that in some cases is been coordinated, and i think that it spreads across multiple platforms very quickly. We have these echo chambers, and we have them in 2014, but went but this misinformation bounces within people who have the same belief system. It is very hard to teach that. Thank you. I yield back. Mr. Foster is recognized for five minutes. Rep. Foster thanks to our witnesses. I have been sitting here trying to hear what coherent plan to try to actually do something over the next decade would really move the ball. So the first step it seems to me, is to actually characterize up to 1. 7 million potential of the viruses. And i think there may be hope for developing technology, so that we can sort of this 1. 7 million seems like a big number, but with technology development, you might be able to bring the cost down. And then to potentially to potentially do things to mitigate animal reservoirs and things like gene drives and other things. They are talking about releasing mosquitoes that cant transmit certain harassment. That sort of approach may be important. Possibly to identify sequences across the broad classes. There was an example of this in my district. They recently sold the protein nsp 15, which conservative among coronavirus. It is apparently involved in the replication and an attractive drug target, but actually, do something that would persist over a time longer than Congress Attention deficit disorder. To actually stay focused on a handful of attractive targets or a large number of attractive targets and develop these for drugs, both as treatments and vaccines. I perceive there is a real difference. We could potentially do things pretty quickly for treatments, but the vaccine problem is much tougher because of the Clinical Trial bottleneck. I dont know if theres any great breakthrough ideas, so if you have thousands of potential viruses and everything about them understood but you havent done the Clinical Trial and you have identified targets, clinicalneed trials. Are there any way to accelerate that by any potential technologies out there . It seems like an unsolved problem from the testimony. And for the developing highvolume generalpurpose manufacturing, that is on standby, which is something that dr. Sell mentioned. This seems like it is something where you can throw money at the problem. If there are really generalpurpose technologies out there, theres a lot of overlap with this, frankly, with money we are spending on bioterror defense. It might be this exact same equipment that you need. I would be interested in first off, have i missed any parts of this are there significant rapid , detection, that something of aentioned that was sort parallel track to this. Dr. Brownstein if i could mention one thing, this idea of a national or International Service forecasting, weve done this for the weather. We collected it and make connections. That does not exist today in disease forecasting. As an investment to be made in addition to imported pipelines and manufacturing would be developing a way to predict this sort of, the next coronaviruslike pandemic. Rep. Foster dr. Hotez . Dr. Hotez yes, i think you point out a very good bottleneck in the clinical testing time. There have been a lot of effort to apply innovation towards streamlining clinical safety testing. Systems we call it vaccinology and the idea is we , can do more things in parallel rather than sequentially. In fact, it was already started with ebola vaccine, and we did a lot of things in parallel. So it really went through an information on the echo and a safety and time. As it wasnt for this particular safety signal around this enhancement, we might have broken a record, because there is an appetite to figure out how to streamline vaccine safety testing. There is this unique, quirky feature about coronavirus vaccines and some other virus other respiratory virus vaccines. You will see that streamlining conical trials of just not sure this is the one to do it. Dr. Sell i have one other thing, i think when we come up with these tools, its very interesting, and they exist out there, but we really need a way to sort of integrate them into practice. So i think practice focus research, public agencies, and the cdc is really important to make sure that we actually moved research and make a difference on the ground. Rep. Foster have there been big studies that actually come up with, here is a holistic plan, here is the rough budget . This done like maybe 15 years ago or so, or is there actually a need for doing this. Lets just sit down and do an International Context to come up with a plan that has elements that i mentioned along with others. Dr. Murray . Dr. Murray negatives are part i can enter part of that. The first part of your question, that. An answer part of the first part of your question, there is a group of newly formed global viral project that is looking at the 1. 7 million as yet unknown viruses. Their goal is to identify and characterize all of that, in much where the human genome project started with a wealth of information. We have had for the last 10 years a Global Program looking at human and Animal Health as well as surveillance in countries, laboratory buildings. That is the one i was describing that is in the process of shutting down now. I would suggest that this is not the time for the u. S. To be pulling out, but if we have a program that is doing it, if anything else, you need to continue and expand and incorporate more of the folks that we have here. And part of the program also, as dr. Sell is working on. Rep. Foster im sorry, we are running out of time here. We are going to try to get one last question. The gentleman from virginia, mr. Beyer. Rep. Beyer thank you. Thank you so much for being here for this incredibly important topic. Dr. Hotez it is nice to see you again 30 years after first coming across your incredible landmark work on the lukewarm. Good luck. Ill start by submitting a letter. Dr. Sell, first, with apologies, i tend to hate asking yes or no questions, so please know that time allowing, there will be time for paragraph questions later, but i want to make this a quick point, so five yes or no questions. First, the World Health Organization says the death toll of coronavirus is over 3 of those affected. Do you have any reason to believe the actual figure is a fraction of 1 . Dr. Sell a fraction of 1 . Rep. Beyer yes. Dr. Sell yes. Rep. Beyer ok thank you. Would you say the World Health Organization statistics on the spread of the Coronavirus Spread is false question. Dr. Sell no. Rep. Beyer will we have a vaccine sooner in a few months . Dr. Sell no. Rep. Beyer will we be getting a quick cure . Dr. Sell by cure do you mean a treatment . I would say possibly because our because there are drug trials. Rep. Beyer would you generally agree that all of these statements are false . The panel. Let me go on. Dr. Sell, one last question, would you say the danger of it would endanger american lives have spread disinformation to get people to go to work and potentially spread the coronavirus because the public was misled on the dangers of this deadly disease . Dr. Sell misleading the public about a disease is wrong. Rep. Beyer the sad part is these statements, which most scientists, every scientist testifying today would endanger lives were made by our president in the last three days. They just told me trumps coronavirus statements about a quick vaccine, quick cure, its ok to go to work, that all these things are endangering american lives. And to be clear, the cdc advises anybody exhibiting symptoms of coronavirus such as a fever, coughing, shortness of breath, should stay home from work, avoid public areas as much as possible, and seek medical attention. The tuesday briefing from Vice President was not televised. He came here and talked i think four different times. On monday, we heard reports of the cdc stopped disclosing how Many Americans are being tested. At a time of high uncertainty in the face of a likely pandemic, should the American Administration be more transparent or less . Maybe dr. Hotez . Dr. Sell . Dr. Sell i will just be quick. The administration should be transparent, they should be clear about what they know, be clear about what they dont know, what they are trying to do to find out those missing pieces of information. And be clear about what the course is and what information might change that course. Rep. Beyer ok. Thank you. Dr. Brownstein, we proclaim that we have heard it claimed that focusing on testing is no longer needed once the disease has spread. If its in the community, testing is moot. We have also had test sediment for many that they would rather over test than under test. Do you think the testing will still be valuable when the when it starts to spread to the community . Dr. Brownstein yeah, i think its important to actually have an accurate picture, so the dynamic of this virus is going to change from community to community, and we need to understand the impact its having to scale is critical. So just like we do this for the influenza on a seasonal basis, we test for flume to understand the underlying illness. We need to do that to scale with coronavirus makes a lot of sense. Rep. Beyer youve done so much work on vaccines over the decades. You testified earlier quite well about it. What is the best the American People can hope for in terms of a quick vaccine . Or soon vaccine . Dr. Hotez well, i think it is really important to remember that vaccines are not quick. And that has a lot to do with Vaccine Confidence the united in the United States. As you know, we have a very aggressive Antivaccine Movement in this country. As for the last couple of years, its affecting Public Health. Measles came back in 2019 because of the Antivaccine Movement. Historically when we have had measles epidemics, it peaks now, late winter, early spring, so we may be battling two epidemics. We still have 16,000 americans who died of the flu. We have hundreds who have those not getting vaccinated. I think its important to not tell the American Public that we will have a quick vaccine, because thats not how works. We have to reassure the public that we do not give out vaccines unless they are thoroughly tested, and they are the most thoroughly tested pharmaceuticals we have for safety. Rep. Beyer thank you. Mr. Chairman, as i yield back, i otez forthank dr. H leading the fight for the misinformation. Before bring this hearing to a close, i want to thank all of our witnesses for testifying before the committee today. The record remain open for two weeks for additional statements for members and any additional questions the committee may ask of the witnesses. With that, the witnesses are excused and this hearing is now adjourned. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] to follow the federal response of the coronavirus outbreak, go to cspan. Org coronavirus. You can find all of our coverage, including hearings, briefings, and review the latest events at any time at cspan. Org coronavirus. Here is a look at our live coverage friday. On cspan at 11 00 a. M. Eastern, the head of the National Association of county and city officials talks about the steps local Health Officials are taking to prepare for the coronavirus. At 1 30 p. M. Eastern, Johns Hopkins University Provides an update on the coronavirus added a briefing ont capitol hill. And on cspan2, a discussion on the Coronavirus Response with two former Obama Administration officials. That is live from the center for American Progress at 11 30 a. M. Eastern. Eastern coming up on washington journal, a look at the u. S. Response