>> again we are live on capitol hill wait for a senate appropriations committee getting ready for their hearing, questioning obama administration officials questioning their response to the ebola outbreak. we just saw one of the folks from the administration who will testify today into the room, health and human services secretary, silvia burr well. the administration is asking for over $6 billion in emergency aid for ebola. among the proposed spending, 4.64 billion in immediate spending to fight the epidemic in west africa, to shore up u.s. preparedness and speed the

development and testing of ebola vaccines and treatments. jeh johnson, the homeland security secretary and other administration officials now prepared to testify before the senate appropriations committee. the hearing should get under way shortly here on c-span3. a

[ gavel bangs ] >> good afternoon, everybody. the full committee of the appropriations committee will come to order. the purpose of today's hearing is on the united states' government response to fighting ebola and protecting the united states of america. today, we will hear what we are doing and we will hear what resources are needed to do that fight. first of all, the -- congratulations are in order to some of our checks who have won we want to acknowledge senator

reid and senator con's victory and on this side, we want to acknowledge the victory of senator cochran and senator collins and we want to congratulate them and note the -- note their victory. today is a day where we really have to pay attention to an international and national challenge that we are examining. a look at an infectious horrific disease that is wasting a key continent in west africa and also threatening the united states of america. but for me, this will be the last full committee hearing that i will chair. before we go into the substance and i make my statement, i want to thank senator shelby and his staff for the wonderful way that we have been able to work

together and though we will exchange gavels, we will also continue to exchange the views in the way we have. i have found in senator shelby and on the other side of the aisle, always a tone of civility and candor and an ability to, in this committee, to try to try to work together and find common ground to deal with america's problems in a way that achieves sound results and to do it in a way that's affordable. i think that's characteristic of our committee and i hope that as we move ahead, that we will continue to do so. i would also particularly note senator cochran, who chaired this committee before and who also, during the time of senator inouye's passing, was a very important bridge to help me as senator shelby and i both moved into new rules and senator, i'm going to acknowledge your

graciousness and wisdom. so, we are about to, on january 3rd, change who controls the united states senate. but until now, this committee's chaired my me and i look forward to working with my colleagues to deal with really moving what i hope will be an omnibus and that we, on december 11th, will not be voting on a cr, but be voting on an omnibus that meets our fiscal 2015 responsibilities and also deals with the urgent need that we are going to hear today. i'm deeply concerned about ebola and, of course, so is all of america, both at home and abroad. i think there's a national consensus that agrees that we need to contain the disease and we need to eradicate it. and also, face very clearly the fear that it generates. now, the epidemiology tells us

that there have been 13,500 cases of ebola in west africa. here in the united states of america, there are currently no cases of ebola and we look forward for that to be ratified or correct by our esteemed panelists. however, the united states of america has treated nine, n-i-n-e patients with ebola, two have contracted it in texas, the west africa. eight have recovered, one, regrettably, has passed away. so, there have been nine in america, 13,500 in west africa. the situation is serious. and it means that all of government has to respond in a way to do so. my strong suggestive principles are this, first, we must fight the disease at its epicenter in west africa, in liberia, guinea

and sierra leone. we also want to look at the countries contiguous to these three areas that has not spread beyond these three countries. we want to use the expertise of the department of state, usaid, cdc, dod, nih, fda, any government agency that can play a role in making the world, west africa safe and us safe is where -- what we want to do. the second principle is we must protect america and we must do it at your points of entry. and finally, in looking at our country, we need to utilize the best science and employ our public health and public health safety agencies in a way that's effective that's the center for disease control, state and local health departments and scientists developing vaccines and treatments at nih and approving their safety and

efficacy at fda. as we look at what government's going to do, i want to thank the people, both in our own country and all over the world, that have really been working on this. doctors and nurses, lab technicians, disease detectives, aid workers, soldiers from our own defense department, working shoulder to shoulder in africa and also working at our border, and our ports of entry here and in our own country. in these important agencies, usaid, state, cdc, hih, fda, ever and of course, our ever had-ready military. there have also been very wonderful volunteers that were willing to go to the danger zone and we want to thank them for their role that they played in west africa. we also want to thank those in our own country who though not called upon places like university of maryland and johns

hopkins in my own community were ready to be able to deal with this. i'm glad today to have witnesses from our major government agencies to present testimony. ordinarily, protocol calls for the most senior cabinet member to testify first. in my usual kind of out-of-the-box way of thinking, i'm going to deal with the problem rather than focus on protocol. you know, sometime in the senate, there's a lot of pomp and circumstance. i'm gonna dispel with the pomp and get to the right circumstances. so the way we have organized the testimony is to really start internationally to hear from the department of state and then mr. lumpkin from the department of defense, then going to our ports of entry, then with silvia burrell, who will be here to talk about hhs. we will hear from deputy secretary of state heather higgin bottom, accompanied by nancy anymore berg of usid who

will tell us how are we going to do this in west of a nick ka and how are we going to do it not only in those three countries but in the contiguous countries. we are then going to turn to assistant secretary of defense, mr. michael lump kin. we know that's the official ebola coordinator designated by secretary hagel and he's accompanied by major james laravair. then we will hear from secretary jeh johnson to discuss america's ports of entry. then from secretary health and human services, silvia burrell, accompanied by dr. freiden of cdc and dr. anthony fauci of nih. and then we say to drs. fauci and friedman, mr. lindberg, vet good general who's here, we will ask you to join us after they testify to be able to answer questions from really this robust participation that we have. opening statements will be from the four witnesses.

now, we have before us an administration request to contain and fight ebola. an emergency spending request of $6.2 billion. because the ebola, in my mind, meets the criteria for emergency spending. it's sudden, unanticipated, unforeseen, urgent and temporary. the request includes funds from the state department and u.s. id for $2.9 billion. the department of defense to develop technologies to fight ebola and shorten vaccine development, $112 million. the department of health and human services to contain ebola, both with cdc in west africa and remember, cdc is both here in our country and also in west africa. to also fortify, strengthen domestic capacity to treat ebola with treatment centers available in every state and the appropriate personal protective

equipment for caregivers, like our very valued and treasured nurses. we also have money in here to develop new tests for treatment and vaccines, which would be a total of 3.12 billion for hhs. so, state is talking about 2.9 billion. hhs 3.12 billion. 112 for department of defense and right now, homeland security says it's okay but it needs a lot of flexibility. now the reason i talk about my colleagues to focus on not only the money, but on funding in an emergency, i say to my colleagues, we face infectious disease emergencies before. one under president bush in 2006 and the other in 2009 under president obama. we worked on a bipartisan basis to do this. in 2009, we were faced with the

h 191 -- h1n1 flu epidemic. we provided 6.4 billion and designated that as emergency spending. the bipartisan emergency response in 2009 mired what he we did to help president bush, again, bipartisan basis, when we faced avian flu when at that time, congress responded with 6.1 billion in emergency funding. so, we have done this before when we have been faced with an emergency related to infectious disease. i would hope that we would follow the models that we have used in the past. today, we live in a world that's free from smallpox, that cut polio cases by 99%. now we have to tackle the new diseases and we have to have a strong worldwide public health effort, vaccines to prevent

diseases, therapeutics to treat diseases, the people and the infrastructure to do that. we have also invited, in addition to government, we have asked for the american hospital association, crucial ntos, and also schools of public health, like the bloomberg school and may own state of johns hopkins to submit testimony. i want to acknowledge that we have got 56 submissions already and we will definitely pay attention to them. the common themes are sustained investment is needed in public health, both at home and abroad and emergency money is needed in the short term. so, that kind of lays out the framework for the hearing. i look forward to the testimony and now i turn to my colleague, senator shelby. >> thank you -- thank you, madam chair. today as the chairperson has laid out, we will discuss the administration's $6 billion

request to address the ebola outbreak, both domestically and in west africa. given the size of the request, the slow progress in detaining plans for how the money will be spent and some of the missteps made so far, careful oversight and scrutiny. as we have seen in recent week, the vast majority of american health care professionals have little to no experience with this virus. the appearance of the disease on our shores can have devastating consequences for our health care system and our society at large. consequently, it is the fundamental responsibility, i believe, of the federal government, to respond effectively to this crisis. every prudent step must be taken to protect the american people. instead of an effective response, what we have witnessed, i believe these past few months from various agency has been confusing and at times

contradictory plans. for example, the cdc's guidance to hospitals has been a moving target. this uncertainty may have exposed health care professionals to unnecessary risks. the administration also has sent mixed messages on the issue of quarantine. while the president has discouraged straight quarantine rules, defense secretary hagel has prudently put in place a 21-day mandatory quarantine for troops returning from west africa. in addition, the administration did not call for enhanced airport screenings for travelers entering the u.s. from west africa until months after the epidemic became severe. it still remains to be seen whether these cursory screenings will be effective. not surprisingly, americans have been frustrated by the lack of clarity and coordination within their government. even though the president has named a so-called ebola czar to

coordinate a response, all reports indicate that he has no actual authority to direct government agencies here. from the beginning of this outbreak, the administration has appeared to be preparing for only the best case scenario. competent crisis planning must include contingencies for the worst case scenario as well. therefore, i think we should not rule out any reasonable options to prevent the reintroduction of ebola in the u.s., including travel and visa restrictions. if the history of disease outbreaks has taught us anything, it is that things can change quickly and without warning. therefore, federal agencies must be ready to aggressively implement a clear and organized strategy. it is my hope that today's witnesses can assure this committee and the american people that the president has a

plan, that the funds he has requested are necessary to execute it, but we will wait our testimony. thank you, madam chair. >> mr. shelby, thank you. ms. higgin bottom, i'm going to ask you to start and then we will go down the line. >> chairwoman mikulski, ranking member shelby and distinguished members of the senate appropriations committee, thank you for the opportunity to testify today on the u.s. department of state and u.s. aid emergency request for assistance to combat the ongoing ebola epidemic. i'm pleased to be accompanied by nancy limb bourg, usaid assistant administrator for the bureau of democrat circumstance conflict and humanitarian assistance who is helping to lead usaid a response on the ground. madam chairwoman, i have submitted to the committee a detailed statement for the record and in the interest of time, i will briefly summarize my statement here. the ebola epidemic in west africa has already resulted in

over 14,000 ebola infected persons and over 5,000 deaths. while liberia, sierra leone and guinea have borne the brunt of the epidemic, we have also seen cases in mali, nigeria, senegal and spain. and of course, isolated cases in the united states highlight the u.s. national security implications of this national epidemic. the department of state and usaid are working in concert with agencies represented at this hearing today and alongside our global partners to stop the spread of the ebola virus at its source. the state and u.s. aid strategy to eradicate ebola in west africa rests upon four pillars, controlling the epidemic, managing the secondary consequences of the outbreak, building coherent leadership in operations and ensuring global health security. state and u.s. aid have taken immediate action within existing resources to begin implementing

this strategy. u.s. aid deployed a disaster assistance response team or a darth team to lead the u.s. response on the ground in all three affected countries. secretary kerry create and ebola coordination unit to drive our diplomatic efforts to raise international contributions. over $1 billion in bilateral commitments and near lids 800 million commitments to the u.n. have already been made as a result of these efforts, alongside our colleagues across those of government, we are beginning to see results but it is important to recognize that the epidemic is not yet controlled and that the number of cases will continue to grow. it's clear that we must intensify and scale our efforts to eradicate the epidemic and to do so will require additional resources. the department of state and usaid are jointly requesting $2.9 billion to end the epidemic at its source in west africa, including $2.1 billion in base funding to meet immediate needs

and $792 million in contingency funding to address emerging requirements as the epidemic evolves. $1.3 billion in base funding will be directed to the first pillar of our response strategy, controlling the outbreak. these resources will support the construction, staffing and operation of up to 20 ebola treatment units and establish and staff up to 150 community care locations in ruralal and hard-to-reach areas in the region. this funding will also be used to scale up contact tracing, train and mobilize health care workers and safe burial teams and remen nish vital logistics and supplies, including personal protective equipment. our base request also includes $388 million to support the second pillar of our response strategy, mitigating second order impacts. ebola has decimated the health system's infrastructure within these three countries and has wreaked half vong on local

economies. we are particularly concerned about food security. the usaid funded famine early warning systems network has issued an alert that a major food crisis is expected to occur in 2015 if the epidemic proceeds through march. our funding request seeks to counter these destructive consequences, which if left unchecked, will undermine our efforts to combat ebola at the source and could create instability in the region. our base request includes $77 million to support the third pillar of our response strategy, coherent leadership and operations. these funds are critical to expanding the department's medical support and evacuation capacity in the region and for supporting key diplomatic operations, such as ebola coordination unit and the usaid staff engaged in the ebola response. finally, our base request for the fourth pillar of the strategy, ensuring global health security in west africa includes $62 million to support pandemic

preparedness and strengthen public health systems in liberia, sierra leone and guinea and 278 million to prevent the spread of ebola to other vulnerable nations through the global health security agenda. in sum, our emergency request will allow state and usaid to scale up our existing efforts across all pillars of the response strategy. we are seeing some promising signs on the ground, but it is clear that the epidemic is not yet controlled. these resources are imperative to eradicating the ebola outbreak at its source, which is the most effective way of protecting americans here at home. thank you for your time and i look forward to your questions. >> mr. lump kin? >> chairwoman mikulski, ranking member shelby and distinguished members of the committee, thank you for the opportunity to testify today regarding the department of defense's role in the united states comprehensive ebola response efforts, which is a national security priority in response to a global threat. due to the united states

military's unique capabilities, the department has been called upon to provide interim solutions that will allow other departments and agencies the time necessary to expand and deploy their own capabilities. the united states military efforts are also galvanizing a more robust and coordinate international effort, which is seeming to contain this threat and reduce human suffering. before address the specific elements of the dod's response efforts i would like to share my -- and increasing response. after recently visiting liberia, i was left with a number of overarching impressions that are shaping the department's role as we support usaid. first, our government has deployed a top-notch team experienced in dealing with disasters and humanitarian assistance. second, the liberian government is doing what it can with its very limited resources. third, the international response is increasing rapidly

due to our government's response efforts. fourth, i traveled to the region thinking we faced a health care crisis with a logistics challenge. in reality, we face a logistics crisis focused on a health care challenge. fifth, speed and scaled response matter. incremental response -- responses will be outpaced by this dynamic epidemic. finally, the ebola epidemic we face is truly a national security issue. absent our government's coordinated response in west africa, the virus spread brings the risk of more cases here to the united states. i'd like to now turn my attention to dod's role in our nation's ebola response efforts in west africa and here at home. in mid-september, president obama order the department to undertake military operations in west africa in direct support of usaid. secretary hagel directed the u.s. military forces undertake a two-fold mission. first, support usaid in an

overall u.s. government effort and the second is respond to department of state requests for security or evacuation assistance if required. great patient care of ebola exposed patients in west africa is not part of dod's mission. secretary hagel approved unique military activities falling under four lines of effort, command and control, logistic support, engineering support, and training assistance. in the last eight weeks, dod has undertaken a number of synchronized activities in support of these lines of effort to include designating a named operation, operation united assistance, establishing an intermediate staging base into senegal. providing strategic and tactical airlift. constructing a 25-bed hospital in monrovia. constructing 12 ebola treatment units in liberia. training local and third country health care support personnel,

enabling them to serve as first responders and etus, ebola treatment unit, throughout liberia. in all circumstances, the protection of our personnel and the preservation of any additional transmission of this disease remain paramount planning factors there is no higher operational priority than protecting our department of defense personnel. dod has also increased support to the departments of health and human service and homeland security, the league agencies for ebola response in the united states, by activating a medical support team that can rap midly augment the centers of disease control convention and capabilities anywhere in the country. we have longer term assignments to combat ebola, requesting $112 million for the defense advance research project agency, darpa, in this emergency funding request. the $112 million for darpa will

support intermediate efforts aimed at technologies relevant to the ebola crisis. this includes new research focused on utilizing the antibodies of ebola survivors to provide temporary immunity for infected patients and the accelerated development and testing of new ebola vaccines and diagnostics. these efforts complement existing development at the national institutes of health and the defense threat reduction agency. with more than 50 years of experience successfully developing technology to develop seemingly impossible goals, darpa is uniquely positioned to fulfill a critical role within the whole of government response to contain and eliminate the ebola outbreak. because darpa's approaches to these research and developments die verge from conventional avenues, they have a real potential to produce game-changing advances in the prevention, diagnosis and treatment of ebola. in conclusion, we have a comprehensive u.s. government response and increasingly, a coordinated international response. the department of defense's

interim measures are an essential element of the u.s. response to late necessary groundwork for the international community to mobilize its response capabilities. with that, i would like to introduce my colleague behind me, major general jim laravair, the joint staffs director for political military affairs with regard to africa. the general and myself look forward to answering your questions. thank you. >> secretary johnson? >> thank you, chairman mikulski, senator she will business you have my prepared statement. let me just mention a couple of things in my five minutes. first, we all agree that the thing necessary to -- that the key priority is ensuring the safety of the american puchbl i agree with chairman mckulski that first and foremost that means fighting the disease at its epicenter. let me mention a couple of things about screening we are

doing with regard to passengers who may come to the united states from the three affected countries. first of all, we have the authority to issue do not board orders to air passengers who may seek to travel here from the three affected countries. we have, in fact, used that authority on occasion to prevent people from leaving the three affected countries to come to the united states. we have, in fact, used that authority already if we have reason to believe the person might be infected with the virus. the second thing i would like to mention is that in the affected countries with our assistance and advice, they have put in place screening to screen outbound passengers from the three affected countries. that includes taking temperatures and other mechanisms. fourth, we have worked with the airlines that fly from those countries to our country. i have personally engaged

airline ceos about the ebola virus. i know that cdc issued guidance to the air lines about flight crews and cleaning cargo and cargo personnel. there are no longer any direct flights from the three affected countries into the united states. there was at one point, there is no longer. to fly from the three affected countries to the united states, you have to get on one of a handful of flights that go through transit airports, mostly brussels, paris and morocco. at one point in may, the number of flights leaving any of these three countries to any place in the world is over 400. some data to suggest that month to month, it is about 600. it is now down to about somewhere between 100 and 150 flights in an entire month from those three countries to any place in the world.

the number of passengers daily that fly from those he affected countries into the united states used to be an average of about 150 per day. that is it fluctuates significantly day to day, some days, i look at the numbers daily, some days, it's as many as 100 or 75 or a little over 100. some days, like today, for example, it's just five or six much the averagesing? now about less than 100 on handful of commercial flights. we have set up enhanced screening at the five airports that were receiving approximately 95% of the itinerary passengers coming from those three countries. they are newark, jfk, dull less, atlanta and chicago. that enhanced screening, as you probably know, involves a

passenger declaration, enhanced questioning and taking their temperature and asking for and looking for symptoms of the ebola virus. that screening, to date, has received approximately 2,000 passengers. we have also identified through our questioning by our customs inspectors, a number of people who have flown indirectly from the three countries. they, too, have been submitted for enhanced screening. and on october 22nd, we used our authority to effectively funnel everyone coming from the three affected countries into those five airports that are conducting the enhanced screening. the other thing i will say is that at every port of entry at this point, land, sea or air, we are prepared to engage in secondary screening. if we identify somebody from the three affected countries who may have the ebola virus, guidance

has gone out to our customers personnel. we have put in place protocols for people who may be arriving by vessel. we have authority to identify people from the last five ports of call if any of those are from the three affected countries. we put in place protocols there. we continually evaluate whether more is necessary. so i look forward to your questionings. thank you very much. >> thank you. secretary burwell. >> chairwoman mikulski, ranking member she will business thank you all and committee members for inviting me here today to discuss the department of health and human services response to the ebola epidemic and our request for funding. as you know, we are deeply focused on domestic preparedness and since the first cases of ebola were reported in west africa in march of 2014, the united states has mounted a whole of government approach to protect the american people and to contain and eliminate the

epidemic at its source. at hhs, this response involves close coordination and collaboration of the national institutes of health, the centers for disease control, of the food and drug administration, of the office of global affairs, the office of the assistant secretary for preparedness and the office that has the u.s. public health service commission corps, which i think everyone knows has deployed to the region and i'm blessed today to be joined by both dr. freiden and dr. fauci today, who will join me as part of the questioning. we believe we have the right strategy in place, both at home and abroad. and the strategy is designed around four core principles. the first is to strengthen our domestic preparedness and while we may see additional cases, we are confident that we can limit the number of cases in the

united states. second, to stop the epidemic at its sources in west africa, as my colleagues have discussed, that, in turn, will protect our homeland. third, we need to alaska sell rate the research and development of vaccines, rapid diagnostics and theraputics so that we work on the crisis right now as well as think about preventing future crises in the future. and fourth, we need to invest in our public health capacity around the world through the global health security agenda. this is something that was started before the ebola epidemic but it is something that i think we see the incredible importance of right now. this preparation, in turn will help prepare the u.s. as part of the strategy, the administration is taking a number of actions and some of these actions are delivering results. for example, we are hearing encouraging news from the hospitals that have treated ebola patients, as was reflected

in the chairman's testimony, eight of nine individuals treated so far have survived. second, we have seen signs that our screening and monitoring system is working. recently in oklahoma, north carolina, oregon and maryland, individuals were identified with potential symptoms. those were reported to local authorities through the correct protocols. they, therefore, were transported through appropriate protocols that did not expose anyone. we are very fortunate. those cases have all been negative in the past weeks. but this is the kind of thing that is part of this emergency funding. we need to continue and support the local and state efforts as well as cdc and efforts to do. last week, there was also an important milestone. those sides will have been monitored in ohio and dallas came off of their 21-day incubation period. and they are no longer being monitored. we need to make sure that we support state and local public health officials to be able to

continue to do this kind of work. to date, more than a quarter of a million health care personnel have been trained by the cdc and the assistant secretary for preparedness and response, doctors, nurses, emts, fire departments, but we need to continue this training and make sure that the training is getting through. in west africa, the strategy is showing some positive results but as we saw in mali and learned last night there are additional cases there. while the u.s. government's response to ebola outbreak to date has resulted in progress, additional funding is needed and that's what we are here to talk about today. our department request is $2.43 billion in emergency funding. first, the funding will allow the department to enhance our ongoing preparedness here in the united states and our efforts to ensure that states and localities are prepared. for example, it will be about the purchase of ppe, that personal protective equipment, training of thousands of health

care workers. second, the emergency request will further strengthen the department's i don't going work to contain the ebola in west africa. we will continue to work with communities, governments and other partners on the ground in west africa to ensure that people are promptly diagnosed, effectively treated and if they die, safely buried. third, this request will expedite the research, development, manufacturing, production and regulatory review of the vaccines, diagnostics and therapeutics to combat the virus. finally, with an eye toward detecting and preventing outbreaks of this magnitude in the future, the emergency request will strengthen our global health security around the world. and this means providing that there are safe and secure laboratory capabilities to fight the diseases and emergency response capability in countries if these diseases occur. i understand americans are concerned.

ebola is scary and it's a deadly disease that is new to the united states. we have taken active steps here and abroad to protect the public health and safety of the american people and this emergency funding request is vital to continuing that work. i want to just conclude by recognizing the health care workers who are on the front lines of this response, both here at home as well as abroad, including the more than 650 department -- from our department at hhs who have deployed to either west africa or served here in the united states. we are proud of these brave and dedicated men and women across our department. i also want to recognize the men and women who are health care workers in this nation who have treated the parents that are here. and also recognize those who are suffering right now in the three west african countries where this is the worst. members of the committee, thank you for inviting me. i look forward to your

questions. thank you. >> thank you very much, secretary burwell. now, in order to get to questions, we limited the number of people testifying we don't limit the number to people who can answer questions. each one of have you been accompanied by really experts and esteemed witnesses, so if they could come up and join the table, doctors freiden and fall chill, the good general, the coordinator usaid, ms. lind berks you-all want to come up and get there so that, you know, we can have wide open discussion and wide-open questions. i'm going to go to the first question, wait till the general gets settled.

and everybody a he is got their names. before i get to actually to my question, first of all, i'd like to thank, again, all of you at this table and at the tables you have in why you are respective agencies here and around the world. i really want to say that as we have watched this unfold in both west africa and here, i want to thank you, because i know many of you worked a 36-hour day. and i know many of you worked a ten-hour workweek. so think we need to say that as we evaluate what does it take to be able to respond in an effective bay? it was a crisis, which calls for the need for maintaining a critical infrastructure and our critical public health infrastructure. i also want to particularly acknowledge those institutions in states that really stepped forward to treat the patient, emory university, the university of nebraska and of course, the nih special clinical studies center, all three that were

there to meet the needs of the american people as they returned home that needed our help, our prayers and quite frankly, our medical advances. so, we want to thank them for that. you know what it shows was, you know, these weren't red states or blue states, these were american states so as we look forward on solving this, it has to be looked that the way. now, let me get right to my question, which is this. my job as united states senator and i know at this table is to protect the american people and also, protect the people that are protecting us. and this, therefore, goes to the people who render hnds on service or those that were concerned about doing this work. so, let me go to secretary burwell, to you. in your testimony, you talk about domestic preparedness and thank everyone for the gallant and generous and dedicated work of health care workers here.

but i was also really wore rained wasn't only really worried but so were the national nurses united, i receive adler from them that really articulated my concerns. what they said to me, and now i quote them, is that the president needs to invoke his executive authority to maintain uniform national standards and protocols, that all hospitals must follow safety-protected patients or health care workers and the public. they then go on to talk about the personal protective equipment needed, particularly hazmat equipment, and they identified the actual osha standard number. my question to you, secretary burwell, is do you feel confident that now in the way we are responding, that the doctors and the you were ins who are actually touching patients have the protective equipment that they need, that these are national standards for not only the equipment but the training so that we have a national

response regardless of whether where someone might appear that needs help? could you share with us and did you respond or did the president respond to the national nurses united request? >> so, with regard to the issue of make something you are that our health care workers were prepared, i think we need to think about it in a number of different levels. the first is in that screening and monitoring and that's what state and local health care workers are doing, with then checking on the people who have come from these countries. second is that that initial front line worker, in a health care institution that needs to be able to detect and isolate, ask the right question. if off fever what is your travel history? the next is the level where treatment will occur and as we describe in our submission, this will be in a more state by state basis and where the cases are in terms of treatment. the question i think the nurses were posing was on the category that had to do with that front line. as i mentioned in both my oral and written testimony, at this point, we have trained over 250,000 people. what we need to do now, and

that's part of what this request is about, is to make sure that that training continues and extends and we need to measure it, what we are hearing when we hear from the nurses, we want to make sure we respond. do they know? is the training working? do they feel confident? right now, we are working with the association of state and tribal health care organizations to make sure that we are going to put in place a measurement so we can understand they have what they need with regard to training much the second part the nurses mention is ppe, protective equipment. >> yes. >> provided guidelines to the cdc in terms of what's needed, training and what to do, the second issue is access to that and through the assistant secretary assistance and sport, bart ta, working with the manufacturers, producing 24/7 now, working with them and working with the states to make sure that those who have the greatest need and will most likely treat get that equipment. >> well, madam secretary, let follow up on this.

so do you feel confident that we have -- that if ebola appears, you used -- on page four of your testimony, the maryland case example, a young lady came in, she took her temperature, she thought she might have it, she wasn't gonna go to nih, she was gonna go to either mary land or hopkins. that those who would be once identified with the high temperature, et cetera, that they would have the equipment and that they would know how to use the equipment, but regardless of whether they are at a high-tech urban hospital, like a hopkins or a maryland, an academic center, but could be a community-based hospital in a rural area, that you would be ready to respond to see that they had the equipment and the training? >> that is why we are doing the, aggressive training that we are doing. >> do we have the -- do you feel confident that we have this now or we are in process? >> right now, what we have seen in all the cases that you

articulated and all those that have come through, also providing at the border a kit so any individual that is coming through, which is where the case would originate gets a phone number they are supposed to call. they get a to take their own temperature. >> what i need to get is for that nurse to feel that if she has to walk into a room and provide the care that she has taken an oath to do, along with the doctors and others that are the support staff that they're going to have what they need to do the job and that they also have what they need to protect themselves. >> that is what we are working to do with all the training. at this point we've trained 250,000 and the funds that were -- >> isn't this what your money is for? >> yes. >> really? >> to continue this effort. >> isn't that part of the public health infrastructure? >> it is. it is the basic not just for

ee eebl. >> i have to put their minds at ease, but that we have their back and we cover their back and their arms and legs, et cetera. a question for our constituents that go towards the military. we're now sending our military in harm's way to protect against terrorism but now we're sending them to get ebola. my constituents were deeply concerned that in deploying our military to do the task that you just identified that they were going to be exposed to ebola and we were putting them in harm's way to get ebola. do you believe in your employment and if the good general needs to respond, are our military actually going to come in contact with people with ebola and our are military at risk of getting ebola? and are we sending them in

harm's way with a disease? >> in my opening remarks, dod personnel are not doing direct patient care of those that are infected with the ebola virus. we've taken great steps to ensure that our military personnel receive comprehensive training before we go, that we monitor them while they're there and we have a controlled monitoring situation. i'll defer to my joint staff counterpart who can go into the specifics about it. >> general, welcome. >> thank you very much. >> we've instituted four levels of predeployment training for all personnel who are going for

our transient peoples, think about air crews flying in, not getting off the airplane, and flying out. graduating up to personnel who will be in country, who will have to interact with liberian nationals as they go about their day-to-day business. those personnel will receive training in how not to come in close contact with those personnel and will be issued ppe that they will carry with them in the cases necessary. health care professionals who will be in country at the two rural hospitals, one in morovia. senegal, who will be there to treat our military personnel for regular injuries and be able to treat them if they somehow do come in -- do contract ebola. and, finally, to the highest level of training for our lab workers who are there now, testing blood samples as part of the support there. yes, we've got a complete

protection package for those personne personnel. >> i look forward to you perhaps submitting an answer to that. we protect those who are trying to protect us. senator shelby? >> thank you, madame chair. on october 17th, president obama named ron clain to a white house post responsible for coordinating our response to the ebola crisis. how many times have you met with mr. clain since his mo appointment and what has he brought to the table that was missing? madame secretary, start with you. >> i've been in touch with mr. clain every day since he has begun, face to face, by phone or

by e-mail. in terms of what he has brought to bear it's been my experience and my experience last time when i served in government, the importance of policy coordination, i was there at the beginning of the national economic council where we did much consultation. it's a very important role in terms of when a whole of government is occurring. and mr. clain is doing a -- >> what has mr. clain brought to the table? >> i can't say i've been in touch with him every single day. i've been in touch with him countless number of times. >> okay. >> i believe that the critical value that ron has brought to this is coordinating the federal response between and among all the agencies, components you see represented here and having

somebody who is dedicated full time to the white house to doing exactly that. >> secretary? >> nearly every day in contact with him and he has done an outstanding job of doing just that, coordinating and singular focus for the administration of coordinating across interagency. >> i've just been back from maternity leave for two weeks, senator. ron was appointed to his position prior to my returning. >> you'll be excused. >> since then we've had frequent interactions. it's the policy coordination that's so key to our response. >> to your knowledge, does mr. clain have the authority or power to direct your agencies to perform any specific actions or is it main ly trying to bring yu together? >> with regard to the execution

of the agency's responsibilities, those sit with me and the head of the operating division like dr. freeden. >> secretary birdwell, states that issued more stringent rules for returning health care workers, stating we don't just react based on our fears. we react base d on facts. as we've all known, secretary hagel has approved mandatory quarantine for troops who have been deployed to the ebola-affected areas. furthermo furthermore, we have limited, we hope, patient contact while civilian medical workers will have direct patient contact. what facts, that was the word the president used, should we base quarantine guidelines on had, ma'am secretary? >> certainly, i will also -- i

will start but then turn to dr.s freeden and fauchy. we've determined level of risks. quarantine base system based on their level of risk. and that's based on the epidemiology, i think dr. fauchy has been working on this well over 30 years, in terms of the experience that we see. that's how we determine what's done with each and every group of people and different groups of people. that's how we base the decision. that's an individual basis often which is why we monitor directly and actively every day those health care workers that return. >> is the assessment -- i'll direct this to you, too, doctor, since you'll be in on this. in the assessment of risk difficult when people are coming from various countries and perhaps don't divulge where

they've been? i know you can keep up with it to some extent. is the assessment tough to come by? >> several levels of assessment, first to assess the fever to see if someone is ill and then to determine the cause. second to see what exposures they may have had working in an ebola unit or are being a health care worker otherwise or having potential exposure to someone who may have had ebola. but for every one of the individuals who returns, we ask the states to undertake an active monitoring process and we facilitate that process, as secretary burwell said so they're taking their own temperature and if develop fever, they rapidly contact the health department of their state where they can be safely transported to a facility that is ready for them. ebola, as far as everything we've seen only spreads from someone who is ill.

it doesn't spread from someone who is not ill. if you can find that illness quickly and isolate them, then you can stop them from transmitting to anyone else. that, essentially, is the way of protecting not only their health but the community's health. >> doctor, you want to add -- >> sure. so in some circumstances when we stratisfy risk, there is sometimes the functional equivalent of a quarantine if someone is at high risk. it isn't as if it's all or none, but not saying there's a blanket quarantine we're being somewhat reckless of making everyone have the same sort of movement. i took care of nina pham. i'm in the low if not moderate risk. if i had to be quarantined i wouldn't be able to be here testifying. because of the fact that i'm l