>> the subcommittee will come to order. good afternoon to everyone. i called this emergency hearing during recess to address a grave answer is health threat which has in recent weeks ripped the mass media and heighten public fears of an epidemic of the ebola virus. what we hope to gain from today's hearing is a realistic understanding of what we are up against while avoiding sensationalism. ebola is a severe and often fatal disease that first emerged

or was discovered in 1976 and has killed 90% of its victims in some past outbreaks. since march of this year, there have been more than 1700 cases of ebola, including more than 900 fatalities in guinea, liberia, sierra leone, and nigeria. this time, the average fertility rate in this outbreak is fromated at 55%, ranging 74% in guinea 242% in sierra leone. ratessparity in mortality are partially linked to the capacity of governments to treat and contain the disease and capita health expending by effective governments. there is also concern giving -- given modern air travel and the latency time of the disease that the virus will jump borders and threat lies elsewhere in africa and even here in the united states. ,n my own state of new jersey

and a hospital just a few hundred yards from my district office, precautions were taken. a person who had traveled from west africa begin manifesting symptoms including a high fever. he was put in isolation. thankfully it was not ebola and the patient has been released. the new jersey health commissioner reiterated to me yesterday that new jersey programs have control in which they train and our deal -- ready to deal with infectious patients who come through their doors. she told me physicians and hospital workers follow specific protocols prescribed by the cdc on how to protect themselves as well as other patients and how to observe a patient if they have any concerns, which include protocols like managing a patient in isolation so they are not around others who are not appropriately protected. the commissioner also underscored that the federal

government has u.s. quarantine stations throughout the country to limit introduction to any disease that might come into the united states at words of entry liberty jersey's international airport. i hope our distinguished witnesses will confirm whether sufficient resources are available and are being properly deployed to assist victims and contained the ebola disease. are there gaps in law and policy that congress needs to address? to the government witnesses, my plea to you is that if legislation is needed, i will work and i know i will be joined by colleagues on both sides of the aisle who will work with you to write those new policies. symptoms of ebola include fever, weakness, joint, muscle thomas throat and stomach aches. the invite him -- then vomiting, diarrhea, rashes and bleeding. these symptoms are seen in other diseases besides ebola which make an accurate diagnosis early

on uncertain. earlier today, i had a full and lengthy reefing with the deputy chief of staff of the president of guinea. he said the virus has masked many other diseases, including loss of fever. many doctors, including those who have never seen a bowl and is part of the world before, it has been in other parts of africa but not in west africa, just simply did not think this would be ebola. many of them have died. ebola punches holes in blood vessels by breaking down vessel causing massive bleeding and shock. most people cannot fight the infection effectively and as a result, there is massive leading within seven to 10 days. the infection too often results in the death of the affected person. fruit that are suspected of being a primary transmitter of

ebola to humans in west africa. the virus is transmitted to humans with close contact in the blood, secretions or other organs of infected animals. some health workers such as the heroic air -- heroic american missionary aid workers contracted the disease despite taking every precaution while helping ebola patients. both of them are now being treated at emory hospital in atlanta, georgia in an isolated unit after being flown to the u.s. in a specially equipped air ambulance all stop -- air ambulance. while there is no known cure for ebola, the doctors have been given doses of the next bear mental antivirus cocktail developed by san diego company. they are reportedly both feeling stronger after receiving the drug but it is considered too early to tell whether the drug

itself caused the improvement in their conditions all stop -- in their conditions will stop the pharmaceutical company has been working with an arm of the houndingsponsible for weapons of mass destruction to ebola -- to develop an ebola treatment for several years. the drug attaches to the virus itself and it has never been the twon humans before doctors who gave their consent to be the first human trials. that itll be great hope works in the two americans who bravely agreed to test it and it has a positive effect. been it would be produced in great quantities and sent to people in west africa. it is still an experimental drug. those who use it might the given complete information on its use but that's something our experts i hope will address.

there's also promising research a company who has come up with a drug and process -- one of the comments that has been made that it has never been tested on humans and that it has been provided 100% protection from an otherwise lethal dose of zaire ebola iris, but not -- zaire ebola virus, but not in humans. unfortunately, it impacts the ability of the international community and assisting the government to meet the self challenge. some of the leading doctors in those countries have died treating ebola victims. the nongovernmental and american personnel there say they are besieged not only because they are among the lay medical personnel treating these exponentially spreading disease that because they are under suspicion by some people in these countries who are familiar with this disease and -- who are

unfamiliar with this disease and fear doctors may have brought it with them. it is untrue and myths abound. the current outbreak as we know is unprecedented. many people are not cooperating with efforts to contain the disease. there is an information gap. despite the efforts through cell phone and radio to get the message out, there is a learning curve. to do tosider what meet this health challenge, i suggest we get funding levels for pandemic preparedness. this is for congress and the executive branch. in a restricted environment, funding has fallen from $201 million in fiscal year 2010 two an estimated in 2010. change followrt

efforts to save these people in this country. our expert witness, tom frieden, is trying to assure the government we are doing what we can do to address the crisis. he announced the dispatch of 50 or more public health officials in the next 30 days. who, the world bank him and many in andare also joining trying to meet this crisis. to those who say we have no plan, i would say planning is definitely underway and is being done so aggressively. still, there is much more that needs to be done. legislationduced known as the and neglected tropical disease act which broadishes to support a range of research activities to achieve cost-effective and sustainable treatment and control and, where possible, the elimination of neglected

tropical diseases. ofla is not on the top list 17 neglected tropical diseases but it does fit the definition of an infection caused by pathogens that is proportionally impact individuals living in extreme poverty, especially in developing countries. it ebola had been thought to be limited to areas where it could be contained. we know that is no longer true. we need to take seriously the effort to devise more effective means of addressing this and all neglected tropical diseases. i now yield to my good friend and colleague, the ranking member. >> mr. chairman, thank you for your leadership and calling today's emergency hearing to give us an opportunity to learn about and work to address the current ebola outbreak in west africa. i look forward to hearing directly from our witnesses on

the work their agencies are doing to combat the deadly outbreak and how they have coordinated with the government of impacted countries. i appreciate their efforts at outreach to keep congress informed on this devastating situation. this outbreak comes as nearly 50 african heads of state join us here in washington dc this week as part of the first in history u.s.-africa leaders summit. i have been honored to join my african and american colleagues as we join together to reach the full capacity and promise of the african continent. we had several production sessions that further cemented the relationships between u.s. and african nations and highlighted opportunities for us to continue to work together. despite the meaningful dialogue and collaboration that occurred this week, there is still work to be done. careevelopment of health capacity and global security is just one area of collaboration for the u.s. and african nations. that a little dismayed

with all the activities that happened this week around the summit, the crisis we are dealing with today is very important, but when it came to coverage on africa, the coverage centered solely around ebola. i want to commend the steps being taken by the government of nigeria sierra leone, and the u.s. and the great work of the health professionals throughout the world who are doing everything they can to help people who have contracted this awful disease will stop with over 1700 suspected and confirmed cases and over 900 deaths since march, the current outbreak is the longest lasting, widest spread, and deadliest outbreak recorded. it's also the first ebola outbreak in west africa and the first outbreak to be spreading in both rural areas and capital cities. thisnique nature of outbreak has made combating the disease difficult.

west africa has not faced this disease before and immunities among governments and health care professionals do not have the expertise and capacity to address the scale, spread, and proper treatment of the outbreak. this lack of logistical expertise, health care workforce and supplies has hindered the ability of governments to identify, track and isolate new cases and properly care for those infected. officials have had to fight against fear of the disease and culture -- the literal unfamiliarity with robert treatment which has really contribute to the spread and cap people from seeking care. yesterday, i had the privilege to speak to president ellen johnson about the impact on her country and the work they have done to fight the disease. i asked what more we could be doing and one thing she talked about was the need for logistical support, the need for training of their health care workforce so they would know how

to prevent the disease. tom frieden is going to say we do know how to prevent the spread of the disease but that is where our efforts need to be directed. the other thing the president said was the problem with the outbreak is all the resources are centered toward the outbreak and then routine medical care has suffered because there has not been the workforce to be able to handle both will stop so the call for increased international assistance to provide food and water to impacted communities -- she said the communities that were most heavily impacted were quarantined and that there needed to be food and water brought into the areas, especially in situations like this where you have a concern civil unrest, there could be an outbreak in areas that are

quarantined and feel they do not have access. that was one of the ways the united states could help the best. it's in our interest in the world interests to continue to support nations as they fight this outbreak and work to .evelop health care is a human right. we're hoping to prevent future health epidemics from occurring. both the chairman and i have introduced legislation to respond to this crisis and i look forward to your testimonies. i'm interested in hearing from all of you about what more congress can do to assist your efforts to combat the disease, outbreaks, and support international efforts to improve health care systems around the world. >> thank you very much. i would like to recognize in the audience the special representative to the secretary-general of the u.n. on

sexual violence in conflict. thank you for joining us today. to the like to now yield distinguished chairman of the state department, commerce and justice department subcommittee of the appropriations committee, congressman frank wolf, who has of a 34 year career tremendous support for the weakest and most vulnerable, and a matter of fact, the genesis of this hearing was a conversation with ken isaacs last week. a hearing oning on the ebola virus force number and the sense of urgency and chairman wolf set up the conference call, the sense of urgency was so great that the thought was it that are now and we can have more hearings in the future and more action plans and the like. so i would like to thank the chairman for his tireless efforts on behalf of the weekend vulnerable.

-- week and vulnerable. >> i like to thank my good friend for pulling today's hearing together amid the escalating outbreak of ebola across west africa, countries including liberia, sierra leone, and now nigeria. , i dogh i'm not a member serve on the state and foreign operations appropriations subcommittee which funds the state department and foreign aid programs. i would also say to the witnesses that if you need extra money, ask for reprogramming. forshould not wait september, october -- you should ask for it immediately and him confident the appropriate committees will allow it. but if there is any doubt, there should be request for reprogramming. the current ebola epidemic has claimed over 900 people. it was detected earlier this year and is proving to be the world's worst outbreak of the

virus ever recorded. alarming,ears this contagious disease could be on the verge of spreading. on july 28, i received a call from ken isaacs. let me say samaritans purse and doctors without borders have done more to help the poor and suffering in many faces than almost any other groups around. so i want to commend samaritans purse and doctors without borders. wherever you go in africa, they will either one other groups have long gone. samaritans purse is on the front line, working to curtail the ebola outbreak. absence of the united states was bleak. obama administration underestimated the magnitude and scope of the epidemic. despite well-intentioned efforts by local and international aid workers, actors and nurses

working on the ground, it seems the international community in the u.s. had been noticeably absent in helping these west african countries to get out in front of the spread of this epidemic. of the first part epidemic, the international community led three of the most impoverished countries in the world deal with it ebola essentially on their own. it should be no surprise the health systems and night -- in liberia, guinea and sierra leone do not have the resources or capacity to deal with this epidemic on their own. despite early warnings from ngos working on the ground, there was little action taken to get in front of this problem and now we are seeing the consequences. nothing can bring back the lives that were lost and money and personnel deployed to help may not be enough to contain the epidemic. i spent much of last monday on the phone with the white house, state department, cdc, and aj just trying to understand what, if anything the u.s. is doing to

contain the out rate and prevent the spread of ebola to the u.s. i was concerned no one could tell me who was in charge within the administration on this issue. no one could explain what actions would be taken to ensure the u.s. was prepared to respond. has beenmore progress made over the last week since these conversations, it is clear the government is still trying to catch up will stop -- to catch up. this requires efforts from agencies and countries, france, great britain, many of the countries experienced in africa should be brought in. it has also come to my attention that there seems to be deficiencies in the planning procedures and protocols in response to the ebola threat will stop as mr. isaacs will share today and i have read his testimony -- when the health care workers confirmed with

ebola, getting guidance for returning health care workers soon became apparent there were significant gap in existing procedures for dealing with this. the cdc had no available registry of medical facilities capable of treating ebola patients in the united states. there are no quarantines or travel restrictions in place and there was concerned the gaps in the protocols and how do you deal with them? i appreciate them very much. -- heeciate dr. frieden took the cold call when his getting on the airplane. i hope you will talk about any deficiencies and how they can be addressed by the government and the congress of stop -- and the congress. i want to thank chairman smith for calling this hearing during the august recess and i also want to recognize the men and women of the cdc and other international response groups who are on the ground and soon

will be on the ground in africa as well as the doctors and nurses helping the two patients in atlanta. i want to thank them because this is very dangerous, what a will be doing all stop and people we do not know their names, we should tell them we appreciate them. i want to thank the state department and department of defense for their invaluable assistance as this thing is taking place. this is important and serious work and i knew if the american people if they knew what was being done would appreciate their efforts. this should be a very top priority of the white house, the political leadership of the nation. you know with the career people are going to do, but the white house, the american people deserve to know what their government is doing to prevent the spread of this epidemic and keep the country safe. with that, mr. chairman, thank you and i yield back. >> i would like to now introduce our first panel of two panels. the getting first with dr. tom

frieden, who has been the director of the centers of disease control since june of 2009 and has worked to control infectious diseases in the united states and globally. he led new york city's program to control tuberculosis and reduced the multidrug resistant cases by 80% and worked in india for five years, helping to build a tuberculosis control program that has saved nearly 3 million lives. founded programs that increased life expectancies and is the recipient of numerous awards and honors and has published more than 200 scientific articles and has previously testified before this committee on drug-resistant diseases as well as other very important health topics. thank you, dr., for being here. we would like to introduce ariel pablo mendez, the assistant

administrator for global health at usaid. he's been in that position since 2011. he joined usaid's leadership team to shape the bureau for global health's efforts to accomplish scalable, sustainable, and measurable impact on the lives of people living in developing countries. on mobile health strategy in the transformation of health system and africa and asia and served as the director of knowledge management at the world health organization. certifiedard internist and until recently was practicing as a professor of clinical medicine and epidemiology at columbia university. we will hear from ambassador williams, career member of the foreign service with the rank of mr. counselor -- minister deputy of affairs at the department state. she serves as ambassador to the republic of niger and has served

at u.s. in the season hannah montana france and guinea. her postings have included director for international organizations in national security council at the white house and advisor at the u.s. mission to the united nations in new york. without objection, fuller resumes conair deep and distinguished, but they will be entered as part of the record. dr. frieden, the floor is yours. >> inc. you very much for your interest in global health, your interest in ebola and calling this hearing at this critical and pivotal time. first, let's are member the lives and faces of the men, women and children who are outbreaksy the ebola in the four countries currently affected, especially the health care workers who account for a substantial proportion of cases.

those are the people we must focus on. those are the people we must support, and it is in africa we can stop this outbreak and protect not only this country but ourselves as well. we focus on what works and i'm incredibly proud of the staff of the centers for disease control -- disease control and prevention and i think every american who would know the expertise, dedication of the disease detectives, laboratory experts, disease and intervention specialists who have an on the ground in the past few weeks and months and you are now searching for our response would be proud to know what we are doing there. i want to start with the bottom line. three basic fact. stop ebola.n we know how to do it. fightl be a long and hard and the situation in lagos, nigeria is particularly concerning, but we can stop ebola.

second, we have to stop it at the source in africa. that is the only way to get control. third, we have to stop it at the source through tried and true means -- the core public health interventions that work and i will go through in a few moments. by way of background, ebola is one of several viral hemorrhagic fevers. there are others, but ebola is the most feared in part because it had a movie made about it. there are others that are just as deadly. the first ebola virus was identified in 1976 in what is now the democratic republic of congo. there have been sporadic outbreaks since the natural reservoir is not known but is believe to possibly be that which pass it to primates and other forest living mammals and humans may come into contact with them by eating bush meat or contact with bats.

that is a theory. there's increasing evidence for but we are not certain of it. what we are certain of is when ebola gets into human populations, it spreads by two people whoirst, two are getting care to individuals who are sick with ebola. ebola does not spread from people who have been infected but are not yet set. it's only sick people the transmitted. second, it's transmitted only by close contact with exchange of body fluid. so a health-care worker or family caregiver who comes into contact with a patient who is very ill, maybe leading or have body fluids on the individual, that is how ebola spreads. in the outbreak in africa, there have been two main drivers -- health settings and other caregiving settings, including the family, and burial practices , where there may be practices that involve contact with the recently deceased person.

those are the drivers of ebola in africa. ebola only spreads from people who are sick and only spreads through contact with infectious body fluids. it does not spread through casual contact. it is not an air board -- an airborne disease, does not spread through water or food. and incubation time is usually between eight and 10 days from exposure to onset of illness. it can be as short as two days and possibly as long as 21 days. but in that time, it is essential any contact he closely theyored to determine if have developed the symptoms of ebola and if they have, are followed up. we do know how to stop ebola. case finding, isolation, contact tracing and management full we have been able to stop every ebola outbreak today and i am confident that if we do what works, we will stop this one

also. but it won't be quick and it won't be easy. it requires meticulous attention to detail. if you leave behind even a single burning ember, it's like a forest fire. it flares back up. one patient not isolated, not diagnose, one health-care worker not protected, one contact not traced, each of those lapses can result in another train of -- another chain of transmission. the chat really isn't the strategy. the challenge is the implementation of that strategy. mr. chairman, we provided to the committee this basic information on how ebola can be controlled. and if you would permit me, i'll just go very quickly through this, because i think it's important to get the fundamentals out there. first, to find patients and diagnosis them. that means fever or other symptoms, the only way to diagnosis ebola is with a

laboratory test. that's generally done by a blood test in africa and we, working in partners from the department of defense, from the pasture institute of france, from other countries and the countries where the disease is present, are scaling up the ability to diagnosis patients. so the first -- that diagnosis is suspected with fever, test with blood, get it tested in the lab. that's a critical first step. the second step is to respond to those individual cases. we do that by putting patients in isolation, by interviewing them and eliciting their contact and then by following each and every contact every day for 21 days and if a contact develops fever, begin that process all over again. interview them, isolate them, find out who their contacts are. it's laborious, it's hard. it requires local knowledge and local action, but it's how ebola is stopped. and third, prevent it.

prevented through infection control in health care, safe burial practices and reducing the consumption or unsafe consumption of bushmeat in contact with bats. the current outbreak is a crisis. it is unprecedented. and it's unprecedented in five different ways. first, it's the largest outbreak ever. in fact, at the current trend, within another few weeks there will have been more cases in this outbreak than in all previous recognized outbreaks of ebola put together. second, it's multicountry. and one of the biggest challenges is one of the epicenters is on the confluence of three different countries and cases have moved between countries. one country gets control and then patients come in from another country, so that tricountry area is a critical challenge. first, this is the first outbreak in west africa. this was a disease that was unknown as far as we know in

that area before and because of this it's been a particular challenge and the health systems in these countries are quite weight and this also is a challenge. fourth, many of the cases have been in urban areas and there has been spread in urban areas. and this is something we have not seen to this extent before. from everything we know to date, this doesn't appear to be a change in the virus, but it is a new development in how and where the virus is spreading and it makes control much more difficult. and fifth, it's the first time we're having to deal with it here in the united states. and that's not merely because of the two people who became ill caring for ebola patients and were brought back to the u.s. by their organization. that's primarily because we are all connected, and inevitably there will be travelers, american citizens and others, who go from these three countries or from lagos, if it doesn't get it under control, and with those symptoms.

those symptoms might be ebola or something else. we have to deal with oebola in the u.s. in a way we have never had to deal with it before. the u.s. is working in a coordinated way to support partner governments and the world health organization. i have activated the c.d.c. emergency operation center at level one for this outbreak. this is our highest level of response. it doesn't mean there's an increased risk to americans, but it does mean we are taking an extensive effort to do everything we can to stop the outbreaks. we can't do it alone. there are many partners throughout the u.s. government who are working with, the world health organization, the world bank, governments around the world as well as most importantly people in-country will be key to stopping the outbreak. we will send, as i have said, at least 50 staff to the region within the next week or two, actually, we will reach that 50 number. but i think it's important to

understand that the 50 in-country are supported at our home base in atlanta by a much larger group. as of today, even before the full surge and activation, we have more than 200 staff working on this outbreak response and we will increase that number substantially in the coming days and weeks. you'll hear more about the work we're doing with the u.s. agency for international development where we're using an unprecedented model to work together in a collaborative way to rapidly identify and call in for reinforcements and assistance. when we finish this response, we're determined to not only stop the outbreak but leave behind strong systems that will be better at finding the disease and other threats, stopping it before it spreads, preventing it in the first place. in fact, if those systems had been there in the first place we wouldn't be here today. the outbreak would have been over already. we don't know how to treat ebola and we don't know how to

vaccinate. we don't have medications that cure it but we do know how to care patients with ebola. you might have seen press coverage with experimental treatment, and the plain fact is we don't know whether that treatment is helpful, harmful or doesn't have any impact. and we're unlikely to know from the experience of twor handful of patients whether it works.o know that supportive ca for patients with ebola makes a big difference. supportive care saves people's lives, giving them fluid, making sure they're not over or under their fluid balance, giving them supplemental oxygen that's needed, treating other infections that occur, providing them good quality health care. we'reinating with n.i.h., f.d.a., the department of defense and others to see whether there can be new treatments and whether these treatments can be effective and available, but there's a lot we don't know about that yet. it's important that we keep in mind that we do know, even without medicines that are

specific to ebola or a vaccine, we do know how to control it and we can stop it i want to spend a moment on what we're doing to protect people in this country. first off, the single most important thing we can do is to stop the outbreaks, to stop it at the source. the second issue that we're working on is to help these countries do a better job screening people who are leaving their countries so they'll screen out people who are ill or who may be inc. baiting ebola. -- incubatting ebola. because we're interconnected, we're working with state and local health providers so there are -- they are aware people may come in with fever or other symptoms, they should think if it's ebola, immediately hospitalize them in the hospital and get them tested at c.d.c. we've issued a level three travel advisory against all nonessential travel to new

genie, sierra leon and liberia and enhanced precautions on nigeria and we'll reassess that situation daily or as frequently as needed. there is strict infection control possible in hospitals in the u.s. there have been some misconception about this. ebola is not as highly infectious as something like influenza or the common cold. what's so concerning about ebola is that the stakes are so high, that a single lapse in standard infection control could be fatal. that's why the key is to identify rapidly and strictly follow infection control guidance. it is certainly possible that we could have ill people in the u.s. who develop ebola while here after having been exposed elsewhere. it is possible they could spread it to close family members or to health care workers if their infection is not rapidly identified. but we're confident that there will not be a large ebola

outbreak in the u.s. we're confident that we have the facilities here to isolate patients, not only at the highly advanced ones like the one at emery, but really at virtually every major hospital in the u.s. what's needed is not fancy equipment. what's needed is standard infection control rigorously applied. we've released guidance for doctors and other health care providers in the u.s. on identifying,ining and treating patients and guidance for airline flight crews, and c personnel. fundamentally to end here, we have three roads before us. we can do nothing and let the outbreak rage. i don't think anyone wants to do that. we can focus on stopping these outbreaks, and that's something we will certainly do. or we can focus not only on stopping these outbreaks but also on putting in place the laboratories, the disease detectives, the emergency

response systems that will find, stop and prevent future outbreaks of ebola and other threats. we do face in this country a perfect storm of vulnerability with emerging infections like ebola, intentionally created infections which remain a real threat. but we have unique opportunities to confront them with stronger technology, more political commitment and success stories on real progress from around the world. earlier this year, the u.s. joined with the world health organization and more than two dozen other countries to launch a global health security agenda. that global health security agenda is exactly what we need to make progress, not only in stopping ebola but in preventing the next outbreak. the second document that we provided for you provides a summary of what the mapping is between what we launched back in february before this outbreak was known or reported to have started and what's

needed to stop the ebola outbreak. they're closely aligned. the president's budget includes a request of $45 million to c.d.c. to accelerate progress in the detection, prevention and response. a former secretary of state for africa said to me -- undersecretary of state for africa said to me citing his decades of work that c.d.c. is the 911 for the rorled. though i was happy to hear that, i realized that really what we want to make sure is every country or region has its own public health 911. it will be good for us and their safety, it will promote economic and social stability and expanding that work, strengthening health security will allow us to not only stop this outbreak but also prevent future outbreaks and stop them faster if they do occur. thank you so much for your interest in this topic. >> dr. frieden, thank you very much for that very comprehensive and inseesive testimony.

i'd like to go now to dr. pablos-mendez. ranking you, chairman, member, allow the u.s. agency for international development to present to you an update where we are on this tragic and alarming outbreak of ebola in south africa. you have been a strong supporter of this area. and member bass, also for africa. we couldn't have better champions than this. the epidemic is historic -- it has the never occurred in this region and spreading the cities -- and risk of spreading throughout the region. i am saddened to see the devastation of the lost of lives caused by this outbreak. ut also the social, economic disruption that's inflicting in

the region. what is really fledgling democracies in africa. the good news is we have -- we know how to deal with ebola. there have been 30 or so breaks in central africa. in each of those they were contained. the systems don't have to be perfect. the basics have to be in place. people have to be familiar. uganda has a track record that's worth noting in the year 2000 they had 425 cases during that outbreak. the support that we provided allowed that outbreak to be contained. 2008, only 149 cases. 2/3 reduction. and in the last outbreak in the region, 2011, 2012, the number was only 32. so systems can learn, can prepare, can deal with this outbreak. we have done it many times and as tom said, we know exactly what to do.

usaid, provided with team funding to both c.d.c., the world health organization in geneva and africa to have preparedness, planning and response and indeed that has been part of the machinery that has been put in place here. we support about 22 laboratories in 18 countries in africa and asia where almost 500 new viruses have been detected in just the last five years. there's a lot of activity going all the time. this particular virus, ebola, s, again, familiar to us and as far as we can tell from a biological, genetic point of view, it's really the same virus. it's not a new mutant virus that's taken on new powers. it is the same virus we are familiar with, but it's entered a new region and entered, as we speculate, because bats have been tested positive in central africa and now also tested positive in western africa. this ecological dimension has to be kept in mind.

and because of the novelty of these, neither the people in africa nor the health systems were experienced in dealing with the outbreak which has contributed to these. usaid has targeted in this year the response in western africa. we started earlier this year, supporting with a $2.1 million investment to unicef and it's being reinforced now with $2.4 million to support c.d.c.. indeed, it's important to note to chairman wolf's comments that the outbreak in sierra leonnd in liberia had -- it started really -- in retrospect, we all can see earlier on, but the cases where identified in late march and for a couple weeks we had this outbreak. it then went down so in the

spring, the initial outbreaks went down. as tom frieden pointed out. if you report one case can reignite the whole thing and indeed that's what we have seen with a secondary spike that has been truly a difficult to control. this investment has allowed us to work with unicef, w.t.o., to allow to deploy 30 or so technical experts, provide support, including 35,000 sets of personal protective equipment and supplies. also, the basics. soap, water. that sort of thing. very important in this type of situation. and it's taking place as we speak. usaid is closely coordinating its response to ebola with the department of state, health and human services and the department of defense as well as with w.t.o. the c.d.c. has the lead in the response to the ebola outbreak. and -- but the coordination has been truly exemplary.

i want to really point that out. it's been something the last couple of weeks that colonization has worked to make sure we support those countries to stop this outbreak. usaid in addition has activated the response team. something you are familiar with. that we have deployed in other emergencies, from fukushima, to typhoons, to haiti, earthquakes, and this provides the architecture for the response of the u.s. government once the u.s. ambassador on the ground has declared an emergency and the dart has deployed and the team members, the deputy team leaders are in place. c.d.c. is responsible for the health and a medical part of this response so there's plenty of other activities, in communications, engaging with usaid and local governments and

other partners i mentioned before. i spoke with our mission director in liberia where we have a large platform for work that works very closely with the administrator of health. we have a regular one in guinea. in sierra leon we don't have a mission. we are building out of the dark and working with the c.d.c. and others to have the required staff and experts on the ground to facilitate the report. i want to report that the morale is high in our teams. although, the family members have been ordered to leave the countries, our teams are staying put, working with the c.d.c., working with unicef, working with others, taking all the precautions to ensure the safety but also working effectively begins this outbreak. this reminds us, of course, that an outbreak requires prevention, not only to avoid the growth of this epidemic, but the globalization we must

maintain to see these viruses no-no border. it is a national security priority to contain this ebola outbreak as quickly as possible. it will take probably months to end it, but i think we can turn around the tables in the next couple of weeks if the response is deployed and executed as planned. the government is fully engaged in the response. we are confident we can stop the epidemic. as i said, it will not be easy and will take several months. in the long term, we must assist developing in countries in strengthening their own health systems. those dedicated to infectious diseases like these but the capability of the systems to deal. it is about the workers in primary care settings, in communities and this time ebola in western africa, we have seen -- these pathogens can jump anywhere and health systems

need to be prepared to deal with these things as they occur. with your support, usaid will continue to make this a priority in our global health investments in africa. as tom frieden has alluded also, the administration is working on the global health security agenda for which we look to work with you in the plans which will require support in the future. we look forward to working with you on that. thank you for giving me this opportunity, and i look forward to your questions. >> doctor, thank you very much for your testimony and for your leadership. i want to note that we have been joined by augustine, the foreign minister of liberia. thank you for being with us today. and now i'd like to yield to ambassador williams. >> thank you very much, chairman smith, ranking member bass, chairman wolf, and members of this committee. for the chance to testify before you on this very important topic. e evolving ebola crisis in

guinea, liberia, sierra leon and now nige is one of the most -- nigeria is one of the most downtowning challenges. to date more than 1,600 suspected and confirmed cases of ebola have been reported, including over 900 total deaths. although these affected countries are home to many heroic and dedicated health workers, the rapid spread of the disease reflects the lack of national capacity. particularly in the three epicenter countries of liberia, guinea and sierra leon. to limit the spread of the disease and to treat patients. the n.g.o. community, providing frontline medical care to patients, is hard pressed to continue to provide care in all affected regions. compounding the issue, affected populations lack of understanding of the virus and widespread mistrust of health care providers and treatment methods have further hampered response efforts.

in significant proportions of the affected regions, local tradition, such as public funerals and cultural mourning customs, including preparing bodies of the deceased for burial, have contributed to the spread of the virus and have led locals to block access to patients and in some places have led to attacks on health care workers. following one such incident in liberia, major care providers have begun pulling out of the region due to concerns for the safety of their staff. thus, in addition to proper medical care, there is an urgent need for effective health messaging campaigns and public outreach as an integral and crucial component of these response efforts. we are reaching out to ensure our response is coordinated with -- coordinated with the w.h.o. and other countries that can assist, both through our representatives at w.h.o. headquarters in geneva and through direct discussion with other governments.

liberia and sierra leon are still rebounding from lengthy conflict. these conflicts destroyed lives, institutions and infrastructure. this was especially acute in liberia and sierra leon where the fighting went on for years. these countries have taken important steps to reverse the effects of deterioration and neglect and to build lasting security and stability. border control and other factors key to checking ebola spread also are challenging for the countries in this region. aside from our interest in making sure that the ebola virus does not spread to the united states or further in africa, we don't want the virus to erode the capacity of african countries to address other important national and regional challenges. we want to ensure these countries remain strong, strategic allies to the united states in a region facing serious development and security challenges. sadly, this virus already has

impacted peacekeeping in somalia. the african union canceled a lanned deployed of sierra leon peacekeeping forces. given the critical importance of this issue, we are fully committed to doing everything possible to shore up each government's efforts to combat the viral outbreak and control of spread. we're confident that through the concerted efforts of our government and international partners we can contain and stop this virus. in fact, mr. chairman, the department has established a monitoring group on the humanitarian situation in west africa to monitor and coordinate information. the task force may be reached at the following email address. that's taskforce-5@state.gov. since the crisis, the department has been in contact with all of the affected

countries and have closely monitored their operational plans to combat the viral outbreak. in sierra leon, the president directed government officials to make containment of the virus their top priority, and set up a presidential task force to lead the government's efforts. in guinea, improved messaging to the populous helped health care workers -- health care providers gain access to infected regions. president ria, johnson asked for a combat of the spread of the virus. the three presidents detailed their collected strategy for eradicating the virus in a joint commune kay -- communique. we want to thank them for taking this virus importantly. this week's news of new cases in lagos, nigeria, a city of over 20 million people, makes the need for an effective, well-supported and

well-coordinated national plan and international response more important than ever. in fact, mr. chairman, i just met today with of a president and with a doctor who told me that the health ministers of the three affected states will meet again. they will meet at the end of this week on august 11-14 and that following that, the health ministers of all of the states will meet on august 28. the intensified attention of the minute -- health ministers of the entire region is a good sign and it demonstrates that the whole region is seized with this cry suss. -- cry suss. assistant secretary linda thomas greenfield has spoken with the governments of guinea, liberia and sierra leon to ensure them of our assistance to stop the spread of the virus. on august 4, the department hosted and moderated a meeting on ebola on the sidelines of the u.s.-africa leader summit

to discuss the next steps for controlling and ending the virus. h.h.s. secretary sylvia burrow, c.d.c. director, my colleague, tom frieden, and francis collins, usaid administrator of health, dr. pablos-mendez, and the liberian minister of foreign affairs, sierra leon ambassador to the united states, the president of the nigerian academy of science participated in the meeting. representatives from d.o.d., from the n.s.c., the world bank as well as private partners like the g.e. foundation also joined. in addition to emphasizing the need to focus on detection, isolation and adequate training for health workers in the field, we also emphasized our long-term commitment to building the health care capacities of individual west african nations beyond this immediate crisis intervention.

we continue to work with our international partners and the w.h.o. to assess what is needed, to properly treat patients and to mount a sustainable response. such support has included providing financial and technical assistance to properly equip treatment centers and supporting communication efforts to help health care workers assess affected communities -- access affected communities. the w.h.o. subregional coordination center opened on july 23 and is coordinating all surveillance efforts, harmonizing technical support and mobilizing resources being provided to the affected countries. the organization has also launched a $100 million emergency response plan to surge resources to mount a more effective response. we are in continuous discussions to find new ways to provide assistance. the department of state has no higher priority than the protection of u.s. citizens. we extend our deep sympathies

to the family of patrick sawyer, a u.s. citizen who died in nigeria after contracting the virus in liberia. at least two additional citizens affiliated with response organizations have been infected in liberia and are currently undergoing treatment. we are in close contact with the sponsoring organizations of those two individuals and our thoughts and prayers go out to them and to their families. u.s. embassies in the affected countries have disseminated security messages, including the c.d.c.'s warnings to resident and traveling u.s. citizens. we continue to take steps to educate citizens about the virus, to dispel rumors and to provide information on preventive measures. we also take the safety and well-being of our staff very seriously. to that end, the department's chief of infectious disease traveled to west africa to provide embassy staff with assistance regarding protection measures and case recognition.

additionally, embassies in the affected region have organized regular town hall meetings to answer questions and concerns of mission personnel and u.s. citizens. embassies in neighbors countries like mali, senegal and togo have held meetings to assess their host governments and to make contingency plans for embassy personnel and resident citizens in the event r embassy personnel and resident citizens in the event of an outbreak. in closing, mr. chairman, i would like to reiterate and assure this committee the department of state takes the ebola threat very seriously and to working dedicated with our governmental and nongovernmental allies in the affected countries to respond to this crisis, prevent its spread, and restore stability to the region. i look forward to answering your questions. >> thank you, ambassador williams. eden, as you said,

with no effective drug vaccine, you outlined how important those services are, including hydration and i'm sure antibiotics. disproportionality in results when it comes to whether or not we are talking about a frail, elderly person, it woman who plans to be -- who happens to be pregnant, someone with a compromised immune system? centers,w treatment for example in guinea, there are three or four treatment centers, but it is very hard for people in that country and in liberia and sierra leone as well to get to those treatment centers. there's the problem of

the person is very sick, others could come in contact with him or her. there seems to be an overwhelming need. thing that is underappreciated in many days, when someone is dying, there is a psychological trauma with being alone. it almost exacerbates the spread of the disease because people want to be around, near, touching, and when that person is highly infectious, that is when family members -- if you could speak to that. the lack of testing, testing areas, whether they be part of the treatment centers, part of the testing lab. it is my understanding as this parallels what looks like other , like ebola, but how long does it take to get that test

back? how long does that take? programs -- up following bush's program, which is then followed by obama, health capacity in slabs in africa is a very high priority, and now we are seeing a lack of labs leads people to being sick and not even knowing it. and i want to add the curry edge of the health care workers means -- the courage of the health care workers means exclamation points. writebol -- andms. tebol, and others. i have read things that his wife has put out. been 50ia, there have

health-care workers infected. 35 are dead. in guinea, 30 health-care workers infected, 20 dead. how does a country attract or retain health-care workers who say, if i go into that arena, the prospects of me getting this are very real. is there enough protective equipment? the gallons, the plastic to mitigate the possibility of transfer? and finally i do have other questions, but i will yield to my colleagues. there are a number of promising drugs. certainly, one that was in phase one trials, but the fda has a hold on it. they were contracted by the department of defense. from what i have read -- and it is only what i have read, the available data, it was showing promise and i wonder if there is a way to accelerate, knowing you

do not want to put something out there because it is risky. fatal.s not 100% we do not want people to exact -- to be exacerbated by the remedy. myy people have contacted office to ascertain how safe is grab someonext to who has changed flights en route to the united states coming from liberia, for example. and are the efforts at the airport, particularly where there is a large yes for a population, i do not -- there is population, ira do not know. are they protecting at points of imbrication passengers who may be sick from ebola? >> let me quickly try to give you clear answers to all of

those questions. the first is the relative case to tell the rate of different groups. in the current outbreak, the data is still too foggy for us to give you clear data. there is not the robust data we will have eventually, but do not have now to give you what we would call a case the totality -- case totality rating for different groups. was an accident in marburg, germany. virus wasg identified. it was similar to ebola. fatality rate in germany was about 80%. that it was to radically

different, and i think that is important point. good supportive health care is a proven way of saving lives, and we should never lose sight of that. second, you're absolutely correct. there is a challenge and in fact priority.e number one the cdc is on the ground today in liberia to assess. the biggest challenge is both in the city of monrovia, where there continue to be chains of looking atn and -- multiple facilities, where the facilities will be, that is nextcal to determining the several days. i was speaking with the american from sierraaires

leone. >> things like giving them -- simple things like giving them cell phones to talk to the family. if patients do not believe they will be well treated, they will not come in and will continue to spread it through communities. good quality care is essential. as you know, the cdc has helped create the african society for laboratory medicine and that for the first time ever has had high-quality laboratories established all over africa. these have not been focused countries, so they have limited in that area. these are not >> laboratory test laboratory tests. false positives are possible if you are not scrupulously careful, and that would be a real problem. thatll scale of the labs

can do testing. we are working with international partners in this and with the defense department that has a very apt to program, for example, in sierra leone. and the national institutes of health has been very helpful. we will also establish safe specimen transport means. we have done this in uganda. it is quite possible to get transport in the lab. the courage of health-care workers, i certainly agree with you, and it is an issue not just for health-care workers. it is an issue for patients. functional, less illnesses like malaria, they become more deadly. there are conditions that are not treated because of ebola. are so important in protecting the responders is so very important. a key aspect we're working on with the world health organization, with the countries

and others, making sure there is protective equipment there for health-care workers. we believe it is possible to take care of ebola patients, even in africa, safely. in terms of the promising drugs, i can assure you that the u.s. government is looking at this very carefully. but i do not want any false hopes up there. if wenow, we do not know can have them in significant numbers. we hope that might change. these medicines that have been far as i understand it, are not easy to use. they require infusion. they may have adverse events. we do, we have to do the basics right. and when might or might not have effective or available treatment in a week or six months or one year or five years.

but today we have the means to stop outbreaks. regarding airline flights, we do have teams in the affected --ntries working with basically with the equivalent of services.er patrol simple measure. it is key first to reduce the number of cases. questions to be asked or temperatures to be taken or list to be cross patients anden known contacts. these take time. we are working on them now. a if someone is exposed to sneeze or a cough, is that a mode of transmission? >> in medicine, we often say never say never. in general, the way we have seen

the disease spread is close contact with very ill people. as you know, the individual who traveled to liberia from ill on theecome plane. we have assisted those countries tracking his fellow passengers. generally it is from close contact -- with someone who is very ill. >> so, at the fever stage, that would be construed to be very get itu're not likely to from someone at the fever stage? >> you are not going to get it from someone who is not sick from ebola. if they are clearing their throat or sneezing or coughing, but they do not have a fever, they have not become ill with ebola, they are not infectious with others. if someone becomes ill on the

orne and begins sneezing bleeding, that might present a risk to people in contact with that who did not take proper precautions. >> is there a way of advising airline personnel, for example flight attendants? advise them and airlines like delta, which lies numerous flights to the region question marks about yes, we have provided detailed advice to the airlines. williams, you spoke, and i think it was very good insight about the handling .or funeral arrangements i know it is part of the public information campaign in guinea, for example. some 9 million cell phones are being used and text messages are being sent with the number for the red cross. one of the text messages are, the bodies of ebola victims are very contagious. do not manipulate. call the red cross.

i wonder if there is any thought been given -- i remember with operation provide comfort when the kurds made their way to the border, fleeing iraqi after saddam hussein, i was there five or six days after that. grounditary was on the and they were using psi ops to leafleting in a way we would do in a not so benign situation. in this case it was to get food out. .t was amazing it made the kurds very aware of what they need to do. is there any thought of helping the liberians and other countries with a benign psi ops effort? i know that radio is being used, but it seems to me that more needs to be done. any thoughts? >> thank you, chairman. i can't say we have moved to the point of that, but i think you have hit a very important issue.

holger makes a difference. you have to adjust your messaging and condenser campaign according to the sensitivities and routines and practices for the culture. what was extremely effective in was not-- in guinea only what you mentioned, chairman, but the fact that they started talking about survivors. the survivors came on the radio. they went around and said, look, i was sick. this and this happened to me. you should go get treatment. you should isolate. you should make sure people know you have this. that is very important. our military has been helping out in ways that have already been described as far as logistics and making sure you can get body bags, protective equipment for the health care providers. we are relying on the host governments to help explain to us what are the most effective,

what sensitivities, what messages we need to get out. we were helping with the means of communication, but they know best what the people need. >> thank you. i healed. >> thank you, mr. chairman. the doctr the -- for ors. moreder if you can talk about the disease. we know about fevers. having spent years working in emergency rooms, i can imagine what is happening in emergency rooms around the country. everyone with a fever is running in, being concerned. i wonder if you could talk about the other symptoms of the disease. and maybe if you have any thoughts why some folks are surviving, since my understanding of part of the diseases it interferes and takes over the immune system. >> so, fever is one symptom. nausea,weakness, diarrhea are other symptoms.

isut 45% of cases, there bleeding, both internal and external. that is a feared complication. symptoms, which you have both pointed out, are not pacific to ebola. that is what laboratory testing is so important. a person willhy know they have ebola and go to a special ebola unit. this country, what we have told health-care workers to do is take a travel history. has the person been in one of these countries in the past 21 days? if yes, and if they have fever do a test.mptoms, we have had five people in the u.s. who have come in with a travel history to one of these countries in the last five days. all five have turned out not to have ebola. two that malaria, one had influenza and two that something else. we expect this to happen.

indext there to be a high of suspicion so doctors will rapidly isolate the person and rapidly test them. >> how do you screen? just as the chairman asked, and --now what is in the press yesterday when we spoke, these -- there are these pictures and the news out the wands. they are doing some kind of screen. i think you pointed out but that is not really effective. how does one screen short of a blood testing a facility question mark >> there is no way to diagnose ebola without a laboratory test. if someone has fever and may have been exposed, may have been to one of these countries, they need to be isolated and tested. for people in the u.s., that isy we have a test relatively quick. and the department of defense

also has a test and we are working in collaboration with them to see if we can get that test out to what is called the laboratory response network, or lrbn. a network that cdc coordinates around the country to test for dangerous pathogens. ebola is not in their usual network. this would be a new procedure, but either through the defense department's assets or our own, we will look into going into that. we also have safe ways for specimens to be transported to cdc if they need to be transported. >> one thing that we touched on a couple of times today -- zmapp. i would like you to talk a little bit about that, because there is a lot of concern that we have access to this and we are not providing access. one of the things that you -- ioned, there might

need to refer you to the national institute of health. the information i have on that is quite incorrect. of differentnation enter promo bodies. this is part of what the body does to prevent infection and there is evidence that at least one animal study could have some effect on the illness. however, i would caution we really do not know. i think that has to be emphasized. we hope that they and every other person with ebola will get better, as some people do, but we will not know from their experience whether these drugs antibodies are only one

part of our response to an illness. there are other responses. it isnot know until rigorously studied scientifically. i also cannot tell you definitively how many such courses there are. i have heard that there are a handful. fewer than the fingers of one hand. i have no direct information about that. other manufacturers have said that they could have some or make some. others have said it could take months to make even a few courses. i do not have definitive information. i would refer you to the national institute of health. let's always go back to the basics. support now how to them. and to reduce the risk of death by treating and preventing other

infections they can get when they are sick, providing fluids, careful management of their health condition, these are proven things. if there is a new treatment, we can do everything we can, to get it out to people they need most. we would also be very interested in a vaccine. bealso would need to health-care workers to protect themselves. we are months or a year away from significant quantities of either drugs or a vaccine. it iss available today -- not sufficient to stop the outbreaks in africa.

>> it is not the case that someone had a miraculous turnaround because he walked out of the ambulance. that leads to the belief that we have a care -- a cure out there that were not sharing. what do see as causing the difference? what is the difference question mark >> in the terms of the death rates, the data are very -- are variable. important, i would say the country of guinea is furthest along in responding. there are two that have continued spread and health care

and that is at the core of the center. as far as having treatment facilities available in mind. and importing a dutch treatment there. it is a response that is needed in the three countries. also, we need a first deliverable of the team that the cdc is leading to identify in that region what can be provided rapidly to assist with caring for patients to allow us to reverse the outbreak. in addition, even if there , we would have to recognize the cases.

so, it can vary on that. but on the whole, we have seen the disease is quite deadly. there is a very important power in the study. if people think you are going to get bad, there is no relation to go to the services, to protect the family. the outbreak in the last month. especially in the border area. but on the whole, the response of guinea has implemented and the education in this place is very important. before the patients and we are not dumb enough to -- first of all think of the equipment that is available. now, and ie more

want to emphasize health workers are trained to do their best to save the lives of other people. those who have already died in this outbreak are true heroes. tohink we have a commitment doing this. when we mentioned earlier the state department has advised families of hours to leave the countries, it is not so much that they are in immediate risk, but the health systems are so overwhelmed, if you have anything else, there is nowhere for you to go to. in addition to adults, kids who may start school. soon the schools may not be opening. asking the family members is wise, not because they are in immediate danger. >> you know, you mentioned a

couple of different figures. maybe i confuse them. you said 75000 and 30,000 pieces of protective gear. i was wondering -- number one, what is the difference? did i get them mixed up, or was that a different time? and number two, hasn't reached the area. earlier, speaking to president johnson, she was very concerned and expressed the need for additional units of protective gear. thank you. we already had some in a storage location in the region. that may be made available now. the question is distribution. we are supporting those countries to make sure that they reach all of the front-line workers that are required. that with additional resources, reach 70,000 or such --

that is the space you have seen. we have now -- we have the production part and we have to be prepared. now.is what we are right bpe's,ct to reach 70,000 as we call them. we also have some of these available to them. we have all along modeled how this can spread. ghana has been another where we can pay attention. so, we are preparing. we have someone who is available there. >> thank you. ambassador williams? >> as i said earlier, we are

continually monitoring the situation in all of the affected countries. theprimary concern is health and well-being of citizens abroad. theave not in fact ordered departure of our family members althoughof our places, that is one of the things under consideration. at this time, we haven't. i know since we do have an agency, according committee talking about a number of things, it has been amongst the things we are considering -- usaid? >> no american personnel. it is one of the options under consideration, but we will continue to look. our families, our dependence follow the government offices all over. we are on the front lines all day, all over in very dangerous places. and airing in mind the -- stresses inind the

these countries now and the anxiety levels of our family has been discussed. at this point, we have not ordered the departure of any of our family members. -- the panelion referred to be security issues in liberia. when i spoke to president johnson yesterday, she did not mention that. but when i was watching the news this morning, she said that she was very concerned about it, and i wondered if you could address what is happening. is this something new? >> what i was trying to stress is this is putting it in a context. -- this is a rather torturous past. the president of liberia. to declare a disaster in our she was theause

international community to pay attention, and she was trying also to explain to her people why she is mobilizing and intensified for us to specifically focus on ebola. but there is no new security threat. >> thank you. >> thank you, mr. chairman. in what country did this first began? first cases are in guinea . for us dider is areas that have a confluence of the three countries. ambassador williams, we have heard from ambassadors and him taff thatmassy s washington does not take cables from them seriously. when did washington first get a cable from the emissaries of guinea, sierra leone, and liberia about the crisis?

-- i'm going to look through my notebook to see if i have the exact date. i am not sure if i have the exact date. if you will just give me a second? >> sure. >> mr. chairman, i will have to look up the cable. i do not have the cable traffic. i will say, we are in daily communication with our embassies, if not through cables, e-mail, telephones. i can find the answer to your question and get it back to you. they say that sometimes the cable gets sent and they wonder -- but i would like to know when the cables are sent, but secondly, how high in the state department are the concerns raised? >> thank you, i will take the question.

i have to find the exact date. we have been aware of this for a while now and working on it. inas our ambassador to niger 2010. covering west africa in the bureau for african affairs, i am paying close attention to what the embassy is saying and i know what the people their art going through and i will get the answers to your questions as soon as possible. >> you mentioned the work of usaid and others. can you give us a list of the countries. can you tell us what england and france is doing? can you give us some numbers. the united all be

states. what are the european allies doing? can.rs, if you >> i think it would be best if we got back to you. it is something of a moving target. the british have been very active. and we have the longer-term response to the world health organization. as you may be aware, they issued $100 billion to respond to be utbreaks >> has the white house been involved? the british has a history in africa.

has there been a formal request? >> we have had multiple conversations with different countries -- sorry, were you ?oing to say something >> the british government particularly is supporting the response in sierra leone. presence withng the ministry of health and liberia. the response was particularly important there. someone mentioned the emergency -- they put forward originally got $30 million of covered, including some of the support we have been providing. the world bank coming through also just this week with the amount of $200 million that would allow us to fill the gap to plan for the immediate

response. in addition, we must invest in the months to come for that part of the world. many of these things are working -- moving very fast. we're are trying to continue that conversation. there is countries are having periodic updates on resources. but that division of labor is already underway. even though cvc presence is in all those -- cvc presence is in all those countries. >> has the african union been engaged question mark >> the african union has been engaged. to your earlier question, and liberia, our 27th is when the first cases were reported. there were only a dozen or so cases. outbreakspical of the in central africa. there were not many new cases. in fact, the early behavior of was like previous

outbreaks. it was not like other areas where we have seen the expansion. in guinea, it has been after the .nitial outbreak >> are the chinese involved, who historically have invested in soccer stadiums in africa. are they involved? is the chinese government, which soccer stadiums in africa, are they involved question like that but we will have to get back to you. >> madam ambassador, can you tell us? you were with the state department. >> i will have to check. i have not heard about the chinese involvement at this point, but i will check. regionalt of the governments, they are meeting this week and then 10 days after that. if someonerman --

wanted to raise a question, call somebody, do something, had a great idea, but are they call? is there one person? is it the cdc question mark is it usaid? don't you need one person? is there one person and one place and one number? let me just say again to dr. frieden, he took the call, got off the airplane. is there one place you would go to question mark >> for a response to any potential case or problem here, that is the cdc. >> what if a nation wanted to contribute, involves? how do they do that? >> there is an overall response.

to contact?a person dr. -- that would be >> how accurate is the data? even in the most pristine situations is hard to obtain, but here we are talking about proximity issues, difficulty ascertaining what is really going on. report on cbs news that suggested there may be as much as 50% higher prevalence of ebola, and i wonder if you might want to comment on that? is there underreporting of cases as well as fatalities? fda is notoriously slow and notoriously copperheads it. i do not want to exaggerate or understate, but zmapp, km ebola

-- were contracted by our department of defense to work on that. but those trials have been halted in phase one. i wonder if there is an effort to rethink that, because those who have lost their lives and are sick, it is a tragedy beyond words, but many more could become sick and die. in your an effort agency to say, let's look at that? there might be some reason to lift that phase one trial halt? testimony --n his there is a man that congressman wolf and i spoke to last week. he has a profound sense of urgency and thought we ought to be doing more. he said it took two americans getting the disease in order for the international immunity and the nine mistakes to take seriously the largest outbreak

of the disease in history. yesterday the president of oferia declared a state emergency in the nation. this declaration, he went on, is a month late. not only for the countries now affected, four of them, what might be the fifth or sixth? heightened concern about another nation, particularly one that might be contiguous with these four? answer to your first question, yes, we think the data may not be as full as we like. the lack of treatment facilities, the lack of laboratory facilities make it so the data coming out, it is kind of a fog of war situation. that is one thing we want to resolve quickly. but if there are not treatment facilities, patients will not come forward and we will not be -- i can tell you they

are leaning very far forward on this and they are quite willing and quite constructive and thinking how to get things out there sooner if there is anything available. i think on one hand, we have to do everything we can. have theo recognize we tools today to save lives and stop the outbreak. in terms of future countries, we cannot predict where that might be, but we know outbreak anywhere is a threat everywhere. one of the reasons we have focused on the global health security program is we have international health regulations which require countries to report outbreaks and new diseases, so we can all as a global community were together because it is in all of our best interest, not only to protect help, but to strengthen our work in this area. >> i want to thank our very distinguished panelists for your

work. thank you for being here today to enlighten our subcommittee and other americans who are tuning in and watching this. thank you very much. >> thank you. our would like to introduce second panelists, beginning with mr. ken isaacs, who served as office of foreign disaster assistance in usaid. he courtney did the u.s. government's response to the indonesian tsunami, the pakistani earthquake, relief to darfur and southern sudan, as well as niger and easy open emergency responses. he has more than 27 years experience working in the disaster relief field. he is currently leading the samaritans purse organizational toort in liberia in response

the ebola epidemic. we will then hear from dr. frank clover, the director of the neurology institute -- the .rology institute his discovery of the world's highest rate of prostate cancer in jamaica has been internationally recognized and published in numerous turtles and textbooks. -- he iss wife dedicated to building a medical school in liberia, training doctors in various surgical specialties and providing loan forgiveness for liberian doctors who have trained in the united states and would like to go back and treat patients in liberia. he has been involved in treating ebola in africa since the early

1990's. mr. isaacs, please proceed. >> thank you. members smith, esteemed of the council, fellow guests of this committee. i am privileged to testify before you today on the ebola outbreak in west africa and samaritan's purse to sponsor their. i will read this one page so i do not forget to say anything and then i will put the script away to say things that need to be said. over 100orked in countries, including afghanistan, north korea, south sudan, and liberia. we have responded to medical emergencies such as the cholera epidemic in haiti and we have provided medical care to the --ple of wozniak, rwanda,'s

bosnia, rwanda. i would like to share with you about our experience in liberia. i would like to take this opportunity to thank the united states government, particularly the department of state, the department of defense for assisting samaritans purse in the evacuation of american personnel. we would particularly like to thank dr. kathleen ferguson, dr. william walters, phyllis gotti, congressman wolf, and yourself. we would also like to make certain staff members of the cdc and the national institutes of health for bringing to our attention and obtaining the medication as a treatment option for our two infected staff members. as an organization we work to contain the ebola crisis in liberia and we were devastated to learn two of our personnel

contract that -- contracted the deadly virus. thanks you forse helping bring the two of them home in the face of the incredible challenges. the ebola crisis was not a surprise to us at samaritan's purse. we saw it coming in april. our epidemiologists predicted it. by the middle of june, i was withg conversations leaders. in the 32 years since the disease was discovered, there 2232a total of 2300 -- infections. easily this presents outbreak is going to surpass that, in dr. frieden as well as overall -- s,rpassed that, in fatalitie

as well as known cases. the disease is out-of-control. the international response to the disease has been a failure. it is important to understand that. coordinated intervention of the international community is the only thing that will slow the size and the speed of the disease. currently who is reporting 1100 ebola diagnoses. our you but -- our epidemiologists and medical personnel believe these numbers represent 25% to 50% of what is happening. the ministries of health in guinea, liberia, and sierra leon simply do not have the capacity to handle the crisis in their countries. if a mechanism is not found to create an acceptable paradigm

for the international community to become directly involved, then the world will be effectively relegating the containment of this disease that threatens africa and other three of the poorest nations in the world. of community and development philosophy is to work with your local partner and build capacity. in capacity that is needed the nations that are fighting ebola should have been built three to five years ago, but in times of crisis, i believe the attention needs to be put on the crisis and the building of capacity should be a secondary function. we undertook a massive public awareness campaign in liberia starting in april and we have go over 435,000 people through that training, but there are three point 6 million people there and the majority are illiterate. it is not going to be easy to

change the way people think and what their cultural moore's are -- cultural mores are. , doctors without borders, also known as msf -- the only two known aircraft in liberia flying support -- we flew personal, personal, and supplies back and forth across the country. it makes a difference from the triangulation area dr. frieden was talking about, reducing it from a 16-hour road trip to a flight.e i want to take a moment to recognize our coworkers and doctors without borders for standing in the trenches with us. iny are in sierra leone, guinea, and they are filling the gap for us in liberia as we have had to pull back and plan what

we are going to do next. thing thats any one needed to demonstrate a lack of attention of the international community on this crisis, which has now become an epidemic, it is the fact that the international community was comfortable in allowing two relief agencies to provide all of the clinical care for the ebola victims and three countries. two relief agencies. samaritan's purse and doctors without borders. it was not until july 26 when brantly andy -- nancy writebol were infected that the world sat up and hate attention. today we see headlines of ebola fears. there is a man who has bled to death, evidently in saudi the government has

confirmed it was the hemorrhagic fever and he came from sierra leone. there was a man, i liberian a hospitalho came to with one of the most prominent physicians in liberia, and that physician openly mocked the existence of ebola. he tried to go into our isolation ward with no gloves, no protective gear. of no gloves.ssue it is an issue of, you cannot have a millimeter of skin exposed or you will most likely die. hospital in the jfk downtown monrovia where the doctor did examine ebola patients and he was dead four days later. the other man was dead five days later, but not before he went to nigeria, and now there are cases of a death from ebola in nigeria and eight more people in isolation.

-- ourthe gynecologist epidemiologists believes what we are going to see is a spike of disease in nigeria. it will go quiet or about three weeks and when it comes out it will come out with a fury. as i am talking to you today, we are making preparations for a hospital we support 200 miles west of legos, what they're going to do when ebola comes to them. to fight a bullet, i have identified four levels of society that need intensive instruction, because they simply do not understand what is going on. one is the general public. of custom that they have denigrating be dead by washing the body -- i'm going to be graphic as i think people need to know. part of that is kissing the corpse. in the hours after death from ebola, that is when the body is most infectious. thebody is loaded with

virus. everybody who touches the corpse is another infection. we have encountered violets on numerous occasions by people in the general public when we have gone out at the request of the ministry of health to sanitize the body for a proper burial. this is going to be a tough thing to do. you about this general awareness in the public and the general public. the number two area that needs to be addressed is community health workers. the entire international community has built a medical system around community health workers which is essentially a moderately educated person who mple medicalew si supplies, and outdoor them here, are you passing blood -- the doctor can talk about this more than i, but i think i am getting this right. they do not have the information to understand what ebola is. this last friday, we had 12 patients with ebola present.

communityhem were health workers. everyone of those greedy health workers had seen a patient, had diagnosed him for whatever they thought -- every one of those immunity health workers had seen a patient, had diagnosed him for whatever they thought they had. is third level of society actually medical professionals. something needs to be done with the focused attention on medical professionals, because when i hear reports that prominent physicians, who are educated and ,redentialed and respected denied the disease, i think they need a little bit more education. the fourth level is leadership in politics, academics, and religion. i don't know how to make those things happen, but those are the four stratus that i see. to turn the disease back. turning the tide on the disease has to be focused and containment.

to contain it means you have to identify it. of the previous panel was saying it could be contained. we have the information. ok. ginnya, sierra leone, and -- guina are poor. countries, they have their problems with pointless bureaucracy and corruption. i know the second-largest center were ebola is manifesting in liberia, the workers at the ministry of health clinic were not paid for five months even after the european union put the money forward. the money just did not get downstream. again, i will say ebola is out of control in west africa, and we are starting to see panic now. around the world, people want to know. know about you folks. i look of the drudge report. it can drive a lot of panic. there is a guy in new york, a

woman in england. six people tested in the united states. there are reports of 340 peace corps workers coming back. i greatly appreciate the work of the cdc. i have spoken. they have helped articulate their procedures and protocols for america's returning to this country and we are grateful for that. while our liberian office remains open during public awareness campaigns, we have suspended all other program activity. i would say we are in the process right now of backing up, planning, and reloading. we intend to back up and fight the disease more, but we have found some things needed. one of the things i have recognized her in the evacuation onlyr staff is there is one airplane in the world with one chamber to carry a level for pathogenic disease victim. that plane is in the united states.

there is no other aircraft in the world that i can find. that means the united states does not have the capacity to evacuate its citizens back in unless thecant mass, defense department has something that i am not aware of. it was not easy to get the plane back. but one thing that is important is if the united states -- and i believe the united states is going to have to take the lead on this. it may not be popular for us to take the lead today, but i believe we need to take the lead . if we're going to expect people, including the cdc people to go abroad and put their lives on the line there has to be some assurance we can care for them if they are sick. that may be a regional health care facility that is exclusive to the citizens and workers, or that may be a demonstrated capacity to get them home. one airplane with one chamber to get them back is a bit of a slow process.

lastly, i think i want to say, i think it is a necessary thing that more laboratories be set up just in liberia. the one laboratory now is at the jfk hospital. there is another one in guinea. it can take 30 hours to get a sample back. i have had conversations with the cdc on that. if you can lean into that, that would be helpful. if you have six people come in and for our suspected, you have to put them in a semi-quarantines area and you have to hold that until you get a positive or negative back on them, and that takes time. i understand the world bank has just committed $200 million to fight the disease. that's fine. that's good. it's a little late, but it's good.

with 26 years of experience, including being the running manyfd a, darts around the world, interacting with governments on multiple levels, i have some practical questions. i would like to know where the money will go. i would like to know what it would actually produce. i would like to know what it would actually buy. i disagree with earlier testimony that there is ppe in liberia. that is inaccurate. i have an e-mail i received in the last 90 minutes from the , with more personal protection gear. this is a problem everywhere. i am in touch with the headquarters in brussels and we are working hand in glove. forpreciate them so much the way they are fighting this. the logistical support to get

the supplies on the ground to fight this disease. quoted, if we do not fight and contain this disease, we will be fighting this disease. the cat is most likely already out of the bag. i want to recognize them for who had been there and done a valiant job at great risk to their own lives. i want to know that the reintegration back into their country is awkward. people are afraid to get around them. they do not know if it is safe to hug them. their communities may be ostracized. we are doing everything that we place tove them a safe be to protect their privacy. i want you to know how difficult it is for american citizens and

citizens of all countries that came from maybe seven countries also for these issues. i believe this is a very nasty and bloody disease. i can give you descriptions of people dying that you cannot even believe. we have to fight it now. we will fight it here or somewhere else. i think an international court nader is something significantly needed. >> thank you for that testimony and i think for underscoring your experience in the office of i don'tdisaster relief. think your resume tells the story of all those years of dedication. thank you and we will take extraordinarily serious your recommendations in the questions you posed.

>> thank you for the opportunity to share with you. i am a board-certified urologist. i earned my degree at johns hopkins and also a doctorate of public health in health systems. i have also done some work as a research fellow at johns hopkins and epidemiology. missionary medical working with the christian missions organization with works in over 60 countries. of shield inident africa, a us-based ngo working in liberia. my first experience was in 1988. we did medical missionary work called elwa. eternal love winnign africa.

-- winning africa. i had teams of doctors and nurses several times a year. i have spent time rendering services of teaching, training, and patient care. they assessed the hospitals and clinics throughout liberia. this ebola outbreak in liberia has exposed a countries inherently weak health system. after the outbreak in march of prior to the ebola

outbreak, they went on strike. this was true in counties that had been hit hardest by the epidemic. just before you bullet entered the country. after the outbreak began claiming the lives of the nurses that did not have protective .ear after a second died, they shut down. patients are tw too terrified to into the buildings. nurses will not return to work unless they are issued adequate protection. doctors and nurses continue to treat ebola patients. there are five doctors and 77 nurses and aides.

this is the only place where treatment for ebola takes place. currently there is only enough space for 25 patients in the isolation center. initial attempts to expand the unit were met by protesters a local community that did not want ebola patients coming from all over liberia into their community. samaritan's first will complete a unit in the next two weeks. the only other treatment center in liberia is a 40 bed unit. the case fatality rate range from 80 to 90% at both facilities. patients die within 24 hours of presentation. , a only functioning hospital population of one million people . many patients are dying with a bullet in their communities and in part because there is simply no open health facilities.

this creates problems because whole families were getting infected and dying. there is no way to count all the people dying of ebola. the cause of death is often unknown and suspicion towards government health workers. information is often withheld. advice on safe burial practices is oftentimes met with resistance and even violence against health workers. to complicate matters further, usual illnesses like malaria, typhoid, pneumonia, in certain emergencies result in death as there are no functioning facilities at this time. the death toll will undoubtedly reach into the tens of thousands unless immediate actions are capacity,ncrease the create an effective koran team for those having been exposed to ebola.

gear forde protective those that have expired. given the episodic nature of ebola, we must begin investing in health care systems strengthening as he prepared to deal with future outbreaks. they assist in the building of capacity for west africans by training and producing more african health care professionals. >> thank you so very much for your lifelong commitment and building up capacity and doing let me ask you a few questions. your testimonies i think were very comprehensive. you said, mr. isaac, that the international response that you deemed a failure, no failure need be a failure in perpetuity and i wonder if there has been the turn of a corner, again, inspired by the tragedy of two

of your workers being affected by the ebola virus. and you can you tell us how they are doing. sense if not fully backed by science yet, that the drug may have had an impact? asked toe questions i the earlier panel is is some of these interventions proved to be efficacious, delay is denial if you have ebola. in this is that this seems to be your thoughts on an aggressive fda working in conjunction with the other onncies of government based opting in, recognizing the risks?

>> on the failure aspect, i i think the full international impact of ebola has not been realized. i believe that ebola threatens the stability of the three countries where it is affected right now. my staff met with the president of liberia for almost six hours last wednesday and they described to me that the atmosphere in the room was somber because she realized the full gravity of it. if you read the ministry of health status reports to come liberia, iay from but itean to be dramatic has an atmosphere of apocalypse in inow in it. today, there are gangs threatening to burn down hospitals.

is essentially a society that is, let's say, a generation where everybody had ptsd from a horrible war. they can go from a normal conversation to a fist fight to sticks in the flash of the night. -- of an eye. temperamentot of and a lot of emotion but it is not just liberia. it is all of these countries. you can use your own imagination in nigeria. but what can happen there? i believe this disease has the potential to be a national security risk for many nations and i think it will have an impact even on our national security. ithas been a failure because has now jumped another country.

epidemiologists have totally misread the magnitude of the disease and because there are not resources on the ground, the -- is of the two patients can say that i hear the same thing everybody does. they seem to be getting a little better every day and i don't think this will be a fast process. after that medicine was administered and brought to us by the nih people, dr. brantley was very much involved giving his informed consent and he that there was improvement and as doctors were saying, i'm not a doctor and i don't want to guess at science but i will say that they seem to have gotten better. they are in emery. emery.eciate they get good treatment and we pray they survive and can recover their health.

>> you pointed out for different areas. let me ask you about the community health partnership. in one cluster of infected individuals, eight out of 12 or community health workers. higher obviously have a degree of training and they understand the importance of protective garb. in your view, are they much more at risk because they are more .udimentary

>> it puts them in untenable and weak positions. i don't think putting a poster on the wall that says ebola they is going to do it. deal with the things that come to them. >> if properly trained, they get the same outcome of coverage as physicians.

what you have to understand is that health workers don't get ebola because of carelessness. necessarily. or because of lapses in technique. in the case of these workers, it is very likely. they got the disease from the community. if you are working alongside someone and they happen to have ebola, and you get it from the staff. there are a number of documented cases of staph infecting staff. as was reported wherefore nurses died, a 11 more were infected. lot about the infected that we don't realize in terms of how it happens. in terms of getting the message out in a way that will be most likely received so people understand the

catastrophic nature of the disease, my understanding is that ginny today is recruiting retired doctors, nurses, and midwives to convey this message. countries in nigeria looking to do that? for example, burial practices and the like. civil war,is brutal during that time, people did not go to school. we have a large population of illiterate people. many of the languages are not scripted so you can't write something. languageds to be appropriate in each dialect and a way that each community can understand so they can get the message. figureseen as authority and people that are able to

communicate in the spoken language are able to get the message. >> the president of liberia was a month late. is it too late? >> the month statement was not a scientific statement it was an opinionated statement. i think liberia would have been better served if the status of emergency had been declared earlier. i don't know all of the actual mechanisms to go along with that declaration.

it is a severe crisis that i believe threatens the stability of society as it exists today. and i think as you see the disease spread in freetown and chronically, it has peaked there. going to see more instability and insecurity. >> we do ask about the question of testing. we heard the exchange earlier about the lack of labs. even in the best of circumstances, in new york or new jersey, how long does it take to get a test back? it does move very fast. u.s.,pecial test in the but logistically, the

infrastructure of these countries to go from one point to another. it might look 50 miles but it could take you eight hours because you can only drive three miles an hour through roads that are impassable. there are logistical problems here but i think the number one cause of health care worker infections in liberia is lack of protective gear. they are asking people to go to work, take care of patients, and they don't have gloves. this is unconscionable. onwe're going to put people the line, the brightest and best people in the country, we owe it to them to give them a fighting chance. how this country, no matter well trained doctor is, if any ebola patient comes up to him before he or she knows what he has, he has already been infected. where will the money go? what will it by echo where should the money go and what should it by? i feel that international

personnel are needed. i do not think the ministry of health of liberia can fight this. they do not have the case investigation capacity. i talked with a senior person at the cdc. i won't name her but she is a well-known person who told me that in the united states, if there was one person that had a level for infectious disease, they would have many hundreds of contacts to run down. there are no contacts being run down in liberia. i do not believe the liberian government, well-intentioned as they are, and i do believe they are, i just simply do not think that they have the capacity. that there needs to be something to augment their capacity. adding guineas to be some kind of a coronation unit.

something with a bit more of an operational edge to it. but more is needed. they clearly do not have the capacity to contain it. that is the essential question. let>> you worked on the outbreak of ebola a couple years ago? >> i was there during the

outbreak and was not working with ebola. i how does this compare to that outbreak. >> it was a sparsely populated rural area where they burrowed itself out. city so that the when you look at a taxi or a bus, you wonder how they can get so many people jampacked in there. the concentration of the population means that in this epidemic, no matter what we do, there will be tremendous loss of life just for the nature of this disease.

is there anything you would like to add before we conclude the hearing? that i am just say certain there is much more than we know of but this concept of research is very important. see death tolls and numbers we can't imagine right now. that is the potential. i will tell you that we are the person to process he will a readiness information. >> any final words? i want to thank you both for your extraordinary service to thomas and the disabled those that are suffering this terrible outbreak of ebola.

this is the first of a series of hearings. we are looking to make sure that whatever we need to do as a , yourss and subcommittee guidance is absolutely essential. thank you for sharing your wisdom and insight. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2014]

>> all day, we have been asking with the ebola outbreak in west africa, do you feel safe? jeff says, europeans make mistakes and bringing -- human beings make mistakes. bringing this virus to the constant u.s. is one of them. when it escapes, that will be another. another says, let the fear mongering begin. go to our facebook page to join the conversation. >> this month, c-span presents debates on what makes america great. evolution and genetically modified foods. issue spotlight with in-depth look at health care, irs oversight, student loan debt, and campus sexual assault. warming,cluding global voting rights, infectious disease and food safety. enjoy sights and sounds from america's historic places.

schedule one week in advance at c-span.org. join the conversation, like us on facebook, follow us on twitter. >> it has been 40 years since the watergate investigation that led to the investigation of president nixon. a washington post reporter carl bernstein takes part in the discussion on the presidency of richard nixon and watergate. atwill speak with historians the museum here in washington. coveragec-span's 2014 and in use with a look at state races in hawaii, tennessee, and virginia. today.mary is

alexander andar joe carter. the primary on saturday, we will show you the debate between the democratic incumbent and colleen hanabusa who represents hawaii's first district it is mostly in the honolulu area. the 2014 coverage tonight. all this month while congress is first, from the 2014 eagle forum on her book "never three, liberal over especially a republican. and after that, former south carolina senator jim dement on his book "falling in love with

america again. 2. that is tonight on c-span >> book tv this weekend with ands on marriage equality the autobiography of former mayor of washington. and the scandal with sunday afternoon of 5:00, anthony marks, president and ceo of the new york public library shedding light on the library's past, .resent, and future for serious readers. on thea discussion israeli-palestinian conflict and a recent poll conducted about americans attitudes towards arabs and muslims. from washington journal, this is 45 minutes. " continues. host: joining us now is james

the arab american institute founder and president. what has to go into a long-term cease-fire in gaza? guest: a long-term cease-fire has to include really for the people of that very depressed strip of land. anita and opening to the outside world, and it is not just sincehama -- since hamas took over. since 1994 there was a restriction on labor crossing gaza, and israel is not allowing imports are experts for gaza to freely deal with the outside world. source of largest wealth were day labor jobs in israel. when they close the border, unemployment skyrocketed, and we are still at the point where gaza cannot import or export

freely, and the result is 70% youth unemployment, very limited except through the tunnels that have come in, so there is a real need to open gaza, to give people opportunity and hope they can have a better future. host: so when it comes to the long-term solution? long-term solution is freedom and independence for the palestinian people. we have talked about statehood, it will have in the right to determine their own future. i have not been given that right -- they have not been given that right. unless there is a recognition of full sovereignty, not just within the prison walls, but the ability to freely move in the world, there is not going to be a solution. they need an independent state. is a story in "the wall street journal," as far as ,iscussions going on in cairo letting the palestinian

authority take control. guest: nobody wants to ride in on the back of the israeli tanks. if it is a freely agreed upon solution by the palestinian parties, that could work. was apeful thing is there reconciliation agreement. israel did not recognize it. the u.s. did. israel tried to scratch the agreement, and then try to literally destroy hamas, but the reconciliation has held the. you have a combined negotiating team in cairo right now working together to find a solution. i would hope that they would agree they should be but one police force, one armed presence, and that should be through the palestinian authority. if that is the case, we're on the road to a solution. ,ost: when it comes to hamas how do you handle that and the lyrical and military side of that is political and military side of that?

guest: they have made some bad choices, their ideology cannot be endorsed, and the tactics have been the portable. the suicide bombing was --damentally wrong and evil and deplorable. the suicide bombing was fundamentally wrong and evil. been terrorist groups that have moved into governments. the african national congress was a terrorist group. the point is are they ready to turn a corner? if they are ready to turn a corner, then i do not think one should box back into a corner, as netanyahu did, but we should allow the reconciliation process to work through. understand that the current wave of violence started with the tragic kidnapping and killing of those three young men, but then continued with 400 hamas leaders

in the west bank arrested, and israel bombarding gaza, and hamas responding to that. it is as if israel created a trap and hamas and in responding, hamas created a trap, and israel went into it. the two of them paid a price. we have to go back to the beginning as hard as it is and say what we do to get out of out isnd the way to get opportunity and hope for the people of gaza, adult and independence. mr. manana spoke in a press conference addressing these issues and hamas as well. [video clip] >> nearly everyone says they support israel's right to defend itself and we appreciate those who say this, but there are those that refuse to recognize or let israel exercise that right. to attack allow hamas

with impunity because they say they are fine from schools, mosques, hospitals, and israel should not take action against him. that is obviously a mistake. it is a moral mistake. it is an operational mistake. it would legitimize the use of human shields and hand an enormous victory to terrorists everywhere in a devastating effect to the free societies that are fighting terrorism. if this were to happen, more and more civilians will die around the world, because this is a testing period now. can a terrorist organization fire thousands of rockets at the cities of a democracy? can a terrorist organization and dhat itself in civilian -- embe itself in civilian areas, dig tunnels in civilian areas, and do so with impunity because

accounts on the victimized country to respond as it must, as any country would, and be blamed for it. host: mr. zogby? respondo many things to to. let me just say that in the also, can weld, continue to accept a country occupying and strangling and denying freedom and rights to an entire other people? emerges, when conflict using disproportionate violence and force, taking a tremendous toll in human life? look, israel has the right to defend itself. everybody does, but when you use the right as badly as they do, i thank you for fit the right in the eyes of the -- for fit -- forfeited the right in the eyes of the international community.

it is also -- bombing the power plant -- what is the point other than to deny people, not just electricity during a very hot period of time, but also deny them water because was a -- water in gaza comes through electric pumping. the crimes committed during this assault on gaza go beyond an occasional accidental target and it does not hold. we tell our kids you cannot say "i am sorry, but." it does not work for me for netanyahu to say "i'm sorry there were civilian casualties, but they made us do it." nothing made them strangling population, deny them their freedom and the ability to grow, and transform themselves into a functioning society. it is israel that created this,

and they owe it to themselves to own it and create -- take paternity, responsibility, for what they have done in gaza. it is a terrible crime. the prime minister might try to do this cleanup operation to straighten out the world, and if you do not agree with me, you are not on the civilized side, you are on the barbarian side. it does not wash. there were wrongs committed here. hamas clearly committed wrongs, but israel, as the occupying force has special responsibilities and they have not lived up to those responsibilities. host: james zogby of the arab american institute to take your calls. athens, ohio. good morning. caller: good morning. work,gby, i respect your

but as you said, this has been going on a long time, 5, 6 decades. this is the first time that i think the american public -- i'm a media watcher, right, left, and center, and i think this is the first time the american media has shown what the palestinian people have been going through for decades. in 2008, israel blocked journalists from reporting what was going on. if you could talk about what is going on in the media, and while we hang -- while we hearing pundits talk about the people of gaza and said of the palestinians living in gaza? westn put up a map of the think and israel, and they continually put up an accurate maps of what is taking place? if you could comment on that. maps, i have not seen the but i can't comment on media. you're right. television has done a much better job, a fundamentally better job than we have seen

before, and the folks, some of the people from cnn on the ground there covering, and some of those from nbc on the ground covering have done a brilliant job and i appreciate that. print media, not so good. i think print media has continued to suffer from what i call the fundamental distortion of the issue, which goes back before the conflict. it goes back to the early period ,n the 1920's and the 1930's where israel is seen as the bastion of western civilization going into the harbor us world westerno create a outpost. they were dealing with what they called the red indians, how they characterize the indigenous people, the palestinians, and it stayed that way. "thete a critical piece in washington post," a while back,

and a column in "the huffington post," and i noted that when they focus on the palestinians in an enormous body count, going to get the israelis, there was the face of the prison, interviews with the mother, interviews with the citizens. the lost israelis were humanized. the lost palestinians were objectified and presented as a lump sum. that is a problem of print media and i think it is still a problem. television has done a somewhat better job, certainly from the earlier gaza assault that you noted when television did nothing but cover it from outside of the borders. this time they had people on the ground doing, i think, a very extraordinary work. i appreciated that. i will tell you, there was a piece in "the new york times," version, in the online a gaza diary. look it up.

just extraordinary. look up el monitor, the news and lghoulation website and a -- she has done a great job on the ground day today telling the story of what gazans are enduring. some of it is heartbreaking, but all of it is informing. is the kind of thing and should be doing but it is -- print should be doing but it is not owing. a column --host: a column written by august can be found on our website. joseph. i never couldler: understand why the israelis think they have authority over the entire region. they only have authority in israel. the blockade against the palestinians is an act of war. they have every right to fight

as hard as they can because they have no rights to do anything outside of israel. of thethe issue occupation is ignored, and israel makes the case that they left gaza in 2005. if you leave gaza, take your settlements out, continue to air, and c,by land, then you have not left. what you have done, and they hate this term, but it is a fact -- they have created an open air prison. there are young people in the who have never had a job, have no prospects of a job, and it never left gaza because they cannot get out. that is under occupation. when the oslo peace agreement was signed, there were 170 thousand settlers in the west bank. today there are almost 600,000 in occupied lands it has tripled since we signed the oslo agreements. they say we honor the of course

and the palestinians have not. the issue of occupation is fundamental and has been ignored in the media. israel says they have the right to defend themselves, but they do not have the right to strangle people in gaza. they do not have the right to build on other people's land, to confiscate lands, to demolish homes, to deny people the opportunity to import, export, and grow an economy. i had the latent -- the latin patriarch, the catholic bishop of jerusalem, talking about a convent right outside of jerusalem, in land that is not jerusalem, but israel has occupied it and called the jerusalem, and israel is taking the land of the convent, denying them access to their school, putting up an almost 30-foot wall with a date that will allow the kids from the villages to go through the gate through security checkpoints to the school, but otherwise they will not have the ability to go there

on the playground, and deal with after school activities. there also pulling up the vineyard that makes wine that is used at all tours around the world as altar wine and also the olive orchard that has been there for hundreds of years. -- patriarch was urging americans to do something to stop this. tons of issues like this -- israel has no right to continue doing it, and yet they do, and they escape with impunity. there is simply no sanction from the united states in any of this behavior. host: roberta. california. republican line. go ahead. i am 77 years old and i have never heard anything from theisraelis that they want palestinians off of the face of the earth, but i have heard however the hamas organization definitely wants the israelis off the face of the earth.

withnot think we can deal people who absolutely, for whatever reason, take in hamas like they are the red cross, when obviously they are not. i do not know how we try to justify these things. i have seen an awful lot of an awful loteing of the same kind of garbage conversations and i do not think anyone should be mistreated or in any way cap from reaching their potential, but i do think we need to do a little bit of looking around because i see our young people in this country having the very same kind of thing going on with them. their potential is not being realized, they are encouraged to go into debt, there are no jobs for them. host: ok, caller. thank you. guest: thank you. listen, from the very outset israel sought to create a jewish

state, and i understand the yearning of people. is thedo not understand displacement of palestinians and i cannot tolerate or accept that. today exceptrians the fact that they committed ethnic cleansing against palestinians. a book just recently out and highly acclaimed, even though he attempts to reconcile himself to the fact -- i do not, because i have spent time with palestinians in refugee camps in lebanon, he makes the case that we did it, yeah, we did it, and he lays out in detail how they expel the people. maybe some palestinians said they wanted to wipe israel off the earth, but israel actually did wipe palestinians off. they destroyed 323 villages and what became israel. they simply demolish them so that the refugees outside had no

place to go. they forcibly expelled them. they try to do the same kind of cleanup operation after the war -- "no, no, no, we did not force them out. ."eir leaders told him to go historians are now making the case that they did order them to leave, they did create panic and fear and force them out. let me also say that it is true that there are deplorable things said on the palestinian side and they should the announced and condemned by those that say them, -- denounced and condemned by those that say them, but there are deplorable things being said on the israeli side and they are not being taken note of. there are jewish writers in israel and in the united states today pulling out these quotes that we should commit genocide, take them all out, they're women, we should do this or that to them. website, ornberg's

the recent piece by andrew sullivan on his site. there are articles making clear that there is extremist language on both sides. do not humanize one and demonize the other. look at both. both societies have their flaws, their pluses, and their good sides, but we have to see both. this is a conflict between two human groups of people, not between humanity and barbarism. that is not the case at all. so, get a rounded picture of both sides, and i think you will understand the difficulty that we face here a lot clear. chicago. independent line. c-span.thank you for i watch as much as i can. i have a question. i have been following what has been happening there from what i have ready, and i am trying to

get a hold on this -- isn't it just that palestine was invaded displaceded in 1940i european jews that did not want to go back to europe after the war, and for some reason they were not accepted here in the united states. i know,, as far as without any consultation with the palestinians. her country was overran -- and their country was overran and occupied. if the people trying to get their country back. i cannot see what is wrong with that mms in a point there? missing a-- am i point there? also, why is the united states supporting this? again, i think the u.s. is on the wrong side. government support over the years has been a mystery to me. i'm wondering if you can address that, and clear up what possible justification could there be for the israelis to occupied

palestine. conflictt: the actually began in the form that it takes place right now after world war i. arabs were promised that if they joined the allies against the axis, they would get independence, an independent arab state. at the same time the british were assigning letters to the arabs promising them independence from the ottoman empire, they were also making an andement with the french, accord in which they pledged --ng themselves to decide and the region into spheres of influence with the french control in one part, and the british on in another, and the -- at the same time, they were signed and agreed with the world zionist movement saying we will give you a jewish state. the reason britain said we will recognize a jewish homeland was to protect the northern part of

the suez canal. they needed a company. britain occupied and colonized places through companies. they use to frame the zionist movement as if it were one of their companies that would operate and help control the region for them, but it did not work out because the arabs do not accepted. woodrow wilson, american president at the time, said we should give people the right to determine what they want for themselves, so he commissioned a survey called the king crane commission. it is the first time the arab was ever polled. my brother and i are in the polling business. the one that he is actually started in and made the family name can we value the king crane commission because it was the first time a whole was done in the arab world, and it was also the first time a poll was done in the arab world and had been ignored, as many have been sent. an overwhelming majority, in the

90%-range -- in the said no, they wanted a unitary state, and they rejected the zionist claim to palestine. wilson argued for it. you.ritish said damn said theour aspirations of the 700,000 meane people of that land nothing to me. i will ignore them in favor of the zionist movement. that means much more to me. that was the beginning of this whole issue back then. yes, the holocaust played a role, because it certainly sent lots of people who were escaping the orders of europe's 2 -- horrors of europe to palestine and it fueled the concept further, but the palestinians were resisting the notion that their land should be promised to

other people early on. there was a wonderful u.n. document -- i was on c-span a while ago and told people the same thing. it is on my website. -- j zogbyil me at y ogby, i will e-mail you the trajectory. host: a viewer off of twitter says that the people of gaza realize that hamas brings only death to them, can the people renew -- remove hamas from power? guest: we did a poll and said if you thought these were possible, who would you vote for, and 70% said they would vote for the party of mahmoud abbas. dated nothing piece was

possible. -- they did not think peace was possible. that you need to transform the economy of gaza some people do not fear despair. people turn to extremism when they feel hopeless and despair. if you want to change the width people think you give them -- if you want to change the way people think, you give them opportunity and hope and options in their lives. if we fundamentally transform the conditions of life and gaza, a legsimply will not have to stand on, but as long as we continue the blockade, deny them importing, exporting, the ability to leave the country -- there were american fulbright fellows and israel would not let them out. as long as you continue to do that, you make them pray that this kind of extremist movement -- to this kind of extremist movement. it is something that we ought to

have a goal -- change the politics of the palestinians in gaza. they, in all of our polling show insteadnot favor hamas of other movements, but we force them into that mode by not giving them that option. host: another viewer -- don't the people of palestine have to get rid of their hatred of israel before they can ever become a state? ift: if israel did --guest: israel did things to stop them from hating them, then we could start. israel did not just kill hope, it killed cases where families were born, rituals were celebrated, destroyed entire 1800 people,led 9000 wounded, and 60 that thousand people now without homes at all to go back to. it is a tough sell to say do not look this way, look that way.

i understand, that give people a moment to grieve and to be angry. they are deserving of it. it always amazes me that the powerful are entitled to anger but we deny the victims the right to anger. the powerful, we allow them to say we're vulnerable, victims, and we are suffering, so please defend us. but we do not allow the powerless in does that to say we are victims and we are suffering , filling loss right now, and we and in despair and maybe even a little revenge. with human to deal beings, understand why their emotions are the way they are. it does not justify them, but it helps us understand what they are so we can help move them to the next stage. host: thomas is next from san jose, california for our guest james zogby. caller: thank you for c-span,

and thank you, mr. zogby. i really appreciate the education that you are providing me and all of the american people on this issue. important -- so your message is not getting out to the major media whatsoever. encourage people to learn about this struggle, because it is so important with the truth is here. i think that the only real solution to this problem will come once israel agrees to all of theom occupied territories, not just gaza which technically they do not occupy at the moment but they control everything that gaza does. it is basically a ghetto, like you say, a prison.

fromsrael has to back off its hegemonic control of the palestinian people and their way of life. guest: i agree. you know, the way to solve this is to separate. i would love to see reconciliation. but at this point, i think reconciliation comes after separation. space need to have some to they need to be in a position where they can feel free, unencumbered -- not just free in their little town or village, but really free, free to build a society and grow an economy, free to see their children have jobs and hope and bring home grandkids and have a different life. this notion that palestinians celebrate death is nonsense and

evil. it is a racist notion that tries to absolve the killer and blame the victim. sayit means that those who it either do not understand or do not want to understand the palestinian reality. i do not want to see anybody -- i do not just the jewish babies dying, arab babies dying. i do not want to see children of freight in israel or in palestine. but at the point where we are right now, people need to be separated so that they can, each of them, have their own rights protected within their own society. i will tell you, israel built the wall. the problem i have with that wall, build it on your own damn to build a are going wall, but it snakes in and out of the west bank. it takes valuable property. it denies palestinians in some villages to go to their land. it