the 80% range in africa. the case fatality rate in germany was 23%. have been because of the better supportive care. there is no antiviral treatment or because they were healthier going in. we don't know. but we do know that it was dramatically different. care ispportive health a proven way of saving lives and we should never lose sight of that. in terms of treatment centers, you are correct that there is a challenge in getting treatment centers. ,hat is the number one priority which 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 transmission in the tri-country area.

looking at one facility or multiple facilities or where the facilities will be, that is a critical issue for us to determine in the coming days. treatment centers are important to support. treatment centers as you point out are very important to support. i was speaking with the american from sierra leone and speaking about simple things like giving them cell phones to talk to their family or things that they can do while there was very important. and if patients don't believe that they will be well treated in the treatment centers they won't come in and may continue to spread it in the communities. good quality care is important. in terms of testing you are absolutely correct. as you know, mr. chairman, with support from the c.d.c. has represented crowiate the african sew tiety for laboratory and that has for the first time ever had high quality laboratories established all over africa. the countries have not been the focus countries so they have

limited activities in the a area scaling up laboratory testing is important. in two ways. first, this isn't simple laboratory tests. h is a real-time p.r.r. the results back within a day but false positives are possible if you are not careful and that would be a real problem. we are working with international partners involved and with the defense department which has a very active program for example in sierra leone. we will also establish safe specimen transport means. we have done in in uganda. hard to get a lab out all over but quite possible to get transport into the lab and this is what we will establish in the coming days. in terms of the courage of healthcare workers i certainly agree with you and it is an issue not just for healthcare workers. for patients. we heard that with healthcare systems less functional problems like malaria may become more deadly. there are other conditions that aren't treated because of ebola.

so responding is so very important and protecting the responders is so very important. to a see aspect that we are working on with the world health organization and countries and others is making sure there is protettive equipment there for healthcare workers. we believe it the possible to take care of ebola patients even in africa safely but takes meticulous i tension to detail. -- meticulous attention to detail. i can assure you that the u.s. government is looking at promising drugs and we will look at this as ways to expedite development or production but i don't want any false hopes out there. right now we don't know if they work and we can't force we know have them in any significant numbers. the medicines used in the experimental cases as far as i understand it are not easy to use. they require infusion and may have adverse events and basic supportive care in place as a rerequisite to giving the

treatments. we have to do the basics right and might or might not have effective and available treatment in three months or six months or one year or five years but we today have the means to stop the outbreaks. and finally in terms of airline flights, we do have teams in the affected countries working with their basically the equivalent of their border protection services helping them to do screening at the airports. it is not a simple measure. it is key first to reduce the number of cases. that is what is going to be the safe effort. and there are other things that can be done at airports in terms of questions to be asked or temperatures to be taken. or lists to be cross matched against known patients with known contacts. all of those procedures do take time to set up but we have teams work on them now.

>> if somebody is in proximity to a sneeze or a cough is that a mode of transmission? >> in medicine we often say never say never. so in general the way we have seen the disease spread is by close contact with very ill people. as you know, the individual who traveled from liberia to lagos did become ill on the plane and we have assisted the countries to track the travel ares who travellers who have traveled with them and as of now have not identified illness in any of them. in general not from sneeze or a cough. in general, close contact with someone who is very ill but we to have concerns there could be transmission from someone who is very ill. >> at the fever stage, you are not likely to get it from somebody at fever stage? >> if they are just clearing

their throat or sneeze original coughing but do not have a fever and have not become ill with ebola they are not infectious to others. if someone became ill on the plane and was having fever or started bleeding that might present a risk to those who came in contact with that and didn't take appropriate precautions. >> is there a way of advising airline personnel, particularly flight attendants who might be in close proximity to the plane. does the c.d.c. advise them and the airlines on numerous flights to the region? >> we have provided detailed advice to the airlines. >> you spoke and i think it was good insight about the handling of for funeral arrangements and sensitivity to the culture. i know it is part of the public information campaign in guinea for example, text messages are being sent with a number of the

red cross and one of the text messages are the bodies of ebola victims are very contagious, do not manipulate, call the red cross. i'm wondering if there is any thought being given. i remember after operation provide comfort when the kurds made their way to the border of fleeing iraq after saddam hussein, i was there five or six days after that and the military was on ground and they are using cyops to educate and leafletting that was done in a way that we used in a not so benign situation in this case it was to get food out and meals ready to eat and it was amazing how that kind of information made the kurds who were at great risk of the elements and starvation very aware of what they needed to do. any thought with helping with a benign effort to make people aware.

i know that radio is being used. seems more needs to be done. >> i can't say that we moved to that point but i think you are hitting a very, very important issue which is that culture makes a difference and you have to adjust the messaging and do the campaign according to the sensitivities and routines and practices per culture. what was extremely effective in gu oat you mentioned, mr. chairman, but the fact this they started talking about survivors and the survivors came on the radio and they went around and said look, i was sick but this and this and this happened to mow and i did such and such and i'm still alive. go get treatment and isolate and make sure people know you have this. that is very, very important. our military is helping in ways with logistics and making sure we can get in body bags and protective equipment for the healthcare providers and that is where we are so far.

we are relying upon the host governments to help explain to us one what are the sensitivities and what messaging needs to get out and then helping with the moans of the communicate but not the -- means of the communication but not the actual message because they know best what they need . >> thank you. i once know if you could talk more about the days. i wonder if you can talk more 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. chills, weakness, nausea, diarrhea are other symptoms. about 45% of cases, there is bleeding, both internal and external. that is a feared complication. these are symptoms, which you have both pointed out, are not pacific to ebola. that is what laboratory testing is so important. that is also why a person will know they have ebola and go to a special ebola unit. in 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 or other symptoms, do a test. 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. we want there to be a high index of suspicion so doctors will rapidly isolate the person and rapidly test them. >> how do you screen? just as the chairman asked, and i know what is in the press -- yesterday when we spoke, these -- there are these pictures and the news out the wands.

we are working in collaboration with them to see you get the test out to what is called a laboratory response network. cdc is a network the 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 mentioned, there might -- i need to refer you to the national institute of health. the information i have on that is quite incorrect. it is a combination of different 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 work. at antibodies are only one part of our response to an illness. there are other responses. we do not know until it is 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. we known now how to support 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. we also would need to be health-care workers to protect themselves. we are months or a year away from significant quantities of either drugs or a vaccine. what is available today -- it is 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? each a situation where addressingtries is it differently?

>> in the terms of the death rates, the data are very -- are variable. what is important, i would say the country of guinea is furthest along in responding. there are two that have continued spread and health care facilities 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 were more cases, 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. we have seen 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. we will have more now, and i want to emphasize health workers are trained to do their best to save the lives of other people. so, those who have already died in this outbreak are true heroes. i think we have a commitment to 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. so, 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, we will 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. that is what we are right now. we expect to reach 70,000 bpe's, 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. our primary concern is the health and well-being of citizens abroad. we have not in fact ordered the departure of our family members from any of our places, although 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 among 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. bearing in mind the stresses in 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. >> last question -- the panel 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 country -- this is a rather torturous past.

the president of liberia. to declare a disaster in our country, because she was the 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? >> the first cases are in guinea. the epicenter is for us did areas that have a confluence of the three countries. the epicenter is the for us

today area that has the confluence of the three countries. the forrested area that has the confluence of the three countries. >> ambassador williams, we have heard from ambassadors and him busy -- emassy staff that 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? >> chairman -- 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. i was our ambassador to niger in 2010. and 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. this cannot all be the united states. what are the european allies doing? numbers, if you can. >> 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 outbreaks

we've been in close coordination colleagues around the world. >> 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 going to say something? >> the british government particularly is supporting the response in sierra leone. we have a strong presence with the ministry of health and liberia. the response was particularly important there. someone mentioned the emergency plan who put forward -- they originally got $30 million of that 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 -- cvd's 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. this is typical of the outbreaks in central africa. for a month, there were not many new cases. in fact, the early behavior of we would have to get back to you about their involvement. >> i have not heard about that.

reiterate theo regional governments are involved with this. >> mr. chairman -- if someone 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? >> 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. >> is there a person to contact? >> yes, that would be dr. -- >> how accurate is the data? 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. there was a 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? i know the fda is notoriously slow and notoriously copperheads it. -- comprehensive, . i do not want to exaggerate or understate, but zmapp, km ebola -- they 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. is there an effort in your agency to say, let's look at that? there might be some reason to lift that phase one trial halt? and finally in his testimony --

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 us to take seriously the largest outbreak of the disease in history. yesterday the president of liberia declared a state of 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? is there a heightened concern about another nation, particularly one that might be contiguous with these four? >> in 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 able to -- 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. we have to recognize we have the 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 health, 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. >> i would like to introduce our second panelists, beginning with mr. ken isaacs, who served as the office of foreign disaster assistance in usaid. he coordinated the u.s. government's response to the indonesian tsunami, the pakistani earthquake, relief to darfur and southern sudan, as

well as niger and ethiopian emergency responses. he has more than 27 years experience working in the disaster relief field. he is currently leading the samaritans purse organizational effort in liberia in response to the ebola epidemic. we will then hear from dr. frank clover, the director of the urology institute. his discovery of the world's highest rate of prostate cancer in jamaica has been internationally recognized and published in numerous journals and textbooks. he and his wife -- he is 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. chairman smith, esteemed members 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. we have worked in over 100 countries, including afghanistan, north korea, south sudan, sudan, and liberia.

we have responded to medical emergencies such as the cholera epidemic in haiti and we have provided medical care to the people of 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 experimental 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 contracted the deadly virus. samaritan's purse thanks you for 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 having conversations with leaders. in the 32 years since the disease was discovered, there

were a total of 2232 infections. easily this presents outbreak is going to surpass that, in dr. -- surpassed that, in fatalities, 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. a broader, 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 1700 ebola diagnoses. 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 countries to three of the poorest nations in the world. i know a part of community and development philosophy is to work with your local partner and build capacity. the capacity that is needed in 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 had over 435,000 people go through that training, but there are 3.6 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 mores are. the cdc, 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 40-minute flight.

i want to take a moment to recognize our coworkers and doctors without borders for standing in the trenches with us. they are in sierra leone, in 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. if there was any one thing that 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 in three countries. two relief agencies. samaritan's purse and doctors without borders. it was not until july 26 when

kent brantly and nancy writebol were infected that the world sat up and paid attention. today we see headlines of ebola fears. there is a man who has bled to death, evidently in saudi arabia, and the government has confirmed it was the hemorrhagic fever and he came from sierra leone. there was a man, a liberian american, who came to a hospital 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. it is not an issue of gloves. it is an issue of, you cannot have a millimeter of skin exposed or you will most likely die. they went to the jfk hospital in

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 death from ebola in nigeria and eight more people in isolation. our 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. the custom that they have of

venerating 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. the body is loaded with the 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 is given a few simple medical 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. eight of them were community health workers. everyone of those 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. the third level of society is 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 credentialed 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. i think 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. liberia, sierra leone, and ginny -- guinea are poor. like all countries, they have their problems with pointless bureaucracy and corruption. i know the second-largest center where 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. i don't 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. dr. frieden and 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, replanning, 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 during in the evacuation of our staff is there is only one airplane in the world with one chamber to carry a level four 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 any significant mass, unless the 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 four are 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. as someone with 26 years of experience, including being the director of ofd a, running many 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 will actually produce. would like to know what it will actually buy. 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 hospital, 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. i appreciate them so much for the way they are fighting this. the logistical support to get the supplies on the ground to fight this disease. as one of you 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 can to give them a safe place to 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 is something significantly needed. >> thank you for that testimony and i think for underscoring your experience in the office of

foreign disaster relief. i don't 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. i am also a medical missionary working with the christian missions organization with works in over 60 countries. i am the president of shield in africa, a us-based ngo working in liberia.

my first experience was in 1988. we did medical missionary work at a hospital called elwa. eternal love 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 country's

inherently weak health system. after the outbreak in march of this year, prior to the ebola outbreak, they went on strike. this was true in counties that had been hit hardest by the epidemic. just before ebola entered the country. after the outbreak began claiming the lives of the nurses that did not have protective gear. after a second died, they shut down.

patients are too terrified to enter 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. many patients die within 24

hours of presentation. the only functioning hospital, a population of one million people. many patients are dying with a -- ebola 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 taken to increase the capacity, create an effective koran team quarantine for those having been exposed to ebola. and provide protective gear for 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 it yourself. 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. if there is a sense if not fully backed by science yet, that the drug may have had an impact? one of the questions i asked to 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 ramping up, it your thoughts on

an aggressive fda working in conjunction with the other agencies of government based on opting in, recognizing the risks? >> on the failure aspect, i would say that 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 out every day from liberia, i don't mean to be dramatic but it

has an atmosphere of apocalypse now in it. today, there are gangs threatening to burn down hospitals. this 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 to sticks in the flash of an eye. there is a lot of temperament 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. it has been a failure because it has now jumped another country. epidemiologists have totally misread the magnitude of the disease and because there are not resources on the ground, the status of the two patients -- i 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 understood 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. we appreciate emery. 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. doctors obviously have a higher degree of training and they understand the importance of protective garb. in your view, are they much more at risk because they are more rudimentary.

>> it puts them in untenable and weak positions. i don't think putting a poster on the wall that says ebola kills is going to do it. they 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 staff infecting staff. as was reported wherefore nurses

died, a 11 more were infected. there's a 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 guinea today is recruiting retired doctors, nurses, and midwives to convey this message. are the other countries in nigeria looking to do that? for example, burial practices and the like. >> after this brutal civil war, 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. there needs to be language appropriate in each dialect and a way that each community can understand so they can get the message. people seen as authority figures 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 monrovia, you're 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. >> a special test in the u.s., 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. if we're going to put people on the line, the brightest and best people in the country, we owe it to them to give them a fighting chance. even this country, no matter how 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. i think that there needs to be something to augment their capacity. adding guineas to be some kind of a coordination 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.

>> you worked on the outbreak of ebola a couple years ago? >> i was there during the outbreak and was not working with ebola. >> how does this compare to that outbreak. >> it was a sparsely populated rural area where they burrowed -- it burned itself out. they moved to the city so that 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? >> i would just say that i am certain there is much more than we know of but this concept of research is very important. you will see death tolls and numbers we can't imagine right now. that is the potential. i will tell you that we are the

-- in the process of distributing readiness information. >> any final words? i want to thank you both for your extraordinary service to mankind and the disabled thomas 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 congress and subcommittee, your 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]

>> the president of somalia was in washington for the africa summit. he will sit down to talk about some of the challenges facing his country. securitys include concerns and oil exploration. live coverage from the brookings institution. the european court of justice ruled google and other search consider requests system to delete information about them to rid the committee hosted discussion -- about them. hosted discussion about online privacy. live on c-span. president obama signed the veterans affairs bill. then he -- an update on the

progress against hiv aids. >> while congress is in recess primetime, programming continues with the conservative summit in denver. q&a, admin morris -- edmund morris. >> president obama signed a veterans bill. the signing, the president spoke with veterans. this 90 minute event was hosted by the kaiser family foundation and held in virginia. [applause] >> hello.

[applause] everybody have a seat. take the sergeant major on the road. i'm going to have him introduce me wherever i go. he got me excited. i get introduced all the time. for your incredible service to our country. if him a round of applause. [applause] to give a big thanks to the new secretary of veterans

affairs. then up, bob. up, bob. headed up one of the most successful companies in the world but was also a west point ranger who served on behalf of his country. this is a labor of love for him. he he is heading to be a hospitals and clinics around the country. thank you for accepting this charge. in this challenge. making sure we are doing right. proud of him.

i want to think all the members of congress who are here today. give them a big round of applause. thank you. good work. grateful to the veterans service organization. the work they do. thank you very much to all the service organizations. buchanan thank general -- for nearly a

century the space has helped keep america safe and secure. 70 years ago, forces from here were among the first to storm omaha beach. recently many of you were deployed to iraq and afghanistan and have used your lives to defend our nation. as a country, we have a sacred obligation to serve you as well as you have served us. an obligation that does not end with your tour of duty. every day, hundreds of thousands of dedicated public servants at the v.a. help us honor those commitments. at va hospital's across america, you have doctors and hospitals delivering care to veterans and families. you have veterans who are profoundly grateful for the good work done at the v.a., and as commander-in-chief, i am grateful, too. but over the last few months, we have discovered inexcusable conduct at some of our v.a. facilities, veterans waiting on care they needed, long wait times being covered up on the books. this is wrong.

this is outrageous. and working together, we set out to fix it time a do right i our veterans -- we set out to fix it, do right by our veterans, no matter how long it took. we have held those responsible for misconduct. some have been relieved of their duties. the investigation is ongoing. we have reached out to veterans, making sure we're are getting them off wait lists and into clinics inside the v.a. system. we are instituting a critical altar of accountability. and rebuilding our leadership teams, starting at the top with secretary mcdonald. his first act -- he has directed all v.a. facilities to hold town halls to hear directly from veterans they serve, to make sure we are hearing honest

assessments about what is going on. in a few minutes, we will take another step. i will sign into law a bipartisan bill -- that does not happen often -- passed by congress. [applause] it is a good deal. this bill covers a lot of ground. from standing survivor benefits to educational opportunities, to improving care for veterans struggling with traumatic brain injury and victims of sexual assault. but i want to focus on the ways this bill will help ensure veterans have access to care. first of all, this will give the v.a. more of the resources it needs. it will help the v.a. hire more doctors and nurses, staff more

clinics. as a new generation of americans returned home from war and transitions to civilian life, we have to make sure the v.a. system can keep pace with that new demand. keeping in mind i have increased funding for the v.a. since i came into office by extraordinary amounts. but we also have extraordinary numbers of veterans coming home. so, the demand, even though we have increased the v.a. budget, is still higher than the resources that we have got. this bill helps to address that. second, for veterans who can't get timely care through the v.a., this bill will help them get the care they need somewhere else. this is particularly important for veterans in more remote areas, rural areas. if you live more than 40 miles from a v.a. facility or v.a. doctors cannot see you within a reasonable amount of time, you will have a chance to see a

doctor outside the v.a. system. and we are giving the v.a. secretary to hold more people accountable. we are giving bob the authorities so he can move quickly to remove executives who fail to meet the standard of competence the american people demand. if you engage in unethical practice, if you cover up a serious problem, you should be fired, period. it should not be that difficult. [applause] and if you blow the whistle on an unethical practice or bring a problem to the attention of higher-ups, you should be thanked. you should be protected for doing the right thing. you should not be ignored. you should not be ignored. you certainly shouldn't be punished. to care for him or her who shall have borne the battle.

that is the heart of the v.a.'s motto. this bill i am about to sign will help us achieve it. at but let's be clear. this cannot be the end of our effort. implementing will take time. it will require focus on the part of all of us. even as we focus on urgent reforms we need at the v.a. right now, particularly around wait lists, we cannot forget our long-term service goals for our veterans. the good news is we have cut the disability claims backlog by more than half. but let's now eliminate the backlog. let's get rid of it. [applause] the good news is, we have poured major resources into health care. the good news is, we have helped

get thousands of homeless veterans off the street, made an unprecedented effort to end veterans homelessness. we have zero tolerance for that. but we have more work to do in cities and towns across america to get more veterans into the homes they deserve. we have helped more than a million veterans and spouses go to college under the post-9/11 g.i. bill. but now we have to help even more of them earned her education and ensure they are getting a good bargain in the schools they enroll in. we have rallied companies to hire hundreds of thousands of veterans and their spouses. that is the good news. with the help of jill biden and michelle obama -- two pretty capable women -- [laughter] they know what they are doing and no one says no to them, including me. but we have to help veterans it america has to do right by all

who serve under our proud flag. and congress needs to do more also. i urge the senate once again to finally confirm my nominee for assistant secretary for policy at the v.a., ms. schwartz. my nominee for c.f.o., ellen tierny. each of them have been waiting more than four months for a yes or no vote. more than a's case, year. they are ready to serve. they are ready to get to work. it is not hard. it didn't used to be this hard to go ahead and get somebody confirmed who is well gaul qualified. nobody says they are not. it's just the senate doesn't seem to move very fast. as soon as the senate gets back in september, they should act to put these outstanding public servants in place. our veterans don't have time for politics, they need these public servants on the job right now. [applause]

let me wrap up by saying two months ago, i had a chance to spend some time with america's oldest veterans. some of you may have seen on television the commemoration, those incredible days in the 70th anniversary of d-day. it is a place where it is impossible not to be moved by the courage and sacrifice of free men and women volunteered to lay down their lives for people they have never met. ideals that they can't live without. that's why they are willing to do these things. some of these folks that you met, they were 18 at the time, some of them were lying about their age, they were 16.

landing either at the beach or behind the lines. the casualty rates were unbelievable. being there brought back memories of my own grandfather who then came home, and like so many veterans of his generation, they went to school, got married, raised families. he eventually helped to raise me. on that visit to normandy, i brought some of today's service members with me. i wanted to introduce them to d-day and show the veterans of d-day that their legacy is in good hands. that there is a direct line between the sacrifices then and the sacrifices folks have made in remote places today. because in more than a decade, today's men and women in une form, we have met every mission we asked of them. today our troops continue to risk their lives.

it continues to be a dangerous and difficult mission as we were tragically reminded this week in an attack that injured some of our coalition troops and took the life of major general harold greene. our prayers are with the greene family as they are with all the families of those who sacrificed so much for our nation. four months from now or combat mission in afghanistan will be complete, and our longest war will come to an end. many will step out of uniform. their legacy will be secure. whether or not this country properly repays their heroism, repays their service and sacrifice, that's in our hands. i'm committed to see that we fulfill that commitment because the men and women of this generation, this 9/11 generation of

service members are the people we need for our time. the community leaders, business leaders and i hope maybe some leaders in our politics as well. from the greatest generation to the 9/11 generation america's heros have called the -- answered the call to serve. as your commander-in-chief i have no greater privilege than to make sure our country keeps the promises we made to everybody who signs up to serve. as long as i hold this office, we will work to do right by you and your families. i am grateful to you. god bless you. god bless america. with that, i am going to sign this bill. thank you. [applause]

>> this is good work. thank you. when we signed the workforce training bill, i say, this feels good. we should do it more often. it is a good piece of legislation and it will help create -- and it will help. [applause]

>> good job. ♪ >> on the next "washington journal," we will talk to doug

schoen about gridlock and bipartisanship in washington. and then we will discuss the richard nixon's resignation. we will also take your phone calls and you can join the conversation on facebook and twitter. live each morning at 7:00 a.m. eastern on c-span. tv thisn2's book weekend, with books on marriage equality, the obamas, and the former mayor of washington. interviews former counsel for president nixon john dean on the watergate scandal. the president of the new york public library sheds light on the library's past, public, and future.

>> now, doctors and resources -- and resource -- and researchers on combating the aids virus. this follows the aids conference in melbourne, australia. >> good afternoon, everyone. welcome to the kaiser foundation. we have three distinguished guests with us today who i will introduce in a moment. and also a very large audience. thank you. i first want to acknowledge and ongoingeve for this collaboration. we have come together, our organizations, for five major conferences to do this kind of

and take stock of each conference to try to understand what we learned from it and what it means going forward. so thank you so much. given the live audience that signed up for this, i am just curious, how many people in this room went to the conference this year? raise your hands. most of you did not. understandably, it was far away. this is why we were trying to do this, so we could bring you together. on a more serious note, i want to say a few words about the tragedy that befell all of us, the crash of malaysian airlines mh17 on the day that most of us were traveling to melbourne. i cannot speak to how it felt here, but i can say that it cannot be separated from the experience and the meaning of the conference itself.

all of us collectively lost six incredible people who spent their lives fighting aids, en route to do this very work. i actually want to name them all. the codirector of the hiv netherlands-australia research collaboration. the former president of the international aids society. amsterdam institute for health development. martin, who is also at stop aids now. glen of the world health organization. this experience should the beginning of the conference, which was somber and serious and full of a lot of shock and pain. it reminded all of us something really important about our community. it is a community of scientists.

many are embodied in the same person. just to remember these individuals, i would like to quote a friend of mine who as ad very closely reminder of who they were and what it means for our community. and also to recognize the act of violence that occurred. these are kate's words. a tribute that she just gave a few days ago. is incomprehensible that people who work so hard to save the lives of others should be shot down and the collateral damage in a war. each of us needs to reflect on how to celebrate their memories. this world is a better place for them having walked among us. let that be said of each of us too." i want to say a few more words on the conference and where it

was in terms of the attendance. scientificd to have breakthroughs, but nevertheless, it had an incredible depth in what was resented and -- presented and the come together in what was a consensus on where we need to go from here that has not always been present and emphasizing the importance of focusing on key relations that are marginalized. individuals, sex workers, and confronting discrimination in all of their forms around the world. the emphasis on the need to scale up treatment and what we know now about treatment and how effective it is, and the power of convention again, some exciting new information about rep -- prep, which i am sure we will talk about.

for now, i will leave it at that. i would like to ask our three panelists to come up. , dr.mbassador at large birx. , president ofer the international aids society. teve morrison, director of the center for strategic and international studies. so please join me -- [applause] chris is here. that is my most important job today. ok. events, weth our will ask a few questions of our panelists and quickly get to your question. i hope this is a dialogue, especially for those who were not there and want to get a sense of how things played out. we know that the media itself did not cover the conference extensively.

that has been a trend that we have seen for a long time. bringing that information here is a critical task. , i will startion with ambassador birx to get a sense of your main impressions and takeaways. what were some big themes that came out? >> thank you for having me here again today. thank you for all of your information that you put on the hiv-aids.out and every question that i have had from every african press. 2014, when you start out with that level of heartbreak, all of us were very introspective the entire week because many of us came from that time when there were so many unexpected deaths among our friends for an unknown reason back in the early 1980's.

i think you have to have that reflection at the beginning. every time i heard something, i was able to think about the history of hiv-aids and where we are. was the historic content of our 30 years together and where we have been. what started out as heartbreak came forward very much as hope when they released the global report. i believe you all have seen it. it is a return to fundamental aidsreporting from u.n. with clear analysis that we can all understand. you only have to look at the pictures, which i really appreciate, and you get a sense of where we are around the globe. me, the last thing was renewed commitments and the beginning of the week -- when

things happened and advocates and activists spoke, there was a true resonating theme from all of us. abouthey were talking they want to be undetectable, we all agree to that. it is so important. i think there is consensus. , probablympression the biggest impact on me personally was a session done with individuals who have lived with hiv-aids for more than 20 years. it was really -- i had somehow, in my years of travel, lost track of how those days felt and how sick those patients were. hearing them relive the number of days they spent in the clinic, in the hospital, throughout their 20's, 30's, 40's, they were unable to work, unable to access effective

treatment. we had monotherapy and then bi-therapy. in thately, all of them room made it to combination. hearing about their life experiences and the impact it is making in their 60's and 70's having lost their most productive work years reminded turnedthe united states to a huge epidemic in sub-saharan africa and said we cannot stand by this. hearing their stories and understanding that their life journey had a tremendous impact and we all need to resonate with that and understand that we have a lot of patience now who live successfully with hiv but do not have the wherewithal to retire successfully. it renewed my commitment to oferstand all of the stages a life experience, from

prevention of mother to child to treatment that we are approaching and being able to understand people's life is princes. -- like experiences. think this is your third of these that you have done. just put it on your calendar for two years as well. >> two years from now, we will be talking about -- i will come back to that at the end. i just want to add to those reflections. tragedy changed all of our experiences, had a huge impact on the conference. to summarize the response of our community, by midweek, we heard it repeatedly, unity. it just draws people together. i think this will be remembered

as one of the conferences where the divides that we sometimes see in our community really got dissolved. there really was a unanimity of purpose and engagement, which i know we will need for the next phases. big picture messages that came out of the conference were lkstainly -- and debbie's ta on the u.n. aids data, there is on -- a consistent theme using the data that we have more consistently and focusing on better quality, focusing on the people. the human age report showed that -- that isnew cases an incredibly important thing.

they are relatively small portions of our community but bearing this burden. that is a combination we have to change. refinement of the thatnse was a theme occurred. just go through a couple of highlights from each of the tracks. we have five tracks now. while there was not any one or two single big studies, there was a number of advances in each of the tracks that i think are important. particularly because so many of you will not be able to attend, hopefully this will be your 10 or 12-minute go through the signs. there were a couple of key talks a,her example, with track

there is a lot of focus on the cure. the big news was the ofakthrough after 27 months the functional remission of the mississippi child who is now four years old and doing well on therapy, but unfortunately was offle to us -- to stay antiviral therapy. thethe curing plenary on opening day is a masterful summary. she managed to do both things. not dumb it down and keep us all appraised. the big news from the focus on concept that you try and get hiv out of the reservoirs it is hiding in and use immunotherapies or gene therapies or drug therapies to

try to go after that reactivation of the virus. quite a lot of information on thatand early studies suggest this may be the way forward. there is clearly a consensus emerging that the best thing from make your perspective and probably also from a clinical earlierive is initiation of therapy is better and the people who are likely to be the most to benefit from cure strategies -- strategies are the people that start in the very near term. this includes a large pool of children worldwide. so that is going to be a very important area. the clinical track him the great

basically 13 million people worldwide are on antiviral therapy at this moment. guidelines, w.h.o. another number the will to that are now eligible for therapy. enormous still untreated population. than atple have started to other time, partly due the global fund. areas that treatment emerged, there was a big focus on tuberculosis. there was a great summary with very important findings. there are some new combination therapies that looked quite promising. there is an emerging area

related to clinical care and smoking, particularly thinking about chronic obstruction pulmonary disease. .robably the next tier there is a lot of action on that front. c, then probably track epidemiology and prevention, the area where there was the most action because there has been the most news and trials out. a couple of things to highlight. o.rst of all, new w.h.. guidelines were released just for the conference. i should say that i cochaired the guideline process. the university of the medicals cool -- the medical school in malaysia.

those guidelines made one of the strong recommendations for more consideration of the use of exposure prophylactics for men who have sex with men as an additional prevention option. some of you saw that this got very misconstrued in the media, saying that all gay men should be on prep. please do read the guidelines. i think they are a real advance. is thetion, there recommendation for community distribution. in companies where there is good of a.r.v.'s, it can replace hiv as the leading cause of death. there was also good news on prep with transgender women who have

sex with men. the critical trial that came out in 2011. this is the open label extension. this is really the question of the effectiveness of the prep where people know what they are taking and can choose to take it or not. the good news is that the thectiveness was higher in trial, about 50% overall. looking at blood levels and people who took the drug, it turns out that the efficacy was 100% as measured in people who took it every day. just as good at six ,imes a week, five times a week four times a week. while that is a difficult message to put out there and we are not backing away from daily prep at this point, the

adherence does not have to be perfect. that is a real advance. the other thing that emerged from that study is that people had a good sense of their own risk. taking the drug daily was more common for people who had a high risk of exposure. less common among men and transgender women who did not. they know smart and what kind of behaviors they are engaging in. nevertheless, important. there has been all kinds of concern about people being on this drug and using condoms less. lots of science around this. turns out it is theoretical. condom use is better in couples where one of them is being treated there was great data on that from zambia.

no evidence of behavioral -- there was also encouraging news -- on voluntary male medical circumcision. the first trial showing the benefits for women of male circumcision. that is the data we have been waiting for. it is very encouraging. track d, ourn human rights policy and law, there was an enormous amount of work. ffchael kirby let us all -- o with that theme. data fromempirical

the special issues that have been happening regularly at these conferences. this one was on hiv and sex workers. i also edited that. full disclosure. it is a wonderful group of young investigators who wrote those papers. i am very excited. there is strong human rights evidence for potential benefits of reducing hiv incidence. on decriminalization as hiv prevention. finally, the implementation track now has the largest number of abstract submissions of any track. those of you who work out there, you are an enormous sector. there was great science so very encouraging outcomes. also one or two warnings.

good news that earlier to havere turned out adherence to therapy. that is an important finding. happily, in africa, many of those kids are surviving. , challenging issue with plan b occluding the hiv therapy which looks like their retention is not as good as we had hoped. they are falling off and that is going to be an important challenge. say that finally, the other thing that emerged was how -- you areranular talking about the data and