of bundled payments? >> i can't give a concrete example, no. no. other questions? yes. >> he thought about how some of these estimates may change at the national level? like for instance, does massachusetts choose nurse practitioners for a lot of care already? >> that's a good question. we have actually started doing some estimates at the national level and are hoping to develop a white papers in. i think that sort of the biggest difference is the national level we can certainly envision medicare playing along. so that would mean the savings potential for many of the different reforms is bigger because medicare consumes such a big portion of total spending. >> in your modeling, how did you assign a role for medicaid? because at the state level, that's the big consumer of state budgets.

>> right. we use data from the medical expenditure panel survey and we used the dissolution of the medicaid spending that was in an altered that spending basically in the same way we altered spending for other payers. okay. are there other questions? all right. thank you very much, everyone, for your time and i would be happy to take questions afterwards if you would just like to contact me personally. thanks again.

in a few moments, the first news conference with dr. francis collins, the new director of the fast institutes of health. -- national institutes of health.

>> the new director of the national institutes of health, dr. collins, held his first news conference yesterday, since being confirmed a little over a week ago. as we begin, he outlines some of his priorities. this is about an hour. >> in my presentation to the town meeting this morning, i tried to outline five specific themes that i think are useful in terms of portraying particular areas of unique opportunity and i will do that briefly for you now and then i will be glad to answer your questions. i've arrived at these over the course of the past several months, talking to a lot of people, thinking about where the science is going, where the national and international needs are, and these are broad stroke themes and again, i was a little worried in bringing up anything as an area of emphasis that people who don't hear their disease or their favorite technology specifically mentioned will feel that they've

somehow fallen off the list. this is not a laundry list, this is a higher level of general application to many diseases an many organ systems and many disciplines that i think are ripe for even more vigorous exploration. the first of those is more in the basic science arena and that is to apply the truly remarkable opportunities that are coming forth from high put-through technologies, such as nanotechnology, geometry, computationial biology, environmental science, all of those areas undergoing real revolutions in their ability to collect data sets that are really quite comprehensive about how life works and how sometimes, something goes wrong and disease occurs. in the past, investigators were often limited in terms of the kinds of questions they could ask and the ways in which they could approach biological problems. you had to study this particular protein or this particular cies

logical phenomenon or this particular cell type. we increasingly have the ability to ask questions that have the word all in them. like what are all of the transcripts in a cell, what are all of the ion channels in a particular cell, what are hall of the ways that development gets you from a single cell to something much more complicated? and there are areas in particular that i think are ripe for this exploration, this is not intended to be exclusive. cancer would certainly be one, the ability to determine all of the reasons that a good cell goes bad and goes from being a well behaved cell to one that's a malignancy. we have the chance now with a variety of tools and that is already being undertaken in a pilot way, by the cancer genome at last and is -- atlas and is something that is ripe for expansion. same kinds of thing that could be said about autism. clearly a disorder of great interest for parents for the public at large, for the

administration and the could be, for all us, scientists to understand, this puzzling and frustrating disorder and the tools that we may not be able to bear on them. some of them environmental science, some of them genomics are poised to answer questions that have really been difficult to come up with answers for in the past. things like the microboome to catalog awful microbes that live on us and in us, and which when balanced properly are good for us, but if unbalanced, can cause disease its, maybe in a way we don't even know yet. those kinds of things. but this approach to a comprehensive understanding of biological processes has never had a better shot than it does right now towards shedding really new light and i'd like to see that be one of the themes that we try to apply. a second theme is going to be the focus on translation to take the basic science discoveries

that are bursting around us, and bring those to bear in the direction of the development of diagnostics, of preventive strategies, and of therapeutics. obviously, this is an area where public-private partnership is going to be crucial. we've already seen the beginnings of efforts to empower academic investigators to play a larger role in the early stages of the development of therapeutics, with things like the small molecules initiative, the road map project and many investigators who really, in the paths, would have assumed someone else would pick up the ball and run with it after they make a discovery about a rare disease are now taking that next step themselves. i think nih by investing in those kinds of therapeutic opportunities, can develop partnerships with the private sector, where nih funding essentially derisks a project to the point where even if the market is not particularly large, this becomes por attractive for a pharmaceutical

company or a biotech company to pick up a particular product along the way towards a clinical trial and run with it. there's been a lot of discussion about that and i think that fits so nicely, both with where the science is going and with what the public hopes we are going to be pushing hardest of all, which is to come up with interventions for people who suffer from diseases for which we currently don't have good preventive or therapeutic measures. along the lines of this investment in translation, certainly stem cell research in my mind is a natural area for increased investment and sort of innovation given the fact that we now have the president's executive order, and nih has now issued final guidelines about how to review the use of embryonic stem cell lines for nih-funded purposes and we have the new development of the ips cells, which have efor must, but uncertainly -- enormous, but uncertainly process for a long

list of application to certain diseases. this is clearly an area that we want to see pushed forward with great energy and creativity. so first two areas then, applying technologies to the fundamental questions in biology and then translation of basic science into treatments and diagnostics and prevention strategies. the third one fits very much with where we are right now in our national conversation about health care reform and i think nih should be right in the middle of that by not providing political advice, because that's not what we do, but by providing evidence that is going to be useful in assisting decision makers about the directions we need to go in, in order to both produce better health care for our nation, and also to try to rein in that really scary curve of increasing health care costs. that means putting science to work. for the benefit of health care reform. you've heard quite a bit about comparative effectiveness

research, the ability to try to assess with there is more than one possible intervention, what is the benefit of one over the other and nih has actually been doing that research for many years, although i'm not sure it was quite called by that label, and i think we will in fact be called to do more of it. we already are as part of the stimulus funding, and i would say from my perspective, nih embraces that as an opportunity to do good clinical research that's going to produce rigorous outcome date that -- data that is going to assist in making wise health care decisions for america. obviously, there have to be tempered concerns when it comes to the way comparative effectiveness research may collide with personalized medicine, because you would not want to lose the individual in this mix, but i believe there are ways to balance that. along with this area of science that may help health care reform would be farm cogenomics, and doing a better job of

identifying what's the right drug at the right dose for the right time for the right person to reduce the number of adverse effects from the drugs. and along with that, there needs to be a focus on how to implement prevention in a truly effective way, that is going to both require good science, that will enable prevention to be more individualized, personalized medicine if you will, and also focuses on the behavioral aspects of that equation, and gives us a better sense of what is it that motivates people to actually receive this sort of information and then use it to their own benefit, by modifying health behaviors. health disparities will also needs to be a major focus of this conversation, about how to practice more effective therapeutics and intervention and that is something i am interested in seeing being made as a high priority. a fourth theme and one which has been already been invested in considerably by nih and other organizations is global holt.

we are at a time, it seems, where our national effort to try to exercise soft power as part of both diplomacy and as part of our american personality of trying to try to exercise benevolence to the world is being strongly promoted to the rest of the world and nih has that strong motivation as a central part of who we are. we do support a lot of global health, particularly in areas like aids, tuberculosis and to look at non-communicable diseases that betsy able has been championing and i think there's opportunities to also look at some of the infectious diseases that have not gotten so much attention, but which affects hundreds of millions of people and for which the science now offers an opportunity to push forward new ideas about therapeutics in the same way that rare diseases in the u.s. may need some help from nih to get them boosted along the development of a therapeutic

pathway, so not so rare diseases that happen in the developing world, which also suffer from a lack of a compelling economic motive, could be a benefit by investments that nih could make in trying to come up with new ideas about prevention and treatment. and i personally from having spent some time as a volunteer physician in the developing world, see this as a great and compelling opportunity. finally, the fifth theme is about reinventing, reinvigorating and reempowerring the research community through the ability to support young investigators to work on our training programs, to further enhance their quality, to emphasize the diversity of the work force, to focus our peer review system on innovation an frankly to try to achieve something in the way of a stable and predictable funding trajectory for biomedical

research. the feast or famine transportation -- you see lots of other countries who are achieving much more impressive and predictable funding trajectories right now than we perhaps have been doing in the last few years. in that regard, perhaps the concern that i have that wakes me up already, even on day one, it's been waking me up for several weeks, at most, what's going to happen after the two years of the era, the american recovery and reinvestment act funding expires, and of course, that funding has to be spent if fiscal year 2009 and 2010 and it's being spent in a very creative way and we'll be hearing a lot more about that in the next couple of months in terms of what nih is doing to invest the dollars in highlily innovative signature initiatives, but what happens when we get to fy-11. does the nih resource drift back

to where it had been prior to this remarkable and unprecedented moment. that would result, if one does the modeling, in successites for grantees plummeting to historic lows. the opportunity that was presented by the stimulus package was responded to by investigators in remarkable ways. i don't know if you've seen those numbers, but for instance, for the challenge grants, which we put forward as a major new component of what the stimulus money might fund, expecting perhaps to get a couple thank you, of applications, and maybe to fund something like 300 or 400, there were more than 20,000 applications received, all of which had to be reviewed, all of which have been reviewed, decisions will be made -- decisions will be made shortly which will receive funds, because the funds need to be awarded before the end of this fiscal year. there's fabulous science here. this tells you what a pentup

demand and opportunity exists out there in the minds of biomedical researchers, but obviously the success rate here is going to be really, really low. maybe 3% of these will get funded when the dust settles. the rest will presumably, because their good ideas come back as applications next year and the year after. so we're going to see both a potential falling off of a cliff, in the fy-11 budget doesn't take some account of this, and along with that, an additional bolus of new ideas, stimulated by this very moment of economic opportunity, a perfect storm if you will. i think we can make the case with great compelling logic, that the support of biomedical research is value that is almost unmatched in terms of its economic returns, in terms of its improvement in human health with longevity increasing by one year every six years, a trend that continues, and which can be traced in large part to

nih-funded research, and with the way in which every dollar that goes into an nih grant reveals -- or returns about $2.25 in one year in terms of economic goods and services, so if you want to be purely looking at our economic situation, this is a very good place to put funds, but obviously, there are going to be many other concerns that the appropriators will be wrestling with in terms of the future of where the discretionary budget goes, in the next couple of years. and many of those other needs will also be quite serious. so this cannot be considered in any way as an easy conversation with an easy outcome. and again, i think if there's one area that for myself, personally, i feel will occupy the most intense energy and effort, is to make that case that for the success of our nation's leadership in biomedicine and for the health of our people, to achieve that

kind of predictable, stable funding circumstance, so that a young investigator, who is starting a career in biomedicine has the confidence that there is a career there for them, that has to be our number one priority in the coming years. and i will try, whenever i can, and maybe with your help, in conversations like this, to try to make those points to those who i hope will be interested in hearing it. so i'm going to stop here other than to say, again, i hope to lead a phase of nih where openness is an important feature of everything that we do, and that includes being open with the press about what questions you may have and making myself available as much as i can to address those questions. thank you. >> thank you very much, dr. collins. we'll open it up to questions here, just please state your name and your affiliation and then after a while, we'll go to the phone. thanks.

>> donna young from bioworld. i would like you to expand a little bit on when you said the fiscal year, 2011, is what is keeping you awake at night. i'm assuming that you already are trying to come up with how to present this to congress and to the american people. what are some of those things that you are working on, as far as like being able to make that jump from, you know, just the fact that you need the dollars to do research to the importance of why. >> so it is my first day, so i haven't completely formulated the multipronged plan that's going to be necessary to try to make this case, but i think i could mention a number of directions. clearly, to simply make this case on the basis of success rate, of grant applications is not going to be sufficient. i mean, we have at nih often pointed to that as something that matters a lot, because it is going to be a reflection of

the biomedical health enterprise and the chance investigators have to keep pursuing ideas, so that will be on the list, but the skeptics will say, maybe you just have too many investigators and too many grants and you've like overfilled the pipe lined it's your foam. i don't agree with that. i think our pipeline actually is underfilled in terms of the promise, but i think we have to go beyond success rates to making the case about the way in which scientific opportunities are truly unique at this point and those five themes that i mentioned will be part of what i have will try to talk about with people who are interested in learning more about the science and why this is such a special time. i think i'll also need to make the case, not just me, but others will do this has well, about the economic returns for this kind of investment of public money, which are in fact extremely impressive when you compare the rapidity the rate at which a dollar of nih money feeds back into the economy.

one of the things i would like to look at, we have a plan for a bit of a quick brainstorming session about this with leading economists is to also make a case that i'm not sure has been generally heard or at least not that often, that medical research supported by nih is actually a way of identifying pathways towards holt care options -- health care options that are not as expensive. if you look at our cost per person, in this country, it's out of line for the health care there's delivered. there's an assumption out there, many of the commentators that talk about this are particularly talking about expensive scans, that whenever nih does another study, health care gets more expensive and i think there are good counterexamples to that, and increasingly, i think we need to be putting forward information of that sort as people are looking at that scary trajectory of our health care costs rising to reach from where they are now at 16% of gdp and going on up.

we have to bend that curve, and nih putting it's of self forward in -- itself forward in the ability to use other tools to figure out optimal therapies for people instead of using approaches that turn out to be wasteful, and compare tv effectiveness research in new innovations to do a better job of treating diseases with compounds that are going to be less likely to cause toxicities, which results in more medical expense, all of those things have to be part of the case to be made. and bottom line has to be then i think put forward, is that a dollar invested in nih has all of these potential benefits, and furthermore, that if you don't figure out a way to do that, you really are at risk of losing a generation of young investigators who are our hope for the future and can only stand so many of these ups and downs before they decide to go to law school or do some other thing that is not going to meet this vision that we all have for

what nih could become. >> bob, you had a question? >> bob grant, scientist magazine. previously, you voiced a vision for a very a -- very broad cross-sectional study, from everything from genomics to -- tell me how that looks with a time constrained budget and especially with this sort of current focus on research that can produce a direct economic benefit in sort of a short time scale. >> that's a great question, bob. i have been enthusiastic now for five years and published a paper about this quite some time ago promoting the idea of a u.s. large scale prospective cohort study, enrolling individuals numbing between half a million and a million, selecting them across the country by geographic

and socioeconomic and education and gender and age and population background to be a snapshot of our country and then collecting information on all of those -- all those individuals as far as their medical experiences, their environmental exposures, their genetics and so on. this was studied intensively by expert group of about 60 people, and got all the way to the point of getting pretty specific in terms of saying exactly how such a study could be run and even down to what clinical items would be determined on each person who came in every four years for a face-to-face exam. the cost of this at that point came out to be in the neighborhood of $400 million a year for a half a million people. and that draft of that particular protocol is still available on the web. that i think attracted a lot of interest, but the price tag particularly during the time of flat budgets for the nih, which is what we're talking about,

never really got off the ground. i -- various proposals were made about well, could you kind of cobble together the existing prospective studies that are being run by some of the institutes, like nci and hartland and blood and create a virtual, large-scale prospective study. it wouldn't work nearly as ideally as you'd like. it would turn out to be very heavily loaded with older individuals, it would turn out not to have the geographic or the racial kind of representation that you'd like to see for a study of this sort. it would be very much a second choice. i do think perhaps we could look again though at the opportunity at least trying to do something along those lines, as not being quite so ambitious, but i will be bold and say if we don't start a study of this sort pretty soon, we'll be kicking ourselves in another 10 years when we wish we had the data from this.

this is like framingham on steroids, if you will, to be able to answer questions about all diseases and in many ways, a study of this sort, might preclude the need to start disease specific studies in the future, which we would be spending a fair amount of money on otherwise, but it's not an easy case to make for a high price tag of this sort. now that i'm here on day one, i'd really like to initiate some more conversation about this. we have a study of course, that is somewhat similar to this in terms of its national snapshot of health, but it's focused on children. the national children's study, which has been as you know, under a pilot phase already, and which has many similar goals in terms of trying to identify environmental and genomics nit particular risk factors for childhood diseases, but it won't tell us much about middle age or laid on set disorders for a very long time and if we're interested in knowing more about diabetes and hearts disease an cancer and alzheimer's and parkinson's and the long list of

other diseases that afflicts people in mid to late life, we probably need another way to get there, so yeah, i guess i'd like to see the conversation explored a bit further. maybe there's a way. a lot of this will depend upon what happens with the resources. >> just to follow up. is it something that could be funded with the common fund? >> certainly the common fund is, as most of you know, a component of the budget, which is now tomb live legislatured as parts of the nih3 act and has the potential of supporting projects which are not appropriate for a single l institute jump in on. in terms of the science, it would be a good fit. at the moment, the common fund annual budget is about $500 million, so this would be 80% of it, and i will tell you, the common fund is already

supporting a lot of pretty exciting science and many of which is multiyear projects, so there's not going to be a large amount of money coming available in the common fund for new initial testifies. certainly nothing on this scale, unless the common fund were to be substantially enlarged. now there is a provision in the reauthorization act for the common fund to grow, but only if the nih budget as a whole grows similarly, so again, it's coming back, i guess, to where we were through several of these iterations. it's going to be very much dependent on what the resource base is, whether we can tackle something like that. i agree that in an ideal world, if a project of this sort was financially feasible, the common fund might be a sensible place for the resources to come from, at least in part. >> i was wondering about your second focus on translational medicine. you mentioned nih taking on the

risk that some of the drug companies aren't willing to do and i wonder if in return, the taxpayers should respect a break on therapeutics developed with this, should they have cheaper drugs, if they put their own money up on the risk. >> there's a sensitive topic, dan, so those of you who have been around a while, will remember the debates about reasonable pricing clauses from 10 years ago, which made it very clear to me watching it that this was a third rail for the pharmaceutical and biotech companies and the idea of there being some kind of government intervention in terms of setting pricing for products that they had brought to market through clinical trials and f.d.a. approval, would make them very uninterested in approaching such a project in the first place. but i do think there's a model here, that could achieve some of that, in a way that would be more acceptable. the idea here, and this is already being investigated through a program called trend, which stands for therapeutics

for rare and neglected diseases, which just started this year, with $24 million allocated by the congress, the idea here is for this category of rare and neglected diseases, there may be an investigator who understands something about that disease that sets off a light bulb about a new possible approach to therapy. that could be approached using the high through-put screening centers that we now fund through the common fund, four of them, that had the staple capacity, each one of them is a mid-sized pharmaceutical company to begin to screen for compounds that might have potential benefit. trend even then allows the next step for a selected set of projects to go forward where you have a promising compound, but it's got to get across the so-called valley of he death and get through the toxicity testing and the ability to optimize that molecule so that it has appropriate pharm cokinetic properties and is efficacy

likely. that's where many things got less. trend will enable a select number of nih projects to go through that project. now on the other end of that, a successful project, a compound that would be of interest to a biotech or a pharmaceutical company to want to license. that compound will at that point have intellectual property attached to it, because it will have clearly passed into the zone of hue tilt, so the -- utility, so the model that people are talking about is then to arrange through a licensing opportunities and this would be competitive, so many companies could ask to be given a crack at it, an arrangement where the compound is licensed, the company then takes it through clinical trials and f.d.a. approval, but the license involves royalties that would then return to the government to support research, if in fact, the product makes some money, so there you're not regulating the cost of the compound that the company is going to set, which

seems to be the deal breaker, but you are engineering a system that allows some pay back to the public, for the public investment. >> we're going to go to the phones too. >> i'm brit with chemical an engineering news. you mentioned increased private and public sector, but do you see there will be any increased collaboration with other federal agencies, like the f.d.a.? >> absolutely. i'm glad you asked the question, because i think this is a really important priority and certainly for me personally, i want to build very strong relationships with other agencies, both within hhs and outside and f.d.a. would be at the top of that list, if we're going to see this kind of successful translational opportunity. i know peggy hamburg from previous experiences back in the

clinton administration, and i know from speaking with her, that she's extremely enthusiastic also about strengthening those relationships, so i think there are needs there, and in particular, when it comes to rare diseases, there are issues where the standard f.d.a. approach of trying to evaluate a compound at the ind phase may not be very friendly. to diseases for which there aren't that many patients out there. and likewise, when it comes to final approval. so peggy seems very amenable to the idea of having some serious conversations about how we could work more effectively together. as long as we're talking about other agencies, i also think our relationships with cdc should be prioritized as extremely important, especially in the era of things like h1n1 and that will be a focus for myself and with arc, with the focus on comparative effectiveness research, where nih is often the

producer of the clinical research studies and arc is often in the position of trying to look in a meta analysis way across multiple studies and draw robust conclusions, we have a lot of reasons in this current climate to be even closer together and carol and i have had initial discussion about how to do that. >> we'll take one question from the floor and then go back and forth. we want to give people the chance. >> hi, dr. collins. i'm from wpot radio here in washington. one of the questions that came to mind for me when you were talking about the need for -- to continue the funding beyond 2011 when the era of funding runs out, is the need to continue to keep younger researchers in the pipeline. all throughout the federal government, there is concern about the retirement wave that's going to be moving through, as

somewhat more baby boomers reach retirement age and decide to mover on to another phase of their lives. how do you understand the challenge here at an at at nih t regard and how does that relate to keep the funding levels up to keep the young are researchers working? >> so the demographics are complex here, and they are somewhat different from mile an hour understanding, and again, i need to know more about this, since this is my first day, i can keep saying that. i think it's certainly true, that within the nih extramural staff and administrative staff that we have serious concerns about the likelihood of retirements thinning our work force in the course of the coming years, with a lot of the people who have labored so effectively on our approaching retirement age, and a less

vigorous pipeline of young scientists and administrators coming in to hour extramural and administrative programs. in terms of the work force of scientific investigators out there in universities and institutes, it is a little bit less of a problem, because science has been growing at a really exciting rate, there's been a lot of interest, not enough i would say, but a lot of interest amongst young people in seeing this as a career and so the grading of the research enterprise is not quite as much of a concern in laboratories doing bench research or clinical research as it perhaps is in those who are doing the grants administration. but there i think even with that said, i still think the most major concern we would have as far as generational one is in

the young scientists that are just starting their careers because they're at a fragile state. you go through many years of graduate school, you often spend many more years as a post doctoral fellow. our system right now is often because it's so hard to get supported, a young person is not actually funded by their first independent grant until they're after 40. and if you lose that person, then at that point, that's a tragedy. you have lost their future, scientific contributions and you've also spent all of this money in training that person to be a cutting edge scientist and now they're going to go off and do something else, so of all the issues in terms of generational ones, i think that still has to be number one. >> thank you for. we're going to go to the phones. first caller, please identify yourself and your affiliation. thanks.

>> no question. >> all right. we'll go back to the floor. palm and then susan. >> thanks, palm baskin with the chronicles of higher ed. following up on that last one, you mentioned here this morning about the need to encourage more young investigators, but i guess beyond the object vows problem of the budget are you suggesting as a way of doing that? is it basically all tied to the budget must be larger or is there some kind of strategic way within a certain dollar value to kind of make that happen more? >> well, nih has been trying various approaches, the institutes have been very creative about this and it's good that there's some diversity. we're sort of doing the science of science policy by looking at ways to do that. many of the institutes have programs where young investigators coming into their

first application get a special leg up in the review process, where their priority scores are improved slightly by the fact that they are coming for the first time and councils take that into account when they decide about how to do the funding. we should continue that effort. of course, that's not the ultimate solution. if you have a budget that's overall too limited and you're trying to get people started in the pipeline and then they come back after they've had their first successful grant and they can't get a second one, then you haven't really solved the problem. that's sort of a stopgap. i think we need to do something about the aging of the investigators before they come to their first application, something i mentioned a minute ago, where the average age has current up to i think 42 now, before you get your first ro1 or other equivalent independent grant funded. one thing i've wondered about, but this is purely blue sky, whether we could at least pilot on a small scale the kind of program which is famous at the

whitehead institute in boston, where you take an extremely promising student who has just finished ph.d. and instead of requiring them to go through six, seven years of post doctoral fellowship under the directorship of a principal investigator, you give them a small amount of resources, a laboratory, a technician and a mentor who can guide them as far as not making missteps, but it's really up to them to decide what's the project they're going to work on, what direction they're going to go. that's not for everybody. i mean, post doctoral fellowships are good as part of training for lots of people, but for an exceptional person, sort of a joe, who is an example who do this at ucsf or a number of the whitehead fellows who have achieved great success, this might be a way to get that person going while they're still young and full of spit and ginger and ready to set the world on fire and they haven't had the post doctoral experience

that sort of wears them out. i think that kind of thing, hall though it might not be a big contribution, could be worth exploring. >> thank you. >> dr. collins, could you talk a little bit about your priorities imaiting h1n1 and specifically administering a vaccine. >> again being on day one and recognizing that there has been an intense national effort to organize a response to this remarkable rival on the scene of the h1n1 influenza virus, i'm not going to tell you anything that you can't derive by looking at the extensive information that you can find on the web at the flu.gov site. i attended the flu summit that was held here aft nih, at which no less than three cabinet members appeared from homeland security, h.h.s. and education and i was very impressed by the level of knowledge and detail that was presented at that

meeting and how much that had clearly involved people at the highest level making the plans. here a at at nih, when i have questions about h1n1, i know i can go to a world expert and that is tony and get the latest plan about what's going to happen with the vaccine. as you know, there has been a decision made about particular groups that are high risk for which the vaccine ought to be particularly target, including children, including pregnant women, including people with other chronic illnesses, and there is a very strong effort being made to try to move tea prodigious pace and considerable expense to have the vaccine ready in the fall, before this virus reappears in a big way. obviously everybody is holding their breath here about the timing, knowing that this is seriously a virus that seems to have very high infec infectivit.

the virus is going to react the way it has in the spring n in the southern hemisphere. the fear that it might acquire increased virulence and increase mortality rates is not founded. if you want the real scoop, talk to tony. >> susan denser from health affairs. dr. collins, congratulations. i want to ask you if you've composed a song for your first day of work. >> that was considered and rejected by those who had better judgment than i. i was considering it and they thought it would be undignified. but at some future point -- >> we'll he still wait for that. two quick questions. one is as you know, some of the research advocacy groups are targeting a $40 billion a year

an you'll appropriation for nih has a goal to work for in the next several years and i wonder if you resonate with that particular number, and secondly, you mentioned earlier the words peer review and innovation in the same sentence. of course, there are many in the research field who believe that, particularly in eras of straight funding, the study groups that review many of the ro1 proposals frankly aren't innovative and take the path of least resistance and there just simply isn't enough money to go around so i'm wondering about your particular ideas of addressing that concern. >> sure. two great questions. thank you, susan. in terms of that $40 billion number, well, gosh, wouldn't that be lovely. i can promise you if that were to come to pass, there would be wonderful ideas and ways to spend it that would be pretty exciting scientific cliff. if you look at what's been lost as far as buying power for nih

as far as 2003, setting aside this wonderful two years of the stimulus package, just looking at the rest of that trajectory, nih lost about 17% of its buying power over that timetable and simply to try to recover that would bring you back up into the range of 36 to $37 billion. i guess one has to balance the opportunity with the reality. if you want to simply do the math and say what would it take to have nih stay on a stable trajectory, recognizing that the era dollars were spread out over two years, that means that there was about an extra $5 billion in the budget for 2009 and 10. if you wanted to stay at least flat with that, that would carry you up to 35. and if you wanted to actually see some growth potential, you'd need to go a bit higher. those are just numbers. and obviously, many reasons why the nih director i guess has to be realistic in dealing with this, and not simply unrealistic

numbers. i do think when you ask, as congress often does, for a professional judgment budget, that is, what could you actually spend if it were available, 40 billion would certainly fit within that envelope. in terms of innovation, this is a chronic issue, as long as i've been involved with nih, which is now 16 years. the question about how to stimulate innovation in hour peer review system has come up repeatedly, and it comes up especially at times of difficult budget crunches. because then there is a great concern about spending even $1 on a project that might fail when you have in front of you a bunch of very other credible investigators with long track records who are doing solid research and you have trouble imagining pulling the plug, although that might in many instances be the wrong decision, it is the herd mentality and it is interesting, we've met the enemy in terms of the opposition to innovation and it is ourself, that if you're the scientist that sent in the grant that was

highlily innovative and it got dinged, you're offended by the process, but that same scientist may be sitting on a study section three months later and joining with the chorus of saying, well, you know, this idea just needs a little bit more preliminary data and maybe we should let them come back again for another application, because we have all these others that seem more l solid. if we're serious about innovation, we have to mean it and that means we have to be willing to take risks, and see grants supported that ultimately fail to produce, because they were that high risk. nih is trying a lot of things to try to encourage this and a strong promoter of new ways to try to promote that, things like the new innovator grant, like the pioneer grants, where you ask people to come up with a ground breaking, transformational idea and you don't ask them for much in the

way of preliminary ideas, and there's a whole category of support that requires innovation if you're going to get on its on ramp, but still, with it comes to the rank and file of what goes on in study sections, this is an issue we have to pay close attention to. there was, as you may know, review of the peer review process that was ably co-led by jeremy berg and reported about a year ago on a number of recommendations for revising peer review to try to do a better job of encouraging innovation and less concern about did you actually get the ph exactly right in the buffer you were going to use in step 39 of your protocol and the steps that were recommended by that group are being implemented now, some have been, some are almost there. it will be interesting to see how much of a reinvention did we achieve, and how much do we need to go back and look at this again and push it again. i will tell you, as an nih director, this will be a very high priority to make sure that

our system encourages people to do thanks that are not obvious, that's what we should be all about. >> there's time for one more question. >> maggie fox with reuters. you started to say you're holding out to congress a carrot in perhaps the form of comparative effectiveness research or something else in return for a more steady funding source? >> i'm not sure i would say it quite like that. i think i am trying to say that nih should not be sort of a reluctant partner in what is a national priority of trying to understand how we can best modify health care to get the best outcomes, and that's part of our mission, and has been all along. but it seems at this point, that mission is getting particularly high priority, and public attention for reasons that i resonate with, and i think most

of you in the room would as well, so i don't know if i would say it's a carrot. it is certainly a circumstance where we're raising our hand, saying, there's a feed here, we can meet it. it is going to cost some money to do these research efforts, so if you want us to meet it, we need to have a conversation about that, but it's not sort of flipped around the other way of trying to figure out, ok, what could we come up with that would improve our budget. it's really being driven by the scientific opportunity. >> actually, i saw your hand. >> thank you. stacey cohan, fox 5. while we anticipate the scientific debate and i enjoy the music, it is sort of that character that makes you relatable and i think as we've all seen by the recent health care debate, the american public wants to be engaged in what is happening in this country, so how can you explain to the american public at large in an easy relatable fashion why this agency is important and deserving of its attention and

funding. >> that's a big charge, and something that i agree, we have not necessarily succeeded at so far. most of the american public does not recognize nih as meaning anything. they certainly don't know as much as about nih as they do about nasa, for instance and i think we have an opportunity, perhaps with some of the new media that's out there, using the internet, maybe i should start tweeting. i don't know. to be able to engage particularly the very turned on, tuned in, internet savvy generation, to get excited about what we're doing, so inform the public about why they should care about medical research and what it's doing for them, and to get the next generation of young peep excited about playing some role. and john and i have had a couple of brief conversations about this. i would like to see this as a serious opportunity for nih to be more visible, to come up with more communication strategies,

to be more proactive and not wait for someone to call us up and say do you have a comment on the following but to actually engineer an outreach program that has its fingers in a lot of different directions, not in a way that we would be self-promoting or over hype the results of what science is doing but as part of our educational role. we have a lot of cool stuff going on and we don't necessarily tell the world about it as often or as effectively as we should. i made a list of the kinds of things i would like to accomplish in the first six months hat nih. i have that list in my pocket, i'm not going to show it to you, because i might be embarrassed i only get three of them done, but this is one of them on the list is to come up with a new and more effective outreach communications strategy that has a broader impact and let's the public know what we're doing. you all can help with that. >> can i follow up with that just briefly? do you think congress recognizes the importance of any any

funding to the -- nih funding to the small business community which is america? >> congress is a bunch of citizens of the u.s., of various sorts, with various backgrounds, some certainly do, and certainly those that are in the position who have the largest influence on nih in the appropriating or the authorizing committees tend to get themselves informed and we do our best to try to make sure we're available to do that. but it's variable and every member of congress brings their own personal experience to the table and if they happen to have had personal experience of seeing how that's true, they're likely to be much more jazzed about what we can do. one of the things that i think we should have had do more of is to encourage our grantees to invite their -- invite their members to see what's happening with nih funding in their own districts and their own states. and i certainly hope we can see more of that happening. >> this doesn't preclude individual interviews, so just want to make sure that you know that. eli, i know you've been dying to

ask a question for quite a while. then we'll wrap up and again, come to us if you'd like to have some followup interviews. >> thanks. nature news. just two quick questions about here on campus, wondering if there's any immediate plans for big infrastructure repairs that have been talked about or any changes to any of the heads of the institute, and as a second, unrelated question, if we can expect the stem cell registry any time soon. >> good questions. as far as infrastructure, you may know that there were funds put into era for buildings and facilities, both for extramural and intramural purpose its and that was wonderful to see, because we've gone through a number of years where bnf as we call it around here has had very little in the way of financial support and a lot of the buildings in the infrastructure have really suffered as a result of lack of even basic maintenance to be able to carry out, but with this influx of

funds that comes from the stimulus package for shovel ready projects, like porter two, we're now in a better position at least in the short term to be able to catch up on some of the things that had been delayed. in terms of the stem cell registry, you've seen the nih final guidelines about stem cell research, and you know that involves the convening of a working group of the advisory committee to the director who will be empowered with the need to look over the evidence that various stem cell lines have in fact lived up to the standards put forward by the administration in terms of informed consent and so on and that working group will be assembled quite soon and will begin their work. the way this works out though, as you probably noticed, an investigators needs to come forward with a proposal about a particular line, asking for that approve. nih doesn't go out and try to dig those out of people and that

guarantees, we hope, that the lines that are of greatest scientific interest will come forward first. i can't tell you what the timetable for that is going to be, in terms of how long it will take, once the working group is impaneled and the applications begin to come in. i don't think that's quite clear yet and again it's my first day, but i can tell for myself personally, this has to be a really high priority to get this done and turn loose all of the incredibly creative ideas of nih funded investigators to see where we can go with the field that's obviously been moving more slowly in the past than it will now have the chance to do. is there another component to your question or was that it? changes ahead. the national human genome institute, my former institute is led by a very able acting director, the search committee has been reviewing the applications, so it is hoped that a new director for that

institute will be put forward sometime in the not too distant future. you may know the national cancer institute is a presidential appointment, although to doesn't require senate confirmation and so that process, which is of course officially led by the white house is also one of great interest and to follow up on, not as clear at the present time what that process will ultimately turn out to be, but i think this administration cares a lot about cancer, as you've heard in many of the president's pronouncements, so this is going to be a high priority to identify an absolutely superb leader. the national institute of alcoholism and alcohol abuse is also led by an acting director at the moment, but you may know that there's a discussion going on led by the scientific management review boards about the possibility of whether nia hand the drug abuse institute, nida, might be merged, and that's going to play out over many months and i think for that

reason, dr. zerhouni felt it might not be a great idea to go out and begin the process of recruiting an institute director until it was clear whether there might actually be a merger in the works. we'll have to see how that plays out. i don't know the current status of those deliberations. >> ok. dr. collins, if you had closing remarks, if any, then we'll wrap it up. thanks. >> well, i will say, i'm surprised that one question did not come up hand that was my involvement in discussions about science and faith, which has certainly been something that has graced many pages of the blogosphere in the course of the last three or four weeks since the nomination was announced and even resulted in a couple of op-eds, even in the "new york times." i want to assure the scientific community that i have completely stepped aside from any involvement in those activities, although i was involved prior to

today, i resigned from the foundation that focused on science faith conversations, which i founded previously, and that will go on under the direction of others. i want to reassure everybody that i am here to lead the nih has best i can as a scientist and that my hone personal interests, which will continue in a personal way about the interface between science and faith will not interfere with the judgments that i will need to make as the director of the nih. >> well thank you very much, everyone, for joining the session and thank you, dr. collins. >> all right. :

at 11:00, a pentagon briefing on the presidential election in afghanistan. our special prime-time book deprogramming continues tonight.

>> president obama bose egyptian president mubarak at the white house today. yesterday, a coalition of egyptian and american organizations discussed relations between the two countries and the role of the u.s. in the middle east. this is of little less than an hour and a half. >> we are ready to get going. good afternoon, thank you for coming, thank you for your patience. you all know why we are here, we are here on the occasion of the first visit of the egyptian president mubarak to the white house after a number of years.

by way of introduction, we are a coalition of the egyptian, egyptian american organizations comprised of muslims and nubian the like who are representing the various segments of egyptian society and we are united by a common desire to see a democratic egypt that respects human rights and guided by the rule of law. i will be introducing all of the panelists here. i will begin by giving a statement on behalf of my organization, voices for democratic egypt, and then we will have dr. ahmed subhy mansour of the international qur'anic center, and then we will have mr. cameel haleem of the coptic assembly of america.

then we will have the head of the american egyptian alliance followed by the nubian project, and then we will have mr. ibrahim hussein, representing the members of the coalition, followed by at the muslim society, and the chairman of the center for development studies. i will go ahead and get started with a statement on behalf of my organization as i said. i am here today on behalf of voices for democratic egypt to express my grave concern over the past egypt has taken that is increasingly witnessing the abridgement of freedom, respect for human rights and rule of law and president of this principle of the government. i am concerned that despite

promises by candidate obama to abandon old u.s. policies supporting, quote, friendly dictators, the administration is saying the status quo with egypt, sending the wrong signals to the government of egypt and alienating the peoples of the region. my fear is the administration is insufficiently attending to the goal of supporting the aspirations of the people of the middle east for human rights and good governance which are becoming strategic imperatives in my view. only a mile and foreign-policy framework would see that working for the regional goals of peace in the middle east and security should come at the expense of advancing the cause of reform in areas of governance and human rights. egypt is a key strategic u.s. partner the administration must recognize the democratic egypt that respects human rights and is guided by the rule of law is the strongest and most reliable ally in advancing peace and security in the region. the status quo in egypt will yield anything but stability. with upcoming the egyptian parliamentary and presidential

elections scheduled for 2010, and 2011, respectively, the u.s. has a keen interest in seeing that the process be transparent and fair, that it yields credible results and incorporates political forces that respect democratic principles. instead, however, in the lead up to those elections the government of egypt failed to undertake the necessary changes that will ensure such a thing. the government of egypt has significantly regressed on governments and human rights front. most disturbingly, much of that regression continues to take place after obama's speech in cairo which gives serious concern and highlights the need for the obama administration to act and insure that the principles highlighted in the cairo speech are not inadvertently forgotten and were not intended as a meaningless exercise in public relations. in cairo, president obama talked

about, quote, the ability to speak your mind and have a say in how you are governed. in the past year alone, egypt witnessed when the ability to have a say in how one is governed. the emergency law which has been in place since 1981, 28 years ago, would suspend basic constitutional protections, prevailed, it was extended for another two years, and despite promises to the contrary, in cairo, president obama talked about the need for people to have, quote, confidence in the rule of law and the oil administration of justice, yet emergency laws continue to undermine noticeably through the imposition of administrative detention orders. better known as hezbollah lawsuits brought by ruling national democratic party affiliate's, and political scores against students and artists among others. dozens of torture cases were

also documented in 2008, and 2009, including several resulting in death. as of may of 2009 reorganization for human rights documented at least 40 cases of torture since 2008. reena nadler ended in debt at the hands of police officers, a four fold increase over 2007. is widely know the most tortured cases go unreported and torture is largely unaccountable accept in a few highly publicized cases. amnesty international and other human-rights organizations regularly repeats -- release excessive use of force. this predicted the ability to monitor elections, serious blow to a tenuous process. president obama talked about the need for government to, quote, place the interests of their people and the legitimate

workings of the political process above their party, yet ironically, the u.s. government under the obama administration has agreed to make condition that would allow funding only for egyptian government approved registered organizations and the u.s. egyptian bilateral framework. this represents a disconcerting step in the wrong direction that only serves and consolidates the power of the ruling national democratic party. the egyptian government has taken steps that indicate the paving of the way for the succession of the lucky upcoming presidential elections to the exclusion of all other political forces. this is occurring under the direct nose of the u.s. administration. in cairo, president obama talked about the need for, quote, richness of religious diversity being upheld, whether it is for those in lebanon or cops in egypt but since then, there have been at least 20 documented

incidence of sectarian virus -- incidents targeting the largest christian population, and other religious minorities including others. the egyptian government response continues to be inadequate and between political accommodation in between equal rights and equal protection of the law between of religious minorities. as for their full integration in government and society, president obama, in your speech, you concluded it is clear that governments that protect these rights, mainly political and religious and respect for human rights, those are my words, are ultimately more stable, successful and secure. you exhorted governments to maintain power through consent, not coercion. now is the time to put these words into action by clearly stating to mubarak the u.s. interest in seeing an immediate reform agenda take hold. we commend president obama's efforts in re-establishing a strong and positive relationship with cairo based on mutual

respect, we insist that this not be done at the expense of the legitimate rights of the egyptian people for universal human rights and freedom. it is those people whose voices you must stand up for in your talks with president mubarak tomorrow and an overall bilateral u.s./the egyptian relations. that concludes my statement. on behalf of the coalition i would like to state that we support a strong u.s./egyptian strategic relationship built on mutual respect and we support a democratic egypt that supports human rights. without further ado idol and the floor over to dr. ahmed subhy mansour. >> my name is ahmed subhy mansour, i represent the international qur'anic center in washington.

i visit also koran muslim squares. i believe in islam as peace, justice, tolerance and loving humanity. we are also activists for political reform. beginning with democratic state and unlimited freedom of speech and human dignity. muslim scholars, because they're qualified against terrorists, there have been persecuted by

president mubarak. that comes the problem in egypt from within islam. he also refused the reforms from outside. it is time to be stopped. we need reform. we need reform because we are concerned, talking about the koran muslim scholar, we want to enjoy peace of mind and live.

we believe -- we want reform because we believe this situation continues, egypt will suffer. in the near future. the stability in the middle east will be in real danger. we want the reform peacefully, and we want mubarak himself to pave the way for this reform. and the rest of his party, and making a graduate reform,

beginning with reforming the egyptian legislation, human-rights and justice, reform the egyptian court, a normal right and justice also. to release all of that, built up the political bridge and conscience, stock applying the virginity lot, these other graduate steps. i have a dream. we want egypt to have a democratic state, a state-owned by the egyptian people, not to own the egyptian people. we want any egyptian army to defend egypt's water, not to

hide the egyptian people. we want the egyptian police to protect and to serve the egyptian individuals, not to torture them. we believe that egyptians deserve this. we are here to argue mubarak to make this good deed in the last days for -- in his life. thank you. [applause] >> good afternoon, everybody.

i am cameel haleem, coptic center of america. i welcome you all here and i sank dr. ahmed subhy mansour for saying everything about the situation. i won't repeater anything of what the two of them have said. i am just going to say about this coalition, i will explain to the panel who we are and why we are formed. i am coptic man and have been in the coptic movement for many years. we have organized it, we have an organization, we have done a wonderful job in fighting for human rights in egypt. we went to the congress. now is the time to talk about egypt, this has to do with

everybody in this coalition. we are going to continue to fight for human rights, but you have to look at our country. you have to see what is going on in egypt. egypt, since 52 years, have gone in the state, we have cholera, sewer water in the drinking water, we have human rights abuses for all minorities, abusing everybody. the u.s. constitution is completely outdated. it gives the president so much power, the people in egypt can't govern themselves. they need a guardian to take care of them. the middle east, first thing, what is going in egypt that mr.

mubarak is late in his age, the middle east itself, showing iran in the last election, people are hungry for democracy. everybody in the area wants to be free. i saw a blocker giving his testimony in front of the congress and he said i am here, i just want to be free. give me my freedom. it was so emotional, when you listen to this young man, he said i want nothing, this gives me my freedom. i think this is the state of all the people in the middle east. we want our freedom. we are tired of the army governing us, people telling us what to do, not to do here, not to come here, we want our freedom. this coalition here is formed because we're going to fight for our freedom. we are going to ask for our freedom. we are egyptians when we left

egypt, i know there are 700,000 cops in the united states, 700,000 muslims. we were not doing our job fighting for our country. this coalition here is the start of us. we are living in america here and demand changes miss -- mr obama getting mr. mubarak here to make a deal with him in spite of the condition of our country, we do not want that. we want him to talk about our country, how to change democracy, how to give power to the people and not to treat us like a herd of sheep, telling us what to do. we want our freedom. i think the people in the united states, the egyptian people have the duty, all of them, to think of their country. we want human-rights for all our minority, we want human rights

for women in egypt for, we want to be represented in parliament to defend s, and we want the corruption to end. there's so much corruption. mr. obama, it is not ok for you to meet with president mubarak and say everything is okay because you want to make peace in the middle east. this is not acceptable and this is not acceptable in the whole region. the middle east has to come out from the middle ages and has to come to the new age of democracy. thank you very much. the black applause] >> the american legion of lions >> i represent the alliance of

egyptian americans which was incorporated in 2005 in the state of florida as a nonprofit educational corporation. it has two aims, to empower american citizens and presidents of egypt in decent in their communities. and to contribute to developments in egypt leading to true democracy, sustainable development and social justice. why being an independent organization not affiliated with any other organization, we work very closely with egyptian american organizations to share our goals and our objectives,

and that is illustrated by being a part of the coalition of february 28th. our strategy, the alliance, includes encouraging its members and the egyptian american community at large, become involved in the american political process, supporting elected officials and candidates whose platforms are based on informed, balance, and objective views, on both domestic and foreign policy issues, especially those dealing with the middle east in general and with egypt in particular.

it has clearly been declared from day one that it has no political or financial ambitions in egypt, neither as the group or as individuals. while aea does not support or endorse any critique of the party or movement, we follow with interest the reports that indicate efforts by some parties to coordinate their position, and possibly offering one candidate in the fourthcoming presidential election. as well as other efforts in that direction. we feel that all or most of us have been complaining, and we

have reasons to complain, about the exceedingly deteriorating situation in egypt, going down for years. and we believe it is about time that we offer a very specific remedies, alternatives to the status quo. there has been many writings by scholars and activists in this direction. but we've endorsed, in the alliance, very specific recipe, formula that has been articulated by a prominent political scientist in egypt, a professor of political science, he published it in october 2008.

it has very detailed, very specific, scholarly formulated articles, how to do it. in this co, as we endorse the articles, prepare a transitional government to prepare the country for fully democratic and transparent national parliamentary and presidential elections under a new constitution, repeal the emergency laws and free all political prisoners. under this formula, president mubarak would religion the chairmanship of the national

democratic party and let it compete on equal basis with other parties. appoint a nationally respected prime minister with no political ambition beyond the term of the transition of government and. possible candidates in our opinion, include a few respected individuals. restore the prime minister, the full presidential authority for domestic affairs with president mubarak retaining control on the military and foreign affairs. and dr. nafa anticipating that

some people might criticize that, articulated very convincing reasons to do that during the transition. the prime minister, the prime minister's mandate would be to run the daily affairs of state through equally competent, non partisan cabinet members, and without future political ambitions, cabinet members have to renounce any future political ambition. to convene a constitutional convention of recognized dollars representing the entire spectrum of the egyptian, political,

ideological landscaped, to draft a moderate constitution that guarantees true separation of powers and the supremacy of the rule of law for all egyptians. in the meantime, the cabinet would undertake to repair the damage done to all national institutions through long years of nepotism, subjective choices of individuals and policy. we at aea endorse this specific firm because it seems to be specific, objective and scholarly prepared, of all --

clearly declares from the beginning its lack of interest in any future political ambition. thank you. [applause] >> thank you, mr. mahmoud el-shazly. we now have the new be a project. >> i am a former sudanese diplomat and head of sudan human rights organization in the new be a project in washington d.c. i have been here for the last two years struggling for causes of the oppressed people of sudan. and i am here to address the issues concerning the nubians are marginalized by the sudanese

government and the egyptian government. certain dubious sacrifice its land for the prosperity of egypt, and egypt is keeping its waters for the last 45 years on the land for free. we are living in darkness, no electricity while egypt is shipping electricity across the suez canal to neighboring countries, just across the border, the nubians are in total darkness, marginalized, their land is destroyed by the sudanese and egyptians. and we want the egyptian government to be sincere for and

listen to our problems. we don't want to give our land for free for those who are coming to invade our land, established -- along the nile from alexandria -- they are buying the whole land across egypt and sudan to deep in africa. started buying the whole land, going to kick us out into the desert. we don't want to be second-class citizens in our land. enough is enough. we gave more than we can for the prosperity of the egyptian people. we do love and respect the egyptian people but we don't

love the egyptian regimes. since 1902, when the aswan dam was built and later on it came to the high balance and so on. we gave and gave, but we were not recognized. our gift, our free gift wasn't recognized. as nubian americans, we are told, the obama administration and the congress, we are the taxpayers and we don't want our money to go to regime that are destroying us. building a series of dams in the nubian land. very few years, we will fight back. it is not a joke. because we have nothing to lose after this. if we lose our land, we have nothing to do is. that is that.

this is a friendly message to our brothers and sisters in egypt, and also to our brothers and sisters, the coptic, who are oppressed like us, we are going to fight again this policy of destruction of nubia, and we will also ask the american people and the congress administration, a part of the money given to president mubarak's regime, this is our money, they cannot destroy us with our money. this motion is moving inside the congress now. egypt, president mubarak, egypt is not -- only the regime. president mubarak is pretending to be very friendly and

protecting the government. he is wanted by the international criminal court as a war criminal. president mubarak is giving the blanket. why president mubarak is occupying the size of jordan. how can an occupier protecting an occupied country, so if there is sincerity in making a unity between sudan and egypt, these aggressive policies must stop. we have the land, we have the natural resources, we have underground water and everything. we have enough land to

accommodate not only egypt, other neighboring countries and so on. not to become second-class citizens, we want to be first class citizens. = to all people of the land. nubia, which protected in 71 b.c. 3,000 years ago, jerusalem is coming to replace us of. there is no other pocket between egypt and sudan. this is a message to our brothers and sisters in egypt that they must take seriously. we stand firmly in support of

the rights of the coptic. through history, the nubians were believers of the coptic religion. we share many things, we share the history, we are the owners of the land, the history of the nile. this is the only language which is spoken for the last 3,000 years, the new the language, this is the coptic alphabet. we learned after 800 years, we brought it back to life. we are on a very big journey. we want to resist, we want to live, we want to stay on our ancestral land. and also live in peace.

we are not enemies to anybody but we will resist any destruction to nubia. you want you to help us stop the building of these dams in the nile because it is going to destroy the richest archaeological sites of the world. we said we don't want -- throughout the last 20 years, he never gave any chance to a nubian to hold a position in the media, minister or politician or diplomat or so on. nubians are pushed over there. when we talk about unity between nubians and egypt and sudan, it is not talking about the unity between us to syria to mauritania. it is not allowed for the

nubians to talk about their unity. we are one nation. our coptic believers, brothers and sisters and nubians, we share the same history, we want to fight back, we want to resist, we want to live on our ancestral land. we are the oldest people of the nile valley. thank you very much. [applause] >> thank you for preserving the richness and uniqueness of this coalition, that brings together a diverse elements of the egyptian population that recently have been alienated from each other. we are certainly very sympathetic to the cause and we hope everyone listening pays attention to this critical

cause. next, we have the president of the rights of the people, we may need translation assistance. >> not much room for you. he is the president of the rights of the people, which is an organization that tries to bring together the people, bridges the gap between security

forces and egypt and the people. jerome -- [speaking in native tongue] >> translator: he believes torture and treating people with indignity is the main driver of terrorism and insecurity not just in the middle east but across the world. [speaking in native tongue]

>> translator: the coalition demands to end the state of emergency in egypt and release political prisoners and ratified the unified houses of construction of worship law. these are demands we place in a letter to president mubarak which was sent in the name of the coalition. >> [speaking in native tongue] [applause] >> translator: he said we still hope president mubarak will respond positively to these demands, and that will be the first step towards national reconciliation that will bring together muslims and coptics and

all the children of the egyptian homeland. next, on behalf of the individuals who are not part of any organization within the coalition, we have mr. ibrahim hussein, who was nominated by individuals to give a word on their behalf. >> good afternoon. my name is ibrahim hussein. i retired here in washington d.c. about ten years ago after a long career in mental health administration in michigan and new york. i am delighted to be here. i speak for myself, but i think i am reflecting the views of hundreds, perhaps hundreds of thousands of egyptians across the united states who are settled here, and they are part of this coalition without being members of a specific group. what we are witnessing this

afternoon is a historical event, to have eight organizations throughout egypt, is remarkable. we have differences, we have views on certain issues but we are all united in our desire to have democracy, freedom, supremacy of law, religious freedom throughout egypt. i want to repeat what has been said. this story of two speeches, both were in june and both were in cairo. the first, june twentieth, 2005, by former secretary of state condoleezza rice. she said for 60 years, stability at the expense of democracy in

the middle east, she went on to say this was for democracy. as we all know, nothing followed this talk. five years later, june 4th, president obama made a similar speech, similar declaration in cairo on the same subject of democracy. he said i do have an unyielding belief that all people yearn for certain things, the ability to speak your mind and to have a say on how you are governed, confidence in the rule of law. i sure hope president obama will not reap the what the former administration did, too walks off, talk is cheap. what we need is to take necessary measures. what i am hoping president obama, when he leaves tomorrow, is to pressure the four or five issues we talked about in this

conference and expect him to give answers because this is not within the united states or egypt, the two countries are linked, their interests are common. what happened between us affects both egypt and the united states. the so-called stability under president mubarak is a facade and it could fall apart at united states policy in the middle east could be exposed. i would like to ask president mubarak, we sent him a letter, but he in his talk tomorrow with president obama, can make a down payment to show his interest in reform, he can make tomorrow a declaration to free the political prisoners, he can make a declaration tomorrow that emergency laws will be suspended, and three or four things, he can show his good

will. but if he is serious, he has the opportunity to make such a dramatic, bold action. what is needed from president obama is to pressure president mubarak to do what is good for egypt and the united states. i think that is all i have to say. thank you. [applause] i would like to show this live picture of oppression in egypt. the police, some guy was trying to express their views in a non-violent way and see what happened to him. [applause] >> thank you.

the next to last speaker for the american society. >> i am here to read a short statement to the have of the muslim american society. fully transparent grass-roots american muslim organization representing all sectors of muslim society including a very large egyptian/american segment and on behalf of that segment we are calling for the following. free, fair elections to allow for full judicial independence, to allow for the judiciary to supervise the electoral process, calling for international, local monitoring of the election process, free and fair elections will lead to a healthy and more robust dejection society. we are also calling for the

immediate replacement of emergency law and remove those restrictions. thank you very much for your time. >> thank you, shafi kahn. last is saad eddin ibrahim, chairman of the center for development studies, who will conclude this press conference by articulating the message that we would like to send to president obama and president mubarak when they meet tomorrow. >> thank you, dina girguis. thank you all for coming this afternoon and sharing this press conference with us. i think my colleagues have said everything that ought to be said. we have been in touch with

senior advisers of the obama administration before this press conference, before the planned demonstration tomorrow, again to make many of the demands, expressly highlighted. president obama has repeatedly said during his campaign, and in the immigration speech and and in his cairo speech and on many other occasions that he will uphold democracy, human rights. he will not stand with dictators anywhere in the world. however as my colleague said, this was all very welcome talk.

what we are waiting for is for him to walk the walk. having made the talk, we are waiting for him to walk the walk. we are concerned about similar backsliding by the obama administration, similar to that that we saw are in the closing years of the bush

administration. we saw old politics coming back into play. expedient, short range strategic objectives. we say both could be achieved only through principled foreign policy. this country has a history of having, at times, followed very principled foreign policy, from the days of the prison system, during the first world war, all the way to carter and clinton. we have seen american administrations which form very principled foreign policies in egypt, to the arab world, the

muslim world and also serving american interests. we do not think it is a contradiction between the two. that is the message. i know you are eager cause -- to ask questions. i would like just to say over the last 28 years of president mubarak's rule, egypt has slipped down on every development in decatur, and you only need to look even at the u.s. state department annual reports on the state of human rights to see that steady deterioration under mubarak in the last ten years. amnesty international confirms that, human-rights watch confirm

that, so those human-rights first, and egyptian and arab organizations have equally confirmed all of that. what i am saying is because of the promises mubarak had made during four election campaigns. we counted them. he has made -- in four election campaigns. what my colleagues talk about, we hope president obama will hold him accountable on these

processes. in 2005, the judiciary, to restore that independence, to end the state of emergency. he promised to have free media, he promised to have fair and free elections. what did we see after that? two very hasty -- to undermine even modest gains the egyptian had made in the previous six years. in the year 2000, the supreme court in egypt asserted that any election that is not totally and fully supervised by the judiciary will not be considered legitimate. the egyptian government

grudgingly observed the stipulation and in 2000, 2005, we had two elections that are not perfect. anything that preceded them in the previous 40 years. by two, basically, that have basically stolen everything. what my colleagues referred to, 76, article 18 -- 88. let me take one minute to tell you how tricky the regime has been. americans, egyptians, if you can

find an article in any institution in the world from the time of the magna kara in 1215 to today, article in any institution that is 300 words, almost as equal as the constitution. in order to make sure that one person will be elected, it is impossible to contest these two gentlemen. article 76. other articles they amended

again show that the first order, article eighty-eight which t devoid the supreme court speculation -- we have pre to elections in 2010, and 2011, won parliamentary, and one presidential, without an incredible supervision. and where impossible, to run in a fair competition. that is what we are pressing president obama to take up.

last february 28th, we submitted it, we submitted again. we have not heard any answer, we submitted the demands to both of them come and prevailing on president obama and president mubarak to take the egyptian people seriously, and to give them a chance, join the risk to the world that has been democratizing very swiftly in the last 50 years in what is called the third wave of democracy, have been democratized in the last 70 years. e egyptians need to join that wave of democracy. thank you. [applause]

now we take questions directly to me or any of my colleagues. >> in what way would you like the demonstration to put pressure on the e egyptian government in a practical way? are we talking about each receiving more aid than other arab countries? would you like to see that attached to some conditions from the government? >> this is a very exclusive issue. whatever we say here is always reworded, distorted back in egypt. let me give you something at least from america's policy. in 1975, when the soviet union and eastern bloc needed aid and technology from the west, led by the united states, on one

condition, more freedom. more freedom. within five years, we were directing in poland and another did -- another ten years, the dismantling -- the whole eastern and central europe. what we are saying is there are precedents in american foreign policy where we put principle ahead of expediency and it produced good results, a win/win situation. that is what we would like to see. creative conditions to bring the egyptian people back into the political -- process. >> question here?

>> would you please tell me, if you are contingent on the organization, terrorist organizations, i appreciate if you would talk about that now. can you relate it or not? >> professors do not answer questions like that. they always have -- i know, i know. you ask your question, i have the freedom to answer. i believe personally, not my colleagues, on behalf of anyone here, speaking on my -- a social scientist, i say the muslim brothers were a terrorist organization at a certain period in their evolution. nowadays i do not think they are. >> national of live radio, i want to ask about these

restrictions of the notion of government who, with his can you explain a little bit the evolution of that? >> the u.s. gives $2 billion a year to the mubarak commission. a few years ago under the middle day and decided who to earmark a very tiny part, 1%, to civil society and given directly by aid or other organization to civil society organizations, at that very time,

was given to egypt, is now after the visits by both secretary of defense robert gates and secretary of state hillary clinton, would be subject to the egyptian government's own administration. the we consider that to be the wrong signal to of the democratic egypt again, this is the fight of democrats. we are fighting on two friends. we are fighting the autocrat on the one hand and the field rat that many of you are frightened of on the other hand. even that little room was a tiny -- we are being squeezed out.

that will be the enemy of democracy. >> they sade quote we will find out along the way, ways of helping but this is something we have to do because the president mubarak regime threaten to have it. we needed for other issues. >> yes, dr.? >> we announced in egypt that mubarak is the most eligible candidate for the presidency. do you think that this view represents the views in the u.s.? @. ..

>> is carried by the people. i think a lot of it is carried by the regime, and they say that we are protecting, okay? an incidence. this the church there was two explosions in cars where there was ceremony going, so i think

they evicted the coach, and the police came and -- church, and the police came and showed they are good guys protecting the cops. and i don't think this goes to the cops even. i think this goes to the muslims, too, because there is a big attack, the muslim brothers, and i think the people in egypt said this is not the direction we want, we want mubarak to save us from the radicals. there is a big movement to beat the muslim brothers, and this is something that's like indication everybody in egypt's scared of them. and i tell you, the coptic people, as of now they are going for -- i can tell you that. and this is because of what the muslim brothers have done in the last 20 years. i was talking to my wife today and forget about the copts.

think about women, okay? the muslim brothers said no women can be president, no copt can be president. is there any place now a woman can be president in egypt? we're not ready for that yet. but they announced it. no copts, no women. mubarak said i'm going to put 65 women in the parliament. what do you expect they're going to vote for? they're going to vote for mubarak. he put all the other parties he stifled them down. the muslim brothers have fell in the creek, and they went in this radical thinking. no copts, no women. we're very radical, and people in egypt don't want that, so they're going for gamal mubarak. they are very, the the regime is very tricky, and they're

professionals. they know what to do how to do it. >> you supported this. >> huh? >> you support this view? >> me? no. >> no. >> i do support a new constitution in e vicinity. egypt. i prefer that for my personal opinion for what is now the opposition, there are no opposition in egypt. who's going to -- think of the government. assume now mubarak stepped down or he died. who's going to take it? there's going to be chaos in the country. so the first thing for us to do in egypt is to have a constitution, a democratic constitution and have the liberal -- remember something that when mansour went for election, he was not a strong candidate. it took 600,000 votes in this environment. they were cutting his

microphones. people of egypt wants democracy. muslims, christians, they want freedom. first you need to give them this chance, to be free, and then you can make an election in egypt. who are they going to vote for, people? they're not. so we are in a corner put by mubarak, we don't know what to do with it. >> i have a quick question. >> sure. >> mubarak is the president of muslim. do you think during this environment we can see civilian revolution for coptic and -- or is this civilian revolution start since ham a or whatever? and to start we can see all of the details or i can see there's a civilian revolution for coptic under, under explosion and we

can see everything and even today there is coptic starting to talk about making our parliament in exile. >> this is all coptic people are peaceful people. we've been there for thousands of years. we were very peaceful, and this is what our problem -- and the nubian people the same like us. we're peaceful. we don't fight, we don't revolt, we stay, we pray. the coptic people when they get in a very bad situation, they go to their churches and pray. and this is what our problem, the people -- >> [inaudible] >> huh? >> [inaudible] >> fast and pray. fast and pray, and it works because we are the biggest minority in the middle east. 15 million people. our praying and fasting worked. we don't fight, we don't carry guns, we don't do any of that. we fast and pray. >> this is civilian -- >> i -- we have to move on. i'm sorry, we'll take the next question. >> khomeini promised iranian for

a democratic country and justice and all that. look what has happened. in a era of -- >> i'm sorry, could you identify the person to whom you're directing your question, please? >> mr. halim. yes. in iraq there was a free election and there is a government in power which is influenced by iranian government. how do you garon toe that a free -- guarantee that a free election doesn't end with the radicals coming to power who don't understand freedom and free speech? >> my personal opinion that the biggest danger in egypt now is the revolution of the people which will have no chaos. and this is our biggest enemy. because there are no organization and could be radical, could be street people, could be burn the street,

it's -- what mubarak have left the country now is a very dangerous -- and i think iran, i think it was a chaos revolution when it happened. it was organized by khomeini from outside, but it is not within constitution, there were no constitution, anything. and this is what they said, we need a modern constitution, egypt. we need to get rid of that constitution. thereby. >> i have a question. i just wonder if the doctor, how do you assist what monsieur said of the -- mansour said of -- >> civil war. >> how can you assist such -- >> well, let me say the following: of course, everybody -- you heard mr. halim worried about chaos, and you

heard dr. mansour worried about the civil war. well, as a social scientist i go with the evidence. what we have seen in egypt in the last 300 years is exponential rise in acts of civil disobedience. acts of civil disobedience. in 2006 there was fewer than 100. in 2007 it jumped ten times from 100 to over 1,000. last year, 2008, which we have complete statistics it was over 3,000. 3,000 acts of civil disobedience. from the nubians in upper egypt to the copts in middle egypt to

the bedouins in the north of egypt and so on. so acts of civil disobedience while so far they have remained peaceful, there is no guarantee that will remain peaceful because we have seen imbeciles when the crowds got out of control like in 1977 during the food riots, during the when the people were victims of landslides and when the government unable to salvage them. and when the central security forces, the stick with which the regime uses to beat the people, that stick, that hand rebelled against the regime in 1980, i think --

87. so we have these episodes, memory of the food riots, the state security riots, and these things show how precarious the situation is. mubarak, nevertheless, has traded and has promoted himself and now is trying to promote his son as the guardian of stability. not only in egypt, but in the middle east. he's not, he has not advanced the cause of peace one inch beyond what sadat did. he has not delivered for those hundred billion dollars that he got from both the united states and western europe, he has not delivered any substantial development that could have been reflected on all of those indicators of the undp report i referred to in passing my remark. so they are concerned, they are justified in their concern.

i do not think that civil war is imminent, but we should not be relaxed and say it is not imminent, therefore, we will leave business as usual. we have to take measures, we have to take steps, we have to pressure mubarak either through ourselves here -- and we have been doing that peacefully -- or through friends of egypt like the united states to engage in real reform in, as i said, benchmark, road map. show us. we're going to do this year, next year, three years from now. he has two years, two and a half more years to go in his presidency until the election in 2011, and that is enough time to amend the constitution, to prepare the country for fair and free election, to have what mr.

hah mood suggested to prepare the country for that -- >> i have another question -- >> follow up. >> no, it's not follow up, just another question. i wonder if the people -- [inaudible] why here are demanding and why not there? >> first rule, i am official. i forget to say that. i have present sentences pending against me in egypt. >> even now? >> of course. six cases. >> [inaudible] >> you're talking about one. for every one i win in court, there are three more filed by members of the undp -- members of the ndp, national democratic party, some of who have become very proficient. every few months he files a case, and there is another two or three lawyers, members of the

party that have become very professional as if they have nothing else to do but to file cases against this 70 years old very feeble man. so i'm here as a fugitive, i am here as an exile, and that's why i'm fighting from here, but these are egyptian-americans who feel some loyalty and some debt to their country, and they see their country sliding into chaos and into injustice, and they are speaking out. and they're screaming. yes, sir. >> yeah, hi. andrew albertson, and this is for you, dr. saad or any of the other panelists. a lot of us are looking at iran and the youth protesting fraudulent elections out in the streets. i would just as we're talking about what might happen in the next year or so in egypt ask if that's a useful amie.

tell us -- analogy. tell us about the use of new media technology and whether they might react to a fraudulent election in the same way. >> thank you very much. this is very good question, very pertinent and asked earlier about iran. here is one very interesting development that happened when the contested election took place in iran, and the ayatollah, the clergy that's ruling iran, shut down the internet in iran. immediately, egyptian bloggers put their blogs and their proxies at the disposal of their young iranian counterpart. no coordination, they did not know them, but this was a spontaneous act of solidarity

that shows as some of my panelists, co-panelists said that how hungry the whole region is for democracy. for freedom. and any country that makes some gain is cheered by everybody all over the middle east. and this gives me also doesn't to thank them for the courageous work they're doing in promoting and monitoring and seeing what is happening in the middle east on that front, the democratic front. now, there are three very important events that, again, give us a signal of where we could go to, where we can drift. the elections in lebanon those who are very frightened about the islamists and who have swallowed the bait that was given by the likes of mubarak

frightening everybody of the coming of islamists, well, in lebanon they were beaten. it was a secular liberal opposition that won the day in lebanon. and then in kuwait, again, the islamists who had been in the majority in parliament were beaten by the secular, the liberal in kuwait. not only that, but for the first time four women in the history of kuwaiti democracy were elected to office. and then the con testation of what happened in iran. and i talked about the acts of civil disobedience, all of these groups and, of course, our coalition, all of these developments while they are still in their infancy, but they show that there is a promise, a promise that we have to all nurture and work for until comes

to full fruition. yes. >> yes, this question is directed to any one of the panelists who'd like to answer it. given the political unrest we've seen over the years in egypt whether it be through the rise in activism online, the strikes, the champion stations and the mobilization of political parties, does it feel as though your efforts here in the united states as well as what's happening on the ground in egypt is pressuring the mubarak government to stay on edge and watch your movements more than they had in the past? >> well, as you said, you noted what the mubarak administration is doing and how they are encircling every autonomous initiative for freedom or asking for interest. so what we are doing here is to give voice to the voiceless in egypt. given how controlling the regime has been with the media

including the so-called independent media which is increasingly becoming less independent because of all of the efforts and tricks that the regime is using especially through advertising, public sector promotion and so on. so they can stifle, they can suffocate any independent voice. and we have here i'd like to note and to salute one of our great writers and journalists, and she probably can after this session she can tell you more of what the media is subject to by this regime. yes. >> my name's ibrahim. my question is our, your, the egyptian coalition opinion about

the triangle, the opinion of the coalition about the mubarak regime and where do the people they treated badly and there is a massive human rights violation. what is your coalition's opinion about that? >> the coalition has not taken up this issue. i'm being very candid with you. but we have a nubian vote in the coalition. we will welcome him to give us a full presentation on the issue, and the coalition -- i promise you and promise all our nubian brothers and sisters here that the coalition has no problem taking up any issue that is brought to its attention.

they will deliberate it, they will debate it, and they will take a stand on it. so i can promise you that much. so if there's no other questions -- >> i did want to -- >> go ahead. >> caroline, would you -- okay. >> is that it? you want to conclude? >> thank you very much. nothing more to say. thank you very much for coming today and actually i do have two more things to say. afraid i may have forgotten to introduce myself. i'm dina guirguis, and i call upon you, everybody who supports human rights and democracy worldwide to join in a protest tomorrow in front of the white house between madison avenue and 15th street calling for democracy and human rights in egypt, and that'll take place starting 10 a.m. tomorrow. so we hope to see you there, and thank you again for coming. [applause]

[inaudible conversations]

>> bruce alpert of the new orleans "times-picayune," congress continues to look at post-hurricane recovery efforts. how's the recovery going in louisiana? >> it continues to be slow, but there is progress being made. ironically, our economy hasn't been as hurt as badly as other parts of the country mainly because there's still some spending going on on construction, a lot of rebuilding still taking place

though not enough in the view of residents that are still waiting, perhaps, for homes to be repaired or rebuilt or for public infrastructure projects to be completed. but our unemployment job loss has been much less than job losses elsewhere and, you know, you hate to go through a major disaster like that to weather a recession, but that has helped. >> well, what sort of bureaucratic changes have been put in place to avoid what happened in the response to katrina four years ago? >> one recent development was the establishment by the department of homeland security which, of course, manages the federal emergency management agency which distributes federal funding for rebuilding is to set up an arbitration process to settle disputes between local and state governments and the federal bureaucracy of what exactly qualifies for federal funds. a lot of projects were stalled because the locals wanted the

projects to be built in a certain way, and fema said its regulations didn't allow for that process. so local governments wanted to change some of the specifications, make the buildings adapt a little bit better to the more modern building techniques -- >> and this is moving some of those projects now? >> yeah, it's starting to because the arbitration panel will basically through a couple of federal administrative judges will determine what prompts k indeed, go and what can't, and it'll speed up the process. it's just started, so, you know, the jury's out on how much it will speed things up, but every expectation is that this will help. >> how many people are still living in temporary shelters in and around new orleans? >> there are people living in temporary housing, but most of the people in the trailers have, have moved into at least some temporary participants or -- apartments or other temporary housing. but the vast majority are now out of, out of temporary

housing, have either moved back into their old homes or have found alternative housing. >> can you give us an idea about how much money the federal government has spent on recoifer and what about the state efforts? >> it's been well over $100 billion spent by the federal government on katrina and rita combined. not just louisiana alone, that's where most of the money was spent, but several of the gulf states that were impacted by those two hurricanes. locals have spent in the, you know, tens of billions of dollars in terms of matching, so it's been a massively expensive disaster. >> what about federal/state cooperation? are there measures now in place to address some of the issues that rose following hurricane katrina? >> the arbitration process is designed to deal with those disputes and come up with a process that resolves them much more expeditiously than had been the case before. >> what do you hear from the louisiana congressional delegation about the next stage of recovery for the state?

what needs to be done? >> it's all about flood protection, hurricane protection and the big fight will be over the goal of the delegation to eventually come up with category 5 which is the most destructive hurricane, protect the new orleans area from a category 5 storm. right now we're trying to rebuild to the level where we can protect against a category 3 hurricane. category 5 would be mump, much more -- much, much more expensive, but in the view of members of congress from louisiana very, very important. give folks confidence that -- and businesses confidence -- that they could either move back or relocate to the area and not worry about major destructive hurricanes. >> an update on hurricane katrina recovery. bruce alpert of the new orleans "times-picayune," thanks for joining us. >> my pleasure. >> now that hearing looking at improving government response to catastrophic disasters. fema directer craig fugate and other panelists spoke before a

house subcommittee to talk about the federal government's role and what communities can do to prepare for emergencies such as hurricanes. this is three-and-a-half hours. >> i apologize that i was detained because this is a hearing of some considerable importance to the subcommittee. it's not about any disaster that we have seen except 9/11 and katrina, so it looks to the future in a way that perhaps we should have done before katrina except that katrina was such an unimaginable event that it did not occur to anyone. i believe, to think of such a gargantuan matter. but today's hearing will address

very important new and unresolved questions that hurricane katrina raised for our country for the first time. what is a catastrophic disaster? note that word, catastrophic disaster. think of it as a new invention. we haven't used that word before. what is the role of the federal government before, during, and after these events? is additional authority needed to address response and recovery from these events? we cannot sit by and merely hope that outsized disasters such as hurricane katrina and 9/11 will never occur again. our obligation to the public requires investigation by the subcommittee to prepare us for the possibility of these contingencies.

hurricane katrina made landfall august 29th, 2005, and proved to be the most costly natural disaster in american history. congress and particularly this subcommittee have spend the nearly four years since katrina looking at the action of the federal government as well as state and local governments, voluntary agencies and citizens themselves from response to recovery. which continues to this day on the golf course, gulf coast. totoday's hearing focuses on net step, what have we learned from hurricane katrina as well as from other disasters in the united states and around the world? concerning what should be cone to respond -- done to respond to catastrophic disasters and to facilitate recovery. most important, what steps should all concerned be taking now to prepare for and mitigate

the risks to lives and property from these events? the robert t. stafford disaster relief and emergency assistance act, or stafford act, was signed into law on november 23, 1988, but it is not clear that congress contemplated gargantuan disasters with recovery proceeding for years. the act authorized by our committee is the federal government's primary authority for addressing major disasters from all hazards and events. for the most part, this authority has proven sufficient to address all types of disasters and emergencies, but it is an open question whether the stafford act is sufficient when measured against the background hurricane katrina now

provides. the stafford act and our nation's emergency management system are grounded in our federal system of government that recognizes that the primary responsibility to address disasters and emergencies resides with states and communities, not the federal government. as a result, the assistance provided after a disaster is, as the stafford act provides to -- and i'm quoting here -- supplement, supplement the efforts and available resources of states, local governments and disaster relief organizations, end quote. however, it is already clear that one characteristic that distinguishes catastrophic disasters from other disasters is that the magnitude of a huge disaster often has national

impact, national impact, impact beyond the seat of the disaster. rather than effects limbed largely to -- limited largely to a particular state or community. we must, therefore, reevaluate the role of the federal government as well as fema's authorities, policies and regulations that presume federal assistance is always supplemental. regardless of the disaster. the stafford act's existing authority and systems for the emergencies and disasters that the country faces are so detailed and time-proven that this landmark statute provides a necessary base for additions or revision if needed. however defined, katrina teaches that catastrophic disasters are complex, unusually large in effects, hard to predict, and

expensive. moreover, they are distinguishable because they require months rather than days or weeks, months indeed and probably years rather than days or weeks to move from response to recovery. inevitably, therefore, the subcommittee cannot avoid the question whether new extraordinary authority should be given to the president of the united states in advance and whether congress should provide for the recovery from catastrophic disasters, that is specific and targeted to the size of these unusually large and pervasive events. the subcommittee looks forward to hearing the testimony of today's witnesses to help us address how we can prepare for these catastrophic events. we particularly welcome

administrator fugate who has recently taken office and is testifying before this committee for the first time. i'm pleased to ask ranking member mr. diaz balart if he has any opening remarks. >> thank you, madam chair. i want to thank you for holding this important hearing, and obviously for the witnesses as always for their contributions and their expert testimony. it's good to see you, sir. i also want to welcome, madam chairwoman, administrator fugate in his first hearing before this committee in his new position. now, he's been doing this kind of thing before at a different level, and it's going to -- i'm actually very excited that now he's doing it here at the federal level. after hurricane katrina that congress made it clear we need a fema administrator who knows what he's doing and has the authority to get the job done, and the president, i think,

found the best person in the country. a person who knows what he's doing, who has, i guess, unfortunately a lot of experience dealing with large and small emergencies. and, again, i have tremendous confidence in administrator fugate, and i'm really looking forward to continuing to work with him. hopefully, he will not be too busy. that's something that we're, obviously, all hoping for. i also need to acknowledge the tremendous work that congressman kao has done to speed the recovery funding in louisiana. we still have issues after that storm. he's held several round tables with fema and with members of congress -- i've been involved in some of them -- and, frankly, he's helped free up hundreds of millions of dollars for those stricken by katrina. he's also been working closely with the experts such as the witness today, mr. mccarthy of the congressional research service on possible changes in recommendations to the stafford

act. now, i believe many of the options presented to the committee for reforming the stafford act are, frankly, a direct result of congressman gao's effort and, again, i thank you him for his aggressive involvement with this committee on these important issues. thank you, sir. now, obviously, as the chairwoman said katrina was a huge, def tating -- devastating hurricane. unfortunately, as we know, it is very unlikely that will be the largest one that hits us or the largest catastrophe, the most damaging one that hits our country. a category 5 hurricane in south florida could come at any moment or an 8.0 earthquake in california or a pandemic flu. we keep hearing about pandemic flus right now. all those are possibilities that could hit us at any time, so while disasters obviously that large would stress the entire emergency management system, but i want to focus on a few

important areas that are, i think, of the most concern. there needs to be, obviously, a clear federal chain of command, and that's essential during a catastrophic disaster. and it can be critical point of failure. and as we saw during katrina. i've mentioned this before as i mentioned earlier as well. you know, congress changed the law to insure that the nation has a qualified, a qualified fema administrator who really knows what he's doing who would coordinate the federal response on behalf of the president. now, unfortunately, the president has yet to update the presidential directive on incident management which is hspd-5. to reflect this change. and dhs has built a duplicate incident management organization outside of fema. and congress continuously tries to defund -- and i'll get into that later. so as i recall, the entire

reason fema had to be within dhs, that's what we were told, was so that we could use fema to manage the response. dhs and the government could use fema to manage the response to a terrorist attack. and yet for the last three years dhs has built a parallel incident command structure that bipasses fema. again, makes no sense. as a result, it's, frankly, not clear to me or to some of the witnesses of our witnesses who will be in charge, those who will be in charge to coordinate the federal response if the secretary decides to appoint a principal federal officer during the disaster. who would be in charge? fema or this outside pfo? this confusion, frankly, is a recipe for failure and also, you know, another thing, madam chairwoman, the department needs to follow the law, and i know

you're even writing letters to the president on this. another critical issue i hope we can crease is the role of the -- address is the role of the department of defense. during a disaster department of defense equipment will be needed immediately. first, obviously, what is the effort of dod? they need to be available quickly, and we saw how well they responded during katrina. and they have to be well coordinated with fee fema. and they also have to be in a supporting role to the states, the states when they run out of resources, that's when you need dod to come in, and if it's a big disaster, to come in big. i understand the department of defence is recommending a change in the way they would respond to disaster and i've also heard that's caused concern among a number of governors, and i have to admit i share many of the governors' concerns. so i hope that we can talk about that. another critical failure, and

this is something that the chairwoman has brought up many times, as a matter of fact, we had a hearing in south florida, and you brought that up, madam chairwoman, to deal with the housing issue. what to do with the 500,000 or over a million families forced out of their homes by one of these horrible catastrophic disasters. despite the release of a national disaster housing strategy, there is still no clear solution to addressing the housing issue at that scale. now, i do need to commend fema for i read that they're looking at other options, thinking outside the box, even looking at the possibility of in some cases using homes that may be under foreclosure, so i commend fema for thinking outside the box, but again, we need to make sure we have a strategy for the big storm or the big event if it comes or when it comes. mitigation and preparation are other issues that must be examined and clearly improved. earlier this year i introduced the integrated public alert and

warning system, a modernization act, along with chairwoman norton and representatives gao, guthrie and graves of this subcommittee. i also introduced a safe building code incentive act. both of these bills are intended to help prepare for a big storm and to mitigate against disasters. providing incentives for states to enact building codes is, frankly, a very effective, common sense way to minimize damage and the loss of life that a catastrophic disaster could entail, and we've seen that it does work. and developing a truly integrated public alert warning system is, obviously, critical to saving lives. now, with countless methods of communication available today, you know, twitter, facebook, e-mail, etc., etc., we're still using a 1950s model which is that little beep on our tvs and radios and, frankly, that's not enough because there are

more ways we can communicate, and we need to do that. so the issues i've raised disasters of all sizes, but the catastrophic disasters magnify, obviously, their sentence and -- significance and importance. should there be more capabilities and flexibility built into the system? so i, again, hope we will hear from our witnesses today on these and other issues. i want to thank you, madam chairwoman, for convening this meeting. it's something that means a lot to us, particularly those of us who live in states that are prone to disasters. thank you. >> thank you, mr. diaz-balart, you raised some of the salient questions before us. mr. cao, do you have any opening statement? >> thank you, madam chair. first of all, i'd like to thank

the chairwoman for holding this hearing today and for sustained attention to the recovery of new orleans and jefferson parishes. i also appreciate their recognizing the significant challenges to recovery presented by certain aspects of the stafford act, and when we are talking about the stafford act, one of the questions that we are exploring today is whether we should create under the act a separate incident level for catastrophic events. and to help us clarify what these terms may imply, i would like to tell you what katrina did to my district. many of the critical institutions like charity hospital and basically the entire health care infrastructures in the hardest-hit new orleans east have never reopened. other basic services like police, fire, and rescue, libraries and schools were wiped away by the flood waters and are simply today shells of

buildings. in the immediate area around new orleans, 80 percent of the buildings and 40 percent of the housing stock were damaged in some way. in my mind and in the mind of my constituents, what katrina did to the gulf coast and orleans and jefferson parishes was without doubt a catastrophe. after katrina i spent a significant amount of time talking to my constituents and also to federal officials with administrator fugate, with mr. mccarthy about what changes need to be made to the stafford act. we are taking a comprehensive relook at the stafford act and the recommendations that support it, and i would seek your support, madam chairwoman and mr. ranking member, in these efforts. the stafford act is currently set up to provide recovery dollars on a project-by-project basis. for the gulf coast states that were hit by hurricanes katrina

and rita, this is not optimal due to the extent of destruction. the fact that we are nearly four years from these events and the states and fema are still arguing over doorknobs and whether a building that was flooded, gutted and is falling down was more or less than 50 percent damaged demonstrates this. in catastrophic or mega disasters, the state and low cagties need to have the flexibility to rethink and replan their recovery and hazard mitigation plans. they need to have the flexibility to decide whether rebuilding in the predisaster footprint is the best solution for the communities long term. what are some of the fixes that i hope to look at in regards to the stafford act? legislatively, creating an incident level for catastrophes or mega disasters for which a holistic look at the community's

needs would be taken. the feasibility of lump-sum settlements in mega disasters like that which was legislated to respond to the disaster of september 11th. shifting more responsibility to and thereby incentivizing states and localities to prepare better for disasters. for example, tieing building codes to the amount of recovery dollars ultimately provided by the federal government. this is something that the ranking member has been working on through legislation, and i'm proud to support this. revising the management structure of fema and other agencies to shift decision making from the upper level management where bottle necks occurred to the staff that is on the ground and meeting with local government representatives on a daily basis. in the course of my conversations with the different

parties, it has become abundantly clear to me that fema employees have been almost indoctrinated to believe that they are handcuffed by the stafford act and, therefore, can't come up with out of the box solutions. when you have major disasters like hurricane katrina that, we need creative thinking, but fema employees are allowing themselves to be mired in red tape causing them to retreat from difficult questions and creative solutions by hiding behind the stafford act. and what it does and does not allow. my reading of the stafford act is that it is an incredibly flexible piece of legislation that was always envisioned to provide a framework. the real problem is for decades fema has been layering regulations one on top of another which is actually what is hampering fema employees. fema has restricted itself with inconsistent regulations so much

so that they can't be a partner in communities' recovery which is what they ought to be. i am hopeful that secretary napolitano and administrator fugate will have the same sort of self-awakening about the restrictions to fema and that they will fundamentally rework the regulations hampering performance. however, i want to make it clear that if we don't see real progress in freeing up the creativity and proact i have thinking -- proactive thinking of fema employees, we will draft legislation that requires you to do so. with that, i'm looking forward to your testimonies, and i hope to work with you further in the future to look at the stafford act and how we can improve the cooperations of fema with the state and local employees. thank you very much, madam chair. >> thank you, mr. cao. we are very pleased now to

welcome our colleague, mr. loebsack, of iowa who has remarks and testimony of his own. i'm pleased to receive them at this time, mr. loebsack. >> well, i want to thank chairwoman norton, ranking member diaz-balart, members of the subcommittee for giving me the opportunity to testify today. i'm not the expert, i'm just a congressman from the second district of iowa, an area where we had essentially our own katrina in june of 2008, and it's really, this has just been wonderful for me at the outset here to listen to my colleagues. and mr. cao, i really appreciate what you had to say because while new orleans is sort of, you know, at the end of the line, if you will, as far as the mississippi river is concerned and we're way up north, there are a lot of things that, i think, we have in common in terms of our thoughts about how to do this differently, and i do want to say at the outset that i think fema did a pretty darn

good job in iowa and has done a good job, but there are a lot of things that obviously can be changed, so i'm looking forward to working with you folks in the future as to how we can change things. and i also want to say at the outset, too, i said throughout when this first happened to iowa in june of 2008, there's nothing partisan about catastrophes. it doesn't matter whether you're republican or democrat, you're going to get hit by a catastrophe, and working together, i think, in a bipartisan way is really absolutely critical. so that's what i'm looking forward to doing as well. our flood in iowa was truly a 500-year flood, 85 of the 99 counties were presidentially declared disaster areas, and it represented about 85 percent of the state. some of the hardest hits in my district were cedar rapids, iowa city, coralville. it's estimated that cedar rapids alone has nearly $5.6 billion in

recoifer needs -- recovery needs. with this in mind then, consider that about 3 billion has been allocated to the entire state of iowa for disaster recovery which includes a large amount of state funds even though damage statewide early on was estimated at about $10 billion. when considering what constitutes a catastrophic disaster, one indicator would be the damages relative to community or state budgets and resources. the state of iowa had receipts for ny-'09 of around 6.9 billion compared to the estimated 10 billion in statewide technology, and the city of cedar rapids had a become of year hi -- budget of nearly 380 million. and then to further bring the magnitude of this disaster in perspective, when calculating estimated damage through fema's public assistance program, the iowa floods alone rank as the fifth largest disaster in u.s.

history. and if you take away nothing from my testimony besides the largesse, the significance of the wide spread magnitude of this disaster, then i will have accomplished something. it's my job to keep this in the forefront of your minds and the mind of the american people. fema was not, of course, our only source of assistance. many agencies were mobilized and utilized during and after our disaster. fema, for example, agreed to lower the cost share to 10 percent for all of our public assistance categories because we had to get waivers and extensions and changes to the current law, we had to work to put in place and this was one example. in addition, the application periods for fema's individual assistance disaster unemployment assistance and public assistance were extended. and numerous other waivers were granted through various federal departments or agencies. i also worked with my colleagues in the last congress to pass appropriations bills, the

largest of these funds allocated to iowa $800 million comes from the community development block grant program through hud. it's my understanding that effective use of cdbg funds after hurricane katrina continues to be an issue as well, and mention was made of housing. cdbg funds are not traditionally used, as you all know, for disaster relief, and, therefore, they're not ideally suited to be flexible enough, nimble enough. this is something that i heard from you folks, the need for nimbleness, if you will, to meet the immediate post-disaster recovery needs of states and communities. during a visit to my district that the state of iowa and the city of cedar rapids are models for efficiently utilizing funds for disaster recovery. i'm proud of that distinction, but i do have to wonder why the federal government is still looking for models of efficiency. i know it has not been an easy journey for my district, but as

cedar rapids and iowa can provide examples of beth practices -- best practices for the future, then i look forward to working with all of you on this committee, to those who are about to testify, to mr. fugate and so we can deal more effectively and more efficiently with these issues when they arise, with these catastrophic disasters. and perhaps i think maybe we should begin with a simple assumption, that we are going to be faced with catastrophes in the future. we have to just simply accept that fact. i know that in the past we said that we knew that, but i think all of us who have been through these catastrophes wonder if, in fact, we really believe that they're going to happen again because we need to be better prepared. there's no doubt about it. so thank you very much for allowing me to testify today. i really appreciate this opportunity. i'm going to turn it over now to the experts, and i'm looking forward to what they have to say an