medical center. he still gets an $11,000 bonus at the end of the year. these bureaucrats are living on easy street. they are putting us on the road to serfdom. think about what has happened as a result. our government has truly been hijacked by people that don't share our values, don't value our freedom. they put the state ahead of the individual. our president is presiding over the downgrading of our economy and the degrading of our constitutional rights. but you and i have a rendezvous with destiny. because we are going to elect the president of the united

states that will fully repeal the obama health law. a president who will reign in the power and cost and size of this behemoth federal government. we should eliminate the department of energy, environmental protection, education, and most importantly, let's get rid of the department of the interior. the land belongs to us not the federal government. that's right. and we will elect a president that takes seriously his or her oath to defend the constitution of the united states, the greatest document created by mankind. the fight of our lifetimes. this is a fight we must win

because you and i know one thing for sure. freedom isn't free. it's up to you and me. thank you. thank you. we can do this. thank you. thank you. thank you very much. >> thank you so much. recentr today, a discussion with the former secretary of state, madeleine albright, and condoleezza rice, along with robert gates. russialk about u.s. and relations another foreign-policy issues, including ukraine, iraq, and the u.s. role abroad. we have that at 4:30 eastern time. this month, c-span presents

debate on what makes america great. evolution, genetically modified food. issue spotlight with benefit health care, student loan debt, and sexual assault on campus. discussions include global warming, voting rights, fighting infectious disease, and food safety. and our history tour, showing sites and sounds from america's historic places. let us know what you think about the programs you are watching. call us or e-mail us. join the conversation. like us on facebook, follow us on twitter. summoned news about the ebola virus separate. some samples were sent to the cdc. a man from saudi arabia, who died from those symptoms, did not have the virus.

the man, 40 years old, he died last week after returning from a region in africa that had seen an outbreak of the virus. cdc is conducting additional tests to further confirm the negative results and see if another virus might be to blame. to date, he was the only person in saudi arabia infected. outbreak in west africa was the topic of a recent hearing on capitol hill. the head of the cdc testified about what they're doing to monitor the situation. the committee also heard from two missionary groups working in west africa, that included two american to later contracted ebola. they are now being monitored and treated in the u.s. so far, over 900 people have died. this hearing is 2.5 hours.

>> 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 throat and stomach aches. 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 that are suspected of being a primary transmitter of ebola to humans in west africa. the virus is transmitted to humans with close contact in the blood, secretions or other organs of infected animals. some health workers such as the heroic american missionary aid workers contracted the disease despite taking every precaution while helping ebola patients. both of them are now being treated at emory hospital in atlanta, georgia in an isolated unit after being flown to the u.s. in a specially equipped air

ambulance. while there is no known cure for ebola, the doctors have been given doses of the next bear mental antivirus cocktail developed by san diego company. they are reportedly both feeling stronger after receiving the drug but it is considered too early to tell whether the drug itself caused the improvement in their conditions will stop the pharmaceutical company has been working with an arm of the 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 that it works in the two americans who bravely agreed to test it and it has a positive effect.

that would mean 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 iris, but not -- zaire ebola virus, but not in humans. unfortunately, it impacts the ability of the international community and assisting the government to meet the self challenge. some of the leading doctors in those countries have died treating ebola victims. the nongovernmental and american personnel there say they are

besieged not only because they are among the lay medical personnel treating these exponentially spreading disease that because they are under suspicion by some people in these countries who are familiar with this disease and -- who are unfamiliar with this disease and fear doctors may have brought it with them. it is untrue and myths abound. the current outbreak as we know is unprecedented. many people are not cooperating with efforts to contain the disease. there is an information gap. despite the efforts through cell phone and radio to get the message out, there is a learning curve. 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 an 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 pathogens that is proportionally impact individuals living in extreme poverty, especially in developing countries. it ebola had been thought to be limited to areas where it could be contained. we know that is no longer true. we need to take seriously the effort to devise more effective means of addressing this and all neglected tropical diseases. i now yield to my good friend and colleague, the ranking member.

>> mr. chairman, thank you for your leadership and calling today's emergency hearing to give us an opportunity to learn about and work to address the current ebola outbreak in west africa. i look forward to hearing directly from our witnesses on the work their agencies are doing to combat the deadly outbreak and how they have coordinated with the government of impacted countries. i appreciate their efforts at outreach to keep congress informed on this devastating situation. this outbreak comes as nearly 50 african heads of state join us here in washington dc this week as part of the first in history u.s.-africa leaders summit. i have been honored to join my african and american colleagues as we join together to reach the full capacity and promise of the african continent. we had several production sessions that further cemented the relationships between u.s. and african nations and highlighted opportunities for us to continue to work together.

despite the meaningful dialogue and collaboration that occurred this week, there is still work to be done. 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 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 immunities among governments and health care professionals do not have the expertise and capacity to address the scale, spread, and proper treatment of the outbreak. this lack of logistical expertise, health care workforce and supplies has hindered the ability of governments to identify, track and isolate new cases and properly care for those infected. officials have had to fight against fear of the disease and culture -- the literal unfamiliarity with robert treatment which has really contribute to the spread and cap people from seeking care. yesterday, i had the privilege

to speak to president ellen johnson about the impact on her country and the work they have done to fight the disease. i asked what more we could be doing and one thing she talked about was the need for logistical support, the need for training of their health care workforce so they would know how to prevent the disease. 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 and then routine medical care has suffered because there has not been the workforce to be able to handle both will stop so the call for increased international assistance to provide food and water to impacted communities -- she said the communities that were most

heavily impacted were quarantined and that there needed to be food and water brought into the areas, especially in situations like this where you have a concern civil unrest, there could be an outbreak in areas that are quarantined and feel they do not have access. 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 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, and now nigeria. although i'm not a member, 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 almost any other groups around. so i want to commend samaritans purse and doctors without borders. wherever you go in africa, they will either one other groups have long gone. samaritans purse is on the front line, working to curtail the ebola outbreak.

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 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 will stop -- to catch up. this requires efforts from agencies and countries, france, great britain, many of the countries experienced in africa should be brought in. it has also come to my attention

that there seems to be deficiencies in the planning procedures and protocols in response to the ebola threat . 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. i want to thank chairman smith for calling this hearing during the august recess and i also want to recognize the men and women of the cdc and other international response groups who are on the ground and soon will be on the ground in africa as well as the doctors and nurses helping the two patients in atlanta. i want to thank them because this is very dangerous, what a will be doing all stop and people we do not know their names, we should tell them we appreciate them. i want to thank the state department and department of defense for their invaluable assistance as this thing is taking place. this is important and serious work and i knew if the american people if they knew what was being done would appreciate their efforts. this should be a very top priority of the white house, the political leadership of the nation. you know with the career people

are going to do, but the white house, the american people deserve to know what their government is doing to prevent the spread of this epidemic and keep the country safe. with that, mr. chairman, thank you and i yield back. >> i would like to now introduce our first panel of two panels. the getting first with dr. tom frieden, who has been the director of the centers of disease control since june of 2009 and has worked to control infectious diseases in the united states and globally. he led new york city's program to control tuberculosis and reduced the multidrug resistant cases by 80% and worked in india for five years, helping to build a tuberculosis control program that has saved nearly 3 million lives. 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, doctor, 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 foreign service with the rank of mr. counselor -- minister consular and deputy of affairs at the department state. she serves as ambassador to the republic of niger and has served at u.s. in the season hannah montana france and guinea. her postings have included director for international organizations in national security council at the white house and advisor at the u.s. mission to the united nations in new york. without objection, fuller resumes conair deep and distinguished, but they will be entered as part of the record. dr. frieden, the floor is yours. >> inc. you very much for your interest in global health, your interest in ebola and calling this hearing at this critical and pivotal time.

first, let's are member the lives and faces of the men, women and children who are affected 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 -- 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 through contact with infectious body fluids. it does not spread through casual contact. it is not an airborne disease, does not spread through water or food. and incubation time is usually between eight and 10 days from exposure to onset of illness. it can be as short as two days and possibly as long as 21 days. but in that time, it is essential any contact he closely 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 full we have been able to stop every ebola outbreak today and i am confident that if we do what works, we will stop this one also. but it won't be quick and it won't be easy. it requires meticulous attention to detail. if you leave behind even a single burning ember, it's like a forest fire. it flares back up. one patient not isolated, not diagnose, one health-care worker not protected, one contact not traced, each of those lapses can result in another train of -- another chain of transmission. to control the outbreak, we have to work effectively. the challenge is not the strategy, it's the implementation. mr. chairman, we have provided to the committee this basic

informational information on how ebola can be controlled. if you would permit me, i will just go very quickly through this. i think it is important to get the fundamentals. first, find patients and diagnose them. that means fever or other symptoms. the only way to diagnose us with laboratory intervention. is by working with partners from the department of defense, from france, from other countries. and from countries where the disease is present. they're scaling the ability to diagnose patient. first, the diagnosis is fever. , blood tested in the lab. the next of us to respond to individual cases. we do that by putting patients in isolation. by interviewing them and anditing their contacts

then by following each and every contact every day for 21 days. fever, contact develops begin the process all over again. interview them, isolate them, find out who their contacts are. it is laborious, it is hard. it requires local knowledge and local action. but that is how it is stopped. third, prevent it. convention control and health care, safe burial practices. and reducing the consumption of bush meat and contact with bats. the current outbreak is a crisis. it is unprecedented. it is unprecedented in five ways. first, it is the largest topic ever. with the current trend, there will be more cases in this outbreak then in all previous recognized outbreaks together. second, it is multicountry. one of the biggest challenges is

that one of the epicenters is on the confluence of three different countries. cases have moved between countries. one country get control, then they come from another country. that primary is a critical challenge. third, this is the first outbreak in west africa. it was unknown as far as we know in that area before. because of this, it has been a particular challenge to the health systems in this country. they are quite weak. ourth, many of the victims have been in urban areas. there has been spread in urban areas. this is something we have not before.this extent from everything we know to date, there does not appear to be a change in the virus. it is a new development in solving where the virus is spreading. it makes control much more difficult. we are having to deal with it in the united states.

that is not merely because of two people who became ill caring for a full of patients who were brought back to the u.s.. that is primarily because we are all connected. inevitably, there will be travelers who go from these three countries or lagos and are here with symptoms. so symptoms may be ebola, or something else. we will have to deal with it in a way we never have before. the u.s. is working in a coordinated way to support other governments and the world health organization. i have activated the cdc centerncy operations at level one for this outbreak. this is our highest level of response. it does not mean an increased risk to americans. it does mean we are taking an extensive effort to make sure we do everything we can to stop the operate. we cannot do it alone. there are many partners we are working with.

world health organization, world bank. governments around the world, as well as -- people in country. they will be key to stopping this outbreak. we will spend at least 50 staff to the region within the next week or two. but, i think it is important to understand that the people in country are supportive at her home base in atlanta by a much larger group. as of today, even before the full activation, we have more than 200 staff working on this outbreak response. we will increase that number substantially in the coming days and weeks. about theear more work that we're doing with the u.s. agency for international development. we are using an unprecedented model to work together in a collaborative way to identify and calling for reinforcements. we finish this response, we

are determined that not only will we stop the outbreak, but leave behind strong systems that will be better at finding the disease and other threats and stopping it before it spreads and preventing in the first place. if those symptoms have been there in the first place, we would not be here. the outbreak would be over already. we do not know how to treat people. we do not know how to vaccinate. we do not know how to cure it. we do know how to help people with ebola. the plain fact is, we do not know whether treatment is helpful, harmful, or does not have 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 saves people's lives. giving them fluid, making sure they are not over or under the

fluid balance. treating infections that occur. providing good quality health care. we are currently coordinating , fda, and others. there is a lot we do not know yet. it is important that we keep in we do know, even without medicines specific to ebola, we do know how to control this and we can stop it. i want to spend a moment on what we're doing to protect people in this country. first off, the single most important thing we can do is to stop the outbreak. stop it at the source. the second issue we are working on is to help these countries do of screening people in their countries to screen out those who are ill or incubating ebola. we recognize that we are

interconnected and working closely with state and local health departments and health providers throughout the united states. we want them to be aware that there are people who could come from the three countries who could come in with fever or other symptoms that could be ebola. we immediately place them in the hospital and get them tested. we have issued a level three travel advisory against all nonessential travel to save the -- liberia. we will reassess the nigerian situation daily or more frequently as needed. there is a strict infection control possible in hospitals in the u.s.. there has been some misconceptions. as easy to spread as the flu. the stakes are so high. the infection control could be fatal with a single lapse.

the key is to identify rapidly and strictly follow up on guidance. it is certainly possible that we could have ill people in the u.s. who develop ebola after being exposed elsewhere. couldpossible that they spread to close family members or health care workers if the infection is not rapidly identified. we are confident that there will not be a large evil outbreak in the u.s. we are confident we have the facilities here to isolate, not only the highly advanced ones like those at emory, but virtually every major hospital in the u.s. what is needed is not fancy equipment. what is needed is standard infection control. guidance onased identifying and diagnosing. we have guidance for airline flight foods and cargo personnel. be fundamentally and here.

we have three rows before us. we can do nothing and let the outbreak rate. i do not think anyone wants to do that. we can focus on stopping these outbreaks and that is something we will certainly do. or, we can focus not only on stopping these outbreaks, but also on putting in place laboratories. the emergency response systems that will find, stop, and prevent future outbreaks. ofdo face a perfect storm vulnerability with emerging infections like ebola. there are intentionally created infections that remain a real threat. we have unique opportunities to confront them with stronger technology and more commitment and success stories on real progress from around the world. year, the u.s. joined with the world health organization and more than two dozen other countries to launch a global health initiative.

that agenda is exactly what we need for it to make progress not only in stopping ebola, but in preventing the next outbreak. the next document that we provided for you provides a summary of what the mapping is between what we launched back in february before this outbreak was known, and what is needed to stop the outbreak. there closely aligned. the president's budget has a request of $45 million to accelerate the prevention and response. a former secretary of state said to me -- citing decades of war, that cdc is the 911 of the world. though i was happy to hear that, i realize that really what we want is to make sure that every country or every region has its own public health 911. that will be good for them. it will be good for us in terms

of safety and food, economic and social stability, and expanding that type of work, strengthening security will allow us not only to stop this outbreak, but also prevent future outbreaks. thank you so much for your help. >> thank you very much for that summary. i would like to know yield back to pablo's mendes. >> thank you. thank you for this opportunity. it is very timely, to allow international development to present where we are with this outbreak in western africa. there has been a long-standing supporter of this area. we need to have better champions in this emergency. the issue in western africa is historic trip it has never

really occurred in this region. cities andding to beyond the region. devastation and loss of life caused by this outbreak. but also, the social and economic destruction in the region. really a set of democracies in western africa. the good news is, we know how to deal with ebola. been arty outbreaks in western africa. each of those have been contained. the system has to be perfect. it has to be familiar. there is a record that is worth noting. in 2000, there were 425 cases without outbreak. that outbreak is now contained.

in 2008. that was a two thirds reduction. in 2011 and 2012, the number was lower. systems can deal with this outbreak. we have shown this many times. we know what to do. we appreciate the support they gave us all along. it requires repeat funding. we need to have planning and thatnse and the machinery has been put in place here. asia, there are 400 or 500 new viruses. there's a lot going on all the time. ebola is familiar to us. from aas we can tell,

biological and genetic point of view -- it is a mutant virus that has taken on new powers. it has entered a new region. it has tested positive in africa. the psychological dimension has to be kept in mind. ,ecause of the novelty of this and the immune systems of people in western africa, we are experienced with dealing with the outbreak. u.s. ade has also targeted the response in western africa. we also started supporting and $4ents to unicef, million to support. indeed, it is important to note that the chairman's comments --

ehe outbreak in sierra leon and liberia started in wretch retrospect, we can see it was earlier on. the cases were in the march. for a couple weeks, we have this outbreak. then, in the spring, the initial outbreak went down. if you allow one case -- they can reignite the whole thing. that is what we have seen. so far, it has been truly difficult to control. unicef torked with allow to deploy 30 or so technical experts and provide additional operational support. 35,000 additional sets of equipment and supplies. also, it is very important in this situation -- it is taking place as we speak.

servicestment of state and department of defense -- thecdc has responded to outbreak, and the coordination -- i have been part of many efforts. i want to really put that out. it is something in the last couple of weeks that we have been working, to make sure that we support those guys. to stop this outbreak. has has been that the -- enacted an emergency response. this provides the architecture for the response of the u.s. government. there is an ambassador on the ground who declared an emergency. y are now deployed and

the leaders are in place. cdc is responsible for the health and medical part of this response. there are plenty of other activities in planning and operations and communications in the government. i spoke with our mission director in liberia, where we large platform that works very closely with the minister of health. we have one in sierra leone. build been a mission to with the cdc and others, to require people on the ground. i want to report that the morale is high. although the family members have been ordered -- our teams are staying put. working with cdc, unicef, and

others. they ensure their safety, but also support working effectively against this outbreak. this reminds us that an outbreak also requires information. to avoid the growth of this epidemic, but also to contain, since this virus knows no borders. it is imperative that national security contains this outbreak as quickly as possible. it will take probably months, but i think that we can turn around the tables in the next couple of weeks if the proposal has been mounted and executed as planned. the u.s. government is fully engaged and we are confident that we can stop the epidemic. it will not be easy and it may take several months. in the long term, we must assist in strengthening their own health systems.

for those who are educated, and also others -- it is about the work in primary care settings. this time, the evil is in western africa. we did not expect that. these can jump anywhere. we have to be prepared to deal with these things as they occur. willyour support, usad begin with investments in africa. also, the administration is working on the global health security agenda, for which we you and wek with require your support in the future. we look forward to working with you on that. thank you very much for this opportunity. >> thank you very much for your testimony. and for your leadership. i would like to note that we have been joined by augustine, who is the foreign minister of

liberia. thank you for being with us today. minister. now i would like to yield. >> thank you very much, chairman. for the chance to testify before you on this very important topic. in evolving ebola crisis guinea, sierra leone, and now nigeria, is one of the most daunting challenges those countries and the region have faced in decades. 1600 suspectedn and confirmed cases of ebola have been confirmed, including over 900 total debts. although the although these countries are home to dedicated health workers, the lack of the spread of disease reflects the lack of capacity in the three epicenter countries of liberia, guinea, and sierra leone. the ngo community which has

played a significant role in the response effort by providing front-line medical care to patients is hard-pressed to continue to provide care in all affected regions. compounding the issue, affected populations'lack of understanding of the virus and widespread this trust of providers and treatment methods have further hampered response efforts. in significant portions of the affected regions, local havetions such as funerals contributed to the spread of the virus and lead vocals to block access to patients. and in some patients have led to attacks on health care workers. following one incident in liberia, major care providers have begun pulling out of the region due to concerns for the safety of their staff. medicalion to proper care, there is an urgent need for messaging campaigns and

public outreach as a crucial component of these response efforts. we are reaching out to ensure our response is coordinated with the who and other countries that can assist through our representatives at headquarters in geneva and through direct discussion with other governments. -- they are still rebounding from lengthy conflicts that destroyed lives and infrastructure. acute inespecially liberia and sierra leone where the fighting went on for years. these countries have taken important steps to reverse the effects of deterioration and neglect and build lasting security and stability. factorsontrol and other key to checking the spread also are challenging for the countries in this region. aside from our interest in making sure this virus does not

spread to the united states or farther in africa, we do not want the virus to erode the capacity of african countries to address other important challenges. theset to ensure countries remain strong strategic allies to the united states in a region facing serious and relevant and security challenges. virus has already impacted peacekeeping in somalia. the african union canceled a planned deployment of peacekeeping forces due to fears the virus could be introduced into the country. given the critical importance of this issue, we are fully committed to doing everything possible to shore up each government effort to combat the viral outbreak in control its spread. we are confident that through the coordinated efforts of our government and international partners we can contain and stop this fibrous. mr. chairman, the department has established a monitoring group

on the humanitarian situation in west africa to monitor and coordinate information. the task force may be reached at the following e-mail address. since the beginning of the crisis, the department has maintained close contact and coordination with the governments of all the affected countries and closely monitored their operational plans to combat the viral outbreak. in sierra leone, the president elected government officials to make containment of the virus are top priority and set up a presidential task force to lead the efforts. guinea, improved messaging helped them gain access to affected regions. president, the announced a national task force to combat the spread of the virus. on august 1, the three presidents detailed the collective strategy for eradicating the virus following

a meeting. we commend all three countries were taking this outbreak seriously and taking concrete steps to address it. this weeks news of new cases in of overigeria, a city 20 million people, makes the need for a well coordinator national plan and international response more important than ever. with thet today president and head of the commission who told me that the health ministers of the three affected states will meet at the end of this week on august 11 through august 11 14. following that, the health ministers of all states will meet on august 28. the intensified attention of the ministers of the regions is a the sign and demonstrates

region is seized with the crisis. thomas greenfield has spoken to the president's to express support and assure them of our assistance to stop the spread of the virus. on august 4, the department hosted and moderated a meeting on ebola on the sidelines of the u.s.-africa leaders summit to discuss the next steps for controlling and ending the virus. the hhs secretary, the cdc director,and nih usaid assistant administrator for public help, and the president of guinea, the library and minister of foreign affairs, sierra leone's ambassador to the united states, and the president of the nigerian academy of science which is updated in the meeting. theesentatives from dod, world bank, as well as private

partners also joined. in addition to emphasizing the need to focus on detection, isolation, and training for health workers, we also emphasized our long-term commitment to building the health care capacities of individual west african nations beyond this immediate crisis intervention. we continue to work with international partners and the who to assess what is needed to properly treat patients and mount a sustainable response. support has included providing financial and technical assistance to properly equip treatment centers and supporting communication efforts to help health-care workers assess affected communities -- access affected communities. opened july 23er and is coordinating surveillance efforts, harmonizing technical

support, and mobilizing resources to the affected countries. the organization has launched a $100 million emergency response plan to surge resources to mount a more effective response. we are in continuous conversations to provide additional assistance. the department of state has no higher irony than the protection of u.s. citizens could we extend our deep sympathies to the family of patrick sawyer who died after contracting the virus in liberia. at least two other citizens affiliated with response limitations have been affected in liberia and are currently undergoing treatment. we are in close contact with the sponsoring organizations and our thoughts and prayers go to them and their families. u.s. embassies in the affected countries have disseminated security messages including cdc warnings to residents and traveling u.s. citizens.

we continue to take steps to educate citizens about the virus, to dispel rumors, and provide information on preventive measures. we take the safety and well-being of our staff very seriously. to that end, the department's chief of infectious disease traveled to west africa to provide embassy staff with assistance regarding protection methods and case recognition. embassies have- organized town hall meetings to answer questions personnel and citizens. ssies in neighboring countries have held meetings to assess capabilities of their host governments and make contingency plans for personnel and resident citizens in the event of an outbreak. in closing, i would like to reiterate and assure this committee the department of state takes the threat very seriously and are fully dedicated to working with our

governmental and nongovernmental allies and host evan mintz in the affected countries to respond to this crisis, prevent spread, and restore stability to the region. i look forward to answering your questions. >> i do have a few questions for our panel. >> you outline how important services are coming including 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 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 -- if i go into 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. there are a number of promising drugs.

zmapp is one of them. another was in 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 what i read, the available data is showing promise. we don't want to put something out there that is risky because the bullet is not 100% fatal and we do not want people getting sick from the supposedly middy. 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 itice to ascertain how safe is 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 has a similar fatality rate to ebola.

if anything, a little higher, around 80%. outbreaks in the 80% range in a frica. the fatality rate in germany in the marburg outbreak 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. we do know it was dramatically , 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 -- medical help aspects of on the ground today in liberia to assess. the biggest challenge in the city of monrovia and in the five-country 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 -- who was speaking movingly about the patient's and 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 fromed the african society laboratory medicine. 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. this is real-time. the results back within a day but false positives are possible if you are not careful and that would be a real problem. we will scale up the labs that can do testing. we are working with international partners involved and with the defense department which has a very active program for example in sierra leone. it is providing services there and with the national institutes of health. we will also establish safe specimen transport means. we have done this in uganda. into andfely transport out of the lab. 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. it is an issue 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. a key aspect that we are working on with the world health organization and countries and others is making sure there is effective protective equipment there for healthcare workers. we believe it the possible to take care of ebola patients even in africa safely but takes meticulous attention to detail. i can assure you that the u.s. government is looking at promising drugs and we will look at anyway 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 cannot have them in any significant numbers. we hope that will change. 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 . we 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 safest. 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 -- travelers who have traveled with them and as of now have not identified illness in any of them. in general, it is not from a 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?

that would not be construed to be very ill? >> you're not going to get it from someone who is not sick with ebola. if they are just clearing their throat or sneezing or 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. there could be someone on there. does the c.d.c. advise them and the airlines on numerous flights to the region? >> we have provided detailed advice to the airlines. >> ambassador, 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 psyops 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. is there any thought with

helping the countries with a benign effort to make people aware? i know that radio is being used. it seems more needs to be done. any thoughts? >> 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 already described as far as 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 we are helping with the means of the communication but not the actual message because they know best what they need. >> thank you. i.e. yield. >> i wanted to know if you could talk a little bit more about the disease. we all know about fevers. having spent a number of years working in emergency rooms, i can imagine what is happening in our emergency rooms around the country. everybody with a fever is running in and being concerned. if you couldng talk more about the other symptoms. maybe if you have any thoughts

about why some folks are surviving. my understanding is that it 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. that is a feared complication. 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. that is why it is important health facilities think of the risk and rapidly isolate people. in this country, we have told health-care workers to take a travel history. has the person been in one of these countries in the past 21 days?

if yes and they have fever or other symptoms, do tests. we have had five people in different parts of the u.s. who come in with a travel history. all five have turned out to not have ebola. one had malaria, one had influenza, others had something else. we expect this to happen. we want there to be a high index of suspicion so the doctors will rapidly isolate the person and rapidly test them. >> how do you screen? i know what is in the press is if someone on airlines sees someone with a fever. there are pictures in the news of these wands are there doing some type of screen. you have talked about how it is really not effective. how does one screen short of a blood test in a facility.

>> there is no way to diagnose ebola without a laboratory test. and hasne has fever been in one of these countries, they need to be isolated and tested. for people within the u.s., we have a test that is accurate and relatively quick. a few hours once the specimen gets to our lab. 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. coordinates to test for dangerous pathogens. ebola is not in their usual network. this would be a new procedure. either through the defense or other aspects, we can look to getting that available. that way not all tests have to come to the cdc in atlanta. that way they could be tested locally. we also have safe ways for them

to be transported to cdc if they need to be transported. on zmapp. touched i would like you to talk about that. there is concern we have access and are not providing that. one thing it was mentioned that you could maybe elaborate is there might only be a couple of doses made. i would need to refer you to the national institutes of health who is the lead on developing back scenes and treatments against ebola. the information i have on that is quite indirect. my understanding is it is a combination of different antibodies. this is part of what the body does to respond to infection. there is infection -- evidence from at least one animal study they have some affect on illness. i think i would caution that we

really don't know. it has to be emphasized. whatever happens with these two individuals, and we hope they and every person with ebola will get better, as some do. but we will not know from their experience whether these drugs work. antibodies are only one part of our response to illness. there are many different parts to the immune response. in some conditions antibodies , can make the disease course worse in some cases. we will 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 on that. other manufacturers are coming forward to say they have some or could make some. we have heard from some companies that it would take months to make a few dozen courses.

this is rapidly changing information. i don't have definitive information and would refer you to the national institutes of health. let's always go back to the basics. we know how to stop ebola. if a person has ebola, we know how to support them to reduce the risk of death, by treating 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. if there were a vaccine, we would offer it to health-care workers has a way of protecting them. right now we are months or a , year away from everything i have seen and heard 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. what is available to us today right now is the means to stop the outbreak in africa. >> 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. in 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 -- it a situation where each of the countries have addressed the outbreak differently? >> in terms of the death rates, the data is still very fluid. it is not clear that each of those rates is actually

comparable given the different ways the cases are diagnosed counted, and reported. , each of the countries have their own challenges. the country of guinea is probably furthest along in responding. they have reduced the number of cases. they have continued spread and health care facilities. the tri-border area seems to be a core epicenter. security problems in liberia have led to treatment facilities not being available in liberia, s moving over to giunea. it will be a regional response needed for the countries. it will be a core first deliverable of the dart team that usaid 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. one difficulty in establishing the denominator of the epicenter that he is referring to, the fact is even if there were more cases that we recognized, the percentage can vary. on the whole, we are seeing that the disease is quite deadly. but not universally fatal. that is important. guinea, it is an important part of educating the public. if people think that if you're going to get it you're going to die, there is the motivation to the blush no motivation to -- there is no motivation to get services or protect families. education has been paramount. we have seen a plateau of the

outbreak because of the border area. the response guinea has implemented has been very important, both for the patients and the health workers. the personal protective equipment will be available. we had it in storage in the reading. the blush in the region. we are having more equipment that is to be prepared to protect health workers. health workers are trying to do their best to save lives of other people. the 120 plus of them have already died in this outbreak are true heroes. i think support for health workers is paramount. we are committed to doing that. when we mentioned earlier that the state department has advised the families of our staff to is nothe countries, it so much because they are at immediate risk but because the health care system is overwhelmed. if you had anything else, there

is nowhere for you to go to. kids will start school soon. the schools may not be opening. they are asking family members to leave. it is wise even though they are not in immediate danger. >> doctor, you have mentioned a couple of different figures. maybe i have confused them. you said 75000 and 35 thousand pieces of protective gear. what was the difference? did i get them 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. >> the 35,000 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.

one in the region has been made available. the question is the logistics of distribution. that is where the dart team deployed will make sure that they reach the front line workers that require them. with the additional resources we are mobilizing, we will reach 70,000, which is the number you have seen. that is the space suits you have seen. to be prepared. they do not come ready to use. that is where we are now. we expect to reach 70,000 bpe's, as we call them. we also have in neighboring countries some of these available to them. that is for them to become familiar with them in case we need to scale up. ghana has been another where we are paying attention.

that couldbe a route allow us to escape the countries we have today. we are preparing. we have training. we have resources available. >> 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 american 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 coordinating committee talking about it, it has been among the things considered. no american personnel.

no american personnel or their families have been ordered. it is one of the options under consideration, but we will continue to look. our families, our dependence ts 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. i just wanted to make sure you understood. >> the last question, it may have been one of the panelists that referred to the 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, there were text messages across the news that said 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. it is one thing to have this health crisis. the country was still trying to build itself up from a rather torturous past. the president of liberia did declare a disaster in her country as a result of this crisis does she wants the international community to pay attention. she is trying to explain to her people why she is mobilizing and intensified force specifically on ebola. but there is no new security threat. >> thank you. >> thank you, mr. chairman. in what country did this first begin? >> the first cases were reported in guinea. i don't know at this point the history of it. the epicenter is the forested area that has the confluence of the three countries.

>> ambassador williams, we have heard from ambassadors and him -- and embassy staff that washington does not take cables from them seriously. when did washington first get a cable notification from the embassies of guinea, sierra leone, and liberia about the crisis? >> chairman, i will look through my notes to see if i have the exact date. if you could 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. we are in constant contact. i will find the specific answer to your question and get it back to you.

>> you were an ambassador. they say that sometimes the cable gets sent and they wonder . would like to know when the cables were sent and how high in the state department are the -- where 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 -- they're are -- i know what the people there are going through. i will get the answers to your questions as soon as possible. >> you mentioned the work of usaid and others. what other donor nations have got involved in the effort?

what are they doing? can you give us a list of the countries? can you tell us what england and france is doing? give us some specifications as to the numbers and how they are coordinating. it all cannot 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 french have been very active. they have laboratory and others services. the british have also been very active. and have provided resources on the ground. we had an announcement earlier this week from the world bank of a commitment of $60 million to $70 million for the emergency responses and a longer-term response. the world health organization issued an appeal for $100 million to respond to the

outbreaks. we have been in close court nation with 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? has there been a formal request from the white house to the heads of those governments that they participate to help your effort? intensive had conversations with multiple other countries. were you going to say something? >> ambassadors have met in geneva from the various countries. there are many historical linkages. 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 -- in liberia. the response was particularly important there. someone mentioned the emergency put forward a week

ago is for $100 million. 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 announcement of $200 million that would allow us to fill the gap in the plan for the immediate response. invest inn, we will the months to come in strengthening that system in those parts of the world. many things are moving fast and we're are trying to continue that conversation. geneva has been a focus for the donor countries as to resources. the geographic location of the division of labor is already underway. the cdc presence is in all of these countries. >> is the african union engaged? >> the african union has been engaged. to your earlier question, and

27 is whenia, march 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 rekindled again in this three-border area. 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 has invested in soccer stadiums in africa, are they involved ? >> we would 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? -- who do they call? is there one person? is it the cdc? 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 bouncing from here to there. he took the call.

is there one place someone 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? >> in terms of the global collaboration, 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 comprehensive. i do not want to exaggerate or understate, but zmapp, km ebola contracted by our own department of defense. 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?

in his testimony today, the man from samaritans purse who had a profound sense of urgency and thought we needed to be doing more thomas he said it took two americans getting the disease in order for the international community and the united states 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 at least 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 are not as accurate as we would like. there may be cases counted as ebola that are not. there may be many cases not counted that are.

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 do the controlled activities. there are calls will couple times a day on coordination. 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 -- worked together -- work together because it is in all of our best interest, not only to , but tohealth 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 -- programs and government relations for samaritan's purse. he has served as the director of the office of foreign disaster assistance in usaid. he cordon aided -- coordinator the response to the tsunami, dar

southernher suzanne -- sudan and other crises. 27 yearsre than working in the response field and has led ager efforts in dozens of countries. he is currently leading the effort in response to the ebola epidemic. we will then hear from dr. frank glover, 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 turtles -- journals and textbooks. he and his wife founded s.h.i.e.l.d., which 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 developments of the ebola outbreak in west africa and samaritan's purse experience and response there. i will read this one page so i do not forget to say anything i want to say and then i will put the script away to say things that need to be said. -- samaritan's purse has 30 years dedicated to humanitarian relief.

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, and sudan during the genocide of those countries. the ebola outbreak has had a profound impact on our organization, and 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 samaritan's purse in the evacuation of american personnel. we could not have done it without them. we would especially like to call to attention and thank dr. kathleen ferguson, dr. william tty,ers, phil sco congressman wolf, and yourself. we would also like to thank

certain staff members of the cdc and the national institute 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 have worked to contain the ebola crisis in liberia and we were devastated to learn two of our personnel had contracted the deadly virus. the support the u.s. government has shown to our organization is tremendous. 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 by -- having private conversations with leaders. by july, i was writing editorials in "the new york times" saying this was out of control.

in the 32 years since the disease was discovered, there were a total of 2232 infections. which killed 1503 people. present outbreak is going to surpass that in fatalities and overall cases. it is clear to say the diseases is uncontained and it is out of control in africa. 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 w.h.o. is reporting 711 ebola diagnoses and 932 diagnoses and 932 deaths in west africa. 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 e 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 that 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 the times of crisis, i believe that 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. in the furthest months, we were -- in the first months, we were able to provide support to the world health organization, the cdc, the minister of health, and doctors without borders, also known as msf -- with our two aircraft. the only two known aircraft in liberia flying support -- we flew personnel, supplies back and forth across the country. it makes a difference from the triangulation area that dr. frieden was talking about, it reduces it from a 16-hour road trip to a 40-minute

helicopter flight. i want to take a moment to recognize our coworkers and doctors without borders for standing in the trenches with us. they are still 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 was 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 samaritan's purse and doctors without borders.

it was not until july 26 when kent brantly and nancy writebol were confirmed positive 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 saudi 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 no gloves. it is an issue of no millimeter of your skin can be exposed or you will most likely die. that is the reality of it. those two men left our hospital.

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 there are eight more people in isolation. our epidemiologist believes what we are going to see is a spike of disease in nigeria. it will go quiet for 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 that we support 200 miles north of lagos, what they're going to do when ebola comes to them. to fight ebola, 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 the 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 violence 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. 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. 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 strata that i see to turn the disease back. i think turning the tide on the disease has to be focused on containment. to contain it means you have to identify it. the previous panel was saying it could be contained. we have the information. ok. liberia, sierra leone, and 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 have been 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 americans returning to this country and we are grateful for that. while our liberian office remains open doing 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 that are 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 think that 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. but one airplane with one chamber to get them back is a bit of a slow process. lastly, i think i want to say, i 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 sometimes 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. the problem is, if you have six people come in and for our

suspected, you have to put them in a semi-quarantined 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 ofda, 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 would actually produce. i would like to know what it would actually buy. i fear that money alone cannot solve this problem. i disagree with earlier testimony that there is ppe in liberia. that is inaccurate. i have an e-mail i received in the last 90 minutes from the hospital, the sim hospital, they

are asking us for more personal protection gear. this is a problem everywhere. i am in touch with the headquarters of msf in brussels and we are working hand in glove. i appreciate them so much for the way they are fighting this. the biggest challenge that we all have is the logistical support to get the materials and the supplies on the ground to fight this disease. as one of you quoted, if we do not fight and contain this disease in west africa, we will be fighting and containing an multiple other countries around the world. the truth is -- the cat is most likely already out of the bag. i want to thank my staff and recognize them for who had been there and done a valiant job at great risk to their own lives. i want to let you know that the

reintegration back into their country is awkward. people are afraid to get around them. their husbands and their wives do not know if it is safe to hug them. their communities may be ostracize them. we are doing everything that we can in the staff care way 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 in fact citizens of all country -- we have people on that team that came from maybe seven countries -- they all suffer these issues. i believe this is a very nasty and bloody disease. i could give you descriptions of people dying that you cannot even believe. bo i think we have to fight this disease and we have to fight it now. we will fight it here or somewhere else. i am talking about here in west africa, but i do believe that an international coordinated response, something significantly more is needed. thank you. >> thank you very much, mr. isaac, for that testimony and i think for underscoring your

experience in the office of foreign disaster relief. i mean, you have lived it. 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. i thank you for it. dr. glover. >> do, mr. chairman and members of congress, for the opportunity to share with you. my name is dr. frank glover. i am a board-certified urologist. i earned my md 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 in epidemiology. i am also a medical missionary

working with sim, which is a christian missions organization with works in over 60 countries. in addition, i am the president of s.h.i.e.l.d. in africa, a u.s.-based ngo working in liberia. my first experience was in 1988. as a medical student, i did two months doing medical missionary work at a hospital called elwa. eternal love winning africa. i worked at various hospitals throughout liberia. i had teams of doctors and nurses several times a year. during this time period, we're taking care of thousands of medical and surgical patients. i have spent time rendering services of teaching, training, and patient care in most of the counties in liberia. i have therefore had the opportunity to assess many hospitals and clinics throughout liberia. in every case, the hospitals were understaffed and lacking in many basic essentials and pharmaceuticals.

this ebola outbreak in liberia has exposed the country's inherently weak health system. less than 200 doctors existed prior to this epidemic. after the outbreak in march of this year, prior to the ebola outbreak, that number went down to 50. the nurses went on strike or slowed down work in the country due to work grievances. this was true in counties that had been hit hardest by the epidemic. this was just before ebola entered the country. after the outbreak began claiming the lives of the nurses, who did not have protective gear, the nurses fled the hospital. after the second dr. died, all of the hospitals shut down. the patients are too terrified

to into the buildings. the nurses have said they will not return to work unless they are issued adequate protection. gloves, gowns, and goggles. doctors and nurses continue to treat ebola patients. there are five doctors and 77 nurses and aides. this is the only place in the area 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 protests in the local community that did not want ebola patients coming from all over liberia into their community. samaritan's purse will complete an 80-bed 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 owing in part to people seeking treatment.

many patients die within 24 hours of presentation. elwa is the only functioning hospital in the county, a population of one million people where it is located. many patients are dying with 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 in the villages and remote areas. the cause of death is often unknown and there is suspicion towards government health workers. as a result, information is often withheld from government workers. 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, and

emergencies result in death as there are no functioning facilities at this time. the death toll will undoubtedly reach into the tens of thousands in liberia unless immediate actions are taken to increase the capacity to treat patients in isolation, create an effective 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 invest in health care systems strengthening as we prepared to deal with future outbreaks. they stand ready to assist in the building of capacity for west africans by training and producing more african health care professionals. thank you. >> thank you so very much for your lifelong commitment and building up capacity and doing it yourself and working with others at sim. 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 secondly, 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, as dr. brantly certainly did, and ms. writebol. >> 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. 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 that come

out every day from liberia, i don't mean to be dramatic, but it has an atmosphere of "apocalypse now" in it. it is on the cover of the "wall street journal." 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 sticks in the flash of an eye. so they have 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? lagos.

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. brantly was very much involved giving his informed consent and he understood -- as did nancy

writebol -- 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 emory. we appreciate emory. they get good treatment and we pray they survive and can recover their health. >> you pointed out four different areas. let me ask you about the community health partnership. in one cluster of infected individuals, eight out of 12 were community health workers. doctors obviously have a higher degree of training and they understand the importance of protective garb. community health workers might not have that same level of indoctrination of how important that is. in your view, are they much more at risk because they are more

rudimentary? and what they do and therefore are not taking the precautions. >> in my view, yes, they are much more at risk. it is not just -- if you look at the disease, vomiting, diarrhea, i guess that is 50% of all presented to them. it puts them in untenable and weak positions in being exposed to the disease and not exactly knowing what it is. i am i think there needs to be focused education levels on these four areas of society. i don't think putting a poster on the wall that says ebola kills is going to do it. i think there has to be a programmatic approach to each

one of these strata of society to get the information that they need to encourage people from their position and to deal with the things that come to them. >> i would take a slightly different take on it. i believe that community health workers, if properly trained, can get the same outcome of coverage as physicians. what we 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 that they contracted the disease from other workers who have gotten the disease from the community. if you are working alongside someone and they happen to have ebola, then you get it from the staff. there are a number of documented

cases of staff infecting staff. as was reported where four nurses died and 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 that 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. have you heard that, and are the other two countries, perhaps even nigeria, too, looking to do that so they can convey the paramount importance of, for example, burial practices and the like? >> one of the challenges we have in liberia is after this 14-year brutal civil war, during that time, people did not go to

school. we have a large population of illiterate people. many of the languages in liberia are not scripted, so you can't write something. there needs to be language appropriate in each dialect in 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. so as he says, putting a poster up is not going to help someone when you have an illiteracy rate of 75%. >> finally, let me ask, mr. isaacs, if you could come you said the president of liberia was a month late. is it too late? and what would have happened had that state of emergency been declared a month ago? >> the month statement was not a scientific statement -- it is just an opinionated statement.

when i do not have knowledge, i have opinions, rightly or wrongly. i do think liberia would have been better served if the status of emergency had been declared earlier. i do not know all of the actual mechanisms to go along with that declaration. but liberia is in 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 elsewhere, hopefully it has peaked there. 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. lack of testing capability. you might want to comment on it,

but even in the best of circumstances, say in new york or new jersey, how long does it take to get a test back? because this does move very fast. >> well, we have a special test in the u.s. of a matter of a few hours, 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 the protective gear. they are asking people to go to work, to take care of patients, and they don't have gloves. to me this is unconscionable. if we're going to put people on the line, the brightest and best people in the country on the line, we owe it to them to give them a fighting chance. even in this country, no matter how well trained doctor is, if

an ebola patient comes up to him before he or she knows what he has, he has already been infected. >> mr. isaacs, you ask the question earlier -- where will the money go? in your opinion, where should the money go, and what should it buy? >> 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 four 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