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tv   Lectures in History  CSPAN  February 17, 2016 10:13am-11:32am EST

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i just want to commend you again for calling this hearing. i know you're planning to have a classified briefing when we come back from the february recess. i think that's a good other step. and i would just offer my input and of the minority staff and members to help come up with a robust hearing schedule for the rest of the year. i think if there's nothing else we do, spend time on this report and recommendations, trying to get our arms around it and get that sense of urgency to our respective leaderships and it will have been successful. and i want to thank everybody again from the commission for doing this deep dive. this really is important. on march 2nd, we will have a hearing on the zika virus where many of these issues will come up. we'll take a deep dive as well as what my friend said about getting into classified briefing and some of the bio defense issues critically important and should be a wake-up call for america.
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but as you said a couple of times, mr. greenwood, we may not do these things until after the fact and that would be a tragedy. in conclusion, again, i want to thank all the witnesses and members who participated in today's hearing. members have ten business days to respond to the record. with that, this committee meeting is adjourned.
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more road to the white house coverage today from south carolina where donald trump holds a campaign event. live coverage at 5:00 p.m. eastern. at 6:00 also live on c-span senator marco rubio holds a town hall in chapin. we'll take viewer phone calls and talk to attendees. south carolina holds the presidential primary saturday.
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tonight at 8:00 each on c-span former counter terrorism director daniel rosenthal joins a discussion about guantanamo bay prison. two attorneys whepted detainees there. thomas wilne r talks about why the prison should be closed. guantanamo is terribly important to the country. i'm worried about the people there. i want them treat ed well and i want them home. i'm worried about what it needs for the country. guantanamo was established to avoid the law. the whole purpose of guantanamo, the bush administration considered the law an impediment it would have to avoid. if we put foreigners in a place that's technically outside sovereign ter tori, we can deprive them of legal rights.
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although we won the case saying there is a right to habeas corpus the d.c. circuit said they don't have the right to due process. if the government can put them there they are beyond the reach of the constitution in other ways. that's a horrible loophole. i find it rep rehenceable. i want the people home and i want the law corrected so the united states can stand by its principles and be proud and not try to avoid them. >> the panel features rolling stone contributing editor janet reitman the last reporter inside the prison and carol rosenburg. fordham university law school hosted the event. you can see it tonight at 8:00 eastern on c-span. up next a congressional panel looks into the long term threat et from the zika virus.
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dr. tom friedman and dr. anthony fouche of allergy and infectious diseases were joined in describing the current efforts to curb the spread of the virus and plans for a vaccine. >> the subcommittees will come to order. welcome. in 1947 in a remote area of uganda, scientists discovered a priestl previously unknown virus among a resusc monkey population. they called it the zika virus. it is spread almost exclusively through the bite of a mosquito, an aggressive daytime biter they have been diminished in the united states until the resurgence of dengue and chicken
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ghunga. we know a great deal about them but there is much scientists add mits they don't know about the virus. some of the reasons we don't know more about the disease include a small proportion, one in five, develop symptoms. it is only detectable for a few days in infected people's blood. the failure of current tests distinguished zika from current viruses.
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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 links with the zika infection of pregnant mothers and disorders affecting unborn
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children. they are quick to point out no definitive link. according to brazil's ambassador micro cephaly in newborn babies can be caused by other diseases. they are dealing with something new. the link is unprecedented he says in the scientific literature and it requires in depth studies and analysis. as a matter of fact, an ap study that ran onle april 6, the president of columbia has said inle all cases there is not one case of microcephaly. $1.8 million to combat the virus. the white house says there, quote, may be a connection between zika virus. the health organization said there is a broad spectrum of
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impacts for microcephaly from mild to severe. in boston hospitals children's hospital they noticed some children with microcephaly experience no problems with school work or aspects of their lives but especially those with severe cases face mild to significant disabilities, impaired motor function, difficulty with movement and speech delays. we must work hard to prevent intern infections and decide ways to ensure this or any other infection is welcomed, loved and getses the care needed. le aerial mendes will testify we need to expand best practices for supporting children with microcephaly. parents of children with disabilities need to be
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supported as well. a journalist told ricardo senra in a february 5 interview the conditions is a box of surprises. you may suffer from serious problems or you may not. on the day i was born she said the doctor said i had no chance of survival. she will not walk, will not talk.
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but he like many others the doctor that is, was wrong. i grew up, went to school, went to university. today i'm a journalist and i write a blog. people need to put their prejudices aside and learn about this syndrome, closed quote. this hearing will look at 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 u.s. agency for international development to help us to understand where we are and where do we go from here. it just note parenthetically that for more than four years i've been urging passage of my bill and dr. menendez or pablo menendez has been very supportive and has testified at several hearings on this issue of neglected tropical diseases. the full foreign affairs committee approved the bill last month. since 2011 our committee has discussed efforts on more study and identify tropical diseases and find diagnostics, vaccines and treatments of such illnesses. at that time 2011 west nile virus was quickly making its way across the globe including in the united states from origins in east africa. ebola first discovered in remote area of africa in 1976 caused a global health crisis only two years ago. and finally, and i say this with some concern, for the second
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consecutive year the administration has slashed funding for global health accounts in the budget proposal released this week including a 19% cut for global programs on tuberculosis, the world's leading infectious disease killer. i know that the three distinguished witnesses today that is not your prerogative, but that is what was sent up to the capitol hill. additionally the administration is being short sided in regards with tropical diseases cutting that program by nearly 15%. in the face of the wave of infectious diseases in recent years including multidrug resistant tuberculosis, west nile virus, ebola and now zika the administration's disregard for this danger is inexplicable. zika created global alarm, before the next explosive health crisis appears we must provide sufficient resources to the study of tropical diseases. i would note hr-1797 authorizes the creation of centers of
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excellence to study every aspect of these diseases. and i would note in the year 2000 and even most recently just a few years ago legislation i authored on autism created such centers of excellence at nih and cdc and i think that has had a huge impact in combatting that developmental disability. so hopefully we'll get some traction on that legislation. i'd like to now yield to the distinguished chairman my good friend mr. duncan. >> well, i thank the chairman, chairman smith, for the joint hearing here. and appreciate us being involved. the western hemisphere subcommittee is wanting to get engaged in this issue because we're seeing this virus here. and there's a lot of concern
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with the allies and neighbors in the region before 30 days ago a lot of folks in my district never heard the word zika virus. so the zika virus virtually unknown until the first reported case was on easter island in february 2014. it's now exploded in the region with cases of 26 countries, territories and the world health organization projecting zika will likely spread almost to 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 has created panic around the region. last month brazil having reported over 4,000 suspected cases of microcephaly potentially linked to zika as of october 2015. although further investigation is confirmed microcephaly in
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just 400 of the suspected 4,000 cases and only 17 in which tested positive for zika, concerns remain very real for those living in the conditions. 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. in may of 2015 pan american health organization issued an alert regarding the first confirmed zika case in brazil. last month u.s. centers for disease control issued a level two alert warning to follow enhanced precautions for pregnant women and women of childbearing age and any travel to zika infected places. subsequently last week the w.h.o. declared the spread of zika an international public health emergency. president obama has since responded. the request this week for
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congress to provide an additional $1.8 billion to address the zika crisis. i'm deeply concerned about the impact zika virus can have where most of the population has little or no immunity where mosquitos are simply a part of everyday life especially in poor communities. many governments health care systems are not equipped to handle a mass influx of microcephaly or gbs cases. in particular venezuela is reporting of having over 4700 zika cases with a lack of even basic health care options available due to horrible economic mismanagement, 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 zika cases. in contrast, brazil, the host of this year's summer olympics in august, has made huge efforts to curb the spread of zika but fighting with genetically modified mosquitos, deploying hundreds of thousands of troops to help educate the population
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about and to help research the virus and develop treatments. given the rapid spread of the zika virus and americas, several countries have tried to buy time to address the problems by urging women to postpone pregnancy. colombia, jamaica, ecuador and el salvador all issued these recommendations. however they may try to delay, 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 cross hairs 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
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have some of the strongest laws on the books protecting life of the unborn. chile, dominican republic and el salvador ban abortion completely, uruguay and cuba legalized abortion, other countries only allow abortion in the case of rape, incest or the threat of the life of the mother. this pushed for more abortion access due to the potential birth defects from microcephaly is heartbreaking especially since there are different degrees and some children born with the special needs may go onto live very normal lives. i think you gave a prime example flt regardless i believe every person including the unborn child is made an 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 america and the caribbean who are facing incredibly difficult situations while also seeking to protect the lives of the unborn children. so in conclusion it's my hope witnesses today will provide testimony of how the u.s. and countries around the world,
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especially here in the western hemisphere can fight protect against the spread of zika while simultaneously working together to provide health care that addresses the needs of women, promotes life of the unborn and promotes therapy options for those born with microcephaly and gbs. i yield back. >> thank you very much. i would like to yield to dr. burr. >> thank you, gentlemen. thank you for the timely hearing here. obviously this is an esteemed panel. as a physician who has public health work in nicaragua, in areas that we're finding endemic of certainly dengue fever when i was down there but now with zika virus, this is going to be a challenge. certainly the mosquito we're
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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 dispel 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're doing things in a responsible way. i look forward to the testimony of our witnesses on, you know, how we're 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's a lot that we don't know. i mean, we've got to come up with more rapid diagnostic tests. we've certainly got to, you know, understand the extent of folks that are infected but also the fact that the vast majority of folks that do get infected probably are asymptommatic. we also know there's heightened risk in women of childbearing age and certainly women who are currently pregnant.
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you know, 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 childbearing age in endemic regions have access to full contraception. this isn't about abortion or not abortion, this is about, you know, 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're dealing with. and i would make a strong push in endemic countries to dedicate
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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, you know, obviously if you're of childbearing age, you know, we would urge you to take the caution. if you're 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 i'd be curious, you know, it is my sense that, you know, given the interconnectedness of the globe, we've started to see some zika virus cases pop up in the united states. my sense is these are generally folks that have traveled to endemic area who is are now returning. i'd also be curious about the epidemiology in terms of where we're seeing the virus. we may be potentially seeing it in semen and saliva and other bodily fluids. what we can do in terms of recommendations there. again, you know, i applaud the
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panel here. you know, again, looking at this as a health care professional, i would urge that we don't panic. i would urge that we collect the data, the information. you know, if folks are traveling to endemic areas, obviously take the usual precautions to prevent mosquito bites. if you're of childbearing age, you know, 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 childbearing age in these endemic regions. that is one simple thing we can do to prevent, you know, congenital abnormalities and so forth. again, i don't think anyone argues that that isn't good medicine or -- and good prevention. i look forward to the testimony of the witnesses and again, thank you. >> i would like to now yield to the ranking member of the western hemisphere committee, my
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good friend and colleague from new jersey. >> 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. very concerned now that we have the olympics, a lot of people going into brazil. and i think the brazilian people
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should be -- 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 panicky. so i want to hear what the panel has to say. and i want to thank the chairman, again, and ranking member for holding this hearing. thank you. >> i would like to acknowledge professor of entimology. she's an expert on the mosquitos that carry zika and provided us some testimony without objection will be made part of the record. introducing our very distinguished panel beginning first with dr. tom frieden who's been director of the centers of disease control and prevention since june of 2009 and has dedicated his career to fighting infectious and chronic diseases both here and the united states abroad. he led new york city's program that controlled tuberculosis and reduced multidrug cases by more
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than 80% and worked in india for five years helping build a tuberculosis control program that saved nearly 3 million lives. as the commissioner of new york's health department, led illness and death increased life expectancy substantially. he's a recipient of numerous awards and honors and has published more than 200 scientific articles. we'll then go to dr. anthony fauci who is director of the national institute and allergy and infectious diseases at the institute of health. dr. fauci has overseen an extensive research portfolio devoted to preventing and treating infectious diseases made numerous important discoveries regarding hiv/aids. dr. fauci serves as one of the key advisers to the white house 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's also one of the principle
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architects of the president's emergency plan for aids relief. now we'll hear from dr. ariel pablo menendez who is the assistant administrator for global health at usaid, a position he assumed in august of 2011. dr. pablo menendez joined the leadership team with a vision to shape the bureau for global health's efforts to accomplish a measurable and sustainable impact on the lives of people in developing countries. before joining usaid he worked on global health strategy and transformation of health systems in africa as well as asia. he also served as director of knowledge management at the world health organization. dr. pablo menendez is a board certified internist and was a professor of clinical medicine and epidemiology. the floor is yours. >> thank you very much for calling this hearing and thank you ranking member for the opportunity to discuss zika with you.
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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're 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
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thing for americans to know is this, if you're pregnant, we recommend you not go to a place where zika is spreading. and if you're pregnant and you live in an area where zika is spreading, do everything you can to protect yourself against mosquito bites. the '80s mosquito that spreads this particular virus is very difficult to control. and i'll talk about that more in a bit, but it's 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 one after our 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 health care 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
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health threats wherever they emerge around the world, both to 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 in an outbreak that the cdc scientists investigated in 2007. it is believed to cause no symptoms in approximately 80% of the people infected. and mild symptoms in virtually all of the rest. the mosquito that spreads it, species, i'll show a picture of our enemy here, if i can advance this. oops.
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all right. there's the enemy. the aedes aegypti mosquito is a very challenging what we call disease vector to control. it's 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 can be drought resistant and 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's hard to eliminate. i want to show a bit about what has happened in recent years with dengue and two viruses spread by the very same mosquito as zika is. in red on this map you see the
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approximate geographic distribution of dengue around the world. and you see that it's 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. it's a word means bent over in pain. can cause a severe painful disease. and dengue can be very severe and fatal. 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's spread widely within our hemisphere.
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and these are the current known places where both dengue and chikungunya have been documented to 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 the vaccine we've virtually eliminated that in the u.s. in 1962 scientists identified another virus as a cause of severe fetal malformations. and in the past fifty years we're not aware of any other viral cause of a significant number of birth defects. in fact, we're not aware of any prior mosquito borne cause of fee toll malformations, if in fact this is confirmed. syndrome you've heard about a weakness after infections is a
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different of many proses seize can occur in one in 1,000 or one in 100,000 people who've had an infection and increasingly looks like it's related as a post-infection. it can be severe. but the big difference here is the microcephaly. next i'd like to talk about what based on what we know today is likely to happen over the coming weeks and months. and what we're doing about it to protect americans. first, we will discover more each and every day. and i'll show you later today some new data that was just released within the past hour. we'll 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
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transmitted to her fetus. we'll learn more about the relationship with both microcephaly and gbs from studies we're doing today with partners in brazil, colombia, puerto rico and other places. we'll develop better diagnostics. currently we can diagnose the active zika infection. if someone is sick with zika, we can find it in their blood. but if it's a couple of weeks or couple of months later, figuring out if they've had zika is very complex. and cdc scientists have worked for years to develop a test for that, we have a test but it is one that can have false positives of prior infection. we'll learn more about the level of risk, whether symptomatic zika is more likely to cause than asymptomatic. we'll learn about how long a man infected with zika may continue to harbor zika in semen.
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we'll learn more how to stop the vector, the mosquito that zika virus. for all of those things we'll need additional resources, which is why the emergency supplemental request is so important. one thing that will happen is we'll learn more. a second thing that will happen is we'll see more cases among travelers to the u.s. some of them will be pregnant. that's why we've issued travel advice not to travel if you're pregnant. and we've worked with doctors and 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'd like to show you a series of slides that show what happened in the chinengunya
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outbreak two years ago. may 5, 20134, the first case of chickengunya was identified. two weeks later it had begun to spread and two weeks later, two weeks later, two 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. this can spread very rapidly in a population. >> we will move rapidly to support pregnant women and reduce the risk that pregnant woman become infected. monitor and reduce mosquito populations to the greatest extent possible. and the next thing that we may see happen is cases or clusters
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in part of the u.s., that has have had dengue clusters in the past. that's 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're 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, who are 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
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developed the diagnostics that are being used in this country. and we're working around the clock to get these diagnostics out so that more people who want to be tested can be tested. we'll improve clinical diagnosis and reporting. and insecticides, which is important though 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 of among four infants, two miscarriages, 10 and 11 weeks 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
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microcephaly. this is the strongest evidence to date that zika is the cause of microcephaly, but it's still not definitive. we'll still need to understand the clinical and epi deemological patterns to make that definitive. 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. >> dr. friedman, thank you very much. dr. fauci?
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thank you very much, mr. chairman, chairman duncan. dr. berra. it's 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's 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 and 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 and infectious diseases, but simultaneously to
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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 foo weeks an in the "new england journal of med significance" zika virus in america is yet another arbovirus threat. if you look just in the americas, not withstanding the rest of the world, in the last few decades, what we have seen was an explosion of dengue. but new viruss that had never before been seen in the western hemisphere. dr. friedman mentioned a couple of those. west nile, chikungunya in the caribbean and now zika in the americas. these are mosquito-borne viruss that have the capability of spreading very rapidly. and what we've been able to do and i'm going to describe a bit of that for you. and then obviously leave time for questions later. of what the approach of the nih
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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 in 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. friedan mentioned the issue of epidemiology and natural history we have our grantees and contractors who have been studying similar diseases like the flave viruses, dengue to try to understand what we call the natural history. what's the difference of symptomatic and asymptomatic disease? what is the relationship, direct or indirect, alone or synergistic between an infected pregnant woman and the development of congenital
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abnormalities like microcephaly? what indeed is the broad spectrum of the bathogenesis of microcephaly? all of these are questions that we're asking alone and together with our colleagues, including those at the cdc to try to get quick answers to them. 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've learned an awful lot. we need to dot same thing with zika. studying the viral structure. comparing for example the nature of the virus in an outbreak in the island of yap, together with french polynesia. together with what we're seeing now. has it evolved? if it's evolved, has it impacted the pathogenesis and
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manifestations of disease. in addition we'll be establishing animal models. in any new disease to understand pathogenesis as well as to screen for drugs and test for vaccines, animal models are critical. dr. friedan mentioned the issue of vector control. there are a number of ways to do that. the classic way,s about also some novel ways which we are exploring but should not take the place of the classic ways, things like the genetic manipulation of mosquitos or infection with malbacchia material. to emphasize this is not an easy thing to do. as dr. friedan 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 our grantees and contractors are using some of the knowledge gained from our study in chikungunya, in dengue and in other, to get more precise, state-of-the-art point
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of contact 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. our role in developing a vaccine is encouraging news. and the reason i say encouraging is we've had positive experience with the development of vaccines with other flave viruses. case in point, dengue, which there's already an approved vaccine in brazil and mexico. and we started last month a phase 3 trial of dengue in brazil in collaboration with the institute
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. . . . . . . . . . . . technologies that we use to develop the vaccines for other flave viruses. we're already manufacturing the, what we call the construct for that. which will make to the point of gnp, detox and get into a phase 1 trial. i would think and almost be certain by the middle of this summer. which would be asking for safety and immunogenicity. this is the schematic diagram we used for west nile. the dna construct in which you insert the gene first of west nile. we'll substitute and stick the gene of zika in. inject it into an individual which would produce now,
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viral-like particles which we know are safe and we know they're immunojenic. and therapeutics, 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 flavi viruses. 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're talking about zika today. and next month or next year we'll be talking about something else in the same way as last year, we spoke about ebola. and hopefully, and i know i want to thank the congress for the support that you've given us over the years. to allow us to address these problems. thank you very much, mr. chairman, i'd be happy to answer any questions.
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>> 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 part of the record. i would like to go now to dr. mendez. >> thank you chairman smith and chairman duncan. >> all the distinguished members of the committees for inviting me here today to testify on the united states agency for international development asaid's response to to the serious concerns raised by the spreading in the americas of the zika virus. i want to recognize the leadership of my colleagues, dr. friedan and dr. fauci that have been rapidly mobilized in the response and the immediate investigation that we're learning a lot. we cannot wait to figure it all out before we have a discussion and a response. on monday the president
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submitted a supplemental request to aggressively respond to the zika virus outbreak. the supplemental requests $335 million for programs at usaid to help countries in the region affected by zika, respond and protect their citizens and in doing so attent wait its spread to our homeland. let me briefly describe the components of the work that we propose for implementation by usaid. first, we will sport risk communications and behavioral change programs as dr. bara recognized. empowering people with the right information. this will be a rapidly evolving field we don't want panic to take place in the region as we actively take actions to help people 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 in pregnancy and how to protect themselves.
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community-level messaging will be combined with mass media and social media campaigns. we will also partner with the private sector and our are in discussions with companies in brazil at this moment to help us do that. >> second, 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 to 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 mosquitos breed. and focal larvaecides and endorse screening to reduce mosquito entry into homes, schools, hospitals and workplaces. the approaches we today to to reduce mosquitos are not optimal. but they have been shown to work
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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 that they become available rapidly in the region. this efforts will build 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, mapping expertise in entomology that can be brought to bear also in the sfons to zika. third, usaid will help insure that women in affected countries will have access to health care and support. training of health care workers to provide advice. providing support for pregnant women. including helping them access repellent to protect against mosquitos and insuring access to family planning as we heard from mr. duncan. this will be important to have information, to have services, to have commodities, to have methods. as well as the care of the affected newborns.
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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. 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, organized and markets incentives can be significantly important 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 of diagnostics for vaccines, as well as to incentivize, late-state product development, manufacturing and skill in response to the ebola epidemic, usaid used grant
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challenges to rapidly source new innovations to address key gaps in our response. we are planning also considering a new grant challenge to bring new ideas to bring the private sector and diagnostics, vector control, personal protection and the like. mr. chairman, zika, like mers, sars, influenza and ebola, point to a landscape where the interaction between humans, animals, vectors is constantly changing. in our civilization for the first time we're seeing an explosion in the tropical regions of the world of the deforestation and increased meat demand as economic development takes place, urbanization. changes in global travel and the like. ecological transformation and climate weather pattern changes are increasingly interconnected in our world. and that means that mosquito-borne diseases such as zika can appear in areas they hadn't before. this rapidly changing dynamics means we have to be prepared for
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what is seemingly unpredictable. and when we have a respond, we seem to be as smart as the viruses. recent report from the national academy of medicine of global health framework estimates the annualized cost of pan dell demic risk is about $60 billion a year. and 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. we as we address the immediate needs of the zika-affected population, we must underscore the need to improve national systems to prevent and directly response to the pathogens, i think this is the effort at the heart of the global security agenda launched in early 2014. beyond dealing with individual outbreaks, we are seen as dr. fauci put it as perpetual challenge, one coming after the other. we need to also pay attention to the landscape where they're coming, better understand the
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territory where they're coming. usaid for a number of years has supported work that builds capacity and expands the evidence base, that helps predict and mitigate the impact of pathogens, every year we're detecting hundreds of these new pathogens, we are screening and insuring that they don't jump into the human space. we find them in primates, in birds, in bats, we find them in rodents, but it's not an infinite landscape. there's a logic to it and we want to make sure science is brought to bear to address indeed and prepare and predict this 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 combatting the zika virus outbreak of today and strengthen capacities to insure that future threats will be rapidly and
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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 this contributions, the contributions that we're making in this battle, thank you very much. >> dr. panel lo mendez, thank you very much. i would like to begin i'll throw out questions and yield to my friends and colleagues. on vector control capacity. in africa it took years to build up that capability. especially with the malaria efforts. i know that safe and effective is important so we don't have obviously unintended consequences from unsafe pesticides for example. i know personally we use, my wife and i use diotomaceous earth for bugs. the question is what are you suggesting they use? is there an adequate supply in these countries and an adequate delivery mode? secondly on brazil, it seems
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that the areas of the highest prevalence is in areas of extreme poverty. i know because we work on stunting and other issues in this subcommittee all the time. the first 1,000 days of life in my opinion is one of the most transformative efforts where nutrition, micronutrients and other kinds of assistance, pre-natal, efforts, increases the immunity on the part of the baby and it 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 where there's extreme poverty and lack of nutrition, are likely to have that problem? third, on mother-to-child transmission, is that something you'll 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 finally in the united
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states, the americans with disabilities act, insures that persons with disabilities are fully enfran compri y enfranchi. dr. pablos-mendez. will looking to support best practices for children with microcephaly. you might want to explain what that will look like in terms of helping those countries care for children with disabilities. >> maybe i can start with your first couple of questions. on vector control, our approach is to reduce mosquito populations by an integrated kpree hence i have approach. that means reducing standing water using larvaecides, and there are various forms of larvaeci larvaecides, we've looked at outdoor spraying. many countries use outdoor spraying, because the vector bites indoors and there's other characteristics, there may be limited effectiveness of outdoor spraying. and one approach has been used in some places, is targeted
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indoor residual spraying. it's a different type of spraying than spraying done with malaria. different areas of the house. there may be efficacy there. there's a labor-intensive and complex area. underlying all four of those critical approaches is rigorous surveillance for where the mosquitos are and which insecticides they may be resistant to. we have those studying underway now in puerto rico we don't yet know what the resistance levels are. in terms of nutritional or other co-factors and impact of poverty. that's exactly one of the things that we'll be studying in the case control study. there's a lot that we don't know if there is a causal association, we don't yet know which trimester is highest risk. and what might be the risk or protective factors, that's a critical thing that we're investigating now. >> thank you, mr. chairman. let me address the question of mother-to-child transmission,
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which is really important. the major difference between mother-to-child transmission and the advances that we've made with hiv-aids, and the particular challenge of zika infection in a mother and the transmission to the baby. is the chronic nature of the viremia in hiv, in which you could suppress it in the mother by treating the mother. and we know for certain by many good studies, that when you bring the level of viremia in the mother to below detectible level you dramatically decrease the likelihood that the mother will transmit to the baby. because you have a lot of time, because it's chronic. when you're dealing with an infection like zika, which is a flash infection. it comes, it's a few days, and then it's 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 '60s,
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there were 20,000 cases of congenital rubella syndrome in the united states. that's astounding. 20,000. 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, it essentially targeted everyone. but it was specifically targeted to women of child-bearing age. because rubella is a relatively mild disease, very similar to zika. so i would answer your question about mother-to-child transmission. the best way to do that is to get an effective vaccine and make sure that in the target countries that women of child-bearing age are protected by a vaccine. >> mr. chairman i would like to address two of your points, one on nutrition and the other on children with microcephaly and
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disabilities. we fully agree, we just yesterday we're having a review of our nutrition portfolio. and the 1,000 days have been the way in which our work has been best framed to have the most impact. we also review the parallels to the current institution with zika. those 1,000 days seems to be crucial, crucial to the prevention because as you said, malnutrition will expose you to severe infection and then that's the complications we may be seeing. also malnutrition could play a role itself in leading to undernutrition in utero and even associations of certain deficiencies with complications on formations and the like. the experience in the war we have on the nutrition around 1,000 days, bring to bear an thropmetrics. the measuring of the heads and so forth and the experience and the communities we have in working with nutrition can be mobilized in this regard.
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we have been very successful with child survival. 100 million children's lives have been saved in the last 20 years. and in a way we're looking to the end of preventible child maternal death we move from survival, to well-being. and as the more we do that, we pay attention indeed to many of the factors from nutrition, education have to do disabilities is very important and the u.s. leadership is in that space for americans, but also in the u.n. there's been an awakening of the importance of paying attention and support for children with disabilities. the experience we have built on hiv and more recently on ebola in terms who have is affected and stigma, medical care and research and what to what would be the spectrum of the impact of this phenomena we're working on today and social work to support those families. there's a lot of needs. we have a a center for children
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that's in usaid that is correct's that's working in these areas. we have all of those mobilize in a region that we is a 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 most deaths in child and maternal health as well as tuberculosis. >> we've got a numb of members, think dr. friedan 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're pretty optimistic we might be able to develop something fairly quickly. >> let me explain that so it's
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clear. in general, vaccines take anywhere from three to eight years to get all the i's dotted and the t's crossed. full fda approval, approving safety and efficacy. when you're dealing with a situation like this. we have the advantage of we already have the construct that you need, the candidate vaccine platform. so if you look at the timetable, you always know that in vaccinology, you have to be careful that things can slip. we feel pretty confident that we'll have enough construct to be able to do preclinical tox by the summer. which means we could start a phase 1 trial let's say in august. they usually take three to four months which means we'll be finished by the end of 2016. now the critical issue, if it's safe and immunogeneric and the outbreak is still raging, then you could go into an accelerated phase 2 a, 2 b which means that
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you could likely determine if it's effective within six to eight months. and if it is, you could 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 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 if i'm talking to you in february of 2017, and we still have a massive outbreak in south america, we likely would prove safety and efficacy within six to eight months. >> are we going to run into terms of commercialization in terms of wrapping up that vaccine. working off the private sector to get that vaccine commercialized and distributed? will that be a problem? >> i do not think so, dr. bera. and the reason-day not think so is because we are already, unlike other emerging infections, having calls from
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pharmaceutical companies, big pharmaceutical companies, very interested in partnering with us. so i don't think we're going to have that problem. >> again, all three of you touched on the importance of funding global health, the importance of funding global disease surveillance. this is just another case of the interconnected world. disease is going to travel a lot faster and so forth. i would just put out there the importance of funding and making those funds available and working together this is again just. we had ebola last year. we got zika virus today. we'll have another infection next year. and again, i would emphasize the importance of this funding. so mr. chairman, i'll yield back. >> we could be back in about 15 or 20 minutes? would that be okay? i deeply appreciate it. we stand in brief recess.
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>> the subcommittees will reconvene. since i've already had my turn, i will yield to them. i did ask the question earlier. maybe if you could just elaborate a bit on that. that is the capacity, the actual volume of potential pesticides? i know dr. frieden you talked about the utter importance of draining, sitting water.
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and i know even in the big island, in hawaii, there's just a new emergency call because of dengue, to go after spare tires, that are housing water and then becoming breeding grounds for mosquitos. and i get that. that's labor-intensive. but not necessarily you know doesn't require chemicals per y se. but what are the actual pesticides that are considered safe? and what is the potential supply of those? >> thank you very much. i'm glad you came back to that because i wasn't able to address some of the really critical issue there is 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 emergency request is to strengthen mosquito control in the parts of the u.s. that have mosquitos that could spread the zika virus.
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and here we, we look at a comprehensive approach. so on the one hand, there's the things that you can do to reduce lafral population and the use of bacillus and two different bacteria that actually infect and kill the larval mosquitos are very effective and are used widely in not just human health, but agriculture and other areas. >> 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're looking very carefully at what's been done in other countries including australia with, targeted indoor residual
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spraying of insecticides and seeing what would be safe and effective here. so that's something that we're in frequent discussions with industry partners, as well as epa, and other entities. but there are issues of what we could do that's safe and effective. the mosquito control efforts are also more than just chemicals. it's about having a surveillance system. the cdc has invented a trap currently in california and elsewhere that can monitor what the mosquito populations are. the cdc labs have developed a simple way of testing insecticide resistance. so we can get a better sense of what can be used. we are seeing reports of insecticide resistance. and looking at where the mosquitos are and what insecticides they're susceptible to. we would then proceed with recommendations for mosquito control. but this is all quite labor
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intensive. it needs to be done in the same way you need a public health system to find, stop and prevent problems. you need a vector control or a mosquito control system to track where the mosquitos are and respond in real-time to where the problems emerge. >> dr. fauci. i appreciated your comments on the rush to get to a safe and effective vaccine. as you pointed out in your testimony and in your comments, 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? >> 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 go into an accelerated
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phase 2-a, 2-b. which if you do the math and the statistics, depending on the number of cases and how effective the vaccine is, in anywhere from six to eight 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 ultimate final stamp of approval, there is a mechanism of accelerated approval and accelerated access that you could implement, if in fact you have a good safety profile and you've shown efficacy. so could you receivably have it by the end of 2017. which is really rocket speed for a vaccine. >> could i just ask anyone who would like to respond to this. there are about 20,000 children and adults with microcephaly today in the united states. there's support groups, a great deal of knowledge that's been gleaned from their experiences.
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as i said earlier, the spectrum, it's not unlike maybe 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'm wondering, you know 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? >> yes. thanks for the question. as you know, mr. chairman, from your past work, the center force 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 general etists, we need to learn more about what the spectrum is in this case. we may well see a broad spectrum
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of some more severe, some less severe. and this is something that we want to provide all of the expert assistance we can. >> just to add that 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 problems we are deploying international. >> i appreciate that. i would like to yield to the distinguished chairman of the western hemisphere committee. >> thank you, mr. chairman. there will be a lot of folks traveling to brazil this summer. what, what steps are being taken in brazil that you can tell us about? you know, we've even heard calls for canceling the olympics. because people are concerned. so what are the brazilians doing? what are you doing to help?
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and what do we need to know? >> brazil has taken this very seriously. they consider it i think absolute top national priority. and as the chairman mentioned, the other chairman mentioned in his opening remarks, they have deployed hundreds of thousands of people in the response. they're working to reduce mosquito populations. they're 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're traveling. so whether it's 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've

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