we have 14 or 15 counties that are free of ebola for the past 21 days. some have gone 42 days and some have gone in 60 days and some have gone 90 days. some communities have gone more than 95 days without a single ebola case. this morning i read a report that 14 counties are still free from ebola virus disease. we have transmission taking place on a weekly basis sometimes three cases or two cases but what is important is one single case of ebola is an outbreak. so the fact that monrovia is reporting one or two cases we are not out of the woods yet and in fact also new guineans sierra leone are still reporting a huge

amount of cases. we hope the three countries can get to zero at the same time and then we can celebrate and say okay ebola is over. after ebola is the rebuilding of the health care system. why ebola in the first place? it's because of the weak health care system. it's because of lack of equipment to support health care system so we need to build a health care system not -- and then we can build they were selling at health care system that we can stop not only ebola but other epidemics in the future. so this is the role that we play play. now we were into phase two of the ebola outbreak. phase two had four strategies. the number one strategy is to

continue community engagement and social mobilization. the number two strategy for phase two is the rapid isolation and treatment of ebola. that is the right strategy. what we do if there's a hotspot removed the cases to the etu and give them care. number four is real-time contact racing. that is making sure every single case the contacts are 100% making sure we are getting all the context or treatment early and number four in face to degette's 20 is the cross-border initiative. where we can have synergy in our interventions and have the disease under control.

the international work and the great help we got from our international partners and the united states government the major -- that would happen in the guinea and sierra leone is our international partners. by the time this thing is over to jump on an airplane and move to geneva and washington and new york and leave the health system and help us to build it would be the worst mistake. ebola is i said earlier is not only a west african problem. he can have an effect on other parts of the world so we should take that very very seriously. as i listen to "cnn" and the bbc and the news headlines what you care about now is the syrian war

war, terrorism and we are not hearing about ebola as we were hearing about a poll in september, october and november. that is also in effect because it drives international support. so shoe we should maintain our focus in the region and ensure the great help that we got from the international world getting to zero in these countries should be maintained so that we help the national governments through budgetary support to make sure the health care systems, make sure that our government the major priorities of madam president sureley

agriculture, education, health care and better living for the people of liberia. thank you. [applause] >> thank you very much. >> this week we have discussed earlier this week president obama spoke publicly after leave wednesday afternoon to announce that the u.s. response was entering a new phase that our military would be facing down to a residual force, residual presence of about 100 troops. it had been at its peak at 2800 i believe was the number. ..

you see the vastness of the response. and then congress came forward and made an

emergency appropriation of 5.4 billion, 3.7 of, 3.7 of which is outside our borders there is a focus on building capacity, building health security capacity, helping in the recovery strategy. at least for the next few years there ample resources for. spending is smartly and wisely is going to be one of the challenges, i think that we face, but we are an unfortunate position. there is always the danger of the emergency phase of the threat and interest fading and you lose the commitment. so howdy so howdy to love having you here reminding us

of this is important. some of the pathways have been laid down. if you could say a few words and reflection specifically about the military engagement and what the significance was in your mind of having the commitment on september 16 by the pres. of up to 3000 and 3000 then having the employment that followed soon after. >> thank you. i think my reaction to that i think the military met their goal. they were able to partner very well with our armed forces of liberia and give them capacity building the partnership to build more than 17 in bullet treatment units. the military did give help

with the laboratory testing. the turnaround time for my less than four hours. the results are available. logistics moving around during the peak of the outbreak. so they met that goal. scaling them down a very good time but we have -- and what i do also no, the need to have more cases. in opportunity to get that kind of support. but i think the requirement the goal was met. we worked together closely

to get the bullet treatment unit built, give logistics out there make sure the system was strengthened commit build capacity. >> you feel confident that today you have through the incident with the oversight of the incident management system, access to sufficient ambulances and laboratories the isolation and containment, the case investigation contact racing teams and the data coordination. that infrastructure is in place. nice to be sustained and strengthened and come as you say, within liberia itself the biggest immediate challenge. >> right. the capacity is there. we can respond effectively at any time. every county has a

well-built isolation unit 2nd to last. every county its own in bullet treatment unit. so if they're were any resurgence in any given county you have at least 50 to 100 beds isolation unit accountable. better pre- position our labs at the regional level there were nine labs that have been placed in the regions so that we can have our technical capacity. it does not affect the contact tracers. committed to committed to

help volunteers, some of the active case moving from house to house looking for contact, social. the other thing is how we leverage the resources, the ball response what we need to do now the process is going costing detailed plans looking at the facilities and how you leverage the resources. support the health care system. yesterday i was at a blood bank trying to talk to our colleagues there are the resources to raise our healthcare system the

additional resources to support the health centers. the human resources for health is a critical challenge. we lost a lot of our health records. the confidence in healthcare system has to be built so that the people have the confidence to utilize the health care services, and by doing that you have to train more positions, positions, trademark physician assistants, trained nurses midwives, even we still have not gotten to the level yet where somebody can walk less than one hour to get to a healthcare facility. with those kind of systems you need your military health weapons to regional the last path from preventable diseases and improved human resource for

health capacity strengthening infrastructure supply chain and all of these. but how do you leverage now these resources to get the health care system? and the united nations has also been very, very much. i what time the united nations vegan and ebola response. we think that was very much useful. the national partnership. >> can you say a word about two issues? first is the regional context. trying to figure out how to coordinate and knit together

prefecture districts on his large border areas where they're are huge vulnerabilities. as she moves towards zero the bigger regional context becomes ever more important in understanding and beginning to get a better understanding and control over that. your president has been in the lead and trying to stir action in that area. where is that leading? >> has been on the minds of the president of liberia. liberia. she is director of the technical team leading a response to give support to the rest.

our healthcare workers have been mobilizing to support sierra leone so that we can get to zero. we have one of our counties neema, got 62 days without ebola. but then across the border you have a town called lola very active use transmission. answer somebody left traveled. her parents and emma. got infected. similarly in the area people

believe. right now we are very much concerned more than 90 days. it's very critical. to address that were working a three-pronged approach. the community engagement working together. the president working very closely together with a regular summit and gave us the support of technical people to move across borders, move interventions because if you see right now

liberia alone, all of the counties along the border area where ginny and sierra leone there is no ebola transmission taking place. but across and ginny their is active transmission still going on. areas like -- our last count knew the border the transmission of disease. grown over 25 days. and then transmission. * concentration is how can you go close to the border cases that you can bring across from liberia, given liberia, given treatment in our treatment unit, make our case files our contact,

community health volunteers, community, community engagement, that kind of collaboration with any liberian cross-border support is part of the intervention. so were working on that very closely. >> can you just say a quick word about the field trials that are beginning? the vaccines in particular but they're are also a lot of work going on in therapeutics. the vaccine peace it's historic, moving ahead at a very rapid pace. there are a lot of questions around this. can you say a few words? >> and liberia it's good you put me in this seat because back home i am always also in a house seat trying to give explanations to the public about what it's all about, what about what we need to do about that, why at this time we

carry on vaccine trials, but basically we are going to make history as a country to find a permanent solution for a bola. and this is not the 1st time liberia is making history in the global public health community. and community. and liberia we were able to carry on research for antipsychotics. we get 19 countries using this treatment for antipsychotics in the region and the highest burden of a bola. so it is very much important for us as a country to find a lasting solution. the lasting solution for my

public health background is immunization, the gold standard for prevention. immunization has immunization has made us in the world to eradicate smallpox. my professor and myself were in close discussion. he led the global efforts to eradicate smallpox in the world and in the who global effort at hopkins. in a word we were -- he was one of my professors. this was another. and we eradicated smallpox because of vaccination. today polio is also on the verge of eradication. we have three countries in the world that still have an active till -- active polio transmission. nigeria is one of those. nigeria is doing very well now. pakistan, somalia.

there were a few years to eradicate polio, and this is because of vaccinations. in our program we have nine different antigens. and the reason i'm giving you this history is for us to have the confidence. my clinical trials for a bola vaccine on the way right now and liberia to go ahead and for us to be hopeful that we can have a vaccine this year a promising vaccine for a bola. so the two different vaccine trials, the trials, the placebo has already started and liberia. we had a fight at one of our hospitals. before i left liberia we had

about 80 persons enrolled already in the trial. trial. by the 1st of march we we will have 600 more enrolled in the vaccine trial and monitor the situation. 70,000 people to study. and this is under the of the liberian government the ministry of health, the us government, national institutes of health, and the liberian government liberian institute of biomedical research liberian institute of biomedical research carrying on this partnership. we are hopeful that this vaccine works and we can have a a lasting solution for the rest of the world for a bola. >> thank you. let's moved to our audience. >> and for trials, trials, i started. so we hope to go along have therapy and vaccines. work by the end of the year. if we can have a a vaccine

that i think we've made significant progress. >> thank you. we're going to take a number a number of comments and bundle them together. we have about 35 minutes. we also we also have a number of people hear who have been working very actively in liberia and liberia, and i would like to here from them. could you bring the microphone? introduce yourself and be sustained in your comment or question. >> thank you. good morning. >> introduce yourself. >> and jacob hughes with hdi a program manager is the

deputy for the incident management system. the presentation was enlightening about the different experiences that the liberian people have endured. as we move post a bola and do it to strengthen and rebuild the health system i wonder if you could share with us what you think are two or three of the key lessons that must be incorporated into the strengthening of the health system to help prevent this in the future. >> and he thought? 's okay. sir. >> thank you. i work with the president. i just wanted to thank you for your work. your success was shown by the fact that the people are wondering what there going to do.

that speaks pretty well of your success. you did a great job. thank you. >> thank you. >> good morning. i am a physician at georgetown university. honored to be able to work in monrovia. november 14, and prior to that and sierra leone in august. i would like to thank the minister for making time to come to the united states from liberia in the midst of the beginning of the vaccine trials and so much of the work he has been involved with. i really appreciate also you mentioned a shocking number of healthcare workers and liberia have been infected with ebola virus. in fact who this week their weekly their weekly update around 830 healthcare workers in west africa altogether you have been infected with the virus in almost 500 u of died.

i wonder if you could offer suggestions or ideas for how perhaps the region and the world could have helped more in terms of providing healthcare providers to take care of so many patients and liberia and in the region, particularly as you mentioned during a terribly dark day july, august or september. >> down in front. >> such a dynamic recount of the ebola outbreak and the multinational approach by the people of liberia to get us to zero. and so i i commend you and your team on the work that has been done. i am faith cooper. i am actually an independent

consultant. a couple of months ago i was with the department of defense health expenditure that implemented the us disaster preparedness program. i was there in april 2014, not necessarily related, but we were working with the government. coincidentally working with the government to help in the development of the national pandemic preparedness plant which was supported by us disaster preparedness program. my question is is one, my observation at the time while i was on the ground the behavior of our people the liberian people. they did not believe that ebola was real. that cause a spike in the disease. i am i am interested in hearing about their approach now moving forward and i'm glad you touched on the regional capacity building because ultimately that is absolutely important for the region. the economic community of west african states mandates that all of the 15 member nations at had some time must have a disaster

management organization independent that oversees disaster management for the country. we were moving toward the progress. how will this experience and liberia contribute to the establishment of that entity's that we will take responsibility for disasters in the country? >> one more additional question in the back. we will come back to you. >> hi. i am with the emergency management association. she summed it up in terms of the disaster management, the emergency management network guinea, liberia, sierra leone, the west african nations, that needs to be established. i think that was outstanding, setting that up the coordination with the stakeholders, and that we will be a a key to rebuilding your healthcare structure especially from

the committee level and i want to commend you for the work you have done. one of the things that he mentioned with the response to that command usually response worldwide, how our volunteers get reimbursed. i think you are leading toward that. we discussed that. i did not did not talk to you yesterday, but you mentioned that those plans you have in place, you are at best days to build. that's all i wanted to say. >> why don't we come back. back. we will do a 2nd round, i promise. >> thank you. these are very, very critical and important questions that you all raised. i'm happy to touch on the. the issue of post a bola lessons learned very strong one of the lessons learned that we need to take them to

rebuilding the healthcare system is the issue of itc the special prevention and control. we need to have prevention and control champions, all of our healthcare facilities. we need to have people ees in place to make sure that we train every healthcare worker to use the prevention control materials i know very well that the number of healthcare workers the died liberia did not die because they were providing services individually. they died from know more healthcare facilities clinics never giving services. these are real specialists some of them that died in major hospitals. and and so special prevention control is very very key. and then a lesson learned.

we need to improve the issue we need we need to build a real-time surveillance system that would track every single outbreak, every single infectious disease every single disease of epidemic potential in our healthcare system. human resources, they're were a lot of healthcare workers that were trained in the ebola response. we use health volunteers that provide services, active case. how can we put these people to work for us? no more healthcare facilities. as one of the lessons learned going forward to the posted bola era always spend millions of dollars during the emergency phase of the

ebola outbreak. these resources need to have concrete support to look at the six critical building blocks of our health system. if we do that supporting our national health plant for national resilient health system plant before ebola we have it in your national health plant. we had an essential practice of health services, the roadmap for the celebration of reduction. for human resources talk about that.

you need to change real-time trainers physicians that have the skills to go in medical institutions. some of our professors. some of the medical teams. right now in our healthcare facilities. we need to give more to train our professional. provide them not only a the bow of the train them. behavior is critical. people die from the very beginning. we learned the hard way. a lot of people lost their lives before we realized.

play with there. so many times in that community. into the process. so military ownership and engagement is very good. the disaster preparedness network actually spoke about the overall working on that. the us department of defense their ministry of defense ministry of internal affairs trying to get a regional disaster network. the preparedness plant that we are working on. the ebola we need to concentrate. 190 percent of the tally

rates. the liberian situation so a lot of versus the got infected did survive. we have about 1,400 ebola survivors. .. >>

>> then it is the stigma. in due be assured ebola does not mean to be stigmatized. let there were 3,000 of them >> wells. can you talk about the income of the liberia

middle-class? >> we're very proud of the jobs hopkins care. [laughter] also mentioned the capacity building, but to dig down was the most pacific impact? that gave the possibility to respond as you have? where the weaknesses revealed from the civil war in health care initiative?

>> i have of the question regarding if you have any comments such as the forces and also with the imf and ministry of health to be excluded from the initial planning? >> repeat that one. >> with the ims they met in the did you were excluded. >> this was during the first week of october with the planning talks. >> to be and not included.

>> spin that was a very interesting sort of moment of evolution. we will come back for another round. >> i am with the defense department working on a surveillance program. acyl break started what did you find was the best message board disseminating information not only health care workers but to the general public and how deeply and to provide information as we approach? >> we use multiple channels of communication. at 1.we reusing radio communication ebola is this or that door this is how you

prevent it. but at some point when you have entered personal control and interpersonal communication. so the ipc played a critical role. >> but first of all, the solidarity event communities got the information with the orders about what a disease. was printings of fliers of

the health care workers with community engagement and town hall meetings but it is very much critical. they can turn the tide by themselves. there was a time when they had to put their own roadblocks that they would amount to quarantine to get you to the health facilities so that information was also critical. security quarantine did not

work well. angela with the process of liberia. so it changed the strategy. to be policed by security personnel. and then they started to see a great level of improvement. but then planning as the u.n. agency but what we did with the planning meeting was over from liberia in an

old debt very, very well because we work together but that was set a council meeting the call that the presidential ebola council and that was presented to the president. >> with the health system we

have a strong system the coming from all the efforts were the supply chain systems to train medical doctors so there is a lot of work to do with the house when -- with the health care system. when a lot of strange people knew what to do. but they already started.

within the car spun dash the care started to bend. and get help to deal with the situation. >> we have a lot of hands up the we will start at the back with the two gentlemen there. >> thank you for coming. and i want to mask about the mix of the implementation of the response one being coordinated by the imf and the government and the other with support given directly to the government to implement its self. something that we thought was interesting is how it

was very mixed with its approach and i wanted your thoughts on bull's-eyes of the clinical side. >>. >> i am the director of the new program called prepared this and response. we're focused on looking at emerging imminent threats and of course, ebola is one of those diseases. with the post he below world in liberia, what approach busey taken for the preparedness of response that may be of an unknown origin? >> i was wondering if you

could talk about how women and children were uniquely impacted in what planning you are thinking about going forward? >> i retired for health service officer. have a of a couple of quick questions. one is the response of liberia seems to be different from mobilization in and communication and jihadist experience with key as well? and valued the more effective and the second question that we have seen

some reporting to say that it was late. in from the perspective on the ground. >>. >> i was just wondering if you could speak to the private sector response in terms of the ngo nonprofits and how of a did they respond in what type of partnership at uc and what would be you like to see from our of the private sector? >> thank you for your time and prospective for our work

at the national institutes of health. could you speak more to the psychological remnants of the scare in your community and the workers and more upon the experience of the fear and anxiety that the united in your community with the outbreak in other ways you have learned to incite hope. >> thank you. the coordination of the response is very interesting. one strategy, one program, one response. so all of the international partners the message was one response, one strategy. under the leadership of the

president the president got very much involved. we saw that uniqueness and togetherness of the government in the people. so she did in power the public health experts who work with international police to deal with this situation for are the very beginning it was difficult and a bit chaotic because this is a public health crisis. so it has to be dealt with by the minister of health in liberia.

the government did realize that to permit the of the minister of health in charge. so we develop that market area that i mentioned with a social mobilization all these areas so the issue to put cdc in its lot. but also a meeting with the imf said what happened.

to have the resources so with the social globalization with unicef to say the mobilized resources could mobilize but the critical issue with the imf meeting. to have those jubilee units so the cdc is also in charge.

but that is out of the cohesiveness of the response of one strategy and how it is chaired so regarding the played with a boat tour the vehicles so with the correct support because you're held accountable. >> we didn't have the resources from the u.s. government so to feel they are implementing with those dignified barriers. international federation of the red cross and of the ngo

usaid play a very critical role. and then to establish their teams. but then they have to answer but why aren't they doing this on time? >> did he say get works very well. respond with the lessons learned.

working with the international partners again. to have an agency called the foundation now with operations central to liberia but we are working with them to bill prepared this and response. we are leveraging to rebuild the health care system. is fairly highly effective. and very much moving flying from liberia into china in into the region in kidney and ghana it into the market

of liguria guess what happened? with that ebola crisis because everybody was afraid of ebola. in venice some point that it made a social impact. but many died. that is a critical problem. working together things up are working very well but

also that others are hurting from and the fact that there is pressure from guinea to put pressure on organizations by supporting this country. so we're learning from each other to move forward. and also working together not with force. so with the education he cannot do it. but u.s. response that the entire word came late.

but it came very late to the crisis. the entire world. that is one of the lessons until the global health community. and if it is in southeast asia or europe or america. to develop countries and then that we knew for the first time this is the population.

sova whole world is a lesson learned of the have a discussion end of message to all of them but they came very big. united states government caved very big to the rescue. i am very optimistic because of the support that usaid was there.

that was done in march or april. with 8,000 lives in the region. but they came huge and we appreciate that. >> that is a very resounding compelling conclusion to the 90 minutes together this morning. thank you so much for being so compassionate and candid and details to take on these issues with such clarity and a sensitivity. kenneth a. . . the leadership that has been sustained over many months. your contribution is enormous and the story that you tell is positive at the end of the day.

of 84 being with us. congratulations. [applause] [inaudible conversations]