business friend least a twisted has not been in a long time. the government would get off our back. . .

a negative ebola test result means a patient doesn't have ebola but just this week a physician died after being flown to nebraska for emergency treatment after initial tests showed a negative test. his colleagues are in quarantine causing greater anxiety in a medical profession lost more than 500 to ebola. hospitals and healthcare workers were to have proper guidance on personal protective kwichlt. cdc guideline do not require a three-week self-isolation period for healthcare officials. they can return to work immediately.

but the hospitals i talked to did not agree. i asked an er doctor from my district about whether any of his colleagues volunteering in west africa could come back to work immediately. he had a simple response. i quote him. he said, they should stay away. the administration continues to pose travel restrictions and quarantines yet respected institutions have policies to ensure public health is protected. it's impossible for the american people to understand why the government would have one standard for the military yet another for people who may have been in the same or possibly more perilous circumstances. consider the cost of the administration's position. senator shumer asked the government to reimburse new york $20 million for the costs associated with the healthcare work terz toog to prevent an outbreak in new york city because of the case of dr. craig spencer. the taxpayers have every right

to ask, wouldn't it have been cost-effective for them to require all healthcare workers to adhere an isolation policy? we all niece honesty and humility today. the american public is fine with a doctor who says this is sfienl based on we what we node but as the facts change, then we have to change our approaches. the public expects that. anthony fauci said we should not look at the what ifs. i disagree. that's what we need to do, what congress needs to do and everybody involved with this needs to do. what if the outbreak migrates to other countries. what if it extends to other continents? if we get new information that says a change in policy is needed, tell us what you have learned and why a change is required. we have a set of screening protocols at five different airports. is this complex approach the easiest and safest approach?

can we track the hunts or perhaps thousands who might have been exposed if we have five u.s. arrival points, countless destinations and numerous connections through europe? with a disease that has no margin of error, i would rather be good than lucky. we need to consider whether there should be a simpler approach of one arrival point that would allow us to track the returning aid workers and government professionals copping from west africa. the administration must review whether government charter flights are needed to help get workers to west africa. they have concerns about shipping supplies to africa. i would like to ask the administration czar to appear. we were told he wasn't ready. another congressional committee made a similar request. i understand they were told the response coordinator had no operational responsibility. for a very few press interviews, he seems to be missing in action. no wonder the american people have concerns with the

administration's response planning. we want to clear that up today. we have good panelists to do that. the public has been given plans led by a czar who isn't ready. we stand ready to work with the administration to keep the american people safe from the ebola outbreak and welcome all the witnesses and look forward to learning more about the latest public health actions and more details about the emergency funding request. i now turn to miss caster. >> thank you very much for holding today's hearing, the second we sw had on the ebola outbreak. at our hearing last month, americans were concerned about the news they were hearing. it was weeks after thomas duncan arrived at texas presbyterian and days after two nurses who had been -- who had treated him had become infected. in response to the cases, cdc updated their protocols for treatment of ebola patients and

issued travel guidelines for those who had treated order been exposed to ebola. our hearing back then was held just three weeks before the election and it seemed that much of the discussion of quarantines and travel bans reflected political concerns instead of the advise of public health experts. but today, when we look at where things stand with regard to domestic preparedness, we are in a better place. no cases of ebola have been transmitted to any member of the general public in the united states. with new procedures in place and with the exception of dr. craig spencer in new york, no individual has unknowingly entered the u.s. while affected with ebola. airport screening and new cdc monitoring guidelines implemented by state and local public health departments are in place. and we have successfully treated eight ebola patients that have entered u.s. hospitals. i want to give credit to these hospitals and healthcare

professionals that have treated these patients. the professionals at emory university, the nih, the university of nebraska medical center, bellevue and texas presbyterian, their readiness has made a huge difference. i want to welcome dr. gold from the university of nebraska and thank him for sharing his expertise today. unfortunately, the news from west africa is not as good. while case counts in liberia have slowed, there continue to be increased in the number of ebola cases in sierra lee own and guinea. officials are now concerned about the appearance of ebola in mali. that, mr. chairman, is why we immediate to focus on the u.s. response in west africa. it's a credit to our country that we're leading the effort to end the epidemic in west africa. the early results from liberia indicate that our efforts and the efforts of our partner countries can milwauky s caies . but there's much work to do.

i want to acknowledge all of the medical professionals who are doing that work. in particular, say a few words about dr. martin s ya. we learned yesterday that dr. salia, who had been flown to nebraska for treatment after developing ebola while working in sieree sierra leone died fr disease. we sent condolences and acknowledge his bravery in helping fight this disease. west africa is balanced on the edge. if our efforts and the efforts of the world health organization are not successful, millions of people in these countries faying a looming humanitarian crisis will continue to suffer. i am grlad that mr. isaacs is here to give the perspective of the international aid community on the west african outbreak. mr. isaacs, your group and other groups like you'res are doing difficult but critical work. you deserve support. we are in a better position to

address cases of ebola that appear in the united states than we were a few months ago. i appreciate dr. frieden, dr. lucniac for joining us to share lessons learned and tell us how we can move forward. i'm looking forward to hearing about the supplemental ebola request. it's critical congress support the appropriation request. it would support domestic preparedness, help treatment centers. it would support treatment and vaccine and it would support us a d and the military in their effort to eliminate ebola in west africa. mr. chairman, i suspect in the year to come we will have our share of discussions about the budget. we support the goals of the president's ebola outbreak plan to combat it. i hope we can move quickly to provide the requested appropriations. thank you. i yield back.

>> now recognize the vice-chair, ms. blackman. >> thank you, mr. chairman. i appreciate the hearing. i want to say welcome to all of our witnesses. we appreciate your time. i think we have to realize with the nearly 15,000 cases and over 5,000 deaths that this ebola epidemic is the worst since the discovery of the vice russ in '76. you need to look at what the precedent is there. 2,400 cases known cases of ebola prior to this outbreak. we know that this is something that is this is something that will be difficult and take time to deal with. we appreciate your efforts. there is good news out of liberia. there is a mixed bag of news that's coming out of the region. it all leads us to look at the

magnitude of the situation in front of us and the human to human transmission of the virus which leads us to keep america safe. that's the goal. most believe it ises the job of oh the cdc to keep americans safe from infectious disease. and that all efforts need to be on the table when it comes to keeping americans safe. don't take anything off the table. the chairman mentioned some of the suggestions made at the last hearing. indeed yesterday i was at fort campbell with troops trying to build hospitals and training medical personnel. they have been opposed to items they think might work. even the institute held a

workshop where there were a number of questions about the characteristics of the ebola virus. they concluded, and i'm quoting, many of the current risk, quarantine policies could be better informed and more effective if the means and potential routes for transmission were more thoroughly characterized. until we know more about the nature of the deadly virus it seems prudent to keep all common sense measures on the table. with that, i yield to dr. burgess. >> i thank the gentle lady for yielding. thank our witnesses for being here. dr. laky, good to see you. >> this will be one of the most serious public health crises of the last hundred years. at our last hearing we had a great deal to discuss.

many of the brave pronouncements from september were found to be nonoperational by the middle of october oh. there were failures in dealing with the crisis. certainly communication was lacking. systems and protocols broke down. provisions that we all thought were readily at hand were never in place to begin with. i hope we know better than to let it happen again. this summer's emergency, to me, emphasized one thing. have a lot of hue mill ti when dealing with the virus. it is difficult to predict. as a physician, one of my big concerns, since july has been the safety and protection of health care workers. i want to thank the cdc for being responsive to my telephone calls and the various conference calls we had over the summer were helpful. i've got to tell you. until you have this thing in your backyard it's hard to

estimate how it will affect daily life on so many levels. sure, we had a hospital that was hurt by the crisis. we are probably lucky we didn't have more than one hurt. trash collection, sewer treatment, school districts. every one down the line was affected by having this virus in our area. we do have to take great care. it is important that it be brought under control. i have to tell you i al grateful for services of the hospitals that handled the known ebola patient. i was much more worried about the unknown patient who could walk through the door at 3:00 tomorrow morning, unknown to anyone, unannounced and provide the same set of circumstances that we have already been through. i'm not sure we have learned entirely the lessons. thank you mr. chairman. i will yield back.

>> the gentleman yields back. now mr. waxman is recognized for five minutes. >> thank you. i'm pleased you are holding this hearing. this is an important topic. it's appropriate for congress to learn about it. the american people want to know what's happening and want some answers. i picked up a couple of comments from the other side about having humility, learning from what's happened. and hope we know better because of what we have learned. when we last had a hearing in october, there was a pronounced disconnect between what the public health experts were telling the committee and the rhetoric of the committee members. some members called for quarantines and travel bans that experts determined would be harmful. some claim the administration's protocols for screening and tracking travellers wouldn't work.

some even insinuated immigrants with ebola would soon be crossing the southern border or that ebola had hue tated and become trance misable by air. this is mister call rhetoric. it induces a great deal of fear. mr. chairman, none of these things were true. after two cases were transmitted in texas the cdc acknowledged the gaps, revised protocols. it learned from its experience. it was 33 days since the last ebola hearing. since then, not one case of ebola has been transmitted this the united states. only one with traveller since then, dr. craig aspencer, has brought ebola into the country. it appears our health care system responded effectively.

dr. spencer knew how to immediately report symptoms, was isolated and safely transported to a hospital equipped to treat a patient with ebola and his close contacts were monitored. the health experts told us that our public health measures could protect the public from ebola. it turns out, mr. chairman, they were right. it's good that we have a chance today to show humility and acknowledge that the fears expressed openly this this hearing at our last meeting were not justified. as i said in that first hearing we should have a sense of urgency about the epidemic in africa. there is a lot of work to be done to stop the ongoing humanitarian crisis there. and we should view the appearance of ebola caseses in the united states as a wake-up

call about the need to invest in public health preparedness at the federal, state and local levels. president obama is trying to address these challenges. we should support those efforts. if we don't stop ebola in africa, it could travel to other places. it could spread. we've got to control the epidemic where it's happening. the president submitted a $6.2 million emergency supplemental funding request to congress to improve domestic and global health cap cities in three critical areas. containment and treatment in west africa, enhanced prevention, detection and response to ebola entering the u.s., and butt residencing the u.s. public healthle system to respond rapidly and flexible many the future.

it's critical that congress support the request. in november of 2005 the bush administration requested $7.1 million in emergency supplemental funding to speed up the development of a vaccine and fund preparedness. a bipartisan congress provided funding. in 2009 congress provided the obama administration to combat h1n1 influenza virus. congress did the right thing by making the investments. they saved lives, enhanced preparedness and congress should do the right thing now.

>> we are joined by dr. thomas frieden from the cdc, nicole lurie from preparedness and response at the department of health and human services. rear admiral boris lushniak who oversees operations of the united states public health commission corps comprised of 600 uniformeded health officers. i will swear in the witnesses. you are aware the committee is holding a hearing and when doing so had the practice of taking testimony under oath. do you have objections to testifying under oath? all the witnesses say they do not. the chair would advise you under the rules of the house and committee you are entitleded to be advised by counsel. do you desire to be advised by counsel today? the panel waives that. would you all please rise and

raise you're right hand? i will swear you in. do you swear the testimony you are about to give is the truth, the whole truth, and nothing but the truth? thank you. the panelists have answered in in the affirmative. you are now under oath. you may now each give a five-minute summary. we'll start with with you. >> thank you very much. we appreciate the opportunity to come before you and discuss what's happened in the month since the last hearing. in the basics of ebola we continue to see the pattern we have seen over the past four decades. in fact, in the more than 400 contacts with we have traced in the u.s. we have not seen spread outside of the one incident in dallas in the health care setting among travellers monitored since arriving from west africa.

we have seen a series with fevers but none with ebola. nothing changes the experience we have to date that ebola spreads from someone who is sick and spreads through unsafe care giving in the home or health care facility or in unsafe burial practices. emergency funding is critical to protect americans. it's critical to stop the outbreak at the source in africa and strengthen our protections here at home. globally, in each of the three epicenter countries we have seen rapid change and flexibility is key to the response. in liberia, we have seen promising developments in recent weeks. we have some decrease in numbers, but still the number of oh new cases each week is in the many hundreds. our ability to stop it is very challenging because it is now present in at least 13 of 15 counties of liberia. our staff are now responding to as many as one new cluster or outbreak per day compared with

the past four decades with one cluster or outbreak per every year or two. it's going to require a very intense effort to trace each one of the chains of transmission and stop it so we can end ebola. in sierra leone we are seeing widespread transmission. although some of the areas that implemented strategies we would recommend have seen significant decreases as well . guinea is in some ways the most interesting or concerning or instructive to look at. it shows what might happen in the future if we have progress in the first two countries. there is a challenge to trace each outbreak, each case, to reach each community and end the transmission. that's why the emergency funding request outlines a comprehensive approach that's simple, straightforward, focused and approaches things by prevention, detection, response. three main categories. in west africa that prevention

involves quarantine and screening, infection control in hospitals and burials. it involves detection so we find outbreaks promptly an strengthen surveillance and the ability of health care facilities and public health care workers there to stop transmission and response through core public health functions of contact tracing, training, infection control, public health education, outreach and rapid response teams. globally, we are seeing new threats with a clus of cases in mali. cdc surged. we have 12 staff on the ground today in mali. we were there before their first case. they are tracing more than 400 contacts. we are helping them do that and test any who may have symptoms that could be ebola. we are also aware with the end of the rainy season, other parts of west africa may experience an increase in travellers from the affect ed countries and may be at increased risk. the metaphor of a forest fire

holds here with the center burning strongly with a series of brush fires around the region and with sparks with with the potential of united statesing new challenges in the struggle against ebola. the funding request also addresses the security aspect so we can, with an emergency focus, look at what keeps other countries vulnerable and us. three quarters of the cdc component is to strengthen the warning systems detection, laboratory networks and others. there are funds to respond r57dly and prevent where possible. covering the u.s., we have made progress. we are doing it through a series of levels. each requires significant investments. stopping it at the source. screening travellers when they leave africa, when they arrive to the u.s. tracing each traveller for 21

days in all of the 50 states. the states are doing an excellent job. with excellent participation from custom and border protection which has electronically collected data in hours. we are seeing most states reaching 100% of travellers regularly according to the information they are reporting to us. this is a relatively new program. it's going smoothly. it is working on borrowed dollarsmedollar s. we need funding to support this and key measures of prevention, ke text and response in the u.s., public health systems, hospitals, laboratory networks, active monitoring and more. finally, i would emphasize that intensive public health action can stop ebola. in nigeria they were able to surge and stop a cluster from spreading. mali is in the balance. whether it become it is next nigeria having successfully contained a cluster or sierra

leon with with wide transmission. the shifts and changes in the epidemiology in africa are just emphasis for the need for rapid response and the only way to protect us is to stop us at the source and build systems in africa and the u.s. that will find, stop and prevent ebola and other infectious disease threats. thank you very much. >> thank you. dr. lurie, you are recognized for five minutes. >> good afternoon, chairman murphy, member caster and other members of the committee. i'm the assistant secretary for preparedness response at hhs is. i appreciate the opportunity to talk today about actions that asper has taken to enhance national preparedness and strengthen our resilience to public health threats. while it is essential we continue to focus on controlling

the ebola outbreak in west africa, we also have a critical responsibility to protect our country from this disease. today i will highlight three areas this which as per's work is critical to the domestic response. first the biomedical advanced e reor barta building on counter measure development is speeding the development, testing and manufacture of oh ebola vaccine and treatments. second, the hospital preparedness program has since the beginning of this outbreak been preparing hospitals and first responders to recognize and treat patientses with suspected ebola. third, our federal resources and responders,s whether the national disaster medicalle system, the medical reserve core, or the public health service staying ready to support a comprehensive response should it be needed in the coming months. barta with other medical partners hases a great track record in expanding the medical counter measures pipeline and building needed infrastructure to do soment in addition to

developing and procuring 12 products since project bioshield's inception over a decade ago the centers for innovation and and advanced development and manufacturing are being used to produce, formulate and fill vaccines and treatments for ebola. complementing our

emergencies and disasters, asper is responsible for services and coordinates assistance to supplement state and tribal resources and response to public health and medical care needs during emergencies. i would like to close with an overview of the recent emergency funding request from the administration. it includes 2.43 million dollars for hhs. barta's product development efforts and hpp's preparedness. funding will support development of an ebola vaccine and therapeutic candidates, clinical trials and commercial scale manufacturing. funding will ensure communities can purchase additional protective equipment that health care workers will receive additional training and patient detection, isolation and infection control. and we further build preparedness for the future by

ensuring that all states have facilities that can handle an infectious disease as serious as ebola. mr. chairman and members of the committee, the top priority of my office is protecting the health of americans. i can assure you my team, the department, and our partners have been working and continue to work to ensure our nation is prepared to respond to threats like ebola. thank you for the opportunity to address these issues. i welcome your question s. >> thank you. now, you are recognized for five minutes. >> thank you very much for the opportunity chairman murphy, members of the oversight & investigation subbing committee. thanks for something us here to testify about the u.s. public health commission core and its role in responding to the ebola outbreak in west africa. i am here to provide frvegs about what the office of the surgeon general and the united states public health service corps has contributed to the wide effort to stop the spread of ebola virus disease. in essence where it began in west africa.

the commission core of the u.s. public health service is made of 6700 uniformed officers assigned to 26 departments and agencies of the federal government serving in 800 locations worldwide. i'm proud of this group. they are highly trained, mobile, medical and public health professionals, operating under the departmental leadership of the secretary of health & human services and the oversight of the surgeon general and assistant secretary for health. commission corps is one of seven university forled services of the nation. the only service of its kind in the world. it is an unarmed uniformed service dedicated to a public health mission and medical care for under served and vulnerable populations. the mission is to protect, promote and advance the health and safety of the medication. for 125 years this is an anniversary year for us, corps officers have been the dependable resource for public health emergency services

working with closely with the asper in times of war in the past and national or oh international agencies. corps officers like others of our sister services can be deployed at a moment's notice anywhere in the world to meet the needs of the president, hhs, address the needs related to the well-being, security and defense of the united states. we have had a long history of doing this, protecting the health and safety of the nation by addressing infectious disease over sea s. smallpox, polio, now ebola. to ensure we can meet the mandate to respond rapidly to urgent or emergency public health care needs around the globe there is a tiered response system composed of 41 different general and specialty response teams. we have deployed in the past to events ranging from terrorist events, 9/11, the boston bombings, anthrax, natural disasters, hurricanes, haw humanitarian assistance in haiti, reare construction

stabilization in iraq and afghanistan, public health crisis, h1n1, suicide clusters on indian reservations, hospital infrastructure rescue in the mariana islands. over the past ten years the corps has over taken 15,000 officer deployments this in support of nearly 500 missions and events. corps officers are operating in the united states and in west africa in clinical, education, management, liaison roles supporting the department of health and human services and working under the auspices of the centers for disease control & prevention. we have 900 officers with the cdc. one critical element of the plan for combatting the ebola outbreak targets the ongoing need for health care personnel in the ebola affected countries. united nations estimated at 1,000 international health care workers would be needed on the ground in west africa to bring the outbreak to an end. there is a wide consensus that in order to create conditions to

encourage both west african and international health care workers to contribute, yes, the time and skill to contain and end the ebola outbreak, it is essential to establish a dedicated facility to provide high level care for those health care workers should they become infected with the virus. in support of this objective the corps deployed trained clinicians, physicians, nurses, behavioral health specialists, infection control officers, pharmacists, laboratory workers, management, personnel to liberia to staff the mmu. this is a u.s. government funded 25-bed hospital that has been configured to function as an ebola treatment unit. it provides advanced ebola treatment to liberian and international health care workers. and to nongovernmental organizations and u.n. personnel involved in the ebola response. d.o.d., the state department, u.s. aid have prorided invaluable support for the

missionment it ises being carried out with the full cooperation of the liberian government and its ministry of health. corps officers -- i'm sorry. the first team of the commission corps officers completed one week of advanced training in alabama in october. they arrived in liberia october 27. the full complement is staff thing of 70 core officers, each of whom voluntarily accepted the assignment to provide direct care for ebola patients. additional training was completed in liberia with support of ngos such as doctors without borders and the meddle call corps. we have the commitment. have gone through management protocols. on november 12, the mmu accepted its first patient, a liberian health care worker. the fourth patient is soon to be admitted. four overlapping teams of 70 officers will be scheduled for

rotations to approximately 60-day deployments for an estimated six months of operations at the mmu. in conclusion the safety of the personnel is the highest priority. we are making every effort to ensure that all core officers on the ground are working in an environment to minimize and the risk to personal safety and security following guidance from the cdc. to ensure the safety of the officers, familieses, friends, co-workers and the communities in which they live, work and play upon return officers will undergo exposure risk assessment and, as indicated being monitored by pub p lick health authorities. we look forward to welcoming home the personnel providing support and thanking them for the extraordinary efforts on behalf of the thags that people of west africa. thank you, mr. chairman. other members and members of the subcommittee. i will be happy to answer questions at this time. >> thank you, doctor. i will authorize myself five minuteses for questions. dr. frieden, so in the weeks you have been dealing with this in

the united states can you highlight the lessons learned and modified that could give the public assurances that you are adapting as need be? is. >> the most important principle we are following in ebola control is to find out, as quickly as possible, as definitively as possible what works and implement that on the ground in west africa and the u.s. we found that treating ebola in the u.s. is difficult. the two infections in dallas were an indication of that. we immediately moved to add a margin of safety to our guidelines for infection control and personal protective equipment. we also have put into place multiple levels of protection. our top priority is protecting americans. we do that through control at the source in africa, screening on exit, screening on entry, and the active monitoring program as

well as work with individual hospitals and health departments. we have something called rapid ebola preparedness teams that have now visited more than 30 hospitals in more than ten states to get the hospitals ready for the next ebola case, if one occurs and a team had been to bell view before dr. spencer became ill. so the rapid response is key and rapid adjustment as we learn more about ebola in the u.s. >> on august 2014 under the food & drug cosmetic act secretary burrwell declared circumstances exist justifying emergency use of in vitro diagnostics for detection of the ebola virus. did you help advise of the declaration? >> yes. >> she declared ebola to be an emergency for the purpose of the fda law she has not declared it a public health emergency under

this. the world health organization in august declared ebola to be a public health emergency. do you agree or oh disagree? is in a public health emergency in the united states? >> in order for the drug to be used in the united states the secretary has the authority to declare that the conditions of a potential pub p lick health emergency exist. as i think dr. frieden and others highlighted, fortunately we have been successful in the united states in detecting and controlling the disease. we had two unfortunate cases of transmission of the disease in the united states, but no others. we believe all of our efforts are effective in controlling the disease at this time. >> we want to make sure we are doing everything we can. on page six of the testimony, you mentioned the response coordinating the support function using domestic or emergencies. is that an operational

responsibility that you have? >> my responses are policy advice and operational response, yes. >> that's been activated under the response to ebola? >> yes. the secretary's operation sent er is activated. all components are hard at work. >> you're still the coordinator for emergency support function? is it now mr. clean? >> mr. clean is the ebola coordinator for the country, yes. >> okay. let me look at this. >> what data are you modeling or have you done data modeling to determine the number of cases we may anticipate. >> one of the things we have done, as a lesson learned from h1n1 that brought together modelers -- subpoena. >> -- >> how many cases are you planning for? >> the model suggests if we continue to be aggressive about

exit skreeng from west africa, entrance screening, tracking travellers with direct active monitoring that we might expect a handful of cases in the united states, potentially in an unrecognized cluster. but we don't ant 'ticipate a widespread outbreak. >> you are looking for $6.2 billion and you expect a handful of cases. senator schumer said we have to track all those who came in contact with someone. you don't believe in self-isolation though many of the ngos do. there is a disconnect here. expect a handful of cases. don't expect more. but asking for 50 hospitals to be prepared throughout the united states. help me understand. >> i don't think there is a disconnect at all. our strategy for hospital preparedness first looks at being sure that beyond the biocontainment facilitieses at emery and nebraska and nih we

have good strong hospital capacity to recognize and treat through the entire course of illness. first in the five cities where all passengers are being funneled. a next ring of hospitals is needed for geographic dispersion around the country to place where is travellers are most like willy to go. and that's a pretty good range of states now throughout the country. one of the things we have learned and you asked dr. frieden about lessons learned is mother nature always has the upper hand. that means we have to think about what's next after ebola. ebola taught us that we really need high containment facilities. so far our planning has been for pandemic preparedness on something airborne like the. the infection control needs for something like ebola are very different. part of the emergency request is being able to meet our needs now by having a broad geographically

disperse network of hospitals to treat ebola p. it's building toward the future because we don't know where the next cases or next travellers will uh show up. we need to be prepared not only for today but for the next decade and century. >> i'm way over my time. >> thank you very much. on november 5 the president requested #.2 billion from congress to enhance the u.s. ebola response. the president's request focuses on stopping the outbreak at its source in west africa. in your testimony you said you were focused on detext and response. 603 million to cdc for international response efforts. discuss how the funds would be used. >> thank you very much. our approach would be on the prevention side. to implement screening

procedures so they could be continued long term and individuals with ebola or potentially exposed to ebola would be isolated traced and isolated p if they were ill. second on the prevention side is infection control. this is a challenge for west africa. each of the facilities caring for patients needs to think of ebola in a country and countries where malaria is endemic and the symptoms aren't easily distinguishable. that's infection control, quarantine. on the detection side laboratory and related services to find infections and find illnesses as soon as they occur. that relates to some of the u.s. funding which would allow us to work with companies and other parts of the u.s. government to optimize testing modalities and surveillanc surveillance. we are tracking what's going on. and training of health care

facilities to identify cases so they are found, isolated, cared for and don't cause outbreaks. then response. the core pub p lick health activities of contact tracing, training of health care workers, surveillance, public health education and outreach, rapid response teams and support to ministries of health so we don't need to be there long term. >> what, if any, public health infrastructure was in place in west africa. >> there were weak systems in place prior to this. public health or health care. a shortage of trained workerers. part of the effort is to build up systems so they can continue it for years to come. >> the budget request also would direct 1.98 billion to u.s. aid, 112 million to the department of defense and 127 million to the department of state. can you go through how funding to those agencies would assist in the broader effort?

>> i would have to refer you to them for details. in general, u.s. aid is coordinating under the dart or disastrous assistance response team. they are recruiting partners in countries. for example for burial team which is s exist all over liberia and are rapidly, safely and respectfully collecting human remains of people who may have died from ebola. we are addressing the critically important areas of supporting development in areas like the guinea forest region. there is a lot of resistance and resentment. services in the region will be important in allowing us to get in and do ebola control. >> doctor, how would the funding assist in the work in west africa? >> certainly running the monrovia medical unit supported by multiple agencieses in the department of health & human services. certainly it will assist in that endeavor. d.o.d. plays a key partnership

role. they are supplying us with equipment, supplies, logistics support on the ground. u.s. aid is really out there also pushing ahead. from our perspective to have a continuous presence, if we believe the mission is important providing the medical care to health care workers. >> we have heard from doctors without borders and other organizations about the need for flexibility and adaptability in the response. in the budget request. what measures are built into the supplemental budget request that would give us the flexibility and adaptability. >> first there is the contingency fund requested by the president split equally between the state departme department/u.s. aid. that would be available if the disease breaks out in another part of africa that we need to

surge to or if we have an effective vaccine to implement the campaign will be challenging. second, within the budget request there is transfer authority. that's extremely important so we can adapt the response to what's needed. third, within the cdc budget in particular it would be a single budget line so we would have flexibility within cdc to spend resources specifically for ebola control as they will be most efficient and effective. >> thank you very much. i yield back. >> now recognizes ms. blackburn. >> thank you, mr. chairman. let me come to you. as i mentioned in my opening, keeping america safe, this is where the focus ought to be. you said in your testimony 621 million would be used to fortify domestic public health strategies. you didn't mention the managing of waste products from patients with ebola.

according to the institutes of medicine report from earlier this month a patient with ebola generates 30 to 40 times more medical waste than another patient. the report states there is limited ability to handle ebola, medical waste in the u.s. i have a couple of questions. i can take a yes or no answer and that will help us missouri quickly. part of the 621 million will be directed to managing medical waste products from treating ebola patients or will hospitals be expected to build on site incinerators or auto claifs to decontaminate waste? >> funding will go to support hospitals to strengthen waste management systems. >> do you have plans for

sterilization of waste including ebola waste on site or as close as the source -- to the source as possible. >> cdc provides guidelines to the waste potentially contaminated with the ebola virus. we would continue to recommend the same guidelines. >> does this include on site? >> decontamination could be done on site or could be moved off site. >> where is it going to go. >> we are supporting hospitals to deal with ebola. we would want it done on site. >> all right. kind of got a little skirting the question there. do you plan to procure and utilize mobile medical waste sterilizers? >> that would be one option that could beer considered. >> do you plan to do it? >> it depends on whether it made sense for the facility. >> what about the waste in africa? where are your supporting efforts? >> incineration is used in

general. >> on site? >> generally on site, yes. >> dr. lurie, i would like to come to you for a moment. the funding request includes 157 million for barta the to support the manufacture of vaccines and synthetic therapeutics for use in clinical trials. would the funding be slated to support manufacturing at one of the three centers for innovation and advanced development and manufacturing that were established through previous funding for barta or are you looking at other potential manufacturing partners? >> right now funding is being used. it would be anticipated to use to support both vaccine development, vaccine manufacturing and fill and finish vaccine cap is it city. also the continued capacity and fill and finish of therapeutic products such as z-map. we are actively engaged both with the centers for innovation

and advanced manufacturing and with a fill finish network components to look at the role they can play. >> so you were engaging other partners? >> we are engaging the range ofs -- >> private sector. >> the range of partners it takes to get vaccine and therapeutics. >> okay. we read secretary burrwell's testimony last week as i'm sure you have from the senate aprops committee and it seems it would go to manufacturing quantities of products that under go successful early development at nih. we know there are several private companies who have committed significant resources to develop treatments or vaccines for ebolament we want to make certain those companies are involved in processes going forward. so it is my understanding, you're saying you plan to include and invite them.

>> any company with a promising product is welcomed into barta. we have a system to sit and talk with them, determine whether they have promising candidates and for them to submit proposals that are evaluated. what i can tell you is it is generally nih's role. bart that's role to support advanced development of products. barta is and will support the advanced development of vaccines and therapeutics and get them scaled up so that if they work they can be used in a mass vaccination campaign or in therapies. >> thank you. i yield back. >> now recognize mr. wax man for five minutes. >> thank you, mr. chairman. dr. frieden, you and other experts have said numerous times the key to protecting americans from ebola is stopping the disease at its source in west

africa. can you explain the approach in west africa to contain the spread? >> in brief to identify patients with ebola promptly, get them isolated and cared for safely. and in the event that individuals die, have them buried respectfully and safely without spreading disease. to turn off unsafe care and unsafe burial. that's what ef we have done until now. instead of dozens or a handful of cases, thousands of cases to deal with. >> would you say the epidemic is moving too quickly to keep up? >> the decrease of is some cases is proof of principle that the approach works. we are stiller far from the finish line.

>> what are the consequences of failure in africa? >> if we are not able to stop the ebola epidemic the risks are high that it would spread because of travel within africa. if that were to occur it could be a matter of years before we would be able to control it and the threat to the u.s. and other countries would be proportionately greater. >> some people say if that's the concern why not seal off africa and not let other people travel from africa. would that solve the problem? >> from the standpoint of public health we look first at protecting americans from risk. protecting americans from threats. we have systems in place that trace each person who leaves one of the three affected countries, each person who arrives to the u.s. and follows them for 21

days. we have had people who developed fever, called the 24/7 number provided and have been safely transported and cared for and have been ruled out for ebola. the systems rely on knowing where people are coming from and how they are getting there. >> the president asked for more money in the supplemental budget. a big budget goes to our efforts in africa to stop and contain the disease. some of the money will be used here in the united states to en hans u.s. government response to the ebola outbreak. can you give a brief summary of what initiatives are covered by the funding? >> thank you. these would allow us to work with states so all travellers are traced on a daily basis. if they become ill, they are promptly and safely taken to a facility ready to care for them.

it would result in safer hospitals and other infectious disease threats. there is a small research component the to allow us to implement a vaccine trial, probably in sierra leone. others would ep help with diagnostics to detect more rapidly if someone became ill. we woul support all jurisdictions to be better prepared for ebola and other infectious disease threats, have safer hospitals, more rapid response and work closely with the state -- between the state and hospital systems within the state on infection control generally, ebola and other deadly threats specifically working closely with the funding for asper and other parts of hospital preparedness. >> it seems to me that it shouldn't be partisan in any way for us to give a grant of money the president requested to deal with the terrible epidemic in

africa. and request is balanced in helping us deal with the situation as we now have it. we have always had bipartisan support. talking about here in the united states, what if we had a pandemic flu. that would be more dangerous because of how fast it could spread. would these funds help us to deal with that? secondly, are we prepared for a pan demic flu? do we have a stock pile of the medications. are we ready -- as you said we don't know what will come next. but are we ready for it? >> we always work to be better prepared today than yesterday and better prepared tomorrow than today. a pandemic of influenza remains. one of the most concerning

possibilities, the funding in the emergency funding request would assist this country, health departments, hospitals, the health care system, the public to be better prepared for ebola and other infectious disease threats such as the pandemic influenza. >> without objection. >> dr. frieden, the administration's additional funding request states money will go toward 50 ebola treatment centers throughout the united states. some states, texas, has already start started on their own. will it be includeded in 50 or in addition to? >> i will comment and dr. lurie may want to continue.

our approach is to strengthen the statewide systems. it would be the states responsible for -- in collaboration and determining which hospitals would be used. what we have asked each state to do is four things related to the active monitoring program. first, establish the program including information flow from the state health department to local health departments. second, establish a 24/7 hotline for any traveller who thinks they have ebola to call so they can be safely managed. third, establish safe transport between wherever the person calls from and the facility that the state decided would be the facility to assess or treat them for ebola. the fourth is to work with their hospitals to identify facilities that are able to do that assessment and treatment. >> let me add it would be great if you got a --

let me ask you the same question. the 50 centers designated in the president's budget request is that in addition to the state designated centers or would those state designated centers in texas fall under the purview of the 50 centers president obama is describing? >> as dr. frieden said, our process and plans have been to work through the states to identify facilities. the process works -- >> make it simple. the two centers governor perry designated in the state of texas. do thosele fall under the parameters of what president's budget request as it exists today. >> the funding will go to the states and the states in conjunction with the hospitals will determine which of the hospitals will serve as infectious disease containment centers or the ebola treatment centers system i guess that's as close as i will get to an answer. let me ask you a question. do you report to ron clane? is that someone in the

hierarchical reporting structure you have? is he a person to whom you report? >> i report to the secretary. i interface with mr. clane on a regular basis. >> in your testimony you say that under the national response framework, my office, your office, is responsible for coordinating the emergency support function number 8 response which is listed here. so where does mr. clane's responsibility fall in the emergency support function number 8? >> so during different event this is the united states whether they are national disasters or other kinds of emergencies, either fema is activated and as it is for hurricanes and floods and i know we have worked together in texas on a number of things. fema is has activated an emergency support system number 8. ser vises are activated under that framework. in other -- >> let me interrupt you. that's under the coordination

and control of secretary burwell. is that correct? >> emergency support function 8, yes. >> does mr. clane have a role? >> in this situation we have not had a declared national emergency. fema has not been activated. however, we have a very serious situation in the united states and mr. clane is the national coordinator -- >> my time is going to run out. it's not fair to say you have an emergency plan, but do you have a serious situation plan you are working under? >> we are doing aggressive planning both for what we have in the here and now and for the what-ifs. we work across hhs and the rest of the components of the federal government on the what-if planning. >> i will assume you will be able to make the details of the plan available to the committee staff? >> it is -- continues to be in draft. we continue to work through what ifs with the partners across government, yesment. >> yes was the answer.

>> yes, when we have the rest of the plan together. it's something that's a whole of oh oh government plan, not an hhs plan. >> it's time. dr. frieden, i have to ask. we had two nurses at presbyterian hospital infected. i have to tell you. when you get the call at 2:00 on a sunday morning that a nurse is infected you don't have confidence that things are working the way they were outlined. do you have insight as to how those nurses became infected and what we can do to protect our health care workers going forward? >> we don't know how those infections occurred. the evidence points to them having been infected in the first 48 hours after mr. duncan was admitted to the hospital, before his diagnosis was confirmed. that's consistent with the period of time between on set of similar. toms and exposure. it's consistent with the observations of the ta s team o from cdc that arrived and found

in the intense efforts of the health care workers to protect themselves they may have increased their risk by some of the ways they were working with personal protective equipment. that's why cdc strengthened the martin of safety and established new guidelines for personal protective equipment that in collude as two critical components practicing repeatedly so the health care workers have comfort with the equipment they will be using and direct observation of oh every step of taking on -- putting on and taking off the protective equipment. >> this just under scores why it is important to have treatment centers available around the country. because i could just tell you the average icu is not set up for that type of activity of the donning and dof f'ing of protective commitment. i have a problem with the time frame. mr. duncan's family never became symptomatic. i would suspect it is later in the course when he was throwing off massive amounts of viral

particles where the greater risk for exposure to those health care workers occurred. i'm sure you and i will have future discussions about that. i will yield back. >> just to clarify, during that time mr. duncan, at what point did he disclose he was in western africa e posed the to ebola? >> my understanding is he disclosed that he was from west africa on the earlier emergency department visit on the 25th of is september. he was admitted on the 28th of september. >> thank you. now mr. green is recognized for five minutes is. >> thank you sh mr. chairman. to follow up my colleague from texas i know our state has designated two locations. two months ago i was at texas meddle call a center in houston and there was interest in trying to do that, too. that may not be one of the two locations that the governor has designated. but i have a question later for dr. gold from the university of nebraska. how it was unique that the university of nebraska created the facility there and how it happened.

let me get to my question for you dr. frieden. what is the process and timeline for updating and communicating changes for protocols to local health care providers. we know there was an issue about that last month. what is the process or have the processes changed at the cdc from what we did, say, in october? >> with respect to cdc guidelines we used the latest data, information and experience. we consult widely with affected parties for input. when we have a clear set of guidelines we then disseminate those through a wide variety of networks. >> what we have learned is personnel protection from the experience at texas presbyterian and how the lessons are shared with other hospitals. again, the feeling somebody shows up at 3:00 at one of my not for profit hospitals in an

urban houston, how are they going to deal with that? >> we are dealing with this from both sides of the equation. first, the patient side. what we have done is for every single person coming from west africa, they are greeted, asked detailed questions, the temperature is taken and they are provided a care kit that includes a thermometer, a log for taking their temperature, a wallet card with 24/7 number to call. we have already had multiple times in the past few weeks individuals take their temperature, find they had an elevated temperature, call the number, be safely transported to and safely cared for in a facility. they all ruled out for ebola. but the system worked in those cases. we can't guarantee guarantee it in every case. that's why we are working very intensively with hospitals throughout the u.s. to prepare them for the possibility that they could have someone with ebola. at least guidelines which are in conjunction with the rest of hhs training sessions. we had hospital visits by rapid

preparedness teams to more than 30 hospitals and ten states and continue to work intensively with the system so that they are increasingly well-prepared to address a possible case of ebola. >> how can you provide clarity over the cdc's authority and responsibilities and setting and enforcement? do you have authority and enforcement over hospital settings? >> cdc provides guidelines and information and tools and feedback to facilities. we do not regulate in that area. that would be up to other entities within the federal and state governments. >> okay. without a commercial market, many counter measures like those against ebola and infectious diseases require skpbl private partnership. they recognized this when it created a drive by providing a stable source of funding so that a reliable market was in place.

that can take the urge urgy was that was not enough. can you provide a dollar figure on what you think is needed for ebola, vaccines and drugs to get to the chance of successfully developing a product. >> i didn't hear the last part of the question. >> can you provide us a dollar amount on how much investment you received as needed for ebola vaccines and drugs to allow us the best chance of successfully developing these products. like i said earlier, the research program and ebola has been going on for a decade. are there resources and how much would we need to do to get that drug. >> absolutely. one of the reasons we now have

two vaccines that are finishing safety trials is because of prior investments made across the u.s. government in trying to develop an ebola vaccine and also with ebola therapeutics. as you may know, the vaccines are finishing those early trials and thanks to money provided in the cr. they work on vaccines and therapeutics. whether they work we will learn over the coming months. at the same time we have now gone ahead and invested in the advanced development of three other vaccine candidates and making the therapeutics so that we never put all of our eggs in basket. we want to do better and we will continue to do that through the investments. we support the support from congress.

>> i'm all out of time and i want to thank the panel today. >> i yield back and recognize the chairman for ten minutes. >> congressman green department want to brag, but he has a family member who is active at nebraska we appreciate them on the frontlines. we will welcome our witnesses from texas and glad you are here. my first question i'm going to ask, the rear admiral and surgeon general. i believe we should treat this as a health issue and not as any other issue. it puzzles me that we have not really effectively put in a travel ban from west africa. i know we have alerted people

and all of that, but when we had the hearing down in dallas at airport, the answer we got is we need to send personnel over there. we don't want to prevent people traveling to here. as a pure public health official and the surgeon general, why would we not put in a true quarantine and flat prevent any travel from west africa. >> certainly as stated and have a strong belief in this, is that currently as we have it, the idea of having a travel ban prohibits all travel. there is that sense of travel of health care workers to western africa and i stated earlier, the real resolution to this issue is solving the problem. at the same time instilling a

travel ban has a total loss of control of who enters and how they enter this country. as the doctor stated earlier, we set up the systems. the systems in place right now allow us to know where people are coming from. it allows us to track them appropriately through the public health endeavors at the state and local level and to be able ultimately to follow them appropriately and to be able to intervene if symptoms appear and direct them and detect them appropriately and instill the right response for that. as the system works, as the surgeon general, i find that the appropriate course of action. >> okay. it puzzles me if we were to have a health outbreak like tuberculosis, there wouldn't be in question that the texas department of health would put a true quarantine in place. i understand some of the external reasons, but if you are

trying to contain an epidemic, a quarantine does work. when i asked dr. friedin, there has been concern that perhaps we don't know how this disease is transmitted. unless something came out recently some of the individuals in texas that were potentially infect and put on a watch list had no means. do you have any way of finding out the methods of transmission than we do today. >> we do research specifically on ebola and spread of it. the two infections are the two nurses at texas presbyterian

occurred at the time when mr. duncan was highly infectious with large quantities of highly infectious colors of diarrhea and vomiting. they were most likely to have been infected although we don't know for certain. we describe what we see in africa. people become infected by caring for or touching someone who is either very ill or died from it. we analyzed the amount of virus in a patient's that goes from undetectible to small quantities when they first become ill and as they get sicker, they increase enormously. they are quite large. >> as a medical professional yourself, what's your confident that there is no other method of transmission than we know about today. are you 100% certain there is no

other way. they spread from a vearlt of ways. but the way it is spreading by and large. they are the two main mechanisms of touching body fluids. i will mention one of the things we looked at in the new guidance is what is done in u.s. health care facility facilities. there is more ventilation somewhere. that may generate the particles and the respiratory equipment guidelines. >> thank you, mr. chairman. my time is expired. >> i recognize mr. braley for five minutes. >> thank you, mr. chairman. i want to clarify the questions that congress person blackburn

was asking you. at the 50 hearing on october 16th, the doctor was kind enough to present us with materials to walk us through including this product development pipeline which i think you described in your testimony, talking about early concept and product development being the province of nih and the advanced development being the province of barta and commercial manufacturing by the industry and regulatory review. the next page was therapeutic development. the treatments for the symptoms of the ebola virus as opposed to a vaccine that would hopefully prevent the virus from spreading, correct? he had a slide that talked about the vaccines that were in or approaching phase one trial. the first is the glaxo smithkline. the second was new link

genetics. i asked him questions about that at the time. i questioned doctor robinson. in this particular slide, it appeared there were only two companies, glaxo smithkline and a new link that had phase one trials ongoing. has there been a change to that since the hearing? >> since the hearing on october 16th, the phase one trial has been under way. they are almost complete and they are very optimistic that they start next phase of the trial with both of those vaccines in west africa. >> this slide indicated that there was a third company, but they were not expected to engage in phase one trials until the fall of 2015 which is a substantial ways away from where we are today. >> there other potential vaccine candidates in the pipeline. we are supporting some of those. they are behind this timeline

and we are right now focused on trying to figure out if these vaccines are and effective and if they are, get them into use to control the epidemic in west africa. part of the emergency funding request will be $157 million for barta to continue to accelerate the development and manufacturing of vaccines and therapeutics for the outbreak. >> my understanding from talking to the folks at new link genetics is these clinical trials that have been ongoing at walter reed and the national sn institute of allergy and infectious disease, there is good rapport against the agencies and the company involved. that there is continuing to be ongoing interactions with the department of defense sponsors as well. that would be the defense threat reduction agency and the joint vaccine acquisition program. is that your understanding as well? >> that is in fact every week

once or twice a week i run a call with all of the parties. so that we are all joined at the hip through every step of the process. we know what's going on and we share information and we know what to anticipate. fda has been a key partner as well. because of the fact that it's their regulatory authority. it is going to determine what moves forward and what doesn't. i never thought i would find myself in this situation, but we are racing to catch up with fda. it's a great situation to be in. everybody is working extremely effectively. >> great. >> doctor, mr. barton asked you a question about trying to contain an em demmic with an absolute quarantine. is there an ebola epidemic in the united states right now?

>> there is not. and that's why they are trying to contain it there. >> one of the things we talked about during these hearings is the importance of focusing on facts and science and medicine. in 1900, the two leading causes of death in this country were influenza, pneumonia and tuberculosis. neither is a leading cause of death because of the response of science and medical health. when you look at the fact that in 2012, there were 25 million people living with hiv around the globe and the case of ebola, with the proper application of science and medicine and public health, we should be able to manage this crisis if we devote the necessary resources on a global basis. would you agree? are. >> yes, i agree. >> thank you. >> you are recognized fo five minutes. >> thank you and i appreciate

you having this second hearing on ebola and i want to thank the panelists for coming. we would like to see mr. kline be a part of this. the committee made a request for a new one here. they will have transparency to talk about it. they would be focussed on working with us to get solutions to this. the last time you were here, we talked about a number of things. one was the comments that we heard from samaritans to groups that will be on the second panel. one of the things is the comments you previously made. they were blown off by the agency and i asked a few about that. you said you heard about it.

have you looked into it to see what's going on? can you follow-up on that last conversation we had about those complaints? >> i am not familiar with suggestions or complaints or concerns that have been raised that we have not addressed. >> one was a quote that kind of blue me off and made others that implied they were not being taken seriously. you said you would look into it.

do you agree with that statement or have response? >> we are certainly still learning about ebola and the best way to fight it. that's a critical component of activities and a component of the emergency funding request as well. is it still going on and you think it was being under estimated and not being under estimated to that level? >> the cdc publications estimated the degree of under reporting could be as high as 25 back over the summer. our sense is that is likely to have decreased in areas.

including systems to track the disease and they don't have a place to come in. they are less likely to be accounted for. >> is there new conversation that we had especially the white house about what has been talked about by a lot of members having a travel ban for those having direct contact with people in west africa and come back into the united states to have them to make sure we didn't come back with ebola? >> my top priority is to protect the american people. i have said and others have said that we will look at anything. we don't want to interfere with the system that allows us to

track people when they leave and arrive for 21 days after at 100% follow-up for most people who come into the country. if we don't have it, it could result in a greater than a lower degree of risk. >> let me ask you about ron kline. we did ask that he participate in this. he is designated as the ebola czar. have you had contact about strategy and how to deal with this? >> i have frequent contact with him. he advances. >> the two had disagreements on how to approach this. >> we have not. if you felt he ought to go that way, is there a hierarchy right now? >> he has been clear and

specific decisions that are at the cdc. >> i appreciate your questions and answers and thanks for coming in. >> thank you to our panelists for dedicated work. we heard that the key to keeping the united states is to e raticate them at their course. while we had early indications of momentum begin to emerge, it seems as if the situations in sierra leone and guinea are not showing the promising signs. what additional resources are they doing? >> the emergency funding is essential to our ability to protect ourselves here at home an