what's driving the decisions -- the president's decision rating process. extenti ask you to what histhe meetings have an extentt decision-making on airstrikes would be? link atld not draw a this point. the president is concerned there are issue, other countries around the world that are concerned about this issue. this will be a topic of discussion at the un security council. that is different than -- not necessarily connected to the set of decisions that the president has to make about how this our practiceto for defeating isil.

you belabored the virtues of the president's response becomes to isis, his deliberate strategy that allows him to avoid making for theg decision american forces. does this not given opportunity to the opponents of the united states interest? >> i do not think it does. the top priority here is making sure that american national security interest are safeguarded and protected. and if possible, advanced. but as with the president is going to continue to do. of course, there will be cocky relations and decisions that are

made by adversaries of the toted states, trying anticipate or plan for any decision that the president may order down the road. be president is going to deliberate about making decisions he believes are in the best interest of the united states. he will not be shy about ordering military force if you think it will be impactful. an example would be bringing down osama bin laden. ordering ait is military strike in somalia to counter a terrorist threat in that country. evidence of a president and and and administration who is willing to use american military force to protect america and our interest. because of the service of the sacrifice and bravery and skill of our

american service men and women that that weapon is so particle -- so powerful and so affect david protecting our interest. the president will not be reluctant to use the element of american military might if he believes it will be affect -- effective. and -- your resident, your predecessor and the have all declined [indiscernible] a you look at this as positive referendum? i'm a little roulette to to weigh in on the u.s. midterm election.

i am sure they are just as interesting in scotland, but i've been not following them as closely. thank you. have a great week. president obama will be in estonia tonight where he will meet with the presidents

of estonia, latvia, and let the win you. -- lithuania. be back in washington on friday. and the state department released a video by the president on the ebola virus. the disease is spread, and says with the proper treatment and a medical center about have the people can recover. -- half the people can recover. we will be live shortly with today's defense department reefing. briefing. real -- rear admiral john kirby will be answering

questions. pentagon briefing is expected to start shortly. live coverage on c-span.

again, waiting for the start of the defense department briefing was rear admiral john kirby. while we wait, and look ahead to this week. here is today's pentagon briefing. things to open. first we have all seen press reporting about the potential l of mr. sotloff.

informationve any today, and our thoughts and prayers continue to go to to the hardshipho've endured by virtue of just his captivity. i cannot confirm those press reports right now. i know you have all been tracking events in somalia last night. if you will bear with me i will walk you through what i can right now. yesterday at approximately 11:20 u.s. specialtime, operations forces destroyed and it can't met and a vehicle -- and in commitment a vehicle using laserguided munitions.

we are still assessing the results of the operation, and we were provide additional information when it is appropriate, and i will not be able to provide specifics about the unit or the intelligence of cells, and certainly not anything regarding to tactics, techniques, or procedures. in the operation occurred south and south-central somalia and did result in the destruction of that the article. i think it is a port to remind everybody that in september of 2013 he publicly proclaims they were responsible attack.nairobi mall they are also responsible for oughoutmbings thr

somalia. they claim responsibility for the deaths of numerous government officials, aid workers, peace activists. conducted terrorist activities in the region that have resulted in the loss of much innocent life. they continue to target westerners, including u.s. personnel in east africa. months they claimed responsibility for a car bomb at the mogadishu therefore the targeted and killed members of the united nations convoy. so the operation that we conduct it is an example of the u.s. government and our allies commitment to the people and the government of somalia to detect, deter, disrupt, and defeat violent extremists to run

progress in the region as well as threaten to conduct terrorist attacks against innocent people around the world. will continue to use all of disposalrces that are -- at our disposal to dismantle terror groups. of the request of the iraqi government, we dropped humanitarian aid to thousands of residents who have been cut off from water and supplies. france and the united kingdom also dropped much-needed supplies. coordinated airstrikes to helpisil terrorists,

facilitate the delivery of the a. id. forces are inish control of the township and are providing for the citizen needs their. re. , as we've said before, we want to adjoin with andinternational partners where and when we can do that, we will do it. any questions? >> in somalia, incident a single argument andgle vehicle, or was it two strikes and two targets? the strike was taken at an a vehicle that was at the kent -- that was atehicle

the encampment. was plural in terms of munitions dropped, but they were dropped on one target, and it can't met that was there. encampment that was there. hit what wewe wer were aiming at, and that it was actionable. i would not go into assessing the effectiveness right now. i will not get into assessments right now. , as i said earlier,

we have more information to share with certainly welill. >> laserguided munitions. were there u.s. forces on the ground? >> no u.s. forces on the ground. before or after the strike. >> anyone else on the ground? >> all i would tell you is that we continue to work with the and in the somalia region, but i will not get any more specific than that. >> did the u.s. informed somalia about the mission? >> i do not have the notification process. this is very much in keeping with the kind of operations that we conduct throughout the region and in partnership with the leadership there. >> they announced early last month's new operation indian

ocean about combating al-shabaab in particular. was the strike in conjunction? >> not to my knowledge. >> if the target was killed, what do you think it would say about the group? what it means for the group going forward? he is the recognized appointed leader of the al-shabaab network in somalia. if he was killed, this is a very significant low to their network, to their organization, and to their ability to continue terrorist attacks. it is a network, and we understand that. that there remain

other leaders of the organization at large. recognized leader, and if we killed him, a significant low to their organization and to their abilities. more broadly, can you answer the critics who are saying the administration does not have a strategy, does not have a counterterror strategy that is good enough? is there a strategy, can you articulate that? >> absolutely there is a strategy for our votes the middle east. i can always be in the military for active. -- i can only speak from the military perspective. we have been consistently going against the terrorist threat and not part of the world -- in that part of the world. inside iraq about the mission is very clear, we are there to support iraqi and kurdish

forces as they take the fight to isil. certainly there to help defend and protect u.s. personnel and facilities. iraqe mission set inside is very clear. the strategy with respect to the middle east has also been very clarify it is not something that we just started doing. we have been going to terrorist networks enough part of the world for more than a decade with very good success. it does not mean it has been eliminated but we certainly have been very active and energetic. the objectives have been clear. you have gone after isis as soon as you possibly could? was the and how early day intelligence that was being brought to the white house about the isis threat? >> i am not quit his big about

intelligence matters, and certainly not about those race raised to the white house. we have talked about isil for many months now. and as i have said before we were very closely monitoring and tracking their progress, growth, development, well before they rolled into balls will. this is not an organization that we have not been watching. the speed with which they took iraq got a lot of people's attention. i've said that publicly too. no one expected the iraqi army to fold the way they did. there is a speed there that did unnoticed.oticed -- it is helpful to go back and

look at the last couple of months. we are all fixated right on targeted airstrikes with we are conduct ring with very good tactical effect. long before that started we upped our presence in the persian gulf. we added more security assistance and personnel in and around back dead. -- baghdad. joint operations centers that are advising and assisting and sharing information with iraqi and kurdish forces. done numerousve jobs in two different operations to alleviate suffering. not going to be just a military solution here. ultimately the long-term answer has to be inclusive, responsible, responsive, good governance inside iraq to alleviate and take away those that they can exploit

for their own purposes. as you may know, the majority of the fallen fighters for are going through syria to turkey. what should turkey's role be? >> it is not for me to goya -- to evaluate. we have a strong relationship with -- i know that, i'm not going to answer a question that should be asked of the church against government -- turkish government. there were an important partner in the region, a needle ally. -- nato ally. they are concerned about foreign fighters and rightly should.

no doubt this will be a discussion between secretary hegel and his counterpart. a helpful role? because they have concerns just like other partners in the they arear admiral expending their effort energy in [indiscernible] >> why does the united states keep launching airstrikes at that location? sil keepse i trying to take it back. >> secretary kerry wrote in the new york times that he and secretary hegel will be germanic forion -- will be asking

help in this campaign. how many nations will they be approaching, and what help with ask for in building that coalition? togetherstill putting an agenda for on the sidelines of the nato summit. secretary kerry and secretary hegel do want to get together with some of these partner nations. allies,them are nato and i do not have a list right now. this is going to be more of an informal arrangement. of a very fulls .genda on wales i do not have a date or a time when they're going to do that, but we're looking for those opportunities. it could be more than one.

smaller numbers of nations and a time. do they want partners for industries, do they want humanitarian aid what will they ask for? they want partner nations to contribute whatever and willing they are able to contribute. understanding of course that of domestic concerns as well. populations that have different resisting against the threat. it is not about going in there with demands and a laundry list, it is going in there to thank them for what they have been doing, encourage them to continue and assist in any way they deem fit. going back to somalia, you had told us of some other leaders in the area.

it was the senior al-shabaab meeting. were there any other targets that were at that i encampment? l assessingtil the results. was ansaid there unmanned and a manned attack? was the actual hit by a drone or by the manned aircraft? participated in the strike, i do not say what tribe of aircraft -- type of aircraft guided these missiles and guidance, and i will not detail the platforms here today. >> do you consider the operations to be a success, and how are they defining success

the islamics to state? i would just like some clarity on what that would look for for this campaign. >> i do not know that i would call it a campaign. we do believe that the operations have been nominally successful. iraqi security forces and kurdish forces are now in control of the township. we are watching that, we are monitoring that, we're not taking it for granted. if we need to to continue to take strikes to disrupt isil, we will do that but so far we believe the mission has succeeded.

by a large we were able to get needed provisions to the people there. they were able to sustain themselves with the food and water it has provided. there were other countries involved and we are grateful for that support. the president also has been very clear about -- from an anti-isl perspective, what we're trying to do there. to put u.s. personnel and facilities at risk or juice red more humanitarian crisis. the real measure of success is that the ideology is ultimately defeated. the only way to do that is through good governance. worth repeating. i do not think there will be a military solution to this. the answer is the ideology is

isect it because there responsive and inclusive government in iraq. >> before this video was released, was there any indication or suspicion that he was killed the same time? >> we do not have definitive knowledge one way or another. we still cannot confirm the press reporting about this next video and potential new murder. >> on the al-shabaab operation, was there any intelligence that they were plotting an imminent terrorist attack? was that the reason this was taken when it was? this action was taken because

of the history of terrorist attacks and violence that this organization is responsible for. again, and i would just tell you, actionable intelligence led us to that site where we believe he was. >> was wondering if you might be -- able to think to the size and force of the soldiers on the ukrainian border and the escalating situation there. >> we continue to assess that alongn forces aggregate the border with ukraine.

i am loath, as i typically am, to get into a hard number. but it is certainly north of 10,000. numbers arent than the technical capability. they could move on a moments notice. in addition to that we continue to see support for separatist and we continued to see russian .orces inside ukraine i would say in the thousands is safe. .othing has changed that activity needs to stop, our and weneed to leave,

continued to see action by moscow that does nothing but increase tension inside ukraine. >> the secretary-general said he plans to build a nato response to put along the eastern portion of the nato nations and response to russia's aggression. how would the u.s. participate in that? with a provide truce, support, weapons, air cover? i think we would certainly participate in any discussion about the development of this rapid reaction force.

to your other question, we would certainly participate in discussions out that. secretary hegel looks forward to , but wehose discussions would be way a set of ourselves to try to speculate how he would realizing that source. a must continue to work with who -- a commitment to work with our allies and to article five of the treaty. we have done ground exercises in the baltics, we have exercised more aggressively in the black sea, which continues. >> does the u.s. think that

those eastern nato borders are threatened in the by russia looking to take over part of ukraine? stood by article five of the treaty, and we have them not, and i will continue to express that again. ukrainian forces have suffered a little bit more set backs. some of the language from moscow is increasingly strong. are you changing your approach thehe summit in terms of urgency of situation or --cussions of white u.s.

what the u.s. might need to be given given the changing conditions on the ground/>> from ? >> from a defense perspective only. nothing essentially changes about the manner in which we continue to monitor the situation. it has brought into sharp relief the need for all nato partners and allies to continue sufficient and adequate defense

spending for their own defense and for the does sense of their allies and to look for ways to combat threat on the continent. i'm not aware of a specific item. i do not when to leave you with the impression that we are not of the intensity of operations in and around ukraine right now. hegel gets ready to leave a for wales, he is certainly mindful of what is going on there and how they alliance has got to be able to approve going forward. >> the general secretary spoke taskme detail about the force. he said they will be able to strike and a very few days. there would have to be a

position supplies of this laundries. he also spoke of it as a dove ne deal. is if you get ahead of where the united states is, and as secretary hegel and the nput to thed i other nato leaders about the creation of the strikeforce or will they be hearing about it for the first time in wales. i do not think anyone from the united states side will be hearing about it for the first time. wales said they looked forward to having these discussions. it is another idea that is worth exploring when it comes to standing by article five commitments. will be no doubt part of the discussions when we get to

wales. >> the russian- responded today that ovocatived be a pr move and they would have to reconsider their own stance. do you have concerns about them creating a strikeforce as a return for the provocation? >> if you want to talk about provocative you should talk about a few russian thousand -- 2000 russian troops inside ukraine supporting separatist with heavy weapons. that is ready provocative. it is entirely reasonable, prudent, and responsible for nato leaders to bolster the alliance the commitments we have with europe.

said a few minutes ago the the airstrikes continue because i still continues to try to take the dam. they are taking offense of maneuvers toward the dam and the purpose of the airstrikes is to deflect that? horse the current military policy and strategy some sort of denigration of ice will capability in the area? if they were to stand down and not taking the offensive men e measures against the dam, would we support them? we have specific authorities under which we are conducting the airstrikes. to protect u.s. personnel and to theies, to contribute efforts, and the

humanitarian side. nothing has changed about that. as we talked about when the emotional dam operation started, mosul dam operation started, it also protect u.s. personnel and facilities. them,l continue to strike and you have seen that continue. using the pressure we get every day. that will continue as long as we sit in that facility because it is very important. i think what you're getting at is if there is some sort of broader mechanism or where playing fast and loose with the rules. we are not.

pretty the president was clear with the goal with respect to iraq, and it was to disrupt misil's capability. could argue we are disrupting their capabilities through these humanitarian missions because we are denying .hem what they thought strategically, long-term, the real answer is good governance. i know you guys do not like to hear that grant i know that does not make for a good copy and the pentagon pressroom, but that is in fact would has to happen. to solve thisg

militarily, and we are not going [indiscernible] you mentioned that an army unit -- nato response force that is staffed by the army, i can do to more details on this. it is a normal rotation of the deployment. the same unit we up and talking about. units the movement of the then sped up? they were not supposed to start moving until next month. >> i want to get back to you. >> my question is about career.

there have an recent reports that we've completed a site survey for the missile-defense system. china and russia have very strong opposition. gothe u.s. military going to ahead with these? >> i do not have anything for you on that today. we are caused in consultation with our allies on the peninsula. --ut the required >> said the principal qualities .f the somalia operation i meant the facility, the encampment and the vehicle.

that is what we were talking about. -- thank youared for making me clarify. that was not a settlement that we think we know we got him. when we have information we can share with you we certainly will. specific the lavrov -- deliverables that came out of this? this is a nato summit of the have the state -- heads of state. deliverables coming in and out of it, he is looking forward to participating in the discussions. one of the things we do want to accomplish as we want to talk to some of our allies and partners about additional things that can be done inside iraq. that is clear.

meeting with many of his , to talk about not just what is going on in russia and the u.k., but what is lying on in afghanistan. this summit provides the alliance a great opportunity to look not only at what has been happening in the last few months in russia and ukraine but the future of the alliance of health from the spent spending two operations to exercises to interoperability and capabilities across the spectrum of military operations. thank you. >> this briefing is focusing on

u.s. airstrikes to prevent names in the military group isis. a video has come out purporting to show the beheading .f stephen sotloff here is some of what the state department said about the video. >> have you seen this purported video of the beheading of stephen sotloff? our human in a position to confirm it? >> the intelligence community will work as quickly as possible to determine authenticity. genuine we are

second by these brutal acts. our hearts go out to the sotloff family and we will provide more information as it becomes available. we do not have more information at this point. >> if you really do not have anything else to say -- >> i do not. >> [indiscernible] not get into specific numbers for the safety and security of individuals. we have said a few, and that continues to be accurate. alive as of last week? what is your last information? >> we do not have any information to provide. >> does the u.s. government actually have the video? has an out there through many outlets. so the authentec vacation --

the verification process has begun? >> i do not know if it has officially started, but that would be happening rapidly. >> do you know when you were made aware of this? before they put it out? do you know the intel community was aware of it before then? >> i am not sure there's much more i'm going to be able to say. does the obama administration consider this an act of war? >> i am not going to put new labels on it. i would say we consider this reported act and the killing of james foley as a horrific terrorist act that we certainly

see as one of the motivating to greet in the effort him international coalition to address this. >> we have two american journalists beheaded by this group. do we have any doubt that we are at war at isis? >> we have not confirmed through the proper processes,'s being on the behalf of the u.s. government, i'm not going to put new labels on it. we are concerned about the threat of isil to western interest in the region. ist is why secretary hagel going to be working every contact they have to build a coalition to address this threat. theore reactions to beheading in the washington

journal. 's work has been published in a variety of news outlets. members of congress have been tweeting about what happened. for the second time this year president obama is visiting the baltic region near russia. the president will meet with the presidents up estonia, latvia, and let the waning -- and little whe lithuania.

onattends the nato summit thursday and returned to washington dc on friday. here's a look at some of our programming this week on the c-span networks. 8:00 p.m.tonight at eastern, oral argument in the case of aclu versus clapper. of second circuit court appeals hears challenge to the phone security program. on wednesday, live coverage of the north carolina senate debate. p.m., a hearing on sexual assault on knowledge campuses. the senate, agricultural committee looks into school lunches and nutrition. tv, elizabethook

through talks about her 1975 book washington journal about the watergate scandal. coverage. on thursday, emily miller on her book emily gets a gun. historians tonight discussed the battle of regensburg and the burning of washington in the war of 1812. and a symposium marking the 200th anniversary of the war. all of this begins at 8:30 a.m. let us know what you think about the programs you're watching, the us a, on twitter use

#c123. join the c-span conversation. like us on facebook, follow us on twitter. this afternoon we will have live coverage on a discussion of global health. allergy and infectious diseases were one of the topics posted by a panel by the center for strategic and international studies. "washington journal" continues. host: joining us is thomas gentzel. as we dive into the topic of local school boards in the education debates, tell us about your group and its mission. a represents our state association of school boards. they are the ones that have the

membership of the local school boards. local school boards are comprised of folks out of the community who have an interest in public education. they are usually elected. as a civic duty because they have a concern about good public schools. how many people are we talking about? guest: we have about 15,000 school district. , in its own way, created something called the school board. mandate ora federal a requirement. they recognized the value of having people leaving the local education effort. host: how would you describe your organization's relationship secretary of education? guest: we work closely with the

secretary. communication has been good. understand the importance of the role of local school boards in these overarching debates on the landscape of education in the united states? guest: i like to remind him. it is important. there is some tension between the federal role in education and the local school district role. there is always tension around that. there is probably more today than in the past. it is important that schools are led at the community level. showscent gallup poll that people think the school boards should play the lead role in determining what is taught in public schools. only 15% said that about the federal government. we have to get to a place where

we have a serious conversation about where the decisions are made and have people feel as though the schools and the communities are there schools. outpost of some federal agency, but they are the owners of the local schools. explain the flexibility act. thet: it is legislation in house and senate. it is designed to to try to limit the federal role.

>> we've seen over a number of years the growing federal role that is getting more and more about what is happening in our local schools. as we saw in the results, the public is getting kind of tired of that. we have to figure out a better

way to have the conversation then we have had recently. if you want to join and you can give us a call. our phone lines are open. we would especially like to hear from you in this segment as we're with the direct your of the national school board association. before we leave, we want to ask for one more question. ould this give a de facto veto over some of the rules coming out? it would not do that.

what we're really talking about is a process. federal department of education wishes to impose new regulations. they need to the grounded in the law. they need to go through a process that allows local school board members and superintendents to be able to comment on them before their enacted into law -- they are enacted into law. that has not been happening. we have seen rules coming up that have not gone through that process. questions already coming through twitter. does the average school board have the resources to collect and analyze local data to determine what kids need to do to keep up in the world? my answer to that is not, many have very limited federal resources.

our concern is the overreach issue. but i think we would be the first to argue that there needs to be a balance between what the federal government is doing with local government school districts and with state government. many are concerned about it overreach when it comes to the common core. cato about where you -- can you talk about where you stand? strongwe support the academic standards and the career ready standards. there are other options that different states of the developing. we believe that is important. common core began as an effort by the governors to come up with a joint set of standards that they could all subscribe to. we thought that was an important initiative. as we have seen again, there's a public concern about

common core. i think there is a perception that the standards are being direct did the washington, and i think that is hurting a lot. but we need time to do that. we need time for teachers to be trained, to put the curriculum into place to make sure it is done right and i think they're not quite there yet. >> talking with tom council, executive director the nationald association. the numbers are on your screen and we will be getting to your calls. tom council on the line. >> i do not even know where to start 20 comes to the subject but i have two quick points. aren't care what you

teaching, core, the new programs, whatever, the bottom line is it all starts at home. of kids outlot there who respect the teachers and principals and there are a lot of kids that don't. cares about a student that talks down a teacher right in front of everybody else. when you view -- you lose that respect, no one listens anymore. the bottom line is we respected our teachers and certainly our principal because he had a paddle. there is a level of discipline that is not at home. it is the home's fault, not the schools. it was so bad with addressing and the hip-hop that we sent them to a military high school. my son went in with a 1.9 and graduated 3.8 52 years later.

one to give tom a chance to respond. tom is making a point we cannot emphasize enough. this is about schools working very closely with parents. rex the first day after labor day. summer is over, fall is beginning and we are off to a very good start here. we are really thrilled today to come together. really as a celebration of larry kosten's work and very important focus on global health law that have come out this year. where he the idea a few months a book about having event. we do different kinds of both events. a pillar of the community here. he has done so much over the

the and leadership at o'neill school of medicine and prolific outlook. he has had so much influence over all of us in such a constructive, forward looking, gracious way that we thought it was a great occasion. thank you for turning to us and let us pick it up. we are thrilled to be able to do it. we also thought, let's do this as a conversation around big questions and big ideas and bring in larry's closest friends and allies over the years that could help in the celebration in a deliberate tom at interactive brisk discussion. the. agreed to since 2004. another huge presence in our matters pertaining

global health. we will be joined by tim evans from the world bank of the third party to this. the way we will go about doing our business, we will run up to .:30 no later we will see how things go. we will open up with larry saying a few words about this work. it is the culmination of many years of effort. large,ot just the only comprehensive and cyclic ketek -- encyclopedic work. i wanted to have him offer a few quick reflections from his chair around the genesis, the experience of writing the book and then we will morph from

there into the discussion. the discussion will be centered around to questions that are very future oriented, each of them. trying to get us thinking about the future. ,he first one is going to be what is the single this -- biggest challenge or problem we need to keep our focus upon looking ahead over the next 5-10 years? we have international law expert. tony coming at this from a perspective someone involved deeply in the science, research, development and technology. tim evans, someone whose life is centered in the science of delivery and implementing programs. so we will begin with the first question and will morph into

what we believe the biggest idea will be over the same time that and changennovation the calculus. so welcome, thank you for being with us. you have the biographies. i will not go into great detail. we have close friends and call uponat we constantly integrating any dimension of global health. thank you. a great location. >> it is a great occasion. wanted to start by thanking you and cs i asked -- csis, because there is no place like this in america. you have built something incredible.

a longtime friend. i feel like i am surrounded by friends but more than that i am surrounded i two of my heroes that have worked so hard and global health. there is no book on global health law and governance. as and to think of law esoteric field, but in fact the governance of global health is really critical. think about the tobacco control or ebola. governmentlared up emergency of international health regulations and evoke various powers and the like. what really drew me to the book local healthof two marriages operating out there.

is what you hear from the really great thinkers in global andth indicates foundation who. that is the story of remarkable progress where we were to where we are now with incredible achievements through the millennial development goals of the sustainable development goals. that is a true narrative, no question about it. if you look at age and mental health and malaria, we have done very well. i also have done work civil forety around the framework mental health so i have talked to people on the ground. their experience is completely different, a different narrative. there is is a narrative of deep

impoverishment. and narrative few can see in west africa today quite frankly of food insecurity, human rights violation, ebola. a hole for i-80 of other conditions. people are afraid to go to the hospital. we are really facing a crisis there. it turns out both global health narratives are bright. globale improvements in health, but those improvements are not equitable across the board. is a reallyustice major theme in this book. i asked three basic questions and then i will move on. the first question is what would've perfect state of global health look like? if we could what we aspire to,

what would it be? for that, i try to place a premium on public health public health services. disease prevention and control are really important. not think ofe do as global health but it is. air, sanitation, hygiene, vector control. all of those things make life much more livable. the second question is what would global health with justice look like and the third is how we would get there? if you do manage to pick up my book from the outside, i think the best part of it in the best advice from harvard, they said do not get someone like bloomberg or bill gates to write the forward, no one cares what they think. so i did.

what we have in the beginning our global health narratives, stories from children around the world in their own words. it is really powerful. it is really important for us to capture the idea of what it is like to live in a poor country filled with injury and disease. without further a due, we can get on to the important part. not mention at the outset that over the course of the discussion we will open things up and hear from you. please think about your comments and questions as we move through this dialogue. we will get through this quickly. want to begin by offering a few minutes of thoughts about the most important problem and

challenge? come on up. we are just getting rolling here. welcome. >> great to see you. offhy don't you kick things with a few things around what is the biggest challenge we face in looking ahead? >> i think the biggest challenge is equity and justice. mean this tobacco guru lipservice is very small. they argue with one another. ofo not know how i got part it, but i was. they talk about and games and tobacco. they are very popular with aids. -- talk about end games. you can get it with all these

different areas. i asked them an ethical question. i said suppose you could get to the end game in tobacco, which means you have a prevalence rate youercent or less, but still have mentally ill, poor, working-class with relatively high rate. would that be ethically acceptable to you? every single zealot said yes, it was acceptable because the main goal was held improvement. biggest goal was health improvement with justice. trying to look and make the world a place where it does not matter if you were born income paul a or new york -- in apollo or new york or mail or female or with child or an adult or sick or healthy, disabled or not. what matters is that you have

to live intunity and the conditions which are healthy. one thing that really struck me, i came back while i was doing the last chapter of the book from a very typical sub-saharan african city. i came back and i realized i really was not feeling well. i did not have malaria or anything like that but my throat was bad from the fumes. my tummy is was a little bit bad. i came backzed when from any of the lower income countries i did not feel well. and that told me something. that's when -- where euclid makes a lot of difference. it was not the doctors i concede

that the environment in which i laid in which people live every day of their lives. >> thank you. is the singleout biggest challenge or problem for the next five or 10 years is one that is certainly not new or creative but very real. it really has to do a bit with what i am as an infectious disease hersen in dealing with the problem as i stated is the disparities in health and developing versus developed much, which relates very to the justice that larry was talking about but i am thiscularly involved in with the arena of ebola. let me just take my 2.5 minutes that i have left to go over that

with you. i always talk about disparities in health. malaria,about malnutrition, lack of clean water -- all of the things related to countries that are or are limitedch in resources -- resources related to health. me thing that has impressed like nothing else is what i have experienced over the past couple of months with ebola. some of you may have heard me get the i always question, should we be worried about ebola here? on answer is someone look it a plane from west africa and end up in west africa or london and be well on the plane get here, get sick, go to an emergency room, get sick, maybe die in infected nurse or doctor and

everyone will realize it is ebola. will be isolation and the proper precautions in the outbreak would end their. in west africa we are dealing with a situation where we are seeing an exponential case with 1500 plus deaths and the projections of going to 10,000 cases is not hyperbole because now the curve is exponential. the reason it is happening is because of the disparity in health care capability. is the only reason it is happening because you cannot have infection control, no infrastructure for isolation. no infrastructure for quarantines and properly and no infrastructure for contact tracing. if there were the first two or three cases that were in the

united states, it would be very frightening to everyone, all over the newspapers but it would stop. so i was adding prepared to get of what i think the granite -- greatest challenge is is just that. there would not be be ebola academic if there were not absolutely does an -- stunning disparities upheld in the west african countries compared to our country. >> great. this is going to be a bit of a repetitive theme. there may be selection bias at work. let me first apologize for being late. it was something called ebola

consuming many of us that are directly or directly involved in the response. not think today there is a greater challenge, because i think it is symbolic and indicative of the vast disparities that continue and which not only threaten the country's and the economies and butility and security, certainly has made it clear the west african context is with beast --haky with respect to containment of ebola and the rest of the continent and therefore the rest of the world. but i wanted to first begin by saying congratulations to mary.

i do not know very as many as well of -- as well as many of you but i have always thought from a distance he has been a mess leader -- massive leader and really writes what he talks about so eloquently and that is bringing the discipline of law to global health and i feel this book that i have not read but will give it a glowing endorsement based on your reputation, but congratulations, i am delighted to be here. having wasted two of my three minutes now or spent them on more important things, add my me, thes on this. to biggest challenge is inequality or in equity. withineen countries and countries, the fact that you have major gaps in life expectancy and health achievement in this country with

all of the means that it has to is an assault on a fundamental sense of justice. thatnk it is also one needs to move increasingly to evaluate equally, no matter where they are based. i think that i -- ethical principle needs to be much more fundamentally ingrained in everything. the challenge of that is multi-factorial. i think we will have more time to chat about the points of to really allow the principle to manifest itself in a meaningful way. thatld say, however, relative to where we were 20 years ago, there has been a massive mobilization and something called global health

or around global health that has multiple manifestations, which i think embodies to a significant impatience sense of and intolerance of local inequities in health, and i am personally encouraged we are moving but when you look at the clearcrisis today, it is we could move an awful lot faster, and i think we have to look at how we can do that. ebola first came to our attention earlier in the spring and the initial response was it andnot look that different we moved into april and june and perceptions began to change, there was a certain confidence in the ability at that time to

toll use the tools we had address this. there was a recognition that the inequities and gaps were feeding ,reast along with distrust mobility and speed that was happening. wasquity was -- inequity recognized in west africa. i do not sense people made the leap from that to say the inequities of that kind were more than and normative consideration, that they were more than something to lament as versusty of life something that is normative and ethical. strikesething that

security considerations in a way that would motivate people to see inequities as something that requires much more aggressive action. today, when you look at what is happening with the exponential leap over the past six week's, one of the stunning things to me is that it is not registered as a security issue. it is competing against some geopoliticalble crises, in which there are no major ones.hree the field is very crowded. when you all raised these issues and reference the ebola crisis and very poignant excruciating example to witness and our lifetimes, the backdrop

of dramatic gains made in the past years, how do you make the case, the security case? the inequities are the ones that have to be addressed. i think we are still struggling today as this crisis unfolds. we are still struggling how to for not just our government but many others. >> i think you are very insightful. you raise a lot of important questions. undoubtably it is a geostrategic security issue. the whole region that is destabilized. ebola is first and foremost a traveledisis but has and cut off food security, employment, the economy, to that he.

all of that is down. focused on the whole region of the world. there has been international spread. invoked a public health emergency. and yet government has and basically left to itself with the u.s. government and others but not at the higher u.n. level that we need. i think it is clearly a security issue. i think my worst fear is this could be another haiti where it humanitarianuge response. then when the humanitarian response gets up and leaves, the same conditions exist. you still have the fragile health systems.

you still have enormous deficits and doctors, nurses, midwives. there are places like liberia thatand one 20th ofng like what they would need in terms of health work force. and yet they have lost a lot of nurses and doctors to ebola. what will happen when we do contain it? we will eventually and then move onto the next thing. this is a development issue as well as a security issue and infectious disease issue. >> scanning back to the point about security humming you said when will this we recognize as a security issue? soon.

it will be recognized soon because if you look at the kurds and projections of mathematical have 3000when you people infected and 1500 die, that is a humanitarian issue compounded by the fact that people who do not have ebola do not go to the hospitals because they are afraid. many people are dying from bleeding ulcers and automobile accidents and the need for care at birth and do not have it because they're just not going to the hospital. it has become a security issue when you look at the model that goes from 3000 to tens of thousands and government starts collapsing. remember in the mid-to early , andof the aids epidemic it was not that early into it when it became -- that it became

very clear in the developing world that there were militaries of different countries of strategic interest that had 30-35% of the people were infected. i remember because i went with colin powell to the united nation special session on aids, and he, for the first time articulated he consider this a security problem. then all of a sudden everything "and people began to consider that. so i think it will happen and reasonably soon if you look at the kurds of where it is going exponentially. >> one is how do you make the on that front,nk is weakest link in the chain

one that is a threat to us all globally. -- two five when who thousand five when who passed the world will health regulations all countries were supposed to become a client by 2012. any experience in the low income or more -- or even middle income country after every country signed up for that knew there was not a snowballs chance in a hot base for that to actually happened. because the investments were not being made. is the threat to disappears,en it the countries did not make

basic investment in the core infrastructure. emma when you have something like this and no where near the infrastructure you need , then you do not have the ability, which is not complex to really snuff it out he for it essentially becomes endemic. so the rationale for investment needs to be strong, but it has to go beyond the immediate threat and look at the return on investment from investments in health. evidence.ve tons of larry summers, commissioner on investing came out to show it is one of the best investments that with respect to economic growth in the economy. really need finance to understand these sorts of investments are not only ones that help people live and

survive, but ones that make abundance of sense in terms of prosperity and economic growth. toing said that, in addition mobilizing, as larry said in, hopefully the commencement level of response, and i would like to are aboutear, that we 25-30% of the mobilization ofessary is the who roadmap 400 90 million and have not heard it from the u.n. senior warden nader david navarro in terms of what is required above of the immediate health response to respond to the crisis. the price tagged will go up. tore is a long way to go respect of the immediate response. the challenge is that it needs to happen tomorrow, not in three

weeks. i was listening to the president of the u.n. this morning. and she said we need a search at which isty paramilitary in character. she was saying the biohazard haved that many countries has to be deployed in the to seec if we are going there grate of response necessary to get on top of it. this is coming from the institution that has cared for two thirds of all of the cases to date in west africa. so i think there's sense of the urgency is critical. the feeling we can do that -- assuming we can do that, and that is a big assumption, because i think all of you in haveoom, in addition to us

a responsibility to make sure the requisite mobilization takes legs, but the aftermath is critical. here we need to begin thinking about the investments, not only --help answer structure health infrastructure but particularly the health infrastructure that will make sure we do not have a repeat of this in west africa and affected countries but in others and that is why we designated half of the designated response for building the median to longer-term public health infrastructure we think would be necessary to look with equipped countries to be able to respond to these challenges. thank you. a someone mentioned earlier bit of a katrina moment. when you think about where we

are with ebola, the moment at the end of the 90's when you approached the u.n. special and the shocks that was felt was katrina and it other things in terms of the method, then sues to show method that came to the table initially in good faith. and considerable courage. others find themselves washed over. making this case for the dire need for introduction at a much higher level of new capacities that have been absent. considerable effort for how who itself is falling

short in this time considerably. and the way in which our own efforts have national and local cdcrnment -- 75 or 80 personnel on the ground. it is becoming increasingly imperative to simply protect them. it is becoming much more difficult than that. this watershed moment. gaps and ensure to chanel -- are at international capacity levels. i hope you're right that it comes forward at the level of world leadership. because that has been missing. over the course of the summer there was not engagement by world statement at the time you would have expected when you look at the implosion across multiple sectors that was

unfolding in august and july. to a more positive outlook. what do you think and let's go back to larry and what do you think the most promising will be that can guide and drive innovation and raise hope and change the calculus of the way we go about doing business cap it is a good question. when you mentioned katrina and tony and i were talking about that. if this is a katrina moment, the question is who is fema to? differentere are some places we might .2. what are the big ideas cap don't i will build off what tim said

about international law of international health regulations. countries signed on to the international health regulations. builduires countries to capacity and international immunities to help old capacity. very little has happened. have not even begun to meet those standards. even the own independent commission on the functioning of the international health regulations. critical andhly they recommended and even then in 2011 a search capacity. no one did anything about it. what is the answer? them is theof fienberg report to get the standing search capacity so we can go in and help workers

really knit these things in the but. is where i've proposed a health systems fund based upon the ebola crisis. which would have two components. one is an emergency component. an emergency capacity with a standing contingency fund that could be mobilized. mobilized, and that had happened perhaps the who would have incentive to declare global health emergency much earlier than they did. five months after the first international spread of ebola before they called the global health emergency. i think that is waiting too long to raffle out of control.

the second thing is the longer-term health system. i think this would be a multibillion dollar investment. i realize i am asking a lot. it is not really that much. people tell me you cannot do it. we did it for aids. quite justifiably. and now you have so many calling for universal health coverage, the health system strengthening. but we have no mechanism to do it. we do not have international law because everyone ignores it. we do not have a designated funds. we cannot leave this to charity. i think the whole global health

aide model is corrupt and bankrupt. have a wealthy good to work, philanthropist that at their discretion will needyoney and you have a recipient wanting a handout. that is not mobile health justice. requires is to have mutual obligations. states themselves, even poor state's should give a certain percentage of national budget to the health sector, as africans -- african heads of states promised but never delivered. at the same time, it is very clear the health systems are broken. they do not have the capacity. we need an international fund to do that. i think it is simple come a doable and would make a world of

difference not just for this crisis but going forward for the future. >> whenever i talk about ideas i have to apologize to my noncommunicable diseases friends. i recognize there are other diseases besides infectious and case any of you think i have lost sight of that. having said that, let me stick with that. thing that is not missed because it has been established within the past here that i think it fits in were full effect would have had a major impact. i am sitting down thinking people ask me all the time, what could we do to alleviate or perhaps completely neutralized the disparity i was speaking that is a decade-long job

if you are talking about the there iseconomies, but one idea that was implemented in a policy or an agenda that i think some of the people may be aware of that if it were fully operational it may have had an is the global health security agenda. the global health security has three objectives in mind. one was for the recent interest in microbial existence and have that is the worldwide issue and you cannot just tackle it in the. the other is for defense because of the fact that there could be with nefarious motives that might unleash a microbe upon us.

the other is the challenge of emerging and reemerging infectious diseases. the global health security and agenda, because it was predicated on the concept that local health is infinitely joined to security apropos of you are asking me a question is what will this be taken up as a security issue and has nine objectives and three major divisions, preventable epidemics, detect threats early, and respond readily and affect sleep. if you look at that and i do not want to take the time to go butugh the object to its, if they were even marginally in place, we may not be in the situation we are right now with ebola getting back to that. particularly the area that includes an interconnect the network of emergency

operations centers. and how long it took to get an emergency operations center that isld essentially handle what going on in west africa was that if you have this in place it would have hit the ground running. healthr is the global security agenda implement the agenda. -- my idea. >> this was launched in february. severalone through meetings outside the united states. in 27 othermented countries and a very timely point tony is making because september 26 is when the summit will occur here in washington. level.ch higher

and for the usg one of the problems has been finding, making the case for making it operational. is the $45ia didn't million per year, which means it is an idea being tested. perhaps this moment in a positive way, the crisis we face and the fact that the new initiative is struggling to get off the ground with white house backing and the like may be able to bring this to the next stage and politicaley will applies to that. >> as a banker, let me build on that. one thing we notice in being involved in the response since

we put money into the pot is just how difficult it is to mobilize the resources. and who has made it clear indication that they started at 100 million and now at a billion and are likely to double and likely to give us the minimum response needed to get on top of this and preserve the livelihoods of the affected countries. , the sobering and humbling reality is we do not have a good health security van. we are contingent upon antiquated let's hope we can make a case of severity to those

that have money that they will ante up in a way in which is commemorated -- commensurate with the need and timely. so i think part of the thinking at the bank is one of the lessons coming out of this for the future is we have to develop some form of health security fund. the reason it is so important is something that tony lake, the executive director of unicef said the other day in discussing with the un's secretary-general, to wake upis robust and realized viruses can be as deadly or more deadly than bullets and bombs. what he was pointing to was that is an affiliated institution and fonts with

specialties is virtually impotent one it comes to mounting the critical response to a health crisis. tsunami tsunami and the ,e had almost a decade ago there were war looking for .urvivors off the i went volunteers were moving in from all over the world. isthis situation where there a bug that is lethal, no one is coming. u.n. mail put out a call to 53 countries for volunteers. one response. out of 53 countries. ok. of how quickly. i think the investment side of

the such that we can mobilize the requisite resources and the ploy quickly is absolutely essential and i do not think we will are anywhere close to this. underfunded,cally has been for decades. everyone has an expectation that who should be and are the go to agency to give us advice on what buto and how to respond, they have no financial mobilization capability as we have seen in this setting. so i think that is the first part of the response. the second is, pushing into the development agenda. it countries move systematically toward universal health coverage in which they got adequate financing for provision of all of the citizens for essential basic care for requisite investments and those key , we would have a

such that weespond would be much less dependent on international response of huge magnitude. so i think this could be a equivalent to your idea of a health systems fund but really focusing on building the strength and integrity of the systems for the longer-term is the best prevention that we can prescribe. thank you. let's open things up and invite questions and comments. folks put your hands up with microphones and we will bundle together a series of comments and questions. please put your hands up and we we will notryone -- get everyone in the first round but we will get several.

i am from and shall national health. this is -- from international health. i think many of us are struggling with not wanting to build on the ebola outbreak as an opportunity. at the same time it really is an opportunity to talk about health system strengthening in a different way. i love the idea of a fund and pulling together. the question is we talk about the financial limitations of who. i am thinking about what are the limitations in general about global health governance? and what structure? who has other limitations in addition to not having significant funding. how when any of you envision strengthening global health governance so we are able to both respond to emergencies and also continued the long-term investments and health system strengthening?

that for a moment. the hand over here. come over here, please. please introduce yourself. officer. medical i am stationed at uses. a yeartationed in iraq ago, and i would love to share my experience about some of the shortcomings related to global health and global engagement. to go, he my orders said adviser to the iraqi certain josh church in general. check. i go around and the commander general set the priority is to take care of the forces. if you have time, you deal with the infrastructure. so i noticed we do not have a doctrine to engage the nations. then, a week later i got a phone

call from the ministry of haveior telling me they 9000 entities and another 30,000 from the iraqi and iranian war, can you help us? i go back and say they need help . they said this is ministry of interior. thereing to engage is not -- authority to engage is not there. and tell myback surgeon general, this is what we have, we do not have a policy to engage. the bottom line, any global theth engagement, we need doctrine to engage, or authority to engage and the policy to engage. if we combine all of these, we will have sustainable. that is where i see the issue is. all of the things you gentlemen mentioned are important, but how do we implement that yak of the united states has more than 100

security assistance agreements. this is capacity holding for transferable of knowledge from this great nation and many other nations to more difficult countries. we do not have to wait for a crisis to mobilize the mobile assets. efforts like ae lot of issues can be sold. that have been my experience, actually. >> write-down in front, please. [inaudible] international health law. i have two or three questions. >> please, give us one. and last.st

this the first time between this sort of situation? this is not the first ebola outbreak? most of these countries have countries neighboring them for which they share similar conditions for gdp but have contained the ebola virus before , should we be learning from these countries, rather than approach international taco >> thank you very much. we will do another round, i assure you. >> the world health organization. i would like to hear a little the analysis of

noncommunicable diseases. it is not seen as an emergency, but we know it is killing so many people. i see too much emphasis on this but what do you think is the health in the we are not facing viruses but hughes economic viruses that have huge powers. can we confront that it is not a virus but really deadly? >> thank you very much. who would like to jump in first? like to answer the gentleman's question since we have contained ebola and other outbreaks, can't -- why can't we learn from that and apply it here? it is a really good question because it it's asked for it really.

in 1976 ebola was first isolated in outbreaks in failure in sudan. since then, there have been about 24, almost two dozen out rakes over the years ranging in size from two people to the last second biggest one into gonda in 2000 that had 425 p old. the issue with all of those was for the most part they were in geographically restrict dead small village type settings where it was not easy but relatively less difficult to get isolation, contact tracing because when you are in the village is the isolated, the contacts are not necessarily that widespread. an outbreak in where it was a

serious outbreak, but those people are not likely to get on the plane and go to london the next day. what you have in the current situation is you have a couple countries with porous borders, and it has gotten into the cities, and that is the critical problem. that it is more difficult as you get more and more people. like if you look at one contact, you might have 90-100 people in the city where in the contact tracing and a small village, maybe three people. so the mechanisms of what you want to do are similar, but magnitude is amplified and the more exponential it gets.

previousparadigms of outbreaks are no longer meaningful. it is a different ballgame. >> well, i think tony has answered that question. i think -- i just wanted to agree with the issue raised by l about how to implement. it is not simply just do it. it is worth some of the , in this is fundamental, and we can learn. the other thing we can respond thinkthe ncd's, where i part