that include a willingness for both sides to make serious compromises? because i haven't heard that word much over two years. >> if think it is concessions. [laughter] obviously if we're not ready to compromise why would we start negotiations? we need to see what is on the table and the prairies and that is what makes it complicated and why we engage we need to compromise >> we have gotten good at compromising.

>> i am a reporter and i am curious at what point of the article was it used to pull out doesn't change the priorities of your office to negotiate? is that torahs the beginning read the end your leaving were during the process? when does that begin to alter how views the priorities? >> the british government has to evoke article 50 and obviously that will not happen prior at the european council as a call for an extraordinary meeting in september to discuss. so this formal exit

discussion at what pace for the budget or the access all of the technical things to be negotiated that is what article 58 is about the and this type of relationship what should we have? to they want total independence with the free trade agreement? we don't know it is up for them to define so that will depend on that and once day exit of course, they have to exit all the trade agreements as well and later if they think that is appropriate and there is 37 then there's the other ongoing trade agreements

that is case by case what to do with the u.k. so that is a quite heavy exercise though we cannot start before we know the relationship i think whatever solution they choose they cannot automatically be in the trade agreements they have to go out to even if they're part of the internal market. >> i am with the "wall street journal" how will you set the priorities for trade negotiations is to have the you exiting isis are the -- u.k. exiting it doesn't have

its own trade negotiators then you also need to work on the deal with the united states you divide your negotiating teams? some voters seem to think their civil servants that is interesting to know what that might be also mr. trumka can you say if you would support the no-frills trade talks as the republican leaders have? >> thank you very much about the concern there already overstretched though we are negotiating as he just finished with canada and the philippines mexico and geneva and are prepared with indonesia and chile sirree

already have a heavy agenda so where do we put the u.k.? i am not in a position to tell you today. >> but of course, we would reflect upon that

this is just under two hours. [inaudible conversations] >> good morning the roundtable will come to order. we'll enter into the record we do have a vote at 1032 keep this going to want to give you reach an opportunity of an opening statement. this is the very serious health problem rather than

meet for testimonials like to throw open as quickly e as possible then we will get your statements. >> for me what would be most helpful is what should the congress be doing? to enable us to successfully meet this challenge and help to overcome it if we can walk out of here today in our hearts and minds it is a good day. >> short and sweet i appreciate that. the first witness diaster name had a time still got a wrong. deputy principal director for the cdc prevention and

served as a number of capacities and worked internationally with respiratory syndrome. >> people have been following the situation and potentially the bottom line is retried to do everything we can to protect pregnant women one mosquitos i can leave a pregnant woman to deliver a baby with a devastating condition called microsoft only in that child whenever be able to walk or talk or swallowwort care for themselves and could be ted million dollars cost of they survive in mosquitos season is here cases are increasing in p.r. him more than blood donors had evidence just that week and we know that the mosquitos season is arriving right now we're falling nearly 500 pregnant women in the united states

ended the 50 states and territories that have a zika infected pregnancy we need to states to detect and respond and prevent infections and surveillance for the disease, and everything we can to make sure that travelers and their loved ones have the information they need to protect themselves the cdc is very busy with laboratory response evaluation on the mosquito front and to protect americans. >> as johnson is fifth generation everyone to say how much we appreciate that

you are here. >> i am honored to have a chance to represent our company as you mentioned we are the maker of the largest manufacturer of household insecticides and propellant in the world. >> we have been in this business for more than 60 years after decades we have to help to combat mosquito transmitted diseases around the world including west nile and malaria killing more than 400,000 people in the world every year. and hospitalizes hundreds of thousands of latin america

and as you invest millions of dollars into a new malaria campaigns around the world every year we also work with the bill in melinda gates foundation to help develop better tools and more effective ways to combat mosquito transmitted diseases a number of countries. we also operates the largest urban private center in the world in wisconsin so we are no stranger as a company to mosquito transmitted disease. what makes zika so tragic is that strikes the most believable and if i could wave a magic wand to eliminate this disease i would because we would just as soon not have this business when the story broke in brazil with microsoft's lead restarted to marshal resources for the

manufacturing team working 24 severed over several months we also launched full series of educational programs and donated product to those most in need mosquitos season is largely over in brazil but just to dimensional lies what we did be surprised a triple amount of propellant to this last season than we did the prior year. we have taken some of that same focus am prepared this to the united states factories for the united states beginning running 24/7 in february and our suppliers also greatly increased production we have worked with the epa to has given us permission to import products from argentinian and european factories in case we might need it so we are truly gearing up for the worse case scenario if it comes to that.

i hope it never does and i hope mosquitos transmission never makes across our border. our company is committed to donate a million -- a minimum of $50 million of product and other services to help fight against zika off to the cdc foundation and support of the summit also donations to the international federation of red cross the american red cross and the children's health association of brazil among others and we are prepared to donate more than $15 million if the need is there. we've also set up the web site with the educational resources and tips and videos have people can protect themselves translated into 13 languages reaching more than 69 million people across latin america and the caribbean and we also put

all this material onto the internet which is a free download service provided by facebook i am proud of the men and women in our company working so hard to fight the fight with our manufacturing facilities in the united states they're working a lot of long hours to help families in this country if there is a need. one of the most important ways we can help is with the environmental control before they breed with education and public service announcements and communication to help people understand what they can do to help eliminate the mosquitos threat on mosquito breeding grounds it is important to get to the highest risk cities in the southern united states

largely in my mind and urban issue that bites humans almost exclusively in breeds in areas of high population density and the risk of transmission is highest in the big city so getting to those high-risk cities with education programs and communications programs are the most important. in closing i will reiterate again i am honored to be here all of us at s.c. johnson are happy to help anyway we can. >> thank you dr. johnson for efforts and your generosity. our next witness vice president of practice activity for the american college of obstetrics and gynecologist of the board of directors board certified in obstetrics, why is that in there three times?

[laughter] as well as the anatomic pathology. >> it is an honor to be your representing and thanks for the invitation approximately 57,000 ob/gyn responsible for women's health and we see the effects of this virus impacting firsthand as the council linen and addressing the request that they have we work closely with the cbc to provide information as well as our partner organizations to get the most up-to-date information however the reality is far less known than what we know of the virus impact has said roughly at this point in june a little over 500 and in that have been infected patients are asking question those that are planning to travel or planning a pregnancy are also asking we're trying to provide

answers based on limited evidence unfortunately. we do know with the cdc publications that zika virus is in a call so relationship with birth defects another study published sites that is relatively limited evidence but the risk of the infected fetus depending on the timing of the infection can range more than 13% but to put that into perspective a congenital heart defect what is the most common is 1% so this is 13 times even higher. we do have recommendations how long to wait for women that are contemplating pregnancy that are exposed that they wait eight weeks and it is recommended they wait at least six months of infected because of the limited evidence we have suggests the virus last much

longer in the semen than in the bloodstream so there is terms about sexual transmission and what we don't have is if they are infected via sexual transmission risk to the fetus. >> the only guaranteed way to prevent this is contraception to paraphrase from the cdc we don't know how to stop the virus but we know how to stop pregnancy is crucial to address this issue for pregnant women and those considering pregnancy to avoid exposure were avoiding travel use insect repellents air-conditioning in areas although we know nothing will work perfectly. diagnostic testing is important and there are guidelines as far as what to test and when as far as when exposed to the challenges there is very few labs across the country that have the capability as a testing

is very complicated as the king's cross with other viruses. and because of that there are delays over a month the of these results and you can imagine the impact that has for a pregnant woman as well as what she will do with the information when she gets it. we also recommend serial ultrasounds to look for the impact that is a significant burden on the health care commit - - committee of ultrasound is limited because of radiologists a available to do the scans the we are in regular communication with the cdc to talk about guidance we're working closely with there is a true crisis in p.r. to address the issues they are having we have a number of resources available to

spread the word about what we know and we don't. we're definitely trying to learn more about the effects on pregnancy we need resources and prevention strategies as including the of vaccine but also a critically important aspect so again thanks very much it is an honor to be here. >>. >> as an expert in insect entomology. >> i appreciate the opportunity to be here. in addition to those other things from fort myers

florida we have the largest districts the capacity for mosquito control that is almost nothing from a lot of states. >>. >> is on now. >> the capacity for states to do mosquito control varies across united states some have no programmer infrastructure some have very good infrastructure. states like florida and california and new jersey virginia have state level coordination of mosquito control others have local levels and as i speak states

and territories and municipalities are scrambling with their need to implement and shore up their existing capabilities based on the new threat of zika. florida is conducting tabletop exercises as we speak with local health organizations for mosquito control and emergency management personnel to write scenarios to determine capabilities and state capabilities the governor has provided $26 million of emergency funding in florida specifically to health and mosquito control organizations. new york is implementing a state wide surveillance program with 1,000 different locations to try to detect these mosquitos have identified 14 high-risk counties in developing plans

for how to go about combating mosquitos in those counties him p.r. just had a workshop recently which included 47 experts and the outcome of that workshop is they will try to put up the mosquito control program based to the infrastructure of california or florida where they have a commission it is a five-year plan but initially trying to set up the infrastructure and control efforts on the country wide basis. municipalities are also working to figure out what you do your lens has started to trap and mapped areas of risk creating a public education program community service announcement working

with coordinating efforts with code enforcement people to develop plans for responding to control these mosquitos. is a difficult endeavor the cdc calls these the cockroach mosquitos because they're like to live closely associated with people and essentially have to have have the industrial site to get control so it takes a lot of working and boots on the ground and a lot of resources. one of the big needs across the nation right now is education and training programs especially for those states that don't have existing programs you cannot put up a mosquito infrastructure overnight so the american mosquito control association is working with the cdc on a training contract to develop

certification programs nationwide for mosquito control personnel and as well as they train the trainer where we will set up 10 regional locations across united states to provide training to the strainers to share the information we have some recommendations for funding that needs to be accomplished as senator nelson has the bill called the smash act which is strengthening of mosquito abatement for safety and health the appropriation of $130 million that would go to shore up mosquito control infrastructure costs united states. the states currently get

money for epidemiology and laboratory capacity grants some of that stays at cdc some is passed to the states there is $27 million to the itc that increase at $55 million and that is where we were one decade ago after west nile cave in to the united states. half of the new money would stay at cdc have we recommend distributed to the states to build that laboratory capacity to shore up those capabilities. one big area where we have an incredible need is funding for the registrations of the materials and the development of new materials

and with that development is extremely expensive. .

we have a real significant problem right now with potential resistance. the mosquitoes of a very effective genetic mechanism for developing resistance to the most common chemical that is used to control adult mosquitoes. we have only two classes we are using to control these mosquitoes and if they develop significant resistance to one class and we are limited to only one other class the potential for developing further resistance is there so we need help with the development of future materials. there's also cutting-edge research going on with regard to using genetically modified mosquitoes are using sterile insect technique's and research funding for those types of endeavors is needed so that some of the fears to the public with regard to those types of endeavors can be a laid.

>> thank you mr. gale. our fellow wisconsinite dr. david o'connor professor at laboratory medicine at the university with wisconsin madison and chairs the global infectious disease at the primate center. after studying the zika virus dr. o'connor. >> i want to echo what everyone is said about being thrilled to be here and to add that i'm very surprised to be here because he or go few would have told me we would be talking about zika virus i would have believed you at all because until recently we simply didn't view zika virus is a major threat to human health and to add to what chris said, the key phrase is limited evidence. because it's an understudy virus we simply don't know much about it. there are many assumptions we

can make about the virus because it's related to dengue virus but at this point so much for research needs to be done to understand how the virus is transmitted to understand when ender what's circumstances pregnant women are at risk and under what circumstances nonpregnant people are at risk of other researchers guillain barre syndrome and this needs to stretch across multiple types of science. the reason that we have been able to develop some preliminary understanding of zika virus isn't part in brazil i've been -- hiv issues and group hurts first reports of microcephaly in babies coming out of brazil my colleagues asked if i would be able to assist. assume that the suspicions were narrowed to the zika virus we immediately begin developing experimental systems in collaboration with some of our

colleagues from vw medicine who had been looking at the zika virus in columbia. we started this work rack in december and that position to a shovel-ready project to begin studying z-10 laboratory in january and february of this year and fortunately with the support of the national institutes of health or j. and infectious diseases we were able to begin developing a non-primate level for his zika virus. some of the key findings that have come from that so far our first set in pregnant women the virus is persistent or detectable in the blood for considerably longer than a nonpregnant men and women so typical zika virus infection in a monkey in a person less about a week. the virus gets in the blood and then it goes away. in the nonhuman primates that we have infected three out of four of them had an extended duration of virus in the blood which we hypothesize is due to the fetus being infected and shedding the

virus back into the mother's bloodstream. the implication of this is that there may be other effects of fetal infection that go beyond the microcephaly that was described earlier so microcephaly is very vivid and it's very obvious. it's tragic that what we don't know right now is what the spectrum of other zika associated birth defects might include. in fact because many of the babies or all of the babies in brazil who were born last summer are when you are all that reach those developmental milestones at one, two and five years of age and they could indicate more mild but still significant issues that will need to be addressed as part of the medical management of the zika virus. but the other type of information that we have learned from our preliminary studies is that once you have been infected with the zika virus wants you are going to be immune from being reinfected for some period

of time in this goes hand-in-hand with observations from asia where they had explosive outbreaks five to seven years ago but once the virus went through like a waive it didn't come back. it infected a huge number of people very quickly and then it went away and that's probably because the people who got infected initially written to me and from being reinfected. the implications of that with respect to protection of the u.s. and also central and south america is that we have a number of people who are going to get infected naturally in puerto rico potentially here in the continental u.s. and certainly in central and south america and those people at the given acted now are probably not going to get reinfected. we don't know how long immunity lasts but as i think chris said we are a few years away from having a vaccine city can imagine getting a natural infection with the zika virus now could effectively eyes some time until such time that

vaccine is available to boost immunity or revise rod immunity to everyone. there are so many answers -- unanswered questions we don't know the answer to so because the zika virus is spread in the same places as any virus a lot of scientists expected the severe zika virus at murnau these are due to people having previous dengue infections and being reinfected with the go but with the dengue infection predisposing them to the severe outbreak. we don't know to the reciprocal might be churro. people are infected will eventually receive the sake of vaccine are going to -- there are literally dozens of large types. this is a type that we need to answer them right now any information that we get is uniquely valuable so the study

we have been doing so far has been using small numbers of research and less than a dozen or so. in studies of small numbers of patients now are going to provide way new information than studies of hundreds or potentially thousands of patients years from now. because will begin to put the data now as we can begin to add that ineptly wait we won't be able to do that and let the virus get the upper hand. thank you. >> thank you dr. o'connor. let me start and dr. zahn mentioned we are a couple of years away from a vaccine in your work shows that a vaccine should work though, correct? >> correct. >> what is the stumbling block? we can develop a vaccine quickly with those viruses. is there a vaccine right now for dengue fever by chance? >> there is a vaccine is partially effective for dengue

and some mint advanced testing. hiv scientist on my says that to make full predictions about vaccines but in this case there are lots of biological reasons why should be fairly straightforward to make his zika virus vaccine and why such a vaccine should be feasible and should work. some work that came out of dam baruk's group showed the same concepts that they used to deploy vaccines to other diseases shows effectiveness in my so again we have lots of reasons to think of vaccine is feasible however the vaccine still need to be tested first for safety and small numbers of people and then they need to be tested in small efficacy trials and finally they need to be tested in large efficacy trials. the studies are going to be particularly difficult in pregnant women because it's going to be difficult to want to expose pregnant women to the risk of a vaccine and we also have to guard against unintended consequences. for example if you vaccinate

someone for secret you increase their risk for inquiring -- acquiring dengue there will be risk calculations that will need to be made. >> is there anyway to speed up the process? >> i would echo that they are not released tumbling blocks but rather takes time to do the necessary steps in this yield been hearing and i've been preparing to launch a vaccine trial but there's a certain amount of time that has to elapse. people are working 24/7 to get the trials ready but that's when the reasons the additional resources are needed. >> there's really no way safely to trim that down or is there? >> i think it started being shrunk because the first second and third bay street -- phase three trials, they are trying to impress this and a two to three years so assuming everything works it will take time also to

produce a vaccine that is carefully produced for lot to lot consistency. stated in your testimony there are 500 women better pregnant with the zika virus pregnant in their blood. is that correct? >> fit the states for d.c. and u.s. territories as our latest data have 481 women with laboratories proven zika in pregnancy. there are many thousands in the americas. as you have been hearing from some of these studies we are concerned particularly in first and early second trimester the chances of that problem mike like microcephaly may be substantial only don't know whether babies that are born looking healthy look. >> dr. zahn you are talking about a one to 13% chance of having an adverse affect the somebody infected with the zika virus, your best knowledge right

now. >> that's basically what we know now. the. of effective fetuses may be as high as 29%. it's not as well-known some of the risk factors and also the timing pregnancy in one of the concerns is some of the earlier data would suggest this might make sense if you are infected early in pregnancy and the chance for a development lab and rally might be higher later but i remember correctly the recent case in florida was the woman was infected for 30 weeks. the other concern about this and dave might have information from the primate studies in one of the cases of new england journal there was research in finland by one of the co-authors where they cultured cells in the infected host cells with the virus and they grew in brain cells. the concern was a lot of back.

a bit damaged organ damage occurs because of the immune response. in addition to the actual infection. one of the concerns in these initial investigations is that the viruses directly attacking the cell causing damage without necessitating an immune response. even if the woman is infected late in pregnancy and doesn't have any significant severe adverse outcomes at birth we don't know that irs is still not killing up rain cells is the amp and starts to grow. again as dave pointed out we don't know what's going to happen to them later on. >> again, pardon? what i would suggest as people go and vote and i will go. i've got a lot of questions myself.

i'm not quite done with mine yet but so do you want to stick around? >> i have got a conflict on their vote. >> i guess we will start with broth because i will be sticking around the whole time so i will yield to rob. >> i appreciate this issue. we have a legislative as you know force right now. google get to it in the next couple of days. as a group do you support the legislative initiative that is passed the senate and the house and back to the senate? do you think this will help? >> my concern is i talked to admiral schuchat about is the revocation efforts and there's incredible science that needs to go on here for us to better

understand this problem. i understand the need for that in the legislation is so important because it funds the research and mrs. -- research and science necessary but what we do know is eradicating it is important each one of you talked about that. mr. johnson you talked about some of the efforts in latin america for instance and one of my concerns is what i've heard around around the country subdued the mosquito abatement that is needed and specifically would have the federal capabilities. i happen to come from a higher we have a youngstown reserve station the one fixed-wing in the military. they do it on some job. they did this in texas and louisiana following katrina which was very helpful in terms of reducing the risk of infection. they also do other for vegetation but my question to you all is are you concerned

about that also one of your colleagues spoke at a hearing. he said one of the things we think is really important about the zika outbreak is to revitalize the mosquito control efforts. this was what rear admiral stephen. he said the ability of mosquito control some localities have their own enterprises and you talked about that today little bit. some have hardly any at all. i think it could be a role for the federal air wing location capabilities needed. could you comment on that come his comments and tell me what you want to be doing in the federal response for some these areas that don't have effective mosquito control? >> that's right. mosquito control is critical and i don't think anyone could have made up of viruslike zika a mosquito bite that can cause such devastating health complications and can be sexually-transmitted.

we know that mosquito-borne diseases can emerging cause problems. the country's capacity to tackle these diseases is very important. i agree completely with the need at the federal level to have the technical assistance and the ability to supplement what the state and localities can do. much of this is learning what works best because what works best verse because different than what irks best for west nile and the opportunity to do aerial spraying is important in many control efforts. >> i would certainly agree that there needs to be aerial spray capability in greater extent across the united states. we probably in lake county have some of the best there is but we actually have a fly in every year where people come to her district to aerial spray in the air force participates in out

with us. our plan with regard to attacking zika and the mosquitoes involved aerial. if we get to a situation where we have local transmission going on it will involve using aerial assets for both adults and larvae of these mosquitoes. we have technology that will allow us to do also low-volume spray to need similar to the adult control technique that we can put larvicide into these cryptic habitats that these mosquitoes live in and we can be very successful in controlling these mosquitoes over a wide area with these kinds of assets. it's very expensive and again it's technical issue but that is how we plan on attacking it locally. >> this is an area we can all agree, that there's a need for

this kind of mosquito abatement in the federal government has a low -- has a role here. i'm glad you are working with us and i'm concerned they are about to be deployed to the middle east and only have one plane available in one fixed-wing plane available for the united states. we are working with the air force on that but i would appreciate you all giving us your advice so we can make sure we end up with a fixed-wing operation that is effective to respond should we have a situation of the infections. thank you mr. chairman. >> thank you and i yield to senator tester. >> with me ask a quick question and i would be happy, couple of quick questions. dr. o'connor thank you so much for being here and sharing your insights to the specific question of broader person about the research agenda. you talked about the zika virus remaining in the bloodstream of

pregnant women longer than others. is there any correlation that has been discovered at this point to their propensity for later developing key on parade to cuss about longer infection exposure? virus exposure? >> we simply don't know some people there's only one case report that came out earlier this year from researchers and colleagues in their data from the primates is still very new. one of the studies that's going to need to be done in that i know my colleagues in brazil are doing this and i'm guessing it's done elsewhere is we need to do follow-up of pregnant women where one of the readouts is that we test them multiple times for the presence of the zika virus in nucleic acid for zika. then we assess whether there's a difference in the risk for guillain-barré.

>> you spoke in your testimony about how uniquely valuable the research being done now is even if it's on small samples etc.. what would you identify as the major gaps in research right now if you are in a position of -- where would you target most aggressively the research dollars to fill in those knowledge gaps? >> i think that there are a couple of very. [inaudible] we don't know the extent to which mosquitoes and sexual transmission -- [inaudible] that may or may not have an impact. it may be that there are other types besides those of the party been identified that are also

able to harbor or spread the virus. those studies are underway but they are far from being complete. for example in africa it's not the aedes aegypti responsible for spreading the zika so there other types of mosquitoes that are also present in the u.s.. we need to assess their risk so that we can figure out their risk factors that are most likely to be associated with transmission and sustained spread. bill sitting to understand what the implications are for pregnancy so we can provide better and more informed guidance to pregnant women. in addition to those who have laboratory confirmed infections during pregnancy you have to think that in an area where the zika virus bread is occurring it leads to enormous amounts of anxiety for all pregnant women whether they have zika or whether they don't whether they are at risk or whether they are

not in for the women's would have the zika virus during pregnancy we need to come up with ways of assessing the likelihood that they are going to have impacted fetuses whether by measuring the duration of uremia or using a combination of ultrasound and other types of tests that haven't been developed yet. i think that's going to be critically important so it's doing things that can help manage the risk and quantify it that we need to be focusing a lot of attention on. >> dr. schuchat do you have anything to add to that question in the primary gaps in research? >> i echo the idea that this is a critical time because studies that are carried out right now could really help us guide the response and get critical information to people who are scared for trying to protect themselves and their families. a couple of other areas that i think are quite important. one is the persistence of the virus and different body sites are right in our precondition about sexual transmission are

based on very little information about how long the virus can persist. whether it's the pregnancy and the harms of that causes in understanding whether the virus eventually does clear and whether the issue of sexual transmission can have more evidence-based guidelines. another area is the work on diagnostics. i'm very proud of my cdc laboratory scientist who has developed rapidly a couple of different diagnostic tests and shared them and commercial companies are developing similar once or using hours but what would be better diagnostics so it woman can know i already have zika. this pregnancy will be okay. that is what we have put the rubella, german measles virus. we vaccinated against it for children and we never screened to see whether they had antibodies to rubella and we wouldn't have to worry about it during the pregnancy. it would be great to have that

diagnostic test for zika if we don't have such a test and we have to do maneuvering to differentiate the infection that might at then dengue versus the current zika infection. of course the vaccine work is important and one other area is the area of insect repellent. we are very happy that there are products available but there probably is a potential for newer ones to come on line so i think these bad diseases are a minor of the need for protection in many different areas. >> i wasn't intending to ask it but you brought it up. since s. c. johnson is one of the largest urban entomology privately funded labs are there opportunities for private sector or public sector collaboration in the research you are just describing? >> yes, absolutely and i do want to hoblick we thank s. c. johnson for the extraordinary generosity of their collaboration, collaborations in

terms of donations of products and resources and also of expertise. we really appreciate the public either partnerships establishing former land and formally. we really need to be working together. everybody has a role to play in lot of private industry has expertise and channels that we can use in the research community both academic and commercial. it's a huge resource right now. >> we are always looking for new more effective repellents and we work with universities and we are happy to collaborate with the government in any way we can to do that. >> thank you senator baldwin. let me ask a couple of questions along these lines and if i have to i will recess and senator carper will come back and ask

questions. one of your testimony said that lasts about a week in the blood, and the zika virus but we don't know how long it lasts in seaman. is it easy to determine that? what is the difficulty in understanding how long it lasts? >> the study needs to be done so they are in progress but every time you are testing testing ths is still there coming up to keep looking. you may remember any bullet that we had survivors who have persistent viruses and we have that imitation of a virus present after 15 months and we have an example of a flareup of ebola that we leap occurred 18 months after an individual survived ebola. he was able to spread it to someone else so it's not that many months that we have been tracking zika. >> a kind of surprised me.

>> the reason is and i don't mean to interrupt you, the immune system protects the so all of those antibodies that are fighting the virus in your blood don't get into the so the seaman is protected from. >> so we are pretty confident that is free from the bloodstream with about a week. we are still learning but we are pretty confident of that. do you know how long it's detected in seaman? >> at least two months is what we are saying that the recommendation of six months is we don't have data longer than two months. >> mr. gale talking about registration on different chemicals can you tell me what you are talking about there? >> each material we use has to go through a registration process with the epa.

it's a very extensive and thorough testing. >> let me hold you on that. what we would do his will rece and fix the mic of funds at that point in time and i'll come back as soon as possible and senator carper will come back as well. thank you. >> thank you for your leadership i am not going to ask this question initially but i'm going to ask you to think about it and then we will talk about it. we have been requested by the administration to provide a certain amount of money. some people think that's a reasonable out of money and some people think not. i'm going to come i want to ask you to help us put a on the many demands on the resources that you all have been talking about. the question i asked earlier, i

hope to walk out of here with a greater sense of urgency in what we should do. i have some idea what states you will be doing it and certainly our state that wants to talk about what we should do is a federal government of the congress and the legislative legislative branch per in what should we be doing? >> can do everything and we all share a sense of responsibility. admiral schuchat, is that correct? schuchat. >> we do think this is an emergency that has devastating potential complications that are permanent and we have recognized that it's very challenging to respond to an emergency but the timeline that's rather delayed so we are working very hard with the states, with puerto rico and the clinical community and the research community to try to prevent, detect and respond.

>> let me interrupt. we have had a growing debate in the congress for months now on whether the senate should take up a hearing on the presence nomination for the supreme court and our site keeps saying we should -- with respect to judicial nominations. what is our job, what is our job in the congress and the senate? what should we be doing? >> that's what i'm asking. snap we do believe responding to the request for emergency funding is critical and that would be an answer. and just one comment is that there has been a lot of discussion about ebola and i just want to make sure that people know that our perspective on ebola is that assad over and we still have about 75 cdc staff in west africa and their counterparts in west africa are working everyday to keep ebola from flaring up again because of

the thousands of survivors every time there's a new case. there's enormous response is needed so we are nervous about the idea of making sure we can continue to fight ebola and keep americans safe while dealing with this terrible new virus threat in the americas. >> dr. jackson. >> i'd like to abdicate that the government help with consumer communication and education programs. there is a lot of misperception out there about what's zika is. there was a recent poll that was conducted. 30% of that survey thought zika was a conspiracy. i think in terms of environmental control the public can really help. standing water is a breeding ground for mosquitoes. the education and the public service, communication programs in argentina on dengue for example.

there is a lot that the public can do to help control mosquitoes in their area. it goes beyond aerial spraying. it's got to be multipronged integrated approach and i think the government could go a long way from communication and education standpoint. we would be happy to help up his it's kind of our cup of tea. >> thank you. doctors o'connor. >> speaking from a clinician cited think the research aspect is critical to assist the cdc as well as researchers like dave and others around the country in order to do the surveillance as well as the clinical research needed to identify what the immune response is and what we can do to prevent it and what we can do to treated. the vaccine trials are critical as well. from an organizational organizational perspective we need that kind of information so we can better educate our providers and their patients. we are giving providers

information based unlimited evidence and that makes it more more -- advise patients on what to do and the recommendations for how long they should wait for detecting pregnancy is based on very little data. we don't know that that's a deal timeframe. the research pieces critical to affect the clinical side. >> thank you. commander gale. >> is a mentioned previously in my opening statement i did mention that we need support for h.r. bill 897 the senate bill 1500 which is the sensible environment of protection act which releases the mosquito control of the requirement of having permits under the clean water act to apply pesticides to waters of the united states. to duplicate it and unnecessary requirement that puts mosquito control districts at risk of

significant lawsuits. >> i support the senate version. even choirs need to be preached to. >> ican i mentioned the existing legislation that needs to be supported the smash out for $130 million. the increase to cdc epidemiological capacity grants and assistance with the registration reregistration process or pesticides used for public health. >> thank you. doctors o'connor and make sure your microphone is on. >> i think there are a few lessons. rather than get drawn into what the dollar value should be a wanted struck i think it's most important that work began now in earnest because what has happened is a small number of

fortunate labs like mine have gotten supplemental funding from the federal government but on the research side most labs who are doing the work are doing so with diverted funds from other projects because the m. i h. awards rants over two to five-year period, they don't have a lot of money to redirect to zika research. if you look at the manuscript that you published yesterday talked about earlier was written from the perspective of someone who studied hiv for a long time. the perspective the narrow biologist and people who bring different sources of expertise. history has taught us especially with hiv that if we wait even a year or two we let the virus get an upper hand is going to cost much much more later on to deal with the consequences. secondly i think we need to knowledge there's not going to be any one-size-fits-all approach that's going to work for either prevention or

mosquito abatement are dealing with the consequence of zika virus infections that we need to make sure that there is a plan in place to support multi- disciplinary work in a way that is still coordinated. finally i think it's important to underscore what was said earlier with respect to ebola which is the zika response to my opinion needs to be considered as part of an integrated response to emerging infectious disease threats. two years ago it may have been ebola. this year it is zika in a few years from now to be something else. as dr. friedan suggested a few weeks ago having something like a public health emergency management agency makes a lot of sense so in a situation might does rather than having to deal with it in isolation and pits zika virus against the ebola virus control there are people who can make these decisions quickly and allocate funds

before a new situation becomes a crisis. >> thank you all and i yield to senator -- but before you do one of you mentioned the cost of raising a child with microcephaly and i think someone mentioned as much as $10 million per child. and i did some quick math, there are 1000 children that are born and survive microcephaly at $10 million per child that's $10 billion that's a lot of money. senator langford. >> in 1947 if i remember the day curt read-ins is when zika was discovered and identified as what it is. what has changed now from the 1940s when we first discovered it is the frequency, is that the numbers of the movement? what is that change right now

and why is there so much attention focused? >> there a couple of to say. one is that the virus, the virus arrival in brazil was in an area of very dense human population and very dense mosquito population. that probably allowed explosive transmission of the virus that was mosquito-borne for decades. it's also possible that in sparsely populated areas in africa or some of the asian islands, there was zika related earth effects that were not recognize because the numbers were fairly small. people have gone back now to french polynesia and recognize that there were consequences of that outbreak that word immediately recognized. the explosive spread in northeastern brazil and what we have seen in colombia and what

is happening today in puerto rico probably relates to the virus getting into much more urban densely populated areas where there is less protection for people from the mosquitoes. their other scientists looking at the strains to see if the change. >> let me talk about the mosquito site of this conversation what a pleasant conversation this is. how is it transmitted through the mosquito? is at the mesquite and as silly as it sounds i have not seen it but it's a mosquito biting someone and now the mosquito is the carrier and transmitting it to another person? is that the straight orders that or is there another way it's transferred to? >> that's basically what happens but it's not immediately. the person has the blood in their virus and the mosquito bites a person and takes up the virus and have to do processing and then subsequently is able to have many blood meals and in

fact many of the people. >> the mosquito itself is not caring the virus. the blood from the original person. the virus from the person transfers it to the mosquito itself and then it's also transmitting. i have not seen a lot of public information and this goes back to your comments on information getting out to the public. they are so many people in public. trying to figure out a couple of things where mosquitoes carrying this and why only certain types so is that the belief that only certain types of mosquitoes can take of that particular virus and carry it? >> the aedes aegypti mosquito is considered the best spec or are for this virus because one of the reasons is a primarily feeds on people so it's biting people getting the virus and biting of the people getting the virus. the other is capable of carrying

the virus but not considered a good a factor. you may want to supplement with additional comments wayne. i did want to remember to say one thing. because of this idea that mosquitoes can get the virus by biting people we really want people to know if they are traveling back from an area where the virus is spreading even if they didn't have any symptoms and were not aware of being infected we want people to use mosquito repellent for three weeks after they return so they won't infect our mosquitoes. >> this zika is what we call a mosquito disease and the intermediate effectors the mosquito as opposed to a disease like west nile virus were actually the primary host our birds or other animals. man is an incidental hosts but we still have to combat those diseases because those

mosquitoes can bite me and incidentally. as the admiral said aedes aegypti likes to bite people so that's what makes it an efficient effective these diseases. >> do we know how long basically the host of the person from the time that they are infected with the virus that they can continue to transmit that to the mosquito is that time period then -- span we are are seeing one to two weeks for the question now is pregnant women based on the model that is described where some women may have the virus in their blood longer than one to two weeks. >> anyone disagree with that? >> what i would add to that though as is there is a spike in the amount of virus in the bloodstream that lasts only a few days and i'll like to have the probability that a mosquito is going to get infected from a mosquito is going to be proportional to the amount of virus.

while it's possible a woman who has a low amount of virus in the blood can transfer to mosquito is probably much more likely with a high amount is going to transmit to mosquito but these are studies that need to be completed. that's just an educated yes. >> helping get the timing on this again. the mosquito that has zika bites of individual data what point would you say the virus is spreading? is a several days that it takes or does it become a risk and they can transmit over? >> i will add just one slight verification. some of these bascue dozer serial biter so they can bite multiple people. if you have a mosquito i would modify that to a mosquito bites us ehrsam or several people and within one day you begin to see the zika virus the bloodstream that it looked tend to peak in concentration somewhere between days to in days five and after that it receives the immuno

response brings it under control so during that period from days two to five that is probably going to be the most likely to be transmitted back to the mosquito. >> when do most people know that they have zika? is a day to divide blacks people that do know they have some sort of am less and they are experiencing some sort of symptoms. are they experiencing symptoms day two to five? i know a lot of people don't be at. >> we think four out of five people don't have the symptoms and the people that do will have symptoms for a two week or so. it's not long condition for most people. >> most people don't know exactly which mosquito bite infected and they don't know that they when they got infected so it's a little fuzzy after how many days after being infected they begin to develop a rash. >> which would explain there is then little to no conversation about quarantining individuals that are known to have zika. basically by the time you get

someone quarantines a person could transmitted at that point. is that correct? >> you would be wholly inappropriate to consider quarantines as part of the conversation with the zika virus. >> the other part of that quarantining is not a human-to-human spread so i think warren teaming would likely be ineffective. >> i will have other questions. >> so let's be clear currently where saying that there is nobody in america but has zika transmitted by the mosquito in a sultry travel? >> in the continental u.s. and hawaii the cases are travel associated or a handful that are sexually-transmitted. >> but there is virtually no doubt that some humans that have zika will be bitten by mosquito in the mosquito becomes infected and will start having those.

>> we think it's likely we'll have locally transmitted cases. we don't think it's like the we will have lots of them but we think it's going to be important for state and local health departments to look for them and it's not going to be that easy to find them because they won't be declaring themselves a locally transmitted case. right now the testing testing ae workups of people are getting are usually because they have traveled. we need to do some work with the states and locals and communities to make sure that we recognize a rash that might be zika. so there is a lot of work to do in the next few weeks. >> currently there are two different mosquito friday secure this preview on this primary but there's another one that's been identified. how many different for righties of mosquitoes are there? >> there over 200 species in the united states. florida has 90 plus in my county has 47 species. we deal usually with 10 or 12 of those species being pressed it

for a sore disease-carrying. >> they could continue to grow? where the disparate -- this edition of states that have these mosquitoes? >> our latest map suggests that parts of 30 states may have the aedes aegypti mosquito. that doesn't mean the whole state has them. that means somebody has found a mosquito in at least one county. one of the things we would like to see is better data on the geographic distribution of the aedes aegypti. that's the kind of thing that health departments and control groups are trying to develop right now. >> let me get back to the question i was asking about the registration of the chemicals we need for pesticides are potentially products like off. you said you needed funding for registration.

explain that to me. >> the food quality protection act basically change the way pesticides are registered by the epa. pesticides are registered under fit for a and under the food quality protection act basically in order to ensure that our food supply is protected when pesticides are applied to crops there is sufficient time and research is done to prevent people from being exposed to pesticides. the research requirements in the data requirements to register any pesticide became very expensive overnight. consequently chemical companies have to make a determination and they have to look at the cost of what is going to cost to generate the data to do the registration and then look at profit margins to see if down the road it's going to be profitable to continue. >> are these chemicals that have been used for quite some time?

said the existing chemicals go through a 15 year preregistration process and if you are doing a new chemical you are starting from scratch. the new chemical is more expensive because the existing ones have existing data. when they come up fo reregistration they look at existing data to determine does there need to be additional data generated in order to register a? i will give an example. the met mosquito larva said that we use routinely in my district to manufacture did the calculations and looked at what the data call was for the reregistration and decided it was not economically profitable to reregister the product that we no longer have that product to use. >> senator carper is always looking for something we can do legislatively legislatively. would that be a give an emergency way for? >> i mentioned the food quality protection act recognized the

fact public health were at risk by passing these stringent regulations. there was an appropriation to pay for the reregistration registration of pesticides. >> obviously that didn't work. >> the money is never been appropriated and that's what we are asking for. >> would maybe a better approach be using a pesticide for decades to create a waiver and way of registration of back? you have been using that in the world didn't end. dr. o'connor we have that had chancellor blank who goes along the same area of the cost and the consequences of a collation. the last time or the time before last chancellor blank came in with a study commissioned by research universities and said 42 cents of every -- 42% of the

time researcher time on federal grants research projects is spent trying to figure out how to comply with the federal regulations grant. are you seeing, d.c. the results of that and you obviously have gotten important grant research funding for your efforts here. or you seeing that type of bird and? >> is a combination of different types of predatory compliance. certainly they federal regulatory compliance can be an issue. a recent example is the contract i'm related to the zika virus i've been asked to comply with fisma regulations for data security and data integrity for data that is destined to be made entirely publicly available so we are trying to ensure compliance with data keeping data private when they state of the data is to make it public. there are instances like that but there's a lot of the time that includes making sure that you are doing animal experiments safely and you are compliant if

you were doing human subjects research and safety research under the appropriate standards and the appropriate safeguards. there certainly is room for improvement but it cuts across-the-board. a huge amount of our time is spent on administration. the federal regulations aren't the sole contributor to that. >> that would be something maybe we could work on to reduce that regulatory burdens of the dollars spent or put towards the research and preventing tragedies. you brought it up here in your testimony me talk about sharing information which i would just assume particularly on federal grants projects of that information be widely distributed and easily shared but it's almost groundbreaking that we are tried to make his information widely available so other researchers can manage the

good work you have done so you won't have to duplicate efforts. can you speak specifically on what you are talking about there? >> one of the aspects of our work that is mated innovative that from the outset -- alpha and we have made data publicly available on line to researchers and the notion of making data transparent as is being collected is one that's very new to science. >> that why? >> there is a lot of historical precedent that dates back to how science has been done but then there's also legitimate issues about how credit and precedence established in science as well as how one can take that information and if you were to put something up that is wrong and someone takes action and data that i can have deleterious consequences. some of the last outbreaks we have had beginning in 2009 in a

pandemic influenza some researchers who have been working at a decision that making data available more quickly during these public health emergencies outweighs the potential cost so we contend with ebola and we have taken it a step further with the zika work. >> i would think it would be relatively easy problems are overcome by saying this is raw data. hasn't been peer-reviewed so use it with that caveat that we are not 100% sure but we can advance knowledge quicker. >> i feel the same way about that raise. >> i commend you for pushing the envelope on that. i think there are legitimate concerns. as someone else want to chime in on that? >> i have one quick question. >> go ahead. >> let me ask one quick question well and make one request. the breathing thing here we to do tracking information and where it's moving and the speed

up this movement. mosquito population control and the vaccine. are those the three big buckets? >> i want to add that public education is really important. >> in that indication from the government out. are you talking more about facts of zika and making sure there is not outside standing water and putting mosquito repellent on? of those four things that i listed which one are we not doing well or not doing enough of because it sounds like all of those have started. which one needs the greatest amount of celebration and? >> in these areas there's a lot more that needs to be done or there are issues that are about to meet response. we have developed laboratory tests amid ship them out but as the mosquito season is here and as we are looking for local

submission we will have a surge in the lab testing. we been doing medication but as you have heard some people aren't hearing the messages and we need to increase concern in certain groups and address the other groups. the factor issue is likely to get more more complicated because we did that throughout what works in the really scale it. there are couple of other things that aren't exactly in those categories. in particular we would like to be able to better protect regnant women in addition to the mosquito control. we think things like screens on the homes of the helpful for them. that's the kind of thing we haven't been able to get to scale. >> if i could add a couple of others that are close to that the slightly unrelated i think we also need to understand the contribution of sexual transmission. we talk about mosquitoes and we need to remember that this may be a disease were a lot of it is spread in the u.s. could be fueled. somewhat related to that the

point that i made at the beginning which is that once someone has been infected with the virus they are not going to be reinfected again at least for some period of time. we don't know how long it this but we can guess from some the previous outbreaks in asia it's going to be's probably several years. in that sense the things that we can do to empower. women or women who might become pregnant to protect themselves if they are pregnant potentially make decisions that would allow them to avoid the immediate risk that is present in puerto rico especially would be really valuable. if they get infected this summer in puerto rico in puerto rico do they get pregnant next year or later next year their risk of having these events during pregnancy is going to be somewhat slower so that they're not how to quantify the level of protection we very important. >> i would make one request as you are working on a vaccine for those that grew up in the 60s

and 70s i dealt with by polio exit with a sugar cube and i'm making a statement for all the children of america to work on a sugar vaccine for for zika in mesquite batch trend going and thank you all very much. >> senator ayotte is next. >> well, thank you. i was thin enough so i'm not sure if you were asked this question but in terms of the diagnostic tests for zika doctor either doctor how much of a challenge is that in terms of understanding who has become with the situation as and the other question that i have is thinking about localized transmission of the virus. how is cdc working with our international partners in these countries and how was the

international relationship in trying to address the challenges this is obviously an intercontinental problem we have to address. >> we had developed diagnostic tests that are good but they are not great so there are additional types of diagnostic tests that are really needed. we have also been able to share the diagnostic kits that we have developed with state and local laboratories for a laboratory response network and also with almost 100 countries that have requested the test. we know there is going to be a search made it so we are pleased that some of the commercial laboratories are now getting permission to run tests as well. we are a lot better than we would have been a year ago with the test capacity but we think the researching continued support to be able to handle the surge of testing is important. we know we still have challenges in getting information and test results quickly to patients so

there are some improvements that are needed. the running of the test can be five or six days but getting the specimen to the lab that is going to do the test and result out to the stadium that the doctor and the patient can take a while. we don't think it is where it needs to be especially for pregnant women who are very keen to get the result. our labs are reprising tests for pregnant women first but we don't have the system yet. as one of the things that is a big focus to improve it in terms of local transmission we have released an interim response plan for the state and localities of the continental u.s. about getting ready to protect local transmission and how to manage it. we are also collaborating with other countries. we have had teams in brazil and in colombia and panama where they are ahead of us in terms of mosquitoes already having widely

spread the go. >> if i can expand on the testik closely with the cdc but for everybody's understanding the ts putting a few drops of serum and then wait for the magic to happen in a positive for negative. testing that is done depends on the timing so within the first couple of weeks there is dna te. after that his blood testing looking for antibodies. ..

>> >> and the other real challenge getting back to what we just test people that are exposed if they are now in the and there is no good test for the antibody that would be ideal but we don't have it. so there is a lot of factors about the test itself and as i alluded to all testing comes to the state health departments and for those conditions with a relatively small rule practice the may come upon one of the women that travel to get over the, to try to figure out the administrative aspects to coordinate. fortunately the cdc works

very closely to smooth that process people that work through to smooth the up process having worked to the state health departments can create a challenge and really they had an effective but that presents challenges >> so you have to take a dna analysis? that is significant to go to the dna lab. >> right. >> but if your states get that to where you are i can understand it is pretty complicated process. the fda has provided emergency use authorization to be dead in certain settings which can be done at the state and local laboratories not the doctor's office or most hospitals that's what i have

to send a specimen there are a couple big volume commercial labs that are beginning to get the same type of the emergency approval that may elect clinicians have quicker access we are working hard to get that lab test capacity to be very easy and we're not finished we have more work to do. >> if you start talking about the very complexity of diagnostics there isn't a good solution so the emphasis should be prevention of mosquito control, a vaccine and repellents. in terms. >> that want to interrupt but the chairman is right contraception we haven't really drill down.

>> now in terms of condom and semen and pregnancy when it comes to mosquito control to talk about the sterile mosquitos how far are we in terms of the process? >> actually fairly recently therein is an attempt to be genetically modified mosquitos there has been pushed back by the local public but that has been done successfully. >> why the push back? >> so they allow the local population to make the decision and there is a

significant number that don't understand it well enough. but until just recently and to the radiation of mosquitos and sterilize them there may be an indication they are overcoming that. and for them to try to implement that. that should be permanently directed to identifying to direct their resources to eradicate them mosquito populations. is that the approach that is being used? >> so there is a test for

the new were approaches what will these approaches be scalable to address the mosquitos but the diagnostic seems like it is a real problem. that would be directed toward so that is my point. >> to be extraordinarily difficult. >> let's use the word control.

so with these efforts it should be done in parallel. with those current diagnostic test to find better ones is critical because this will not be over into with three months we probably have a couple of years. and it improved the last couple months and then to read even a better test. >> i don't want to panic people talking about a 30 percent chance to have an adverse effect -- effective live virus am not minimizing but i guess so if you are a

woman with the main use of the diagnostics to figure out where have all blacks -- up breaks to have significant control efforts that is incredibly important for surveillance. >> by a understand that. >> i want to go back to an issue of contraception. if anybody wants to speak more about that. >> and share our colleague is the most experts but i

was surprised to learn that bin p.r. to read a three pregnancies were not intended. we think it is about 50% and so we certainly think those decisions to make of family or discussions but access to safe and effective contraception if they are not trying to be pregnant could be very helpful to address the threat and if you're not trying to be pregnant we have learned in p.r. access is quite limited >> i know how to prevent pregnancy we have made

progress and availability to find the right match bids so they can tolerate the side effects. so they are willing to stay with at that pitted the challenge. but the unintended rate is 50% but to discuss family planning is challenging so what of my supposed to do? so it is clearly challenging for those who tried to plan a family so contraception is an important aspect. so we will never allow never killed 100 percent of the mosquitos so with

long-lasting contraceptive is that the compliance level as well as providers with those efforts to increase training so that is multifactorial with an effort that is certainly made to have access of, prevention sampling with all due respect to my colleague said the mosquito control aspect. >> there isn't a linear

relationship i know it takes density and a critical mass of the mosquito population so when you are talking about controlling mosquitos just did it down to a low enough level to pretty much transmission i do think those control methods are important. it isn't just about spraying or personal repellents that window screens and air-conditioning and paying attention to standing water and education and all of those things and if you can do those in the high risk cities it can make a big

difference. >> and those women want to still have children so we really do need to concentrate control from my standpoint one of the biggest things we have to do at that level. >> so making the point of the unplanned pregnancy rate with respect to hiv in the answer of how do we mention this is all of the above because if you don't get pregnant through accidents than potentially few are infected you could minimize your risk and tell a better vaccine is available. that isn't an option to have those ways to protect

themselves is so individualized there is not a one-size-fits-all solution will be important natalie to minimize the downstream cost of getting pregnant to have the virus and having babies but also potentially as the protective effect until such time the vaccine is available but i would add contraception all other modalities used successfully to minimize risk with other disease outbreaks from before. >> so let's take a little detour with contraception but the one to find out where is the intersection between zika virus and micra supplely and having an abortion? and talking about the cost

per child somebody said the cost is $10 million per child so well what point in the pregnancy do we know there is a real problem? >> we are really at the beginning of understanding zika virus and pregnancy there is probably a lot to say here. alito know what that means that it is something like it down syndrome test for genetic testing that is done there is a lot of science behind the counseling that goes on with a family about what that means for the up pregnancy but with zika we don't know. >> we don't know if a child is born with the aggressively until they are

delivered? >> the clinicians will do cirio ultrasounds to see if the brain is developing or if there are warning signs like calcifications but we don't have a big enough experience to know how predictive those are so we have examples where the ultrasounds were looking okay but the navy wasn't and others were there seemed to be problems but then the navy turned out to be o.k. but it is too soon to have a confidence set of information to counsel women what to expect or how to plan. >> it is based on some of the initial data that someone affected earlier pregnancy had a higher risk but the most recent case even just the little that we know that may not be quite as reliable the only thing we have once a woman test positive with a fatal outcome is following the

ultrasound. certainly there are severe outcomes that can develop better relatively obvious and should be apparent for counseling and other times it is more subtle and may not show the effects into laughter bursts and we don't know of the virus continues to impact the ebb nurse cells or the brain neurons beyond birth and the impact of that. what really becomes challenging because we don't have the confirmatory test of the clear it -- the fetus is clearly affected and the ultrasound if a woman travels then gets infected at the first trimester then test positive then we start a ultrasounds she may not show effects featherbrain until 30 weeks or further so now she is based being in the third trimester seven months along and you can

imagine the psychological stress that creates with anxiety. it is unfortunate that the testing that we do have knowing if the fetus will be affected and to what degree is very challenging. >> again i would like to give you your opportunity to wrap it up. >> talking about vaccines but i would say how much we appreciate your testimony and of work that you'd do several of you have mentioned in the vaccine may be a few years out so give us an update of where we are. >> their several different candidates using approaches that have been successful

for other similar viruses we're expecting the for small scale trials of the immune response, likely begin by september. if those go well they are small numbers so by the beginning of 2017 there would expect at least one site to launch a large-scale production phase number two or face number three trial whether that will show good results is not known. if it does over the year than it was still take time for all the other information that goes into to get the vaccine license such as the manufacturer to produce reliable and consistently in the ways the fda would require so a lot of interest in the research community with those studies but it would be a couple

years out and a common to that could be given to pregnant women it is tricky to develop a vaccine exclusive for pregnancy and that's causes terrible birth defect. so that may be of great travel vaccine in the areas where the local spread. >> my final question then you can now closing comments. we all understand many to get the money flowing but i do want to ask other than funding issues for different

researcher activities as we talk about the registration is there impediments' based on governmental policy. >> you to start at the other end of the table. [laughter] said. >> this is vital there are better ways to find divergences so the response is leading. >> with the ingredients. there is a lot of new regulations they are there

to protect the safety of the public there is always room for improvement is very, very expensive if of the order of 88 of $100 million so it is the big hurdle to get over those new ingredients. so it is something we deal with a regularly we work with the big agricultural companies who have the scale to invest in something like that to get new things approved for use but i do think that regulation is good for good reason. >> from a clinical perspective i think access to new contraception at bids particularit