[House Hearing, 114 Congress]
[From the U.S. Government Publishing Office]
THE GLOBAL ZIKA EPIDEMIC
=======================================================================
JOINT HEARING
BEFORE THE
SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH,
GLOBAL HUMAN RIGHTS, AND
INTERNATIONAL ORGANIZATIONS
AND THE
SUBCOMMITTEE ON
THE WESTERN HEMISPHERE
OF THE
COMMITTEE ON FOREIGN AFFAIRS
HOUSE OF REPRESENTATIVES
ONE HUNDRED FOURTEENTH CONGRESS
SECOND SESSION
__________
FEBRUARY 10, 2016
__________
Serial No. 114-184
__________
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COMMITTEE ON FOREIGN AFFAIRS
EDWARD R. ROYCE, California, Chairman
CHRISTOPHER H. SMITH, New Jersey ELIOT L. ENGEL, New York
ILEANA ROS-LEHTINEN, Florida BRAD SHERMAN, California
DANA ROHRABACHER, California GREGORY W. MEEKS, New York
STEVE CHABOT, Ohio ALBIO SIRES, New Jersey
JOE WILSON, South Carolina GERALD E. CONNOLLY, Virginia
MICHAEL T. McCAUL, Texas THEODORE E. DEUTCH, Florida
TED POE, Texas BRIAN HIGGINS, New York
MATT SALMON, Arizona KAREN BASS, California
DARRELL E. ISSA, California WILLIAM KEATING, Massachusetts
TOM MARINO, Pennsylvania DAVID CICILLINE, Rhode Island
JEFF DUNCAN, South Carolina ALAN GRAYSON, Florida
MO BROOKS, Alabama AMI BERA, California
PAUL COOK, California ALAN S. LOWENTHAL, California
RANDY K. WEBER SR., Texas GRACE MENG, New York
SCOTT PERRY, Pennsylvania LOIS FRANKEL, Florida
RON DeSANTIS, Florida TULSI GABBARD, Hawaii
MARK MEADOWS, North Carolina JOAQUIN CASTRO, Texas
TED S. YOHO, Florida ROBIN L. KELLY, Illinois
CURT CLAWSON, Florida BRENDAN F. BOYLE, Pennsylvania
SCOTT DesJARLAIS, Tennessee
REID J. RIBBLE, Wisconsin
DAVID A. TROTT, Michigan
LEE M. ZELDIN, New York
DANIEL DONOVAN, New York
Amy Porter, Chief of Staff Thomas Sheehy, Staff Director
Jason Steinbaum, Democratic Staff Director
Subcommittee on Africa, Global Health, Global Human Rights, and
International Organizations
CHRISTOPHER H. SMITH, New Jersey, Chairman
MARK MEADOWS, North Carolina KAREN BASS, California
CURT CLAWSON, Florida DAVID CICILLINE, Rhode Island
SCOTT DesJARLAIS, Tennessee AMI BERA, California
DANIEL DONOVAN, New York
------
Subcommittee on the Western Hemisphere
JEFF DUNCAN, South Carolina, Chairman
CHRISTOPHER H. SMITH, New Jersey ALBIO SIRES, New Jersey
ILEANA ROS-LEHTINEN, Florida JOAQUIN CASTRO, Texas
MICHAEL T. McCAUL, Texas ROBIN L. KELLY, Illinois
MATT SALMON, Arizona GREGORY W. MEEKS, New York
RON DeSANTIS, Florida ALAN GRAYSON, Florida
TED S. YOHO, Florida ALAN S. LOWENTHAL, California
DANIEL DONOVAN, New York
C O N T E N T S
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Page
WITNESSES
Tom Frieden, M.D., Director, Centers for Disease Control and
Prevention, U.S. Department of Health and Human Services....... 8
Anthony S. Fauci, M.D., Director, National Institute of Allergy
and Infectious Diseases, National Institutes of Health, U.S.
Department of Health and Human Services........................ 24
The Honorable Ariel Pablos-Mendez, M.D., Assistant Administrator,
Bureau for Global Health, U.S. Agency for International
Development.................................................... 38
LETTERS, STATEMENTS, ETC., SUBMITTED FOR THE HEARING
Tom Frieden, M.D.: Prepared statement............................ 12
Anthony S. Fauci, M.D.: Prepared statement....................... 27
The Honorable Ariel Pablos-Mendez, M.D.: Prepared statement...... 41
APPENDIX
Hearing notice................................................... 64
Hearing minutes.................................................. 65
Questions submitted for the record by the Honorable Ami Bera, a
Representative in Congress from the State of California, to the
Honorable Ariel Pablos-Mendez, M.D............................. 66
The Honorable Christopher H. Smith, a Representative in Congress
from the State of New Jersey, and chairman, Subcommittee on
Africa, Global Health, Global Human Rights, and International
Organizations: Fonseca paper................................... 67
THE GLOBAL ZIKA EPIDEMIC
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WEDNESDAY, FEBRUARY 10, 2016
House of Representatives,
Subcommittee on Africa, Global Health,
Global Human Rights, and International Organizations and
Subcommittee on the Western Hemisphere,
Committee on Foreign Affairs,
Washington, DC.
The subcommittees met, pursuant to notice, at 1:15 p.m., in
room 2172 Rayburn House Office Building, Hon. Christopher H.
Smith (chairman of the Subcommittee on Africa, Global Health,
Global Human Rights, and International Organizations)
presiding.
Mr. Smith. The subcommittees will come to order and
welcome.
In 1947, in a remote area of Uganda, scientists discovered
a previously unknown virus among the rhesus monkey population.
They called it the Zika virus for the forest in which it was
found. It is endemic to Africa and to Southeast Asia.
Scientists know that the Zika virus, like dengue fever and
chikungunya, is spread almost exclusively through the bite of
the Aedes species mosquito, an aggressive daytime biter. These
mosquitos have been significantly diminished in this
hemisphere, certainly in the United States, until the recent
resurgence of dengue and chikungunya disease. We know a great
deal about these disease vectors but there is much scientists
admit they don't know about the Zika virus itself.
Lack of knowledge and misinformation has stoked
apprehension and fear among many. According to the World Health
Organization, some of the reasons why we don't know more about
this disease include a relatively small proportion, about one
in four, some say one in five, of infected people develop
symptoms; a virus that is only detectable for a few days in
infected people's blood; the failure of current test to
definitively distinguish Zika from similar viruses such as
dengue and chikungunya.
The World Health Organization recommends that all people in
areas with potentially infected mosquitos, especially pregnant
women, wear protective clothing and repellants and stay indoors
to the extent possible with windows closed or screened.
Pregnant women are urged to postpone travel to affected areas
or to diligently protect against mosquito bites if travel is
unavoidable.
Currently, no therapeutics exist to treat the Zika virus,
nor is there a vaccine but that gap need not be forever. One of
our distinguished witnesses today, Dr. Anthony Fauci, Director
of NIH's Allergy and Infectious Disease Institute will explain
the scope of NIH research on the Zika virus, as well as vector
control. Surely lessons learned from malaria vector control
have applicability to Zika virus.
Our two other distinguished witnesses include Dr. Thomas
Frieden, who has been here many times, so many times during the
Ebola problem, and Ariel Pablos-Mendez, the Assistant
Administrator for Global Health at USAID, who in like manor has
been here and has done a wonderful job on all of these issues.
The U.S. Government has, for quite some time, promoted such
tactics as insecticide-laced mosquito nets, window-endorsed
screens, small pool and container drainage, and the use of
strong but safe pesticides to eradicate mosquitos. However, our
programs largely are tailored for developing countries. With
the reemergence of dengue fever and chikungunya in the southern
United States and in Hawaii, we have to step up our domestic
efforts to control mosquitoes before warmer weather leads to an
explosion of mosquito population during an imminent epidemic in
the homeland.
According to Dr. Luiz Alberto Machado, Ambassador of
Brazil, one of the areas most affected, and he is the
Ambassador to the United States, the Brazilian Government has
deployed 220,000 troops and 300,000 health agents to fight the
vector of the infection by visiting communities to educate the
population and help eliminate all mosquito breeding grounds.
Experts cite possible links with the Zika infection of pregnant
mothers and disorders affecting their unborn children, while
they, including our witnesses today, are quick to point out
that there is no definitive proof of such a linkage.
According to Brazil's Ambassador, and I quote him in part,
Microcephaly in newborn babies can also be caused by a
number of other diseases. Health experts are dealing
with something new: the link between Zika and
microcephaly is unprecedented in the scientific
literature and requires in-depth studies and analyses .
. . .
As a matter of fact, an AP story that just ran on February
6th points out that the President of Colombia has said that in
all of their cases, there is not one case of microcephaly.
In fact, in announcing the administration's proposal for a
supplemental sum of $1.8 billion to fund efforts to combat the
Zika virus, the White House statement says that there ``may''
be a connection between the Zika virus and disorders
experienced by newborns in affected countries.
Dr. Marcos Espinal, Director of Communicable Diseases and
Health Analysis at PAHO, the Pan American Health Organization,
said there is a broad spectrum of impacts for microcephaly from
mild to severe.
A fact sheet on microcephaly in Boston Hospital's
Children's Hospital notes that some children with microcephaly
have normal intelligence and experience no particular
difficulty with schoolwork, physical activity, relationships,
or any other aspect of their lives. However, many children with
the disease, especially those with more severe cases, face mild
to significant learning disabilities, impaired motor functions,
difficulty with movement and balance, speech delays.
In the meantime, we must work harder to prevent maternal
infections and devise compassionate ways to ensure that any
child born with disabilities from this or any other infection
is welcomed, loved, and gets the care he or she needs. USAID's
Ariel Pablos-Mendez will testify today that we need to expand
best practices for supporting children with microcephaly. In
like manner, parents of children with disabilities need to be
tangibly supported as well.
Ana Carolina Caceres, a Brazilian journalist born with
microcephaly, told the BBC's Ricardo Senra in a February 5th
interview that the condition, and I quote her in pertinent
part,
is a box of surprises. You may suffer from serious
problems or you may not . . . . On the day I was born,
the doctor said I had no chance of survival. ``She will
not walk, she will not talk . . .''. But he--like many
others--was wrong. I grew up, went to school, went to
university. Today I am a journalist and I write a blog
. . . . People need to put their prejudices aside and
learn about this syndrome.
This hearing will look into the implications of the current
and long-term threat from the Zika virus, and we have assembled
expert infectious health leaders from the Centers for Disease
Control and Prevention, the National Institutes of Health, and
the U.S. Agency for International Development to help us to
understand where we are and where we go from here.
I will just note, parenthetically, that for more than 4
years, I have been urging passage of my bill the End Neglected
Tropical Diseases Act and Dr. Pablos-Mendez has been very
supportive and has testified at several hearings on this issue
of neglected tropical diseases. The full Committee on Foreign
Affairs approved it last month.
Since 2011, our committee has accelerated our discussions
on the need for more study and funded efforts to identify
tropical diseases and find diagnostics, vaccines and treatments
of such illnesses. At that time, 2011, West Nile virus was
quietly making its way across the globe, including the United
States, from its origins in east Africa.
Ebola virus, first discovered in a remote area of central
Africa in 1976, caused a global health crisis only 2 years ago.
And finally, and I say this with some concern, for the
second consecutive year, the administration has slashed funding
for global health accounts in the budget proposal released this
week, including a 19-percent cut for global program on
tuberculosis, the world's leading infectious disease killer.
And I know that the three distinguished witnesses today, that
is not your prerogative but that is what was sent up to Capitol
Hill.
Additionally, the administration is being short-sighted
with regard to neglected tropical diseases, cutting that
program by nearly 15 percent. In the face of the waves of
infectious disease epidemics in recent years, including multi-
drug resistant tuberculosis, West Nile virus, Ebola and now
Zika, the administration's disregard for this danger is simply
inexplicable.
Zika has now joined the ranks of previously little-known
diseases that have created global alarm. Before the next
explosive health crisis appears, we must provide sufficient
resources to the study of tropical diseases.
I would note parenthetically, H.R. 1797 authorizes the
creation of Centers of Excellence to study every aspect of
these dreaded diseases. And I would note in the year 2000 and
even most recently, just a few years ago, legislation that I
authored on autisms created such Centers of Excellence at NIH
and CDC and I think that has had a huge impact in combating
that development disability. So, hopefully, we will get some
traction on that legislation.
I would like to now yield to the distinguished chairman, my
good friend, Mr. Duncan.
Mr. Duncan. I want to thank the chairman, Chairman Smith,
for the joint hearing here and appreciate us being involved.
The Western Hemisphere Subcommittee is wanting to engaged
in this issue because we are seeing this virus here and there
is a lot of concern with the allies and neighbors in the
region. Before 30 days ago, a lot of folks in my district never
heard the words Zika virus. So, the Zika virus, virtually
unknown in the Western Hemisphere until the first reported case
was on Easter Island, west of Chile in February 2014. It has
not exploded in the region with cases in 26 counties,
territories, and the World Health Organization projecting Zika
will likely spread to almost every single country in the
Americas.
While symptoms for the majority of people who contract Zika
are quite mild, the disturbing potential links of Zika causing
microcephaly in unborn babies and GBS syndrome in some
individuals has created panic around the region. Last month
Brazil reported having over 4,000 suspected cases of
microcephaly potentially linked to Zika as of October 2015.
Although further investigation has confirmed microcephaly in
just 400 of the suspected 4,000 cases, and only 17 of which
tested positive Zika, concerns remain very real for pregnant
women living in Zika-affected areas.
In addition, Brazil, El Salvador, Martinique, and Suriname
have also reported an increase in GBS cases, potentially
connected to Zika. Just last week, Colombia confirmed the first
three deaths of patients infected with Zika who exhibited
symptoms similar to GBS.
In May 2015, Pan American Health Organization issued an
alert regarding the first confirmed Zika case in Brazil.
Last month, the U.S. Centers for Disease Control and
Prevention issued a Level 2 alert warning to follow enhanced
precautions for pregnant women and women of child bearing age
and any travel to Zika-infected places. Subsequently, last
week, the WHO declared the spread of Zika an international
public health emergency and President Obama has since
responded, the request this week for Congress to provide an
additional $1.8 billion to address the Zika crisis.
I am deeply concerned about the impact that the Zika virus
could have on women and future generations in Latin America and
the Caribbean, where most of the population has little or no
immunity, where mosquitos are simply part of everyday life,
especially in poor communities, and where many governments'
healthcare systems are not equipped to handle a mass influx of
microcephaly or GBS cases as a result of the rising numbers of
Zika cases.
In particular, Venezuela is reporting having over 4,700
Zika cases. With the lack of even basic healthcare options
available due to horrible economic mismanagement, the
Venezuela's ability to address rising numbers of Zika cases and
provide the needed care for women in particular is severely in
doubt and deeply worrisome, with some predicting that Venezuela
could see the region's worst cases.
In contrast, Brazil, the host of this year's summer
Olympics in August, has made huge efforts to curb the spread of
Zika by fighting it with genetically modified mosquitos,
deploying hundreds of thousands of troops to help educate the
population about prevention, and working with the U.S. and
international community to research the virus and development
treatments.
Given the rapid spread of Zika virus in the Americas,
several countries have tried to buy time to address the
problems by urging women to postpone pregnancy. Colombia,
Jamaica, Ecuador, and El Salvador have all issued these
recommendations. However, while these governments may try to
delay the spread of the virus through such announcements, many
women unfortunately do not have the luxury of simply choosing
to wait. Crime and violence plague much of the region.
Corruption and impunity are endemic and women are often caught
in the crosshairs, consequently facing unexpected pregnancies.
As a result, the Zika virus has created a growing push for
Latin American countries to liberalize their laws to allow
greater access to contraception and abortion.
On February 5th, the U.N. High Commissioner for Human
Rights called on Latin American countries affected by the Zika
virus to increase this access. Today, Latin American countries
have some of the strongest laws on the books protecting the
life of the unborn. Chile, the Dominican Republic, Nicaragua,
and El Salvador ban abortion completely, while only Uruguay and
Cuba have legalized abortion, making it widely available. Other
countries only allow abortion in the case of rape, incest, or
the threat of the life of the mother. This push for more
abortion access due to the potential birth defects from
microcephaly is heartbreaking, especially since there are
different degrees of microcephaly in some children born with
these special needs may go on to live very normal lives. I
think you gave a prime example.
Regardless, I believe every person, including the unborn
child is made in the image of God and, therefore, has inherent
worth. Thus, we must do everything we can to support the very
real needs of women in Latin American and the Caribbean who are
facing incredibly difficult situations, while also seeking to
protect the lives of the unborn children.
So, in conclusion, it is my hope that our witnesses today
will provide testimony of how the U.S. and countries around the
world, especially here in the Western Hemisphere can fight and
protect against the spread of Zika, while simultaneously
working together to improve healthcare that address the needs
of women, promotes life of the unborn, and improves therapy
options for babies born with microcephaly and individuals
affected with GBS.
And so with that, Mr. Chairman, I yield back.
Mr. Smith. Chairman Duncan, thank you very much.
I would like to now yield to Dr. Bera.
Mr. Bera. Thank you, Mr. Chairman. Thank you for the timely
hearing here. Obviously, this is an esteemed panel.
As a physician who has done public health work in Nicaragua
in areas that we are finding endemic of certainly dengue fever
when I was down there, but now it is Zika virus, this is going
to be a challenge. Certainly, the mosquito we are dealing with
is not an easy one to eradicate, not an easy one to prevent.
But the purpose of this hearing is to make sure we get
information out and also dispell misinformation. And in
epidemics like this, that is incredibly important because lack
of knowledge, because the spread of misinformation certainly
can create panic and what we want to do is reassure the public
that we are taking this outbreak and this epidemic very
seriously but we are doing things in a responsible way.
I look forward to the testimony of our witnesses on how we
are approaching this, the steps that we need to take, I applaud
the President for his request of $1.8 billion, how we best can
utilize those funds. But there is a lot that we don't know. I
mean we have got to come up with more rapid diagnostic tests.
We have certainly got to understand the extent of folks that
are infected but also the fact that the vast majority of folks
that do get infected probably are asymptomatic.
We also know that there is heightened risk in women of
child bearing age and certainly women who are currently
pregnant. We certainly want to hear the testimony of the
witnesses with regards to what we can be doing. But as a
physician, myself, certainly one thing we can do in endemic
areas is liberalizing access to contraception, making sure that
more women of child bearing age in endemic regions have access
to full contraception. This isn't about abortion or not
abortion. This is about making sure that those women who are
not planning on getting pregnant have the ability to prevent
that pregnancy, until we get a better understanding of what we
are dealing with. And I would make a strong push in endemic
countries to dedicate some of those resources to access to
those family planning services, to access to contraception, to
access to birth control, again, incredibly important.
For U.S. citizens that are planning on travel, obviously,
if you are of child bearing age, we would urge you to take the
caution. If you are pregnant, again, I would hear what those
travel restrictions are but my sense is we would urge those
women who are currently pregnant not to travel to endemic
areas.
In addition, it is my sense that given the
interconnectedness of the globe, we have started to see some
Zika virus cases pop up in the United States. Epidemiologically
I would be curious, my sense is these are generally folks who
have traveled to endemic areas who are now returning. I would
also be curious about the epidemiology in terms of where we are
seeing the virus. It sounds like we may potentially be seeing
it in semen. We may be seeing it in saliva and other bodily
fluids; so, what we can do in terms of recommendations there.
Again, I applaud the panel here. Again, looking at this as
a healthcare professional, I would urge that we don't panic. I
would urge that we collect the data, the information. If folks
are traveling to endemic areas, obviously, take the usual
precautions to prevent mosquito bites. If you are of child
bearing age, certainly take those precautions. I would urge
that we do use some of the resources that the President has
requested to make access to full contraception more available
for women of child bearing age in these endemic regions. That
is one simple thing that we can do to prevent congenital
abnormalities and so forth. And again, I don't think anyone
argues that that isn't good medicine and good prevention.
So, again, I look forward to the testimony of the witnesses
and, again, thank you, Mr. Chairman.
Mr. Smith. Thank you very much.
I would like to now yield to the ranking member of the
Western Hemisphere Subcommittee, my good friend from New
Jersey, Albio Sires.
Mr. Sires. Thank you, Chairman, and thank you for holding
these hearings. I know how much you care about world health and
people. And this certainly is a theme, a situation that we have
to deal with right now.
You know the lack of clarity on the virus, and its effects,
and its treatment make it all more important that we respond to
this more aggressively than we have in some of the other
diseases. I am very concerned now that we have the Olympics
with our people going into Brazil. I think the Brazilian
Government should be very concerned that a crisis doesn't spur
because I don't think anybody would go to the Olympics if you
have the situation where it gets to be panicking.
So, I want to hear what the panel has to say and I want to
thank the chairman again and the ranking member for holding
this hearing. Thank you.
Mr. Smith. Thank you very much, Mr. Sires.
I would like to acknowledge Dina Fonseca, professor of
entomology, ecology, and evolution at the Public Health
Department at Rutgers in my home State of New Jersey. She is an
expert on the mosquitos that carry Zika and other diseases and
she has provided us some testimony that, without objection,
will be made part of the record.
Introducing our very distinguished panel, beginning first
with Dr. Tom Frieden, who has been the Director of the Centers
for Disease Control and Prevention since June 2009 and has
dedicated his career to fighting infectious and chronic
diseases both here in the United States and abroad.
He led New York City's program that controlled
tuberculosis, and reduced multi-drug resistant cases by 80
percent, and worked in India for 5 years helping to build a
tuberculosis control program that saved nearly 3 million lives.
As the commissioner of New York City's Health Department,
Dr. Frieden led programs that reduce illness and death and
increase life expectancy substantially. He is the recipient of
numerous awards and honors and has published more than 200
scientific articles.
We then go to Dr. Anthony Fauci, who is the Director of the
National Institute of Allergy and Infectious Diseases at the
National Institutes of Health. Since his appointment to NIAID,
Director in 1984, Dr. Fauci has overseen an extensive research
portfolio devoted to preventing, diagnosing, and treating,
infectious and immune-mediated diseases. He has made numerous
important discoveries related to HIV/AIDS, is one of the most
cited scientists in the field.
Dr. Fauci serves as one of the key advisors to the White
House and the Department of Health and Human Services on global
AIDS issues and on initiatives to bolster medical and public
health preparedness against emerging infectious disease
threats, such as Ebola and pandemic influenza. He is also one
of the principle architects of the President's Emergency Plan
for AIDS Relief.
Then, we will hear from Dr. Ariel Pablos-Mendez, who is the
Assistant Administrator for Global Health at USAID, a position
he assumed in August 2011. Dr. Pablos-Mendez joined USAID's
leadership team with a vision to shape the Bureau for Global
Health's efforts to accomplish a measurable and sustainable
impact in the lives of people in developing countries.
Before joining USAID, he worked on global health strategy
and the transformation of health systems in Africa as well as
Asia. He also served as Director of Knowledge Management at the
World Health Organization.
Dr. Pablos-Mendez is a board certified internist and was a
professor of clinical medicine and epidemiology at Columbia
University.
Dr. Frieden, the floor is yours.
STATEMENT OF TOM FRIEDEN, M.D., DIRECTOR, CENTERS FOR DISEASE
CONTROL AND PREVENTION, U.S. DEPARTMENT OF HEALTH AND HUMAN
SERVICES
Dr. Frieden. Thank you very much, Mr. Chairman, for calling
this hearing. And thank you, Chairman Duncan, Dr. Bera, Ranking
Member Sires for the opportunity to discuss Zika with you.
We look forward to a full and open discussion and I want to
start at the outset with some basic facts. First, we are quite
literally discovering more about Zika every single day. We are
working around the clock to find out as much as we can, as
quickly as we can, to inform the public and to do everything
that we can do to reduce the risk to pregnant women.
Zika is new and new diseases can be scary, particularly
when they may affect the most vulnerable among us. Right now
the most important thing for Americans to know is this. If you
are pregnant, we recommend you not go to a place where Zika is
spreading. And if you are pregnant and you live in an area
where Zika is spreading, do everything you can to protect
yourself against mosquito bites.
The Aedes mosquito that spreads this particular virus is
very difficult to control and I will talk about that more in a
bit but it is a very important point, when we think about what
we can do to respond to Zika in the short-term and in the
longer term.
CDC is working 24/7 to get more information. We elevated
our level of response on Monday of this week to Level 1, after
your activation of our Emergency Operations Center last month.
We are committed to continuing to share information as quickly
as possible with the public and with healthcare providers and
policymakers, so that people can make the best possible
decisions about health based on the most recent and accurate
data.
We will also continue to provide and update our guidance as
soon as we know and learn more.
This is the latest in a series of unpredicted and, in many
cases, unpredictable health threats and it emphasizes how
crucially important it is that we continue to strengthen the
systems that will find, stop, and prevent health threats,
wherever they emerge around the world both the help other
countries and to protect Americans here at home.
I want to start with what we know. As you said, Mr.
Chairman, the virus was first identified in 1947. It was first
identified to cause an outbreak and an outbreak that the CDC
scientists investigated in 2007. It is believed to cause no
symptoms in approximately 80 percent of the people infected and
mild symptoms in virtually all of the rest. The mosquito that
spreads it, the Aedes species. All right, there is the enemy.
The Aedes aegypti mosquito is a very challenging, what we call,
disease vector to control. It is an indoor biter. It bites all
through the day, including at dawn and dusk. It hides in
closets and under tables and places that are hard to get to.
Its larvae or eggs, its eggs can be drought-resistant and can
persist for some time. And it can bite four or five people in
the course of one blood meal, meaning it can spread disease
quite quickly. Our efforts to control it are challenging. It is
hard to eliminate.
I want to show a bit about what has happened in recent
years with dengue and chikungunya. These are two viruses spread
by the very same mosquito as Zika is. In red on this map, you
see the approximate geographic distribution of dengue around
the world and you see that is widely distributed in that
equatorial band, essentially above and below, throughout the
world. Dengue has been increasingly present in recent years.
Now, if you look at chikungunya, chikungunya is spread by
the same mosquito. It is a word that means bent over with pain.
So, it can cause a severe, painful disease. And dengue, of
course, can be very severe or fatal. And for more than 60
years, chikungunya was present in other parts of the world but
not in our hemisphere. But over the past few years, it has
spread widely within our hemisphere.
And these are the current known places where both dengue
and chikungunya have been documented as spread. Anywhere either
of these diseases is present, Zika may well follow in the
coming weeks, months, and years.
Now, on microcephaly, this is an extraordinarily unusual
event and I want to emphasize that. In 1941, scientists
recognized that rubella causes the rubella syndrome. And with
rubella vaccine, we have now virtually eliminated that in the
U.S.
In 1962, scientists identified Cytomegalovirus, another
virus, as a cause of severe fetal malformations. And in the
past 50 years, we are not aware of any other viral cause of a
significant number of birth defects. In fact, we are not aware
of any prior mosquito-borne cause of fetal malformations, if in
fact this is confirmed.
Guillain-Barre syndrome, which you have heard about, or a
weakness after infections is a recognized complication of many
different infectious processes, both bacterial and viral. It
can occur in one in 1,000 or one in 100,000 people who have had
an infection and it increasingly looks like that it is
associated with Zika virus infection as a post-infectious
complication and it can be severe. But the big thing that is
different here is the microcephaly.
Next, I would like to talk about what, based on what we
know today, is likely to happen over the coming weeks and
months and what we are doing about it to protect Americans.
First, we will discover more each and every day. And I will
show you later today some new data that was just released
within the past hour. We will learn about maternal to child
transmission, about any possible cofactors such as other
infections, or nutritional factors that may increase or
decrease a woman's likelihood of having the Zika infection
transmitted to her fetus. We will learn about the relationship
with both microcephaly and Guillain-Barre from studies that we
are doing today with partners in Brazil, Colombia, Puerto Rico,
and other places.
We will develop better diagnostics. Currently, we can
diagnose the active Zika infection. And when someone is sick
with Zika, we can find it in their blood. But if it is a couple
of weeks or a couple of months later, figuring out if they have
had Zika is very complex. And CDC scientists have worked for
years to develop serological tests for that. We have a test but
it is one that can have false positives for prior infection.
We will learn more about the level of risk, whether
symptomatic Zika is more likely to cause other adverse health
outcomes than asymptomatic Zika. We will learn more about how
long a man who has been infected with Zika may continue to
harbor Zika in semen and potentially spread it to sexual
partners. We will learn more about how to optimally stop the
vector, the mosquito that spreads Zika virus.
And for all of these things, we will need additional
resources, which is why the emergency supplemental request is
so important.
So, one thing that will happen is we will learn more. A
second thing that will happen is we will see more cases among
travelers to the U.S. Some of them will be pregnant and that is
why we have issued travel advice not to travel if you are
pregnant and we have worked with doctors, clinicians, and
others to provide that advice.
Third, we will likely see significant numbers of cases in
Puerto Rico and other U.S. territories, where there may be
intensive spread of Zika. This is a particularly urgent area
and I would like to show you a series of slides that show what
happened in the chikungunya outbreak a little under 2 years
ago.
On May 5, 2014, the first chikungunya case was identified
in Puerto Rico. Two weeks' later, it had begun to spread and
each of these slides is a 2-week period. Two weeks later, 2
weeks later, 2 weeks later, and by October, it was in almost
all of Puerto Rico and has now affected at least a quarter of
the adult population of Puerto Rico. So, this can spread very
rapidly in a population.
We will move rapidly to support pregnant women and reduce
the risk that pregnant women will become infected, to monitor
and reduce mosquito populations to the greatest extent
possible. And the next thing that we may see happen is cases or
clusters in part of the U.S. that have had dengue clusters in
the past. That is why we need support for local mosquito
surveillance and control measures. We may also see sporadic
cases elsewhere in the U.S. and, of course, unfortunately,
continued spread around the world.
To finish what we are doing now is, in a whole of
government way but with HHS as the lead, looking at what can be
done to reduce the risk to pregnant women. And the CDC part of
the supplemental request is $828 million to scale up
prevention, both for pregnant women, for reducing the risk of
mosquitos, to prevent transfusion, organ transplant, or other
what we believe are rare potential forms of transmission and in
the future, with NIH in the lead, vaccination.
To detect through laboratory tests, CDC laboratories have
developed the diagnostics that are being used in this country
and we are working around the clock to get these diagnostics
out so that more people who want to be tested can be tested. We
will improve clinical diagnosis and reporting, mosquito
surveillance, and including the resistance of mosquitos to
insecticides, which is very important to know so we can target
our actions, and to understand microcephaly more.
Within the past hour, CDC has released information from
Brazil on the findings among four infants, two miscarriages at
age 10 and 11 weeks, spontaneous miscarriages, and two infants
who tragically had microcephaly and died within the first 24
hours of life. And working with our Brazilian colleagues, the
CDC laboratory was able to identify the genetic material of the
Zika virus in the brain tissue of the two infants who died with
microcephaly. This is the strongest evidence to date that Zika
is the cause of microcephaly but it is still not definitive. We
will still need to understand the clinical and epidemiological
patterns to make that link definitive.
To do these investigations and to do the response, we will
need additional resources. Vector control is complex and
expensive. There are a series of measures we can take,
particularly in the U.S. area of Puerto Rico and other parts
that have had dengue transmission and we look forward to
working with you to inform people about the latest information
on Zika and what we can do to stop it.
So, thank you very much and I look forward to answering
your questions.
[The prepared statement of Dr. Frieden follows:]
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Mr. Smith. Dr. Frieden, thank you very much for your
testimony.
Dr. Fauci.
STATEMENT OF ANTHONY S. FAUCI, M.D., DIRECTOR, NATIONAL
INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES, NATIONAL
INSTITUTES OF HEALTH, U.S. DEPARTMENT OF HEALTH AND HUMAN
SERVICES
Dr. Fauci. Thank you very much, Mr. Chairman, Chairman
Duncan, Dr. Bera. It is a pleasure to be with you this
afternoon and to discuss with you the research conducted and
supported by the National Institutes of Health in addressing
the Zika virus situation that we currently find ourselves in.
It is important to point out that we are part of a
government-wide and HHS concentrated effort with our sister
agencies CDC, FDA, and others within HHS to address the public
health issue of Zika. Our role is in the area of basic and
clinical biomedical research.
As shown on this slide, the National Institute of Allergy
and Infectious Diseases, the institute that I direct, has a
dual mandate. And the mandate is to not only, in the classic
way, support a robust basic and clinical research portfolio in
microbiology infectious diseases, but simultaneously, to be
able to respond almost immediately to a new and emerging
threat, the situation we find ourselves in right now with Zika.
As I wrote in this article just a few weeks ago in the New
England Journal of Medicine, ``Zika Virus in the Americas: Yet
Another Arbovirus Threat,'' and the point that I made in this
article is that if you look just in the Americas,
notwithstanding the rest of the world, over the last few
decades, what we have seen was an explosion of not only dengue
virus but new viruses that had never before been seen in the
Western Hemisphere. Dr. Frieden mentioned a couple of those:
West Nile virus, chikungunya virus in the Caribbean, and now
Zika virus in the Americas. These are mosquito-borne viruses
that have the capability of spreading very rapidly. And what we
have been able to do, and I am going to describe a bit of that
for you and then, obviously, leave time for questions later, of
what the approach of the NIH and NIAID has been.
Our major mandate is to provide the basic understanding of
the disease, the clinical research, the resources for
researchers throughout the country and the world, as well as
biotech companies, with the ultimate goal of developing what we
call our countermeasures in the form of diagnostics,
therapeutics, and vaccines. So, let's take a very quick look at
some of these and how they relate to the situation with Zika.
Dr. Frieden mentioned the issue of epidemiology and natural
history. We have our grantees and contractors who have been
studying similar diseases like the flavivirus dengue to try and
understand what we call the natural history. What is the
difference between symptomatic and asymptomatic disease and
what is the relationship direct or indirect, alone or
synergistic between an infected pregnant woman and the
development of congenital abnormalities like microcephaly?
What, indeed, is the broad spectrum of the pathogenesis of
microcephaly? All of these are questions that we are asking
alone and together with our colleagues, including those at the
CDC, to try and get quick answers.
If one looks at the basic science, if you look at other
viruses that we have been studying, HIV, influenza, or even
Ebola, because of the effort in trying to understand the
fundamental molecular virology. We have put an incredible
amount of effort and learned an awful lot. We need to do the
same thing with Zika virus, studying the viral structure,
comparing for example the nature of the virus in outbreaks in
the Island of Yap, together with French Polynesia, together
with what we are seeing now. Has it evolved? If it has evolved,
has it impacted the pathogenesis and manifestations of disease?
In addition, we will be establishing animal models. With
any new disease it is important to understand pathogenesis, as
well as to screen for drugs and test for vaccines, and animal
models are critical to these efforts.
Dr. Frieden mentioned the issue of vector control. There
are a number of ways to do that, the classic ways but also some
novel ways which we are exploring but should not take the place
of the classic ways and that is things like the genetic
manipulation of mosquitos or infection of mosquitos with
Wolbachia bacteria. Again, I want to emphasize that this is not
an easy thing to do, as Dr. Frieden has emphasized. Vector
control is a very important tool but it is not easy to
implement.
We mentioned diagnostics. The CDC is taking the lead on
that, but our grantees and contractors are using some of the
knowledge gained from our studies in chikungunya, in dengue,
and in other viruses to get more precise state-of-the-art,
point-of-care specific diagnosis so we can tell a woman who may
not know whether she got infected, whether she actually had
been infected with Zika during her pregnancy or before.
Importantly, our role in the development of a vaccine is
actually encouraging news. And the reason I say encouraging is
because we have had positive experience with the development of
vaccines for other flaviviruses. Case in point, dengue, in
which there is already an approved vaccine in Brazil and
Mexico, and we have started last month a Phase 3 trial of a
dengue vaccine candidate in Brazil, in collaboration with the
Instituto Butantan.
In addition, for West Nile virus, another flavivirus, we
successfully made a vaccine. Unfortunately, even though we went
through Phase 1 clinical trials with good safety and
immunogenicity data, we could not find a pharmaceutical company
that wanted to partner with us because it was felt that this
was not something that would have a good profit because of the
target population for this vaccine. I don't believe at all that
we will be left with this problem with Zika, since we already
have a considerable amount of interest on the part of
pharmaceutical companies. We are going to use the same
technologies that we used to develop the vaccines for other
flaviviruses. We are already manufacturing what we call the
construct for that, which we will make to the point of GMP,
conduct toxicity studies, and get into a Phase 1 trial I would
think, and almost be certain, by the middle of this summer,
which will be asking for safety and immunogenicity.
This is the schematic diagram of the vaccine that we used
for West Nile. It is what is called the DNA construct in which
you insert the gene first of West Nile virus. We will
substitute the gene of Zika virus, inject it into an individual
which would produce now viral-like particles which we know are
safe and we know they are immunogenic.
And also therapeutics, although it isn't as high a priority
as vaccines, since it is a transient infection and we have to
do a lot of screening, we, nonetheless, are looking very
carefully with our drug screening capability at possible
therapeutics for the entire class of flaviviruses.
I want to close with this last slide, which reminds us of
something that I said in the very beginning of my presentation,
that microbes have emerged, are emerging, and will continue to
emerge. And I refer to it as the perpetual challenge because we
know that we are talking about Zika today and next month or
next year, we will be talking about something else in the same
way as last year we spoke about Ebola. And I know I want to
thank the Congress for the support that you have given us over
the years to allow us to address these problems.
Thank you very much, Mr. Chairman. I will happy to answer
any questions.
[The prepared statement of Dr. Fauci follows:]
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Mr. Smith. Dr. Fauci, thank you very much for your
testimony. Without objection, all of your full statements,
which are very lengthy and detailed will be made a part of the
record.
I would like to now go to Dr. Pablos-Mendez.
STATEMENT OF THE HONORABLE ARIEL PABLOS-MENDEZ, M.D., ASSISTANT
ADMINISTRATOR, BUREAU FOR GLOBAL HEALTH, U.S. AGENCY FOR
INTERNATIONAL DEVELOPMENT
Dr. Pablos-Mendez. Thank you, Chairman Smith, Chairman
Duncan, Ranking Member Sires, and Dr. Bera and all the
distinguished members of the subcommittees for inviting me here
today to testify on the United States Agency for International
Development, USAID's response to the serious concerns raised by
the spreading in the Americas of the Zika virus.
And I want to recognize the leadership of my colleagues,
Dr. Frieden and Dr. Fauci that have been rapidly mobilized in
the response and the immediate investigation that we already
are learning a lot. But as we have learned from other
outbreaks, we cannot wait to figure it all out before we begin
to have this discussion and a response.
And on Monday, the President submitted a Fiscal Year 2016
supplemental request to aggressively respond to the Zika virus
outbreak. The supplemental request includes $335 million for
programs to be implemented by USAID so that we can help
countries in the region affected by Zika respond and protect
their citizens and, in doing so, attenuate its spread to our
homeland.
Let me briefly describe the components of the work that we
propose for implementation by USAID. First, we will support
brisk communications and behavior change programs. As Dr. Bera
recognized, getting the right information to the people,
empowering people with the right information, and this is going
to be a rapidly evolving field, we don't want panic to take
place in the region as we actually take actions to help protect
themselves from the Zika, as well as other mosquito-borne
diseases. This includes mobilizing communities on vector
control, providing clear information for women concerning the
risk of the Zika virus and pregnancy, and how to protect
themselves. Community level messaging will be combined with
mass media and social media campaigns. We will also partner
with the private sector and I am in discussions with companies
in Brazil at this moment to help us do that.
Secondly, USAID will support implementation of a package of
integrated vector management, vector control activities in
communities at risk of Zika. This will help reduce exposure to
mosquitos and will help protect against other vector-borne
diseases such as dengue, as we heard just now.
Specific activities will include community mobilization
campaigns to reduce or eliminate standing water sources where
Aedes aegypti mosquitos breed, focal larviciding based on
vector mapping to eliminate major breeding sites and window-
endorsed screening to reduce mosquito entry to homes, schools,
hospitals, and workplaces.
The approaches we have today to reduce Aedes aegypti
mosquito are not optimal. They have been shown to work in a
number of settings and we certainly are going to be working
with our partners in developing new tools and as they do, we
want to make sure they become available rapidly in the region.
These efforts were built upon the foundation of experience of
the successful President's Malaria Initiative, aware that the
Zika virus is carried by a different mosquito. We have
expertise in mapping, expertise in entomology, and so that can
be brought to bear also in the response to Zika.
Thirdly, USAID will help ensure that women in affected
countries have access to appropriate healthcare and support.
This will include training of healthcare workers to provide
advice, providing support for pregnant women, including helping
them access repellant to protect against mosquitos and ensuring
access to voluntary family planning, as we heard from Mr.
Duncan. These will be important to have information, to have
services, to have community, to have methods, as well as the
care of the affected newborns. And I know that Chairman Smith
has always had a concern for the newborn.
Finally, innovation. We can take steps to spur development
of new tools and other innovations to enhance our response and
prevent future outbreaks. And the baseline of research that NIH
leads is significant. Our partners at NIH and CDC are
supporting this critical research already and we need to better
understand the virus and the relationship with birth defects,
and developing new tools.
As we have learned, the markets need to be incentivized,
need to be organized and market incentives can be of
significant importance to help us bring those tools to fruition
and to quickly deploy them in the region.
Market incentives can be used throughout the development
process from catalyzing early stage development of diagnostics,
therapeutics and vaccines, and as well to incentivize most
costly, late-stage product development manufacturing and scale.
In response to the Ebola epidemic, USAID used grant
challenges to rapidly source new innovations to address key
gaps in a response and we are planning also considering new
grant challenges to bring new ideas to bring to private sector
in diagnostics, vector control, personal control, and the like.
Mr. Chairman, Zika, like MERS, SARS, avian influenza, and
Ebola all point to a landscape where the interaction between
humans, animals, vectors is constantly changing. In our
civilization, for the first time, we are seeing an explosion in
the tropical regions of the world of the forestation and
increase in need demand as economic development takes place,
urbanization changes, and global travel and the like.
Ecological transformation and climate, weather patterns change
are increasingly interconnected in our world and that means
that mosquito-borne diseases, such as Zika, can appear in areas
they haven't before. These rapidly changing dynamics means that
we have to be prepared for what is seemingly unpredictable and
when we have a response, we seem to be as outsmarted by these
viruses.
A recent report from the National Academy of Medicine on
Global Health Risk Framework estimates the annualized cost of
pandemic risk is about $60 billion a year and there are other
estimates that are actually higher than that. So, we need to
make sure that we are prepared because both the cost in life
and the cost to the economy is likely to grow in coming
decades.
As we address the immediate needs of the Zika-affected
population, we must underscore the need to improve national
systems to prevent, detect and respond to these pathogens and I
think this is the effort at the heart of the Global Health
Security Agenda launched in early 2014.
Beyond dealing with individual outbreaks, and we are
seeing, as Dr. Fauci put it, a perpetual challenge, one coming
after the other, we need to also pay attention to the landscape
where they are coming, better understand the territory where
they are coming. USAID, for a number of years, has supported
work that builds capacities and expands the evidence base, that
helps predict and mitigate the impact of novel high consequence
pathogens. And we, every year, we are detecting hundreds of
these new pathogens. We are screening them. We are ensuring
that they don't jump into the human space. We find them in
primates. We find them in birds. We find them in bats. We find
them in rodents but it is not an infinite landscape. There is a
logic to it and we want to make sure science is brought to bear
to address, indeed and prepare and predict these challenges.
We must keep this bigger picture and the long-term view if
we are to prevail against this rapidly evolving what I call the
microbiome of the world.
In conclusion, Mr. Chairman, USAID is strongly committed to
combating the Zika virus outbreak of today and is strengthening
the capacities to ensure that future threats will be rapidly
and effectively controlled at their source and before they pose
a threat to the global community. We look to your partnership
and your leadership as we continue this fight.
I appreciate the opportunity to share the contributions
that we are making in this battle. Thank you very much.
[The prepared statement of Dr. Pablos-Mendez follows:]
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Mr. Smith. Dr. Pablos-Mendez, thank you very much.
The committees will be following the 5-minute rule for
member questioning. I would like to begin and I will just throw
out some questions, and then yield to my good friends and
colleagues.
First, on vector control capacity, in Africa it took years
to build up that capability, especially with the malaria
efforts. I know that being safe and effective is important so
that we don't have, obviously, unintended consequences from
unsafe pesticides, for example. I know, personally, we use, my
wife and I, diatomaceous earth at home for certain bugs and
insects. Pyrethrum is obviously another possibility. But the
question would arise, what are you suggesting that they use? Is
there an adequate supply in these countries and an adequate
delivery mode?
Secondly, on Brazil, it seems that the areas of the highest
prevalence is in areas of extreme poverty. And I know because
we work on stunting and other issues in this subcommittee all
the time, as a matter of fact, the first 1,000 days of life, in
my opinion, is one of the most transformative efforts where
nutrition, micro-nutrients, and other kinds of assistance
efforts increases the immunity on the part of the baby. It also
makes the mom healthier. So, from conception to the second
birthday, those first 1,000 days are absolutely transformative.
Are you looking into vulnerabilities based on weak or
compromised immune systems? And certainly children living where
there is extreme poverty and lack of nutrition are likely to
have that problem.
Third, on mother-to-child transmission, is that something
that you will be looking to develop a way like you, the
pharmaceuticals and others did so effectively with regards to
mother-to-child transmission with HIV/AIDS?
And then finally, in the United States landmark civil
rights legislation, the Americans with Disabilities Act ensures
that persons with disabilities are fully enfranchised into
society. Dr. Pablos-Mendez, you mentioned in your testimony,
looking to encourage other countries to adopt best practices
for supporting children with microcephaly, you might want to
explain what that will look like in terms of helping those
countries care for children with disabilities.
Dr. Frieden. Maybe I can start with your first couple of
questions.
On vector control, our approach is to reduce mosquito
populations by an integrated comprehensive approach. That means
reducing standing water, using larvicides, and there are
various forms of larvicides.
We have looked at outdoor spraying and many countries use
outdoor spraying. Because the vector bites indoors and because
of some other characteristics, there may be limited
effectiveness of outdoor spraying.
And one approach that has been used in some places is
targeted indoor residual spraying. It is a different type of
spraying than spraying done with malaria, different areas of
the house, but there may be efficacy there. That is a labor-
intensive and complex area.
And underlying all four of those critical approaches is
rigorous surveillance for where the mosquitos are and which
insecticides they may be resistant to. And we have those
studies underway now in Puerto Rico. We don't yet know what the
resistance levels are.
In terms of nutritional or other cofactors and the impact
of poverty, that is exactly one of the things that we will be
studying in the case control study. There is a lot that we
don't know. If there is a causal association, we don't yet know
which trimester of pregnancy is the highest risk and, within
that, whether it is all pregnancies or a small proportion of
them that is affected. And if it is fewer, what might be the
risk or protective factors? That is a critical thing that we
are investigating now.
Dr. Fauci. Thank you, Mr. Chairman, let me just address the
question of mother-to-child transmission, which is really
important. The major difference between mother-to-child
transmission and the advances that we have made with HIV/AIDS
and the particular challenge of Zika infection in the mother
and the transmission to the baby is the chronic nature of the
viremia in HIV in which you could suppress the virus in the
mother by treating the mother. And we know for certain, by many
good studies, that when you bring the level of HIV viremia in
the mother to below detectable level, you dramatically decrease
the likelihood that the mother will transmit HIV to the baby
because you have a lot of time because it is a chronic
infection.
When you are dealing with an infection like Zika, which is
a flash infection, it comes, it lasts a few days, and then it
is gone in the person who gets infected, the way to prevent
mother-to-child transmission is exactly what we did with the
rubella model. You recall that in the 1960s there were 20,000
cases of congenital rubella syndrome annually in the United
States. That is astounding, 20,000 cases, leading to blindness,
deafness, heart disease, mental retardation, and other types of
congenital abnormalities. If you look at the curve of the
epidemiology, when we instituted the rubella vaccine, we
essentially targeted everyone--it was specifically targeted to
women of child-bearing age because rubella is a relatively mild
disease very similar to Zika.
In answer to your question about mother-to-child
transmission, the best way to prevent that is to get an
effective vaccine and make sure that in the target countries,
women of child-bearing age are protected by a vaccine.
Dr. Pablos-Mendez. Mr. Chairman, I would like to address
two of your points, one on nutrition and the other on children
with microcephaly and disabilities.
We fully agree. Just yesterday we having a review of our
nutrition portfolio and the first 1,000 days had been the way
in which our work has been best framed to have the most impact
but also we drew on the parallels to the current situation with
Zika. Those first 1,000 days needs to be crucial, crucial both
to the prevention because as you said, malnutrition will expose
you to severe infection and then that is the complications that
we may be seeing.
Also, malnutrition could play a role itself in leading to
under nutrition in utero and even associations of certain
deficiencies with complications and deformations and the like.
But the experience and the work that we have in nutrition
around the first 1,000 days also bring to bear anthropometrics.
The measurement of the heads, for example, is something we need
to do better. We need to have surveillance and reporting system
that allows us to do that and the experience and the community
centers that we have working in nutrition can be mobilized in
this regard.
As you know, we have been very successful with child
survival. One hundred million children's lives have been saved
in the last 20 years. And in a way, we are looking to the end
of preventable child and maternal death and, as we do that, we
move from survival to well-being. And the more we do that, we
pay attention, indeed, to many of the factors from nutrition
education that we have to do, disabilities very important. And
the U.S. Government leadership in that space for Americans but
also in the U.N. there has been awakening of the importance of
paying attention to support for children with disabilities.
The experience we have built on HIV and more recently on
Ebola, in terms of those who are affected, in terms of
education on the stigma, medical care, and research, as to what
will be the spectrum of the impact of these phenomenon we are
working on today, and social work to support those families.
There is a lot of needs.
We do have, as you know a Center for Children in Adversity
at USAID that has been working in this area. So, we look
forward to continue to work with you. And we have all of these
to mobilize in a region that we have in a way not been as
present because of the success in development in this region.
We have moved most of our resources to Africa and Asia, where
we had the most deaths maternal child health, as well as AIDS,
malaria, and tuberculosis.
Mr. Smith. Thank you.
Dr. Bera.
Mr. Bera. Thank you, Mr. Chairman. And I will try to keep
my remarks tight because I know we just we got votes called and
we have got a number of members.
I think Dr. Frieden pointed out the difficulty of vector
control with this particular mosquito, obviously, that is one
of our primary tools but, again, not as easy as with certain
other types of mosquitos.
Dr. Fauci, you touched on the importance of developing a
vaccine and perhaps the rapidity of developing that vaccine. I
would be curious, you were pretty optimistic that we might be
able to develop something fairly quickly.
Dr. Fauci. Let me explain that so that it is clear. In
general, vaccines take anywhere from 3 to 8 years to get all
the I's dots and the T's crossed, full FDA approval by proving
safety and efficacy.
When you are dealing with a situation like this, we have
the advantage that we already have the construct that you need,
the candidate vaccine platform. If you look at the timetable,
you always know that in vaccinology you have to be careful that
timetables can slip. But we feel confident that we will have
enough construct to be able to do preclinical toxicity studies
by this summer, which means we could start a Phase 1 trial,
let's say in August. They usually take 3 to 4 months, which
means we could be finished by the end of 2016.
Now, the critical issue. If it is safe and immunogenic and
the outbreak is still raging, then you could go into an
accelerated Phase 2A/2B trial, which means that you could
likely determine if it is effective within 6 to 8 months. And
if it is, you can get an accelerated approval from the
regulatory bodies. However, if when we get to 2017, all of the
cases go down, which is what we faced with Ebola. We had an
Ebola vaccine and then all of a sudden, the cases disappeared
and it was difficult to definitively prove. If it goes down,
then you stretch it into several years. But if I am talking to
you in February 2017 and we still have a massive outbreak in
South America, we likely could prove safety and efficacy within
6 to 8 months.
Mr. Bera. Now, are we going to run into, in terms of
commercialization of that vaccine and wrapping up that vaccine,
you know working with the private sector to get that vaccine
commercialized and distributed, will that be a problem?
Dr. Fauci. I do not think so, Dr. Bera. And the reason I do
not think so is because we are already, unlike the case with
other emerging infections, receiving calls from pharmaceutical
companies, big pharmaceutical companies very interested in
partnering with us. I don't think we are going to have that
problem.
Mr. Bera. Great. And again, all three of you touched on the
importance of funding global health, the importance of funding
global disease surveillance. You know this is just another case
of the interconnected world. Disease is going to travel a lot
faster and so forth. And I would just put out there the
importance of funding and making those funds available and
working together.
This is, again, just, you know we had Ebola last year. We
have got Zika virus today. We will have another infection next
year and again, I would emphasize the importance of this
funding.
So, Mr. Chairman, I will go ahead and yield back.
Mr. Smith. We have a series of votes. I am not sure what
your availability is to stay. We could be back in about 15 or
20 minutes. Would that be okay? I deeply appreciate it.
We stand in brief recess.
[Recess.]
Mr. Smith. The subcommittees will reconvene. And as soon as
my colleagues who come, since I have already had my turn, I
will yield to them.
But I did ask the question earlier and maybe if you could
just elaborate a bit on it and that is the capacity, the actual
volume of potential pesticides. I know Dr. Frieden, you talked
about the utter importance of draining sitting water. And I
know even in the Big Island in Hawaii, there is just a new
emergency call because of dengue to go after spare tires that
are housing water and then becoming breeding grounds for
mosquitos. I get that. That is labor intensive but doesn't
require chemicals, per se. What are the actual pesticides that
are considered safe and what is the potential supply of those?
Dr. Frieden. Thank you very much. I am glad you came back
to that because I wasn't able to address some of the really
critical issues there in my earlier reply.
The U.S. capacity for mosquito control is quite variable.
So, some parts of the U.S. do this extremely well, some parts
not so well. And one of the critical components of the
supplemental request is to strengthen mosquito control in the
parts of the U.S. that have mosquitos that could spread the
Zika virus. And here, we look at a comprehensive approach.
So, on the one hand there are things that you can do to
reduce larval populations and their use of what is called BTI
or Bacillus and the sphaericus, two different bacteria that
actually infect and kill the larval mosquitos are very
effective and are used pretty widely in not just human health
but agriculture and other areas. There are various other ways
of reducing mosquito larva populations but that is one of them.
For the adult mosquitos, there are three broad classes of
insecticide and then within those there are many different
types of insecticides. Not all of them are licensed for use in
the U.S. and we are looking very carefully at what has been
done in other countries, including Australia with targeted,
indoor residual spraying of insecticides and seeing what would
be safe and effective here. So, that is something that we are
in frequent discussions with industry partners, as well as EPA
and other entities. But there are issues of what we could do
that is safe and effective.
The mosquito control efforts are also more than just
chemicals. It is about having a surveillance system. So, CDC
has invented a type of trap which is currently in use in
California and elsewhere that can monitor what the mosquito
populations are. CDC laboratories have developed a simple way
of testing for insecticide resistance so that we can get a
better sense of which should be used because we are seeing
reports of insecticide resistance and then looking at where the
mosquitos are and what insecticides they are susceptible to, we
would then proceed with recommendations for mosquito control.
But this is all quite labor-intensive. It needs to be done in
the same way you need a public health system to find, stop, and
prevent problems, we need a vector control or a mosquito
control system to track where the mosquitos are and then
respond in real time to where the problems emerge.
Mr. Smith. Dr. Fauci, I appreciated your comments on the
rush to get to a safe and effective vaccine. And as you pointed
out in your testimony and in your comments, and I heard you on
the radio talking about this recently, it may not be through
the normal channel but we are in an emergency with regards to a
vaccine. How quickly could such a vaccine be available?
Dr. Fauci. Thank you for the question. If you go to a
continually emergent situation and all things work well, if we
finish the Phase 1 trial, as I predict we will by the end of
2016, and we still have literally thousands of cases into 2017,
you could then go into an accelerated Phase 2A/2B clinical
trial. If you do the math and the statistics, depending on the
number of cases and how effective the vaccine is, in anywhere
from 6 to 8 months, you may be able to show that it is, in
fact, effective and safe.
At that point, even though it would take maybe a few years
to get the final stamp of approval, there are mechanisms of
accelerated approval and accelerated access that you could
potentially implement, if in fact you have a good safety
profile and you have shown efficacy.
So, you could conceivably have it by the end of 2017, which
is really rocket speed for a vaccine.
Mr. Smith. Can I just ask anyone who would like to respond
to this, there are about 25,000 children and adults with
microcephaly today in the United States. Obviously, there are
support groups. There is a great deal of knowledge that has
been gleaned from their experiences. And as I said earlier, the
spectrum, it is not unlike, maybe it is not a good comparison
but it reminds me of the autism spectrum, the fact that there
are people who are severely autistic and some who are higher
functioning. And I am wondering if some of those lessons and
from those groups like Boston Children's Hospital which has
done wonderful work in that area, are you looking to tap that
so that we share best practices with these countries which may
not have that experience?
Dr. Frieden. Yes, thanks for the question. As you know, Mr.
Chairman, from your past work, the Centers for Disease Control
and Prevention includes the National Center for Birth Defects
and Developmental Disabilities. And in our emergency response,
they are fully integrated, including clinical geneticists, who
are traveling to Brazil and Colombia to assist with assessment
and plans.
We need to learn more about what the spectrum is in this
case. As noted, we may well see a broad spectrum of some more
severe, some less severe, and this is something that we want to
provide all of the expert assistance we can to support women,
families and communities that are dealing with this very
challenging situation.
Mr. Smith. Yes, Dr. Pablos.
Dr. Pablos-Mendez. Just to add, one of our partners in the
Saving Lives at Birth Initiative is the American Pediatric
Association. So, we are working already with them and they can
help us bridge domestic lessons to the progress we are
deploying internationally.
Mr. Smith. I appreciate that very much.
I would like to now yield to the distinguished chairman of
the Western Hemisphere Subcommittee.
Mr. Duncan. Thank you, Mr. Chairman.
There are going to be a lot of folks traveling to Brazil
this summer. What steps are being taken in Brazil that you can
tell us about? We have even heard calls for canceling the
Olympics because people are concerned.
So, what are the Brazilians doing? What are you doing to
help? And what do we need to know?
Dr. Frieden. So, Brazil has taken this very seriously. They
consider it, I think, an absolute top national priority and, as
the other chairman mentioned in his opening remarks, they have
deployed hundreds of thousands of people in the response. They
are working to reduce mosquito populations. They are trying new
forms of mosquito control. They point out that the season of
the Olympics is a cooler season, so generally has less mosquito
activities, though not none.
But I think from our standpoint at CDC, our role is to give
travel advice to people, regardless of why they are traveling.
So, whether someone is traveling for the Olympics or any other
reason, our advice would essentially be the same. And from the
very first days when we had strong evidence suggesting a link
between the presence of Zika virus and microcephaly, we have
advised that pregnant women strongly consider not going to a
place that has Zika spreading.
So, that is our advice from CDC. And that for women who
live in such areas, or people who go there, to take really good
steps to prevent mosquito bites. And there are things you can
do, applying DEET multiple times a day, mosquito repellant,
wearing long-sleeve shirts and long pants, using clothing that
has permethrin treatment, so it repels mosquitos, and, to the
extent possible, staying indoors within air conditioning, or at
least screened and enclosed spaces.
And I think as we learn more in the coming weeks and
months, more will be understood about what can be done to keep
any risk that might be there to the absolute minimum.
Mr. Duncan. I think it will definitely smell like DEET down
there, sure enough.
I was in Pucallpa, Peru and there is a mosquito and dengue
research project going on and tracking individuals that may
have been contracted and where they have traveled to and who
else may have been exposed or mosquitos in that area.
A lot of folks in my district are concerned, Mr. Chairman,
about unaccompanied children coming north from Latin America.
It has been an issue. Now, it is been exacerbated with Zika.
And do we need to know anything? I mean how prevalent for a
child, a minor to carry a disease? I know you said it has got a
very short period where its symptoms are prevalent but are we
researching how long an adolescent would carry the disease and
whether say they come north of the border and are bitten? Do
you see where I am going with that?
Dr. Frieden. Yes.
Mr. Duncan. So, what do we need to know about that?
Dr. Frieden. So, we have studied this in a variety of prior
outbreaks, as have others. The virus stays in the blood for
about a week after people begin to get sick. We don't see long-
term persistence. So, unlike for example HIV or hepatitis which
can stay in your blood really for life, this is a short-lived
virus that doesn't persist in the blood beyond a week. And if
you think about the numbers, they are really quite striking.
There is a lot of travel from Americans going to Central and
South America and the Caribbean on the order of 40 million
visits per year.
So, lots of travel. And if you think about the different
types of travel, that is a very large number compared to
different types of risk.
The one area I would, just to give full information, what
we don't yet know is how long the virus can persist in semen.
And we are doing studies on that but that is the one area where
we might see the potential for transmission through sexual
contact for more than a week. And we won't know until we do the
studies. That is why we have recommended that for men who have
sexual contact with women who are pregnant, that to avoid the
transmission of Zika----
Mr. Duncan. Right, you had mentioned that earlier. I get
that.
So, when Ebola outbreak was happening, we were doing
airport screening of folks that had traveled to the African
continent, especially those three main countries. Latin America
travel is much broader than that. Is there any proposal, any
talk about doing airport screening for potential symptoms that
you know of?
Dr. Frieden. Yes, as you point out, the situation is very
different. We have roughly 20,000 visitors versus 40 million.
We have a disease which is spread from person-to-person in the
case of Ebola, whereas it is not with other than the rare
sexual contact.
Mr. Duncan. The sexual activity, right.
Dr. Frieden. Right. So, I think the situation is really
very different in terms of Zika and our goal really is to
protect pregnant women. That is the key priority now.
Mr. Duncan. Right. So, we have an El Nino going on. It is
very wet across the South. The amount of water I have seen in
Arkansas, Louisiana, Texas, South Carolina, Alabama,
Mississippi, and North Carolina means that there is going to be
a lot of standing water in the South this year. That means that
mosquitos are going to be very, very prevalent, whether they
are in the no-see-um variety or whether they are the tiger
variety that you mentioned earlier.
So, what are you proposing to help the States address maybe
a mosquito outbreak?
Dr. Frieden. This is exactly what is one of the core
components of the emergency supplemental request. We will be
issuing grants to States at risk and Southern States, as well
as U.S. territories to better control mosquito populations.
Mr. Duncan. Right. Historically, that has been a winning
strategy against malaria and other with mosquito-borne viruses.
Well, listen, as someone who chairs the Western Hemisphere
Subcommittee, who is going to be continually focused on this,
who may see congressional travel in that area, individual
congressmen are going to be concerned, wanting to know what
level of information we have and how can we waylay their fears
and the general public that continually travel down in that
area.
So, this has been very helpful, Mr. Chairman, and with
that, I will yield back.
Mr. Smith. Chairman Duncan, thank you very much for your
questions and for this collaboration of the two subcommittees.
I would like to now yield to Mr. Donovan, the gentleman
from Staten Island.
Mr. Donovan. Thank you, Mr. Chairman, and thank you
panelists for sharing your expertise with us and welcome, my
friend, Tom Frieden. It has been a long time. I look forward to
visiting you in Atlanta. And thank you for all the work you did
for the people of New York City when you were Health
Commissioner there. I think we were fighting West Nile at that
time. It was in its infancy stage in New York when you were the
Health Commissioner.
I know that you need more resources. Until we figure that
out, is there an ability for you to redirect some resources
that you have to address this?
Dr. Frieden. We will do everything within our power to
address the Zika challenge. But the supplemental calls for $828
million for CDC in three broad areas, emergency response in
Puerto Rico, which has a significant risk of seeing widespread
transmission Zika, support for the continental U.S. for States
at risk, including mosquito control diagnostics and a series of
other measures, and then international support. And while we
can get started with that, we can't do it at scale to the level
that we would need and we have already had to curtail some
other activities, such as our activities that deal with Lyme
disease.
Mr. Donovan. I ask that because one of the proudest moments
I have had in the short 9 months I have been here is when we
passed the 21st Century Cures Act to fund CDC and NIH to come
up with remedies and vaccines for some of the diseases that are
known in the world.
I also realize that it takes a while, even after you have
done your work, for the FDA to approve a lot of these things.
Is there any mechanism in place, Tom, that we could help you
speed that up, whether it is through legislation or something
of that nature?
Dr. Frieden. We have been working very closely with the FDA
and in both Ebola and Zika, they have been able to rapidly
allow us to use effective test technologies within a day or two
of our asking. So, that has worked well.
Dr. Fauci can comment further.
Dr. Fauci. Yes, we really want to tip our hat to the FDA
and how they have helped us with with Ebola. When we really
needed to get the vaccine trial out quickly and go from a
preclinical to a Phase 1, without cutting corners on safety,
they greatly expedited their review to allow us to get the
Phase 1 trial done here in the United States and in Europe and
in Africa and then we went into a Phase 2 trial.
We are working very closely with them right from the
beginning. One of the most productive interactions that you
have is that you involve the FDA right from the very beginning
of a project. You don't do it and then go to the FDA and see
how you can get something approved. They work with us right
from the beginning, and that is exactly what they are going to
be doing as we start developing things like vaccines for Zika.
So, we are very optimistic about that relationship.
Mr. Donovan. That is very comforting.
The last comment I have, it isn't really a question but a
comment, Dr. Fauci, during your testimony, I was dismayed when
you told me that you worked so hard and your colleagues worked
so hard to find a vaccine, I think it was for West Nile, and
that no pharmaceutical company wanted to produce it because
there wasn't a profit. All your doctors take a Hippocratic Oath
to serve people. I am just dismayed but thank you for sharing
that with us.
Dr. Fauci. You are welcome. That is frustrating for us
because we think in terms of what is good for the public health
and the global health. And sometimes when you get involved in
things that are profit developing, that comes in and gets in
the way of that.
Having said that, I feel confident that from the
indications we are currently getting from pharmaceutical
companies, that we won't have this problem with Zika.
Mr. Donovan. So, we should be blessed that there is a
profit in the Zika virus.
Dr. Fauci. Well, unfortunately, that is a perverse way of
doing it but you are quite correct.
Mr. Donovan. Thank you. Thank you all.
Dr. Pablos-Mendez. If I may add, this region may have more
resources but we are also exploring financial mechanisms that
we had used in the past for vaccines, where market failure
prevent the final development by the companies. And we have an
experience within advanced market commitment that has been done
through the Global Alliance for Vaccines and Immunizations,
which allowed the introduction of scale of the pneumococcal
vaccines for children.
Mr. Smith. The chair recognizes the gentleman from Florida,
Mr. Clawson.
Mr. Clawson. Thank you for coming again, guys and I am
going to ask for some quick answers because I have got several
questions and I think people are ready to go. Okay?
First of all, it is the same mosquito that carries dengue,
chikungunya, and Zika, much of the time. Is that correct?
Dr. Frieden. That is correct.
Mr. Clawson. And so is anybody thinking about a genetic
therapy fix here? I don't want Frankenstein mosquitos but it
seems to me that you get the Trojan horse and the soldiers
inside the Trojan horse are going to die with it.
And so as I thought about my own legislation for this
obvious problem and being from southern Florida, it seemed to
me that genetic fix ought to be something that is thought about
and if you all tell me it is practical, then with my team, I am
going to keep pursuing what we could do legislatively to
motivate that.
Are you all in agreement with me on that?
Dr. Frieden. It is a promising technology. The biggest
challenge is scalability and community acceptance.
Mr. Clawson. Agreed but companies work all over the world
and that acceptance factor might be different as we get closer
to the equator. You would agree with that, too, right?
Dr. Frieden. I don't have----
Mr. Clawson. In terms of because you have got a bigger
outbreak, you have got a bigger problem.
Okay, thank you for that. We have a vaccination for dengue
in Brazil. Right?
Dr. Fauci. Correct.
Mr. Clawson. I know they were working on one in southeast
Asia for a long time. I don't remember where it got. Do they go
quicker on this sort of thing to get vaccines in Brazil? Would
Americans that are worried about dengue fever, should they go
to Brazil for vaccination or are you all hesitant about the
safety of this? It just seems like the obvious question.
Dr. Fauci. No, actually, that is a good question. There is
an approved vaccine in Mexico and Brazil--a dengue vaccine that
is about 60-plus percent effective.
Mr. Clawson. There are four different types of dengue to
my----
Dr. Fauci. You are correct.
Mr. Clawson. And if you get a vaccine for dengue fever in
Mexico, would it work in India? That is a different strain and
sometimes a different mosquito.
Dr. Fauci. It is the relative proportion of the serotype
that is dominant in a particular area. The one that didn't
quite get off the ground in Asia didn't have a good protection
against all four serotypes; the one that is in Brazil now
appears to cover all four.
Mr. Clawson. So, it works better with whatever the mosquito
here is and maybe the one adjacent that is closer in the serum,
as you say.
Dr. Fauci. Right. And we actually have a Phase 3 trial that
is ongoing that started just about 4 weeks ago in Brazil in
collaboration with the Instituto Butantan. The NIH is actually
running the trial with them.
Mr. Clawson. And is anybody working in Asia now, so that if
somebody gets off a plane during the rainy season, in the
monsoon in India, they don't bring a different strain to Mexico
or Brazil?
Dr. Fauci. Well, I don't think that it is a question of a
different strain because you have four dengue serotypes that
are essentially universally seen all over. So, even in India,
there will be all four strains. Rather than one strain or the
other, it is the one that is dominant.
Mr. Clawson. Got it.
Dr. Fauci. For example, serotype 2 is one of the most
problematic ones.
Mr. Clawson. Got it. Thank you.
Okay, look, for me that is a big deal. I have had breakbone
fever and I don't want number two and then have hemorrhagic
complication here, guys.
Dr. Fauci. Yes.
Mr. Clawson. And so, as I think through that from my own
experience, I say okay, in a world of international travel, the
second time is going to be worse. I am in the 50 and older
crowd, right, which makes my liver even more susceptible to
swelling. So, we also have to think about that global nature of
this. Am I right about that or am I missing the boat here?
Dr. Fauci. You are correct.
Mr. Clawson. Okay. My idea, our idea legislatively was we
could always use government money here. It seems to me that as
long as, to Mr. Donovan's point, as long as a drug companies
see a profit motive, and I am always worried about that in Zika
because I have got one of the few districts that might be
actually impacted here, it is not going to get impacted in New
Hampshire but it could be impacted in my district, Naples.
Nonetheless, I mean if we gave somebody tax credits for their
research and development in order to expedite research into
battling this virus or coming up with a vaccine, do you see any
downside on that, trying to accelerate the private sector to
jump in the game here? Because it feels to me like they sat out
dengue fever. It feels like they are sitting out chikungunya.
And we don't want them to sit out Zika. Am I right about all of
that?
Dr. Fauci. Incentives to the pharmaceutical companies are
often helpful in getting themselves engaged in this work. We
have another way to incentivize them. What we do at NIH is de-
risk their investment. We do a lot of the work that they would
otherwise pay for themselves so that their investment risk is
less. Some companies take the vaccine from the concept to the
product. They don't need anybody. They don't need the NIH. They
don't need anybody. But when something is a public health
imperative, and they are not interested, if we push the
envelope to the point where we can say we have a product that
we know is good, it is safe, and it is immunogenic, they are
much more enthusiastic about getting involved because we have
already made a major investment.
In addition to what you said, which I agree with, that is a
good way to incentivize them.
Mr. Clawson. Can I have one more question, Mr. Chairman?
One more question.
So, we always think about these diseases as if they were
malaria, which means outdoor nighttime. These are indoor
daytime mosquitos. And so spraying, whenever I see the spray
trucks I say well that is a wasted bullet. On the other hand,
in our country and in my district, we don't have as much water
sitting around, fresh water sitting around like you find in the
Caribbean or in Brazil. If we do a good job on making sure we
don't have a lot of pooling water around, is that enough? Are
we going to be okay until there is a vaccination?
Dr. Frieden. It is really going to depend on the local
environment.
Mr. Clawson. How about southwest Florida?
Dr. Frieden. Well, this is one of the reasons we need the
supplemental, to give resources so that we can look at mosquito
populations, track them, analyze them, and then sometimes
larviciding can have a very major impact on reducing mosquito
populations.
Your point is quite correct that the outdoor spraying may
have limited impact, if any, on this mosquito population but we
are looking at different ways of doing mosquito control. And in
some circumstances, what they have done in Australia, for
example, is used targeted indoor residual spraying for this
particular mosquito with, as far as we have seen, some pretty
effective results. But all of that is quite complex to do.
Mr. Clawson. And let me see, just taking off on that point
so that I understand it correctly. Because again, we want to
get in the game here, legislatively. So, I am not asking to
just take your time here.
Like a lot of things, it always impacts the poor; life is
never fair. And so in my house, I have air conditioning. If I
see a mosquito inside, I say to myself it is not chikungunya,
it is not Zika. So, if I get bit, I don't have to worry about
it but someone else who may not be able to afford that is more
at risk.
Am I right about that? Do I understand the information
correctly?
Dr. Frieden. You are exactly right.
Mr. Clawson. But that should drive some of our policy here
as well. Pooling water at my house is not as much of a problem
as it is going to be at someone less fortunate. Am I right
about that, economically speaking?
Dr. Frieden. If we look at a study done by CDC doctors and
scientists of a dengue outbreak in Brownsville-Matamoros in
South Texas a few years back, the rate of infection was eight
times higher in Matamoros than it was in Brownsville.
Mr. Clawson. Really?
Dr. Frieden. And the two driving forces for that were air
conditioning----
Mr. Clawson. Really?
Dr. Frieden [continuing]. Reduced people's risk 15-fold and
smaller house plots, which increased crowding and increased
risk 7-fold.
Mr. Clawson. Right. And then even if they have air
conditioning, they often don't have it in the bathroom, where
the water is or in the kitchen where the water is. Am I right
about that, too? So, it complicates it.
Dr. Pablos-Mendez, is there anything on my line of
questioning that you have heard me say? [Speaking foreign
language.]
Dr. Pablos-Mendez. [Speaking foreign language.]
You are so knowledgeable and we discussed this last time
when we were talking about dengue. You were almost prescient
that clearly this scenario deserves attention.
I just want to report that under the President's Malaria
Initiative, we work with the Gates Foundation and many other
partners on an Innovative Vector Control Consortium. We are
interacting with industry. We are looking at new insecticides,
new tools.
That effort was focusing on Africa, malaria but that
capability can be deployed to address this need in the region.
Mr. Clawson. Can I interrupt just one? You are making a
great point. I got bit at 9 o'clock in the morning in an auto
parts plant that you are never going to air condition, right?
So, the work environment is an area that we have got to keep in
mind. I think that is a great point.
Dr. Pablos-Mendez. And you are correct also, that is
usually the poor. It is northeast section of Brazil, a poor
area, more tropical area. So yes, there are local conditions
that make it more likely that you will get the disease.
The other point I would like to just mention is of course
we do have for a while now the Orphan Drug Act that provides so
many incentives for industry to develop diseases where
otherwise market failure would prevent them.
So, we have some tools and we have different markets,
different diseases, as Dr. Fauci has alluded. We are looking at
how we are going to work in that space so that industry is
engaged not only in finally developing these products but in
scaling them up and so that they can reach the poor, in
particular.
Mr. Clawson. You all keep talking. You all are great. And
we need to spend some money on this. It is real-life impact on
a lot of people, so thanks for what you are doing.
And thanks for being so patient with me here asking all
these questions.
Mr. Smith. Thank you very much, Mr. Clawson. Just two final
quick questions.
First, I remember my first trip to El Salvador in the early
1980s being struck by how many people--I remember being in
Ambassador Corr's home, President Duarte was actually there,
and there wasn't a screen in the place that I can recall. And
for many trips to Central and South America, very often, people
do not have screens. And even our Foreign Service Officers,
obviously, in their homes, they are at risk, it would seem to
me, if there are no screens.
Is that something that is being looked at to promote
screening as one of the best practices?
Secondly, there are press reports that some NGOs are
planning to exploit child disability and the potential link of
microcephaly with Zika to promote abortion. And I am wondering
and I am hoping, and maybe you can verify, that none of the
$1.8 billion and the President's strategy does not have that
agenda.
Dr. Frieden. Thank you very much. Yes, we do believe
screens may play a role. There are also permethrin treated
screens that may be even more effective and this is something
that we are very actively looking at now.
I can assure you that the emergency supplemental request
does not contain any proposal to change in any way current
policy regarding abortion.
Mr. Smith. Yes, Doctor?
Dr. Pablos-Mendez. Well thank you very much. Indeed, USAID
fully advised by the U.S. law, which includes a Helms amendment
that precludes us from using any foreign assistance resources
to pay for the performance of abortion as a method of family
planning or to motivate, of course, any person to practice
abortions. We don't do abortions.
Mr. Smith. And of course the Siljander amendment makes
clear that even the promotion is not----
Dr. Pablos-Mendez. Correct, even the promotion.
The only thing I will say is that because we are so careful
with this, we monitor this very carefully everywhere we do
work. Part of the request includes some--request because we
will need to have staff deployed to ensure that our partners
and the work that is deployed does not go into areas the law
does not let us go.
Mr. Smith. I appreciate that.
You have been tremendous in providing information to both
subcommittees, insights and I thank you for your service, which
is extraordinary, and for allowing us to benefit from that
expertise and that knowledge.
The hearing is adjourned.
[Whereupon, at 3:22 p.m., the subcommittee was adjourned.]
A P P E N D I X
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Material Submitted for the Record
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Material submitted for the record by the Honorable Christopher H.
Smith, a Representative in Congress from the State of New Jersey, and
chairman, Subcommittee on Africa, Global Health, Global Human Rights,
and International Organizations
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