then, we have a public event thatnnounced the release and announce the -- public event and announce the release of the volume, and give an overview of the volume. that's our purpose here today, thank you all very much for coming. here is the program we are going to follow for the event today. first, after i get through janet currie, who is one of the senior editors of this volume, and the professor of economics and public affairs, at princeton -- i am not sure how she sleeps. she does all of that stuff. i am going to give a brief description of the policy brief and tell you what the argument of the policy brief is. our event is organized around the policy brief rather than the entire journal. the only time we will talk about the entire journal is in the beginning. then we are very fortunate to have deborah lubar here, to talk about administration's proposal on the zika virus. then we will be joined on a panel. a panel of four people will discuss several issues that have come up, and we will give each of you a chance to ask questions of the panel. alan barreca will participate. that is the plan. janet. ms. currie: thank you very much, ron. this starting point is the idea that climate change is centered around the effect on our children, but we are not specific about what those effects might be, so the volume is to get more effective -- specific on what the effects of climate change might be on children. there are four broad themes. one important theme is this is no longer something which we are speculating about. this is something that is already happening and will continue to happen, and it is going to, and is already, affecting children's health and well-being. children are likely, for various reasons, to bear a disproportionate share of the brunt of climate change. poor children, children in developing countries, and especially children in countries that do not have very strong institutions are particularly at risk. although we know this is already happening and will continue to happen, we still have a lot of uncertainty about exactly how bad it is going to be. that depends, in part, on what we do. the fact that there is this uncertainty, and also that the costs and the benefits are in the future, and also that they are going to be very unevenly distributed, i think makes the politics surrounding climate change particularly difficult. so, i am going to start off just with this article, which many of you may have seen. it appeared in "the new york times" yesterday, and i thought it was perfect for this presentation because it hits all the themes i have talked about. climate change is already happening. as you can see here in the united states, we have our first climate refugees, who have been moved off the island that has lost 90% of its landmass and most of its trees because of salt coming up through the water table. $48 million has been allocated to move people off of the island to different locations. you can see literally the poster child of the article is a 3 -year-old girl whose family is going to have to move. this is a poor community. this is a native american community, illustrating again that it is a poor that are most likely to suffer. then, on the political front, even this relatively small and well-defined thing -- let's take these people on a sinking island and move them somewhere else, is still, kind of, a heavy lift, and fraught with various difficulties that are discussed further in the newspaper article. so, in terms of what this volume covers, we start by talking about the science of climate change -- what is known, what is not known. having set the stage, with an focus on temperature extremes, which are one of the most obvious implications of climate change. children are particularly vulnerable to health effects of high temperature, which is one of the many ways in which climate change affects children. we talk about climate change and conflict. there is a growing body of idence that high temperatures are related to conflict, in part because they can have severe economic effect. so, in parts of the world that are prone to conflict anyway, if you do things that threaten farmer's livelihoods, that makes it more likely there will be an armed conflict. we discussed natural disasters and effects on children. again, that is one of the things that is expected to become more common due to climate change. we talk about pollution and climate change, which i will go into a little bit more detail about in a minute. climate change in developing countries, which is a particular problem. and then we talk -- it is a little more technical, not just a little about how we measure the costs and benefits of climate change. a lot of the standard ways economists think about things are quite difficult to apply when you have something that is going to have -- take place a long time in the future, and also where there is substantial uncertainty, and that, i think, bedevils efforts to talk about this in a really rational way. then, finally, we come back to the political problem that it is so difficult to mobilize effort to combat climate change. ok, so, looking at temperature, this figure, which is from the chapter on temperature, shows the number of days over 90 degrees that are expected in four u.s. cities. the white bar is for 2001-2010. that has already happened. the next graybar is 2046-2055. the black bar is the end of the century, 2090-2099. what you are going to see is it is going to get even hotter in houston, although it is pretty hot in houston already in the summer. maybe, arguably, people in houston are used to dealing with that. if you look at kansas city and new york, the two middle sets of bars, you have a really big increase in expected hot days. so, in new york, it goes from 10 days in the summer to 70 days in the summer by the end of the century, so that is a big change. then seattle comes off relatively easily with an increase to only 20 days of really hot weather. so, this is just illustrating how the cost of climate change, even within the u.s., will be unequally distributed across regions. now, some of the things that we could do about climate change in the short term, which will also have some benefits in the short term are reducing pollution by, for example, switching more to renewables from fossil fuels. so, this table here, which is based on the projection made by the intergovernmental panel on climate change projection a1b, for those of you that follow these things -- is based on the idea that we use more renewables. and if you just look at the far right column of the table, there is an estimate of how much the switch to renewables would reduce infant mortality by reducing particulate matter. so, this would be a benefit of something that would affect climate change in the longer run, but would have a short-term benefit on pollution. you can see these benefits are also unevenly distributed. and the south east you would have a decrease in infant mortality. in the northeast, you have a fairly large decrease. in the west, not so much. this figure is just summarizing what is in that column, showing the decreases in infant mortality that are projected by region compared to doing nothing, which is the light gray bars. similarly, infant mortality is obviously very important, but one reason why it is important is it is a more general marker for child health. the same things that reduce infant mortality are the same things that will increase people's health in the long term, and healthier people will have higher earnings, so this projection is projecting that earnings would also increase in the same places that had the biggest decreases in infant mortality. now, moving a little bit from the u.s. to the rest of the world, this figure is just showing particulates for one u.s. city, pittsburgh, where we have data over a long period of time, and we all know the air to be really bad in pittsburgh, but it has really improved over time, and showing by way of comparison, numbers for the same particulate matter of pollution for mexico and for china. and see things have also been improving in china, actually, but they started at a much higher level, so people were being exposed to really bad air. so, again, anything that affects pollution and also affect climate change would be a win-win in that it would have both short and long-term affect on people's health. staying with the developing countries area, i mentioned a little bit about the research on conflict. this map is showing the horn of africa, which is a place that has a lot of conflict. on the left, what you see is a map showing how much change in temperature that has been sent -- since 1991 to 2009. you can see even within that relatively small area, there are some places having even more temperature change than other places, and then using that kind of variation, the authors of this study, which is summarized in the chapter on conflict shows that you would expect to have both a short-run and a longer-term increase in conflict as a result of the temperature change. so, turning again -- this is a, kind of, rapid walk through the volume, but turning to the chapter on cost and benefits, this table illustrates one of the problems. so, what it is actually showing is the solid line being a projection of economic growth -- not paying any attention to climate change. so, standard economic models that forecast economic growth don't usually take climate change into effect. so, we think that growth continues, and in the future we should all be richer. now, the dashed line is showing what happens if you have catastrophic climate change, and the interesting thing is that nothing happens immediately. it is happening at the end of the century, and then you have a decline in real consumption compared to business as usual. ok, so this is one of the things that makes climate change a heavy lift in the sense that if we do nothing today, nothing will happen tomorrow. it will happen in the future. then, another issue with respect to thinking about costs and benefits is the issue of what discount rate we should use in the future -- that is how much should we value things that will happen in the future relative to today? if you look at the numbers on the far right, it is showing a 5% discount rate, which is really standard, and what that says is we do not value at all . $1000 in 2200, because that is too far in the future to care about. in order to have a discussion about climate change, we also have to change the way we talk about future costs versus benefits to take into account the needs of future generations. ok, so i just wanted to make one comment about the heavy lift. to talk about one particular example, the waxman-markey bill of 2009, which was not passed -- so, 2009, only seven years ago, already seems like a long time ago -- if it had been passed it would have reduced carbon emissions by 83% by 2050, so that would have made a really significant impact on what is going to happen in the future. now, of course, it wasn't passed. after going through the house, it didn't make it through the senate. and -- so, this is just one illustration of a history of failure to address the issue. so, that is all i have time for. you would like to take a look at the issue, i think you can get copies at the back, or it is all online at this website. [applause] mr. haskins: thank you, janet. i appreciate it. as i said before, whenever we published a volume twice a year, we write a 3000-word policy brief trying to seize upon some issue that is implied in the volume, but to play it out a little bit, especially in a policy sense, and we try to pick things that are actively under consideration in washington, and we were quite forward -- fortunate this time that zika appeared. it is unfortunate for people's health -- we do not know the extent yet, but it certainly does lend gravity to this event and this issue, and it makes our point, which is there are a lot of implications here for public policy, especially for children's health. so, we will learn a lot more about zika in a few moments. so, here is the logic of the brief. temperatures are rising. janet already covered things. i am going to mention a few other things i think are interesting. rising temperatures have impacts on children's health. there is a whole chapter that goes into that in some detail, and one of the indirect effects -- paths is through infectious illness, which a lot of people might not think of as being related to environment, but i will show you how that is the case. zika is a great example of that, and i will talk about why. in doing so, we will focus a lot of attention on the 1980's egypt time mosquito, which is a strange creature that has all sorts of habits that make it unlike other mosquitoes, and some of it there on its vector, the means of transition. we are fortunate to have debra here to talk about the administration's proposal, and as is good in washington, we will have an argument about the proposal. i want to talk about temperatures. this is from the national oceanic and atmospheric association. if you look at it, the trendline begins in 1950, but it looks like it is starting to pick up around 1980, which is consistent with other evidence, and it has gone way out. the last two years have been huge temperatures. i think 2015 was the hottest year we ever had, and we are on course in 2016 to repeat that. so, temperatures are going up, and especially -- this is an important point. this is a difficult draft. we undoubtedly have great experts that understand this stuff, but for a normal person, what has happened is the red is temperatures, and the white is normal distribution. and what is happening is that the temperatures are shifting up. the entire distribution of temperatures have shifted up. and an especially important feature of that is the details of the distribution, is increasing even more. so, we are getting even more increases in extremely hot days, usually defined as 90 degrees, or more often defined as 90 degrees or more. those are the one suggested pointed out can have a big impact on health, especially on infants. studies show that infant death rises at temperatures above 90 degrees. so, if projections are correct, these are really important considerations. so, temperatures going up. it has an egg on children. it has direct impact -- it has an attack on children. it has a direct impact on infant death, and indirect effects, especially on vector-borne diseases. i want to focus on vectorborne decisions, and the vector here is 80's egypt i. it was said of this little mosquito, he loves us. it loves our cities. he loves our blood. it is a colorful statement of what this little guy is like. this guy is especially thirsty. this particular mosquito carries a lot of infectious diseases, including yellow fever, dengue fever, and i have read several arguments about how you pronounce this word, but i'm going to say it with an english-american way of saying it, chikungunya. there is a more fancy way to say it, but i could not master it. it carries all of those, in addition to the zika. so, this guy is a very important means of transmission of disease two children. why is that the case, and why are we concerned about zika and the role of aegypti? there is some evidence that has the widest range now that it has ever had. places that have increasing temperatures -- many mosquitoes are more likely. it is easier for them to breathe, they multiply faster, and occupy new areas productions -- i think these are mentioned in the journal, but our journal is more focused on climate and children -- that say even in the united states we are going to start getting zika. quite a bit of expansion of territory is present in the southeast, but it will expand. it breathes in and around standing water, which is extremely important. especially when it is hot, people like to have more water, and especially more traditional societies, they keep it in buckets and pails, and all sorts of things all around, and if that can be breeding grounds for mosquitoes and all sorts of other things. so, that is an important idea on what might have an impact, and has in the past, on trying to control insects, and especially zika, that you need to do something about standing water. also, a rising temperature allows the zika virus to multiply more quickly, and there is a particular feature of this mosquito that i found fascinating. i did not know anything about this until i started reading into this. most mosquitoes bite you and talk up your blood, and they go away, and they do not bite another person. they are satisfied for a while. this mosquito only takes a little bit of blood, goes to the next victim, takes another little bit of blood. they can infect several people if they happen to be carrying whatever they happen to be carrying, so this aedes aegypti is really a formidable weapon in nature's attempt to get us. it is after our blood, and it has the capacity to affect many people at one time. that is why margaret chan, the head of the world health organization, in discussing the zika virus, she said it is the main cause of what she called explosive spread in the americas. i am sure she was referring primarily to south america. this, of course, raises the question now what? what are we going to do? it is not an emergency at this moment in the united states, but it is potentially a very serious problem. so, should we do something? and here to answer that question is debra lubar from the centers of disease control and prevention. thank you so much for coming. ms. lubar: thank you, ron. i am glad to be here, and i'm glad you set of our nemesis so well in the fight by describing the aedes aegypti in some detail. i am going to tell you a little bit about cdc, what we are doing, and what we need to do, and give a little bit of background about the zika outbreak. just a little bit about this great agency that i represent -- cdc was founded in 1946, and we were founded to deal with malaria, so mosquitoes are part of our origin story and continue to be part of the work that we do. we are in atlanta. we are the only, i think, federal agency headquartered outside of washington, which gives us a different perspective on life than many of you probably have. so, our mission is to save lives and protect americans from health, safety, and security threats. and one of the interesting things about this outbreak has been seeing all of the expertise at cdc that we are able to draw on. a lot of times, when we are responding to emergencies, it is infectious disease outbreak and infectious disease doctors and experts leading the outbreak. in this case, we have really seen, across the agency, drawing on expertise in vectorborne disease, environmental health, birth defects, reproductive health -- i think we are a very unusual collection of people that are able to bring all that together to support this response. so, we base our actions in science, but we are very much a practical agency who is out in the field, and you will hear more about that. we work in partnership with state and local public health agencies. so, there is the public health system in this country, and cdc is not in charge of it. that is an interesting thing about our work. a lot of the authorities for public health interventions are local and state-controlled, so i'm going to talk a little bit about cdc's budget, because a lot of what we do is fund and support the public health system in this country and around the world. we are all over the united states, even though we are headquartered in atlanta. this gives you a little bit of a sense of where we are. we have some very specialized labs around the country, and one of them that you will hear a lot about today is in san juan, puerto rico, where we do our work on dengue and increasingly, zika. and this600 people, will give you -- i'm just going to go through this very quickly. we are working on disease detection in general, polio eradication and measles immunizations, flu, still working on malaria all of these years later. global hiv and aids is a huge part of our footprint. we are training in partnership with other nations, and we are working across governmental initiative called global health initiative that i will mention a little bit later. cdc's budget is really complicated, and my job, which i should have mentioned, is running the office of appropriations. so, i work with congress and the white house on cdc's budget, which is why i'm here today to talk about the zika request. cdc is funded from a number of different sources, and this gives you a pretty big picture of what our money does and where it comes from, and i can answer questions about that if people want to dive in deeper. our core budget is about $7 billion that congress decides on each year. this is a budget history of your budget, and you can see 2013 was low. you guys remember 2013 in d.c.. we had some sequestration, and things like that, but it has been relatively steady the rest of years. we are funded in these broad categories you see on the screen. something people do not really know or understand about cdc's budget is how detailed this is -- this is one page out of a five-page table where 160-ish budget-line items are presented as congress directs us to spend we are bound by that. it is one of the reasons that, when we have emergencies and a need to surge, it can be challenging for the agency financially, and we are not always able to be as nimble as we would like. so, just as one example that is relevant here, this is a budget history on vectorborne diseases. we have a line item for that. the name has changed a little bit over the years. you can see there was some growth there. you remember the west nile outbreaks of the early 2000's, and there was some attention to vectorborne diseases in the united states. it has been, kind of, relatively steady since then, since the drop in 2007. that is the place where congress has this is how much money, you will spend this much, and only this much, on vectorborne diseases. we get that direction every year. so, zika comes along, and this is an overview of the transmission patterns. until the last few months we actually did not know about two of these transmission patterns, or transmission pathways. so, this is really a space where we are learning more every day, and we are more and more alarmed by some of what we are learning. we expect to continue to find new -- hopefully new solutions, and also new challenges with this virus. the sexual transmission pathways and the pathway to the fetus are the new findings. so, just an overview, this is a virus related to other viruses, as ron explained. this virus is not new, it was discovered in 1947. for 57 years, there were 13 cases reported. very surprising, there was an outbreak in 2007. at the end of last year we started to see huge spike in cases in brazil. authorities in brazil suspected there were nearly one million cases. that is tremendous growth, and not what we expected. the other thing that we did not expect was the significant risk to pregnant women. the efforts that you will hear about --zika is not a serious disease for most people. most people don't know they had it. and it might look like any other cases in brazil. authorities in brazil suspected there were nearly one million cases. that is tremendous growth, and viral infection that we might get over. the tragic outcome has come for pregnant women. this is the first time in more than 50 years that we have discovered an infectious disease cause of birth defects. it is really the first time the mosquito bite could cause these lifetime consequences for families. it is also an association with guillain-barre. zika virus is section during pregnancy. we have now determined it is a cause of microcephaly and other brain defects. what we don't know is the full range of health problems that might result from this infection to the fetus. that is something we really do need to study. it will take time to see how children who may have been exposed develop. that is part of the work we are starting now and that we hope to continue with, some emergency funding. this is what we have been doing, what we have been able to do to date good we have determined the length of the microcephaly and guillain-barre. we are looking at other pregnancy outcomes, we have seen miscarriages and other things. we learn that sexual transmission is more common than expected. it seems to be happening more than we would have predicted. there a lot more to be learned. here are some of the things we're doing. i hope you have all heard about our travel guidance, or particularly for pregnant women. we are working with clinicians so they know what to do was somebody in the united states who may have traveled. this is not an emergency yet in the u.s. it is an emergency and pair -- in puerto rico and the territories. a lot of our early response has been to support those areas. i'll talk more on that. we have been doing a lot in the laboratory diagnostic area. we have several different tests that we have been getting out to the public health labs around the country, that system where it is not all cdc during the testing. we do a lot of validation. we have been developing new diagnostics that are easier to use and better at detecting. this is a picture that you have described well. of our foe. i want to talk a little bit about the factors that contribute to spread. we have heard a lot about climate change. certainly vector-borne disease and being able to track where the vectors are happening are part of understanding changes in the climate. what we see is it is not easy to determine what role climate might be playing. there are a number of other factors that are affecting the spread of the disease, including global travel and movement of infected humans and we have over 400 zika inspections in the continental united states. living conditions, i'll talk a little bit more about our very big factor. as ron described in terms of standing water and urbanization. the disease reaching populations who have not been exposed before cause large outbreaks as well. there may be changes in the virus. this could be our public health intervention, if we can get the mosquitoes to just avoid us and go to happy hour, that would be a most excellent outcome. but that is not available. we are looking at one of these other factors. this is a really interesting case. this is spread of the same mosquitoes spread at the u.s. and mexico border. what you see is obviously these places do not have difference in climate and vegetation, but they are very much in the same place. but the living conditions are dramatically different. you see 4% infection rate in brownsville, texas and 32% infection rate across the border in mexico. here are the factors are 85% of the homes in brownsville are air-conditioned and only 29% across the border. there is a lot in texas, you are not crowded together. that is part of what we are seeing in puerto rico, infection rates that are close to what you would expect in that kind of an environment. this is the map of air travel. this is where i come back to the global health security agenda. the cdc is a part of the cdc is a part of governmentwide effort to improve health around the world because of the connection that we have with the rest of the world, that we are all connected by the air we breathe, the environment that we live in and by the human connections through all of the travel and trade that goes on across the world. the effort that underlies the outbreaks that we see is to bring other countries capacity to respond and prevent diseases around the world. to strengthen that globally. that will help us -- ebola was a stunning example of how an outbreak in one part of the world can affect the global health and economy. this has been a major effort, and is part of the ongoing public health capacity building that we are doing following the ebola outbreak. just to show you some maps, this is the spread. of dengue. from 1950 to 2013 this is spread of chikungunya. this is zika moving is part of this trend. you can see that these are fairly regular patterns. i want to talk about puerto rico quickly. where we have seen these outbreaks as the bellwether for the u.s. this is chikungunya in 2013. this is what we are seeing now in puerto rico, the top line is zika. you can see the dramatic increase in the third or fourth week of the year. this is what puerto rico looks like today. with over 600 locally acquired infections. their labs have done over 6000 tests. the have 6500 pregnant women 65 pregnanet women with zika. the lab needed a lot of support. we have a lab in puerto rico, we have been and will to partner with them effectively. we are also helping with pregnant women and newborns to understand what the risks are longer-term. here is the map. we have some concern about transmission. what i want to say about this map is this is the best data that we have. a lot of it is based on models and other things. we don't have really strong vect or surveillance. we like to go out and confiscate a spirit we are hoping that one of the things we can do through this response is really improve our vector surveillance and's country. this is a challenging mosquito. that is why people call it the cockroach of mosquito. we have to do many things to try to control it. there is not one specific intervention that doesn't job. in puerto rico, those efforts are focused on the homes of pregnant women. very targeted. it is not something that is effective if you try to do a communitywide. we have over 400 travel-related and sexually transmitted cases in the continental u.s. right now. we are working with state health departments to monitor those, and to provide clinical guidance particularly for pregnant women. i will get to the spending request. the administration has as asked congress for $1.9 billion in emergency funding. 1.5 of that is for the department of health and human services. you have heard me talk about some of the work we're doing. we really need to dramatically expand, and we need to do it before mosquitoes even hit the hits theto season continental united states. we are already working with some funding that we repurposed to work with all of the states, particularly those that appear on the maps. we know that we have seen limited outbreaks in the united states. we don't think we will have explosive outbreaks. we need to be vigilant about that. we need to continue to support puerto rico. we also really need to learn more. some of the things that we would like to get started on as soon as possible are some of those longer-term studies, to see if we follow babies born to women who are exposed to zika. what are some of the factors or youwhat are some of the factors or in -- risky for those women? what are some innovative message -- methods and what are some better diagnostics. that's an overview. thank you. [applause] >> we would like to hear from alan brekke from tulane. >> hello. i work on thinking about ways for us to mitigate the health cost of climate change. today i was sure some lessons -- today, i am going to share some the lessons i learned from my research on malaria. we will see how we can apply those lessons to zika today. i want to start in a nonfictional setting. i will tell you more about this location later. where you have a one in 10,000 chance from dying from malaria. you also have a one in 50 chance of contracting this malaria, it brings on serious fevers and chills, very challenging for you to go to work or school. as i have found in my research if you happen to be a child who , is born in a particularly bad epidemic year, where there are high malaria rates, you may have development delays in childhood, 10% less likely chance of finishing high school, 10% higher chance of ending up in poverty. this is not the case in the u.s. today. throughout the world, there are some 200 million cases of malaria every year. 500,000 deaths. these are our best guesses. there is virtually no chance of contracting malaria in the u.s. what can we learn from our experience with malaria? i should say that this fictional setting i am taking you too, is we will look at malaria in the united states. the u.s. in the 1920's and 1930's, malaria was a serious problem. what can we learn from our experience? i have a map for you of malaria death rates. malaria cases were very hard to record in the early 20th century this map shows places like louisiana, panhandle, mississippi delta, was the area where this was most prevalent. 10 times higher than say in virginia. the south, malaria was a southern problem. also, the south is also poor. this is also the case regarding zika. there is another important lesson for our talk today, given our focus on climate change. the south is shocking revelation, warmer than the rest of the u.s. i am from new orleans, and i can preach to that. laboratory experiment says malaria. populations rise when the temperatures are in the 70's and 80's. it has to be nice and warm. these are from lab experiments. what does this mean for us in the future? as ron noted, we will see the distributional shift in temperatures in the u.s. we will even end up with more temperatures in the extreme. to put this into a nice and simple statistic, climate change model predicts something like 60 more days of 80 height.air in fahrenheit. the study that i have seen on the 1980's, they suggest though temperatures are ideal. that is suggesting that we will see increased risk of mosquito borne illnesses in the u.s.. more risk in the south, throughout larger parts of the year. also the risk of moving north. what can be done. a little bit of hope. malaria is not a problem anymore for the united states. what happened over time? in the 1930's, malaria death rate was 10 per 100,000 per -- per 10,000 -- per 100,000. that's about the same level we have for our debts through motor -- for our deaths through motor vehicle accidents. that's relatively high. that's a real number. they think the infection rate was 200 times higher than that. in the 1930's, malaria transitioned in the u.s. was relatively stable. then a big drop between 1935 and 1940. what happened? there are a few things. the first being the new deal allocated a considerable amount of money to drain ponds, constructing better drains. something like tens of thousands of ponds were drained, and thousands of miles of ditches were also better drained. this is the first thing that we think led to this drastic decline between 1935 and 1940. the second thing we think is that populations were moving out of rural areas in the united states, where the context -- where the contact between humans and mosquito was relatively frequent. when you take people and mosquitoes and you separate them, you break the cycle of the disease. as part of the new deal, they paid farmers to follow their land, this led from a church is transitional way of sharecropping, where we had large numbers of farmers with small plots of land who ended up having to leave because there was no need for their labor. they moved to urban places or and it up moving north. that helped to break some of the cycle. i want to mention is where we don't have as much as evidence for is that education was increasing over this time. we can't account for the start -- the stark decline between 1935 in 1940. it wasn't until 1900 where people knew the malaria parasite was caused by the mosquito. they used to think it was caused by bad air. at the earliest 20th century people did not quite have the grasp of where this was coming from. there might be some lesson here about how we can use education to reduce the prevalence of zika. the cdc came into being around. 1946. we began spraying for mosquitoes around that time after world war ii, because we knew to conceive ddt chemicals, very powerful chemical. it wasn't the spraying back caused this massive decline. old-school technologies ended up having a sizable affect on the mosquito borne disease in the u.s. keep three things in mind, one, southern states are more at risk. i would expect children to be more effective. climate change will increase these risks. 60 additional days in really hot temperatures, and some old-school -- i don't want to say that these are the magic bullet to solve the zika problem. to think about spring with powerful insecticide. some effective tools we can draw on from the past. we could think about another plan, drainage, economic development possibly drawing people in from subsistence farming and to an urban environment. we could also think about teaching and educating people about the ultimate cause of zika . the final thing i want to leave you with is a quote by the dalai lama," if you think you are too small make a difference, try sleeping with the mosquito". thank you. [applause] >> thank you for the those great presentations. i really enjoyed them. i want to talk first, i'm going to ask a few questions but i want to talk about timing. in the journal, a lot of articles about what we can really expect for nations to change carbon emissions. if we could do that, which is no means certain how successful we will be at doing that, how long would it take before you begin seeing of the as a result impact on the mosquito. the spread of illness, all the various effects that are shown to have an impact. how long will it take? >> i can talk about that. when of the problems with talking about climate change is that there's so many timescales to be aware of. the scientists say now that even if we cut carbon emissions to zero tomorrow, temperatures will keep rising for a while. we are already on that path and we will have to start dealing with it. we probably won't see a reduction in temperature, but we want to see a but it doesn't keep increasing anymore will take a while. there are some things like reducing pollution, which will have an affect on climate change, but we could see a more immediate benefit. it also has a more local benefit, if you are a diverse particulate matter in washington dc, people there will benefit from that say in the next decade. then the timescale we are talking about for the zika virus, that is where we need to respond right now. we wish we had responded yesterday. that just makes it difficult, because you have to juggle all these timescales. >> here's another time-related question. i mostly do not study public health issues. i am fairly new to this question -- questions are coming up a mile a minute. one thing about this area that is interesting and public in general, is that a lot of things haven't happened yet that you're worried about. those are hard to convince people that they ought to watch out because this could happen. it is also difficult to convince congress that we are to spend money on things that didn't happen yet. this is a problem with this whole area of trying to get people prepared for what could five or 10he next years from now with pregnant women. that is a great example. we don't really have great information from brazil yet. how do you deal with that? what are the conclusions we should draw from this? how do we convince policymakers that this is a big threat, and you better take care now or you'll be sorry later. >> i think that how we market climate change, we always talk about it in terms of these one and two degrees celsius increases, if it is december, it's hard to feel that is a bad thing. what i like to do -- that's what -- i think that is important to emphasize, coming up with these metrics that are really easy to feel. a lot of hot days we will experience. how many days are we going to experience that are above 80 or 90 degrees fahrenheit. even in december, i feel what that's like. >> this is a huge challenge for public health in general, and not because we have to get people to pay attention to things that haven't happened yet. when we are successful, things -- when we are successful, bad things do not happen. it is hard to point to the successes as well. sometimes in public health, they feel like it is invisible because the only time people notice -- i think zika has been an interesting example because it has been creeping our way. it is not something where there is huge person to person transmission like ebola, where people wear afraid that if we had even one case in the u.s. that we would see something very dramatic happen. i do feel that they are recognizing the seriousness of this issue, and seeing what is happening in puerto rico has moved people. i am hopeful that we have been effective in communicating what the risk is. at the same time, the risk to the continental united states we think is fairly limited in terms of person to person, it mosquito -- in terms of mosquito transmission on the continent. we don't want to alarm people, but we do want to have and be -- we do want to have better data and be able to target interventions and prevent as many cases of pregnant women as possible. >> one of the things i think we have to discuss briefly, this mosquito seems different from other mosquitoes. in many ways. one of them seems to be that it is hard to kill. a lot of things we have done in the past, especially spray them and spray in areas like we was in ake we would spray forest where we have an impact or a modest impact. if you cannot use sprays, doesn't that limit our -- they will be less effective -- the most effective is going to people's houses and spray their house, which a lot of people will resist. that is not off the table, but it cannot be a major method of control. what are we going to do and we control the spread and kill the mosquito in areas where worried worried?people are >> drainage, attacking them at the source. the ades ageypti cannot breathe in small pools of water, this is an informational campaigns to just be mindful around your house. if we can stop that part. this probably suggest going into developing countries where there is this problem. that's where the returns will be, not necessarily in the south of the united states. the returns will be higher there with educational campaigns. the u.s. had yellow fever up till 1905, and it was a problem in new orleans. they conquered it despite -- with educational campaigns. they had a lot of economic incentive to do so. it was an important trade town. >> people respond if they think it is their health or the health of their children, that's a motivator. >> what is happening in puerto rico is the behavior change and wearing long clothing and staying indoors, are focused literally on the pregnant women. we have been working with puerto rico department of health to identify women who are at risk and working with the health department to bring the spraying to their homes, screening the windows, provide individualized protection packs on things they can use in their home. it is very targeted. outdoor spraying, by itself is not going to solve the problem. >> i want to talk about the administration, and policy. this is an interesting case. i had the opportunity of talked to several people in congress, republicans. here is what i think the situation is. i have not heard republicans oppose the administration, not saying we don't need this proposal, not saying this is not a big problem. they are claiming it is not an emergency, and that the administration should not pay $1.9 million for his proposal, the ship administration should increase taxes or cut another benefit. them they suggested using money from the ebola fund. how do you respond to that? it is the case were republicans not opposed to the policy, they are opposed to the financing. how do you think administration can respond to that? >> the administration requested it be designated as emergency spending. our position is that it meets the requirements. congress said it is necessary to protect the health of the u.s. and others around the world. this was sudden. we were not expecting the spread of this disease in two brazil and other countries. it is urgent that we act. this is a temporary surge that we need. there are some longer-term things that we need, but in general it is a temporary surge. for us it meets the criteria. i was sitting after dinner with my daughter who was doing homework. she said i have all these questions from congress and about zika. she said of course you need money for zika. but she said why don't you just use your ebola money? >> she going to grow up to be a republican. >> the issue there, we cannot stop working on ebola. we have had recurrences and flareups that have created the need to do contact tracing with hundreds of people. the reason we are finding this is because of our continuing work in the other countries. the way our budget is structured, we are asking to turn towards something. we had to repurpose funding temporarily, and we are hoping we can replenish that. that is part of the proposal. >> i think that public health spending is underfunded. in this country in general. the responses saying, we have this zika, so let's take money away from something else. what should you take it away from? should you take it away from other maternal and child health programs, other infectious disease programs? the cdc relies on state and local agencies, and those are woefully underfunded. i live in new jersey and work with the new jersey department of public health. i have seen the number of staff cut by half over the 15 years i have been working with them. if the government does not want to pay people what they are worth, they can get a lot more somewhere else. personally, i think it is outrageous to say that we rob peter to pay paul, as the saying goes. >> the other thing is to get a from the chinese and the saudis, which is a normal course of actions. if you decide you're not going and onlyse taxes increase of the economy goes bad then you are really limited at what you can do. that's the situation we are in. we have a situation not in public health funding, but all kinds of agencies and issues. stay tuned. this will continue. this will happen over and over again. it seems on its face to meet the congressional definition. the congress so far is standing firm to we will see what happens. questions from the audience. i will recognize you and stand up and introduce yourself. as for question, try to make a question and not a comment. >> i had one comment, this reects my age. i have friends who looked at the chart of lead in children's blood before and after we band banned leaded gasoline. i remember he said he wished he had that for his dissertation statistic. i have a question about a risk issue, the focus is on pregnant women and the military has offered to pull pregnant soldiers out. what about childbearing age of your not pregnant. it is also a risk to your childbearing age and might become pregnant, and how do we know about the male soldiers? some reporter said there are mosquitoes carrying yellow fever someplace on capitol hill. if that is true, i would be interested. >> in terms of women of childbearing age, that is part of the communication strategy, is for women who could become pregnant to know the risks to manage their travel decisions in an informed way. we do know that there are many unintended pregnancies as well. so encouraging people to avoid exposure to zika if they become pregnant is part of the intervention. >> we do a lot of work on prevention and unplanned pregnancy, for couples of any age. it is very difficult to affect people's sexual behavior. teen pregnancies declined every year since 1991. it is still difficult, especially for people in their 20's. >> women who are in their 20's and expects sunday to become mothers, should they stay away from brazil and puerto rico forever? till their past menopause >> there is not evidence that an infection prior to pregnancy has any ill effects on future pregnancies. >> i'm from singapore. what about cdc's work with clinicians. what do the clinicians tell the women you see traveling or have traveled and in terms of people looking for fertility treatments, is there a message to tell them to put that off for certain time until further notice? and on educational outreach. what are you doing in terms of educational outreach? >> in terms of clinical advice in the u.s., the travel advisories are out there and clinicians, we work with them to make them aware. for pregnant women who may have traveled, the advice for being tested. this is asymptomatic. we don't know if it has the same effect on a pregnancy. that is one of the things we need to study. we don't have as many answers as we would like to have for clinicians. that's one of the reasons we think having testing available across the country is important. women who have traveled or may have otherwise been exposed are concerned and we want them to be able to get testing. the testing is not perfect. there is also advice about monitoring a pregnancy. been zikakely to have exposed. we are working with doctors on the kind of monitoring. we have many channels for communicating to clinicians, and you can get messages and materials on our website. that is also true on more general educational outreach. there is a lot of outreach going on in puerto rico right now. all of the things you would imagine for an educational campaign -- broadcasts and posters, all of those things. doing less of that in the continental united states right now. i think you will see that increasing with supplemental funding and the ability to set that up. >> thank you. >> i'm wondering what the environmental factors are that are making zika more prominent in puerto rico. you mentioned air-conditioning. >> we had an article, just last week on an academic study in puerto rico. breeding areas like standing water. when you think about standing water it is not just about buckets. it's little microenvironments. a lack of window screens and air-conditioning, junkyards and abandoned homes that have a lot of standing water. it is also the close proximity in which people are living. i would think some of that is associated with poverty. it is not contained to areas of poverty because of the environment. >> heat and humidity are obviously important. >> it is less clear what the causal relationship is between poverty and mosquito borne diseases, because historically we have had a lot of people living in hot and humid places. you can't say if this is just from the history of poverty or spuriously correlated. i would think it is more of the heat. >> with dengue, we have limited outbreaks in texas and florida, in that the living conditions, if the heat and humidity is there but we don't get that kind of spread that you see in puerto rico or the virgin islands. >> there's a checklist, and all of the things have to be checked off. poverty, poor living conditions, all those things have to be met. when you start to break any of those links, in the south of the u.s., when people moved away from these places where the mosquitoes were, the transmission goes to zero. >> i have a question for you, dr. curry. you just briefly touched upon the failure to pass that and in terms of temperatures and other things. as we are looking to rally more public support and engagement around climate change solutions, and leveraging the health frame, the importance to our own personal health and children, the most cherished population. very vulnerable. what opportunity do you see to highlight this new threat, and at the same time not overstate the connection to climate change. it seems like a really important opportunity to get the public more engaged about how this is personally affecting us, especially during a presidential election cycle this summer. i am curious about any of your responses to that. >> you just gave a great summary of the spread of zika and climate change. >> one reason is i am trained as an economist. i would say every economist thinks that cap and trade is the most rational way to try to approach greenhouse gas emission. the bill which will do cap and trade, it didn't get any traction. i think that's a lesson in what allen was talking about earlier, that you have to present things in a way that what is appealing to people, to understand why this is a good way to do things. so cap and trade people -- people just like the control. if i am an environmentalist, i just want to tell people not to pollute. that is not practical in many cases. so trying to do the work to explain to people why this is a reasonable way to proceed is important. on the threat from zika, people have been saying a number of times, this is probably not going to be an explosive threat in the u.s. i think it will be more like west nile, where we saw something, it was introduced, it follows very much the geography of places where there are lots of mosquitoes. we have it in new jersey. there are not huge numbers of cases of west nile, but there are cases every year. if zika takes hold, we saw the map of where the mosquitoes are, yes, we probably won't get thousands of cases that -- but there probably are going to be cases every year. there are probably going to be kids born with these horrible birth defects. it is important for people to know that so that it doesn't get established and we don't end up upsetting the equilibrium. >> it's another opportunity in response to your question, you can make the argument, and you did, just one of the problems with making the public health argument is if we are successful the problem does not get egg. people say see we spent all that money. and it didn't get big. you can turn it around and say, you have to be on the offensive to do this, is to say the reason this didn't get out of control is because we took the questions and answers, you could make, a case of babies with stunted brains it will have to have before people -- and spend dollars on something like that. >> one of the things that we do is educate parents between the link between climate change and health. i have a question about the zika epidemic. i was just wondering if you think we have any evidence that this epidemic is fueled by climate change, or rather do you see this as an example of how climate change may threaten us in the future? this is important in terms of how we frame our education to our members. >> we are not really able to determine the role that climate has played in this outbreak. it did not happen slowly over time and we cannot disentangle that from other factors like global travel, living toditions, the virus getting a certain population. there is not a way for us to know that. what would help us understand some of the changes that could be if we did have better surveillance data on mosquitoes and the disease. that is one of the things we would like to do. also, understanding what some of the longer-term effects might be for babies is part of what we need to understand. to inform some of the arguments you're suggesting, what can we -- what did we avoid by having an effect requires knowing what the full range is. >> if you want to at some states for theve some states control group, give me a call and i can tell you stay so we can put in the control group. >> i think debra's responses our appropriately cautious, but -- are appropriately cautious, but it is also clear that because a tropical disease, the u.s. is becoming more tropical because of climate change. there is a larger area that is affected. we know that these kinds of vectors are spreading north. you cannot make a solid line connecting all of the dots, but i think it is pretty clear that the dots are connected. >> you can't say definitively that climate change caused the outbreak, that it but -- but it will make it worse in the future because mosquitoes like hot weather. this will make it more costly to contain. >> and go on to make another point which is standby, there will be more like those, and impacts like this on the vector and therefore on the disease. >> hello, i am here for interest, but i have two questions. the first is that hawaii has had a big outbreak of dengue fever. you haven't talked about zika being a problem in hawaii. what happens if hurricane katrina happens again, with new orleans having standing water everywhere. how does fema work that into their plans? >> we have been engaged with hawaii in the dengue outbreak, one of the places where we have concern about local transmission with zika. you are right about that. one of the things that the cdc's role is really to have to help health departments prepare for if it is likely to occur. we work with all of the hurricane prone areas, and certainly one of the areas they need to prepared for his -- need to be prepared for is vector control. >> good morning. i was wondering if you could talk about any emerging technologies that may be helpful in combating the spread of zika. >> i'm not expert at some of the emerging technologies, but i do know that we are very interested in innovative vector control technologies. you have heard us say how challenging it is to control the specter and all of the methods that do combine to be able to reduce the risk. there are lots of media reports and there is lots of interest in new technologies. we have to use what we know works. we do work with some of our hhs partners on developing new and innovative ways. we are doing that a lot in the diagnostics area. on has a lot of work done vaccine development and vector control is another area where it makes a difference. >> i want to add a comment, everybody likes to think about new technologies, this is making sure that you don't have little bits of standing water on your property, that's an old technology. you take the bottle cap and turn it over. i think there is a lot of room for that type of thing. i know it is possible to reduce the number of mosquitoes on your own property just by doing things like that. if people did that on a larger scale it would probably have an impact. >> i want to thank you for coming. you have been a very attentive audience and have asked great questions. please join me in thanking the panel. [applause] >> here on c-span this morning, washington journal is next. then the governor of puerto rico talks about the island's debt situation on newsmakers. share his chair will thoughts on the 2016 presidential race and upcoming convention in cleveland with my gallon. -- with mike allen. coming up on today's washington >> coming up on "washington journal" -- a look at women in politics with jennifer lawless. and sarah jane glynn with the center for american progress talks about current federal policies that affect working mothers. we'll also take your calls and look for comments on facebook and twitter. ♪ host: good morning. the house and senate both returning this week with congress taking up funding to neal with a growing heroi epidemic across the country. senator ted cruz expected to return to washington after ending his presidential campaign. paul ryann speaker when he meets with presumptive gop nominee donald trump this thursday on capitol hill. it is sunday, may 8. on this mother's day we want to focus on women's issues and hear from

Related Keywords

New York , United States , Louisiana , Capitol Hill , New Jersey , Nile , Washington , Texas , Brazil , Florida , China , Virginia , District Of Columbia , Mississippi , Mexico , Puerto Rico , Egypt , Virgin Islands , Saudi Arabia , Houston , Jersey , Singapore , Hawaii , Princeton , Saudis , Americans , America , Chinese , American , Jonathan Wallace , Dalai Lama , Alan Brekke , Janet Currie , Margaret Chan , Sarah Jane Glynn , Ted Cruz , Paul Ryan , Mike Allen ,