In 1947, in a room more remote area of uganda, virus,sts discovered a called the zika virus in the forest of which it was found. It is an epidemic for africa and southeast asia. Exclusively almost mosquito,e bite of a and aggressive daytime biter. It significantly diminished in this hemisphere until the recently resurfacing of the disease. We know a great deal about these disease factors, but there is much scientists do not know about the virus itself. Lack of knowledge and misinformation has created fear among many. According to the World Health Organization, the reason we do not know or about this include the relatively small proportion, one in five of infected people develop symptoms. A virus that is only detectable for a few days. The failure of a current test has distinguished zika from other viruses. The World Health Organization recommends that all people in areas with potentially infected mosquitoes, especially pregnant women, where protective clothing and repellents and stay indoors with the windows closed or screen. Postpone travel to affected areas. Existtly, no therapeutics to treat the zika virus, nor is there a vaccine, but that may not be for ever. One of our distinguished witnesses today, the director of institute will explain the scope of the research on the zika virus and the control. Lessons learned of years of Malaria Control have applicability to the zika virus. Distinguished speakers include the cdc mendez who has. Been here and has done a wonderful job on all of these issues. The u. S. Government has for quite some time, promoted tactics such as insecticides, mosquito nets, window and door screens and the use of strong that safe test to eradicate mosquitoes. The programs are tailored to developing countries. With the reemergence of this in the Southern United States and hawaii, we have to step up our domestic efforts to control mosquitoes before warmer weather leads to an explosion of mosquito population leading to an epidemic in the homeland. , oneding to the documents of the areas most effective, the ambassador to the United States, the brazilian government has displayed 220,000 troops to fight the vector of the infection by visiting communities, educating the population and health eliminating mosquito breeding grounds. Experts cite possible links to pregnant mothers and disorders affecting their unborn children. Noy are quick to point out definitive proof of such a linkage exists. According to brazils ambassador , this defect can cause other diseases. Experts are dealing with this and it requires an indepth study and analysis. Ran, thery that just president of columbia has said and all of the cases, there is not one case of this birth defect. In announcing the administrations proposal of 1. 8 billion to combat the zika virus, the white house statement said there may be a connection between the zika virus and disorders experienced by newborns in affected countries. He is the director at the pan america Health Organization and said there is a broad impacts for these birth defects, from mild to severe. Boston hospitals know that children with this birth defect experience normal intelligence and no difficulty with relationships or any other aspect of their lives, however many children with the disease, especially in severe cases have mild learning disabilities, impaired motor functions and speech delay. In the meantime, we much work hard to prevent the infection and provide compassionate ways to ensure any child born with disabilities from this or any other infection is welcomed, loved and gets the care he or she needs. Todayndez will testify that we need to expand best practices for supporting children. Parents with children of disabilities need to be supported as well. Journalists born ,ith this disorder told the bbc and a february 5 interview, that the condition is a box of surprises. You may suffer from Serious Problems or you may not. Says, day i was born, he the doctor said i had no chance of survival. He will not walk, talk, and he like many others found out the doctor was wrong. I grew up and went to university and now i am a journalist and run a blog. People need to put their prejudice aside and learn about the injuries. This hearing will look at the current implications of the zika virus and we have assembled experts and Health Leaders from the center for Disease Control prevention. Understandelp us where we are and where we go from here. I was just talking her statically that for more than four years i have urged the passage of my bill, the tropical diseases act, and dr. Mendez has ive it wassupport approved last month. 2011, we need more study in efforts to identify tropical diseases and find diagnostics. Time, the west nile virus was quickly making its way across the globe, including the United States. The ebola virus, first discovered in remote areas of central africa, caused a Global Health crisis only two years ago. Finally, and i say this with some concern, for the second consecutive year, the administration has slashed funding for Global Health accounts. Includes a 19 cut for Global Programs on tuberculosis, the world leading Infectious Disease killer. I know that is not your prerogative, but that is what was sent up to capitol hill. The administration is being shortsighted with tropical diseases, cutting that program by 15 . In the face of the Infectious Disease epidemics including tuberculosis, west nile virus, ebola and now zika virus, the administrations disregard is unacceptable. We must provide a sufficient resources to the study of tropical diseases before the next crisis appears. The study ofes these diseases, and in the year 2000 and even most recently, two years ago, legislation on autism and i thinkcies, that has had a huge impact on combating that developmental disability. Hopefully we will get some traction on that legislation. I would like to yield to the distinguished chairman, my good friend mr. Duncan. The chairman, chairman smith for the joint hearing and i appreciate us being involved. Subcommitteesphere is wanting to get engaged in this issue because we are seeing this virus here. There is a lot of concern about the allies and neighbors in the region. Ago, folks in my district had never heard of the zika virus. T is virtually unknown it has now exploded with cases in 26 countries, territories and the World Health Organization rejecting it will likely spread to almost every single country in the americas. Symptoms of the majority of people who contract zika are quite mild, links causing defects to unborn babies has created panic around the region. Last month, purcell recorded having over 4000 suspected cases brazil recorded having 4000 suspected cases. Further investigation has justrmed this defect in 400 of the suspected 4000 cases, and only 17 which tested positive for zika. A real threatains for pregnant mothers. Just last week, columbia confirmed the first three deaths with zika patients. And you those 15, the panamerican Health Organization issued an alert regarding the first confirmed zika case in brazil. Last month, the center for Disease Control issued a level to alert for pregnant women for any travel to zika infected places. The spready declared is the gut and international emergency. President obama has since responded for this week this week for congress to provide an additional 1. 8 billion to address the zika virus. I am deeply concerned of the impact this could have on future populations. Mosquitoes are simply part of everyday life here, especially in poor communities and where many Government Health care systems are not ready to handle a mass influx of these defects and zika cases, in particular, venezuela is reporting having over 4700 zika cases without basic health care. It cannot provide the needed care for women and it is deeply worrisome, with some predicting venezuela could see the regions worst zika cases. In contrast, brazil, the host of the olympics in august, has made huge progress, deploying hundreds of thousands of troops to help educate the population about prevention and to work with United StatesInternational Community to develop treatments. Given the rapid spread of zika virus in the americas, countries have tried to buy time to address the problems involving women and postpregnancy. El salvador has issued these recommendations. These governments may try to delay the spread of the virus, many do not have the luxury of simply choosing the way crime and violence plague the countries, and women are involved in the crosshairs. On february 5, the human high commissioner for the human rights call latin american countries infected by the zika virus to increase these i guess. They have some of the strongest loss on the books protecting the unborn. These latin american countries ban abortion completely while cuba has legalized abortion, making it widely available. This push for more Abortion Access is heartbreaking, especially because there are different degrees of this birth defect, and some children may go on to live very normal lives. Regardless, i believe every person, including in unborn child is made in the image of god, and therefore has inherent worth. We must do everything we can to support the women in latin america and the women in the caribbean facing difficult circumstances. In conclusion, as the witnesses will provide testimony of countries around the world, especially in the western hemisphere will fight and virus, against the zika while some intensely working together to improve health care and address the needs of women and the unborn child. With that, mr. Chairman, i yield back. Thank you very much. Thank you mr. Chairman. Virus, this isa going to be a challenge. Certainly, the mosquito we are dealing with is not an easy one to eradicate. , but not easy to prevent the purpose of this hearing is to make sure we get information out and not to give misinformation. Knowledge, the spread of misinformation can create panic, and what we want to do is we assure the public that we are and thisis outbreak epidemic very seriously. We need to be doing things in a responsible way. I look forward to the testimony ofwitnesses on how we our witnesses on how we are approaching this. How we are utilizing the funds. There is a lot that we do not know, and they need to come up with more rapid diagnostics. We certainly need to understand the extent of folks that are infected. The vast majority of folks are asymptomatic. We also know this heightened risk in women of childbearing age and women that are currently pregnant, and we certainly want to hear the testimony of the witnesses in regard to what we can be doing. Istainly what we can do liberalize the access to contraception, making sure that more women of childbearing age accesscted regions have to health care. It is about making sure those women who are not planning on getting pregnant, have the ability to terminate the pregnancy until we understand what we are dealing with. Countries need to dedicate resources to access to Family Planning services, contraceptives, birth control. This is incredibly important. For u. S. Citizens that are. Lanning on travel obviously, if you are of childbearing age, we would urge you to take caution. If you are pregnant, i would adhere to the travel restrictions. My sense is we would urge those women it currently pregnant not to travel to affected areas. That, given the interconnectedness of the globe that we have started to see some zika virus cases pop up in the United States. I would be curious, my senses these are generally folks that have traveled in infected areas and are returning. I would also be curious about the epidemic terms and where we are seeing the virus, we may be , saliva and semen other bodily fluids. I applaud the panel here. I am looking at this as a healthcare professional, and i would urge that we do not panic area i would urge that we collect the data and information , and if folks are traveling to infected areas, take the usual precautions. If you are off childbearing age, take those precautions. I would urge that we do use some of the resources the president has requested to make access to full contraception more available for women of childbearing age in these infected regions. That is one simple thing we can do to prevent the congenital abnormalities. I do not think anyone argues that that is not good medicine or in good prevention. Witnessesward to the and again, thank you. I would like to yield to the western hemisphere committee. This is my good calling from new jersey. Thank you, chairman. Thank you to the witnesses. I know how much you care about world health, and for people, this certainly is a situation that we have to deal with right now. Clarity on the virus and its effects and its treatment make it more important that we respond aggressively, more than we have the other diseases. I am very concerned that we have the olympics, a lot of people , and i thinkazil the brazilian people should be that the crisis i do notspur because think anyone would go to the olympics if you have a situation like this panic. 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. Thank you very much. I would like to acknowledge the evolution. Nd ecology she has provided us testimony in with that objection, it will be made part of the record. I want to introduce the panel. Starting with the director for the center of Disease Control since 2009. He has dedicated himself to fighting diseases. He led new york citys program that controls tuberculosis and reduce cases by 80 . He has helped to build a Tuberculosis Control Program that has saved more than 3 million lives. As a commissioner to the new york health department, he led programs that decreased illness and death. He has received numerous awards and has published more than 200 scientific articles. I want to go to the director of the National Institute of allergy and illness. He has been a director since 1984. He has overseen Extensive Research to preventing treatingg and in diseases. He has made numerous discoveries , and is one of the most cited scientists in the field. He served as one of the key advisors to the white house and on the global aids crisis. He has worked on disease threats such as ebola. He is one of the principal architects of the president s emerging plan for aids relief. I would hear from dr. Mendez, the administrator for Global Health. He has served since 2011. He adjoined he joined the Leadership Team to shape Global Health efforts to impact developing countries. Strategyking global 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. Document does is Board Certified dr. Mendez is a Board Certified. Thank you veryn much for calling this hearing and for the opportunity to discuss zika with you. We look forward to a full and open discussion. I want to start on the outset with some basic facts. First, we are quite literally discovering more about zika every single day. Clock working around the to find out as much as we can, as quickly as we can to inform the public and do everything we can to reduce the risk in pregnant women. Zika is new and new diseases can theyary, particularly when 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. If you are pregnant and live in an area where zika is spreading, do everything you can to protect yourself against mosquito bites. Mosquito that spreads this virus is difficult to control. I will talk about that more in a bit, but it is an important point. I want to think about what we can do to respond to zika in the shortterm and longerterm. The cdc is working 24 7 to get more information. We have elevated our level of oneonse on monday to level last month. Are committed to continuing to share information as quickly as possible with the public and health care providers, policymakers so that people can make the best possible decisions about health based on the recent and accurate data. 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 of threats. It emphasizes how crucially important it is that we continue to strengthen the systems that will find, stop and prevent Health Threats wherever they emerged over the world. Other countries and protect americans at home. I want to start with what we know. As you said, mr. Chairman, the virus was first identified in 1947. In 2007. Rst identified it is believed to cause no symptoms and 80 of the people effected, and mild symptoms in virtually all of the rest. , i mosquito that spreads it will show a picture of our enemy here. All right. There is the enemy. Mosquito is a very challenging, what we call disease factor to control. It is an indoor biter and bites throughout the day including dawn and dusk. It ties in closets and under tables and places that are hard to get to. Eggs can be drought resistant and persist for some time. Bite for five people quickly. Areefforts to control it challenging. It is hard to eliminate. I want to show you a bit about what is happening in recent two viruses spread by the same mosquito as zika is. On this map, you see the approximate geographic distribution of this disease are around the world. Near widely distributed the equator. Dengue has been recently present throughout the years. Means bentord that over with pain. It is a severe and painful disease. It can be very severe and fatal. Years, it was60 present in other parts of the world, but not in the western hemisphere. Over the last few years, it has spread widely within our hemisphere. These are the current known to viruseshere these two have been documented to spread. Anywhere, either of these diseases are present, zika may follow in the coming weeks, months and years. On the birth defect, this is an extraordinarily unusual defect. I want to emphasize that. In 1941, scientists identified rubella is causing the rubella syndrome. We have virtually eliminated this in the u. S. With the vaccine. Identifiedientists another virus as a cause for fetal abnormalities. We are not aware of any other viral cause of a significant number of birth defects. In fact, we are not aware of any other prior mosquito causes of birth defects, is in fact this is confirmed. The center, which you have heard the syndrome, which you have heard about, can occur in one in 100,000 people who have an infection. It is looking like it is associated with the zika virus infection as a post virus infection. The big difference is the microcephaly. I would like to talk about, based on what we know today is likely to happen over the next coming weeks and months. I want to talk about what we are doing to protect americans. First, we will discover more each and every day. I will show you later in the day, some new data that was released within the last hour. We will learn about child to child transmission, about cofactors, including other factors that may increase or decrease a womans likelihood of having the infection transmitted to her fetus. We will learn about the relationship with microcephaly from studies we are doing with partners and purcell, colombia and other places. We will develop better diagnostics. Currently, we can diagnose the active zika infection. We can find it in their blood. If it is a couple weeks or couple months later, figuring out if they had zika is very complex. Cdc scientists have worked for years to develop tests for that. We have a test but it is one that can have false positives for prior infections. We will learn more about the level of risk, whether symptomatic zika is likely to outcomes ashealth opposed to a somatic zika. We will learn how long a man rnfected with zika may harbo zika and spread it to sexual partners. We will learn how to stop the mosquito that spreads the zika these and for all of things, we will need additional resources, which is why the emergency supplemental request is so important. 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. We will see significant number of cases in puerto rico and other United States 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 outbreak of little over two years ago. 2014, the first case was identified in puerto rico. Each of these slides is a twoweek. Two weeks later, two weeks later and by october, it was an almost all of puerto rico and has affected 25 of the population. This can spread rapidly in a population. We will move rapidly to support pregnant women and reduce the risk pregnant women will become infected to monitor and reduce mosquito populations to the greatest extent possible, and the next thing we will see happen is cases or clusters in part of the u. S. That mimic clusters and the past. That is why we need support or local mosquito surveillance measures. We may see sporadic cases elsewhere in the u. S. And of course, unfortunately, continuous spread throughout the world. To finish, what we are doing now way, lookingnment at what can be done to reduce the risk in pregnant women. This cdc part of the supplemental request goes to pregnant women, reducing the risk of mosquitoes, preventing transfusion from rare forms of transmission, it in the future, vaccination. , andnduct Laboratory Tests develop the diagnostics used in this country. We are working around the clock to get these diagnostics out so that more people who want to the tested can be tested. We will improve clinical diagnosis and record mosquito surveillance, including resistance of mosquitoes to insecticides in to understand microcephaly more. Within the last hours, the cdc has released information from brazil about the findings among miscarriages two and two infants who had microcephaly and died within the first 24 hours. In working with our brazilian colleagues, we were able to material of genetic 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 we still need to understand the clinical and epidemic logical patterns to make that link defended it. Definitive. To do these investigations and do these well, we will need additional resources. Are a series of measures we can take, particularly in the u. S. Area of puerto rico and other parts that have had the virus 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. Thank you very much. Thank you for your testimony. Dr. Fauci thank you very much,. R. Chairman, mr. Duncan it is a pleasure to be with you this afternoon and to discuss with you the Research Conducted and supported by the National Institute of health in addressing the zika virus situation that we currently find ourselves in. It is important to point out that we are part of a government wide concentration effort with our Sister Agency cdc, fda and others to address the Public Health issue of zika, and our role is in the biomedical research. As shown on the slide, the National Institute of infected diseases, has a dual mandate. The mandate is not to only support a robust, basic and Clinical Research portfolio in microbiology and Infectious Diseases, but simultaneously, respond almost immediately to a new and emerging threat. The situation we find ourselves in right now with zika. Ago wrote just a few weeks in the journal of medicine, the virusirus is another threat. If you look just in the americas, not the rest of the world, over the last few decades, what we have seen was thatplosion of new viruses had never been seen in the western hemisphere. The doctor mentioned a couple of west nile and the zika in americas. These have the capability of spreading rapidly. What we have been able to do, and i will describe a bit of that for you, and then leave time for questions later, but what the approach has been our major mandates to provide the basic understanding of the disease, the Clinical Research, the resources throughout the country in the world, as well as Biotech Companies with the ultimate goal of developing what forall our countermeasures diagnostics and vaccines. Lets take a quick look at some of these and how they relate to the situation with zika. The doctor mentioned the issue of natural history. Contractors who have been studying similar diseases to try and understand the natural history. What is the definition difference between symptomatic and asymptomatic disease . What is the difference between andnfected pregnant women abnormalities like microcephaly . What is the spectrum for the pathogenesis . These are questions we are asking alone and together, including those at the cdc to try to get quick answers to them. If one looks at the basic science, if you look at other viruses we have been studying, ebola, ther even effort is trying to understand the fundamental microbiology and we have put an incredible amount of effort and know it helps a lot. We need to do the same thing with zika, studying the viral structures, comparing the nature of the virus in an outbreak in the island of yap with what we have seen now. Has evolved . Pathogenesised the and information of the disease . In any new disease, to understand pathogenesis, as well as to screen for drugs and test for vaccines, animal models are critical. The doctor mentioned the issue of control. There are a number of ways to do that. The classic way but also the novel ways in which we are exploring but should not take the place of the classic way, things like genetic manipulation of mosquitoes and bacteria. Again, to emphasize that this is not an easy thing to do as the doctor emphasize. Control is important, but it is not easy to implement. We mentioned diagnostics, and the cdc has taken the lead on that, but our contractors are using studies of other viruses to get more precise, stateoftheart, points of contact, specific diagnosis so women ifan tell they have been infected with zika during a pregnancy or before. Importantly, our role in the development of the vaccine is encouraging news, and the reason i say encouraging is because we have had positive experience with the development of vaccines for other viruses. Dangue in which there is already in approved vaccine in mexico. This was in collaboration with the institute. Nile, weon, west successfully made a vaccine but unfortunately, even though we went through phase one, we could not find a Pharmaceutical Company that wanted to partner they felt thise would not have something with a good profit because of the target population. I do not believe we will be left with this problem was he got, because we have already had a considerable amount of interest from the pharmaceutical companies. We will use the same technologies we used to develop the vaccinate vaccines for other viruses. We are already manufacturing the construct of that, which will make the gmp get into a phase one trial. I would think it would be certain by the middle of the summer, which is asking for safety. This is the schematic diagram of the vaccine we used for west nile. It is what we call the dna construct in which you insert the gene with west nile, but substituted and use zika, injected in an individual which will produce viral like particles which we know are safe. Therapeutics also, although it is not high on the priority, and we have to do a lot of screen. We nonetheless, are looking very carefully at Drug Screening capabilities and possible therapeutics for the entire virus. F the i want to close with the last slide, which reminds us of something i said at the beginning of my presentation, that microbes have emerged and will continue to emerge. Theuld add this is perpetual challenge, because we know 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 of ebola, and hopefully, i want to thank the congress for the support you have given us over the years to allow us to address these problems. Take you very much, mr. Chairman. I would be happy to answer any questions. Thank you for your testimony. Your statements have been very detailed. I want to go to dr. Mendez. Dr. Pablosmendez thank you. Thank you chairman duncan. Distinguish members of the committee for hearing us in the response to the serious concerns raised by the spreading in the americas of the zika virus. I also want to thank my colleagues who have mobilized in the response in the immediate investigation that we are already learning a lot in. As we learn from more outbreaks, we cannot wait before having this discussion and a response. We have submitted a 2016 supplemental request for the zika virus outbreak. Million so we25 can help countries infected by as it is spread to our homeland. First, we will support risk andunications and programs get the right information to the people and empower people with the right administer information. We do not want to panic to take place in the region as we implement actions to help people protect themselves from zika and other mosquito borne diseases. That includes mobilizing communities on Vector Control and women who are pregnant to protect themselves. We will implement social media campaigns and partner with companies in brazil to help us do that. Second, we will support implementation of a package of integrated ve cctor control activities in the regions at risk of zika. Specific activities would include Community Decisions and , vector mapping and window and door screening in homes and workplaces. What we have today is not optimal. They have been shown to work in a number of settings, and we need to work with our partners, developing new tools. As we do, we want to make sure they are available in these regions. We will build upon the foundations of the successful malaria initiative, aware zika is carried by a different mosquito, but we have the expertise and etymology in the response to zika. Thirdly, we will help ensure that women in affected countries will get support. This will include training of Health Care Workers to provide advice, support for a woman, ensuring them access to health care. This will be important to have information, services and theods as well as care for infected newborns. I know that is a concern. Finally, innovation. Toolsl implement the new , andevent future outbreaks the research we lead and is significant. We need to better understand the virus and the relationship with birth defects and develop new tools. As we have learned, the americas , and this organized will be important for us to bring tools and help the region. This can help with early diagnostics and product development, manufacturing and skill. In response to the ebola innovatione used new and addressed gaps in a response. We are creating a new branch to bring new ideas in the private sector. Ebolaairman, zika like points to a landscape where the animals, of the human, vectors are constantly changing. We are seeing an explosion in the tropical regions of the and urbanization changes. Ecological transformation, weather patterns changes are increasing the threat in a mosquito borne virus world. This is rapidly changing dynamics and we need to be prepared for the unpredictable. A recent report from the National Account of medicine discussed the animal life cost, 60 billion a year. Other estimates are higher than that. We need to make sure we are ofpared, because the cost life and economy is likely to grow in the coming decades. As we address the immediate improve National System systems, and i think this is the effort at the heart of the Global Health agenda since 2014. This is a perpetual challenge. We need to Pay Attention to the landscape and better understand and to build capacities and expand the base with pathogens. Detecting, we are hundreds of these new pathogens. We are screening and making sure they are not jumping into the human spaces. Many landscapes. We need to make sure science is there to address every prepare predict these challenges. We must keep this Bigger Picture and a longterm view if we are going to succeed against the micro time micro biome of the world. Conclusion, we need to ensure that future threats will be under control at their source and before they are a threat to the global community. With your partnership and leadership, as we continue this fight, i appreciate the opportunity to share these contributions. Thank you very much. Thank you. The committees will be following the fiveminute rule for questioning. I want to begin by throwing up questions. Control vector capacity. In africa, it took years to build up that capability, especially with the malaria efforts. I know the importance of this, if they dont have consequences from unsafe pesticides. Suggesting theou use in these countries and inadequate delivery mode . Secondly, in brazil, the areas of the highest prevalence are in extreme poverty. As a matter fact, the first 1000 days of life are the most ,ransformative efforts increases the immunity on the part of the baby, and it makes the mother healthier. From conception to the second birthday, these are absolutely transformative. We are looking on compromised immunity, and children in impoverished areas will have a lack. Like you, the pharmaceuticals developed transformers secondly with aids. Finally, in the United States, with civil rights legislation and the disabilities act, ensuring the persons with disability are franchised in society, you look to encourage other countries with best practices for supporting children with microcephaly, and you might want to explain what that would like like in terms of helping those countries care for children with disabilities. Director frieden maybe i can start with saying, your first couple of questions on Vector Control. We want to reduce mosquitoes reducing standing water, larva scides. And have looked at outdoor spraying because of characteristics and there may be limited effectiveness of outdoor spread. One approach has been used in some places is targeted indoor spraying. It is a different type of spring done with malaria, but there may a solution there, but it is labor intensive. Outline all of those critical approaches is rigorous surveillance for where the mosquitoes are and which insecticides they may be resistant to. We have a study underway in puerto rico, but we yet have found out what the resistance levels are. In terms of the impact of poverty, that is one of the things we will be studying. There is a lot we do not know. If there is an association, he did not know which trimester is of the highest risk. Is fewer pregnancies at risk, that is a critical thing we are investigating out. Thank you. Address thist me question. The main difference between the motherchild transmission and the one we have seen with hivaids in the particular challenge with zika infection and he mother and transmission to the baby is the chronic nature of the hiv in which you can suppress it in the mother by treating the mother. We know for certain by many good studies, that when you bring the levels in the mother to below to taxable levels, you dramatically decrease the likelihood that the mother would transmit to the baby, because you have a lot of time he does it is chronic. When you are dealing with an infection like seeker, which is a flash infection. Like the zika, which is a flash infection, and it is gone within a few days, the way to prevent motherchild transmission is what we did with the rubella model. If you recall in the 60s, there were 20,000 cases of congenital rubella syndrome in the United States. That is astounding. If you look at the curb when we instituted the rubella vaccine, which essentially targeted everyone, but it was specifically targeted to women of childbearing age, because rubella was a relatively mild disease similar to zika. I would answer your question about what is the transmission, and the best way to do that is to get an effective vaccine and and in a and i would like to adjust to of your points. We fully agree. The 1000 days have been the way which is happy best impact. Those 1000 days are crucial. Crucial both for prevention, because as you said, malnutrition will expose you to severe infection. Also malnutrition could play a role itself in leading to undernutrition and even associations of certain deficiencies with complications and the like. But the experience we have in nutrition also bring to bear the measurement of the head. That is something we knew to do better. We need surveillance and a system to do that. Workingrience we have in nutrition can be mobilized in this regard. As you know, we have been very successful with child survival. Hundred million child lives have been saved in the last 20 years. That, we moved from survival to wellbeing, and as the more we do that we Pay Attention to many factors. Disabilities is very important. In the u. N. , there has been an awakening of importance in paying attention to children with disabilities. In experience we have built on hiv and ebola. Education and research as to what will be the impact. And a social work to support those families. There are a lot of needs. We look forward to working with you. In a region we have not been as ofscient because of Success Development in this region, we have moved our researchers to africa and asia. Thank you mr. Chairman. I will keep my remarks tight. The difficulty with this particular mosquito, that is one of our primary tools, but not as easy as with certain other types of mosquitoes. Thefauci, you touched on importance of developing a vaccine. You arecurious pretty optimistic we could develop something fairly quickly. Let explain it so that it is clear. In general, the axes anywhere from three to eight years to get all the is dotted the and the ts crossed. We already have the construct you need, the candidate vaccine platform. So if you look at the timetable, you always know that in thats analogy, you have to know things can slip. We could start a phase one trial in august. They usually take three to four months, which means we could be finished by the end of 2016. Now the critical issue is if it is safe and immunogenic. If the outbreak is still raging, then you can go into an accelerated phase. You could likely determine if it is effective within six to eight months, and if it is, you could get an accelerated approval from the regulatory bodies. However, if only get two 2017 all the cases go down, it is what we faced with ebola. We had an ebola vaccine than all the cases disappeared. If it goes down, then you stretch it into several years. Inim talking to you february 2017 and we still have africa, weutbreak in likely could prove safety and efficacy in six months. Working with the private sector to get that vaccine commercialized and treated. Without the a problem . Dr. Fauci i do not think so. Already havinge calls with from cervical companies, Big Pharmaceutical Companies interested with partnering with us. I do not think we will have that problem. Of you touched on the importance of funding Global Health, global disease surveillance. Is this just another case of the interconnected world. I would just put out there the importance of funding and making that funding available and working together. We had ebola last year, we got zika virus today, we will have another infection next year. Good. Chairman, all im not sure what your ability what your availability is. We stand in brief recess. The subcommittees will reconvene and as soon as my colleagues come i will yield to them. I did as a question earlier in maybe you could elaborate. Actual the capacity, the volume of potential pesticides. I know you talked about the utter importance of draining city water. Hawaii, there is a to go aftery call spare tires that are housing water and then becoming breeding grounds for mosquitoes. I get that is labor intensive, but doesnt necessarily require chemicals. But what are the actual pes