The Zika fight in the United States is finally about to be funded. On Wednesday, Congress approved a $1.1 billion deal, which is now waiting on President Barack Obama’s signature. The amount is less than the $1.9 billion the president originally asked for in February, but much more than the zero federal dollars the government’s been working with in the seven months since then.

“Did that delay cause harm? Did that set you back?” Jonathan Karl, ABC News’s chief White House correspondent, asked the Secretary of Health and Human Services, Sylvia Mathews Burwell, on Thursday at the Washington Ideas Forum, an event produced by The Aspen Institute and The Atlantic.

“In a number of things, it did,” Burwell said. “We had to make decisions that were not what I would like. The first was to take money from Ebola. The second thing we had to do—and I had to do this in August, because we expected [the funding bill] would be passed before, and it wasn’t—I had to take money from the rest of the department. I had to take money from things like cancer research in order to keep the efforts going.”

In the 233 days since President Obama first requested funding, a lot has happened. Zika was determined to definitively cause the birth defect microcephaly and the neurological disorder Guillain-Barré. Scientists learned the mosquito-borne virus can also be spread sexually a few days before the funding request, but it has since been determined that it can be spread by women as well as men, and that it can survive in semen for weeks or possibly months.

Pronouncements of the public-health and economic impact Zika could have on the United States have been grave, with experts predicting “a catastrophe to rival Hurricane Katrina,” and calling Zika the “most difficult” public health response ever. While America waited for funds, this catastrophe started to unfold. Zika exploded in Puerto Rico, and at the end of July, it began to spread locally in Florida. But while Florida’s local transmission has gotten a lot of media attention, there have also been thousands of travel-related cases, which are the overwhelming majority of cases in the 50 states. Added to the intense local spread of Zika in the U.S. territories, the impact of Zika on the U.S. is already huge.

“I think most people don’t realize that in the U.S., including our territories, Puerto Rico mainly: 23,000 cases of Zika already,” Burwell said. “Here in the 50 states there are over 3,000 cases. And the other thing I think most people don’t realize is that we’ve already had 21 births in the 50 states and territories—children who are born with microcephaly and test positive for Zika.”

A murmur ran through the crowd at the Washington Ideas Forum—clearly many people did not realize this.

“That negative outcome that we’re all so fearful about, we’re already seeing,” Burwell said.