A transcript of Senator Romney’s exchange with Dr. Francis Collins from the National Institutes of Health (NIH) and Dr. Gary Disbrow from the Biomedical Advanced Research and Development Authority (BARDA) can be found below.
Senator Romney: Those of us who have been in the business world have to deal with probabilities. People at NASA I’m sure do, doctors certainly have to. What is the probability we will have a generally available vaccine for the American public by the end of the year? What is your personal sense of what the probability is? 50%, 90%, 20%? What is the likelihood?
Dr. Disbrow: I'm not a betting person, but if we don't set lofty goals, we will never achieve the goals. We are working very hard across the federal government to make sure we are doing everything we can to expedite the development.
Senator Romney: I know that. I know we all have lofty goals. I'm not asking for goals, I'm asking for the probability. What is the probability, is it 50/50, 90/10, 60/40? What is your sense of what the likelihood is we will actually have the vaccine available for the general public, let’s say, by the beginning of the year for the population of our country? I know what our goal is. Of course our goal is 100%, but what is your sense of the probability? You have been in this vaccine world for a long time—you have experience here—what should we be thinking about?
Dr. Disbrow: That is why I don't like to set timelines..
Senator Romney: Okay, never mind. If you don't want to answer the question, we’ll move on. My second question is to Dr. Collins. The Abbott machine, which is already providing information, I guess, almost on a real-time basis. What is wrong with making a lot more of those and using that as a machine that can be available at most businesses, retailers, and so forth. Is it just inadequate? Is it the false negatives it gives? It strikes me that we already have a technology that works. Am I wrong on that?
Dr. Collins: No, it is a great machine, Senator. This is the Abbott “ID NOW” approach. It does provide you point-of-care, and it does it very quickly in the space of 15 minutes. It does require having a special machine, and of course, there is a limited number of those machines out there. I think it is 18,000 or something like that. To be able to really meet the need, that would have to go up substantially, and the machines are not exactly inexpensive. I think the other concern has been that it does have about a 15% false negative rate. If you are in a circumstance where you really don't want to miss a diagnosis of somebody who is already carrying the virus, you would like to have something that has a higher sensitivity than that. I know they are working on how to make that happen, but so it is certainly one of the most exciting things we have right now, but we think we can even do better.
Senator Romney: Your judgment is a lot better and more experienced than mine in this regard, but it does seem to me that, given in fact, we have a test that works, it could perhaps be made more sensitive. If we were to devote a lot of resources to making a lot of these machines, perhaps having other some people around the world, or around the country at least, making these machines on an accelerated basis, why we could fulfill the need that we are talking about with technology that already exists, because the probability of finding a new technology—I hope we can find that—but it strikes me this kind of machine has potential.
Finally, the last question for you, Dr. Collins. I have been puzzled by the conflicting data that I see, and I'm sure you see the same thing. The reports that came out of Massachusetts as to the number of people there that were asymptomatic, the testing in New York that suggested that over 20% of the people there had already had COVID-19, the prison tests as well in five states in the South, which is, as I recall, 93% of the people who had tested positive never had any symptoms. Then, the experience of Sweden, which said, we’re not really going to test everybody, and we’re going to let the economy keep going. Do we really need to have the kind of testing we are talking about, or does this information suggest that, given so many people that are asymptomatic—I was in a hearing yesterday with the Homeland Security Committee, and the suggestion was that 50% to 90% of the people that get COVID-19 have no symptoms. If that is the case, should we let this run its course through the population and not try to test every person? I’m saying that a bit as a strawman, but I’m interested in your perspective.
Dr. Collins: I appreciate your putting it forward as a strawman. It is true that a lot of people seem to get this virus without any symptoms at all, and the estimates are that maybe 60% of new cases are transmitted by such people, it is still the case that 74,000 people have died from this disease. So the people who are out there infected, who may not themselves be suffering, are passing this on and becoming a vector to others who are vulnerable with chronic illnesses or in the older age group, and sometimes, young people too. Let's not say that they are not immune. There are certainly plenty of sad circumstances where young people who you wouldn't have thought would be hard hit by this who have gotten very sick or even died. I think it is extremely unusual to have a virus like this that is so capable of infecting people without symptoms, but having them then spread it on. We just have not encountered something like that before, but it does not mean that it is not a terribly dangerous virus for those people who aren’t so lucky and who get very sick and end up in the ICU and perhaps lose their lives. The only way we are really going to put a stop to that is to know who the people are who are infected, even if they have no symptoms, get them quarantined, follow their contacts—that is just good shoe leather public health, and we’ve learned it over the decades, and it applies here too.