Transcripts For CSPAN2 Discussion On Climate Change And The Zika Virus 20160519

Accused of being very corrupt and costing a lot of grievances that he was unable to control the borders and theres a lot of illicit act dividend 30 take place in northern mali prior to the attacks by the terrorists attacked that peaked in 2012. On the other hand, the neighboring country to mali, which then shares a direct order with libya because the government have better control of the borders, because the government has come out with a policy in the processes. And allowing people at the level that impact lives directly. Is nothing but a worthy country that it is surviving in a neighborhood invested by terrorists on the northern border with libya, with northern mali and the southern border with northeastern nigeria. It is not necessarily better able to manage its Human Capital they can respond to needs in remittances in the country still doing well today. Thank you. We are way beyond time. We had a really started harrowing than the peacekeepers. And the abuses that are taking place. Id like to ask and closing when this is happening, what does that do relative to populations in their feeling amount to, you know, people working with them to keep peace, but also if it does, how does that feel additional attraction to terrorist groups. But its tolerable enough or it happened and puts its credit and you have saved the secretary general condemning it strongly. He condemns that, but it still happens and we see almost no action. Condemning that doesnt mean anything. He has condemned it when it happened. We have dismissed the head of the mission. We have named the countries that the perpetrators are coming. They go to jail. Whos going to jail. The secretarygeneral has named those countries that have done it. It behooves the countries. You understand from my perspective that would be like naming the terrorists the bad guy is doing nothing about it. The secretarygeneral has also nominated the official court nader from the u. S. To coordinate the efforts of the u. N. By this despicable, underlying happen. Prosecutions are well thought and that, not naming people, not naming countries. Mr. Chair come mr. Chair, you would know that the u. N. Has nospace for soldiers giving contributing countries. If you use both countries to do the prosecution went they are named. I want to just join with the chairman. I am not satisfied that the United Nations has done everything it needs to do. I understand you dont have independent ability to do that. I understand you have the politics of dealing with member states. But with the peacekeepers, it was very, very late in the game and the action was not adequate and we know that secretarygeneral is very since the year. We know the Security Council is taking action, but we have not seen what we expect. But this is true with the various programs under the United Nations, the Development Programs are we importing. But if you are not prepared to break your partnership with a corrupt regime, then i think you are doing a disservice. I understand the humanitarian needs. I understand dealing with particularly ngo types of direct humanitarian service. Contracts need to be prepared to walk away. So just one quick question to mr. Fomunyoh. What would you like the night dates due to respond to the perception of the perception that they give free passes to Coalition Partners in regards to human rights violations. Is there something specific you would like to see us do . Seminar company touched on the issues. I think speaking out more publicly against some of the violations, but also taking action that can assure or reassure and when the United States is democracy and the pillars of the policy that really means it. Even at the highest level on the mind and everything else. The Additional Resources for dave and Good Governance programs and also a sense that the program to be a fact is because youre talking about changing attitudes and behaviors in dealing with people who back did one way for decades and would now need to act differently. A sustained support is more likely to pay dividends and shortterm surgical type interventions because you need time to be able to create relationships of trust. You need time for people to entrust picture Technical Assistant in terms of raising the wellbeing of citizens and putting in place processes that can into your beyond one government or one later and that requires time and sustained resources. That will go a long way because fortunately, for the three decade that can be im institute and other organizations have been doing this kind of work, with established relation ships in the country that could have a huge impact of the resources were available. Thank you, mr. Chairman. Thank you, mr. Dieye. I know you are speaking up regarding the u. N. It is not shared areas of expertise. I think you can understand where none of us on the panel are particularly field but the way you handled peacekeeping issues and prosecute it caused to take place. Then they just close with this. Certainly this hearing has given us a good sense of the complexities that exist. We have similar complexities in the middle east where we are dealing with countries that, you know, be it the fact you, discriminate against various fact that are not of their own. This is the challenge throughout the world dealing with issues like this. Are we thank you for your focus today on africa as you mentioned the last panel, third base of members and writing. We will close that as 30 afternoon. If you could respond briefly, we thank you their expertise and knowledge and willingness to share with us today. With that, the meeting is adjourned. Thank you. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] because so many women were a front saying i dont know if that do what you are fighting for, but you need to come home because weve got a fit of the crop would normally do. I just buried her youngest in the back and we are not going to have anything left. You need to come home. Vietnam veterans have been used as political footballs. They produced as part of the morality play. They had been used as many things, but hardly anyone got to tell who they were, the trauma of war they went to, but this great big dreams, funny times from a horrible time that what happened to the best generations of state have been home. For what reason did anybody want to come and kill my daddy . Go annihilate it. They to kill the whole family. There were meetings held throughout the various churches, preparing the residents informing them of their political riot and getting ready to register to vote. The center for Disease Control and prevention top about the link between Climate Change and the zika barry affecting parts of that america appeared Princeton University released a report on the topic of this is 90 minute. [inaudible conversations] [inaudible conversations] name is ron haskins. Im codirect their Forest Center on children and family. We are especially into issues of economic mobility. Along with my cspan colleagues, im also an editor of the future children, which we publish twice a year with colleagues from princeton. Sarah mcclanahan is the editor in chief and the managing editor Jonathan Wallace is here. Thank you for coming. You are primarily keeping an eye on us i think. Whenever weve released a volume, which we do twice a year, we read 3000 were policy brief about some issue covered in the volume that we try to take an issue in public policy. We have a public event approaching and announced the release of the volume and go over the volume is so forth. Thats our purpose. Thank you for coming. Heres the plan we will follow for the event today. First after janet curry, one of the senior editors of the journal and also one of the two editors of this volume. Shes also been repugnant professor of economics and Public Affairs and director of the center for health and wellbeing. Im not sure she sleeps, but she does all that stuff. And then were all going to sit down and be joined on a panel to will have a panel of four people discuss the issues that come up and then we will give each of you a chance to ask questions of the panel and alan barreca is here from tulane who also participate in the Panel Discussion. So thats our plan. I hope you like it. Lets have a good time. Janet . Thank you very much, ron. So this volume starting point is the idea that the debate about Climate Change is often framed around a facts on our children, but we are not generally specific about what those effects might be. So the aim of this volume is really to get more specific about what the effects of Climate Change are likely to be on children. So theres for broad themes that come out of the various chapters. One important theme is this is no longer something which we are speculating about. This is something thats already happening and will continue to happen. And it is going and is already affecting Childrens 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 a special children in countries that dont have very strong institutions are particularly at risk. And although we know this is already happening and will continue to happen, we still have a lot of uncertainty about exactly how bad its going to be. That depends in part on what we do, and the fact that it is some certainty and also the costs and benefits are in the future, and also that theyre going to be very unevenly distributed i think make the politics surrounding Climate Change particularly difficult. So im 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 saw, it was perfect for this presentation because it hits all the things that i just talked about, Climate Change is already happening. That you can see here in the United States, we had our first climate refugees who are being moved off which has lost 90 of its land mass, and most of its trees because of salt coming up through the water table. And so 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 three Year Old Girl whose family is going to have to move. This is a poor community. Its a native american community, illustrating again its the poor who are most likely to suffer. And then on the political front even the sort of relatively small and well defined thing but taking people who are on a sinking island and then somewhere else is still kind of a heavy lift and fraught with various difficulties that are discussed further in a 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 we then 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 in conflict. Theres a growing body of evidence that High Temperatures are related to conflict, in part because they can have severe economic effects. So in parts of the world that are prone to conflict anyway, if you do think that threatened farmers livelihoods, that makes it more likely that there will be armed conflict. We discussed natural disasters and the effects on children. Again, thats one of the things thats expected to become more common to do 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, and to love it more technical chapter but just not how do we measure the cost and benefits of Climate Change . A lot of the standards what economists think about things are quite difficult to apply when you have something that is going to 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. And then finally we come back to the political problem, that its so difficult to mobilize efforts to combat Climate Change. So looking at temperature, this figure which is from the chapter on temperature shows the number of days over 90 degrees that are already expected in four u. S. Cities. The white bar is for 20012010, so thats already happened. Then the next bar is 20462055. And the black bar is the end of the century, 20902099. So what you can see, this is going to get even hotter in houston although its pretty hot in houston already in the summer. So maybe arguably people in houston are used to dealing with that. If you look at kansas city and new york, but to middlesex, the two in the middle, you increased hot day. In new york because some 10 days in the summer to 70 days in the summer by the end of the century. So thats a big change. And then seattle comes off relatively easily with increased only 20 days of really hot weather. So this is just illustrating how the cost of Climate Change even within the u. S. Are going to be an equally 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, its the projection for those of you follow these things, is based on the idea we use more renewable trick and if you just look at the far right column of the table, theres 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 shortterm effect on pollution. You can see these benefits are also an evenly distributed. So when the southeast you would get almost a 20 increase, or decrease in infant mortality. In the northeast you would also have a fairly large decrease. In the west not so much. So again this figure is just summarizing whats in that column showing the decreases in infant mortality that are projected by region, compared to doing nothing, which is a light gray bar. Similarly, infant mortality is very important that one reason why its important is because its a more general marker for child health. So the same things that reduce infant mortality are expected to improve Peoples Health and the longerterm. Healthier people will have higher earnings, and so this projection is suggesting that earnings would also increase in the same places that have 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 long period of time, and we all know the air used to be really bad in pittsburgh that it has really improved over time. And showing by way of comparison numbers for the same particular matter, aleutian for mexico and for china. So what you can see is that things have also been improving in china actually but a start at a much higher level so people being exposed to really bad air. And so again anything that affects pollution and also affects Climate Change would be a winwin and that it would have both short run and long run effects on Peoples Health. Staying with the developing countries, area, mr. Chancellor about the research on conflict. This map is showing the horn of africa which is a place that has a lot of conflict. And on the left what you see is a map showing how much change in temperature theres been since 19912005, 2000. You can see even within a relatively small area theres some places are having much more temperature change and 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 longterm increase in conflict as the result of the temperature change. Turning again, this is kind of a rapid walk through the volume, but turning to the chapter on costs and benefits. This table illustrates one of the problems. And so what its 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 dont you should take Climate Change into effect. So we think that growth continues, and so in the future we should all be richer. Now, the dashed line issue of what happens if you have catastrophic Climate Change. I do think the interesting thing about the dashed line is that nothing happens immediately. Its happening at the end of the century, and then you have a decline in real consumption compared to business as usual. 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. And then another issue with respect to think about costs and benefits is the issue of what discount rate we should use for the future. That is, how much we value things that will happen in the future relative to today. And again if you look at the numbers on the far right that showing a 5 discount rate, which is fairly standard, and what does this is we dont value at all, 1000 in 2002. Thats too far in future for us to care about. In order to have a discussion of Climate Change we have to also change the way we evaluate future costs versus benefits in order to take account of the needs of future generations. So i just wanted to make one comment about the heavy lift to talk about one gig of example, the waxmanmarkey bill 2000 which was not passed, the 2009, thats 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 make a really Significant Impact on whats going to happen in the future. Now, of course it wasnt passed. After going through the house it didnt make it through the senate, and so this is just one illustration of sort of a history of failure to address the issue. So thats all i have time for your if youd like to take a look at the issue, i think you can get copies at the back, or its all online at this website. [applause] thank you, janet. Appreciate it. As i said before whenever we publish a volume twice a year we write a 3000 word policy trying to seize upon some issue that is implied in the volume a to point out all of it, especially in the policy sense, and would try to pick things that are actively under consideration in washington and we are quite fortunate this time that zika appeared. Its unfortunate for people, we dont know the extent yet but it certainly does lend gravity to this event and to the issue. Are a lot of implications here for public policy, especially for Childrens Health. And so we learned a lot more about zika in a few moments. So here is the logic of the greater temperatures are rising. Im going to mention a few things which i think are quite interesting the rising temperatures have effects on Childrens Health. Theres a phone that goes into that in some detail both direct and indirect effects. One of the indirect paths is infectious illnesses which a lot of people might not think of as being related to environment but i will show you how thats the case. And zeke is a great example and i will talk about why. We will in doing so we will focus a lot of attention on the 80s egypt i miscued which is a strange little creature which has all kinds of habits schmick unlike other miscued and some of those bear on its effector as Public Health officials call the method of transmission or the means of transmission. And then were fortunate to have debra to talk to the administration proposal, and as is good in washington will have a proposal. I want to show two things about temperature. This is temperature from the National Oceanic and Atmospheric Association and shows the temperature come if youd like medicare but i think the statistic with the trendline and so begins in 195 1950 but lookse it really starts picking up around 1980 which is consistent with other evidence. It has gone way up. In the last two years, huge temperatures, i think 2015 was the hottest year weve ever had. We are on course in 2016 maybe to repay debt. So temperatures are going up, especially, this is an important point, this is kind of a difficult draft. We have great experts who understand this stuff very well but for a normal person what is happened . The red is temperatures and the white is normal distribution. And what is happening is that the temperatures are shifting of the entire distribution of temperatures have shifted up. And especially important feature of that is that details of the dispute especially positive tale is increasing even more. So were getting even more increases in extremely hot days, usually defined as 90 degrees or more. Those are the want of janet pointed out at this point out in the volume that can big impacts on health, special on infant. The chapter on infants shows that infant death even rise to temperatures above approximately 90 degrees. So if the projections are correct these are really important considerations. So temperature is going up. And it has impact on children, direct impacts as i do plan on mortality come on knows, on infant deaths and it is intricate effects especially in infectious born disease and these are laid out in greater details and the chapter but i want to focus on the vector Borne Diseases and the vector here is \80{l1}s{l0}\80{l1}s{l0} egypt i. So Martin Edwards them famous entomologist at of this little mosquito, he loves us. It most our cities. It loves our blood. Kind of powerful statement about what this will do is electric this guy is especially thirsty. This particular mosquito carries a lot of Infectious Diseases including yellow fever, dengue fever. Ive read several articles about how you pronounce this but im going to set it with an english american way of saying that, chikungunya. Theres a more fancy way to say but i couldnt. It carries all of those in addition to the zika. So this guy is a very important means of transmission of disease to children. And why is that the case and why we concerned especially about both zeke and the role of the aedes aegypti . First of all theres some evidence that has the widest range its ever had. Places that have increasing temperatures, many mosquitoes are more likely. Its easier for them to breed. They multiply faster and so they occupy new areas. Predictions go i think these are mentioned in the journal but if not there are other journals more focus on climate and children that say that even in the United States we will start getting zika quite a bit of expansion of territory. Its present out in the southeast let it will expand. It breeds in and around standing water which is actually important because especially when its hot, people like that more water. And especially the more traditional societies they keep it in buckets and tails and all sorts of things all around. In any of that can be breeding ground for zika as well as other mosquitoes. So thats an important idea that might have an impact and as in the past in trying to control mosquitoes and especially zika that you do something about standing water. Also rising temperature allows the zika virus to multiply more quickly, and theres a particular feature of this mosquito that i found fascinating. I did not anything about this until i started reading into this. Old stos by jude and suck up your blood and they go away and they dont bite another person. They are satisfied for a while. Some miscued i think only do a couple of times. At this mosquito takes only a little bit of blood, goes to the next victim and takes obit of blood, goes to the next victim and takes a little blood. So they can effect several people if they are doing whatever they happen to be kidding. So this aedes aegypti is really a formidable weapon in natures attempt to get us. It is after our blood and it has the capacity to affect many people at one time. And that is why margaret who is head of the World Health Organization in discussing zika virus, she said that its the main cause of what she called explosive spread in the americas. Im sure she was referring primarily to south america. So this of course raises a question, now what . What are we going to do . Its not an emergency at this moment in the United States, but its potentially a very serious problem. So should we do something . Integer add to that question is debra lubar from the centers for Disease Control and prevention. Debra, thank you so much for coming. Thank you, ron. Im glad to be here, glad you set up our nemesis so well in this fight by describing the aedes aegypti in some detail. Im going to get a little bit about cdc and what were doing and what we need to do. And give a bit of background about the zika outbreak. So just a little bit about this great agency that i represent the cdc was done in 1936 and we were founded to deal with malaria, since 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 the agency headquartered outside of washington which gives us a different perspective on life and many of you probably have to. So our mission is to save lives and protect americans from Health Safety and security threats. One of the really interesting things about this outbreak has been seen all the expertise that cdc that were able to draw on. So a lot of times when responding to emergencies its an Infectious Disease outbreak and its our Infectious Disease doctors and experts who are leading outbreak. In this case weve really seen across the agency drawing on expertise and vectorBorne Disease and environmental health, important effects, and reproductive health. I think that we are a very unusual collection of people who were able to bring all of that together to support this response. 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. Theres a Public Health system in this country, and cdc is not in charge of it. Thats an interesting thing about our work. A lot of the authorities for Public Health interventions and things like that our local and state control. And so im going to talk about about cdc budget because a lot of what we do is find and support the Public Health system in this country and around the world. So we are all over the United States even though we are headquartered in atlanta. So to give you a sense of where we are, we have some very specialized labs around the country, and one of them that you a lot about today is in san juan, puerto rico, we do our work on dengue and increase we on zika. We have over 1600 people located in 60 countries, and this will give you just cant just go to go through this really quickly. We are working on Disease Detection in general, on polio eradication, measles immunizations, the flu. Still working on malaria all these years later. Global hiv aids is a huge part of our global footprint. We are training the Public Health workforce in partnership with other nations, and we are working on, across government initiatives called the Global Health Security Initiative which i will mention more later. Cdcs budget is complicated, and my job which i should mention is running for office of appropriations. So i worked with congress and the white house on cdcs budget which is why im here today to talk about the zika request. That cdc is funded from many different sources and this gives you a pretty big picture of what our money does and where it comes from. I can answer questions about that if people want to dive in deeper. The amount of our current budget is a 7 billion that congress decide on each year. This is a budget history of that core budget and you can see its 2013 was look at you guys are number 2013. We had sequestered and things like that. But relatively steady over the last few years. We are funded in these broad categories like you can see on the screen, but something that people dont really know or understand about cdcs budget is how detailed it is. Youre not supposed to be able to rea redistrict this is one pe out of probably a five page table where 160ish different budget line items are presented as Congress Directs us to spend it. We interact a lot with congress about where our funding goes, and we are bound by that, which is one of the reasons that we have emergencies and the need to surge, it can be challenging for the agency financially and we are not able to be as nimble as we would like. So just this one example thats relevant here. This is a budget his job vector Borne Diseases. We do have a budget line item for the. The name has changed a little bit over the years, and you can see there was some growth. You all remember the west nile virus outbreaks of the early 2000s, and it was some attention to vector Borne Diseases in the United States. Its been kind of relatively steady since then, since the drop in 2007. But thats a place where congress is this is how much money youll spend this budget only this much on vector Borne Diseases, and 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 didnt know about two of these transmission patterns, or pathways. So this is really a space where we are learning more every day. More and more alarmed by some of what we are learning, and we expect to continue to find hopefully new solutions and also new challenges with this virus. The sexual transmission pathway and the pathway to the fetus are the new findings. So just an overview. This is related to other viruses as ron explained, dengue, yellow fever and west nile. Primarily we think through aedes aegypti but maybe not exclusively. This virus is not new. It was discovered in 1947, and for 57 years there were a whopping 13 cases reported. So very surprising. There was an outbreak in yap in 2007, but very surprising at the end of last year when we started to see huge spike in cases in brazil. The authorities in brazil suspect that there were nearly a million cases. So that his tremendous growth and not what we expected. The other thing that we didnt expect was a significant risk to pregnant women. So the effort you hear about zika is not a very sued disease for most people. Some peopl people never know the the other people have sort of general symptoms that might look like any other viral infection that we would all sort of live less and get over. The really tragic outcomes have been for pregnant women. This is the first time in more than 50 years that weve discovered an Infectious Disease caused birth defects. And its really the first time that a mosquito bite could cause these kind of lifetime consequences for families. Theres also been noted an association with gimp or a judgment zika virus during infection of pregnancy we are determined is a cause of microcephaly and other fetal brain defects. What we dont know is the full range of Health Problems that might result from this infection to the fetus. Thats going to be, thats something we really do need to study. Its going to take time to see how children they been exposed development as part of the work we are starting now, and that we hope to continue with some emergency funding. So this is what we have been doing, what we been able to do today. We have determined the link with microcephaly. Were examining the link with guillainbarre. Wheezy miscarriage and other things associated with the zika. Weve learned cycle turns vision is more common than expected. It was sort of theoretically known but he seemed to happening more than we would have predicted, and theres a lot more to deliver their some the things were doing but i hope youll have heard about our travel guides, particularly for pregnant women. Were working with clinicians so that they know what to do with someone in the United States who may have traveled i do want to say i think ron said this is not an emergency it in the United States. This is an emergency in puerto rico right now and the territories. About the early response has been to support those areas. I will talk more about that. We been doing a lot in the Laboratory Diagnostic area, something that had 13 cases reported in 57 years. Most labs are not testing for. We have several different tests that weve been getting out to the Public Health labs around the country. Again, that system were its not all cdc doing the testing, although we do a lot of validation. And weve been developing new diagnostics that are easier to use, better at detecting. This is a picture that you described well. I want to talk a little bit about the factors that contribute to spread. So for a lot this morning about Climate Change, and certainly vector Borne Diseases and being able to track where factors are and where vector Borne Diseases are happening, an important part of understanding changes in the climate. What weve seen though is with, its not geeky determine what role climate might be playing. The are a number of other factors that are affecting the spread of this disease, including Global Travel and movement of infected humans. We have over 400 zika infections in the continental u. S. , including puerto rico and those were primarily travelers, some sexual transmission, but thats happening all over the globe. Living traditions, ill talk more about, a very big factor, as ron described in terms of standing water and urbanization. The disease reaching population can cause these large outbreaks as well. And there may be changes in the virus. We are still studying that. This could be a Public Health intervention advocate gets just get the mosquitoes to avoid us and go to happy hour. That would be most excellent outcome, but thats not available. So we are looking at what are these other factors and how can we work with them. So this is the think a really interesting case. This is the study of dengue in chikungunya at the border of yes and mexico. What you see is these places did not have differences in climates, vegetation. They are very much in the same place but the Living Conditions are dramatically different. So you see a 4 infection rate in brownsville, texas, and a 32 infection rate just across the border in mexico. And hear some of these factors on that 85 of the homes in brownsville are airconditioned, and only 29 across the border. They are are bigger lots in texas, so you are not as crowded together. And thats part of what we are seeing in puerto rico we are seeing infection rates that are close to what you would expect in that kind of an environment. So this is a map of air travel anand this is why comeback tour Global Security agenda. Cdc is part of a governmentwide effort to include Global Health security across 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, by the environment that we live in and by our human connections through all of the travel and trade that goes on across the world. So the effort that sort of underlies these outbreaks that we see is to bring other countries capacity to have two respond and prevent diseases around the world, to strengthen that globally. And that will help us, that would help, ebola was a stunning example of how an outbreak in one part of the world can affect the Global Health and global economy. This is part of the ongoing Public Health Capacity Building network you have been following on the ebola outbreak. So just to show some maps. This is dengue spread by the same mosquito from zika. From 19502013 this was the spread of chikungunya. And then back into the western hemisphere in 20132015. Zika moving is part of this trend as well. You can see these are fairly similar patterns. I just want to quickly talk about puerto rico, where we have seen these outbreaks as kind of the bellwether for the u. S. So this is chikungunya in 2014, and this is, that was a week by week map that shows you the spread. And this was the final map for chikungunya. This is what we are seeing now in puerto rico from novemberapril. That topline is zika, the other lines are dengue in chikungunya come and get it to the dramatic increase in the third or fourth week of the year. And this is what puerto rico looks like today with over 600 locally acquired infections. They are labs have done over 6000 test. They know they have at least 65 pregnant women with zika, and that has been the real focus of our work with puerto rico. So the lab obviously needed a lot of support. We have a lab in puerto rico that works on dengue and so weve been able to partner with them very effectively. We are also doing surveillance of pregnant women and newborns to understand what the risks are longerterm. And im going to talk about so heres the map of the aedes aegypti. What i want to say about this map is this is the best data we have. A lot of it is based on models and other things that scientists have done. We dont really strong vector surveillance. Public Health People are weird. Would like to go out and count mosquitoes. We are hoping one of the things we can do through this response is really improve our vector surveillance in this country, which health was target the control efforts. As ron explained this is a really challenging this could ive heard people call it a cockroach of mosquitoes. We have to do many, many things to try and control it. There is not one specific intervention that does the job. So, for example, in puerto rico, those efforts are focused on the homes of pregnant women. Very, very targeted. Its not something that is effective if you try and give it communitywide. Ron was surprised to hear we have over 400 travel related in and sexual transmitted cases in the continental u. S. Right now. And we are working with the state Health Departments to monitor those and to provide clinical guidance, particularly for pregnant women. Im going to get to the funding request in my last few minutes. The administration has asked congress for 1. 9 billion in emergency funding. 1. 5 is for the department of health and human services, and i will speak specifically to what cdc has requested. Youve kind of heard me talk about throughout the some of the work we are doing. We really need to dramatically expand, and we need to do it before mosquito season hits the continental United States. So we are already working with some funding that weve we proposed to work with all of the states, particularly does that appeared on the map that have the mosquito. We know we have seen limited outbreaks of dengue in chikungunya into United States come and we dont think will have exclusive outbreaks like puerto rico or brazil. But we need to be vigilant about that. We need to continue to support puerto rico. We also really need to learn more. And so some of the things that would like to get started on as soon as possible are some of those longerterm studies to see if we follow babies born to women who are exposed to zika can what are some of the effects can what are some of the factors that were risky for those women . What are some innovative methods for controlling mosquitoes, and what are some better diagnostics that we can introduce . And you can see some of the activities here are so thats an overview, and i suppose we will have questions for the panel. Thank you. [applause] before we begin our Panel Discussion we would like to hear from alan barreca from tulane. Hi. Im alan barreca and i worked on thinking about ways for us to mitigate the health costs of Climate Change but today im going to share some lessons ive gleaned from our research on malaria in which is a disease that also transmitted by mosquitoes. We will learn three things and well see how we can apply those lessons to fighting zika today. So i want to start in a nonfictional setting adequately more about this location later. Where yeah, they one in 10,000 chance from dying from malay which is called by differ from the malaria parasite. One in 10,000 chance of dying in displays. You have a one in 50 chance of contracting this malaria and brings on series the first and chills, which is very challenging for you to make it to get to work or go to school for that matter. And as i find my research if you just happen to be a child born in a particularly bad epidemic do with as high malaria rates, you go on your lifetime possibly the development of delays in early childhood. You going to have a 10 less likely chance of finishing eighth grade or high school, and 10 higher chance of ending up in poverty. So this is not the case for the United States today. Throughout the world there some 200 million cases of malaria every year, 500,000 deaths. These are best guesses. But its virtually no chance of contracting malaria into United States. So what can we learn from our experience with malaria . I should say the fictional setting that im taking to kind of jump a little head, is that were going to look at malaria actually in the United States. So the u. S. Actually in the 1920s and 1930s, malaria was a surge problem. What im going to be able to learn from our experiment . Ive got a map for of the malaria pathway. Malaria cases were hard to record in early 20th century. What this map is showing is that places like louisiana, florida panhandle, this is a be dealt with the places where the malaria was the most prevalent. These were 10 times higher say than in virginia. So the south, malaria was a southern problem, okay . Following up on janets point, that the south is also poor. We are thinking that zika, this is also going to be the case were well see the poor parts of the u. S. Will be most effective. But theres also another important lesson for our talk today given our focus on Climate Change, and that is the south is, shocking revelation, warmer than the rest of the u. S. Im from new orleans and i can definitely preach to that. To Laboratory Experience suggest that malaria parasites, these mosquito populations thrive when the temperatures are in the 70s and 80s. Its got to be nice and warm. These are from laboratory experiments. What does this mean then for us in the future . As ron noted that we will see this distribution will shift in temperatures in the u. S. We will end up with more temperatures in the extreme, so more warm temperatures. To put this into a nice simple statistic, the Climate Change model predicts Something Like 60 more days about 80 degrees fahrenheit. So this is right in that range at least the mosquitoes like. In the studies ive seen on the aedes aegypti, they also suggested those temperatures are ideal. So that suggesting that we will see increased risk of mosquito borne illnesses in the u. S. So more risk in the south, potentially throughout larger part of the year, but also those risks moving north. So what can be done . A little bit of hope youre malaria is not a problem anymore for the United States. So what happened over time . So in the 1930s of malaria death rate was about 10 per 100,000. Thats about the same level we have for deaths from Motor Vehicle accidents. This is relatively high. 10 and 100,000 would be like when student at tulane were i teach dying every year from malay. Thats a real, real number. They think the infection rate was Something Like 200 times higher than that. In the 1930s malaria transmission in the United States was relatively stable. But then there was this big drop between 19351940. So what happened . There are a few things. The first to have pretty good evidence on. The first being that the new deal allocated consider the amount of money to training ponds, to constructing better drains along ditches. Something like tens of thousands of ponds were drained and thousands of miles of ditches were also better trained. So this is the first thing we think led to this drastic decline between 19351940. The second thing we think is that populations were moving out of rural areas in the United States where the contact between humans and mosquitoes was relatively frequent. So when you take people and to take mosquitoes and you separate them, you break the cycle of the disease. So as part of any deal they paid farmers to follow their land. This led from the transition away from sharecropping we had large numbers of farmers relatively small plots of land who ended up having to leave because there was no need for their labor anymore. So they moved to urban places or the ended up moving north. So that helped break some of the cycle. The third thing i want to mention is that where we dont have as much evidence for is that education was increasing over this time period. It cant necessarily account for this stark decline between 19351940, but it wasnt really and tell 1900 where people actually knew the malaria parasite was caused by the mosquito. Thei used to think it was just caused why bad and are. So as the early 20th century, people didnt quite have a grasp of where this was coming from. I think there may be some lesson here about how we can use education to hopefully reduce the prevalence of zika. I also want to point out that the cdc came into being around 1946, so we began spraying for these mosquitoes starting around that time after world war ii because we needed to conserve our spray, that ddt chemical, but very powerful chemical, and tell them. So it wasnt the spraying that necessarily caused this massive decline. So Old School Technologies ended up having a pretty sizable effect on mosquito Borne Disease in the United States. So to recap, 53 things i would like to leave you with is that, one, seven states are at more at risk because of poor blood sugar i would expect children in these places to be more affordable. Climate change is likely to increase these risks. So we saw about 60 additional days in these really hot temperatures, these days about 80 degrees fahrenheit. And weve got some old School Policy tools. I dont want to say these are the magic bullet to solve the zika problem. I only wish to say like in addition to thinking about insecticide treated bed nets come in addition to think about spring with powerful insecticides that were some effective tools from the past that we can draw on. In my pun moment of the evening when i was preparing to go we to think about another ddt. We could think about drainage, economic development, possibly drawing people in from a subsistence farming into the urban environments, and we could also think about teaching and educating people about the ultimate cause of zika. And the final thing i want to leave you with is a quote by the dalai lama. Ev think you are too small to make a difference, try sleeping with the mosquito. So thank you. [applause] an[inaudible conversations] so thank you for this great presentation. A lot of information to try to sort. I want to talk first and then well give the audience a chance to ask questions. But im going to ask the a few first. The first is tony. In the journal, a lot of articles about this and popular press about what we could expect to change emissions, especially Carbon Emissions. So the question is, if we could do that, which is by no means certain well be successful doing that, how long would it take before you begin seeing impacts on the mosquito, on the spread of illness, all that there is a facts that we were shown in this kind of impact, that are impacted by temperature . How long will it take . I can talk about that. I guess one of the problems with talk about Climate Changes is there someway different timescales to be aware of. So i think the Scientists Say now, even if we cannot Carbon Emissions to zero tomorrow, temperatures are still going to keep rising for a while. So we are already on the path and we will have to deal with it. So it will take a long time before we see, well, we probably wont see reduction in temperature, but to see that it doesnt keep increasing even more. That will take a while. What i was trying to talk about in my presentation is theres some things like reducing pollution would love impact on Climate Change, we would also see a more immediate benefit because that has an Immediate Health benefit. If you reduce, it also is a more local benefit. If you reduce particulate matter in washington, d. C. , people in washington, d. C. Will benefit from that. Pretty much say in the next decade. And then the timescales where we are talking about responding to the zika virus, thats something we need to respond right now. We wish we had responded yesterday. So i think, yeah, that just makes it difficult because you have to juggle all these timescales. Heres another time related question. I mostly dont study Public Health issues so i am fairly new to this and, of course, questions are coming up a mile a minute about the difference between this and other areas. One thing about this area that is interesting, and Public Health in general, is that a lot of things happened happened yet that you were worried about. And those are particularly hard to convince people that they ought to watch out because this could happen. And its also difficult to convince the congress that we are to spend money on something that happened yet because we have a lot of things that went to spend money on that we are spending money on. So well come back to this later, but this is a problem with this whole area of trying to get people prepared for what could happen a year or five or 10 years from now come example of pregnant women is a great example, and we dont have really good information from brazil yet about exactly what percentage would get and all that sort of thing. So the day of laying off the problem is pretty how do you do without . What are the conclusions we should draw from this . Do you have ideas of how we can convince people, the public, and especially policymakers that this is a big threat and you better take care now or be sorry later . I can say one thing on that, which is i think that how we market change, we always talk about it in terms of these one, two degrees celsius increases, which if its a december its kind of hard to like this or we feel thats a bad thing. What i like to do should we plan our hearings in washington on days when it is 100 . I like how you brought up the distribution changes and i think thats important to emphasize. So coming up with these metrics that are really easy come easy to feel. So the amount of hot days were going to experience. So not a two degrees increase in celsius, like how many days are we going to experience about art above 80, 90 degrees fahrenheit . Because even in december i deal with that. I think this is a huge challenge for Public Health in general, and not just because there to get people to Pay Attention to things that have not happened yet but there will we were very successful at things dont happen. Its hard to point to the successes as well. So sometimes in Public Health, people say we feel sort of invisible because it would die people notice this if it goes really badly. I think zika has been an interesting example because it has been creeping our way. And so its not something where theres huge persontoperson transmission like ebola where people were very afraid that if we had come into town, even one case in detroit that were going to do something very dramatic happen. But i do feel in argumentation think august and the statements that ive been seeing that they are recognizing the seriousness of this issue and i think seeing whats happening in puerto rico has really moved people. So im 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 rather limited in terms of persontoperson, or in terms of mosquito transmission on the continent. We dont want to alarm people and make it sound scarier than it is but we do want to have better data, prevent as many cases in pregnant women as possible. One other thing i think not to discuss briefly, for just a brief period, this mosquito seems, it differs according to entomologist, from other mosquitoes in many ways unrelated to this atlas. One of them seems to be its hard to kill. A lot of the things weve done in the past, especially spray them and spring in areas like we spray can force and so forth will not have an impact in or have modest impact. So if you cant use of sprays, doesnt that kind of limit, not that you cant use them but to be less effective, and the most effective means is to go into peoples houses and spray their house, which a lot of people are going to resist. So if thats off the table but not going to be a major method of control, what are we going to do . How are we going to control the spread and kill the mosquito in the areas we are worried about . Be. Not necessarily the south United States. It is higher for the Educational Campaigns. The United States at yellow fever, it was a real problem in new orleans and they conquered it with an Informational Campaign and a lot of economic incentive to do so because it was an important trade town. People feel their health and the health of their children is definitely a motivator. What is happening in puerto rico is sector control initiatives and the behavior change, wearing long clothes and staying indoors are focused literally on pregnant women. We have been working with the Puerto Rico Department of health, 90 of the pregnant women in puerto rico, identify women who are at risk and literally working with the Health Department to bring this strain to their home, screening windows, provide individualized protection pads that include things they can use in their homes. If you are very targeted, outdoor spraying by itself is not a problem. I will talk about the administration, people hang out in washington, this is an interesting case. I had the opportunity to talk to congress, here is what the situation is. I have not heard republicans oppose administration proposals, dont need this proposal or this is not a big problem at all, they are claiming it is not an emergency, the administration wants to not pay 1. 9 billion for its proposal so they are saying the administration should increase benefits and they suggest using money from the ebola fund. How do you respond to that . It is a case where republicans not opposed to the policy or science or that is what they say. How do you think the administration can respond . The administration requested this be designated emergency spending. Our position is it meets the Requirements Congress set for that. It is necessary to protect the health of the United States and others around the world, it was sudden, we were not anticipating this kind of threat, into brazil and other countries and territories. It is urgent that we act. I have already seen them, this is a temporary search we have seen. There are longerterm things we need to build up and be ready for continued transition. For us it meets the criteria. I was sitting at the dinner table reading emails and have these questions about zika because they know what they need the money for. Why dont we use your ebola money . I cant figure out. A 10yearold said that . Why are you laughing at me . The issue there, i showed you the budget structure, we cant stop working on ebola. We had recurrences and flareups that have created the need to trace hundreds of people, the fact that we are finding this is because of the continuing work in this country. The way our budget is structured, for us to turn towards something means turning away from something and that is not what we like to do. Repurpose funding in order to respond in a timely way and hoping we are able to replenish that. Im sure deborah is not allowed to say this. Public Health Spending is woefully underfunded in this country in general so the response, we have this zika emergency so lets take money from something else. What should you take it away from . Should we take it away from other Child Health Programs . Other Infectious Disease programs . The cdc realize on state and local Public Health agencies and those are underfunded. I work with the new Jersey Department of Public Housing and the number of stops over the 15 years i have been working with them. Almost everyone when they started is working somewhere else so they are very capable people. If the government doesnt want to pay them they can get more somewhere else. It is outrageous that we should rob peter to pay paul as the saying goes. The other choices to get them from the chinese and saudis which is the normal course of action. This is what congress is trying to deal with. Revenues only increase if the economy grows like mad. We will only have a little bit of money and you are limited in what you can do in that situation. We have a situation not in Public Health funding but funding in all kinds of agencies and issues some people would like to address. I think stay tuned, this will continue. This will happen over and over again. The first thing i thought of, it seems on its face to meet the congressional definition of an emergency. So far Congress Stands firm. I will recognize you in the microphone, right up here, ask your question. Make it a question, not a comment. There we go. I had one comment. If you are looking for a success story, i have friends before and after we banned leaded gasoline and after the first summer of the band i remember him saying he wished he had that for his dissertation, the clearest link he had ever seen. I have a question about the risk issue. The focus is on pregnant women and the military offered to pull pregnant soldiers out. What about childbearing age if you are not pregnant, treating women who are pregnant, is it a risk to childbearing age, how do we know about the male soldiers . One other question, some reporter, there are mosquitoes carrying yellow fever someplace like capitol hill. If that is true i would be interested. Go ahead. Women of childbearing age, that is part of the communication strategy for women who could become pregnant to know the risk, to manage, maker travel decisions in an important way. There are many unintended pregnancies so encouraging people to avoid exposure to zika before they become pregnant is part of the Public Health intervention for sure. We do a lot of work here. Teen pregnancy prevention and unplanned pregnancy. It turns out very difficult to affect peoples sexual behavior, we had some success more than any other group, teen pregnancy has declined every year since 1991 except two years over 50 so that is a huge triumph but it is difficult for people who are coming down a little bit, but rates in historical terms are huge. Women in their 20s expect some day to become mothers should they stay away from brazil and puerto rico forever . My question, when the military is pulling out pregnant soldiers, get away from the unintended. There isnt evidence an infection prior to pregnancy has any ill effects . Next question right up here. I am from singapore. I want to talk about clinicians. Have you spoken what do clinicians tell a woman who are traveling or have traveled in terms of people looking for fertility treatment is there a message until further notice . Second question on Educational Outreach, what are they doing in Educational Outreach . And if there is anything to that effect . In terms of clinical advice in the United States the travel advisories, working to make them aware, for pregnant women who may have traveled the advice of talking about potential of being tested is symptomatic. We dont know enough whether having an asymptomatic infection has the same effect on pregnancy so that is something to study so we dont have as many answers as we would like to have for clinicians but that is one of the reasons having Testing Available in Public Health labs across the country is important. If you traveler been exposed, really concerned and we want to be able to tests are not perfect and what is known to be the cut exposed, working on that kind of monitoring. We have many channels for clinicians and you can see those messages and materials on our website. That is also true on more general Educational Outreach. A lot of outreach is going on in puerto rico and all the things for an Educational Campaign broadcast and posters and all kinds of things, we are doing less about in the continental United States, you would see that increasing with supplemental funding and the ability to stand out. Thank you. I am a reporter, i wonder what the environmental factors or economic factors are that are making zika more prominent in puerto rico. You mentioned airconditioning. We had an article come out last week excitingly named immortality reports. The epidemiology in puerto rico what answer questions. I think what you see is a lot of breeding areas, standing water. A mosquito can breathe in a bottlecap. When we think about standing water it is not just a bucket but little micro environments where they can breed. There is lack of window screens and airconditioning, junkyards, abandoned homes with a lot of standing water. It is the proximity with which people are living as well. Is it mostly other things . Some of that is associated with poverty. I dont think it is necessarily contained 2 areas of poverty on an island. Heat and humidity are important. Less clear the causal relationship between poverty and mosquito Borne Disease because historically we had a lot of People Living in hot and humid places. You cant say if this is the history of poverty. Island territories as opposed to the mainland