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 low

and not zero risk -- >> maybe you would have liked that. >> if you are, we're going out the door. >> right. >> doctor, to dr. freeden, head of the centers for disease control, what can you say to the american people today about their and it's widespread of a possibly ebola outbreak in this country? >> we certainly understand people's concerns. ebola is scary, deadly. and the images from africa are frightening. but ebola spreads by direct contact with we know unsafe care giving in the home or health care facility and unsafe burial practices. the burial practices that are spreading ebola in west africa are not things that we do here, not to be concerned about.

but care giving is. that means for every individual who comes back from a place that may have ebola, very important to be monitored actively for 21 days. at the first sign of any symptom, even if it's not severe illness, what we're seeing now is, as appropriate. people are coming in, being tested. coming in and being isolated. as soon as that happens, we reduce the risk of spread. so from everything we've seen the last nearly 40 years working on ebola in africa and from everything we've seen here, no household contacts became infected, ebola doesn't spread like flu or measles or other infectious diseases but it is deadly. that's why the hospital infection control is so important. but from everything we've seen, we do not think a large outbreak is at all likely in this country. it's just not how ebola has spread either here or in africa to date.

>> why it reached epidemic proportions in the first place. a major public health emergency but it should not be a cause for panic or journalistically provoked fear among our populous. it should serve as a reminder and a wake-up call. let me read you something that senator mark hatfield, former chair of this committee said when he retired in 1996. he gave us his farewell speech on the senate floor. here is what he said, and i quote. it was at the end of the cold war. this is exactly what mark hatfield said. quote, the russians are not coming. the greatest enemy we face today externally are the viruses are coming.

the viruses are coming. end quote. 1996. former chair of this committee. a decade later, a similar warning at the emergence at the avian influenza. another virus will emerge with the potential to create a global disease outbreak. history teaches us that everything we do today to prepare for that eventuality will have many lasting benefits for the future. mike levitt, end quote. both were right. syndrome, mers. yet during this time, when new viruses are emerging and new viruses are becoming drug resistant, we reduced investments in nih and cdc and

acting short-sighted cut that is have left us less prepared. we have to accept the fact that we don't live on an island with airline flights every day around the world, every virus is de facto and airborne virus. we must stop chasing diseases after the fact. we cannot be everywhere at once and we will never run faster than a microbe. our only chance lies in building public health systems capable of detecting and stopping diseases before they become epidemics. we have the knowledge, right here. we have the expertise and the systems to combat ebola and other infectious diseases. our challenge here is to act calmly, based on science and facts and with resolve, double our resources and build that capacity.

i say that because there's some talk in this emergency funding that we should only address ebola and not look to future viral outbreaks and viruses. so i looked up the word emergency. this is emergency funding, right? >> we hope so. >> emergency funding. it comes from the word emerge. how about that? emerge. merriam-webster dictionary says it's a need for e mechlt rgent relief. this is to stop a disaster. that's what this is. viruses are mute ating. some of them, we know, are becoming more drug resistant and diseases that we are looking at now, ebola is just one of those. they're now global in their impact. dr. freeden, you and i have spoken many times on our trip to

africa, a year and a half or so ago, to stop these diseases where they start. those conversations as well as the work of a group started by your predecessor, jeff copeland, inspired me to create a federal health program in last year's appropriations bill. we must invest in countries with weak public health systems so they can stop these disease before they cross the borders. we only need look at h5n1, southeast asia, to be reminded of the virus threats that are still out there. they're still out there. i've said before if h5n1 starts jumping from birds to humans and humans to humans, we better look out. it will make ebola look like a picnic. so the need to address the

emergency now to keep it from coming on our doorstep at home. approximately $600 million at your request would go to doing just that. but considering the need, that seems very low to this senator. very low. $600 million to build the cdcs, to put in the laboratories, get the equipment, train the technicians, train the epidem yolgss? it seems low to me. can you explain that number? what do you hope to accomplish with that investment? and could we use more to address emerging, emergency outbreaks? dr. freeden? >> thank you very much. you don't need to look any further than the difference between what happened in nigeria with ebola and what happened in liberia with ebola to see what a difference prepared public health systems make. in nigeria, through extensive

effort, because there was an emergency operation center, because there was a laboratory network, because there were trained disease detectives, because there was a public health system that could respond to the outbreak, they stopped it. it took enormous effort but they stopped it. and today, from that importation, nigeria is ebola free. the world would be a very different place today if liberia, gui nechlt a and sierra leone had those systems in place a year ago. they could have contained this outbreak. global health portion of this request aims to protect not only these countries but ourselves against that type of threat whether it's the next ebola, the next sars or even the next hiv. there are three fundamental areas we work in. they're all very specific, measure measurable and will leave behind as temporary assistance something that will protect us for many years to come. the first are prevention

methods, how to ensure we keep our laboratories safe, that we stop the spread from animals to human whenever possible. and that we're able to immunize with whatever we can to reduce the risk of things spreading. second, and the largest component is detection. putting in place the laboratories, the disease detectives and also the surveillance systems to find problems when they first emerge so we can stop them at the source before they spread. thi third, of course, is the response. emergency operations systems, the ability to work with medical counter measures and to stop outbreaks before they spread. those are the three key interventions that we would be able to implement with these emergency funds to protect ourselves against these emergencies going forward. >> thank you, doctor. i see my time is out. i'm sure i just think that's a low figure confronting what we have to confront worldwide. and i'll ask a point of personal

privilege. this is probably my last -- >> yes, i woos going to note that. >> -- committee meeting after serving on it 30 years. let me thank you all to your commitment to public service and for your great leadership. if you don't mind i especially want to thank tony fauchy with whom i've had a 30-year relationship. we both came here at the same time. you came there. i came here. you have had the better of it, believe me. also, thank you for your great leadership at nih and also dr. frieden with who i have had about a decade-long association, first in new york city and later at cdc. thank you for your great leadership. and to staying calm and targeted and focused when others around you might be losing their heads. thank you very much. thank you, madame chair. >> i think we could say the same about you. i don't know about the calm part. >> i don't know about that. >> by the way, we're going in

the order of arrival, so -- >> yeah. let me start with you, secretary burwell. in your written testimony, you mention the contribution that emery made, the university of nebraska made. i would think the cdc would recognize the guidelines you're using, significant input was provided by those institutions. as i have looked through the request for funding here, $6 billion request, we have money to reimburse the world health organization. we have money to reimburse civil aviation organization. i could go on and on. i don't see funding that would be available to reimburse any institution in the united states that provides care and treatment

and training relative to ebola. i've talked to staff for the relevant subcommittees and talked to some of the members. and it appears to me to be an oversight. and it would seem to me to be logical, because you asked emery to take patients. you asked the university of nebraska medical center to take patients. we were glad to do it. but it seems at this point some assistance in terms of reimbursement would be appropriate because treating an ebola patient is a world different than treating mike johans who walks in with a severe case of the flu. do you know what i'm saying? go ahead, secretary. >> so, with regard to, i think there's the issue of the treatment facilities and there is funding within this request to make sure that we have

treatment facilities around the country and that there will be funding. but with regard to the special institutions like the university of nebraska and dr. gold and the team there, who have had the opportunity to spend time and talk to, and the emory folks, what we have done is there is funding about the creation of an education training facility and it is our hope that both of those institutions will team with cdc. we will do financing for those institutions to be part of our training of the other institutions and hospitals around the country. with regard to the specific issue of treatment and the treatment of patients, to date, much of the conversation has been between private insurers and the hospitals themselves. if this is something that the congress -- to date it has not been an issue that has come to us. if this is something that folks want to discuss as part of this funding, we're happy to entertain that. >> great. it's an appropriate discussion because the private insurer,

when they look at the cost of care for an ebola patient, i mean, it's through the roof. they will cover a minuscule amount if there is private insurance coverage. it will come nowhere near to cover the cost. and i will tell you what you know already. and that is in the early days of this problem, couple of months ago, you folks were scrambling to figure out what to do with these patients. we were glad to be there. this was -- this was started when i was governor. we're just glad we have world-class treatment there. we want to be helpful but again i think it's a conversation we need to have. second point i wanted to make here -- and i think this is a very important point. i understand the expediency of putting money in each state. each state will get a certain

amount of money. it seems that the formula is based upon population. i think we're going to look back in three or four years. i'm not going to be here to question you about it. but i think we're going to look back and say i wonder what that got us. here is the reason. treating an ebola patient is very, very challenging. and there is risk involved if it's not done properly. i don't know that every hospital out there would want to get into this business, to be honest with you. i think some hospitals around nebraska would say they seem to be doing a pretty good job over there in omaha. let's fund them and support them. i think you need a more regional concept than what is called for by this legislation, because there are facilities out there that were way ahead in terms of

what was provided here. i would like your reaction, secretary. and then i would like the reaction of the director of centers for disease control to what i've just said. >> so with regard to the question of where we do treatment in the nation and how we do that, what we have started with is certainly we were fortunate that the congress had funded and we had supported the university of nebraska, nih and emory to be bio facilities. those are our anchors. >> i'm not convinced that there were federal funding. maybe a very small amount. but i think it was a state initiative. >> as those then go out from that ring of three, what we've done is we have focused our effort on the five airports that secretary johnson said that's where the cases we believed would come in. so we put in place the training and cdc did that training in conversations with the other hospitals for new york, dulles,

o'hare, atlanta and newark. and so that was the next ring in terms of treatment, to your point of the question of a strategic approach. and then beyond that, we have been doing tracking of where the income of the people are coming. that is how we are starting in terms of your question about a focused approach. as we have started this process, though, many states have approached us because of their desire to make sure that they have a facility within their state. as we were thinking about it, where is the concentration and where is their geographic proximity so that a patient could be within eight hours anywhere in the united states as well as what we're receiving in terms of incoming. that's how we have started to design and are working on where the phils should be.

states reaching out to us as well as the strategy we're seeing analytically and the risk. >> it's really a question of stratifying risk and which hospitals can do what. with the active monitoring program, we'll have a head start on being able to plan for if someone has just come back, where would they go. the issue of ebola is one deadly infectious disease that's complicated to take care of in hospitals. but the more -- the broader issue is hospital infection control for ebola and other deadly infections. and what can we do to strengthen what each state has in their hospitals? something that's valuable not just for ebola but other hospital acquired infections.

>> with a small amount of money that's going to each state, what you're going to end up with is double wide units that won't be adequate for the next crisis. i just think that money is going to go out there and it's just not going to be enough to do the kind of work that you're trying to describe to this committee. thank you, madame chair. >> to the gentleman from nebraska, first of all, you sent me a letter on this matter just a few days ago. when i went to acknowledge the receipt of the letter, asking for consideration and of funds for hospital workers and also for those hospitals that agree to treat and are able to treat these patients, i think the gentleman raises an important point. >> thank you. >> i'm not sure it can be addressed urgently in this supplemental but it could be ebola or another infectious disease and i think we need to

look at this. i want to acknowledge the validity of the issues you've raised because for those of us who faced -- and i don't mean it in a way to say oh, my god, we faced it. but we're willing to provide care as the university of nebraska, we should be committed to support those hospitals. it's costly. >> yeah. >> it is costly. and in this era of stringent reimbursements from the private and public sector, hospitals are already stretched to meeting their bottom line and if the generosity of spirit and the technical capability to absorb, your point is we shouldn't add to the fiscal burden while they have to deal with the care burden and also the stringent reimbursement systems that they're already under. is that kind of your issue in a nutshell? >> madame chair, it is exactly. we want to be helpful.

we never had any reservations about this. and i could not be more proud of what was happening there. but the cost in this is just huge. >> so let's talk about this, okay? >> let's keep working on it. >> okay. senator reed? >> thank you very much, madame chairwoman and thank you, ladies and gentlemen, for your testimony. one of the major objectives we have is to suppress the disease in west africa. one critical factor is health care workers. can you elaborate how internationally we're doing in terms of local health care workers, supporting them and also attracting international volunteers? the bottom line is do we have enough health care workers to deal with this crisis? >> stopping ebola at the source in west africa requires improving care and burial, two key ways it's spreading. usaid has stepped up safe burial services. department of defense and others are helping to establish

treatment units. one of the things that is encouraging is 90% or more of the health care staff caring for ebola patients in west africa are from those countries but there's still a need for international assistance. one of the things that has been very encouraging is the african union has been willing to send hundreds of health care workers in. that's in process now. we've also seen an increase in health care workers from other parts of the world. and one of the things that we try to ensure that every step is taken to make care as safe as possible there. there's still a gap, as nancy can discuss, to help address the epidemic at the source. not only to save lives there, but to protect us here as well. >> what are we doing to fill that gap is the obvious question. either you or your colleague can respond. >> yes, thank you. as you know, there's a

significant need for health care workers and, in part, because it's a very high burnout job. we have to continue to replenish the pipeline. there's a significant effort to recruit internationally. i would just add that ensuring that they have the training and equipment that they need is an important part of the equation. and having them feel comfortable, that if they go and serve, they will be taken care of. to that end, our colleagues from dod have built a hospital, 25-bed hospital that is being staffed by u.s. public health care workers, medical personnel. and we are working with dod, with w.h.o. and others to have a continual supply of protective gear and dod has stood up a training facility in monrovia to

ensure the specialized training that's required. >> on that very note, if i may, to train u.s. health care workers going over, cdc began a training course in alabama in conjunction with the fema site there. all the u.s. public health service workers went through that training. it's based on years of experience that doctors without borders have. and that's the type of very intensive training that we're implementing. >> and the resources asked for in this legislation will be. >> absolutely. >> and without these resources the gap will persist and the disease will be further beyond our means of suppression? >> these resources are essential to stop the outbreak in africa and protect us. >> secretary lumkin, dod is set up there. the question is, that i've gotten, is how do you get to the

last mile, dakhar, supplies, trained personnel out? and the other issue comiing basd on our discussions is the end of the rainy season, what impact does that have? does that give us special urgency in getting this bill done? >> thank you for the question. i would like to address the issue with the end of the rainy season first. i think that's a temporal issue before us. liberia gets 200 inches of rain a year. what's been moving during the rainy season is people by foot. many roads are closed and, therefore, carrying the disease. what's hard to do is get supplies to where they need it to be. that's why it was crucial to build up these logistic networks. in the drying season, you have more freedom of movement for people, is one. which means an increase in spread of disease potentially, but also the temperatures go up. the time that health care

workers can spend in their ppe, personal protective equipment, is reduced significantly. so that adds another burden. i will defer. >> senator, thank you very much for the question. intermediate staging base is fully operational at this time with 101st brigade running that operation there. they've established a rotator flights, c-130s down to monrovia. from there we have helicopters on the deck that can take personnel and equipment out to the various locations or to do what they need to do. we've got the -- starting to get the equipment and the personnel in place, able to transfer that equipment to the last tactical mile. >> my time has expired. quickly, ma'am. >> senator, quickly, part of what this request does is enable funding so that dod can depart and there's a civilian capacity in place for logistics, including the last mile transport. >> thank you, madame chair.

>> senator blount? >> thank you, madame chair. there was a report november 7th that said that public health experts warned that the actual number of ebola-related cases and deaths in africa was likely much higher than the numbers being reported. do you have an opinion on that report one way or another? >> we have previously estimated that there is probably underdiagnosis and underreporting of cases. so, yes, we believe the number of true cases is larger than the number of reported cases. >> do you have any idea how much difference there might be? >> in september we estimated that for august onward there could be as many as 2 1/2 times more than were diagnosed up to that point.

since that point we believe that the monitoring systems have improved and we don't have a more recent estimate of the difference between what's reported and what we actually think may be happening. >> i think in guinea and -- the numbers have gone up pretty dramatically lately and seem to be heading the other way in liberia and sierra leone, is there a reason for that? >> we see different trends within each of the three countries and different trends in different areas in each of the three countries. in guinea, waves of disease, increasing then decreasing, from a forested area deep in the country, which is where the outbreak is believed to have begun. and where it has never been completely controlled. that has been the epicenter for sources receding other parts of the forest area. not only in guinea but the other two countries. in the parts of each of the countries which have implemented

the strategy, we have proof of principle. we've seen big decreases in cases in individual areas when we get the safer care contract care, infectious control and health care systems those standard disease control methods that have worked for every ebola outbreak and i'm told now have worked for the firestone company and near monrovia, which implemented them and individual community. we ha >> how long should this money last that you're asking for? and what's the significance of the contingency fund and how long in the future do you think that money will be there? >> in the context of what we know, as director frieden just talked about, the evolution of the epidemic is something that ebbs and flows.

in terms of what works we believe that the base amount of funding is the amount of money that we need across the departments. that will stave off the epidemic. the contingency fund was asked for because to the point that was made in opening remarks about preparedness and making sure, when we have elements that aren't predictable we want to make sure that that funding is in place and that would be for different types of things. to give you some examples, if another country, another ring country has a number of cases and starts to be elevated, that may change the needs. another thing that could change the needs that we would use the contingency funding for would be if we actually get a vaccine and we're still at a stage where we believe you need to do deeper and would do more distribution of vaccines to a broader group of health care workers. those are some of the things that the contingency fund is about. it is a fund that we have

submitted for. we want to make sure there's a block that funding is not used unless needed. but that we put in appropriate preparedness. >> and on vaccines you've asked for money for fda here to -- >> uh-huh. >> how would you do that process differently? are there steps in an emergency situation like this where there's a way to go through them more quickly or go around them, to get to the end product quicker? >> yes, sir. we've seen that in process right now. congress gave us emergency use authorization that would allow us to approve diagnostics quickly. we've suesed that authorization six times. we approve friday start to finish in 36 hours. one of those diagnostics. with regard to other emergency

authorities that fda has, we have approved drugs. when a drug is not approved if a clinician asks fda for approval for that individual to receive the drug, every patient that's been treated in the united states has received a drug. can't speak to the specifics because of hippa but each one has received a drug. those have been approved. one was approved in one hour. right now fda is on a path. there are over 300 people working on these efforts because it cuts across therapeutics, diagnostics, vaccines. the team is working across all of those issues to make sure that we are moving as fast as we possibly can to support and approve. we're supporting the efforts and hundreds of questions have come in from commercial entities. and that's great. a number of commercial entities are out there and they want to help us find the solutions to ebola. most of those questions are legitimate. it's about speeding their efforts. some things as you know, people

are saying there are things that work when they don't. fda needs to watch for that, too, in this important time. the funding is about that speed and moving things through quickly. >> one last question, on that topic, for anybody who would know the answer, is there anything we need to do or we're doing in this bill to be sure that ebola is clearly defined as one of the things that you can use those accelerated processes for? >> we have not had the authorities that you all have given us, i mentioned, have been in a way that we can use them. we can add to definition when we've needed to. so far, we have not. i will take your question and make sure with the fda that it is answered for all categories. you know, there are a number of categories. we need to make sure. so far we've not had any be issues. thank you for the authorities you have given us. we are using them as quickly as we can. >> chairman, while everybody else is making a comment i would

like to thank you for your really talented and great leadership of this committee. thank you for all you've done. >> thank you. we're now going to turn to senator kuntz. i'm going to ask senator shahine to call the superintendent and ask that the air conditioning be turned off. i asked 45 minutes ago. >> i would be delighted to do that, madame chair. i have tried to get him to turn down the air conditioning in this building before. >> now because this committee really doesn't want to waste energy, either that of the members or of the taxpayer paying for air conditioning that is unneeded, unnecessary and unwanted. okay? better to have heated discussion than wasted money. secretary -- senator coons?

>> thank you. to the many witnesses who have testified today, i want to thank you for the vigorous discussion of the funding request to deal with this global funding crisis. and remind all of us that the ebola outbreak has been characterized as among the most severe public health emergencies we've faced in modern times. emphatically agree with your characterization that our first priority is to protect american lives and that the single best way for us to protect american lives. first by strengthening and bolstering and preventing its spread to neighboring countries. i did want to take a moment to share that i recently had my

third recent conversation with president johnson, who i visited several times in previous years and who wanted to make a point to thank the american people for our generosity and engagement but urged us not to let off now because just because there is some hopeful news doesn't mean we've turned the corner on this and in the region it still remains a very dangerous and difficult time. i visited with delawareans here and liberians who have lost their entire family to this disease. i want to acknowledge the remarkable sacrifice, dedication of our uniformed men and women, thousands of missionaries who are on the front line against ebola. americans who go abroad should not be stigmatized when they return. should have confidence that they can return from their service and be supported when they do so. let me turn to the global health security agenda, if i might. a piece of this emergency

request is for the global health security agenda, activities within cdc that are designed to strengthen the whole health security systems of a ring of countries around guinea and sierra leone. i wondered if you wanted to speak to how many total nations will you target with this funding request? what will you do to increase their capacity? why is this essential to ensuring that americans are safe from ebola and that this outbreak, this epidemic is effectively contained? >> to strengthen the systems that will find problems when they first emerge, respond effectively and prevent them from wherever possible. and the goal there, if we just think of what could have happened in rural guinea, if there had been a monitoring system that found the initial cluster, that responded to it promptly, we would see a very

different outcome today. in fact, over the past 24 to 48 hours, we've been dealing urgently with the situation in mali, a real illustration of this. so as part of our response to the west african outbreak, cdc had already sent teams to each of the surrounding countries to ensure that they went through a clear checklist of the things that were needed, laboratory systems, surveillance systems, isolation capacity, emergency response capacity, contact tracing, public health and a series of other things needed. the team was actually in mali when the 2-year-old child came from guinea there, sadly died in mali. but the team helped to organize a response of tracing more than 100 people. over the past day or two, we've learned of a new situation of great concern where an individual died probably from ebola in the funeral services, family members were infected. in the care of that individual before he died and other

individuals, health care workers were probably if he can'ted and now we're facing a cluster in mali. the challenge is to make sure that that cluster ends as the nigerian cluster did with making mali ebola free again. whether or not that happens is entirely dependent on the ability to have those systems in place, in advance, to find problems before they get out of hand to respond effectively. that's what the global health security aspect of this emergency request is essential for. it's about understanding their vulnerability is our vulnerability. that what we do to find problems and stop them there will help us. >> if i hear you right, dr. frieden, the difference in outcomes in nigeria versus the other three countries is the difference in having had a robust public health infrastructure that made it possible to do the contact tracing and do the immediate response? part of this is a legacy of a great investment in public health across the region. part of this is a challenge. how well cdc and usaid

coordinate to make sure that these investments are made wisely and effectively and that we strengthen the whole region's public health structure? >> thank you, senator. we work hand in glove, aid with cdc. cdc is essential for setting the policy for bringing the technical and medical expertise forward. and we work very closely with them, implementing these approaches, these policies. we've jointly been conducting workshops for the 12 countries in the region, for example, around the issues that dr. frieden just outlined. we're also looking forward to the fact that you have increased population pressures in areas that were previously forested. so the possibility of increased jumps of diseases from animals to humans is something that is very much a part of looking forward to how to get ahead of

these kinds of outbreaks in the future. >> i appreciate that. my last question will be this -- >> senator, your time has expired. >> thank you, madame chair. >> and i don't mean to be brusque to anyone. we've now been here an hour and a half and we have two, four, six, eight -- ten more senators to go. senator coates, i'm going to be a little more strict now. >> madame chairman, it's good to see that you haven't lost your touch. >> well, we have a vote, so -- >> yes, i understand. i'll try to be brief here. >> sorry. >> first of all, thank you for calling the hearing. i think there's so much misinformation, disinformation and misperceptions and a lot of nervousness out there among the public. we've all had to address that and i think this hearing gives us a better clarity in terms of where we are, where we've been and where we're going. i think all of that is helpful.

i commend everyone sitting at the table there, because when madame secretary johnson called me week ago saying this is going to be a government-wide effort. this is a crisis deserving of full response, all hands on deck and a lot of those hands are sitting here at the table. there has been some positive news here in terms of some steps that have been taken, despite some early struggles and a couple of bumbles. that made all of us nervous. we've corrected those and that's positive. we do have some questions as to how we're going to continue to go forward. as secretary burwell said, we have to fight this battle at the source. i understand that. some countries and others have said if you're going to fight it at the source, you need to have it contained at the source. and while the military has taken -- set one set of standards in terms of anyone who

has been at the source relative to what they need to do when they return, that standard stands in contrast to what our current standard is relative to people coming back and, of course, the screening is important. secretary johnson talked about that and so forth. couple of questions here relative to all of that. is canada and australia and these countries that have basically said if we're going to fight it at the source we're going to close our borders to anybody coming from the source. that's the best way to keep our country free of that. that may or may not be the necessary thing to do. nevertheless, it certainly assured their public that, okay, they're fighting it at the source. general williams over at africa,

then noticed at that point they weren't -- they were not going to send any soldiers in there. the president made a decision. they did send people in. they're sending people in. swren williams came home and immediately the team that he was with, which i think is about a dozen or so, quarantined themselves and so what are we to tell people back at home about the military is taking these steps. the rest of the public is taking these steps. and so i guess i would like some response to that. and then i do have -- if i have time -- a question for secretary johnson. maybe one person could speak for the group. or, secretary, you want to take a shot at that? >> yes, if i may. thank you, sir. as you mentioned, secretary hagel approved the 21-day controlled monitoring program at the request of the service chiefs and the chairman of the joint chiefs of staff. the military is a unique entity.

and because of the scope and the scale of the number of people that we have in the region, it seemed like a prudent course of action. i'll defer to my colleague over at the joint staff who can tell about the formulation that have recommendatio recommendation. >> senator, thank you for the question. as the secretary said we have the youngest and largest personnel responding to this crisis. as the chairman said on 30 october, we have had a unique role and responsibility for military personnel due to the scale of the deployment and the responsibility to the health of our service personnel and to their families. we decided to take this more conservative approach. it's not because we don't know -- we know something more than everybody else. this is the way we chose to redeploy our personnel. >> the question from the public -- my question is, okay.

people say -- are gratified to hear that. our soldiers are doing everything they can to protect themselves, not to be a carrier back and have this spread through and we appreciate that the military is taking those stands. on the other hand we're saying the health workers don't rise to the level of having the same standards applied. all those who are courageously putting themselves in harm's way, not wearing the uniform, there's a different standard there. who wants to respond to that? >> i guess before i let my colleagues respond i would like to point out this was not a medically based decision but operational decision made by the chairman based on the recommendation. >> it kind of makes common sense, doesn't it? if you've just been over in an infested area, you could potentially be a carrier. why not take the extra conservative step to go under quarantine so we know for sure someone's not out bowling with a

fever? >> let me jump in here. >> who is jumping in? >> i'm jumping. >> oh. >> senator coates, who also chairs the homeland security, ranking homeland security, raises a question that is continually asked. why the military has one standard and the civilians have another. though his time has expired, because this is a question that is continually raised nationally, i'm going to ask you, miss burwell, to answer it or call upon the scientific expert to clarify that and then we'll move on. >> thank you, madame chair. >> the distinction -- and i think my colleague from the department of defense spoke -- that this was not based upon the science. this was based on the management of the force and the forces desires. as we work through this, that's something we want to respect for anyone and everyone. with regard to the civilian parts of the defense department,

they are under the same guidance that we are using and cdc has issued. i think what's important is that we make decisions based on the risk and the science. and that's what the standards are about. i think it is also important that we respect those that are serving and that those that are there and what they actually ask and want to do. there's the question of the science and standard that we need to set to protect the nation. but there's also the desire of those that have taken the steps to serve. that's part of what my colleague was reflecting in terms of what the force was requesting of the joint chiefs. i think we will want to hear that, too. when there's the return -- as there are people who come back, people will make choices. we need to do the steps that we believe are science based to protect the nation. if there are those that have a desire, a wish to do others or more, that's something they should do. the decisions we put in place are based on risk levels and the science related to that.

i don't know if dr. frieden you want to add to that? >> in ebola there is no carrier state. you cannot make other people ill unless you, yourself, are ill, from everything we've seen of how the at cdc itself we've already had more than a hundred of our top disease detectives and public health specialists go to fight the outbreak and then come back to cdc. they come back into affective work at cdc so they can be productive in their response and protecting americans in other ways. but our active monitoring program is to work to ensure that every person who comes back is monitored. their temperature is taken everyday because the key is that wherever you are, quarantine or your own home or workplace, as soon as you develop any symptoms whatsoever, even 23 they don't turn out to be ebola, you are isolated. that's how we can protect americans most effectively in terms of people coming back

themselves. >> thank you very much, dr. frieden. to dr. fauci, did you have something to add? because as i understand the statement is the 21-day monitoring is mandatory. the 21 the residential approach of the military is precautionary and they also have our command and control organization. is that in the a nutshell. >> it is true. another was a decision based on the stratification of risk and as i mentioned earlier in the hearing that there are aspects of what the cdc recommendation is that are the functional equivalent of a quarantine but that's based solely on the stratification of the risk. as you go lower down, you're monitored in a direct active way and if the risk is low you have a monitoring every single day

and you have to flexibility of making decision on the restriction of the movement based on the monitoring. >> madam chairwoman, if i could have ten seconds to make a point, i know i don't have time to have it answered. that assumes you know everyone that needs to be screened. that assumes you haven't missed anybody. and i can't -- i know we've got five airports but we've got thousands of people coming across the borders. >> okay, thank you. i think this clarify add very important national question. now we will move on. >> thank you very much gentlemen. i fresh@your doing this hearing. i'm sure all of us are -- have heard conditions are from our constituents about how ebola could impact them and what we're doing to stop this disease and

up emergency operations to control this outbreak, including providing critical support for the centers for disease control

and prevention and i think i speak on behalf of the entire nation that we're very grateful to that. secretary burwell, i wanted to ask you more about the role of ngos and the foundation support in the ebola outbreak and even what percent of funding is coming from private non-governmental groups to support this fight and what more private foundations and actors can do. >> i agree with your statements about the efforts that have been made by a number of organizations and i think i would put it into two buckets in terms of the type of assistance. one is very important and we've been questioned about which the health care workers. there are a number of ngos in community-based organizations and my colleague from the usaid can speak to, that is essential, that is specific, that is important, that's part of what the fund willing do to support to get the people in country in west africa so that we can assist while 90%, as was mentioned by director frieden,

of the people who who are doing the work and care are locals. we need that 10% to come and be experienced. so that's one entire area. i think there's the other area and that's where the bill gates foundation, the paul g. allen, that's helping in area where they have expertise. the gates foundation is not only funding and helping with the cdc foundation, nih is working very closely with the gates foundation so we make sure we have the best experts. zmapp, one of the drugs, it's not just about a drug, it's an agricultural product because it comes from tobacco. so gates agricultural experts are part of our conversation to make sure we're speeding that along. in addition, people like the paul allen foundation found places that they could help us. one of the critical path issues is medevacing health care workers out and paul allen has focused on those issues. >> and getting the gay a which they talked to me about. >> absolutely. so there is a range of issues that i think they can be helpful with and are and then there's

the whole issue of the ngos that have health care workers and help and relief on the ground in the country. >> i want to ask one of the questions and i know my time is going to run out. i think it's important that we recognize those groups that are doing that and look forward to hearing more from you about that. but i wanted to follow up on how the money is going to be allocated to hospitals in particular and for all of us to think about that. i want to asked ask you, secretary burwell, in the funding request you have funds designated for readiness within state and local public health departments and laboratories. i wanted to ask how you're going to distribute that funding and how do you expect states and localities. >> i think there are two different pieces of the money that will go to states and localities. part of that comes from the assistant secretary for preparedness and response and uses our preparedness network

that were basically set up post-9/11. we will use those networks and work with the state health departments to determine who wants to set up treatment facilities so that's one portion of it. parts of the money go through cdc and alliance director fried on the talk about that money. so there's a portion in one part of hhs and there's the cdc money. >> at cdc we would provide support for local entities in a variety of ways, the public health emergency preparedness fund would be formula based, based on improving infection control and emergency response. we would support networks like the emerging laboratory capacity grant program that support cutting islamic jihad work and prevention epicenter to look at infection control training and documentation of how to improve infection control as well as laboratory networks, the laboratory response network which is ten or 15 years old sand why now we have 27 lance around the u.s. able to test in just a few hours for ebola.

but that needs to be upgraded and extended as well as our emerging infectious disease programs. so a variety of programs we're able to deploy. >> so you're confident that they're in place and the best way to use them? >> yes, we are. >> thank you, we're going to turn to senator bozeman on -- and i want to remind everybody we have nine other senators who wish to ask questions. i ask people kind of come to the end when we're at the end and otherwise we will adjourn for the -- recess for the vote and come back after the vote. >> i'd just like one question

and be respectful of the time. hopefully u.n. leadership will remember it. i'd like to ask the senator has eluded to something i have that concern about. you mentioned the difference in nigeria and the good job that it did and then we've got liberia on the other extent where things have really had such difficult time my concern is when you go to west earn africa or africa in general we see many examples of the $20 million processing plant that was built to help 2 t locals when they only needed a $250,000 processing plant. we leave, they go bankrupt and it's just sitting there because that's not what they needed. liberia is a country where they tell me their electricity output would have trouble powering the jumbotron at dallas stadium.

is this something we're going to put in and it will be an ongoing cost for us forever? is that the program or are we talking about doing something and turning it over to them? again in situations where you have countries that maybe have less than one doctor per hundred thousand people? >> that's a wonderful question and something that we're working very closely with is is to try not only to respond to the immediate needs of the outbreak but to leave behind a strengthened health system and the other impacts we're seeing in terms of food security and the economic impacts. it's e seine thashl we leave behind a system that can be sustained and that can help that country stay more on the pathway of development. they as you know were coming out of a decades-long civil war.

>> i understand. >> and so they've -- they were just starting to see the progress when this outbreak is -- >> well, not only that country but others and, again we need to move on but i really hope that we're looking that in terms of equipment, servicing equipment, just basic things we take for granted we really do need to look so that when we walk away -- and we will walk away through the appropriations process or whatever that they have something that they can maintain and do a good job. thank you, madam chair. >> thank you, madam chairman and thank you to all of our panelists for being here today and the hard work you've been doing to address the ebola outbreak in africa and the cases here. i think question is a follow-up to secretary burwell and dr. frieden about just to make sure i'm clear for what senator murray was asking about, the

impact on state and local public health authorities and our ability to build infrastructure. as i understand your response to her, you were suggesting that the support in this legislation will go not just to address ebola specifically but also to build capacity for future potential outbreaks or future local and state needs is that correct? >> it will do both when we talk about the hospital preparedness funding that will go, that has prepared to send funding to the front line which is were some of the issue the chairwoman began with in temples of the training for the front lines. in terms of the infectious disease treatment facilities, those will be facilities that will do ebola but be able to do other things on the effort here and now, it will extend -- just

as the 500 people being trained on the department can speak to, those will be in place in west africa simply our work will be in place here. >> thank you. i will just relay that i've spoke within the new hampshire public health officials and they have been very preesh i have the of the close working relationship with cdc and nih and so i hope that will continue and i'm sure it will. one of the things i have heard from dartmouth hitchcock, the designated hospital in new hampshire to be the state's ebola critical referral hospital they have indicated that they're having trouble getting the personal protective equipment. that it is not available. and what is being done to make sure that equipment is available to hospitals that need it and therefore personnel? >> there are three things we're doing to make sure that equipment is available.

the first is working with the manufacturers to make sure they are producing as much as they possibly can. the manufacturers are now working 24/7 and we're working directly with them through the assistant secretary for preparedness and response. the second thing -- and this is part of this package's funding -- we are going to purchase ppe will that will sit with cdc so if there is a case and a treatment hospital doesn't have what it needs, cdc can provide it. the third thing we're doing is working -- >> sorry to interrupt. can you tell me what your proposed schedule for having that in place? >> for the national stockpile we've already begun to assemble kits that are available today. if there were cases and we needed to provide them to hospitals we don't want to soak up all that's available from the market so as secretary burwell was noting we're encouraging the manufacturers to provide it first to those hospitals on the front lines as more becomes available we will have enough in the strategic national stockpile

to provide for the care of up to depending upon the amount of use two dozen patients for their entire course of illness and to get that to the u.s. within hours. >> great, thank you. >> new hampshire brigadier general corey who is a member of our new hampshire national guard is deployed currently to liberia to assist with the effort there and commend him and the other members of our military who are working to contain the outbreak in africa at great sacrifice to themselves and their families. as i understand his mission there and the mission of our other military members, it's to build facilities for training, i think that's what people have spoken to today as well. one of the things i'm not clear

about, and i think this is for deputy secretary higginbottom, when you were talking about the funding request, you pointed out that $1.3 billion in base funding is to go to, mock other things, construction of the ebola treatment units. are those the same treatment units our members of the military will be constructing or that piece somewhere else in that this budget request? >> as you know, the mission of the department of defense personnel is limited in time and skoeb and the resources we ear requesting will build additional ebola treatment units and we've also requested resources to support the staffing and operation of those. so it's a seamless operation from that perspective and hopefully the dod mission will exit as planned and have the resources and built to step forward and construct those units. >> i'm still not clear, though.

is this $1.3 billion a separate request? does the dod request someplace else? >> i'll let my colleague respond but i believe dod has reprogrammed funds to meet that need. >> yes, we did a reprogramming request that was supported by this committee to contingency operations funding at the end of fiscal year '14 to move that over to a program to support dod's effort and we appreciate the support of the congress to make that happen. >> thank you. >> thank you, madam chair. >> senator cochran? i understand that if your caucus concurs, you will chair this committee in the next congress is that right? >> i hope so. >> senator cochran, please? >> thank you, madam chair. i think this is directed to t s this -- to the secretary and it relates to what senator shaheen

was discussing, the concerns about some of the facilities being envisioned by the department and the funding that's being requested in this supplement almay be unable to meet the goals established by the administration specifically i have concerns that the amount provided by by the creation of more than 50 regional ebola treatment centers may be totally inadequate to accomplish the administration's goal. what is your reaction to that? >> thank you, senator. let me taken a official response and ask my colleague to jump in. first, the request that we're making here is to support a u.s. government funded total number of 20 ebola treatment units. there is a larger number in a global strategy and one of the things we've been doing at the state department is to encourage and ask for donations from

partner governments around the world. it is the true of the experts that that number of fixed unit treatment beds is critical to controlling the epidemic but we're also requesting resources for community care centers that can go into more rural places and basically be mobile to go where there are spikes in the disease for immediate isolation and containment and then funnel patients to the etus. but let me ask nancy to join here. >> simply that. that we're looking at a strategy that is care and isolation. also the safe burials and intensive social outreach so people change their habits all taken together is what we're seeing in the highly affected areas to yield results and we need to keep at that in a way that is anymore sobl that as the virus changes and moves, we're able to put the right strategic element against it.

>> madam chair, thank you very much and let me commend the panel. i think the quality of the discussion in exchange we've had today is excellent. certainly to inform -- better inform the meters of our committee. it's a serious responsibility that all of you have and i understand that you do take it seriously and i commend you for your efforts. >> thank you, madam chair. and i am following part of this from my office and part running from other things secretary burwell, you've always been available and i appreciate our talk we had earlier this week secretary johnson, you have, too. dr. fauci i've known forever and ever. his hair was dark and i had hair when we first met. but i might ask this question of

dr. fauci and anybody else who would like to try to g ahead. today as i understand it zero americans have died of ebola even though we see headlines everyday. but thousands of americans die every year of other contagious diseases. i'm thinking of influenza especially. something that we can curtail greatly. but half of the ---less than half of our population never even gets vaccinated for the flu. is there a disconnect here? should the news be -- putting up a big chart saying "zero ebola, 2,253 flu deaths"? would that make people start paying attention? >> you bring up an excellent point senator that when you have

something that is new and when you look at what goes on in west africa it's rather cataclysmic when you look at what's happened with ebola because as we look at our capability as dr. frieden has describe you're correct. from the standpoint of the control, we've done very well. often we forget when you have something that year after year after year has a terrible burden of illness and disease you get used to it and take it for granted. but i'm very glad you brought up the issue of influenza which is an extraordinarily important disease that we face constantly season after season after season with always the looming threat of a pandemic. so there are things that we can do about it. you brought up one of them. we need to make sure that everyone from six months of age or older gets vaccinated for

influenza. we could decrease dramatically the burden of disease, death, and hospitalization for influenza so that's not to at all diminish what needs to be done and what we're doing with ebola, but when we do that we shouldn't forget other important diseases in our society. >> and the reason i use that as an example -- and i agree with you, not to down play ebola at all -- but i'm looking at -- it tend to vary from state to state, sometimes almost draconian measures taken on health care workers who've come back from liberia or places with ebola and i realize people are trying often times people have no medical knowledge and are trying to protect everyone and i understand that. but do we have a countervailing thing that might happen that we're going to make it more

difficult to find health care workers who are willing to go from the united states to follow the commitment to the united states government to help countries like liberia. >> that's one of the reasons why several of us have said it's very important to respect the health care workers and to develop policies that are based on fundamental science to protect them when they go, to protect them when they're there and to respect and protect them when they return. so i take your point very strongly because i feel very strongly myself being a health care worker and having so many of my colleagues who've actually volunteered and now have come back and want to resume their regular lives and their duties. >> i think ant my wife, a medical surgical nurse and when she was working she was sometimes highly, highly infectious patients and they would do all the things that now

i see on television putting on the suits and all the rest. we follow these things. one last question, i might ask, and if anybody wants to answer it, feel free. the president requested hundreds of millions of dollars for the development and testing of an ebola vaccine. knowing the amount of time it takes to develop a vaccine and test it, what are we talking about in time? anybody care to -- >> sure. well we've -- as you may have heard fully enrolled a phase one trial at the nih that started on september 2. i just reviewed the data that came in from that. it looks good. we're going to move on towards the end of this year to a phase two/three trial to determine efficacy there will be two trials, one that will take place in liberia and one that will take place in sierra leone, the one in liberia will be a randomized control trial by the nih. the one many sierra leone will

be a step wedge trial that the cdc will be responsible for. if, in fact, this is an effective vaccine, and if the infection rate remains at a high level, we could know by the middle of 2015 whether or not we have an effective vaccine. so we're hoping that will be the case but we fully are now already geared to start this towards tend of this year and the very first month of 2015. >> i appreciate that very much and the chair is back. >> senator collins, he's been remarkably patient and we're just going to go straight down the republican aisle which they'd like anyway. senator kirk, is senator mortar rand coming back? senator hogan and senator

alexander. but senator collins, why don't you get started then we'll go to senator kirk and see who else 1 here. >> madam chairman, let me first thank you for your leadership of this committee. you may no longer be our chair but i know you're still going to be a powerhouse on this committee. dr. frieden, all of us are grateful to the health care workers who have traveled to western africa to help control this epidemic and treat the patients there. but a major reason that the american pub slick alarmed about washington's response to ebola is that the cdc seemed to be reacting to events rather than getting out in front of them. and let me give you some examples. first of all, the cdc and cbp

did not begin enhanced entry screening of individuals arriving from west africa until after the diagnosis and subsequent death of thomas eric duncan second, the cdc did not issue updated guidance on the use of personal protective equipment until after the diagnosis of the two dallas nurses. third, the cdc did not issue revised guidance for monitoring and the movement of individuals with potential ebola exposure and until after it had told one of those nurses that she was free to travel on two commercial airline flights and until after dr. craig spencer, who fortunately has recovered from ebola, road the subway, went out

to dinner and even went bowling. all of those activities could potentially is exposed others to the virus. then the department of defense implements a totally different protocol for military members despite the fact that they are not involved in direct patient care. so from my perspective it's not surprising that the american public is concerned about whether the response from washington is the correct response. it is also no surprise that so many state governments, including major states, large states, new york, new jersey, california, georgia, illinois, virginia, florida, and my home state of maine have lost confidence and have used their

authority to implement policies that go beyond the cdc guidelines so i guess my bottom line question to you is are you sure the cdc's guidance is correct and the best way to protect the american people? >> cdc bases its guidance and its actions on the best available data and experience. we have faced now the first case of ebola in the united states. the guidance we've provided by was based on decades of experience in africa and had been effective in protecting our own staff and others. when it did not work here, we changed that guidance. we will change our guidance based on the experience and what the science and data shows us to be most protect i have of health care workers and most protective of americans. what we know clearly is that we need to adjust our approach based on experience. right now we're dealing with a

cluster in mali. that cluster has to be controlled or we're going to have another front in the battle against ebola and we have staff on the ground doing that there. within the u.s., we're intensively working with health care workers to increase training and the resources in the emergency funding request would allow us and other parts of hhs to scale that up even more. >> dr. fauci, first of all, let me commend you for taking care of one of the nurses who was infected. in your experience, should we be worried about the ebola virus mutating into a virus that could be more easily transmitted the way the flu is, for example. >> senator, thank you far question. the ebola virus continues to mutate because it replicates very rapidly. that's not surprising. all viruses, particularly rna

viruses, do that. the question that's the important question, are the mutations associated with significant functional changes in the virus? and by functional change, the question everyone ask, can it all of a sudden go from a virus that is not transmitted by the respiratory route like flu where it does not now. could do it that? and the answer it it would be extremely unlikely that there that's the case i say "extremely unlikely" because you never say never and you never say always. but the reason i can comfortably say extremely unlikely is that this would be unprecedented because of all the viruss that replicate and mutate, there really no examples of a virus that has completely changed its method of trance missability. it can get a little more virulent, a little less virulent, a little bit more readily transmitted, a little

bit less. now completely change its method of transmission would be unprecedented. that doesn't mean we're not following it carefully to make sure it doesn't do that but it would be an unprecedented situation in virologist. >> thank you. >> thank you, i have one question for dr. fauci. could you describe your opinion of the technical expertise inning a dem deem ya and medicine of the canadian government? >> canadian government? they're very good. i mean, we have many colleagues in canada. we deal with them almost on a continual basis. they're as good as you can get. >> let me follow up. if they're very good, why were they wrong in shutting down their visa line in the source countries of ebola? >> senator, i wouldn't say they were wrong. i would say that they made a decision based on what their judgment was for the best -- for their citizens. when it comes to what we do, we

make our decisions based on the scientific data which might be different from people who in good faith are trying to do the best for their citizens. so i don't say they're wrong and i don't criticize them. >> and yet we made a different decision. we have insisted on keeping the visa line open in the source countries. i would say that is likely a mistake. we should probably follow the direction of our canadian allies. >> may i comment on that, please? this specific question is one i've thought a lot about myself and, in fact, the number of flights that are coming from west africa that would enable you to get here have been dramatically reduced and on those flights, only about 30% of those passengers are non-immigrant visa holders from those three countries. a number of visa applications

are denied by our state department already. my biggest concern with limiting the number of visas is that if the united states of america does that, a lot of other nations are going to follow us. which will have the effect of isolating those countries which i don't think we want to see happen. i'm proud of the fact that our military, our health care workers, are leading the international effort there i don't want to see this country become a leader in isolating those three countries so what we do as a nation is followed by other countries in the world is that's my overriding concern with taking that action. >> dr. fauci, let me have you characterize the scientific and medical expertise of the australian government. >> again, similar to canada. they're excellent. they're as good as you can get internationall

internationally. >> in their case they made a similar decision on the canadians, october 28. think shut down their visa line in the source countries. if they're so excellent, why would we ignore the action they have taken? secretary johnson? >> well of course i pay very close attention to what our friends the canadian government do. in fact they have limited the number of visas, they haven't banned them entirely. and it's what i said before. this country is leading the international effort there. and i'm concerned that if we talk the same action it would have a cascading effect on other nations in europe, most prominently that you have with the effect of isolating those countries and making it harder for health care workers to go in and out of those countries. i think we have to pay very careful attention to what the

airline industry would do in reaction to limiting visas because if you -- if the airlines start cancelling flights, there's no way to come and go. >> and i would just like that add, senator, one of the most important things to us is protecting the homeland. when we know and we've had this conversation through most of it, there are four things we know about this disease -- detect, isolate, contact trace, and treat. our ability to do that and as the secretary said there are no direct flights here. anyone who's coming here is coming indirectly. right now our ability, because we if you believe and not only we had five airports that did 94, now we funnel all. and we funnel through and we create a monitoring mechanism at the point of departure where everyone who leaves that country is checked. their temperature is checked, they are questioned. when they come to this country three things happen, they get their temperature checked, they're questioned and they

write down their contact information so we make sure if they need to be referred the next ten is they go to cdc for a further effort there. then we do the monitoring. that's an important part and that's what we've seen work. and whether that's what we've seen in the cases in oregon, oklahoma, across the kroint, when we can be on top of it because we know and get ahead of it as dr. fauci and dr. frieden have both said before someone is systematic and can spread. so it is our judgment that that is the best way, especially when a larger sentage, as the secretary said, of those returning are actually american citizens from these countries. >> if i may add one thing about our visa operations. we have taken steps to ensure we're asking the same questions of visa applicant it is a that are asked when they are transiting -- when they're departing and transiting. >> can i follow up here? i have sent a letter to you on october 17, i wonder if the state department could respond to the letter? >> absolutely. >> thank you.

>> i would just conclude by saying if any of the questions are answered affirmatively, we deny the visa, it's not issued and we refer to cbp and cdc to ensure that person can't travel. >> senator moran? >> thank you very much. as you can see, there continues to be a lot of interest in this issue about quarantining people who return from west africa. it was indicated earlier in the testimony about the difference between the department of defense and others and there was a comment that was made that says well, that's been clarified now. i'd like to say it's been explained, i don't think it's been clarified in the distinction between or the rationale for how we're going to treat troops versus how we're going to treat others. here's what i'd like to ask. who is president at the table if i wanted to ask the question about how successful we are in our toord nation efforts among the various agencies and

departments. and what strikes me is that the president's ebola coordinator is not part of the panel and maybe that's the committee choice and not yours but one i would think as a member interested in this topic, i remember our hearing on september 16 in which the question was asked, i think it was mostly about coordination abroad in africa and the answer was usaid and more senior members than me on this committee had this kind of it wasn't an audible gasp but it was like that doesn't make sense, there has to be more to this story. are we really trusting usaid to coordinate the activities in west africa? the president has now appointed an ebola coordinator and that person isn't part of the witness panel today and that strikes me as odd. >> the chair would like to take the opportunity to respond. i reached out to mr. klain through the office of the white house, his employer, the white

house declined his participation saying that he had no operational role, his role is that of a coordinator and was an employee of the white house and the president. the white house rather than us getting into a lot of arguments back and forth, because i had some -- you know, you and i think a lot alike. >> thank you for that compliment. >> that really going back to presidents -- we've looked all the way back to ronald reagan and wherever there was an employee of the white house that had an important role, it was the right of the president to decline so president obama didn't do this, but they neat the people who had the real responsibility for doing this actual governance of response and the ones who would be in charge of the money from this committee should be the ones to testify and i think by all accounts this is a pretty solid

group. >> certainly, madam chairman, you and i agree with this being a solid group and i appreciate the testimony and education i've had today. but i did notice among committee members on our september hearing this concern about coordination and i'd like to follow up and find out what's transpired since we met, ask that question and how the coordination has changed and been altered since then. dr. fauci, what developments have occurred? in some ways you've answered this question, i think, but what's different today than the last time we met. when you testified in september, i think september 16, what's changed in the care, treatment, protoc protocols? i guess this may be a dr. frieden question as well. what's transpired that is different today than it was when we met a month and a half ago in regard to treatment and the prospect of hope in this battle against ebola?

>> i'll take a shot at it first. the first thing is that at the time we met last time we were still in the stage of doing contact tracing of people who were exsupposed in this country. and as it turns out now when you look at the contacts of the infected individuals they are now beyond the 21-day period. so we can now comfortably say that the united states of america is ebola-free. and that's something i couldn't tell you at the last hearing because we were not sure at the time. the next is that we've made a significant progress on the road to the testing of a vaccine for its efficacy because we had just started the phase one trial at the time of the last hearing and now the results look good in that trial and we're all set to go at the end of the year into the efficacy trial in west africa. then the other thing is that the

downturn in liberia is encouraging. we're not saying that the ball game is over by any means but the downturn there is encouraging which means that the prevention and contact tracing and funeral issues have worked. >> dr. brantley testified that he was unable to say whether his treatment improved his condition or not. can we answer that question today? >> no, we can't. and i'm glad you asked that because that is the real important argument for doing the controlled clinical trials that we are now planning, we had a meeting last evening at the nih where we brought together all of the people who had taken care of ebola patients in the united states. we had nebraska there, we had emory there, we had the nih there and we had others and when we looked at the data, the cdc presented all the data and it was clear that we have no idea what works or doesn't work because it was just given on an

impeer i can basis which is a very strong argument for clinical trials. >> madam chairman, thank you very much. >> thank you, madam chairman. my first question is for assistant secretary lumpkin. in your statement you mentioned $112 million of the president's recent request for emergency fund willing go to darpa to develop technologies and provide temporary immunity. i understand the defense threat reduction agency has been looking for rapidly available ebola vaccines and treatments. can you elaborate on what darpa will be looking for the requested funds and whether there are technologies in the pipeline that show a promise in the short term? >> first of all, i don't propose to promise anything. this is a research capability we're trying to fund to accelerate development programs and i think the key to look at

that is that this is in conjunction with nih efforts in conjunction with ditra efforts and i think the key is we have to pull out all stops as we look at doing ground breaking new innovati innovative technologies to address the treatment and ultimately a vaccine to prevent ebola. so darpa has unique cape bts and methodologies, how they look at problem solving that's led to capabilities that we have today to everything from gps to the mouse that runs your commuter. they have innovative technologies as the way they look at problem solving so we'd like to resource them to look at this problem set and to adjust one more set of eyes to move this forward as fast as possible. >> and then to coordinate that effort with ditr snarks. >> absolutely. and with nih as well. >> we generally think of it as the continuum. ditra and darpa, many times in

the earliest stages. ennih at the next level and then barda at the next level when we're getting to that stage of manufacturing in terms of thinking about the continuum of getting product that from that initial idea through production and use. >> madam secretary, i see that the hhs request for biomedical advance research development authority is specifically requesting an additional $157 million manufacture having seens and therapeutics for use in clinical trials in. the upper midwest region, there's very promising therapeutic but as i understand it's not synthetic. meaning it's developed outside the lab. this has pruch effective with m,rs and the flu so how is your request flexible enough to take advantage of new technologies like this? >> what we want to do is work and we have been working on

zmapp which is tobacco-based currently, one of the things in terms with getting enough production that we can do trials. this is a therapeutic. why we've turned to synthetics is because we think we can get volume. with any of these issues we want to work to what will get us there fast er and to the level f production and so as we're reviewing and with the finances we were given earlier, we have been working on zmapp in a non-seinon non-synthetic fashion. >> give than many early vaccines fail, how many candidates will barda be able to support with this $157 million request? >> i will turn to dr. fauci to talk about the number of different -- there are two main vaccine candidates that are there, but there are a number of others on the list. >> does the funding allow for scale out for manufacture when you find something that works? >> so the answer to the question

is that as the secretary correctly said, there are two major ones but there are three right behind them that barda has their sites on. so if you're asking what can barda do, we're talking about five. >> i would just add depending on where and how quickly the issue of the distribution of those, there's the manufacturing and production, which barda is focused on but there's also distribution and that's why we have put in the contingency fund. a part of the contingency fund is if we get something and believe we need to support further distribution that's something that we would do as well. so distribute a successful vaccine. >> that allows for large scale manufacture and distribution? >> right now we have put in funds that will help us get to the manufacturing. that is what we are focused on 234 the barda element. >> thank you. >> thank you very much, senator hogan as we wrap up today's

hearing i'd like to thank these witnesses for their cogent testimony. i think we've learned a lot. i think it gives us great insight into the president's request and why that significant amount of money is needed and why even though it might not be a headline the urgency continues and i would like to follow the model established under president bush and then with president obama when we had an infectious disease situation before. before i wrap up i want to comment about dr. frieden and dr. fauci who spent a lot of time both dealing with the disease and dealing with the fear the public had around the disease and you did a great job while you were trying to do several other jobs. so secretary burwell do you

think you work would have been facilitated while these two fine doctors -- because the question is who is america's doctor? should we move rapidly to confirm a surgeon general which in no way minimizes the work that these men have significant operational responsibility and in many ways they acted as america's doctors. >> it would be helpful. this is carry to the american people having an additional voice that would be a voice that is a trusted doctor voice about how to understand it is certainly something that would be helpful but it would be help informal things that the department does like opioids. so the answer to that question is it would be helpful to us and thank you to dr. frieden and fauci who took that responsibility on. >> and they did do that job.

>> and they did do that job. >> but they had a lot of other jobs. >> that's correct. >> well, we're going to wrap up but i want to thank everyone in our civil service. from the administrative support team to the top level and for our military personnel. but for our civil service, federal employees often trashed and bashed i would like to say thank you i think we need to acknowledge this, that in a democracy we need to be able to have a civil service that is reliable and continue to do the job. you just can't dial up a civil service. you can't order it on amazon.com and i know that in every single one of the agencies that they face sequester, they face the a shutdown. just one year ago they were told they were non-essential and now we want them to risk their lives or to spend night and someday

trying to protect america. so i think we need to respect them and the way we show that respect is making sure they have the resources to do the job that they were. and this also cautions us when we make unnecessary travel restrictions, our federal government doesn't -- we're not talking about taking a lavish trip to an exotic foreign capital like many of us do. that this is really on the job. so i want to say thank you and we want to thank every single one of them that we need to do our job so we have what they have to do their job. thank you very much. [ applause ] in addition to this -- thank you. we've heard need the committee has also received 60 written submissions from 116 organizations that will be made part of the hearing record. if there are no further questions, senators may submit additional questions for the comm

committe committee's official record. we asked the agencies not to take their usual to 30 days. we asked the agencies to respond in two weeks. the reason why is this committee is going to be moving on this request and the senators have a right to have their questions answered. so if everyone could make sure any additional questions are and then senator shelby and i working with congressman hall rogers under the guidance of our leadership intend to be moving on the urgent request but also our responsibilities for fiscal 2015 for which we need to do our job so others can get on with theirs. having said that, the committee now stands in recess subject to the call of the chair and i thank everyone very much.

>> the conversation on this hearing is continuing on c-span's facebook page. we're asking is the $6.2 billion request enough or too much? here's what a couple of viewers had to say. jeff says "way too much. most of this is apparently going in someone's pocket." and mare write writes "well, considering how broke our country is, i'd like to know

where this money is coming from. we can't do for our own yet magically money appears for other countries." you can weigh in at facebook.com/c-span and share your thoughts. we're going to go back now to the beginning of the hearing and show you the opening statements from the committee chair and the top republican as they explain their concerns with the u.s. respon response. >> 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 in 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, congratulations are in order to some of our colleagues who've won. we first of all want to acknowledge senator reid and senator koontz' victory and on this side we want to acknowledge the victory of senator cochran and senator collins and we want to congratulate them today is a day where we have to pay attention to a national challenge is -- that we're examining. the look at a horrific infectious 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 thatly

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've 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 always a tone of civility and candor and in the ability to in this committee to try to work together and find common ground too deal with america's problems in a way that achieve sound results and to do it in a they's affordable. i think that's characteristic of our committee and i hope as we move ahead that we will continue to do so. i'm going to 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 in to new roles and senator i'm going acknowledge your graciousness and 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 corrected 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 rest in 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 deploy 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, nih, fda, ever and of course, our ever 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 higginbottom, accompanied by nancy lindbergh of usaid, who will tell us about how are we going to do this in west africa and how are we going to do it not only in those three countries but in the con dig use countries. we are then going to turn to assistant secretary of defense, mr. michael lumpkin. 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 james 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 frieden, to ms. lindbergh, to

the very good general who's here, we'll ask you to join us after they testify to be able to answer questions from this really 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. h1n1 flu epidemic. in which nearly 3,000 died. we provided 6.4 billion and designated that as emergency spending. the bipartisan emergency response in 2009 mirrored what we did to help president bush, again, bipartisan basis, when we faced aviationi fac 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 ngos, and also schools of public health, like the bloomberg school and my own state at 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 pe