	Introduction

As of June 16, 2016, the World Health Organization (WHO) reported that 60 countries worldwide had experienced mosquito-borne transmission of Zika, 46 of which had never had Zika cases before (see Figure 1 ). The United States will likely experience an increase in travel-associated cases and possibly local transmission. Although U.S. health assistance (bilateral and regional) to Latin America in general has declined, U.S. support for the Pan American Health Organization (PAHO) has increased. Regional a pportionment and components of global health budget . In recent years, Aedes mosquitoes have caused three disease outbreaks (dengue, chikungunya, and Zika) in Latin America and the Caribbean, all of which have been imported into the United States, with the latter being only travel-associated at the time of this report. This report provides background information on the Zika virus, discusses challenges faced by governments and implementing partners in the Latin America and Caribbean region that are attempting to control the ongoing outbreak, and analyzes the above issues in the context of the U.S. Zika response. Zika in Latin America and the Caribbean

Scientists are unsure how many people have been infected by Zika in the Western Hemisphere, but as many as 4 million people may be at risk of infection, and nearly all countries have recorded cases. Territories

As of June 16, 2016, all Zika cases detected in the continental United States (755) had been either acquired abroad or sexually transmitted, although the U.S. Virgin Islands, American Samoa, and Puerto Rico have experienced local transmission by mosquito. International Zika Responses in Latin America and the Caribbean

		Country Efforts

The number of Zika cases, the capacity of health systems to address them and related complications, and the plans to do so vary widely across Latin America and the Caribbean. Some observers have expressed concerns about the adequacy of Brazil's efforts, particularly in low-income areas. Reprogrammed Funds for USAID and CDC Programs

On April 6, 2016, the Administration announced that it would reprogram $589 million in unspent Ebola funds to address the Zika outbreak. USAID is reprogramming $215 million of that funding to support short-term efforts in Latin America, including a transfer of $78 million to CDC for Zika activities in the region and a $4 million transfer to the Department of State for a contribution to the International Atomic Energy Agency. Congressional Action on the Budget Request63

In mid-May 2016, both the House and the Senate passed supplemental appropriations measures for Zika response. The House bill, H.R. 5243 , would provide $622.1 million in Zika funding and rescind an equal amount of budget authority. The Senate measure ( S.Amdt. 3900 to H.R. 2577 , the combined FY2017 Military Construction-Veterans Affairs and Transportation-Housing and Urban Development appropriations bills) would provide $1.1 billion in Zika response funding without rescissions. On June 23, 2016, the House agreed to a conference agreement (see H.Rept. 114-640 ) that would provide $1.1 billion for Zika response, including $175.1 million for State Department and USAID activities. On June 28, 2016, the Senate voted not to invoke cloture on the conference agreement. In the international context, Congress may consider how to balance support for U.S. bilateral and multilateral Zika responses. Discussions about controlling the Zika outbreak may also focus on U.S. support for global pandemic preparedness efforts, as well as research and development for diagnostics, treatments, and prevention measures for certain neglected diseases. The WHO has not reported voluntary contributions from the U.S. government for the plan, although the Administration's February 2016 Zika budget request includes $10 million for the WHO/PAHO response and the Administration reprogrammed $14 million of Ebola funds for voluntary contributions to WHO, PAHO, and UNICEF for Zika activities in April 2016. U.S.
Congress is debating how to respond to an ongoing outbreak of Zika virus, a mosquito-borne illness that has no treatment or vaccine and can cause microcephaly—a severe birth defect—and other neurological complications. As of June 16, 2016, 60 countries and territories had reported mosquito-borne transmission of the virus, 39 of which are in Latin America and the Caribbean and are reporting cases of Zika for the first time. Brazil, which has registered the most confirmed cases of Zika in Latin America, will host the summer Olympics in August 2016. Scientists expect that travel destinations in the Caribbean will see more cases as the summer's warm, rainy season continues. More than 750 U.S. citizens, including pregnant women, have become infected through either travel or sexual transmission.
Frequent business and tourist travel, combined with the close proximity and similar climates of Latin America and the southern United States, means that mosquito-borne Zika infections are likely in the United States. Zika is primarily spread by Aedes mosquitoes—primarily Aedes aegypti but also Aedes albopictus, the latter of which is present in a majority of U.S. states. Local (or mosquito-borne) transmission has not yet occurred in the continental United States but is occurring in Puerto Rico and the U.S. Virgin Islands.
On February 8, 2016, the Obama Administration submitted an emergency request for almost $1.9 billion in supplemental funding to respond to the Zika outbreak, including $526 million for international efforts. On April 6, 2016, the Administration announced that it would reprogram $589 million in unobligated funds, including $510 million in Ebola supplemental funds, for efforts to address the Zika outbreak. The U.S. Agency for International Development (USAID) is reprogramming $215 million of that funding—including a $78 million transfer to the U.S. Centers for Disease Control and Prevention (CDC)—for international efforts. In mid-May 2016, both the House and the Senate passed supplemental appropriations measures for Zika response. The House bill, H.R. 5243, would provide $622.1 million in Zika funding and rescind an equal amount of budget authority. The Senate measure (S.Amdt. 3900 to H.R. 2577, the combined FY2017 Military Construction-Veterans Affairs and Transportation-Housing and Urban Development appropriations bills) would provide $1.1 billion in Zika response funding without rescissions. On June 23, 2016, the House agreed to a conference agreement (see H.Rept. 114-640) that would provide $1.1 billion for Zika response, including $175.1 million for State Department and USAID activities. On June 28, 2016, the Senate voted not to invoke cloture on the conference agreement.
The number of people in the Western Hemisphere affected by Zika is unknown, but as many as 4 million people may be at risk of infection in 2016, and nearly all countries in Latin America and the Caribbean have recorded cases of the virus. Zika responses in the region have been led by Brazil and Colombia, multilateral organizations such as the World Health Organization (WHO)/Pan American Health Organization (PAHO), and the U.S. government. Health experts have expressed concerns about the capacity of health systems—particularly in Central America and the Caribbean—to prevent, diagnose, and care for Zika cases and associated complications, particularly among pregnant women. Related issues of interest to Congress include how to balance support for U.S. initiatives and multilateral approaches, the proper scope and components of U.S. health assistance to the region, and funding for pandemic preparedness and research on neglected tropical illnesses in Latin America.
This report focuses on the Latin American dimensions of the Zika virus. For more information, see CRS Report R44549, Supplemental Appropriations for Zika Response: The FY2016 Conference Agreement in Brief, by [author name scrubbed] and [author name scrubbed] This report will be updated periodically.