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>> about 5800 illnesses have been documented since the first cases of ebola were reported six months ago. next, the centers for disease control takes part in a discussion about the outbreak of ebola in western africa. this is hosted by the university of expert medical center. [inaudible conversations] >> hello. we are going to begin. i am the senior foreign-policy adviser for senator coons and i would like to welcome everybody today and we have a remarkable panel with us. we are very excited to have so many people interested in this

critical issue. and i would like to thank anita cicero so much for pulling this event together. i would also like to recognize the center for health security for hosting this event and i would like to turn it over to our moderator today that will introduce our distinguished panel. thank you. >> thank you, haley, and thank you to senator coons and the senate foreign relations subcommittee on african affairs for cohosting this event with us today. welcome to our distinguished guests who i will introduce any moment and welcome and thank you all for joining us today for this very important discussion. we are so thankful to have c-span here for those who can take part in this. are those that don't know, the

center or health security is a nonprofit organization dedicated to protecting people's health and epidemics and we are so pleased to be here today with you. there are as many as 20,000 cases of a bola projected and as many as 1.4 million cases of ebola by the end of january without an immediate and massive scale and successful response. we have an economic hardship on the ground. doctors and nurses have died in high numbers. and the health care systems have largely stopped functioning. it is an extraordinarily hard

disease to treatment and doubling time and shored as 20 days. there are no other infectious diseases like this. and it's now affecting to take hold in africa. but there are major new efforts under way by the u.s. government and other governments in the world, and the cdc is making its largest response in history. more than 100 people on the ground in west africa and hundreds of people in the cdc center in atlanta providing expertise that we will hear all about from doctor thomas frieden. usaid is providing tons of training and information and its people are moving 100,000 units of pp to west africa and we are establishing a regional staging base to facilitate the arrival of equipment and supplies and

preparing to train hundreds of health care providers. we know that who has created a world map for providing expertise and is seeking funding from governments around the world and ngos will of heroically led article efforts 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 those that are leading the effort now. we are going to learn what the u.s. government is doing in more detail and perhaps most importantly we are going to discuss measures that we can take to end this crisis in the time ahead. each of our panelists will give opening remarks for about five minutes and then after that we will have a panel discussion and turn to questions to answer his from the audience and from twitter as well. the four speakers today we are so fortunate to have given all they are doing in this response. they are first, jeremy konyndyk,

who is the director of the usaid office of assistance and tom frieden, the director of u.s. centers of disease control and joseph fair, who is adviser to sierra leone and the foundation they are they are. and andrew weber. we are very sorry not to have an extra guest. we thought we had him until 24 hours ago when his boss said she needed him in new york today. and so it back among going to turn to jeremy. feel free to make your comments from there or come to the podium, whatever you feel like. >> thank you very much. and thank you for the opportunity to speak. it is great to see this level of

interest here on the hill and this is a remarkable challenge and i think that it will take -- it will take the whole of society and government to fully supported the liberian government and the sierra leone government and the level of engagement is just a crucial piece to our ultimate success. i will talk for just a few minutes about the overarching u.s. strategy that was laid out last tuesday. and there are specific pieces of that and i will turn it over to my colleagues go into more depth with these pieces. 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 and look beyond the immediate outbreak as the longer-term needs of the health system and the resilience of these countries will be featured as well. now that this is as we have seen in other countries, it is likely to recur and we obviously don't want this whole episode to resolve the next time that happens. we do know that this can be controlled when we have the ability to do so. the first pillar of the strategy is focused on controlling the immediate epidemic and outbreak. the second tour focuses on mitigating impact. that's things like economic stability, political stability. and ensuring that as we struggle with the immediate outbreak, that we don't see second-order

impact than or equal to or not greater than the outbreak itself. and the third piece is to coordinate an effective u.s. government agency response and coordination would be critical to the success both at the country level and the global level and there are many countries that are looking to play a role here and in any major response that we undertake, there is an element with the hundreds of ngos and in this case it is even more critical because this is something that none of us have ever done on a scale of our. 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 and in the region beyond there is an ability to prevent future outbreaks of this magnitude.

but it's critical that the long-term future of these countries understand this and also with the immediate term that some of them do not see outbreaks on this scale. i think the fact that cases have popped up in a few neighboring countries, so far not triggering any major outbreaks, is indicated above the rest and the potential to keep this managed with swift and decisive action. so just to talk briefly about the role. it has the standing role in the federal government coordinated for international disaster response. in that capacity we have sent a team through the region and has representation from across the interagency and working closely with the larger team that is also there on the ground.

and the focus of this team is both to coordinate the interagency and also to deliver and execute on the usaid pieces of the response. our current focus and i won't reiterate everything that we have already announced, but the current focus is along effort, the first being effective in countries management and leadership of the response and we are very pleased to announce that as of today. the liberian emergency center has opened officially and so all of the elements of the government's coronation assets under one roof after a great deal of u.s. government support. the second element is to focus on scaling up isolation and treatment and we are focusing heavily on getting that set up and working closely with them in that effort, the ebola treatment unit, if i use ackermanacronymsy

don't recognize, let me know. it's hard not to think of them. and so the third piece of that, we are on track and i think that is one of the things that we have seen for the most rapid progress. we are on a good track their and the fourth element is infection control within the country and a big piece of that will be the committee care strategy that the president announced last tuesday that will focus beyond this, and enabling households to isolate and provide care to community members on the lawn treatment is not available. because that takes time. and so the opening remarks are an important part of that and we hope to talk more about that. if this element is communications and social

mobilization. this is a new disease in all of these countries and there's a lot of misinformation and misunderstanding about it, ensuring that there is accurate understanding and accurate information and the people know the basics on how to protect themselves is so critical. underpinning that is a huge logistical effort to both we and the dod are working on very intensively to ensure that adequate procurement and transport as well as adequate supply chain management in the country because the volume of personal protective equipment and other supplies that are required to run on the scale is just enormous. so that is a huge piece that we are referring to as well. >> thank you. >> thank you very much for bringing us together and to the senator's office as well for the interest. i have been doing public health

and running public health agencies for a few decades now and on two continents and i became a doctor working in new york city in the 80s where i cared for 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. i have never seen anything like that until i was in monrovia recently. and i went to a ebola treatment unit run by msf. the doctors are working with incredible effort and their largest response ever exceeding their capacity, stretching the limits of their operation. and we ran into a treatment unit and we saw a scene. it was patience in all stages of

the disease, from those suspected that maybe didn't have it and maybe might get it if they were not effectively separated from others. in our lab next door was working more than 12 hours a day confirming within a few hours whether people have the disease or not. people who were just getting in and being cared for and desperately needed rehydration to survive in patients that were recovering, including one guy that was healthy enough to complain about the food. and i thought that he should probably be helping to make the food if he could complain about the food. also tragically, three patients who had died in the past few hours and the staff was so overwhelmed that they could not remove their bodies. and the facility in which there are 14 to 20 beds per tent.

one person in one tent that had died was next to the other patient that was struggling to live. that kind of situation is the real world exemplification of what it means to have an ax potentially increasing outbreak. it's a very hard term for all of us to wrap our minds around. but it doubles in 20 to 30 days in this region. and that facility had 60 bodies removed that day. so the situation right now in west africa is an absolute crisis and it is moving faster than we need to understand particularly in liberia. and we have already seen experts to both cynical and nigeria and we now have the ability of

looking at the possibility of cases they are. but if i were to summarize here for a minute, what we need is an immediate response that is sustained and then to make sure that this doesn't happen again. and if i can just outlined those three concepts for a moment, i have never seen a public-health situation with this much need for immediacy as i have explained to people, and adequate response today is much better than a great response in a week. it is that urgent. and so that is the case in all three countries that are affected, even though liberia has the most out-of-control situation. but there are districts within liberia that have relatively few cases and they have the

opportunity to stop it before it spreads. and where there are many cases, we are intensively trying to steal so we can reduce the spread and in sierra leone where cases have not increased quite as quickly as in liberia, we have the opportunity to present a liberia like situation for cases that have three consecutive waves and they have the potential of keeping it under control and the best analogy really with this metaphor is forest fire. we have teamed this region in many districts to both sierra leone and liberia. especially the tri-country area and there is a border area where the three countries come together and it has very poor infrastructure and relationships with the countries, but it is the crucible epidemic and now the capital city in monrovia,

which is experiencing the world's first extensive urban spread of ebola in the context of the world's first ebola epidemic. so an immediate response is critically important. and that is why president obama's announcement made last week is so particularly important that the department of defense is already on the ground and usaid is there as well and the needs are extraordinarily large. that is what is hard to get our minds around it. because not only are the needs lunch today but it will be twice as large in less than a month and if we are going to be successful, we have to build where they are going to be in a month and we are going to have to sustain this. because once we camp it down, controlling ebola is something that the cdc has done for decades and in 2012 where we worked on it many times,

tragically a 12-year-old girl died from it. and what was striking was that she was the only one who got ebola. and that's the only time in history we have seen a situation like that that i am aware of, where there is someone who immediately thought, oh, this might be it. they immediately confirmed it was ebola and they ensure that when she died that she was safely buried in nature than any contact -- that they would not have spread it further. if that kind of poor public health service, the binding problem, if that was in place a year ago in these countries, the world would be a very different place today. but the fact is that we now have an outbreak that is likely to continue for a significant amount of time. and to protect other countries we need to surge forward.

when one individual -- a city of 21 million people, about the same as africa, we immediately got on the phone with the governor of lagos and we sent a team of experts within 48 hours and we brought in 40 people whom we had trained as part of this in nigeria who had worked very effectively on that. and now they had not been completely out of the woods but it does look like they control the outbreak and that involved more than a thousand health care workers, more than 19,000 home visits to measure temperature of nearly a thousand contacts and that was to address one case of ebola. so we need to have a response that is immediate and sustained and that prevents future events

like this because we could have prevented this in the first place. sars cost the world $30 billion in just about three months. the implications not just for west africa but for the world are quite substantial. who has raised the possibility of ebola becoming a pandemic in africa and that would mean, for those of you who are not a public-health, that it would continue on an ongoing level indefinitely. and we think that that's not inevitable. if that were to happen, it would be an enormous problem and we would always have to be thinking about the possibility of that and anyone who had been in any region may have had a case of ebola. so i would just reiterate that it's an approach that obama has outlined and it's exactly what we need. and we need to get the scale and

the speed that will match the exponential growth of the outbreak to ensure that we have an immediate response that sustains and prevents this from happening again anywhere whether it is ebola or any other health threat. thank you. >> thank you. let me start by saying i completely echo the director's comments and we happen to see each other while we were there. i would like to preference my remarks with the fact and understanding that i am mostly speaking from my own experience and my remarks tend to be skewed towards those countries which are currently experiencing worse part of the outbreak. so when we say that the situation is dire, we can't emphasize that strongly enough. what we are facing is a biblical

proportion scenario. the people of those two countries largely feel abandoned by the international community, however that response starting to trickle in and there is a light at the end of that, although it is something that could become more so. and i'd like you to keep in mind as we talk about two countries that endured almost a decade of civil conflict. so we are approximately 11 years out from the civil conflict and considering building a public health care infrastructure in just 11 years, it's an enormous task. we were dealing with regions which were almost on the brink of not being able to offer sufficient health care on a normal day or it and what we have seen since the outbreak is a complete breakdown in the public health care infrastructure. schools are closed, hospitals would have an even experience

this are closed and i think that from that we may never know the toll of death that resulted from non-ebola cases and normative infections that occur every day and the headline today ran on cnn do you have it unless proven otherwise and that is indeed the case. before this outbreak, i could argue that the case would be you have malaria unless proven otherwise. and we have complicated this factor that it is now occurring in highly mobile environments well-connected by roads and we are dealing only with colonial orders. the tribal languages amongst these countries are all the same, so it's really considered much as we consider going to canada from the united states. through this region. and we are still very much experiencing upward trend in the number of cases especially in sierra leone.

while i truly applaud the move by the msf to reach out for support, building of treatment centers is something that i don't want to talk about in stopping this academic. we could build them for the next several months, but at this time we are over task for treatment center. you can see horrific scenes i can tell you and i can tell you just in panama when we were in a situation much like was described where we had 10 persons and no body bags until approximately 10 bodies just outside of the treatment center and is the director mentioned come as a patient you can imagine that you are trying to survive this and your

mentality is very important. however, you are lucky to see people they were there just hours or in all that you can imagine is you're going to be next. and so you can see why there is a tendency that we have all read about people fleeing and running and not coming into the treatment centers and that's because the treatment centers are considered a house of death. we are turning the corner, i think in that opinion. recently saw that was much of the messaging that we gave early on in this epidemic, which was accurate but not locally understood, was that there is no licensed treatment for ebola. so what we have as a result is a large portion of the population, one that didn't believe in the ebola virus, but second, why should we report to a treatment center if there is no treatment for ebola.

rather than hearing that this will increase your chances, what they heard was there is no treatment for it. and so that led almost half of the population to speak out and seek traditional healers and that involves blood letting a lot of times, which is probably the worst thing you can do and that is also greatly contributed to the spread of the virus as well. where we are today in going back to the treatment center, our priority has to be stopping transmission of the virus and we are going to do that with boots on the ground and epidemiologists with a very sustained effort. as we saw in guinea, we thought that the outbreak was over. we miss two or three contacts and that is really all that it took to stop this largest outbreak in history. concurrent with that is construction of 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 the transmission and save the people that are not infected and treat those that are currently infected. and i would like to caution that the phenomenon that we have seen since the introduction of things like z-mapp in the experimental vaccines is that that is going to be the answer for the outbreaks. and we have these miracle drugs and it's going to stop these outbreaks and that's how were going to halt the outbreak. and i go back to the number one priority and we're going to stop it with the permission change and improving our control and treatment centers and the long-term will require almost rebuilding the infrastructure and setting that and we are all

so going to be dealing with the derivative and most commercial airlines and so that was largely dependent on the cargo and a lot of the commercial trade that countries are doing, which have threatened to stop this and that would create another set of problems and so those are all things that we want to deal with concurrently and lastly i would say that we are facing a unique situation especially in sierra leone and to a lesser extent in guinea. this is the first time that we have had an outbreak of this fever in an area where we already have a hyper epidemic as well. and so as of last week we are starting to enter the dry heat

season. so the areas that have been most effective in panama and other areas, they have been effective in a happen to be our hyper endemic areas and celebrity status and we will have multiples presenting at the same time and right now there is not even a place to print all of the locations. so we have to think about how we separate the loss of patience from the ebola patients and we don't want to mix chances of survival with those of ebola and there is treatment for that. so i will end my comments with that. >> thank you. thank you, tom for the center of

health security and the u.s. senate for organizing this meeting and clearly there is a lot of interest in this important and urgent crisis. this is a national security imperative and a human tragedy and an international health emergency on a scale that we have not seen before. and so one thing i want to stress is that this team that you see today, we didn't disney because of the crisis, but we have been working together on these issues and tom and i regularly for the last five years, we have a very strong partnership between the department of defense and the hhs elements and cdc that goes back many years. this is not new to global health and going back to our tradition of walter reed and the work that

he did on yellow fever virus. last week we established operation united assistance which would either dod support to this global effort that is led by the united nations and the special mission was established this week in support of our civilian agency counterparts, working with allies, including the united kingdom and france and others that have reach into the affected countries. the dod will focus our contribution on her strengths and our unique capabilities and capacities, including command and control and logistics and training, as well as engineering support. we established the joint forces command under the u.s. africa

command and major general darrel williams has been on the ground since last week doing the assessment. he is also the commander of u.s. army africa. the command headquarters is being established in monrovia, in addition to a regional and intermediate staging in senegal that provides a lot of logistical support to ensure the flow of personnel, equipment, and material for this very large area of west africa. and in addition the united states this week will send to more and diagnostic laboratories some of our best scientists and

microbiologist from the medical research center will deploy with the units to liberia and one in liberia and they will be associated with ebola treatment unit so we can have the diagnostics. and the department is providing a hospital that will be staffed by international health workers and medical personnel. the department of defense will not be involved in direct patient care is a part of this. we are going to construct 17100 bed ebola treatment units in liberia. and the planning and preparation and contrasting for that activity is under way.

and that should start to show results on the ground in the next few weeks. and these units will be staffed by local and international health care providers. and again the department will provide training based on msf and what they have established in belgium and we are going to establish a similar training center 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 requesting support from congress

for up to $1 billion to commit to this effort and they are pending here on the hill. and this includes the cooperative biological engagement program that is also going to invest over $60 million in strengthening global health security capacity and laboratory capacity of affected countries and also the neighboring countries as well. in the department of defense program has been involved for many years in the development of therapeutic vaccines to the

affected country as well as personal protective equipment. and so i'd like to note that the very 13th of this year, the u.s. government launched a global effort and that has grown and it wasn't in response to ebola, but the white house will be hosting an event of 44 countries at this level and we have health ministers, defense ministers in different sectors which is necessary for the whole of government response and to build

those that west africa could have prevented this from becoming an epidemic to prevent and detect and respond to infectious disease outbreaks as required under the international health regulations. secretary hagel will participate at the agenda on friday and secretary john kerry and it will be hosted by ambassador rice with the participation of president obama. i would like to finally think people like joseph and the workers that are on the ground. those that are on the ground who have just returned from there for their truly heroic efforts and we owe them all a deep debt

of gratitude for the work that they're doing on the ground every day in west africa. thank you. >> thank you, andy. and thank you all for setting up this discussion for so much insight and information to start the discussion. we are now going to turn the discussion for those of you following along. for those online, submit the questions to ebola on the hill. so before we get too specific questions about the response, because i think people really want to understand the nuances with the leaders here. i just want to ask one more question about the consequences if we get this wrong and if we don't rise to the occasion and he began to paint the picture here about what is at stake. but we hear things in the media along the way in the long lines of this country has enough on its plate and we love our national security threats.

why is it important to invest so much of our time and talent on this problem and what happens if we get this wrong. the usa today headline was that it could the ebola epidemic on forever, which i think is one way of saying pandemic, which was talked about. so what are the consequences for african security if they get the strong? >> earlier in my career i spent three years living in guinea, working with refugees from liberia. and as joseph said we're only about 11 or so from the civil wars in this country. and the u.s. invested a large amount of effort and political capital and resources to bring peace to these countries and

this outbreak is unchecked, if it is unchecked, it could undo a lot of effort in terms of strong investments that the u.s. has made for international interest reasons. but at a human level it threatens to devastate and it already is devastating in these countries and i think that there is a strong humanitarian impulse in the politics and it's the reason why we are a leader. and i would say the global leader on humanitarian action and disaster response. and anytime there is a disaster on this magnitude, the u.s. is on the frontline and this is this is an absolute national security priority and the

president has articulated it as such. and so i think if you look at the level of interest in the media, there is a clear desire to beat this thing and we know that we can. >> i think that the sad fact is that the worst-case scenario is really bad and yesterday the cdc outlined what would happen if the ex-potential growth were to continue at the rate that it was growing a few weeks ago. we don't think that that will happen because of the response the u.s. and others that the worst-case scenario within a relatively short period of time, not only would affect one's africa but would inevitably spread to other countries, we have two disease exportation

events with the first couple thousand cases. how many events will we have as the president said for hundreds of cases and whatever we may think, it is not possible to seal the borders. it just doesn't happen as it did in troll of drugs and diamonds of people and it just doesn't. and so what that means is that we really are all connected. and so while we do not think that they will continue to spread as we believe it has been spreading it all along, it will present a significant health risk to people in the u.s. and it could change the way that we work and the economy of the world and the way that we assess anyone who has traveled anywhere that might've had ebola. that is why a president obama

highlighted the whole of government response with what they can do to stop this as quickly as possible and recognizing as the president said that it's going to get worse before it gets better and we have to recognize that although we have to work immediately, it's going to take time as it comes around. and the other key findings was that progress is possible and when you isolate this, the disease stops spreading and can decline in numbers almost as much as the numbers we're seeing now. but what we found particularly striking was the mathematical documentation of the urgency that we all feel even a delay of one month and scaling of the response resulting in a tripling

of the epidemic and that kind of shocking increase is very hard, as i have said, to really get our minds around as we try to make sure that we are anticipating what is likely to be recognize the situation is fluid almost beyond description and it changes day to day. but the response has to be with the urgency that will turn around and i think that we can do so. but the risks are not just to west africa but the whole world. >> sure. first of all, i would like to draw attention to something we've mentioned several times. there were two other nations, nigeria and senegal. and we looked at the response in those countries and how they contained it very quickly and we can't ignore the fact that the gdp is approximately

$503 million per year and when you compare that to the gdp of liberia, around 1.9 billion, you cannot ignore the fact that the socioeconomics of the disease are upsetting. so it disproportionately affects the poor. i would argue that we are experiencing a level of mental and social, not seen since the civil conflict and a lot of us may question the mentality with ebola. and it's a direct result of the conflict at the time. the only way that you're going to talk about is to see live with live with her family in that sober talk about right now. we are turning the quarter convincing that bite keeping

someone in their home, not only are you greatly increasing the chance of that person will be okay, but you could infect your family and that has happened many times for that message to come through and we are likely to see major impacts on the governments of these countries. for example, liberia. johnson was certainly one of the most popular presidents in africa until this epidemic and now you have seen a determinist of negativity flowing towards the current administration and we face a similar circumstance. but the current episode, if you look at it, the book will divide is much like we have in the u.s., a two-party system. where the current epicenter occurs is the opposition party stronghold in this includes

those that are all being used as political fodder in office in sierra leone even though they have greatly improved the conditions in the past 10 years. and i think everyone on this panel is familiar that we have spent much of the last 10 years focusing on bioterrorism since i'm 11 and another term which we use, bioerror. this is the worst case scenario that we have thousands of individuals with the ebola virus. taken by technicians that are baseline phlebotomists and a lot of infections occur because of this and there are no good trappings for that. in addition, all of the clinical laboratory services that are

needed with illyria, common infections of people have, it's understandable because when you receive this sample you assume that it is the ebola virus. so to echo this, i think were going to have a lot of long-term effects, which we are also going to have to address and to echo the previous comments, every single day we delay, we are experiencing an ex-potential increase in these number of cases. >> opening it up to the audience or questions as well as online. but it relates to the pillars of response and we will need numbers of nurses that are not available now. there's an element of training going on in the planning and

recruiting and so how do doctors and nurses get involved in this in our country and also in the world if they are willing? >> is a critically important question and prior to that there was no global reserve capacity in every previous response had been a relatively modest scale in comparison to this one. and so the global capacity to treat this was premised on that sort of response and we are now faced in a situation where we need a response scale that involves funding institutions, organizations, and nonprofit, medical teams are able to come forward and it involves

identifying this traffic and staff those and one thing i think is important to underscore is that the treatment unit model that is being widely applied, only five to 10% of the staff are professionals in the vast majority of the people who are taking a rest risk on putting themselves on want to control this are nationals of other countries and we are working seriously to set up training models and the world help organization has been reorganizing training in the country itself as well. in working with, working with people to put them through this training, and the health organization recently opened with a large complement of the

staff and we are looking for those to join in the response. and it is reachable from our webpage. were we are collecting contact information for people that are interested and we are making that information available to ngos and other partners who are looking for staff to step up their own responses. and it's a resource for them that they can draw on to help to comput understaffing. >> there is a fear that ebola causes -- and the african union with the cdc and the department of state and they are now on the

ground helping out providing care. and this is a great example and there are some barriers we need to break down and even for their own citizenship we have to help people in their habit. 90% of the staff or local staff intensively trained and willing to work in these areas. in this week the cdc can see the first-ever training course outside of the nmfs model, now e have trained trainers and we're going to see the result. >> we will take questions from

the audience. >> would you say your name and where you're from and ask your question? >> my understanding may not be accurate and that is roughly 75% of the current victims that are women and children. if that is true, what do you think the particular socioeconomic impact as in these countries and communities would be as a result and how does that change or alter your response? >> actually the publication from yesterday found that that although there was the female predominance which we have been due to caregiving, we have seen like a 5050 response and children tend to be less affected directly because they don't tend to be caregivers. but we are seeing horrific implications of this and one i was thinking of one survivor and

her nephew as their kind of bouncing off the walls. and they finally said that the neighbors don't let him go outside because they are so afraid of him. and the second is the young boy untrained girl whose parents died and we are seeing really horrific problems and i saw one who had done the post employment screening of the staff with one of our staff described to try to save their child's life, hoping that someone else would help them and the implications are upsetting for themselves.

>> in addition, once a person does survive the disease, there is a stigmatizing of them once they reenter the community much like he was talking about and as was said, the majority of caregiving is for women and we are experiencing around a 5050 split. considering the burden as caregivers, they are primarily farmers with cassava being the main consumable and in addition to that, just touching on the point, we had entire families wiped out. but we have an untold number of orphans now coming into a system where the social map for things

but orphans was already under developed until again, going back to this, we are seeing numbers now that are not exactly equivalent to what they saw during that content, but it's reaching that content with a number of orphans that we are seeing in the areas. >> very quickly to add to the second pillar, and there are many effects that we are going to try to address. we are building on that as well. >> next question. thank you. i have a question about the evolution of the virus and the buyers has seen more human host than ever before and there was an article published at the end of august that documented the evolution of the virus through

99 human host and the question is what is the current and ongoing efforts to understand the direction. .. >>

>>&yny than by genetic monitoring but they should go by hand in hand. >> i am from the senator's office. following up on your comments, with containment and response with the response potentially of the expansion of the virus. it is my understanding cdc of a santry currently is passive surveillance. doctor, can you elaborate when the threshold from passive9&:ñ surveillance and what that looks like based

on if that is coordinating training for cdc? >> i think of us as having three lines of defense against ebola and thinking carefully how to do that most effectively and practically. the first is to stop that in africa and we have been talking about that. that is the most effective way. and continuing for a while we need to do more of that. second is those that are departing the country to put people in each of the airports with multiple temperature readings was well was of a questionnaire and they remove from the departure line anyone with a fever that may have ebola clearly that is not the

perfect way to eliminate ebola because of somebody was just exposed land incubation period is between eight and 21 days. that doesn't mean we keep these people close. but it is a very important thing to do to keep travel safe and to keep those airlines flying because then expectation nobody will get very sick on the plane. so we need to recognize it is not impossible someone will come into the hospital or health center with symptoms of ebola that may have that. 13 people have come on that were potentially consistent

in the area the past 21 days. so we have ruled that out more than one dozen times. with12rt more than 100 health care facilitiesqhrj we put more then one dozen labs across the country. but in terms of border protection we have a close working relationship with the cdc and quarantine stations and we work very closely with porter protocols that we follow someone would call in if it was consistent with ebola. we could respond effectively. one of the challenges is what we hope would be possible if somebody had ebola it is just not$ñ.6ñ

possible. said to understand it is something we will dynamicallyyw; reassess with vhs and others. >> -- ada jazz and other. >> that was handed a microphone. >> we heard from our panelists that the effort to that not go had a hard over three months than we are done but we heard about the u.s. response this is what you represent period"eñ including the $1 billion of sending that would cover six month period to build up the efforts.

can you give us a sense of what you mean sustained by a length of time? and the response that you believe is needed from other countries besides the united states? because we're doing a lot but it needs to be a major international response. >> i will say a couple things. basically give them un number and the dates but not together. but we do know this sooner we get out there the sooner they will control it. so it is critically important.$uax with of waterfall collaboration several parts of the department of defense and then i h them french in the italian all running laboratories but there has

been a robust global response as with the peacekeepers is on the ground. there is a robust international response to have that unique ability to have those skills and scope

>> is focused on that very question reno the u.s. government could carry this entire response on its own with the u. k stepping up in a substantial way to mention the international partners stepping up doing regular calls. been passed have the day we have been on twice with the u. k and donor partners.

that make intents -- intensified the efforts. >> international of reach is the area that president obama emphasized in his announcement in atlanta us cdc. the u.s. objectives is to mobilize the community to improve the of coordination among the international community. next week you k will host an event focused on sierra leone to coordinate contributions. of the private partnerships for example, the gates foundation has pledged $60 million to this effort and others are contributing.

the agenda we will leverage that the real commitments commitments, real commitments fraction of funding for in kind contributions for security around the world also specifically the current crisis. and does ambassador paul to lead this effort for the donor coordination the. >> i forgot to mention the world bank. they have been terrific they have already put 100 people in the field. but they get not just the emergency or the immediate response but those laboratories that would have

prevented that in the first place. and can prevent similar events in the future i will discuss at the white house on friday. >> i would like to add i don't want to speak to the timing. the with the decrease in number but for me sustainability so we can prevent this from happening again. there will be medium term training and a long-term training coupled with investments and sustainable technologies. that will take time and effort and will continue to do so throughout the life span of the outbreak. but the african union

secretary it all of them being extremely responsive and is coming together as far as governments. and the dates foundation all of them have started to contribute funds. when you look at the on the ground situation it is those bodies in the local population of government health care workers met that will be key to sustainability. >> the stakes for getting it right are extremely high because even before we succeed in liberia or sierra leone it seems like a crucial element of the response. >> thank you.

i am wondering as to evaluate the funding streams and the short-term time lines is their limitations to the current funding or those challenges? >> can i add on to that question? it would be great to hear from the panelist what they believe congress in particular could do since we are here today. bad is that that particular point what can they do to support this response. >> i will address cdc just for the 11 weeks of the sea are cost $30 million we're grateful for congress to do advocate that just at the level we're going. that is no scale up that is just 11 weeks and it does not involve addressing other countries which may deal

with large outbreaks to strengthen their resistance to surgeon in that area as well to produce the risk that would ignite forest fires elsewhere it does not deal with the medium long-term issues to make sure we have the technical capacity in the country to do that. we're working very closely with the world bank and others these are substantial and will continue for some time. >> just as the panel reflects. and with those potential toecaps and with the

prospective the highest priority with the programming request. with the overseas contingency operations. so immediate attention into those two will avoid any possible operations. >> from the usaid side one of the top priorities is to ensure the dod reprogramming is improved because that will allow the large scale cooperation in the way that with this response just like any others that dod and aid

worked extremely closely together where it works with dod to route those requirements that is well-suited. so having that resources available will turbocharge the type of scale of response that we absolutely need to mount. of the '80s side come as we move into 2015 we have a better handle on what this will look like. but i don't want to get ahead. >> i think we have talked about the short-term financial needs i will speak more thinking about now as well as save holistic approach but in the medium

term and long term objectives for sustainability, and to prevent this is we will require investment in infrastructure or laboratory setter permanently based you diagnose these log their own and investments of human capital with regards to new training and epidemiology and the laboratory. and another aspect is something that will be implemented is training of crisis management in the emergency operations. prior to the outbreak they did not have to deal with acute humanitarian disasters. they were long-term but not acute. so that is the medium and long-term investments i argue to ensure this does

not happen again. with the holistic aspect in addition to stopping the outbreak how do we deliver fuel to the area? and then to rebuild right before the outbreak and hopefully the silver lining they would have strengthened healthier systems. >> with the alliance from buy a security but a couple of you mentioned misinformation we have seen with the outbreak so far and i am worried about government to engagement to fix the problem to address those concerns about getting

a the correct messaging in the understandable way to the affected communities. what is the level of engagement and how is that going? and how critical is it done correctly in this timeframe for success? >> thank-you. i would be happy to talk to that. with regards to the issue -- mr. j remember there have been conflicting messages within a the government. there are opposition parties and political opposition but we have seen a term in that. and with the political consortium and maybe not so accurate.

but still dealing with messages from groups -- groups you may not immediately suspect bike from nigeria and that is something we've tried to fight against but that being said it is essential to work to religious leaders in the area but with that armageddon like situation people are flocking the large focus is on the religious community that was miss portrayed as a lot down there really the mobilization is how you can identify it and has a well as identifying cases in the home.

so a the messaging is taking place. i feel we're turning the corner but the messaging needs to be concise from everyone. >> can each of the three countries has a point person. our role at cdc and dod is a support and noted the group is moving into of management building for more than by a coalition. and the incident manager this week moved into his new office. in and within the system so

instead of everyone doing their own thing the coal is to have clear evidence based objectives based on information in coming back in with the household survey+% done by sierra leone's showing a surprisingly high level of awareness from the key messages that involves the logistics' sending someone to be cared for safely. >> time for a few more questions. >> afternoon. you spokejs about the history of the region with a decade of civil war. how will the reaction be when there is such a

traumatic path dealing with their own military and their mistrust of the services provided prior going back to the rumors that there is no care or we cannot provide care? what is the military doing to address that psychological impact of that force showing up on their doorstep? >> i believe the involvement of the department of defense will actually will build confidence in the government's hand in the region the resources commensurate with the scale of the challenge to support

the response. >> that is absolute a right to. there was the desire on the part of the liberian government and people to see a massive scale up of the response getting from the teams out there and the arrival of three resources has been extremely well-received. people can easily distinguish between what the u.s. military comes to do with that conflict that they have. >> if i may i will add to that is specially liberia is the the first time they have experienced u.s. troops on their soil we have a large station there that has been training with over the past four or five years.

all in there is much the same where5thec< u.s. was straining the militaries of the two countries. in liberia and happens to be one of the most staunch allies. so liberians are is static and adding to do that was the request that the dod to participate. that despite being a humanitarian organization operates like of the tilt -- military so the military is widely known for having both of those qualities and it is welcome to everyone on the ground. >> i have two quick things.

what about the front line health workers and also dr. frieden group of staffers were able to meet with the team combating the response. to help ministers don't always get as much attention and. and had to make get their attention for long-term growth? >> it is our experience people pay attention in the middle of an outbreak. within countries you will find the public health

aspect is weak. but for senator harkin to establish to run laboratory networks. in that would be a tragic that as we respond to you ebola that would be the systems that prevent the next outbreak to get out of hand as it has. >> and health care workers on the front line? >>. >> they say you vermis challenges in the enormous risks. and those innermost dash risk working in the whole system.

it does not have the equipment#ç it needs or the staff does not have the training that they need. with these are countries with extremely weak health systems. so with those procedures within the health system and the knowledge. the community care program which it is intended in my part it will pave the prior day across liberia providing training and equipment so the health workers can better protect themselves. there already popping a.

that's not getting support. this will provide support degree of training so that hopes facilities to have a place to go so those effected with ebola rather than keeping in a health center roy they cannot handle it. >> but the doctor has the unviable final comments about the situation.rc >> thanks for the opportunity. i am more than welcome to talk to people after words. largely liberian and health workers take a tremendous tool we're at the beginning of the epidemic we have ben

working in this space for decades. the supports has they try to provide community care centers in it is critical. that we give those family members living care givers the best opportunities for those practices to have the units fully functional and support with the duty and others. there are some tragic stories but the most compelling reason with those workers on the front line day or there.r they just want to be trained

to to show them how to do the job effectively. but prevention control that touche -- will have long-term benefits long after the epidemic is under control and will decrease of clients of possible acquired infections as well as protecting health care workers. i will stick around. thank you. >> thank you for being here. >> many of us have friends or colleagues working on the front line in west africa. but to share realtime information m.

we call it the t. levin knowledge forumé to put first impressions the anecdotes and stories for formal guidance so now we are pastime. i'd like to thank our distinguished panel last for their time and the end to all of you looked -- you worked to put this together. [applause] and.

[inaudible conversations]

>> vitter esther must be destroyed. it has terrorized all do they come across in iraq and syria. brothers, sisters, and daughters have been subjected to rape. innocent children have been gunned down. and then dumped in a mass grave. religious minorities starved to death. the most terrific crimes imaginable then be headed

with videos to shock the conscience of the world. no guide condones this terror. no grievance justifies these actions. no reasoning or negotiation and. the only language understood by killers like this is the language of force. and to dismantle this network in this effort we do not act alone. nor will we send troops to occupy foreign land instead we will support the iraqis and syrians and use of military might to roll back isil and train and equip

forces on the ground. we will work to cut off financing and stop the flow of buyers into the region and already 40 nations have offered tojoin the coalition. today i asked of world to join in this effort. those who have joined isil to stop weld they can those who will continue to fight will find they are alone. we will not succumb to threats, we will demonstrate those who build on those whose drive. >> you can wash stolid his speech in front of united nations general assembly later at the u.n. security council meeting on our web site.

c-span.org "washington journal" continues. >> host: this morning here at the "washington journal" we are going over to the we are going over to the >> in the washington area tear talk to the institute and its director about what this nash's -- facility does as well as some news made about ebola and what they're doing to fight that. joining us from their facility is dr. collins director of nih. beginning with breaking news yesterday's cnn treated

there are no additional interventions the ebola death toll could rise according to the cdc. what is the of role of the nih to fight ebola? >> good morning to the c-span audience. great to have you here so we can talk about topics like this. the nih is deeply engaged to try to turn back and very frightening outbreak of ebola in west africa. yesterday dr. frieden did make this projection of nothing happens because the get more than 1 million cases of the next few months that is a frighteningly large number.c, so what is our role? nih of biomedical research in the world includes infectious diseases led by a the best experts in the of

world. and partly for treatments for those who are affected it is moving toward at the unprecedented rate. 13 years ago we anticipated there could be any need for a vaccine. it has been around since 1976. this is this generation. a looks very good in the animal model where it seems to be protected. so we did just start the phase one trial and they have now been injected. from the clinical center it is all going well and no red flags. for a couple of months we will have to see to be

protective against the disease. but then to get into the phase to trial it is very complicated where liberia there is a great deal of stress for the health care system mounting clinical research studies to figure out a way to do that. >> host: what is the timeline? >> before we have the evidence if the vaccine is looking promising in the stage one trial of that looks good it is surely after that. their readings go on how to do the design reid try to set up a more extensive trial. to find out if this is effective or not.

but to develop in canada also we have partners in england. all hands on deck. to speed up the process. >> host: you said this is unprecedented. describe what it is like to ramp up the research and effort. >> we did not know when this might happen but we were fearful it would. when the disease spreads into this city making it difficult to follow. says far as research support1& but do not be in a position right now to have this vaccine ready to distribute

but to speed up the process of the approval but we wish we were a little further along. but that tries to make half highest priority. >> congress voted recently for a continuing resolution there was extra of money to fight ebola. >> there is for cdc but also for the organization to speed up the therapeutic development. vaccines are preventive but for people who are already infected that will not help. so people have heard about this cocktail of antibodies that were shown to be protected if you're already

infected. so they have received that including the two individuals we first heard about that were airlifted into georgia. but whether this works in humans are not the problem is but to push for the s it is the scale above a after. but these antibodies are developed but that does not just turn the crank to have a lot of it it takes a lot of time. but it those that are potentially promising but as

far as nih. but then it goes through december 11. that we will hope for additional of dollars. >> host: we are talking about ebola and other topics with nih director dr. collins joining us. the nihg funding is about 30 billion and to be enacted was 30-point to billion. the nationalists into bells was founded 8087 looking at the different institutes and centers the largest hospital dedicated to clinical research. with unique patients since 2013.

your questions and comments for the director of nih. our first caller is said democratic caller from michigan. go ahead. >> caller:. >> actually i am from mississippi. >> host: sorry about that. >> first of all, thank you for allowing me to comment. i don't want you to lie about health because i love to help other people.tz if you are funded for the ebola operation i am

understand what you say to reach out to the cities or the countries or the states to ask the other people because the country needs to survive. i believe those whole world is out of hand. >> host: dr. collins do you fear or are you preparing for the ebola outbreak in the united states? >> a chance of the sustained outbreak is pretty low. on the other hand, it would not be shocking if someone with ebola got off of a plane in the united states because there is such a large outbreak in west africa. even though they are screaming at the airport.

but to be rapidly identified. to make sure that quarantine extremely low that is the testimony that has built up over many decades. but to suggest to help in this situation the world health organization of those that try to help and the ngos there want to give the shout out to the doctors without borders who have been carrying fellow. but to mention the statistics most money is not spent here but it goes out

to the best and finestí' cheering from the university of chicago. but it was funded by giant -- and i h. >> but the "wall street journal" has the numbers of 1.4 million. the worst case estimate of myth january 200-0811 the latest death toll. so the 1.4 million that is if nothing happens and it doesn't take a the calculation that was announced recently with more money to send the west military down to liberia? >> with that projection those that do this type of modeling come up with different answers.

but then to see the numbers go very fast. but we want to stop that. but i was very heartened by with the different parts of the government to try to put in place that efforts to stop the outbreak from going further. 1700 beds in liberia for those who have been exposed to get that treatment in isolation they deserve. said you have to actively pursue how to handle those individuals? because we don't have enough for all of them.

of for where this is happening. into the engage with their communities. but the u.s. has of interest not only to be soldiers to the world but doctors to the world. >> host: indiana independent scholar. >> caller:. >> good morning. thinks for putting himself in harm's way. to get at these issues. there are things they have not spoken of but what is taking so long to get a handle.

the added has been here since 1973 could you cut down or anything we could do? do have to analyze before we get the idea this is important? >> that is a very sobering question. no one anticipated when the first case appeared in march of this year the reza potential for this explosive outbreak. and then something that was quite alarming given the already difficult circumstances in the west african countries with the public health systems in many cases are rudimentary and that has made this

difficult. the fact that the operator is in the city is much harder than the previous of breaks that ray and roll area is so easily contained. so it is a perfect storm. has been but i am heartened by the steps we have taken the last couple of weeks especially the u.s. government4ncy. no one should hang back if they have resources to contribute. >> host: i want to introduce another topic, dr. collins. that is security at labs. it's a story in the news recently with lab agencies, not just your own but cdc and others, here's u.s.a.

today yesterday. what has nih done since reports have come out about mice being infected with the ebola. what has nih done? >> guest: we're taking this very seriously greta, an issue we really need to attend to maintain public trust. important to point out that though there have been surprise discoveries of agents around for a long time, decades in some instances that have been lost track of, no individuals were hurt as a result of it. no risk to the public. at the same time, recognizing that it is possible for things to slip through after many years of people coming and going from an institution like nih or cdc. we are in the midst of doing a thorough sweep of every freezer, refrigerator,

shelf, drawer, to make sure that everything is where it should be and we're well along with that and by the end of this month will have a full reporting of what we have found here at nih and likewise, we have asked all our granting institutions, most of the people in the u.s. that do medical research to do the same. a good opportunity to take a full inventory. again, i will not want anyone to be alarmed that there is a serious risk to public health as a result of this, but it is prudent for us to be sure our house is in order and that's what we're doing. >> host: is there enough money for the nih and laboratories at universities, enough money separated out for security? >> guest: i think so. >> guest: i think so. . >> guest: i think so. universities as many obligations to day we havez a new recommendation that will

might potentially be used for nefarious purposes by those that have malintent about what they want to do with certain types of research, dual use research of concern. universities are struggling now. nih is struggling. frankly in answer to your question, maybe i should point out that nih and all granting institutions have lost about 25% of our purchasing power for research over the last 10 years. putting a stress on the system and a lot of great science that we'd like to do is slowed down or stopped as a result of this ten year decline. it's rather ironic when america has led the world in biomedical research for about 50 years that we are now slipping in that regard when other countries are coming up fast. that is bad for the potential here of medical sad vanses, bad for our economy. i'm hoping that over the course of time and very soon, in fact, decision makers in the congress will figure out a way to turn this corner and bring us

back into a stable support for this remarkable engine of discovery, biomedical research in the united states. >> host: who has oversight over the university labs? is it the federal government? >> guest: yes. every one of our granting institutions as part of the contract they sign on with us in order to receive taxpayer money to do research have certain obligations they have to follow and institutional biosafety committees that oversee this issue of biosafety in place for a long time. those are activity involved in this current business of looking for any evidence that their are agents in places that shouldn't be. they are strongly in a place i think which ought to provide a lot of confidence that these institutions are very much taking care of the issue. >> host: we go do michael, north carolina, independent caller. good morning. >> caller: hi.

how are you today? >> good morning. go ahead. >> caller: dr. collins, with all the good help we do around the world, that's what america is about, when are we going to remember the three million people here that have help tie at this time b. add450 coming out. fda is real slow on letting that out. they let everything else out. commercials that you wouldn't want to be stuck with the disease you have before you try the side effects. this is no side effects. for three million nonresponders. $120,000 for a 90 day course of steadily funded technology. they use federal money to come up with this drug. my tax money and right now, i'm dying. i'm in stage 3. the insurance companies with the no caps are turning me down. on getting this medication. yet you have three million people in the country that are nonresponders. you are a cure, a proven

cure for this disease yet i have no problems with helping the rest of the world, doctor, but three million people, out of the three million, how many people are not going to be able to afford this with insurance companies turning them down to buy the medication and the next step is a liver transplant. i'm 258 years old. i will not take a liver transplant because a 4-year-old deserves a new liver before a 58-year-old. >> guest: that's a troubling story from our caller from north carolina but there is a lot of excitement right now about the ability to cure hepatitis c with the new come points just pushed through and approved by the fda. i'm deeply troubled that the caller is not able to get access to that because of the cost and there is a lot of discussion about the cost. point out however that even though the drugs are expensive, it is very expensive also not to be cured of help tie at this time c an such things as

transplants cost more than the drug. i don't know exactly the caller's situation but i would think in this circumstance tans, there oughted to be a plan by the drug manufacturer to make this available to those that can't find the resources or don't have the insurance to cover it and i don't know how to handle this on the air but i would encourage the caller certainly to get in touch with the company and ask if there is some way to get access if the insurance is not providing coverage. >> host: okay. fred in florida. democrat. >> caller: good morning. i'm confines are fused. about 10 or 12 years ago, you made a movie about the ebola virus in africa, dustin hoffman, morgan freeman. all these people was in the movie and another question, why is it you got the white doctors out and two of them but left a few behind causing all of these

illnesses. doesn't make sense. at. >> guest: i'm not sure about the relationship to the movie. halves an opportunity to raise consciousness about the facts there are these new viruses emerging all the time that place potentially a worldwide community at risk and something we should be working hard to anticipate, develop therapeutics and vaccines for. what we've been talking about. the two individuals that were air lifted from liberia, that was something that their organizations, samaritan's purse wanted to put in the resources to do. that was not. money that was responsible for their traveling to the u.s. and being cared for. but in fact, u.s. citizens, as they were, are entitled as they were, are entitled but in fact u.s. citizens are entitled to asked to come back into the country if they need medical care. there was no reason to refuse that