Skip to main content

tv   Key Capitol Hill Hearings  CSPAN  June 29, 2016 10:00am-12:01pm EDT

10:00 am
10:01 am
10:02 am
10:03 am
>> good morning. the roundtable will come to order. statement.itten like to keep this thing going. we want to give each an opportunity to have an opening statement. we know this is a very serious is grippingem that us. i would rather throw this over to you as quickly as possible. i will throw this over to be senator. then we will get your opening statements. mostr me, one of the helpful things to learn is, what should congress be doing? what should congress be doing to enable us to successfully meet this challenge and overcome it. and if we can walk out of here today with that in our hearts
10:04 am
and minds, it will have been a good morning. thank you. short and sweet, i appreciate that. first witness is dr. anne schuchat. the deputy principal director for the cdc. she has served a number of the centers for disease control. people haveuchat: been following the situation and we are trying to do everything we can to protect pregnant woman. leave pregnant woman to deliver a baby with a devastating condition where the child may never be able to walk, talk or care for themselves.
10:05 am
mosquito season is here. cases are increasing. in puerto rico, more than 1.1% of blood donors had an evidence in that week, a single week. and we know that in the southern states, it is arriving. following 500 pregnant women in the united states, in the territories and the states, who have the zika infection in pregnancy. be able to states to detect, respond and prevent infections. we need to strengthen surveillance for the disease with mosquitoes. we need to do everything we can to control the mosquitoes to make sure that travelers and loved ones have the information they need to protect themselves. with communication, laboratory response, communication about what does an doesn't work and we have been working as hard as we can to protect americans.
10:06 am
our next witness is dr. johnson. fifth-generation -- [indiscernible] >> thank you. i am really honored to be here today to have a chance to represent our company. we are the maker of raid and the larger -- the largest manufacturer of household invectives in the world. sorry. ok, it looks on. there we go. thank you.
10:07 am
we have been in this business for more than 60 years. we have worked to combat mosquito transmitted diseases around the world, including malaria, west nile and others. malaria kills more than 400,000 people in the world every year. as hundreds of thousands in latin america and we, as a company, invest millions of dollars in malaria and dengue awareness campaigns around the world. bill andork with the melinda gates foundation to develop better tools and more effective ways of combating the skeeter transmitted diseases in a number of countries. we also happen to operate the largest urban private and apology center in the world in wisconsin. so we are no stranger, as a company, to transmitted disease. makes zika virus
10:08 am
so tragic is that it strikes the if i couldable and wave a magic wand to eliminate this disease, i would because we would just as soon not have this business. but when the stories broke in brazil linking the zika virus to , we started manufacturing resources and a team to work for several months. we also launched a series of educational programs and donated products to those most in need. mosquito season is largely over two-dimensional eyes what we did, we supplied triple the amount of repellent this last season then we gave the prior year. some of thataken same focus and preparedness to the united states in the factories for the u.s., we began -- we began0 47
10:09 am
4/7.ing 2 permission toiven import products from the argentinian factories in case we might need it. to beare truly gearing up able to supply the worst case and scenario, if it comes to that. we hope it never comes to that. i hope that the mosquito transmission of the zika virus never makes it across our border. our company is committed to donate a minimum of $15 million over the course of this year in product and other services to help fight against the zika virus. centersde often to the for disease control foundation, the white house zika summit and we have made donations to the red cross, the american red american children's
10:10 am
health association in brazil and others and we are prepared to donate more than $15 million if the need is there. set up a website with educational resources, tips and videos on how people can protect themselves. languages ando 30 reaching more than 69 million people. we also have put all of this material on the internet, a free download service provided by facebook. the men and women in our company who have the working so hard to fight this fight. was in our manufacturing facility in the u.s. and people have been working long hours and they have done it for one reason, to help families in this country if there is a need. think one of the most important ways the government and the people in this country can help is an environmental
10:11 am
control controlling mosquitoes before the breed and helping and publicion service announcements, communication. helping people understand what they can do to help eliminate the mosquito threat and breeding ground. is particularly important to get to the highest risk cities in the southern u.s., this is largely an urban issue. mosquitoes bite humans almost exclusively so it breeds in areas of high population and the risk of transmission is highest in a big city. so getting too high risk cities with education programs is most important. closing, let me reiterate that i am honored to be here and all of us are very happy to help in any way we can. thank you dr. johnson for
10:12 am
your efforts and the efforts of the men and women in your organization. -- he is onaker is the board of directors of the american board of subjects and gynecology. he is board certified -- i don't know why have to have that three the anatomicell as pathology. >> thank you. it is an honor to be here. invitation.r the cog is an organization of 50,000 , we work closely with the centers for disease control to provide information as well as with the partner
10:13 am
organizations to try to present the best information but there is less known about the impact on pregnant women. at this point in june there are a little over 500 women who have been affected. patients who are infected have been asking questions. patients who are considering travel or planning pregnancy -- we are trying to provide answers on limited evidence. we do know that based on centers for disease control publications zika virus does cause a correlation with birth defects. and there is limited evidence but the risk of an effect to the fetus depending on the time of the infection can range from 1%-13%. the risk of the congenital heart defect, the most common defect is 1%.
10:14 am
recommendations as far as how long to wait for women who are contemplating pregnancy if women are exposed, it is recommended they wait eight weeks. is recommended they wait at least six months and that is because of the limited evidence that we have, it suggests it can last longer in men then in the bloodstream. the only guaranteed way to prevent this is contraception. the centers for disease control, we don't know how to prevent the zika virus but we know how to prevent contraception. access to contraception is crucial for this issue. for pregnant women, preventative avoidings include
10:15 am
exposure, avoiding travel, using insect repellents, using air-conditioned and screened in areas although we know that nothing will work perfectly. diagnostic testing is also important. there are guidelines as far as when the test and what the test to use based on when the person is exposed. there are very few labs across the country that have the capability to do the testing at the testing is there a confusing because of cross reaction with other viruses. there is also -- because of that -- there are some women who are waiting up to a few weeks or over a month to get tested and you can imagine the impact that has, waiting for the results. for pregnant women with positive or inconclusive tests we recommend doing serial ultrasounds to look for the impact and that puts a significant burden on the health
10:16 am
care community, jiggly in those areas where ultrasound capabilities may be limited because of the supply or physicians or a radiologist to do the scans. we are in regular communication with the centers for disease control to discuss updates on critical guidance. we are working closely with puerto rico where there is the true crisis, in addressing the issues that they are having. we have a number of resources available to try to spread the word about what we know. we are trying to learn more about the zika virus as it impacts pregnancy. as for what can congress do -- we need resources to deal with protection and prevention strategies and treatment efforts vaccine including the which is unfortunately a few years away. we thank you very much, it is an honor to be here. thank you. >> thank you.
10:17 am
next -- the mosquito control association. a commander and expert in preventative [indiscernible] thank you for your service. >> thank you, we appreciate the opportunity to be here. in addition to those other things, i am also the executive florida,and fort myers one of the largest districts in the united states. the capacity for mosquito in myl across the u.s. district -- >> [indiscernible] >> is it on now? do i need to start over russian ? >>
10:18 am
some have no programs or infrastructure and some have very good infrastructure. states like florida, california, new jersey, virginia have state-level coordination of mosquito control. other states have local level control and some have none at all. , states and territories are scrambling to of mosquito needs capabilities based on the new threat of the zika virus. is conducting tabletop exercises as we speak. organizations,th mosquito control districts and emergency management personnel to run scenarios and determine capabilities and state capabilities. $26governor has provided
10:19 am
million in emergency funding in helpda, specifically to mosquito control organizations. they are implementing a ,tatewide surveillance program they have identified 1000 locations where they want to track these mosquitoes. they have identified 14 high risk counties and are developing plans for how to go about combating the mosquitoes in those counties. puerto rico had a workshop recently which included 47 and the outcome of that workshop is that they will try to set up a mosquito control program for puerto rico-based similarly to the infrastructure of california or florida, it is a five-year plan. to sete initially trying
10:20 am
up the infrastructure and begin control efforts on a countrywide basis. workinglities are also to figure out what to do. new orleans has started mapping areas at risk, and has created a public education program. community service announcements and are working with coordinating efforts between the inlth department people order to develop plans for responding to trying to control these mosquitoes. it is a difficult endeavor. ofy are "the cockroach " because they are associated and live with people. based in industrial sites, in order to get control, so it takes a lot of work and boots on the ground and resources.
10:21 am
one of the big needs across the nation right now is the education and training program. especially for states that don't have existing programs. stand up mosquito infrastructure overnight so we are currently working with the centers for disease control on a training contract to develop training and certification programs nationwide to train up pest-control work mosquito control personnel. programas the trainer where we will be setting up 10 regional locations across the united states to provide specific training to trainers who can share that information and spread the information. we have some recommendations for funding that needs to be accomplished. senator king and senator nelson
10:22 am
have a bill called the smash act, which is strengthening mosquito abatement for safety and health with an appropriation of $130 million. that money would go to shore up mosquito control infrastructure across united states. the states currently get money with laboratory capacity grants. so that money stays at centers for disease control and is passed down to the states. they are at $27 million but we would like to see that increase to $55 million, where they were a decade ago after west nile. half that new money would stay at centers for disease control and half, we recommend, would be streaming into the states to
10:23 am
help build state laboratory capacity and shore up mosquito control capabilities. we reallyea where have a critical need is funding for wii registration of the materials that we are currently andg to control mosquitoes the development of new materials to control materials -- control mosquitoes. ofticide, the development pesticide is extremely expensive. the data requirements to get through the epa registration process are expensive. sc johnson hadke to decide if it will be possible to develop control or not. the quality protection the safety noted in for the pesticide was going to be expensive and there is money in the protection act to be
10:24 am
appropriated for helping pay some of those costs. asking that $27 million be appropriated. that to help keep the existing registrations that we have and $15 million to help develop new products. we have a significant problem right now with resistance. they have an effective genetic mechanism for developing synthetic to resources, the most comical, -- the most common chemical use. we have confidence we're using. resistance top one class, the potential for developing further resistance is there. we need help with the development of future materials.
10:25 am
there is cutting edge resource with using genetic modified mosquitoes and funding is needed so that some of the fears of the public with regards to the type of endeavors can be delayed. our final participant is a professor of pathology and laboratory medicine at the university of wisconsin. he develop the first nonhuman model for investigating the zika virus. >> and to echo what everyone else's saying about being thrilled to be here. a year ago, if you have told me i would be here talking about the zika virus, i wouldn't have believed you. recently, we
10:26 am
simply didn't view the zika virus as a major threat to human health. said, theo what chris key phrase is "limited evidence." we simply don't know very much about it. there are many assumptions we can make about the virus because it is related to the dengue virus but at this point, so much more research needs to be done to understand how the virus is whenmitted, to understand and what circumstances pregnant women are at risk and under what circumstances nonpregnant people are at risk of other complications. and this research needs to stretch across multiple weciplines the reason that somebeen able to develop preliminary understanding of the zika virus is in part because i have been in brazil working on
10:27 am
hiv issues for the past 10 years and when the first reports of cames with microcephaly out of brazil, my colleagues down there asked if i would be able to assist. and as soon as the suspicion was narrowed to the zika virus, we immediately began developing developmental systems in collaboration with colleagues to look at the zika virus in columbia. so we started this work in december. that position us to begin studying the zika virus in a laboratory in january and february of this year. supports, wewith were able to debate developing a non-living human -- a nonliving primate model. first, in pregnant women, the virus is persistent or detectable in the blood for considerably longer than in
10:28 am
nonpregnant men and women. so a typical zika virus infection in a monkey and person lasts for a week. in the nonhuman primate that we have infected, three out of four of them had an extended duration of the virus in the blood each we hypothesize is due to the fetus being infected and shutting 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 microcephaly. is vivid and obvious and tragic. but what we don't know is what the spectrum of other zika associated birth defects might include. and because many of the babies were all of the babies in brazil are only one year old, they haven't reached developmental milestones that could indicate thatsignificant issues
10:29 am
will need to be addressed as part of the medical management. of information we have learned is that once you have been infected with the zika virus, you are going to be reinfected forg quite some time. hand-in-hand with our asia.ence in it affected a huge number of people quickly and then it went away. and that is probably because the people who got infected and initially work immune from being reinfected. that isimplications of that we have a number of people who are going to get infected in puerto rico,
10:30 am
central and south america and potentially the u.s., and if they get infected now, they will probably not get reinfected. we don't know how long the immunity lasts but we are probably a few yours away -- a few years away from having a vaccine. it could effectively buy some time until the time at which a that he available to boost immunity or provide broad immunity to everyone. but there are so many unanswered questions that we don't know the answer to. so because it is spread in the same places as the dengue virus, a lot of scientists suspect that severe abnormalities are due to people having had a previous dengue virus infection and then being reinfected with the zika virus. the dengue infection predisposes them to a severe outcome. we don't know if the reciprocal may be true. reachple who had zika who
10:31 am
-- who received the zika vaccine -- >> [indiscernible] there are dozens of these questions that will engage the scientists that we need to answer and right now, any information we get is uniquely valuable. so the studies that we have been doing so far have been using small numbers of research animals. less than a dozen. but a dozen animals now in studies of small numbers now will provide way more information of hundreds or thousands of patients years from now. and because what we can do with the data now is begin to act. if we wait, we won't be able to do that and the virus will get the upper hand. >> thank you. you also mentioned that we are a couple of years away from a vaccine.
10:32 am
your work shows that a vaccine should work? >> correct. >> what is the stumble block? we approved that we could develop those acting quickly. is there a vaccine for the dengue fever? >> there is a vaccine that is partially effective and there are centers in advanced testing. but the stumbling block -- i am hesitant to make bold predictions -- but in this case there are lots of biological reasons why it should be fairly straightforward to make a zika virus vaccine and why such a vaccine should be feasible. there was work that came out of a group the other day that showed in mice that the same concepts that we used to deploy the vaccine to other diseases showed effectiveness in mice. so we have lots of reason to think that a vaccine is feasible but the vaccines need to be tested. tested for safety in small
10:33 am
numbers of people and then tested in small efficacy trials and then tested in large efficacy trials. and these studies are difficult to do with pregnant women toause it will be difficult want to expose pregnant women to the risks of a vaccine. and we have to guard against unintended consequences. so if you vaccinate someone from the zika virus and you increase their risk for acquiring severe dengue, there will be convocations. is there any way to speed up that process? : i would echohat that there are not stumbling blocks. it just takes time. there is a certain amount of time that has to be allowed. people are working 24/7 to get those trials going and that is one of the reasons that additional resources are needed. they are funding for the
10:34 am
small-scale studies. is no way to safely shrink that timeframe down? >> i think that the first and second and third phase of the trial are being done at the same time. they are trying to compress that into 2-3 years. assuming that works it will take time to produce the vaccine that is carefully produced. there are already 500 women who are pregnant with the zika virus present currently? the 50 states, d.c. and the u.s. territories, of our latest with the 480 women zika virus. those women have not delivered yet. and we were concerned that particularly with the first and
10:35 am
second trimester, the chances of a problem like microcephaly might be substantial and we don't know whether babies that are born looking healthy will reach their milestones. >> and you are talking about a 1%-13% chance of having an adverse effect with the zika virus? >> that is basically what we know now, based on small series of information's address that the attack rate or theater -- where the rate could be as high as 29% but a lot of that is not as well-known. the timing in pregnancy -- one of the concerns is some of the earlier data would suggest that this might make sense, if you are affected earlier, the chance for developmental abnormality might be higher later. what if i member correctly, the recent case of a woman infected at 30 weeks.
10:36 am
the other concern about this with the primate study is that one of the cases reported that some research was done in finland where they cultured cells and affected the cells with the virus and they grew in neurons. rain cells. and the concern is that a lot of exterior and viral infections, organ damage that occurs because of the immune response in relation to the actual affection -- one of the concerns is that the virus is actually directly attacking those cells and causing damage without an immune response. that had real concern coming back to neural abnormalities. even if a woman is affected late and doesn't have serious outcomes at birth, we don't know if that virus is not killing off brain cells if it starts to grow. so again, as dave pointed out,
10:37 am
we don't know what is going to happen with that later on. >> so again -- pardon? ok. people who want to go vote, go vote. i will go at the end. i have a lot of questions. that's fine. i'm not done with mine. do you want to stick around? >> yes, i have a conflict. i have a hearing. they are all over the place. will start with rob. i will be sticking around the whole time. i will yield to rob. >> i appreciate you being here. a legislative issue and we voted on it. i assume we will get to it again in the next couple days.
10:38 am
do you support the legislative issue that has gone through the senate and the house? >> [indiscernible] concern is this eradication effort. there is incredible signs that needs to go on here in order for us better to understand this problem. i understand the need for that. the reason legislation is important is to fund that. each one of you talked about that in your own way. you talked about some of the efforts that have already been one of this regard and my concerns is that we are not prepared as a country to do the mosquito abatement that is needed. and specifically, we don't have the federal capabilities. and we have the
10:39 am
operation in the military where they do an awesome job. in a texas and louisiana following katrina -- which was fairly helpful in terms of reducing the risk of infections. they also do other spring conditions for education. my question to you all, are you concerned about that also? one of your colleagues spoke at a hearing for weeks ago and he said that one of the things we think is really important is revitalizing mosquito control efforts. he said the variability of this keto control districts is a markable. some localities have finely honed ability but some have barely any at all. could you comment on that? on his comments and tell me what
10:40 am
you think we ought to be doing in terms of having a federal response to the areas that don't have effective mosquito control? >> that's right. mosquito control is critical and i don't think anyone could have ,ade up a viruslike zika virus a mosquito bite that can cause such devastating health convocations and can be sexually transmitted. but we know that mosquito borne diseases continue to emerge. so the country's capacity to tackle these diseases is very important. , at the federal level, to have the assistance and see what the state and localities can do. what works best for the zika virus is different than what works best for west nile. and the opportunity to do aerial spraying is important for many efforts. yes, i would certainly agree that there needs to be aerial
10:41 am
spray capabilities. in greater extent, across the united states. we have some of the best there we actually have a fly in every year where people come to our district to train in aerial spray and the air force participates in that with us. >so our plan with regard to attacking the zika virus involves aerial. if we get to a situation where we have local transmission, it will involve using aerial assets . we have technology that will allow us to do a spray technique, similar to the adult mosquito technique that we can put larva citing material into
10:42 am
those habitats where mosquitoes live in and we can be very with these kinds of assets. it is very expensive. again, it is a technical issue. but that is how we plan on attacking it locally. >> this is an area where we can all agree that there is a need for this kind of mosquito abatement. especially for the communities that don't have those types of assets. -- they will be about to be deployed to the middle east and there will be one plane available. and we are working on that with the air force but i would appreciate more about getting the advice on this so we end up with an operation that is effective to be able to respond should be happy situation. >> you want to yield to the senator? >> let me ask a quick question.
10:43 am
and then i would be happy. dr. o'connor, thank you so much for being here. there is a specific question and then a broader question about the research agenda. viruslked about the zika remaining in the bloodstream of pregnant women longer than others. >> correct. >> is there any correlation that has been discovered at this point about the propensity for later developing -- because of the longer infection exposure? virus exposure? >> we simply don't know. in people, there is only one case report that came out earlier this year and our data from the primates is still new. one of the studies that is going to need to be done, and i know my colleagues in was ill are doing this, is to do follow-up
10:44 am
.f pregnant women one of the readouts is that we test them multiple times for the presence of the zika virus, nucleic acid, during pregnancy. and then we assess whether there is a difference in the risk. >> you spoke in your testimony about how uniquely valuable the research being done is, even if etc. -- whatles or would you example as -- what you identify as the major gap in research now? if you were in the position of grantmaking, where would you target aggressively the research dollars to fill in the knowledge gaps? >> there are a couple of -- [indiscernible]
10:45 am
that may or may not have an impact. it may be that there are other types of these mosquitoes that have already been identified. those the vector confidence studies are underway. africa, it is not -- that is responsible for spreading zika virus to our knowledge. there are other types of that are also present. we need to assess their risk so that we can figure out the risk factors that are most likely to be associated with transmission. we also need to understand what the applications are for pregnancy so that we can provide that are and more informed
10:46 am
guidance to pregnant women. in addition to those who have confirmed infections during pregnancy, you have to think that in an area where the zika itus threat is occurring, gives an enormous amount of anxiety for all pregnant women. whether they had zika or don't. and for the women who have the zika virus during pregnancy, we need to come up with ways of thatsing the likelihood they will have impacted fetuses. theher that is measuring duration or using a combination of ultrasound and other types of test that have not been developed. i think that will be critically important. so it is doing things that can help manage the risks that we need to be focused a lot of attention on. do you have anything to add to that? to fill in the primary gaps in research? iso the idea that this
10:47 am
is a critical time. we can get critical information to people who are scared. a couple of other areas that are is aboutortant, one the persistence of the virus in different body sites. right now, our resolution is about sexual transmission is based on their little information about how long the virus can persist. of the harmtion that it causes and we are interesting. about whether it does clear in semen. is the work on diagnostics. i am very proud of my centers for disease control laboratory scientists who have developed different diagnostic tests and shared them and commercial companies are developing similar ones.
10:48 am
diagnosticsbetter so that a woman can know, oh, i already had zika. with rubella, we vaccinate against it for children and women are screened to see whether they already have the antibodies. so then we don't need to worry about it. it would be great to have that kind of diagnostic test with the zika virus but we don't have such a test. the infection that might have been the dengue virus versus current zika. propellants --is we are happy that there are the products available that there is the potential for even you were once to come online. so i think that is the reminder for the need of protection. >> you brought it up. since sc johnson has one of the
10:49 am
and demolish defunded labs, are there opportunities for public sector collaborations that you are describing? yes, we think sc johnson for the incredible generosity of their collaborations. collaborations in terms of donations of products. we really appreciate the partnerships that are establishing formally and informally. this is the point for the american public where we need to be working together. everybody has a role to play. everybody has expertise and channels that we can use. it is a huge resource right now. we are always looking for new and more effective repellent and we work with universities and we
10:50 am
are happy to collaborate with the government in any way we can to do that. >> you can go vote. i will be doing it shortly. let me ask a couple questions on this line and if i have to recess, i will come back and ask questions. so when a few in the testimony said it lasts for a week in the blood. but we don't know how long it isn't it easy to determine that? what is the difficulty in understanding how long it lasts? >> there are studies that need to be done. so there is progress but if every time we are testing, you have to keep looking. with ebola, we had survivors who had persistent virus in semen and we have documentation of
10:51 am
that present out to 15 months. and we have an example of a flareup in ebola that occurred 18 months after the individual survived ebola. that many months that we have been tracking the zika virus. so it can last in semen and not blood? >> the immune system protects all he antibodies that are fighting it in the blood don't get into the testes. >> so we're pretty confident that it is in the bloodstream for a week? are still learning but we are still confident of that. do you know how long you have men?cted it in se >> at least two months.
10:52 am
and the reason we have recommended up to six months is because we don't have the data yet. >> ok. can you tell me what you're talking about their -- >> sure. the material used has to go through a registration process at the epa, it is an extensive and the road testing. >> let me hold you up, i have to go. we will recess and maybe fix the microphones during that point. and i will come back. thank you.
10:53 am
10:54 am
>> as you may have heard, taking a break so that he can go to cast his vote on a measure, advancing a measure, to rescue puerto rico from the debt crisis. the bill has advanced on the senate floor. we expect that this hearing on the zika virus will continue shortly on c-span. this is one day after the senate failed to move forward on a zika funding bill yesterday. 60 to movehey needed forward. rejecting provisions
10:55 am
with planned parenthood funding. the washington post wrote about that saying that congressional efforts to fight the zika failed as lawmakers accused each other of fighting politics with a looming health crisis. as anical experts warn outbreak. that is for the washington post. we expect this hearing and roundtable on the zika virus to continue shortly live here on c-span.
10:56 am
>> thank you for your leadership. going to ask you to think about this. been requested by the administration to provide a certain amount of money. some people think it is reasonable and others think not. ask you to try to $ on the many demands of the resources that you have been talking about. earliertion i asked you all of us walk
10:57 am
out of you with a greater sense of urgency. as to what we should do. some idea what we should be doing and what we are doing in our state. but i want to talk about what we should be doing in the federal government, what should we be doing? he can't do everything. it is a shared responsibility. what to we be doing in the federal government? we do thinkuchat: emergency that has devastating convocations that are permanent. we recognize it has been challenging to respond to an emergency with a timeline that is rather delayed. with are working very hard the states and puerto rico and the clinical community and research community to try to prevent, protect and respond. debateave been having a
10:58 am
in congress for months now on whether or not the senate should on thehearing president's nomination for the supreme court. our side keeps saying we should do our job. what is our job? in congress and the senate? what should be doing? we do believe that responding to the request for emergency funding is critical. that would be an answer. there'scomment is that been a lot of discussion about the balance from ebola and i want to make sure people understand that our perspective on ebola is that it is not over. we still have staff in west africa, working every day to keep ebola from flaring up. thousands ofe
10:59 am
survivors, every time there is a new case, there is animal rights response that is needed. so we nervous about the idea of not -- of making sure that we can continue to fight ebola. while dealing with this terrible new virus in america. would like to advocate that the government help with consumer communication and education programs. there is a lot of misperception about what the zika is. there was a recent poll that was conducted. thought theurvey zika virus was a conspiracy. and i think in terms of environmental control, it could help. standing water is a breeding ground for mosquitoes. the education in the public service communication programs in argentina on dengue virus, there is a lot that the public can do to help control
11:00 am
mosquitoes in your area. it goes beyond aerial spraying. it has to be a multipronged, integrated approach. and i think the government could go a long way in the communication and education standpoint. >> speaking from a clinician's side, i think the research aspect is critical. to assist the cdc and others like dave around the country, in surveillance and clinical research needed to identify what the immune response is and what we can do to prevent it and treated, the vaccine trials are critical. from an organizational perspective, we need that kind of education. we are giving providers information to manage patients based on very limited evidence and that makes it more counseling to advise patients on
11:01 am
what to do. the idealnow timeframe. criticalrch piece is to affect the clinical side. >> i'm going to give you some very specific things. previously in my opening statement, we need theort for hr bill 1897 or the sensible environmental protection act which releases mosquito control and allows them to apply pesticides. it is a duplicate of and unnecessary requirement that the scio control district at risk from significant lawsuits. >> in this case, you are
11:02 am
preaching to the choir but even choirs need to be preached to. existingioned legislation and the smash act, the cdceased to epidemiological capacity grants with thetance registration process for the pesticide use for public health. >> i think there are a few lessons. think it stress that i is important that work begin now in earnest. what has happened is a small number of labs like mine have gotten funding from the federal government on the research side, most labs doing z go work --
11:03 am
awardsrk, when the grants over a two-year or five-year timeframe, they don't have a lot of money they can redirect. manuscript, it was written from the perspective of someone who had studied hiv for a long time. get theeed to perspective of obstetricians and rogue biologists and people who bring different sorts of expertise. history has taught us that especially with hiv, if we wait a year or two and we let the virus get the upper hand, it's going to cost much more later on. to acknowledge there's not a one-size-fits-all approach that works for prevention or mosquito abatement or dealing with the consequences of zika virus infection. we need to make sure there's a
11:04 am
plan in place that supports multidisciplinary work in a way that is coordinated. finally, it is important to underscore what was said about ebola. the response needs to be part of an integrated response to emerging infectious disease threats. two years ago it may have been ebola, this year it is zika and a few years from now it will be something else. having something like a public health emergency management agency makes a lot of sense so this,n a situation like rather than having to deal with it in isolation and hit zika virus and control, there are people who can make these decisions and allocate funds before any situation becomes a crisis. you mentioned the cost
11:05 am
of raising a child with microcephaly. i think someone mentioned as much as $10 million a child. a thousand children who are born who survive, at $10 million per child, that's $10 billion. that's a lot of money. : me ask some medical and some process questions. when zika was discovered. what has changed now from the 1940's when we first covered it? is it the frequency, the number or the movement? why is her so much attention and focus? there are a couple of things to say.
11:06 am
brazil wasrrival in populated area and very dense mosquito population area. explosiveed transmission of a virus that was mosquito borne for decades. in sparselyossible waslated areas that there zika related birth defects that were not recognize. people have gone back to french polynesia and recognize there were consequences that were not immediately recognized. the spread in northeastern brazil and what is happening today in puerto rico, probably relating to the virus getting
11:07 am
into densely populated areas where there is less protection for people from mosquitoes. there are other scientists looking at the strains to see if anything has changed. : -- senator lankford: how is it transmitted? is a mosquito lighting someone who has zika and then the mosquito transmits it to someone else or is there another way that it is transmitted? dr. schuchat: that is basically what happens, but it is not immediate. the mosquito bites the person, takes up the virus and subsequently is able to infect other people. senator lankford: it's not
11:08 am
necessarily be blood from the other people -- the blood has been transmitted to the mosquito itself and then it is also transmitted? that is the part that is interesting that i have not seen in a lot of public information. so many people in the public are trying to figure out why our mosquitoes carrying this and why is it only certain types? mosquitoesn types of can take in the virus. one particular mosquito is the best sector for this virus because it primarily feeds on people. they are capable of carrying the virus but it's not a good effector. you may want to supplement that with additional comments.
11:09 am
because of this idea that mosquitoes can get the virus by biting people, we want people to they are traveling to an area where the virus is spreading and we are not where of being infected, we want people to use mosquito repellent for at least three weeks so that they won't infect our skeeters. >> this is what we call a mosquito-man-mosquito disease. the intermediate vector is a mosquito. is birth orhost other animals and man is an infidel host, but we still have .o combat those but as the admiral said, one of
11:10 am
them likes to bite people and that makes it an efficient vector. long the hosthow of the person that they can continue to transmit that? we are seeing one or two weeks. based on the models that have been described, some women may have the virus in their blood longer than one or two weeks. >> i would add to that that there is a spike in the virus in the blood stream that last only a few days. a mosquito isy going to get infected from a --od meal is going to be while it is possible a woman with a little amount of blood can transmit to a mosquito, it's probably much more likely
11:11 am
someone with a high amount can transmit to a mosquito, but these are studies that need to be studied and it is just an educated guess. senator lankford: an individual bites -- a mosquito bites an individual -- does it take several days to start multiplying out? if another mosquito bites, they can transmit over? these mosquitoes are serial biters. i could modify that to a mosquito bites several people and within one day, you will get to see the zika virus in the bloodstream and it will peak in concentration between days two and five. after that, it receives too much lower levels. to fivering days to that is going to be morse -- most likely to be transmitted.
11:12 am
lankford: the people who do know they have some sort of senate -- some sort of sickness, are they experiencing those symptoms days to to five? we think four out of five people don't have any symptoms and those who do will have it for a week or so. >> people don't know which mosquito bite infected them and they don't know exactly when they were infected. it's a little fuzzy. they begin to develop a rash. : there has been little to no conversation about trying to quarantine individuals . by the time you get someone quarantines, they are not really a person who can transmitted at that point. >> i would say it would be
11:13 am
wholly inappropriate to consider quarantine. >> the other part of that is that it is not a human to human spread. many quarantining would likely be ineffective. >> let's be clear. currently, nobody in america has zika transmitted by mosquito. it's all due to travel? dr. schuchat: in the continental there areawaii, travel related and couple that are sexually transmitted. >> some humans who have zika will be bitten by a mosquito and we will start having those infections? dr. schuchat: we think it is likely we will have locally transmitted cases. we think it is going to be important for state and local health departments to
11:14 am
intensively look for them and it's not that easy to find them because they won't be declaring themselves a locally contracted case. we need to do some work with states and locals and clinical communities to make sure we recognize a rash and conjunctivitis so there's a lot of work to do. johnson: there are two different varieties of mosquitoes that carry this. made to forh -- how an varieties of mosquitoes are there? differentre over 200 species. there are over 90 species just in florida. are tests or them disease carrying species.
11:15 am
senator johnson: which distribution of states have these? are we talking all 50 or maybe a dozen? to 30huchat: parts of up states may have the mosquito. one of the things we would like to see is better data. that's the kind of thing health departments and vector control groups are trying to develop right now. : let me get back to the registration of different chemicals we need for pesticides . you say you needed funding for registration. >> the food funding protection act changed the way pesticides
11:16 am
are registered at the epa. under the food quality protection act, to ensure the food supply is protected, there is sufficient time and research done to prevent people from being exposed to pesticides. becamea requirements very expensive overnight and so chemical companies have to make a determination and look at what is going to cost to generate the see if it is going to be profitable. senator johnson: please chemicals that have been used for quite some time? >> if you are doing a new
11:17 am
chemical, you are starting from scratch. existing ones have existing data. they determine does there need to be additional data generated. a mosquito larva side that we ,se routinely in my district the manufacturer looked at what the data call was and decided it was not economically profitable to re-regular -- reregister the product. senator johnson: is that a suggestion to get an emergency waiver? food quality protection that recognize they were at risk and so there was an approach for then to help pay
11:18 am
registration of public health pesticides. senator johnson: but that didn't work. >> the money has not been appropriated. johnson: could we create an emergency waiver? you have been using it and the world and not end. chancellor blanck and it goes along with the unintended consequences. last time i met with chancellor blanck, she came in with a commission by research university. the researcher time on federal grant research project is spent
11:19 am
trying to figure out how to comply. you obviously have important grant research funding here. are you seeing that type of burden? >> i think there are different types of regulatory compliance. certainly the federal regulatory .ompliance i've been asked to comply with data integrity destined to be made entirely public the available, so we are ensuring compliance with data, keeping data private when the fate of the data is to keep it public. it includes things like making sure you are doing animal .xperiments if you are doing human human biosafety research with the
11:20 am
appropriate safeguards so there certainly is room for improvement, but it cuts across were a huge amount of time is spent on it but it is not the sole contributor. senator johnson: maybe we can work on that so the dollars that on -- areours bent spent on preventing some tragedies. you talked about the sharing of information which would assume on federal grant projects that it would the widely distributed so that theyared can take advantage of the good work you have done. can you speak specifically about what you are talking about there? >> one aspect of our work that
11:21 am
has made it innovative is we started a study in february and made our data publicly available online. the notion of making data transparent as it is being collected is still very new to science. mark >> isnson: why a lot of historical precedent that dates back to how science how credit and established as well as how well one can take that information and if you are to put something up that was wrong and put information at that has not been fully vetted, that could have deleterious consequences. the 2009 h1n1 researchers have made the decision that making data available more quickly
11:22 am
during these public health emergencies outweighs those potential costs. step forward it a with the zika work. johnson: i think that's an easy problem to overcome. ,t has not been here reviewed so use it with the caveat that we are not 100% sure but it can advance knowledge a lot quicker. pushing theu for envelope and that's the way we should be doing it. question.ask one do three things we need to do, tracking information, this the of its movement and where it is moving, the mosquito population .ontrol and the vaccine
11:23 am
>> i would add public education is really important. senator lankford: are you talking more about facts about zika and what we can do like emptying buckets and making sure there is not outside standing water? >> all of those things. senator lankford: which one are we not doing well and not doing enough? it sounds like all of those have started. which one needs the greatest amount of acceleration? dr. schuchat: in each of these areas, there's a lot more that needs to be done. we have developed new tests but as we ship them out in the mosquito season is here and we are looking for local transmission, we are going to have a surge. , we need to address
11:24 am
the myths in the other groups. it's likely to get more and more complicated. there are couple of things not exactly in those categories. in puerto rico, we would like to better protect pregnant women in addition to mosquito control, we think things like screens on the homes would the really helpful. that's the kind of thing we have not been able to get to scale. need tonk we also understand the contribution of the sexual transmission. it spread in the u.s. could be fueled sexually. once someone has been infected
11:25 am
with the virus, they are not going to be reinfected again. we don't know how long it is but we can guess from some previous outbreaks that it is probably at least several years. women who might become pregnant protect themselves and thattially make decisions would allow them to avoid the immediate risk. infectedappen to get this summer in puerto rico and get pregnant next year, their risk of having adverse events will be so much lower. to quantify how that is going to be very important. senator lankford: i would make one request that you are working on the vaccine -- i don't with my polio vaccine with a sugar cube and i make a statement for
11:26 am
all the children of america and work on a sugar cube vaccine for zika. senator ayotte: i was in and out, so not sure if you asked this question, but in terms of how much ofic test, a challenge is that in terms of understanding who has it and what the situation is? the other question i have is thinking about local , how are we working with our international partners? how have in the international relationships? this is an international,
11:27 am
country to country challenge. dr. schuchat: we have developed a couple of diagnostic tests that are good but not great. there are tests that are really needed and we have been able to diagnostic kits with laboratories. we know there is going to be a and theeded laboratories are getting permission to run tests as well. we are a lot better than we would have been a year ago with the tests capacity and we think ability to handle the surge in testing is important. there are some system improvements that are needed. the running of the tests can be five or six days.
11:28 am
getting the specimen to the lab it's going to do the test can take a while. is where itnk it needs to be, especially for pregnant women who are keen to get that result. smooth system a yet. it's one thing that is a big focus to improve. in terms of local transmission, we have an interim response plan about getting ready to detect local transmission and how to manage it. we are also collaborating with other countries who are deep into the response. in colombia and panama, they are ahead of us. >> if i could expand on the testing -- for everybody's
11:29 am
understanding, the testing is not as simple as a few drops and then waiting for something to happen. it depends on the timing. is blood testing looking for anti-bodies. if the test comes back positive, you have to do an additional layer of testing to exclude some of these others to confirm it is just zika. one of the concerns doing some , the otherting factor is getting back to the immune response, developing one type of antibiotic first there is a quick acceleration and it clients. we don't know what the immune response to this virus is.
11:30 am
we assume based on other viruses that we presume to know what it is an part of that is the rationale on timing related to pregnancy, but we don't know that it specifically follows the same pattern. the other challenge is getting back to people who have been exposed and now are immune. there's no good test for this anti-body. of factors about cliniciannd for the in a small, rural practice you one of theseross women travel, it would be hard to coordinate that with state health -- state health departments. we have worked to try to identify contacts and people who
11:31 am
have worked through to smooth this process, but it can sometimes create a challenge. again, it presents challenges. senator ayotte: you have to lab,take that at a dna that's a big undertaking. is -- i cane understand this is complicated. fda haschat: the provided emergency use for this so that it can be done in the state and local laboratories, not in the doctors office. that's why the clinician has to send a specimen to the commercial labs.
11:32 am
might lead clinicians who are used to sending specimens to his commercial labs have quicker aspect -- have quicker asked -- quicker access. we have more work to do. >> you start talking about diagnostics and it's not a good solution to the efforts really ought to be in prevention, mosquito control, vaccine, repellents. >> i think the chairman is right -- a couple of you have mentioned this but we have not -- led down
11:33 am
and notrms of condoms being pregnant, that's where the real problem lies. one thing we have not talked is i want to talk about sterile mosquitoes. a wish and a hope? there'srarely recently, an attempt to do a test with genetically modified mosquitoes in the florida keys and there's been a lot of pushback. >> why the pushback? >> they are allowing the local population to make the decision as to whether it gets done or not. there's a significant number that don't understand well enough and are scared of it.
11:34 am
recently, they have not been able to do radiation of mosquitoes and sterilize them so that they were competitive with local populations, but there indications --e i'm going into a workshop in vienna in august where that will be discussed as far as test sites and how to implement that. >> that would be primarily directed toward identifying out rake so that we can direct as weces to do as much can to eradicate mosquito populations where there may be an outbreak. dr. schuchat: i think the urgency of the situation means there are a lot of places that would be good sites to test some of the newer approaches.
11:35 am
the science is exciting and compelling in the concern from the field is what will these approaches will these scalable? for addressing the mosquitoes. the diagnostic seems like a real problem. it would be directed toward where we would find the efforts of eradication is my point. i think we think eradicating this mosquito is going to be technically and biologically extraordinarily different. >> use the word control. we thinkhat:
11:36 am
aggressive control efforts should be done in parallel, aggressively scaling up the diagnostic because it's not going to be over in two or three months. we probably have a couple of more years of this problem. anhave diagnostics that have improved but we know for consumers it is still not good enough and we need to get better tests and quicker systems. senator johnson: i don't want to be panicking people here. it is an enormous risk and i'm ,ot minimizing it whatsoever but i guess i'm trying to understand the place of diagnostics on this. i'm not saying an easy diagnostic tests.
11:37 am
i was trying to do it in terms of where we have outbreak so we can focus on that. dr. schuchat: diagnostics are important for an individual they are incredibly important for surveillance and understanding what is going on. absolutelyright, we need to be tracking the disease. i want to go back to the issue of contraceptive. to speak a bitnt about that? i want to make a few comments, but i was surprised to learn it puerto rico that two out of three pregnancies were not intended.
11:38 am
in the u.s., we think it is about 50%. decisionsainly think about having children are personal and made in the family and made in discussions with one's health care provider but access to safe and effective contraception for those who are not trying to get pregnant could be very helpful in addressing some of the threat zika poses on pregnant women. if you are not trying to get pregnant, there are safe and effective ways to get pregnant. in puerto rico, access is quite limited and we have been working closely with the private sector to try to improve that. >> we know how to provide access and we have made a lot of
11:39 am
progress in finding the right method for patients so that it works for them and they can s.lerate side effect it is always a challenge, certainly before zika cable. but the unintended pregnancy rate in the u.s. is 50%. discussing family planning is challenging. how do i plan and what am i ?upposed to do it is clearly challenging for those people trying to plan a .amily contraception is an important aspect and arguably, we may do great with mosquito control but we are never going to get rid of 100% of them. but in theory, we could prevent 100% of the pregnancies. but i want to highlight the issue in puerto rico.
11:40 am
contraceptives such as taking a daily pill or changing a patch weekly are limited. there has been inordinate efforts by the folks in puerto rico to increase training in various long acting methods and increasing the supply, but it is multifactorial for the lack of and efforts are being made to increase access. a prevention standpoint and with all due respect to my colleagues, we could theoretically achieve 100% prevention if women use contraception. don't inc. there is a linear relationship between the mosquito population and transmission of the disease.
11:41 am
mass of a critical start theopulation to transmission. when you are talking about controlling mosquitoes, you need to get down to a low enough level, not 20 23 much eliminate transmission of the disease. i think control methods are very important and integrated control methods are important. it's not just about spraying, it's not just about personal repellents, it's about people paying attention to standing water in their backyard and it is about education. i think if you can do a lot of those things in the high risk , it can make a big difference.
11:42 am
>> pregnancies being planned, i want to have more grandkids, so we need to concentrate on control. , we want todpoint control and get it down to that level. >> with respect to hiv, one of the things we have learned is the answer to how we should just manage this sort of question is all of the above. people whoencourage want to remain absent to do so because if you do not get pregnant through abstinence, if you get infected through zika, you may minimize your risk until a better vaccine is available. having access to contraceptive and access to ways to protect yourself is so individualized.
11:43 am
going to be really important not only to minimize the downstream cost of having zika and having babies with these abnormalities but as a protective effect until such time as the vaccine is available. i would add all the other modalities that have been used successfully to try to minimize risk and other disease out rake's before. before.eaks i want to find out where is the intersection microcephaly, a woman's right to have an abortion, when we have the thisty to determine that is going to be a child and there may be severe damage. we have talked about if a child
11:44 am
has microcephaly, someone said $10 million per child. pregnancyint during a do we know there is a real problem? we are really at the beginning of understanding zika and regnant see. there's probably a lot to say here. we don't know if a woman has laboratory confirmed zika exactly what that means for her and her baby. with something like a down syndrome test, there's a lot of science behind the counseling that goes on about what that means. but with zika, we really don't know. we don't know a child is going to be born with microcephaly until the child is one? -- a child is born?
11:45 am
forschuchat: they will look calcification and other warning signs but we don't know how big the findings are. where ultrasound are looking ok but the baby wasn't ok and others where there seem to be problems and the baby turned out ok. i think it is too soon to have a confident set of information to councilwoman with how to expect and how to plan. >> it would suggest someone infected earlier had a higher , whate most recent case we know about the virology may not be as reliable. the only thing we really have to determine what the outcome might be is following with ultrasound. certainly, there are severe
11:46 am
outcomes and they should be apparent for counseling and other times, it's a little more subtle. furthermore, we don't know if the virus will continue to the on diverse what the impact of that might be. what becomes challenging because to knowt have a test the fetus will be affected and to what degree, the ultrasound at time. a woman travels and gets infected in her first trimester and test positive within a few weeks and we start the ultrasounds, she may not show a severe effect of the brain until 20, 30 weeks or further along and now she is faced with being in the third trimester, seven months along and what do i do? thecan imagine psychological stress that
11:47 am
creates. even with the testing that we do have, knowing whether the fetus will be effective -- effective is challenging. >> i would like to give you an opportunity to wrap it up. i want to say how much we appreciate you being here and the work that you do. we thank you for all of that. several of you mentioned a vaccine may be a few years out. could you give us more of an up date and where we are in terms of developing a vaccine? dr. schuchat: there are several candidate vaccines using approaches similar to other viruses. the nih is in the first trial of
11:48 am
small-scale ones that look at tolerability and immune response and that could like to begin by some number. .hose are just small numbers if they go well by the beginning of 2017, they would expect one site to launch a large-scale trial of protection. whether that will show good , it would still take time for all the other information to go into trying to get a vaccine license like the manufacture of being able to produce it reliably, consistently and carefully in the ways the fda would require. we think lots of interest in the research community, it would be a couple of years out. would such a vaccine given to
11:49 am
other people? it's tricky. if you don't even know you are pregnant and have your pregnancies are not planned, it may not be as effect of a strategy. our strategy with children -- this type of vaccine might the a great travel vaccine and might be a general population vaccine in areas where spreading is a risk. question and i will give you an opportunity to have closing comments. understand and hopefully we can find an agreement and get that done, but other than the funding issue, needing more ,unds for different activities as we talked about
11:50 am
reregistration, are there impediments and self-inflicted wounds that we could move that area away to make things more effective? if you have one, speak up and i will give you a chance to close it out. dr. schuchat: this is an emergency and our ability to react quickly as vital. better waysobably to fund emergencies and public health rapidly so that the response is leading. with thel reregistration of ingredients and looking at new ingredients all the time and there are a lot of new regulations and a lot of them are very good. are there to protect the safety of the public and in that respect, they are excellent.
11:51 am
there's always room for improvement. expensive, on the order of $80 million to $100 million to get a new ingredients approved. hurdle to get over. it is something we deal with regularly. we work with a lot of the companies that have the scale to invest in something like that to , but i things approved think a lot of the regulation there is good and is therefore good reason. from a clinical perspective, access to this, particularly with the challenges to puerto rico, there are some challenges researchof the
11:52 am
requirements and hurdle in the grant application review and awarding process, every day we another day there could be an infected woman and the longer it takes to get this research we need to break ground and have a better understanding is critical. >> one of the impediments is people in general are willing to tolerate a certain level of mosquito biting pressure. it depends on where you are from and where you live. the same extent are willing to fund the infrastructure necessary to fund control. that is why there is such a diversity of capability across the united states. impediment in that we do not have established programs where in the future you might need one but it takes time to build infrastructure.
11:53 am
having the ability to respond is very important. that nih indd particular, having the ability for investigators who have awards to study other conditions or diseases to have explicit permission to redirect that lending to support pilot projects would be very useful delay is costing us time and knowledge. with respect to international arearch, a lot of what we going to be able to do to control zika virus in the u.s. is contingent on relationships we build in the central and south american countries we are returning from. taking sure there are as few possible would be important to make sure there are
11:54 am
as few barriers as possible that inhibit our interactions with our brazilian, colombian or other colleagues. senator johnson: could you grow in some examples of some of those? an award from my colleague from about two years ago and there was a one-year delay in getting that sub award issued in part because of the administrative paperwork that needs to be done on the u.s. side and there's an extensive requirement on the brazilian government side. atn though we did a good job nih, we were handcuffed until we were able to get through the hurdles on the brazilian side. where ourt be places
11:55 am
government can apply effective resistance to streamline things and make those go faster. beforenow been two years we been able to start work on the resilient component of that project. senator johnson: i would usingiate where you are regulatory streamlining. we have to cut through the red tape. one final comment before we go down the list again? just to remind people that we live in a world where we don't have one infectious disease at a time. we live in a world where ebola and zika can happen at the same time. i would like to emphasize the
11:56 am
importance of control. we did a study on malaria gatestion with the foundation in indonesia. a 30% reduction in fights led to a 70% reduction in disease transmission. i think you have to take an integrative approach and i do want to support an emergency reprieve on registration of some toredients to get access those this year if they are expiring. would like to thank you for the opportunity to be here. we are incredibly passionate about women's health and this is not exclusively, but the vast majority is related to women's health. >> zika is the disease of the
11:57 am
diseases inave florida. we have people coming into florida every day with active of mosquito borne diseases and they can travel to any state in the country. oft have mosquitoes capable picking up these diseases and potentially transmitting them. as well as dealing with west nile virus and encephalitis. the key to responding and eliminating these diseases is suppressing the mosquito population capable of transmitting these diseases, so it is important to have some sort of coordinated ability to deal with this issue. >> scientifically, the key
11:58 am
messages we still don't know what we don't know and this is going to require a lot of knowledge and a lot of work from a lot of people to rapidly increase what we do know. there iscial side, likely going to be a sense of other ring that is going to happen if the zika virus reaches the u.s. where people are going to be blamed and certain groups are going to be specifically targeted as those responsible for zika virus and that is very ineffective. we should do everything we can to make sure that the message is we are all in this together. thank you all for your work. of tryinghe same goal to do everything we can. work and the your time you took care. the record will remain open until july 15 for submission of
11:59 am
statements to the record. this roundtable is adjourned. which is responsible for its caption content and accuracy. visit ncicap.org] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org]
12:00 pm

18 Views

info Stream Only

Uploaded by TV Archive on