a fact of life in iraq. they do recruit. philip, for your own amusement -- [inaudible] >> but they do exist. they will be part of the political structure. i am not so confident they will be 10 feet tall however particularly on the political front because all of these groups, they are normal groups. they have competed in elections before. for those of you who have forgotten that the elections just a few years ago hashd al-shabbi had an edge. hezbollah, all of those groups competed and they did not do very well. we have to be realistic.

.. the final death sentence for those groups in those areas. those groups tend to overplay their hand. they have to be careful. they have to be very careful about how to act. i do not to mention the role of

-- and reining in those groups, maybe not militarily but he still very influential. you don't want to cause trouble and you don't want to be direct enemy every day because in iraqi will come out on top. it's very difficult. and, finally, i don't think there will be a hezbollah anymore. i've heard different metaphors about what will happen at right. somebody told it would be like libya with different groups competing. i don't think it will be that. there's a safe structure that those groups out to be part of protecting. it cannot be like hezbollah for simple reason, it's different kind of threat and different groups. hezbollah was only dominant group in lebanon during the lebanese civil war. in iraq of all of these groups. you have 150, eight of them are

really big. we have to wonder which one will be the biggest group. i don't think any of them can. and, finally, from a military perspective the events in iraq to spell isis many areas i doing this but many of those groups will be called back to syria by the iranian government because the syrian government is suffering militarily and those groups will be needed to shore up the syrian government. so with that ladies and gentlemen, i look forward to your questions. thank you. [applause] >> just to kick off the discussion, just ask duke lacrosse and and if you could respond very quickly am actually don't respond to both just pick one i want to get onto the audience. first of all prime minister abadi figures almost, was

completely missing in the discussion today. i'd like to ask how does he relate to the popular militias? what's the role of nouri al-maliki? and has he been do they see this as base of support? how does abadi fit in? is he totally out of the loop even though he is commander-in-chief of the armed forces? made i will ask mike unmilitary. given the weakness of iraqi security forces and the fact that ahmed said popular mobile station force or effect of life how do we work with them? we made a distinction between those under federal government control, more directly under iranian control. philip come if you want to weigh in. is that more a fiction or is there just a fact of life went to live with and the fact of the

matter is they are under the military chain of command, or are they really under iran's chain of command? we have to find a way to work with because that's just a fact of life. why don't we start with ahmed speak with take both questions is because be quick. >> let me talk about the chain of command. the chain of command is certain that the iraqi government. that is a big problem because in any country if you just have armed groups that are not responsible to go but but i think his engagement in iraq even more so. therefore, the prime minister will have, he has major responsibility to take control of these groups or at least try to manage them. sometimes even though he doesn't fully control them, i've been very intrigued by two developments. in anbar the u.s. reportedly

advised the iraq government -- the iraq government did it and the armed groups giunta they can do it on their own they can go and no one can stop them. they didn't actually do. secondly the same issue happened. it was the u.s. condition and clearly a prime minister conveyed that message and those groups did not go. it's not a matter of completely they can completely go around. a. giunta take into account these things. prime minister maliki is working very hard to capitalize to become he says his the founder of the pm use in many ways. he might actually be right because in october of 2013 i remember writing a report that there was an effort underway by the iraq government to inform iraqis you armed groups to defend baghdad.

it was called the baghdad division to keep go back and read it, or ask me about it later on. that effort did not materialize but it formed the basis of the pmus. the big difference between that time and is very clear. it is not in office anymore therefore he doesn't have the same control. they don't need them anymore really. it is a relationship that they will seek to capitalize somehow. >> i will try to answer the last question regarding most of that one where the iranian president is that i would disagree with you ahmed on one piece. you brought up the creeds were a number the iranian backed shia militia supposedly stepped down. so what did they do instant? that other groups which were

less known to western observers and also the iraqi government. in one of these articles they said this group, it has less connection to the iranians. meanwhile, on their official website this is where believers and absolute life the commander actually was in iran from a splinter group and he fought along side with other forces. epc shots of tikrit, that's a shot at the groups. they've done everything in the power to undermine when they're given a chance. i'm not going to say they do it all the time but if they're given the chance they will take it. but beyond that if we are looking at these other groups, i know you bring up the fact there are other shia militias which do not adhere to absolute -- they do not adhere to the iranians want and that they are some lesser strings that are there. i really, every time i try to

find another one one of them and i see condemning his party jumping immediately and co-opt them. they are very, very smart crafty. you guys want arms? advisors? this that? it's a problem for the united states when we look at this. we are not jumping in. we are not taking advantage of what could be an opportunity to use. the vast majority of organizations, the big seven these groups are not all that new. save for maybe -- if you're counting it. even that one has a strong amount of iranian influence. they are running many of the training programs. they are setting up with encoder setting up these apparatuses to try to do these apparatuses to cut into the trickle-down will down will filter down sort of ideology. it's a worry for me but it don't want to leave it there with this kind of sour taste in the mouth thing just give it to to ron that's it. most people who join up they are not join because they want

to fight for khamenei's is long but -- islamic government. they are being co-opted and being brought in under these are gross and it's very, very hard or anybody to really do anything to change that sort of equation. >> normally i don't talk too much anyways, but philip is right. those groups, i will go even further. when they stopped, seized their participation in tikrit they were the first group to go into tikrit. that's what they do. i want to claim credit. you do have to look at or at least what i look at his you have two groups -- i think when

you go there, especially those relationships that are all intertwined. that you forgot we talk about -- [inaudible] so i'm making a difference essentially. i'm with you. those groups want to claim credit as much as possible. >> two sides to this. one is this idea of think the critical thing is command and control. involvement of various pmu composed, our ability to control which pmu composed are involved in operations is probably somewhat limited. and our ability to tell good pmu from that pmu is government officials say behind closed doors, it's probably pretty limited to some extent. the question is not who's involved, but it's not a commitment to of the operation is handled and it's how people

behave in combat. so we shouldn't try to put a blanket ban on the involved of groups because it's a variable we can't control. we don't know if we are achieving the objectives we are setting. so that's one thing. the second thing i was the on abadi. i'm interested in the idea of sunni units but it's been coming for a long time but it's been all over the map. everywhere, the units have been popping up. eventually little unit become something significant when you do it enough. i think it's a great idea to be honest. the national guard model that i was very keen on is probably going to be significant problems getting through. we have an institution that is up and running. they have a lot of reputation in

iraq maybe because, become something prosecuting to maybe more sunni leaders in a sort has begun to happen in a little way. i think i'm with prime minister abadi when it comes to square the circle with what do you do? create a totally new slightly alienated institute national guard, try to squash they mobilize them. or you could just take make what we want to be. some aspects of that. that's on abadi. the final point command-and-control is important to our ability to provide airpower is important or that's another real tangible thing about how we work with pmus in iraq. and realistically the only people we are providing great erica report is the kurds and that's not just because we love the kurds. it's also because you can deploy

the traders special forces to say confronted in iraqi kurdistan. the front lines are relatively static so your special forces can go in place in case his position and take it out from the safety of the very well secured area. and the peshmerga are not threatening to kill us which some of the other units are which is a bit rude. [laughter] so take that into account. we are not our challenge of providing airpower and environment were bad pmu's operating our first challenge is let's provide some effective airpower to the federal iraq anyway because yesterday we did 10 airstrikes which is ridiculous. so until we can actually put down special forces and commit some serious airpower, the issue of whether not we're helping any bad pmu's the second of because

we were not helping anyone. >> we will start taking questions. i will take down your name. we have right there in the middle, please identify yourself and make sure to wait for the mic before you ask a question. >> i wanted to build on that last comment you made michael with my question which is to carry the question further. obviously, the big debate in washington is politically about iraq is whether the obama administration created a vacuum in its claimed withdrawal, and whether it's not too late for the u.s. to get more robustly involved in the form of special forces presence more frontline special forces present airstrikes reactivating our intelligence network, all about. the blunt question is and each of you could add to this this that i know this is hard to say because each of you are not a military expert, if that's true is it a

true first of all is it too late for the u.s. to get back into basically reduce the influence of iran? secondly, what would it take to do that in terms of what we would be doing better and so on? >> it's very important to know that the u.s. at the moment has more influence than it did four years ago when there were 50,000 u.s. troops. it's very simple because the u.s. deploys hard power. the u.s. when it objected to the leader become matters of injury, he did not become minister of interior. i know philip phillipa call me out on this so let me agree, he still has a lot of influence but he did not become ministry of interior himself but i think what should happen is a robust

u.s. air campaign, an expansive u.s. air campaign. it is done a great deal of difference for the peshmerga because the peshmerga are committed and to fight and michael is correct. m. and i were in iraq at the same time having conversation with different people back in march. it's very much critical for the u.s. but because the rules of engagement that the u.s. has said are very restrictive, it is not easy to do. i was reminded recently that back in 2006-2007 when there were 35,000 euros soldiers been on par for example the u.s. conducted 300 airstrikes today just been in basra, southern iraq. because you had spotters compare forward control. that made it easy. so if the u.s. is able and feels

that it is safe for your special forces to be on the ground providing coordinates the u.s. airstrikes i think would be much easier but that's also difficult for some areas particularly and/or were it's not a particular environment at the moment. >> we have in the middle, there was somebody -- okay, go over here. [inaudible] >> if you could just wait for the mic. there's a microphone right there. >> thank you very much. brigadier general from iraq. while we are dealing with an iraq, this is an iraqi perspective by the way, because we are dealing with two critical serious threats in iraq. one is more priority than the

other. what we have right now is a dire situation that we have to deal with is isis. and the second which has been postponed until the juncture of pushing isis out of iraqi -- that is when the shia militias, pmu's will be prevailing in iraq without reintegrating them in national security forces, which i am very thin of mr. knight that we have to reiterate an empty national security guards in the future. i assume that one of the most interested american interest from a strategy to drive isis out if you have an iraq table consistent as well as having

sustainable government that could empower themselves and rule iraq towards prosperity. but i'm really cautious to understand why american strategy is so cautious to not engage with respecting iraq or remain options. we don't have options other than bringing the pmus to the fight against isis. and i think this is the main priority for the strategy, for the coalition, to do the isis or to degrade isis. i understand this is for a sensitive issue that can bring united states supporting militias that backed by iran but, and i understand that it's

very important that any militia within build prosperous country. there's no doubt about it. so why, we are giving isis a very negative messages into times. the first time in tikrit and the second time in ramadi. and we are losing because of those two locations unfortunately. >> does anybody want to respond? okay. we have over here thank you very much for your contribution to we have right over here and then we will move back across, okay. >> good afternoon. thank you very much dana. i with the american university. can you all hear me? just making sure. isis spread to most is galvanized by sunni tribes and military commanders but were disenfranchised by the

government in place. how might the iranian backed iraqi government reintegrate archivists and i would to resist the isis, and should they? >> we will piggyback because we short time this say that thought and we're moving back. right over there. will do the next -- >> technical question. speaking about the pitiful number of sorties that we are flying do they count as a sortie if the plan goes in ready with a target that does not release its bombs because of the rules of engagement? is that counted as a sortie? >> yes, it does count as a sortie. i have been collecting statistics on how many sorties come back with weapons on board without having released been. >> indie media they been saying

about three quarters. i don't know if that's true but a big part of the problem is hard intelligence capabilities are in afghanistan helping gather and as a result the effort in iraq is underresourced from the point of view. we also the question of the sunnis i think. >> i'm not really in the business of giving advice to giving us on how to do their job but i mean come on both in terms of trying to win over sunni population, for starters one companies to be cash. let's be honest. you need to pay off fighters. you need to have a willing populace to join a. i'm not saying there is not a good amount of anger within anbar and within a lot of the tribal groups. but there's also a lot of anger towards those militias and it's still there. there was a misstep in anbar where the governor was pulled out. that doesn't send a very good signal.

it just doesn't send a very good signal in terms of trying to open up to a sunni populace. sometimes you need to give a little and then you can take. i just don't see enough of that. at a don't really see it from certain shia militia groups, primarily the iranian backed once. they will put the canvassing hey put the canvassing a taking a 500 sunnis joined? but meanwhile they will still engage in the same nasty behavior the same kind of ethnic cleansing, the same sort of activities that don't live in a populace over. i think their strategy to the way a tactic the way to do it they smashed entire blocks. they are not doing targeted strikes. they are marching door-to-door and this is what they were doing. things like that are not very good. i'm icing at the shia militias during that? know, but those groups, iranian backed groups it engaged in a lot of bad business spin we have time for just two more. i will piggyback them.

abe, right of your first. >> thank you. hudson institute. it seems that he plays a very important role in an potentially rainy in the kind of iranian influence over the militia that you would see him say lebanon someplace like that. that raises the important question, how well do you think we understand in the government and just in washington community generally, how the process of succession will play out when it does point out? one dozen of of course but ayatollah, the ayatollah is not a young man and that would seem to be a major important point.

and i assume the iranians are very well informed about what goes on in have been working at it. i'm just wondering do you have any sense of how much we understand how does process would actually work into the candidates might be? >> we have one more question in the back. all the way in the back. thank you. >> thank you very much. i with the foreign policy institute at johns hopkins. a couple of comments or maybe one in 10 a question. on the cleansing issue i would urge you to reconsider the word because when we talk about cleansing, one ethnicity drives another away. and what happened with people who -- even in areas, ramadi where did they go? they went to shia cities to i dined with them actually recently the antidote cleanse

people -- yes, that was cleansing in isis area. either they were killed or they were driven out. they have 189,000 iraqis supporting. [inaudible] so cleansing i think is not correct word. the other one is talking about iran does was the psychotropic here's the story from inside. you go there like i did and speak with him. there are two kinds of people. if either within one second because this is important for everybody to see. the are the turn 11 and these are the names if you to talk about -- et cetera come a single

core that is standing core of those forces. whether there is a war or not. they will be after isis is taken up the these either the and these are not more than come into hundred in each one of these organizations. and then the kind of government that is the huge number for taking huge relatively speaking, the people joined after the that while. these are people have nothing to do with iran or nothing to do with even those groups. they wanted to go and fight. i was there when this sort and they could not find a government that would take them. they go to these basis katrina does not given a bottle of water waiting for them. they went to the structures that were already there, really co-op and they were welcomed. how did they choose to go?

simple. they go to the one that is having booth of volunteers that day. those are the ones that they can send to fight with the stroke of the pen or can bring them back to their homes with the stroke of a pen. so if he does not quit any of those united states to say -- hash'd sikkim and as people find themselves fighting for a couple of hundreds and i will be the kiss of death for the. my question which is really to the panel is this. all of this debate is irrelevant from an iraqi perspective as ahmed alluded to it. iraqis it is either these guys are isis. with isis i know i will have my head. this is not just about of the kurds as well. we've seen that and also a lot of sunnis in the sunni areas.

it's more than 90% of iraqis. and the question you if we were to sit and say these are bad guys, many of them are bad you don't get into a counter argument can what is the alternative? mr. abadi told them not to interfere. at the end of the day the military and the police forces left the equipment as a gift to isis and went back and said kind of them please. so thank you. thank you very much. >> do we have on this last point anybody want to say anything? >> i think it has been a concern for a long time. i don't know of any candidate. i don't even know if there's a discussion underway, but you're right the grand ayatollah is involved in many ways will be crucial to see who will come after him in the event he is not here anymore.

>> i'll comment. out and a little bit about that. the main question was doesn't the american government have an idea competitive talk to all that many people in the american government, but i would say no. i mean, i am actually more i am a firmer believer now that they are pretty intelligent about this big we worry. i'm quaking in my boots was going to happen when he dies? the last time a member the same discussion. who would take over? all of us in which i got a wonderful he is. i think there are mechanisms in place to allow for succession for somebody who may not be of the political company not be with the iranians. i don't think ever in a really going to hurt the. however, we were talking about hard force, have because iranians have the pockets on the ground they have presence

combined with they've used a proxy before to knock off certain clerics they didn't like. i don't see that happening now. i think the risk is too high, but you never know. that could always come back up again. >> you've got the final word mike. >> in iraq today we all know this but there is a lot of hate. there's a lot of hate of the iraqis towards each other, but is also planning a lot of hate, for instance between the u.s. and some of the iranian backed groups that killed so many of us. they hate us right back. but as well as there being a lot of hate there's a lot of need right now. i don't think we need to convince anyone in the sunni community and the iraqi government to accept u.s. air power, u.s. help anything like that the there some special groups that don't want to get involved but for the most part if we get support that support will be soaked up like a sponge. it's just we are not getting it.

going back to the first question about whether, wealthiest should do we should do something like operation viking hammer back in 2003 when put a special forces group to support the curtains across the northern front in iraq. the fact is we've got the capability to do all of this stuff and we've had it since 2011. we've had it since mole cell bill. with addison's ramadi fell. the shortfall is our intent. we could do more if we wanted to do that you would be hard effective it would turn the campaign around in the iraqi factions would accept that assistant. we've got more coalition backing can we ever did have back in 2003 through 2011. we've got big australian, new zealand special forces group said in baghdad funded the we have canadians on the frontline and none of this stuff really was there in the same way back in 2003. wmd did not exist but isis does.

we should be thinking of this as the same war that we left. this is a different port and we need to get in it. >> let me thank you all are adding a lot of clarity to this debate, editor we will be talking with us again in the future. thank you. [applause] [inaudible conversations] >> tonight more booktv in primetime with our coverage of past book festivals from across the country

>> this week on q&a our guest is a two-time pulitzer prize winner david mccallum. t-shirt stores about his new book, the wright brothers. >> he didn't even graduate from high school but that was because of their father always encourage them if they had some interesting project. he would say stay home and do that. you don't have to go to school. he knew how bright they were. wilber without any question was a genius. orville was very bright inventive, clever mechanically i didn't have the reach of mind that wilber had. they love the music. they love the books.

nathaniel hawthorne was orville's favorite writer. catherine loved sir walter scott. on one of her birthdays the brothers gave her a bust of sir walter scott. here are these people living in a little house in ohio with no running water no indoor plumbing no electricity and they're giving a bust of a great english literary giant to their sister for her birthday present. there's a lot of hope in the but i think what i would like to get to know even more about was the sense of purpose that they had. sounds like a bad pun but high purpose. but something ordinary, big idea. we're going to achieve this big idea. nothing was going to stop them. >> sunday night on c-span's q&a.

>> the heritage foundation hosted a discussion about the u.s. military effort to prevent the spread of the ebola virus which has killed more than 11,000, mostly in west africa. three army colonels working in public health took part in the discussion. it's an hour and 20 minutes. >> good afternoon come welcome to the heritage foundation and our lewis lehrman auditorium. we of course, welcome those who join us on all of these occasions on our heritage.org website. would ask everyone in house if you'll be so kind to make that last courtesy check that your cell phones have been turned off, always appreciated. we will of course post the

program on the heritage home page following today's presentation for everyone's future reference come and our internet viewers are always welcome to send questions or comments simply e-mailing speaker@heritage.org. hosting our discussion debate is cully stimson. he is manager of our national security law program. is also a senior legal fellow in the kathryn and shelby colin davis institute for national security and foreign policy. he is a nationally recognized expert on national security homeland security as well as crime control. he writes and lectures widely on these issues as well as military detention and commissions come intelligence and criminal law immigration and the war on drugs. before joining us here in 2007 he served as deputy assistant secretary of defense for detainee affairs. he has also worked as a prosecutor at the local, state and federal levels trickiest served for three tours on active duty in the navy judge advocate

general's corps as well. please join me in welcoming cully stimson. cully? [applause] >> thank you very much, john. and want to welcome all of you to heritage on this is second at the summer, 2015. a couple years ago my colleagues at heritage form an ebola task force to look at the policy decisions and actions our federal government took with respect to the ebola outbreak. the task forces mandate was to identify and make certain findings on how the u.s. could better respond to future crises. they issued a heritage paper. these were scholars in and outside of heritage which was published on the 24th of april

issue. three days later we hosted a panel event entitled ebola outbreak and response assessment of initial u.s. actions. we heard from dr. daniel has new ski from george washington university peter pham director of the africa center at the atlantic council and their very own dr. john o'shea senior fellow, center for health policy studies. they shared their thoughts on state court in federal preparedness can the world health organization, or w.h.o. preparedness and process to deal with ebola. the role of u.s. doctors and the centers for disease control and other related domestic issues. but that's not the whole story which brings us to today's panel. i think it's altogether fitting that on the day after memorial day we highlight dvds critical

-- dod is critical medical research and develop role in fighting the ebola virus. theirs is a story quite frankly that is not well known and hasn't been well publicized. but one which is nevertheless impressive and was critical to stemming the tide. we have assembled leaders of four key dod organizations who are dedicated to protecting our warfighters and our country against injury and disease to include ebola. i'm not a doctor but as a 23 year veteran of the navy i have immense respect for what dod can bring to the table and almost every area of national defense. and i have followed the task force's work closely, and in civil society i happen to know one of the key leaders in the dod medical research field when speaking with him at a social event we thought that we needed

to tell dod's story a little better. heritage is delighted to do so today. the format for today's event is quite simple. i'm going to sit down and be quiet and going to turn to the experts come and were going to go in the order in which they are sitting. each will make prepared remarks assisted by some powerpoint slides perhaps. at the end of their collective talks i'll moderate i q&a. carmen spencer is the joint program executive officer for chemical and biological defense. and in a position to provide acquisition management and professional leadership on publics measure issued limited joint service chemical and biological defense acquisition programs. he plans directs and manages and coordinates the execution of that mission and is responsible for the development, acquisition, this division into

bona fide specialist and dynamic joint chemical and biological defense devices as well as medical, agnostic systems drugs and vaccines. he also revived management oversight of the chemical demilitarization program, and acquisition category one program for the assistant secretary of the army and army acquisition executive. tbc gives a degree from hawaii. colonel russell coleman ph.d come into the joint program manager of the joint project management office for medical countermeasure systems headquartered in lovely for deer tracks barely. he leads the dod or position responsible for the development of acquisition and fielding of food and drug initiation to put medical countermeasures to chemical biological radiological and nuclear threats. he is the author of over 85 peer-reviewed scientific publications and has been the primary investigator on nih come

world health organization in dod grants. in 1995 colonel coleman deployed to zaire as part of a w.h.o. team responded to an ebola virus outbreak and in 2003 he was deployed for operation iraqi freedom as the chief of preventive medicine section of the 520th theater army medical laboratory. in 2008 he became deputy commander of u.s. army medical material development activity. he was selected as the 10th commander of that organization in 2010 answered in this position until 2013. he received his b.s. in biology from the state university of new york. you can tell by his accent is a new yorker. a masters degree in medical entomology and a doctorate in entomology from the university of massachusetts. colonel stephen thomas, m.d. come as the deputy commander for

operations and ebola response management team leader at walter reed institute of, on institute of research. u.s. army medical research and material command. he also serves as the infectious diseases consulted to the army surgeon general. he is the chief operating officer for the enterprise which encompasses over 2000 military u.s. government, civilian, for national and contract employees and laboratory facilities in north come africom pacom. colonel thomas is also an internationally recognized urologist and vaccinology's and spent more than five years of his early career living and working in thailand and other areas in southeast asia. he has authored more than 55 articles and seven book chapters and routinely represents army medicines expertise by speaking at national and international scientific events. he said the expert scientific committees and boards for the

dod, nih the bill and melinda gates foundation, and numerous pharmaceutical companies working on u.s. military development priorities. he took his bachelor's degree with honors in biomedical ethics from brown university and a medical degree from albany medical college. finally colonel neal woollen, dmv mss ph.d is director biosecurity that u.s. army medical research institute of infectious diseases. this is one arm acronym i do not, usamriid. dedicate that right? all right. a biological defense laboratory that is part of u.s. army medical research and material command. during his first tour of duty at usamriid to participate in ebola outbreak investigations inside your and the thai force of the ivory coast as was and the outbreak investigations into studies in the northwest territories of canada and montana for anthrax plague and other diseases.

in 2010 he returned to usamriid reserve in his current position but also completing senior service college at the army war college. he received his doctorate in veterinary medicine in 1985 and a doctorate infantry pathology in 1989 both from kansas state university. he received a master's degree in strategic studies in 2012 from the u.s. army war college. mr. spencer, the floor is yours. >> thank you. >> first off thanks, cully for giving dod the opportunity to tell the story. that's kind of rare force but when you tell folks that your job in life is preparing the armed forces for chemical and biological and radiological events you're not the most

popular guy at cocktail parties. and most people just run away, we do appreciate the opportunity. our mission is pretty simple actually. what we do in dod, we develop a medical countermeasures to combat chemical biological, radiological and nuclear threats. the threats are real. when we look at the last four years and what we've experienced in global crisis around the globe, we've had three major events. in march 2011 at fukushima went three to six nuclear generators went down creating a global crisis. dod was a therefore the response. in august of 2013 the use of chemical weapons in the country of syria and the u.s. was called upon as part of a u.n. effort and in support of the u.n. effort and we destroyed those syrian chemical weapons. of course we are here to talk about in april of last year with

the ebola outbreak. then we had the dialogical. so three out of the last four years major global threats that dod has had to respond to. despite numerous smaller scale outbreaks we still don't know the origins, and natural vector or the carrier of the ebola virus. it's highly contagious on its own. we all know that. it is a pathogen that poses a risk of deliberate misuse with significant potential for mass casualties or devastating effects. that dod has been engaged in research and countermeasure development for many years, and during that time we've developed a number of unique capabilities. this outbreak though pose some new challenges for us. sierra leone, liberia and guinea and never experienced a widespread epidemic of this kind. moreover, the public health infrastructure presented

challenges. the lack of trained medical professionals was a critical problem. for example do with epidemic started, the cia reported that for every doctor in liberia there were 100,000 patients. in the u.s. that ratio is roughly 242 doctors for every 100,000 patients. the affected populations were large mobile and urban. local funeral customs included prolonged exposure to the infected pcs personal. -- deceased -- in responders are limited, very limited incentives for private industry to proactively develop response tools, whether their diagnostics can their tvs taxes or other related equipment. even with therapeutics and vaccines in development, largely with support from the u.s. government, the path to fda approval is somewhat unclear. no mass production capability for these materials is readily

available. and in the response dod did not leave a response. we are part of a massive hole of government response in support of it hold of government response but it really was a great example of the interagency working at pulling together for a common cause. our government is bureaucracy. in time of crisis it is amazing what we can accomplish in short order. this certainly was a time of crisis. even within dod to was a team approach as you see these gentlemen. not only was my office that is responsive for the likes life will development of these products involve but we also had medical countermeasures systems that leads the effort to develop and require safe come effective and innovative medical solutions. the walter reed medical army institute of research or rare

conducts research about that is responsive to needs and delivers life-saving products that sustains the effectiveness of all of our warfighter. and, of course, a united states army medical research institute for infectious diseases, or usamriid to its affiliate laboratory for medical biological defense research. let me talk for a few minutes and give you an overview of the response. the response was four-pronged. identifying the causes of aging providing diagnostic tools, treating the infected, and preventing further infection. the diagnostics therapeutics and vaccines and working protocols developed by the department of defense provided the core for this response. usamriid and r.a.r.e. and others partnered to respond to the outbreak. mcs under colonel coleman solution provided diagnostic by a surveillance efforts et cetera but production efforts. it also accelerated the

development of production of two experimental drugs that colonel coleman will discuss in his presentation. and lastly, mcs also funded clinical trials for ebola vaccines. the planning and executing of a safe deployment of u.s. forces relied on r.a.r.e. redeployment training and global bio surveillance. the results of the training speak for themselves. while deployed not an american service members contracted ebola, or for that matter, malaria, a disease which infected 44 of 150 deployed marines in 2003. usamriid supported training and consultation on patient care transport, and dead body management. they rapidly help fill the public health knowledge gaps in the outbreak a renewed in conclusion given the events of the last four years, fukushima, syria, west africa, we know these threats are not academic and the surprise is becoming

routine. preparing to respond to unknown threats requires massive flexibility. preparation from bio surveillance to intelligence, research, development, planning and coordination is key to minimizing or containing the next major event. the u.s. department of defense is leading the way in each of these areas. thank you again thank you to the heritage foundation are hosting this event and i'm really looking forward to the q&a period. thank you very much spent all introduced colonel neal woollen. >> thank you, sir. ladies and gentlemen, it's a real pleasure to be here with you this afternoon to be able to represent the u.s. army medical research institute of infectious diseases anthology about the contributions of that organization. i'm a veterinarian and currently serving as the director of biosecurity at usamriid and usamriid mission is to provide

solutions can provide capabilities to service members in the way of medical countermeasures to counter a bio threat. the hallmark i believe from this outbreak response is if you see the bottom line of the slide where is this medical biological defense insurance pose for the nation, this is what our commander wants us to be. everyone that walked into that building daily, this is what he wants us to be. the irony of this is that solutions built for biodefense were readily and easily transfer will do a real-world outbreak of infectious diseases. i think that's one of the hallmark of this current outbreak response. this next slide shows you will be considered to be our mission essential task list at usamriid. they are simply core capabilities that the organization must excel at. for it to be successful in its contribution to the global effort. these are what the command has established for usamriid, providing world-class expertise

of medical biological defense come to rapid identify biological agent, train and educate the force daily, and everywhere we go established biosafety, biosecurity and bio surely capabilities and protocols, and to develop and test, if i would medical countermeasures. most importantly allows the mr. vitter for tomorrow's problems, being prepared for elements of uncertainty. usamriid has a legacy research program that has given us a wealth of knowledge and experience in working with the ebola virus. usamriid you know has a basic science program as its core fundamental element of contribution where it works on both discovery and development of medical countermeasures, and it is has done that with ebola for sure yours. it leverages this in field activities as well.

kikwit outbreak in 1995 was one of my first expenses with ebola and it's one i would bring to your attention today as the field experts we have but usamriid a presence in outbreak investigations predates the 1995 kikwit outbreak. again this was a great unique field situation because the concern was a virus may be high up in the canopy. and never looked as hot in the canopy and we partner with other nations in this effort develop catwalks through the canopy and trap and collected blood from species to live high up in the canopy rather than on the forest floor. we brought an element of experience to these and coupled with our interagency and international partners build strong teams both in kikwit where we were -- work in collaboration with the centers for disease control and world

health organization. this is a pretty busy slight officials our entire portfolio of areas that we are currently working on, the research and develop an and test and evaluation. but i want to draw your attention to the four bolded bullet obviously. ebola therapeutics, vaccines, and in the joint biological identification system. and the ebola virus diagnostics. vaccines and therapeutics usamriid i think there may be only one other good candidates that has not passed through usamriid for some form of testing and evaluation. usamriid supports this effort heavily, has a lot invested in looking at these various candidate therapeutics and vaccines. the joint biological identification detection system was heavily tested and it was one of the field trial tests that we did when were talking in the introduction by the times we

spent up in the northwest territories of canada look at natural outbreaks. we would take those to the field and try to field test them. then the most important for ebola zaire diagnostic for this outbreak. it provided a real-time diagnostic capability on the ground. i do want to take just a moment to highlight that because when i was in kikwit in 1995 one of the critical things that was missing was the ability to diagnose real-time on the ground because every patient after the first patient was diagnosed as ebola come any patient after that it looked like ebola went into the global award. doing this outbreak with real-time diagnostics on the ground were able to set of screening capabilities to where patients could be tested and then sent to a different treatment facility if they were not positive for ebola. this is critical. this assay was also approved by the fda emergency use

authorization to give to diagnose samples from u.s. citizens on the ground. .. the intent was to be able to monitor the virus, to be able to track any genetic changes because if it was genetically

mutate. we want to track that throughout the outbreak. a number of standard publications were used as reference materials and training courses by one to highlight the other system support. this is where the personnel stuck with the challenge to stop productive core element. they provided over 4,000 deployed personnel have to offer the personal equipment investing over 200 man-hours to do that. they also consulted with various agencies on the patient transport to minimize the spread of ebola in the course of the action and in the field identification warfare agent standard course it was leveraged heavily going into liberia to assist.

this is shows the summary and i'm not going to run through this what you will see how each of the commanders core capabilities were able to be brought to bear on this outbreak it seems right to do that in the future with any other agents that we have a mandate to work on and therefore have the training and knowledge and expertise to do so. the bottom line is that it has provided and can continue to provide nonstandard skill sets and solutions to operate the high consequence type of organism. the pathogenic infectious disease outbreak we must be prepared for uncertainty. thank you for listening to the presentation. i will be followed by russ.

>> good afternoon. my name is russ coleman. i can still remember clear as day by my wife was seven months pregnant and she heard that they were going to give me a thermometer and if i had a temperature they want to throw me in the slammer, for those that don't know it is the isolation unit where if you came down with something bad or nasty that's where the isolate you. my wife, knowing there were no diagnostics or vaccine and concern about her own health and the health of our orange filed. so you fell short 95 to now about 30 years and he will look at where we are and there were

complaints and we've all heard them but i think the story we are telling us that we have come a long way and i want to highlight some of those issues. so i'm an advanced developer and what does that mean, i have to put that in the context. they investigate things and look at what our potential ways to block the virus from developing in a person but that's basic science and that doesn't get a feel that drug or vaccine or therapeutic and that is where the joint project management office from the medical systems comes into play. there is a handoff that occurs it is at as a potential therapeutic products for ebola.

my job is to take that science and work with a commercial company and somehow spit out a fielded product at the end that is approved by the fda that we know is safe and effective and manufactured consistently so it is a different skill set that exists in my group. some of the areas we've been involved as mr. spencer said nothing we do takes place in a vacuum so i may talk about what occurs in my organization but we partner with rare and commercial partners and we partner with the centers for disease control and the nih. it's a true collaborative effort on so many levels. so a little bit of history and how we got involved.

i'm going to talk about the whole of government approach and for example we worked with rare giving a clinical trial to see how safe is this ebola vaccine that they were working on it we had a direct role partnering with van and we work on different essays and different screening and aspects into testing going on in their facility. and really what you hear the stories we are telling here is throughout the whole ebola outbreak we remain agile and flexible and responsive. so as mr. spencer has mentioned our mission in the executive office is chemical and biological threats. we have the capability to provide, to respond when the natural outbreaks occur.

so i don't know how -- i would gather you can't see that at all where you said that this highlights the areas that our organization actively was involved in and it ranges on top of the virus. we get into the treatment of the virus and its vaccine development. how and when and where we were involved. i have more detailed slides i will use to highlight some of these point. when it comes to the ebola virus protection our team with our partners we really identified the first cases in west africa in this outbreak. we were on the ground and used to detect the cases. the cases in the u.s. was all conducted by the cbc.

they were developed with existing memorandums of agreement between the department of defense and the department of health and human services allow us to provide the essays and we were able to support them and their mission. and so you may have heard about the challenges of developing these medical countermeasures. and what i need is we are developing products that we hope will never be used and that is a fundamental fact. we are developing contacts for the threats that we don't know what, when where it will occur we just know something will happen. we've seen an outbreak, use of chemical weapons and nuclear.

we were not asked to predict any of those. so that could have been ebola or something else if that we have to be prepared for all of it. the challenge is my group faces is when it comes to developing the countermeasures we do this in partnership with commercial companies and these are companies driven by the return on investments. they've got to make money for the business model that exists is tremendously challenging. we want you to work with us and make these countermeasures that you're not going to make any money doing it and that's the reality of the business we are in so it is extremely difficult and when you hear an outcry from the folks in west africa, where were the drugs and vaccines they should have been here, we agree with that. however it's challenging and it's the u.s. government department of health and human

services and other dod with the laboratories conducting the research that goes into the development of the products. i will get back to it at the end about the challenge of getting the countermeasures available. we tried to be prepared to respond to offer different threats out there and it would be cost prohibitive to develop everything in the near term. we haven't been able to do everything we want. but what we have is that he positioned with the food and drug administration that showed they were safe and effective and when this outbreak hit in less than 30 days we were able to get the fda approval under an emergency use authorization to use these in the pub is and covers a tremendous couple

schmidt and that allowed us to move forward throughout the u.s. and work with the cdc where they were available to detect those patients. when it comes to ebola treatment obviously there are no current approvals. they don't exist and it's a hard business when you take a virus like ebola which is highly lethal. it's difficult to say but we know it is highly lethal. they've been working on ebola for many years to find products for the challenge comes how do you get them approved by the fda with a commercial partner on board. the story that's lost is sitting here with the biological

therapeutic state funded the development of a number of promising candidates they have commercial partners but not enough to get full fda approval and so by working with the fda is worried worried to take some of the compounds and they were put into patients in the u.s. by the emergency-based uses. so the two compounds listed here in the portfolio. it was developed by the japanese for influenza but it's effective against a wide range of viruses and it's getting the data to show that this works against influenza and also against ebola so this went into a total of 13 patients here in the u.s.. at this point we can't say for sure that the product work

because they were getting a whole shortest part of treatments. the second compound is interesting because it is what is called a platform technology. it's capable of spitting out a product i'm pretty sure on the notice. in the short order you are able to identify the threat and produce a compound that will hopefully be able to treat it. we had a product we were developing. it turns out that strain of the virus is different from the one that is circulated in africa. working with our commercial partner in a span of two to three months to be able to identify the sequence and develop a candidate product specific to the virus in west

africa. there are some ongoing compounds in west africa not done with us but the european consortium. in many ways their international efforts. in the last of the areas of prevention we began working on the ebola vaccines back in the 2010 but they've been working on it for longer than that swept the time of the out break we had the effort ongoing.

we are dealing with ebola working with the dod and health and human services to identify the vaccine candidate to treat the disease circulating and you've all heard about the vaccine candidate and that's the testing has gone on into the group was involved so you will hear more and touch upon that in your talk. what i try to highlight is that when we talk about medical countermeasures it's more than just a science that has to take place. it's the commercial partners and business model. i don't know if any of you are familiar with the priority voucher program when a number of years ago it was recognized that we were not delivering medical countermeasures in the threats that occurred in less developed parts of the world where disease

can occur but it's just not a commercial market and so u.s. congress established the priority voucher system that would incentivize the industry to work on diseases that were seen but what i would like to highlight is we face the same situation when it occurs to chemical biological nuclear threats that we recognize the importance that we have such a difficult time getting the commercial partners to work with us. >> you heard about the organization work with partners working with the other government agencies to deal directly with this outbreak and my final point here is we need to be proactive about looking at medical countermeasure development for the ebola were other threats that face the

nation. with that i'm going to turn it over to stephen thomas. >> good afternoon. i'm glad to be here. i want to talk about the walter reed research and tell you who we are and what we do and how both of those are leveraged to participate in the response. so this is a picture located in silver spring maryland on the side of the beltway established in 1893 so just over 120 years. it's been a very long time. we have the largest biomedical research facility. as you've heard before we have a road u.s. government military foreign service national and contract employees working not only in the silver springs but the number of locations around the world. first would be the hero health, so we work on issues like dramatic brain injury posttraumatic stress disorder.

i'm going to highlight this for you today. as long as we've had in rv indignation is posed a threat only to the service member to the citizen. and that occurs in peacetime and war and locally as well as overseas. the organization that i work for to try to develop the countermeasures to mitigate or eliminate the threat to the service member into the nation we have done that successfully and i listed a couple examples of the vaccines we have developed. and the snake a difference not only in military recruits but those that deploy overseas into harms way. we've done that successfully in the past working to figure out solutions to pass the problems

but we are also looking at the current threats and with future threats may be in use via couple of examples, things like hiv and ebola fall into that as well. and we do that because we are an institution of competencies and capacities and research platforms. we have people that are not only experts in infectious disease but they also know how to do research and development and to combine those two things is important and very strategic. and in addition to the expertise that we have in the domestic platforms that we have, we also have a large network of overseas research capabilities. we have a behavioral health unit in germany which is currently in the process of transitioning into washington state. these are very deep partnerships

with the host nations where we identify common threats and common interests and then work together. at the government level in civil society level in the community level to come up with countermeasures that serve both of our need. and as you will hear they are incredibly important for the u.s. military and countermeasure development activities. so that's who we are in where we are and what we do. the first you've already heard was the testing of the vaccines. so, when these vaccines complete, they eventually need to be tested and that is the core competencies that we have when we do that here domestically as well as overseas. so in the defense reduction agency when they asked if we wanted to participate and we were able to do the first human trial of the vaccine candidate we were pleased to be a part of

that. and we did that and we did it very quickly and we were able to do that because we were agile and able to redirect personnel and other resources to look at the needs. so in a short pier coat of time in the volunteers we were able to demonstrate the vaccine is safe and produced the immune response we wanted it to. but we didn't do that in isolation. we worked with doctor felt -- fauci with a parallel study they were doing at the same time with the candidate. and we jointly publish those results in the last couple of months. but it didn't stop at the u.s. government. we were also working with the world health organization that were also doing these small safety trials and together we were able to take all of the blood samples to send them over and then they were able to generate the data that was required to make informed decisions about what the vaccines needed vaccines needed

to be used in west africa. and you've probably seen them press those trials around right now. so as the colonel mentioned it's not just the dod. the vaccine trial that we did this past year we broke holding on the military research program that had a presence for many years and collaboration for many years. on the continent of africa starting in 2008 those results were published as well. they just finished enrolling in the second vaccine trial and we are scheduled to start in ebola vaccine trial so this is a prime

example and exemplar of how the dod is good at expeditionary medicine but more than that expeditionary development and that is a unique characteristic of the organization that was the vaccine testing story and we responded in other ways to support operation assistance at domestic preparedness. this is the 101st airborne and other operational groups have been involved in before. so it was important to provide them the employment training. but they understood what the threats and the risks were and in my mind the ebola wasn't the number one threat to the force. it was the most severe form of malaria so we conducted a lot of briefings with the command.

you remember me telling you about the behavioral health side we also send them to gain their understanding and perspective about the operation they were about to undertake and understand what the mental-health stressors might have been on the group. we also looked at controlled monitoring into that data is coming in and we are analyzing it. if you look at the large presence of conversations of those nations have travelers returning that they needed to test and they need to understand if it was being imported into the borders. we've had 50 or 60 years of collaborating with the nations and so we provided technical assistance to them. when you've heard his activities at the level but that this is

being tracked at the highest level of the government so the working group that was occurring they were responsible for coordinating the response in west africa so they could needed the activities in support they got all the different stakeholders together and we ran through through them on a weekly basis all of the issues. they represented the joint staff and they worked with congress to make sure people were remaining informed. the point here is they've are tracking very paper tracking very closely on a weekly basis all of this work that we were just telling you about.

they wanted to know what were the results and all this information was going up to the president said that's the summary of the people to read institute contributions were to the supporting operation on domestic ebola preparedness and i think taken with all of the other talks it gives you a pretty good idea of what the department of defense was doing so thank you for your time and i'm going to turn it over. >> thank you very much. first i want to commend you on not developing into the military acronym speak.

this term may not be a term you have have in the army army but in the navy we have a term after you do something you get all the stakeholders together and use it around the table and figure out what worked, what didn't work how to figure it out and the best way forward. i assume you had a version not only within the various components but across the dod and i was surprised to learn that they played the role they did because that's interesting. and i would like to go down the road and ask you what are the

top three lessons learned from your perspective through the ebola response crisis management way forward? we will start with you. >> the biggest lesson for us was not one agency in the federal government has all the answers. it is a whole of government response to any type of global crisis and when it comes to something like a biological incident there are no borders. it's not a dod issue is a public-health issue and dod has resources and can assist, but we don't have all the answers and we must work as a part of the whole of government team to provide the capabilities that we can provide.

it gets to the point that you get tired of hearing it the war college. the joint interagency multinational is what it talks about. and students are encouraged to start thinking in that area. this rolled all of that together and it has to be a joint intergovernmental multinational type of solution. there can be no single agency that can respond to this type of outbreak and bring to their the resources that are needed to be able to render a positive solution. the other thing i talked about david it in my presentation is that we cannot be stove piped in our thinking as we develop

solutions in the name of the bio defense, we have to be thinking about how they should be used and infectious disease outbreak is a classic example of how something that is being developed for a relatively specific intent and purpose has tremendous ability for other purposes as well. >> on a similar threat it's unappreciated and sometimes it is more treating rather than preventing that we know that it works and in this case i think we thought it. investments have been made over many period we are trying to be prepared for any contingency that might occur whether it is naturally occurring diseases or a bioterrorism event. we've seen the benefits of that

investment has been made, but prevention and the foresight and that we were well positioned to provide support for this outbreak when it came to the investments have resulted in the diagnostics or the therapeutics. >> the lesson learned is that once again the world is a small place. that can have an incredible ramifications and financial ramifications in the political ramifications. so to me i think the requirement to enhance our bio surveillance networks globally are of incredible importance and

it is not just the ability to identify him detect and characterize the pathogen but when you build the bio surveillance you are building public health infrastructure as the dual-purpose, which of course i think if the west african nations hadn't been so challenged in those areas there may have been a different outcome so that's the lesson that i've gotten. >> the last question i have is let's assume for the sake of the question that there is a verifiable outbreak in a west african country where people highly suspect because of ebola. it happened this morning. this is a hypothetical of course it's not a beyond the realm of possibility.

walk us through to the extent that you can put each of your organizations does on day number one. >> the first thing russia and i would be on the phone together for a nice long phone call and getting the best and the brightest minds that we have together. what do we know what don't we know, what are the capability gaps, where do we need to put investment in the short term to get the biggest bang for the buck and strategizing was going to happen over the next few week's and how we will be ready to meet that challenge.

>> there's going to be personnel eventually put in that. doctors were civilians or somebody. they are not experts to assume we are going to have people on the ground pretty quickly to figure out how widespread it is etc.. we will react to the warning orders they produced and we are if we are going to be asking a lot of questions. and so that's why we did the best lines available to respond to the questions and what would it take to provide response.

one of the first things we want to know is why we want them on the ground as soon as possible. it is tormented today and it will come back but it will keyboards and it will be different every time we see it and we need to find out exactly what that is to determine the best and most efficacious there appeared that we can provide and the diagnostic essays. until we get a request for the assistance of the current outbreak was a little bit different.

we are having meetings discussing the task list that i talked about, what capabilities we possess that could be brought to bear on the problem if asked to assist and that's a standard. whenever the first news of an outbreak hits coming our commander starts convening those meetings and sometimes does take the commander to initiate that. but it all hinges on the request for assistance. this was a little different though because we had a presence in west africa and people on the ground as biological engagement programs to have the capacity for these types of diagnostics.

they rapidly transition specifically to the diagnostics both in sierra leone and liberia for the dod operations, if this occurs in west africa it's not a traditional dod mission and that's how it evolved. i have to look at what the capabilities are. it would be responsible for homeland defense and the diagnostics and so forth. we have to look at every of the we have the mechanisms in place to provide the cbc with things like wise when it came to those patients here in the u.s. how we

provide our therapeutics that are u.s. government owned to respond and we have to look at those mechanisms to figure out how we can provide the support and those are conversations that took place with mr. spencer as well. it's not just the desire to go but it's the ask in the diplomatic channels into the department of defense. if it's coming from africa, then my particular organization is what we can do because we did expeditionary research and development and we can take the drug candidates and can relatively quickly deploy if you will to start doing trials.

>> in the process of doing that you are setting up public health infrastructure you are setting up surveillance systems committee were educating the local communities who are then forced multipliers and helping you achieve your mission. >> if there's anything you want to add to what the panelists have said. >> one of the microphones will come to you and please identify yourself by name and organization and ask your question. we be in the front, please. thank you so much for your trailblazing work.

i feel a lot safer with you. my questions are more of the r. and the commercialization of the products that product that you're working on. i would assume in addition to the vouchers they will get an extension of what happens. are there any considerations on the advanced market commitment. it is in center by his to come through the commercialization and also once these products are finished are they subjected to the licensing in the agreement and a bonus question.

it may not get approved in west africa. to give consent to the west african population? hispanic between the two of us we can probably handle that one. guess we talked to the commercial companies about their ability to provide long-term. it's important to understand that the dod requirements for example when we develop a vaccine we may require 400000 doses and depending on the shelf life we may only need it every couple of years. a very small number. when you talk about the cost and investment companies have to make there's a lot of reluctance on their part to say this is something we are going to take our resources and put them into

words. even the small licensing commitment is not enough so i'm glad you mentioned there are priority vouchers, patent extensions into that sort of thing. those are the discussions we need to get into. this is a strategic national priority. the ability to respond to these outbreaks whether they are naturally occurring like ebola or a chemical biological weapons events. now i believe the most difficult aspect of this whole process we have great scientists doing great things coming up with the technology getting them across the finish line. i think a second part of the question is related to what is the desired end state to be at we want the products. that is the gold standard and that is what we strive for. in this case we didn't have the fda approved products.

however, they have mechanisms that allow not across the finish line products like the emergency use authorization and like expanded use protocols sojourning this outbreak we took full advantage of those used in the diagnostic products. they've taken some of these experimental compounds and treated individual patients here in the u.s. to read and those that involve informed consent so there was a spectrum of tools but we have to adhere to those requirements established to ensure patient safety first and foremost and now i will turn it over to the position of the group. >> in terms of the trials, we were able to move faster than usual but it wasn't because we escaped any regulatory steps. we just focused a lot of research and we were able to do things in parallel which is how that normally works.

my organization is not involved in vaccine trials that are ongoing in west africa now. what i can see from the experience we've had in the field trials and other parts of the world, informed consent is also a component of the indian asset -- and an asset if that is a population that is involved but is also always a component of what we do. so my assumption is i would be very surprised if that was not the case but is also ongoing in west africa now and these countries have their own review committees and regulatory frameworks. >> so the question in multiple parts, did we touch upon the multiple parts?

>> one thing i will add it to what my colleagues have commented on is the high impact disease and ukraine you kind of had on the subject already. one of the things that has been looked at by several scientists that are working on therapeutics gets repurposed and drugs that have another intended purpose but have significant potential merit to also treat the ebola virus and you also get a leapfrog start with a repurposed and other drugs that are also being researched for another type of disease because you can leverage the early clinical trial safety testing that can help propel them forward so that is a lot of the areas that scientists are looking at. >> we mentioned regarding vouchers and i thought it was

great to be fda of the legislation added where ebola is on the list of eligible for the priority vouchers. that's terrific if it occurred in the middle of an outbreak and that that isn't the optimal time to think about these things so when you look at the development cycles in order to be prepared you have to be doing the thinking far and in the advanced so it's great that we are able to respond that we could have been better positioned if we have the tools in place. >> that's what we are looking at now is the preparedness piece. when a crisis hits but was time to exchange business cards. we've got to be prepared and ready for any eventuality anytime, anywhere and that's what we are concentrating our efforts on now. >> this does speak to why they

need to be involved in infectious disease r&d and counter measurement because a lot of the problems do not necessarily have a large market share and it's not necessarily going to be the case that there's a corporate or pharmaceutical entity that would be willing to take it on a per service member still needs a countermeasure for the department of defense in some cases has to be the one taking the initiative to develop it and needs to have a seat at the table to ensure the military get what they need. >> thanks to the panel by the way this has been a great session. i would like to build on a comment made. given that you can get from

uganda. they hailed response in a timely manner. a member of the panel members stressed the importance. what is the capability because it is a public health issue. that is the early warning and the indicators. we can say anything we want but it's going to be their only there only warning signal and that is a question of time. so our bio surveillance effort right now come in the dod is leading the way it's going to be

the cornerstone of the early warning system and we are expanding as fast as we can. it's the global surveillance system. >> so the department of defense has the surveillance and response system led by colonel jim cummings. they are an approximation of the 70 countries and that is both the dod academic host nation government facilities but it's not enough. the network in west africa is not as robust as it should be. that is an issue for the people that allocate resources and prioritize programs. the network needs to be larger and again because of the secondary effect of building the bio surveillance.

>> again i personally believe there are literally hundreds of outbreaks occurring. most of them are within the means of the population to respond. the concern is what is that outbreak is larger when the local entity of the government or the nation can respond effectively or what is the true pandemic potential and how do you separate that out? that is a big concern. so the networks that are described are truly fundamental to allowing us to get that information. it's a long way to go obviously there's been tremendous progress made in these years. >> one comment i will add it to that point the point has been raised that we don't know

whether it could pop back up again. it reemphasizes the point about the urgency for something like a global surveillance system. >> the gentleman in the middle please. >> i'm a physician scientist and i specialized in facilitating the interface between the industry and the government particularly the dod and dhhs. personally i think you are being way too modest. the advanced risk taking to the product development and i saw flexibility and contracting as i have never seen before.

and i think the fact that we have millions of doses of the potent vaccine available in the fall reflected that risk-taking and forward thinking. the question i have on this is what happened to the whole logic of that entity to address this kind of problem in the intergovernmental issues that were quite abundant. and i haven't had anybody explain to me where that broke down and i would love to understand it. >> your voice sort of dropped. that is the question on the table. do you want me to take a stab at

that? spinnaker go ahead and i will follow on. it is an emergency medical countermeasure. and to ensure that the u.s. government as a whole is working collaboratively with each other and not competitively to make the best use of the limited resources that we have because it is fairly accurate and so the various bodies intend to facilitate this. and so, although door position may be i would say at the outset there were discussions occurring at the level looking at the candidates that were available. they could be accelerated to respond and there were decisions made. but of of course taken to a higher level as well with decisions.

the vaccine is one that had the material accelerated so some of those decisions were made. additionally i don't know whether we understand that medical countermeasure development is a risky activity. and succumb even so, even though we may prioritize the zmap for the vaccine come a please look at the other things in your portfolio and consider how you can accelerate those. so those sort of discussions were taking place and the discussions were sent back for their awareness. >> i am a member and we did have discussions. but in the early phases it is but can each partner bring to the table if you will.

>> i would acknowledge that. >> we attend a lot of meetings so from the dod perspective we were bringing everything we could into the fight to get there as quickly as we could. we may have left some people behind in the process. and that may be one of the lessons learned to come out of this but it's been a very good tool for me to ensure the department of homeland security or what the cdc is doing or the conflict so we are out spending money not spending money on the same problems.

>> [inaudible] >> we get a lot of money from the taxpayers to do this business, and i want to spend it where i can get the biggest bang for the buck. i don't want to be working on it. i want to leverage what they are getting a ticket to the next level. and i want them to know it so they can leverage the great research and debate can get the biggest bang for the buck and it's very good at that. >> things that were in place many people don't know. there's a lot of activities going on. so the virus, nonclinical working group in a number of years they have the efforts on not just the dod that

standardizing -- what type of pathogen will be used and that is providing a tremendous value to the organizations and in many ways best positioned us to be able to respond as effectively as needed. >> please speak a little bit louder. >> i had understood that the directive is by the charter to play the key role in a situation like this. in an operational sense tactical and operational sense that is the gap that i was referred to.

>> other questions for the panelist? please join me in thinking this group thanking this group of experts and for keeping us all safe. [applause] [inaudible conversations]

>> it is worth noting that none of us know anything about the future and we certainly don't know anything about how the economy is performing the short term or the long run --

>> about with that said it is a scary and dark uncertain world? >> that is the state of mankind. it's sad to admit it but it's true. in that context i do think that the u.s. is gradually getting -- >> slightly less dark and scary. >> we are a very resilient country. and i think a much stronger country than any other major economy. ..