or even as the case of liberia, this past august, the liberilib government took measure when they quarantined west point, the capital of liberia. it created more internal problems, spread the disease further and eroded what little trust was left in the national government. more than 50,000 people live in shacks in west point. it is the perfect environment for the disease to radically spread. there is also limited education about the disease that meant public health officials weren't able to get ahead of of some of the cultural that will challenges that speed up transmission. rates of ebola, particularly around the bure yal of victimvi many wanted to ensure they were given proper bure yals, which meant removed the body or washing the bodies themselves.

b bodies are extremely contagious after the person has died. the u.s. and partnership of local governments and ngos along with education campaigns in these countries are working to get ahead of some of these behavioral and cultural challenges. one easy fix has been blanket used white body bags the caretakers are using. there have been some small improvements on the ground. even the head of liberia's ebola response is one of the few neighborhoods where residents have taken charge of the containment effort. some may argue that's because the government was not present for some time. still, there are not enough ambulances or beds to accommodate the number of victims and organizations are resorting to distributing home care kits because they don't have enough to get them to emergency treatments. this is better than nothing. ensure proper ice laigslation,

things are not moving fast enough to get ahead of the infection. because of infrastructure challenges op the ground and, the operation has been slow to get off the ground. in addition to the heavy toll it has taken on the lives of individuals in the affected country, we're now starting to see the real second and third ramifications of the outbreak. upwards of 3,700 children have been orphaned. most health care workers have been redirected to the effort, meaning those who have common diseases in the region have fewer places to turn to for care. it's estimated that nearly 800,000 women will give birth over the next year in all three countries. in sierra leone, 700,000 people are living with hiv. nearly 3,000 died last year from aids. schools have been b closed for months. there's a real possibility of

food shortage. markets have been closed. farmers aren't farming. people aren't able to work. as the world bank has highlighted beyond the costs to contain the epidemic, there are series consequences, including output, high eer fiscal deficit and worsening poverty. growth estimates for guinea had been haved. they've experienced an exodus of farm workers. such as cocoa and palm oil. for sierra leone, a country that's often cited as one of the fastest growth rates in the country, their projected dwrout has dropped in 2014 and likely to be no growth in 2015. the country has also experienced a substantial slowdown in critical mining operations. in the hardest hit country,

liberia, the world bank revised its 2014 growth projection from 5.9 to 2.5% and will likely experience negative growth in 2015. liberia's two largest companies have suspended because of the outbreak. addressing the problem will be critical to containing it in the long-term. nonaffected governments also need to commit to this effort because just as the u.s. faces this challenge, the heart of the outbreak is in their region and in their neighbor's yards. uganda along with the drc, countries that have faced outbreaks in the past, continue to help the ebola affected countries providinging health care workers and training.

region and community leaders to address the economic and social konz yeconsequence consequences. the u.s. will -- once the outbreak is contained in west africa. >> thanks for putting this panel together and for maryland rating. i agree with everything my copanelists have said thus far. the only exception i would make is a minor one and in contrast to what steve said, i do not believe that the fact we're having an election next week is i hope you takt 6gbf in v+fpi am writingv yueá

7jutááháhese kinds of into history. =ñ i 1918 flu. as many as 50 million. in the u.s., it was 675,000, which is a staggering number.

the number of u.s. soldiers who died was about 116,000. there is overlap between the 675,000 and 116,000 because some died of the flu, but the number people who died from flu, much greater number in that situation and in the process of working on my book, i looked into what president wilson did about this. this really disastrous situation. the worst disease outbreak in u.s. history and i'm really shocked and somewhat mortified to say what president wilson did was basically nothing as we have this disastrous situation and hurricanes of thousa hundreds of thousands of americans dying. there is one point at which is own personal doctor said the him we've got this problem and it is being spread in part by u.s. troop transports and the u.s. troop transports not only spreading the disease among other americans in these narrow,

confined conditions as they're going across the sea to fight the war, but also, they're spreading the disease around the world as american troops are deployed into different places and president wilson raised this issue in the white house with the person who was the equivalance lent of the army chief of staff at the time, army general said that we absolutely could not change troop transports in any way. we could not change our policy. we needed to send as many troops over in order to win the war and that there was to be no change in policy and to this assault from the general, president wilson weakly assented and raised no other point about it. now, this is particularly interesting, you can see that traps the general had a point. also try not to angering special forces members, i try not to contradict generals too often, but the fact of the matter, when they had this conversation, it was one month from when hostilities in europe were about to hit.

another aspect of the wilson administration's approach in this was not directly related to the disease, but it had negative reprecussio reprecussions, which is very strong propaganda effort by the u.s. during that war in order to not only promote happy talk at home, but also to really suppress decent. a frightening time in the u.s. there was the george krill, head of the office of public information and had a much more directive approach to it than you would have someone with the u.s. today. in that effort, they tried not to scare people about the flu. everything was about winning the war and.

in st. louis and philadelphia, both of which were about the same size at the time and st. louis instituted social distancesing, you shouldn't get tolgt for big parties and get together at movie theatres and philadelphia put together no such suggestions and death rate in st. louis was about five times less. we didn't understand much about disease spread at the time, we know more today, but you need presidential and good government leadership in order to deal with these situations and take to heart dr. bob's comments about the need for bipartisan cooperation. mid 1990s, both speaker gingrich and president clinton, who every recalls were in the middle of pretty nasty partisan fights between themselves. both of them read the book, the

hot zone, which deals with weaponized ebola and agreed there were things the government should do to be better prepared. in 2004, president bush read a book by john barry called the great influenza and he was very moved by that book. about that situation and pushed the u.s. government to have a plan in place for the flu. it included a number of opponents, storage of countermeasures and the answering of key questionings about how to deploy, distribute resources, who's in charge in various situations. it included a number of types of scenario planning and exercises

and what we found is that every time you had these exercises and i'm sure tara can talk about how useful they are, you raise questi questions that you didn't have the answers to. you find out there are holes in your system and things that need to be of interest better and things you need to think about for the next time. so, transitioning a moment for ebola, i think that wouldn't call it exercise, but obviously the devastation is as far as talking about somewhat, there's a lot of panic and has been one death in the u.s. and potentially more, is highlighted certain holes or flaws in our system. detecti

detection, development, deployment i think the government was a little slow to pick up on the problem of ebola. not just the u.s. government, i think the world health organization has been almost criminally asleep orrin the b job in this and should have been warning about it sooner. in 2009 when they had the h1n1, the mexican government was slow to pick up on the problem of what was going on in mexico on h1n1 and american authorization, both of them were about three weeks behind what certain private sector economies were able to do. and the truth of the matter is we had much better technologies for detecting problematic disease outbreaks today than in the past and even something like google searches can give you something about the development of symptoms in a certain area. obviously need to be more technologically savvy than that,

but it's just an indication of the tools we have now that we didn't in the past, so i think we need to be faster about the transmission of diseases. second, in terms of development and talked about this a little bit, we obviously have been way behind -- to cure viruses that are ked kated to certain conditions and we need to accelerate efforts. we have been on that front and especially on the vaccine. nih in 2000 announced a promising trial for dealing with vaccines for ebola in monkeys. 2014, there's an ebola crisis raging and no vaccine has yet to reach a commercially and proved available situation. we need to improve our

countermeasure problems. in terms of deployment, there's all kinds of questions about the use of military and i agree about obama's decision to send troops there, but there are questions about rules of engagement and there have been a lot of questions about what exactly they'll be doing. i think they're doing the right things in terms of building capacity and public health facilities in west africa, but it seems like some of this stuff is being figured out on the fly. there was a report by the inspector general that said that the department of homeland security seems woefully ignorant of what all the -- in terms of directive, every time there's another ebola situation.

what are the cdc protocals and these u things are adjusted and i think for the most part, the cdc has done a good job in recognize i recognizing the deaf rinses -- rural first world health situation and modern urban health care setting. there's different dangers and approaches and we need to be cognizant of that in developing our protocalls for that, but as we learn from every exercise it se seems like there are additional questions that need to be answered, so in some, i would say we are much better off today than we were i'd say even 10, 12 years ago in terms of deal lg with some kind of dangerous viral outbreak, but there's many questions that need to be answered and we have more work today. thank you. >> thank you for having me.

>> many aspects of this outbreak would be familiar to people fighting the asian war. which was interrupted in important ways by some kind of especially epidemic we still can't identify. the epidemics of infectious disease are something that have been written as major events in human history. the black plague have chiwhich third of the earth's population, i think was very instrumental in the beginning of capitalism. but epidemics are always with us. we have had an unusual hundred years in the developing world. in which epidemics have been

much less present and much less terrifying than they were in previous history in part because of better sanitation and nutrition in the developed world. in part because we have antibiotics and better science. in 1918, we didn't know what a virus was. we didn't know they existeded. so this explosion we had over the last century i would argue that the last 50 years has been a game changer. but we can now expect to have a lot more epidemics that challenge us. could go on for hours about, but that would be another lecture.

we're adding 70 million people to the planet every year, living in megacities where most -- two-thirds of the diseases we discovered in tlas several decades have been -- as bob said, that infect both animals and humans and jump from one to the other as aids did from apes as e boll. >> alana: has done from bats and chimps. we live in a world in which you can fly around the planet in 24 hours as opposed to the six weeks it took to cross the atlantic in 1918 and we are very, very interdependent. in terms of supply changes, in the way we live our lives. mr. duncan, the man who got sick

in africa and died in texas. came over to be mawith his fami. that didn't happen a whole lot. ooefb even a decade ago, let alone two. so, we're going to have a lot more epidemics and we have a lot fewer effective antibiotics because of our misuse of those miracle cures and we have been trying in the u.s. government at least over the past couple of decades to get better at our response to these. the things that are similar in all epidemics is first of all, it's very hard to see in the beginning. they start slowly. these are not like sirens events. they're not like explosions. by the time you see them, usually, even in the u.s., they're bigger than you'd like them to be because what you want to do is see them soon and

quench them when they're little. we tried all kinds of surveillance approaches. for infectious disease and none had worked well for reasons we can discuss. we've got to get better at that. one component is really good rapid dig nosagnostics, not our current situation where we get the answer back in 48 hours in days in africa. we need something that works more like a band-aid that turns blue or pregnancy test that individuals can apply and figure out if they need to isolate themselves or stop worrying. they also, also inagenda a fear. it's wup of the reasons so many novels are about plagues.

it's pretty freaky to think you might end up bleeding from your eyeballs in the case of ebola, but also, disease is something that comes into your home, so people immediately worry about their children in particular and their family and everybody feels vulnerable in a disease. and after 9/11, everybody in the area of the country was very focused on that event and feeling very shaky about it. went out to the west coast, it was a very different situation. they felt very removed from being targets. all right? not so with disease. everybody feels vulnerable. so fear drives a lot of the reactions amongst politicians as well as normal people all the time. they're not over fast. this is not going to be over in a month or a year and i think that's perhaps something that the governors who are quarantined in the northeast overlooked. this isn't going to go away in

60 days. they're looking at having to quarantine travelers for probably a year or two. and let me tell you, there's going to be cases coming out of the u.k. are we going to forbid travel from london? this is going to go on for a while even if we're successful in containing it. it always exacerbates the seams in a society. you're also looking for someone to blame. when we had smallpox outbreaks, the immigrants were blamed. that's a fairly common group to blame in any epidemic situation. people have a hard time understanding the unpredictability of disease and

want surety on how they might be kept safe. who they could lock up to make them safe, so all these things happen every epidemic we're seeing now. part of what we have to do is understand phenomena and guard against letting them rule our better judgment. so, for a variety of reasons, we're going to be more vulnerable to epidemics. for a variety of reasons, we're much better able to manage them. bob talked about all of the different programs put in place in the late '90s. i would be less polite than they were. i think they've mostly failed. particularly those aimed at generating counter measures. we've learned a lot from these programs. they have not been useless.

we had our usual election to fund heavily when the crisis occurs and then the money dribbles away. got moved to flu, not necessarily a bad thing. particularly with rnd, this lumpy bumpy budget pattern is we are at an amazing moment in history of science and technology. biology is entering a revolutionary phase building on the achievements of the computer

we are understanding how living organisms organize, build and man auage themselves. we have a capacity now to really take on the task of being able to recognize disease as it comes. as it first appears and also to be able to generate diagnostics when we need them, manufacture at scale and distribute them where they need to be. we should take that on as a national security priority, but it has to be a serious strategic undertaking. i can talk about why i think the science and technology is there. i think the fact that we don't have that already in infectious disease is a clear market failure.

infectious diseases is not something pharma is investing in. bob knows this deeply and well. they can make lot more money investing in pills that you're going to take every day for the rest of your life like lipitor. infectious diseases, you take that antibiotic for two weeks and you're over. just don't make a lot of money off of it, so we've had a remarkable diminishment in the last decade in the pharma investment in antiinfectives and we've got to do something about that. and we can. i was going to say something about the response in merkamer hospitals. let me say two wards. i think the rest of the medical system learned a lot from texas. i was surprised that texas wasn't able to manage containment of infectious diseases. this is a big sophisticated

hospital we're talking about. i think what we've learned is we probably have been making a lot of mistakes in disease containment all along across the united states, but it was more forgiving with tb. you make a mistake with ebola, around these very sick patients, are going to get sick. hopkins has now trained about 500 people in this enhanced personal protective gear and procedures that we're now using and i think other major hospitals are doing the same. we ought to be able to protect our health care workers. this is imperative here and in africa and i think we will start doing that. i think one of the questions ahead of us is are we really going to be able to do this in a handful of hospitals, the designated receiver sites or do

we need more hospitals to be able to handle this? if we don't contain this in africa, then ebola will become a fact of life and every time you get a fever, you're going to wonder what you got in days ahead. so the primary thing we've got to do is got to contain this in aft africa. and understand what's at staandw much of the burden the united states is going to have to bear to remove this threat from the planet. >> thank you. >> i have a couple of questions, but i'll let you go first. we have microphones, so when i call on you, just hold up your hand. we'll get the mike, identify yourself and ask your question. within two sentences, i want to

hear the question mark at the end. yes, sir. >> my name's dave price. retired reporter and educator. one of the questions i have for the panelists, how do you think the media has helped or hurt this and i have my own feelings. certainly. i just want to thank the panel. in a time of fear, just stable facts is what we need more of, so maybe this could replace modern family this week. maybe we could give up one, or honey boo boo's been canceled. go into that slot. anybody want to take that? the scorecard on the press. how did they do? >> i think media served an important role in highlight iin the situation. really kind of barometer of what's resognating out there and i think they've got a good feel

for it and i don't think that as a matter of policy, u.s. government should follow the media, they should be ahead of it, but unfortunately, that's not always the case. is there some ebola panic being stoked by the media? absolutely. sure. some of the coverage about domestic outbreaks has been overly hysterical, but at the same time, it is highlighted the fact that cdc's initial response was inadequate. and we need to do better. i think there's a difficult messaging challenge in this situation. what you want to do is avoid panic, right? that way, you send the worried well to the hospitals and people start to storing stuff in their home and hoarding. you don't want that. but in the same time, you've got to be absolutely up front and

honest about what the challenges are and i think there was some happy talk from both the white house and cdc that said this was a problem. in ebola, that's always a difficult kind of narrow to bridge to walk across. but ebola is particularly difficult because you have the situation as charlotte was talking about, it's absolutely devastating in africa and we need to address the problem in aft africa, but the dangers of a widespread outbreak has remained low. doesn't mean there won't be outbreaks in the u.s., expect to see more cases in the u.s., but i think we have the capacity if we do the right thing. if we do the right thing, we have the capacity to control the spread of ebola in the u.s. so, i think that it's tough from a messaging standpoint and then reporter hysteria difficulties and challenges. >> can i add to that?

>> the other problem is we learn as we go. so, the story changes and the media present that as they really don't know what they're doing. i was surprised that the hospital in texas didn't do the right thing. we didn't know how to protect health care workers. now we know ta. we're changing those regulationses just to make one little point. that's seen or presented by some media as the cdc doesn't know what it's doing. and we have to recognize especially now when we have much more powerful means of learning as we go, we're going to our amend our original views as we learn more and people have to expect that. i also think some of the best

pieces have been in the media. particularly the written media. gerson's article on friday was excellent. but you know, they're tapping in to this emotional string that people find addictive and it's you know, not always helpful. >> may i add quickly, there's both, a nerve that is struck, i think the representative from books like the hot zone and movies that are sometimes really good and sometimes really bad. kind of grab people's popular per spepgs and then that becomes the frame of reference they act upon. in some ways, doesn't take much for the media to say to really kind of stimulate that fear in the public's mind. >> okay. next question. right here. >> i'm a health policy analyst.

we're seeing fda regulations serve a barrier to access for some of these new tests and new drugs. do you think there's any kind of room for reform of those practi practices and trails and that kind of stuff in order to get better access to these? >> sure. >> i think fda's doing the right thing. i think the real question is why the heck do we not have an ebola vaccine by now. why didn't that get through these trials before now and we ought to go back and really look at barta and nih, both working very hard now and figure out why it was that we had more than half dozen ebola therapeutics and vaccine in the pipeline and didn't get any through by now. bob personally work ed very har on those programs when they were originally conceived and set up.

and they don't resemble those original ideas in their current incarnation. i'm with fda on this one. i had a colleague, a former colleague who was taking care of patients in africa, who got a needle stick. didn't develop ebola symptoms, but as you can imagine, everybody was very worried about him and he took one of the new therapeutics and got really, really ill. and you see that a lot. in antiinfectives that you're trying to tweak the immune system. you're trying to trick the immune system into mustering its defenses against this bug and the case of ebola, which you know, it's whole motive is to turn off the immune system and kind of sneak around into all the organs and the immune system doesn't know it's there until it's really multiplied beyond control. you turn on the immune system in the wrong way and you can kill people, so we have to do safety trials. it is crazy to think about

giving out i think vaccine or therapeutics, particularly therapeutics, without safety trials. we do have to figure out how to do them very efficiently and effectively. about which this much brouhaha right now at the w.h.o. and elsewhere, but you do not want to just go giving people stuff that's untested in this situation. it could really backfire and cost you the confidence of the public without which you cannot contain this disease. that's a problem in charlotte. >> let me build on that a little bit. i agree with tara that you can't say it's the fda's fault. that's not the case. the question is and i certainly think that you can't, you can't go forward without safety trials, the question is does fda change its practices to some degree in recognizing what is a mortal threat to people.

this disease has very high mortality rates and you have seen the what i call the pendulum at fda shift sometimes when it comes to facing deadly diseases, so, for example, in late '80s, early '90s, when you had the hiv aids situation, there were a lot of protesters yelling at fda, saying that fda needs to loosen up some of the rules on trials in order to allow people who have or facing a death sentence to try therapeutics that they might ordinarily not try if they were facing a life or death situation, so the pendulum does shift. you saw it shift a little bit in that period and you actually saw in the mid '90s, the highest number of new approvals in fda. i think those are not unrelated, so this might lead to some of those kinds of shifts within fda b about how to approach these things. >> just to get your point

though, and there are two principle mechanisms used today. compassionate used and authorization, which allows fda to make a judgment subject to the data available at the time. subject to the use of particularly drug or therapeutic, but what tara said originally, the first principle medicines do no harm. in light of these materials particularly now, the counter measure now, they're early in their clinical phase testing and tara's raised the right question, why is it taken so long if in 2000, we had an ebola vaccine candidate. they're still early in clinical evaluation, so the likelihood is they may fail. because they're not effective, because they can actually cause harm or be therapeutic. >> okay. yes. >> hi. molly andrews. i had a question, this is sort of related to the last one.

about rnd and you said that there needs to somehow take place a reform in how it's conducted and this is related, are you seeing any of that now? any of those reforms take place and what specifically can you see happening on the ground? that would have helped. >> i'm not trying to stand the question. related to ebola? oh, i think, i think there's a lot of people trying to understand the science of ebola. if you go into any of the major journals, nature, science, the new england journal has been on ebola all the time for the past several weeks. you'll see them trying. the experts are trying to gather what's known. okay. and solidify their understanding of what the remaining questions are and how to approach them. hence the science argument --

about how to proceed with vaccine trials. so, the verge community will rise to the occasion, but it will do so as it does research, investigated by principal investigator. what i'm looking for -- figure out how to rationally design the vaccine. i think there's different avenu avenues, it's an exercise, some of this is a manufacturing exercise, but i think i would organize it differently than basic rnd and i would argue it's time, not just because of ebola, and not just because of epidemic threat, but because of economic competitiveness, it's time for america to have a strategic

approach to the biological sciences, to the life sciences we've never had before. we've done it with the physical sciences because we see it's importance to national defense. national defense is going to start to depend upon biology in the big way, whether you're talking -- i'll leave it at that. >> but if i could offer one additional thing. there is an effort undergoing or ongoing in the house energy and commerce committee, which has if you'll domain health issues for the house and that is a 21st century cures. which is not directed about ebola, but afford the opportunity and the vehicle that tara is talking about. the idea that there has to be a new way of doing this. it's not eunique to ebola, it would not be unique to some other disease, but quite frankly, it's common to any diseases we have in society that

we have a hit or miss approach to develop countermeasures, whether it be for heart disease or cancer, b in some ways, having a more rationalized approach broadly would benefit across disciplines and not only improve health, but also lower the cost of health and that's another part of the equation here. but there are opportunities to quote rahm emanuel, which i don't often do, is to cite the idea that you know, you don't take a, don't let a crisis go to waste. in this case, is rather than trying to address the ebola problem, try to address a larger set of issues through the problem b to identify the things that will make a difference for the next common thing that also has a way of causing us both significant disruption and cost. >> i would just add quickly to that, i'm not sure i put it as starkly as tara did, that programs to generate countermeasu countermeasures have mostly failed, but i would say those

programs could improve. we need to do better at research and at generating new research for the challenges that we face as opposed to finding ways for bio pharma companies to leverage their existing companies into something the stockpile problem might want to have. >> the young lady. this one, we'll get you next. all right? >> talk radio news. you guys touched on this, but i was wondering if you could give your perspective on the quarantine policies that have been put in place by a few states. >> being a new yorker, i believe the governor are going what is in the best interest of their people. it highlights a little bit of the ching in the armor of the guidelines the cdc put out.

i'll just kind of cite the facts. besides potentially eating bush meat or being exposed to bats in africa, probably the dpraetest risk factor for anything or anybody is being a health care worker, tabing care of someone who has ebola. the issue in the current cdc guidelines leaves open for interpretation the role of controlled movement or unfettered movement, the word for that. that could be used for a variety of different people. they don't necessarily highlight health care workers who have been exposed to ebola to be at a higher risk. now, obviously, the dallas case, it was the only risk for those two nurses, but i think in the case as you look at the national especially deem yol ji in africa, the health care workers have a greater risk and it's dependent on their ability to effectively manage and protect

themselves, personal protective equipment. in africa today, that's a well exercised effort by the number of volunteers and health care workers who are doing the right things. the question is that the same in the united states. aga again, you could argue at least in the case of dallas, people who are familiar with this -- that maybe an issue. now, you can look what's happening in new jersey right now with the nurse today, who's effectively in quarantine. you can say maybe that was a little bit too stark of an approach. maybe the right choice would have been a staycation, if you will, in terms of ensuring you know, that person remained at home, had the assistance available to do so and be able to monitor them, but i think it just represents sometimes the challenges of trying to put together guidelines that are

universal in their reach, again, cdc just makes recommendations. it really is a state and local responsibility to implement them. and state laws determine that. and that's again, a reserved function identified in the institution. that they have the right to do that. how that gets implemented or if it gets implemented appropriately will be sorted out here soon enough, but it just highlighted some of the challenges that are out there. >> i think that there's a reason this is a challenging issue is because there are some important principles that are in conflict on this. there's obviously the constitutional right to free movement and the can't be incarcerated by your own government without just cause. at the same time, there's the right of the public to safety. and you want to encourage people to feel safe going about those, their daily lives.

appear to be some conflicts here. one thing i was thinking about was perhaps doctors without borders has a smart policy of telling doctors who go to serve in these areas that they should not return to their hospitals for 21 days after they return. and agree tog that in advance and perhaps, public health care workers who go there should agree to not only aggressive self-monitoring, but self-quarantine before they go. now, one other issue here is this question of will it encourage or discourage, more likely, will it discourage health care workers from volunteering to address the real problem in the larger problem in africa, in west africa and will it discourage health care workers from going to compassionately serve and try to control the spread of the virus there and obviously, we don't want to discourage people from going there.

i'd love to hear charlotte's views on this. >> i think that his comments on discouraging people, even with what usa and dod are going to be doing in the affected countries, they're building facilities. there's no one that's going to be staffing those facilities. it's going to be reliant upon local public health officials or those volunteers willing to put themselves in harm's way and so, i think we're about to have 17 new facilities online by next year and they're going to need doctors to fill those facilities to treat victims, so i think that's another side of it. and kind of looking at what other governments have done in the region, i think senegal, nigeria, both declared ebola free last week, from their particular cases, they're still not out of the woods yet. i think they're in the neighborhood that travelers and other people will likely come back, but in looking at the quarantine policy that the

nigerians put in place kind of layered upon an already existed polio outbreak protocall, but it was if you had been this is because they don't have enough officials to actually go visit constantly during the day. i know that new york has altered their system. but i think there are lessons to be learned for some of these countries that have successfully contained an outbreak that the original liberian diplomat had tracing through the system. looking at the successes of that model and seeing it does work. you have to act quickly and efficiently. we have been successful. >> i think that point deserves emphasis. imposing quarantine in 24 hours is irresponsible. it's a big deal to do this. and it's not going to be one nurse or one doctor. i mean, we're going to have

cases come into the united states through all kinds of airports. and you have to be able to explain why you're quarantining somebody who has no symptoms of ebola. because there's no scientific evidence that that person actually that represents a public safety threat. and you have to make sure that person can get something more than what was it? a granola bar the nurse had over 12 hours? which of us could actually stay in our home for 21 days without some kind of outside support. i would run out of corn flakes in about three days. so, if you're going to quarantine people for a good reason, you have to be able to explain that reason. again, the confidence of the public is your key tool in controlling disease. and you have to be able to actually effectively implement it. and that is really hard in modern society.

it is really challenging. and i think doing it cavalierly kind of blows both points. makes you seem uninformed as a leader and it also diminishes the public's capacity in confidence in your effectiveness. so i think this was a mistake. we'll recover from it, we'll amend it. and, again, you always learn in epidemi epidemics. >> okay. the young lady right there. >> hi, middle east institute. there have been numerous calls for travel ban and those who have traveled to high-risk ebola countries. what do you think of the effectiveness of this proposal? >> look, we're in the bush administration, we looked at this question of travel ban. and the way you need to look at it is there's pros and cons, and you only would want to do something this significant when the advantages outweigh the

costs. and you have to think about what those costs are. and the costs are discouraging travel for health care workers, making it harder to get resources there. you also have the issue of you don't know how governments will react to the u.s. or any other country shutting off travel from that nation. so, for example, when we were dealing with flu situations, one thing we were very worried about was maintaining the cooperation of the indonesian government which didn't always want to share flu samples with the u.s. you might think that liberia, guinea, these are tiny countries. you can't necessarily predict how another state actor will react. you can't always assume there's going to be, what we consider to be rational responses. and so countries can react very strongly to this, which is really an assault on their ability to maintain a viable economic system. so, i am loathed to impose a

complete travel ban. also not sure a travel ban. if you say liberians, for example, couldn't come to the u.s., that wouldn't necessarily stop the situation of dr. spencer who was a u.s. citizen and he could come into the country. you have to think very carefully about how you do it. and i'm reluctant to do a blanket travel ban by this point in the situation. >> i do think that there are kind of similar lessons to be learned again from senegal and nigeria. senegal, you know, shares a 330 kilometer border with liberia so their position, i think, is a bit different than nigeria that did not implement any travel bans. they did within, i think, near 48-hour period where they were limiting local carriers because they had not put in monitoring check points, but after that point, they did reopen all links on the other side of that. senegal that does share a direct border with an affected country

did close down all of their border check points, even shipping coming into the coun y country, also canceled until the ebola -- till they were declared ebola free. i think those have been reopened at this point. but i think kind of seeing that in nigeria, it's much more economically connected in part of this hub. but it is, you know, couple steps removed from the affected countries, and so kind of thinking along those lines and some of the other countries. ethiopia is another one that has a lot of travel links to the region. they've put in some strict temperature measures when you enter the country, from one of those places, but, again, they've kept links open. and even looking at the considerations of the travel ban, there are no direct, most people know this at this point now, there are no direct flights from the region to the united states. then starts getting into what do we do with our european friends? or our middle eastern friends.

several flights into the region. so i think it kind of -- it mushrooms out a lot faster than i think people initially realize when it sounds like a quick fix. >> okay. i'm going to exercise my moderator's prerogative here. i'm going to ask the last question. same question for all four of you. you have about a minute apiece to answer. you have been named the ebola czar. and i have to tell you, there are a couple of people standing up in front of you here that would have been good candidates for the ebola czar based on their experience and knowledge. what is the one thing that you would put into place today? whoever's ready can go first. nobody's ready. >> ladies first. >> for medical workers that get sick in africa to advance medical care. >> okay. >> so the first thing i would do

would be attempt to refuse. but william f. buckley asked in 1965 if he had won, and his attempt to win the new york mayoral election. he said the first thing he would do would be to demand a recount. but obviously, i think the number one thing you have to do, and from that, the perspective of that position is to get a better handle on the u.s. capabilities and better cooperation within the siloed pieces and make sure they are working in concert and not lauger heads. >> i think leveraging private sector in the u.s. and the region, there have been some efforts, i know there's a u.n. committee. there's plenty of private sector organizations and plenty of these countries, american or, you know, liberian, sierra leone have the ability to actually change what's going on on the ground.

>> i'm going to cheat a little bit, i think there are three things that have to be done i think the logistics. the second thing is, i particularly believe there's got to be a means to basically fill those ebola treatment facilities. and we need to think creatively about that. we've really been relying on faith-based organizations, nongovernmental organizations. and i just highlight what the germans did where they offer the german military health care workers basically to go on paid leave to basically respond and help to the ebola outbreak. and the third thing is, the one thing the united states has that we can pull on this is really to provide and to accelerate.

finding safe and effective counter measures. which we have, you know, certainly early in development and in that way but could be deployed fairly quickly if they go through the kind of necess y necessary, if you will, clinical trials. >> all right, folks. i don't know about you, but this has been one of the most reasonable, fact-based bodies i've seen discuss this whether it was on tv, on the radio, or in print. it's a treat to talk with professionals about things that their knowledge informs rather than just on emotions. i want to thank all of you and the folks here either online or on tv for joining us this morning. thank you very much.

next, c-span's washington journal recently conducting interviews with presidents at universities in the big 10 conference. we'll show you our conversation with penn state president and rutgers university president robert barche. then telephone scams that target the elderly. after that a senate hearing on intellectual theft and trade secret theft. c-span's washington journal recently conducted interviews with presidents at universities in the big ten conference. challenges facing higher