that means now. and with my organization to bring together the world's efforts cities of those efforts -- a reference to come up with a document within 60 days business says usual but you don't wait so to me that is very important

that we have nine. i am understand but we don't know. it is the travesty with the single step was one location in zero leone they know what the hell they're talking about we need that agenda right now. to understand those transmissions is it just of population? our other things going on? but we have an obligation not to have another blacks one event.

but we don't have a clue we need data in clinical outcomes. but looking at what makes a difference what can we do about that? can we? with those dire conditions with those intensive care of kids. and also i just have to say right now we have to do a better job.

but we have a problem that we always couched things with certainty but that does not exist. that is different from being scary. seeing the "l.a. times" on sunday with a piece on fever. but there is the problem with that with that definition so there was a certain sense of selection maybe it was minimal but it was their. i personally heard clinicians' with the ignition of the treatment center 101 fever but he

never did. but what happens when the media gets allover there'd be a fever but those patients didn't even know what you're talking about. tell them what you might have happened and then when it happens you don't tell them the complete truth. i just want to say to comments please understand the different issues there

is a series of things written about this recently. . .

>> this is more of a classic example of what we shouldn't do. i have been talking to a number of virologists that are very concerned about it. and they make me concerned about it. and in the media we were recently talking about it. and it is not this great evolutionary mutation that will happen. let me just tell you how someone will take it. most people would say he is a very noted science writer. he said the chances are tiny. but ebola itself is very unlikely to change to be airborne. and that is like saying that you're worried about wolves and you're afraid they're going to be like wolves and grow wings. and until we understood which

sells the virus has been and in we understood it wouldn't be an issue. that's different than this. number one, we had talked about what had been transmitted and it was interesting because one of the people that common and a lot on its axis but that's not a problem because they think they were cleaning up the litter on the floor that did this and that is even worse. the point being that some people are concerned because we don't understand why that virus past the first time. and today i had been given permission something that i had known about for a few weeks. gary actually took one of the strains from guinea and put it

in their little over a month and a half ago and what they saw was remarkable. it was unlike any of the viruses they have ever seen. it was much more severe and if gary said it was one of the most prominent biologist in the world said maybe this is a different virus. maybe there is that possibility. and maybe someone might cough it up. i'm not saying that scare people. plan be. what the heck are we going to do if we suddenly see the potential for transmission? we have a plan? i don't know if it's a one in a million chance, but the point is if we can't talk about that because people say you're scaring people, the blowback has been substantial. i guess i'm getting old and it doesn't bother me so much

anymore because it was all based on what i believe to be the true science. it was an attempt to help people think about this. so now we really have a reason to be concerned and i don't know what the chances. and this is not just based on idle speculation. slummy just conclude by saying that we all want certain things in this situation and i guarantee you that we will not get it and mother nature will not allow us to have it. we can still provide various public health messages and we can still be in control of our own destiny as to how it relates to we respond. but we have to understand this. so to final comments were very important, in terms of being a kid from iowa, a one said if you don't know where you're going

from any road will get you ere. and i worry, and we know what the roadmap road map is here? has who given us one? but that one has ari been thrown out. we need a global response that addresses this uncertainty that we have and does it in a timely way. we can't accept donations, we can't accept numbers, we need action. and finally one of the wisest people of all time says that are these the shadows of things that will be where the shadows that may be only remapped ebenezer scrooge. thank you. [applause] [applause] >> so actually we are going to go on into our panel discussion so we can ask questions of mike as well as our panelists here. i would like to introduce right

now josh who has kindly agreed to be the moderator for our panel discussion questions. >> hello. [inaudible] [inaudible] thank you, everyone, for letting us speak. i'm a little of this and it because i would've hoped that doctor michael osterholm would've told us what he really thought. [laughter] and i do hope that we have a chance to draw him out a little bit as the questions end. okay, going on down the line, i am part of the department of health and mental hygiene and i am looking forward to this discussion.

the main point of this is to get questions and answers. but in order to prepare, i think it would be helpful to each of the panelists just to give us introductions and what they do and their interest in ebola. >> good morning, i am an emergency physician here at johns hopkins and i'm also a professor and vice chair for research at the department of emergency medicine. i have done work for the past 20 years i have been here and i have been in program development and emergency settings for rapid diagnosis of infectious diseases specifically hiv and influence. and we have looked at developing diagnostics for various infectious agents and now i am a codirector of the center for excellence here at johns

hopkins. >> my name is nancy kass, i am here in the institute of bioethics and i think that i am involved in thinking about the ethics issue going on in ebola. we have a long history thinking about this in public health including infectious outbreaks and we are starting to do a little bit of work here in liberia. >> hello, i am bill glass, director of strategic communications at our program here at the school. and i oversee the teams that manage our field work here in 30 countries. my main message is part of this panel today that communication is at the heart of our response today. and it's important throughout the care continuum that communication can help us present and care safely and treat safely and have faith

aerials. as was mentioned before, have increased vigilance and increased complacency. so to do that, we have to have better coordination and consistency of our message and if we can do that, we can build trust and reduce fear and address rumors and we can raise confidence and inspire people to take action and provide households ways to stay safe. until we have been involved in the response since the very first cases throughout our staff that have been there under usaid funding. recently we have been asked wrapup our response in liberia and regionally in liberia we are doing all kinds of communication activities, including helping with the hotline that is overwhelmed there these days. as well as working on monitoring the evaluation systems where we have put them into the field

recently. soon we will be involved in mass media community care. the second part of our response is regional preparedness and working with everyone locally, at developing tools in helping countries create their preparedness strategy in terms of communication. and finally i would like to say that it has been a fabulous effort on behalf of the staff around the world to mobilize for this and kudos to the staff that has been there for some time and are traveling there as we speak. so i thank you and i look forward to the conversation. >> good morning. i'm an associate professor here at the school and i've worked in multiple emerging pathogens to characterize influenza and others and ebola, i have worked

to characterize it transmissions on massive scale data and i'm working with doctor peters and others to design and characterize critical outcomes for the units that you heard about being deployed. so couple points i would like to make. i think that the burden due to other pathogens, it's something that we need to be concerned about both now and in the future. but i also think that there is an opportunity to integrate them into the response and there's lots of fevers and symptoms that will be potentially might be presented to clinics and this might be the only sort of capacity to treat them. so there might be an opportunity with the impact associated with malaria, and in all three of

these countries and also reducing the burden that might show up later because of potentially distributing anti-malaria in broad response. so picking up something that the doctor said, international research agenda, some of the details of this response and where it is failing and where does exceeding the target of research. we have tools that have contained ebola epidemics in the past and i think we have a problem in scale that it really makes it -- as it spreads, it's harder to contain it because you're taking up all of the capacity and responding in ways to control these small epidemics and other locations. but i think that working out the details of where we are failing in this response, we just don't

have the hospital beds to perform the situation that we need to respond. so we are hampered as well. >> thank you. >> my name is michael osterholm. [laughter] and i often do that. i'm here at the school of medicine and i have a appointment at the bloomberg school as well. we are both practicing emergency physicians and so there's a certain reality where the rubber hits the road for us in regards to ebola. i'm here and probably my role is the office of critical event preparedness and an organization that has been given birth in 2003, managing the overall response of the institution including the health system and the university. >> hello, i'm a reporter here at

"the washington post" and i have no expertise in this matter whatsoever. [laughter] i spent a lot of my time calling folks on this channel and asking them to explain this. i did go to monroeville for two weeks in september and saw virtually all of what the doctor spoke about and my assessment is that it's probably even worse than he described and i would be happy to get into that when you all want to ask questions. >> great. this is a tremendously talented panel with an unbelievably interesting bunch of individuals so far. had a couple of questions and i'm hoping that maybe we could give a little bit more detail about the experiences. >> sure.

>> cut me off whenever you want here. i got there on september 12 and on september 13 in the morning we started by going to the treatment centers. i've been to two of the three centers in a place called redemption hospital which is a hospital that has been turned into a transfer point. at any point in the next two weeks that i wanted to i could go to those places, i would always find the same thing. the treatment centers were full and there were people sitting, standing, lying on the ground outside the gates of all of those facilities trying to get in, generally they could not get in. they could not give an end if their symptoms were particularly dire, they might jump the line. and that is a chronic condition there is a shortage of beds. they opened another treatment center the sunday before i left called island clinic because it

was on the island and the open on a sunday with 150 beds and on wednesday it had 173 patients senate. and that is just the way it is. they have begun a program in liberia before i left to isolate the sick. they had said we will never be able to treat everyone with fluids and electrolytes until maybe we can bend the reproductive curve by simply taking the sick and putting them in schools away from other people. so we start affecting two people, each infected person, maybe we can get down 1.5 or something like that. most of liberia is not working. i could never get a really good number on this, but many people would say 80 or 90% of the people are unemployed. schools are closed. there are a lot of people in the streets just kind of milling about aimlessly. and you don't have a sense of

purpose. before ebola the monthly income was about $400 per month median income and i have no idea what it is now but i'm sure it's much lower. and so in the two big bombs in monrovia just to show you the kind of thing that public health folks are up against, most people have no water or electricity or sanitation or refrigeration. for the city that has 1.5 million residents, there are probably 12 ambulances. you can call for an interview and see if you get ebola or something else and it won't come. and so the chances of finding this or next to zero. breaking this down into two broad categories are the people that understand the situation is

real and are ill-equipped to do so, and the people that don't you leave that it is real and are either denying it because of stigma associated with denying it because denial is a coping strategy. for those who do understand it, i saw people bringing sick and dying relatives to treatment centers and it would take those little plastic bags that you get at the grocery store and they would wrap their hands and sometimes try to put them on other parts of their body because they knew when they brought this person here to the treatment center they were going to have to take that person out with their own hands and bring them to the date and they would try to cover themselves in whatever way they could. i would call that a minority of the people. most people just pull up in a taxicab and try to get some help for their relatives, they have the money and they drive off to the next treatment center and a lot of people don't have the money for more than one trip and they were just leaving the person they are and a lot of

people were very sick and dying outside of treatment centers. >> asking about having her that respond to the emergency department, what do you see as the key priority in this? are we on a trajectory to begin to meet that? >> i very much like the message and i'm not trying to say more than you actually know. the main priority as you are hearing in the news is to try to prevent even the remotest likelihood of transmission in a health care setting. and it is scary to the point

that we think that there is a mechanism of transmission and if you take care of that then you are fine. but i don't recall an infectious disease respiratory or otherwise where the tiniest amount that it might be a part of this, we don't actually know but to train everyone that might come into contact in a health care setting. we have many that might come into contact with patients and that's a pretty big deal. and so that is an even bigger deal because you have residents and students and nurses and those who are coming in from an

agency and so to get everybody trained properly is a problem. and so based upon us, as you have suggested, things change and reacting to some extent these onerous, we did have a plan and we are forming teams to take your potential patients so that we have a highly trained highly drilled staff who takes care of people rather than trying to figure out a way to train for 5000 people that might come in contact. >> i would like to echo those points. i think that the improving and ramping up the infrastructure across the country in hospitals and as he speak to the u.s. situation, building that infrastructure, i think the point about screening approaches

, to gather that information and create infrastructure for that condition than most effective methods for screening, one of the things we have worked on over the years with various programs is developing what was not specifically mentioned but it could be used more quickly isolate patients at risk and more quickly make decisions about the isolation and treatment. >> asking a couple more questions and then we will go to the other questions if that is okay. one of the things is the vulnerability of the week system in this country, and ebola has really played on that. typically you think about prevention, education, but the absence of this data structure

has made it very difficult to contain ebola. so the question i have is to what extent are the interventions going to happen and how important is the that they build on the internal capacity that they leave behind a meaningful capacity or ability to take care of patients or is this sort of a problem that can be followed through a focused effort on ebola. >> well, i think that there are two very laudable goal is. and this is less utility that would build upon the long-term resources of the country.

but we are just behind the curve and i want to talk about the projections in the models. we don't even need a very complex model because we have a pretty good forecaster will happen and this has been doubling the number of cases over roughly 20 to 50 days depending on the setting and it will be very odd for a tuesday in the next 28 days, something dramatic would have to happen that we don't see cases double. so these cases estimates, i think it's extremely optimistic and probably not doable. we are ready had 8000 in a month. so are we going to be doing things all that differently? >> the model that you are

working on to translate over, how does that relate to this? is that something that would happen in this capacity? >> it's very much sort of a caveat to provide resources ahead of it. i think it does help long-term capacity because with every six months goes on and it's going to reduce all sorts of factors that will impact the long-term capacity. >> well, first of all, does the lid on what was said, i think that that's a very important point. one of the observations is striking that we are getting one more from the ground that this is not like little explosions. we are seeing clusters of activity flaming and causing a

big problem and then they kind of died down and come back together. and so one of the big questions is when it be nice for us to see what is happening in house lawyer are they and what is really going on. the other part you asked about was the infrastructure and i know you have some really good now surgeons at this place and if you had a sledge hammer and chisel and that's all you have to work with, they'd have problems as well. but what we have done is basically given him an equivalent of that on top of trying to deal with everything else that is going on and lenny really articularly laid out in trying to overlay the comprehensive medical care on top of that is just so difficult. and that is why the doctor says come out of criticism of one group that they are not doing more for liberia and i have a day that i think that they are right on the market to do the

best they can with what they have under those conditions of doing what they're doing. so that is the underlying issue and i don't think we have a good idea of how bad things are. the thing that worries me is that if you look carefully across africa, anywhere in the developing world, those same conditions are everywhere. this got into mum buy. some worker got it there and it's got into nairobi in a slum and they are. so i don't know what would be any different. and that is the message we all have to understand. >> okay, so the last question you mentioned would be a critical part of diagnostic tests and so in order to test this there are a whole range of different questions above,, of

view of what are the ethical issues in terms of getting it out there and making good policy decisions including how do you communicate without doing research in the middle of a crisis like this. so i think that i would like to ask for comments on that. >> in echoing so much of what you said in regards to the messaging, and we have lost in this in regards to the public health response. at least some media reports come across as what is wrong with these people that they are running away when the health care workers -- clearly people are responding from a place of fear and maybe messages not having been crafted in a way that may make a difference in the public health response. we have that on steroids is a

challenge with regards to research. they are certainly the research ethics challenges about when we will start rolling out vaccines, who gets them first, do we test, this is a place where sophisticated methodology and public health compassion can all be aligned but it takes sophisticated thinking and i had a conversation yesterday that really made me convinced that adaptive designs are the way to go so we feel confident that we are learning whether or not the treatments work while to maximize its this seems to be effective. we know from the ethics including as we work for the last 15 years on these challenges that there is so much suspicion about medical research when it comes from the west. we saw what happens with polio and meningitis and we go in with

the best of intentions thinking that you're going to hell. whether the research is sort of just taking blood for all of these virology studies, which can make a tremendous difference, we all know that it happens when we take blood and then people die and then the rumor started. where the messages have to do with them trying to understand what a placebo is an what you're coming from the united states in giving people nothing and i think that there are people -- there's more and more people trying to help your, but there's a lot of challenges. >> is there anything you'd like at a maximum has wanted to take the opportunity to talk about the kind of research that we are doing in liberia and as i said, being part of hopkins, people look to us for behavior change and communication change as experts to be able to attribute the effects to the interventions that were designing.

so the kind of things that we are trying is a media monitoring system to see how messages are trending, we are involved in knowledge and attitude mounted in collaboration with the government and multilateral agencies. we are also trying to innovate a quick system to look at a few indicators to get some information from key informants quickly back to the comment that was made before about the virus and having to adapt our methodology in order to get very quick information. all of this as we try to uncover the key factors in terms of norms and behaviors that are affecting people's risk behaviors and confidence to act. >> having heard that, what is your level of confidence that we

would have a vaccine that we would be able to develop an approach that could engage the population and retest it? >> well, first of all i want to be clear, i don't think it's going to be an easy issue. i think in the middle of a crisis people will tend to overcome other issues of fear. but i think that we have also seen one of the issues that i've having to learn very quickly, and i think that we all need to learn, is socially and culturally and i invite people who know more about this than i do, we are talking about these three countries as one kind of place and it's not. very different populations. why were those individuals killed? and to understand the background that is actually quite hard to understand how they could, and

these are important individuals that were attacked and had to get into a number of different issues. so i think that will be complicated and this is where i talk about rolling up a vaccine, i talk about inviting and mandating that any program have that research and input component to start understanding that and i think we have a big outbreak in nigeria with this, you are right, the polio vaccine issue in northern nigeria, why would we expect not to have some kind of issue there is not so i don't think it'll be build it and they will comment on the other hand i think that we have an opportunity here to put our best foot forward if we start thinking about it now and don't handle it like a bunch of public health epidemiologist but a social cultural event that really needs all of us on board. so i want to make sure that i

get the vaccine first and you can't do that as of yet. but we need to get that in. >> okay, go ahead with questions. i think we're going to start either way. [inaudible conversations] >> thank you very much. this has been a very informative situation. i happen to be the president of the library and this is the asian and most of what you have said is true. i think we need to talk about the information we can use with our community and our people back home. her question has to do with one of the presentations and one of the presenters and testing on animals and how it has proved not to work and so recently

there was a report of a doctor in liberia who is demanding at one of the treatment centers. he had 15 ebola patients in his care and just studying it and trying to understand without the right tools work with, he discovered that it is actually could destroy the internal organs. and so he decided to use what he had end of the 15 patients, 13 of them survived. there were two who died in the two who died were patients that were taking five or six days

after they had contracted the disease. and so my question is, have you given that a thought or is that a possibility that we are to have a vaccine that could possibly help fight this and would you be willing to talk about this as a possibility at this time. >> thank you for asking that. i think that we heard from some and maybe this is part of this to you as well. i don't know if there's anything further that you want to say what anyone wants to further comment on that. did i get that right? >> let me just say that we were aware of the report and the

although we suspect that this would not work, it is the reason we did the testing as i showed in the data. and those two drugs have one of virus replication and its presence than in its absence. that's not to say that every drug shouldn't be tested. but from our standpoint we were unable to confirm whether those might have worked. >> thank you. it reminds me that one of the critical functions is not only to work with our health care institutions but also the community that is connected to west africa and the governor is asked to reach out and we are

reaching out here in maryland. and we will be talking about ways to support them in terms of giving them information that can be helpful and also anything else that they need that we can provide. either comments or thoughts about school or the health department and how we are connected to people in africa? i'd be very interested. >> one of the challenges that we are seeing right now, and i come from the twin cities as you heard earlier, we have the largest library in liberian population outside of the country of liberia presiding and it's a community that has been incredibly concerned and organize to try to address this issue and they've gone through a great deal of pain, many living in minnesota knowing what is going on back home. the big issue and it has come up with individuals and also in the

private sector jobs are tuition, someone wanted to go back home because their mother and father are now dead and they have to eat younger siblings may want to go back into that issue and then come back to the united states. and it's been a very heart-wrenching experience to say are you going to take more risks and what's going to happen to you and what can you do with your siblings and such. we don't have answers for that. this is one of the concerns that has come up and we have seen businesses that are actually looking at for lowing people for at least 21 days after they return from west africa. if you do that without pay, it's likely that you will not find out and if you pay them how are you going to follow this. so the policies are always a day late and a dollar short of the odds look at these kinds of things now. we're going to have the same thing. so this is a huge thing right

now particularly in the united states and other countries as well when we run into this. >> i think also is as private as well. [inaudible] >> it's hard to believe because we are so short on this and it's actually only the second worst problem over there. and the major problem will be once they are built and they will be inadequate once they are built. the number will be inadequate. they don't have the people to stop them. so any physician or nurse or other kind of health care worker who feels like they can go over there and do something, i think that they should try to find a way to do so because that is going to be the number one issue. and so the one thing that provides a glimmer of hope is

when the resources and training and leadership for their, liberians are taking those jobs and a lot of that is a matter of the economy and they are taking high-risk jobs of any money. and they are stepping up and taking very dangerous jobs to try to combat this crisis and we need folks of expertise who can come over and run the facilities and train people and i say that that is probably their most serious need. >> that's very helpful and i would also emphasized in west africa as well as here, the critical need is obviously very critical. >> just adding one thing, just think about this. yesterday the liberia national health care workers all went on strike and they went on strike because of the 80% of them do not have certain things and they

are being asked work in these settings are twice that happening two you know? we can deliver iphone's from asia in 24 hours. why can't we deliver masks and goggles and gloves to others. that is the part that frustrates me because losing that group of liberians right now is huge. they are the backbone of what is being done as you saw over there. and yet i know how hard that is for them to strike because they want to be there to care but they don't have that and that is the part that is the disconnect about bureaucracy time and we have to get those two together and they are not. >> you might notice actually more so, but it's not really getting the equipment even before the u.s. and various governments donated all sorts of institutions and withdrawing all

types of this and getting it over there and there's been a tremendous amount all the way back to august. because the person who arranged that was the oppositional leader and not the government. but the distribution model that exists in these technically failed states are tremendous. so we are left with a plea that we need health care workers. and we have a go to the has been trained to go into these conditions. and we are left with a gut wrenching decision would we really center teams into a dangerous situation where ppe

can be assured and then the next week you have another type of ppe and we're only now is the intensive training starting to ramp up, what are the security arrangements, can we get you out if you are there. there's a huge number of logistics and yet everyone is looking for health care workers and you might have a fighting chance that there's other ngos and groups that are looking more health care workers and it's really just not quite as simple as it seems on the surface. >> let me go to the next question. >> hello, thank you. i'm a student here and i think this discussion certainly highlights my question about what the department of defense will play nice and we talked today about the financial situations. if i heard correctly i believe

that note military personnel will be involved directly with us and we can all understand the complexity of that but i would love to hear the panel's decisions as we talk about the severe shortage in training health care workers and why they are saying that people won't be involved in helping. >> first of all, let me just say that one of the historic nature is is the fact that we now have urged military involvement which after all those years has given you an idea just how far we have come. we need him and i think he was getting at is, we need with adjustable supply chains are welcome and we also need command and control and "the new york

times" piece caught a lot of flak. everyone said well, it's broken we can't fix it up. but we need at least a mission so that we can have a command and control capture where the u.s. and the japanese and the chinese, the cubans and the russian people, the canadians, the eu and the countries can all have one hopefully command and control structure and it's still a problem. but the key thing is if they can bring this, that is great. that is a key issue that we are going to have. and so often we get into the public health crisis just like us and then they tend to be short-term. this one could go on a long time. so we are going to have to realize that we are in a sprint and a marathon. how we staff is going to have to

be looked at. maybe one or two recruitments over there, how do we get people to stay and how do you support this emotionally or psychologically? we need a much greater global commitment. and i just want to echo the fact as i said earlier, i'm proud that the u.s. has done as much as they have both from the government standpoint and from the your philanthropic standpoint. where is the rest of the world two why are we not seeing that and to obama's credit, he's been saying that over and over again. where is the rest of the world to secretary john kerry, who said that the other day. if you don't care about that, shame on you, but this is in your self interest. go to worry about terrorism and the infrastructure and so that i can't understand.

>> i would just sort of pick up on that and i would think that it would be they be worthwhile with the professors here, they are eligible and i think that the question and your answer raises the issue of global leadership and there's a lot of different things that are moving in the same direction or who and its role and how does this casts a light on international health or other important situations as well. >> i had a completely different idea. >> okay, i will come back to you. just from an international health perspective, this is a huge challenge right now and so

feel free to come up. >> you have raised a question that can't be answered and 10 seconds and i will say that by all evidence court nation that needs to be there and that governments are pleading for really hasn't been there. one of the unprecedented things that has occurred is that the u.n. has created a mission for the response. this is the first time that this has been done for a public health event at and that is meant to serve as the structure which brings all of these different players together working toward the same goal. but that's not to say that it's completely set yet because it is not. that is what is meant to happen. and so the u.n., that is leadership function and the u.s.

military doesn't want to and doesn't need to play that role. they can't come in there and take that role. and they are doing this even within the u.s. government structure. but they do provide this critical logistical and other support that was mentioned by doctor michael osterholm. and i think that there is a lot more to do in terms of generating the coordination necessary to get the resources going when they need to be there. >> i would agree with that and i think that we are in the process of will rebuilding the coordination approaches as the epidemic is ongoing and the aftermath is to re-look at how this is done. i think the coordination center is being set up in terms of

command and control and we are a long ways down from a coherent approach. when the time comes we will have to look at how we do that. there's a lot of leadership both within countries and i think that this is a good one and a good example as well as undergoing the epidemic but i think that there will be a role for looking at new ways in which we can have preparedness and response to these kinds of epidemics in the coming years. >> last question and then we will go on. >> one thing is that the risk is controversial. i am absolutely convinced that this outbreak is the 9/11 of who. and that i think that the future of who is in question in terms of how it will act in the future. and i think there's a to be a lot of consideration about this

both in terms of civilian response and authority and financial support, coordination and all of these things. everyone talks about when these regulations came through and i'm not saying that it's going to be gone, but i don't believe this is the same one that we have seen today that will be here years from now. i think that this will be a very important time for reconsidering global health and how we respond to the global health crisis. >> thank you. [applause] >> all this discussion about global leadership and supplies and infrastructure, i just want to comment on the kind of issues that david was talking about earlier in the day and the importance of local leadership and the experience is one hopeful sign in liberia where

the cases there peaked at about 790 cases in august and have been going down ever sent and we talked about this last friday in monrovia with what happened and what didn't. they highlighted all of those issues. local leaders that were committed, mobilization through women's groups and youth groups and burial teams and other teams to trace cases. there are some hopeful signs when we focus on the local level interventions and local leaderships unsocial mobilizations that can uncover those resources at the community level. >> question?

[inaudible] >> for all members who have studied ebola. we are talking about people from three countries that have been included in this group. we are talking about people on the ground already when an issue started and they don't send troops, they send doctors. and just recently. so we have all these troops on the ground right now until we have been in america since 1822 and we were the first to fight

world war ii. and the relationships have not been beneficial. monologue but what about when we know something about it. [applause] >> thank you. >> question? >> first i would like to thank all the speakers in regard to all that is needed. >> could you speak a minute? >> i will try. >> okay, so there's currently 3000 people working in the three main countries. and we have 690.

we have admitted and i have just done a lot and so that means there is not enough staff and there's not enough of everything ..

>> >> [applause] people want to know about those efforts specifically but what else could people be doing? >> people pushing politicians. there is a lot of promises. so to push the politicians for public health to evaluate quickly to make

them available and affordable. the access issue in the affordability issue. >> comments? >> so very briefly something that will help the entire response. last wednesday we launched a website called ebola of communication network.org it has over 4,000 hits and 170 materials on that the whole purpose of this site is to share experiences with materials so i just wanted to quickly since people of listening on the web for concrete things they can do

but to share their experiences so thanks for the chance to share that. >> the question on vaccines vaccines, what is the pathway to a messenger for the ebola vaccine? >> look when i worked at the fda we responsible for licensing. there are some people will

be working closely with those to think it is necessary of efficacy and safety. i think hit may well be the case you need to have all the people figure out two's set the standards so it can be done quickly with those creative designs. this is a challenge but knowing the people there is one of the best deals for me. and our kids. >> and mentioned it briefly

but i will say it again. n i h is about to launch a comparison with the clinical trial. 30,000 people and we will hope to have the results of that study analyzed. >> a quick story on the vaccine at that time with that experimental vaccine pushing to get the data for the licensor. it would be a lot better fit to be licensed so i think

the framework is very important rather than just saying the risk is on new so i think the idea to design it with nih so few rule something out you're standing behind the product. >> there is a problem that is great to have had you have evidence of that with 15,000? and to engage those country partners because having

hundred thousand doses of vaccine is not that easy to think about health care workers is a group to target as well but there will be lots of issues of equity about it is being used and trying to figure out the outbreak. >> we may be winding down. this may be the last question. >> i am from the bloomberg school and i have two questions presley have trauma centers with the first institutions that they might be overwhelmed to

respond who had traces of ebola? times speaking to the u.s. and other developed nations. yes. >> the recommendation was to a shelter in place and then regardless and then to give some insight to what that means. a concept sealing off all other patient areas and stand-alone. with 4200 half of them are under 100 beds.

but we're likely to go to that direction to have as a designated site on hospital. and with those specifications with the nih and emory that preemptively funded this over one year ago at a very high cost. talk about the public health system with public and private hospitals that are now faced with i want to play i want to contribute our one to be dead designated type. we have to figure out to do it quickly and pay for its.

by the way what about my other patients? where do they go? the ebola hospital? also facing the same issues with hiv is think we have overcome them and to be a major hiv treatment center and today we see all the benefits of that. but all the patients will run away and what happens to the business model? or the system that could shore that up? but to go in that direction with the concept of the designated centers with a highly trained group of people. would you add to that?

>>. >> and just a little extension for a couple more questions. we can turn the microphone back on again. >> and the family medicine doctor and of resident here at the school of public health. on september 13 the fourth zero the own doctor to pass away from a bullet and it occurred when there was a hospital ready to receive her the who declined transportation she is just one of the number of the irreplaceable assets of this epidemic of local doctors on the front lines.

in support of considering transferring local doctors to the outside facilities to get the foreign aid workers out when they become sick? >>. >> it is a great question. i want to separate the question if that is who's responsibility. but least so far employers have made commitments to their own employees but to heirs of them out if they are sick is not unusual. but it is essential but

johns hopkins will send people over there have to be guaranteed to be well trained and if something happens they will be airlifted out that somebody from the "washington post" or abc news was covering the war in afghanistan their baking is blown off you assume cbs will air lift them out so with the international people is is that you see what happens in sierra leone. for transparency right now there are those that are willing to contribute the extraordinary amount of money as a wealthy foundation trying to figure

out what to do that would be helpful particularly in the context to donate a lot of money. so what could potentially be set up? what is the role of who i don't know what that is that is a slippery slope that has to be anticipated with the number of health care workers that are infected and what the budget would be it is not just one person airlift did battle lot of people that is a lot to take on it is an important conversation to raise and something to think about addressing but i want to separate that from the role of who. >> digest 12 follow-up i agree 100 percent but at

that time the air frame movement was dramatically impacted for refusal of landing rights and there was a problem even to get certain aircraft than and some contracts for who could come in and out we had a problem with the aircraft that was available if you and the medevac for 12 hours since deal you off that was the only contract that existed. upon the hill one of the first briefings i didn't there was their congressmen was angry to bring the individual back to treatment. and i realized i had no live wire but i actually painted

out to understand first of all, a service man issue if we send somebody in harm's way as a country are we willing to bring them back? but the biggest problem we have right now is getting people to go there. not that they are afraid if they are sick someone will bring them home. he said i never thought about it now becomes one of the strongest supporters. we have decisions as policy makers and funders why it is important it is about a standard to say we will bring our own home not with just u.s. but that is one of the few fringe benefits you might get to give a precious part of your life to do this.

that is huge. we will bring you home. >> one thing i have been surprised about just with the general population is they know health care is more available outside of liberia. because they checked their infrared thermometers you thought you could wait all year and that would very easily cleared of be heard jack. most people -- most of the things holding him back is but something that is so whole other situation.

>> i am not an expert with the ethics but we can move the medical response cutoff to talk about people coming out but also it is important to change the discussion how much we should be offering people in of field. but with those interventions we can improve the outcome of the merit of health care workers that are there. so thinking about a from a public health point of view i really feel this is part of our messaging that we need to change the paradigm to really think about that

we may not have the funds to bring betty out of africa. >> follow-up on that. >> the dative it is strongest with dehydration even some of the work done with doctors without borders and other people that you give people a colorado like dyer bse you have to aggressively hydrate them with the electorate replacement and this is been done in this setting even with these testing machines to allow was elected electrolytes to do it rationally or with a more developed setting. that is something you can manage there not russia prepare you can manage their

fever. there are things that we're doing in developed countries that turn not necessarily that expensive but can bundle of care. also to prove how can we incorporate some of that into a bundle of care. >> entity suggests that you turned it isn't terribly expensive but there is also a huge discussion going on when a patient comes in should the insurer we are

not talking about fancy stuff or extra of machines. we are talking about but to treat this as a diary. but is it is about what you said earlier in your remarks which is the big deal about cases where people learn not preventing with -- presenting with fever. i heard that back in july. and i heard the comment a couple of times since then.

looking at the literature from a the cdc or other organizations you don't see that. fever and a hope the other symptoms. so can you shed some light on this to make me understand what's going on? been a figure for that question. i think it is sending the cannot be afraid to ask the question. >> it is so tightly to a policy that is so richard -- richard they said republican we need to keep an open mind most patients have had a fever. do they think there is of some such thing group yes.

what is the implication? they are real. i am reiter that we have another black swan and doesn't have ahead but they will say public health didn't tell us the answers. me to send this. i don't understand that i have spent too many positions and some selected period 90 percent of the fever sumacs have a rather say that we have a crash -- a threshold and they have been calling us around the state. we want to be open to with never heard have been so the

net debt first i want to sink it put showing all of the different an incredible resources that can be bought. it is the interval path we research and not just to understand but also our but

we cannot afford to fail. and now for the rest of the day. >> but i can only imagine how busy you are. >> and for your duty this is a bowl of a sarah manson and his principal bad bet but i

would point people to the twitter feeds from the school and various others from me and others that are summarized. and on our schools who so they are a renewable powerplant her someday insightful comments but they would not just do that with the public health workers spin in prayer was the man.

>> we tried and failed and apologize for that. i think they called this the test. but mike said did you a joke has changed but we will always change if you think about we now have vaccines about to go into clinical trials it shows maybe not in

fibrous time that we are not where we were to read three years ago we saw how saar's changed and my hope is this current test will make this better. said in a thank-you who also has said they job to be here today. [applause] and our officer of external affairs we had a mere 2500 people watching and the sound quality was excellent. that is important to get this information out. the interest in people show about today is how some of them are framing the insights.

but it was a tour day force. but of course, everyone came from several countries away. and bernie came back from liberia and is here with us. but insight said we are remarkable provide did want to mention but it is also on the web site. >> please pick up a copy. in fact, we are having a live event this afternoon if

they're still in the building, of life kickoff with refreshments to talk about the articles in there. and again my thanks to everybody who did a phenomenal job and to rededicate itself and the emerging diseases. thanks very much. [applause] [inaudible conversations]

>> afternoon i would like to welcome everybody to this subcommittee of the house government oversight and reform committee. for this hearing october 14 and first of all, to the ranking member for being here and to negotiating and working together to make this hearing a real adult -- a reality. we had plans to make this hearing twice before.

one time members to return then another time hot others were scheduled and we tried to conduct as many oversight hearings as we can. not only this committee but congress tuesday have taxpayer dollars are suspended - - are spent and i will think the ranking member and in this campaign a top priority and the taxpayers to pay the bill. then it title in falls jim memberships, a gift cards, hair salons, said the purpose is the issues of government supplied credit

cards. and with the purpose of the hearings of this committee and subcommittee there are some in congress who write legislation that is created by lot are funded by congress. but the founding fathers created the forebear of this committee and not the government reform and oversight committee and we had various names of that purpose that one of the few governments that i know on the planet that has an additional check or programs

and authorized by government and is an important response ability the public has the right to know how their money is spent. so with that little opening statement of our principles and purpose of the committee i want to turn to the order of business of opening statements to recognize the witnesses we have five witnesses today them proceed with questions. but the purpose of the hearing is to look at of way that credit cards and micro paul small purchases are made. we formed a program several

years back, 30 years with the use of credit cards that allows a government issued credit-card for small purposes. and as administered and we did a hearing prior to 2012 looking at the countries that they submitted and in anticipation to remove that process. with the federal departments and agencies of flexibility for these small purchases which are currently capped at $3,000. one of the key benefits allows the government with that burdensome administrative costs and paperwork and unfortunately well that simplified the process to save money it has

serious drawback. the gao published a report that found internal control weaknesses with the programs expose the federal government to fried waste and abuse and congress responded to this and other audit findings by it is called government charge card abuse prevention act of 2012 and this hearing is a follow-up to see what has taken place since we pass that law and how effective it has been. it require tighter controls to allow departments and agencies to fire employees to graduate and fraudulent

use in-house note forces them to write an annual leave you in the hearing today. but it does not apply to the department of defense. harvard today we invited one director's son down the test but also we will hear for like they have with the a government charge card abuse protection act. and we know the question when that type of law was imposed.

but today i expect to hear from the civilian agencies about the effectiveness. >> this is a relative few and. by the office of inspector general:88. >> that with those inappropriate purchases purchases, also with. [applause] that regard that npr did not pledge effective role sun catcher ron dash conjecture. more than half the credit card purchases sample.

>> you need to sell it. >> it is the erroneous perches. >> again it is quite startling than 94 percent of the review or their review of the epa transactions were not in compliance all purchases and charges at one coffee shop in california there is about $12,000 worth of stuff at this california

location and 2013. looking at the coast guard and at one starbucks to have a bill with his credit cards but now we're up to more than $31,000 teeeight just has spent at that starbucks looking at the different reports found per recent reports suggest the bureau of land management at least used $800,000 of gift parents. this is another boy added meet. some of they have another agency that has gone wild but with the micro charge

card purchase. they are not with us today but we will follow-up with them with that agency and many others that cbs's. another example from the department of labor and inspector general office is with us today in the office is audited. let me focus on this report for just a moment if it is the model. >> sows of labor department office of inspector general received a request for an audit from the job corps in my home state of miami from the department of labor management. their request related to how

the suspect with those using prepaid debit cards for their own personal gain. it helps to supply the similar abuses stemming specific to miami via cards for used over 100,000 trips to. ceramic cat at of the department of labor. but this demonstrates how the system should work with some strong authority in that 2012 law to act.

however the department of defense is not covered but actually one of the largest purchasers of and here is what is serious abuse that need to be addressed. this committee has examined similar interest is -- instances the it infrastructure committee which i chaired at the time on the infamous gsa las vegas conference. september 25th, the now infamous gsa employee responsible for organizing the las vegas conference.

>> ag gas it puts you in a hot -- a time zone. to go after those travel vouchers and statements that mr. neely had made. >> but as a result you need to identify the rare example of federal workers in a federal workplace. the vast majority of federal employees are honest and hardworking and dedicated individuals. but today's hearing will

serve as a reminder to do a better job to monitor this program. >> congress, inspector general, king, and the rest of us to hold accountable. they expect and they deserve to have accountability and responsible use of their tax dollars. the 2012 law needs additional reform and that we could take the appropriate action and i hope this will achieve that goal. today again, not republican

or democrat issue but of fiscal responsibility and proper responsibility of our federal and government and agencies and mr. connolly has worked in lockstep and has never faltered one moment to assist in that effort to go after the people who would use the lot. is joining me today to send out letter as an update for the investigations previously conducted on and credit-card fraud. mr. connolly has signed on to this request and without objection a copy of that will be made part of the record without objection.

but thank you again to mr. connolly for his steadfast commitment to go after abuses we're really see it and read tries to make sure they're recognized and rewarded well this is a small choir a hearing today it is important and thinks for his commitment and the witness is participation looking forward to their testimony to recognize the distinguished ranking member from the state of virginia. >> thanks for the two years we had the opportunity to work together absolutely i appreciate for our staff to make this happen is a model

for how the structure can work. we don't pretend we have disagreements but we have coming ground. i also appreciate your friendship. thank you chairman mica and we're the only show in town today. [laughter] >> small but important activity. >> i was reading the panel to tell them how lucky they were to be a part of the only show in town. bet with the outcomes to reduce excessive waste fraud and abuse with carry credit cards while ensuring the identified those abusers with enforcement actions to deter such conduct.

i have long believed to build trust it is vital for public servants to conduct themselves in a manner of real and perceived risks. when i served at the fairfax county board of supervisors and made it a policy never to use or possess but also considerable value with a bridle characteristic that is difficult to quantify i don't recommend that for entire government but with the response to the ig recommendation is part of

that oversight in addition into reviewing those reports also how the air force improves the charge card program after $24,000 procurement that must be highly quality special machines for thousands of service members on the daily basis of of this acquisition was not a small dollar charge card purchase it had negative press attention to provide with necessary context with the costs associated with the effectiveness with the prevention act of 2012 that you mentioned the oversight

committee favorably reported back to its unanimous passage through 2012. important that we do not throw the baby with the bathwater with specific cases of abuse that makes my blood boil after 16 years of experience to make micro purchases congress has facilitated more procurement system to achieve cost savings that outstrip the cost that is obviously unacceptable of charge card abuse. according to the idea say because they cost agencies

nothing to obtain services and the use of the card has generated more than $1 billion of gross agency rebates resulting of provisions requiring the credit-card companies to pay two agencies based on the amount charged to the card. it is vital we don't overreact that refer our system back to the pre-1998 era that has more cumbersome bureaucracy resulting from agencies that able to use them to use streamline acquisition but to consider those small businesses when making micro purchases

260,000 cards in circulation and are in the hands of those to officially support mission and delivery but to be clear i'm not minimizing the findings to remember inconsistent controls with respect that is one of the reasons i enthusiastically supported the government charge card protection act while congress codified those the findings of d.h. us much more work remains to be done with that initial legislative remedy if that is what is required.

the nature of this contact results in inconsequent says as ceo rages battle the federal government may has long been a the pendulum in your direction the republicans and private sectors the bottom line is we cannot rest until they lessen the risk of waste fraud and abuse period rove must ensure the consequences are consistently implemented in relation to the severity of the abuse.

and to ensure credibility and also of do right as hard-working servants and with that of the board to the hearing and the testimony. thank you. >> the ranking member for his statement and all members may have seven days to submit opening statements for the record now let me turn to recognize our panel. i will introduce them first janet caspar from assistant agreements from the u.s. epa kelly lewis is the assistant

inspector general at the u.s. department of labor. mr. lyle assistant deputy sick - - secretary for contract in the united states air force and mr. larry then deputy director for services that united states air force. so if you come before the subcommittee for the investigations in accordance with rules reduce swear in witnesses i will administer the oath. raise your right hand please do you solemnly swear or affirm that testimony you're about to give is the whole

truth and nothing but the truce? all of the witnesses the record will reflect answered in the affirmative. and thank you for coming today. of course, we don't have as many members today that we try to limit to five minutes we do have copies of your statements that will be made a part of the record if so ordered. see you can make some major points to the panel this afternoon