As Congress weighs Obama's Zika proposal, threat of outbreak looms

    NIH National Institute of Allergy and Infectious Diseases Director Anthony Fauci, left, and CDC Director Thomas Frieden, second from left, shake hands with Senate Labor, Health and Human Services, Education, and Related Agencies subcommittee Chairman Roy Blunt, R-Mo., and subcommittee member Sen. Thad Cochran, R-Miss., right, at the conclusion of the subcommittee's hearing Â?to review emerging health threats and the Zika supplemental request,Â? Thursday, Feb. 11, 2016, on Capitol Hill in Washington. (AP Photo/Manuel Balce Ceneta)

    Members of Congress have moved quickly to take up President Barack Obama's request for $1.8 billion to combat the Zika virus, but potential legislative hurdles remain and one expert said it would be wiser, and cheaper, to take steps against the disease now before a wider outbreak occurs.

    The directors of the Centers for Disease Control and Prevention (CDC) and the National Institute of Allergy and Infectious Diseases (NIAID) testified before House and Senate committees this week.

    "We must act urgently and swiftly to stop the spread of the Zika virus," CDC Director Tom Frieden told a Senate appropriations subcommittee on Thursday.

    The agency needs the $828 million requested by the president in order to conduct research to better understand the virus and to establish protocols to treat and contain it, according to Frieden.

    "This emergency funding request is designed to support immediate response activities to reduce the Zika risk in the United States and around the world," he said in his testimony.

    U.S. citizens have had limited exposure to Zika so far, with only about 50 confirmed cases, mostly involving Americans who traveled abroad to countries where it is more prevalent. It is primarily transmitted by Aedes mosquitoes, but there have been rare instances of sexual transmission from men to women as well.

    Not all patients experience symptoms, which can include fever, rash, and joint pain. The greatest concern is for pregnant women because researchers believe the Zika infection may be linked to serious birth defects.

    NIAID Director Anthony Fauci told the committees that his agency is committed to researching and developing a vaccine for Zika and chikungunya, another disease carried by Aedes mosquitoes. Testing and approval of a safe vaccine could take years, but officials hope to begin early clinical tests this year.

    The House and Senate hearings coming just days after the White House put forth its $1.8 billion proposal are a promising sign for the urgency with which Congress may handle the issue, but it is still a long way from actually putting money in the hands of doctors and researchers.

    In order to provide the funding the administration is seeking, supplemental appropriations legislation would need to be introduced in the House or a provision would have to be attached to an existing bill.

    While supplementals used to be relatively common, they have become much rarer in recent years and could be a hard sell with budget-conscious Republicans in an election year. Funding to address Ebola treatment in 2014 was ultimately handled through the regular appropriations process, but that would not be an option for Zika until the fall at this point.

    Republicans have proposed legislation that would give the administration the ability to use leftover Ebola funding to deal with Zika, but Health and Human Services Secretary Sylvia Burwell told reporters Tuesday that money may still be needed to "finish the job" with Ebola. Sen. Roy Blunt (R-MO) raised that issue at Thursday's hearing.

    "After the Department of Health and Human Services received $2.7 billion to spend on Ebola and other infectious diseases, more than half remains unspent," Blunt said, "and none of the remaining funding thus far has been used for the current Zika outbreak. This shows the fundamental problem in our public health system: it has a short attention span. We immediately forget about the outbreak that came before and do not adequately plan for the ones on the horizon."

    The quickest path to get exactly what Obama has requested would be to attach funding to some other must-pass legislation, but there may not be such a bill on the horizon. If it handled as a standalone measure, it might quickly sail through the House, but it could face controversial amendments or even a filibuster in the Senate that would delay passage.

    Democrats who have been fighting for emergency funds for the residents of Flint, Michigan suggested to Bloomberg News that they may try to tie that to a Zika appropriations measure. Sen. Jeanne Shaheen (D-NH) said Thursday that she would consider linking it to emergency aid to respond to opioid overdoses.

    With Zika only affecting a few dozen Americans so far, other issues may carry more political importance for members of Congress. The CDC confirmed Friday, though, that two U.S. women have miscarried after being infected with the virus, according to ABC News.

    "There are no must pass pieces of legislation that Congress is considering," said Mark Harkins, a senior fellow at the Government Affairs Institute at Georgetown University. "For an emergency Zika funding bill to pass without amendments there would need to be a groundswell of support from the public."

    "I still see more support for funding to Flint for their water system," he added. Without that kind of public pressure for Congress to act, the matter might not be addressed until October.

    House Minority Leader Nancy Pelosi expressed optimism about both parties being able to act quickly at a press conference Thursday.

    "My read from the Speaker is that this will be bipartisan, hopefully noncontroversial, as we go forward to meet the President's request for Zika, emergency Zika funding," she said.

    Some have suggested the government is overreacting to the Zika threat, but Dr. Kathleen Neuzil, director of the Center for Vaccine Development at the University of Maryland, believes the CDC's response is "absolutely justified."

    "From a prevention and control standpoint," she explained, "it's always better to start sooner than later. It's always less costly to start sooner than later...The most cost-effective approach is always to get on it as soon as possible."

    Since a vaccine inevitably will take time to develop, Neuzil believes the more immediate concern in the U.S. will be mosquito control and preventing mosquito bites. With the number of infections rising elsewhere in the world, the danger is not going to go away soon.

    "We know this takes a long time, so starting now is absolutely what we need to do," she said.

    While Neuzil--who has not closely studied the president's proposal--argued the public health community should be acting quickly to prevent and contain Zika infections, and government funding may assist with that, the general public should not overreact to the threat.

    "In the United States, right now, there's clearly no reason to panic," she said. That could change, though.

    According to the National Institutes of Health (NIH), the virus has the potential to spread widely and quickly in the U.S. if Aedes mosquitos here become infected.

    More than 200 million Americans live in areas where Aedes mosquitos are active during warmer months, and about 22.7 million are in climates that could support the spread of the disease all year. The NIH called for an intensification of research to prevent that from happening.

    However, Neuzil explained that such an outbreak is unlikely as long as the number of existing infections remains low.

    As the virus is currently understood--and she noted it is a rapidly evolving situation--a patient who has Zika would need to be bitten by an Aedes mosquito in the U.S. while the virus is active in their bloodstream, and the mosquito would then transmit it to other people.

    This pattern has occurred rapidly in some countries with tropical climates, but the mosquitos are inactive in most states during the winter months and the odds remain low of a particular insect biting one of the handful of infected U.S. residents during the window of time that the person is carrying the virus.

    "Simply it's a numbers game," Neuzil said.

    "You want to knock down the mosquito population and you want to knock down the population of people who are infected," she explained, in order to avoid sustained and widespread transmission. Accomplishing that and developing effective vaccines and treatments will be significant and potentially expensive challenges.

    "You want to be sure that it's not finances that are holding back the response."

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