Federal health and science agency officials testified on the road ahead in combatting COVID-19 on Nov. 4 before the Senate Health, Education, Labor, and Pensions (HELP) Committee. The testimony followed related HELP Committee hearings on the country’s COVID-19 response [refer to Washington Highlights, May 14, July 23].
Committee members questioned witnesses on issues including the availability of COVID-19 tests and therapeutics, vaccine hesitancy and requirements, viral research, the domestic supply chain, future preparedness, and the pandemic’s impacts on children.
In her opening statement, Chair Patty Murray (D-Wash.) mentioned her ongoing work with Ranking Member Richard Burr (R-N.C.) to develop bipartisan preparedness legislation and noted her support for public health investments in the Build Back Better Act including infrastructure improvements, data modernization, increased lab capacity, and strengthening the supply chain [refer to related story].
In his opening statement, Burr noted that Congress’s work on the Build Back Better Act would need to conclude before the release of the bipartisan preparedness bill. Burr also raised concerns over shortages of COVID-19 tests and therapeutics and urged the witnesses to look ahead and identify next steps to better respond to the ongoing pandemic and future threats. Additionally, Burr urged the president to nominate strong candidates to lead the Food and Drug Administration (FDA) and the National Institutes of Health (NIH) [see Washington Highlights, Oct. 8].
In her opening statement, Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky, MD, MPH, identified the impact of the more contagious delta variant on increased COVID-19 cases, hospitalizations, and deaths since she appeared before the committee in July. She added that the country still averages 1,000 deaths per day from COVID-19. She stated that “unvaccinated people have six times greater risk of testing positive for COVID-19 and 11 times greater risk of dying from COVID-19 than people who are fully vaccinated.”
Committee members addressed the administration’s newly released vaccine requirement regulations for certain hospital settings and businesses with over 100 employees [refer to related story]. Burr and Sens. Bill Cassidy, MD (R-La.) and Roger Marshall, MD (R-Kan.) specifically inquired if individuals who recovered from previous COVID-19 infection could be exempt from a vaccine requirement due to the development of infection-acquired immunity, to which Walensky and NIH’s National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony Fauci, MD replied that current evidence shows enhanced immune responses with a vaccine. In his opening statement, Fauci also addressed waning immunity provided by the COVID-19 vaccines in highlighting the importance of vaccine booster doses. Sen. Mitt Romney (R-Utah) added that he would like to see an estimate of the number of lives that would be saved with a vaccine requirement.
Committee members also highlighted the recent approval of COVID-19 vaccines for children ages 5-11, which Walensky noted was 91% effective with no serious side effects in clinical trials.
Several members in both parties described recent surges in hospitalizations in their states. Fauci noted that while vaccines are not 100% effective and breakthrough infections are being recorded, currently it is predominantly unvaccinated individuals in hospitals and dying from COVID-19.
Members from both sides of the aisle raised concerns about limited supply of COVID-19 tests, and the important role tests play in quickly tracking and responding to infection outbreaks, especially in schools and the workplace. Regarding availability of rapid at-home COVID-19 tests, Acting Commissioner of the U.S. Food and Drug Administration (FDA) Janet Woodcock, MD, added that increasing access to the tests is a priority for the FDA. Assistant Secretary for Preparedness and Response (ASPR) Dawn O’Connell noted that ASPR has invested $1 billion in bringing at-home tests to market.
Sen. Tim Kaine (D-Va.) highlighted his legislation, the Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667, S. 610), which aims to address mental health concerns in front line workers. The Senate passed the bill in August, and the House Energy and Commerce health subcommittee approved it on Nov. 4 [refer to related story]. Kaine also asked Fauci about the NIH’s efforts to address long COVID, to which Fauci responded that the NIH has invested $1.5 billion to launch the RECOVER research program, including awards to three academic medical center leads — NYU Langone, Massachusetts General Hospital, and the Mayo Clinic.
Sen. Tammy Baldwin (D-Wisc.) mentioned forthcoming legislation to create a new loan repayment program to support the career paths of infectious disease clinicians and enhance preparedness. Walensky noted the debt that current medical school graduates incur and added that additional support like the proposed bill would be important to bolster the public health workforce.
Several Republican members questioned Fauci on gain-of-function research and the origins of the COVID-19 pandemic. Fauci reiterated the role of a federal advisory committee and external experts in years-long process to define gain-of-function research. He added that the NIH and Department of Health and Human Services are “very much in favor of all transparency” regarding investigations in China into the origins of the current pandemic.
To address future preparedness, Walensky stated that sustained disease-agnostic funding for public health is one of the most important steps Congress could take to better prepare for future pandemics. When asked about new tools developed during the COVID-19 response to be leveraged in future pandemics, Walensky highlighted the need for a skilled, more diverse public health workforce as well as investments in laboratory infrastructure including machinery, sequencing capabilities, and cross-sector collaborations.
Sen. Bob Casey (D-Pa.) shared his support of the Hospital Preparedness Program (HPP) and asked about lessons learned for the program. O’Connell noted the program’s critical role in the pandemic response but also acknowledged the “uneven use and success of the HPP based on regional strengths,” before sharing her intent to work towards a more uniform model for the program moving forward.
Regarding the two-year outlook for COVID-19, Sen. Tina Smith (D-Minn.) asked the panelists what it may look like to come out of the current pandemic. Fauci described the natural course of transitioning from a pandemic to a deceleration phase before the phases of control, elimination, and eradication. He posited that a control phase is the most likely scenario in which the virus would not have a major impact on public health and day-to-day life. Fauci added that what happens globally will impact this country’s transition out of the pandemic phase.
Sen. Lisa Murkowski (R-Alaska) also urged NIH and FDA to invest in additional vaccine platforms that offer broader protection against different variants, do not require cold storage, and that could be more easily distributed and administered to assist in both the domestic and global pandemic response.