From the U.S. Government Accountability Office, www.gao.gov Transcript for: Challenges Responding to Zika Outbreaks Description: Zika virus infections during pregnancy can cause serious birth defects, as well as a nervous system disease in adults called Guillain-Barr, syndrome. So, what lessons has the government learned about responding effectively to an outbreak? Related GAO Work: GAO-17-445: Emerging Infectious Diseases: Actions Needed to Address the Challenges of Responding to Zika Virus Disease Outbreaks Released: May 2017 [ Background Music ] [ Tim Persons: ] We really don't know the total number of infections. [ Background Music ] [ Sarah Kaczmarek: ] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. I'm Sarah Kaczmarek. The Zika virus can cause serious issues during pregnancy, such as birth defects. It can also lead to nervous system diseases in adults. Given this ongoing threat, GAO's Chief Scientist, Doctor Tim Persons, lead an independent investigation into how federal agencies have responded to Zika outbreaks. I was actually pregnant last year when the Zika outbreak began and I'm curious: what's changed since then? [ Tim Persons: ] Short answer, Sarah, is that we know more from a medical perspective about Zika. We know now what its case definition is. In other words, when you go to a clinic, the doctor can apply a criterion -- say, "yes, that's Zika" versus "that's flu" or some other type disease. We also know a little bit more about the incidence, where it is in terms of the rates or the expected account based upon all the available evidence. And where those cases are. So, the geographic distribution which is, of course, always important. And then, of course, we do know some health outcomes. The primary one was a more confirmatory finding in terms of what's called microcephaly-the idea of those children with underdeveloped heads because of the nature of Zika disease attacking the neurodevelopment of these children. There used to be questions about, "Well, is Zika exactly the cause of that?" And it's believed now to be more confirmed along those lines. [ Sarah Kaczmarek: ] Okay. So, let me ask you about what we don't know. For example, do we even know how many cases of Zika there've been? [ Tim Persons: ] We really don't know the total number of infections. I'll just say here are the numbers as we know them today. For example, we know that there's been about 5,200 cases in the U.S. and the territories since the outbreak from last year. We know that there's now some mosquito-borne transmission in both Florida and Texas: 216 in Florida and 6 in Texas. The biggest challenge is that four in five people may have the virus in their blood stream, but they don't know that they have the virus in their blood stream. So, when you're talking about 80 percent of folks that may have it, but not show symptoms -- that just causes a risk in them being potential -- rather what they call "reservoirs" [inaudible] around to be able to pass it on whether it's mother to child, whether it's mosquito transmission, or whether it's sexual transmission. [ Sarah Kaczmarek: ] Okay. So, what test can people get to see if they have the Zika virus? [ Tim Persons: ] Well, unfortunately, at this time there's no over-the-counter test for Zika in the same way that say you can do for a pregnancy test. These are highly specialized. They're highly scientific. The challenge to the federal government and then all the public health entities that work this is that because it's an emerging infectious disease, it's new. They haven't seen it before. And so mechanisms or the ability to test for it is relatively immature. Now there are some tests that are being used and were led and developed by our U.S. Centers for Disease Control. One test has to do -- it's very fast and is considered reliable and accurate, but it's limited because you have to test within the window of time when there's a lot of virus in the person's blood. So, if you miss that window, you may still have had Zika, but remember that asymptomatic problem -- that test wouldn't detect it later on when maybe the virus calms down. The second test is highly complex, is run only by certified government labs. And it's considered very authoritative but it involves a blood draw and it's really looking for antibodies or highly specialized things that come out of a Zika infection. And so, we're really limited and there's not a lot there, but that is indeed what the Department of Health and Human Services as a whole is working on developing. [ Sarah Kaczmarek: ] What can state and local governments do to reduce the spread of the virus? [ Tim Persons: ] Well, in addition to their public health labs and their activities there, one of the things that they can do is also just implement good integrated vector management or IVM. That's just a way of saying have a holistic approach to mosquito control. I remember the former CDC Director referred to the Aedes aegypti mosquito, the one primarily of concern, as the cockroach of mosquitoes. It's very hard to kill. So it's going be more than just judiciously applied pesticides in the right way. It's going to be more than just traps, more than different or advanced technologies. It's also going to involve social education campaigns. It's going to involve knowledge and awareness and doing what you can and again a communitywide sense. Not just an individual office of a city, county, or locality alone. [ Background Music ] [ Sarah Kaczmarek: ] So given the lessons the government has learned about Zika, how can they better respond to the next outbreak? I knew Tim could walk me through the recommendations his team made in this report. [ Tim Persons: ] Our primary recommendations focus on really just making the basis of science in the development of the diagnostics as transparent and as open as possible. We're also just recommending on terms of better data on the mosquito-control side of things that we just get better information locally on where are the actual mosquitoes? [ Sarah Kaczmarek: ] So with mosquito season right around the corner, what do you see as the bottom line of this report? [ Tim Persons: ] We need to be more prepared. And I mean this in a whole of government sense in meaning at the federal, state, and local levels. I think that we need to have a more agile posture. We need to think about how we not only do the initial pioneering science in understanding an emerging infectious disease like Zika, or in 2015, like Ebola. But we also need to have an ability to take that brilliance, that innovation, that technical information and get it rapidly out to the manufacturing base or the diagnostic community, in this case, or the scientific community to do better and more science. We also just need better data in terms of not only where the disease is going on, but also just in this case of mosquito-borne disease is where the mosquitoes actually are. So just doing those day-to-day, very important, not necessarily the most desirable or glorious part of science, but it's hugely important to have that data in order to have a better basis for information to better tackle these diseases in a proactive way rather than a reactive way. [ Background Music ] [ Sarah Kaczmarek: ] Thanks for listening to the Watchdog Report. [ Background Music ] [ Sarah Kaczmarek: ] To hear more podcasts, subscribe to us on iTunes. [ Background Music ] [ Sarah Kaczmarek: ] For more from the Congressional Watchdog, The U.S. Government Accountability Office, visit us at gao.gov.