Next, a Public Health official looks at efforts to improve. Vaccine and develop a universal flu vaccine. This house, science, space and Technology Committee hearing is about 2 and half hours. This hearing will come to order and without objection, declare a recess at any time. Good morning and welcome to our witnesses. Todays hearing on science and innovation, the worlds population, killing approximately 300 Million People in the 20th century alone. Smallpox is the only human disease to be eradicated thanks to the development of the vaccine. Another devastating disease, polio, 33 cases reported worldwide in 2018 compared to 350,000 cases in 1988. Every day it save lives especially lives of children and other vulnerable populations. There is no such thing as healthy skepticism when it comes to vaccines. Unfortunately there is a wellfunded Disinformation Campaign targeting the public and weakening Public Health laws. School vaccination requirements have been commonplace in the us for generations and exemptions were granted only for legitimate medical reasons. However in my home state of texas the number of unvaccinated children has spiked since 2003 when the Texas Legislature expanded exemptions to include nonmedical reasons. The number of exemptions rolled from 2000, 2003, 50,000 last year. We see this replayed across the country, innocent children, Health Officials have confirmed 21 measles cases in texas this year and 1261 nationwide. 61 of which led to serious complications. Is the first nurse elected to congress, i have been dedicated to Public Health my entire career. The science committee, health and Human Service agencies, we have long had a role involving Public Health through good science. This morning we will export the signs and Innovation Challenges for Vaccine Development through the lens of influenza. For the healthiest among us, the flu just lay this out for several days with no lasting side effects. However for the very young, the elderly, pregnant women and other vulnerable groups the flu can be deadly. The centers for Disease Control recorded an estimated 48. 8 million illnesses, 79,000 deaths during the 201718 flu season. Approximately 600 of those deaths were children. Influential vaccine production began with collection, analysis of data before the beginning of the flu season. The virus is changed constantly and by the time flu season begins the vaccine may not fully match the circulating viruses. Scientists are working to develop viable and more effective alternatives, eight eggbased vaccines as well as universal vaccine that would not require annual updates, yet another scientific challenge to influenza and many other Infectious Diseases are complete. Disease, incomplete data, antiquated data systems through modernization, data systems and data analytic across the federal and state level, we accelerate vaccine for many diseases, that will help us understand the full cycle from basic research to Vaccine Development for deployment and surveillance. Of the witnesses would also describe the role of federal agencies, state agencies and the private sector including the partnerships among all the stakeholders. I want to extend a warm welcome to all of you and thank the vice chair for his leadership on this issue. I look forward to todays discussion. I might say i have a markup in another committee so i will have to leave before we get through all the deliberations. The chair will recognize mister lucas for an Opening Statement. I would like to thank you for holding this hearing given we are in the middle of flu season. In the United States million individuals are hospitalized for the flu every year including more than 48,000 children. And oklahoma since the 2019 flu season began september 1st, there have been several hospitalizations from the flu but these numbers would be far worse if we did not have vaccines. Vaccination is by far the best flu prevention measure, it is easy to forget 100 years ago the world faced one of the deadliest pandemics in history, the 1980, h1 out and one epidemic known as spanish flu, killed an estimated 50 Million People worldwide including 675,000 people in the United States. The countermeasures of the time were limited, isolation and quarantine. Isolation vaccines did not exist and antibiotics were not fully developed yet. Due to basic research, advancements were made in treatment and prevention of the flu. The development of vaccines played an Important Role in producing and eliminating disease. I can still recall my fathers stories how late summer and fall were a terrifying time as a child because of the threat of polio during those seasons. I did not have to experience this fear because of the first polio vaccine in 1955 and thanks to widespread vaccination polio has been nearly eradicated in the United States, 33 cases reported in 2018. However polio remains a threat in some countries, with the world becoming more connected through modern transportation it only takes one traveler with polio to bring the disease into the United States and as im sure we will hear this morning from our witnesses the best way to keep the United States polio free is to maintain high immunity through vaccination. Considerable advancements have been made in disease surveillance, medical care, medicines, drugs, vaccines and pandemic planning, significant progress has been made, a severe pandemic could be devastating to the global population. If the immune population has grown so has the poultry population to feed them. Increased opportunities for unique viruses from birds, cattle and pigs to infect people. As a member of the House Agriculture Committee i supported the creation of the National Animal vaccination vaccine and veterinarian countermeasures which was included in the last farm bill. This vaccine bank will maintain a sufficient quantity of animal vaccines and other countermeasures to provide Rapid Response to an animal disease outbreak. If an outbreak were to occur and we were not prepared our entire Agricultural Sector would suffer immense losses causing longterm harm to the economic viability of the United States livestock, poultry and swine production not to mention the damage to human health. I look forward hearing from our witnesses about the current state of our stockpile Human Health Vaccines the capacity for Rapid Responses for emergency situations. The influenza vaccine manufacturing infrastructure supporting publicprivate partnerships with domestic vaccine manufacturers for response capacities for events in the United States. The recent executive order to address modernizing flu vaccines. The executive order recognizes influenza as a Public Health and National Security priority with potential to inflict harm on the United States through largescale illness and death. Most important leader establishes a National Passport to explore alternative vaccine production methods and new technologies including a plan to accelerate developers of universal flu vaccine. I look forward to seeing what recommendations come from the passports. I would like to thank chairman johnson for holding this hearing and i would like to thank both witness panels for taking the time to share your expertise, insights, with us this morning and i yield back the balance of my time. If there are members would like to make additional statement your statement will be added to the record. At this time i will introduce witnesses, first witness on the panel, doctor Daniel Jernigan at cdc. He is responsible for oversight and direction, abroad program to improve detection, prevention, treatment and response with seasonal novel and pandemic. And national and global surveillance of influenza and serve as world health organization, collaborating center for the surveillance and control of influenza. Doctor jernigan entered the cdc in 1994 and the captain of the Public Health service and was a recipient of the 2019 service, the next witness on this panel, Anthony Fauci from the National Institutes of Infectious Diseases, a position he has held since 1984 and oversees Extensive Research portfolio, applied research to prevent and treat established Infectious Diseases like hivaids, respiratory diseases, tuberculosis and malaria as well as emerging diseases such as ebola and seek a. He supports research on the transportation, transplantation related illnesses. Asthma and allergies. He is advised 6 president s on hivaids and many other Global Health issues. He was one of the principal architects of the president s emergency plan for aids relief, a program that has saved millions of lives throughout the developing world. As our witnesses should know, 5 minutes for your spoken testimony. Your written testimony will be included in the hearing. We begin with questions. Each member will have 5 minutes. We start with doctor lofgren. Jernigan. Thank you, dismissed members of the committee. Im doctor dan jernigan the, from the centers for Disease Control and prevention. I think the committee for the opportunity to discuss the work supporting vaccine innovations to improve prevention of influenza. This is a Significant Health burden in the United States with millions of americans becoming a, hundreds of thousands requiring hospitalization and tens of thousands die income. Influenza viruses are constantly changing requiring us to update the vaccine components every year. These changes can be sudden and significant resulting influence strains that can lead to devastating pandemics. Hospitalization and death can happen in any flu season and each year flu vaccination prevents millions of illnesses, thousands of severe tragic outcomes. This is the way for people to fight the flu. Despite the significant benefits the effectiveness of the flu vaccine at the numbers of americans being vaccinated are not optimal. We are working with nih and other federal and State Government partners to use cuttingedge science to make influenza vaccines better. The probably affected dexa vaccines are the ultimate goal for flu prevention. However, these vaccines are still years away. In the near term, millions of americans making incremental improvements to vaccines that can be produced using already available production platforms and getting more americans each flu season. Cdc has a part of the Vaccine Development administration cycle including continuous virus tracking around the globe. Preparation of vaccine viruses 10 of flu vaccines used in the United States and monitoring vaccine coverage, safety and effectiveness. Cdc has implemented innovations throughout the vaccine lifecycle, cdc is invested in and collaborated with every department on flu surveillance, this is invested in automated realtime reporting of influenza test results for cdc using cloudbased messaging. Cdc transformed flu surveillance by using next generation genomic sequencing to characterize everything received at cdc meaning we can identify and track viruses much more quickly and accurately leading to more candidate vaccine viruses and Early Detection of viruses with pandemic potential. Genomic sequencing equipment which was filled a room now fits in the palm of your hand. We have a mobile mini lab that can be taken on the plane as a carryon, set up almost anywhere in the world including rural resource constraint settings. Cdc has implemented innovations for supporting they were vaccines by developing candidate vaccine viruses and providing genomic sequences used to make recombinant protein vaccine. Both of these new were vaccines have potential to be manufactured more quickly and may be more effective than traditional vaccines. Cdc routinely generates vaccine viruses using a technique called reverse genetics allowing us to build a vaccine in a matter of days or weeks much faster than traditional methods making the us more prepared to respond quickly to a pandemic. Cdc was first to develop a system for the routine monitoring of influenza vaccine effectiveness and the Vaccine Effectiveness Network provides critical information for manufacturers and researchers in developing enhanced vaccines by collecting more specific data how well the vaccine works each season. Recently we have expanded the network and are planning to add new immunity consisting to better evaluate vaccine effectiveness. A component is getting more people vaccinated. Fewer than half of adults in the us receive their influenza vaccines. Despite all of our successes and Global Leadership in detection and prevention there is still more we need to be able to do. Each of the topics i mentioned from working with domestic Public Health partners to developing vaccine candidates and studying vaccine effectiveness will benefit from investment in generating more precise and timely data. I believe we can harness this to make vaccines work better. I want to close by reminding you that you and your families are vaccinated before the holidays when travel begins and thank you for the opportunity to talk about cdc, i look forward to your questions. Thank you. Members of the committee, thank you for the opportunity to testify before you today. Im doctor Anthony Fauci from the institute of Infectious Diseases and i want to talk over the next couple minutes about nih efforts to improve the influence of vaccines and develop the universal flu vaccine. As shown on this slide, although as jernigan mentioned it is important to be vaccinated because even if it is not 100 effective or even 50 effective the benefits to the individual to get vaccinated and to the community is profound. However we can do better because seasonal influenza vaccines are not optimally effective. In addition we know through history pandemics occur but usually too late in our response as we were in the 2009 h1 in one and we spend considerable time chasing after pandemics as we had with the age 5 and one at age 7 and one in which we made significant investments. We needed to do that but those pandemics never occurred. This slide shows the journal of Infectious Diseases containing cases in which my colleagues and i gave the introduction emphasizing the point i made that although influenza vaccines are good and important and should be utilized, we can do better. By doing better we need to improve the seasonal influenza vaccines which would lead to better capability to respond to pandemic influenza which ultimately will get us to the goal that we will speak about in the next minute or two and that is developed of a universal influenza vaccine. In the summer of 2017 we brought a group together to develop a plan we published in 2018 for the Strategic Plan and Research Agenda to mobilize scientists throughout the country and the world to develop universal flu vaccine. Let me explain what we mean by universal flu vaccine, this is a complicated slide but it does make the point. We will not get a universal flu vaccine overnight. I mean it will be a stepwise process in which we go from improvement, broad capability of responding to a particular type of strain versus the ability to respond to all strains. On the lower lefthand part of the slide, divided into two groups of influenza, group 1 and group 2. On the righthand part of the slide the tip of the triangle is what we do today. We make the vaccine for this season that is highly specific to the strains that are circulating this season but those strains change, mutate, drift. What we want to do is go to the next step. Make a vaccine that will cover all the age one in ones in the next step would be to get one that would do all the group 1s and group 2s until ultimately we have a universal vaccine that essentially covers all of these. We will do that with new technologies, we currently have a technique of growing the virus eggs and develop vaccines. Although that is triedandtrue and timehonored it is an efficient and has many areas of going wrong. We are using new platforms as shown here in the slide such as recombinant proteins, viral vectors, nanoparticles and others. This is a blowup of the influenza virus and an important protein. It is important to note the hemoagglutinin has two components, the head and a stem. The head is the part of the response, but it mutates often, changes leading to the ineffectiveness but the dark blue is the stem which doesnt change much at all. The strategy, one of several strategies is to develop a vaccine in which you cut off that head, take the stem and put it on a nano particle which will ultimately serve the vaccine. If i could show you this, this is a 4 million times blowup of what the first un