and i am comfortable saying that it functions as a program where not everybody will be able to get everything they put into it debuted to otherwise it doesn't work for those who are low-income or doesn't work very long. when i don't bring it up it's the one that gets brought up the most by people i talk about and that is the most popular one. it didn't come up here today. but what confuses me about the means testing is an area that seems to go to this partisan divide where you have generally many people on the left don't like the idea of means testing because what they think it would do in virginia or anyone else and correct me if i'm not representing this this well but it would undermine support for the system so everybody is into getting a lot of what they put into the program or the return on the contributions they

wouldn't suffer the system as much as they do so there is a resistance from people on the left and progressive often making its progressive because it progressive because they worry that it would undermine support. is that a fair representation tracks >> it undermines the support but i think that on the question of the progressivity i guess that you could look at and i agree with your point that it makes sense for the system to be progressive and it also makes sense that not everybody will get back what they put in or more but if we want the progressivity that in a clear way one could look on the revenue side and let everybody pay all year long and in terms of solvency that does a whole lot more trying to track down a few millionaires to make sure they don't get their social

security benefits so just as the progressivity you get much more bang for the buck than on the benefit side. >> that makes one of my plants which is one of the interesting things if your objective is to make it more progressive which i would personally advocate for and one of the keys is that you have to protect people while we're figuring out how to fix it often times people on the left would prefer to do that through tax increases and people on the right through benefit cuts but ultimately at the end if you are taxing the same amount it has the same distribution affect but it seems to make such a difference to people whether it is taxes or spending so i've always been surprised if people don't like the means testing it certainly makes sense to say that as we left the gap you don't need to give more benefits for the people contributing to the program. it would make more sense to use those resources to plow them

back into social security or someplace else. >> the problem with means testing is that it creates the wrong incentive which is that not to save and not to do well you will not be doing what you should be so there are a couple ways to structure it. the best way is to base it on your lifetime earnings so that it doesn't incentivize you not to save that it basically says if you are working a lot for your whole life than you then you would get less benefits at the high end. >> classic means testing is a test of your current need as opposed to what you just described as the issue of what you did in the course of your lifetime but when we hear the term means testing it's something different.

>> was >> to the question of what it means for public support they are cut for the high earners would that undermine their support for the program or undermine the solidarity that there is behind a social security is a little bit of evidence that it does which is part of why people on the left are afraid of cutting benefits for high income people and that is that the 83 amendments to introduce a form of means testing which is to say that the income taxation for social security benefits for high earners and if you look at support for social security over time by income level the gap did widen after the change. so they were narrow and they became less supportive after the program became less of a good

deal when obtained previously. there are legitimate concerns about the means testing social security too much by whatever means it is carried out. >> can i ask a question on that? i wondered if you have reduced the benefits instead of taxing them whether there would have been a different response because other than this poll people don't like paying taxes. we see that all the time and if you are visualizing is abroad at the drawdown of popularity rather than if you lower the replacement rate. >> it's much more visible than the replacement rate. >> i want to alert the audience we are going to go to questions right after that city have a question, get ready. >> it's interesting social security is a popular question that i get on the washington

particularly where a lot of people are in the room and inevitably with a glass of wine in hand they will come up to me and say we can either i or my friends need social security so why don't we just means test the program so that they don't receive it and then we will solve the issue. then i come back and say this is social insurance. the concept of insurance is actually fundamental that you pay into a system of insurance so that when you experience the need to, you can get it. sometimes that doesn't happen over a lifetime but sometimes it does happen and what do you do if you don't have it so selected the concept of private insurance. is anybody suggesting that

people don't need to purchase homeowners insurance? day purchase just in case they experience a fire so let's take this back to the concept of social insurance. what is the fire that faces people in the context of social insurance. can anybody say bernie made off or enron? there are many that have a lot in the bank account and the next morning woke up destitute and many of them unfortunately for seniors and have been for bed if they had no alternatives and nothing to back them up or rely on, so the issue of means testing social security should be a moot point because one of the underlining tenants of social security is basic fairness and that means that in fairness up and down and come scale and that means that any to make sure the protection is there regardless of what your

net worth is just in case the fire comes. >> it is pretty high up the income distribution and that's correct but it's a distorted way of looking at it because even people of high net worth gets to their 90s and they've sent down everything else and social security -- did you want to offer a quick comment? >> i was thinking about it needs to be insurance. it needs to be a plan that pays the benefits if you need them but i'm not going to the same cocktail parties and i don't want to give this back at the time it's something to fix the program. we have to bring revenues into the program but if people are saying they want to give part of

it back that seems like a pretty good option as one of the things to look at. >> and i say there is a form you can go on the website and there is a form you can fill out where you can actually not even apply for it. hispanic but again you are talking about the kurds need versus the means testing against the earnings of a lifetime so i still think that there is some confusion about what we need about the means testing. >> so you want to do that carefully and thoughtfully. >> let's open up the questioning to the audience and please introduce yourself briefly. >> i am representing myself and the question is how many candidates in the upcoming november election will mention this report either in campaign

ads and the means such as that. hispanic we would be glad to have you share as many as you can. >> there is a fair amount of advertising going on in some of the key battleground states in some peculiar things are going on. we are seeing some attacks on democrats and by a republican super packs. accusing democrats of being weak supporters of social security because maybe at one point they said something nice about some . there is a lot of distortion going on in the tv advertising in the races that is unfortunate hispanic i don't think that i

have seen people talking about the specifics of how they would fix the program which is the problem. >> i would like to add on that comment there begins to be more specific proposals introduced by individual members of congress to actually do that actually do come up with responsible cost estimates that include paying for the system and some modest benefit improvements. >> and we have a handful of candidates. alaska is probably the best example. another question? the >> disconnect we have time for one last one? you say there's a scarcity of resources and that you support revenue as part of a solution because the budget constraints but at the same time there is a

security crisis people need to save more. why do we have money for people to put more into the four o. one k. but not enough to contribute payroll taxes on social security wouldn't it be more equitable to have that money go through the system rather than having people get a larger deduction then continued into the four o. one k.? >> domain resource constraint is there is a political constraint and there's only so much we can tax. we want to tax 100% or probably 90% or 80%. i don't know where the political limit is. so then the question is what is the best use of resources to do and how many things are underfunded and you need to look at whether it is an investment or children, more benefits, there's all these competing things. in terms of saving, i don't know which one is more progressive until you determine the design.

you were talking about tax breaks that tend to be progressive but i've had one for some time which is progressive savings so you would have mandated savings if you want to use behavioral economics and if if your envelope income at the scale you would receive the government matches. it's not just what the limit of how much people are willing to pay on taxes but that's what they would most want to give it to. so that is where it would go but it's a political limit that people are only willing to pay so much in taxes and the more you pay at some point it becomes inefficient and determined to the economy. >> i want to speak to something that is a misunderstanding i think in terms of the way that this is framed. they will look at and we are

spending all of this on seniors and we need to make sure that there is equitable spending on the younger end of the life expectancy on the widescale. it is looking at all americans regardless of age that you have babies on social security, teenagers on social security, the age adults on social security and you've got seniors on social security. so there is not a trade-off. this is an important program across the widescale for all americans and so we shouldn't hit social security versus investments in k-12 education or pre- k.. when i say that it's a pillar of progress, this is the housecall of america and if you destroy the pillar and to bring the part

of the house crashing down weekend to forget to put it on par with the rest of the budget it needs to be considered its own portion that we consider it that way. that being said if you are looking at the rest of the budget aside from social security and medicare, then certainly there are important things we need to do with regards to shifting resources to invest in younger people and one of them is looking at the funding. thank you. >> any other audience questions? each is its own risk pool and how much money do people have extra to put aside the have to keep in mind where we have one third of households that make 200% of the poverty level or less they don't have extra money to put aside in private settings and so they tend to benefit

those that have disposable income of the most which tend to be the affluent and it doesn't help lower income folks whereas instead we increased the payroll increase the payroll tax by 1% as the poll suggests then we can use the entire nationwide pool but we distribute a little bit more from the burners to make up for the fact that they don't have access income. >> there are a lot of variables you want to talk about how you structure it and where the will to put more money is. i would add that the consideration finding a way to increase national savings is a priority. it's good for the economy. we don't have a high savings rate in this country and one of the problems that we have is we haven't figured out how if we put more into the system we can

actually truly move those so that they are increasing national savings and when we founded in the past it's been unclear and it seems that they didn't increase the national savings so that is some of the challenges of other people have worked on and we haven't come up with good ideas but if we put more in social security and you would like to see that increase because that would be good for the economy as a whole. >> we actually do believe we need to increase savings as a form of wealth for particularly low income households and so titled a savings account is something that we are in favor of where we accrued interest over the lifetime outside of the social security system there is a lot we can do for asset

building in the communities of color and low-income populations so that is one avenue that we should consider. hispanic sometimes it comes up as a trade-off against something in social security and other times not that it is an intriguing idea that if you are able to those dollars compounded tremendously. any other audience questions? i have one about the finding that the confidence in social security improves when people have more accurate information i thought was interesting and it made me think as a member of the media myself what you think about the media role to inform. anybody that feels like

answering. >> it is no secret that the american public has been done a disservice when it comes to the nations insurance programs particularly social security. we have allowed person politics into the talking points of the political parties to guide the narrative no matter, irregardless you're regardless of the facts in many cases and so that is what is perfect is that they seek to educate the american people about the facts. and then they find that when the american people are actually informed of the facts they make different decisions and so we need to do more to educate the media about these programs because frankly it's been decimated and many are operating

on a shoestring was and people don't have that deep expertise that they need to report accurately so we need to make sure that the journalists have the information that they need so that they can discern the political arguments from the facts and explain that to the american people. spirit virginia has been virginia has been an expert getting better and worse about the same in the press coverage. hispanic it is beginning to get a better but for a long time its strength has become its own enemy that it is a system that is so fiscally responsible that there is a report that has 75 years out into the future and this is how are we doing this is a system that cannot borrow money. it has to pay for itself like

other reason or if it should get out of balance and through that extraordinary responsibility of the story seems to be every year when is it going bankrupt. while it's not going bankrupt. it has a shortfall that it's time to consider how you want to fix that in balance. >> when the trust fund was released and the commissioner of the system was practically begging with reporters who were there to understand with reference to the trust fund it's just a begging people almost not to use the word bankrupt and ensure. >> on that point i would say the same thing.

it's not as though this is a perfectly rosy situation but what i would say is go read the trustees report because some of the best information and the congressional budget office puts out great documents people want to learn impartial stuff into the trusty is where you can learn more than you ever but if you go to the first documents. >> we are out of time and we do need to wrap up. with me remind you coming up those evaluation forms and think the panelists for doing such a wonderful job. [applause] and thanks to the academy for convening us to hear about this important new study on the future of social security. have a good day.

visiting the memorial dedicated to the soldiers and servicemembers around the national mall in washington, d.c. we are here at the vietnam bitter ends memorial wall which honors u.s. service members who fought and died throughout southeast asia at the time designed by american architect that opened with the original 195 names inscribed.

[inaudible conversations] [inaudible conversations]

activities and dedications planned here and around the city today we had live coverage from arlington national cemetery over on c-span and the tomb of the unknown where vice presidential biden will be laying a wreath in honor of america's fallen soldiers. we will have live coverage from arlington starting at about 11:00 eastern time on c-span. then later today live from the national press club arizona senator and a veteran john mccain profiles the lives of americans alters who served in the war from the u.s. revolution to iraq and afghanistan in his new book and we will have live coverage at 6:30 tonight on c-span2. on the facebook page share a message for the nation's veterans. melissa writes happy veterans day to those that stood up and risked everything to uphold our freedoms and gail posted thank

you for your service, devotion, sacrifice. the greatest nation in every generation. share your thoughts at facebook.com/c-span. members also sharing their thoughts. senator claire mccaskill in kansas city today i missed my data. congresswoman

rechartered with partner communications for a visit to madison wisconsin. >> is a glorious service for the country and the call comes to every citizen as a struggle to make and keep government representative. >> is probably the most important political figure in wisconsin history and one of the most important in the history of the 21st century in the united states. he was a reforming governor. he defined what progressivism is and was one of the first to use the term to self identify. he was a united states senator that was recognized by his peers in the 1950s as one of the

five greatest senators in history and was an opponent of world war i and stood his ground for free speech. after the civil war america changed radically from a nation of small farmers and producers and manufacturers and by the late 70s, 80s, 90s, we had concentrations of wealth, we had growing inequality and we had concern about the influence of money in government. so we spent the later part of 1890s giving speeches all over wisconsin he went to the county fairs will come every kind of events that you could imagine and build a reputation for himself.

by 1900, he was ready to run for governor advocating on behalf of of the people. and he had two issues. the direct primary, no more selecting the candidates and the convention. number two, stop the interests specifically the railroads. >> some of the international health and security challenges from the virus. a biological biological and chemical warfare and humanitarian crisis. this is hosted by the center for terrorism studies. they spoke for just under two hours. >> i want to welcome everybody again to another very timely seminar and i want to thank all of the people that put this

together with a great deal of haste considering the topic, the health challenges that we have in the security responses from ebola to terrorism, and i think it is an extraordinarily timely event. ..

i think that says it all. >> thank you, general, for your kind words, and since you mentioned it, i would like to call your attention to extraordinary book that general gray has and we had the information in the package that we provided to you with come if you read this know what leadership is all about. actually after learning the lessons what worked, what didn't work and the general made many contributions as we know for many years. before we move on to our

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

time, the center for national security law, the university of virginia school of law, particularly professor more and professor bob turner. i have to mention also my colleague, professor brenner who died several years ago. we worked together for many years at the university center for legal studies and international institute. now, let me first introduce our panel and i have to make some remarks before they speak. on, doctor robert cadillac right here and you'll see a bio very, very impressive, bottle as the general mentioned. we do have former senior officials the white house, the

pentagon, u.s. senate and so on. so you can read the files of the speakers. next one is doctor khatami, right here. also doctor who is a fellow at the potomac institute. also has a very rich background and you can see that. our third panelist is professor lawrence velte who is now with the new east -- near east center for studies at national defense university. he also participated in the 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 to our discussion. before that i would like to mention that in general and we discuss the security and terrorism, we dedicate this summer or the session or discussion, first of all in the memory of the victims of violence, both man-made and mother nature which i will come back to it. now, of course, the victims 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 the challenge which is very serious with implications originally globally and all that. and we certainly have to think about the victims. also some specific segments of the society that are particularly targeted by terrorism, for example. some of the journalists. those who cover the events and trying to bring us the information all the way from -- who was assassinated in pakistan in 2010, and to the islamic states, a video of the execution of james foley. so wanted to dedication to the

victims, and secondly also we have two separate -- celebrate the work of those who served to protect our societies. in this case of course the medical communities, the first responders, the law enforcement people, the military government and the civic society in general. secondly, i think if i may, we tried to put together a seminar that would have two major challenges. in other words, one is the natural disasters -- [inaudible] okay. i have very quickly a few slides. humanity has faced two major

challenges. natural disasters and man-made disasters, all the way from earthquakes to the deadly diseases, now ebola. and secondly of course man-made all the way from the economic collapse of ecological disasters, crime, poverty, radicalization, terrorism and war. 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 connections between the historical experiences as well as contemporary times. i don't know what is going on

with the technology. as they say, nothing is new under the sun except technology, right? i'm using the wrong thing. after all, i'm an academic. [laughter] anyways, we just set the publication here on the challenges in africa that was published yesterday and we are releasing it and i will provide you with copies dealing with both the ebola as well as the terrorism challenges. so if, for example, 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 that was to blame for some of this disasters natural as well as man-made? we can look what shakespeare said in a you're right there to point the fingers who i was guiy of the disasters. but i think the best answer was provided by noah we built the ark because he basically sent a 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 in decisions. so governments have to move and the society has to move in order to deal with the challenges. so if you look back, we can look back at history, the time of the pharaohs if you will, the middle

ages, particularly the black death. the thing is that the middle ages and the black death is not just a chapter in history. even today we find in some contemporary struggle that some extremists, they try to push an idea that one can call blood rival. in other words, for example, in the gaza, i think the crisis and war, there were communications that the jews are pushing some of the water in gaza in order to kill more and more people. if we look back, 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, oilcloth, covering his face with the mask and a sponge with vinegar. to do with the issues of the mass. so we have to learn from the past the and i found the fact i think professor don wallace and i, remember we were together at the conference in turkey, and we saw the monument of kamal ataturk, the father of the turkish republic. by the way, just celebrated 91st anniversary of the turkish republic. and i think kamal ataturk in this particular statement trying

to equate -- was really on the market. it seems to me that the set of values for us to follow and humanity, that we cannot be detached from reality and we have to look at the situation as it is. so today we're going to deal with the virus and the threat of ebola. and what we learn from history that there are two emotions that drive people per one these fear and one is hope. with fear, we see what happened 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, but again each time we are surprised because we did not anticipate that kind of activity. in activity -- in africa we knew that many cases all the way from malaria after typhoid and so when. number one we're going to discuss the people specifically, -- the ebola specifically what are some the challenges we're going to face in the coming months and years. finally, we're going to discuss also the security issue which has to do with, particularly racing what happened with isis. i suggest we look at some of the other groups as well. for example, the hezbollah, and

we also mark this month in october, the 31st anniversary of the attack on the marine base and the french forces in lebanon. and i think we have to look at hezbollah was -- as well because with the hezbollah is a much engage as we know in syria. and according to all kinds of reports, hezbollah was able to upgrade its capacity. and according to different reports, there are probably about 100,000 rockets of hezbollah. it in case of a third lebanon war between hezbollah and israel, we're going to see obviously that kind of capability. in addition to that i think we're 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. went to look at the groups and we'll discuss it with one of our panelists, professor velte. and in this is an older map in the beginning of the year. we're going to have an upgraded map to indicate what's happening now in the region and elsewhere with the groups in the region and elsewhere. we have to deal also with the hamas issue, and particularly

now we find that the most recent attack in the sinai that we witnessed the attack on the egyptian army and the sinai, and apparently some connection with the hamas and other external groups in the region. and clearly i think egypt in order to the security they must construct a buffer zone in the region between the sinai and gaza and israel. and there is no doubt that we have to pay very close attention to the stability in a chip which is the most important country in the middle east. finally, the islamic state, the islamic state that we're going to discuss in some detail.

and what is really interesting about the islamic state is there able to somehow recruit thousands of volunteers from all over the world. as we know the foreign fighters, for example, from tunisia today according to reports, there are about 3000 i think volunteers. despite the fact that this somehow developed the democracy and we found that those who fight for the islamic state, and the caliphate is very well known by like to mention not only the journalists also women and children and so forth. so we know that the islamic state controls territories as

well, and, of course, the concern is that the islamic state has a grand plan, whether it is five years or 10 years and we have to be concerned about this. finally, in regard to the role of serving the links in security, we're going to discuss the humanitarian crisis in the middle east and in africa, we will 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 it's been 10 million, if you take into account the refugees over

3 million who left for various countries in the middle east. and i think the same thing is in the maghreb and we're going to discuss it. so they said that 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 consideration and human rights and civil liberties. with that i'm going to call upon dr. kadlec to come and speak. >> thank you, yonah. i appreciate it.

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

want to highlight for you is give you a sense of we enter into this circumstance with great humanitarian crisis and quite frankly national security crisis in western africa to a fair bit of work that has been done over the last decade to improve our gene in terms of health security. i will give some sense of what has been done and what remains to be done in the fault lines i think from a policy perspective exists both for the current administration, whoever is president next, he or she, whoever that is, and certainly the new congress that will begin in january. i think the current ebola crisis from this perspective highlights the great affordability of our health care system to a single case of ebola that basically walked to the emergency room door in dallas and was sent out after all the warnings and messages the cdc its and.

is saying that it was possible, more than possible that an ebola victim could walk into your emergency room or hospital. what's worse is the fact, and you could argue that this has been largely media hype, but i would argue something very different, that there is a corridor in the american public that predates the the events that happened in october that the low back, and i have an example of this, back in 1946. many of you, i realized during world war ii we had to manhattan project that were conducted. one with the puppet in nuclear bomb and we know who the oppenheimer was there, dr. oppenheimer. but there was a biological oppenheimer. a judgment by the name of george merck. is me me simply because there's a billion dollar multinational

pharmaceutical company named after him but he was the american oppenheimer for the offensive bw program. quite frankly during the summer years that it was in existence in world war ii quite frankly they were never able to train a functional biological weapon that they intended to use had either japan or germany use those kinds of weapons against us. i only make that point because i think there's a historical point about the role of intelligence. in 1943 when president fdr was one of the possible biological warfare, the u.s. intelligence community basically informing german had a biological weapons program and japan didn't. we found after the war the exact opposite was true. you can probably relate to a more recent example with intelligence community has not been 100% right on these issues but i think it's worthy to note it was the case then and now

that in some ways if we relied on intelligence we may be very disappointed. particularly about not only terrorism and use of these kinds of weapons but also about disease itself. the point i'm trying to make is in 1946 george merck released the report about the efforts to develop biological weapons. it's one of the few cases i know of where a report was unclassified released to the public and later reclassified as secret and pulled from all the shelves. why was that? because it scared the be jesus out of the american public. it created a firestone, and you can recount that if you ever go visit the archives of "newsweek" magazine and "time" magazine when it printed on paper and actually evaluate what was not only the scientific debate but the fear that was the concept that you could create agents that would be invisible, that would be totally alien to our

senses, that could kill you in a rapid fashion. i would argue everybody has been sick in the and so there some element of what i was a personal reference to the idea of illness as it is. a few people have had ebola in america but if you recall, the hot zone, he makes a compelling case why you should fear such an organism like ebola virus. in some ways there's innate fear by the american public and there's also the view will be created here by public press, popular movies of the subject and, obviously, the media serving not miss their chance to sell print or advertise in today's world. but the point is, this represent an interesting nexus with potential for terrorist. at this kind of what we experienced in around 9/11 with anthrax letter attacks. i would just argue for the

purposes of this august panel that in some ways while they do the ebola crisis as it is today, national -- naturally think of it could migrate to a different space should someone take advantage of the ability of the virus like ebola and use means basically deliberately infect people. this is not new news to you but if you think in some ways you need to understand the health care system that we have today. is a 2.8 trillion dollars to be ambiguous government currently spends about $225 million. that represent 1/100th of 1% of what we annually have been health care. you can imagine what we came out of the federal investment around health preparedness is evident when a single case of ebola

basically walks through the door, or could be any other disease of significance like smallpox or pandemic influenza. the quite frankly the affordable health care act, and to throw stones at it, but does not have a shred of preparedness weaved through the basically short that the health care system that we will develop over time for every american has not only access to put the right to health care is a system that is prepared to meet the challenges of the 21st century. and ebola represents as the poster children for the challenges that we face ahead of us. the other thing to understand, and i will try 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. 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 do need to convey to you there is a wealth of things that have been done beginning back in the mid '90s during the clinton administration that really have if you will ebola policy and legislative action to the point where 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 to priority to the things that have been established by presidential policy and legislative statute. i will give you some examples of that. first of all as i mentioned president clinton basically recognized the concern about the bioterrorism. ..

indicated emerging diseases were going to be a significant consideration in the future. in 1992, before the shoes if you will of global climate change, before the issues of globalization were realized, dr. leonardburg and his colleague, the distinguished biologist recognized we were on a converging path potentially with disaster with the possibility of emerging diseases and by a terrorism and it was their work and his warning to clinton that

basically initiated things. i am a great believer in our system of government that at best we can hope for incrementalism. you can look at any issue in the united states's history whether there be civil rights, defense policy or in this case public and medical preparedness that we demonstrate imperfect incrementalism, we take a few steps forward and one step back, real line and move forward again. with that there have been s series of legislative initiatives that happened after 9/11 that were worse, one is the preparedness act. i would like to take credit for it because i was a staff director for the senate subcommittee that drafted but it was actually senator richard burr from north carolina and senator ted kennedy. championed that bill. the significance of that bill

was basically it used national security to basically define, if you will, read the fine the u.s. government's role in preparing for these events. interestingly enough, making reference to a project general gray was involved in, we use the goldwater/nichols act as the template for this bill not because we think public health or medical capabilities should be aligned along the dod access but it did identify having joint operations, putting somebody in charge and creating a command structure overall so with that the position was created with health and human services for the assistant secretary and response. in the crisis at hand you don't hear much about that office but it was their function to basically do the necessary things to all line with the u.s. government in this space

realizing in some ways it is not only hhs, dod and va that significant assets to bring to the fight but this idea that to basically all line state and local authorities who are if you will the front-line soldiers in this activity. you can argue that was effective or not. the story will be written but i do hope as a result of this ebola event someone will have the wisdom that in the 1980s to commission a holloway report that general gray was part of an talked-about and before these proceedings that really did assess why did things fail. in that case desert 1. what they identified in the blueprint they made, the vision they left, was one said over two decades went from the point in

time, a tremendous failure in the iranian hostage rescue to the point in time we celebrate the demise of osama bin laden. somebody says let's do it. and the special operations community to do four essentials things. and the public health preparedness we look to address the current ebola crisis in the future public health crisis we encounter. one is recruit the best people. if you look at the record right now we have a tremendous brain drain over the public health community. people who operate at state and local levels basically ensure that people abide by their quarantine, people do the things that lower the risks to the public for the disease and also acknowledge that in the medical community in many ways we don't

necessarily train or equip them to manage these events. the events in dallas approved as they did prove in the case of desert i there is no such thing as just in time preparedness. the idea is that you need to have a force at the ready, they need to be trained and they need the exercise. yesterday i spent the entire day as co-chair of 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 we heard from a local public health and medical leaders from atlanta, nebraska, new york and dallas, or at least indirectly from dallas of the experience so far and what they said is what we really need to do is make sure we have equipment at hand and are well trained not just in time training but continual

training to ensure we could meet the mission. says these are essential elements of the challenge that we face right now in terms of preparing it. you hear of teams from cdc, department of defense, those are truly at hawk. as we look forward to the events before us, i think it does raise the question how much are we going to invest in this space? how much priority are we going to put in this space? after this ebola crisis is over realizing the next one may be on the near horizon. there are two major political policy issues that are outstanding and need to be addressed and i think i will 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 have been a lot worse. we know from the wm d commission report by senator graham that they recognize that perpetrator likely dietrich, taking a single envelope about anthrax putting into a ventilation shaft in but metro, wouldn't have killed several people, would have infected several hundred or several thousand people. this points out a very important issue of in a version that has happened in the policy towards these events so we talk about inversion about u.s. companies moving overseas, let me give you a policy of version around health care, and the critical element is considering these events, it was always believe in some way bio terrorism and biowarfare, conducting this short group conducting these kinds of attacks, these disease

agents, we create a situation that was not seen in nature but the risk was you could basically in fact millions of people simultaneously by releasing a cloud of infectious diseases. overtime the belief is if we prepare for natural events like ebola which don't have the same epidemiology, that somehow we will get the benefit of improving public health and medical infrastructure and a lower-cost but in some ways a more likely scenario. like telling an army or better yet, the football analogy, taking the washington redskins, paying the local high school teams as a way to practice when they are going to play the dallas cowboys seattle seahawks,

and if you define it in a certain way and we are on the wrong track at the same time that we will basically not prepare ourselves to address the worst-case scenario, where terrorism tries to use these kinds of agents as weapons. in ebola case, we have not proved ourselves necessarily competent to deal with a single case of a naturally occurring disease as reported in the united states. the second issue is another policy issue is in all the efforts and the efforts of preparedness and health and security preparedness was somehow outside the domain of regular health care. kind of an adjunct. the answer has to be in trouble. that is another major policy issues that i think is

outstanding. i think in the construct of my comments today, alluding to the point of professor alexander around black death, we have to look get the events that are going to make our life challenging no matter what, whether it is a disease that is natural in origin or deliberate in origin and that is three essentials factors, climate change a little bit, globalization, the opportunity when you get on a plane today and be in the united states at the same day, the next day carrying a disease that either he acquirer she acquired that could represent a public health threat or basically having 10 people purposely inoculated by a particular disease being infiltrated in the united states by commercial airlines and i

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

incrementalism, we're two decades into a dedicated effort to improve the preparedness of public health and medical infrastructure, we have many more mounds before we sleep, before we get it right. this is not rocket science. i think the experiences or analogy's we have done in other areas and the experience is one in point, that there is a way to rapidly fix this problem. is not entirely expensive but it takes priority, it takes leadership and some modicum of resources to do so. the last thing is we need to be fine the problem correctly. the challenges before us are likely to be more frequent, they may represent a deliberate component that represents something that is entirely different than we are dealing with now and we should have the wisdom and fortitude to develop what we need before it happens

because there's no just-in-time prepared this. with that i will conclude my remarks. [applause] >> general gray, distinguished guests, it is difficult to go after somebody i respect tremendously, who has and friend, mentor and adviser for many years, dr. robert kadlec in terms of policy issues. i'm going to specifically focus on some of the facts and some of the ethical issues related to this particular disease. in africa, ebola occurred in the villages in tropical rain forests in central and west africa. confirmed cases were reported in democratic republic of the condo formerly known as xi year, sudan, you gone the, the

republic of congo and for the first time you have seen cases in guinea, liberia and sierra leone. 1976 and 2012, 288 cases and one thousand 90 deaths were reported. when we look at that and the numbers today we are amazed. that is what we want to keep in perspective. another important thing to understand and appreciate is how does ebola spread? recent studies have clearly indicated that route that's our reservoir for ebola and nonhuman primates such as the aid and the monkeys are carriers that transmits it to humans. let's move human to human transmission, the way in which the virus appears in humans, starting at the outbreak, so far unknown. we know how it comes the really don't know what exactly happens. the first stage patient is

infected through contact like fruit bats as i mentioned and primates, causing a spillover event. person to person transmission can lead to a large number of people getting affected. in past ebola outbreaks, primates were also affected and a lot of primates also died during these outbreaks and humans when they consumed the needs of those primate's touch those primates and dealing with those primates, got infected. the virus can spread in several ways through direct contact, the broken skin, mucous membrane, eyes, nose, mouth, blood and bodily fluids of the sick person and it is not limited to urine, saliva, sweat, feces and vomit that breast milk and semen.

objects like needles can contaminate and transmit the virus and from infected as we also mentioned, the food bags and primates. past research has established, we are still working on it and there is still some question but past research has clearly suggested that the disease does not spread through the air or by water. orting general buy food. in africa ebola may spread as a result of as you mentioned earlier handling of the bush meat which is very critical to understand and appreciate. there is no evidence mosquitos or other insects can transmit ebola. once someone recovers from ebola they can no longer spread the virus. however the ebola virus has been found in semen for up to three months. that is something all set to consider. as of oct. 29 for the current epidemic in west africa caused by the zairean strain has resulted in in affecting 13,000

people, close to 5,000 deaths which brings the current vitality or mortality rate to 36%. the three main countries are liberia, sierra leone and guinea. nigeria had 20 cases and we deaths and was declared ebola of free on october 19th. send all has one case, the country was declared ebola free on october 17th. molly just recently reported a child who died of ebola, all districts of sierra leone reported one case of ebola and did to its proximity to the guinea, being the next potential countries that could get the disease. or 500 health care workers contracted the disease out of which 50% have died which is a high number because the case in the general population is about 36%. interestingly, the first outbreak that happened in 1976,

the fatality rate was 30% and that was the desire strain. the last outbreak around 2000, 2001 which was due to is i year, had a fatality rate of 32%. we are getting close to the percentages we anticipate that are going to be that particular strain. we all know in spain there was a case on october 6th and a nurse was taking care of two missionaries on october 20th, no trace was found in her blood and after 21 days ebola free, actually 42 days ebola free, we all know about the cases of united states and robert kadlec talked about it in detail and the problems and issues of preparedness and recognition of disease is big, something we need to look at very carefully and appreciate.

there were a couple other cases, one case is in new york right now that was diagnosed on october 23rd in a physician who worked with doctors without borders and is currently being treated and all the tracking in terms of people he was in contact with is being done in new york. there was another potential case in new york of a little child, 5-year-old child was taken to the hospital but tested negative, there was a case in maryland taken to the university of maryland medical system on october 27th and turned out that was not a positive case of ebola. things that happened on october 27th, the cdc outlined plans to monitor travel. most health care workers returning from west africa or the ebola hot zone would be considered to be at some risk for infection while health care workers attending to ebola

patients in the united states facilities would be seen as no threat to the population. these guidelines are mandatory quarantines 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 well beyond previous established a military protocol. the u.s. army isolated a dozen soldiers as part of the base in italy including major general carol williams who oversaw the initial response of the ebola outbreak in africa. dozens more will be isolated in the coming days as we rotate out of west africa where the military has been building infrastructure to help the authorities treat ebola victims. all of you know we had 3,000 boots on the grounds, and rotation in africa helping this problem. one of the critical problems with ebola is how to diagnose

this disease, we did not have a very effective way of diagnosing it. in response to the epidemic, on august 5th, the fda issued an emergency use authorization for the defense department, but a political chain reaction for ebola. on october 25th, the fda issued another emergency authorization for two new diagnostic tests called the bio fire test which is done on urine or blood and gives a result in an hour. france is close to developing tools called the ebola they stream which is developed by the french atomic energy commission and potentially diagnose a patient in 15 minutes. when it comes to treatment there is no approved the treatment for the disease. clinical management is focused on complications'. however, multiple therapeutics

or drugs being developed are in potential process of being developed that could help this -- help work on this disease. there are two particular vaccine the interest over here, one being developed by glaxosmithkline and the other by new links which is a canadian vaccine being produced essentially in ilo. these vaccines get tested, and efficacy and safety in humans being done right now comes out ok, there should be a decent amount of supply, and 2015. and being given to health care workers and first responders in africa. one of the other important factors to consider is what is going on in terms of the beds in africa. there are not enough beds for the patients.

latest data indicate only 22% of the ebola treatment center beds and 4% of the prime community care center beds are now operational which leaves a huge void in terms of providing health to the population. the current epidemic, as all of you know is the largest and most complex on record with an unprecedented number of affected countries, thousands of cases of deaths and general population, hundreds of health care workers affected. the scale and mortality of the outbreak has reinforced the urgent need for large-scale development for specific and effective medical interventions. subject to the outcome of an initial studies and trials, and mentioning earlier therapeutics and vaccines that will be available to work on this disease. and appropriate measures not

taken, we can expect approximately 10,000 cases starting in december, and two countries the outbreak is currently going on, we are seeing a little bit of decline in terms of the cases so there is some hope, and this outbreak can be missed in january if opprobrium measures taken. as robert kadlec suggested the world is making this up as it goes end we have more uncertainty. it is a huge problem. the current epidemic, which is struggled with, they do not have a health care structure dealing with regular issues that go on with health care perspective, now we are adding to the injury,

and to the country the ebola outbreak. the first focuses on relatively simple things to decrease mortality and west africa, and hide frazier replacing electrolytes, managing nausea, fever and superimposed bacteria infections, and abundant package to establish. the critical needs of the best -- the most affected countries, and protective gear needs to be provided to the hospital staff to take care of the cases, and dealing with the process, there are complex ethical challenges which are related to the use of untested intervention, quarantine, special care and other issues. in the u.s. national institutes of health biomedical research always played a critical role in improving physical and mental health for americans and the globe which in turn yielded significant social economic and

societal economic benefits. better funding has been a cornerstone of for and i h, for the american biomedical research sectors that leads the world in investment and innovation and the budget being stagnated after 2003 and declined after 2010. the cost of conducting by medical research has rapidly increased also at the same time. this was hurt further hurt by the recent budget cuts and sequestration in order to secure america's position as a global leader in biomedical research for the foreseeable future. congress would pursue significant new investments. there is no evidence of far that we have appreciated in scientific literature that closing borders will cause the disease to come to a specific nation. we also need to deal with the

other ethical factors in terms of health care workers. should we do that? yes. we should accept those workers. we should make special arrangements and special commitments to health care workers that currently working in these particular countries, frontline dealing with the disease that is extremely deadly. these doctors and nurses must be promised not only high quality of training and equipment going forward but also that if something happens we must take care of them. someone must take care of the heroes, not just the civilians who are there but the three dozen troops we have in the heart zone when they come back. we have to make sure that they are taken care of. signs that the epidemic is slowing down in some areas, we will -- it will cause a bigger devastations and we ever thought we could think about. and efficacious vaccine i believe is the only hope for

containing the outbreak. the u.s. investment in vaccine research is a drop in the bucket. needed to increase funding support and the u.s. department of defense with research and development and advanced development of vaccines and therapeutics as well as diagnostic devices. we have to make a concerted effort to develop manufacturing facilities in the united states for diseases such as ebola and other infectious diseases we might encounter in the future. countries and funding agencies, private and public, only 40% -- 17% of the pledges so far have been fulfilled. countries promise and pledge private institutions, promise and pledge, those pledges never come through. they need to stand up and fulfil their commitment. and the last word is remembered

diseases do not know boundaries so we can have these diseases come to the united states or any other part of the world if you are only reactive and not proactive. [applause] >> thank you. with dr. alexander's permission and more importantly our media colleagues i will speak from the table here rather than the podium. i appreciate the opportunity of being here. i asked to speak about terrorists 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 -- potential for humanitarian disasters in the region. there's plenty of literature analyzing these groups. some of the best right here in this building.

so i am not going to go into what al qaeda is all about or what isis is all about except for just a little bit. what i want to do is talk about activities at these groups and the potential for the development of true humanitarian crises in the region. that is primarily through the issue of refugees and displaced persons. ..

moving a little bit further north in the situation and in the activities in the al qaeda and the islamic model rather further north in algeria there are 300,000 internally displaced people. i mentioned 50,000. and in both of those situations the un is monitoring. although i do want to emphasize the humanitarian disasters that the humanitarian disaster that can haphazard to me more than just medically related disasters.

in libya i can argue is kind of the beginning of this whole process especially. there are people displaced in libya in the country where any sort of government whether it be the central government with the regional governments the rich doesn't extend very far beyond the building in which they are meeting. there are also a million refugees according to the un and tunisia. >> it's maybe even one third of the 2,011th population. tunisia has the capabilities and there has been a joke about that and if we have time i will tell a joke about death but this is

still it really taxes the capacities of the countries to handle these people. now let's talk about isis a little bit and i should switch to these other numbers relatively and then i will talk little bit about isis at the end of my remarks. at the un says there are 3.2 million registered refugees, that is registered in the un from this year the cbn civil war and sectarian fighting there are more than a million each in jordan from both iraq and syria and jordan has seen the waves of refugees from 1948 writeup until this year. about 1.3 million in turkey.

1.2 million lebanon. 500,000 syrian refugees in iraq depending on your perspective and they sought refuge in iraq and there are 900,000 internally displaced people in iraq and syria there are about 4 million that are displaced they are not necessarily open the refugee camps but it's more than 3.2 million refugees. as winter gets close, about 5.2 million people in iraq are in need or will be in need of humanitarian assistance as winter sets in to.

fuel, shelter, and in iraq and syria this is a chilling statistic and i will talk about that towards the end of there are now about 10 million people living in areas controlled by the islamic state in the serious and iraq in both countries. that's larger than most states in the region. this creates large populations of camps of emergency needs and there are as we have heard by the previous speakers -- i don't mind going after folks that have spoken before me there are a lot of obstacles to both governments and international organizations. there are obstacles providing

the humanitarian assistance ranging from the ridiculous teams that are vaccinated for polio in pakistan are actually there to sterilize your daughters so don't let them into the village and in fact several have been killed. medical workers are actually bringing ebola into your part of the country. it is information and propaganda that we have to counteract. there are terrorist attacks going on in all these countries i mentioned and they threaten the indigenous also.

any humanitarian team providing assistance need armed escorts outside of the capital that certainly inhibits people. there are kidnappings and we have seen the beheading of those that were there for humanitarian purposes. the undersecretary for the humanitarian affairs and i will quote her says, and this is in the syrian civil war we have had 66 humanitarian workers who've lost their lives since the start of the conflict and hundreds more have been kidnapped and

abducted. that is an obstacle to bring assistance to take care of these people. and as we have seen in the refugee camps in jordan and probably elsewhere the war into syria in syria or the sectarian fighting can spread to the camps themselves in other words they can infiltrate or go as refugees and carry on the fight within the camps which they are trying to police the camps. so we've got the situation with millions of people and it wouldn't take much to have a medical humanitarian crisis of food, water, shelter in the

camps. let me talk a little bit about because this represents a new situation. i retired and so i'm speaking just for myself our government insists on calling it the islamic state that they have their eyes on a lot more than just iraq and the serious. if you look at the map of the world wide caliphate it resembles nothing that ever existed in the history of islam. it is a very globally looking whether they have the capacity to execute it but they have a vision of this worldwide

caliphate that has been able to control for atari in the daytime as well as in the night. and this is the key territory. these are infrastructures, roadways, rivers that sort of thing. they live in the area they can control. now we can say that the groups like that that roam the desert is true but these people control territory. they have displaced to the government both the national government and the more traditional tribal authorities and that sort of thing in the places they control but they haven't filled the vacuum, the governance vacuum that they

themselves created or that they had been growing before they even came upon the scene such as places like iraq or syria. they are not providing services to the people that live in the area. they don't even seem to care about providing the services to these people. i don't surf the website. it seeks to show how they have made life better for the people in knows -- in mosul. propaganda is about the beheadings and this sort of thing. this is a topic area and organization in the classic sense of the word. if you are not one of us, we will kill you and even if you are one of us and you don't throw the line and believe what we do we will kill you, to max that this is ask if this is a different, very different organization and al qaeda.

al qaeda never really took that and now we are seeing the organizations in africa that are swearing allegiance like they did to al qaeda central to isis. we are getting these nihilistic totalitarian organizations that are controlling a lot of territory. liberals are getting into these places that isis doesn't approve and above red cross says that it did manage to provide some medical equipment to the hospital and those mosul and the icrc says that it has

established the context with some people inside of falluja in iraq into these are very small efforts. so that's the situation as i see it and we are facing a very difficult situation under resourced as the previous speakers said. [applause] and foreign fighters. i am a grandfather. young men worldwide find ways to get in trouble. i don't care where they are from. in tunisia and other places they are no exception. it could be through video games or drugs or alcohol or something like this. but fortunately in the west into europe the outlets for getting in trouble are much less lethal

than they are in a particular. it's 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 the revolution in tunisia were drawn into these groups when they were in europe to find a better life which they didn't find so therefore they were attracted by these groups because they were separated from their real families. they had to find a virtual family and they get sucked into these groups and a lot of them went to serious. now they are recruiting. a lot can be said. be sent. there's a lot you can blame on the jobs of the economics, the social despair. but essentially there is always a group of young men that are going to find ways for excitement and to get into

trouble. >> if you would like to make a comment now. [inaudible] there's always one golden thread that runs through it and i think it is the goal of the richness of what is said. i find it difficult to pull it all together in my head and i think today we have a common set of themes. i thought initially we would be talking about the fear but i think that we are talking about the underlying realities as we

don't have to put a gate into the excessive reaction and someone mentioned the core fear. let me talk about isis. we had a program before that was called isil before. and i think that someone called it terrorism that i think but i think it is probably deeper than terrorism. this is something we have to be concerned about and i think that we have seen the collapse of the middle east. someone mentioned that yesterday was the 91st anniversary of the establishment of the turkish republic. roughly the same time as the caliphate and i wonder when people will turn against them at the end of the caliphate. i think there is a rule unraveling in the profound. as so many of these problems

fear comes from ignorance but even if you are knowledgeable and you are not afraid i think that it is hard to get a total grip on the underlying reality as it is evil thing. the art keeps growing and i don't see how we would link ebola but it's over ability to cope coping and then possibly bioterrorism and their you get something very deep in america which is our priority. i'm certainly not 18 party republican. now, the disinclination to spend money on public goods into the idea that and the idea that private life is what it is all about in the buildings, the beautiful houses, the meals, we

think that there is something wrong with our manhood and wanting to spend money on public goods and get it is pointed out that we do that at our peril. it's not the same. but the liberties. they are our unwillingness to sacrifice as a short and long-term and i don't know whether they are serious about it or not. even in the face of emergencies in crisis. what we are not his marines. the general is a marine and the military has a discipline of the civilian public of the west do not have it so i think that we are going to lurch but we have to put up with it and i hope that we do not succumb to the fear in the process.

>> on the discussion isn't a question of fear but a question of hope. the big issue is the way that they exaggerate sometimes we have to start with some sort of a realistic. >> thanks very much. i spent many years in the counterterrorism state and i've been working on the issue with a group called the global health response reliance and i think

that there are some parallels in fighting terrorism one of the things especially by president bush as we fight them overseas and one of the efforts fighting evil is to continue in africa -- fighting ebola in africa. it is in the effort to help the people there. and there is a certain irony that we spend millions of dollars of training other countries to beef up the counterterrorism force and in fact they overlook the kind of benghazi that god broke up trying to attack the embassies in both countries. in the area you know better than i do that we try to improve the capabilities of other countries. but now we are running into a problem to encourage health workers to go overseas and they

say they are worried there is a chilling effect by the quarantine in new york and new jersey and governor christie admitted that he did and and talk to health officials. we have two major allies in canada and australia which have good health systems and are reluctant to send health workers to worry about how they are going to train them. but i am trying to get at is being counterproductive by discouraging people from going overseas. and there is another effort. the proposal is to develop a sort of phase number two to develop the containment zone in the areas on the countries affected around the countries to keep it from spreading.

it's even passed around along the family and other things. they made some progress in this effort and there are some teams that are going out there but the basic effort is to try to educate the villages and to put some teams to deal with the psychological and other aspects of phase number two and the alliance that includes mainly the group of public health specialists and some former military people to put that together. my point is that when you have to look not only at the immediate problem of getting the health workers trained up also to develop a better way of containing it before it spreads

further. >> thank you very much. >> so, i agree with you that developing the vaccine is not the only way to deal with this problem, but what i want to emphasize is if we want to get rid of this problem for good, we need to have a vaccine. the prime thing that is needed is to provide the effective countries with basic needs and those are some of the basic needs for those that identify which are from beds to iv fluids to antibiotics for example we have to understand and appreciate that we have a cultural bias that we have to deal with in those nations and that has to deal with the way they deal with food.

he pointed out that that is doing it printing the food back into close proximity to the population not only the human population that the primates and once the primates gets it and the food supplies are short in those countries guess what they depend upon for the food supply perspective. so they eat the apes and monkeys and basically that is the meat that they utilize and if the animal is infected once they slaughter the animal, they will potentially come if the animal is infected it will get the disease and those practices have to change. a lot of work has to be done but one of the critical things before that is we have to help those nations build up a healthcare infrastructures.

they just do not have the capacity to deal with the regular issues that are encountered on a day-to-day basis on the problem is impossible for them to deal with it. >> to follow up on your question what is your view of the medical experts on this quarantine. some define that. where should we go from there. >> wanting to understand to highlight the fact that a guideline in the cdc published and what they have evil of two

interims of the current setting and i think that it is one of the areas that is causing some concern and maybe a little bit of confusion in the states is that they do have authority under the constitution for those things that are not reserved by the federal government and public health but falls into that so they have the domain since their interpretation of how they should take the recommendations at the cdc. the difficulty in the guidelines as stated is that we do not proceed in the current setting the healthcare workers at greater risk and what happened in dallas now we understand why

they became ill and they didn't have the right personal protective equipment and probably didn't receive proper training and didn't know how to take the equipment off but that's causing people to ask should we not view a healthcare workers who've been contacted by the patients at a somewhat higher risk and with that risk what are the considerations, should be self isolate. that is the recommendation is that they should go home and stay out of public spaces. but in the states where there is a lot of fear and ignorance to go with it, there seems to be the demand politically for action. obviously we know in the states of new york and new jersey those quarantine orders didn't last

very long. and as events evil and the guidance is refined you may see that the politicians are less likely. they are with the governor seeking the injunction to enforce the quarantine under the nurse that is up there right now to be determined by guess. so just wait it will change again. and that is like the watchword that needs to be joked but certainly some of the efforts

are probably viewed one way along the way. >> one more thing to quickly add to that. the first thing is that 21 days after you are not eliciting any symptoms you should not have the disease. that is the number one rule. number two, we have to have compassion for the healthcare workers. and we cannot ostracize them. from an ethical perspective, we have to take that consideration and consider the law as well as the ethics but full on this nation. we have to make sure that we follow all of those things and provide them all to provide them all of the supposedly to provide them. one of the critical things i would like to see and as it was mentioned there has to be a voluntarily executed a quarantine that individuals can

pose on themselves and i hope that after doing such tremendous work working with patients with ebola and being on the front line dealing with the situation that he will have enough sense to stay indoors for 21 days. ..