U.S. GOVERNMENT PUBLISHING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Publishing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001

23–028 PDF 2017

THE ZIKA VIRUS: COORDINATION OF A MULTI– 

AGENCY RESPONSE 

HEARING 

BEFORE THE

SUBCOMMITTEE ON 

TRANSPORTATION AND PUBLIC ASSETS 

OF THE

COMMITTEE ON OVERSIGHT 

AND GOVERNMENT REFORM 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED FOURTEENTH CONGRESS 

SECOND SESSION 

FEBRUARY 24, 2016 

Serial No. 114–101 

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

( 

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

http://www.house.gov/reform 


AKING-6430 with DISTILLER
(II) 

COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM 

JASON CHAFFETZ, Utah, Chairman 

JOHN L. MICA, Florida 

MICHAEL R. TURNER, Ohio 

JOHN J. DUNCAN, JR., Tennessee 

JIM JORDAN, Ohio 

TIM WALBERG, Michigan 

JUSTIN AMASH, Michigan 

PAUL A. GOSAR, Arizona 

SCOTT DESJARLAIS, Tennessee 

TREY GOWDY, South Carolina 

BLAKE FARENTHOLD, Texas 

CYNTHIA M. LUMMIS, Wyoming 

THOMAS MASSIE, Kentucky 

MARK MEADOWS, North Carolina 

RON DESANTIS, Florida 

MICK, MULVANEY, South Carolina 

KEN BUCK, Colorado 

MARK WALKER, North Carolina 

ROD BLUM, Massachusetts 

JODY B. HICE, Georgia 

STEVE RUSSELL, Oklahoma 

EARL L. ‘‘BUDDY’’ CARTER, Georgia 

GLENN GROTHMAN, Wisconsin 

WILL HURD, Texas 

GARY J. PALMER, Alabama 

ELIJAH E. CUMMINGS, Maryland, Ranking 

Minority Member 

CAROLYN B. MALONEY, New York 

ELEANOR HOLMES NORTON, District of 

Columbia 

WM. LACY CLAY, Missouri 

STEPHEN F. LYNCH, Massachusetts 

JIM COOPER, Tennessee 

GERALD E. CONNOLLY, Virginia 

MATT CARTWRIGHT, Pennsylvania 

TAMMY DUCKWORTH, Illinois 

ROBIN L. KELLY, Illinois 

BRENDA L. LAWRENCE, Michigan 

TED LIEU, California 

BONNIE WATSON COLEMAN, New Jersey 

STACEY E. PLASKETT, Virgin Islands 

MARK DeSAULNIER, California 

BRENDAN F. BOYLE, Pennsylvania 

PETER WELCH, Vermont 

MICHELLE LUJAN GRISHAM, New Mexico 

JENNIFER HEMINGWAY, Staff Director 

DAVID RAPALLO, Minority Staff Director 

MICHAEL KIKO, Subcommittee Staff Director 

WILLIE MARX, Clerk 

SUBCOMMITTEE ON TRANSPORTATION AND PUBLIC ASSETS

JOHN L. MICA Florida, Chairman 

MICHAEL R. TURNER, Ohio 

JOHN J. DUNCAN, JR., Tennessee 

JUSTIN AMASH, Michigan 

THOMAS MASSIE, Kentucky 

GLENN GROTHMAN, Wisconsin, Vice Chair 

TAMMY DUCKWORTH, Illinois, Ranking 

Member 

BONNIE WATSON COLEMAN, New Jersey 

MARK DESAULNIER, California 

BRENDAN F. BOYLE, Pennsylvania 


AKING-6430 with DISTILLER
(III) 

C O N T E N T S 

Page 

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

WITNESSES 

Anne Schuchat, M.D., Principal Deputy Director, Centers for Disease Control 

and Prevention 

Oral Statement ................................................................................................. 6 

Written Statement ............................................................................................ 8 

Anthony Fauci, M.D., Director, National Institutes of Health National Institute of Allergy and Infectious Diseases 

Oral Statement ................................................................................................. 16 

Written Statement ............................................................................................ 18 

John Armstrong, M.D., Surgeon General and Secretary of Health, State of 

Florida 

Oral Statement ................................................................................................. 29 

Written Statement ............................................................................................ 32 

Bill Moreau, D.C., Managing Director for Sports Medicine, United States 

Olympic Committee 

Oral Statement ................................................................................................. 38 

Written Statement ............................................................................................ 40 

APPENDIX 

Written Statement from the American Mosquito Control Association, Submitted by Chairman Mica ................................................................................... 56 

Written Statement from Ariel Pablos-Mendez MD, MPH, Assistant Administrator for Global Health, U.S. Agency for International Development, Submitted by Chairman Mica ................................................................................... 64 

Robert G. Salesses, Deputy Assistant Secretary for Homeland Defense Integration and Defense Support of Civil Authorities, Department of Defense .... 70 

Dr. Anne Schuchat’s Responses to Questions for the Record, Submitted by 

Rep. Earl L. ‘‘Buddy’’ Carter (GA) ...................................................................... 72 

January 29, 2016, International Olympic Committee Statement on Zika .......... 76 

February 10, 2016 Memo from Scott Blackmun, CEO of the United States 

Olympic Committee, to Prospective Members of the 2016 U.S. Olympic 

and Paralympic Delegations ................................................................................ 78 


AKING-6430 with DISTILLER

AKING-6430 with DISTILLER
(1) 

THE ZIKA VIRUS: COORDINATION OF A 

MULTI–AGENCY RESPONSE 

Wednesday, February 24, 2016 

HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON TRANSPORTATION AND PUBLIC

ASSETS, COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM, Washington, D.C. 

The subcommittee met, pursuant to call, at 2:05 p.m., in Room 

2154, Rayburn House Office Building, Hon. John L. Mica [chairman of the subcommittee] presiding. 

Present: Representatives Mica, Duncan, Amash, Massie, 

Grothman, Duckworth, DeSaulnier, and Boyle. 

Mr. MICA. Good afternoon. And I’d like to call the Subcommittee 

on Transportation and Public Assets to order, this hearing. And 

this is a subcommittee of the Committee on Oversight and Government Reform. 

Today, we are conducting a hearing on the Zika virus, and we 

are looking at the coordination of a multi-agency response to that 

virus. I’m very pleased to have everyone joining us today. The 

order of business will be as follows: We will have opening statements; myself and Ms. Duckworth are here and other members 

joining us. And we will then hear from our witnesses. And from the 

witnesses, we will hear your testimony, and then we’ll go into questions. That will be the order of business. 

So, without objection, the chair is authorized to declare a recess 

at any time. And I will start with my opening statement, and then 

I will yield to Ms. Duckworth. 

Again, I want to thank everyone for attending. There are probably some people that didn’t want us to hold this hearing, but I 

think it is very necessary that we do conduct it. I think that the 

Zika virus is probably one of the more difficult health challenges 

that the Nation and the world have faced probably since the Ebola 

crisis. And unlike that particular crisis, there is some very good 

news to report in this hearing, and the purpose of the hearing is 

also to hear from some of those involved in making certain that the 

public health, welfare, and safety is preserved while we face this 

possible epidemic. 

And I might say, this isn’t something just facing the United 

States; it’s facing the world. So it’s spread, again, we know, across 

the many continents. And we have international events, like the 

Olympics this summer in Brazil. We want to make certain that 

American travelers there are protected. And I might say, also, we 

have American personnel throughout the infected area and the 


AKING-6430 with DISTILLER
2 

world who are our responsibility to make sure they are safe and 

secure. Many of them are abroad serving the United States in diplomatic posts, with the military, and others, and we want to make 

sure that those individuals that we’re responsible for are also protected. 

I’m pleased, too, with the World Health Organization. You’ve 

heard me from this dais raise some serious questions during Ebola, 

that they did not act to alert the public and declare the seriousness 

of Ebola at the time. That is not the case here. They have acted. 

They have been proactive. 

I’m also pleased that we have had a very good response, both 

from the Federal level and the State level and other agencies in 

government. And we need to keep it that way, and we need to keep 

going forward. 

Today, the purpose of this hearing is to see where we are and 

what we have done and where we need to go and how we can keep 

this under control. 

I’m very pleased to have a representative from my State, which 

has taken the lead, and Governor Scott and others. We have our 

surgeon general of Florida with us. And we’ll hear from, again, 

NIH. And they have done a great job. The Centers for Disease Control, we’ll hear where they are and get an opportunity to get an update on a great world event which we’re looking at in Brazil later 

this year. 

Right now—and I want to say this and make this very clear— 

there has been no detected Zika infection from an insect or mosquito in the United States of America. No transmission that I’m 

aware of. Most of what we found so far are individuals who have 

traveled somewhere else and come into the United States. 

This isn’t a South United States problem. In fact, right now— 

and, look, we have a chart we can show later: I think as far as Wisconsin in the United States, and—what is it?—23 States that have 

now had cases where they have determined that someone was infected with the Zika virus. 

So we don’t have that infection from mosquitos in the United 

States, but we do have people coming in outside who have been infected with that disease. 

So we still have a long way to go in the detection process. We 

don’t have a vaccination available. We don’t know all the connections, and we’ll have questions and some directions about where 

we’re going to look at how we can go after the disease, either for 

vaccination or for treatment. 

The numbers that we have seen so far are, again, somewhat limited in the United States, but, again, getting a head start on it— 

in Florida, we’ve had 28 cases, and I think two of my counties with 

a single case. I just had lunch with the local health director, and 

I thought that was very informative, because I wanted to hear from 

him how things that we are doing here have filtered down to the 

local level. And I will say that report is also good. 

But they do face challenges. They want to make certain that they 

have the test kits available. They want to make certain that the 

testing is available. They want to know where to go next. And some 

of that has been provided. And the State of Florida acted in early 

February, the Governor and others, and they have been in close 


AKING-6430 with DISTILLER
3 

contact with the local officials, which I think is extremely important. 

There’s some simple things that can be done, and we know what 

they are: using insecticides, using mosquito repellant, staying in 

air-conditioned locations. And that, again, is where people are getting the infection. But if we do have the problem in the United 

States, we want to make certain that people are aware of the risk 

that they face and the simple solutions to tackle this. It’s just like 

mosquitos that we have from coast to coast and from border to border. 

While the CDC remains hesitant to confirm some of the links— 

we’ll hear more about that—experts are confident that Zika is causing some outcomes that we’ve seen, and we’ll talk about them. The 

most notable and at risk are women and pregnant women, and 

they seem to have—or seem to be fairly certain of the link there. 

We’ll find out more about that and other possible links to individuals that may cause them serious health damage. 

The administration—I woke up at 3 o’clock in the morning. I 

have this folder and fell asleep reading it. I woke up at 3 and finished it last night. And I did read it. The administration, last week, 

the President sent a communication to the Members of Congress 

and asking for $1.8 billion request for emergency action. I also read 

where Mr. Rogers, our chairman of Appropriations, said we happen 

to have almost the exact amount left over from Ebola and the possibility of using that. I want to make certain that the funds are 

available, particularly for the research for finding out anything 

that can stop this, either with a mosquito or keep people safe with 

possible vaccination, wherever we are going to go, but that also 

needs funding ASAP. And we want to make certain that those 

funds are available. 

I’ll have some questions about the money flow, because money 

usually solves most of our problems. 

The situation is rapidly developing and changing, and Americans 

have concerns, but they need to know that their government on 

each level, Federal, State, and local, are making certain that the 

challenge is being met, and we want to ensure the public that we’re 

all receiving the latest information and coordinating in good fashion so that we can do the best. 

The United States is fortunate. We have the world’s most advanced healthcare system in the United States. It’s impressive. We 

want to keep it that way and make certain that we’re well coordinated, we use common sense, and that we’ll be able to contain the 

spread of this virus and be well-equipped for any future threats it 

may pose. 

So I’ll look forward to hearing from the panel. I welcome our witnesses. 

I would like to turn to our ranking member, the gentlelady from 

Illinois, Ms. Duckworth, for her opening comment. 

Ms. DUCKWORTH. Thank you, Mr. Chairman. 

And thank you to our expert witnesses for being here today. Today’s hearing is an important opportunity to examine the effectiveness of our current efforts to combat the Zika virus and to ensure 

that the interagency response is efficiently coordinated. There have 

been 82 reported cases of Zika in the United States, including four 


AKING-6430 with DISTILLER
4 

cases in my home State of Illinois. To date, these cases have been 

limited to travelers returning to the United States from affected 

countries or from individuals who have had sexual relationships 

with returning travelers. 

As a new mother, I deeply understand the public’s concern over 

the Zika virus. The recent outbreak of this public health threat in 

Brazil has shed light on a disease of which most Americans are not 

aware. And as the head of the Centers for Disease Control Prevention, Dr. Tom Frieden, recently explained, even the scientific community, there is an astounding lack of literature examining the 

Zika virus. 

Fortunately, our public health community is working hard to 

change this. Since the last major Zika outbreak in 2007, the CDC 

developed a test to detect Zika in the first week of an illness or in 

a sample taken from an infected child. More recently, the CDC activated its Emergency Operations Center last month in response to 

this latest outbreak, and on February 1, the World Health Organization designated the outbreak a public health emergency of international concern. 

Our public health system has acted quickly to increase its surveillance and diagnosis capabilities in affected areas and to ramp 

up what had been very limited scientific research on this virus. I 

want to thank the CDC and NIH for their very hard work and 

rapid response in this case. However, much work remains to be 

done so that we can better understand the Zika virus and develop 

proven strategies to treat affected individuals to contain the virus’ 

spread and, ultimately, to develop effective therapies and vaccines 

that would neutralize the threat entirely. 

Further, we must work diligently to assess every available control measure and adopt the most effective policies to prevent the 

virus from entering the mosquito population in the continental 

United States. 

Equally important, in light of what appears to be the Zika virus’ 

capacity to cause severe birth defects, we must also provide safe, 

effective, and affordable contraception to individuals living in areas 

of risk for Zika transmission. This includes taking actions to 

strengthen the healthcare services in areas where mosquito populations are already carrying Zika, such as Puerto Rico and the Virgin Islands. 

Zika, like the pandemics before it, knows no boundaries. Our contributions to public health efforts in Central and South America 

are first and foremost the right thing to do. But they are also critical to controlling the spread of this disease. That’s why I fully support the President’s proposal for $1.9 billion in emergency funding 

for domestic and international response to Zika. I also emphasize 

that continued consistent investment in public health remains critical in periods of crisis as well as in periods of calm. Our public 

health agencies are able to mobilize with agility today because they 

have built on decades of institutional knowledge, capacity, and lessons learned to anticipate and better respond to emerging threats, 

some of which we’ve never even imagined. The emergence of Zika 

should serve as a warning that we must continue to invest in our 

world class public health infrastructure to defend us both against 

this threat and the viruses that will surely appear in the future. 


AKING-6430 with DISTILLER
5 

Until we have more answers, we all must remain vigilant against 

Zika. We must all take reasonable precautions so that we give the 

next generation the best chance at full, healthy lives. This requires 

the cooperation of both men and women to prevent transmissions 

to other humans or to mosquitos in the continental United States. 

I urge everyone to proceed with caution to protect themselves, their 

partners, their families, and their communities. I really look forward to the testimony of our witnesses. 

And thank you, Mr. Chairman, for holding this hearing today. 

I yield back. 

Mr. MICA. I thank the gentlelady. 

And if no other members have opening statements, what we’ll do 

is, with unanimous consent, we’ll hold the record open for 5 legislative days. 

Did you have an opening statement? 

Mr. BOYLE. That’s fine. 

Mr. MICA. Okay. 

But we will hold, with unanimous consent, the record open for 

5 legislative days for members who would like to submit a written 

statement, and we may be asking our witnesses questions in addition to what’s done in this formal setting. And they will also be 

made part of the record. 

Without objection, so ordered. 

Okay. Now we’ll welcome our—and recognize our panel of witnesses today. And I’m pleased to welcome Dr. Anne Schuchat, and 

she is the Principal Deputy Director of the Centers for Disease 

Control and Prevention. 

Dr. Anthony Fauci, and he is the Director of the National Institute of Allergy and Infectious Diseases at the National Institutes 

of Health. 

Welcome back, Doctor. 

Dr. John Armstrong, and he is the surgeon general and secretary 

of health for the State of Florida. 

And then we have Dr. Bill Moreau, and he is the managing director for sports medicine for the United States Olympic Committee. 

I want to welcome all of you. And pursuant to the committee 

rules—and this is an investigation, an Oversight Subcommittee, a 

committee of Congress. 

I’ll ask you to stand and be sworn. Raise your right hand, please. 

Do you solemnly swear or affirm that the testimony you are 

about to give before this subcommittee of Congress is the whole 

truth and nothing but the truth? 

Let the record reflect that the witnesses have answered in the 

affirmative. 

And while Dr. Fauci has been here before, and maybe others, it’s 

customary to give a 5-minute statement, and if you have additional 

information or data you’d like to be made part of the official record 

of these proceedings, ask through the chair or a member that they 

be included, and we’ll do that. 

So we will start right out. I want to welcome, again, the Deputy 

Director of the Centers for Disease Control, Dr. Anne Schuchat. 

Welcome, and you’re recognized. 


AKING-6430 with DISTILLER
6 

WITNESS STATEMENTS 

STATEMENT OF ANNE SCHUCHAT, M.D. 

Dr. SCHUCHAT. Thank you so much, Chairman Mica, Congresswoman Duckworth, and members of the subcommittee. 

CDC and partners here and overseas are working around the 

clock to find out as much as we can as quickly as we can, and we 

are learning more every single day. To accomplish this, CDC is coordinating here at home with others across the Department of 

Health and Human Services, including my colleague, Dr. Fauci, 

and we’re working with partners across the U.S. Government as 

well as with other parts of the society to make sure that we communicate with travelers and healthcare providers, update travel 

alerts and clinical guidance, develop improved mosquito control 

methods, and we’re coordinating internationally with the World 

Health Organization and Pan American Health Organization on 

the Zika response. We’re working directly with Brazil and other nations, and we’re all trying to learn more about Zika and help prevent its spread. 

I want to begin with three key points. This is a dynamic situation. It’s changing very frequently. We are committed to share 

what we know when we know it and to revise and adapt to the new 

information. 

Secondly, emerging infections come from nature, and they can be 

challenging. A new syndrome like this can be scary, particularly for 

vulnerable pregnant women. But we can and should do more to detect, respond, and prevent these new infectious threats. 

Thirdly, CDC has a unique decades-long experience in core public 

health functions that are critical for this kind of response. We work 

on emerging pathogens like Zika. We work on disease detection, lab 

capacity, epidemiology and surveillance, response and partnership 

with State and local governments and with other countries. 

What are the facts? Well, we’ve known about this virus for a long 

time, but only in 2007 was the first outbreak recognized. We think 

the virus usually causes a mild syndrome, but we’ve recently 

learned that it appears to be associated with serious birth defects, 

microcephaly and possibly others. There may also be links with a 

neurologic problem, Guillain-Barre syndrome. It’s principally 

spread by the Aedes mosquito, a very difficult mosquito to control, 

and that is one of our challenges. 

Where is this going? There have already been more than a million cases in Brazil. A number of countries in Latin America are 

seeing sharp increases in Zika virus infections. We expect many 

travelers returning to the United States to have Zika virus infection, but we are doing what we can to prevent the severe complications. That’s why we issued the guidance for pregnant women to 

avoid traveling to areas where the virus is spreading, because at 

this time avoiding the virus and the mosquitos that spread it is the 

best way to protect a pregnancy. 

We expect there may be a little bit of local transmission in the 

Southern United States, because the mosquito that carries this 

virus is resident in those communities. We don’t right now expect 

a lot of local transmission, but we need to be ready for it, one of 

the reasons that the Florida Governor did declare that emergency. 


AKING-6430 with DISTILLER
7 

We think that other countries are the place where critical information can be learned, and that’s why we’re working side by side 

with our colleagues in Brazil and Colombia to learn as much as we 

can and as quickly as we can. CDC has been very busy. As you’ve 

heard, we’ve activated our Emergency Operations Center to our 

highest level. We’ve actually got more than 500 people working on 

this response, not just our infectious disease experts and our insect 

experts, but also our experts in birth defects, in communication, in 

travel health. We have developed and distributed kits for laboratory detection, and we’re working with State and local health departments so that they can deploy those tests. We’re working on 

the ground in Brazil and Colombia trying to uncover the mysteries 

of those links that you were talking about. 

While we’re doing much already, Zika requires a robust, all-ofgovernment response, as put forward in the emergency Zika funding request. 

CDC’s part of that request was to provide support to Puerto Rico 

and other areas in the United States, the territories where the 

virus is already spreading; secondly, for the rest of the U.S., where 

the travelers may be returning and where laboratory capacity and 

communication is going to be vital as well as insect monitoring; 

and, thirdly, for our international partners, where we do have a 

chance to learn as much as we can and to protect Americans in 

that way. 

This funding would support CDC’s work in prevention, detection, 

and response. To conclude, we must act swiftly to address the challenge of Zika virus. We are learning more every day, but there’s 

much more to learn and much more to do. And CDC will continue 

to work collaboratively across HHS and with other departments 

and with Congress to ensure an effective response. 

Thank you. 

[Prepared statement of Dr. Schuchat follows:] 


AKING-6430 with DISTILLER
8 


AKING-6430 with DISTILLERInsert offset folio 1 here 23028.001
9 


AKING-6430 with DISTILLERInsert offset folio 2 here 23028.002
10 


AKING-6430 with DISTILLERInsert offset folio 3 here 23028.003
11 


AKING-6430 with DISTILLERInsert offset folio 4 here 23028.004
12 


AKING-6430 with DISTILLERInsert offset folio 5 here 23028.005
13 


AKING-6430 with DISTILLERInsert offset folio 6 here 23028.006
14 


AKING-6430 with DISTILLERInsert offset folio 7 here 23028.007
15 


AKING-6430 with DISTILLERInsert offset folio 8 here 23028.008
16 

Mr. MICA. Thank you for your testimony. 

We’ll now turn to Dr. Fauci, representing NIH. 

Welcome, sir, and you’re recognized. 

STATEMENT OF ANTHONY FAUCI, M.D. 

Dr. FAUCI. Thank you very much, Chairman Mica, Ranking 

Member Duckworth, members of the committee. First, I want to 

thank you for the opportunity to discuss with you and the committee this morning the role of the National Institute of Allergy 

and Infectious Diseases in the research component of the broader 

approach toward addressing the Zika virus threat. 

The NIAID, the institute that I direct, has a dual mandate 

among NIH institutes. First, we maintain and grow a robust basic 

and research portfolio in the disciplines of microbiology, infectious 

diseases, and immune-mediated diseases. However, despite that 

long-term commitment, we are also prepared and are part of our 

mandate to rapidly respond to new and emerging disease threats. 

And this has been something that we have been doing essentially 

from the beginning. 

In fact, if one takes a look at this slide, it is the title of a perspective that I wrote last month for the New England Journal Medicine, and you will see from the title, it says, ‘‘Zika Virus in the 

Americas—Yet Another Arbovirus Threat.’’ And what I was referring to is that, over the past couple of decades, we’ve see new diseases of the arbovirus type in the Western Hemisphere that we 

have not seen before: West Nile; dengue, from decades ago; 

chikungunya in 2013; and most recently, in 2015, Zika. When one 

looks at the role of what we do—if we can go back one—the role 

of what we do, the NIH’s mandate is to do basic and clinical research to provide the research resources for industry and academia 

with the ultimate mandate to develop vaccines, therapeutics, and 

diagnostics. So let me take a couple of minutes to just describe 

some of these. When you look at things like the epidemiology and 

natural history, we are focusing on looking at symptomatic versus 

asymptomatic disease. What about the role of virus and how long 

it lasts in an individual following infection, a question extraordinarily important to pregnant women and women who want to become pregnant? What about cohort studies to actually nail down 

the causative relationship or not between infection and pregnancy 

and the development of congenital abnormalities, such as 

microcephaly, as well as understanding the pathogenesis of disease? 

With regard to basic research, it is very similar to the basic research we’ve done with other viruses throughout the years, ranging 

from HIV 30-plus years ago to most recently with Ebola. And that 

is to look at viral structure, viral pathology, medical virology, the 

pathogenesis of disease, looking at the immune response, which 

gives us great insight into the development of vaccines. 

In addition, as you know, the CDC takes the lead role as disease 

detectives in trying to determine the diagnosis of a disease, something they are doing right now. NIH grantees and contractors are 

also working on a more sensitive and specific antibody test to determine if, in fact, someone has been infected, because we know 


AKING-6430 with DISTILLER
17 

now the current tests that are available have a degree of cross-reactivity. 

One of the most important things we do is to develop vaccines, 

as we’ve done for so many other of these emerging threats. The 

candidates you see on the slide, the two marked with red, are the 

two that are most advanced and are essentially ready to go into 

early trials. We’re partnering with our industrial colleagues, and 

right now, let me give you an example of why it’s important to 

have done decades of research in other diseases that gives us a 

head start. Years ago, we developed a vaccine for West Nile virus. 

We went into phase 1. It was shown to be safe, and it was shown 

to induce an immune response that you would predict would be 

protective. We didn’t have any industrial partners, so we never 

made it to the advanced development. But we used that platform 

to develop now a Zika vaccine that is essentially ready to go in the 

development of the early preclinical studies. And it really is a very 

interesting phenomenon. We took what’s called a DNA piece of 

genes, and we stuck in it a West Nile gene to express a protein of 

West Nile. So all we did this time was take that same platform, 

take out the West Nile gene, and stick in the Zika gene. So, right 

now, we are making this vaccine, and we predict it will be ready 

to go into phase 1 trial by the summer of this year, and hopefully, 

by the end of 2016, we’ll have enough information to decide if we 

can even go further to an advanced trial. And I will be happy to 

discuss that during the questioning period. 

Finally, when one looks at therapy, we’re doing screening of 

drugs of known activity against certain of these viruses, as well as 

new drugs that have potential activity. This is a very important 

issue, and we are now partnering with many of our industrial and 

biotech partners to do this. 

Finally, on this last slide, I just want to recapitulate what I said 

from the very beginning. Emerging infections have been with us all 

along. They are with us now, and they will always be with us. I 

call it the perpetual challenge, as I did in this review from a few 

years ago. And I would like to thank this committee and other committees for the extraordinary support that you have given us over 

the years to allow us to fulfill this mandate. Thank you. 

[Prepared statement of Dr. Fauci follows:] 


AKING-6430 with DISTILLER
18 


AKING-6430 with DISTILLERInsert offset folio 9 here 23028.009
19 


AKING-6430 with DISTILLERInsert offset folio 10 here 23028.010
20 


AKING-6430 with DISTILLERInsert offset folio 11 here 23028.011
21 


AKING-6430 with DISTILLERInsert offset folio 12 here 23028.012
22 


AKING-6430 with DISTILLERInsert offset folio 13 here 23028.013
23 


AKING-6430 with DISTILLERInsert offset folio 14 here 23028.014
24 


AKING-6430 with DISTILLERInsert offset folio 15 here 23028.015
25 


AKING-6430 with DISTILLERInsert offset folio 16 here 23028.016
26 


AKING-6430 with DISTILLERInsert offset folio 17 here 23028.017
27 


AKING-6430 with DISTILLERInsert offset folio 18 here 23028.018
28 


AKING-6430 with DISTILLERInsert offset folio 19 here 23028.019
29 

Mr. MICA. Thank you, Dr. Fauci. 

Now we’ll recognize our Florida surgeon general, Dr. Armstrong. 

Welcome, and you are recognized, sir. 

STATEMENT OF JOHN ARMSTRONG, M.D. 

Dr. ARMSTRONG. Thank you, Chair Mica, Ranking Member 

Duckworth, and members of the subcommittee. I’m glad for the opportunity to be here with you this afternoon. 

Florida has a long tradition of combating and eradicating mosquito-borne diseases. In fact, the Florida Department of Health was 

created out of an epidemic of yellow fever in 1889. Our mosquitoborne outbreaks in modern times have been local and of short duration. Consistently, the approach has been threefold: first, mosquito control; next, public information; and, third, health professional education. And we have seen success with containment of 

West Nile virus, dengue, and chikungunya. This afternoon, I’ll provide an update on the status of Zika virus in Florida, and an overview of how Florida has successfully applied CDC guidelines to protect our residents and visitors. 

To date, we have had no transmission of the Zika virus in the 

State of Florida. Through healthcare professional readiness, our department has reported 29 travel-related Zika cases to the CDC, 

most recently from Seminole County. A travel-related case is defined as a disease that was contracted outside of the State prior to 

arrival. 

None of our confirmed cases of active Zika virus involve pregnant 

women. We have, however, identified three pregnant women who 

traveled to countries affected by Zika and who likely had Zika virus 

in those countries and who have returned without any symptoms. 

They have evidence of remote infection with Zika, and we are applying CDC guidelines to ensure that these women receive care 

through their health professionals consistent with those guidelines. 

We’ve had 29 cases in 11 Florida counties, and we currently have 

the laboratory capacity to conduct over 4,800 viral tests for active 

Zika and over 1,200 antibody tests to detect past Zika infection. 

We’ve been conducting approximately 300 tests for Zika a week and 

reporting positive results to our partners and the public daily. 

Recognizing the increase of travel-related cases of Zika in Florida, on February 1, Governor Rick Scott requested a briefing with 

the CDC on the Zika virus, and on that call, we confirmed that the 

Aedes mosquito, the carrier of Zika, is common in Florida and that 

there are potential links between Zika and newborn microcephaly 

as well as adult neurologic disorders, including Guillain-Barre syndrome. What was most clear from that briefing is that there is scientific uncertainty about Zika transmission beyond the mosquito 

bite and about the impacts of Zika after an individual becomes infected. 

Guidance from the CDC should account for this uncertainty 

while providing actionable recommendations with what is known. 

Based on the information from that meeting and the tripling of 

travel-related cases in the following week from three to nine, on 

February 3, Governor Rick Scott issued an executive order directing me to declare public health emergencies in the counties with 

diagnosed travel-related cases, and on that same day, I declared 


AKING-6430 with DISTILLER
30 

public health emergencies in the four impacted counties at that 

time and have since added counties to the declaration, as I’ve 

shared. 

The public health emergency included three key directives: one, 

notification of Florida’s commissioner of agriculture, who oversees 

the Office of Mosquito Control, which connects with Florida’s local 

mosquito control boards; next, mobilization of local leaders to coordinate mosquito-control efforts and public outreach to vulnerable 

populations with meeting summaries and action plans reported 

back to the Department of Health; and, finally, outreach to medical 

professionals with up-to-date CDC guidance to increase awareness 

and access to diagnostic tools. At the department, we established 

an incident command team to address comprehensive readiness activities. 

Florida has one of the premiere State lab systems in the country 

with a central laboratory in Jacksonville and branch laboratories in 

Miami and Tampa. When the public health emergency was issued, 

Governor Scott recognized that with over 20 million residents and 

over 100 million tourists annually, Florida must stay ahead of the 

possible spread of the Zika virus and that our lab capacity plays 

an essential role in that effort. He called on the Florida Department of Health to have on hand at least 4,000 viral tests, which 

are commercially available and were ordered the next day. Governor Scott called on the CDC to provide at least 1,000 Zika antibody tests so that we could test individuals, especially pregnant 

women and new mothers, who have traveled to affected areas and 

had symptoms of Zika. The antibody test allows the State to see 

if individuals ever had the Zika virus. At that time, we had a capacity for only 475 tests. On February 9, the CDC provided Florida 

with 950 additional antibody tests, bringing our total to 1,425. 

So, with our existing lab infrastructure and the needed testing 

resources we are now equipped to work with medical professionals 

to test patients with symptoms of the Zika virus and associated 

travel history to an impacted country based on CDC guidance. The 

Florida Department of Health licenses all Florida medical professionals and has existing communication channels with our licensees, and we have used these channels to share CDC guidance on 

the disease, treatment and testing protocols, as well as recent FDA 

recommendations regarding blood donation from individuals who 

have been to areas with active Zika virus transmission. Healthcare 

professional safety has always been of paramount importance, and 

we have emphasized CDC guidance that universal precautions provide the appropriate level of protection. 

On February 12, at the request of Governor Scott, the CDC 

hosted a conference call for Florida medical professionals to provide 

information on the symptoms, treatments, and proper precautions 

for Zika. Nearly 600 medical professionals and healthcare facilities 

dialed into the call to hear directly from the CDC on the measures 

they need to take to help patients. Strengthening the connection 

between healthcare professionals and the public health system is 

essential for tracking and containing disease, and we remain in frequent contact with the CDC and FDA for the latest guidelines on 

how best to prepare communities in Florida. 


AKING-6430 with DISTILLER
31 

Finally, public outreach. We work to keep the public informed as 

one of the best ways to calm fears and educate for action. At the 

direction of Governor Scott, we’ve established a Zika virus information hotline for Florida residents and visitors as well as anyone 

planning on traveling to Florida in the near future. We want Florida residents and visitors to have access to an open line of communication to receive the latest updates, have their questions answered, and get advice on what steps they can take to protect their 

homes and families. We issue a daily press release with up-to-date 

diagnosis counts and tips for Floridians on how to protect themselves. We’ve established a Web page with links to CDC guidance 

and public information on community meetings. We’ve developed 

infographics to explain clearly what the virus is and the best practices for mosquito protection. And these materials have been requested for rebranding by other States. And we’ve made materials 

and presentations available to our 67 county health officers as an 

integrated Department of Health to inform community stakeholders and partners. 

We are sharing three key messages about Zika virus: One, anyone who is pregnant, intends to become pregnant, or might become 

pregnant should not travel to a country with active Zika virus 

transmission as determined by the CDC. Two, travelers from Zika 

infected countries should have protected sex for at least a month 

upon returning to the United States due to the lingering presence 

of the virus and various bodily fluids. And, three, the best way to 

prevent Zika and other mosquito-borne viruses is through mosquito 

control, which includes individual responsibility to eliminate any 

sources of standing water where the mosquito can breed, to use 

mosquito repellant and cover with proper clothing, and to ensure 

that window and door screens are in place and intact. 

Our residents play an important role in helping prevent the 

spread of mosquito-borne viruses, and we want them to have all 

the information they need to join the effort. 

In Florida, we have developed a proven seamless model to take 

CDC guidance from the Federal Government and get it to our residents, our visitors, our health professionals, and partner organizations to protect them from emerging mosquito-borne diseases. I’m 

confident that our history as a department has prepared us to address this issue. In the past, we’ve had success in containing other 

mosquito-borne viruses, such as chikungunya and dengue, with 

systems of readiness that mirror the level of preparedness that we 

currently maintain. We have made it a priority to stay ahead of the 

possible spread of the virus in Florida, and we will continue to do 

all we can to keep Floridians safe. 

Thank you. 

[Prepared statement of Dr. Armstrong follows:] 


AKING-6430 with DISTILLER
32 


AKING-6430 with DISTILLERInsert offset folio 20 here 23028.020
33 


AKING-6430 with DISTILLERInsert offset folio 21 here 23028.021
34 


AKING-6430 with DISTILLERInsert offset folio 22 here 23028.022
35 


AKING-6430 with DISTILLERInsert offset folio 23 here 23028.023
36 


AKING-6430 with DISTILLERInsert offset folio 24 here 23028.024
37 


AKING-6430 with DISTILLERInsert offset folio 25 here 23028.025
38 

Mr. MICA. Thank you, Dr. Armstrong. 

And we will a now hear from the representative from the U.S. 

Olympic Committee, Dr. Moreau. 

Welcome, and you are recognized. 

STATEMENT OF BILL MOREAU, D.C. 

Dr. MOREAU. Thank you, Chairman Mica, Ranking Member 

Duckworth, and the other members of the subcommittee for holding this hearing on Zika and U.S. governmental preparedness. 

The USOC recognizes that Zika is a serious global health concern 

and an issue that we are proactively addressing with Team USA. 

The U.S. Olympic Committee is a sports organization. Our mission is to support U.S. Olympic and Paralympic athletes in achieving sustained competitive excellence while demonstrating the values of the Olympic movement, thereby inspiring Americans. Every 

2 years, we bring Team USA to the Olympic and Paralympic 

Games. In the between games, we work very closely with 47 national governing bodies of sport to build Team USA. 

The safety of our athletes and staff is our number one priority. 

As the managing director of sports medicine for the U.S. Olympic 

Committee, my mission is to build and coordinate a complex network of medical doctors, healthcare services, and academic experts 

across numerous medical fields. 

The U.S. Olympic Committee is not an organization with a focus 

on the specialty of infectious disease. We rely on the tremendous 

expertise of the Centers for Disease Control and Prevention and 

other public and private infectious disease experts to address and 

help us to understand the threats that viruses, such as Zika, pose 

for our athletes. We have been in regular contact with the CDC 

and other experts for months. They continue to provide us sound 

recommendations based on the information available to date. We 

have supported these recommendations, developed a protocol to 

mitigate risks, and provided this information to all potential Team 

USA athletes and support staff likely to travel to Rio before and 

during the Summer Olympic and Paralympic Games. 

I have submitted the most recent USOC communications to the 

athletes with this testimony. Working with the CDC and other experts, the USOC has developed a protocol to mitigate the risk 

posed by Zika. Let me walk you through that right now. We’re continuously communicating the latest information to our athletes, 

staff, and other stakeholders. We are steadily communicating with 

partners, such as the International Olympic Committee, the World 

Health Organization, the CDC, Department of Defense, and infectious disease specialists. We are monitoring evidence-based sources 

for information regarding viral pathogens. We are following the 

mosquito bite precautions, as provided by the CDC. We are following insect repellant selection, as recommended by the DOD. We 

are maintaining awareness through our partners regarding new 

interventions as they are identified. We are training our medical 

team regarding the early recognition and interventions for viral infection such as Zika. We are stocking our formulary with the best 

supportive medical interventions. We are providing DEET-containing insect repellant for personnel, issued prior to departure 

with additional supplies on hand in Rio. We are considering 


AKING-6430 with DISTILLER
39 

pretreatment with permethrin kits for all USOC personal clothing. 

We are also considering providing bed nets for all personnel, and 

we are identifying Brazilian locations for additional support regarding viral pathogens. 

In conclusion, knowledge about Zika virus is growing on an almost daily basis. We are following all of the developments. We are 

incredibly pleased with the support and collaboration that we’ve received from the CDC, the DOD, and others and are, indeed, indebted to them for sharing this information so that we can provide 

the best, most accurate information to our athletes and staff who 

most directly serve and support our athletes. We will continue to 

work closely with the CDC, the DOD, and other infectious disease 

experts throughout the Rio games, and we will continue to follow 

the CDC recommendations. 

Thank you, again, for the opportunity to address this important 

issue. 

[Prepared statement of Dr. Moreau follows:] 


AKING-6430 with DISTILLER
40 


AKING-6430 with DISTILLERInsert offset folio 26 here 23028.026
41 


AKING-6430 with DISTILLERInsert offset folio 27 here 23028.027
42 


AKING-6430 with DISTILLERInsert offset folio 28 here 23028.028
43 

Mr. MICA. Thank you, each of our witnesses, for their testimony. 

And we’ll turn to questions. And I’ll begin. Dr. Schuchat, can the 

CDC confirm what I said earlier, that we have not had a case of 

Zika infection from a mosquito in the United States? Everything is 

coming in so far from another source. Is that correct? 

Dr. SCHUCHAT. For the 50 States and the District of Columbia, 

that’s right. We do have cases in Puerto Rico and the territories. 

Mr. MICA. Okay. Okay. So Puerto Rico and the territories, Virgin 

Islands—— 

Dr. SCHUCHAT. The Virgin Islands and American Samoa, at this 

point, I believe they are—but continental U.S., 50 States, not yet, 

right. 

Mr. MICA. Now, the next thing—and I just became more concerned as I heard Dr. Armstrong reveal the issue with pregnant 

women. And we think there’s a link, pretty good link, to some birth 

defects. And this is a Transportation Oversight Subcommittee 

along with other things, but these people are coming in mostly 

from Latin and South America by air. Are there warnings now to 

people coming in? Is everyone getting a warning who comes in, particularly women? I’d be concerned. When I read all the testimony 

last night, it seems like the women are the most at risk. We don’t 

know. But are they getting a warning? 

Dr. SCHUCHAT. We have been working very closely with air travel industry and other travel partners, so there’s signage and so 

forth. 

Mr. MICA. Okay. I think that, again, it would be good to send out 

something that—and the airlines have cooperated. They always cooperate. We’ve had the bird flu; we’ve had—— 

Dr. SCHUCHAT. Absolutely. 

Mr. MICA. —others, Ebola, others. But I think we need to get a 

warning. It’s not that many coming in. We know where they are 

coming in from, but the infected areas, that there be some kind of 

warning to the passengers. 

We do know that there’s this—and I’m not technically qualified; 

I get the wrong terms, incubation or whatever you call it—the period, the period of vulnerability from 21 to 30 days; that’s pretty 

much agreed on, Dr. Fauci, we think? 

Dr. FAUCI. Yes. 

Mr. MICA. You said stop having sex for 30 days or something 

along—— 

Dr. FAUCI. Yes. If you are infected, you will clear the virus within 7 days, usually, and, therefore, for the rest of the time, generally, except if you are a male, and it could be in the semen, which 

has been demonstrated in a number of individuals. 

Mr. MICA. We don’t know how long that’s—— 

Dr. FAUCI. We don’t know. It has been in some, unfortunately, 

as far out as 62 days. 

Mr. MICA. As far as what? 

Dr. FAUCI. One was 62 days, but that’s maybe an outlier, but we 

don’t know how long—— 

Mr. MICA. Well, again, I think the first thing is getting the warning out. These are people coming into the United States from infected areas. So that would be my concern, and we need to work 

with the aviation industry to get these warnings out there, particuVerDate Sep 11 2014 08:41 Jan 17, 2017 Jkt 000000 PO 00000 Frm 00047 Fmt 6633 Sfmt 6633 F:\23028.TXT APRIL

AKING-6430 with DISTILLER
44 

larly among women, and then advise them of the risk that we 

know so far. 

Okay. I have a release from the Governor’s Office just a couple 

of minutes ago, 2:27, asking the Centers for Disease Control for another 250 kits to test for Zika virus. Are you able—now, they— 

you’ve already cooperated, and you guys have been there. Dr. Armstrong, the requests have gone in. Everything has been done in a 

timely fashion. Are we able to meet this request, and where are we 

in the stockpile of making certain we have the test kits? 

Dr. SCHUCHAT. You know, we have been working around the 

clock to produce kits and to develop even better tests, and we—one 

of the reasons for the emergency request is the volume. We estimate about half a million pregnant women will be traveling back 

and forth to affected areas this year, 35,000 pregnant women in 

Puerto Rico alone. So keeping up with that volume for the State 

support is one of the reasons for the emergency request. 

Mr. MICA. But do we have the test kits now or ordered? Is 

there—— 

Dr. SCHUCHAT. Well—— 

Mr. MICA. You just said there may be a big need. Our job is to 

stay ahead of the curve and your job. Do we have the test kits, like 

here’s one small additional order, and can we meet the additional? 

Dr. SCHUCHAT. Where we are right now is—— 

Mr. MICA. You have the orders in—— 

Dr. SCHUCHAT. We’ve produced about 30,000 and we’ll have 

about 90,000 shortly. So we’re working around the clock. 

Mr. MICA. Okay. 

Dr. SCHUCHAT. And we’re working with private partners so that 

they can help us—— 

Mr. MICA. Okay. So we are alerting—we are going—if we 

haven’t, we are going to alert people coming in. We are going to 

work with you on that. On the test kit, we want to make sure we 

have test kits available and the supply. 

The thing that startled me was the blood supply, because this is 

in the blood. We should also have a warning about there ought to 

be 60, 90 days, a warning that people should not donate blood or 

identify that they’ve been to a country where they’ve been exposed 

when they are coming back. 

Dr. SCHUCHAT. Yes. The FDA has—actually, voluntarily, the 

blood banks did that with a month—self-deferral within a month, 

and the FDA instituted it formally. There’s also an effort now in 

Puerto Rico to import blood, because the virus—— 

Mr. MICA. In—— 

Dr. SCHUCHAT. —because they can’t assure that local blood will 

be okay. 

Mr. MICA. And is FDA giving proper warning? 

Dr. SCHUCHAT. Absolutely. 

Mr. MICA. God bless the people of Puerto Rico. They should have 

some transparency in the blood supply, truth—— 

Dr. SCHUCHAT. Right. And there’s accelerated effort to develop 

screening tests so that blood can be assured to be safe in endemic 

locations. 

Mr. MICA. Okay. Now, you guys have been great in identifying 

the course forward. I’ve got a couple of quick questions. The testVerDate Sep 11 2014 08:41 Jan 17, 2017 Jkt 000000 PO 00000 Frm 00048 Fmt 6633 Sfmt 6633 F:\23028.TXT APRIL

AKING-6430 with DISTILLER
45 

ing—and you’re trying to get more advanced tests. And a lot of that 

evolves around the President’s request. It was a good request. I 

just read it. Where is my President’s request here, guys? Here it 

is, from the White House to the Speaker and all the Members. And 

he asked for about $1.8 billion. Now, coincidentally—and I didn’t 

know this; I have a letter back from Mr. Rogers, the chairman of 

Appropriations—there’s about $1.8 billion available with leftover 

money from Ebola. Do you have the ability to move that money 

into where we need it? 

Dr. SCHUCHAT. The—— 

Mr. MICA. I’ll ask both of you, CDC, NIH. 

Dr. SCHUCHAT. A couple of key points about Ebola. The outbreak 

is out of the headlines, but there is still substantial effort. Last 

month—— 

Mr. MICA. But you still have a balance of about 1.8 or 9 billion 

dollars? 

Dr. SCHUCHAT. Not—the CDC does not have that large a balance 

for Ebola. Our Ebola resources are either committed or—— 

Mr. MICA. But the administration does have—again, from Mr. 

Rogers, the chairman of Appropriations, is saying that that’s unexpended dollars. My whole question is: There’s some money available. Do you have money to address this now? 

Dr. SCHUCHAT. We—— 

Mr. MICA. Are you short? 

Dr. SCHUCHAT. The resources for Ebola are committed. They are 

global health security resources, which are fully programmed. 

Mr. MICA. Okay. Then do you have resources now. I mean, we 

do a lot of things around here by executive order. We shift money. 

I mean, in a nanosecond you can see the President or the administration shifting money to some cause. 

Dr. SCHUCHAT. Right. The committee—— 

Mr. MICA. Do you have that ability to get the test kits, to get— 

and then I want to ask Dr. Fauci, because you’ve got a whole bunch 

of things in research. You’re on—it was fantastic news to hear the 

summer trials; by the summer, you’re moving ahead, and you 

showed us how you’re doing that. But I want to know and assure 

these Members that you feel that you have the resources and support from the administration to move forward. Do you, Dr. Fauci? 

Dr. FAUCI. Our proportion of the Ebola money, we have—— 

Mr. MICA. Well, you have Ebola, and you have other money. 

Dr. FAUCI. Right, but I’ll explain to you what we are doing. So 

our proportion of the Ebola money, we’ve essentially spent all of it 

except for maybe $9 million. So we have obligated almost all of our 

Ebola—— 

Mr. MICA. Do you have other sources? 

Dr. FAUCI. Our sources right now, without the supplement that’s 

been asked for by the President, is moving money out of doing 

other things. So let me tell you what we have done. We have 

money that we have been investing in contractors and grantees 

who do Flavivirus research, both in the United States and Brazil. 

We have now directed them to switch over and add on nearly—— 

Mr. MICA. They are under contract to address that—— 

Dr. FAUCI. Right. Yeah. But they are going to have to not do 

other things in order to do that. 


AKING-6430 with DISTILLER
46 

Mr. MICA. Okay. And do you have people under contract? 

Dr. SCHUCHAT. We’ve—the global moneys have—commitments 

have been made to 17 high-risk countries in Africa where we—and 

Asia, where—which are very vulnerable for exactly what happened 

with Ebola. 

Mr. MICA. But you’re directing some of those funds now to Zika. 

And is that 17 countries you talk about—— 

Dr. SCHUCHAT. No. No. That’s—those resources are for African 

countries. The—— 

Mr. MICA. But for what? Ebola? Or for other diseases? All of the 

above? 

Dr. SCHUCHAT. To prevent, detect, and respond to threats, including—— 

Mr. MICA. So it could be Zika? 

Dr. SCHUCHAT. In those countries, they are not having Zika. So, 

essentially—— 

Mr. MICA. Well, it is in different—— 

Dr. SCHUCHAT. Right, exactly. The geography of that global—— 

Mr. MICA. And do you intend to redirect some of that money now 

that we have this? 

Dr. SCHUCHAT. We think that would be terribly dangerous in 

terms of the outbreaks that are ongoing. 

Mr. MICA. Again, what I am trying to get is to make certain you 

have the resources. If you don’t have them, we need to know. We 

need to know that also the things that need to get under contract 

are under contract for the test kits, for the research, for the vaccine, for moving this little protocol forward. 

Dr. Fauci. 

Dr. FAUCI. Yeah. So, Mr. Chairman, just so that I can clarify, in 

order to get a jump start, we took money that we had allocated for 

things like dengue and moved it over. I will not be able to proceed 

with the trial that I described to you without additional money. 

Mr. MICA. Okay. 

Dr. FAUCI. —which is one of the reasons why—— 

Mr. MICA. See, that’s what we need to know—— 

Dr. FAUCI. I won’t be able to do that without additional moneys. 

Mr. MICA. We need to tell our colleagues. The request is in. The 

President gave it to us last week. We’ll have to work with our leadership, but we want you to have the funds available. We don’t want 

to neglect important research. And one of the reasons I voted for 

the omnibus is we have additional money in research. I was told 

Alzheimer’s and some other disease. You can’t rob Peter to pay 

Paul. 

Dr. FAUCI. Our summer plans are dependent upon the supplement. 

Mr. MICA. Okay. All right. 

Well, again, I have other questions, like notifying—you notifying 

our DOD and overseas personnel through State and DOD. Have 

they—are there official notices going out and the risks and the 

warnings and all that? 

Dr. SCHUCHAT. Yes. We have been working closely with those departments for the Americans overseas. 

Mr. MICA. We’ve got families and everybody out all around the 

globe 


AKING-6430 with DISTILLER
47 

Dr. SCHUCHAT. Absolutely. 

Mr. MICA. I have gone over my time. We’ll come back, as we’ve 

got plenty of time, as you can see, with the members that are here. 

Ms. Duckworth, I’ll yield to you. Thank you. 

Ms. DUCKWORTH. Thank you, Mr. Chairman. 

Dr. Schuchat, I want to sort of build on what the chairman was 

talking about in terms of notifying travelers who—they are coming 

back into the United States. I’m wondering about the travelers in 

the United States who might be on their way out or what information is being provided. What guidance has the CDC provided to the 

obstetric community in the continental U.S. regarding Zika? 

Dr. SCHUCHAT. We have been working very closely with the clinical community, including obstetricians. We have developed joint 

guidance. We have used—the obstetricians’ Web site, in fact, has 

distributed our guidance broader than we have been able to, to the 

65,000 obstetricians in America. And we have held calls and sessions for questions and answers. We are very keen to be letting 

women know before they travel, and the signage and the outreach 

is through both direct health clinician channels and through consumer groups as well. I did a Scary Mommy blog, and we have 

been really working all the social media as well as the professional 

groups so that women know and that their families know what to 

expect. We know that women’s most trusted source is their own 

doctor, and so we want their own doctor to know the answers to 

the questions. 

With a breaking syndrome like this, information is updated frequently, so it’s not just a one-time guidance, but ongoing updates. 

Ms. DUCKWORTH. Is that a similar effort with, I guess, family 

physicians or groups where—I’m thinking of these countries; if I 

were travelling to them, I would need to get immunized for a range 

of other diseases before going anyway. And if I was planning a trip, 

I would be going to get those particular immunizations. Is Zika also 

then being added as part of the conversation? 

Dr. SCHUCHAT. Yes, that’s right. Our travel health site is the 

most popular site on CDC’s Web site, and we work really closely 

with both the clinical community and the special travel health and 

travel industry to make sure that people know what to expect 

where they’re going: what to eat and drink or not, and what shots 

they might need before they travel. So Zika has been added to 

those messages. 

Ms. DUCKWORTH. Thank you. 

Dr. Fauci, I’m a big fan of NIH and the work that you do, and 

I certainly think we should be funding you at far higher levels because it’s money—it’s a savings; it’s an investment. Do you know 

if there’s a specific stage during pregnancy when exposure to Zika 

is more likely to cause microcephaly? 

Dr. FAUCI. We don’t know for sure, but if it acts like virtually 

all other viruses that cause congenital abnormalities, the first trimester is overwhelmingly the most vulnerable. Whether or not individuals who might get infected later on in pregnancy have a degree of adverse event with the pregnancy, it’s not entirely clear. I 

wouldn’t be surprised if there are some outliers in which you can 

have late effects of infection later on. But when you think about 

this, almost always the first trimester is the most vulnerable. 


AKING-6430 with DISTILLER
48 

Ms. DUCKWORTH. And I understand that the severity of the birth 

defects caused by Zika do vary? 

Dr. FAUCI. Very much so. 

Ms. DUCKWORTH. Do we have any idea what causes the variance, 

or is this all part of the learning process that we’re in right now? 

Dr. FAUCI. It’s part of the learning process with regard to Zika, 

but, again, you use other models, like rubella, CMV, and others, 

and there isn’t just one size fits all. You have a great degree of variability, and it’s not surprising that you might have something as 

severe microcephaly, to the point of the fetus not even surviving, 

or you might have birth with just some abnormalities of vision or 

perhaps some mental issues, so it goes from one end of the extreme 

to the other. And it’s probably just a variability of the penetration 

of the virus through the placenta to the baby. 

Ms. DUCKWORTH. Are those mental issues, do those also include 

mental illnesses like schizophrenia or bipolar disorder? 

Dr. FAUCI. You know, there have been reports in the past, not 

with Zika yet, of infections that mothers have during early parts 

of pregnancy and what is apparently an increase in the incidence 

of certain types of disorders. There is some controversy about that, 

but there’s enough information to suggest that there would be an 

impact on some aspect of brain function, which might also include 

things like psychiatric issues. 

Ms. DUCKWORTH. Dr. Schuchat, I think you might be the organization that works with the DOD, perhaps. What about military 

women that are being deployed especially? I served in Operation 

New Horizon multiple times and various missions in Latin America. What are we doing with DOD, with military men and women 

who are going over? 

Dr. SCHUCHAT. We have been working closely with the military 

and the Department of State so that our guidance for Americans 

traveling abroad can be consistent for the military that are serving 

abroad as well as for the State Department employees and their 

families. We do think that in places where there’s active circulation 

of Zika virus right now, particularly Latin America, that the ability 

to—that it’s not good for pregnant women to be there. And if 

they’re interested in redeploying elsewhere, I think the departments are working with them on that. 

Ms. DUCKWORTH. Is there any plans to do any type of universal 

testing and monitoring of troops who are assigned there? Most of 

these are going to be Reserve and National Guard troops also. So 

they’re going. They’re in planning. They are going to go. They are 

going to go do their 3 weeks or their 1 month, and they come back. 

But it is a nice population that you can track who will go and come 

back. 

Dr. SCHUCHAT. Absolutely. One of the aspects of coordination 

across the government is the intergovernmental leadership calls 

that we have, and the DOD is very actively participating in that. 

They do enormous amounts of research and monitoring and force 

readiness, so I am not personally aware of whether there is deployment tracking in terms of cohort studies going on, but that is the 

kind of thing that they are able to do. 

Ms. DUCKWORTH. Thank you. 

I yield back, Mr. Chairman. 


AKING-6430 with DISTILLER
49 

Mr. MICA. I thank the gentlelady. 

Mr. DeSaulnier. 

Mr. DESAULNIER. Thank you, Mr. Chairman, and thanks to the 

ranking member, for this really interesting hearing. 

And, first off, congratulations to all of you. I’m always very proud 

of the fact of our robust public health system in the United States. 

I’ve worked in local government, State government. It works best 

when nobody notices. But in this global economy with pandemics, 

always something we have to be cautious about. 

My questions are two lines really of questioning. Dr. Fauci, first 

of all, how would you characterize the American role in global pandemic preparedness? We are looked at both because Americans 

travel a lot, but because of our infrastructure as a leader in this, 

how do we interact with the global community and make sure that 

we’re using our resources in an effective and efficient way, given 

our position? 

Dr. FAUCI. I think we interact quite well, and it’s getting better 

and better. Every time we have a challenge, there are really lessons learned that I think are important, everything from responding to a pandemic influenza or the threat of a pandemic influenza, 

to the global response to Ebola in which there were several lessons 

learned. And, even now, all of are us are experiencing—like Dr. 

Schuchat and I were very much involved in the issue with Ebola 

and as people who are now involved with the issue with Zika—we 

already see the differences in how the global community has responded in a much more robust way than we did before. So the answer to your question is I think we have done well all along, but 

we’re really doing better now because of experience. 

Mr. DESAULNIER. So the global preparedness is going up exponentially, unfortunately, as you get more incidents? 

Dr. FAUCI. Yeah, I believe so. And we have a global health security agenda that we’re a part of, the United States is part of, which 

is also part of that preparedness issue. 

Mr. DESAULNIER. Doctor, you have from the CDC’s perspective? 

Dr. SCHUCHAT. Yes. I think people are taking the issues of preparedness very seriously, and the importance of being able to prevent, detect, and respond everywhere is vital, so the U.S. is a leader in that, but we have now got many other countries joining in the 

process, and the WHO, of course, did jump on this a lot quicker 

than previously. 

Mr. DESAULNIER. So my other line of questioning is similar to 

the ranking member’s. Dr. Fauci, I’m told you were involved when 

the AIDS epidemic first began. And being from the bay area and 

being old enough to remember that, even in the bay area, as we 

were dealing with that and researchers at places like UCSF were 

dealing with it, many of whom are still practicing, the 

miscommunication was a huge struggle, the things that people 

would say, both politically and in terms of our effectiveness. But, 

now, all these years later, you still have that, but then you have 

social media. Just curious, you spend a lot of your time, I imagine, 

correcting misinformation, and how much, if you’d like to talk 

about that, about what you’re learning about how we communicate 

vis—vis social media and what time you have to expend maybe correcting what’s out there, and has that changed over time? 


AKING-6430 with DISTILLER
50 

Dr. FAUCI. Well, part of the administration and, in this case, the 

Department of Health and Human Services, which is the predominant agency involved, is that we try very hard, all of us, to get out 

there publicly with the media, both the classic media and the social 

media, myself and Tom Frieden, and Anne Schuchat; we’re on the 

media all the time, TV, radio, et cetera, trying to get the information out. 

And what we have learned all the way back from the years of 

HIV/AIDS is that we want to get correct information out, and when 

we don’t know the answer to something, we say we don’t know the 

answer. And that’s the reason why you’re hearing us be very cautious, for example, of saying we believe and think that there is a 

direct causal relationship between infection of a pregnant woman 

and microcephaly, but we haven’t yet done the definitive studies. 

And the reason we don’t want to say anything definitive unless we 

do the study, because there may be other cofactors that are involved that we don’t know about. And if we come out confidently 

saying something and then it turns out not to be the case, we lose 

credibility. So we’re very careful to only talk on evidence-based as 

opposed to guessing what we think the answer is. 

Mr. DESAULNIER. From the CDC’s perspective—— 

Dr. SCHUCHAT. Yeah. We think that the changes in communication have both benefit and harm. And so, of course, it’s much easier 

to reach a lot of people, but that means it’s much easier for everyone to reach a lot of people. So the credibility of the public health 

folks doing the talking is critical, and we really want to protect 

that. 

Mr. DESAULNIER. I think we’re all aware in our world about the 

benefits and the curses of social media. 

Mr. Chairman, I yield back the balance of my time. Thank you 

very much. 

Mr. MICA. I thank the gentleman. 

I have a few more followup questions. Okay. We have people in 

the United States who were infected. They were infected outside. 

Right now, it’s winter across the United States, and we’re getting 

into more of the mosquito season. Do we know if the disease can 

be transmitted from a mosquito biting an infected person? 

Dr. Fauci, do you know? We’re gaining in the number of infected 

people in the United States. It’s in their blood. And a mosquito 

bites them; then we infect the mosquito population here. 

Dr. FAUCI. Right. That certainly can happen. 

Mr. MICA. I’m not a scientist. 

Dr. FAUCI. Well, certainly, that’s the way it is spread now in the 

areas where there is local transmission in South America and the 

Caribbean. We have those mosquitos in the United States, particularly in a certain region in the Southeast and part along the Gulf 

Coast. And one of the things that we’re preparing for is that we 

have, as you’ve heard from Dr. Schuchat and others, a considerable 

number of imported cases that got infected elsewhere and come 

home. We’re going to see more of those. What will not be surprising 

is that sometime in the future, we will see local transmission, 

where just what you’re saying happens, where someone comes 

back. They get bit by a mosquito and transmit—— 


AKING-6430 with DISTILLER
51 

Mr. MICA. The way you stop that is you stop the mosquito, like 

we have gone after West Nile. We had West Nile right here in 

Washington, D.C. 

Dr. FAUCI. Right. Exactly. So it’s an enhanced mosquito control. 

And that’s exactly what the people in Florida—— 

Mr. MICA. Okay. That’s mostly a State and local issue. I don’t 

know if we are helping those local entities or if they can use their 

funds. We have CDC funds—not CDC funds. We have it—what is 

it, community block grants? 

Dr. SCHUCHAT. Quite a bit of the emergency request is to be able 

to support State and local mosquito control. Mosquito control is 

very patchy right now. And there aren’t—— 

Mr. MICA. In Florida, we’re damned good at it because we have 

had mosquitos in, well, most of the Gulf Coast region. And I’ve 

worked in Louisiana along the Gulf Coast of Texas, and they’re 

pretty good at it. But, again, there are places that are not as good 

at it. And the reaction that Florida has taken is—Florida has set 

a model already for the United States. But what we want to do is 

make certain we’re covering the rest. It sounds like we have already had a little damage in Puerto Rico, the Virgin Islands, and 

some of the Caribbean region. 

Dr. SCHUCHAT. Yes. The living conditions and the climate in 

Puerto Rico and the Caribbean are such that the mosquitos are 

very intense, circulating year around. In areas that actually have 

good mosquito control in the U.S., the type of mosquito that we’re 

dealing with here is a bit difficult. There are a variety of species. 

But the Aedes aegypti mosquito is a daytime biter. It’s inside and 

outside. 

Mr. MICA. Again, public information for folks in the continental 

United States: You’ve got to use insect repellent. The local authorities and State have to do more spraying. We can’t leave—I’ve seen 

some of the recommendations already—even small amounts of 

standing water are breeding ground for the coming spring and 

summer. 

Dr. SCHUCHAT. It just may need to be more intensive mosquito 

control because this one is quite difficult, particularly, as I mentioned, in Puerto Rico. 

Mr. MICA. Now you didn’t mention this, Dr. Moreau, but I read 

about it and didn’t think about it. Did you mention that the games 

are being held in Brazil in their winter? Did you mention that? It 

might have been in your written testimony. But folks don’t know 

that, which means that you’ve got the best chance of not getting 

infected in Brazil where your Olympics are being held. Is it in July 

or August? I forget the dates. What is it? 

Dr. MOREAU. August for the Olympic Games and September for 

the Paralympic Games. 

Mr. MICA. That’s some of your coldest months down there, so 

you’ve got your least likely time of being infected for folks that 

want to go. We want our U.S. team to participate, to be protected, 

and we want our visitors also to have that. Every time you get a 

chance, Dr. Moreau, you need to tell folks they have the least 

chance of being bitten or infected during that period of time because it’s the opposite of the northern hemisphere. Okay? 


AKING-6430 with DISTILLER
52 

Okay. DOD has already done a lot of work. How have we been 

coordinating with DOD, Department of Defense? For anyone. 

Can you tell us, CDC? 

Dr. SCHUCHAT. Maybe I can begin, and Dr. Fauci can continue. 

There’s quite a bit of the intergovernmental coordination across the 

leadership to do the planning, both for force protection. There’s also 

a lot of research that DOD does, and they are part of our countermeasures group. 

Mr. MICA. So we’re not duplicating. 

Dr. SCHUCHAT. No. And the same with the Ebola research. One 

of the promising vaccines was developed originally through military 

work, so I would say the coordination is good. 

Mr. MICA. What would you say, Dr. Fauci? 

Dr. FAUCI. I totally agree. In fact, we have worked with the DOD 

on a number of issues, the most recent of which was Ebola. We’ll 

be doing it here, and we have very good coordination, and it comes 

centrally. I mean, we coordinate within HHS, but through NSC, we 

coordinate among all the agencies. 

Mr. MICA. At this point in the record—and with your permission, 

Ms. Duckworth—I’ll enter in the record, and we’re trying to get everybody who is involved here, their testimony, and we asked DOD, 

who is not a witness. We have testimony from the Department of 

Defense. We have testimony from U.S. Agency for International 

Development and testimony from the American Mosquito Control 

Association. 

And the gentlelady moves that this be made part of the record. 

Without objection, so ordered. 

Mr. MICA. So we’ll put that in the record at this point. Because, 

again, I’ve got three—well, two Federal agencies here, and we have 

got the State witness association here for our Olympic Committee, 

and we need to know that we have a coordinated and seamless connect with all of our agencies. 

Did you want to comment any more on DOD? 

Okay. I just saw here that there is research outside the United 

States, a British technology company—I don’t know the name—is 

currently testing a genetically modified mosquito named, a famous 

mosquito named OX513A in Brazil. Are you aware of this, Dr. 

Fauci? 

Dr. FAUCI. Yes. 

Mr. MICA. Are we doing anything with these folks? 

Dr. FAUCI. Yes, we are. The idea of genetically modified mosquitos, which you make a male sterile and release it into the environment, is something—— 

Mr. MICA. And they released some of these on an island already? 

Dr. FAUCI. Yes, they have. The release of genetically modified 

mosquitos in order to prevent the procreation of other mosquitos is 

something that has been tried in local ways where you would go 

into a relatively restricted geographic area, and it seems to be rather effective at a local level. The challenge with genetically modified 

mosquitos in addition to somewhat of the societal pushback about 

anything genetically modified being released into the environment 

is that it’s difficult to scale it up on a countrywide basis. That’s one 

of the problems we have with that. 


AKING-6430 with DISTILLER
53 

Mr. MICA. Okay. So, again, I’m just trying to find out if we’re 

covering all of our bases here. Then you’ve got—and I’m learning 

more as we go along—you recommended, CDC, some of the insect 

repellent. And I just found out—I didn’t know they had this—this 

is insect repellent for clothing and gear. And our all-knowledgeable 

ranking member, who knows about DOD, said: Yes, they have this, 

but they’ve also found it causes cancer. 

This seems like a good product. And I go down to like Puerto 

Rico all the time, one of my favorite places to visit. I just came 

back after the holidays. But is this stuff good to use, and are you 

guys recommending that? CDC, tell us if the cure is worse than the 

disease. 

Dr. SCHUCHAT. We work really closely with the EPA, who registers insecticides and repellents and so forth, and so our Web site 

has a link to what is okayed and what is not. So there are many 

repellents, and then there is permethrin treatment for the clothing, 

which some of the products are fine. 

Mr. MICA. The staff said that you said this is okay. But I’ll also 

be conscious of the warning of my very knowledgeable ranking 

member. 

Ms. DUCKWORTH. We used to soak our uniforms in it. 

Mr. MICA. She said they used to soak their uniforms in it. I’ve 

never heard of it, but it’s just interesting. Again, getting information out to people how they can protect themselves is so important, 

so it covered some of that. 

I was kind of shocked the first time I’ve heard your 62 days, at 

least for the males, to possibly be infected and have a—pose some 

risk. I’ve not seen that before. Is that the first time you’ve announced it today? 

Dr. FAUCI. That report has been out for a few weeks now—— 

Mr. MICA. I’ve not heard it publicly. I’ve heard 21 to 30 days advisory, which is a different situation, but I think we need to be 

aware of that. I appreciate your making it known publicly. 

Dr. Armstrong, you haven’t been neglected, and we appreciate 

your coming here. Okay. You’re at the other end of the spectrum. 

I’ve gotten a good report from our local health officials, quick response from the Governor, the quick response from you at the State 

level. Tell us, candid—I know it’s awkward having CDC and NIH 

here—is there something we’re missing? Is there something you 

could recommend that we should pay attention to from the State 

level and local? You’re on the front line. 

Dr. ARMSTRONG. Thank you for your question. We have to manage the situation in the State and locally with what we know. And 

what we have appreciated is guidance from the CDC now that is 

acknowledging uncertainty and what we don’t know and helping us 

to really provide insights for people out of an abundance of caution 

so that we keep them safe. I think that’s been a key change from 

Ebola to Zika, that there is acknowledgement by the CDC that just 

because they don’t have a definitive answer to something doesn’t 

mean something doesn’t need to be said. We still need a guideline, 

and we, again, are leveraging all of the CDC guidelines to protect 

the people of Florida and our visitors. 

Mr. MICA. Question, a followup to my question to Dr. Fauci about 

the genetically modified organisms. I guess there was some effort 


AKING-6430 with DISTILLER
54 

in Florida to curtail some mosquito-borne threats in Florida using 

that approach. Are you aware of that? 

Dr. ARMSTRONG. Yes, I am aware of that in the past, and I think 

that—— 

Mr. MICA. —that’s a route we should take? Was that successful? 

What did we use that on? I don’t recall. 

Dr. ARMSTRONG. I’ll have to get you the specific virus against 

which we were using a mosquito approach, but I would echo what 

Dr. Fauci says. I think there needs to be a great deal of public 

awareness and education before doing that, and we need to be 

aware of unintended consequences from producing genetically 

modified mosquitos. 

Mr. MICA. Now the other thing is you’re at the State level; you’re 

at the Federal level. When I spoke with one of our local health directors, he said: We get these cases. And he says: We’re also responsible for monitoring the individuals who are infected. He says: 

Well, we have very limited staff, and I need people then to be the 

monitors. And as you get multiple people, you need multiple staff 

checking up on them. So some of the resources to the local entities 

to actually monitor these folks, it appears it might be putting a 

strain on them. Do you have a way of dealing with that? Do we 

have some emergency funds at the State level to make certain that 

folks who are infected are monitored? 

Dr. ARMSTRONG. At this point, we are applying what we learned 

through monitoring for Ebola virus. We had a very aggressive program—— 

Mr. MICA. Yes, they told me, actually—listen to this—he said, 

‘‘One way we would go,’’ when they thought someone was infected 

with Ebola, he said they would come with a sign, ‘‘what’s your temperature,’’ he says, because you didn’t want to come in contact with 

them. That was a different situation, but you have to modify your 

approach to the risk even for the worker. My concern was the 

funds to make certain you have the workers who can go out and 

monitor these folks. Right now, these are very limited numbers, 

but we’ll have to make certain at a State level or on an emergency 

basis if we see where we’ve got to have additional personnel, that 

that need is met. I think those are the major questions. 

Again, we have some serious issues here. We have done—or you 

all have done—we have done nothing yet—but you’ve done a great 

job in staying ahead of it. Usually, this committee is very harsh on 

folks, and we had some tough time with the start of Ebola and 

some other issues, but I’m very pleased with where we are right 

now. We just want to keep it under control and go forward. 

Did you have anything else Ms. Duckworth? 

Mr. DeSaulnier? 

We’ll, again, keep the record open for additional questions for our 

witnesses and make any responses part of the record today. 

I want to thank each of you for your good work, for testifying 

today, and look forward to working with you, and we’ll try to 

pledge ourselves to get the resources that are necessary in a timely 

fashion. 

There being no further business before the subcommittee, this 

hearing is adjourned. 

[Whereupon, at 3:25 p.m., the subcommittee was adjourned.] 


AKING-6430 with DISTILLER
(55) 

APPENDIX 

MATERIAL SUBMITTED FOR THE HEARING RECORD


AKING-6430 with DISTILLER
56 


AKING-6430 with DISTILLERInsert offset folio 30 here 23028.030
57 


AKING-6430 with DISTILLERInsert offset folio 31 here 23028.031
58 


AKING-6430 with DISTILLERInsert offset folio 32 here 23028.032
59 


AKING-6430 with DISTILLERInsert offset folio 33 here 23028.033
60 


AKING-6430 with DISTILLERInsert offset folio 34 here 23028.034
61 


AKING-6430 with DISTILLERInsert offset folio 35 here 23028.035
62 


AKING-6430 with DISTILLERInsert offset folio 36 here 23028.036
63 


AKING-6430 with DISTILLERInsert offset folio 37 here 23028.037
64 


AKING-6430 with DISTILLERInsert offset folio 38 here 23028.038
65 


AKING-6430 with DISTILLERInsert offset folio 39 here 23028.039
66 


AKING-6430 with DISTILLERInsert offset folio 40 here 23028.040
67 


AKING-6430 with DISTILLERInsert offset folio 41 here 23028.041
68 


AKING-6430 with DISTILLERInsert offset folio 42 here 23028.042
69 


AKING-6430 with DISTILLERInsert offset folio 43 here 23028.043
70 


AKING-6430 with DISTILLERInsert offset folio 44 here 23028.044
71 


AKING-6430 with DISTILLERInsert offset folio 45 here 23028.045
72 


AKING-6430 with DISTILLERInsert offset folio 46 here 23028.046
73 


AKING-6430 with DISTILLERInsert offset folio 47 here 23028.047
74 


AKING-6430 with DISTILLERInsert offset folio 48 here 23028.048
75 


AKING-6430 with DISTILLERInsert offset folio 49 here 23028.049
76 


AKING-6430 with DISTILLERInsert offset folio 50 here 23028.050
77 


AKING-6430 with DISTILLERInsert offset folio 51 here 23028.051
78 

Æ 


AKING-6430 with DISTILLERInsert offset folio 52 here 23028.052