i believe that embassy if they are in danger they should be withdrawn. we shouldn't put in troops to try to protect them. because you don't know what the situation will be. if brian would just look at what's going on he wouldn't make the statements that he did. the troops are not there for embassy. so many of them are to train commandos. so many are there to help with different kinds of anti-terrorism kind of actions. so if you think the thousand troops on the ground doesn't mean that we're there to put boots on the ground you're absolutely wrong. look at exactly what he has proposed and what he is doing. why do we have drones? why do we have the helicopters? the drones are there because they want to use them. they just don't know who to use the drones on. representative by 2020 an

estimated 280,000 of our residents are going to be 65 and older. you said a couple years ago that the answer to saving medicare was obamacare. rocky rollout, highly unpopular. >> the one thing that we have not enforced is the provision of obamacare that is 3601, and that is the statement that says any savings that is generated from medicare shall be reinvested into medicare and shall go to the reduction of premiums for the elderly and also for the provision of service. if you remember the election both mitt romney and president obama agreed to was there was a 700 billion savings attributed to medicare. but what happened to that money? people tend to put it into deficit reduction versus what

it was intended to. so on the specific issue of medicare if we can hold people's feet to the fire and make them follow the law yes the savings will then keep medicare alive. >> how do we do that? >> the $700 billion instead of looking at it for deficit reduction, if they followed the law the law says obama care says it shall be reinvessed in medicare and reduce the premiums. that's what it says. but if both sides say we're going to use it and look at what a great job we're doing. they will be doing a great disservice. that's the reason why i felt obamacare would assist in the preservation of medicare. >> i think on a very basic level the affordable care act is beginning to work. people with preexisting conditions can get health care. you can stay on your parents' plan until you're 26, a number of other provisions.

health care.gov was obviously a debacle and the connector locally is just not working. it's a failure basically at conception. the math doesn't work because of the health care law and we have too few people participating in this. my view especially with respect to the connector is that they've got to reconfigure their business model. if not they've got to pursue exemptions either at the administrative level or the legislative level to try to reform the connector. there's another piece when it comes to the connector which is they brought down a little more than $200 million from the federal government for the impleltation of the connector. they need to stop spending money as they reconfigure the connector. there are policy choices to make, there are operational choices to make and at least they should not have good money follow bad. >> senator you will receive the next question from grace. >> there has been a lot of vuteni on the national security agency particularly in the last year and i think a lot of

americans are concerned about their privacy and with good reason. where would you draw the line on the issue of surveillance and data mining? what is ok and not ok in your opinion? >> we certainly need a surveillance program but this is an area where we have differed. i voted against the final reauthorization of the foreign intelligence surveillance act and the basic reason was that i did not think it protected privacy rights under the fourth amendment. i also supported certain amendments which ended up failing on the senate floor but they were bipartisan rand paul and ron widen amendments that would have provided more transparency into the fisa court and would have established an advocate position in other words that there would always be somebody in this secret court system who represented regular people, our privacy i want. because in this court you would have the snast submitting something and risea would rubber stamp and approve every request for a wirpte and they

were able to jump and jump and really surveil nearly the entire american public. so this is an area we have to recalibrate the surveillance state. we need to protect ourselves from people who want to do us harm but we've got to protect our fourth amendment rights. >> one minute. >> i don't think he answered your question. he talked about the question but your question was about medicare. when we talk about fisa and nsa the most important thing to remember is the onerous part is the patriot act remember and section 215 of fisa is what did that. when i first got into the office in 2011 i voted against the extension of fisa, section 215 the patriot act. we've had some recent bills in the congress where itch voted again against it because of the fact that it extends again the patriot act supposed to expire in 2015 this bill goes to 2017. quite candidly i don't remember

the senate voting on anything like that. but the amendment that brian talks about is completely different. the amendment that brian talked about that the majority of us supported was because he was extending the right of the the president to act like george bush and dick cheney. you cannot have that. that's worse than anything else we have whether the fisa court or whatever. >> for the last time the candidates will have a chance to ask each other a question on any subject. >> colleen in 2011 you voted with request tea party against against e.p.a. air quality standards to limit the emission of mercury, acid gases and soot from industrial incinerators. these standards would have pretented 8,000 premature deaths and over 5,000 heart attacks per year. do you regret this vote? >> you're talking about boiler mack and i see it in your brochures as well.

i voted against it for one reason. i thought that rule was ill conceived and it would have caused the demise of the last sugar plaptation that we have. because they could not comply with the standards. and if you really understood this bill and what happened, you would also know that the e.p.a. has subsequently in 2013 changed that rule and said they didn't want to do it but they were sued by certain environmentality groups so they had to. what they did do is created a specific category now for the gas which takes into conversation sugar which would then keep it and 800 plus jobs on the island of mowie alive and well. so you really have to understand what you're talking about before you make these statements. >> senator 30 seconds. >> i understand this issue perfectly we just have a disagreement. the disagreement is this.

you think we had to choose between air quality standards and the survile of hcns and the proof is in the pudding your amendment didn't pass the e.p.a. air quality standards got implemented. i understand you're saying there were amendments in terms of the rules but in 2011 these things got implemented and ch and s has had a couple good years so you don't have to choose between the economy and the environment. >> 30 more seconds. >> brian, that's where you're absolutely wrong. when we passed that amendment we passed that amendment after discussing it with the senators in the senate at both senators at that time and they said this will send a message to the e.p.a. that they can't just enforce rules or create rules. that's what this was about. you would have killed the plant if that rule went through. so in e they were able to delay

it and they came up with the rule that we need that now saves it. you're the one who doesn't understand. >> your question for senator shats. >> brian, you know the administration wanted to balance the budget on the back of our retiree pensions. when it really mattered you did nothing to stop governor aber crom by. why were you so afraid to speak up in public for our capunea? can't u you just stand up to your mentor and disagree with him publicly? how can hawaii count on you to be an independent vote in the senate if you can't even do that for us? >> well, this is an area where the governor and i disagreed. i opposed a pension tax but this is another example of your desire to talk about everything under the sun except your record and the united states house and my record in the united states senate. look, you've had an opportunity

to serve for 3-1/2 years for the first congressional district. you've introduced 28 bills one of them has passed. and it is renaming of a post office. you don't want to talk about your record and the congress when it comes to protecting the elderly because you were one of the few democrats to undermine social security by raising the retirement age and reducing the cost of living. so this is an example of the way you've been operating which is to try to taung about everything that you can come up with except your record in the congress and except my record in the senate. >> i'll talk to you any day about my record especially in the areas when it comes to preserving jobs and creating jobs. but let's be also very clear about your problem. you keep saying i oppose this governor. i read every single testimony that was given and you never opposed the governor. and you actually stood with him. i can't bring my picture in

here but people remember my picture and you said we have to do hard things. the bottom line is you are always willing to balance the budget on the backs of our kapuna. >> that's ridiculous this is another example of colleeb throwing the kitschage sink at me and i've become used to it. i have been a strong advocate for our seniors. i have been a strong advocate for reforming the medicare part d program so we get more affordable prescription medication. i've been a strong advocate for strengthening and enhancing social security and colleen is relentless in making these issues tomatoly confusing but they're not confusing. she hasn't been there. >> we are running short of time. one word yes or no answer on this. do you support president obama's policy on immigration and protecting our borders?

>> i do. yes. >> representative? >> i do but i have to say this i do not support that portion of it that is going to be used to deport which is one of the uses of those funds. >> we appreciate both of your responses tonight. to help educate voters. candidates now have 90 seconds for closing remarks. congresswoman u you are up first and your time begins now. >> from the first day in office in 1999 i studied and read the bills because i realized that details matter. my colleagues honored me as the first woman president of the hawaii state senate and the first woman to head either chamber in the legislature. the greatest legislature in this world is the united states senate. and if anyone knows what it takes to be successful if that body it is senators daniel innoy and senator akaka between them 71 years of service.

i am very honored to have their support and trust and confidence in doing this job. if i am fortunate to be elected i will take their values which are your values of humility, hard work, and aloha with me. i've been asked throughout this campaign as to what is my contribution. and i used to say i was chair of this i did this but when i really think about it my contribution to you is to your daughters, grand daurts, your nieces and your sisters. and that is when they look at my journey when they see the girl making that journey, they will say they can do it. this election will come down to one word and that is trust. i believe i am the person who you can trust to carry forth the hawaii that you want. thank you very much for listening to us this evening.

i humbly ask for your vote. >> senator. >> thank you. and thank you to colleen. let me tell you why i love doing the work that i do. we had a lot of good debates five of them, we had lots of good conversations about politics and policy but it's really not about the two of us. my favorite moment over the last three weeks was when i found out for sure that those 220 jobs across our neighbor islands were going to be saved. three months ago we found out that they were going to be moved to minimum wage. and i intervened. and we had a lot of difficulty. d with to work with our colleagues, with the union, with the united airlines folks. eventually we were able to do this. 220 people are going to be able to support their families on the neighbor islands with good quality jobs. that's the kind of thing that i am so passionate about. that's the kind of thing that i know my wife is passionate

about. that's why we make the sacrifices that we do to run for office, to serve in office. i love serving you. i love fighting for you. but in order to continue to do that i need your help. election is coming up on august 9. i would be honored by your support. i humbly ask for your vote. >> thank you to both candidates. that brings us to the end of the senate showdown. don't forget the primary election is just 23 days away. early walk-in voting will begin july 28 at locations across the state.

the president in somalia was in washington this week. topics include security concerns and oil exploration in somalia. live coverage from the brookings institution starts at 10:00 eastern. in may the european court of justice ruled that google and other search engines must consider requests by any citizen to delete information about them under a policy known as the right to be forgotten. the noon internet caulk cuss hosted discussion on online privacy rights.

>> 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 estimated at 55%, ranging from 74% in guinea 242% in sierra leone. the disparity in mortality rates are partially linked to the capacity of governments to treat and contain the disease and perhaps per 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. in 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 hospitals have control programs 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 like new jersey's liberty 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. key 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 walls, causes -- 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 bats 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 dr. brantly and nancy writebol 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 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 called snap pharmaceutical. 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 in their additions -- their conditions will stop the pharmaceutical company has been working with an arm of the

notary responsible for hounding 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 tested on humans before the two doctors who gave their consent to be the first human trials. there will be great hope if z-tap works and if the two americans who bravely agreed to test it and it has a positive effect. that would 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 being done by 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 virus, but not in humans. it's been done in non-humans. unfortunately, it impacts the ability of the international community and assisting the government to meet the self -- health 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 only medical personnel treating these exponentially spreading disease that because they are under suspicion by some people in these countries who are unfamiliar with this disease and fear doctors may have brought it with them. of course this is untrue, and myths do abound. the current outbreak as we know s 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. as we consider what to do to 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 n estimated in 2010. we must in short change follow 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 others are also joining in and 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. i have introduced legislation known as the and neglected tropical disease act which establishes to support a broad range of research activities to achieve cost-effective and sustainable treatment and control and, where possible, the elimination of neglected tropical diseases. ebola is not on the top list of 17 neglected tropical diseases but it does fit the definition of an infection caused by pah -- pathogens that disproportionately 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 ember. >> 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. the development of health care capacity and global security is just one area of collaboration for the u.s. and african nations. i was a little dismayed that 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 liberia, sierra leone, nigeria guinea, 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. the unique nature of this outbreak has made combating the disease difficult. west africa has not faced this disease before, and communities 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 contributed to the spread and kept 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. i'm sure 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 nd 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. she felt 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 develop. 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. >> 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. i would like to now yield to the distinguished chairman of the state department, commerce and justice department subcommittee of the appropriations

committee, congressman frank wolf, who has had a 34 year career of 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. we were planning on a hearing 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, guinea, and now nigeria. although i am not a member of the foreign relations committee, i do 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. you should not wait for 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. it now appears this alarming, 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 -- places than almost any other group 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. the outlook via absence of the united states was bleak. the 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. for the first part of the 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. although more progress has been made over the last week since these conversations, it is clear the government is still trying to catch up. this requires efforts from agencies and countries, france, great britain, many of the countries in europe who are 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. i appreciate dr. frieden -- he 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, will be doing.

i think 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. dr. frieden 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. he developed 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. he is a board certified 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 senior foreign service with the rank of minister consular of foreign service and deputy of affairs at the department state. she serves as ambassador to the republic of niger and has served at the u.s. in 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 dished, 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 nd pivotal time. first, let's are member the lives and faces of the men, women and children who are ffected by the ebola outbreaks 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 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. first, we can stop ebola. we know how to do it. it will be a long and hard fight 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 routes -- first, two people who 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 hrough contact with infectious body fluids. it does not spread through

casual contact. it is not an air borne 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 monitored to determine if they have developed the symptoms of ebola and if they have, are followed up. we do know how to stop ebola. meticulous case finding, isolation, contact tracing and management. we with our partners have been able to stop every ebola outbreak to date. 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. to control the outbreak, we have to work effectively. the challenge is not the strategy, it's the implementation. mr. chairman, we have provided ow this can be controlled. if you will permit me, because i think it is important to get the fundamentals out there. first, to find the patients and diagnose them. that means fever or other symptoms. the only way to diagnosis ebola is with a laboratory test. e working with partners from the department of defense from the past with france, and from countries where the disease is

present are scaling up the ability to diagnosis patients. so the first diagnosis is, suspect is with fever, test with blood, get it in the lab. that's the first step. the steckedsfep is to respond to those cases. we do that by i getting them in isolation, eliciting their contact, and by following each and every contact every day for 21 days. if a contact develops fever, begin that process all over again. isolate them. find out who their contacts are. it is hard. it requires local knowledge and action, but it is how ebloa is stopped. third, prevent it. prevent it through infection control, health care, safe burial practices, and producing the consumption or unsafe consumption of bush meat and contact with bats. the current situation is a

crisis and unprecedented. it is unprecedented in five ifferent ways. first, it is the largest outbreak ever. in fact, at the current trend, within another two weeks, there will be more -- have been more cases in this outbreak than in all previous recognized outbreaks of ebola put together. second, it is multi-continent. cases have moved between countries. one country gets control, and patients come in from another country. so that tri-country area is a particular challenge. third, this is the worst outbreak in africa. this is a disease that was unknown in that area before. because of this it has been a particular challenge. his also has been a challenge. fourth, many of the cases have been in urban areas and

there has been spread in urban areas. this is something we have not seen spread from this work before. 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. fifth, it is the first time we are having to deal with it here in the united states. that's not merely because of the two people that 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. inevitably there will be travelers who go from these countries or from lagos, if they don't get it under control, and appear here with symptoms. those symptoms might be ebola or something else. so we have to deal with ebola in a way we have never had to deal with it before. the u.s. is working to support partner governments and the world health organization. i have activated the c.d.c.

emergency activation center at level one for this outbreak. it doesn't mean there is an increased risk for 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. governments around the world as well as most importantly people in country will be key to stopping the outbreak. we will send -- the next week or two will have reached that 50 number. we are supported at our home base in atlanta by a much larger group. even today before the full

surge of activation, we have more than 200 staff working on this outbreak response. we will increase that number substantially in the upcoming days and weeks. we will hear more about the agency for development where we are using an unprecedented model to work together and rapidly identify and call in for reinforcements and assistance. i think it is important to understand that -- -- if we didn't do this, we wouldn't -- we have ore than 200 staff working on this outbreak. we don't have -- we have medications to care for it. you may have seen press coverage about experimental treatments. the plain fact is, we don't know if that treatment is helpful, harmful, or has any impact.

we are unlikely to know from the experience of two or a handful of patients whether it works. we do know that supportive care for patients with ebola makes a big difference. supportive care gives people -- saves people's lives. making sure they are not under their fluid balance. treating other infections that occur, providing good quality health care. we are currently coordinating 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 treatable thrfment is a lot e don't know about that yet. it is important that we keep in mind that we do know, even without medicines specific to ebola or a vaccine, we do know how to control it and we can

stop it. i want to spend a moment to discuss what we are doing to protect people in this country. first off, the single most important thing we can do is stop the outdaybreak break, stop it at the source. the second thing we are working on is to help these countries do a better job screening people who are leaving their countries so they will screen out people who are ill or who may be incubating ebola. third, because we do recognize that we are interest connected, we are working with state and health workers throughout the united states so they are aware that there could be people who come through these three countries that come in with fever or other symptoms, they should think it could be ebola. immediately isolate them in the hospital and get them tested at c.d.c. we have issued a level three travel advisory against all non-essential travel. we have issued a level two travel advisory about enhanced precautions on nigeria and we will reassess the nigerian situation daily or as needed. there is strict infection control possible in the hospitals in

the u.s. there has been some misconception about this. ebola it not as infectious has the flu or the common cold. what is a concern is that a single lapse in 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 here while having been exposed elsewhere. it is possible they could spread it to close family members or health care workers if their infection is not rapidly identified. but we are confident that there will not be a large ebola outbreak in the united states. we are confident we have the facilities to isolate patients, not only the highly advanced ones like at emery, but at every major hospital in the u.s. what is 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, prodeviding, and treating patients, and guidance for flight crews, and cargo 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. that's something we will certainly do. we can focus not only on stopping outbreaks but putting in position response systems that will find and stop future outbreaks of ebola and other threats. we face in this country a perfect storm of vulnerability like emergence of ebola,

intentionally created infections which remain a real threat. but we have unique opportunities to confront nem with stronger technology, more political commitment, and success stories on real progress from around the world. earlier in 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 preventing the next outbreak. the second document that we've provided for you, provides a summary of what the mapping is between what we launched back in february before this outbreak was joan or reported to have started and what's needed to stop the ebola outbreak, and they are closely aligned. the president's budget includes a request of 45 million to c.d.c. to l help with the detection and response. former under-secretary of state for africa said to me citing

is decade of work that "c.d.c. is the 911 for the world." though i was happy to hear that, i feel that what we manhattan to make sure is that every country or every region has its own public health 911. that will be good for us, it will be good for public safety. expanding that type of work, strengthening global health security will not only help us stop this outbreak but also prevent future outbreaks and stop them faster if they occur. thank you so much for your interest in this. >> dr. frieden, thank you for that comprehensive and insightful testimony. i would like to yield to dr. pablos mendez. >> thank you for that introduction. thank you for your long-standing support to stop

ebola. because this has never occurred in this region, and as we eard from tom, spreading to and beyond the region. i am, like many of you, sadened to see the loss of life by this outbreak but also by the roughter economic disruption this is inflicting in the region. what is really a series of fledgling democracies in western africa. the community has known how to deal with ebola. there have been 30 outbreaks in central africa.

the support we provided allow them to be contained. in 2008 saw a two thirds reduction. in the last outbreak, there were only 32. systems can deal with this outbreak. . we know exactly what to do. the u.s. provides routine

toding in geneva and africa help with planning and response. they're part of the machinery. laboratories were almost 500 new viruses of been detected. this particular virus is familiar to us and as far as we can tell, it it's really the same virus. it is not a new come a mutant virus that has taken over. ares the same virus we familiar with, but it has becausea new region bats tested positive in central africa have now tested positive in west africa. the work we do has to be kept in mind. neither the new systems of the people in western africa were

experienced in dealing with the outbreak. sad has targeted the response in western africa. we started with $1 million investments. withs been reforms to $12.4 million to support cdc and the like. it is important to note that the outbreak in sierra leone and started, inably retrospect, earlier on. but the cases were identified late. for a couple of weeks, we have the outbreak and then it went down. the initial outbreaks one down. -- went down.

one case can reignite the whole thing. that is what we have seen. it has been difficult to control. this investment has allowed us providewith unicef to 30 experts, additional operational support, 35 thousand sets of protective personal equipment and the basics. soap, water you read those things are important in this type of situation. usaid is closely coordinating its responses. the cdc has the lead in the response to the ebola outbreak. has been trulyn exemplary. i want to point that out. the coordination has been

that weto make sure stop this outbreak. the have employed architecture of the u.s. government on the ground and the dart is now deployed and the deputy team leaders are in place. cdc leaders are responsible for the health and medical part of this response. there are plenty of other activities and planning. engaging the knowledge with the local governments and other partners. i spoke with their mission director and liberia where we

have a large platform for work. in sierra leone, we did not have a mission. we are building and working with extras on the ground to facilitate the work. our teams are staying put. and outbreak requires operation. to avoid the growth of the since these viruses know no borders.

it is a national security priority to contain this ebola outbreak as quickly as possible. it would take months to end it, but we can turn around the tables in the next couple of isks, if the robust response employed and executed as planned. we are confident that we can stop the epidemic and it might take several months. we must assist developing countries in strengthening their own health systems. it is about and communities. ebola is in western africa. we have seen h1n1 coming from mexico. these pathogens can jump anywhere.

and we have to be prepared to deal with these things as they occur. we are prepared to make this our priority in africa and also demonstration is working on the global health security agenda for which we look to work with you and in the plans because that would require support in the future and we look forward to working with you on that. thank you very much for giving me this opportunity and i look forward to your questions. >> doctor, thank you very much for your testimony and leadership. i would like to note we have been joined by augustine who is the foreign minister of liberia. thank you for being with us today. this is one of the most daunting diseases this country has faced. today more than 1500 cases have been reported including over 900 total deaths. although the 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, and sierra leone. providing frontline medical care to patients is hard-pressed to continue to provide care in all affected regions.

the ngo community has been 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 virus and widespread mistrust of healthcare 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 led locals to block access to

patients and in some cases led to attacks on healthcare workers. in one such incident in liberia, major care providers have begun pulling out of the region due to concerns for the safety of their staff. in addition to proper medical care, there is a critical need for effective health campaigns and public outreach as a crucial component of the response efforts. we are reaching out to ensure our response is coordinated with the w.h.o. and other countries that can assist both through your representatives at w.h.o. headquarters in geneva and

through directed discussion with other governments. guinea, liberia, and sierra leone are still recovering from lengthy conflicts. this was especially acute in liberia and sierra leone where the fighting went on for years. they have taken important steps to reverse the deterioration and neglect. border control and other factors key to checking ebola spread also are challenging for the countries in the region. aside from our interest in making sure the ebola virus does not spread to the united states or farther in africa, we do not want the virus to erode the capacity of countries to address other important national and regional challenges. we want to ensure these countries remain strong, strategic allies to the united states. sadly, this virus already has impacted peace-keeping in somalia. the african union canceled a plan deployment of peacekeeping force due to fears that the virus could be introduce inside

the country. 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 controllity spread. we are confident that through the concerted and coordinated efforts of our government and our 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 tasks force may be reached at the following e-mail address. taskforce-5@ state.gov. the department has maintained close contact and coordination and closely monitored operational plans to combat the viral outbreak.

in sierra leone, set up a presidential task force. in guinea, improved messaging helped healthcare providers gain access to infected regions, and in liberia the president announced a national task force to combat the spread of the virus. on august 1, the three presidents detailed their collective strategies for eradicating the virus in a joint communique following a meeting of the manu river union. we commend all three countries for taking the outbreak seriously and taking concrete steps to address it. this week's news of a case in lagos, nigeria make need for a national plan and national response more important than ever. i just met today with those who told me that the health ministers of the three affected

states will meet again at the end of this week on august 11 through 14. and that following that the health ministers of all of the states will meet on august 28. the intensified attention of the health ministers of the entire region is a good sign and demonstrates that the whole region is seized with this crisis. assistant secretary greenfield has spoken to the presidents of guinea, liberia and sierra leone. on august 4, the department hosted a moderated a meeting 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, c.d.c. director, and n.i.h. directors,

assistant administrator for global health and the liberian minister and professor, the president of the nigerian academy of science participated in the meeting. representatives from d.o.d., and the world bank and 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 healthcare 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 healthcare workers 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 affects countries. the organization has also launched a $100 million emergency response plan to search -- to mount a more effective response. we are in continuous discussions to find new ways to provide assistance. the department 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. two additional citizens affiliated with the response organizations have been infected

in liberia and are currently undergoing treatment. we are in close contact with the sponsoring organizations of those two structurally deficient bridges 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. warnings to resident and traveling u.s. citizens. we continue to take steps to educate citizens about the virus. and we also take the safety and well-being of our staff 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. addition aally, 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 neighboring countries like mali, senegal and

togo also held meetings and to make contingency plans for embassy personnel and resident citizens in the event of an outbreak. in closing, mr. chairman, i would like to reiterate and assure this committee that the department of state takes the ebola threat very seriously and we are fully dedicated to working with our governmental and nongovernmental allies, the interagency community and host governments in the affected countries to respond to this crisis, prevent its spread and to restore stability to the region. i thank you for your attention to this issue and look forward to answering your questions. >> thank you so very much. ambassador williams. i do have a few questions to pose. beginning first as, dr. frieden, you said supportive services are important with no vaccine or drug treatment, you noted hydration and antibiotics to deal with some of the other co-infections.

is there any disproportionality in result when it comes to whether or not he would are talking about an elderly person, a woman, a man, a child, a woman who happens to be pregnant or someone who has a compromised immune system? what has been the m.o. of that, if you could? secondly, i know that treatment centers, for example, in guinea there is three to four treatment centers but it is hard for people in that country as well as the others liberia and sierra leone to get to the treatment centers. a long trek. not only the person is very sick, others could come in contact with him or her. there seems to be an overwhelming need. one of the points that i think needs to be underscored that is underappreciated in many places is that in dealing with someone who is dying, especially in that

part of the world, there is a psychological trauma alone. almost exacerbates the spread of the disease because people want to be around, near, touching when this person is highly infectious, that is when family members and others might get it if you could speak to that. the lack of testing. testing areas, whether as part of the treatment centers, whether it is a testing lab, it is my understanding especially since this masks and parallels what other -- looks like other things but it is ebola but unless you get this test back, how long does it take to do the test? i know especially through the work with the bush program and to followed up with obama, the building health capacity and labs in africa is a very high priority and now we are seeing

where inadequate labs or lack of labs leads to people being sick and not even knowing it. the courage of the healthcare workers, i think needs exclamation points. i know you go on the frontline all three of you into contagious areas. but dr. brantley and ms. writebol and others who put their lives on the line motivated so often by faith in the case of dr. brantley. i read some of the things his wife put out and the prayers offered up not just for him but for all of the victims. in liberia there have been 60 healthcare workers infected. 35 are dead. in guinea, 33 healthcare workers infected, 20 dead. how does a country now attract or retain healthcare workers who say we went to that arena the

prospects of me getting this are very real. is there enough protective equipment? the gowns, to mitigate the possibility of transfer? and finally, and i do have other questions but i yield to my colleagues. promising drugs. zmat is one of them. the phase one trials and the f.d.a. has a hold on it. they were contracted by the department of defense. from what i read, and it is only when i read the available data it was showing promise. i'm not sure if there is any way to accelerate knowing that you want to obviously put something out there that is risky because ebola is not 100% fatal, as we all mow. we don't want people getting sick from the remedy or supposed remedy. what about accelerating this? is there an effort to do that. and my final we is about the safety of air flight.

many people have contacted my office to as certain how safe is it to fly perhaps next to somebody who maybe changed flights en route to the united states coming from liberia for example? and are the efforts at the airports, particularly where there is a large population, i don't know if you have enhanced efforts there where there is people from west africa are more likely to go, but are they up to the task of detecting at point of embarkation passengers who might be sick from ebola? >> let me try to quickly give you clear answers to all of those questions. the first is a relative case fatality rate of different groups and in the current outbreak the data is still too foggy for us to give you clear data. there is not the kind of robust data that we will have eventually.

there is one intriguing historical fact which i think is worth mentioning. in 1967 there was a laboratory accident in marburg, germany. the marburg virus was then identified. it was a similar fatality rate to ebola. if anything, a little higher, around 80%. outbreaks in the 80% range in a africa. in germany it was 23%. that might have been because of the better supportive care. there was no specific antiviral treatment. or might have been because people were healthier going in. it was interest mattically different and that is an important point. good supportive healthcare is a proven way of saving lives. and we should never lose sight of that. second, in terms of treatment centers you are correct that there is a challenge in getting to treatment centers and that is

in fact the number one priority for the dart team which u.s.a. id is convening and c.d.c. is leading the med caglia health aspects of on the ground today in liberia to assess. the biggest challenge in the city of montori rovey and in the trihundredtry area. looking at whether one facility or multiple facilities a and where the facilities would be is a critical issue for us to determine in the coming days. 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. 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 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 guinea was not only what 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 .

>> i wanted to know if you could talk a little bit more about the disease. everybody with a fever is running in and being concerned. did you talk a little bit more about what are the other symptoms of the disease? maybe if you have any thoughts about why some folks are surviving. is that itnding takes over the immune system. fevers can be one symptom. chills, weakness, nausea, vomiting, diarrhea, other symptoms. in 45% of cases, there is bleeding, internal and external. these are symptoms which are not specific to ebola.

that is why the laboratory testing is so important. it is not the case that someone will know they have ebola and go to a special ebola unit. in this country, we have told health-care workers to take a travel history. tests. we have had five people in different parts of the u.s. who and from a travel history five have turned out to not have ebola. one had malaria, one had influenza, others had something else. be a high index of suspicion so the doctors will rapidly isolate the person and rapidly test them. >> how do you screen?

if someone sees someone with a -- there are pictures in the news of these wands are there doing some type of screen. it is really not effective. screen short of a blood test in a facility. if someone does have -- >> for , we havethin the u.s. a test that is accurate and relatively quick. the department of defense also has a test. we are working in collaboration with them to see if we can get the test out to the laboratory response network. this is a network that cdc

coordinates to test for dangerous pathogens. ebola is not in their usual network. this would be a new procedure. orher through the defense other aspects, we can look to getting that available. that way they could be tested locally. we also have safe ways for them to be transported to cdc of the need to be transported. >> we touched on the z matt. i would like to talk a little bit about that. there is a lot of concern that we may have access to this and we are not providing better access. one of the things that i think was a mention was that there might only be a couple of doses that were even made. first, i would like to refer

you to the national institutes of health. the information i have on that medication is quite indirect. it is a combination of different antibodies. there is some evidence. but i think i would caution that .e really don't know we hope that they and every other person with ebola will get better. we will not know from their experience whether these drugs work. part ofes are only one the response to the on this. antibodies can make the disease

course worse in some cases. i also cannot tell you definitively how many such courses there are. have heard that there are a handful. fewer than the fingers of one hand. i have no direct information on that. we have heard from some companies that it would take months to make a few dozen courses. we don't have definitive information. i would refer you to the national institutes of health. let's always go back to the basics. has ebola, we know how to support them to reduce treatingof death, by other infections when they get sick, providing hydration, fluids, blood transfusions. these are proven things.

if there is a new treatment, we will do everything we can to help get it out to those who need it most. we would also be very interested in a vaccine. a vaccine, we would offer it to health-care workers has a way of protecting them. we are months or a year away from everything i have seen and from significant quantities of either drugs or a vaccine, even if everything goes well and we are able to develop them. that could change. that is the information i have now. >> it has not helped when it is reported that the one individual had a miraculous turnaround and was able to walk out of the ambulance because he had gotten the treatment. that leads to the belief that there is some kind of cure out there that we know about that we are not sharing. looking at the death rates of

the different countries, there is a difference. i wanted to know from the panelists, what do you see causing the difference and is at a situation where each of the countries have addressed the ?utbreak differently >> the data is still very fluid. ofis not clear that each those rates is actually comparable given the different ways aces are diagnosed, counted, and reported. each of the countries have their own challenges. ginny is probably furthest along in responding. they have reduced the number of cases. area seems to be a core epicenter. security problems in liberia

have led to treatment facilities not being available in liberia, patience moving over to g iunea. be a core first deliverable of the dart team that usaid is leaving -- leading. to identify in that region what can be provided rapidly to patients.h caring for the fact is that even if there were more cases that we , theot recognized percentage can very. , we are seeing that the disease is quite deadly. in ginny, there has been -- in

guinea, people think that if you're going to get it you're going to die, there is the motivation to get services or protect families. education has been paramount. we have seen a plateau of the because of the last the border area. hasresponse guinea implemented has been very important, both for the patients and the health workers. the personal protective equipment will be available. we are having more equipment that is to be prepared to protect health workers. trying to dos are their best to save lives of other people. 120 plus of them have already died in this outbreak are true heroes.

support for health workers is paramount. we are committed to doing that. when we mentioned earlier that the state department has advised hundreds of our staff to leave the countries, it is not so much -- it is because the health care system is overwhelmed. also, kids who start school, school monopoly opening. -- may not be opening. ctor, you have mentioned a couple of different figures. you said the protective gear. what was the difference?

did i get the mixed up. maybe it was a different time. has it reached the area? i was speaking to president johnson and she was very concerned and expressed the need for additional units of protective gear. units were part of the first batch that we mobilized early on in the epidemic. we already had some of them in strategic storage locations. the question is the logistics of distribution. that is where the dart team deployed will make sure that they reach everywhere we require. with the additional resources we are mobilizing, we will reach 70,000, which is the number you have seen. it is a production part. they have to be prepared to rid we expect to reach 70,000 -- 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. that can be a rut where airlines flights. -- a route where airlines flights could go. 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 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. 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. did 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. i don't know at this point the history of it. the epicenter is for us did the forest did area -- fores area that have a 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. >> you were an ambassador. you often year. 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. what other donor nations have gotten involved? 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. the french have been very

active. they have laboratory services. the british have also been very active. and have provided resources on the ground. the world bank has committed $60 million to $70 million for the aergency responses and longer-term response. as you may be aware, they issued $100 billion to respond to be outbreaks . we have been in close court nation with many of our colleagues around the world. >> has the white house asked them to be involved? the germans have a history in africa. the french have a history in africa. 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?

>> ambassadors have met in geneva from the various countries. the british government particularly is supporting the response in sierra leone. france is supporting the response in guinea. 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 the geographic location of the division of labor is already underway. the cdc presence is in all of these countries. >> has the african union been engaged? >> 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. the outbreaks fizzled. this is typical of the outbreaks in central africa. for a month, there were not many new cases. in fact, the early behavior of the outbreak was like previous outbreaks. it was not like other areas where we have seen the expansion. in guinea, it has been after the initial outbreak.

>> are the chinese involved, who historically have invested in soccer stadiums in africa. are they involved? is the chinese government, which is invested in 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. i would like to reiterate that the subset of the regional governments, they are meeting this week and then 10 days after that. >> 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?

on the 28th it was very difficult to rid -- it was very difficult. let me just say again to dr. frieden, he took the call, got off the airplane. is there one place he 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? >> and terms of the global the key is to support the world health organization which is the lead for the overall response. >> is there an individual who is responsible who is your personal contact? >> yes. >> thank you. >> before we go to our next

panel, any additional questions? 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 nine mistakes 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.

to try to find new tools. on the other hand, 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 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. >> 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 hashe has served as directore office of foreign disaster assistance within 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 easy open ethiopian emergency responses. he has more than 27 years experience working in the disaster relief field. he is currently leading the samaritans purse organizational efforts in liberia in response to the ebola epidemic. we will then hear from dr. frank glover, the director of the