discussing this really important problem and that is really described on the first slide right here of a pandemic in process. this is not a retrospective analysis of what went on but really a description of what is evolving more and more literally every week not only in the americas but as we see now in singapore. they are starting to have a situation that is quite worrying and i'm sure we'll get into that during the discussion period. what i'm going to do is set the stage is very sad for discussion on zika. i show first this paper that i recently published. it was in january about a month and a half after it became clear to me and my colleagues at nih that we needed to have an accelerated effort. i chose the title the zika virus and the americas yet another irish threat because i wanted to put into context that this is not just a one-off issue that we are facing. if you look over the last several years of all the viruses

that were really not an issue in the americas that all of a sudden became an issue, west nile and 1999, dinghy that can for the now accelerating over the last several years and now most recently zika. so again this is something that we are facing and when i get to the end of the discussion i will tell you it's not the end because we are going to see it again i assure you of that. the reason i say that is a year and a half and ago at the end of a talk that i gave to a large audience about ebola and how the ebola epidemic was sending people said we got through that and that's wonderful. i said it isn't over the something is going to happen again soon. unfortunately i didn't realize it was going to happen a month later with zika but actually did. i'm going to divide my discussion into four areas that i woke reef we touch upon to set the stage. first the zika background. many people right now because of

the public attention that has been put to zika. i show you this not to hit you with microbiological names but to point out one thing. this is a virus that is a genus virus. why is that important? is important because these are the viruses that we have a lot of experience with. the viruses include dinghy, yellow fever japanese encephalitis and west nile virus. it's bad news that we have a new one and it's good news that not only do we have the experience of viruses and investigators working on the viruses but because we have made successful vaccines against the viruses and i will get back to that in a minute. i have a fair amount of confidence that we will have a vaccine for zika, when is really the issue. the other thing that is

transmitted by mosquito that is copious in the americas, that's critical. this didn't happen by accident. the setting was made. the mode of transit -- transmission is predominantly bascue device that you heard tom friedman and i would last several months say the more we learn about zika the more complicated and in some respects the more disturbing it gets because not only is it transmitted via mosquitoes, which flaviviridae art transmitted by mosquitoes but we found there was perinatal transmission which is the thing that sets a zika apart from all other related viruses and of course we'll get to that of the moment. and we found that of sexually-transmitted for some man to woman and we found out from a woman to a man and then we found out it was blood transfusion. we are still waiting to find out any other additional surprises i hope we will not see with this. the history of this is a textbook epidemiological case

study. people are going to be studying this and public health schools for decades to calm. it was first recognized in people confuse recognized in the sense of just evolving, this virus has probably been around forever. it was first recognized in 1947 of the zika virus of uganda hence the word zika virus. the first cases humans were not agonize until 1952 and then it kind of went under the radar screen and by and at the radar screen i mean we really didn't know exactly what the impact was because if there were outbreaks they were unnoticed in africa and southeast asia. when he don't have an outbreak you don't really appreciate the extent of what i virus can do but then as years went by, in 2007 there was a modest outbreak in the islands and in 2013 the french polynesia. that was kind of warming up to what might happen and it worked

its way nicely as it were, not really nicely but unfortunately for us across the pacific until it landed into what i call the perfect storm and what is the perfect storm? a perfect storm is a very populous country that has economic and other conditions that make it conducive to have the spread of mosquito-borne viruses, multitude of mosquitoes that are the right mosquitoes in a country that has a health care system that is good enough to notice what's going on and that's really critical because the fact that there pockets of property in brazil they have a pretty good health care system that can pick up things like microcephaly and other things. so what about zika infections? it can be confusing to people because i call it dichotomous. what do i mean by that? putting pregnant women aside it's a fundamentally relatively benign and somewhat inconsequential disease.

it infects people and 80% don't know they are infected. 20% have symptoms that are usually mild, aches, pains, rash, fever and conjunctivitis. it tends to clear and seven to 10 days and then you are done except and we will get to the except in the moment. the current outbreaks in the caribbean and latin america have galvanized the attention not only a bus in the americas but people throughout the world. if you look at the multiple maps that till you things about zika but i like this map is what it tells you is that if you look at the areas that are environmentally suitable for zika virus transmission like climate, like mosquitoes, all the right things, this is the area. there are about 300 million people in the americas to live in an area that is environmentally suited for zika transmission and within that

rupe there are 5.4 million births per year and obviously as we will get to moment the issue of microcephaly when women are infected during pregnancy is an overwhelming important issue with zika. this is what i meant for the people in brazil first started noticing a dramatic increase in microcephaly over and above the baseline. now you have heard people argue well, they weren't really looking for microcephaly so yes it probably is a bit of an over call but there is no doubt there is a major increase in microcephaly associated with zika and we are seeing back in a number of other countries. what is microcephaly? microcephaly is a congenital abnormality characterized by the underdevelopment of or direct of of -- destruction of the brain.

it's really an anatomic explanation. as the brain develops during in utero development of the fetus the brain pushes up the skull so the contour of your school is because the brain during development pushed up and normally develops a nice smooth contour. if you have developmental impediments of the brain what happens is it doesn't pushed up and to have looks flat or small. there's another thing called fetal brain disruption is syndrome where the brain does develop well but then a person gets infected during pregnancy may be later on in the second trimester and what happens is that the brain caves in and that's when you see pictures of, children very tragically looking that up skin. they have a normal sized head and then it shrinks again and there's a recent paper in radiology that shows pictures that are quite disturbing. we know now in one study that we still have a lot more to learn that a study in brazil a woman

gets infected during the first trimester of pregnancy has a one and 13% chance of the baby will have microcephaly but microcephaly is the tip of the iceberg. what it is, it is a gross manifestation of congenital abnormality but we know from other like congenital rubella syndrome that a baby can actually be born looking morphologically normal and have serious after relatives of hearing, sight and intellectual capacity. there was a deeper they came out three days ago the just show the issue of visual and hearing abnerality's. there also other abnormalities called arthur were poses which is a contraction and curling up of the lambs. we don't know what that's from but it's likely from abnormal neurons. this is a brain issue. it's not an issue of the nervous tissues as a target. one of the things that just

recently came about and everyone was surprised about it, and i got a lot of calls from the president about it, babies who are born with congenital infections had continual viral e-mail for six to seven days after birth. there's nothing new about that. when babies get infected in utero and we have decades of experience with rubella, if you get infected in utero because the immune system of the baby is not fully developed, the baby interprets the virus as itself so it doesn't make a response against it and when the baby is born you could have prolonged by re-mail for months if not years so this is not a surprise. guillain barre is associated with a number of viruses, influenza, bacteria like campylobacter to see an increase is guillain barre is not surprising in something we always expect to read what about zika in the united states?

united states as you know also includes puerto rico and i learned a lesson in that when i was briefing president obama in the situation room at i was talking about the united states and he said timeout tony, puerto rico is in the united states. sorry mr. president. the reason is there are are american citizens having a terrible time right now. they are in the middle of an outbreak that is going to be or already is bad and is going to be a serious situation because what happened with them in 2014 is that 25% of the population got infected. if you look at the potential importation so here's the quick of the problem. there are 200 plus million who journey back and forth from united states to areas of local transmission of zika.

which means in this is something people are starting to appreciate now, the difference between a travel related case and a local traveling case in the united states there are at least 2500. there are probably closer to 10,000 because 2500 recognized cases of travel related, mainly someone who is infected elsewhere and either comes back to the night states or travels to the united states. so if there are those many people in areas where there are mosquitoes that can transmit it, it's not surprising that you then ultimately as we absolutely predicted, would have local transmission. among the people who are infected in the united states, there are close to 600 pregnancies in the territories particular puerto rico there are over 800 so we are going to start seeing as we already are seeing cases of congenital admiralty among pregnant women who are already here in the united states. as you heard larry mention what

is going on in florida is again not unexpected. when you get local transmission and we know this from dinghy and chicken doing and most of the time they are one-off and what are called single cases. a mosquito bite someone who is a traveling case bite someone who has never left the continental united states. they get infected and it is there but occasionally there cases that cluster and are related to one another. we have seen that into defined locations. one in linwood which is a neighborhood close to miami and the other is the south beach section of miami beach so right now there are a total of 46 locally transferred to cases in florida and several other sexual transmitted cases. let me just close and spend a few minutes looking at the road of research and development. like you might expect the response to zika from hhs and

other agencies was very similar to the response that we had to ebola which is the combination that the cdc doing their public health thing that they do so well with zika and its infection control and other public health exchanges and basic and clinical research to understand the disease one and two to develop countermeasures in diagnostics there predicts in vaccines and in fact if you look at that, take a look what just came out two days ago was the identification of some molecules purely by screening that might have some activity that can zika. be careful because an in vitro activity against the virus doesn't necessarily mean it's working that i show that i show you this because he came out two days ago. we are doing what is called a zika pregnancy study in south america and puerto rico looking at 10,000 pregnant women not

necessarily zika infected pregnant women but following brunette women to discover what is the instance of zika and congenital mouth for missions of the baby and following the babies at birth birth birth, three months, six months in the year. also vaccines and this is the combination of basic research with animal models showing that you can actually protect monkeys against challenge when you vaccinate them with a variety of of -- all of which are in the queue that we now have lined up for testing. i mentioned this in the beginning of the talk that i was reasonably confident that but i always say that with a caveat. the reason i believe we will have an effective vaccine against zika is that the body takes a pretty good natural immune response against zika and whenever you have the microbe in which the body art he tells you

that is capable of making a good immune response the chances are if you try hard enough you are going to get it good vaccine could we can't necessarily say that yet with hiv because the body doesn't make a good response against hiv but animal studies indicate that i think we are going in the right direction. this is a public hated slide and i don't like complicated slides but i show it to you to remind you we have about five or six candidates that are lined up fo. the first one that goes into teg to turn out to be the best one. people need to understand that and that's the reason why you have a number of candidates to let me just pick out one is the prototype and tell you where we are with it to coast the assumption that other candidates are anywhere from three months to year behind that but the one that is ahead is one that was developed at the vaccine research center.

to dna vaccine. we started phase one trials on august the second second. we will be testing 80 people. it will take probably until november or december, of 2016 to show that a is safe in p it produces a response that is protected. if we are we are successful in doing that which i think we will be and we will get into the discussion later, if we are given the resources we will move forward to a phase two trial which will determine if it works as opposed to having 80 people in the trial, the phase two trial will have anywhere from 2400 to 5000 people, it would be in south america thomas central america and the caribbean. that's where we are in the me can take the second one down come the third one down and several months behind it but sooner or later we will get there. we began as a mention of testing right here in bethesda of the

phase one trial. it's going to be at the nih at the university of maryland in baltimore and emory in atlanta so i want to close with this slide to remind you of what i said on the second slide where he said yet again another virus infection is we are dealing with and they emergency infectious disease. this is something that i refer to often is a perpetual challenge and i don't mean that to be hyperbolic is it really is their bodies then, there are now and there will always be new emerging and reemerging infectious diseases and i think it's becoming apparent to all of us that when we need to respond we need to have something that is already in place as you heard many of us talk about in an emergency public health funds that we don't have to go through the appropriations process, which is a good process but it takes months and months and months. i will end with that and i will

join the panel and discuss this further. thank you. [applause] [inaudible conversations] [inaudible conversations] >> well thank you very much tony.

that was superb as always. why don't i begin with you and then widen to some of the other political and ethical issues. i think there are many people in the public and it's kind of the dual public reaction. on the one hand as we will be talking about later among the panel is that there is widespread apathy among the population. 77% of the polls thought there was nothing that significant to worry about. there was a marked difference the political reaction to ebola but on the other i think the publishing -- public is wondering is this a hidden epidemic? what are we seeing? we know about the confirmed cases in miami-dade florida. we know about some of the sexually-transmitted cases but

in your sense is this a hidden epidemic? are the things we are are not seeing? are there things that we could do in terms of either epidemiology or diagnostic tests to enable us to have a better understanding of actual transmission in the united states? >> well, if you say hidden epidemic we are going to find something totally transforming that we didn't know about, i don't think that's the case. as we get more and more experience it's clear that when you have larger numbers of cases you will see things that are rare events. there will be rare events like person dying of bowling go encephalitis. it's a benign disease and every once in a while you have someone that gets really sick and ultimately dies. i don't think that this is hidden in the sense of a lot more people getting infected that we don't know about even though you have to be careful of that because 80% of people or without symptoms. but to your point about apathy is very interesting because you

compared ebola. there's something about the lack of connecting the dots when you have to convince the public that something is really serious as it essentially is a mild somewhat trivial infection in everybody except pregnant women. so if you are not thinking in terms of you are woman who is of childbearing age you you are a n who has had a baby and understands how anxious you get during pregnancy or if you are a husband who has children and you understand the risk of pregnancy , people tend to not get upset about it because it's like it's somebody else's problem and whenever you get a situation where people start to think it's somebody else's problem then you get apathy. i don't think there's apathy among pregnant women because i talk to a lot of women who are

really very concerned about his so it's an unusual situation. with ebola, even though the risk of there being ebola and i can say this now, i wanted to say it on tv so many times, even though the risk of having an outbreak of ebola i think is zero. still everybody was concerned about ebola because they felt that they were vulnerable to ebola. people don't feel that way the zika that's why think we have that dichotomy. >> now they don't and yet with print women this is in a way, zika is historic family for the sign to talk about that one of the first about the first time the cdc has issued a travel at pfizer for pregnant women not to travel in the mainland for the united states. let me finish the line of questioning with research and development priorities. i'm going to talk a little bit

later on with the panel about the political situation, but can you tell us or give us a sense about what your concerns are about not only research and development funding for zika vaccine, diagnostic, treatment and the like but also for the wider nih pipeline. it's zika continues in the united states and we don't see significant congressional funding. it's almost an inexplicable situation has arisen about how we are not getting funding for something that is a public health emergency in which, instead of a clean bill let all the politics worry about things later. it's very very disturbing.

the situation as you know, and maybe people in the audience have followed it carefully, and i will describe it in a half a minute but it really is emblematic of what the issue is that you are asking larry. when we first realized we had a problem i got my stuff together, i remember very clearly in our conference room in december and i said all hands on deck. this is going to be a bad problem. we have to get people working on zika related things. we didn't have any designated ceco money so what i did is i borrowed from myself and barred from myself means i took money that i would then be spending in the summer because now it's winter in december. i have money for poor malaria and money for tuberculosis and i started spending it on zika with the hope and i thought assumption that i would get that money back when we got a ceco money. we didn't get any ceco money and then we got to the point where he couldn't borrow any more for

myself secretary burwell allowed us to spend some of the ebola money to do things like get ready for the vaccine trials. then i needed to prepare the site for the phase two trial in january but i are to use all the ebola money for the phase one trial so then the secretary had to make a decision she really did not want to make. to use or transfer authority and say now in and to take money from other nih institutes, from cancer, from heart disease, from diabetes so that we can do phase two, prepare the site for the phase two trial. so she has given me $34 million, 33 million of which is for vaccines to prepare the site. now related to what you say, come the end of september as tom said at cdc the cupboard is bear, it if we go into the new

new -- agreed on get additional money to conduct a phase two trial in member you talk about ethics. we have an ethical responsibility that you not start an experimental trial unless you are certain you can finish it. you taught me that years ago. so therefore we are not going to be able to start a phase two trial unless we absolutely know we can finish the trial which means, october 1st at if the congress doesn't give money to us the secretary will again be faced with the very difficult decision to issue yet again take money from other things and it becomes a very difficult problem. >> is robbing peter to pay paul. ..

>> >> it opens the elway for politics and we are in a period in our history with the political cycle that is very anti-science that is deeply skeptical and in congress we have seen a pattern across multiple legislative challenges with

the failure to act where the basic common sense and decency has disappeared how else you wind up with both parties to score points with the emergency measure one with a humanitarian crisis so that both parties agreed to go away rather than find a solution? if so we are pushed to the brink and also the steps the administration has taken and good faith to scramble with the ad hoc basis to get a response going hatty shame

that institution into acting with that circumstances been that is another factor. that is the problem and unlike what we have seen in other moments of time. that will require a special solution. when congress comes back next week they're only in session three weeks. there is a continuing resolution that with the leadership of congress that is divisive. >> with that overlay of

political contentiousness contraception, abortion, pla nned parenthood. can we talk a little bit about that? we can see what is the multiple factors. take puerto rico which is the most dangerous situation. most americans do not see as part of america in reality. so all of us some way or another faces that problem. so this is a new fiscal crisis with its own

leadership is having trouble and to rise up to confront this. with the territorial leadership of diu unlocked a political problem? how do we get them to focus on the centrality? that is another issue that hasted be put front and center there is a certain resignation and skepticism and on the of surface looks innocuous. we don't have vaccines are therapies to not be widely distributed and controlling

it shows can be quite difficult. that could be countered systematically by the leadership. >> you have talked lot in your work about national security with global health security and we saw during ebola it was remarkable obama ascend the un military but was very proud of america. andrea led a security council resolution and have done similar things do you

see zika virus as a security threat to? but talk little about our approach in the united states of our preparedness but also who give the global response. for example, who strategic plan italy asks 122 million u.s. dollars that is a gross underestimation has all over so tell us a little bit about that and how ebola difference or has lessons that our different.

>> with the ebola they were dramatic and terrific terribly frightened and they set off the media storm of hysteria but zika virus is different vulnerable women struggling and delivering mostly in private conversations with physicians n with family members. this not the public movement is not a big voice so the delayed impact we haven't gotten to that point yet where we have seen the full material reality of this occurring. now the fact there was of a declaration in february by the who that there was a recent declaration importer rico do those really change the climate?

or do they show that those measures alone not sufficient? we have to make the case that does not work with u.s. national or global interest to be treating the emerging threat of the new pathogens as a one-off ad hoc episode we have to have a strategy looking at this of a new normal and a recurrent set of threats to gear ourselves of with leadership within the white house and major institutions as their funding and accessible and ready and not stuck in the political fights. >> i will come back to that in a minute mostly in the terms of the role of the

u.s. to influence and leading old security problem with the role of the united states in the who you have then following not just zika virus that you were in africa for yellow fever and you are a physician. so talk about the effects on for pregnant women and their babies would die this fear is that they have? are they justified? what should the political and international community

do to come to grips? because many of us spending time in latin america i have looked in the eyes of very pori young pregnant women who are terrified. so speaking a physician's conscience. >> first volume have to be a physician to appreciate and have empathy for what is going through the minds and hearts of many of our pregnant voices with their spouses and partners and loved ones when there might be a risk or a known risk which is the case for many countries it is just now started to be documented in west africa.

anyone as a parent can understand that and i greet that microsoft felicia is to the iceberg. more data is coming out so the head size may not be so fall that it needs official measurement for microsoft's lead but could still have significant brain damage. general or localized vision vision, hearing, or a combination and we will not know for sure for years to come the epidemiological studies so this is the progress and in my view will get much worse in the years

the head of certain parts of the world we do know each other but i am very concerned with the virus is going next so few lookit this first documented in colombia of the coast of west africa. and in my opinion not enough attention was made for the country itself and also where it is going next?

basking is important but in any given time and space. so n a sense you can look back to be studied for decades in public helps schools but that has been around a long time before that with africa and asia and multiple other islands and in 2013 although a retrospect had congenital neurological damage but that wasn't apparent in french polynesia but then they had that public health infrastructure in brazil and very distinguished and

accomplished researchers to link with t6 and other brain damage. and then you see that with an island off the coast of the mainland very close to where ebola occurred in west africa so for me the epidemic of zika virus follows that of west africa but there is another country because it is a former portuguese colony as well as from brazil's social life first of this year not just an island but as of the of latest update toward the end of the week there are four

reported cases for genetic sequencing that still has not been finalized as to if it is the african or asian brazilian strain. and since april 5 babies have been born with microcephaly. which means to me you have to go back seven or eight months when it occurred so was probably already there last fall or one year ago which means it is probably in liberia or sierra leone so it isn't going to be an epidemic people debate what

is a pandemic or what isn't but i do agree some people say it isn't done enough continents but regardless of what you call it is a serious international global health problem and will get worse into more parts of africa simic we just finished with the brazil olympics and there was a lot of concern that there would be the amplifying effect that there were a number that the international olympic committee that they wanted to postpone the olympics and i refuse to sign the letter that now that they are over, did

brazil do a good job? the or are we likely to see any amplification ex-con and then tell me about singapore because that was uh time dealing with the medical school and the university they were worried at that time over those conditions and they expressed concern so if anybody wants to discuss if the who helped even up possible defects and where we are likely to see the next greg. >> that comment is somebody did enough or not it was very much in their favor and that is what we spoke about i counted the opinion of the person that wrote that

article that they should cancel the olympics because first of what she might expect it was peaking january and february which was summertime in prison all so right now they don't disappear but they do go down dramatically so what brazil had in their favor that there were much less mosquitos insure they did a pretty good job but naturally they would be of much less at that time of year and the less mosquitos the less infections in the way be infection propagates that also diminishes the threat so by the time we got to august and july in brazil the conditions for a major outbreak were not there so that was fortunate for the conduct of the olympics but the point that was made is a

good point but where is it going right now? because i am watching singapore very carefully phillip those numbers there is a handful 50 common eight now will over what had terrific -- 100 and that is what we see and florida. >> i think we need to keep our eye out to. >> so let me just conclude about going back to the political part of this both steve and tony talked of a public health emergency contingency fund in the united states when the next

outbreak arises then another and another we don't have to keep going to the well that we are prepared and after all the united states is the country that pushed who so what are the prospects of this congress or in the next for that to happen crack's optimistic are we quick. >> we can be reasonably optimistic the next top - - administration as clinton she made the proposal along the lines but it depends on how much continued threat we see how much norways' and threat to the environment but it is requires some determination to get this

done. certainly in circles like hillary clinton may have weighed the option and it deserves to be a priority it think that is the signal with this set of experiences we have just gone through how frustrating and exasperatingly and embarrassing for the united states to be in that position when they should be leading with a much more robust well-financed and predictable way. >> united states leadership is well understood around the low world not only are we supposedly very well prepared but we contribute internationally with the world watches what happens with the ebola and zika virus with the u.s.

reputation is at stake in now with their proposals of the actuality moving money at they promised for ebola to t11 so i think there are very strong grounds for hoping that congress will take a bipartisan position and backed of a public health contingency. so now we'll take a 10 minute break and come back to reassemble the and i will call on the audience and in particular those who have been responses already in this area. [applause]

>> good morning. >> if morning thanks for having me. >> what exactly mill this speech take quick. >> we don't know much. he has belittled vague leading up to the speech but he will still call for a the wall but as of now he is saying that mexico will pay for it although he did sayou he would go meet with the president of mexico before the speech so there could always be changes to the policy that they could talk about in terms of compromise

we do know he will double down on strong for enforcement to get criminals out of the country. >> talk about arizona and then what is the reaction? >> arizona is a republican state not by a attend but it is a comfortable state tog bnp has the endorsement of the sheriff in there who is very strong mind illegal immigration but arizona also has a growing hispanic population seoul mr. trump goes back and forth overwh there with people who do not like his policies that allem and the democrats are trying to tap into that said there is a mixed message but

overall the republicans have an endorsement of the share of the u.s. strong on illegal immigration. >> there are stories leading up to the speech that mr. trump may be taking in terms of immigration so power they watching this speech? >> what we're watching today is severity is any changee from his team but the reason we look for that because last week he met with the hispanic advisers board coming added that meeting he said couple things at one point he said immigration is his signature campaign issue at 1.he called for deportation the other thing said he would be willing to

work with law-abiding undocumented immigrants dwelling to pay taxes but then he said that isn't truet si i was soliciting opinions from people that now that this said change. >> about the meeting with the mexican and president today who was invited and what is on the agenda?gr i imagine emigration issues would top the agenda? >> we don't know very much hillary clinton is invited a president when dash apparently they were elected we did hear anything intel late last night so i know the trump campaign has been working to schedule thist strategically not just travel lies because he can

do his speeches then met with the president of mexicog we came out with these plans that is a presidential moved. not by any means just j directed at donald trump we don't know what they will talk about besides that leading up to the election that the two countries are connected cement and the speech today anything we shed no for the viewers to watch for? indicates think we're just really looking for details tonight you can talk about the wall were getting criminals but what about theig undocumented immigrants in the country right now? what will happen to them because previously he said get them all out or he is

willing to let some of themme say. >> thank you see images speech on immigration is life today at 9:00 p.m. eastern presidential debate starts at the end of september the first debate between clinton and trump is monday september 26 outside new york city on sunday october 9 the town hall is that washington and university last is wednesday october 19 at the university of nevada las vegas you can see them all live on c-span