and prevention. he joins us from cdc headquarters in atlanta. and we're joined by jennifer of politico, sara ferris of the hill newspaper. sara, you're up first. >> doctor, this has been something dominating headlines. it's something many americans are hearing about for the first

time. how concerned are you about what's been happening recently? guest: the real risk is to pregnant women. and it's unusual to discover a new cause of a major fetal malformation. last time this happened was 50 years ago. i'm quite concerned about what we can do to protect pregnant women and use the number of children born with complications. i think it's important to be clear about what is the riskiest situation and what's not likely to be a problem. but it's clearly a major concern. and we understand the anxiety of women who are pregnant and traveled to places with zika spreading, or traveling to places or live in a place where zika is spreading. the key is to focus on the funnel most important thing. protecting pregnant women to reduce the number of infants

born with this potentially devastating fetal malformation. >> doctor, how confident are you in the cdc? it's a new virus. there's a lot of situations you're not sure how this virus works. how it can be a concern to particularly pregnant women. and in the last public health crisis, ebola. any hospital in the u.s. could handle the virus, that wasn't the case. how much can they put in the guidance that the cdc is putting out at this point? guest: we work to protect your health. getting information as rapidly as we can. sharing openly what we know, don't know, and what we're doing to find out what we don't know. and providing the best available guidance based on the science. we are learning more about zika

literally every day. we learn more, and refine the guidance. there's no doubt we will continue to adjust as we learn more. even two weeks ago, it was the first time we issued travel advice for pregnant women not to go to zika-affected areas and we issued that guidance the same week we first identified the zika virus in the brain tissue of infants who tragically had died with zika infection. >> what's most concerning about what you don't know about the zika virus? researchers in brazil are saying that potentially this could be spread through saliva. what's most concerning to you about what you don't know? guest: what's theoretically possible and happening are two things. zika is spread by mosquitoes. they are tough to control. it will bite four or five people at one blood meal.

they can breed in the amount of water it takes a fill up a bottle cap. or theoretically even a drop of water. you have to get rid of maybe 90% of them or more before you protect people. so for me the immediate challenge is getting the best mosquito control into places this is spreading and doing everything we can to inform and provide services and protection to pregnant women to reduce their risk of getting the zika infection. >> doctor, can you step back and put the threat of zika in perspective? where does this rank in terms of health threats facing americans? guest: every health threat has a different nature and characteristic and appropriate response. zika is a particular risk to pregnant women who reside in or thinking of traveling to places where zika is spreading. that's the top level concern about zika. maybe other problems. we wouldn't be surprised to see

some cases of a syndrome which can be very severe. but the bigger issue right now is what can we do to protect pregnant women? the devastation of having a child with a severe fetal abnormality who may die in the first days or year of life. may have a long-lasting or life-long disability. that's something we want to do, and we are doing everything in our power to prevent. >> and doctor, they mentioned the spread of ebola and the comparisons. and light the global efforts to fight ebola, involving countries across the world. how is the u.s. working with the countries where it's spreading most rapidly. countries like brazil may not be sharing data that's helpful to the u.s. how are you working with those countries? what more could be done to cooperate these efforts and what does the next couple of weeks look like for them?

guest: we have had an excellent level of collaboration. what we have seen in brazil is not our experience. they have been open, transparent and collaborative. we have specimens from brazil in the laboratories. that's how we identified it in brain tissue. we have been doing studies of the association between zika and the syndrome. we have another team going down next week to begin studies of the association between zika and microsefali. having gotten the approvals. we're seeing a good global collaboration. the tough part is the enemy. the enemy is nature. and a nasty mosquito that's hard to control and effective at spreading viruses. for that we need global collaboration. we need information sharing and we need to strengthen the ability of countries around the world and puerto rico and territories within the united states to control mosquitoes. controlling mosquitoes is tough.

it's not quick. it's not easy. it requires workday in and day out to track where mosquitoes are and to apply safely the appropriate mosquito control methods. >> doctor, members of congress increased their calls in recent days for the cdc and the administration to really -- a comprehensive plan on how to deal with the zika virus. what would you say to them? and to put that around, is the cdc going to be asking congress for additional funding? anything you're asking in the coming weeks? guest: secretary burwell will be testifying in congress next week. and we are actively discussing with congress how to move forward. there is a consensus that we need to work together to confront health threats wherever they emerge. that's how you protect americans. >> do you need funding to do that? or any kind of additional resources that cdc doesn't have

right now? guest: confronting zika is not easy or quick. there are things to do in the continental u.s. and things in puerto rico which is at particular risk. which i can talk about in a moment. and there are very important collaborations we need to undertake with other countries, not just to help them, but so that we, as a world, can learn what zika is causing, who's most at risk and how to prevent it. >> but is that not something you can put a price tag on in terms of federal dollars to do that? guest: we'll be looking at that in the coming days. >> you're talking about controlling mosquitoes. there's been editorials and a few columns written about eradicating the mosquito. is that something you would go so far as to advocate for. eradicating mosquitoes. guest: it's been tried and it's extraordinarily difficult. these are tough mosquitoes. and they come back.

the tools we have are not optimal. we need to develop new tools to combat mosquitoes. and we hope there will be a way to get rid of them in the future. right now our best hope is to control them. >> in congress right now we're hearing members who say there's a zika czar needed. that's a good ring to it. do you think that's necessary? that came late in the response to ebola. guest: we have been collaborating really excellently across the federal government within hhs we have the food and drug administration addressing issues like diagnostic test approvals. that's been waived. so we're able to get diagnostic tests out there. we have barta which does development working with us on diagnostic tests tests and newe, safer insecticides. and the nih taking the lead on development of a vaccine. the key is we're all working 24/7 to protect americans.

>> doctor, one of the bigger issues here, going back to ebola, a disease rises the to surface of the public awareness and there are immediate calls. why don't we have a cure for this? why don't we have a vaccine? how concerned are you there's going to be future viruses like that this come up and the immediate calls for cures that cost a lot of money to come up with? and what is the administration doing to prioritize which diseases should get the most attention first? guest: over and over nature shows that it's a really tough adversary. that's why it's so important that we invest in laboratories, disease detectives, research, mosquito control. the public health systems around the world to find, stop, track, prevent health threats. it's entirely possible that zika has caused something similar in africa for decades. but we don't know because the systems aren't there to track it.

and when we do have new tools, they're going to be delivered by those public health systems. whether it's mosquito control or vaccination or diagnostic testing. it's so important that we invest in the systems to find, stop, and prevent diseases where they first emerge. that's not only the best thing to do in terms of saving lives, that's the safest things to do for americans. >> so what you're talking about, is that something the cdc currently has the budget for, or does that need to be built into future budgets and kind of added to the agency's ability to do this down the line? guest: with the ebola supplemental funding we have been able to get a jump start ton strengthening global systems to find and stop health threats. we're getting into the field with that. there are huge gaps in the world's knowledge. and our defenses against infectious diseases. the zika outbreak is showing how important it is to scale up our

ability to stop mosquito-borne diseases which are tough to control. >> and is -- right now a better investment right now in your mind, finding a cure or prevention at this point? guest: well, if you look at zika specifically, we need to do better at diagnosing. we don't have a perfect way of diagnosing for zika. that's something we can incrementally improve. we're already rolling out testing developed at cdc's lab to state health departments throughout the country, to countries throughout the world, and to private sector manufacturers so they can scale up manufacturing. nih is taking the lead at developing a vaccine. and we're hopeful maybe by the end of the year, initial trials, and within a few years a vaccine that might be able to be used for this. the other area that's still important is mosquito control.

we have current day tools we don't know how to optimally deploy. mosquito control is hard. track mosquitoes, figure out where they are. reduce breeding sites. make homes mosquito-proof, or mosquito-resistant homes through air-conditioning, screens, and screens that have insecticide in them. this is a tough area. but there's no quick fix. there's no easy answer. fighting zika is going to be hard. it's going to take time and it's going to mean investing. investing in mosquito control, investing in public health systems. investing in our ways of diagnosing and stopping disease. treatment is another area people are looking at. but since four out of five people with zika don't have symptoms, and they are mild. it's hard to think of treatment having a major influence. but a vaccine would be important. improving the diagnosis is important. and mosquito control would help us control zika and other deadly

diseases. >> doctor, you mentioned a potential link between zika and a serious paralysis. what is the research right now? what do we know about the potential link between these and the threat to the people who are not pregnant? guest: we know that from many different infections you can get gianburee syndrome. this is about one in a thousand people with a certain bacteria that causes diarrhea. it can be present in one out of every 100,000 people who have influenza as a post-infectious complication. it's a situation in which the body's own immune system turns on the nerves and the nerve endings and can result in a temporary or longer-lasting paralysis. it can be severe. it's quite rare. one in many thousands of infections. but with hundreds of thousands of zika infections, wouldn't be

surprised to see clusters of it. as time goes by, the association between both zika and microcephaly and that are stronger and stronger. not because of the smoking gun evidence. but because of the weight and pattern of evidence. the pattern of disease and the findings in individual cases. we don't know definitively, we don't know if there are other factors that increase the risk. it does increasingly look like a causal connection. >> and just to be sure, that's a threat not just to pregnant women with it. guest: it's not that rare. we see it with other infectious diseases not that unusually. and zika isn't the only thing you can get from a mosquito of this species. in the u.s. over the past few years we have had hundreds of cases of denge among travelers coming back. it can be life threatening.

and thousands of cases of another that's not life threatening, usually, but it's painful. if you're traveling to a place that has this particular mosquito species, use mosquito repellant. there's a lot you can do to protect yourself with deeet and other products. long sleeves and clothing that has treatment by promethryn. you can stay in air-conditioned or at least screened space. >> the cdc issued guidance for women who are pregnant or may become pregnant from traveling to these countries. and today, now guidance for these women, advising them to use condoms with their partner or abstain from sex altogether. in other countries where it's spreading rapidly, el salvador, they have advised for women to abstain from sex for two years. and public health groups say

it's impractical in some of these countries. and i wonder what you would say to those countries and the women there who are hearing these types of guidance. and whether you think the u.s. guidance might have to be revised if the virus does start spreading more rapidly here. guest: first off, our priority is to provide information services and protection for women who are pregnant so that we can reduce the risk of infants being born with microsefallis. when it comes to the decision of whether or not to become pregnant. that's between the woman and her partner and family and her clinician. there are different situations. at one end of the spectrum, a woman who doesn't want to get pregnant. no religious or philosophical objection to contraceptive. but not on an effective method. and whether or not you are concerned about zika or live in the area, it would be reasonable to get the contraception.

you may have a woman in her 40s using assistive reproductive technology and lives in an area where zika may be spreading. and in that situation, the woman with her partner and clinician may decide to go ahead and try to become pregnant and be careful about mosquito control. whether or not to become pregnant is a personal decision. we leave that to the woman, her family and the clinician. >> doctor, just about five or seven minutes left. not a zika question, but a similar related topic. this week the cdc released an advisory to women about the risks of alcohol and pregnancy. they were -- they told women to stop drinking if they were trying to get pregnant, or not using birth control when they are sexually active. it's been called preachy and condescending and blasted since it was released. was there a better way to

deliver that message that the cdc was trying to get across? guest: let's get the facts straight and the women can decide what to do. there is a clear association of alcohol during pregnancy and fetal alcohol syndrome. in the u.s. tens of thousands of babies are born each year with fetal alcohol syndrome. so reducing the use of alcohol has the ability to improve birth outcomes. it's up to the woman to do what to do. and it's up to us to provide the information to protect your health and the health of your family. >> another public health issues is opioids. they are considering pieces of legislation. there are a lot of proposals being discussed. but as this opioid epidemic has reached really shocking rates in this country, what do you want congress -- what would you

prefer congress do -- how many different routes for prevention, education, for treatment do you want to see congress enact? guest: the opiated epidemic is really serious. it's just about the only major cause of death in this country that's increasing rapidly. and if you look around the country, it affects almost every state. more in some places than others. but lots of states. there's state-specific action that's being tried and needed. the way we look at it from the cdc. think of the country in two groups. one group of individuals who are addicted or dependent to opiates. they need services. they need treatment. we need to increase the availability for reversals. that's what the secretary's plan calls for. in addition the plan calls for improving prescribing for pain. and that's something cdc is focusing on. when we looked out, there really

weren't guidelines on how to treat patients with chronic pain and there wasn't a good balance. i think as a physician i recognize that relieving a patient's pain is one of the boast and most important things that we can do. at the same time i think much of the health profession lost sight of the risk/benefit ratio of opiates. these are dangerous drugs. they're highly-addictive. and you can take just a little bit too much it causes respiratory depression and you can die. and if you look at chronic pain, the evidence that they're effective for chronic pain is slim to non-existence. so we are in the process at cdc of finalizing guideliness, not for acute pain, not for end of life paliation, but the chronic pain that most opiates are prescribed for. we need to get the balance right. there's something we can all do to understand there's not going to be a quick fix for a lot of the pain syndromes that people

have. but we can help people have less pain and be more functional. and we can do in a way that doesn't endanger their lives. >> so do you feel like this is a problem that the medical community and cdc have to answer, or is there something congress needs to do here to help? guest: i think there's something for all of us to work on. we're grateful to congress for the additional resources at the cdc and other parts of the federal government. at the cdc, we are going to be supporting states throughout the u.s. to scale up programs, to improve prescribing. to improve treatment of pain and addiction. and track and understand what's working so we can begin to turn around this terrible epidemic. >> you mentioned rethinking the risk/benefits of some of these prescriptions. and the food and drug administration yesterday announced a sweeping review of their own policies. trying to re-examine, again, what we were talking about, the risk/benefit of these prescriptions. how do you think that effort,

coupled with what the cdc is doing, can actually work to make 2016, again, not a year that we're seeing another all-time high of these drug overdoses? guest: we work very closely with the fda and other federal agencies. in that space what we hope to do is reduce unnecessary and avoidable prescriptions of opiates. and increase prescription of medication that treats opiate abuse disorder. methadone, these are underutilized. we can address individual patient safety, but community safety as well. >> doctor friedman, thank you very much for being our newsmaker this week. guest: thank you. a pleasure speaking with you. >> thank you. >> and now we continue our discussion with sara, jennifer of politico.

you both covered these health issues during the ebola outbreak. i want you to compare the cdc response to zika to the ebola outbreak. where is the cdc now in terms of its response. >> i feel like cdc might have learneds lessons from low -- ebola. he said that any hospital could help a patient. that was to reassure the public that it could not spread. and the first patient went to a hospital that wasn't able to handle it and it spread to two health care professionals. the cdc adjusted their message. and the strategy shifted to putting ebola patients in certain hospitals that were really prepared for it. not only does the health care strategy point to that, but also the public health message. the public was hearing that any hospital could handle this. and then found out that not

every hospital could. and i think that really eroded some trust. so i think cdc is being a little more cautious this time. we heard the doctor say several times. there's a lot they don't know about this virus. they're being a little more careful in saying, repeatedly, they don't really know what this virus can do yet. >> do you agree? >> i do agree. and what is the same is the cdc is trying to reassure the public that this is probably not a threat to most people. because back in ebola, i guess it was a little over a year ago now. but the fears were just rampant. it was making headlines across the country when even we'd only seen two people infected within the u.s. and then if you remember when there was a person in new york returning from treating patients in west africa, there was just fear everywhere. so the cdc had to step in and take this reassuring role to make sure that people weren't losing their heads over a threat

that wasn't real to them. so now we're seeing cdc just a couple -- just last week saying we don't expect there to be a large outbreak at all of zika in the united states. >> but they were able to say it will probably come here. they said it won't be an outbreak. > right. and in a briefing with reporters, there will surely be more cases of this. right now, 51 cases. one of which has been transmitted locally. and he says there's a lot of travel to these areas. it's going to get bigger. >> and he was careful not to put a specific price tag on what it's going to take to combat zika. what are you hearing from the members of congress, the ones that control the purse strings, about cost and what they're willing to put towards this effort? >> there are several lawmakers from both parties. we have this money left over in the ebola crisis. a little over a billion dollars.

quite a bit of money to work on this -- as he said, working on being able to diagnose people better. working on getting treatments. we're going to see, entering next week, the big budget battle starting with the white house releasing its budget. we will see more resources allocated in that document. which members of congress may or may not pick up on. but members are already identifying resources available. >> and several lawmakers early on several weeks ago. lawmakers writing letters to the white house saying you need to get on top of this. which, of course, the white house and the administration was already doing. we saw that he said that today. but really underscores that they see the threat here. this could be a political issue. and they want to prove that they were on top of this from the beginning. sending letters from the white house. interestingly, you know, they're saying you need to get your act together and again a plan. they're not advising the white house or the administration on

what to do. but they want to make sure that they have that letter dated showing that they were doing something about it. >> you both asked the doctor about opioid abuse and concerns about the rising numbers in this country. what do lawmakers want from dr. friedan and the cdc on that problem? >> right now there are several bills on capitol hill to address the opioid epidemic. a lot of the plans are putting money toward programs that have already proven successful. and i think that legislation has legs. it being 2016, a political year. the opioid epidemic is taking place in boston, right near new hampshire. and a lot of the presidential candidates said they first heard about this in a new hampshire town hall. someone asking them, someone they know who has this. i think that has put an exclamation point on this horrible situation for a lot of the politicians. and so i think we will see some

kind of legislation. i don't know if it's going to be as effective as, you know, something the doctor or cdc officials would like. but, again, they want to get ahead of this and prove they're doing something to at least try to get at it. >> jen mentioned boston is one of the epicenters. and they have put a hold on the fda nominee for the obama administration because he doesn't believe they are doing all they can to prevent the widespread prescribing of painkillers that he thinks can be leading and fueling this epidemic. >> democrats and a usual ally of the president putting that on hold. >> right. and as i mentioned, it's 2016, it's an election year. people are trying to beat the drum on this and get action. because we saw an all-time high of drug deaths in 2014. and the trend is on pace to continue. so the fda did say that it's going to take on a sweeping review. they're promising lots of

transparency in the way of prescribing these drugs. and a whole rethinking of outside experts. but senator marky same out yesterday and said it doesn't satisfy me. joe manchin from west virginia says this is not enough. and we will see more. >> that's all the time we have for our roundtable. thank you so much for joining us on newsmakers this week. >> thank you. >> thank you. >> every election cycle will remind us how important it is for citizens to be informed. >> to me, c-span is a home for political junkies and a way to track the government as it happens. >> i think it's a great way for us to stay informed. >> there are a lot of c-span fans on the hill. my colleagues, i saw you an c-span. >> there's so much more that c-span does to make sure people outside the beltway know what's going on inside it.