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Did the pandemic start with a lab leak? Is natural immunity protective? Should healthy children be vaccinated against COVID-19? Lawmakers discussed these and other questions during a hearing of the on Tuesday afternoon.

Underlying each of these questions were tensions over who should be trusted to answer them.

Rep. Debbie Lesko (R-Ariz.) cited reports in the media of Li-Meng Yan, MD, PhD, a Chinese virologist who said SARS-CoV-2 was "intentionally released," and that an accidental leak from a Chinese laboratory was not possible.

Marty Makary, MD, MPH, chief of islet transplant surgery, professor of surgery at Johns Hopkins University in Baltimore, and former editor-in-chief of 番茄社区app, appeared to agree that a lab leak occurred.

That there is debate at all over the origins is due to the U.S. funding the lab, a connection that is "embarrassing" for the government to acknowledge, he argued. "The epicenter of the world [outbreak] is 5 miles from one of the only high-level virology labs in China ... It's a no-brainer that it came from the lab. I mean, at this point, it's impossible to acquire any more information, and if you did, it would only be affirmative."

Debate over the origins of the pandemic flared anew this week after the Department of Energy (DOE) and concluded with "low confidence" that the pandemic likely began with a laboratory leak in Wuhan, China; DOE's change followed the release of a new classified intelligence report.

Jay Bhattacharya, MD, PhD, professor of medicine at Stanford University in California, was more circumspect over the pandemic's origins at the hearing, but said the virus does not appear to have the characteristics of a bioweapon or something that would be intentionally leaked.

"The evidence that I've seen suggests that the lab-leak hypothesis is an active hypothesis, that it's quite possible that this was a lab leak as a result of gain-of-function work ... to try to get vaccines available for the next pandemic," Bhattacharya said.

"I also know that there's a lot of scientists that think it might also have been of natural origin," he said, adding that "Congress absolutely needs to get to the bottom of" this question.

Rep. Richard McCormick, MD, MBA (R-Ga.), argued that the government overstepped its role particularly with regard to vaccine mandates and booster recommendations, and said "the best thing Congress and the government can do is stay out of medicine. Leave this to the physicians."

Witnesses and some Republican lawmakers also questioned the rationale for vaccinating children against COVID-19 and adding the vaccine to the 2023 childhood immunization schedule.

"Has any young healthy child died in the United States of COVID in the last 3 years?" Makary said. Whatever the number is, "[it's] far less than other common respiratory viruses."

Georges Benjamin, MD, executive director of the American Public Health Association, acknowledged that experts were "surprised" by how well kids fared during the pandemic, but stressed that there are still approximately 9,000 kids with multi-system inflammatory syndrome in children.

On the topic of natural immunity, Benjamin noted that early data from China showed that roughly 20% of people who had SARS-CoV-2 infections "got really sick," especially those with chronic diseases, of which communities of color bear a disproportionate burden. "You get 'immunized' [by natural infection], but you've got to survive to be immunized. I don't want to make that dramatic statement, but that's true," he said.

Asked by Rep. John Joyce, MD (R-Pa.), whether he believed in mandating vaccinations for children, Bhattacharya said he did not. "I've seen a rise in vaccine hesitancy for essential vaccines, like measles [and] DTP [diphtheria, tetanus, and pertussis], that's quite alarming," he said. "And I think a lot of the hesitancy is due to the mandates and due to the force. Rather than using ethical principles like informed consent, this mandate has demolished trust in vaccines more broadly."

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