you do a pristine type of a trial, but if you would them employ the people who are needing the vaccine as part of the clinical trial where you compare one vaccine against another or one dose against another so you accomplish two things. you try and determine if it's safe and effective, even though it isn't as definitive as the pristine trial, but getting people in these trials, you make it available. so where we know what the dose is to have an expanded trial. within the context of that trial, more people would get the

opportunity to be vaccinated. i might say that the target of the vaccinations is clearly directed among others to the health care workers. the people on the front line, the emergency responders, because those are the ones that put themselves at risk as did dr. brantley in taking care of individuals. >> if you can prove that it's safe but you don't know if it's effective, you can try to prove its effective by inoculating health care workers and others. it's better than nothing, but it's not quite definitive. >> fully knowing you're not going to get a definitive answer. still, when you're in an emergent situation, you have to do the best with what you have. >> further comments? >> commensurate with the clinical trials is we have to have the product there, the vaccines to be made available.

part of that is taking these products that are in early development and making sure we can go to commercial scale and produce those in large quantities so these studies can be done and shown to be well tolerated that there's more vaccine available. >> thank you all for your extraordinary work. thank your colleagues in the field at risk. thank you. >> thank you very much. senator burr? >> mr. chairman, thank you to this panel and those who will be called into action over the next weeks and months and hopefully not years. you said if we don't act now, can you define now from a standpoint of a timeline? at what point will we have reached the point where we missed our opportunity? >> senator, i wish hi a crystal ball and could tell you precisely the answer to that, but the situation is quite fluid and i think it's quite hard to predict with any kind of precision. i certainly can say that speed and scale is of the essence.

>> you used the term several times controlling the outbreak. is controlling the outbreak the same or do you use that the same way you do containment? >> yes, sir, more or less. >> how do you achieve containment on a disease that's broken the containment. >> i think it's a matter you can think of this as bending a curve. a curve is going in one direction. we want to make it it go in the other direction. in order to do that we have to break these chains of transmission. and the way we break the chains of transmission is by having a way -- effective ways to isolate patients so they can't transmit and to make sure there isn't ongoing transmission happening. for example, in health care facilities or from unsafe burial practices. >> liberia for example, we're surging through d.o.d. the capacity for 1,700 beds in a

country that they have zero now. my math is not great, but it says we're going to be behind the eight ball because we won't have enough beds. i'm told the most infectious method is the back of a cab where individuals ride with their family to find there are no beds in the clinic and ride home. how long can the virus survive whether it's on a cab seat or sheet or table? how long can it infect somebody? >> there have not been definitive studies giving a timeframe. it's a fragile virus, but we do know that people get infected from touching the dead bodies of people who have probably contaminated with blood or bodily fluids. that's when people have been

documented to get infected. i don't think we could go beyond giving you days, weeks or whatever, but it clearly is not instantaneous where once the virus is out of the body it's gone, because we know people have been infected at funerals. by touching the body. >> i understand in previous ebola outbreaks, we've seen five generations of transmission. how many mutations are we seeing as the virus continues to spread with each chain of transmission? >> i can't give you a number on that. when you have an rna virus, it is notoriously is a bad reproducer. it makes mistakes. when it makes mistakes, it mutates. most of the mutations don't mean anything. they are just irrelevant.

they're called synonymous mutations. they don't mean anything. sometimes, rare, they do mean something. sometimes it means it kills the virus. other times it may be modified some of the biological function. i can't tell you how many generations, but that could mathematically likely be figured out on the basis of a paper that just came out a couple weeks ago from boston where they looked at 78 people and the virus taken from them. if you did a mathematical computerized, you'd be able to say how many replications. i don't have that number for you now, but you can determine that. >> if you'd get that to us, i'm appreciate that. there have been reports we could see 28,000 cases a month and the outbreak may last 12 to 18 months, which would calculate to roughly 360,000 cases. again, i think we continue to be a step behind up until this point.

on what projected number of cases and period of outbreak did the administration base its response strategy to date and the latest actions announced today? >> there have been a number of models out there, and we ourselves have been working on a model. i think it is certainly true that a number of these models predict without additional interventions that we could see hundreds of thousands of cases. and so all of those modelling exercises have been taken into account as we've been calling for additional interventions in these countries. i think the critical point here is that those models for the most part are based on not scaling up. what we're doing right now is

scaling up. and in addition to all the things that the u.s. government is doing to scale up including the announcements from the department of defense, there are also many other international partners who are also scaling up. the world health organization, other countries. many non-governmental organizations. some of our colleagues here that will be testifying in the next panel. so there's also more financing that's become available from the world bank, for example. the u.n. is becoming involved. so i think it's fair to say that there is a general mobilization of forces here and what we're looking for is with that mobilization of forces these models what they are predicting is not what we're going to see happen. >> i appreciate that. and follow it very closely. i know the mobilization of most other countries in the united nations is not near the timeframe that ours is and that's why it scares me to

death. mr. chairman, thank you for your generosity. let me say to dr. robinson, does barta have the resources it needs? >> to begin the advanced development, yes, for this fall. we don't have going forward for ebola next year to produce more vaccines and more that you athe. and more therapeutics. we actually want to do more than just zmap. there are others we have under consideration. we and others will need more funding, there's no doubt about that. >> thank you very much to the panel and mr. chairman for having this hearing. i'm proud to represent a state that's producing truly incredible research in the biomedical field, including several ongoing studies and efforts aimed at curing ebola. we've got world vision supporting the ministries of health. the geneva foundation, which is working on a treatment drug.

washington state university's school for global animal help. they are looking at culturally appropriate ways to prevent further transmissions and the university of washington cats lab which is looking at some vaccines and drug development. we're doing a lot out there. the reality is that we all have to do more. and i think it's important to mention that one of the reasons i fought so hard to roll back sequestration in the bipartisan budget act was to provide certainty for organizations like nih and cdc which have had to deal with, as we all know,le some steep and harmful budget cuts. i believe it's going to be very critical that we continue to focus on rolling back this trend of disinvestment in research and development so we can ensure that our country continues to produce the kind of life saving, world changing research that we know we're capable of. i'm very concerned, i need to say this, that fiscal austerity and the return of sequestration next year is going to continue to weaken our ability to respond

to needs like this. so doctor, while you're here, i want to ask you, can you talk a little bit about how the lack of budget certainty and sequestration and the budget fights of the last two years have really impacted the u.s.' ability to respond to the ebola situation. >> thank you for the question, senator murray. i have to tell you honestly, it's been a significant impact on us, as you well know and you have been fighting for us for a long period of time. our budget has been flat since the end of the doubling in 2003 with the 2-plus% inflationary index that over a ten-year period we've lost about 22% in our purchasing power. that was the left hook, the right cross was the sequestration that came in and pulled out a significant amount of money. $1.5 billion which we got

reconstituted not all of it. we try to preserve the fundamental basic research of the investigators, the bright ideas that people have and if you want to preserve that, the money that you have for initiatives such as the development of vaccines and the development of drugs suffers because it's a balance. there's programmatic initiatives. there's investigative initiated awards. when you shrink the budget or don't give even an inflationary increase, all of that starts to whittle away and you get secondary effects like disincentives of getting bright people involved from your state or any state who feel that there's a disincentive to get involved. so it's been both in an acute and in a chronic insidious way eroded our ability to respond in the way that i and my colleagues would like to see us be able to respond to these emerging threats. in my institute particularly, that's responsible for

responding on the dime to an emerging infectious disease threat. this is particularly damaging. >> i hope we all keep that in mind moving forward. again, i'm proud of the folks in my state, the gates foundation gave $50 million to scale up emergency operations. paul g. allen foundation has contributed $9 million to open three emergency sites in three of the most affected countries. dr. robinson, dr. bell, knowing that gates and allen foundations have stepped up that way and the money ha is going to be included in the cr, thank you to our appropriations chair that is sitting next to me, is that enough money and global support to stop this outbreak? >> i'll answer for the cdc. we do appreciate the $30 million that's in the cr. that amount of money is enough to keep us operating through the end of the continuing resolution on december 11th.

it allows us to keep our people in the field to pay for our staff and to begin to scale up in a way we think is necessary. we will be kind of considering over the time period of the cr what additional resources we will need for the rest of the fiscal year in order to fulfill our responsibilities and respond to the ebola outbreak in the way we know we need to. >> dr. robinson? >> the $58 million that we requested will get us through this fall. we want more vaccines and more that you are therapeutics, there will have to be more funding going forward. >> thank you, mr. chairman. >> senator harkin, senator alexander and senator reid all said how proud we are of cdc. as one of the two senators, i want to add how proud we are at

emory university and the staff there. dr. brantly would probably feel the same way, as welling a phoenix air which was the contract i bring from georgia that brought the patients back from liberia to the united states. that was a tremendous effort. for the committee's benefit, i was the only senator reachable by the press the day it was announced they were coming to emory university. and the press looked for an wisdom in bringing an ebola patient back to the united states and whether or not we had the capability of preventing the disease from spreading and emory university did a marvelous job of making those transfers saleless and complete and proving to the media that were trying their best to start a riot that it was going to be safely contained and they were in the best place in the world. so y'all deserve a tremendous amount of credit. i wanted to say that publicly to you. >> thank you, senator. >> you said this is by far the worst ebola outbreak you have ever seen.

what was the next worst before it in terms of numbers? >> so that was about 400 in some cases. >> what makes this one so different? >> there are a number of factors, i think, senator that has made this one quite a bit different. first of all, this is the first time we have seen ebola in a large urban setting. our previous experience with ebola has been primarily in rural areas. and there are many, many different sort of factors that come into play when you have ebola in a situation with people packed very closely together in a large city. so that's one thing. another issue that has been challenging is that the area, three-country area where the outbreak began and has been

propagating from is an area with communities that are sometimes not very receptive to interventions by the government or public health officials. a third point is these are countries with very weak infrastructure to start with. they have been emerging from decades of war. they have very weak health systems and very little capabilities to senator harkin's point about public health capabilities, but even health care capabilities. so very little with which to battle this outbreak from the beginning. >> i have traveled extensively in west africa and i have seen firsthand -- there are almost bereft of health care facilities of anything we'd consider to be reasonable, which means when you described containment, you described a labor intensive process. you talked about people taking temperatures for 21 days to see if somebody exposed had had been

infected. you talked about isolating. we're sending 3,000 american troops to west africa. we have 100 cdc personnel. we have ngos and other volunteers, but it's going to take a lot bigger labor force to contain the disease at its current level, am i correct? >> yes, there's lots of different settings that we can talk about but for example, in the ebola treatment units, 90% of the staff are local. i think it is important to remember that the governments, the people in the countries and the governments themselves are stepping up and with assistance from those of us that have the technical capabilities are really able to fill many of these roles and responsibilities. some of the work in the treatment units, much of this going out into communities every day and checking in with contacts to see how they are doing. these are roles that people themselves, the local people themselves in these countries

can undertake with some technical guidance from some of us that have this experience. this is not to minimize the scale of the human resources that will be needed to contain this. but as i say, i think that there are many of these sorts of functions that we're already seeing the local people help with and there are groups around the african union. many of our field training programs from around africa that are also stepping up. so it is an enormous job, but it's a job, as i say, where i think there are lots of different sectors and parts of the local community in addition to the international community that can work together to address this. >> i wanted to make a comment. the africa summit which was just about a month ago, i had the privilege of participating in a lot of that with a lot of the

leaders, and i noted how they were begging -- not begging, but they were wanting so much american knowledge, cdc, nih, all the technology, but even the bordering countries seemed that they were willing to provide man power, but they badly needed leadership in terms of health care. is that correct? >> yes, sir, we have made quite a bit of progress over the last month or so and are working closely with the african union to have them deploy staff to the area. >> thank you very much. >> before i recognize senator casey, you mentioned all these different entities now addressing this. we have cdc, state department, usa usaid, world health organization, doctors without borders, can you tell us who is in charge of coordinating our government's response effort in africa? >> yes, sir. in terms of the u.s. government in each of the countries, there is the disaster assistance response teams. the d.a.r.t. -- this is a usaid umbrella under which all of the

u.s. government efforts are coordinated. and we are quite well koord are natu coordinated with the organizations. in the larger sort of coordinat organizations. in the larger sort of undertaking, in each of these countries, people are getting organized generally speaking with the government. >> usaid is in charge intracountry. in a country. but overall who is in charge of coordinating -- >> no. the dart is actually the three countries together are all under the umbrella of the dart, of the usaid dart. >> usaid? >> yes. >> i'm kind of startled to find that out. usaid would be -- >> it's a disaster when the disaster is declared.

i don't know as we scale up. i'm sure there will be other mechanisms to collaborate and coordinate with each other for various parts of the government. but there's this kind of structure on the ground, which is meant to -- >> i think this requires further looking into by both these committees. senator casey? >> i would concur, mr. chairman. >> mr. chairman, thank you very much. i want to thank the members of the panel for being here. i also want to note the good work that's been done by this committee and members of this committee for a lot of years. the chairman, chairman har continue, senator mccullsky as well with her experience. grateful to work with them. senator burr, who has spent a lot of time on this and has become such a leading voice on this. i don't want to plow ground that's already been plowed through.

i apologize for having to juggle two hearings. i want to ask dr. well. i know that one of the fundamental questions you asked is the threat to the united states, if any, and how you articulate that. for purposes of process and the mechanics of confronting this kind of a threat, were it to arise here, i'm just thinking about pick a town in pennsylvania. it won't pinpoint one. but if there was someone in pennsylvania that was a patient at a hospital and they tested positive for ebola, what would be the steps that would be undertaken at that point? >> yes, thank you, senator. we have been working quite closely here in the united states to prepare for this sort of eventuality that you described. as we have mentioned, ebola is

really not easily transmitted. and i think in terms of helping to understand the context to answering this question, i want to say a word or two about what a hospital in these countries in africa looks like as a way of contrasting. so when we think of a hospital, most of the hospitals in this region, as many that you have travelled to this area are aware, often times there's no running water. there's no soap. there may not even be beds. there may be mattresses on the floor. every health care worker is caring for a large number of patients. there will be beds all around them. they may not have the appropriate protective equipment like gloves and gowns and masks. so that's the environment in africa where ebola is currently raging. in the united states by contrast, we have many, many protocols in place.

and with these protocols, most hospitals that can isolate a patient in a private room with their own bathroom and can follow very strict and meticulous infection control practices, which have been outlined and health care workers are aware of can take care of ebola patients. while we haven't taken care of any ebola patients prior to this outbreak here in the united states, we have safely cared for at least five patients with other viral fevers in recent years. in each of these circumstances, these patients were cared for quite safely in our hospitals around the country and we didn't see any ongoing transmission. so while this is certainly something to be taken quite seriously and we're doing a lot to educate health care work es, to educate health care workers, to educate laboratory workers and to answer peoples' question,

to educate health care workers, to educate laboratory workers and to answer peoples' questis,s to educate health care workers, to educate laboratory workers and to answer peoples' questions to sensitize them to these issues, most hospitals in the united states with these sort of basic capabilities should be able to safely care for ebola patients. >> i have limited time, but i want to ask one question. you noted in your testimony there are a number of ebola therapeutics and vaccines in development. recognizing that all these products are still rather early in their development, do any of them have clear advantages or disadvantages over the others? can you make that assessment yet? >> i don't think honestly we can say that because a part from zmapp, and one other, perhaps, they have not really been in humans. we have in the past have experience where things look really good in an animal, and

then when they get into a human for one reason or another it doesn't work or it is too toxic. it would be premature. i can say there were a number of candidates that looked favorable enough in an animal model that were enthusiastic about moving them into a phase one, and then beyond that. so there are a number of candidates that have a favorable profile in an animal model, but i think it would be unwise to say this one looks a little better than this one because it's too premature to do that. >> i hope there's nothing that the congress has not been able to achieve that would be an impediment for you to be able to answer that question down the road and to be able to make the progress you want to make on these developments. because we have an obligation, i believe, to fund nih and to fund these research in a manner that leads to the result that we hope. i think that's a bipartisan obligation and i say it for the record. thanks, doctor.

>> thank you, we appreciate it very much, sir. >> thank you, mr. chairman, and thank you very much for having this hearing. you and the rest of the leadership on both sides. this is so important. we appreciate you being here, all of you have just excellent reputations and we appreciate the fact that you're working very hard to keep us safe. from what i have read and the testimony, it seems like speed is important, education is important, coordination is important. we have the cdc involved, we have the nih, we have the dod, we have the department of state, samantha powers is calling the security council for the first time ever for an event like this. i would like to get into a little deeper. we heard that usaid was distributing stuff over there. who is in charge of all of that at the washington level?

who is taking this on so we can get coordination and get speed and get the education component done? is that cdc? are you doing that? >> we have the lead on the public aspects of the response. the dod and usaid have the lead on logistics and material. the national security council is coordinating from washington. it's really important that we draw on all of our assets from all of the different agencies working in our particular lanes and coordinating, as i say, all together. there's very strong interagency coordination. the nsc is deeply involved in bringing the agencies together. we at cdc take the lead in the

public health aspect. >> i hope we get that worked out where we actually have somebody that we can point to, an individual that's kind of in charge of coordinating. the same thing that's going on the ground that needs to be going on over there is simply not going to happen without that happening here. one thing that's happened, there's an ebola outbreak going on in the democratic republic of congo. is that related to this or is that all separate thing that we have seen in the past? >> i will say something. this outbreak is not related to what we're seeing in west africa. as you say, senator, this area of drc is an. area in which we have seen many ebola outbreaks in the past. this outbreak is of the strain that's quite similar to those outbreaks. so while we are taking it very seriously -- and actually

we at cdc have sent a team into that area -- we don't think that that outbreak is at all connected. we're actually aware of the individual case that began that outbreak and had no relationship to what's been going on in west africa. >> you can actually -- and i agree with dr. bell that that will be determined. it does not look like it is the same. the extraordinary ability to do rapid deep sequencing of the genome of these viruses can actually pinpoint whether or not they're related. it's very interesting that the study that was done and published very recently showed the exact point introducing as how it went from and it doesn't look like the strain that's in the democratic republic of the congo is in that lineage. even though it is the same general strain. >> dr. bell, can you reassure

the -- i know the public is concerned about bringing it into the country. can you talk to us a little bit about the steps with helping those that are at the airports and identifying people that possibly have the virus? >> yes, senator, it's certainly quite understandable why people would be concerned. the images are quite alarming. as you note, we have been working in the countries to improve their abilities to do exit screening. we have teams in each of the countries and we have really been able to help them improve their capability to do exit screening considerably over the last month or so. and are quite pleased with the progress in these countries. they have equipment, they understand what they are supposed to do, they have the protocols in place and they are really moving forward. in addition, i'll mention that we have been doing a lot of work

with our own border agencies so with the tsa and with the cbp to train them so that they understand what to look for and they understand when they need to call on us. cdc has quarantine stations at major airports around the country so they are also sensitized to with a needs to be done. the final point i would make on this topic to senator casey's point, we've done a lot of work here in the united states with health care provide ers. even with citizens so that they know what to look for, to remember to ask for a travel history. we have a number of our laboratory response network laboratories around the country who have the capacity to test for ebola. and then the health care facilities themselves are very tuned in to the appropriate isolation methods that would be needed should they have a suspect ebola patient. >> thank you, mr. chairman.

>> thank you. senator bennett? >> thank you for holding this hearing. dr. bell, you mentioned in your opening comments the particular problem in liberia of there being a lack of isolation capacity. i wonder if you could describe for us, if everything worked the way it's supposed to work, make these fundings, first of all, what the experience of somebody today who is infected with ebola is in liberia if they don't have access to an isolation chamber. and second, what you would expect to be the progress points we need to see in order to know that we're actually creating an infrastructure that really can change the outcomes, the course of the disease. >> yes, thank you, senator. as you mentioned, there are not enough treatment facilities, isolation facilities in liberia right now to take care of all of the cases.

and because of that, there's ongoing transmission that's occurring because we can't isolate them. we're working on this on a number of fronts. first, as many of the senators have mentioned, we will be building more ebola treatment units, and in addition a number of other entities, including the government of liberia, are also building ebola treatment units. there will be a scale-up of ebola treatment units. there's a a number of groups that are actually working to scale it up. in the meantime -- >> go ahead. >> there are a number of interim measures that we're also going to be taking so that people can be isolated safely, not in a treatment unit. so there's a number of ways to approach that. there are community holding centers for lack of a better term where people can be isolated safely with one caregiver and that caregiver can be provided with the appropriate personal protective equipment that they need to prevent

transmission to themselves. there's also some efforts afoot to do that in household. so a caregiver in a household would be given a kit which provided all the equipment that the person would need to protect themselves and also some of the medications, such as oral rehydration, for example, tylenol to help with fever, that the patient themselves could use during their illness. so there's a number of different kind of interim measures that we're working to scale up now at the same time that we're working on building additional isolation faciliti facilities. >> how are you or with whom are you working to make sure that that work is actually happening rather than just being thought about? >> there's actually quite a bit going on right now. actually usaid has been working with a number of

non-governmental organizations, including msf. they have actually produced tens of thousands of these kits and have a plan in place to scale them up to hundreds of thousands in the near future. >> thank you. and first question or one of the first questions the chairman talked about, maybe the need to have a cdc or something like it in every country. and that is something we should aspire to. we have a long way to go to get there. i wonder if you could talk a little about your efforts to make a network of realtime detection of diseases and collaboration among these various countries in our response. >> yes, part of our response here is to build up the basic capacities in these countries. in addition right now as an urgent matter, we're working to build up these capacities in the bordering countries. laboratory capacity. imagine operation centers. rapid response teams.

beginning planning on what they would need to do in terms of isolation should they need to do that. working on culturally appropriate burial practices. so in those bordering countries, that's sort of an urgent priority for us. then across the rest of africa, we're working to kind of harden the country's ability to be able to recognize imported cases to know who is the incident manager, how is their emergency operation center going to work and what are the steps that they would take in order to respond to an additional case. do they know how to do contact tracing. who would be responsible for the contact tracing. where would they isolate the patients. these are things we're working on now in the context of this outbreak. in a bigger picture kind of way, they are basic capabilities that the security agenda, for example, has been calling for and as you probably know, we have been working with a number of countries in a pilot kind of

way over the last couple of fiscal years to show the proof of principle of what global health security can mean to detect to respond and to prevent these outbreaks with basic capabilities around laboratory capacity, around communication strategies, around emergency operation centers, basic epidemiology. these are all fundamental capabilities that country by country we need to build if we want to prevent this kind of thing from happening in the future. >> thank you, appreciate that testimony. thank you. >> last year the appropriations committee put in $6 million to start this process of establishing cdcs in key countries designated by cdc. i understand some time this fall cdc will announce those initial grants. we put $10 million in the

appropriations bill this year to continue that effort. in light of the ebola outbreak and others i'm hopeful that maybe we can take a second look at this, if in fact we do have an omnibus appropriations bill that we can do that we might want to put some more in there. understanding you can't do it all at once, but still know that the pipeline is there that we can start bringing people here to train them, train them in laboratory procedures, start buying the equipment they need to kind of get a jump start on even more countries next year. >> i appreciate that. i think there are a number of us that would love to work with you and the chair and the appropriations committee on it. >> we just need the money. >> senator whitehouse? >> two questions. i'm not an expert in epidemics,

and i don't know if there are accepted stages in the acceleration of an epidemic when it goes from an outbreak to a full-on epidemic to a raging out of control forest fire. if there are, what are the red flags that we should be looking for that this epidemic has gone to the next stage in terms of the threat that it presents? >> there are some key indicators that we use that sort of depends on the situation, what the indicators are. in this situation, there are basic indicators like the number of cases and the number of cases per week as senator alexander has discussed. there are other indicators, for example, the number of cases in health care workers. we should not be seeing cases in health care workers. if our infection control interventions are working. after that, i think that we are

working to track things like whether patients that need to be isolated have a way to be appropriately isolated. whether we are not -- we stop seeing bodies that can't be picked up in a timely fashion and a number of different indicators like that that we use to help us understand if we're bending the curve and whether it's going in the right direction. >> when you consider the existing effort, which has been heroic but measured against the threat has obviously not kept it from accelerating. how many multiples of the existing level of effort do you think are required to be able to get ahead of this and bring it back under control. ten times the effort? hundred times the effort? >> i would say a very large increase in the effort and also a very large increase in the effort with a sense of urgency so that the increase happens very quickly.

it's hard to say, you know, how many multiples, but there needs to be -- and i think we can safely say -- >> we're not even close to meeting the threat right now. >> i would say that the sorts of interventions and scale-up that we've been hearing about in recent days is the sort of scale that we need in order to address had this outbreak, it this epidemic. >> and is this a virus that's capable of being manipulated by humans? could one go into it if one had a sample of the ebola virus and meddle with a portion of the dna strain that relates to how it's transmitted? could somebody up to mischief try to make something that was more transmittable out of this existing virus? >> theoretically, you can manipulate almost any virus to

change it any way you want. so i mean that's a question that always raises red flags about it, but the fact is, yes, the only trouble is it wouldn't be easy for somebody to do that in their laboratory backyard. they would probably kill themselves doing that. it would take a state type thing. i don't know if you were here when i made my opening presentation, senator white house, but i mentioned that our getting involved in the hemorrhagic fever viruses was part of a biodefense agenda because, way back during the cold war, it was clear from intelligence, and proven, that the soviets were stockpiling hemorrhagic fever viruses and things like that for just the purpose that you make. so it would have to be a state thing. i don't think you're going to get some rogue person being able to do that. >> others would love to work with you on trying to explore that further.

thank you very much. >> senator durbin? >> dr. bell, is cdc working with the world health organization? >> yes, we are, senator, very, very closely. >> it's my understanding that the president submitted the name of dr. frieden from the cdc to be our representative to the world health organization in july of this year and it's still lost somewhere in the united states senate. i would hope before this week ends and we return home, that we might consider bringing this to the floor on a bipartisan basis and expedite the appointment of dr. frieden whom we know well and we have studied. we know his background. so that he can be with the w.h.o. and not wait for two months or more for you to return and consider that nomination. i'd like to suggest that to the

chairman and see if we can get that done. i'd like to ask a second question following up on what senator casey said. senator casey said i hope that there's nothing that's been done on a budgetary basis that slowed down the development of a ebola vaccine or response that might be helpful. you've talked about 22% decline in the funding in nih research over the last ten years and the impact of sequestration. has there been, to your knowledge, any shortage of funds, which has led to a delay in testing or development of ebola vaccine? >> i think one could say honestly, senator, that everything really over the last several years, with few xepgsz, has been at a level less productive than we would have been purely on the basis of significant constraints. i don't think we can say there's been a serious delay in this

particular vaccine. that would be an overexaggeration. i would put it under the umbrella of the entire effort that we have been putting forth over the last several years have had to be muted somewhat by a budget that in real dollars is shrinking. >> it's my understanding based on w.h.o. statistics that i've read about the physicians per capita that in my hometown of springfield, illinois, with a population of about 100,000, there would be expected to be 240 physicians. in sierra leone, two physicians for 100,000 people. and in liberia one physician for 100,000 people. that's an indication, at least a few years ago, a snapshot of the scarcity of medical professionals at the highest level of doctors and such. i have been working and we included in the immigration

bill, which passed the united states senate, a provision which provided in one respect if you are medically trained in africa and promised to serve in africa for a certain period of time before going anywhere else that we would honor that, respect that and not allow people to be recruited into the united states when they still have an obligation to their country. secondly, that doctors in the united states would be able to serve in these crisis situations overseas without jeopardizing their immigration status. that passed the senate. that was in the immigration bill. it was never called for consideration in the house of representatives. speak to not just the terrible infrastructure when it comes to hospitals, but the medical professionals and health workers available in these countries that are facing this. >> yes, senator, you're right that the number of doctors in liberia and in sierra leone is

extremely small. liberia the number of doctors was in the hundreds, as you say. tragically, because of sort of the lack of infection control and the very, very poor conditions in the health care facilities and the inability of the health care workers to recognize ebola patients when they came with a fever, you think it's malaria and turns out it's ebola and the health care workers are not able to protect themselves, tragically a lot of these sort of scarce health care workers have died in the context of the ebola outbreak. the rest of them, many of these facilities now that were rudimentary already are closed. and this is one of the things that we need do, is to train in infection control, provide appropriate personal protective equipment and get the facilities back up and running safely so that we don't sort of continue

this spiral of not only the ebola outbreak, but also many other conditions that are not getting treated right now in the countries. >> we have learned the hard way that countries with very few medical resources, when they face this kind of epidemic and challenge are only a ten-hour plane ride away from the united states. thank you. >> senator durbin, i must say when you talked about dr. frieden's nomination, i thought, did we drop the ball on this? how could we have dropped the ball on something like this. i just found out that it does not come to this committee but foreign relations committee. so hopefully -- hopefully we can -- >> mr. chairman, the information we have is the president didn't nominate him until the end of july. we were gone in august. the foreign relations committee staff is meeting with him tomorrow. >> okay. >> they're doing that in a bipartisan way. they could move him. i heard senator mcconnell say he supported president obama's proposals to deal with ebola.

so i know of reason why the majority leader and whip couldn't work with senator mcconnell and bring it up before we leave. i would hope so, and i would be glad to support that as i imagine the chairman would. >> i'm not on the committee, but. one of those meetings in the back of the senate floor like we do all the time and get that job done in a hurry. our wonderful chairman of the full appropriations committee, senator mikulski. >> thank you very much, mr. chairman. first of all, thank you for organizing this hearing of both the authorizing and the appropriations committee and to my colleagues for such strong bipartisan participation in this. i want to, first of all, thank the people at the head table and all who work behind them for the outstanding job they are doing to organize the american

government's response to this. and also to mr. charles, representative of the people who are really in africa trying to help people in this most horrific of challenges facing not only the countries, but the people and particularly the workers who are there that must be facing just incredible stress. this is such a grim, horrific proportion and they are working 36-hour days, just as you are. so we want to acknowledge that and thank them. mr. charles, it's wonderful to have you here. dr. brantly and mrs. brantly, good to see you. what's so great about seeing you, dr. brantly, is one, that you're well enough to be here. you were well enough to travel here and you're well enough that we're not afraid to have you

here. and we can smile, but this is a stunning, stunning, stunning accomplishment. but again, we're glad to see you. mrs. brantly you look so much like samantha powers. i say what is samantha powers doing sitting next to dr. brantly? but we could send you to the u.n. and i bet you'd have a lot to say that would shake them up and help them to respond. so we're glad that you're here. i want to make a couple comments and then a few questions, if i could. first of all on this issue of who is in charge that was raised by senator harkin and senator boozman. i think usaid has -- is in charge of responding in a disaster. an earthquake in haiti, the many disasters and they are to be acknowledged for their ability to do that. but the size and scope and multiple government agencies involved in this, i think needs

a higher authority that actually can command personnel and organize working with us on bipartisan basis for the kind of resources to do this. because just listening to what we're doing today, we need the help, just go to the appropriations. we're going to need foreign ops and we're going to need dod and within the labor hhs, it's cdc, it's nih, it's fda. so i think, mr. chairman, working across the aisle, we should ask the president through whatever mechanism they are going to say, we need a point person in addition to omb, which will be here to do this. do you want to comment? >> i just wanted to make sure i didn't create a misconception in what i said about the dart.

what i meant was on-the-ground coordination in the middle of that area, that usaid is coordinated. i take your point and i think -- >> here's my point. >> yes, ma'am. >> presuming there's a bipartisan group and there's the will here, we have one of the leaders within the republican republican, party beau has been one of the leads experts on biohazards. if we wants to meet with the person in charge, who would be the person in charge? aid? frieden? dempsey? kerry? >> i take your point, senator. >> dr. rice. this is not -- so let's do that because, again, we want to maximize and leverage everything we have. and also create that sense of urgency. now let's talk about resources.

first of all, i'll be leaving shortly, dr. brantly if you see me go before your testify, i'm going to work on the continuing resolution, so we can have again in a bipartisan basis, bicameral basis, pass that. but i'm looking ahead to december 11th and also the fiscal year for fiscal '16. so the cr is really a down payment to keep your current response functioning, but it is not of the size and scope that you need to respond in africa and prevent it from spreading globally. am i correct in that? >> from cdc perspective, yes. it will allow us to continue or field operations through the end of the cr. but the situation is very fluid and we're assessing what we would need for the rest of the year. >> dr. bell, when did you have

to submit to omb your fiscal '16 request? >> i'm sorry, senator, i don't know the answer to that question. >> let me tell you. >> i thought you might be able to. >> it was a few months ago. so whatever dr. frieden told omb and the white house that he needed for cdc that is really three to five months behind. so as we get ready to work, we're encouraging omb -- this is our administration here, to go back and say, what is it that you need for the cr, an omnibus which i hope that we can achieve, but also a look ahead to fiscal '16 presuming we can find a way to cancel the sequester. so i would say to all the agencies involved, look at that and revisit that and it's our job to get omb to give you the

latitude to come back because of this new need. now dr. fauci, wherever there's been an infectious disease crisis, you've been in the forefront of trying to find solutions for 30 years. since aid to now. we're so lucky to have you at all of these. but you spoke to us eloquently you a few years ago about a pandemic. when you have a global infectious disease crisis, you need to have an infrastructure to be able to respond. am i correct? >> correct. >> now this is contained to one continent. do you think we're heading to a pandemic with this? >> no, i don't, senator mikulski because, as we have mentioned, the spread of this in the west african countries is really a reflection of the extraordinary disparity of lack of health care infrastructure to be able to handle an outbreak, to get the people isolated, taken care of,

contact trace, so that you don't have essentially unfettered spread. in a country like the united states and other developed countries that we may and its entirely conceivable, have one get on a plane infected in the west african country, be asymptomatic and land in washington or new york or paris or london. get out of the plane, get sick and perhaps go to an emergency room and even infect a person or two because someone didn't take a travel history. but at that point once it's recognized, the kinds of capabilities we have would make it almost impossible to have the kind of outbreak that you're seeing in a country in which the outbreak is driven by a lack of ability to handle infection control. and we have that. >> well, then let's go to the disease. if this disease mutates, would

mutation be of concern to you? and if it would mutate, do the current suggested treatments, possible treatments be ineffective because it's a new disease, and then could it even become airborne? >> well, any hypothetical you say we have to say it's not impossible. do i think as a person who's been dealing with viruses for so long that i think that this is likely that this is going to happen? no. you never rule anything out. you always keep an eye on it. we are following the genetic movability of this very carefully. when people ask us this question i say what i know will happen, not hypothetical, is unless we get control of this it will continue to not only devastate but it will be much more difficult to get in control. and so we always in the back of our mind are concerned about

mutations, right now today in september of 2014, mightation is not the problem. the problem is the full-court press we need to put on getting this under control by standard, classical infection control methods. >> which is a public health infrastructure. >> exactly. >> in this country and helping other countries. >> quite correct. >> thank you very much, mr. chairman. >> thank you very much, senator. i want to thank this panel. we're running very late. but it's been very informative. we thank you all very, very much for your great leadership. the record will remain open for ten days. i hope we can continue to call you for advice and consultation moving ahead on this. >> thank you very much. >> thanks, dr. bell. >> now we'll call our second panel. dr. kent brantly and ishmel charles. dr. brantly served as the

medical director for the samaritans first ebola care sentner the liberian capital of monrovia. in july, dr. brantly's life changed abruptly when he contracted the ebola virus while treating patients in liberia. we're thankful that he's recovered and is feeling well enough to offer his unique insight as both a provider, and a patient. dr. brantly as senator mikulski pointed out is joined today by his wife amber. and we welcome you here also. dr. brantly, thank you for being here. and ishmel charles is a survivor of sierra leone's eleven-year brutal civil war. he is a program manager for heli international relief foundation in sierra leone. in that capacity, he manages and monitors all heli international relief foundation projects in sierra leone, including an ebola awareness and prevention project in 11 communities in the rural western district of sierra leone. thank you, mr. charles, also for

being here today. we'll start with dr. brantly. dr. brantly, your statement will be made part of the record in its entirety, as will yours, mr. charles. and again, i apologize for the long period. you can tell the people here are very interested in what's happening with ebola, and you bring a very unique perspective. you had -- you contracted ebola. you are alive and well today. you are a provider. so dr. brantly welcome. and your statement is in the record in its entirety. please proceed as you so desire. >> thank you very much, mr. chairman. chairman harkin, esteemed senators, guests of this committee, i'm grateful for the opportunity to testify before you today about the unprecedented ebola outbreak that's occurring in west africa.

it's already claimed thousands of lives and threatens to kill tens of thousands more. let me also take this opportunity to thank each and every one of you. i know there were many people, maybe some of you on this committee, who helped play a role in bringing me home when i was so sick. and i just want to say thank you. on october 16th, 2013, i moved to liberia with my family to serve as a medical missionary at elwa hospital. in the capital city of monrovia. i worked to support the woefully inadequate health care system in a country that is still struggling to recover from a brutal civil war. in late march of this year we learned there were cases of ebola in our region, and we began preparing our staff as well as our facility to be ready to care for patients in the safest way possible, should that need arise. three months later in june, our hospital had the only available ebola treatment unit in southern liberia, and i was one of two physicians to treat the first

infected individuals in that area. from june 11th when we received our first patient until july 20th, the number of cases continued to grow at an incredible rate. the disease was spiraling out of control, and it was clear we were not equipped to fight it effectively on our own. we began to call for more international assistance, but our pleas appeared to fall on deaf ears. as the ebola virus continued to consume my patients, i witnessed the horror this disease visits upon its victims. the intense pain and humiliation of those who suffer with it. the irrational fear and superstition that pervades communities. and the violence and unrest that now threatens entire nations. then on july 23rd i fell ill. three days later i learned i had tested positive for ebola virus disease, and i came to understand firsthand what my patients had suffered. i was isolated and unsure if i would ever see my family again.

even though i knew most of my caregivers, i could see nothing but their eyes through their protective goggles when they came to treat me. i experienced the humiliation of losing control of my body functions, and i faced the horror of vomiting blood, a sign of the internal bleeding that could have led to my death. i'm grateful to the team that worked tirelessly to keep me alive in liberia, and despite a severe lack of medical resources, they -- they were courageous. i was then evacuated to emory university hospital, where i eventually became one of the few to recover from ebola. as a survivor, it's not only my privilege but it is my duty to speak out on behalf of the people of west africa who continue to face unspeakable devastation because of this horrific disease. this unprecedented outbreak received very little notice from the international community

until the events of mid-july when nancy writebol and i became infected. since that time there's been intense media attention and increased awareness of the situation on the ground in west africa. the response to date, however, has remained sluggish and unacceptably out of step with the scope and the size of the problem that is now before us. the united states government has been closely following the events in west africa since that time if not before. and only now are we seeing a significant commitment to a solution. i had the privilege and honor of meeting with president obama this morning, and we discussed his commitment of more military and medical sources to fight this epidemic. he has also requested increased funding for the cdc. i thanked him for entering into this battle with us in a larger way. now it is imperative that these words are backed up by immediate action. to control this outbreak and

save the lives of thousands of west africans and possibly many americans, we need the promised ebola treatment units. the surge in health care workers. the u.s. military regional command and control center and we need it immediately. we also need the 400,000 home treatment kits that have been committed to be sent without delay. there's no time to waste if we are to contain ebola and adequately care for the thousands of people that epidemiologists are now predicting will fall victim in just the next few weeks. the u.s. military must establish and maintain an air bridge to deliver critically needed personnel and medical supplies, and to continue bringing in more resources in the future. we cannot turn the tide of this disease without regular flights of personnel and large cargo loets of equipment and supplies. i'm grateful to the president for his decision to send tens

of thousands of ebola test kits to the region. but these will only be helpful if we also deploy all available mobile laboratories and increase funding for more to be built as quickly as possible. during my time in liberia, the laboratory we used to confirm ebola virus infection in patients was 45 minutes away from our hospital. and it was inadequately staffed. the turnaround time to positively identify an ebola case was anywhere from 12 to 36 hours after the blood was drawn. if a patient is not infected with the virus, that can be a life threatening delay. more kits are not effective unless we have the facilities and the staffing to use them. as the first human being to ever receive the experimental drug zmapm i'm a strong advocate for the cdc and nih as they research vaccines and drugs that we just heard about. and these drugs can give patients hope for recovery.

i'm deeply grateful to the personnel at mapp pharmaceuticals who even before this outbreak dedicated their lives to combatting ebola. we cannot wait, however, for a magic bullet to halt the spread of this virus in west africa. the current epidemic is beyond anything we have seen before, and it's time to think outside the box. i realize that home health care interventions can be controversial, however, we know many ebola positive people are staying at home and even hiding after they become infected, because of fear and superstition their families, either abandon them, or they lovingly care for them in ways that almost always result in infection of the caregivers. this is a major contributor to the spread of ebola and we cannot contain the disease without addressing this problem head-on. caregivers must be trained in safety measures and supplied with basic protective equipment so they can care for their loved ones while protecting

themselves. as the number of survivors increases, these individuals should be mobilized to help educate and support their own communities. they would be a powerful witness the disease is not 100% fatal and they could provide much needed support to those who are trying to do what is best for their family members. admittedly, home care is less ideal than treatment in an isolation unit. in the home it's impossible to administer iv fluids and other supportive medical interventions. however, there are not enough beds in the ebola treatment units right now and many infe infected people are choosing to suffer and die at home. the least we can do is try to give their caregivers the information and resources they need to protect themselves from this deadly virus. all of these interventions that are needed to stop this horrendous transnational outbreak require significant funding and budgets must be adjusted appropriately. this is not simply a matter of providing humanitarian aid, it's very much a national security

concern. one of my patients in liberia was a man named francis. like most patients, at first he was fearful. but eventually he shared the story of how he contracted the disease. he said to me, doc, i remember who the man was that i got this infection from. he said he was sick at home and his condition worsened. and when he began vomiting blood, everyone around him fled. but his wife was determined to get him to the hospital. since no one else was around to help, francis went to this man's house and helped carry him out of the house and put him in a taxi. on the way to the hospital that man died. if someone had come alongside francis and given him a little bit of education and provided him with the personal protective equipment he needed, his family would still have their father and their son, and their

brother, and the world might still have this good samaritan. but unfortunately francis fell victim to ebola and died. many, including one of the senators today used the analogy of a fire burning out of control to describe this unprecedented ebola outbreak. indeed it is a fire. it is a fire straight from the pit of hell. we cannot fool ourselves into thinking that the vast moat of the atlantic ocean will protect us from the flames of this fire. instead we must move quickly and immediately to deliver the promises that have been made, and to be open to practical, innovative interventions. this is the only way to keep entire nations from being reduced to ashes. thank you very much, mr. chairman. >> thank you, dr. brantly. thank you for your courage and

for being here, being an example. thank you. we'll get on to questions. but mr. charles, welcome. and please proceed. >> thank you very much. chairman harkin, senators, dr. kent brantly, and fellow guests of this committee, thank you for the opportunity to allow me to come all the way from west africa and testify in front of you today. my name is ishmel alfred charles a resident of sierra leone. i'm married. i'm a father of two children. two girls, 9 months, and 10 years. i arrived yesterday morning around 2:00 a.m. to share with you what my country is currently dealing with on a daily basis with the current ebola outbreak. while still trying to rebuild

from the brutal civil war, unlike the civil war, sierra leone, the outbreak creates more fear to the entire population. that's one goal. in the civil, it was at a time a certain population would be afraid of the attack. today the general atmosphere in my country and among all africans within the west african region are afraid of fear. the biggest crisis that we've ever faced. bigger than even the civil war. as a former child soldier, i was able to survive the war. but i fear that this is going to be worse than the war. the heli national relief foundation based in new jersey supports the rebuilding of health care services in sierra leone, and provided relief, and

a lot of support to war-torn countries like sierra leone and they have been working in sierra leone for more than 12 years. the foundation's mission is to invest and support families and individuals affected by disaster, war, adverse socioeconomic conditions. through the delivery of health care, food, and training and other kinds of programs. hence the money to power committees and build the capacity to become self sustaining. the foundation partners with the charitas free town of which i am placed with. and they run all the foundations projects in sierra leone. charitas whose mission is to eradicate poverty, core umgs, injustice, improve equality,

advance good governance and acheap peace and human rights, empower women and the disabled. as a spokesperson for the healing and national relief foundation in sierra leone, i feel privileged to share with you our experience on the ground in the war fronts. as it is today sierra leone is considered to be a war front, and so is liberia, guinea, and the other west african countries. since the outbreak, we have the been implementing the ebola outbreak response project in the western rural area and other districts. we work closely with the ministry of health and sanitation. ministry of social welfare. the emergency operation centers. what this essentially shows is that smaller organizations with lower human capacity and budgets are able to make impacts at the lowest community level because they live within the community.

and they understand the reality on the ground. as part of this project we have been working with a number of communities in the western districts and about 219,000 people raising awareness, providing chlorine which serves as a detergent to kill the virus. soap and buckets to police stations and police posts. in addition, we have strong national media campaign in collaboration with our counterparts charitas organizations in other regions of the country. the growing number of cases recorded on a daily basis has made the situation in sierra leone very scary. each day the situation becomes worse and the effects of ebola cannot be overemphasized as dr. brantly has painted a picture very clearly for you to see. when i was about to leave, my 10 years old daughter asked me,

she said dad are you going to leave us in this country and go to america where there is no ebola? i stare at her for a minute and said, ma, as i call her, my trip is for the general good of the family. and for your future. i will be back in two weeks. and she said again, are you sure? because every day flights have been canceled. as i speak there are only two flights going to sierra leone, liberia. similarly, my wife said, dear, the morning you used to leave normally when you travel is not

going to be enough. this time around because the price of commodities have tripled. what i'm trying to say in essence the situation in sierra leone is getting very difficult every day. and so it is in other countries that have been faced with the current outbreak challenge and the economic burden is getting very heavy on a number of people. as i was about to leave my biggest stress was the situation if anyone gets sick behind me, the health system is not functional. when you go to a hospital the doctors are not there anymore. and even when they are there, they deny, that they're not doctors, because they are afraid that they might be infected. and they're not sure what sort of sickness a patient might have come in with. the ebola phobia is increasing. even people who do not have ebola are being stigmatized.

ee have suffered equally. now let's talk about those who have tested positive. the state's overwhelmed and unable to call it effectively the ebola response. people are losing their confidence every day. the ebola crisis has escalated into a wide economic situation and has damaged further the health care systems which are not prepared to manage such a difficult situation. harvest has been canceled because too many farmers are dying. in the capital free town, hotels have very few number of guests. a very big hotel who may have the capacity to house 300 guests will only have four guests or even less. and the hotels keep dropping their staff every day because

they don't have the money, the resources to take care of this stuff. and this staff that they're dropping are parents who have families they need to take care of. in a country with 70% illiteracy, schools have been closed indefinitely because of ebola. we have no idea when we're going to reopen the schools. our country has high orphan population, and ebola is increasing that on a daily basis. through the foundation, we were able to make donations to the ministry of social welfare and support the ministry of social welfare who are currently taking care of the ebola orphans. while we're also very careful that these orphans could be stigmatized and at the same time could be positive. it's a very delicate situation. people do not have the free will to bury their loved ones anymore and show the compassion and care

and emotional love to those which are sick which normally helps people to recover very fast when you know that you have emotional support around you. flights have been canceled. the economic situation is getting worse every day. as a result, households are struggling. not just the ebola that is killing people in sierra leone. poverty, hunger, lack of medical facilities. families go hungry when breadwinners dies or gets sick or loses their job. which is happening on a daily basis. with the support of the united states, the international community and the spirits of sierra leoneans, we believe we will put ebola at our back. however, a decade of progress will have been lost.

especially so when already the health facilities were in bad shape before the outbreak. i plead to this house and to the united states and international communities not to leave sierra leone when the outbreak might have subside. we will need to help invest in sierra leone so we can be able to be self-reliant again. because we will not need to continue to rely on international support. but if we are self-sustainable we will be able. i've heard about the cdc report that dr. bell spoke about. she gave a numb beof incidents or instances specifically talking about liberia. every picture that she painted is equally as devastating in sierra leone. and probably even worse.

the numbers that the government gives on a daily basis of infections, of infected people is definitely way lesser than what is really happening on the ground. for various reasons. and the health facilities, all the support that we have currently does not mean much with the number of professionals that we have. lastly, i want to thank this house for listening to me. and please, we will look forward to the continued support of the the united states in sierra leone. i thank you very much for your attention and if for the privilege you give me in listening to me. thank you. >> well, thank you mr. charles, and both.

it's always important to put a human face on matters like this. i think people read about it. you get the numbers. you say it's horrible. but again you have to understand the human impact and what this is doing to families in your country, in liberia, and other countries. and the nature that i'm now beginning to understand of how if we don't get it controlled soon, it will spiral out of control and it will have the devastating effects that mr. charles is talking about. a number of people will go there, business will end, the whole economy will start grinding to a halt. dr. brantly, first of all, i'm sure i can speak for many americans around the world when i say thank you. thank you for being such an

example for all of us on how to serve others. we regularly thank our soldiers for marching into harm's way. rightfully so. let me say this is no different. you and others like you run towards the risk to help those standing in the path of this terrible disease. so i want to include you and others like you in that pantheon of american heroes. you do us proud. real proud. i just -- i have so many questions, but i know we're running out of time. but i guess, dr. brantly, what i would probably ask you first is with all that you know, and you've been there with your family. you know what the situation is like. give me, one, two, three, what's the most important thing we can

do now? what's the most important response that we can do now? >> thank you, mr. chairman. >> if the you were in charge and you had a magic wand, what would you do with it? >> i think one of the most important points is in your very question. we have to do it now. this has been in the eye of the government for months. we can't afford to wait months or even weeks to take action. to put people on the ground to begin opening the logistical bridges and pathways, to begin going out into communities and educating caregivers. it's not that we're trying to keep people at home. but we need to increase the capacity to care for them. and that means not only creating more beds but having the staff to care for them in the beds. putting them in a bed may keep them from giving the disease to someone else, but it does

nothing to improve their chances of survival, unless they're receiving good, quality, supportive care. so we need more capacity in ebola treatment units. but we must have the staff for those units, as well. and we need to start educating people right now in their communities about how to safely care for their family members who are hiding at home dying from ebola and ashamed or scared of their own situation. >> you must have a -- you have to have a valuable perspective on liberian culture and society having been there. we send in a lot of people. maybe they're not culturally sensitive. i don't know what i mean by that. but they don't understand the situation. and can people actually become more afraid of the workers we send in if they're not adequately trained and equipped.

>> i think that's a very real possibility, mr. chairman. i think, yes, liberia's civil war ended ten years ago. but think about the situation in the united states ten years after our own civil war. there was still a lot of tension. and in liberia there's still a lot of tension. and there's a sense of distrust. distrust of government, distrust of authority, distrust of foreigners. so yes, people will be resistant to help. but i think because of the devastation of this outbreak, even those people who have been resistant to help are starting to see the need for some assistance, and i think that's why it's important we don't just march in with the military and take over, but we partner with the ngos, like doctors without borders and samaritan's purse and the administrative health of liberia so that it's a partnership and we're using

people like the survivors from ebola. there are being more and more survivors every day in places where they can get good, supportive care. and those survivors are the ones who can go out in what you refer to as a culturally appropriate way, educate and support their communities and distribute the needed personal protective equipment to protect those home care providers. and i think that is very much an important part of the strategy. but again it has to start now. it has to start in a matter of days. from the time i fell sick, just less than two months ago, the death toll has tripled. if we take two months to get our response up and going, even if we only maintained that rate of growth, we're looking at thousands and tens of thousands and in nine months down the road we're looking at hundreds of thousands, of not only cases of ebola but deaths. and we can't afford that.

>> that's where i hope our military airlift capability will come in and start moving material and personnel over there. senator alexander? >> dr. brantly, mr. charles. let me thank you both. mr. charles, thank you for your work in prevention and bringing awareness here and dr. brantly, thanks for being a good samaritan and we greatly admire what you've done. you're a survivor of ebola. is it like cancer? is that in remission? or are you cured? or do you know? >> thank you, senator. i'm cured from ebola. >> so you don't have -- it's gone from you. >> yes, when a person survivors ebola, when they recover, they're not a carrier of the virus. they're not a -- you know, dr. ribner at emery university was very clear to say that nancy

writebol and i pose no public health risk. so there's no risk to the public from a survivor. there's a lot of stigma attached to being a survivor of ebola. but we could -- >> can an ebola survivor become infected once again? or are you then immune from ebola? >> in theory, and i think in practice, i am immune to the strain of ebola that i was infected with. but there are five different strains of ebola. if i went to the democratic republic of congo, i may not be immune to the strain that's causing the outbreak there. >> you talked about you treated a lot of patients. would you say it's accurate that about half the patients who are infected die, or is it higher or lower than that? >> unfortunately, senator, in my experience we did not have a 50% mortality rate or 50% survival

rate in our facility. as we saw patients early on in the outbreak, they were usually showing up very late in their course. and in the month and a half that i was treating ebola patients, we had one survivor. >> from the time you discover an infection until death, how long is that typically? >> that varies greatly depending on how early the person seeks care. we had some people who came and died in a matter of hours from the time they presented. and we had others who were under our care for a matter of days, four or five or six days before they passed away. >> but it's not months? >> no. the illness generally is a two-week course. and by the end of two weeks the person has either died or they're on the road to recovery. >> which is one reason there's such concern because it's so exclusive, it moves so rappedly, is that right? as i listen to you, i hear you talking about lots of people at home sick for a variety of reasons. not -- we don't know about them. we've heard the official statistics say that less than 5,000 infections.

sounds to me like there might be many more. >> i think that's very accurate, sir. as many of the witnesses said, those numbers are based on the cases we have tested and identified or are housing in isolation units but there are many, many more at home. >> so there are many more and what you're saying is the course of the disease might run a couple of weeks and you're either dead, or a survivor after that period of time. in your experience, most -- well in your experience all but one died in that -- and others, they say half. the official statistics say that the cases double. the official cases have doubled over the last three weeks. so you don't have to do much math to see that the numbers are, as you say, can quickly go to tens of thousands, hundreds of thousands, if we don't get control. am i correct the home health kits are primarily for the benefit of the caregivers?

that it's to keep the infection from spreading? does it make the home sort of a hospice for the infected person with ebola? >> i think that's a fair way to look at it. as i said, you can't carry out complicated medical interventions in a home, but you can give people oral rehydration solution. you can give them tylenol to help with the fever and pain. but the most important part of that kit is the part that offers protection to the caregiver. because without that we're not stopping transmission. and that's what has to happen to control the epidemic. is to stop the transmission of this disease. >> you took a great risk in going there and it's obvious from the testimony of you and mr. charles and others that

we'll need hundreds, thousands of people, in addition to the soldiers who are going. what would you say to others, people like yourself. we have a tradition in this country of doctors without borders, samaritan's purse, of which you were a part. what would you say to americans who are seeing this and trying to decide whether to go to west africa to help control this disease? >> thank you, mr. senator. this is a topic very dear to my heart. i think the international president of doctors without borders said it very well in a recent article. she said, comparing ebola to a fire, this is not the time to run away. this is the time to put on our protective gear and run into the burning building. the physicians and health care professionals even if just

symbolic have taken an oath. in many institutions they still take the hippocratic oath, and that oath is to the service of mankind. and i think if we can help people overcome the fear of facing a deadly disease and remember this is not just a disease. these are people who need help. these are societies collapsing because of the weight of this burden. we just need people to go help. >> well, this was -- oh, i'm sorry. >> thank you, mr. chairman. dr. brantly, mr. charles, thank you for being here. mr. charles, when you go back

and see those girls, your daughters, i hope you'll share with them that the purpose of this committee is to try to make sure we can process enough fact to make sure that we can provide what's needed from a standpoint of the resources. there are other pieces of government that has the responsibility to get them there, to train, to equip. but we have to make sure that we have the resources. and what you have shared with us, both of you, is invaluable from the standpoint of how we look at it. and as i think both senators said, to see the human face behind the issue is absolutely crucial to those of us who sit on this committee, and in this institution, and ask taxpayers to, in turn, fund things from people that they'll never meet. but i do have a couple of

questions. dr. brantly, are you convinced zmapp played a role in your cure? >> thank you, senator burr. my opinion -- >> i take for granted that from a standpoint of good supportive care, since you knew them, you were getting it? >> i was receiving the best care they could afford to give me in liberia. my own opinion is that zmapp, i believe, had a beneficial effect in my treatment. but as dr. fauci very clearly said, this is an experimental drug that my story is an anecdote, and while a very convincing one, it's just one. and it really requires more extensive testing of an experimental drug to prove whether or not it is beneficial on a large scale.

and i'm very thankful for the -- for mr. zitland and all the people at mapp biopharmaceuticals because i think it was helpful to me and i think it will be helpful in future ebola outbreaks because there will be more ebola outbreaks. >> let me say this, when the chairman was referring to he was concerned this might spiral out of control. i think we've already spiraled. i think we're in that spiral now. i think had we had more time with robin robinson, we would understand that we're probably january at the earliest for therapy. and that's without extensive clinical trials. as you can imagine, we're january, first quarter with potentially some vaccine product. and that's with, being a doctor you know, if we're talking about a five-month clinical trial

process we have accelerated it greatly. we're going to break every failsafe that exists at the fda just like they did in the decision to administer zmapp to you because that's jurisdictionally under this committee, it's important that we all understand. we're going to sort of recreate the wheel because this is an extraordinary circumstance. and i guess i'm asking for your medical opinion. and your opinion as somebody that knows the folks that are being affected. if we choose to go before we know everything with some type of therapeutic response, is that the best course for us to follow? or should we be prudent and take longer knowing that we know a little more about the therapy or the vaccine?

>> i think w.h.o. came out with a statement several weeks ago saying they believe it's ethical to use experimental drugs in circumstances such as this. i -- i would agree with them. that if we know -- i mean, in my case we didn't even know if it would be harmful for not. i think if you're going to start giving it to people who don't have the background to be able to give really understood, informed consent, it's important that we know that what we're giving them is safe and potentially beneficial. but i think -- i think those types of drugs, especially vaccines, i think the other panel has spoke to that better than i can. but i think they would have a role, especially if we're not --

if we don't have this thing under control by january. the numbers that we look at for every infected individual, that they will infect somewhere between 5 and 20 individuals. the multiples are huge. i think i heard both of you say that when we look at sierra leone 1620 cases, 653 in the last 21 days, liberia, 1383, you think those are woefully understating the size of the problem. did i hear both of you correctly? >> yes, senator. >> okay. >> senator, may i speak just a moment on that? >> sure. >> i think those numbers may be underestimated for sure. i think what you're seeing is a representation of how quickly

this thing is growing when you compare what the numbers were to how fast they're growing now. and those experimental drugs don't have anything to do with the transmission. and that's why we need to intervene in the communities to disrupt the transmission of this disease. >> when the cdc said act now, i'm sort of on your definition of now. now is like tomorrow. i'm not sure that we've ever had that type of turnaround out of government. so facing the reality of what's in front of us is -- is also important. last question. and you've been very patient to stick with us as long as you have. what are the possibilities of using social media as our communication tool in west africa, and can that be effective? >> yes. the use of social media has a

lot of effects in sierra leone specifically, especially among young people, maybe the school-going population and those who also have access to mobile phones. but the cost of communication is tremendously expensive compared to what i can access in america on my cell phone. as a cost. and what i can access in sierra leone on a monthly basis for the same cell phone. so it's very expensive. but it definitely has a very big impact. because a lot of -- a lot of information are being sometimes misleading also. that's another negative aspect. but the fact is a lot of good information is also being transmitted and communicated through what's happening. facebook especially. >> okay. dr. brantly, do you agree? >> i agree.

i think even up till this point, liberia has been using social media and radio and print media to reach the population, and there's even a really catchy tune that they play on the radio about ebola, reminding people that ebola is real, and that they need to protect themselves and protect their families. and it talks about how the disease is spread and i think it's a very important means of reaching people. >> well, again, i want to thank both of you, especially want to thank samaritans first. whenever you have a tragedy somewhere in the world, they are certainly there. they're part of the story. and i think a lot of the presence in north carolina and a lot of franklin and the vision and the commitment, not to say that we don't have a lot of good ngos around the world that respond, but they're certainly consistently there.

and for that we're grateful. i thank you both. >> thank you. >> i just had a -- dr. brantly, i had a point of -- first, thanks to both of you for coming. we're at the end and senator harkin will end this in a minute. i want to make sure i understood something you said. you said you became -- you began to treat patients on june 11th. and became ill on july 20th. is that right? >> july 23rd. yes. >> you became ill on july 23rd. about how many patients did you treat? >> i believe during that time we had about 45 or 50 patients come through our unit. not every one of those was positive for ebola, but even many of them who were negative for ebola died because of the severe illness they came to our hospital with. >> so the 45 or 50, all but one died? >> no, sir. there were some who tested negative and we discharged them from the unit. >> so maybe half -- of those 45

or 50, some had ebola? >> i can't remember the numbers exactly. i would say of the 45 probably 20 of them had ebola, and probably 10 or 12 of them tested negative and discharged. so that would leave another 5 or so who came to us with something other than ebola but unfortunately died because of the severity of their illness. >> yeah. now you became ill on july 23rd. you were tested on july 26th. you said something about a two-week course. does that mean that within two weeks you know whether you're going to recover or die, if you have ebola? is that right? >> in general. most people with ebola, they usually, if they die from it, they die between days four and ten. but it can be a 14 or 16-day illness. so you can't just say you're on day ten, you're out of the woods. that's not the case.

it was day nine when i was the sickest and almost died. >> so you become infected. you don't infect others until you have symptoms, correct? >> so there's a period of time in about two weeks, where you can infect other people. plus the time if you died, there's that period of time. >> correct. you contract the virus and have a 2 to 21-day window before you become symptomatic. once you become symptomatic, it may be three days or two weeks. in my case, i was sick for almost four weeks before the cdc decided that my test was negative enough consecutive times that they could discharge me from the hospital. so you're correct. people are infectious during

their illness. and usually that is less than two or three weeks. >> so what is really different is how fast it moves. is that right? >> the virus moves -- it kills quickly. and like the doctors said, it's not so contagious like the flu virus that someone will get it by sitting near you. but it kills its victims quickly. >> so within that two weeks period or so of, period of infection, do you figure one might infect 5 to 20 other people. they have an incubation period of 2 to 21 days, and then they may have a 2-week period of infection in which they may infect 5 to 20 more people. so that all happens very, very rapidly if that happens. >> yes, sir. >> okay. >> thank you, mr. chairman.

>> thank you very much for being here, for your patience. and for sharing us your personal stories. the obama administration moving rapidly on this today. president obama was down at cdc. we are ourselves working here to do everything we can to rapidly respond. and to support the president in this effort. i think the right time is of the essence. but it has to be done correctly. rather than rushing in and doing things that may even make it worse. certainly we need to get the equipment there. the personal protection gear for home health. health care workers in these countries. we need to do a rapid series of educational programs in these

countries so that the local populous begins to know what to do and how to respond and not to be afraid. and that needs to be done rapidly. i trust that there are ngos, like the one you were with that you know that you are here with that mr. charles, ngos that can be very helpful on this, i believe. and who have been there for some time and who have good relations with people in these countries. so i'm hopeful that as we do this, i hope that we will learn from, lean on, ask the help of the ngos that are in these countries. they can be extremely helpful, i think. do you concur with that? >> yeah, we need to really ask them for their help. so again, thank you very much. i hope and trust that your wife

and your daughters are safe. and if they hear any of this at all, i want to be sure then that you'll be back home and you'll be safe. >> thank you very much. >> thank you. and thank you, dr. brantly, again for your great example. the record will remain open for ten days. thank you very much. we'll stand adjourned.

today cbs news bob schaffer

modrates a discussion when when combatting isis. our live coverage begins at 5:30 p.m. eastern on c-span. some of the upcoming cases include the racial gerrymandering of congressional districts, whistleblower protections and the religious liberties of prisoners live on c-span 2. now a discussion on how the affordable care act is being implemented in southern states including florida, kentucky and texas. this forum hosted by the state university of new york's rockefeller institute is about 90 minutes.

>> let's get started. good afternoon and welcome to the national press club. i'm tom gais. the public policy research arm of the state university of new york. today's forum examines implementation of the affordable care act in the south. first we hear an overview of state's responses and then we will hear from individual states from the respective research teams. finally, we will have a wide ranging discussion among four excellent analysts on what the experiences mean to national health reform. the reports and the forum come out of a 35-state study, the implementation network. it's coordinated by three institutions, the rockefeller, brookings institution and the fells instituted government of the university of pennsylvania. i would like to thank staff at

brookings and fells for their help in organizing this forum. i would like to thank the governing institute and west virginia for their assistance. finally, i would like to thank c-span for broadcasting today's forum and for all those in washington who are not making news so that c-span stays with us. we have a lot to cover today. to save time, i am going to skip trying to summarize the biographies of our speakers. they are all impressive people. if you want more information about it -- about any one of them, we put a nice summary of their bios in the materials that you have -- i think you just got outside of the room. also, they are -- the bios are up on our institute's website, which is www.rockins.org.

i may be mentioning that a few times today. you will be able to find their bios up there as well. you will also find on our website copies of all the reports we will talk about today. i have a couple of requests. if you do ask a question, keep it brief. we don't have that much time. when you do want to ask a question, please raise your hand and wait for the microphone to come to you. also and probably most importantly, this is a great time to power down your cell phones. finally, for media representatives, each presenter will be available for interviewed at the end of the program. enough of the housekeeping stuff. let's get into the discussion of the aca. as many of you know, the affordable care act created a complicated sharing of funds between the federal and state governments. while the federal government

finances it, enforces individual mandate and establishing benefits, it will assign many functions to the states such as creating health insurance exchanges, regulating insurance plans and operating medicaid. so what happens in the states is essential to the performance of the aca. the regional we're talking about -- we're focusing on is esh especially important. depending on how you define the south, between 41 and 46% of the people without health insurance in the united states live in the southern states. if the aca is to achieve its purpose of expanding access to affordable and good quality health care, it has to work in the south. to shed light on what's happening in the southern states as well as other regions, we are issuing reports from a network of scholars across the country. a couple of months ago we released reports out of the western states. today we are releasing rep