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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

Printed for the use of the Committee on Foreign Affairs

(

Available via the World Wide Web: http://www.foreignaffairs.house.gov/ or

http://www.gpo.gov/fdsys/

(II)

COMMITTEE ON FOREIGN AFFAIRS 

EDWARD R. ROYCE, California, Chairman 

CHRISTOPHER H. SMITH, New Jersey 

ILEANA ROS-LEHTINEN, Florida 

DANA ROHRABACHER, California 

STEVE CHABOT, Ohio 

JOE WILSON, South Carolina 

MICHAEL T. MCCAUL, Texas 

TED POE, Texas 

MATT SALMON, Arizona 

DARRELL E. ISSA, California 

TOM MARINO, Pennsylvania 

JEFF DUNCAN, South Carolina 

MO BROOKS, Alabama 

PAUL COOK, California 

RANDY K. WEBER SR., Texas 

SCOTT PERRY, Pennsylvania 

RON DESANTIS, Florida 

MARK MEADOWS, North Carolina 

TED S. YOHO, Florida 

CURT CLAWSON, Florida 

SCOTT DESJARLAIS, Tennessee 

REID J. RIBBLE, Wisconsin 

DAVID A. TROTT, Michigan 

LEE M. ZELDIN, New York 

DANIEL DONOVAN, New York 

ELIOT L. ENGEL, New York 

BRAD SHERMAN, California 

GREGORY W. MEEKS, New York 

ALBIO SIRES, New Jersey 

GERALD E. CONNOLLY, Virginia 

THEODORE E. DEUTCH, Florida 

BRIAN HIGGINS, New York 

KAREN BASS, California 

WILLIAM KEATING, Massachusetts 

DAVID CICILLINE, Rhode Island 

ALAN GRAYSON, Florida 

AMI BERA, California 

ALAN S. LOWENTHAL, California 

GRACE MENG, New York 

LOIS FRANKEL, Florida 

TULSI GABBARD, Hawaii 

JOAQUIN CASTRO, Texas 

ROBIN L. KELLY, Illinois 

BRENDAN F. BOYLE, Pennsylvania

AMY PORTER, Chief of Staff THOMAS SHEEHY, Staff Director

JASON STEINBAUM, Democratic Staff Director 

(III)

SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH, GLOBAL HUMAN RIGHTS, AND

INTERNATIONAL ORGANIZATIONS

CHRISTOPHER H. SMITH, New Jersey, Chairman 

MARK MEADOWS, North Carolina 

CURT CLAWSON, Florida 

SCOTT DESJARLAIS, Tennessee 

DANIEL DONOVAN, New York 

KAREN BASS, California 

DAVID CICILLINE, Rhode Island 

AMI BERA, California

SUBCOMMITTEE ON THE WESTERN HEMISPHERE

JEFF DUNCAN, South Carolina, Chairman 

CHRISTOPHER H. SMITH, New Jersey 

ILEANA ROS-LEHTINEN, Florida 

MICHAEL T. MCCAUL, Texas 

MATT SALMON, Arizona 

RON DESANTIS, Florida 

TED S. YOHO, Florida 

DANIEL DONOVAN, New York 

ALBIO SIRES, New Jersey 

JOAQUIN CASTRO, Texas 

ROBIN L. KELLY, Illinois 

GREGORY W. MEEKS, New York 

ALAN GRAYSON, Florida 

ALAN S. LOWENTHAL, California 

(V)

C O N T E N T S 

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 PablosMendez, 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

(1)

THE GLOBAL ZIKA EPIDEMIC 

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 

2

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. 

3

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 PablosMendez 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 

4

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. 

5

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. 

6

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 

7

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 imVerDate 0ct 09 2002 15:02 Aug 17, 2016 Jkt 000000 PO 00000 Frm 00013 Fmt 6633 Sfmt 6633 F:\WORK\_AGH\021016\98600 SHIRL
8

mune-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. 

9

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 

10

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 

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ures. 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 governmentwide 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 mosquitoborne 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 

25

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. 

26

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 

39

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, latestage 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. 

40

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. PablosMendez, 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 

49

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 

50

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 

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ated 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. 

52

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. 

53

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 

54

DEET multiple times a day, mosquito repellant, wearing longsleeve 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 

55

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. 

56

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 

57

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 collaboraVerDate 0ct 09 2002 15:02 Aug 17, 2016 Jkt 000000 PO 00000 Frm 00063 Fmt 6633 Sfmt 6633 F:\WORK\_AGH\021016\98600 SHIRL
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tion 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. 

59

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 

60

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. 

61

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.] 

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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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Æ


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