recess will be a very robust. if debate regarding national security. everything from when the rendition report comes out -- >> of glad you say why not did. >> i think it is going to come out. you have the military emissions case in the u.s. cole bombing case. you'll have a surveillance reform and i think you will really know we are in the thick of it if there is an appetite for revisited the budget control act because remember twice now they have raised the cap said the pca, budget control act, but they haven't listed it. if they want to pull the band-aid off the bucket that in the administration makes the case because the administration did make a case larger than some people thought would happen cycle this year. we will see if that happens, then you know it's a barometer

that everyone is all in on this debate. >> i miss the beginning of a very long statement have to pay. i wanted to remind everyone of two things. one is following this event -- [inaudible] the second thing is the cq roll call t. is being gifted to everyone coming here tonight. i hope you take that away. we have time for some questions. the fact there are microphones. >> don't be shy. i see the hand of a gentleman ratepayer. >> as he went around the world company focused on the middle east. i was wondering if you take a few minutes and talk about the issue -- i guess my concern is it will be based in some way on

building a coalition of partners. two of those partners and i'm talking south korea and japan make our congress look like a budget is going to play golf and have a couple of beers afterwords. because at least my observation, things are getting more tasty all the time. >> you know, i was just in japan about a year ago i must beg in some of the folks i was talking to to make nice to south korea. both of our allies would really like to do something with you. can you come together? and boy are you right. there's not a lot of love between the two countries of the rational realist way of thinking about things is not cutting a lot of water there. we didn't even touch on asia and it's the biggest part of the world of people. i would be surprised.

we need to get allies together and i don't see that happening without a lot of massaging. >> thanks for introducing that. let's talk about the delayed first-term initiative. it seems to be at least as incomplete. >> yeah, i used to be an english teacher very went to law school and my favorite linux talkers are not good doers. but if people do not what they say. >> you have the chinese navy expanded exponentially. you have chinese making extraordinarily ex-tutorial claims. they are building. their economy is now slowing

down. i think the obama administration will not pay there, but it's going to put the pieces on the chessboard because many to do that. what is on the front page of the paper is isis, russia and i think that gentleman's question is further support for argument that we'll probably see a big debate in the spring and whether we need to lift pca or whether you need to refund and recapitalize on this decade of work. >> obama's national security adviser is giving a speech this week i believe i'm southeast asia in particular. you know, the government -- the united states government, maybe all governments tends to react to what is happening. this is a case that we need to be payor. other than china doing a lot of

hacking, that doesn't -- and the issue. it doesn't make a lot of news right now. that doesn't mean there is a groundwork being laid characters is an interesting position of one of the defense does seem we need to reestablish jungle combat training because he is sadly dedicated base and we don't have it anymore. the thinking is we are going to be in some kind of war at some point with some asian nation. but start being prepared just in case. >> jerry, what happened? it seemed like it was an intent to have an obama doctrine, a new way of thinking particularly of the third world. third world. would have been quite >> first of all, the term. it was probably unfortunate and everyone involved in policy will agree on that. it implies we're not going to do this because were not quite to do that. i think there is some of this actually happening.

it means slowly shifting resources to a part of the world that becomes relatively more important while other parts of the world become less important pair to some extent the picket called something different is still happening. one of the premises and this is clearly where the adf falls down that as we had two wars in the middle east, we can stop paying so much attention to them pay more attention here is the nation, not just policy leaders. people can shift there again for the national security debate. what we've been talking about for an hour and 15 minutes. >> another hand up there. the lady right there. there is a man coming up behind you with a microphone. >> thank you. thank you. in last wednesday's "new york times," tom friedman's column talked about an existential struggle going on within the islamic state with the recent events we've seen in the middle

east. he said among that -- [inaudible] or if anyone did read a comment your thoughts on the column. >> well, i've spent more time than is probably healthy reading islamic state literature than is healthy. but it's fascinating and quite sophisticated. i'm not sure debate is the right word here there's a vigorous conversation going on within the people who are part of the movement about what they mean and why they are different from al qaeda. there is a notion that they have embraced as a group that says essentially al qaeda was wrong. they thought by attacking the west over time you would wear down the opponents of islam and create the conditions lewdly to have a caliphate in the islamic

state. it is here. it is now. you do the right thing in the stuff people who disagree with you. i think as the islamic state movement islamic state movement grows, they're about to be people of differing thoughts in tactical terms. are we going too fast? are regarded too far? we are going to get whacked. i can't believe there's not an interesting debate about whether the beheading videos go back to the good strategic movement therefore. it is hard to know but i guess what my point is, there's a really interesting public window to the islamic state and it does reveal a lot. >> and i would add, this is not a new phenomenon. if you read andy mccarthy's book, he traces not only the birth of the predecessors of al qaeda, but the two general

schools of islamists. one is those who adhere to some form of violent jihads. isis is the most recent radical version of that. the other is a version that says no, you go this route you get more bombs. you said that kurds see. the other lawful means. the two are at each other's throats figuratively speaking. the piece that was really going on within the faction on the side of the debate. >> you can broaden this even bigger. if you back at the ratings for the whole movement really got going, it was an obsessive modernity. what was it doing to the middle east? why were they not catching up?

why would they so clearly behind the west? how did they do at that sense of humiliation and lack of agency that he was feeling and he came up with all sorts of reasons. one way the arab world was dealing with that was what was known as the air of spring was a quite healthy move in my view towards taking agency insane okay you have violent folks over here. they try to retain the ball and move forward. they failed. we are going to do this are peaceful democratic means. one of the real pity is that that movement in most countries didn't succeed that we and others perhaps didn't do quite enough, but really was an internal issue in terms of how much he could succeed on their own. one of the bill paydays is now we are back in a world of sort of hard-core islam rather than another way forward for how you deal with that sense of

humiliation. >> we've got a question that just came in and twitter and it's a great one. both veterans issues play into these terms? >> that's another they try to play out. batteries are very popular for obvious reasons. they should be popular. you haven't seen a lot of pressure from the republican side on that other than another example of how the administration is leading. >> it is a hard issue. north carolina is come up in kay hagan's case. but in general, first of all if you look at the votes come that they voted a lot of money for veterans and so on and on the

other hand you have the va scandal so appoints in a lot of different directions. in general someone is saying someone is knocking on veterans other than the scandal, which is a horrible thing to say hard to to argue. i doubt it will make a huge dance. you do have a couple of races we've got veterans running. says maltin just won an upset primary say that given a number of others. i'm sure they'll use it as a character issue. not sure it will be a policy issue. >> i don't tank that was specifically added the scandal. thank you to do was set back in. [inaudible] i think we have room for one more question. i think i saw one more hand. two more hands. there is a lady with a hand up

right there. [inaudible] there will be real national security concerns coming out. i realize this is not a midterm issue per se, but i wonder people of thoughts about what the long-term it look like in terms of national security issues. >> it is one race already. right prior senate race had an ad where he criticized his opponent spoke on the issue that i think it was health care, bio defenses and he had an ad that got criticized. that is one issuers. >> i think it goes back to the point in the budget and area where there's not any strong push for policy, but in need for

money come especially if the u.s. decides to actually invest our resources and try to help stabilize the regime and west africa. this all goes back to the question of borders all the funding going to come from to handle these crises at once. i think the would be part of the conversation. >> i think that ill-informed people maybe use it as a wedge or an issue by saying obama is getting more people to africa than he is to iraq. that's silly. it is if the strength of these is not addressed by civil society, as a factor attitude for destabilizing that part of africa, but the world.

people forget their history. they spread diseases in the past. and so i think the administration is well within their legal rights to land a hand. >> i agree it's not a political issue. last winter. i think this is going to be treated as an issue of medical need. why are people not leading medical officers take their sick? they don't trust their government. there's some pretty good reasons. getting areas i work on governance. getting serious about how we hope these government is important because this is a bad governance gets you. people who don't trust their government to let their sick be taken by health care workers and

et cetera, et cetera. we are starting to see the problems metastasize. the difference between isis and ebola is less than you might need. >> final question. >> john donnelly with cq roll call. i would like to go back to read real quick if the current negotiations fail. he talked about the inevitability of sanction. what about the inevitability of war? out the patience of negotiations kind of wearing out, what are the odds that israel and/or the united states and the attack on iran. >> that's a heavy question. yes, john. there is a sort of constant agitation for war with iran in various quarters. often the republican side, but not entirely. this is a pretty big game it the

president has made an has made in a split a lot of energy into it. now maybe he can mitigate. maybe what he's been doing allah blondeness mitigating the fear of war by talking about just how difficult it will be. there is actually a next level done so we can go harder on sanctions. we can go pretty, pretty hard on sanctions. , the we've been talking about the red nuclear program and how worried we are and how we might be the attack. whether it goes to the next level is hard to imagine. >> there's a legacy question. one of the stories i saw this week is the final presidential library site. it strikes me this is a president who came to office with two wars, one of which he was steadfastly opposed to.

i think it is now clear to them that is not going to have both of them, that were not totally out of afghanistan and iraq when he leaves office, but he sure doesn't want to have a third quarter. he doesn't want the number to go up by the time he leaves. i think anything this administration can do to avoid new conflicts while trying to do whatever they can to declare the greek in one conflict if that is say no right, we are done. poacher bet that nothing else happens. >> a boxed himself in a little bit because they doubt, promised better bread would not have a nuclear weapon. it might be hard for us to know when the moment arrives better bread had a nuclear weapons. to get themselves more room to negotiate, they've been very bellicose and very harsh in their decision of how they will

not let iran have nuclear weapon at any cost, which of course implies the threat of force. >> we also promised to close guantánamo. >> they don't always keep their promise. you're right. >> first of all, you're absolutely right that there's no appetite this administration won't be for conflict with the rain. the question is how much pressure is exerted from outside forces depends i think a lot on how the negotiations conclude unsuccessfully. there are various ways that could happen. it can in the bank on a whimper, a notion that we got really close. if not for the crazy ayatollah who is the supreme leader, maybe we should just wait. there's a lot of different scenarios in the amount of pressure to do something militarily will depend a great deal on what the endgame looks

like. >> there's also i think a lot of understanding that the military solution doesn't end the problem. they call it the bothell on strategy. about the long, the grass cars again come to you both a lot again. they recognize that obama campaign in their boots on the ground is unthinkable. obama campaign on the gets you so far. so why start down the road six years into the administration? >> yeah, i agree with everybody. i would add if there is any action whatsoever, it would be israel and we would do everything they could down the seats not do that. they will act in ways they think they have to and they made that clear. but i agree with everybody here. i don't think there's any appetite and you also see the evolving definition of what sanctions are. you go up, to the side, this

way. but we'll keep ratcheting pressure, whatever you want to call it because there's no appetite for war against iran. >> the politics of national security are complicated and our representatives come et cetera when it comes to israel as a whole different matter altogether. >> well, i'm not peaceful no, i would like to once again congratulate chose the on this first anniversary. [applause] and i would like to invite all of you to join us for you within a few moments. i would like to thank all of you for coming tonight. my name is david allis firm cq roll call. join me in thanking my guess. thank you. [applause]

>> according to a new cdc report, there could be 1.4 million ebola cases in liberia and sierra leone if the outbreak cannot be controlled. coming up today, the head of the cdc, dr. tom friedman and representative from the world health organization will update them as the congress on the outbreak in west africa. i will provide the dniester here on c-span2. president obama that the unite nations in new york this week. right now he is addressing the general family life i've c-span. this afternoon he will preside over security council meeting with the focus being on the international response to isis. that is scheduled to begin at the rear clock easter. we will have that live on espn. or also gathering your thoughts on what you think the greatest threat is the u.n. should address. share your comments on our face

the a's are on twitter using the hash tag c-span chat. candidates in the state's 10th congressional district are scaring off for a seat long held by frank wolf. the two candidates releasing the numbers of television ads in recent weeks. here is a look at a few of them. >> barbara comstock wants genic abortion illegal, even in cases of, just like the right-wing republicans in congress. they want to overturn roe versus wade here so does she. >> grow versus wade should be -- to undergo transvaginal ultrasounds. that's all i need to now. no. >> i am john foust to nypirg this message. >> trash talking politics from john foust. he is running a negative

campaign against barbara comstock. the attacks are sexist, bizarre, ignorant. barbara comstock is an award-winning legislature who gets things done. millions of dollars in school funding, brought pain jobs. barbara comstock gads results. >> i am john foust and the balanced budget we had to cut a lot of ways. we consolidated printers. we can walk a few feet. replace the computers, but kept the monitors. the phone company overcharges by $3 million. i approve this because congress doesn't need another right winger. they need someone who can balance the budget. and we definitely didn't need so many government studies. >> barbara comstock is a devoted wife, mother, public servant. she was elected to the house of

delegates were she wrote the law to protect women and children from human traffickers. barbara comstock gets results. the leadership create new jobs, save taxpayers millions of dollars and help restore millions more to our schools. barbara comstock was a trusted agent shall be great. >> i am barbara comstock and i approve this message. >> in an historic referendum vote last week, scott rejected independence and voted to stay part of the united kingdom. first minister of scotland, alex salmond who read the gas campaign for independence address the scottish parliament for the first time since the boat. he spoke for about 15 minutes. [applause]

>> i'm glad she decided to do a reflection today because the bottom of your remarks, for which i very much support and agree, actually came in exactly to the first point i was going to make in a statement. because you rightly identify that last week's referendum was the most extreme neroli exhilarating experience. a huge credit and not is due to the campaign. some of what is comparing it for previous experience of constitutional referendums. the vote of 1979 was a botch job, what this site they gained most votes was to have it put into effect. in 1997 of referendum was an altogether different experience. we should remember that referendum however successful with 60%. last week as you correctly

identified, it was 85%. the highest for any vote on this scale ever held on the silence. my estimation of the exception of a handful of missions, both sides of the debate conduct themselves an extra airily democratic civilized unengaged manner. and therefore, to every single campaign border, whatever your view with, i want to stay thank you. this has been the greatest democrat experience in scotland's history and it has brought us great credit both nationally and internationally. [applause] overwhelmingly, to safety the referendum experience. it is ashamed that journalists concentrated on negative and minor elements. because the true story from the referenda is one that had the

most politically engaged population in western europe. for both sides, that is a significant and positive fact to be reckoned with. we need to retain and encourage the people sink hvac, vitality. nothing is more important for the future than now. a couple of caveats towards the end of my speech. right now i want to focus and so i will concentrate on two points in particular, which are priced from the referenda. the first is there is not a shred of evidence that 16 or 17-year-olds should not be allowed to go. [applause] the engagement in this debate, discrete constitutional debate was second to none. they proved themselves to be the committed citizens we always believed they would be. everyone in this chamber should be proud of this chamber is per session to widen the franchise.

there's an overwhelming and unanswerable chase for giving and 17 euros support in all future elections in scotland and indeed across the united kingdom. this parliament i think should make a vote to westminster to make this happen in time for next year's general election. the second question, which is one that is already asked by many people, where do we move forward from here? from the moment the referendum became clear, that means that both the u.k. government and the scottish government have committed to the referenda have been working together with the best interest of scotland and the rest of the u.k. i believe strongly in that section and the eden berg agreement that it was the right issue for the scottish

government in the same way that line issue for the u.k. government was not to have people max on the ballot paper in there for the scottish government would fail to section 70, because we insisted be an agreement. that means the scottish government would empower the scottish government and the scottish people. who people. who will bring forward constructive for doing exactly that. this intention to the prime minister within minutes of the result being confirmed. that is how the scottish government intends to proceed. i welcome the appointment of a trusted person who in recent months has governed, in recent years we should say has governed great service to scotland and to its oversight of the organizing committee was outstanding and exemplary. i should say david cameron surprise me and i suspect others in this chamber with this statement less than an hour

after the outcome of the referendum was concerned. he said in that statement a change in scotland should be in tandem and a case he didn't understand what that meant, at the same pace as change of name one and the rest of the u.k. all of us will not recognize the entire process to delay confusion. they were directly also contradict the clear commitment made during the campaign. i should say the briefings from down the street yesterday afternoon was fairly different from the mortgage statement. that suggests that the u.k. government to understand the commitments during the campaign is crucial, but they do have the understanding. for this parliament, we, all of us have a responsibility to hold westminster's feet to the fire to ensure that the pledges are met. that's not the job for the

scottish government. it's one for all parties in the parliament. indeed, we might argue a special obligation on the promise for the devolution is essential that they deliver. but they should understand this will pit the two gardens of progress i'm not the political processes that westminster. other political in this chamber, and they are the energized electorate this nation. they will not tolerate any equivocation or today. i was sacked yesterday by the statement of the scottish congress. and i suspected that statement he captured the feelings of many, many people in scotland. this is what he had to say. the guy said it was meant for meaningful change is built up in the last two years is impatient for change and will not accept minimalist proposals developed

in a pre-referendum context handed down on a takedown with the bases. they're not going to be passive participants in the process or tolerate compromise. the sooner the politicians recognize the civil society and communities in scotland is to deliver a comprehensive devolution the batter. it is absolutely correct. in every community of the country, the final outcome cannot be a last-minute deal between a small group of westminster politicians. they've already recognize the capture of the referendum debate. all of the should support the commitment to genuine consultation. after all, one thing we now know as proper consultation and debate energizes people rather than distract them. it is worth remembering that sense that you can berg agreement was signed in 2012,

the number of people unemployed in scotland has reduced by 40,000. we now have employment in scotland have the highest in scottish history. we have the fastest rising female employment at her in scotland. the economy is come out the great recession ahead of the rest of the u.k. and has outperformed every part outside london. visitor spending in scotland has increased exports of the scottish government has increased new bills into the parliament and we have delivered the most successful commonwealth games in the history of the commonwealth games. i mentioned that in passing because in the last parliamentary debate before the referenda, the way in which scotland has been on posit the biggest issues facing our country, scotland was nonplussed for the referendum. as they fast-forward on the economy as every statistic

indicates. [applause] proved that really has this in tension and introducing ushers to alleviate the effects of westminster legislation like the coastal reduction scheme to help 500,000 of our fellow citizens with the bedroom tax alleviation to mitigate the impact of the bedroom tax. asking ourselves as a country that was sort of nation we want to be isn't something that is separate from good government. it is part of good government. political confidence in economic confidence comes together. all of us have a responsibility to maintain the political confidence and self believed to enable or empower and engage the election and delivering changes to devolution. any improvement of the devolution settlement would require consent motion hearing

this parliament said there is a clear rule for this parliament in considering what new powers should be delivered. though that would you range of views and proposals. the scottish government's view enhanced devolution settlement would pass three key test. it should a+ to make scotland a more prosperous country. the jobs tax in particular creating powers are important. they should allow us to build a fair society. we need to address the deep line causes of inequality in scottish society and should enable scotland to have a stronger and clearer voice on the international stage. the labour party less than two weeks before the referendum promised scotland and set the united kingdom. they try to deliver the parliament, but also the ambitions of the people of scotland. the new economic powers did not in any way to buy a scotland.

the pope made is clear for the continuation of the resources among the powers of the parliament to raise revenue we can state categorically to the final say in how much is spent to the national health service will be a matter to the parliament. the delayed westminster parliament in devolution at least the former is essential as the basic knowledge until or unless scotland has controlled of ball of her own resources. the u.k. parties will stay true to the promises. we need to ensure that the scottish parliament is an entrenched in legislation and can never be therefore abolished or diminished by westminster. that again is missing from the parliament's emotion that

westminster. and while making that important change, the united kingdom government should finally give us to the basis that they see all convention of legislative consent motions. overall, there is a great opportunity for this parliament. we can work together to help the u.k. government to deliver as promised for this chamber. we can do so in such way that deserves and sustains courage and interest and engagement of the scottish people. there are two caveats i wanted to add to the usually positive nature of the referendum process. both above the criminal law and therefore are worth including in the statement. there is the outstanding matter of that briefing of the evening attempts of september. 45 minutes before finished. we need to establish the circumstances of justification for this briefing and how it can be anything other than section

52 of the criminal justice act of 1993. secondly, the scenes we saw glasco are just clear friday night cannot be calibrated. we expect to know that scott will take proper and necessary action against those who indulge in prearranged against the peaceful demonstration. the sole force of the law will be enabled and be expected to make sure we eradicate such behavior of scottish life. [applause] the mac what i believe to be the speech of his life spoke in this parliament in 1999. it is right that at one point on the discourse of the scottish invite meant, as enabled from the past, which is hoped the

modern scotland. will be seen in these last two years is a new discourse of demographic enlightenment. scotland now has the most politically engaged population in western europe and one of the most engaged if any country anywhere in the democratic world. this has been a hub of peaceful passionate discussions in the work place and on the streets of scotland. across scotland, people have been energized come in to say politics in a way which has never happened in my experience and i suspect in the experience of anyone in this chamber. we have seen a generational change towards independence and greater self-government and also in how politics should be carried forward. we have a totally new body of politics, one that is speaking loud and clear. all of us, all of us must realize that things will never be the same again.

whatever we are traveling together, we are better nation today than we were at the start of this process. we are more informed, more enabled and more empowered. as a result of that great national debate, my estimation will help us make a fair and more prosperous and more democratic country and all of that, all of scotland will emerge as the winner. [applause]

>> at what you shouldn't post.com, the country will vote and chrysalis is also editor says yes, i am still excited. he is joining us on the phone. after being with us.

>> thanks for having me, steve. >> was talk about the senate races committee senate races committee issued that will captivate attention that will control the next congress. right now you say it is still a tossup. >> i think in some ways that is the storyline and important one. today it is a tossup. i think you put a finger on the scale for the republican party. we are still talking about the fact that democrat don't have the most likely outcome, but a past to retain their majority. why do i say that? when we started the election cycle, you look at the wrong numbers and where some of these incumbent democrats were going to have to hold seats. places like santana, west virginia, south dakota, alaska, louisiana, north carolina. these are places that are by their nature hospitable for the democratic party. that is particularly true given what president obama did in terms of his approval rating had

suffered a lack of max baucus retiring to become ambassador to china. kim johnson of south dakota recovering. they've got a lot of cut feet from the start and breaks in terms of her attire made. not anywhere close to what they would like to see. and yet, it is not a slam dunk by any means republicans in the 60s they need. >> we now know about jeb bush will be in kansas for pat roberts. also former senator dole in his home state earlier this week. what is going on there? >> under the radar is the kindest way to poker that race is. this is not erase anyone thought

competitive. in kansas, this is the state that has not been a lack of it. but not one federal race since 1932. what happened? good question. we saw pat roberts is one of the handful of incumbents that had a primary challenge. he wound up winning the race. i think pat roberts assumed. he didn't appear to pay much attention. and now he has a real problem. the independent wealthy businessman. normally independent candidates we would ride off. what is really generated support and excitement and chad taylor, the democratic nominee dropped out of the race and got his name removed from the ballots. now we're looking at a two-way

race whether he would caucus with democrats or republicans if you want. see you in the people around who know the problem that they have. i don't know if they have the time to fix it. >> we are talking with chris cillizza. a new poll showing kay hagan was in the margin of error. in most of these polls she is slightly republican tom tillis. >> if he had gone over the map a year ago or 18 months ago, i would've said mark pryor of arkansas, mark begich in alaska and kay hagan in north carolina. she beat elizabeth dole six years ago and obviously a very good year to be a democrat in 2008, particularly in north carolina. relatively ill-defined. people didn't know her. and yet, she has withstood tens

of billions of dollars of outside spending against her. as is where americans of prosperity, koch brothers, probably spent the most money in television and our numbers continue to sustain. i think a large part of that is tom tillis, speaker of the state house. ps the person the republicans wanted as their nominee. but he has to on what has been a controversial and conservative state legislature over the last year. this is one of those races i tend to think most races, particularly federal senate races are dominated by national issues. this is where some state issues in terms of how people view the state legislature, the governor republican branch played more of a role here than in other states, both because of tillis as the nominee and the controversial things for state legislature, which is republican control has done over the last few years. ..

obama. fighting his agenda and at and at the moment and most of those states that is a pretty powerful message. >> in the year that is a good year for republicans as the president has known the sixth year they've gone by 20 percentage points and as you point out in your piece governor scott of florida and rick snyder in michigan all facing some serious challenges. >> the the governors races are different in the senate and the house races.

it's like kansas for example. what you are seeing is the states where governors if you look at the partisanship they should be in perfect shape and kansas is a great example and another republican governor in the state enacted a very conservative agenda in that state and basically split the party into between moderates and conservatives he would identify with and that was behind a state rep dot -- dan malloy should ensure if you win well, dan malloy is in a dogfight and i think behind that to tom foley who's the nominee and he lost

around 3600 votes so under 10,000 votes and what is interesting is that the lowly is being attacked and pushed to pass a lot of gun control measures saying that was too much of an overreaction. another example of the democratic governor is a pre- democratic state and many of the people are not what you would call swing states. >> we will look for your work online on linux "washington post".com. thanks for joining and you battle the autumn cold. >> i think i'm on the good end of it. >> thank you for being with us on c-span radio.

is the former director of the israeli missile defense organization talked about the

recent israeli-palestinian conflict and discussed the effectiveness of israel current air defense system known as the iron dome. this is just under an hour. >> good morning. i want to thank you for the arms control and defense policy. we are honored today to have ruben who many of you know is the father of the arrow system and ballistic missile system in israel and will be talking about the missile or and some aspects of iron dome. also want to let you know that the seminar series continues on the 25th of the month with the general who is the vice-chairman of the strategic vice chairman of the strategic command, and we will also have scheduled

performer head who will be speaking us in october in the dates to be determined. the space series continues on the 19th of this month. the new space command commander will be our -- will introduce the two speakers from oklahoma on the house armed services committee and the space committee and he will be joined by the high-ranking air force acquisition official who will talk about space acquisition reform, threats to our space assets and secure access to space for our military. on the 18th of this month, we have as you know a triad event in washington, d.c. at the army may be club and i have 200 guests 185 seats so if you knew anything about alchemy, let me know. we also have the bible they come an abiding way, the 18th, the first time in history we love every major nuclear command

represented by a speaker. i want to thank our friends from hungary to england, denmark and israel for defending his being here today and in particular i want to say hello to my friend who is here, representative hello at georgetown university. michaela from the heritage foundation who does so much of their missile defense work and my dear friend professor curtis from the naval academy in annapolis and my sponsors from going and also the congressional staff and i also want to say thank you to all of the military folks that are here today that give us so much and i also want to say thank you to the marshall institute here today filming this event will -- will be broadcasting this event intermittently as we go on.

if you could let me know that you're attending and give a warm welcome to our friend from israel, uzi rubin. [applause] good morning everyone. it is always a pleasure to be here in this magnificent venue. i was scheduled to be here two months ago. i would like to give you some kind of summary and at that time there was no summary. it's a good time to sum up what happened and i titled my presentation and a talk about

the missile defense and the threats and the structure of the strategies. israel is the military defense iron dome mentioned another system here and i will not forget the critics got woke up again and explained so i will educate some words to that. all of the material that you see as the public domain including not using any confidential information here but based on

the open-source material i want to stress again that all of the views and opinions here are my own and don't represent this is a really the views and opinions and some of my opinions are controversial in israel, too. on july 6 the cease-fire pertained with some breaks during the 20 months since the operation of the defense and the reasons for that are controversial and there is one school of thought on the change of events and there's another school of thought that it was deliberate and planned by the factions. this probably causes a lot of historians and analysts to make other causes of the war and in

july 8 we express one aim once again to express the rocket fire by the military and/or the political means. hamas, interestingly, we rarely express objectives specified in the speech and he demanded a list and a spelled-out border crossings and the international directive obligation to support in gaza. but if you go down to what they mean they mean practically with open borders to the rest of the world and the weapons that it

wants and without any obligation to the peace to israel and committed to the destruction eventually. so with this gap and the distance it didn't hold out and hamas broke up the cease-fire will and still holding on and the debate remains debatable whether it will continue for about two weeks now. hamas also [inaudible]

in the operation skipping over this and concentrating this on the rocket assault in israel and be active defense, so we have the two charts that look similar but the left one is by the defense courses and the right one is by hamas to attend is interesting how the graphics are the same. except this is palestine and at the borders on the province's. however if you look at the classification, they show the rocket and let me say here what

is the medium range into the long range it is completely different. it's one of the main cities in israel is the distance from the airport to where we are right now. so, that is a middle range. everything is a microscopic scale. they talk about the sizes so long range is something that can reach tel aviv in the come on matters about the distance and long range can reach here to the 160 kilometers. let me go over that type and again, skipping back to some of the short-range stuff from libya to see the rockets and a

homemade rocket made from sugar and fertilizer and the drainage pipes. and the classic that had thousands of them and this picture by the way was taken in iraq. so they had all those types and now before i go further what happened in the than what happened in the last year in hamas established the long-range markets and sugar and fertilizer don't work anymore and you need

chemicals and pipes and fuses and explosive and the experts it is highly complicated so you need the machinery and they help them and before that they supply everything and it was an underground highway. everything could be important and during that time what it says is there is the need to smuggle big rockets.

so it is going to be smuggled and much easier you can smuggle in instead of the whole rocket but interestingly into the islamic jihad. why is that? because it is reported it was called down to two separate industries and one is a finishing factory so let's go on to the medium range rockets 20 to 35 kilometers now they are

making their own rockets of this type. gaza in last november the rockets main piece of pride is beyond the tel aviv and this is about 5-inch pipes. the designation propaganda basically talks about the same variation between hamas rocket but from our point of view it's about the same. the rockets and the launches are

completely manufactured inside gaza. but they are also manufacturing data which way they displayed last year. it is quite an elaborate piece of machinery and it shows you what level of support and this stream you need to smuggle in a lot of components. interesting enough it is end the 75 so that we understand what it is. so it is very, very important and it is a smart way of looking at the sheet metal and remember

because we see it later on again it can reach tel aviv and beyond tel aviv. they had a large number of them in the defense and they were mostly taken out before the fighting started. some of them remained but the important thing is they get about 150 kilograms while it is maybe 40 or 50. it's carrying the rockets and it is locally made.

it was transported to iran and from there the ship went down to iraq and then it was captured to transport &-and-sign to gaza and then the ship was taken away because it was abandoned or something and they knew nothing about it.

perhaps it is this type of rocket but there is another possibility. it is one of those that is then tel aviv and it was collected into books like a bigger. the numbers are very low. they say they fired 11 and it looks more like a locally made attempts for the beginning of the long-range markets. you can see the distribution and

there are other groups, too. it is not only this organization. but another three or four or five smaller organizations all of them branching weapons and to some extent now that is the important jihad and you can see the short-range and medium-range and the one that can reach tel aviv. there's 40% manufacture so it is a very significant development which is an advantage and also a disadvantage because it can combine the factory and it's very hard not to smuggle again.

so all of this was at the disposal in july 6 and i recorded a number of the filings if it falls on or explodes the numbers here are interesting. one interesting thing is that the highest number of almost 200 day is still lower than the largest number of year and a half ago in the defensive shield almost 300 rockets and bombs in one day. maybe they were saving on the ammunition. the other that you see is slowly going down on time until the

fire and then there was the period and you can see they were fighting breaks out again and we call that phase number one and again it went up but it changed the nature. i will talk about that kind of the policy. the sources have different numbers by almost 10%. now this isn't new after lebanon but i look at the same numbers

and there is a difference in that because it depends what it recalls. i have several other submissions and this is the number i of the lead. the total rockets intercepted 735 and this is a fair number that i have heard several times and a member of the the number of fatalities we lost 71 people, but only to rockets. in the second lebanon war we had 161 people killed out of which 53, one third so nothing this time. this is the pattern and here is the map of the communities and

the cities in the hinterland of israel. you see the numbers are very impressive and if we look at this town here of the 370 rockets, those are not, they were aimed at the city. some of them didn't fall in the city that they fell in an open field. tel aviv a lot this didn't include the gaza strip it says it is the gaza envelope. it's one major city food safety attention of the 182 times and the rest of the envelope is

about 20, 25 communities altogether an aggregate of the majority more than 2200 hirings mostly probably this is hard to say and it takes weeks and months to distinguish but it was aimed against the communities in the envelope. what was the strategy you can learn and guess from the pattern of the filing and in the outlined community is the obvious attempts to spread out the early defense they knew they had a limited amount of defense and the idea was to achieve that and ask that's how the allies in the neighborhood and we had some

palestinian organization in the west and the east so the idea was obviously too see the differences. obvious attempts to pretend the target they fired again and again. they showed the stoppage of the flights at the airport and it is a great success. it is one of the main achievements and they saved one of the gas fields nearby and it is within the range of the medium-range orchids. i don't have to explain what the significance of that is, so obviously there was this attempt

in the economy. the psychological effect the main time was prime time in the evening. at the time is approaching. why? since they were taking pictures in jerusalem and tel aviv it was a psychological warfare. i made that effort not to be caught during that time. [laughter] that was in the beginning. later on they wandered around and in the second phase. again they sold us achievement.

you can see the dozens and dozens of the rockets and targets. there was the attempt to break through the iron dome by flooding it. it didn't succeed. a few days into the campaign, you can see the policy was going down and becoming lean and they prepared to extend to the campaign in the second phase

when they shifted to the third communities we saw a single rockets. obviously they were saving ammunition. there is a possibility that they are already approaching the bottom. the launch is 8 kilometers by 60 kilometers. they dug everything underground and we don't have time to show videos and how distaff and underground shelter and journalists took to the hotel

window. what we can show is what they did was human shielding. they were located in places we attack them and causing a lot of damage. i think this is a hotel in gaza. here you see it is as being fired and i'm sure people have pictures of the house and they can identify the street and the number for which it is firing. they can't take it out because this is a residential area and there are innocent civilians so human shielding was a deliberate policy and i saw on the news this morning that the inquiry about the abuse of human life they made an admission that in

some cases was within the populated center so they had to do it. so this was the policy and strategy. let's now go to speak about it. both offensively and defensively and because the main topic is israel defense and missile defense i will speak very shortly but it doesn't mean that it wasn't used successfully. one point is that this is the map of the district area and this is a neighborhood close to the border where most of the fighting took place and it is the point for which the rocket fired because if you see it from above we can pinpoint where it

was fired from the same it was no problem to go there and we took them one by one and finally finish all of them. so we had the navy and the munitions and precision guided missile fired from the ship and again i don't have time showed the footage of that going in and the media market is taking it out. remember that captured by the israeli ground troops and the objective of the ground offensive wasn't take-up along sure but several were taken out and here is one of them. i hope they took it back but i'm sure they probably blew it up so this is the only thing i'm going

to say about the ground operation and i could fill the whole presentation just on that but with your permission i will go to the iron dome which again i won't speak of civil defense. in my hometown but we didn't get a lot we could hear that it potion rattling the windows but nothing came our way. the iron dome and action and this shows the deployment. this is the based on the published material and the announcement of the interception took place so when i heard they intercepted i realized you cannot do it from tel aviv. when i heard from the first time

that they were intercepted so this is one command and the other is to buy no way show the size. so you see that most of the large communities but not all had iron dome defense at their service and another point is that iron dome does not engage every single rocket that has come its way. rockets are going to hit in the defendant zone is designed by the air defense command which is specific for each target and anything that goes out it goes

to the open area and is allowed to fall harmlessly there. nine batteries, five or six at the beginning and three more goes up into emergency basis. here is the problem because they were contradictory. the defensive shield was a publication for which each major population center we could see how many were fired and how many were missed and how many were shut down. this time the information was partial and the total number of the rockets ended the number of interceptors were 66th and

everybody knows now that was a decision that it could be destroyed unfortunately people didn't realize the psychological political meeting and allowed to fall down. it should have been destroyed anyway. if you look at the record is scored better than 98%. they have a good formation and the total number. we have to pick out the rockets from coming in so it scores of

96%. and let me say that away beyond the sub mission of the design of themselves this reflects the population into the technology and the teams and the nurturing of the strategy, tactics and all of the engagement. the numbers are not really sure. if you take the cities and add them together is about 1700. 735 and now how many rockets lead through the defense. i arrived at this number from all kinds of sources between 1885, something like that. so the score is 90% and a little below the area to the timeline

was shorter and it was about 70% which is also very good. they would be very proud of it. it is lower what they put in and say policy of israel used to be every two or three and this time most of it was on single fire to which 90% for single fire this is amazing. i wouldn't believe it. they knew that to the iron dome security. let's look at some visual

evidence. this is a part of something sticking out during the explosion. you can go to youtube and spend nights but let me look at some with some significant footage. people went out to see the

sights and i ask my fellow citizens don't do that. it can cause a lot of damage and harm. what's interesting here is the explosion and you can see the iron dome [inaudible] in the first few days.

this was taken with a smartphone which i think should be done but it was by the spokesman. the point is real but you can see how they come with large bullets and above significant one [inaudible]

you see the two rockets coming out. look at the iron domes are doing the first one hits the target. [inaudible]

this brings me to the skeptics. some people are not happy. they don't like to see this working and i can give you a whole presentation on why -- a professor at mit is a respectable professor with free textbooks that are widely read and they have several publications that rely on something that was published before. one of the claims as we will

explain in a minute the scores are much lower mostly 40%. that is why there are so many few casualties with explanations by the civil defense and they are going away because -- some serious reasons it makes it smaller so it makes some kind of sense to argue those points and i go into details now let's take the first claim. as a respectable experts the books were read into it the rocket from behind. if you had it from the side it is no good, you have to hit it from the front. this is a good standup material.

this is a picture on the publication about a month ago. look at that picture. he stays parallel to the ground but from this side, no good. and he is actually seen by things of it comes from behind, no good. so let's talk about how reliable those pictures are and i will show you some examples. [inaudible] that huge missile was a passenger aircraft over the

pacific ocean. now you want to see a diving missile look at this one. you see at biting into the ocean the operator isn't worried because it is a satellite launcher and wireless going into the ocean ocean it is climbing very high into space. of those rockets that you saw before our climbing very high towards the target. when it goes above your head that looks like it is climbing. so that much and i kind of wonder if one day he will see the system footage and let me say that [inaudible]

so much for that but let's look at the claim because it is the best way to see the dormitories go back. they are driving back from jerusalem and the rockets are coming up, to explanations and i look below to see if there is a third explosion but nothing. nothing hits the ground. but this is a time lapse. it's climbing up and maneuvering the iron dome is designed to intercept. they are world experts in what

they are doing. let's look at the number of casualties because people are taking -- the second war, the defensive shielding and the present conflict. let's look at the number of battles and each one. in 2006 we had no battles and there were 4200 rockets fired. short-range committal range, communities were hit. the envelope was hit and the same mix of rockets and we had several defense to take shelter and if you take the statistics of that it means that you talk about 79, 80. if you look at the 2,012th there

were 69 rockets and again now that i rockets are much less. it takes 320 rockets to kill an israeli and it's one quarter. they run faster to the shelter? no, same thing. 2014 we had nine batteries but hundreds of them fell into there were two fatalities but still i take them into account because maybe we should have more batteries covering so we went down to 2,000 rockets to kill one in israeli. we didn't invest in the

shelters, we invested in the iron dome. either that rockets are becoming one 20th of the fatality of the iron dome works. now you take your choice. [inaudible] business graduates like numbers. we like charts so you can see the fatality going down and orders of magnitude and if you look at the numbers and figure out what would happen if it were still 80 rockets per fatality

[inaudible] at least 60 israelis are alive today because of iron dome. that is another damaging indicator. there is a special tax dedicated to things only for that assurance as by now the numbers established would have 5 billion, about one and a half billion. for everyone for the damages that were heard. doing the fighting they have officials in every community that was hit.

it is painful and is made by so you can get some notion about the extent if we had about 40,000 rockets, 4,000 workers. each rocket generated seven. willing to behold in the gaza that were damage claims on one third and now the number is from september 3 to last week. it may grow a bit but that was the end of the filing.

there were 2400 claims. if it isn't damaged that means the rocket that end it. this information doesn't have to be talking they did from equations. this is public information. it has to explain that. in my mind and i'm sure yours, too the iron dome works and it saves lives. and again, that number is down and we have no defense. the last claims it is reducing

the size of the warheads. let me show you and let's watch that together. what is this called here? [inaudible] it is designed to kill. so no small warheads, little damage with few casualties. i i want almost to complete my

presentation that i need to mention another which was the air defense. there were about ten reviews made from the assemblies and they were designed by the commercial stuff. but also they probably can be used as cruise missiles with explosives. but apparently intelligence was aware of that and this is a us-made battery deployed and

waiting. at least two and a probably a probably a third one was shot down by great success. let me congratulate them. so at least three, probably for. i don't know about other parts of the book but it's a hostile target taken down. so this is the action and i think it is a small target. it is quite an achievement. i want to come included here. i cannot summarize the war because it is a possibility that in two weeks time there will be

another round of violins but what happened july 8 and august 26 it was one of the heaviest. the iron dome didn't have much else to say. it destroyed nine out of each time that came down. think about that. they are men, women and children and the iron dome and able to them and life went on but about 95% of israel went on.

it secured the daily life and was functioning it could be done because the iron dome was there. the israeli government had the leeway and wasn't pressured by the damage to the important cities. i think that [inaudible] the team that created the iron dome in the engineering or cost-effectiveness group of $50,000 about the price of a new car in israel, not the united

states. think about this and the cost of one apartment that you save. and also i need to mention that the air defense command walking to the working around the clock i again wish to congratulate for the successful and i want to express my feeling of gratitude to the president, congress, people of the united states for the general support of the missile defense and especially the iron dome system people are walking around today. thank you. [applause]

>> i'm richard helmand into first i want to thank you. we were in the support mission the first half of august and saw the smoke over tel aviv on the first day and it felt good being under the iron dome and the other systems. second, two brief questions. after all these years with respect to gaza as an israeli citizen how would you say that is working for you and second, -- >> and giving up the land like gaza for peace how is that working for you? and the second for the missile defense in america, i know there are great differences, but how

would you evaluate as a professional our missile defenses in an america with what you have in israel >> with your permission, because it is a political question and i chose engineering, not politics so i feel uncomfortable about that. it is the same threat that is facing the same type. they are very effective weapons and you still like that which is equivalent in the iron dome yes?

>> bill sweetman with aviation week. the iron dome -- >> can you put the microphone closer because i can't hear you? >> the iron dome was developed quite rapidly. what would you say is that is the lesson for the other missile defense programs -- i'm sorry, but again i can't hear you. [inaudible] >> this is an emergency program

into united states and there is no problem with having the program at the same rate. we take the best engineers and managers and give them all the money they need. but you can't do it on a regular basis for every program otherwise you lose control. for the specific program you can do that as it was made in israel the >> have you seen any more sophisticated threats like any guidance on any other missiles were using tactics like trajectories and things like that to avoid iron dome or are they still using mainly unguided projectiles? >> the conflicts are unguided.

>> doctor curtis from the u.s. naval academy. my question has to do with the missiles -- within the vicinity of the reactor. >> [inaudible] >> nothing hits the reactor. as the next summit is the next summit hailed within the vicinity and i wonder is this an escalation of target selection on the part? >> yes. it's an escalation [inaudible] if nothing was surprising. this was expected to.

>> charles perkins. two quick things. one, there's been a lot of discussion about how to prevent the next round, how to stop the smuggling. how dependent is hamas on an internal ability to manufacture inside gaza versus stopping outside sources? and second, although it isn't directly on the topic, there was a very comprehensive look at the iranian ballistic missile program which obviously is related to what was going on in gaza to some degree and there was a concern about the phased active approach here. i wonder if you could just spend a very brief time talking about where the listed missile program was going. the >> they are very dependent now in the manufacturing and it is a

decision not to rely on the full scaled rocket smuggling but they see it reaching the proficiency so they continue. to what extent they can smuggle independently and how successful they are some of them are still walking and smuggling continues and now we have to smuggle the materials and it is much easier. let me say very emphatically it goes on as energetically as before. for some reason but i don't know why the program goes on before

as the middle and the long range rockets. >> you do wonderful work. [applause] >> thank you and come again next year. >> coming up in a few minutes about 12:5 on c-span2 we will bring you live remarks from the head of the cdc doctor tom friedman on the latest of the outbreak in west africa.

the >> barbara wants to make abortion illegal even in cases of rape and incest just like the right-wing republicans in congress. they want to overturn roe v. wade, so does she. -- that's all i need to know. >> i'm john foust and i approve this message. >> trash talking politics foust has a dishonest and negative campaign against barbara comstock, bizarre, insensitive, ignorant. don't be fooled by foust. barbara comstock is a legislator that gets results. foust or to the wall that protected and children protecting and john foust talked

trash. barbara comstock gets results. >> i'm barbara comstock and i approve this message. the >> the balanced budgets we had to cut a lot of waste. we can walk a few feet. we even discovered the phone company overcharges by $3 million very i approve this message because congress doesn't need another right wing they need someone who can balance a budget. and we definitely don't need so many government studies. >> barbara comstock is a devoted wife, mother and public servant. she was elected to the house of delegates where she broke the law to protect women and children from human traffickers. barbara comstock gets results. her leadership created new jobs, save taxpayers millions of dollars and helped restore

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>> according to a new report from the centers for disease control, there could be 1.4 million ebola cases in liberia and sierra leone by the end of january if the outbreak cannot be controlled. coming up we'll hear from the head of the cdc, dr. tom frieden and the world health organization dr. keiji fukuda on the list developer with the ebola outbreak in west africa. this event on capitol hill is hosted by the university of pittsburgh medical center. you are watching live coverage here on c-span2. >> we are very excited to have so many people interested of course in this critical, critical issue. i would like to thank anita far effort to pull together this event. thank you so much. i would also like to recognize the upn see center for health security for hosting this event. that you for that. i would like to turn it over to thomas inglesby, our moderator today to introduce our

distinguished panel. thank you. well, thank you, so much and thank you, senator coons, senator flake and the senate foreign relations subcommittee on african affairs for cohosting this event with us today. welcome to our distinguished guests whom a letter just in a moment, and welcome and thank you all for joining us today for this very important discussion. we are very glad to see spenders will so others can take part in this. for the leader don't know, our center, center for health security, upmc we're a nonprofit organization dedicated to protecting people's health from academics and disasters and we're so pleased to be a today with you. we are here today for discussion of the urgent ebola crisis in west africa. there've been estimates in the last few days that project as many as 20,000 cases of ebola by

november, and as many as 1.4 million cases of ebola by the end of january, without an immediate and massive scale and successful response. in the affected countries there's terrible consequence and academic hardship on the crimper doctors and nurses have died in high numbers, health care systems have largely stopped functioning even for normal health care but ebola combines extraordinary case fatality rate with the capacity to spread by contact, and inability -- prevent with vaccines, and doubling time as short as 20 days. there's no other infectious disease like this. disease once relegated to remote villages is now threatening to ted gold in major cities in africa. -- to take hold. to our major new efforts underway by the u.s. government and by the w.h.o. and other governments in the world. cdc is making its largest international response in history.

what someone the people on the ground in west africa, hundreds of people in the cdc emergency operations center in atlanta provide expertise, contract tracing, et cetera which will hear from dr. frieden. u.s. -- protection kits, and its people are moving 100,000 units of ppe to west africa personal protective equipment in this department of defense is providing 3000 u.s. forces for the response establishing a regional staging base to facilitate the arrival of equipment and supplies and building ebola treatment units and preparing to train hundreds of health care providers. we know w. h. us create a roadmap of response, providing expertise in west africa and is seeking funds from governments around the world, and ngos like doctors without borders are heroically leading a clinical effort on the ground. in our discussion today we are going to hear about the

situation on the ground in west africa by people who have been there quite recently, and who are leading the effort. we will learn about what the us government is doing in more detail and perhaps most importantly we are going to discuss measures we can take to end this crisis in the time it. each of our panelists will give opening remarks for about five minutes. after that we will have a panel discussion and then turn to questions and answers from the audience, and from twitter. so we have four speakers today. we're so fortunate to have given all that they're doing in this response. first, jeremy konyndyk was the director of the usaid office of u.s. foreign disaster assistance. tom frieden was the correct of you centers for disease control, and cofounder of one or decision, and andy webber was the assistant secretary defense

for nuclear chemical and biological programs. we are sorry not to have keiji fukuda on the agenda. we thought we had keiji until 24 hours ago when his boss, w.h.o. jan said she needed him in new york today. so with that, i'm going to turn to jeremy and if you're free to make your comments from their or come up to the podium. whatever you -- >> thank you very much. and thanks for the opportunity to speak. it's great to see this level of interest here on the hill. this is a remarkable challenge, and i think it will take, it is taking whole of government and will take a whole of society response for us to fully support the government government in tas crisis i think the level of public engagement and interest we're seeing is a crucial piece

to our ultimate success. i will talk for just a few minutes about the overarching u.s. strategy the president laid out last tuesday, and usaid specific piece to that and then turn over to my colleagues to go into more depth on their agencies respective pieces. as the president laid out on tuesday we have a four pillar strategy that the u.s. government is pursuing across all of its many capacities to try and control and hopefully defeat this outbreak, but also to look beyond the immediate outbreak as the longer-term needs of health systems and the resilience of these countries to what will be likely future outbreaks of this as well. not that this is in the environment as we've seen in other countries, such as uganda and drc, is likely to recur again and we don't want this whole episode to result the next

time that happens and we do know from those of the countries that this can be controlled when there's sufficient capacity to do so. so the first focus, the first pillar is to focus on controlling the immediate epidemic and the immediate outbreak. the second pillar focuses on mitigating second order impact, so that things like food security, economic stability, political stability, and ensuring that as these countries struggle with the immediate outbreak, that we don't see second quarter impacts that are equal to if not greater than the outbreak itself in terms of human impact. third piece is to coordinate an effective global and an effective u.s. agency response. coordination with the critical to the success of this both at the country level and at a global level. the are many, many countries that are looking to play a role here, and being any major

response that we undertake there is a large coordination element, hundreds and hundreds of ngos that showed up in haiti are a well-known example of that. in this case it's even more critical because this is something that none of us has ever done on this scale before. and so having coordinated action is all the more important for that reason. and the fourth pillar is fortifying the global health security infrastructure such that in the future in these countries, and in the region beyond, there is an ability to prevent future outbreaks of this magnitude. it's critical for the long-term, the long-term future of these countries but also critical in the immediate term that some of the neighbors to nazi outbreaks on the scale. and i think the fact that cases have popped up in a few of the neighboring countries so far not triggering any major outbreaks is an indicator both of the risk but also of the potential to keep this managed with swift and

decisive action. just to speak briefly about usaid's role, the office the highly, usaid has any role in the federal government is the lead coordinator for international disaster response, and so in that capacity we have sent the dart team to the region that has representation from across the interagency what it works close with a larger cdc team that is also there on the ground. has cdc representation on the dart as well. the focus of the dart team is both too corny care agency input and also to deliver and execute on usaid's pieces of the response. our current focus, and i will reiterate everything that the president has already announced, but our current focus is along five lines effort. the first being effective in country management and leadership of the response, and so we are very least to announce

that as of today the liberian national emergency operations center has opened officially fix all of the elements of the library in government coordination now sit under one roof after great deal of u.s. government support. the second element is to focus on scaling up isolation and treatment. so we are focusing heavily on getting etu set up and working in that effort. the ebola treatment unit, excuse me but if i use acronyms that you also recognize, please just raised a hand. it's hard to think about. fairly ingrained. the third piece of that is burial. and we are on track to have, we are on track, i think that's one where we've seen the most rapid process, one of the more easily scalable piece of this so we're on a good track there. the fourth element of this is infection control. more broadly within the country

and a big piece of that will be community care strategies the president announced last tuesday. that will focus on beyond the btus enabling communities and when necessary households too much more safely isolate and provide care to committee members went full on etu treatment is not available because that takes time to scale. the protective kits that tom referenced in the opening remarks are an important part of that approach and we're happy to talk more about that. and then the fifth element is communications and social mobilization. this is a new disease in all of these countries. there's a lot of misinformation and misunderstanding about it, and ensuring that there's accurate understanding, accurate information and the people know the basics on how to protect themselves is a critical piece. underpinning all of that is a huge logistical effort that both we and dod are working on very intensively to ensure both

adequate procurement, adequate transport as well as adequate supplies and supply chain management within the country. because the volume of personal protective equipment, other supplies that are required to run medical operation on the scale is just enormous. so that's a huge piece we are focusing on. thanks. >> tom? >> so thanks very much for bringing us together and senator coons office, all of you for your interest. i've been doing public health, running public health agencies for a few decades on a few continents and i became a doctor working in new york city in the '80s where i cared for literally hundreds of people dying from aids with a limited ability to do much other than help them die comfortably. and that experience was searing for me personally, and i've never seen anything like that until i was in monrovia

recently. and went during ebola treatment unit run by doctors without borders who are working really with just incredible effort, their largest response ever, exceeding the capacity, stretching the limits of their operations. but we went into a treatment unit and we saw really a scene out of dante. it was patience who were in all stages of the disease, from those suspected but maybe didn't have it and maybe might get it there if it works effectively separated from others, and our lab next door was working more than 12 hours a day confirming within a few hours whether people had these or not. people who were just getting in and being cared for and

desperately needed rehydration to survive. patients who were recovering, including one guy who' who was healthy enough to complain about the food. i thought he should probably be helping to make the food if he could complain complain about t. but also, tragically, three patients who had died in the past few hours, and the staff was so overwhelmed, they could not remove their bodies. and this is the facility in which there are 14-20 beds per 10. so one person in one can't who had died was next to the other patient who are struggling to live. and that kind of situation is the real world example of vacation of what it means to have an exponentially increasing outbreak. it's a very hard term for all of us, myself included, to get our

minds around, that it is doubling in 20-30 days in the region. that facility had to 60 bodies removed that day. so the situation right now in west africa is an absolute crisis. it is moving faster than it is easy to understand, particularly in liberia, and we've already seen exports to both senegal and nigeria. we now have a field team in desperate looking at the possibility of cases there. but if i were to just summarize here for a minute, what we need is an immediate response that is sustained and then make sure that this doesn't happen again. and if i can just outline those three concepts for a moment.

i've never seen a public health situation with this much need for immediacy. as i've explained to people, and adequate response today is much better than a great response in a week. it's better just. -- it's about urging. that case -- that's the case at all three countries affected even though liberia has by far the most out of control situation, but there are districts within liberia that are having relatively few cases. they have the opportunity to stop it before it spreads widely. whether our many cases we are intentionally trying to scale so we can reduce the spread. in sierra leone were cases have not increase quite as quickly as in liberia, we have the opportunity to prevent a liberia like situation in guinea where cases have had three consecutive ways where its expanded and

controlled. they have the potential of keeping it under control. the best analogy really with the metaphor is a forest fire. we see the forest fire raging in many districts of both sierra leone and liberia, especially that try country area. there's a three border area where the three countries come together. it's a deeply force did region. it has very poor infrastructure, has very poor relations with the rest of each of the countries but is the crucible of this epidemic. and other capital cities of freetown and monrovia which are expensive with a the world's first extensive urban spread of ebola in the context of the world's ebola epidemic. so an immediate response is critically important and that's why president obama's announcement that cdc last week is of critical importance that the department of defense is already on the ground. usaid and the dark process is

there. and these are extraordinarily large. and that's what's really hard to get our minds around because not only are the needs large today but he will be twice as large in less than one month. and if we're going to be successful we have to build to where they're going to be in a month. and we're going to have to sustain this because once we can put down, controlling the ball is something that cdc has done for decades with w.h.o., with those countries. in 2012, in uganda where work on ebola many times, tragically a 12 year old girl died from ebola. what was striking was that she was the only one who got ebola. that's the only time in history we've seen a situation like that that i'm aware of, other than a laboratory incident, where there is someone who got it but people thought this might be able, they the media isolated or effectively. they immediately tested.

they confirmed it was ebola. they ensured that when she died she was safely buried, and they ensured that any contacts -- if they would'v would have gotten y would not have spread further. if that kind of core public health service, finding problems quickly, responding and preventing were possible, if that is in place a year ago, in these three countries, the world would be a very different place today. but the fact is we now have an outbreak that is likely to continue for a significant amount of time, and to protect other countries we need to serve. so when one individual went to lagos, a country come a city of 21 my people, about the same as the three countries in west africa, we got on the phone with the governor of lagos and health minister of nigeria. we sent a team of experts within 48 hours to be there. we brought in 40 people who we are trained to to contact tracing is part of the polio ratification -- eradication and

working effectively on the. now they are not completely out of the woods but it does look like they have controlled the outbreak in both lagos and port harcourt. that involve more than 1000 health care workers doing among other things more than 19,000 home visits to measure temperature of nearly 1000 made contact. that was to address one case of ebola. so we need to have a response that is immediate, that is sustained and that prevents future events like this. because we could have prevented this in the first place. sars across the world $30 billion in just about three months. the economic implications of ebola in west africa, not just west africa, not just for africa, but for the world are quite substantial. w.h.o. in the publication yesterday raised the possibility of ebola becoming endemic in

africa, and that would mean for those who are not in the public health world that they would continue on an ongoing low or medium level indefinitely. we think that's not inevitable. we think if that were to happen, it would be an enormous problem, not just west africa and africa but for the world. we would always have to be think about the possibility of ebola and anyone who didn't in any region that might of had a case of ebola. so i would just we get a rate that the approach that the president obama has outlined is exactly what we need, and we need to get, to scale and the speed that will match the exponential growth of the outbreak, to ensure that an immediate response, that prevents this from both happening where it's not happening now and from happening again anywhere whether it's ebola or any other health threat. thanks. >> thank you for the invitation to talk today. let me start -- sorry.

let me start by saying i completely i go director friedan's comments. we happen to see each other in sierra leone while he was there. i'd like to preface my remarks with the fact with the understand that i am mostly speaking from on experts in sierra leone and liberia. by remarks tend to be skewed towards those countries which are experts in the worst parts of the outbreak. and when we say the situation is dire in sierra leone and liberia, we just can't emphasize that strongly enough. what we are facing is intended a center locally of biblical proportions. and for the people of those two countries largely feel abandoned by the international community. however, that response is now starting to trickle in and there is hope, there is a light at the end of the tunnel hopefully although it is owing to become worse before it gets better. i'd like you to keep in mind when we're talking about at least those two countries, we

are document to country that endured almost a decade of civil conflict. we are approximate 11 years out from the end of the civil conflict and considering build a public health care infrastructure in just 11 years is an enormous task. we were dealing with the region's which are almost on the brink of not being able to offer sufficient health care on a normal day. what we've seen since the onset of the outbreak is a complete breakdown in the public health and the health care infrastructure. schools are closed. hospitals that haven't even experienced ebola are closed. and i think from that we may never know the toll of deaths that resulted from non-ebola cases, from very normative infections that occur every day in sierra leone. there was a headline today on cnn that you ebola and unless proven otherwise and that is indeed the case but before this outbreak i could argue the case would be you have malaria unless proven otherwise. we have complicating this factor

that ebola is now occurring in the highly mobile environment, that is well connected by roads. we are dealing only with colonial borders. these are not tribal borders. the tribal that which is almost these three in four countries all over saints would consider much as we consider going to canada from the united states but it's a fairly easy transport through the region. we are still very much experiencing upward trend in the number of cases and liberia especially but also sierra leone, less so in sierra leone. and while i truly applaud the move by msf to reach out to united states military for support, the building of treatment centers is something that i don't want us to put complete faith in something's epidemic because, frankly, we could build treatment centers for the next 12 months. at this point in time we are over capacity for treatment

centers as director frieden described aqc horrific scenes. i can tell you just in one place alone almost one month ago we were at a situation much like doctor friedan described where we had 10 persons that have passed. we had no body bags because nearly all commercial flights have stopped coming into the country so that delayed our delivery of body bags. and so approximate 10 bodies stacked outside of the treatment center. as director frieden mentioned, education you can imagine that you're trying to divide this disease and your mentality is trying to divide the disease but it's important, however, you're looking to side at people that were lying next to just the day before, just hours before and looking at 10 bodies stacked up. all you can imagine i if you wee going to be next. and so you can see why there is a tendency which we've all read about the people fleeing, running, not coming into the treatments and. that's largely because of the

treatment centers are considered a house of death. i think we're turning the corner in kind of that opinion, and the reason we saw that early on was part of the messaging. much of the messaging we gave early on in this epidemic, which was accurate but not locally understood, was it is the licensed treatment for ebola virus. but we had as result of that is a large portion of the population, well, wanda didn't believe in ebola virus to start, but to come why she would report to a treatment center if there is no treatment for ebola? rather than hearing that supportive care will increase your chances, what they heard was there's no treatment for ebola. so that led almost half of the population generally seek out traditional healers. a lot of that involves bloodletting which is probably the worst thing you can do during an ebola outbreak and that is also greatly country would to the spread of the virus. where we are today, going back to the treatment center, in my

opinion our absolute number one for has to be stopping the transmission of the virus. we are going to do that with boots on the ground, with trained epidemiologists and as director frieden mentioned every sustained effort. as we saw in guinea would almost thought the outbreak was over. tuber tuber three days away from having to complete over. we missed two or three context and that's all it took to start the largest ebola outbreak in history. congruent with that is construction of the treatment centers for those that are already infected. but speaking as a public health professional i think our number one priority has to be to stop transmission, save the people who are not yet infected also treat those that are currently infected. and i want to caution that, you know, a phenomenon that we've seen since the introduction of things like you map and the introductions of experimental vaccines, what that has resulted in locally is the belief that that is going to be the answer to the outbreak.

the local population thinks we have these miracle drugs, medical vaccines are going to stop this outbreak and that's how we're going to come in and that's what we're going to halt the outbreak. again i go back to the number one priority is epidemiology. we're going to stop the outbreak by stopping the transmission chain and a pretty are infectious control and treatment centers. and in the long-term what this is going to require is almost a rebuilding of the public health infrastructure of this country. i would say this is conservatively set those countries back in this regard five to six years. and then we're also long-term going to be there with the ethics of the ebola outbreak the foods you could, most commercial airlift the exception of one have stopped flying to these areas. so we are largely depend on them for cargo. and a lot of the commercial trade of those countries are doing. tankers, including oil tankers have not threatened to stop docking in sierra leone and

liberia and that would create a whole other set of problems. no fuel for the cars that we still don't have congress to work at getting ability and transport in place. those are all things we're going to have to deal with concurrently. and allows i will say we are facing a very unique situation, special in sierra leone and liberia to a lesser extent guinea in that this is the first time almost that we have had an outbreak of hemorrhagic fever in an area where we already have a hyperendemic hemorrhagic fever, loss of future. and as of last week really we are starting to into the dry season of sierra leone which is the season so the areas which are the most affected especially -- the areas of library that have been infected, those happen to be our hyperendemic area for fever. so very shortly and we've seen this we're going to multiple hemorrhagic fevers presenting at the same time, and right now that's not even a place really to put all of the ebola patients.

so now we're going to be thinking about how do we separate the patients because that's not something we want to mix. the chances of survival are much greater than those with ebola and their as an approved treatment for the. >> well, thank you, tom, and upmc, center for health security and the u.s. senate for organizing this meeting today. clearly there's a lot of interest in this very important and urgent crisis. this is a national security imperative. it's a human tragedy, and an international health emergency on a scale that we haven't seen before. one thing i want to stress is

that this team that you see here today, we didn't just meet because of the ebola crisis. we've been working together on these issues. tom frieden and i regularly for the last five years. we have a very strong partnership between the department of defense and aig and hhs elements and cdc that goes back many years. dod is not new to global health. going back to our tradition of walter reed in the work on yellow fever virus. last week we established operation united assistance which will be dod's support to this global effort that led by the united nations and their special mission that was established this week. and we are in support of our civilian agency counterparts and

working with allies, including the united kingdom, france and others that have a lot of reached into the affected countries. dod will focus our contribution on our strengths, our unique capabilities and capacities, including demanding control -- command and control, logistics, training and engineering support. we established the joint forces command under u.s.-africa command and major general darryl williams is on the ground since last week doing the assessment. he's also the command of the u.s. army africa. and the command headquarters is being established in monrovia. liberia, in addition to a regional intermediary cached intermediate staging base and

senegal that will provide a lot of the logistical support to ensure the flow of personnel and equipment and material supplies for this very, very large area of west africa. in addition, the united states will send this week to more diagnostic laboratories. some of our best scientists and microbiologist from the naval medical research center will deploy with those units to liberia. one in monrovia and they'll be associated with ebola treatment units. so we can have rapid diagnostics. the department is providing a 25 bed hospital that will be, will

be staffed by international health workers and public health service, medical personnel. the department of defense will not be involved in direct patient care as part of this operation. we are going to construct 17100 ebola treatment units in liberia. and the planning and preparation, contracting for that activity is underway, and that should start to show results on the ground in the next few weeks. these units will be set by local and international health care providers. again, the department will not be engaged in direct patient care but we will provide training, based on the infection

control training that msf was established in belgium and cdc has replicated in alabama at a fema facility there. we're going to establish a summer training center in liberia with the goal of training 500 health workers per week. and the focus of that will be on infection control. the department of defense is prepared and has requested support from congress for up to $1 billion to commit to this effort. there are two major programming actions that are pending here on the hill. and the nunn-lugar cooperative biological engagement program is also going to invest over

$60 million in the strengthening the global health security capacity and laboratory capacity, both in the infected countries and also in the neighboring countries. the department of defense to our biodefense program has been involved for many years in the development of medical countermeasures and therapeutic vaccines as well as diagnostics, and we've sent over 10,000 diagnostic test kits for ebola to the infected countries as well as personal protective equipment. and i want to just note that in february, that were 13 of this year on a date the federal government was closed, the u.s. government launched a global effort called the global health security agenda, and that has grown. it wasn't in response to ebola,

but we are glad we initiated that. and on friday, the white house will be hosting an event of 44 countries at the ministerial level, that's cross sectoral. we have health ministers, home affairs ministers, defense ministers crossing different sectors which is necessary for the whole of government response that these types of events require. and buckle of the global health security agenda is to build those capacities which, had they been in place in west africa, could have prevented this from becoming an epidemic in the first place. those capacities to prevent, detect, and respond to infectious disease outbreaks as required under the international health regulations. secretary hagel will participate in the global health security agenda, event at the white house on friday, together with

secretary burwell, secretary kerry. and that will be hosted by ambassador rice with participation of president obama. finally i would just like to thank people like joseph and aid workers who are on the ground, 100 cdc experts were on the ground like jordan who just returned from there. for -- for their truly heroic efforts. we owe them all a deep debt of gratitude for their heroic work they're doing on the ground everyday in west africa. thank you. >> thank you, andy. thank you all for really setting up this discussion, and for so much insight and information to start a discussion. we are going to now turn the discussion to those of you following along on the web or on twitter you can submit questions to the through hashtag ebola on

the hill. so before we get too specific questions about the response, because i think people want to understand the nuances of the response from the leaders here, i just want to ask one more question about the consequences if we get this wrong. if we don't write to the occasion and you begin to paint the picture here, all of you, about what's at stake. but we hear things in the media or along the way, along the lines of this country has enough on its plate, we're trying to do with isis, with other national security threats. why is it important for us to invest so much of our time and talent on this problem? and what happens if we get this wrong? to "usa today," i think the headline the other day was, could the ebola epidemics go on for ever? which i think was one way of saying in dimmick, which tom talked about. what are the consequences for us, for african security, for health if we get this wrong?

>> early, earlier in my career i spent three years living in guinea working with refugees from sierra leone and liberia. and as joseph system where only about 11 years out from the end of the civil wars in those countries. the u.s. invested large amounts of effort, political capital, resources to bring peace to these countries, particularly library where we always have strong historical ties. and this outbreak, if it is unchecked, could undo a huge amount of effort both in terms of strong investment that the u.s. has made both for humanity and international interest reasons, not at the human level as well. it just threatens to devastate. it already is devastated these countries and i think there is a

strong humanitarian impulse in the american body politic. it's the reason why we are a leader. i would say the global leader on international humanitarian action and disaster response. and anytime there is a disaster on this magnitude, the u.s. is on the front lines. this is, this is for humanitarian reasons and for u.s. interest reasons and that's what national security priority to have a president has to explicitly articulated it as such. i think that if you look at the level of interest as well in the american public, indie media, there's a clear desire to beat this thing. and we know we can. >> well, i think the sad fact is that the worst-case scenarios are really bad. yesterday cdc outlined what

would happen if the exponential growth were to continue at the rate it was going a few weeks ago? we don't think that will happen because of the response the u.s. and others, but the worst-case scenario tops a million cases within a relatively short period of time. and not only would affect west africa but would inevitably spread to other countries. we had to exportation disease exportation events with the first couple thousand cases. how many depends are we going to have if there are tens or as the president said, potentially hundreds of thousands of cases? and whatever we may think, it's not possible to seal borders. it just doesn't happen in today's world. if it did, controlled drugs and diamonds and people would be much easier but it doesn't.

and it's not going to hear. what that means is we really are all connected. so while we do not think it's ebola continue to spread as we believe it has been spreading all along, it will present a significant health risk to people in the u.s. they could absolutely change the way we work here. it could change the economy of the world. it could change the way we assess anyone who must travel to anywhere that might affect ebola. we don't think that will happen. that's why president obama highlighted hold, response with each part of government contributing what they can do to stop this as quickly as possible. recognizing as was said, it's going to get worse before it gets better. we have to recognize that although we have to work immediately come it's going to take time to turn it around. but the other key findings of

the in him wor we released the other day was that progress is possible. when you isolate enough people, the disease begins to stop spreading and then and decline in numbers almost as rapidly as the exponential growth we are seeing now. but what the model found that i found particularly striking was the mathematical documentation of the urgency we all feel, that even a delay of one month in scaling up the response will result in a tripling of the size of the epidemic. and that kind of shocking increase is very hard as i said to really get our minds around and to act in a way that we're trying to make sure that we are anticipating what are likely to be the next problem, even though we recognize that the situation on the field is fluid almost beyond description. it changes day to day, but our

response has to be with the urgency that we will turn it around. and i do think we can do so, but the risks are not just west africa and africa to they are to the whole world. >> sure. so first of all i'd like to try to get something we mentioned on several times. there were two cases of exportation of the virus, to other nations, nigeria and senegal. we look at the response in those countries and how they contained it very quickly. we can't ignore the fact that the gdp of nigeria is approximate $530 million a year, gdp of cynical is approximately $16 billion per year. when you compare that to the gdp of liberia, for example, which is run $1.9 billion per year, you can't ignore the fact socioeconomics of this disease. so it's like most tropical diseases, disproportionately affecting the poor. and i would argue as jeremy

mentioned, that we are experiencing a level of mental and social trauma not seen since the civil conflict in this area. and a lot of us may question, get a, why have we never seen this run and play mentality with ebola. this is a direct result of those complex because that was the mentality that was developed at those times. the only way you're going to stay alive is to run, to hide, to stay with your fellow. that's exactly what we are seeing right now. i believe we're turning the corner and convincing families that by hiding some and keeping them in your home, not only are you greatly increasing the chance that that person will pass, but you also will infect your whole family. that's unfortunately had happened many, many times for that message to come through. we are likely to see major impacts on the governments of these countries. just for example, liberia. johnson-sirleaf is one of the

most popular presidents and west africa until this epidemic. now you'v using the tremendous t of negativity flowing towards the current administration. in sierra leone we face a very similar circumstance. not widely publicized in the current epicenters in sierra leone are in eastern sierra leone. if you look at sierra leone is political divide is much like in the u.s. with the two-party system. and where the virus, the current episodes of ours are currently occurring is the opposition parties stronghold. and so the rate of infection, the epicenter that is all being used as political fodder against the current administration and office in sierra leone given that have greatly improved conditions in sierra leone over the past 10 years. and lastly i think everyone on this panel at least is familiar that we have spent much of the last 10 years focusing on iowa terrorism since 9/11, and another term which we use bio

error. so this is somewhat of a worst-case scenario in the sense that we literally have thousands and thousands of thousands of samples of ebola virus. i do have exact numbers on how many of those are positive going into very low resource labs, taken by technicians that are baseline phlebotomists who have seen a number of infections occur just because of needle sticks, et cetera. and there is no real good tracking system for those samples. and in addition all of the services that are needed on a normal day in these countries, typhoid, malaria, common infections that people have in this area have all but stopped. and that's understandable because now as a lab technician when you see the sample it's safer to assume it is ebola virus. and so just to echo the comments of the panel already. i think we will have a lot of long-term effects which we're also going to have to address, just to echo dr. frieden's comments, every single day we

delay we are experiencing an exponential increase in potential number of cases. >> okay. andy, did you what to say something? okay. i have one more question that will open it up to the audience for questions, as well as online. and it relates to one of the pillars of the response. it's clear we're going to be doctors and nurses in numbers that are not available now. and there's an element of training going on in the planning and an element of recruiting. how to doctors and nurses get involved both in our country and elsewhere in the world, if they're willing? >> that's a critically important question and it's a preoccupation of arthritis because one of the things that has made this such a challenge response is that twiheart to this there was no standing global reserve capacity for a large-scale people response but it just didn't exist a. every previous response had been

a relatively -- we didn't think it was modest scale at the time but it was very modest scale compared to this one, and contained to rural settings. so the global capacity to respond and treat ebola was premised on that sort of response scale. and we are now faced with a situation where we need response scale back its orders of magnitude larger comment that involves -- involves bond -- institutions, nonprofits, foreign medical teams were able to come forward. it involves identifying the staff who can staff those both local and international. one thing that is important to underscore is that the treatment unit model that is being widely applied only five to 10% of the staff are actually international court expatriate professionals. the vast majority of the people who are taking the risk and put themselves on the line to control the our national of the country.

we are working furiously to set up training models and as andy said, dod will have a role in this. cdc is organizing training in the country itself. and working with ministries of health and local institutions to identify national of the country we can put through those trainings, the institute, a new treatment unit that the world health organization recently opened in monrovia has a large complement of recently trained liberian staff. but we are as well looking for international medical professionals to join in the response. usaid has set up a website and it is reachable from our webpage where we are collecting contact information of people are interested in volunteering to the response that we are making that information available to ngos and other partners who are looking for staff to staff

up their own responses. and so as we are getting new grants out to ngos to run treatment units, this list is been a resource for them that they can draw on to help complement their staffing. >> i would just add to that, that there is a lot of interest in assisting, despite the fear that ebola naturally causes. in fact, the african union with cdc and department of state, the support of just a geek, and eu dollars is now on the ground in the countries helping out in providing care. and this is a great example of what's needed. there are some barriers that we need to break down so people are more willing to help. one of those is being able to go back to their home country because some african countries have put up some travel restrictions, even for their own citizens. but we are seeing a lot of interest it and as jeremy said,

90% plus of the staff our local staff, intensively trained, and willing to work in these areas. so the numbers become a little more manageable when you think about it that way but are still very large and needed very quickly. that's why this week, just this week cdc complete the first ever training course for ebola outside of the msf model based on msf training, and that was trainers and we are going to scale that up. >> great. okay, we'll take questions from the audience. i see there are a few questions already. in terms of question just to make it easier, would you say your name and where you're from and then ask a question. >> charlotte from the senate foreign relations committee. by understanding and it may not be accurate, about roughly 75% of the current victims are women and children. if that is true what do you think the particular socioeconomic impacts our, and psychological impact would be as result? and how does that change or

alter your response be? actually the w.h.o. publication from yesterday found that although there was an inflection of female predominance, which we've seen predominance, which we've seen in past the casinos do more of the caregiving, we have seen more like a 50/50 response in the data that w.h.o. published yesterday. children tend to be less affected directly because they don't tend to be caregivers. but we are seeing just horrific implications of this but i'll mention free for children. one, i was speaking with one survivor in her home and her nephew was there, kind of bouncing off the walls. he was about four. they finally said, the neighbors don't let him go outside to play because they are so afraid of him. the second is, i helped a survivor, a young child whose parents died. so she's now with an aunt, but we are seeing really horrific

problems. and, three, i saw one of our staff at cdc was done the post-deployment screening of all of our staff as they have come back and she said the stories they tell are really searing. for example, one of our staff described on the streets seeing babies left by parents who are afraid of infecting them. so to try to save their child's life, or a painting their child hoping someone else would pick them up. so the implications are enormous for the societies themselves. >> i would just add to that that in addition, you know, once, probably something you read about but once a person to survive, if they are fortunate enough to survive the disease, there's a stigmatization which they reenter the committee if, indeed, they are allowed to reenter the committee, much like the child's example. as director frieden said, the majority of caregiving at the local setting is from women.

also we are experiencing about a 50/50 split. however, considering the burden that women in this region, particularly kerry as caregivers as they are the primary farmers for the region with regard to the main consumable, and in addition to that just touching on the point, we've had entire families wiped out. and oftentimes the children have survived because the parents were distancing themselves from them but we have an untold number of orphans now. and if you're coming into a system where the social net for things, people like orphans was already under developed. and so again, going back to the civil conflict we are seeing numbers now are not exactly equal to what they saw during that conflict but it's reaching that category of a number of orphans that we're seeing, especially in the most affected areas. >> just very quickly to add to the. the second part of your strategy which is focusing on the second

order impact is exactly, that is an element of exactly that and that's why we're focusing on that because we know that even getting the impact, the media operate under control from a public health perspective, there are going to be many knock on social and economic effects that will take years to address. so we are building that in the beginning. >> next question. >> i'm from mmr i global to a question about the evolution of the virus. the virus is seen more human hopes than ever before. there's a science article published at the end of august that document the evolution of the virus through 99 human host. the question is, what is the current and ongoing efforts to understand the direction in which this virus is going to devolve now that we've seen more host than ever before? >> as you point out where in an unprecedented situation. we have tracked the genome of ebola for 40 years and we've seen less than 5% genetic change, which is relatively

small for most pathogens. i think though the fact that we have seen now 10, 20 different generations, and we're seeing it in thousands of people does put us in a different environment than we have been in before. we've had some groups looking at this, and there is a need to track the genetic changes in the virus over time, and there are institutions working on doing that. ..

it's passive surveillance. doctor friedman, can you elaborate on when you see a threshold to the surveillance and what that would look like and how does that correlate into training the officers of the points of entry? >> i think of us as having three lines of against ebola the first

is to stop it at the source in africa and we've been talking about that and that's going to be the most effective way of doing it but obviously it's going to be continuing for a while so we need to do more than that. second is stopping people who may have ebola from departing the country and they are putting people in the airports of each of the affected countries and they are doing multiple temperature readings on every person boarding the plane leaving as well as a questionnaire and they are removing from the departure and evil emanating ebola because someone could have just been exposed into the integration period is eight to ten days but can be as long as 21 so that doesn't mean we are going to be able to keep ebola of the country because people travel overland as the individual good and there may be an individual integration period but it's important to keep the travel safe and it's one of the things

that have kept the airlines flying because they have a reasonable expectation that nobody is going to get sick on the plane. we do need to realize that it is not impossible that someone will come into one of our hospitals or health centers with symptoms of ebola. we've already had 13 people come in with symptoms that are considered potentially consistent with ebola who are from the area the past 21 days they've been tested and they've all been negative so we have ruled it out more than a dozen times. we have had inquiries close to 100 different healthcare facilities that we've been able to assess and we've provided more than a dozen labs around the country with the ability to test for the public health can do that quickly.

in terms of border protection we have a working relationship at the cdc and staffing quarantines throughout the u.s. and anyone with suspect that disease we work very closely and we've also worked with at the border protection on protocols that we would follow if someone were to come in with that might be consistent so that we would be able to respond effectively. one of the challenges what we might hope could be possible with come without magically knowing if someone had ebola when they came in is just not possible. so understanding what is done and how we can manage effectively is something we will always continue to assess by the dhs and others.

>> richard with the armed services committee in the senate. we heard from the panelists that the effort and the response will need to be sustained. this isn't just a brief but go at it is hard for three months and then we are done. we also heard about the u.s. response which is what you're representing here today including the billion dollars of the defense department funding but my understanding is that is intended to cover a six-month period to build up the effort of the training and so on. can you give us a sense of what you mean by a sustained in terms of length of time and the response that you believe is needed from other countries besides the united states because we are doing a lot but this needs to be a major international response. >> maybe i will say a couple things. give them a number or a date but don't give them both together.

we don't know what the future is going to hold. we do know that the sooner we get out there the sooner we are going to control it and there's penalties for the delay that are extraordinary. succumb surging now is critically important. we've got several parts of the department of defense running labs and of course the cdc and south africans, canadians, russians, french and italian all running laboratories in these regions so there has been a robust global response to the african union and kind of a hole for cheaper scores as compared with the peacekeeper is already on the ground in helping. so there is a robust international response, but the u.s. has unique capabilities in terms of speed, skills and scope

the >> of the worst affected countries at the moment as you are all aware you're all aware is the sierra leone and liberia. again he is struggling with nowhere near the scale of those two and has a stronger health system to begin with. so the uk is stepping out in a manner to what the u.s. is doing in liberia and they are taking the role of the foundational partner to the sierra leone government in the way that we are doing in liberia. in danny devito new guinea as a reference there also is a smaller outbreak there at the moment. the french are increasing their involvement and it looks like other european partners will be going into new guinea as well. so they are building a coherent

international response to complement the coherent interagency response is really focused on that very question because we know that the u.s. government can't and shouldn't have to carry this entire response on its own. with the uk stepping up in a very substantial way, that is a huge piece of that and as tom and jim the other partners are also stepping up and we are doing very regular calls with international counterparts just in the past half a day i have been on two of them with the uk and other partners so that is a very intensive part of the effort. >> if i could add the international outreach is a big part of this effort. it's an area that president obama emphasized in his announcement in atlanta at the cdc is one of the u.s. objectives is to help mobilize the international community and improve the coordination among

the international community. next week the uk will host an event focused on sierra leone to coordinate the contributions. the public-private partnerships are a big part of this. for example the bill and melinda gates foundation has pledged actually $50 million to this effort and many others around the world are contributing. there's a lot of outreach this week in new york and as i mentioned in my opening remarks, this friday the global health security we are going to leverage that to get real commitments for action, for funding for contributions to the global health security around the world but also specifically for the current crisis in west

africa. and at the state department has named ambassador nancy powell to the former ambassador to india to help lead this effort in the international outreach donor coordination. >> i forgot to mention the world bank and i wouldn't want to leave them out. they've been terrific and leaned forward enormously and already put $100 million in the field and have at least another $100 million they are putting in the field and they get not just the need for the emergency response but also to put into place those laboratories and the diseases and the urgency response capacities that would have prevented in the first place that can prevent similar events in the future and that will be discussed at the white house on friday on the global security which is a top priority for us. >> i don't want to speak to the chiming of the sustainability. that is dependent on how fast we get a handle on the outbreak and

we start seeing a decrease in the number but for me, sustainability is going to be called building human and technical capacities without we prevent this from happening again and that is going to take time and there is going to be short-term and medium-term training and there's going to be long-term training coupled with investments and locally sustainable technologies into that is going to take some time and effort and its things we are currently introducing and we will continue to do so throughout the lifespan of the outbreak. regarding the international coordination, the governance committee african union, all of them have been extremely responsive and all of them are starting to come together as far as governance into the secretary mentioned that the ngos all of them have started to contribute funds to doing this and when you look on the ground situation prior to the epidemic.

they wanted the to keep sustainability of the effort. >> the steps for getting it right in the international coordination are extremely high because even if we succeed in liberia and sierra leone if it continues on its could reignite in liberia. so it seems like that is a crucial element of the response. next question. >> my name is eli greenspan and i'm wondering as you evaluate the funding streams and some of the short-term timelines if you've identified any limitations to the current funding or any challenges that you've identified that we can play a role. >> can i add on to the question since we are on that topic it would be great to hear from the panelists what they believe the congress in particular can do

since we are here today and i think that was the question at that particular point is that the congress can do to support this response that they are not already doing? >> i will start with addressing the cdc just for the 11 weeks of the cr it costs $30 million we are grateful to the congress for allocating that. just to keep our operations going at a level that we are going. that is no scale up and that is even within weeks. that doesn't involve addressing other countries which may be dealing with a large outbreaks and strengthening the fire resistance and we are beginning to surge in that area now as well so that we can reduce the risks that start to ignite forest fires and elsewhere. it doesn't address any of the medium or long-term issues of putting in place the efforts to make sure that we have the technical capacity in the

countries to do that. we are working very closely with the world bank and the dod and others. but the needs are substantial and they are going to continue for some time. >> as the panel reflects the whole of government effort here on capitol hill this spans across many different committees, so we would ask that you work he works closely together with each other to avoid potential gaps and from the dod perspective, the highest priority is getting approval of the $500 million reprogramming requests from overseas contingency operation funds to the overseas humanitarian disaster civic aid funding and the cooperative threat reduction funding so immediately the attention to those two actions

will avoid any pause in our operations. >> from this site i think i would say one of our top priorities certainly is to ensure that the dod reprogramming is approved because that will allow for very large-scale cooperation between the dod and the way that we operate in the field and this response is likely as we did for example in the philippines but dod work extremely closely together where hiv identified and validated the needs and works with dod to been route to those requirements that it is well-suited to. and so getting at the beginning those are substantial. so, having that resource available will really

turbocharge the type of scale and response as it is laid out we absolutely need to mount. i think as we move into 2015 we are getting a better handle on what this is going to look like i'm a bit i don't want to get ahead of the budget process. >> if i may add one comment that as well and i don't think enough of the panelists have heard to be talked about the needs needs, so i will speak more to the medium and the long-term needs we have to start thinking about now as well as a holistic approach but in the mediaman short-term objectives versus the sustainability that we were talking about earlier in the two prevent this from happening again is that we are owing to require investments in the laboratories that are going to be permanently based there and able to diagnose and detect these diseases on their own and investments in human capital especially with regards to

training and epidemiology, clinical care and laboratory and another aspect we've all talked about and something that is going to be implemented is training in the crisis management and emergency operations. prior to the outbreak, the countries have never really had to deal with an acute humanitarian disaster. they've had long-term disasters they've built with over a ten year period but it wasn't acute and have to be responded to exactly so those are the medium and long-term investments that i would argue we are going to have to be prepared to make to ensure that this doesn't happen again. and speaking to the holistic aspect is that in addition to thinking about starting the outbreak we are now going to have to start talking about the food security for the area. however going to deliver fuel to the area if the tinkerers tinkerers stopped at sarah's with the we have to start thinking about aid packages for those countries to help them

rebuild and where they were before the outbreak and hopefully the silver lining of the outbreak will be that afterwards they will have strengthened health care systems >> for the alliance for bio security my question is a couple of you mentioned sort of the issues with messaging and misinformation that we've seen throughout the outbreak so far and i'm curious about the level of local government engagement and sort of trying to fix that problem and address those concerns about getting the correct messaging in an understandable way to the affected communities and sort of first off, you know, what is the level of engagement and how are those relationships going. and how critical is it that that is done correctly this time in this timeframe for success in the overall mission lacks to

>> the most important thing to remember is that there have been comforting messages, sometimes coming from in turn away from within the government and they do what a government does. there are opposition parties, political aspirations, etc.. i think we are seeing a turn turbine in that because the president did liberia and sierra leone rein in those individuals and the political consortium that are giving conflicting messages or maybe are not so accurate information. we are still dealing with messages from the groups that you may not immediately expect such as evangelicals coming in from nigeria bringing prayer and money from churches etc. so that is something that we are trying to fight against right now because the messaging isn't always correct. that being said it's absolutely central but we look to the religious leaders in the area because as i said, you are

facing an armageddon situation of the book of herbs so many people are flocking to the religious community now and is so so a large focus is on the religious community as you will have seen in sierra leone this past weekend it was actually miss portrayed as a lockdown. what it really was was a three day stay at home mobilization campaign of what ebola actually is, how you can identify it, at least symptomatic late and what you can do indicate that you do have it as well as also possibly identifying the possible cases that may be in the home. so i feel the message is taking shape and people are starting to listen to it more. you have much less denial than we did in the earlier days of the epidemic so we are turning the corner of that aspect, but the messaging does need to become vice and it needs to be the same message from everyone. >> i think the key is organization. each of the three countries who

are at the point person for the country that report directly to each of the three respective presidents and our role at the cdc and the dod and throughout the government and the global community is to zip -- support of their entity. they are moving towards their management building that was found by the liberia government including guard and others into the incident manager this week focused on what's being built and in the incident management system there is a communications lead to some instead of everyone kind of doing their own thing, the goal is to have clear evidence-based strategic objectives for each aspect of the response including the communications into based on the information coming back. there was a very interesting household survey done by unicef and others showing the surprisingly high level of awareness of some of the key messages. emphasizing the need to really

go from what people know to what they do in terms of our communication and that involves getting those logistics out so that people can take someone who is sick to be cared for somewhere safely where they can have a higher likelihood of surviving and a lower likelihood of infecting others. >> time for a few more questions. >> good afternoon. you have spoken about the history of the region going through a decade of civil war. how do you think the reaction is going to be with the u.s. military showing up when they have had such a traumatic past dealing with their own military and then also the best trust mistrust of the services that have been provided prior to this again going back to the rumors that there is no care or that we can't provide care what is the military doing to address basically the psychological impact of the large force showing up on their doorstep?

>> ideally that the involvement at the department of defense and this global effort in support of the local governments will actually build the confidence of the local population in the government and the region that resources commensurate with the scale of the challenge are coming from around the world to support the response. >> that's absolutely right. when tom and i were out there a few weeks ago, there was a fervent desire on the part of the liberian government and the liberian people to see the massive scale up of the response that the banks were getting from the teams on the arrival and the announcement of u.s. military

resources that have been extremely well received. i think people can easily distinguish between the u.s. military committed to the u.s. military is coming in to do and what the u.s. military itself into the sorts of conflicts that they have in their history. >> if i made i will add to that especially enlightening. -- especially in liberia we had a fairly large contingent already stationed there which has been training the liberian military over the past four or five years and we have much the same in sierra leone for the international assistance programs whereby government have been training the militaries of the two countries and in liberia in particular iberia happens to be one of the most staunch allies and voted with the united states on every single united states resolutions of the liberians in particular are ecstatic that the u.s. is coming in and i think adding to that is the request that they do

participate and the reason for that in my opinion is that despite being a humanitarian organization that operates much like the military. it's the discipline and logistics data they used to be so effective on the ground and so i think the military is wisely known for having both of those qualities and then i think that is very welcome to everyone on the ground including a local population. >> thanks for being here with the congressman's office. two quick things. what kind of role are the front-line workers using and how are those being perceived in the local community and then also for doctor friedman specifically a group of staffers and myself were at the cbc headquarters and we were able to meet with your team combating and organizing

the response and one of the things we heard is when it comes to public infrastructure that ministers don't always get into big meetings or get as much attention as the other ministers and how is this outbreak of changing the environment and are we able to leverage that situation to get them to pay attention to long-term growth. >> it is generally our experience that people pay more attention in an outbreak or epidemic. and within countries you will find that health ministries are generally weak compared to other ministries into the aspect of that is particularly weak so the congressional initiative from senator harkin and others to establish public health institute that would be able to run laboratory networks to train the disease detectives to host operation centers are very important and it would be tragic if we didn't ensure that as we respond, we also put in place

the kind of systems that would prevent the next outbreak like this from getting out of hand as this has. >> the first question is the work of healthcare on the front line. >> they face enormous challenges and risks and one of the sometimes overlooked fact is the treatment on the units but actually the health workers most at risk are those working in the normal health system because when someone presents a health facility with the symptoms that that facility doesn't have the equipment needs and the staff person doesn't have the training that they needed and they are extremely at risk and as joseph has referenced referenced another subset of these are countries with weak health systems and so there is traditionally not been tested in fiction prevention and the healthcare system both of our

knowledge into the equipment are missing. the community care programs the person announced last tuesday is intended in part to address that. it will be at the priority health facilities across liberia providing training and equipment so that the health workers can better protect themselves and it will also help to set up ebola care centers that are already popping up, the communities are organizing to set up care centers they are just not getting any support service will provide support of the oversight equipment support to the centers so that the facilities will have a place to go with the people infected with ebola rather than have to keep them in the health center where they may not be equipped to handle it. >> he was just in liberia and

have some valuable final comments about the situation. maybe anything you heard today that you want to emphasize or any other comments? >> thank you for the opportunity and i'm happy to talk to people afterwards. i would just want to reiterate the healthcare workers that have been on the frontlines have been largely liberian and healthcare workers they've taken a trend is told in the early days of the epidemic and we need to turn it off quickly and we can do that. but the support that we can get to the communities as they try to provide community care centers while the ebola treatment units are built to host critical element is a family member takes care of their loved ones in the facilities that we get this family members and those

caregivers who leave the hospitals to work in the community care centers the best opportunities for good infection control practices to bridge the gap to when we actually have the treatment units fully functional and stood up with the support of the dod and others that's coming forward. there are some tragic stories, but the most compelling reason for moving in this direction is that the healthcare workers that remain on the front lines are there and they want to come to work. they just want to be trained. they want the physical facilities and the personal protective equipment and training that the training that allows them to do the job effectively and the infection control training practices that were giving this will have long-term benefits well after this epidemic is put under control and will decrease all kinds of hospital acquired

infections as well as protecting healthcare workers who see people when they come for care for the routine services so i would be happy to take questions. i know it know it is one time type of 30 but i will stick around and talk about my personal experience and other things. thank you. >> one more word on the healthcare worker experience. many of us have friends or colleagues working on the frontline in west africa and struck our center that there isn't an easy way for people to be sharing real-time information and learning that's being built into the system so we are trying to experiment at our center that we are calling the share and exchange knowledge forum for the doctors and nurses to put online first impressions and anecdotes stories they are learning it could make their way to formal guidance by the organizations that cdc and hhs if they prove to be useful. so it is now two minutes past

the time and i want to thank all of our very distinguished panelists for their time today and also their service for this country and west africa and then a special thank you to andrea, matt watson, and need a, korea, jason and george who all really works in the last few weeks to put this together and i want to thank the panelists for their work. keep up the good work on the hill. thank you. [inaudible conversations]

[inaudible conversations] president obama is in new york for the united nations general assembly and the suite will provide over a security council meeting where the president will try to rally support for international action against the note and group basis. that meeting is scheduled to begin at three eastern and we we'll have it for you live on c-span. we are also gathering thoughts today on what you think the greatest threat is that the un should address. share your comments on our facebook page or on twitter using the hash tag c-span chat.

the two candidates will be squaring off tomorrow night at nine eastern on c-span. here's a look at some recent television ads released by the two campaigns. >> i am from omaha nebraska and at one point in time our homeless veterans signed a contract with the united states government saying we will go to battle and give your life if our life if necessary. >> when you talk about from list of veterans and veterans cemetery, you hear lee terry's name, you don't hear anyone else in congress. thank you for giving us an opportunity to serve them. >> i am lee terry and i approved this message. >> my dad flew a b. 26 bomber over d-day. he taught me early never forget those that serve our nation.

my disagreements with congressman lee terry aren't personal but his votes against veterans sure are. congressman terry shut down the government, defended his own pay while soldiers were on the battlefield and protected congressional perks like taxpayer paid healthcare for life while cutting veterans care. i brad ashford. our promises to veterans are personal and why i approve this message. >> lee terry's fighting to keep our neighborhoods safe and strong. he secured grants to strengthen community policing. and he fought for the violence against women act, supported new laws to crack down on human trafficking and lee terry passed a law empowering the neighborhood activists to start a new fm radio station giving voice to a community working to stop street violence. lee terry working hard to keep us safe. >> i'm lee terry and i approve this message. >> i'm not running for congress to represent any political party. i'm running to make a difference for nebraska. reducing partisanship in

washington isn't one easy step one single day or electing one member. i'm going to work from day number one to create a collision of 25 members of congress to set aside partisanship and focus on solving problems. just like i've done for 16 years. i am brad ashford and i approve this message. >> brad ashford working together, changing congress. >> and beginning march thursday's debate between those two candidates, lee terry and brad ashford. it's hosted by the omaha world herald and it gets underway tomorrow night at 9:00 eastern over on c-span. the center for american progress yesterday released a report outlining the 20 specific tax reform proposals. the group says its proposals have bipartisan support. speaking at the announcement of the report where former economic advisers from the obama and bush administrations. >> welcome everyone and thank you for joining us today for the

discussion of improving the tax code, the subject which is coincidentally in the news today. for those that don't know me, i am the director of economic policy here at the center for american progress. we organize today's discussion because we think there is a widespread agreement that the tax code needs improvement. we also think that there is a fair agreement on how to improve it. we put together a report entitled improving our tax code and it highlights broad principles with good tax policy on which there is a substantial consensus. this includes simplifying tax rules, broadening the tax base and minimizing economic distortions. this report follows with more than 20 individual measures on which we've identified some or in some cases a substantial degree meant. we cover individual, business,

tax revisions into the earned income tax credit. at the end of the report we have an appendix that lists all of the provisions and the revenue impact over a ten year rise in. these were nontrivial to some and a measure of an already distinct group. of course there are major differences about how to proceed with reform and the matters such as the correct level of the marginal income tax rates whether to move to the territorial corporate tax regime and other issues that are not so obvious. however we think that the tax code can be made significantly better without needing to resolve every issue. to help us think about this, we are very fortunate to have three distinguished guests, to panelists for the moderator who discuss where to discuss where

they believe we can find the consensus on this important policy matter. the first panelist is doctor douglas holtz-eakin, the president of the american action for him and he has had a distinguished career in academia, government and policy work. a few of his achievements he served as the chief economist of president george w. bush economic advisers in 2008 and in 2002. he's the director of the office of management and budget in 2003 and is the chief economic policy advisor to senator john mccain during the senators run in 2008 for the presidency. thank you for joining us today and we look forward to your comments. next i would like to welcome jerry the bernstein, currently a senior fellow at the center on budget and policy priorities. he's also served at the department of labor, the executive director of president obama's white house task force

and the policy advisor to the vice presidential biden. thanks for coming and sharing your thoughts with us which brings me to the moderator at the urban institute and the current director of the urban brookings tax policy center. his impressive experience as a tax economist includes high-level positions at the treasury committee internal revenue service and the congressional budget office and the expertise spans the tax code. we are grateful to you for the conversation today so with that i am going to turn over to the panel. >> thank you for the introduction. i'm very pleased to be here to discuss the important topic of the tax reform.

i was thinking on the way over that republicans and democrats don't agree on anything, even on things that they do agree upon. however, we are not talking about politicians, we are talking about the high-level politicians themselves the distinguished economists and very frightful peoples with their people on both sides of the fence that can find some area of agreement along with their philosophical disagreements, these are the two fellows who could contribute. so i'm going to start off with the question here. i think we all know that the tax system is highly flawed or very few people would defend the tax system but there is less agreement on what should be done to fix it and what constitutes the tax reform. so i would like to ask each of the panelists, i will start with jerry because he is sitting on my right and i go to the right

first. if he could define what he thinks is the major problem in today's tax code and what would be his top priority for the reform and then i will ask the same questions. >> let me start by saying things for the invitation. it's great to be a and i enjoyed this piece very much. i thought that it was a very useful compendium of the loopholes and how they work and the costs of the foregone revenues. however to begin to get to the question i guess having said that i have a number of concerns which frame my view of what the tax reform should look like. i have to talk about the reality of tax reform and it's my view that perhaps the title of the

growing consensus to improve the tax code is optimistic. i'm not sure such a growing consensus agrees although i think it showed and doug is right in his disagreement with me. ask yourself the following questions. but he put me put it this way. it's true among the punditry in general that there is a growing consensus to the reform and clean up. it's demonstrably false among the beneficiaries of the code of the current system and i think you have to ask yourself this question are their beneficiaries that invest serious money in the status quo are they getting more or less powerful and certainly this is an optimistic framing of

the question. so as evidence, and i'm concerned about this as an answer to the question i think a lot ofwhat david can't put forth is that there are a lot of good ideas in that plan and in fact a lot of the ideas are awfully close neighbors to the ideas that are in the president's budget. probably one of the most important from my perspective of really cutting through a lot of garbage in the code is this idea of capping the deductions for the tech expenditures which is 25% cap and 28% in the president's plan which has been there for years by the way and it's gotten absolutely no love from anyone on the hill as far as i can tell. three percentage points is nothing in actually negotiating

a solution. at the top rate is 35% and the administration is closer to 40. again, certainly within spitting distance. so my first point is i do bb delete there is a growing consensus among the folks who think intelligently about the problem but it's a vested interest seems to be if anything more powerful than less. the other thing i will say in my opening comment in here i take a slight bit of issue even if the anti-tax ideology blocks the steps to raise revenue, the report puts forth a plan that would raise 1.4 trillion over ten years and i think that is admirable given future budget constraints that they say even if such are blocked the congress can stomach limited action to improve the tax code some of the

consensus ideas could be paired with bipartisan expansion of the legislation and i bolded this part of no net effect on revenue of their first satisfied grover norquist pays protection pledge. i disagree. i think that even if we can close the loopholes, tax reforms that leaves them lower without walking in the higher revenues will fail to meet the need for higher revenues and budget sustainability down the road. i think there's a strong case to be made to achieve the ability they need to meet. paul krugman did with the long-term budget projections are a boring type of science fiction, i get fat. but i do think that if you look at any realistic baseline, the cbo, president's budget, you will convince yourself and i

think correctly that the near-term is sustainable but many-years-old outside of the ten-year window and i think that his group has written about this as well there is a considerable sustainability problem. so the suggestion that somehow revenue neutrality is a goal of tax reform is one that i strongly reject particularly on the personal income side i would be more into it on the corporate income side. >> i don't hope you give us boring science fiction. >> i'm the author of lots of boring science fiction. >> let's stipulate at the outset that it's very difficult to get done. it's a little over 100-years-old now and had a handle of the general major tax reforms that there is a growing amount into

the agreement is less important than compromised. i don't think we are going to get the agreement that to the agreement that yes that's the one. instead we are going to have to hammer out a compromise for people that are going to walk away disappointed but that process needs to happen and i think it's very important that it gets done. i think the major impediment to this so far is no less vested interest although the attacks is always hard because someone is getting gored at the public doesn't have a lot of appetite for this. we actually did some polling right after april 16 needed to focus groups on the tax reform last year and at the time when people fight over their taxes and were supposed to be totally jammed up up about the topic there was no central enthusiasm

for this and the public has a deep suspicion about this. in the focus groups we learned there were two words you cannot use when discussing tax reform and they are tax and reform because they think tax reform is a trick and they don't think they are going to walk away from it with everyone paying their fair share they think it is going to be some sort of trick of one sort or another so this is a very tough environment. there's not a lot of support back home and if you look at its provision by provision you're going to find out we are not going to get agreement and get some compromise. no less i'm optimistic we can do better. so i hope we can get a better designed tax code and certainly this whole list that we can walk through in the current system and the sooner we get started on getting this done the happier i'll be.

>> let me try to turn this a little bit to the substance of what you think is desirable and then we can go back to the politics. if the idea is that you could trade off the low rates and keep the revenue distribution the same there isn't a consensus today on the revenue were the distribution. i take your point about the polling results today but i believe there wasn't much enthusiasm for reform in 1986 either on the part of the public also -- dimmick it was a big difference though. >> i will let you address that and then finish my question. >> this is a big difference. starting in the late 70s through the 80s there were a

series of politicians on both sides of the aisle. richard gephardt, democrat, jack kemp, republican, ronald reagan who spent a lot of time arguing that the tax code have an important economic implication that the tax code was interfering in the ability. we are going to have a prominent discussion about what is wrong in the current system and why change. >> can i ask a question about that it sounds like what you're saying is that we have i don't want is want to say better politicians but different politicians who are more willing to work together in compromising the spirit. but, so you're not necessarily

that the public was in a different place and if that is where you are i think i would agree it seems like the politicians are more willing to work together than out. i do want to get into the substance. you are saying the tax reform isn't worth doing unless you are raising the revenue even if it is revenue neutral i should be clear about the compromise and i want to state the important preference upfront that i disagreed with a bit in the date in the report also as i said above report is generally endorsing revenue positive to the tune is makes me nervous and as a look at the long-term budget picture i don't think that the revenue neutrality is adequate i'm happy to talk about getting a little bit into the weeds and talk about what we should fix if that's where you want to go.

>> let's go did you look at the list of proposals at some that you think are egregiously should look at cutting back in terms of their effective the benefits of the economy for reducing them does that depend on offsetting them with rate cuts? how many do you think should be left alone because they are desirable. it should be -- >> above report is a great lesson in the difficulty of this whole area so that we talk about a couple of different areas of the tax venture. in the sponsored health insurance it's very difficult to find a policy person that wants to defend the current tax treatment.

why have a bigger subsidies for health insurance for the affluent, white tax one different than the other it's an economic distortion and so it would seem that pairing the spec would be easy to do. what you learn is how you. back matters and there isn't even agreement with republicans how to pare it back. do you want a standard deduction for health insurance, do you want a tax code become a more funded tax credit so i think that 100% needs to be reformed but how is going to take a long time. there are some that many people don't think of as tax expenditures. so for example, i do not endorse the move towards depreciation

schedules. the tax system as a whole into a progressive consumption tax where people are taxed on what they take out of the academy commanded to do academy commanded to do that basically you want to turn everything into a large ira. it would be to the capital cost recovery. i also think that if you think of the other types of investments you get to expand the investment in human capital and it's basically the people in and their ideas and then we have this bond expense of the physical capital investment and i think that equalizing the tax treatment in all kinds of investments is a sensible place to go so i wouldn't endorse that one entirely. and then there's going to be a lot of debate about that.

that is a new tax that has nothing to do with tax expenditures and the attacks on the particular sector of the economy. they don't pick winners and losers to treat the academics as possible. regardless of where you are. if i was a consumption person that taxing of the carried interest is exactly right. if you want to deduct upfront, you should be taxing that at ordinary rates. there is no deduction upfront. so you've got to get the front

and right and right and if you are an income tax person you should tax the manager. the proposal is the most common that is a very hard problem. one of the things that you learn is that these are hard tax problems in and of themselves and when you combine heart attacks problems. of course i agree and that is one reason why this idea of capping deductions is appealing to me. that if it is on the personal

income side president says 28%, and you cut through a lot of decisions about which tax expenditures you want to get rid of. so i'm very attracted to that idea. i know when the president's budget i believe the numbers are in this regard but i believe it raises 500 billion over ten, so that is a serious savings. some other pieces of the report while everything is hard like doug said, some of the things i find really, really important about the kind of egregiousness and violating the nature of the principal you don't want to have your tax system favoring some behavior for the tax avoidance reasons and good economic reasons but i will appreciate the treasury going after today

so let me name a few of my biggest offenders. the corporate code is very distortionary. given a paper that he centered around last night so i'm still absorbing it but then there was a figure that shows the marginal tax rate on investment, on corporate investment and the marginal tax rate on the debt finance investment, and jason is very careful in the work, the negative 60% marginal tax rate on equity investment, 37%. plus 37 is the marginal tax rate on equity finance investment and the debt finance is negative

60%. .. i very much agree with the spirit, broadening the income base, broadening the base, particularly on both income and personal tax sides by nothing one type of income over another. dog and i might argue about

those ideas but i think particularly the favoring of non-labor income and retired interest is a good example of that problem. and my final concern here is, report gets into this a little bit, less than the president's white paper on business tax reform. there is, i think this neutrality principle is violated with incentives for businesses, not just small businesses, larger businesses to become pastors. i think that's another distortion in the code. if you look at the sharp tax receipts that go through c corp's now, the ones who pay the corporate tax, versus all these pastors to the personal side just be 90% of personal receipts, navy 30 years ago, now it's i think 60%. i think those incentives also violate a sound economic neutrality principle. >> before we move on to

corporate and business taxation i just wanted one more question on individual tax expenditures. you both said relatively little about the biggest ones, except doug mentioning health insurance. >> health -- >> mortgage, charitable. i guess the question, the question is, and i guess gerrit mentioned an overall limitation would apply to those things. i guess the question is do you think those tax expenditures should be limited as part of reforming? that's message want to get individual rates down. and is a better to do it on a case by they -- case-by-case basis or some kind of broad basis, as jared has suggested? >> first of all, yes, i believe all of these things should be pared back. no question about it. many of them are poorly designed for the non-tax policy objective they have. i'm in different, and it's a

matter of literally legislative politics, which strategy, limit them as a whole, draw a line or court everybody equally which is a lesson in tax reform. sugar gets over the finish like i don't think matters. matters. >> what's your instinct as to which would be more politically viable? >> i think not having to own picking among the tax expenditures would be easier for members. in my theory of how this gets done, you've got to have outside political cover from the public wanting to get it done. you've got to have real political capital spent by the white house. you've got to have support but a lot of outside groups to get it done. it's not as if, if a going to get to the position we get tax reform done it's not like they're going have to own every little thing anyway. i think it's more current climate where people are terrified.

>> my personal experience and is not as deep as public i did you guys. i've worked with politicians, but i've worked with politicians enough to find that claim doesn't quite resonate, to tidy the truth that less claims about how they cannot own the stuff. the minute you start talking to them about the mortgage interest deduction, many of them just kind of clamp up and can't, have a hard time hearing you. which is what i do like a more broad across the board approach of capping deductions. i will say i'm comfortable with the reports recommendations on all of the expenditures you mention. if i'm being totally honest i would say that state and local is something i'd like to think more about. i could certainly, if we're going to go in that direction, i'd wanted to be very gradual because there's a case where there's considerable differences among states. so i want to try to balance that

more gingerly. >> so is this an area where commonsense like both of you are kind of saying similar things except maybe a little different emphasis on strategy spent i think that's probably true. >> i think it's important, when you get to actually doing something i guess it's important to recognize the facts on the ground. one of the things that's happened over the decade, the '80s since we're systematically taken taxpayers off the rolls. i personally blame the reagan guys for this because they indexed the income tax for inflation which was a great policy idea that he used to be the case that every couple of years inflation would push people into higher tax brackets of both parties would say give anyone a tax break which was always popular. they took that away and the only way to get people attacks but was taken off the rolls. in the process we have transformed individual income tax and a broad-based revenue

into a sort tax on the income americans. >> let me agree with you. >> so having them that come we do have to be more cognizant of the economic lives of high income americans, design a tax code that can be enforced. the biggest problem now is the differential treatment of investment income in the income tax, the alternative income minimum tax, and the new ac eight tax on high income americans. there are three different tax systems floating around. different definitions of investment income and different taxes. that needs to go away. that's just a disaster. >> it sounds like it is slightly discomforting to have so much disagreement -- so much agreement here. but it does strike me that doug is agreeing with the point that i made earlier about the importance of broadening the base by not favoring a

particular type of income. and here i'll perhaps surprise to my fellow progressives by saying, i definitely agree with this problem that doug surfaced about folks coming off the rolls. but the way i think of it is that while lots of progressives talk about the need to achieve a more sustainable budget passed and the way i did in my introduction, it's almost always friend as that's one have to tax the top 1%, tax the top half of the top 1% and all that. in the near term i completely understand that because that's all the grotesque on i don't think we could achieve achieve sustainability. in fact, i'm sure we can't, on the basis of just the top 1%. it may satisfy a certain amount of pitchfork greek, and i'm very sympathetic. it's also important to push back

against the deep inequalities come to income and wealth inequalitieinequality is growine pretext system. but just looking at the massive global income and the need for the kind of sustainability that i have stress, which is just to reduce deficit -- budget deficits, also the demographic challenges, climate challenges, of the good challenges, countercyclical challenges. i don't think, that's just not achievable on the top 1% alone. >> all right. let me just follow-u follow up s 47% issued a little bit since my organization is probably responsible for it being out. by the way, the number is 43 and is projected to go down in the next few years because the child credit is a fixed dollar amount and to overtime its rising, more people paying taxes. another kind of angle, a lot of the reason this number is so high is we decided to do welfare

-- maybe that's a pejorative word, low income subsidy program like the earned income tax credit, child credit rather than through direct outlays. i guess i want to ask both the to respond. how does refundable credits affect the way we perceive the tax system? and should this really be part of the tax reform discussion or should we sort of kind of put this off to the side in some fashion, and kind in our minds treat these as spending when we look at what the tax code is actually doing? >> i think these matter tremendously for perceptions of the tax code and for reforms because there will always, in every policy discussion, there's a distribution the question, whether it's in income distribution, across state distributions. distribution matters to people. it's information that's got to be in the discussion. so the difficult it is, i at

least believe that our current budgetary treatment is just wrong. i would love to see it changed. the way, we're going wonder% in the geek world and i apologize. the way these things work, if you have a refundable credit, especially if $100 in tax leadbelly and a refundable credit worth $150, the first $100 is a reduction in taxes and then the last 50 shows up as spending, outlays. i believe it should all be outlays. i think the way the books should look is, that person is $100 in taxes and the government spends 150, sends them a check. the reason i believe it is would make a commitment at the beginning of a fiscal year to provide the credit regardless of what they earn. so we don't really know they're going to get $100 in taxes paid. i think we should just say, we are committed to spending 150 and budget it that way. it would change the way we think about distribution of neutral tax form because there are low

income people paying taxes, and i think it would change the debate somewhat. nothing changes that dramatically. i think is really important to we know like the eitc has been very successful. so it's not an issue of sort of the efficacy of the policy. it's how it spills over into getting tax reform done. >> first of all let me just say that i completely appreciate and accept a contribution to the debate that your team has made with the 47th and 43, but it's a very, very important to always point out and reiterate and underscore that it's not the case that 47 of 43% don't pay taxes. that's just -- >> income taxes. >> it's a very great important to say that because you actually have to look awfully hard to find someone who doesn't pay any taxes, whether it's payroll tax which workers pay, all of them including the self-employed or local, et cetera.

excise taxes. so we have done this on budget. we look at the sugar really escape taxation and its groups that our students, low income, disabled. so we, just to be very clear about that. i think that when it comes to the refundable's, particularly earned income credit, child tax credit and here i'm not just talking about the original ideas but the extensions that were done under the recovery act that i would love to see made a permanent. year i think we're talking about tax policies that are spending through the codes i agree, i think the implication of eric's question and dogs comment and alan greenspan is a tax expenditures are expending touch i think he's right. these are very important forms of spin and very venerable ones. and effect to be very

hard-pressed to find 30 archconservative said anything negative to say about a very robust income tax-cut which, of course, is an extremely important wage subsidy low-income workers which can boost an income of a low income working mom with a couple of kids, 45, 100, $5000 a year. and effect and it's in this report, i think it's a very smart proposal with some bipartisan support to extend that, particularly the part that goes with childless adults. another smart pro-work policy helping to offset some of the very damaging trans to earnings and employment opportunities for those at the bottom. >> i want to move the topic to business taxation. i knew you guys wanted to talk about that. the president has proposed a business only tax reform. that's been discussed. it's not fully fleshed out, but it seems be the direction he wants to go. and, of course, camp has this

business and individual combined. there's been some talk that might be easier to get business tax reform and leaving the individual stuff out. i guess i wanted to ask jared to start. is it feasible or sensible to do, and doctor, after, this is tax reform a long? is there any concern with having the corporate rate lowered and the individual rate remained the same? and what happens when those things are different? how do you deal with that? >> is a good question. look, these days whenever i say anything about the feasibility, a lot of people's eyes roll. so if we talked about what is feasible right now we have a short conversation. it looks like what is feasible are things the administration can do themselves, and i, for one, was welcomed the inversion changes but was kind of surprised to see that done.

i wrote a piece about it. it's running in the "washington post" right now so you can see where i'm coming from. i think it's an important change but that's not what i think we should you tax policy, just to be clear about that. i do think you could do them separately, and while it's not ideal because for the very specific differentials you've said, i think one of the themes of my comments is that the minute you start having differences within the code and the type of income is preferred relative to outcome, you create lots of interesting work for tax lawyers to define all your income at the lower rate. i do think the differentials are problematic body don't think we're getting britain anytime soon. i don't know that we have hardly ever gotten rid of them in the content protects them. we have to except that as part of life and ask about the realm of the possible. it seems both sides really pretty energize around reforming the corporate side of the code, but this is tax code.

i say that in this kind of growing consensus discussion with the caveat that i begin with, which is it's easy for wonks to come up. it's hard when you start talking about taking goodies away from people who prize them. by tax expenditure is your job creation program. but i do think that if you look at the details of camp and obama, i think on some international issues maybe there's some space between them, but in a climate of compromise and a climate where it's widely recognized that the 35 is a statutory rate is pretty much off the reservation in national terms, i think that would be something we could do before the personal side. >> let me start with the diatribe. what the treasury did is nothing short of appalling and at best pointless. it is i think an inappropriate

use of their powers to take shots at deals that are actually in play right now. good policy lays out the rules and then firms can find appropriate, make their mergers and acquisitions and go on. i have zero interest in a treasury that ask this way. and i think it is a bad precedent to may be unprecedented for them to do what they did last night. i'm not a fan. it's also not going to do anything. let's be very, very clear. all of this centers around the fact that the u.s. corporation income tax is out of step with competitive realities in the world. it doesn't matter who initiate the transaction. what matters is when it's being discussed and the two parts, one in the u.s. and one outside look at it, it will always be better for the headquarters to be outside the u.s. because nearly anyone else has gone to a system that taxes the income only once in a place what it was on and does not put a second day of tax like the u.s.

german firms are now buying used companies -- >> but it's not a second layer of tax. is raising the tax. >> but it has these distortions on earnings. is out of step. everyone else has gone basically one oecd countries a year for a reason it's a competitive reality and we're out of step with the. we're still going to use the headquarters. instead of u.s. firms initiating the transaction, a foreign firm will initiate the transaction to the headquarters are going to come. this isn't going to change anything on inversion. it's not going to change the fundamental problem and it goes the wrong way from the point of view of the ultimate reform. the ultimate reform lowers tax underbid tuitions instantly moves towards territorial systems. this is not making them pay more tax. it's done poorly. echoes the wrong direction from the point of real and it doesn't solve a real economic problem to other than that i'm a fan. and i think this is a series of

important area of tax policy right now. >> what about the business taxes on only, which was the question speak with its incorporation of the pastors. people going to do that, we have to recognize that people pay taxes can businesses do not. they are collectors of taxes. what you want to do is have a system that's neutral across all forms. pastors were great development because we're only taxing in the individual return. there's business income, onto individuals return. it's have the appropriate tax rate applied to this is earnings. the goal is to see if you can get c corp reform that mimics that an assigned tax liability correctly at the individual level. that's a hard thing to do. historically it's never been done super well. the easiest way to do it i think is to go back to the original idea of expensing all the investment, don't allow the interest deductions. occasion essentially a neutral treatment at the c corp level

and tax the interest and dividends at a, right at the individual. that's a you get there. politically will apply? i think it's going to be very hard. i do. because -- >> would that be revenue new tour how would you pay for that? >> i'm less worried about revenue neutrality on the corporate side but if we're going to get the rate down to a competitive one, say 25%, it's going to be a hard time making a revenue neutral. that's all there is to it. >> so that suggests a business on reform might not fly. you need something else with it. >> it runs right into the problem you're cutting taxes for america's largest corporations, and having not for america's small farmers and workers and the politics of that are just toxic. >> i'll let jerry to comment. >> here we have some disagreements, my friend doug do i argue with a lot and i have great respect for.

first of all, i think the inversion critique is an odd one. i hated. it's terrible. it's going -- is just a terrible precedent. it's really awful. it's going to do all these distortions and then it's not going to do anything. seem inconsistent to me, i don't think it's going to do as much as i'd like it to do, as much as, say, carl levin or schumer or someone has proposed. i told a great i should say the optimal way to do tax policy but in the absence of a functional unequivocal system of congress than get around those obstructionists and work together, i think the administration has a very important this possibility try to protect the tax base and it may be negligent of them do not too. which brings me to another disagreement with the dog on this idea that territoriality is somehow the only way to go. -- with doug. i would point to listeners of

this discussion, a very important initiative that's being undertaken by oecd countries called beps. it is one there continually trying to adjust to avoid the very kinds of bay city road and -- pakistan for base erosion & profit shifting. these countries are can't figure out any territory system they can avoid the transfer pricing problems that the c.a.p. report articulates. so i would be quite weary of moving towards a system like that while it looks to me like other coaches are recognizing it as a key source of basie russian. finally, -- base into sugar if you listen to all the discussions, all the problems and the problems are real and deep and it's way too complex, you probably don't need to know anything more than the fact that ge at least when i grew up made

toasters and jet engines, has a thousand tax lawyers on staff. it's critical i think to recognize that american corporations have never been more profitable. that in 2013, the last for your baby, corporate profit the position of national income is the highest on record going back to 1929. not only have they recovered from the loss is and they sustain large losses in the downturn but they have surpassed their prior peak. that doesn't mean that attacks could doesn't need to be fixed. i myself have emphasized many important fixes to the corporate side of the code. but the idea our corporations are somehow being deeply folded and competitors is completely belied by the data as well as the deep erosion in the base. >> if you look at what the treasury actually proposed they are proposing that they have the

power to recharacterize transaction that were taken before a merger and acquisition internationally. some after. and in some cases with arbitrary numerical guidelines that are found on nothing that i can identify. some cases simply judgmentally by the treasury staff. i don't think it represents the tax code. it will create a lot of uncertainty in companies who have found economically beneficial merger acquisition partners internationally. i just think that's a bad precedent procedurally and his bad tax policy. >> okay. >> i mean, let me agree with one thing. here's what i don't like about it because again, it's second best, administration would be negligible not to take these actions in my view, but here's what i don't like and don't use toward precedent. next administration comes in. it may be administration of the of the party. i've been in these

administrations, one, at the beginning and one of the first things you do on day one, too, or three issue reversal of executive orders you don't like unless guy or gal who was in the place. if you start doing that with the tax code, terrible. so i take your point, but i don't think the administration can finally sit on its hands and just allow this jogger not to occur and not do something. >> i suppose we could spend all time talking about conversions but i think we have made your points, and i will not weigh in. you probably don't want me -- >> go ahead. >> so in any event, we are going to talk about politics. we've been through talking about that kind of entered dispersed, but let's say i have one more substantive question. should we be thinking about new

taxes like vat or carbon tax or transaction tax or something else, or are those just so off the map these days we can't even talk about them? >> do you want me to go first? again, i think it's so far off the map we shouldn't talk about it is really not the way to think about this. we talked earlier about the 86 reform. that had like a four year runway or somewhere between two and three. it had a long runway. so nothing wrong with toxin about aspirations. i see some things, i would disagree with text contention earlier that anything that is a new tax is putting words in your mouth, you will correct me, anything that the new tax sort of by definition should be off the table. i don't agree with it. i think there's something, one of the things while i stress the importance of neutrality, that

is not having a tax code that incentivize decisions to tax avoidance versus market economics, so inversions will be a good example, i do think there are negative externalities within any economy with attacks could complete an important corrective role. we've had, i've written about this if folks are interested in following up. we've had a significant increase in dark pools fueled by high speed trading, high-frequency trading which looks to me like a country that's nothing to productivity, and contributes to volatility and the lack of transparency in financial markets creating some of the volatility that is pushing some and of these markets off the rail time and again. i think a small financial transaction with a few basis points would be a good idea. i understand three basis points financial transaction tax raised over 300 billion over 10 years.

that's real money. i like that idea. the only thing, just an asterisk, give doug a chance to respond, i hope we can talk about extenders. i think that's actually where are going to see some new tax policy discussion pretty sent. >> okay >> i didn't say anything about no new taxation, but i don't think anyone should even consider a vat. i think it's a political nonstarter. i don't think that. >> there's a very nice thing on a blackboard called a vat, progressive consumption tax is really progressive vat but if you say that it's over. so i didn't say that. >> understood. >> second is i believe when you lay down the principles of ta

>> policy, you should tax real economic activity, the consumption of goods and services, the wage earnings of people, supply labor, capital income, take a prefer income for your tax -- tax real economic activity for the purpose of raising revenue and not tax financial transaction as much as you can because it is the 10th section of the financial transaction, particularly differential taxation of returns to capital, dividends, interest, capital gains that transforms that cancer saves of tomorrow into tax lawyers and accountants. that's a terrible incentive. it's a big problem with our current system. i wouldn't do the financial transaction tax. you're going down the wrong path. that leaves a carbon tax. it's a consumption tax. i have no reason to oppose consumption taxes. there's an enormous literature that says that if you want to do something on carbon, that the

most economic efficient thing to do is use a carbon tax. i'm all for that. if it gets in there, to let the payroll and the corporation income tax, that's what the literature says you should do. makes a lot of sense. it solves a political problem in a very clear way, which is there is no we'll ever get a carbon policy to pass on the stand-alone vote in u.s. congress in the foreseeable future. it's not going to happen. in the same way you're not going to get most of jared's friends to get the corporation income tax down to five, 10%, my kind of numbers, but if you drag a conservatives to the carbon post because they need to get to five or 10% and if you track the progress is to the local urban rates, you've created a classic coalition of the dredging the walks what irritated that the deal gets done. that's the only scenario i can

are super one of these things happen. >> other than five or 10% you through in their, there's a lot to like in your wrap. let me ask you about a tiny little corner just to see where you come -- >> so we also like the carbon tax, good. >> here's the wrinkle on that that kind of interesting because this came up a few weeks ago. carbon tax i would argue is pretty far from the table. >> right. >> so there was a discussion to increase the federal gas tax, 18.4 cents a gallon since 1992 or 93 or something. interestingly there was a bit of a democrat republican coalition, or at least a couple of members from the opposite side of the aisle who proposed an increase in the federal gas tax, which is a dedicated tax to fund our highway infrastructure, which

actually put something eric has written about. i think such dedicated taxes are smart and good policy. nice connection between what you're doing there at the gas tank and which are driving on when you go on the highways. i thought this was a very good, smart idea. now, i will say to my chagrin, the white house was not very embracing of it at all and it is typical of politicians run away from such things because what's the one thing every sees everyday? it's the gas price. i thought that was a nice little corner of the carbon tax debate that had some promise. i wonder if doug agrees? >> this is likely going to be a big issue. we sort of wandered into a key moment of choice on the future of highway finance. the tradition has been, let's finance it with the user fees, and the user fees that's the gas

tax and have a user pay model for the finance. that's really not what's been going on. we are increasingly using general revenue transfers into highway trust fund so it's become part of the general financing of the government. and rather than have it happen by accident, i think the congress needs to choose. one model is have the user fees and get a user fee that can fund the necessary investments in a sustainable way, or put it in the general corporation coffers and so we're going to make hybrids can be with all the other nondefense discretionary spending needs, and fund it out of general revenue. but there needs to be a choice. what's going on right now is not good policy. if your going to go down the use of the route, there are things that are much better than gas tax. there are very, very clear advantages to vehicle miles traveled. they can be differentiated by axle weights and actually way more closely mirror the harm inflicted on the highways so

you're paying for which he damaged. those are places to go but i just think raising the gas tax doesn't solve the fundamental question of how are we going to finance it and doesn't get the right user. >> if i were bill clinton, don't let the best be the enemy of the good. >> here we have, i just give you an example of a republican and a democrat who in this climate came together and suggested what i think is a smart -- using that's not optimal because it's better to have vehicles miles traveled. come on, let's join the realm -- that wasn't the realm of the possible but it was discouraging to me that i was a very lonely voice out there trying to boost that debate. i don't know where you guys were. >> we weren't really involved. there was some proposal to raise the gas tax and offset it with income tax, which strikes me as getting into the realm of why have a trust fund if you're going to do that?

>> i guess my point here was not to argue against compromised. i started talking about important it is, but let's know what we're trying to publish at the outset. >> i agree with that. >> that's a fair point. >> okay. i'd like to opened up to the audience for questions. >> somebody ask about extenders. >> you can talk about it. >> i get a bonus for every time i talk about extenders. let's fire up the recording or otherwise this is a pointless exercise. so great discussion, really interesting. >> who are you? >> tony. i write for tax notes. my question is, this is kind of a very big picture question but i hope it doesn't just turn into big, like it would be nice, i really want to know what you guys think in terms of the realm

of the possible like we were just talking about. if tax reform so difficult anyway, why not just swing for the fences and just try to remake the system in a fundamental way instead of doing something incremental? it's going to be hard to matter what. this is kind of hypothetical, but what do you think? >> i don't think it is hypothetical. so how does tax reform get done? in my view, the universe. number one, lots of public education as i said. people need to be cognizant of what's wrong with the current system and buy into the fact that when you change, it's going to affect all of us. you have to do that. number two, an essential piece is white house leadership. the white house has to take the lead because only the white house is positioned to make sure the other party, you know, says this is necessary to begin. they say we won't sign unless that's in. only the white house can disappoint their own party and

say to them come look, i know this is a tough vote. will take care of you, campaign for you, raise money, sponsor into migration bill, whatever is important to you. you know, only the white house can make that go. so white house leadership is essential. third piece, 86, what did they do? the treasury, eric, wrote a transformative plan. it was as close to an income tax as you could probably get. and it swung for the fences. it swung hard enough for the fences that the white house itself was made a little uncomfortable, but the white house modified it and send it up to congress. that's an important step because if the white house isn't sending up something, congressman can go and say look, i don't want to do this but the president asked, you need that. you need to give them cover. you need to ask them to do hard things. you need to give them some cover, as they could to fix it. it's all flawed to each committee gets to take credit for fixing it.

i think swinging for the fences in the process is important thing. it's not what comes out of the and probably but there's a place for it. >> well, maybe i'm too much of a creature of this former swamp, and i apologize if my vision of swinging for the fences is more of a bunt. but i actually thought that dave camp kind of swung for, if not the fences, you know, hit something that looks like a double. now, i was critical of the plan for as much as i praised some of the courage, because the way it was structured it actually started out revenue neutral and then lost its revenue neutrality after the first decade. that looked extremely clear to me, both myself and my colleague at the center on the budget to the analytics to support that claim so i'm not saying it was but he kind of did what the cap folks did in his piece which is let's go through the code and take out all this crap that

everybody agrees is distortionary. i very much would support a discussions like that, but camp's idea was dead the afternoon of the day he presented it, not because of the opposing party but because of his own party. so while i appreciate your suggestion and to think that we should start a dialogue as i suggested it takes a long runway that swings for the fences. i think that it's not really helpful to just have that discussion without having the political discussion, how do we get from here to there so we can have some kind of reasonable audience which they don't know, even within their own parties. >> just add one comment. i am not as responsible for the 84 treasure work as doug says. i left during the process.

that was the most politically naïve actions is ever done. treasury was turned over with almost no guidance from president to the obesity -- nothing he said was don't touch deduction. retrospect, maybe a little political naïve may help. >> very principled policy proposal. we need that. >> identify yourself. >> i'm frank, george mason university. i would like to get to the personal income tax because that seems to be the critical barrier. it appears that just as the corporate taxes and extreme tax in terms of other countries our personal income tax, maybe the same thing. but what i haven't seen done is an analysis of where the income of the highest tax brackets goes. the administration seems to talk in moral terms, it's not fair,

people should pay their fair share of taxes. but if you look at the high income of high earners, it has been established that a lot of it goes to expenses, imports, and, of course, a major portion to investments, much of which may be trading income rather than wealth building investments in plant and labor and so on. so i'm wondering if we don't need an in depth, accurate survey of where the money goes as you go up the tax bracket? >> well, that's a really interesting question. i would first of all refer you, well, you may know about the service consumer finances aspires to be this or that you are describing. so the federal reserve every, is it two or three years? i think it's every three years, it's every three years, feels the survey which is intend to give you a very granular look at

the uses of particularly income at the top of the scale. so i commend that to you. where your question leads me in terms of this conversation is a broader macroeconomic observation that i am obsessed with this isn't talk about writing a lot about in my blog, which is it does seem like we are a world awash in savings and divert earnings in the context of our conversation, awash in savings, awash in loanable funds. and jet awash in we commend. and figure out some of what doug's comments about smoothing the road between investment income and investment possibilities i thought were resonant. to figuring out how to connect those two disparate facts of life right now, a lot of

low-level funds -- loanable funds, investment levels that looked kind of low to me, a lot of investment needs whether public or private but certainly in the public space in terms of our public infrastructure, and very weak labor demand. that's a marriage that should happen and to the extent that tax code can facilitate that, as a great i think inspiration for tax reform, particularly on the corporate side but on the personal side as well. >> jared is just wrong. and part of it is just strategy, you should not design a tax reform for the problems of the moment. you should design the tax reform to give you a tax code that is doable and has the permanency that raise the revenue over the long term. i thought your comments were a great lesson in tax policy because they echo with my views, number one. you want to tax people based on what they consume. is it imports?

whatever. i don't know the facts to the question but tax them on the consumption. don't try to tax financial transaction. that get you into trouble. get the financial piece out. the money is too easy to move. it's incredibly expensive but it's never done effective and it's getting harder in a globalized world, and focus on real things, things that i could improve the productive capacity of the economy. those should be building blocks in the principle since. >> that seems extremely or false -- to comment on just wrong. of lot of what you just said is what i was trying to say in the sense, now we might disagree is where our investment needs, productivity enhancing investment needs greatest? we may differ on this. i think there's some real elasticity to tap in terms of investment in public infrastructure. i'm not the only one who thinks

that. larry summers is very articulate on the point. >> that's not tax reform. that's a spending policy. tax reform is hard enough. >> i disagree. >> tax reform is hard enough. if you turn it into macroeconomic stabilization, long-term supply-side investment on the public sector, welfare policy, you have made it too hard. >> no, my point, you're missing my point. my point is there are trillions of dollars lock up overseas, for example, very much as a function of the tax code. they should be unleashed to tax reform. by the way just be very concrete about this and you may not like the president's plans that as a transition to the international taxation, including this minimum tax i mentioned, there's 150 billion of one time savings that is plowed right into infrastructure investment. very concretely there's a plan on the table to do just that. you may not love it but it does link tax reform to these ideas. >> i want to make one comment. i thought this was a very, very interesting question is usually when you look at taxation of high income people, we think

about distribution and incentives. how does it affect to work and save and so forth. this is a question of what happens if high income people get more money, what do they actually do with the money? i think we probably don't look at that kind of question very closely, and as the income distribution gets unequal, are people giving more to charity? are they spending it on yachts? it's kind of an interesting question for examining how progressive we want the tax system to be, leaving aside -- >> my view is we transferred income tax, acer tax on high income taxed people. we often know the economic lives in designing the tax. it's very important. >> let me get to more questions. in the back. >> hi. i'm joe kennedy.

i consult with information technology and innovation foundation. and i actually have two quick questions. one is how much of the burden of the corporate tax is borne by labor? and the second -- >> what? >> i think every sort of agrees that if you get corporate tax reform reform and also individual reform it will have a big, positive effect on the economy and yet in traditional scorekeeping we don't count any of that. and so my second question is, how much of that should we count? is the camp proposal got a score from the joint tax that had significant positive effects, dynamic effects, and should we say that none of that counts, or some portion of accounts, or what? >> those are great questions. before i turn it over to the panelists, on the first question, there's probably not an agreement on this panel.

we say labor bears 20%, capital bears generally 20% and corporate equity, 60%. the reasons for that are described in a paper on our website and that we came to that conclusion. so you can go to the tax policy center website, there's a paper. my colleagues might have totally different views. >> i'll just see you and raise you in terms of links. i recently investigated this question in a blog on my site and i linked as many different analyses of this as i could find. the average is in the 20-25% range in terms of labors bearing the burden, but there are other measures as well. >> i think it's clear there's no consensus. i'm at the other end of the spectrum. i think the majority is borne by labor. we see these companies lose national competition. we lose the best jobs, the best

fringe benefits and that's the labor laws. there's no doubt about it. >> cbo puts it at 70-30. >> they actually don't. there was a model that did that but actually it's 25. >> thereby displaying the uncertainty about this. but i think it's a real concern. >> on dynamic scores, i mean, first of all, and doug and eric should correct me if i mistake -- misstate this, but it's very important to kind of discern what cbo does an than what everybody else does and i think the fact that cbo does incorporate behavioral elasticities in their estimates, but doesn't allow for dynamic supply-side effects in economic terms such that you'd count on

getting a bunch of revenue back from growth effects from the tax reform. it's the right way to go in my view, and i'm quite strongly take that position. it's not true that, so just to clarify, it's not true that there is no dynamic in cbo scoring because there are behavioral affects registered in the score. what they don't do is allow for these feedback effects that end up making predictions about gdp growth because of your tax changes. there's nothing wrong with other folks running around and doing that. i know j.c. -- jct develop it with camp and paul ryan very much enjoys exercise and expect to see a lot more of that from him. but when i see the magnitude of the dynamic effects there, it looks very much to me like extremely exaggerated impacts in

order to make the numbers work. you can't get down to 25%, be revenue neutral and make just a -- astounding assumption in my view about the dynamic effects of your package. that's a very dangerous way to go if you're concerned about fiscal rectitude down the road. >> doug, you had this expense as the cbo director. >> i was director of the congressional budget office and not only be. i supervised the very first dynamic scoring or macroeconomic analysis of the president's budget proposal. jared's characterization is right. cbo holds the size of the economy fixed. the whole idea of putting in growth effects is the line of the becomes dynamic scoring. i am a proponent of this because i believe we should indicate the policymakers, everything is different about the world before and after the policy,

contemplating enacting. you have to give them before and after and if it includes more economic growth or less economic growth, more tax revenue or less tax revenue, that's information that is valuable to them and important to be in there. there is no reason not to put it in. how you put it in is very important because this is called scoring, and scoring is different than forecasting. it's different than modeling. it's scoring. and when you go into the budget world you've entered a cult. it says we're going to treat every proposal the same. and so scoring is operate at some level that you do the same for everybody. here's the best analogy to football games you get 6.4 -- six points for a touchdown. i don't know why. you get one point if you kick the extra point. you get two points if you run it

or throw. i don't know why but the fact thaofthose arbitrary scores aree same for both teams across all games played, and overtime allows you to compare policy proposals in the same way. you always do the score the same. you do it exactly the same way and you will get more information into the process, that's good, and you will treat all proposals fairly, and that's essential. >> i think we have time for one more question. >> my names mary, and i am an independent observer. now, my question is, it doesn't mention here the gross historic proportions income inequality right now we have. what do you think about a negative income tax?

especially for the young that are unemployed or underemployed, part-time employees. i was actually at the debate of the mayoral candidates and there was one gentleman saying, well, i only earned 5000 this year. now, you know, if the minimum would've been standard deduction an exception is about 10,000 for 2013. why wouldn't that young man not be able to claim the government that refund? the other question i have, and that's -- this idea has been around a long time, at least 100 years. the other question i have is the gdp is about, what, 17 trillion? the budget is about 14 trillion. now, what is the proportion of tercel income taxes that go into -- and corporate taxes.

so, you know, at 14 trillion for the budget and 17 that we are producing -- >> we can -- >> what does the government get, you know, the other question was minus 60% on finance. >> i'll talk about that but doug, do you want to go first? >> let me address the first question. we can refer you to places to get statistics. >> i think he may have been thinking of debt as a share of gdp. adept, actually against, the debt held by the public is around 10 trillion right now. anyway, but at any rate, negative income tax. you're right, eric connecticut all the numbers you seek. -- eric can help you get all the numbers you seek. the center on budget where i work we think a lot about anti-poverty policy. one thing i've observed, you can't miss it if you hang around

in this town and think about poverty policy is that the thrust for the last 30 years really has been towards work, for able-bodied working age households. work is a path out of poverty. and in that spirit things like the earned income tax credit, the refundable child tax credit, what i called earlier the refundable. i would add the minimum wage but we would argue about that. in the tax code of those kinds of refundables certainly function like a negative income tax but they're not for everybody. they are conditioned on work and i'm okay with that. >> on that note of agreement we should quit. >> okay. i think we have, by 1:00, we are done by 1:00. we have one minute. did you want a very quick one?

[inaudible] >> all right, a long one. >> i'm a cpa with a small cpa firm, and i think i have an understanding of what individuals go through. just one quick comment. i think tax reform might be a good idea, but people are resistant because you're going to have a major reform in the next year something else. it's like i don't care if i pay $4 a gallon for gas but i don't want to pay $6 a week and then $2.50 the next week. the other thing i want to say is that i think everything should be open to taxation, not just consumption. i don't see why a person like mitt romney can get a billion dollars worth of net worth and not a tax because it's kept inside his hedge fund. i see nothing wrong -- everybody hates taxes but we had to come up with revenues. why not a net worth tax? you could set the limit,

$50 million, 1% over $50 million for someone like -- >> i'm going to have to cut you off. any quick response? >> wealth taxes have been unpopular, probably the most unpopular tax in the united states so i'm not sure that's a route to getting tax reform. i understand your point. i want to say one word about the tax could change all the time to the durability of the reform is important. one of the sad things about the 86 reform is it unwound relatively quickly. a key part of it is you can't do this and be independent of what jared has talked of it in terms of a long-term budget output. and let you fix the spending side to match the revenue side, you will have these deficits because deficits in the late '80s, early '90s. that leads to pressure from revenues which lead you to open up the tax code. the minute you open it up the integrity starts to be unwound.

thank you to durability of tax reform is willingness to get the spinning side in order as well. >> i think you make a very good point, and i like your idea about a net worth or a wealth tax. i will note, and i think the way ut it up is exactly right, on its face consumption tax of course is regressive in the sense that those with lower income consumers, more other income than the wealthy. so i take your point and i like your point but i will just leave where we started, or at least were i started, which was ask yourself, why do we have such a tiny and ineffective estate tax? why do we have an inheritance tax? why do we have a net worth tax? the answer is because the folks who are defending the status quo have more income than ever. we have this toxic combination

of wealth concentration at the top of the scale and money and politics play a greater role than it ever has before. so while i like the way you're u think about this i think it bumps right into the very political strengths i started out with. >> if my would be that important to politics, mitt romney would have been -- >> i'm not saying he gets elected president i am saying issued policy obligations. >> on that note of disagreement on this and agreement on the previous question, i think the two panelists for showing there can be some areas of agreement and for the very high level discussion. [applause] >> right now on c-span we are live at united nations in new york city. ..

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is underway -open-brace students to create a five to seven minute documentary on the theme of three branches that affect you in your community. there is 200 cash prizes for students and teachers totaling $100,000 for the list of rules and how to get started go to student cam.org. the white house national security council's counter biological threats director rules that the outbreak is a global concern not just africa. she spoke to part of the conference hosted by georgetown university hosted tuesday. this portion is about one hour. >> good morning and welcome. thank you for the kind introductions. and it is an honor to be here with you this morning. and we are in for a very long battle against ebola in west africa and the rest of the world and quite possibly in america. we have four speakers and we are

down to about nine minutes each now. and doctor cameron from the white house i would like to show just a few slides primarily from sierra leone and the two sides with very strongly held opinions in that expands and from everything i've done over the last five years. for what is happening and what needs to happen to respond to the ebola crisis that is in west africa and elsewhere. there are signs and symptoms of the ebola virus and what i want to emphasize is that the early clinical parts of the illness of the signs and symptoms are nonspecific they are fever,

diarrhea, vomiting so they are very much imitated of the common diseases in west africa like malaria and typhoid or gastroenteritis and so it is hard to know if someone has ebola or a common diseases such as malaria. so you can see some of the symptoms are fever and diarrhea, muscle pains and other things and only the hemorrhage occurs very late, the red eyes and extreme weakness. very early on it is hard to differentiate from the more common infectious diseases. this is a fine also that you see everywhere not only in sierra leone but other parts of west africa where it is real it is and political. you saw this sign that this is an organization that we saw in the churches on the hospitals and the clinics and the buildings on the street in the airport so there is initially a

perception that ebola isn't real. it isn't a virus that causes a contagious infectious disease and rapid death in the majority of people that are infected with it. from yesterday's who organization update on a number of people i think this is a minimum estimate. everyone is hoping that there won't be a big outbreak and there is one patient who traveled. this is a map from the world health organization as far as the location this is a map of the countries in west africa where the outbreak is most intense. so. the capital freetown is the most

impacted and the most devastating part of the epidemic right now. the outbreak started at the confluence and overall area into three countries and unfortunately it spread through multiple areas almost every district except for one for example in sierra leone as well as most places in liberia and the majority in new guinea. in the 25 outbreaks in the past in africa. it isn't just ebola that we've known for 25 plus years in sudan

it's a different way of controlling the outbreaks in the past which was very effective in treating the isolationist people and quarantines a few people that have been exposed always effective in stopping the optic in humans and back into the animal reservoir for gorillas and chimps and this time the control measures are not effective. in my opinion they are not going to be effective in the other cities. yesterday's numbers from who 348 healthcare workers have become infected with the virus and more than half have died. i do want to emphasize that means almost half of them have survived and i think people that have survived through their own immune system and the help that they have received is very

important and very underemphasized. people that are survivors can provide care and protective equipment and potentially donate antibodies against the virus from their own blood and they should be no longer stigmatized. in terms of personal protective equipment i have to rack up in just a couple of minutes. the personal protective equipment this is what you need to wear and perhaps even more. it's even more complete. this is a training exercise to be able to help participate in as a trainer along with the colleagues in sierra leone in the uk and each afternoon three, three and a half hours each in this type of a personal protective equipment, and three minutes, okay this is the largest testing isolation unit in the hospital which is why 35

years one of the three most precious and memorable hospitals i ever worked in. this is the large referral of the pediatric hospitals in all of sierra leone and its closed august 18 everyone was discharged with pneumonia and typhoid because there was one patient a 4-year-old that wasn't recognized and therefore some people were exposed into the decisions are made were made to close at so many other children and adults now don't have access to medical care for diabetes, for malaria or complicated childbirth because of the outbreak and the cascade of the events have had a devastating effect across the society and the virus itself. this gentleman here is taking the attention of people tested twice and when i was leaving if

there were any symptoms etc. so the last two slides this is just a few of many that could be shown that it could be shunned as a regional campaign across all of west africa where the virus is to stop it but we can't stop it in only one country and expect it to be stopped in the region. the messages are mentioned. i don't think they are working in other large cities. there is a lack of workers especially those that are well-trained and there is a lack of enough good high-quality personnel equipment despite health workers become infected. it is very, very important there's an op-ed or document in the post may be two days ago and the person that emphasized the importance of the survivors so i

would say many important aspects of survivors should be transformed from being stigmatized to being honored. they can provide care to people that are sick including young children from whom there are many and they can offer antibodies from their blood if the system is developed against and they are living proof that people want can be cured. so the slide in the last minute is looking near and far and in my opinion it would be a long time more than a year before we have sufficiently large amounts of safe and effective people of vaccines and drug antibodies against the virus. this is the epidemic likely to last until t. 17 adults bred to more insight into outside of africa. that is my strongly held opinion. i hope i'm wrong but it's important to act now as if these are the defects in the near future. in the trial units based on the 30 plus years of the unix

experience for the antibodies. if it becomes endemic in west africa and that is a possibility in my opinion, then in my opinion we have got campaign global smallpox program that the dr. in the front row participating in his participating stopping it in 1976. i would ask as i have a multimedia interview last week and i will continue to do for my own experience i think that there is a huge gap that can and must be filled soon. in other words, we need to have an authoritative expert in global health crisis leader someone that is has experience in both global health crisis outbreaks and ebola outbreaks for the rapid demand and control the world had against sars in

2003 and who by that response and extensive experience in the outbreaks in the 70s and in the '90s now has worked for more than 12 years and who is the head of the the public-health of england and public health of england and was with the who for many years. so that would be my first vote. i would like to stop you. thank you very much for your time. [applause] the next speaker and the director of the office of counterterrorism at the food and drug administration the fda in the medical countermeasures initiative a key component of the government programs confuse the u.s. capacity who respond quickly and effectively to the outbreaks such as this. he was instrument of the fda's response to the plans in 2009

and she's also been very instrumental in more recent the more recent responses, for example, to them at least and two years of recent bird flu that has become a major concern in east china and will be back soon. please welcome the doctor. [applause] >> thank you for inviting me today to discuss the actions and the effect of the ebola epidemic. it takes a very special person to bear witness to all of these diseases as you do and try to make a big impact. needless to say this outbreak is the most heartbreaking and tragic that we have witnessed in recent history and there are

many complex challenges that we are facing. specifically the minimal health care and public health infrastructure within the affected countries have made this very difficult. and as just mentioned, the primary approach for containing the epidemics like this, the standard tried and true measures they are not working. it's very difficult to implement them in such a large scale in the limited infrastructure. we are talking about identifying the patients and the conforming patients taking care of patients and learning about the contacts to the healthcare workers teams and educating the population to be admission. being able to contact the timeframe to contain the outbreak all of this has been extraordinarily challenging.

in addition, the limited healthcare infrastructure has made it almost impossible to provide the support of care to the patients who need it and by that i mean fluid coming electrolyte replacement and things we take for granted in most of the world. like they say, ebola tells twice, killed people that are infected and kills everybody else that has other diseases and if they cannot access medical care. people die of broken bones and malaria and so many other things we have no treatments or vaccines. needless to say the safe and effective vaccine will be the total game changer. we can change the way that infectious disease is evil. smallpox is an example, polio was another example and one of

the struggles we have in malaria is the fact that we don't yet have the vaccine for widespread use. for developing the vaccine to be able to roll it out to the effect of countries in the safe and effective vaccine and i cannot say how that would be the game changer. now i hear to tell you that often times the fda is depicted are perceived to be a barrier to respond to situations like this. people talk about the predatory hurdles which delay is the product development and causes unnecessary delays and public access to investigations of products, but in fact i would like to tell you that the fda is a catalyst for product development. we work to facilitate the development, to facilitate manufacturing, to scale up manufacturing and the facilitating investigating medical products. we have a very large

professional staff who have unique scientific expertise in all aspects of product development and we provide the expertise to all our colleagues and government agencies that are working to develop the products to the private sector. so we separate the hhs agencies and the department of defense agencies. and work very closely with them in tandem as they move the programs forward. we also work very interactively with a medical product developer to advance the product including the manufacturing scale to make sure the products move again as fast as possible. it is how to commit and we don't know how to see any unnecessary delays in product development and availability. as it becomes available,

everything there is any piece of information, the companies will submit and review it in real time. we don't want any unnecessary delays. product development is also seen as very rigid and linear process because that is hard to impact us that many aspects of the development can be done in parallel and that is where we also also play a bigger role because we can guide the developers to do things in parallel and where can they expedite the studies again to the idea of living things as quickly as we can. we also collaborate internationally with who and our international regulatory counterparts and the regulatory agencies and all of the west african regulatory counterparts. this is crucial because the fda is seen as a leader in the product development regulatory authorities and there is a lot is a lot of need to exchange information. we also have one of the most

flexible regulatory frameworks in the world. we have a lot of authorities to be able to make make decisions based on the best available science and with the goal to promote the public health. so often times the framework is adopted by other regulatory agencies after we do some consultation. i would like to stress that we are talking about the two vaccine candidates and candidate and a handful of investigational drug therapies. they are in the earliest stages of development and for most only small amounts are available. and that is natural when the products are in the development there is no impetus to manufacture it and that in large-scale services for doing the large-scale trials right now and investigational. in the efficacy and to do that we normally would do the clinical trial. to do the clinical trial in the affected countries right now it seems like a daunting endeavor.

my colleague is going to talk about his very critical of only taking care of the ability to improve patient care but also to be able to begin to study the products and the effect of the countries. so we do hope that it would be possible to conduct the trial for the patients and the countries we've already begin to discuss all of the developers about how they can do that. it can be extraordinarily informative to establish the safety advocacy for the products i think that it would be ready to go and the company is already in the planning to do that. it would be to meet with the representatives from the countries because critically and

it is essential and working with them to modify the plan to have a shared plan as we go forward is really essential. the companies that make the products and the u.s. government ability to establish this kind of infrastructure. this is all extremely challenging but failure is not an option here, and we do have to find ways to overcome the challenges. again, failure is not an option. and i just went thank you again. we are highly committed and we have more than 200 scientific staff involved in this response. and we are committed to doing all we can to respond to this epidemic.

to the colleagues of the food and drug administration the next speaker will be doctor jesse bump who has a phd from hopkins from the school of public health where he served as a fellow in the international health policy prior to coming to join the faculty at georgetown. the research focuses on the political economy of the current and historical public health systems in developing countries, community directed programs and, health systems designed to help systems delivery and social science. please join me in welcoming doctor bump. '

[applause] >> great. thank you very much for coming and for inviting me. we have about ten minutes and in ten minutes i'm going to tell you about the historical and political dimensions of the crisis. so it's about how do we get here and where are we going to go. does anybody know what this is? isn't a trick question. you don't get to answer. this is the virus. what do we do about it is the question but hold onto it for a second. here is another pretty picture. this is the measles virus. some people talk about it as a low vaccine coverage and i'm going to give you a couple of pathogens more as a way of talking about the way that

people think about health problems around the world. so this is a bacteria. this is a quote from the who stalked tuberculosis program and i will highlight this part. it's conceptualized as an access problem. it is an access problem in the diagnosis and patient centric treatment. these are malaria plasmodium. in the partnership one thread to malaria is the drug resistance and the solutions to change the policy. here's another malaria aspect. this is the mosquito and this is what transmits malaria and in the global malaria action plan there are two approaches long-lasting insecticide illness and indoor residual spraying. okay so these are three diseases and there are four approaches.

measles, vaccine coverage, promote universal access and malaria, drug treatments come in this case the switch or kill mosquitoes with bats were indoor residual spraying was. so here in ebola, what are the obstacles? here is a quote from one of the fact sheet identifying very weak health systems. here is charles writing in business week and identifies the crumbling health systems. here is a voice of america in the story of the 20th of august noted as the three most effective west african countries to share the culture systems. the world world bank in a press release last week identified weaknesses in the health sector and suggested that limiting

ebola and its economic impact could be done by investing in the health sector. so, why health systems and why don't we talk about it with other diseases? it's not that we don't talk of the other disease that we don't focus on it and one reason for that is that we are at the limit of what we can do with ebola. there is no specific treatment on the cure or preventative technologies and there are no vertical solutions. the things that we are good at and global health tend to be things like disaster relief. they tended to be specific interventions, but in ebola we don't have any of those options so we are left with this remainder where we are saying do help systems and in fact the health system is necessary for all kinds of things but it engages in social, behavioral and cultural patterns that usual interventions and global health don't go near. these included death rituals much as has been made about that

in the west african context where ebola has been spread by the handling of the deceased patients. it includes burial practices, risk factors. general health and sanitary practices also bear on the transmission. preventing and controlling ebola largely relies on the state authority and a citizen trust. in addition to these other factors. well, ebola and this is not exceptional. the health systems have wide benefits. so here's the internal mortality roughly 300,000 women per year die of maternal causes. many of those can be prevented with a functioning health system. by a real diseases buy a real diseases cost us 800,000 children per year. most of that can be prevented with a functioning health care system. a childhood pneumonia claims 1.2 million a year. most of that again can be saved

with a functioning health system. malaria, 600,000 cases a year. hiv-aids, 1.6 million per year. we've done lots of things. we've made tremendous progress, we've narrowed intervention for the specific diseases. however, you always reach a point where you need to have a health system in hiv-aids for instant it is a continuum of care for the decades of treatment now that we are good at it. it's no longer just one thing that we are worried about even in the vertical programs because the health systems are such a large limited factor in our ability to promote health. so, why are the west african health systems so bleak if they are so useful, if they are one of the most fundamental building blocks of a productive invasive society, while, why don't we have functioning health

system's? .. organization tried to approve assistance among many projects but in the 1970s commodity price collapses and oil prices hurt both countries and donors. in the 1980s to try to balance

the economy, structural adjustment is promulgated by the washington institution. one artifact was the country stopped investing in health systems. since the 1980s donors have done little to help in the ebola outbreak is one way to talk about the consequences of three decades of neglect in health systems. donors prefer things that are short term that have easily defined goals and simple links to the screen input and outcomes that are easier to implement. and urgent tasks usually take precedence over others. here is the calculus for you. think how you would conceptualize malaria. vs health system investment. the annual death toll is clear, it can be measured and

estimated. what is the intervention? drugs, spraying, in health systems the intervention is diffuse. there are many possible courses of action. infrastructure, workforce, resistance procurement, funding, popular education. think of credit cleaning opportunities. there are a number of people treated or a burden of third. it is hard to measure it functioning of the elf system. in the health system, in duration, a particular program might end but health systems never do. when it comes to advocacy they look around the room and say who else is engage? who is leaving? many nations entities pay some kind of let service for some investments in health systems

but the answer is to do much more of that. ebola is a warning to us. a warning for a disease that is often fatal, hard to transmit. and nonfunctioning health system as it has gone viral. things used to burn out. little epidemics pop up here and there and is so deadly, kills so fast it should spread. it enters the general population in urban areas so this is a call for us to take care of some long-lost business, to invest in health systems in a health workforce, infrastructure and system capacity and to embrace the political economy for a managing implementation.

thank you. [applause] >> thank you for that presentation. our next and final speaker, dr. elizabeth cameron is the director for counting biological threats with the national security council staff. the office of the secretary of defense and chief of staff, honorable and the weber. she worked from 2003 to 2010 at the department of state. extensive work on the national scale, biological, chemical and

nuclear weapons reduction. and she was a fellow with aaa, american association for advancement of science. at that time she worked for senator edward kennedy. dr. cameron had a bachelor's degree from the university of virginia and a ph.d. in genetics and molecular biology in johns hopkins. please join me in welcoming dr. elizabeth cameron. [applause] >> thanks to everyone for inviting us here today and putting together this hole symposium, and thank you for your heroism for going to the affected countries.

it is an untapped resources. there are people like you who can help. one thing we are trying hard to do is put in place the mechanism so that people will be able to do that more because they will be training in place needed to get more people there. a number of occasions with the ebola epidemic, people talk about the possibility of being an germac and we have seen the numbers continue to rise. today in the modeling coming out from w h o and cdc, shows what could happen if you don't inject a large international assistance, which many of you saw last week. president obama is very dedicated. i have the pleasure today of talking actually not as much

about the immediate response. and what we need to focus on at the same time which is very difficult, how do we get away with this. but all over the world. it is reminders that health systems are at the root of this and one of the difficult things to measure, that is actually one of the reasons we launch the global health security agenda, not a substantive agenda, a political one as well. i will focus remarks on that including in 2011 president obama says we must come together and by this he meant not just the other nations. cement across the government to bring together colleagues like my great colleague dr. borneo and colleagues from across the government and now colleagues from all over the world from the

department of defense, from foreign affairs, from u.s. -- u.s. aid. this cannot be done by one country or one agency alone. it really has to be a group and it has to be synergistic and it has to be organized and all those things may help with strengthening global health security, incredibly difficult but incredibly important. we launch the global health security agenda with 29 other countries and i will talk more about that in a minute but we lunch did in february of this year before the first cases in guinea were reported of ebola. we have been speaking about this not just within the u.s. government but with w. h. o and colleagues around the world for quite some time. how do you make this the issue something that is clinically palatable and as president obama has now said recently about the

ebola epidemic, really and national security priority. is a public health priority, a security priority. what is thought proper vision? our vision is pretty ambitious but i think it is the right vision and that is too a ultimately it in a world that is a can secure from global health threat posed by infectious diseases so we are not going to end outbreaks but what we would like to do is to prevent them from becoming epidemic so we need to put in place the mechanisms that are needed to do that around the world. when we launched the agenda in february, secretary kathleen sebelius of the health and human services, john kerry and assistant to the president for homeland security and counterterrorism lisa monaco, also put out the administration's vision for this agenda and i am going to read it because it is operational and i will tell you when we released it and i was talking about this in february, there were quite a

bit of -- aspirational. if you look at what is happening now, it read the little differently. in the 21st century we can reduce the global epidemic, we can put in place a safe, secure, globally linked, interoperable system to prevent disease threats, detect outbreaks in real-time and share information and expertise to respond effectively. this is the vision. if we could do this we would not be seeing what is happening now in west africa. this is the vision we need to get to. i don't have to answer this question in more. the slide reflects it was made many months ago sell callable health security is no longer a question that needs to be answered but to many that is unfortunate because it took an epidemic of this magnitude to get to that point.

obviously we are interconnected and obviously this is no one nation's responsibility but the international health regulations hearken back to this epidemic, which we talked about earlier. and is important to talk about devastation and economic consequences of sars, a bird investments for ebola and the need for significantly more investment because the gap is enormous in what we need to do, look at the value of prevention and detection and the front end versus what we're paying for on the back end. i am preaching to the choir but the -- these were put in place

after the sars epidemic. to put together the core capacities' countries would need to be able to effectively prevent, detect and respond to outbreaks before they become epidemic. these are wonderful because every country on the planet, the member states of who, have responsibility in implementing them but it is difficult to have resources for all the court capacity's across the board and to energize them in a non disease by disease manner and to seek funding to do that is a difficult challenge. the eye charts have been successful but in 2012, only 20% of countries, were able to report to the who that they had met them which meant 80% of countries in 2012 were not prepared and i think that was a huge wake-up call for us and many other countries around the world and was directly linked to

the global health security agenda. before i show a slide of what the agenda actually is i will say what it is meant to do. it is man to basically discuss and identified three basic risks posed by emerging disease threats, drug resistance and the intentional creation of organisms and bio terrorism. it is supposed to address three opportunities. right now we have enormous societal commitment that has grown tremendously since the slide was conceived of in february. it is the best slide in my deck. one of the challenges is bifurcate in our models and replicating them in an organized way that is not piecemeal so countries end up with capability at the end of it that is sustainable and exerciseable and measurable has been very

difficult. to capitalize on three priorities, preventing where possible, affecting more rapidly and respond effectively. so the agenda itself is much nicer looking online and difficult to fit into a slide and be able to read it signed a rather ugly slide so you could actually read the words. in a sense it capitalizes on everything that is part of the i s are relating to infectious disease threats of representing that it does look at chemical and radiological threats and the agenda does not but related to infectious disease perhaps the agenda it does include all of the elements in support of implementing the i h r but importantly the performance of veterinary services pathway of the 0 i e, world organization for animal health. it also includes areas that have been 8 huge priority for who's that are not included in the eye h.r. prominently like countering antibiotic resistant bacteria. another issue of huge importance to the administration in which

we also announced a large effort earlier this month. we also when we announced the agenda in february we put forward this plan as a way to not only say exactly what we want to achieve in layman's terms but elevate this issue with other countries. if you look at foreign ministers or national security advisers this threat is currently at the top of their list because there is an epidemic going on but that is usually not the case and >> passed over the last decade it is hard to keep this on the front burner generally speaking. one reason for that is it is hard to feel the impact or economic consequences unless you are actually in the middle of it. we are currently in the middle of its endeavour when is feeling the consequences, not the least of which every affected country who's dealing with untold lives and economic consequences.

keeping this as a national security priorities since sars has been incredibly difficult. how can we capitalize on that? by using language leaders understand and targets and affective measures that can actually be utilized by countries to show that they are achieving success and potentially measured externally by others which is another thing z isr is not concluded overtime. we launched a target for ourselves and also published and these are available on line, 12 targets for our own efforts to improve global health security capacity in at least 30 countries over the next five years. the targets i am not going to go through because of an incredibly long list but they were put in place with a lot of consultations from experts across the u.s. government and taking into account scientific literature and ihr implementations that is that have been done over time and we wanted to choose things that were measurable by countries sell i encourage those of you interested in this to take a

look. next up, as dan mentioned earlier and i think john also mentioned in his opening remarks, we have on friday we are bringing together countries at the white house that have seven months of work that has gone on to february with an incredible amount of work and leadership around the world. we had two commitment development meetings, one hosted in finland and one in indonesia that had none 200 participants and bring in 44 countries to the white house on friday with international organizations, directors general from who, we have interpol, the world bank, the european union, african union and united nations and the goal is to highlight the progress that has been made, tremendous number of new commitments in every country invited to bring one for the event. president obama will participate in that event and the goal is to

spur action to prevent this from happening again. we will be looking forward in sustainable mechanisms to keep this going over the next several years and without taking away from the leaders who almost certainly will be making statements about this in coming days, we are very much interested in how we take the small forward and most importantly for this group, have non-governmental and academic sector and young leaders of the united states and the planets can take part. the ebola epidemic has garnered a tremendous amount of interest in the academic and young leaders community and that is another thing george has taken a leadership role on and we are looking forward to how that can be capitalized on to build this agenda and provide greater access to the immediate response including the last thing i say, which is that it is difficult to

focus on the short-term immediate response which is so overwhelming and paramount while also looking at what we need to do for the future but it is critically important and i would like to close by using a quote from our president from last week, where he talked about the immediate response but if you read what he said which is on this slide and read a little bit further on, in that speech, the president himself is focused on the future and i think we have to be because the message is we can do this. we have the tools for this national security threat and many other threats are less tractable than this one but we have to be able to mobilize together in an organized systematic way to do it. thanks. [applause]

>> thank you, dr. cameron. we have just about four minutes left for questions, some of which you submitted to me here now. dr. cameron is going to have to return to her place of work. i was wondering if you would mind joining me up here for a few minutes and just one or two questions. after is this we will transition into our first panel. in the interest of time i was wondering if you would be willing to extend a little bit on what she already mentioned but in more detail with regard to the food and drug administration being a catalyst for helping to bring new

vaccines, medications, devices that are safe and effective to the market for people who need them particularly in the context of ebola in west africa and the international community's response. you are going to geneva, perhaps you were is there not long ago. in terms of clinical trials for candidate ebola vaccines or treatments with drugs or antibodies, can you in general terms without referring to anything proprietary talk about is there a precedent for this type of international response in this emergency and if not, how do you see working with international partners, regulatory and otherwise? >> is this on? clearly there is precedent for

the scale. >> is it on in the back? >> there it is precedent for the scale and rigidity with which we had to respond is somewhat different because of the unique characteristics of this outbreak and also because of where we are today in fda, five years ago as the president launched an initiative which provided additional resources to be able to more effectively engage. i you specifically to address these types of issues. as a result, we have collaboration to the department of defense and we had been engaged with them and writing diagnostics with pathogens such as ebola which are difficult to

validate in the absence of disease, usually a foundation of actual disease. because we had written these works to be here, we were able in a matter of days to authorize the use of their test for emergency use and the diagnostic test is currently used not only overseas but also in our own u.s. based laboratory response network. when patients come back from countries and a suspicion of ebola. and not just the emergency response but a lot of activity happens even before the emergency. and the same thing, the developers, in addition to regulatory review, an expedited review and helping to write the applications we have incentives

we can make land-use to be able to speed development in financial centers so designated one of the company's for orphaned resignation which provides economic incentives and additional resources for clinical testing as well as if they get improved or extend the period of exclusivity which again is an incentive for companies to engage in ebola therapeutics. it is up multifaceted response and again, we will look at every possible way to engage the developers, product development and to fears of a zealot -- facilitate access for the emergency. >> thank you very much. we have two more minutes. one question we have, expand a little bit on what you talk

about, in west africa there's a focus on sleeping sickness, and now in a sense primarily on one disease, ebola virus, could you comment on how the response to the ebola epidemic is going on now might be approached in a more optimal manner in terms of not only responding to the ebola crisis we have now but in going forward in terms of strengthening health care system across the country's impacted by ebola in west africa. i hope this will lead to the next week to panels of the morning as well. >> that is a great question. it is hard to operation elias, easy to imagine what a single innovation would look like and in this case to make a clinical example, this is like someone in

the midst of a heart attack thinking they should exercise -- those things will kill you even if you get over this. it is challenging to conceptualize what is going to look like, our obstacles year began with putting out this fire. ebola is deadly. we need to step up but as we are stepping up we need to think about the underlying systems. where does it work for us? then we have to ask where patients guess information, what is the interface with the government? the underpinnings of the health system include the technical and the moral as well as the political. the most promising and most attractive approaches, think only about the technical.

we need to do that and that is the basis of the response and what the political systems and the decisionmaking processes used to set priorities co-manage implementation and what are the choices, what are the trade-offs of one disease versus another. those are not things that should be done in washington, they should be done by the people. >> thank you. >> thank you all for joining us. this is the first panel of the symposium. this one is giving us some sort of historical, social and political, economic context, for the reasons behind a devastating ebola crisis in west africa. we have a different perspective this morning, a political scientist, economists and cultural anthropologist. but the first introduced the

panelists and we will begin. welcome to dr. sharon -- sharon abramowitz, assistant professor of african studies at the university of florida. dr. sharon abramowitz studied the liberian health sector. and searching for normal inflow wake of the liberian war. and the school foreign service. and african studies program. dr. taylor's research centers on african politics and private-sector governments and political and economic reform. finally we have dr. james ham a hamayana from georgetown

university. is recission choose aren't the political economy with particular interest in constraints to health as well as health policy. he also brings an insider knowledge to the panel in you gone the during the ebola outbreak in 2007. before we begin the discussion among the panelists. i will pose a question to each of the panelists to give us some context on their particular perspective beginning with sharon abramowitz. sharon abramowitz, you have been studying the health sector, this means we conducted years of field work in the region including guinea, the first epicenter of the ebola outbreak. in conflict affected regions of troy liberia. can you provide context for what is it about the situation in liberia, specifically, that has made this crisis get so bad so

quickly? >> sure. thank you for having me. it is an honor to be here and i really applaud the efforts of everybody in this audience to put together an academic and government response as quickly as possible. agricultural anthropologist, i would like to start with a story. ..