invented vonage. he became the father of vonage and what we did. he just said this wonderful thing, i'm a dreamer. and to him, voip was ham radio talking to people all over the world in the internet age. if you make me come to a washington agency and get permission before i do it, i'll still dream, i'll just do it somewhere else. that's the change -- the thing i like about the wheeler proposal and i worry about some of the proposals in this space, is i want to preserve that flexibility for people who come up with strange ideas, have the latitude to try them. >> host: professor christopher yoo of the university of pennsylvania, please come back. >> guest: thank you. >> host: gautham nagesh, thank you. >> thank you. >> c-span, created by america's cable companies 35 years ago and brought to you as a public service by your local cable or satellite provider. >> health and human services

secretary sylvia burwell will speak at the center for american progress today about the upcoming open enrollment period in the health insurance marketplace. she'll also discuss her department's efforts to insure the readiness of healthcare.gov. our live coverage begins at one p.m. eastern on c-span. >> and now a discussion on current international health and security challenges. medical and defense analysts discuss the spread of the e ebola virus, health concerns related to warfare and the humanitarian crises resulting from conflicts being waged by isis and other terror groups. the event is hosted by the university center for terrorism study. it's just under two hours. >> okay. i guess we're ready to start. i want to welcome everybody again to another very, very timely seminar, and i want to thank yona and all of his people really who put this together with a great deal of haste

really considering the topic. the health challenges that we have, the security responses from ebola to terrorism. and, of course, i think it's extraordinarily timely event. and we have a super panel here. i'm going to let yona do the introductions here at the right time and so on, but our panel is, we're blessed really today by having a panel that has a lot of military experience, a lot of government experience, a lot of medical experience, a lot of all the kinds of experience, if you will, that you need to talk about this topic along with don and his international legal advice and all of that kind of thing. somebody, somebody told me one time when i was a young guy, if you want a good idea, read an old book. and i think that is very timely. for example, here's a book that was written by yona 13 years

ago, and the title is "terrorism and medical responses: u.s. lessons and policy implications." and so i think that says it all. and with that, yona? it's yours. >> thank you, general, for your kind word. and since you mentioned the book, i would like to call your attention to the extraordinary book that general gray has, and we have the information in the package that we provided you with. if you read this book, you know what leadership is all about. and we actually have to learn the lessons what worked, what didn't work, and the general made many contributions as we know for many, many, many years. now, before we move on to our

speakers, i have to deal as an academic with some of my duties. first of all, again to thank the cosponsors of this event, of course, the potomac institute for policy studies and the chairman, mike sweatnam, unfortunately, is not here today, but we do have some of the colleagues. katherine, where are you? in the back. i think we do have a few other members here. and my colleague right here for many years, professor don wallace of the international law institute. and i do have to mention also our colleagues who are not here, but they work with us for a long

time; the center for national security law, the university of school of law, particularly professor john moore and professor bob turner. i have to mention also my colleague, professor edgar brenner, who died several years ago. we worked together for many years at the internal university center for legal studies at the international law institute. now, let me, let me first introduce our panel, and then i have to make some remarks before they speak. one, dr. robert -- [inaudible] right here. and you will see a bio, very, very impressive bio, as the general mentioned. we do have some former senior officials from the white house,

the pentagon, u.s. senate and so on. so you can read the bios of the speakers. next one is dr. rashid -- [inaudible] also medical doctor who is a fellow at the potomac institute. also has a very rich background, and you can see that. and our third panel is professor lawrence lufti who is now with the nasa, the near east south asia center for strategic studies at the national defense university, and he also participated in government, the u.n. and so forth. now, you do have the program in front of you, and i would like

to make a few remarks both as an academic and, i think, it's my obligation to try to put some context and rationalization to our discussion. before that i would like to mention that in general when we discuss the issue of security and terrorism, we dedicate the seminar or the session or discussion, first of all, in the memory of the victims of violence both manmade and mother nature which i will come back to it. now, of course, those who died because of the ebola disease and those who were victimized by terrorism throughout the world. as we speak, we have to keep in

mind that we're dealing with a challenge which is very serious with implications -- [inaudible] and we certainly have to think about the victims. also some specificking isments of the society that are particularly targeted by terrorism. for example, some of the journalists, those who cover the events and try to bring us the information all the way from daniel pearl who was assassinated in pakistan in 2010 to the islamic state video of the execution of james foley. so, one, a dedication to the

victims and, secondly, we also have to celebrate the work of those who serve to protect our societies. in this case, of course, the medical community, the first responders, the law enforcement people, the military, governments and the civic society in general. secondly, i think if i may we tried to pull together a seminar that will have two major challengings. in other words, one -- challengings. in other words, one is the -- [inaudible] [inaudible conversations] okay. so i very quickly a few slides. sups time of memorial -- since time of memorial, as we know, humanity faced two major challenges; natural disasters and man made disasters.

all the way from everett quakes to the -- earthquakes to the deadly disease now, ebola. and secondly, of course, manmade. all the way from the economic collapse, technological disasters, crime, piracy, radicalization and extreme itch, terrorism -- extremism, terrorism and war. obviously, we have to deal with both of them in order to understand what are some of the major challenges that we have to deal with. now, if i may, i think we have to make the connection between the historical experiences as well as contemporary times. i don't know what -- we're trying to deal with technology. as we say, nothing's new under

the sun except technology, right? i'm using the wrong thing. right. [laughter] after all, i'm an academic. [laughter] at any rate, we just had the publication here on the challenges in africa that was published yesterday, and we'll provide you with copies dealing with both ebola as well as the terrorism challenges. so if, for example, we hook all the way back -- we look all the way back if you will in the bible and the holy books and all that, and it's very clear what happened to societies at the time and the victimization. but it is interesting to look during history what were the

reactions and who was to blame for some of this disasters, natural as well as manmade. and we can look what shakespeare said in king lear right there to point the fingers, who is guilty of the disasters. but i think the best answer was provided by noah when he build the ark. because he basically sent the message that should be, i think, critical in terms of developing policy, and he said, look, there is no room, there is no room for delays or indecision. so governments have to move, and the society have to move in order to deal with the challenges. so if we look back, obviously, we can look back at history, the time of the pharoahs, if you will, and the ten plagues.

the middle ages, particularly the black death. and the thing is that the middle ages and the black death is not just a chapter in history. even today we find in the contemporary struggle that some extremists, they try to push an idea that one can call blood war. in other words, for example, in the gaza recent, i think, crisis and war there were communications that the jews are poisoning some of the waters in gaza in order to kill more and more people. now, if we look back at the responses, this is one picture of a physician in the middle ages protecting himself from the

black plague. and, basically, you can see that he's really wearing a cloth which is oil cloth, covering his face with a mask and a sponge with vinegar to deal with these issues of the mass mortality. so we have to learn in the past. and i found, in fact, i think the professor and i, i remember we worked together at the conference in turkey, and we saw the monument of the father of the turkish republic. by the way, just celebrated the 91st anniversary of the turkish republic. and i think kamal ataturk in

this statement trying to equate the individual to the nations was really on the mark. it seems to me that he set a value standard for us to follow and humanity that we cannot be detached from reality, and we have to look at the situation as the case. so today we're going to deal with the virus and threat of ebola, and what we learn from history, that there are two emotions that drive people. one is fear and one is hope. with fear, obviously, we see what happens even if there were very few cases in the united states and in the west, and it did generate a great deal of fear. we're going to discuss the whole issue of ebola, and we do have

experts to deal with that. again, each time we're surprised about the surprise because we did not anticipate that kind of activity while in africa. we know that there were many, many cases of infectious diseases all the way from malaria out to typhoid and so on. so, number one, we are going to discuss the ebola specifically, the roots and what are some of the challenges that we're going to face in the coming months and years. finally, we're going to discuss also the security issue which has to deal with terrorism particularly now we have seen what happened with the isis. now, i suggest that we look at some of the other groups as well. for example, the hezbollah and,

honestly, we also marked this month in october, the 33st anniversary of the -- [inaudible] and the french forces in lebanon. and i think we have to look at hezbollah as well because we find that hezbollah is very much engaged, as we know, in syria. and according to all kinds of reports, hezbollah, frankly, was able to upgrade its capacity. and according to different reports, there are probably about 100,000 rocks of hezbollah -- rockets of hezbollah. and in case of a third lebanon war between hezbollah and israel, we are going to see, obviously, that kind of capability. now, in addition to that, i think we have to look at other

groups in the region, and the next one, of course, is the al-qaeda group. but not only al-qaeda central, we have to look at the -- [inaudible] groups, and we're going to discuss it with one of our panelists as well. in the arabian peninsula, in the maghreb, al-shabaab and so on. and this is an older map in the beginning of the year. obviously, we're going to have an upgraded map to indicate what's happening now in the region and elsewhere with the emergence of the group, the groups in the region as well as the center groups. we have to deal also with the hamas issue and particularly now

we find that the most recent -- [inaudible] in the sinai, we witness the i attack on the subscription army in the sinai and -- on the egyptian army in the sigh tie and, frankly, with hamas and other external groups in the region. and, clearly, i think egypt in order to develop security, they must corrupt a buffer zone -- construct a buffer zone in the region between the sinai and gaza and israel. and there is no doubt that we have to -- [inaudible] to the question of stability in egypt which is the most important country in the middle east. finally, the islamic state, the islamic state which we'll discuss in some details.

and what is really interesting about the islamic state, they're able to somehow recruit thousands of volunteers from all over the world, as we know the foreign fight be -- fighters. for example, from tunisia today according to reports, there are about 3,000, i think, volunteers despite the fact that tunisia approved that it can somehow develop democracy in the recent elections that we know. nevertheless, we find those who fight for the islamic state. and the brutality of the islamic state is very well known. i like to mention not only the journalists, but also women and children and so forth. so we know that the islamic state controls our territories

as well, and, of course, the concern is that the islamic state has a grand plan strategy in five years or ten years, and, obviously, we have to be concerned about this. finally, in regard to the role of terrorism linked with our security, we're going to discuss the humanitarian crisis in the middle east and in africa, go into some details the countries that we know if you take, for example, syria, the total number of refugees or displaced persons in syria is around ten million. if you take into account the refugees of three million or less for various countries --

[inaudible] and i think the same thing is in the maghreb, and we're going to discuss it. so the question is, basically, what are we facing in terms of security? and i submit to you that we must discuss not only the ebola, but the biological and chemical and nuclear challenges that society is facing. and then, of course, in order to deal with the issue, we have to strike a balance between the security considerations and human rights and civil liberties. with that, i'm going to call on dr -- [inaudible] and speak. >> thank you, sir, really appreciate it. >> sure.

>> professor alexander, general gray, ladies and gentlemen and my distinguished colleagues on the panel, it's a great pleasure and privilege to be here today. i'm reminded of a plato quote that only the dead have seen the end of war. but i'd amend that to say only the dead have seen the end of war, terrorism and disease. and so on the topic of ebola, it really represents, i think, a very interesting point in time, and i think the historical reference to the black plague is an interesting one because it will highlight some points i'll make later about the risks that we face in the 21st century for future plagues like not only ebola, but other things that are going to be enabled by things like climate change, things like globalization and mega-urbanization. but i'll talk about that a little bit later. i think the issues i'd like to

highlight for you is give you a sense of, you know, we enter into this circumstance with a great humanitarian crisis and, quite frankly, national security crisis in western africa after a fair bit of work that has been done over the last decade to improve our game in terms of health preparedness, and i would say, health security. so it'll be my intent to give you some sense of what has been done and what remains to be done in the fault lines that i think from a policy perspective exist both for the current administration, whoever's post next, he or she, whoever that is, and certainly the new congress that will begin in january is. i think the current ebola crisis, at least from my standpoint, highlights the vulnerability of our health care system from a single case of ebola that walked through the emergency room dollar -- door in dallas and was immediately sent

out saying it was more than possible that an ebola victim could walk into your emergency room or hospital. what's worse about this is the effect -- and you could argue that this has been largely media hype -- but i would argue something very different, that there's a very core fear in the american public that predates the events that happened here in october that go well back. and i have an historical example of it, back to 1946. so many of you may not realize that during world war ii we had two manhattan projects that were conducted. one was developing the nuclear bomb, and we know who the oppenheimer was there, right? dr. oppenheimer. but there was also a biological oppenheimer, a gentleman by the name of george murk. there's a billion dollar multi-national pharmaceutical company named after him.

but he was the american oppenheimer for the offensive bw program. quite frankly, during the several years that it was existent in world war ii, quite frankly, they never were able to create a functional biological weapon that they intended to use had either japan or germany used those kind of weapons against us. i only make that point because i think there's a historical point about the role of intelligence. because in 1943 when president fdr was warned about the possibility of biological warfare in the u.s. intelligence community, then the oss, basically informed him germany had a biological weapons program and japan didn't. we found out after the war the exact opposite was true. and so you probably can relate to more recent examples where the intelligence community hasn't been 100% right on these sets of issues, but i think it's just worthy to note that it was certainly the case then and now that in some ways if we rely on

intelligence, we may be very dispinted. particularly about not -- disappointed. particularly about not only terrorism and the use of these kinds of weapons, but also about disease itself. the point i'm trying to make is in 1946 george merck rereesed a report -- released a report about biological weapons. it's one of the few cases i know of where a report was unclassified, released to the public, later classified as secret and pulled from all the shelf. why was that? it scared the bejesus out of the american public. it created a firestorm in print at that period of time, and you can recount that if you've ever been to the archives of "newsweek" mag chien and "time" magazine and actually evaluate what was not only the scientific debate, but the fear that was invoked by the concept that you could create agents that would be invisible, that would be, if you will, totally alien to our

senses, that could ultimately kill you in a rapid fashion. i would argue you that everybody's been sick in their life, so there's some element of what i'd say personal reference to the idea of illness as it is. now, a few people have had ebola in america, but if you recall barbara preston's book, "the hot zone," certainly a compelling case why you should fear such an organism like ebola virus. so in some ways there's an innate fear by the american public and also, if you will, a created fear by public press. there have been popular movies of the subject and, obviously, the media has certainly not missed their chance to sell print or advertising in today's world. but the point is that this represents an interesting nexus for the potential for terrorism. and that is kind of what we experienced around 9/11 with the anthrax letter attacks. and so i would just argue for the purposes of this august

panel that in some ways while we view the ebola crisis as it is today a natural event, it could certainly migrate into a different space should someone take advantage of the availability of a virus like ebola and use means to basically deliberately infect people. but this is not new news to you. but i do think in some ways you need to understand the health care system that we have to date. it's a $2.8 trillion activity, and the u.s. government currently spends about -- for hospital preparedness -- about $225 million. that represents one-one hundredth of 1% of what we annually spend in health care. so you can imagine that what we gain out of that federal investment around health, health preparedness is evident when a single case of ebola basically walks through a door, or it

could be any other disease of significance like smallpox or pandemic influenza that, quite frankly, the affordable health care act -- and i'm not here to throw stones on it -- but does not have a thread of preparedness weaved through to it basically insure that the health care system we will develop over time where every american has not only access to, but the right to health care is a system that is prepared to meet the challenges of the 21st century. and ebola represents, if you will, the poster child currently for the challenges that we face ahead of us. the other thing you need to understand, and i'll just throw out this quick anecdote, we spend -- the amount of money we spend on health preparedness is about 3% of what the american people spend on potato chips. so as a society, we don't put a lot of investment or priority or significance around this. but while i may be doom and gloom on the monetary side, i need to convey to you that

there's a wealth of things that have been done beginning back in the mid '90s during the clinton administration that really have, if you will, evolved policy and legislative action to the point we are today that in some ways i would say we have enough policy, we have enough legislation to do what we need to do, but we failed on execution and commitment and priority to do the things that have already been established by presidential policy and legislative statute. and i'll give you some examples of that. ..

earlier in the day today in 1990 study for the institute of medicine that indicated that emerging diseases were going to be a significant consideration in the future. again, 1992. for the issues if you will a global climate change, the issues of globalization were realized. doctor lederberg and his colleague from yale university, distinguished biologist basically recognized that we were on a converging path, potentially with disaster with the possibility of emerging diseases in bioterrorism. and it was the work and dr. lederberg's warning to clinton but basically it will initiated

things. i'm a great believer in our system of government that best we could hope for imperfect parental is him. you can look at any issue in the united states history, whether it be civil rights, defense policy or i would argue in this case public and medical preparedness that we demonstra demonstrate. that we make few steps forward, one step back, realign and move forward again. and so it is with that they are been a series of if you will legislative initiatives that basically happened after 9/11 that are worth noting. one is the pandemic hazard awareness act. and like to take credit for because of the staff director for the senate subcommittee that drafted it but it was senator richard burr from north carolina and senator ted kennedy who championed that bill. the significance of the bill was a basically used the lexicon of

national security to basically define and if you will redefine the u.s. government's role in preparing for these events. interesting enough, economic reference to project that general grey was involved in in his career, but we used a goldwater-nichols act as the template for this bill, not because we think public health or medical capability should be a line along the dod access but it didn't identify in the goldwater nichols act the idea of having joint operations, putting somebody in charge, creating a kind of command structure over all. with that division was great at the health and human services department for the assistant secretary of preparedness and response. regrettably and the crisis as hand you don't hear much about the office but it was their function to basically do the necessary things to align that the u.s. government's efforts in this space, realizing in some

ways it's not only hhs, dod and va that assets to bring to the fight, but it's also this idea that basically outlines the state and local authorities who are the front-line soldiers in this kind of activity. we can argue if it was effective or not but i think the story will be written. but i do hope that as a result of this able event someone will have the wisdom that they had in 1980s to commission a holy report that general grey was part of, and we talked about it before these proceedings, -- holloway report, that did assess why did things fail? if in that case desert one, because what they identified in the blueprint day late and a vision they left was one that over two decades went from the point in time when we had a

tremendous failure in the iranian hostage rescue to the point in time that we could all just celebrate the demise of osama bin laden. that didn't come overnight. that didn't happen because somebody just said let's do it. it literally took decades of commitment by the special operations community to do for essential things. for essential things that i would argue today are the essential elements of the kind of public health preparedness we need to address the current ebola crisis and any future public health crisis we may encounter. one is recruit the best people. i think if you look at the record right now we have a tremendous brain drain and if he will drink of the public health community come of people who operate at the state and local levels, basically ensure that people abide by the quantity, that people do do the things that basically there was a risk to the public of the disease. but we also knowledge in the medical community that in many ways we don't necessarily train

or equip them to manage these events. i think the events in dallas prove as they did prove in the case of desert one there is no such thing as just in time preparedness. the idea that you need to have a force at the ready to they need to be trained, equipped and exercise. yesterday i spent the entire day, i co-chaired a panel of the institute of medicine on preparedness, and we spent the day looking at what has already transpired with the ebola virus and. and we heard from local, and local public health and medical leaders from atlanta from nebraska, from new york and from dallas or indirectly from dallas on their experience so far. what they said is, you know, what really needed to do was make sure we have the equipment in hand, and that we were well trained. not just in time training by

continually train to ensure that we could meet the nation. answer these are essential elements of the challenge that we face right now in terms of repairing it. you hear of ad hoc teams from cdc, department of defense, those are truly ad hoc gap fillers. but as we look forward to the events before us i think it does raise the question, how much are going to invest in this space? how much of a priority are we going to put in this space after the ebola crisis is over, realizing the next one may be on the near horizon? there are two major political, policy issues that are outstanding but need to be addressed. and then i think i will probably be at the end of my time, but i will leave you with some final thoughts. first of all one of the lessons we learned in the early 2000-period from the standpoint

of the anthrax letter event, it could've been a lot worse. we know from the wmd commission report i sent it to grams, but they recognized that had the perpetrator, likely bruce ivins from fort dietrich's, taken a single -- put in a ventilation shaft in the metro, it could have infected several hundred or so thousand people. this point out a very important issue of conversion that i think has happened. in the policy towards these events. so we talk about conversion i just companies moving overseas. let me give you a policy in person on health care. number one is, are the critical element here is in considering these events, it was always believed some of these bioterrorism by where for, a state actor conducting this or a group conducting these kind of

attacks using these agents would create a situation which we have not seen in nature. that the risk was you could basically infect millions of people near simultaneously by releasing an aerial sal cloud of infectious disease. overtime the belief is in some ways if we prepare for natural events like ebola, which don't have the same epidemiology that somehow we'll get the benefit of improving our public health and medical infrastructure committee at a lower cost but in some ways that's the more likely scenario. well, it's like telling an army, or to say, or basically better yet let me use a football analogy taking the washington redskins and telling them they will play one of the local high school teams as the way to practice and they are going to play at dallas cowboys or the seattle seahawks. the whole thing is that if you define the problem in a certain

way, i think we're on the wrong track at the current time, that we were basically not prepare ourselves to address, i won't say the worst case scenario but certainly a reasonable case scenario for terrorism basically tries to use these kinds of agents as weapons. and as i think you can see in the events of the ebola case we have not proved ourselves necessarily competent to do with a single case of a natural occurring disease as has been reported in the united states. the second issue is, another policy issue is in all the efforts and even in efforts that i was a participant of, preparedness, health and security preparedness, was somehow outside the domain of regular health care. kind of an add on, an adjunct. and the answer is it has to be integral with. and that's another major policy issue that i think is

outstanding. i think in the construct of my comments today, and again alluding back to the points of professor alexander made around like death, we have to look at the events -- like death, we have to look at the events that make our life challenging the matter what, whether it is a disease natural in origin or delivered in origin, and that is three essential factors. talked about climate change a little bit, globalization, the opportunity that when someone can get a plane today and be in the united states, not the same day but the next day carrying a disease that either he acquired or she acquired that could represent a public health threat, or by basically having 10 people purposely and i collated by a particular disease being if you will implementing the nsa spy commercial airliners. and i think the other element

here is this idea of organization. because ebola wasn't a problem in the past because what happened in -- it would happen in a remote village somewhere. people would get sick, people would die, and because there was no access to the will to modern transportation, the outbreak was naturally contained in those settings. now there are better roads and africa. people are living in large urban environments like in monrovia we have 1 million people living in highly dense urbanized environments. whewhen somebody gets it in that environment particularly when sanitation and other conveniences of life that we take for granted are not available, a basic traits the circumstance where these things can rapidly propagate. i think i probably, if anything, went over my time but i hope i left you with a sense of the landscape that we have done which again, first is an introvert incrementalism, two

decades and a dedicated effort to improve the preparedness of our public health and medical infrastructure. we have many more miles before we sleep, before we get it right. this is not rocket science. i think the experiences or the analogies that we done in other areas, and they use the socom experience has been one point, that there is a way to rapidly fix this problem. it's not entirely expensive but it takes aorta, leadership, and some amount of resources to do so -- takes priority. the last thing is when you to define the problem correctly. that in some ways the challenges before us are likely to be more frequent. they may represent a deliver a component that represents something that is entirely different than we're dealing with now, and we should have the wisdom and the fortitude to develop what we need before it

happens because there is not just in time preparedness. with that conclude my remarks. [applause] >> and. >> distinguished guests, it was difficult to go after somebody who i respect commenced as many friend, mentor and advisor for many years, doctor cadillac in some of his policy issues. so i'm going to do some going to specifically focus on some of the facts and some of the ethical issues related to this particular disease. in africa people a primary occur in remote villages, in tropical rain forests and central and west africa. confirmed cases were reported in democratic republic of congo which is formally known as zaire, sudan, uganda, the public

of congo, ivory coast and the first time you see cases in guinea, liberia and sierra leone. between 1976-2012, 2388 cases, and 1990 deaths were reported. when we look at that and the numbers today, we are amazed. that is something that we want to keep in perspective. another important thing to understand and appreciate is how does ebola spread. recent studies have clearly indicated that a fruit bats are the reservoir for ebola and nonhuman primates such as the eight and the monkeys are carriers that transmit it to humans. let's move to human to human transmission, the way in which virus appear in human to human to the start of the outbreak, so far unknown. we know how it comes don't know what exactly happened. the first patient becomes infected through contact with

infected animals such as fruit bats as i mentioned and primates, which is called a spillover event. person-to-person transmission can lead to large number of people getting infected, and small past ebola prime to shut up for its primates also affected a lot of primates also died during these outbreaks, and humans when they consumed the meat of those primates are touched those primates are we dealing with those primates got infected. once infactions comes into humans, the virus can spread several ways, through direct contact as with all put, rogue and skin, mucous membrane, eyes, nose, mouth, blood and bodily fluids of a sick person. and it's not limited just to human saliva, sweat, vomit, but also breast milk and seaman. objects like needles can also contaminate and transmit the

virus. in front infected, as we also mentioned the fruit bats and the primates. past research as we know has established now and we're still working on it and there still some question but past research has clearly suggested that the spread, that the disease does not spread through air or by water or in general by food. in africa people may spread as result as we mentioned earlier handling of the bush meat, which is very critical to understand and appreciate. there's no evidence that mosquitoes or of insects can transmit ebola. wants some of recover some ebola they can no longer spread the virus. however, ebola virus is found in semen, but up to three months so that something also to consider. as of october 29, the current epidemic in west africa caused by the zaire strain has resulted in infecting over 13,000 people,

and close to 5000 deaths, which brings the current case fatality, mortality rate to about 36%. the three main countries are liberia, sierra leone and guinea. nigeria had 20 cases and in test and was declared a bowl of fruit on october 19. senegal had one case that survived in the country was declared a bowl of fruit on october 17. mali recent reported a child who died of ebola. all discs of sierra leone have not reported at least one case of ebola, and ivory coast due to its proximity to gain is the next potential country that could get the disease. over 500 health care workers have contracted the disease out of which 50% have died which is a very high number because the case fatality rate right now in the general population is about 36%. interestingly, the first outbreak that happened in 1976,

the case fatality rate was about 80% and that was the zaire strain. the last outbreak that was around 2000-2001 which was due to zaire strain had a rate of about 32%. we are getting close to the percentages that we anticipate that are going to be for this particular strain. we all know that in spain there was a case on october 6, and a nurse was taking care of two missionaries who contract the disease on october 20. no trace was found in her blood in spain will be declared after 21 days ebola free, actually 42 days, ebola free. we all know about the cases in the county, united states and dr. kadlec talked about in detail, and the problems and issues with preparedness and recognition of disease is big, is something that we need to look at very carefully and appreciate. there were a couple of the

cases, one case that is in new york right now that was diagnosed on october 23 in a physician who worked for doctors without borders and is currently being treated, and all the tracking and some of the people who was in contact with is being done in new york. there was another potential case in new york of a little child, five year old child was taken to the hospital but who tested negative. there was a case in maryland that was taken to the university of maryland medical system on october 27 and then it turned out that that was not a positive case of ebola. so two very interesting things i think that happened on octobe october 27. cdc outlined plans to monitor travel. most health care workers returning from west africa or the ebola hot zones would be considered to get some risk of infection, while health care workers tending to ebola

patients in the training facilities would be seen as low but no sooner risk threat to the population to these guidelines were short of the controversial mandatory quarantine being imposed by some united states states such as new york and new jersey. same-day united states department of defense came up with its own policy will be on previous established military protocol to u.s. army isolator about a dozen soldiers as part of the, at the base in italy including major general darrel williams who oversaw the initial response of ebola outbreak in africa. dozens more will be isolated in the coming days as they rotate out of west africa where the military has been building infrastructure to help authority street people addicted to all of you about 3000 boots on the ground in rotation in africa helping with this particular problem. one of the critical problems of

people is how to diagnose this particular disease? we didn't have a very effective way of diagnosing it. in response to the epidemic on august 5, fda issued what is known as emergency use authorization for the defense department for the real-time chain reaction for ebola. on october 25 fda issued an emergency authorization for two new diagnostic tests which is called bio fire just what can be done on blood and can give you results in about an hour. france is also developing a tool which is called the ebola disease screen which has been developed by the french atomic energy commission and taken potential diagnose a patient in about 15 minutes. when it comes to treatment there is no approved treatment available for the disease. clinical management is focused on supportive care of complications. however, multiple therapeutics or drugs are being developed or are in potential -- being

developed that could help work on this disease but there are two particular vaccines that are of interest, one being developed i like the smithkline, and the other one by new link which is a canadian vaccine being produced essentially in ames, iowa. both of these vaccines can, if the test of all the efficacy and safety in humans that is being done right now comes out okay, then there should be a decent amount of supply in the mid, or the first quarter of 2015 for populations within the united states, or to be given to help the workers and first responders in africa. one of, one of the other important factors to consider is what is going on in terms of the beds in africa? there are just not enough beds for the patients.

the latest data from w.h.o. indicates only 22% of the planned ebola treatment center beds and 4% of the planned community care center beds on operational which leaves a huge void in terms of providing health for the population. -- help. the current epidemic is the largest and most complex on record with an unprecedented of affected country, thousands of cases and deaths and younger population and hundreds of health care workers infected. and the scale and of the outbreak has reinforced the urgent need for large-scale and accelerate development available specific and effective medical intervention. subject to the outcome of studies and trials, we expect as i mentioned earlier that there will be therapeutic and vaccines that will be available to work on this disease. all of you have heard that it was predicted if appropriate

measures are not taken, we can expect approximately and thousand cases per week starting in december in africa. lelet me say that in two of the countries that outbreak is currently going on we are seeing a little bit of decline in terms of the cases. so there is some hope that this potential outbreak can be nipped by january if appropriate measures are taken. as dr. kadlec has suggested, the world is making this up as we go and we have to become more comfortable. it is a huge problem. the current epidemic which africa's struggles with is something that we should have thought about. they do not have the health care structure that can do with the regular issues that go on over there from health care perspective. now we are adding to this injury by ebola. nature is adding to the

countries with ebola outbreak. the first focus needs to go to the simple things to decrease mortality was africa. aggressive inconvenience hydration, managing zazi, fever and superimposed bacterial infections are relatively inexpensive measures that can be part of a bundled package that can be delivered to west africa but there is critical need of the beds as i mentioned in the most affected countries. proper training and protective your needs to be provided to the hospital staff who take care of the cases, and the burial staff dealing with the corpses. there are ethical challenges which bound and a limited use of untested interventions, quarantines, special care and other issues. in the u.s. national institutes of health biomedical research, always by a critical role in approving physical and mental health. of a americans and the global which in turn has yielded significant social economic and

societal economic benefits. federal funding has been the cornerstone for nih for american biomedical research sector that needs world and investment and innovation to nih budget being stagnated after 2003 and declined after 2010. the cost of conducting biomedical research has rapidly increased also at the same time. this was further hurt by the recent budgetary cuts and sequestration but in order to secure america's position at the global leader in biomedical research for the foreseeable future, congress must pursue significant new investments. there is no evidence so far of that we have appreciated in the scientific literature that says that closing borders will cause of the disease to stop to country specific nation. we also need to do with some of the other ethical factors in

terms of -- should we do that? yes, we should accept those workers but we must make special arrangements and special commitments to health care workers that are currently working in these particular countries, frontline dealing with a disease that is deadly to these doctors and nurses must be promised not only high quality of training and protective equipment going forward and also that if something happens we must take care of them. someone was take care of the heroes, not just the civilians who were there but the 3000 troops that we have in the hot zone when they come back. we have to make sure that you are taking care of. in summary, although there are signs epidemic is slowing down in some areas, it's not effective and effective international response. it will cause a bigger devastation that we could ever think about. a safe vaccine i believe is the only hope of containing the

outbreak, but the u.s. investment in vaccine research is a drop in the bucket. and nonpartisan effort in the u.s. is needed is -- the is department of defense, research and development and advanced development of vaccines and therapeutics as well as diagnostic devices. we also have to make a concerted effort to develop manufacturing facilities right here in united states. countries, ngos and funding agencies private and public need to fulfill the pledges. only 40%, 17% of the pledges so far have been fulfilled. countries promised and pledged private institutions promised and pledged. those pledges never come through. they need to stand up and fulfill their commitment. and the last word is, remember,

diseases do not know boundaries. so reading of these diseases come to the united states or any other part of the world if we do not, if we are only reactive and not proactive. thank you. [applause] >> thank you, yonah. with dr. alexander's permission, and i guess more important, our media colleagues approval i'm going to speak from the table here rather than the podium. i appreciate the opportunity of being here. i've been asked to speak a bit of a terrorist and insurgent groups that are operating not just in africa but also in other parts of the region. and a little bit about how that affects humanitarian, the potential for humanity and disasters in the region. there's been plenty of literature analyzing these groups. some the best has been done right here in this building. so i'm not going to go into

what al-qaeda is all about or what isis is all about, except just a little bit. but what i want to do is talk about activities of these groups and the potential for the development of a true humanitarian crises in the region, and that is primarily through the issue of refugees and displaced persons. i've got some statistics are i will kind of rattle off. the sources of these, most the united nations, the high commission for refugees or undersecretary general for humanitarian affairs in africa boko haram, a group that has certainly made headlines recently. there are probably 10,000 nigerian refugees in cameroon but i know if anyone would go to cameron to seek refuge but there are 10,000 nigerian refugees in

cameroon. there are probably 50,000 nigerians in niger. more about that in a minute. and there are several hundred thousand internally displaced persons within nigeria to maybe even up to a million because these numbers keep changing as things evolve. moving a little further north in tamale situation and in activities of al-qaeda and islamic maghreb further in the north in mali and nigeria, or 300,000 internally displaced people within mali. imagine 50,000 in niger. some of those come from mali. and both of those situations, the u.n. is moderate not for ebola necessary but for yellow fever, cholera and this sort of thing. althougalthough i want in a sizt the humanitarian disasters that can happen are certainly more than just medical related disasters. in libya, which one can argue

this kind of the beginning of this whole process, especially in northern africa, there are 60,000 internally displaced persons within libya, a country where any sort of government, whether it be the central government or regional governments, their reach does not extend very far beyond the building in which they are meeting. there are also a million refugees, according to the u.n., in tunisia, libya and refugees in tunisia. the president of tunisia it will be president at least for another month or six weeks says it's up to 2 million libyans in tunisia. maybe even one-third of the 2011 opposition. now, tunisia has capable medical capabilities and this is bit of a joke about that. at the time i would've a joke

about tunisia and the medical, but this is still, it really taxes the capacities of countries to handle these people. now, let's talk about isis a little bit and i will talk about the refugee situation in isis which the worst these other numbers relatively. and then i will talk a little bit about isis itself at the end of my remarks. the u.n. says there are 3.2 million registered refugees. that is, registered refugees, registered with the u.n. from the isis syrian civil war and sectarian fighting within iraq. there are refugees, more than a million each in jordan from both iraq and see. and jordan has seen successive waves of refugees from 1948 right up until this year. about 1.3 million in turkey.

these are registered. 1.2 mean out of lebanon. 500,000 syrian refugees are in iraq. in other words, they went from syria, from the frying pan into the fire if you will, or the other way around depending on your perspective and they sought refuge in iraq. there are 900,000 internally displaced people within iraq. syria, the numbers suggest, there are about 4 million syrians were displaced within syria. some coaches cities, live with relatives. not necessarily all in refugee camps but this early is a lot more than 3.2 million refugees. as winter gets close, about 5.2 million people in iraq, says the united nations, are in need or will be in need of humanitarian assistance, as winter sets in. fuel, shelter, that sort of

thing. in iraq and syria, is this a bit of a chilling statistic, and i'll talk about that towards the end, there are now about 10 million people living in areas controlled by isis, the islamic state. 10 million people. in syria and iraq, both countries. that's larger than the populations of most of the states in the region. now, this of course creates large refugee populations, camps, emergency needs, and there are as we've heard by our previous speakers, and i don't mind going after previous speakers, i learned a lot from the folks who have spoken before me, there are a lot of obstacles to both governments and international organizations and ngos. there are obstacles that they

are providing a commitment assistance. ranging from, well, seemingly ridiculous, teams that are exacerbating -- -- are there to sterilize their daughter, so don't let them into the village. and attacked several have been killed. medical workers are actually bringing ebola into your part of the country, so stay away from those people. reminds me of the black plague picture with the vinegar. it's misinformation, and it's also propaganda that we have to counteract. obviously there are terrorist attacks and insurgent attacks going on in all these countries i mentioned, and, that threaten especially foreign ngos, not just foreign ngos, indigenous or native ngos also.

in niger the government has said that any ngos, any humanitarian teams providing assistance need armed escorts outside of the capital. that certainly inhibits people flocking to help the victims of there. there are kidnappings and deductions of humanity and aid workers in mali. we've seen the tube brits with her for humanitarian purposes. the undersecretary general of the united nations for managing affairs, and i will quote her comes as we've had, and this is the civil war and isis, we've had 66 humanitarian workers who have lost their lives since the start of the conflict, and hundreds more have been kidnapped and objected. this is what she says.

within syria. that is a certainly an obstacle to bringing the assistance necessary to take care of these people. and as we've seen in refugee camps in jordan and probably elsewhere, the war in syria, or the sectarian fighting in iraq, can spread to the camps themselves. in other words, lighters competes i can infiltrate the candace parker the as refugees and carry on the fight within the camps, which really stresses both the national secure the services return to police these camps, the u.n. if you're running the camps and other organizations. so we've got this situation with the millions of people facing, and it wouldn't take much to have a medical imaging crisis, but certainly other crises in terms of food, water, shelter

and these camps. now, let me talk a little bit about isis because this represents a new situation. we call it a isis. that's what our government insists on calling it, and i am no longer part of the government. i am ex-fed, not fedex, but ex-fed. i actually retired and so i'm speaking just for myself, but our government insists on calling it a isis, islamic state of iraq and syria, a isis has its eyes on a lot more than just iraq and syria. if you look at their map of the worldwide caliphate, it resembles no caliphate that ever existed in the history of islam. most of northern africa, most come into sub-saharan, south asia. it is, it is a very globally looking, whether they have the capacity to execute it, but they have this vision of this

worldwide caliphate. this is the first organization of its kind that has been able to control territory into daytime as well as the night. and this is key territory, these are cities, infrastructure, roadways, rivers, that sort of thing, key territory. as i said 10 million people live in the area that they control. we can say that aqim and the groups like that rome the desert and strike at will, that's true but these people control territory. they have displaced the governments, both the national governments such as the existed and the more traditional tribal authorities from that sort of thing in the places that they control. but haven't filled the vacuum, the governments vacuum that they themselves created, or that had

been growing before the even came upon the scene, such as places in iraq and in syria. they are not providing services to the people on these 10 million people that live in the area. they don't even seem to care about providing a service to these people, or interest. i don't serve the jihadi websites to see what's going on, i haven't seen anything from isis that seeks to show how they have made life better for the people and mosul, now that maliki and this corrupt iraqi government is out. all their propaganda is about beheadings and that sort of thing. this is a totalitarian organization in the classic sense of the word. if you're not one of us, we will kill you. even if you are one of us and you don't toe the line and believe what we do and do it we do, we will kill you, too. so this is a different, a very

different organization than al-qaeda. al-qaeda never really took that line. and now we're seeing isis sort of clown type organizations in northern africa that are swearing allegiance like they did before to al-qaeda, the al-qaeda central, isis. in mali and the northern africa, certain element, boko haram are doing it. so we're getting the sort of almost a nihilistic totalitarian organizations that are controlling a lot of territory. very little is getting into these places that isis doesn't approve. the international committee of the red cross says that it did manage to provide some medical equipment to a hospital and mosul, which isis controls, and the icrc says it has established

contacts with some people inside fallujah in iraq, but these are very, very small efforts. so that's the situation as i see it in that particular region, and we are facing a very difficult situation underresourced as our two previous speakers said. thank you. [applause] >> oh, and foreign fighters. i want to mention foreign fighters. my grandfather, young men worldwide find ways to get in trouble. i don't care where they are from -- i'm a grandfather. in tunisia and other places are no exception. it could be through video games or through drugs or through alcohol or something like this, but fortunately at least in the west and in europe the outlets for getting in trouble are much wider and much less lethal than

they are in that particular area. it is not surprising that young men of that age would see something -- everybody wants to be the person in the video games. a lot of tunisians before, say before the revolution in tunisia, were drawn into these groups when they were in your. in other words, left tunisia to go to europe to find a better life, which they didn't find, and so they were therefore tracked by these groups because they were separated from the real families. they had to find a virtual family which is on the internet someplace, and they get sucked into these groups. a lot of them went to syria. now they're recruiting within tunisia itself. a lot could be said, there's a lot you can the other jobs, the economic, the social despair they have, but essentially there's always a group of young men that are going to find ways for excitement and get into

trouble. >> would you like to take any comments now? okay. [inaudible] >> mic. >> is that okay? is that life? -- life. there's always one golden thread that runs through them, and i think it's the issue, though goal, the richness of what is said. i sometimes find it difficult to pull it all together in my head. i think today we have a fairly common set of things. i mean, i thought initially we would be talking about the fear but think we're really talking

about the underlying reality so we don't have to get into sort of the excessive reaction. someone mentioned the core. no, i think dr. kadlec. and i think, let me talk about isis briefly. we've had a program on isis before. i think it was called isil at the time, and i think yonah or someone all the terrorism, but i think it's probably deeper than terrorism. terrorism is one of the things it spawned, and i think this is something we really have to be cared about. i think we've seen the collapse probably of the middle east. someone mentioned it yesterday or the other was the 91st anniversary of the establishment of the turkish republic, roughly the same time as the end of the caliphate. i'm wondering when people will turn against the turks for having ended the caliphate. but i think there's a real unraveling there. the problems are profound. i think assuming of these

problems, fear comes from ignorance but even if you're knowledgeable, and not afraid i think it's very hard to get a total grip on the underlying reality as it is evolving. i think this is something that will come back to you again and again and yonah has been drawing that part, that picture in the art keeps growing and deepening. it is definitely there. on the other side i thought it was rather interesting, i didn't see how we would link the bullet to this but now i see. -- ebola to its our ability to cope, difficulty in coping with isis but maybe a greater degree a bowl of an impossibly bioterror. i think they're doing to do something very deep in america which is our priority. i'm a republican but absorbing tea party republican. now, the disinclination of americans to spend money on public goods, their belief that private life is what it's all about, the agency buildings in the beautiful houses, the meals.

we think there's something wrong with her minute and want to spend money on public goods, and get dr. kadlec has pointed out we do it at our peril. it's not the same as what joe said before. jones said before that as we cope with security problems we mustn't neglect or civil liberty. i agree completely. i'm a lawyer and lawyers tend to be interested in that, concerned with the big and they're not the same but nonetheless our regard for our liberties is somewhat related to our regard for untrammeled freedoms, our unwillingness really to sacrifice in the short and long-term. and i don't know whether we get serious about or not but even in the face of emergencies, crisis. what we are not is marines. general grey is a marine, the military has a discipline the civilian publics of the west do not have it. i think we will lurch and lurch and large, a little better but we'll just have to put up with it. i hope we don't succumb to fear in the process.

>> well, we will open up the discussion here. it's the question of hope. the big issue is that we tend to exaggerate sometimes the fear and hope. we pray, we hope that things -- so we have to have a realistic balance. but anyway, i think you raise your hand up. >> thanks very much. mike crap, i spent many years encounters and state. more recently have been working on the ebola issue with a group called the global health response reflects but i think

there's some parallels in fighting terrorism, one of the things come especially by president bush, was we fight them overseas before they could hit us here. one the efforts in fighting ebola is to try to contain it in africa. as you all know, as the doctor described, there are efforts to help the people there. there's a certain irony here that in counterterrorism we spend millions of dollars in training other countries to beef up their counterterrorism forces. in fact, we've kind of overlooked a time of in gaza, jordan and indonesia, broke up a couple of rings who tried to attack or embassies here in the bile areas, you know better than i do, we have tried to improve the capabilities of other countries. but now we're running into a problem, and he we're trying to encourage health workers to go

overseas. doctors without borders, a story by reuters today said they are worried already there's a chilling effect by quarantines being imposed in new york and new jersey commend governor christie admitted he didn't talk to health officials. we have two major allies, canada and australia, which have good health systems, who are very reluctant to send health workers because they're worried about how they will train them. what i'm going to get at is we are being counterproductive by imposing quarantines and discouraging people from going overseas. there's another effort that's going on, has not gotten much publicity. here's what i disagree with you a little bit. the oldest solution is not taxing. whether proposals to develop sort of a phase two, to develop containment zones in countries already affected and around the countries to keep people from

spreading. the idea is to help educate the villagers, to abandon some of their burial practices in which even comes of drink are lifted to lips of the dead person and passed around among the family. there some progress in this effort. there's some teams going at the but the basic effort is to try to educate the villagers and put in some teams to do with the psychological and other aspects of these two. and this group which includes mainly a group of public health specialists and some former military people and from dhs is trying to put that together. my point is that we have to look not only at the immediate problem of getting enough people and health workers and train them up for work exist now but also develop a better way of containing it before it spreads

further. >> thank you very much. >> so i agree with you that vaccines, developing a vaccine is not the only way to deal with this problem. but what i want to emphasize was that if we really wanted to get rid of this problem for good, we need to have a vaccine. the primary thing that is needed is to provide the affected countries -- infected countries with some of the basic needs, the once i've identified, which are just from beds to iv fluids and antibiotics, for example. going from there we've got to understand and appreciate that we've got a cultural bias that we've got to do with in those nations. and that has to do with the way that they deal with food, and the practices.

after cadillac pointed out very clearly that clearing the rainforest and the forest in a lot of plans in africa. and what that is doing is it is bringing the fruit bat into close proximity to the population to not only the human population by the primates. once the primate gets it, and the food supplies are short in those countries, and guess what the depend upon for food supply perspective? [inaudible] spent so the the the apes and monkeys, and basically that's the need to utilize. if the animal is infected, once they slaughter the animals they will potentially, if the animal is infected, will get the disease. those practices have to change. those practices have to be modified. so a lot of work needs to be done but one of the critical things beyond all that is what got to help those nations, nations build their health care

infrastructures. they just do not have the bed capacity to deal with the regular issues that they encounter on a day-to-day basis on top of this ebola problem there it is impossible for them to deal with. >> to follow up on your question, what is your view, the medal experts are in particular, on this 21 they quarantines? it is effective in some states? it's not effective in some states. so health workers defied that. where should we go from there? >> so the first thing i think to understand and not to highlight the fact that the guidelines of cdc as published have evolved. and what they have evolved to

insurance of the current setting, and i think it's one of the areas that's causing some concern and maybe a little confusion to states, because states to have authority under the constitution for those things that are not reserved by the federal government, and public health falls into that sort have to remain over there, so it's their interpretation of how they should take recommendations from cdc. but assure point is i think the point that dr. chotani made, the two greatest risk of able transmission our close personal contacts of people with ebola virus, and health care workers who were treating ebola virus, individuals. i think difficult in terms of the guidelines, in the current setting is that we do not perceive in the current setting that health care workers are at greater risk. and this flies a little bit in the face of what happened in dallas when the two nurses became ill.

we understand why they became ill. they didn't have the right personal protective equipment. they probably didn't receive proper training to they did not to take the equipment off. but the short answer is i think that's causing people to ask, should we not view health care workers by been in contact with ebola patients at somewhat higher risk? with a high risk, what are the considerations? should be self isolate? for people who are working for minnesota frontier, that's a recommendation that they should go home and can't stay out of public places for 21 days, self-imposed. it obviously in states where there is a lot of fear, and they think someone said ignorance to go with it, there seems to be a demand politically for action. and, obviously, we know in the states of new york and new jersey, those quarantine orders didn't last very long. and so i think that as the

events evolve, the event evolves and as guidance is refined, you may see that politicians will get less likely to lead with their face, and on the other hand, you may see refinement by cdc to suggest some kind of maybe higher consideration for health care workers who have been in direct contact with ebola patients. the governors seeking a court injunction to enforce quarantine on the nurse who's up there right now, to be determined. so i think as someone told, some very sage said, just wait, it will change again. i think that's kind of like the watchword that probably needs to be involved. a bit of caution, a bit of prudence, but certainly some have probably figured some way

imperfect, along the way. >> so one more thing to just quickly add to that. the first thing is map-21 days is a safe period after which if you are not eliciting any symptoms, you should not have the disease. that's the number one rule that we are following over here. number two, you've got to have compassion for the health care workers. and we cannot ostracize them to and from an ethical perspective we have to take that consideration and consider the law as well as the ethics that we follow in this nation. ..

a lot of this hype will disappear. >> i, thank you, my name is juice seven. i'm from egyptian consul in washington, d.c. i'm learning a lot from this super panel we actually have today. so thank you so much. just some comments regarding what was mentioned by professor

doan and professor lawrence regarding the middle east. what was mentioned by professor wallace regarding the cooperation or international cooperation in fighting epidemic like ebola and terrorism is very low. i think actually the corporation in fighting, much lower than the cooperation fighting endemic disease and so on. what isis is doing in contradict with islam and also contradict with human values which we all actually believe in and so on. the egyptian government, for example, has been calling for international support to fight terrorism in the region like every single western country where a few months ago when

foreign fighter problem emerged and just like, to give you an idea what really will happen if changes in egypt didn't take place lately. washington "times" i think a knew days ago, a few weeks ago, publish ad statistics about the foreign fighters in the middle east and in iraq and syria. and they mentioned something very interesting regarding tunisia for example. they say they have more like, 6,000 tunisia foreign fighters in the region. why while we have 350 something from egypt. we're wondering if really the regime stays in place or former regime in egypt stays in place and compare two populations of countries how many thousands or tens of thousands foreign fighters from egypt will be there. what is very, in my opinion just like professor alexander mentioned situation in sinai and what really happened, we still

find many criticisms towards what the egyptian government is doing to fight terrorism. actually if we look at the statement and public statements made by the former government they were actually supporting the mali terrorist group in their trying to seize power. the jihad in syria. turning the whole situation in syria from mere aspiration by the public to better life to a sectarian conflict and i think we still need by you and all the presidents we need to explore opportunity for more cooperation in fighting isis and through the moderate institutions linked to islam and other relations. thank you. >> yes. >> my name is craig childress. just a quick question, excuse

me. we talked about decontaminating and proper training of health care workers and the thought just struck me that i haven't heard anyone in the press describe how you decontaminate a health care worker. seeing as how this is all being taped and presumably going out to a fairly wide audience, i'm sure there are some of news the room myself included who have actually been through decontamination for a nerve agent, you know, from full mop-4 down to skin and beyond. it is not a quick process. it is very time-consuming. it is resource intensive. then you have got to decontaminate the

decontaminatetors. it is not easy. it goes to your point sir, about training and training continuously. if you know, can you describe how you decontaminate a health care worker that has been treating someone with ebola? >> well, thank you. actually the analogy between nerve agent exposure, particularly persistent agent is very similar to what you would be concerned about in the cases of being exposed to the ebola virus through human secretions of one sort or the other. in many ways the principles are the same, in terms that though the equipment is different, in terms of some of the types of equipment that are available out now. but, the principle, the principle measure is using bleach. so that is the principle rinse or some kind of back tearside or

microside that will render ebola virus dead. it is time-consuming. like the buddy rule you have in the military. basically you start primarily with removing the gown first, retaining the gloves or removing the boots first, going through a shuffle pit like you would in a nerve agent exposure, retaining if you will, the last thing, the respa tear protection and the gloves as the last pieces of equipment that you would take off before you would be clean. now obviously in settings that are in africa which are very different than in the united states you probably have people then probably shower out as a final step and change their clothing because it was probably scrub underneath. in africa they don't have those opportunities. in fact in africa reusing gloves and gowns and many of the personal protective equipment we see as kind of disposables, they reuse them because of

limitations and supported supplies of some of those materials. that is kind of a rough description. >> [inaudible] >> spray. >> they can be -- >> just to give you an example, i can't remember the exact numbers for each individual that needs to be decontaminated you need approximately 32 gallons of water, eight gallons of bleach. for a day, six to eight change of gloves. at least two to three complete coveralls which cost about $32 approximately in africa. you also have to have these boots that go over your boots. so i mean it's a very expensive and intensive process. as dr. kadlec mentioned, you just don't have all the facilities and resources available in africa. a lot of those things are happening over there that shoun't be happening but we,

not we, people in those situations have to improvise. that's why the cost of this epidemic is so high. it is right now the united states is approximately spent $700 million, or is spend about $700 million and sending troops over there, et cetera. you have to, you have to put the numbers, that are, that are going to be used for gowns, gloves, et cetera, all the equipment that is needed to decontaminate them. it is expensive and tedious and resource intensive process. >> not only there, you but know, you spouted off all that equipment list so -- >> [inaudible] >> being ex-military guy, i look around and say, in going back to this prepareness, you know, professor wallace's comments about spending it for the public good, outside the defense department, how many sets of all

of that exist, let's say in the state of texas, that could be brought to that hospital in dallas. >> not enough. >> not enough. >> that raises the real critical thing is the old military axiom, amateurs talk strategy or policy, professionals talk about logistics. this is all about logistics. the answer is, whether domestically, internationally the logistics supply chain for these kind of militaries to address the outbreak whether monorovia or dallas are not sufficient. >> i'm afraid i -- [inaudible]. >> okay. >> the statement that you made that said a poem, that poem belongs to a persian great poet who describes that all humanities are made by the same creator, that belong to the same body and if any part of the body

acheses and nobody bothers, we can name those people humans. that was not arthur turek's statement. this was saudi -- >> [inaudible] >> just one quick footnote on the isis. i think professor spoke about the territory which is true but we do have some parts of territory you referred to that are in libya you and so forth, declared allegiance to isis but aside from the territorial elements i think which is very important is the financial. i think capability of isis is with all of sudden from kidnapping to oil but that's,

that capability is very important to them in order to recruit people in the refugee camps as well as casablanca and elsewhere. many thousands of dollars to allocate for those who would join them and volunteer. those, by the way, the military background will get more funding because of their experience. so number one, when we talk about refugees this great humanitarian issue that you will discuss that deserves much greater attention and support but it is also, i think a potential for future recruitment for many years to come. in other words the children of today can become the terrorists of tomorrow. now, because of the interests of time, let me ask one question

and the all the panelists are welcome to respond. so try to link the issue of the disease in this case, the ebola and terrorism, the -- seems to me can dissass terse be predictable? in other words, can we do the homework to prepare ourselves as you indicated before that again, this is number one and number two, in the broader sense we refer to it to some extent, can we be prepared to mitigate disasters in the future and can we have a list of what works and what does not work? >> well, thank you, professor alexander. that is a great set of questions and i'm recalling a contrary

philosopher, yogi berra that the future is hard to predict. the answer is, i don't know if we can -- i take my page, from a book that's called the black swan, which has nothing to do with public health. nothing to do with disasters of classical sense but certainly economic disasters. it is a whole notion of whether you can predict those things from happening. in retrospect you can't. of course we could see the recession of 2008 coming. look at all the abuses. look at all the loopholes. but the answer is in some ways his contention is, in some ways you can predict these things and really the approach is really about preparedness. and become resilient. there are good black swans and bad black swans and you have to be prepared to recognize either one and take advantage of the

good and mid gait the bad. so i think that's, that is how i would leave it in some ways that in some ways we probably are not going to be 100% accurate in terms of our predictive capabilities. we certainly know when works for better preparedness for these things. it certainly seems in light of investments we made in other areas, i will use national missile defense for example, investments in these areas which are insurance policies for uncertain future are probably reasonable and affordable. >> so quickly, yes, as dr. cad lech mentioned we can not but we can be prepared for things. and what i was pushing for, in my talk when i talked about, you know the resources that are needed for science and technology in this nation that have been the switch which used

to be on all the time has somehow, somehow been shut off and that the numbers in terms of funding has declined. if we continue to do that, we will never have the safety net that dr. kadlec you talked about because we won't have those labs. we understand and appreciate that sometimes those labs and those manufacturing facilities that we need to have in this nation are not going to be doing a lot of active work but if we don't have them, when the time comes they can not do that active work. we also need to invest a lot in looking at the ecology of diseases and we have not recognized all the diseases. if you folks feel that you get influenza vaccine every year and you will not get influenza, you are mistaken. 65, to 70% of the people who will get the vaccine will be protected but 30% will get the

virus. apart from that, you know, a lot of people who get the vaccine still get something which is similar to influenza every single year. those are other viruses we have no idea about. we have not invested enough money to investigate in those things. at is what is needed from a national policy perspective to invest. and if we don't do that, we will never be able to be prepared for anything. >> thank you. this is little bit out of my, we could certainly predict hurricane katrina. we knew it was coming. but, which brings to my mind the comment that, you made, dr. kadlec, about rocket science this is harder than rocket science. laws of physics don't change. you put in right numbers you will hit the moon. when hurricane katrina comes ashore, like a pin pal machine you pull the handle, hope you get three cherries, but if you

don't it is a disaster. you don't know what you will get. you have combination of human failures, bureaucratic issues and all these things that affect these things. finally, growing by berra, great americ philosopher also said, you know i didn't say all those things that said. [laughter] >> somebody go through his book. >> this still working? just as i said extraordinarily intellectual group of presentations here and i think we are all a little smarter this afternoon than we were this morning. i think many would say your first inclination would be throw up your hands, it can't be done, it's just too much. i happen to be the eternal optimist. so i think that something can be

done. on page two of the our recent study on africa you will notice that yonah said what we need for the ebola challenge in africa is some kind of a marshall plan type approach and that's what i would sort of underscore for this whole global topic that we're confronted with here today and will be for a long time. it's going to take a long, long, long, long time, a lot of investment, a lot of brain power, a lot of thinking in a whole bunch of different areas sometimes even seem unrelated before we can come up with a reasonable capability in my opinion to confront these various challenges. on the other hand we face these kind of things before. not only in the manhattan projects and things like that. and i have to say that the second manhattan project, i knew a little bit about two.

i grew up, born in rahway, new jersey. in east rahway is the whole merck establishment so on, and so we learned a little bit about that as youngsters and so on. but the thing we need to remember is all of these challenges, the medical challenges, the nuclear, biological, chemical challenge, and all of that, the solution to all of these is many times different. you don't do the same thing in the chemical threat as you do in the biological threat. one case you gather up and the other case you spread out. so these are kinds of techniques that we have to think about. when you look at enormity of it is interesting to throw up your hand. but we faced a big threat in the 1970s. it was extraordinarily complex in terms of weather, in terms of physics, in terms of ocean, et cetera, et cetera, and it was called the russian submarine threat and it was called the

u.s. american antisubmarine threat as well. it was enormous. so much that we almost didn't want to tackle it but we did and we used an approach where we bit off a little bit of the apple at a time. a little bit more at a time, a little bit more at the time and you know after a while in about 10 or 15 years we had it pretty well whipped. that's what i think we have to do here. we have have to develop a long-range conceptual plan, i call it a campaign plan. we start out by saying this is the end state we really want. we would like to be able to say with the 80, or 75% chance we will lick these kind of challenges, whether they're chemical, biological, medical, et cetera, et cetera, et cetera. and then we put together an organization to do that. it will look like the military, it will involve the military because the military today in the united states of america is

the only organization that's really big enough to comprehend the challenges here, big enough from the standpoint of command and control and intelligence and reconnaissance, surveillance. big enough from the standpoint of logistic, knowledge, all that type of thing. and so we have to, that is one of the reasons why in the mid '90s, we formed, the army develop ad command for this kind of thing that pulled in different dispersed outfits, government and otherwise that were doing these kind of things because they were big enough to comprehend this and big enough to make it a challenge. the marine corps, as small as it is, for 15 years has a chemical, biological defense force down at indian head, maryland. it is a national acidest. just happen to be marines doing it. that is their whole job to be able to handle this chemical and

biological challenge and decontamination, all of that kind of thing. and so we have spread out now throughout the united states incident response to each state. they can be, they can be used by the state and local. there is an inroad here. many of these units are in the national guard and the national guard is a state controlled organization until the president, for whatever reason federalizes. we have embryonic capabilities in all of these areas. we have to marshall the national science foundation. we have to have a tremendous amount of focused research in these different areas. and we have to have the ability then to pull all of this stuff together in what the common word today in government is integration, above all we need to be able to integrate these disparate pieces of information, knowledge and capability into a whole. so it is an enormous challenge. it would be much easier and

simpler to just forget about it and worry about luck and all that kind of thing. i don't think, i don't think that is the american way. i think we can tackle this challenge. it is going to take a long time. we ought to get started yesterday and so on. and that is sort of what my suggestion would be. thank you all very much for being with us today. i think it was a very great panel and it was helped immeasureably by your comments, questions and thoughts. thank you very much. [applause] >> health and human services secretary sylvia burwell will speak at the center of american progress today about the upcoming open enrollment period in the health insurance marketplace. she will also discuss her

department's efforts to insure the readiness of healthcare.gov. our live coverage begins at 1:00 p.m. eastern on c-span. is. >> tonight on "the communicators," christopher yu, professor at university of pennsylvania law school and director of its center for technology, innovation and competition. >> people who oppose prioritization should take a look at the internet header, ibp foreheader. that is the guts, the magic that makes everyone work. that is something everyone speaks. that is different service classes for high bandwidth services low latent fee services different forms of prioritization that was designed from the internet for the beginning. people say, that is just an old artifact. when we designed the internet for ibv-6 because we were running out of internet addresses, they not only kept the field but included another field called label field to do

another form of prioritization. if you look at engineering design to suggest this was never, prioritization was never intended to be allowed i think a little engineering knowledge goes a long way. is a design feature of the network from the beginning. if you talk to the way people are actually using the network, they're using it today to deliver, for example, voice services. we all caught on skype and been frustrated. true, completely i--based over your phone, voice over lte. all prioritization. only way to make the call quality better and other video and other things work the same way. >> tonight at 8:00 eastern on "the communicators" on c-span2. >> c-span veterans day coverage begins tuesday morning at 8:30 eastern during "washington journal" with an interview with american legion executive director verna jones. then at 10:00 the annual usa gala features joint chiefs of

staff general martin dempsey. we're at live at 11 at arlington national cemetery for the wreath laying at the tomb of the unknowns. a discussion on veterans mental health issues and discussions from the white house medal of honor ceremonies. >> now a discussion on the status of hiv vaccines and how the u.s. will need to change its response to the global epidemic. hosted by the center for strategic and international studies this is just under two hours. >> hi, everyone. good afternoon. i'm steve morrison. i'm the senior vice president here at csis and director of our

global policy center. welcome to csis today. we're thrilled at the lineup that we have and thrilled to be able to do what we hope will be a recurrent series of meetings of this sessions of this kind focused upon technologies and their central importance and the evolution of new opportunities and new tools that can be quite important in a number of different areas of global health. and this is a terrific way to kick this effort off. and it is real lit brainchild of micros friend and colleague todd summers. so thank you, todd, for bringing this together ands rooming. and i want to thank sahil angelo, our colleague who worked very hard to pull all the pieces together over sever months. welcome.

i will turn the floor over to todd. >> thank you very much. nice new building for dr. fauci. we're happy to be here. many of us have been working on hiv for some time. for me it is probably my third decade. many of us would like to move on to something else. we see in hiv vaccines the hope for an end to this epidemic. so to start the series that steve mentioned we really wanted to focus on hiv vaccines and to give you a sense of where we are in the research pipeline, what it is that you're likely to see, when you will see it and what it will look like. what the potential impacts it will have on the epidemic. we're extremely thrilled to start this off with dr. tony fauci. most of you know. head of aid at the nih.

he has been head of nihaid since 1984. which is quite an accomplishment. he has been a stalwart champion among vaccine research among many other responsibilities he has leading our nation's hiv research agenda. so, dr. fauci, thank you very much for coming here. we also have joining us mitchell warren who units. avac. used to be the aids vaccine advocacy coalition. we're now avav i'm on the board. we have a big conflict of interest. mitchell talks about the where the research is from a leading advocacy organization focused on hiv prevention. a margie mcglynn is here that runs the international aids vaccine initiative. iavi. runs one of the partnerships bringing together a multiple set of actors to accelerate the development of an