    [House Hearing, 114 Congress]
    [From the U.S. Government Publishing Office]

            THE ZIKA VIRUS: COORDINATION OF A MULTI	AGENCY RESPONSE

    =======================================================================

                                    HEARING

                                   BEFORE THE

                                SUBCOMMITTEE ON
                        TRANSPORTATION AND PUBLIC ASSETS

                                     OF THE

                             COMMITTEE ON OVERSIGHT
                             AND GOVERNMENT REFORM
                            HOUSE OF REPRESENTATIVES

                        ONE HUNDRED FOURTEENTH CONGRESS

                                 SECOND SESSION

                                   __________

                               FEBRUARY 24, 2016

                                   __________

                               Serial No. 114-101

                                   __________

    Printed for the use of the Committee on Oversight and Government Reform

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

             Available via the World Wide Web: http://www.fdsys.gov
                          http://www.house.gov/reform

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                  COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM

                         JASON CHAFFETZ, Utah, Chairman
    JOHN L. MICA, Florida                ELIJAH E. CUMMINGS, Maryland,
    MICHAEL R. TURNER, Ohio                  Ranking Minority Member
    JOHN J. DUNCAN, JR., Tennessee       CAROLYN B. MALONEY, New York
    JIM JORDAN, Ohio                     ELEANOR HOLMES NORTON, District of
    TIM WALBERG, Michigan                    Columbia
    JUSTIN AMASH, Michigan               WM. LACY CLAY, Missouri
    PAUL A. GOSAR, Arizona               STEPHEN F. LYNCH, Massachusetts
    SCOTT DesJARLAIS, Tennessee          JIM COOPER, Tennessee
    TREY GOWDY, South Carolina           GERALD E. CONNOLLY, Virginia
    BLAKE FARENTHOLD, Texas              MATT CARTWRIGHT, Pennsylvania
    CYNTHIA M. LUMMIS, Wyoming           TAMMY DUCKWORTH, Illinois
    THOMAS MASSIE, Kentucky              ROBIN L. KELLY, Illinois
    MARK MEADOWS, North Carolina         BRENDA L. LAWRENCE, Michigan
    RON DeSANTIS, Florida                TED LIEU, California
    MICK, MULVANEY, South Carolina       BONNIE WATSON COLEMAN, New Jersey
    KEN BUCK, Colorado                   STACEY E. PLASKETT, Virgin Islands
    MARK WALKER, North Carolina          MARK DeSAULNIER, California
    ROD BLUM, Massachusetts              BRENDAN F. BOYLE, Pennsylvania
    JODY B. HICE, Georgia                PETER WELCH, Vermont
    STEVE RUSSELL, Oklahoma              MICHELLE LUJAN GRISHAM, New Mexico
    EARL L. ``BUDDY'' CARTER, Georgia
    GLENN GROTHMAN, Wisconsin
    WILL HURD, Texas
    GARY J. PALMER, Alabama

                       Jennifer Hemingway, Staff Director
                     David Rapallo, Minority Staff Director
                   Michael Kiko, Subcommittee Staff Director
                               Willie Marx, Clerk

                                     ------

                Subcommittee on Transportation and Public Assets

                         JOHN L. MICA Florida, Chairman
    MICHAEL R. TURNER, Ohio              TAMMY DUCKWORTH, Illinois, Ranking
    JOHN J. DUNCAN, JR., Tennessee           Member
    JUSTIN AMASH, Michigan               BONNIE WATSON COLEMAN, New Jersey
    THOMAS MASSIE, Kentucky              MARK DESAULNIER, California
    GLENN GROTHMAN, Wisconsin, Vice      BRENDAN F. BOYLE, Pennsylvania
        Chair

                                C O N T E N T S

                                  ----------
                                                                       Page
    Hearing held on February 24, 2016................................     1

                                   WITNESSES

    Anne Schuchat, M.D., Principal Deputy Director, Centers for
      Disease Control and Prevention
        Oral Statement...............................................     6
        Written Statement............................................     8
    Anthony Fauci, M.D., Director, National Institutes of Health
      National Institute of Allergy and Infectious Diseases
        Oral Statement...............................................    16
        Written Statement............................................    18
    John Armstrong, M.D., Surgeon General and Secretary of Health,
      State of Florida
        Oral Statement...............................................    29
        Written Statement............................................    32
    Bill Moreau, D.C., Managing Director for Sports Medicine, United
      States Olympic Committee
        Oral Statement...............................................    38
        Written Statement............................................    40

                                    APPENDIX

    Written Statement from the American Mosquito Control Association,
      Submitted by Chairman Mica.....................................    56
    Written Statement from Ariel Pablos-Mendez MD, MPH, Assistant
      Administrator for Global Health, U.S. Agency for International
      Development, Submitted by Chairman Mica........................    64
    Robert G. Salesses, Deputy Assistant Secretary for Homeland
      Defense Integration and Defense Support of Civil Authorities,
      Department of Defense..........................................    70
    Dr. Anne Schuchat's Responses to Questions for the Record,
      Submitted by Rep. Earl L. ``Buddy'' Carter (GA)................    72
    January 29, 2016, International Olympic Committee Statement on
      Zika...........................................................    76
    February 10, 2016 Memo from Scott Blackmun, CEO of the United
      States Olympic Committee, to Prospective Members of the 2016
      U.S. Olympic and Paralympic Delegations........................    78

            THE ZIKA VIRUS: COORDINATION OF A MULTI-AGENCY RESPONSE

                                  ----------

                          Wednesday, February 24, 2016

                      House of Representatives,
      Subcommittee on Transportation and Public Assets,
                  Committee on Oversight and Government Reform,
                                                       Washington, D.C.
        The subcommittee met, pursuant to call, at 2:05 p.m., in
    Room 2154, Rayburn House Office Building, Hon. John L. Mica
    [chairman of the subcommittee] presiding.
        Present: Representatives Mica, Duncan, Amash, Massie,
    Grothman, Duckworth, DeSaulnier, and Boyle.
        Mr. Mica. Good afternoon. And I'd like to call the
    Subcommittee on Transportation and Public Assets to order, this
    hearing. And this is a subcommittee of the Committee on
    Oversight and Government Reform.
        Today, we are conducting a hearing on the Zika virus, and
    we are looking at the coordination of a multi-agency response
    to that virus. I'm very pleased to have everyone joining us
    today. The order of business will be as follows: We will have
    opening statements; myself and Ms. Duckworth are here and other
    members joining us. And we will then hear from our witnesses.
    And from the witnesses, we will hear your testimony, and then
    we'll go into questions. That will be the order of business.
        So, without objection, the chair is authorized to declare a
    recess at any time. And I will start with my opening statement,
    and then I will yield to Ms. Duckworth.
        Again, I want to thank everyone for attending. There are
    probably some people that didn't want us to hold this hearing,
    but I think it is very necessary that we do conduct it. I think
    that the Zika virus is probably one of the more difficult
    health challenges that the Nation and the world have faced
    probably since the Ebola crisis. And unlike that particular
    crisis, there is some very good news to report in this hearing,
    and the purpose of the hearing is also to hear from some of
    those involved in making certain that the public health,
    welfare, and safety is preserved while we face this possible
    epidemic.
        And I might say, this isn't something just facing the
    United States; it's facing the world. So it's spread, again, we
    know, across the many continents. And we have international
    events, like the Olympics this summer in Brazil. We want to
    make certain that American travelers there are protected. And I
    might say, also, we have American personnel throughout the
    infected area and the world who are our responsibility to make
    sure they are safe and secure. Many of them are abroad serving
    the United States in diplomatic posts, with the military, and
    others, and we want to make sure that those individuals that
    we're responsible for are also protected.
        I'm pleased, too, with the World Health Organization.
    You've heard me from this dais raise some serious questions
    during Ebola, that they did not act to alert the public and
    declare the seriousness of Ebola at the time. That is not the
    case here. They have acted. They have been proactive.
        I'm also pleased that we have had a very good response,
    both from the Federal level and the State level and other
    agencies in government. And we need to keep it that way, and we
    need to keep going forward.
        Today, the purpose of this hearing is to see where we are
    and what we have done and where we need to go and how we can
    keep this under control.
        I'm very pleased to have a representative from my State,
    which has taken the lead, and Governor Scott and others. We
    have our surgeon general of Florida with us. And we'll hear
    from, again, NIH. And they have done a great job. The Centers
    for Disease Control, we'll hear where they are and get an
    opportunity to get an update on a great world event which we're
    looking at in Brazil later this year.
        Right now--and I want to say this and make this very
    clear--there has been no detected Zika infection from an insect
    or mosquito in the United States of America. No transmission
    that I'm aware of. Most of what we found so far are individuals
    who have traveled somewhere else and come into the United
    States.
        This isn't a South United States problem. In fact, right
    now--and, look, we have a chart we can show later: I think as
    far as Wisconsin in the United States, and--what is it?--23
    States that have now had cases where they have determined that
    someone was infected with the Zika virus.
        So we don't have that infection from mosquitos in the
    United States, but we do have people coming in outside who have
    been infected with that disease.
        So we still have a long way to go in the detection process.
    We don't have a vaccination available. We don't know all the
    connections, and we'll have questions and some directions about
    where we're going to look at how we can go after the disease,
    either for vaccination or for treatment.
        The numbers that we have seen so far are, again, somewhat
    limited in the United States, but, again, getting a head start
    on it--in Florida, we've had 28 cases, and I think two of my
    counties with a single case. I just had lunch with the local
    health director, and I thought that was very informative,
    because I wanted to hear from him how things that we are doing
    here have filtered down to the local level. And I will say that
    report is also good.
        But they do face challenges. They want to make certain that
    they have the test kits available. They want to make certain
    that the testing is available. They want to know where to go
    next. And some of that has been provided. And the State of
    Florida acted in early February, the Governor and others, and
    they have been in close contact with the local officials, which
    I think is extremely important.
        There's some simple things that can be done, and we know
    what they are: using insecticides, using mosquito repellant,
    staying in air-conditioned locations. And that, again, is where
    people are getting the infection. But if we do have the problem
    in the United States, we want to make certain that people are
    aware of the risk that they face and the simple solutions to
    tackle this. It's just like mosquitos that we have from coast
    to coast and from border to border.
        While the CDC remains hesitant to confirm some of the
    links--we'll hear more about that--experts are confident that
    Zika is causing some outcomes that we've seen, and we'll talk
    about them. The most notable and at risk are women and pregnant
    women, and they seem to have--or seem to be fairly certain of
    the link there. We'll find out more about that and other
    possible links to individuals that may cause them serious
    health damage.
        The administration--I woke up at 3 o'clock in the morning.
    I have this folder and fell asleep reading it. I woke up at 3
    and finished it last night. And I did read it. The
    administration, last week, the President sent a communication
    to the Members of Congress and asking for $1.8 billion request
    for emergency action. I also read where Mr. Rogers, our
    chairman of Appropriations, said we happen to have almost the
    exact amount left over from Ebola and the possibility of using
    that. I want to make certain that the funds are available,
    particularly for the research for finding out anything that can
    stop this, either with a mosquito or keep people safe with
    possible vaccination, wherever we are going to go, but that
    also needs funding ASAP. And we want to make certain that those
    funds are available.
        I'll have some questions about the money flow, because
    money usually solves most of our problems.
        The situation is rapidly developing and changing, and
    Americans have concerns, but they need to know that their
    government on each level, Federal, State, and local, are making
    certain that the challenge is being met, and we want to ensure
    the public that we're all receiving the latest information and
    coordinating in good fashion so that we can do the best.
        The United States is fortunate. We have the world's most
    advanced healthcare system in the United States. It's
    impressive. We want to keep it that way and make certain that
    we're well coordinated, we use common sense, and that we'll be
    able to contain the spread of this virus and be well-equipped
    for any future threats it may pose.
        So I'll look forward to hearing from the panel. I welcome
    our witnesses.
        I would like to turn to our ranking member, the gentlelady
    from Illinois, Ms. Duckworth, for her opening comment.
        Ms. Duckworth. Thank you, Mr. Chairman.
        And thank you to our expert witnesses for being here today.
    Today's hearing is an important opportunity to examine the
    effectiveness of our current efforts to combat the Zika virus
    and to ensure that the interagency response is efficiently
    coordinated. There have been 82 reported cases of Zika in the
    United States, including four cases in my home State of
    Illinois. To date, these cases have been limited to travelers
    returning to the United States from affected countries or from
    individuals who have had sexual relationships with returning
    travelers.
        As a new mother, I deeply understand the public's concern
    over the Zika virus. The recent outbreak of this public health
    threat in Brazil has shed light on a disease of which most
    Americans are not aware. And as the head of the Centers for
    Disease Control Prevention, Dr. Tom Frieden, recently
    explained, even the scientific community, there is an
    astounding lack of literature examining the Zika virus.
        Fortunately, our public health community is working hard to
    change this. Since the last major Zika outbreak in 2007, the
    CDC developed a test to detect Zika in the first week of an
    illness or in a sample taken from an infected child. More
    recently, the CDC activated its Emergency Operations Center
    last month in response to this latest outbreak, and on February
    1, the World Health Organization designated the outbreak a
    public health emergency of international concern.
        Our public health system has acted quickly to increase its
    surveillance and diagnosis capabilities in affected areas and
    to ramp up what had been very limited scientific research on
    this virus. I want to thank the CDC and NIH for their very hard
    work and rapid response in this case. However, much work
    remains to be done so that we can better understand the Zika
    virus and develop proven strategies to treat affected
    individuals to contain the virus' spread and, ultimately, to
    develop effective therapies and vaccines that would neutralize
    the threat entirely.
        Further, we must work diligently to assess every available
    control measure and adopt the most effective policies to
    prevent the virus from entering the mosquito population in the
    continental United States.
        Equally important, in light of what appears to be the Zika
    virus' capacity to cause severe birth defects, we must also
    provide safe, effective, and affordable contraception to
    individuals living in areas of risk for Zika transmission. This
    includes taking actions to strengthen the healthcare services
    in areas where mosquito populations are already carrying Zika,
    such as Puerto Rico and the Virgin Islands.
        Zika, like the pandemics before it, knows no boundaries.
    Our contributions to public health efforts in Central and South
    America are first and foremost the right thing to do. But they
    are also critical to controlling the spread of this disease.
    That's why I fully support the President's proposal for $1.9
    billion in emergency funding for domestic and international
    response to Zika. I also emphasize that continued consistent
    investment in public health remains critical in periods of
    crisis as well as in periods of calm. Our public health
    agencies are able to mobilize with agility today because they
    have built on decades of institutional knowledge, capacity, and
    lessons learned to anticipate and better respond to emerging
    threats, some of which we've never even imagined. The emergence
    of Zika should serve as a warning that we must continue to
    invest in our world class public health infrastructure to
    defend us both against this threat and the viruses that will
    surely appear in the future. Until we have more answers, we all
    must remain vigilant against Zika. We must all take reasonable
    precautions so that we give the next generation the best chance
    at full, healthy lives. This requires the cooperation of both
    men and women to prevent transmissions to other humans or to
    mosquitos in the continental United States. I urge everyone to
    proceed with caution to protect themselves, their partners,
    their families, and their communities. I really look forward to
    the testimony of our witnesses.
        And thank you, Mr. Chairman, for holding this hearing
    today.
        I yield back.
        Mr. Mica. I thank the gentlelady.
        And if no other members have opening statements, what we'll
    do is, with unanimous consent, we'll hold the record open for 5
    legislative days.
        Did you have an opening statement?
        Mr. Boyle. That's fine.
        Mr. Mica. Okay.
        But we will hold, with unanimous consent, the record open
    for 5 legislative days for members who would like to submit a
    written statement, and we may be asking our witnesses questions
    in addition to what's done in this formal setting. And they
    will also be made part of the record.
        Without objection, so ordered.
        Okay. Now we'll welcome our--and recognize our panel of
    witnesses today. And I'm pleased to welcome Dr. Anne Schuchat,
    and she is the Principal Deputy Director of the Centers for
    Disease Control and Prevention.
        Dr. Anthony Fauci, and he is the Director of the National
    Institute of Allergy and Infectious Diseases at the National
    Institutes of Health.
        Welcome back, Doctor.
        Dr. John Armstrong, and he is the surgeon general and
    secretary of health for the State of Florida.
        And then we have Dr. Bill Moreau, and he is the managing
    director for sports medicine for the United States Olympic
    Committee.
        I want to welcome all of you. And pursuant to the committee
    rules--and this is an investigation, an Oversight Subcommittee,
    a committee of Congress.
        I'll ask you to stand and be sworn. Raise your right hand,
    please.
        Do you solemnly swear or affirm that the testimony you are
    about to give before this subcommittee of Congress is the whole
    truth and nothing but the truth?
        Let the record reflect that the witnesses have answered in
    the affirmative.
        And while Dr. Fauci has been here before, and maybe others,
    it's customary to give a 5-minute statement, and if you have
    additional information or data you'd like to be made part of
    the official record of these proceedings, ask through the chair
    or a member that they be included, and we'll do that.
        So we will start right out. I want to welcome, again, the
    Deputy Director of the Centers for Disease Control, Dr. Anne
    Schuchat.
        Welcome, and you're recognized.

                           WITNESS STATEMENTS

                    STATEMENT OF ANNE SCHUCHAT, M.D.

        Dr. Schuchat. Thank you so much, Chairman Mica,
    Congresswoman Duckworth, and members of the subcommittee.
        CDC and partners here and overseas are working around the
    clock to find out as much as we can as quickly as we can, and
    we are learning more every single day. To accomplish this, CDC
    is coordinating here at home with others across the Department
    of Health and Human Services, including my colleague, Dr.
    Fauci, and we're working with partners across the U.S.
    Government as well as with other parts of the society to make
    sure that we communicate with travelers and healthcare
    providers, update travel alerts and clinical guidance, develop
    improved mosquito control methods, and we're coordinating
    internationally with the World Health Organization and Pan
    American Health Organization on the Zika response. We're
    working directly with Brazil and other nations, and we're all
    trying to learn more about Zika and help prevent its spread.
        I want to begin with three key points. This is a dynamic
    situation. It's changing very frequently. We are committed to
    share what we know when we know it and to revise and adapt to
    the new information.
        Secondly, emerging infections come from nature, and they
    can be challenging. A new syndrome like this can be scary,
    particularly for vulnerable pregnant women. But we can and
    should do more to detect, respond, and prevent these new
    infectious threats.
        Thirdly, CDC has a unique decades-long experience in core
    public health functions that are critical for this kind of
    response. We work on emerging pathogens like Zika. We work on
    disease detection, lab capacity, epidemiology and surveillance,
    response and partnership with State and local governments and
    with other countries.
        What are the facts? Well, we've known about this virus for
    a long time, but only in 2007 was the first outbreak
    recognized. We think the virus usually causes a mild syndrome,
    but we've recently learned that it appears to be associated
    with serious birth defects, microcephaly and possibly others.
    There may also be links with a neurologic problem, Guillain-
    Barre syndrome. It's principally spread by the Aedes mosquito,
    a very difficult mosquito to control, and that is one of our
    challenges.
        Where is this going? There have already been more than a
    million cases in Brazil. A number of countries in Latin America
    are seeing sharp increases in Zika virus infections. We expect
    many travelers returning to the United States to have Zika
    virus infection, but we are doing what we can to prevent the
    severe complications. That's why we issued the guidance for
    pregnant women to avoid traveling to areas where the virus is
    spreading, because at this time avoiding the virus and the
    mosquitos that spread it is the best way to protect a
    pregnancy.
        We expect there may be a little bit of local transmission
    in the Southern United States, because the mosquito that
    carries this virus is resident in those communities. We don't
    right now expect a lot of local transmission, but we need to be
    ready for it, one of the reasons that the Florida Governor did
    declare that emergency.
        We think that other countries are the place where critical
    information can be learned, and that's why we're working side
    by side with our colleagues in Brazil and Colombia to learn as
    much as we can and as quickly as we can. CDC has been very
    busy. As you've heard, we've activated our Emergency Operations
    Center to our highest level. We've actually got more than 500
    people working on this response, not just our infectious
    disease experts and our insect experts, but also our experts in
    birth defects, in communication, in travel health. We have
    developed and distributed kits for laboratory detection, and
    we're working with State and local health departments so that
    they can deploy those tests. We're working on the ground in
    Brazil and Colombia trying to uncover the mysteries of those
    links that you were talking about.
        While we're doing much already, Zika requires a robust,
    all-of-government response, as put forward in the emergency
    Zika funding request.
        CDC's part of that request was to provide support to Puerto
    Rico and other areas in the United States, the territories
    where the virus is already spreading; secondly, for the rest of
    the U.S., where the travelers may be returning and where
    laboratory capacity and communication is going to be vital as
    well as insect monitoring; and, thirdly, for our international
    partners, where we do have a chance to learn as much as we can
    and to protect Americans in that way.
        This funding would support CDC's work in prevention,
    detection, and response. To conclude, we must act swiftly to
    address the challenge of Zika virus. We are learning more every
    day, but there's much more to learn and much more to do. And
    CDC will continue to work collaboratively across HHS and with
    other departments and with Congress to ensure an effective
    response.
        Thank you.
        [Prepared statement of Dr. Schuchat follows:]

        [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Mica. Thank you for your testimony.
        We'll now turn to Dr. Fauci, representing NIH.
        Welcome, sir, and you're recognized.

                    STATEMENT OF ANTHONY FAUCI, M.D.

        Dr. Fauci. Thank you very much, Chairman Mica, Ranking
    Member Duckworth, members of the committee. First, I want to
    thank you for the opportunity to discuss with you and the
    committee this morning the role of the National Institute of
    Allergy and Infectious Diseases in the research component of
    the broader approach toward addressing the Zika virus threat.
        The NIAID, the institute that I direct, has a dual mandate
    among NIH institutes. First, we maintain and grow a robust
    basic and research portfolio in the disciplines of
    microbiology, infectious diseases, and immune-mediated
    diseases. However, despite that long-term commitment, we are
    also prepared and are part of our mandate to rapidly respond to
    new and emerging disease threats. And this has been something
    that we have been doing essentially from the beginning.
        In fact, if one takes a look at this slide, it is the title
    of a perspective that I wrote last month for the New England
    Journal Medicine, and you will see from the title, it says,
    ``Zika Virus in the Americas--Yet Another Arbovirus Threat.''
    And what I was referring to is that, over the past couple of
    decades, we've see new diseases of the arbovirus type in the
    Western Hemisphere that we have not seen before: West Nile;
    dengue, from decades ago; chikungunya in 2013; and most
    recently, in 2015, Zika. When one looks at the role of what we
    do--if we can go back one--the role of what we do, the NIH's
    mandate is to do basic and clinical research to provide the
    research resources for industry and academia with the ultimate
    mandate to develop vaccines, therapeutics, and diagnostics. So
    let me take a couple of minutes to just describe some of these.
    When you look at things like the epidemiology and natural
    history, we are focusing on looking at symptomatic versus
    asymptomatic disease. What about the role of virus and how long
    it lasts in an individual following infection, a question
    extraordinarily important to pregnant women and women who want
    to become pregnant? What about cohort studies to actually nail
    down the causative relationship or not between infection and
    pregnancy and the development of congenital abnormalities, such
    as microcephaly, as well as understanding the pathogenesis of
    disease?
        With regard to basic research, it is very similar to the
    basic research we've done with other viruses throughout the
    years, ranging from HIV 30-plus years ago to most recently with
    Ebola. And that is to look at viral structure, viral pathology,
    medical virology, the pathogenesis of disease, looking at the
    immune response, which gives us great insight into the
    development of vaccines.
        In addition, as you know, the CDC takes the lead role as
    disease detectives in trying to determine the diagnosis of a
    disease, something they are doing right now. NIH grantees and
    contractors are also working on a more sensitive and specific
    antibody test to determine if, in fact, someone has been
    infected, because we know now the current tests that are
    available have a degree of cross-reactivity.
        One of the most important things we do is to develop
    vaccines, as we've done for so many other of these emerging
    threats. The candidates you see on the slide, the two marked
    with red, are the two that are most advanced and are
    essentially ready to go into early trials. We're partnering
    with our industrial colleagues, and right now, let me give you
    an example of why it's important to have done decades of
    research in other diseases that gives us a head start. Years
    ago, we developed a vaccine for West Nile virus. We went into
    phase 1. It was shown to be safe, and it was shown to induce an
    immune response that you would predict would be protective. We
    didn't have any industrial partners, so we never made it to the
    advanced development. But we used that platform to develop now
    a Zika vaccine that is essentially ready to go in the
    development of the early preclinical studies. And it really is
    a very interesting phenomenon. We took what's called a DNA
    piece of genes, and we stuck in it a West Nile gene to express
    a protein of West Nile. So all we did this time was take that
    same platform, take out the West Nile gene, and stick in the
    Zika gene. So, right now, we are making this vaccine, and we
    predict it will be ready to go into phase 1 trial by the summer
    of this year, and hopefully, by the end of 2016, we'll have
    enough information to decide if we can even go further to an
    advanced trial. And I will be happy to discuss that during the
    questioning period.
        Finally, when one looks at therapy, we're doing screening
    of drugs of known activity against certain of these viruses, as
    well as new drugs that have potential activity. This is a very
    important issue, and we are now partnering with many of our
    industrial and biotech partners to do this.
        Finally, on this last slide, I just want to recapitulate
    what I said from the very beginning. Emerging infections have
    been with us all along. They are with us now, and they will
    always be with us. I call it the perpetual challenge, as I did
    in this review from a few years ago. And I would like to thank
    this committee and other committees for the extraordinary
    support that you have given us over the years to allow us to
    fulfill this mandate. Thank you.
        [Prepared statement of Dr. Fauci follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Mica. Thank you, Dr. Fauci.
        Now we'll recognize our Florida surgeon general, Dr.
    Armstrong.
        Welcome, and you are recognized, sir.

                   STATEMENT OF JOHN ARMSTRONG, M.D.

        Dr. Armstrong. Thank you, Chair Mica, Ranking Member
    Duckworth, and members of the subcommittee. I'm glad for the
    opportunity to be here with you this afternoon.
        Florida has a long tradition of combating and eradicating
    mosquito-borne diseases. In fact, the Florida Department of
    Health was created out of an epidemic of yellow fever in 1889.
    Our mosquito-borne outbreaks in modern times have been local
    and of short duration. Consistently, the approach has been
    threefold: first, mosquito control; next, public information;
    and, third, health professional education. And we have seen
    success with containment of West Nile virus, dengue, and
    chikungunya. This afternoon, I'll provide an update on the
    status of Zika virus in Florida, and an overview of how Florida
    has successfully applied CDC guidelines to protect our
    residents and visitors.
        To date, we have had no transmission of the Zika virus in
    the State of Florida. Through healthcare professional
    readiness, our department has reported 29 travel-related Zika
    cases to the CDC, most recently from Seminole County. A travel-
    related case is defined as a disease that was contracted
    outside of the State prior to arrival.
        None of our confirmed cases of active Zika virus involve
    pregnant women. We have, however, identified three pregnant
    women who traveled to countries affected by Zika and who likely
    had Zika virus in those countries and who have returned without
    any symptoms. They have evidence of remote infection with Zika,
    and we are applying CDC guidelines to ensure that these women
    receive care through their health professionals consistent with
    those guidelines.
        We've had 29 cases in 11 Florida counties, and we currently
    have the laboratory capacity to conduct over 4,800 viral tests
    for active Zika and over 1,200 antibody tests to detect past
    Zika infection. We've been conducting approximately 300 tests
    for Zika a week and reporting positive results to our partners
    and the public daily.
        Recognizing the increase of travel-related cases of Zika in
    Florida, on February 1, Governor Rick Scott requested a
    briefing with the CDC on the Zika virus, and on that call, we
    confirmed that the Aedes mosquito, the carrier of Zika, is
    common in Florida and that there are potential links between
    Zika and newborn microcephaly as well as adult neurologic
    disorders, including Guillain-Barre syndrome. What was most
    clear from that briefing is that there is scientific
    uncertainty about Zika transmission beyond the mosquito bite
    and about the impacts of Zika after an individual becomes
    infected.
        Guidance from the CDC should account for this uncertainty
    while providing actionable recommendations with what is known.
    Based on the information from that meeting and the tripling of
    travel-related cases in the following week from three to nine,
    on February 3, Governor Rick Scott issued an executive order
    directing me to declare public health emergencies in the
    counties with diagnosed travel-related cases, and on that same
    day, I declared public health emergencies in the four impacted
    counties at that time and have since added counties to the
    declaration, as I've shared.
        The public health emergency included three key directives:
    one, notification of Florida's commissioner of agriculture, who
    oversees the Office of Mosquito Control, which connects with
    Florida's local mosquito control boards; next, mobilization of
    local leaders to coordinate mosquito-control efforts and public
    outreach to vulnerable populations with meeting summaries and
    action plans reported back to the Department of Health; and,
    finally, outreach to medical professionals with up-to-date CDC
    guidance to increase awareness and access to diagnostic tools.
    At the department, we established an incident command team to
    address comprehensive readiness activities.
        Florida has one of the premiere State lab systems in the
    country with a central laboratory in Jacksonville and branch
    laboratories in Miami and Tampa. When the public health
    emergency was issued, Governor Scott recognized that with over
    20 million residents and over 100 million tourists annually,
    Florida must stay ahead of the possible spread of the Zika
    virus and that our lab capacity plays an essential role in that
    effort. He called on the Florida Department of Health to have
    on hand at least 4,000 viral tests, which are commercially
    available and were ordered the next day. Governor Scott called
    on the CDC to provide at least 1,000 Zika antibody tests so
    that we could test individuals, especially pregnant women and
    new mothers, who have traveled to affected areas and had
    symptoms of Zika. The antibody test allows the State to see if
    individuals ever had the Zika virus. At that time, we had a
    capacity for only 475 tests. On February 9, the CDC provided
    Florida with 950 additional antibody tests, bringing our total
    to 1,425.
        So, with our existing lab infrastructure and the needed
    testing resources we are now equipped to work with medical
    professionals to test patients with symptoms of the Zika virus
    and associated travel history to an impacted country based on
    CDC guidance. The Florida Department of Health licenses all
    Florida medical professionals and has existing communication
    channels with our licensees, and we have used these channels to
    share CDC guidance on the disease, treatment and testing
    protocols, as well as recent FDA recommendations regarding
    blood donation from individuals who have been to areas with
    active Zika virus transmission. Healthcare professional safety
    has always been of paramount importance, and we have emphasized
    CDC guidance that universal precautions provide the appropriate
    level of protection.
        On February 12, at the request of Governor Scott, the CDC
    hosted a conference call for Florida medical professionals to
    provide information on the symptoms, treatments, and proper
    precautions for Zika. Nearly 600 medical professionals and
    healthcare facilities dialed into the call to hear directly
    from the CDC on the measures they need to take to help
    patients. Strengthening the connection between healthcare
    professionals and the public health system is essential for
    tracking and containing disease, and we remain in frequent
    contact with the CDC and FDA for the latest guidelines on how
    best to prepare communities in Florida.
        Finally, public outreach. We work to keep the public
    informed as one of the best ways to calm fears and educate for
    action. At the direction of Governor Scott, we've established a
    Zika virus information hotline for Florida residents and
    visitors as well as anyone planning on traveling to Florida in
    the near future. We want Florida residents and visitors to have
    access to an open line of communication to receive the latest
    updates, have their questions answered, and get advice on what
    steps they can take to protect their homes and families. We
    issue a daily press release with up-to-date diagnosis counts
    and tips for Floridians on how to protect themselves. We've
    established a Web page with links to CDC guidance and public
    information on community meetings. We've developed infographics
    to explain clearly what the virus is and the best practices for
    mosquito protection. And these materials have been requested
    for rebranding by other States. And we've made materials and
    presentations available to our 67 county health officers as an
    integrated Department of Health to inform community
    stakeholders and partners.
        We are sharing three key messages about Zika virus: One,
    anyone who is pregnant, intends to become pregnant, or might
    become pregnant should not travel to a country with active Zika
    virus transmission as determined by the CDC. Two, travelers
    from Zika infected countries should have protected sex for at
    least a month upon returning to the United States due to the
    lingering presence of the virus and various bodily fluids. And,
    three, the best way to prevent Zika and other mosquito-borne
    viruses is through mosquito control, which includes individual
    responsibility to eliminate any sources of standing water where
    the mosquito can breed, to use mosquito repellant and cover
    with proper clothing, and to ensure that window and door
    screens are in place and intact.
        Our residents play an important role in helping prevent the
    spread of mosquito-borne viruses, and we want them to have all
    the information they need to join the effort.
        In Florida, we have developed a proven seamless model to
    take CDC guidance from the Federal Government and get it to our
    residents, our visitors, our health professionals, and partner
    organizations to protect them from emerging mosquito-borne
    diseases. I'm confident that our history as a department has
    prepared us to address this issue. In the past, we've had
    success in containing other mosquito-borne viruses, such as
    chikungunya and dengue, with systems of readiness that mirror
    the level of preparedness that we currently maintain. We have
    made it a priority to stay ahead of the possible spread of the
    virus in Florida, and we will continue to do all we can to keep
    Floridians safe.
        Thank you.
        [Prepared statement of Dr. Armstrong follows:]

     [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Mica. Thank you, Dr. Armstrong.
        And we will a now hear from the representative from the
    U.S. Olympic Committee, Dr. Moreau.
        Welcome, and you are recognized.

                     STATEMENT OF BILL MOREAU, D.C.

        Dr. Moreau. Thank you, Chairman Mica, Ranking Member
    Duckworth, and the other members of the subcommittee for
    holding this hearing on Zika and U.S. governmental
    preparedness.
        The USOC recognizes that Zika is a serious global health
    concern and an issue that we are proactively addressing with
    Team USA.
        The U.S. Olympic Committee is a sports organization. Our
    mission is to support U.S. Olympic and Paralympic athletes in
    achieving sustained competitive excellence while demonstrating
    the values of the Olympic movement, thereby inspiring
    Americans. Every 2 years, we bring Team USA to the Olympic and
    Paralympic Games. In the between games, we work very closely
    with 47 national governing bodies of sport to build Team USA.
        The safety of our athletes and staff is our number one
    priority. As the managing director of sports medicine for the
    U.S. Olympic Committee, my mission is to build and coordinate a
    complex network of medical doctors, healthcare services, and
    academic experts across numerous medical fields.
        The U.S. Olympic Committee is not an organization with a
    focus on the specialty of infectious disease. We rely on the
    tremendous expertise of the Centers for Disease Control and
    Prevention and other public and private infectious disease
    experts to address and help us to understand the threats that
    viruses, such as Zika, pose for our athletes. We have been in
    regular contact with the CDC and other experts for months. They
    continue to provide us sound recommendations based on the
    information available to date. We have supported these
    recommendations, developed a protocol to mitigate risks, and
    provided this information to all potential Team USA athletes
    and support staff likely to travel to Rio before and during the
    Summer Olympic and Paralympic Games.
        I have submitted the most recent USOC communications to the
    athletes with this testimony. Working with the CDC and other
    experts, the USOC has developed a protocol to mitigate the risk
    posed by Zika. Let me walk you through that right now. We're
    continuously communicating the latest information to our
    athletes, staff, and other stakeholders. We are steadily
    communicating with partners, such as the International Olympic
    Committee, the World Health Organization, the CDC, Department
    of Defense, and infectious disease specialists. We are
    monitoring evidence-based sources for information regarding
    viral pathogens. We are following the mosquito bite
    precautions, as provided by the CDC. We are following insect
    repellant selection, as recommended by the DOD. We are
    maintaining awareness through our partners regarding new
    interventions as they are identified. We are training our
    medical team regarding the early recognition and interventions
    for viral infection such as Zika. We are stocking our formulary
    with the best supportive medical interventions. We are
    providing DEET-containing insect repellant for personnel,
    issued prior to departure with additional supplies on hand in
    Rio. We are considering pretreatment with permethrin kits for
    all USOC personal clothing. We are also considering providing
    bed nets for all personnel, and we are identifying Brazilian
    locations for additional support regarding viral pathogens.
        In conclusion, knowledge about Zika virus is growing on an
    almost daily basis. We are following all of the developments.
    We are incredibly pleased with the support and collaboration
    that we've received from the CDC, the DOD, and others and are,
    indeed, indebted to them for sharing this information so that
    we can provide the best, most accurate information to our
    athletes and staff who most directly serve and support our
    athletes. We will continue to work closely with the CDC, the
    DOD, and other infectious disease experts throughout the Rio
    games, and we will continue to follow the CDC recommendations.
        Thank you, again, for the opportunity to address this
    important issue.
        [Prepared statement of Dr. Moreau follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Mr. Mica. Thank you, each of our witnesses, for their
    testimony.
        And we'll turn to questions. And I'll begin. Dr. Schuchat,
    can the CDC confirm what I said earlier, that we have not had a
    case of Zika infection from a mosquito in the United States?
    Everything is coming in so far from another source. Is that
    correct?
        Dr. Schuchat. For the 50 States and the District of
    Columbia, that's right. We do have cases in Puerto Rico and the
    territories.
        Mr. Mica. Okay. Okay. So Puerto Rico and the territories,
    Virgin Islands----
        Dr. Schuchat. The Virgin Islands and American Samoa, at
    this point, I believe they are--but continental U.S., 50
    States, not yet, right.
        Mr. Mica. Now, the next thing--and I just became more
    concerned as I heard Dr. Armstrong reveal the issue with
    pregnant women. And we think there's a link, pretty good link,
    to some birth defects. And this is a Transportation Oversight
    Subcommittee along with other things, but these people are
    coming in mostly from Latin and South America by air. Are there
    warnings now to people coming in? Is everyone getting a warning
    who comes in, particularly women? I'd be concerned. When I read
    all the testimony last night, it seems like the women are the
    most at risk. We don't know. But are they getting a warning?
        Dr. Schuchat. We have been working very closely with air
    travel industry and other travel partners, so there's signage
    and so forth.
        Mr. Mica. Okay. I think that, again, it would be good to
    send out something that--and the airlines have cooperated. They
    always cooperate. We've had the bird flu; we've had----
        Dr. Schuchat. Absolutely.
        Mr. Mica. --others, Ebola, others. But I think we need to
    get a warning. It's not that many coming in. We know where they
    are coming in from, but the infected areas, that there be some
    kind of warning to the passengers.
        We do know that there's this--and I'm not technically
    qualified; I get the wrong terms, incubation or whatever you
    call it--the period, the period of vulnerability from 21 to 30
    days; that's pretty much agreed on, Dr. Fauci, we think?
        Dr. Fauci. Yes.
        Mr. Mica. You said stop having sex for 30 days or something
    along----
        Dr. Fauci. Yes. If you are infected, you will clear the
    virus within 7 days, usually, and, therefore, for the rest of
    the time, generally, except if you are a male, and it could be
    in the semen, which has been demonstrated in a number of
    individuals.
        Mr. Mica. We don't know how long that's----
        Dr. Fauci. We don't know. It has been in some,
    unfortunately, as far out as 62 days.
        Mr. Mica. As far as what?
        Dr. Fauci. One was 62 days, but that's maybe an outlier,
    but we don't know how long----
        Mr. Mica. Well, again, I think the first thing is getting
    the warning out. These are people coming into the United States
    from infected areas. So that would be my concern, and we need
    to work with the aviation industry to get these warnings out
    there, particularly among women, and then advise them of the
    risk that we know so far.
        Okay. I have a release from the Governor's Office just a
    couple of minutes ago, 2:27, asking the Centers for Disease
    Control for another 250 kits to test for Zika virus. Are you
    able--now, they--you've already cooperated, and you guys have
    been there. Dr. Armstrong, the requests have gone in.
    Everything has been done in a timely fashion. Are we able to
    meet this request, and where are we in the stockpile of making
    certain we have the test kits?
        Dr. Schuchat. You know, we have been working around the
    clock to produce kits and to develop even better tests, and
    we--one of the reasons for the emergency request is the volume.
    We estimate about half a million pregnant women will be
    traveling back and forth to affected areas this year, 35,000
    pregnant women in Puerto Rico alone. So keeping up with that
    volume for the State support is one of the reasons for the
    emergency request.
        Mr. Mica. But do we have the test kits now or ordered? Is
    there----
        Dr. Schuchat. Well----
        Mr. Mica. You just said there may be a big need. Our job is
    to stay ahead of the curve and your job. Do we have the test
    kits, like here's one small additional order, and can we meet
    the additional?
        Dr. Schuchat. Where we are right now is----
        Mr. Mica. You have the orders in----
        Dr. Schuchat. We've produced about 30,000 and we'll have
    about 90,000 shortly. So we're working around the clock.
        Mr. Mica. Okay.
        Dr. Schuchat. And we're working with private partners so
    that they can help us----
        Mr. Mica. Okay. So we are alerting--we are going--if we
    haven't, we are going to alert people coming in. We are going
    to work with you on that. On the test kit, we want to make sure
    we have test kits available and the supply.
        The thing that startled me was the blood supply, because
    this is in the blood. We should also have a warning about there
    ought to be 60, 90 days, a warning that people should not
    donate blood or identify that they've been to a country where
    they've been exposed when they are coming back.
        Dr. Schuchat. Yes. The FDA has--actually, voluntarily, the
    blood banks did that with a month--self-deferral within a
    month, and the FDA instituted it formally. There's also an
    effort now in Puerto Rico to import blood, because the virus--
    --
        Mr. Mica. In----
        Dr. Schuchat. --because they can't assure that local blood
    will be okay.
        Mr. Mica. And is FDA giving proper warning?
        Dr. Schuchat. Absolutely.
        Mr. Mica. God bless the people of Puerto Rico. They should
    have some transparency in the blood supply, truth----
        Dr. Schuchat. Right. And there's accelerated effort to
    develop screening tests so that blood can be assured to be safe
    in endemic locations.
        Mr. Mica. Okay. Now, you guys have been great in
    identifying the course forward. I've got a couple of quick
    questions. The testing--and you're trying to get more advanced
    tests. And a lot of that evolves around the President's
    request. It was a good request. I just read it. Where is my
    President's request here, guys? Here it is, from the White
    House to the Speaker and all the Members. And he asked for
    about $1.8 billion. Now, coincidentally--and I didn't know
    this; I have a letter back from Mr. Rogers, the chairman of
    Appropriations--there's about $1.8 billion available with
    leftover money from Ebola. Do you have the ability to move that
    money into where we need it?
        Dr. Schuchat. The----
        Mr. Mica. I'll ask both of you, CDC, NIH.
        Dr. Schuchat. A couple of key points about Ebola. The
    outbreak is out of the headlines, but there is still
    substantial effort. Last month----
        Mr. Mica. But you still have a balance of about 1.8 or 9
    billion dollars?
        Dr. Schuchat. Not--the CDC does not have that large a
    balance for Ebola. Our Ebola resources are either committed
    or----
        Mr. Mica. But the administration does have--again, from Mr.
    Rogers, the chairman of Appropriations, is saying that that's
    unexpended dollars. My whole question is: There's some money
    available. Do you have money to address this now?
        Dr. Schuchat. We----
        Mr. Mica. Are you short?
        Dr. Schuchat. The resources for Ebola are committed. They
    are global health security resources, which are fully
    programmed.
        Mr. Mica. Okay. Then do you have resources now. I mean, we
    do a lot of things around here by executive order. We shift
    money. I mean, in a nanosecond you can see the President or the
    administration shifting money to some cause.
        Dr. Schuchat. Right. The committee----
        Mr. Mica. Do you have that ability to get the test kits, to
    get--and then I want to ask Dr. Fauci, because you've got a
    whole bunch of things in research. You're on--it was fantastic
    news to hear the summer trials; by the summer, you're moving
    ahead, and you showed us how you're doing that. But I want to
    know and assure these Members that you feel that you have the
    resources and support from the administration to move forward.
    Do you, Dr. Fauci?
        Dr. Fauci. Our proportion of the Ebola money, we have----
        Mr. Mica. Well, you have Ebola, and you have other money.
        Dr. Fauci. Right, but I'll explain to you what we are
    doing. So our proportion of the Ebola money, we've essentially
    spent all of it except for maybe $9 million. So we have
    obligated almost all of our Ebola----
        Mr. Mica. Do you have other sources?
        Dr. Fauci. Our sources right now, without the supplement
    that's been asked for by the President, is moving money out of
    doing other things. So let me tell you what we have done. We
    have money that we have been investing in contractors and
    grantees who do Flavivirus research, both in the United States
    and Brazil. We have now directed them to switch over and add on
    nearly----
        Mr. Mica. They are under contract to address that----
        Dr. Fauci. Right. Yeah. But they are going to have to not
    do other things in order to do that.
        Mr. Mica. Okay. And do you have people under contract?
        Dr. Schuchat. We've--the global moneys have--commitments
    have been made to 17 high-risk countries in Africa where we--
    and Asia, where--which are very vulnerable for exactly what
    happened with Ebola.
        Mr. Mica. But you're directing some of those funds now to
    Zika. And is that 17 countries you talk about----
        Dr. Schuchat. No. No. That's--those resources are for
    African countries. The----
        Mr. Mica. But for what? Ebola? Or for other diseases? All
    of the above?
        Dr. Schuchat. To prevent, detect, and respond to threats,
    including----
        Mr. Mica. So it could be Zika?
        Dr. Schuchat. In those countries, they are not having Zika.
    So, essentially----
        Mr. Mica. Well, it is in different----
        Dr. Schuchat. Right, exactly. The geography of that
    global----
        Mr. Mica. And do you intend to redirect some of that money
    now that we have this?
        Dr. Schuchat. We think that would be terribly dangerous in
    terms of the outbreaks that are ongoing.
        Mr. Mica. Again, what I am trying to get is to make certain
    you have the resources. If you don't have them, we need to
    know. We need to know that also the things that need to get
    under contract are under contract for the test kits, for the
    research, for the vaccine, for moving this little protocol
    forward.
        Dr. Fauci.
        Dr. Fauci. Yeah. So, Mr. Chairman, just so that I can
    clarify, in order to get a jump start, we took money that we
    had allocated for things like dengue and moved it over. I will
    not be able to proceed with the trial that I described to you
    without additional money.
        Mr. Mica. Okay.
        Dr. Fauci. --which is one of the reasons why----
        Mr. Mica. See, that's what we need to know----
        Dr. Fauci. I won't be able to do that without additional
    moneys.
        Mr. Mica. We need to tell our colleagues. The request is
    in. The President gave it to us last week. We'll have to work
    with our leadership, but we want you to have the funds
    available. We don't want to neglect important research. And one
    of the reasons I voted for the omnibus is we have additional
    money in research. I was told Alzheimer's and some other
    disease. You can't rob Peter to pay Paul.
        Dr. Fauci. Our summer plans are dependent upon the
    supplement.
        Mr. Mica. Okay. All right.
        Well, again, I have other questions, like notifying--you
    notifying our DOD and overseas personnel through State and DOD.
    Have they--are there official notices going out and the risks
    and the warnings and all that?
        Dr. Schuchat. Yes. We have been working closely with those
    departments for the Americans overseas.
        Mr. Mica. We've got families and everybody out all around
    the globe
        Dr. Schuchat. Absolutely.
        Mr. Mica. I have gone over my time. We'll come back, as
    we've got plenty of time, as you can see, with the members that
    are here.
        Ms. Duckworth, I'll yield to you. Thank you.
        Ms. Duckworth. Thank you, Mr. Chairman.
        Dr. Schuchat, I want to sort of build on what the chairman
    was talking about in terms of notifying travelers who--they are
    coming back into the United States. I'm wondering about the
    travelers in the United States who might be on their way out or
    what information is being provided. What guidance has the CDC
    provided to the obstetric community in the continental U.S.
    regarding Zika?
        Dr. Schuchat. We have been working very closely with the
    clinical community, including obstetricians. We have developed
    joint guidance. We have used--the obstetricians' Web site, in
    fact, has distributed our guidance broader than we have been
    able to, to the 65,000 obstetricians in America. And we have
    held calls and sessions for questions and answers. We are very
    keen to be letting women know before they travel, and the
    signage and the outreach is through both direct health
    clinician channels and through consumer groups as well. I did a
    Scary Mommy blog, and we have been really working all the
    social media as well as the professional groups so that women
    know and that their families know what to expect. We know that
    women's most trusted source is their own doctor, and so we want
    their own doctor to know the answers to the questions.
        With a breaking syndrome like this, information is updated
    frequently, so it's not just a one-time guidance, but ongoing
    updates.
        Ms. Duckworth. Is that a similar effort with, I guess,
    family physicians or groups where--I'm thinking of these
    countries; if I were travelling to them, I would need to get
    immunized for a range of other diseases before going anyway.
    And if I was planning a trip, I would be going to get those
    particular immunizations. Is Zika also then being added as part
    of the conversation?
        Dr. Schuchat. Yes, that's right. Our travel health site is
    the most popular site on CDC's Web site, and we work really
    closely with both the clinical community and the special travel
    health and travel industry to make sure that people know what
    to expect where they're going: what to eat and drink or not,
    and what shots they might need before they travel. So Zika has
    been added to those messages.
        Ms. Duckworth. Thank you.
        Dr. Fauci, I'm a big fan of NIH and the work that you do,
    and I certainly think we should be funding you at far higher
    levels because it's money--it's a savings; it's an investment.
    Do you know if there's a specific stage during pregnancy when
    exposure to Zika is more likely to cause microcephaly?
        Dr. Fauci. We don't know for sure, but if it acts like
    virtually all other viruses that cause congenital
    abnormalities, the first trimester is overwhelmingly the most
    vulnerable. Whether or not individuals who might get infected
    later on in pregnancy have a degree of adverse event with the
    pregnancy, it's not entirely clear. I wouldn't be surprised if
    there are some outliers in which you can have late effects of
    infection later on. But when you think about this, almost
    always the first trimester is the most vulnerable.
        Ms. Duckworth. And I understand that the severity of the
    birth defects caused by Zika do vary?
        Dr. Fauci. Very much so.
        Ms. Duckworth. Do we have any idea what causes the
    variance, or is this all part of the learning process that
    we're in right now?
        Dr. Fauci. It's part of the learning process with regard to
    Zika, but, again, you use other models, like rubella, CMV, and
    others, and there isn't just one size fits all. You have a
    great degree of variability, and it's not surprising that you
    might have something as severe microcephaly, to the point of
    the fetus not even surviving, or you might have birth with just
    some abnormalities of vision or perhaps some mental issues, so
    it goes from one end of the extreme to the other. And it's
    probably just a variability of the penetration of the virus
    through the placenta to the baby.
        Ms. Duckworth. Are those mental issues, do those also
    include mental illnesses like schizophrenia or bipolar
    disorder?
        Dr. Fauci. You know, there have been reports in the past,
    not with Zika yet, of infections that mothers have during early
    parts of pregnancy and what is apparently an increase in the
    incidence of certain types of disorders. There is some
    controversy about that, but there's enough information to
    suggest that there would be an impact on some aspect of brain
    function, which might also include things like psychiatric
    issues.
        Ms. Duckworth. Dr. Schuchat, I think you might be the
    organization that works with the DOD, perhaps. What about
    military women that are being deployed especially? I served in
    Operation New Horizon multiple times and various missions in
    Latin America. What are we doing with DOD, with military men
    and women who are going over?
        Dr. Schuchat. We have been working closely with the
    military and the Department of State so that our guidance for
    Americans traveling abroad can be consistent for the military
    that are serving abroad as well as for the State Department
    employees and their families. We do think that in places where
    there's active circulation of Zika virus right now,
    particularly Latin America, that the ability to--that it's not
    good for pregnant women to be there. And if they're interested
    in redeploying elsewhere, I think the departments are working
    with them on that.
        Ms. Duckworth. Is there any plans to do any type of
    universal testing and monitoring of troops who are assigned
    there? Most of these are going to be Reserve and National Guard
    troops also. So they're going. They're in planning. They are
    going to go. They are going to go do their 3 weeks or their 1
    month, and they come back. But it is a nice population that you
    can track who will go and come back.
        Dr. Schuchat. Absolutely. One of the aspects of
    coordination across the government is the intergovernmental
    leadership calls that we have, and the DOD is very actively
    participating in that. They do enormous amounts of research and
    monitoring and force readiness, so I am not personally aware of
    whether there is deployment tracking in terms of cohort studies
    going on, but that is the kind of thing that they are able to
    do.
        Ms. Duckworth. Thank you.
        I yield back, Mr. Chairman.
        Mr. Mica. I thank the gentlelady.
        Mr. DeSaulnier.
        Mr. DeSaulnier. Thank you, Mr. Chairman, and thanks to the
    ranking member, for this really interesting hearing.
        And, first off, congratulations to all of you. I'm always
    very proud of the fact of our robust public health system in
    the United States. I've worked in local government, State
    government. It works best when nobody notices. But in this
    global economy with pandemics, always something we have to be
    cautious about.
        My questions are two lines really of questioning. Dr.
    Fauci, first of all, how would you characterize the American
    role in global pandemic preparedness? We are looked at both
    because Americans travel a lot, but because of our
    infrastructure as a leader in this, how do we interact with the
    global community and make sure that we're using our resources
    in an effective and efficient way, given our position?
        Dr. Fauci. I think we interact quite well, and it's getting
    better and better. Every time we have a challenge, there are
    really lessons learned that I think are important, everything
    from responding to a pandemic influenza or the threat of a
    pandemic influenza, to the global response to Ebola in which
    there were several lessons learned. And, even now, all of are
    us are experiencing--like Dr. Schuchat and I were very much
    involved in the issue with Ebola and as people who are now
    involved with the issue with Zika--we already see the
    differences in how the global community has responded in a much
    more robust way than we did before. So the answer to your
    question is I think we have done well all along, but we're
    really doing better now because of experience.
        Mr. DeSaulnier. So the global preparedness is going up
    exponentially, unfortunately, as you get more incidents?
        Dr. Fauci. Yeah, I believe so. And we have a global health
    security agenda that we're a part of, the United States is part
    of, which is also part of that preparedness issue.
        Mr. DeSaulnier. Doctor, you have from the CDC's
    perspective?
        Dr. Schuchat. Yes. I think people are taking the issues of
    preparedness very seriously, and the importance of being able
    to prevent, detect, and respond everywhere is vital, so the
    U.S. is a leader in that, but we have now got many other
    countries joining in the process, and the WHO, of course, did
    jump on this a lot quicker than previously.
        Mr. DeSaulnier. So my other line of questioning is similar
    to the ranking member's. Dr. Fauci, I'm told you were involved
    when the AIDS epidemic first began. And being from the bay area
    and being old enough to remember that, even in the bay area, as
    we were dealing with that and researchers at places like UCSF
    were dealing with it, many of whom are still practicing, the
    miscommunication was a huge struggle, the things that people
    would say, both politically and in terms of our effectiveness.
    But, now, all these years later, you still have that, but then
    you have social media. Just curious, you spend a lot of your
    time, I imagine, correcting misinformation, and how much, if
    you'd like to talk about that, about what you're learning about
    how we communicate vis--vis social media and what time you have
    to expend maybe correcting what's out there, and has that
    changed over time?
        Dr. Fauci. Well, part of the administration and, in this
    case, the Department of Health and Human Services, which is the
    predominant agency involved, is that we try very hard, all of
    us, to get out there publicly with the media, both the classic
    media and the social media, myself and Tom Frieden, and Anne
    Schuchat; we're on the media all the time, TV, radio, et
    cetera, trying to get the information out.
        And what we have learned all the way back from the years of
    HIV/AIDS is that we want to get correct information out, and
    when we don't know the answer to something, we say we don't
    know the answer. And that's the reason why you're hearing us be
    very cautious, for example, of saying we believe and think that
    there is a direct causal relationship between infection of a
    pregnant woman and microcephaly, but we haven't yet done the
    definitive studies. And the reason we don't want to say
    anything definitive unless we do the study, because there may
    be other cofactors that are involved that we don't know about.
    And if we come out confidently saying something and then it
    turns out not to be the case, we lose credibility. So we're
    very careful to only talk on evidence-based as opposed to
    guessing what we think the answer is.
        Mr. DeSaulnier. From the CDC's perspective----
        Dr. Schuchat. Yeah. We think that the changes in
    communication have both benefit and harm. And so, of course,
    it's much easier to reach a lot of people, but that means it's
    much easier for everyone to reach a lot of people. So the
    credibility of the public health folks doing the talking is
    critical, and we really want to protect that.
        Mr. DeSaulnier. I think we're all aware in our world about
    the benefits and the curses of social media.
        Mr. Chairman, I yield back the balance of my time. Thank
    you very much.
        Mr. Mica. I thank the gentleman.
        I have a few more followup questions. Okay. We have people
    in the United States who were infected. They were infected
    outside. Right now, it's winter across the United States, and
    we're getting into more of the mosquito season. Do we know if
    the disease can be transmitted from a mosquito biting an
    infected person?
        Dr. Fauci, do you know? We're gaining in the number of
    infected people in the United States. It's in their blood. And
    a mosquito bites them; then we infect the mosquito population
    here.
        Dr. Fauci. Right. That certainly can happen.
        Mr. Mica. I'm not a scientist.
        Dr. Fauci. Well, certainly, that's the way it is spread now
    in the areas where there is local transmission in South America
    and the Caribbean. We have those mosquitos in the United
    States, particularly in a certain region in the Southeast and
    part along the Gulf Coast. And one of the things that we're
    preparing for is that we have, as you've heard from Dr.
    Schuchat and others, a considerable number of imported cases
    that got infected elsewhere and come home. We're going to see
    more of those. What will not be surprising is that sometime in
    the future, we will see local transmission, where just what
    you're saying happens, where someone comes back. They get bit
    by a mosquito and transmit----
        Mr. Mica. The way you stop that is you stop the mosquito,
    like we have gone after West Nile. We had West Nile right here
    in Washington, D.C.
        Dr. Fauci. Right. Exactly. So it's an enhanced mosquito
    control. And that's exactly what the people in Florida----
        Mr. Mica. Okay. That's mostly a State and local issue. I
    don't know if we are helping those local entities or if they
    can use their funds. We have CDC funds--not CDC funds. We have
    it--what is it, community block grants?
        Dr. Schuchat. Quite a bit of the emergency request is to be
    able to support State and local mosquito control. Mosquito
    control is very patchy right now. And there aren't----
        Mr. Mica. In Florida, we're damned good at it because we
    have had mosquitos in, well, most of the Gulf Coast region. And
    I've worked in Louisiana along the Gulf Coast of Texas, and
    they're pretty good at it. But, again, there are places that
    are not as good at it. And the reaction that Florida has taken
    is--Florida has set a model already for the United States. But
    what we want to do is make certain we're covering the rest. It
    sounds like we have already had a little damage in Puerto Rico,
    the Virgin Islands, and some of the Caribbean region.
        Dr. Schuchat. Yes. The living conditions and the climate in
    Puerto Rico and the Caribbean are such that the mosquitos are
    very intense, circulating year around. In areas that actually
    have good mosquito control in the U.S., the type of mosquito
    that we're dealing with here is a bit difficult. There are a
    variety of species. But the Aedes aegypti mosquito is a daytime
    biter. It's inside and outside.
        Mr. Mica. Again, public information for folks in the
    continental United States: You've got to use insect repellent.
    The local authorities and State have to do more spraying. We
    can't leave--I've seen some of the recommendations already--
    even small amounts of standing water are breeding ground for
    the coming spring and summer.
        Dr. Schuchat. It just may need to be more intensive
    mosquito control because this one is quite difficult,
    particularly, as I mentioned, in Puerto Rico.
        Mr. Mica. Now you didn't mention this, Dr. Moreau, but I
    read about it and didn't think about it. Did you mention that
    the games are being held in Brazil in their winter? Did you
    mention that? It might have been in your written testimony. But
    folks don't know that, which means that you've got the best
    chance of not getting infected in Brazil where your Olympics
    are being held. Is it in July or August? I forget the dates.
    What is it?
        Dr. Moreau. August for the Olympic Games and September for
    the Paralympic Games.
        Mr. Mica. That's some of your coldest months down there, so
    you've got your least likely time of being infected for folks
    that want to go. We want our U.S. team to participate, to be
    protected, and we want our visitors also to have that. Every
    time you get a chance, Dr. Moreau, you need to tell folks they
    have the least chance of being bitten or infected during that
    period of time because it's the opposite of the northern
    hemisphere. Okay?
        Okay. DOD has already done a lot of work. How have we been
    coordinating with DOD, Department of Defense? For anyone.
        Can you tell us, CDC?
        Dr. Schuchat. Maybe I can begin, and Dr. Fauci can
    continue. There's quite a bit of the intergovernmental
    coordination across the leadership to do the planning, both for
    force protection. There's also a lot of research that DOD does,
    and they are part of our countermeasures group.
        Mr. Mica. So we're not duplicating.
        Dr. Schuchat. No. And the same with the Ebola research. One
    of the promising vaccines was developed originally through
    military work, so I would say the coordination is good.
        Mr. Mica. What would you say, Dr. Fauci?
        Dr. Fauci. I totally agree. In fact, we have worked with
    the DOD on a number of issues, the most recent of which was
    Ebola. We'll be doing it here, and we have very good
    coordination, and it comes centrally. I mean, we coordinate
    within HHS, but through NSC, we coordinate among all the
    agencies.
        Mr. Mica. At this point in the record--and with your
    permission, Ms. Duckworth--I'll enter in the record, and we're
    trying to get everybody who is involved here, their testimony,
    and we asked DOD, who is not a witness. We have testimony from
    the Department of Defense. We have testimony from U.S. Agency
    for International Development and testimony from the American
    Mosquito Control Association.
        And the gentlelady moves that this be made part of the
    record.
        Without objection, so ordered.
        Mr. Mica. So we'll put that in the record at this point.
    Because, again, I've got three--well, two Federal agencies
    here, and we have got the State witness association here for
    our Olympic Committee, and we need to know that we have a
    coordinated and seamless connect with all of our agencies.
        Did you want to comment any more on DOD?
        Okay. I just saw here that there is research outside the
    United States, a British technology company--I don't know the
    name--is currently testing a genetically modified mosquito
    named, a famous mosquito named OX513A in Brazil. Are you aware
    of this, Dr. Fauci?
        Dr. Fauci. Yes.
        Mr. Mica. Are we doing anything with these folks?
        Dr. Fauci. Yes, we are. The idea of genetically modified
    mosquitos, which you make a male sterile and release it into
    the environment, is something----
        Mr. Mica. And they released some of these on an island
    already?
        Dr. Fauci. Yes, they have. The release of genetically
    modified mosquitos in order to prevent the procreation of other
    mosquitos is something that has been tried in local ways where
    you would go into a relatively restricted geographic area, and
    it seems to be rather effective at a local level. The challenge
    with genetically modified mosquitos in addition to somewhat of
    the societal pushback about anything genetically modified being
    released into the environment is that it's difficult to scale
    it up on a countrywide basis. That's one of the problems we
    have with that.
        Mr. Mica. Okay. So, again, I'm just trying to find out if
    we're covering all of our bases here. Then you've got--and I'm
    learning more as we go along--you recommended, CDC, some of the
    insect repellent. And I just found out--I didn't know they had
    this--this is insect repellent for clothing and gear. And our
    all-knowledgeable ranking member, who knows about DOD, said:
    Yes, they have this, but they've also found it causes cancer.
        This seems like a good product. And I go down to like
    Puerto Rico all the time, one of my favorite places to visit. I
    just came back after the holidays. But is this stuff good to
    use, and are you guys recommending that? CDC, tell us if the
    cure is worse than the disease.
        Dr. Schuchat. We work really closely with the EPA, who
    registers insecticides and repellents and so forth, and so our
    Web site has a link to what is okayed and what is not. So there
    are many repellents, and then there is permethrin treatment for
    the clothing, which some of the products are fine.
        Mr. Mica. The staff said that you said this is okay. But
    I'll also be conscious of the warning of my very knowledgeable
    ranking member.
        Ms. Duckworth. We used to soak our uniforms in it.
        Mr. Mica. She said they used to soak their uniforms in it.
    I've never heard of it, but it's just interesting. Again,
    getting information out to people how they can protect
    themselves is so important, so it covered some of that.
        I was kind of shocked the first time I've heard your 62
    days, at least for the males, to possibly be infected and have
    a--pose some risk. I've not seen that before. Is that the first
    time you've announced it today?
        Dr. Fauci. That report has been out for a few weeks now----
        Mr. Mica. I've not heard it publicly. I've heard 21 to 30
    days advisory, which is a different situation, but I think we
    need to be aware of that. I appreciate your making it known
    publicly.
        Dr. Armstrong, you haven't been neglected, and we
    appreciate your coming here. Okay. You're at the other end of
    the spectrum. I've gotten a good report from our local health
    officials, quick response from the Governor, the quick response
    from you at the State level. Tell us, candid--I know it's
    awkward having CDC and NIH here--is there something we're
    missing? Is there something you could recommend that we should
    pay attention to from the State level and local? You're on the
    front line.
        Dr. Armstrong. Thank you for your question. We have to
    manage the situation in the State and locally with what we
    know. And what we have appreciated is guidance from the CDC now
    that is acknowledging uncertainty and what we don't know and
    helping us to really provide insights for people out of an
    abundance of caution so that we keep them safe. I think that's
    been a key change from Ebola to Zika, that there is
    acknowledgement by the CDC that just because they don't have a
    definitive answer to something doesn't mean something doesn't
    need to be said. We still need a guideline, and we, again, are
    leveraging all of the CDC guidelines to protect the people of
    Florida and our visitors.
        Mr. Mica. Question, a followup to my question to Dr. Fauci
    about the genetically modified organisms. I guess there was
    some effort in Florida to curtail some mosquito-borne threats
    in Florida using that approach. Are you aware of that?
        Dr. Armstrong. Yes, I am aware of that in the past, and I
    think that----
        Mr. Mica. --that's a route we should take? Was that
    successful? What did we use that on? I don't recall.
        Dr. Armstrong. I'll have to get you the specific virus
    against which we were using a mosquito approach, but I would
    echo what Dr. Fauci says. I think there needs to be a great
    deal of public awareness and education before doing that, and
    we need to be aware of unintended consequences from producing
    genetically modified mosquitos.
        Mr. Mica. Now the other thing is you're at the State level;
    you're at the Federal level. When I spoke with one of our local
    health directors, he said: We get these cases. And he says:
    We're also responsible for monitoring the individuals who are
    infected. He says: Well, we have very limited staff, and I need
    people then to be the monitors. And as you get multiple people,
    you need multiple staff checking up on them. So some of the
    resources to the local entities to actually monitor these
    folks, it appears it might be putting a strain on them. Do you
    have a way of dealing with that? Do we have some emergency
    funds at the State level to make certain that folks who are
    infected are monitored?
        Dr. Armstrong. At this point, we are applying what we
    learned through monitoring for Ebola virus. We had a very
    aggressive program----
        Mr. Mica. Yes, they told me, actually--listen to this--he
    said, ``One way we would go,'' when they thought someone was
    infected with Ebola, he said they would come with a sign,
    ``what's your temperature,'' he says, because you didn't want
    to come in contact with them. That was a different situation,
    but you have to modify your approach to the risk even for the
    worker. My concern was the funds to make certain you have the
    workers who can go out and monitor these folks. Right now,
    these are very limited numbers, but we'll have to make certain
    at a State level or on an emergency basis if we see where we've
    got to have additional personnel, that that need is met. I
    think those are the major questions.
        Again, we have some serious issues here. We have done--or
    you all have done--we have done nothing yet--but you've done a
    great job in staying ahead of it. Usually, this committee is
    very harsh on folks, and we had some tough time with the start
    of Ebola and some other issues, but I'm very pleased with where
    we are right now. We just want to keep it under control and go
    forward.
        Did you have anything else Ms. Duckworth?
        Mr. DeSaulnier?
        We'll, again, keep the record open for additional questions
    for our witnesses and make any responses part of the record
    today.
        I want to thank each of you for your good work, for
    testifying today, and look forward to working with you, and
    we'll try to pledge ourselves to get the resources that are
    necessary in a timely fashion.
        There being no further business before the subcommittee,
    this hearing is adjourned.
        [Whereupon, at 3:25 p.m., the subcommittee was adjourned.]

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