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 of what will define the effectiveness or is defining the effectiveness is the global , and i will give you one anecdote. this is on the prevention of overweight, obesity, and meeting, and at that ncd, arned about mexico's policy they enacted about three months earlier, and they stage, andis on the part of it was a major value said,tax on drinks, and i how on earth did you get the big

beverage industry to agree to be and they said it wasn't that easy. they said initially it was , but then west looked to the european union, and there was a directive that all the beverage companies had signed up to, including , so they drew on this eu directive, brought it to mexico, and said if you are able to sign onto a directive in europe, why aren't you able to sign on to a similar directive whatxico, and that is mobilized the beverage industry to sign on.

they realized that by having a they would look at the public side anonymously, so i am using that as an , because what is the value of an eu directive? i mean, g, that is brussels bureaucracy, but here is a case of the value. you,is not only in the ee and this is to tackle some of the sorts of challenges, and i think this is what we call soft law, and i think one can use both hard and soft, and the of diplomacy.eory not everything has to have teeth.

it could be very influential in changing behavior. i am not suggesting that is the when it, but i think comes to global health, part of what is going to determine our effectiveness collectively is our ability to think creatively about how to draw on these instruments, not just a is-size-fits-all, and this how tobacco consumption was beat, and understanding what works in different contexts, it is rarely one-size-fits-all. point about how to get the authority to engage, how to get the policy and the authority to engage, that is one of the fundamental questions on the table today.

we're talking about deployment of exceptional capacities that our military in character to address something that is beyond the scope of terror organizations, and i guess my response would be that only happens when there is a and thosedecision, strategic decisions have not been taken, and, was it 53? after 53, you get one back, and this is in this particular situation. and the question around why didn't we learn from this from or 20 five 24 previous cases, i think it is important to point out, and tony this, thising us --

case in west africa pushed us into the unknown very rapidly, and it jumps from one to three, and when it jumped from the coastal cases, when the numbers began to take off, it did things we had not seen before on a scale and speed and ferocity, and we were slow to get it, and we were slow to come around to where it was going to take us, and there are some places where we naturally fall back and go to the things that work in the past and doubled at effort. and we were at this very difficult moment of saying this and there was a similar logic that the who and the way the who is doing it, it

and it does not fit the situation, and that is -- and likewise that is a very good sub -- segway. i was going to address the who issued. it is such a wonderful promise. agency andfirst u.n. when i wrote the book, it the 1947to me that in to 1940 nine period, there were three fundamental things that happened. the u.n. charter, the who constitution, and the universal declaration of human rights, all of which talk about right. and what happened with who? this is a story that we need to learn from, because tim mentioned that who has chronic challenges. there are mass staff layoffs and

things, and people were so andedibly disheartened, they basically have a begging bowl, where they are going around trying to get money, and that is not the way to do business. the who not only has a shortage, but it does not control two thirds of its budget. what organization could exist when you have no control over two thirds of its budget? because these aren't dedicated funds by donors. are important, polio eradication and so forth, nonetheless, who cannot do anything about it. this has to change before who can't even begin to meet its and govern the way , andwe would like to see that would transition to things

like universal health coverage and commutable diseases and so forth, and we have been talking with global health infectious diseases, but it is and it is notrd, just what is prominent in the news. and it is not polio eradication. it is cancer. it is heart disease, and it is things people never talk about. it is mental health. it is injuries. oft go and see the level devastating injuries. nobody talks about it, so you look at the global burden of disease, and you compare that to the who touch it. todevote very few resources ncd's, mental health, and it is

a sad situation, but we need that political will. another round of questions. lets start on this side, and then there are two hands. let's take these three folks here. >> i am with howard university. the global health fund, and the doctor mentioned about an emergency fund. and it is an idea of having a , and things have been around like the global fund. and i guess i am going back to a comment over here. if there are several different types of funds that people are thinking about, doesn't it go

back to something like the world tank, where there is funding going on to several organizations -- i am sorry, several different priorities, and i am wondering if you could talk about, whether there are and funds in the plural like can you put some cloth onto these funds? >> thank you. you hand the microphone over there, and then a couple of rows in front >> something people should hear about, you mentioned the backdrop of all of the and whous diseases, could do this, wouldn't you

suggest we have extraordinary capabilities here? matching the capabilities to be able to have a broad range of week sets, and given the governments in places like sierra leone and guinea, how'd you compel those who are weak and perhaps riveted with corruption, and the rules-based primaryk with access to care, public health, and access to capabilities? >> thank you. ma'am, right here? we will take two or more questions right here. >> thank you. i am with the voice of vietnamese americans. thank you for the presentations.

and this seems to be the key. and how do you help to have the capacity for the government -- and you can look at the justice. and a young vietnamese man, they have been lured in without any , like when they come and donate a kidney that they had proper surgery done to them, and thetions afterward,

whole village near the borders had that happen to them, and that whole village is devastated, and i think nobody seemed to care, so that is something that i think significantly -- it has not been brought up, but i truly think it is the system with many different issues, and this is not just that case, but there are vaccinations, things being , with a the market cheaper price. >> thank you. >> thank you, gentlemen. i am the vice president of an ngo, and my question has to do with the fuehrer over the use of experimental drugs, and the

--nd what do you think how do you determine the priorities? >> and let's come back. >> thank you. i am a phd student in health care policy, so when we talk about ebola, it very much ssars, and of wednesday sars outbreak happened, i was in high school, and i remember every day i went to school, ok, i might die , and my classmates will not stop learning, so i have to work hard, even if i died findrow, so i think people

sos from people around them, i care, and i wonder how are people in west africa doing, what are they doing, and what are they fighting against this disease and how international organizations help them. >> thank you very much. >> do you want to start with some protocol issues? >> yes, the question of the drugs and vaccines, major, major misconception is that there are effective drugs that have been given selectively to a few people and not to others. the drugs that are in question safe orer shown to be even effective, and when the drugs were given, the antibodies, to the two americans who came, there was a lot of

press. , and there is no scientific evidence that there was any difference made by that drug. aso receiving the drug was spanish priest who died. also receiving the priest was one of three liberian health care providers, who died, so i think the misperception needs to be clarified. drugsou have experimental , even though emotionally went give something to someone who has no other hope, you have got to at least understand that they need to be safe. now, the difference between a drug and a vaccine is another thing that people do not understand. aen someone is dying from very serious disease, and you have a drug that is in a very experimental stage, you want to make that available to them as quickly as you possibly can, and

it is easy if there is a limited amount of drugs. you can do anything from a lottery, a clinical trial, you can randomize it, and it is different when you have a whole variety, and that is not the situation, because there is no drug that has actually been shown to be effective, and that seems to be a different story. safety,mount thing is because you are not giving a vaccine to someone who is desperately ill and need something. you are giving a vaccine to a normal, healthy person, and the big important principle is first, do no harm when you are soing it to the person, right now, the only vaccine that has ever been given to a human for this right now in the context of the epidemic is the first dose that we gave to our patient up in bethesda at about 10:25 this morning.

that is the first time that that vaccine has ever gone into a human, so the first thing is you find out if it is safe. reduces safe, then it the response, and then you have an interesting tension. do you immediately distribute it, or do you try to distribute it in the context of a clinical trial, and that is what you struggle with to do the ethically sound thing, but the main goal of all of this is to get into the africans who need it, but, you understand, none of them have been proven to be effective. >> thank you. to talkld you like about how you engage and persuade governments to make the investments? so it also draws on this issue of selling the organs. first is in every country of the world, people do care.

, and if the public sector is ,bsent, then markets will form and an unregulated market in health, it is a very bad idea. that doesn't mean that the private sector has no role. it just means that the private sector needs to be regulated. if there were no regulations, we would have anarchy, chaos, and unparalleled levels of harm when the principal is to do no harm. matters, so the case of the organs failed in vietnam is a classic failure of public provision of dialysis for people who need it, and, perhaps, this case china.

if the demand for kidney replacement is so great, there is a market for harvesting organs, which is illegal and dangerous, and as you very eloquently described, terrible for the communities affected, and then the best prescription there is to have an adequately funded, publicly accessible system where the private sector can play a role, but in the context of the bigger one. there is an overall question which is, first, your citizens want it. and what we are seeing is many low income country politicians are saying, they want to have access to care, and they want the whole shebang. i am not saying they only want access to hiv treatment, we also

want access to hypertension treatment, high blood pressure treatment, because we are getting old, and we have high blood pressure. so there are those expectations. secondly, if you think about it then, the structure of systems, the institutional capacity to deliver is absolutely fundamental, and health systems and creating that is not just simply the nike expression just do it. we can learn a lot. we can learn a lot about how to weelop infectious disease so can appropriately respond to epidemics and also change things in the context of lifestyles and chronic diseases, but we have to learn much more systematically and be able to support those countries in moving in that

isection, so i think that part of what we need to move forward. there was a doctoral student who lived through sars. are the people responding? how are they thinking and responding today? well, itd you say? >> would be so much similar to tim's. i really think there is a universal aspiration for health, and everybody yearns for it. when youte remarkable have people on the ground, when you have signs of ebola, heart , and there might be a traffic crash, and there is nowhere to turn. the hospital system has

fearful,, and they are so i think that the human spirit , there is nothing more than they want, and it is what they never told you. everything,health, and i think that is a truism that we tend to forget. and how we get there, this is what my book is about. so what do you do with this? post-conflict states. they are very fragile. people have lost trust in their government, to a large extent, and i think that is unacceptable. i think what we need is to have

a rule of law, both nationally and internationally. and it is true that the who or the world health, they have and with the, world trade organization, they have adjudication, and they have rules and norms that countries abide by. i don't see why he would not be possible to do that with health, both at the national level. issues like corruption, transparency, accountability. and we have found that way to bring that kind of govern society for the purposes of health.

>> your results based on sars, as well as this? >> i think everything that larry and tim said, it is different from what it is going on right now, and the people in west ofica have a perfect storm conditions against them. they are frightened. where they do not trust authority. and you can get into isolation by allowing a contact tracing. if they go into the hospital, they will die, and they take the six -- sick person, and they infect everyone

in the home. withdon't cooperate contact tracing because they are afraid of the stigma, and people were frightened of sars in china and countries in the far east, but you were within a pretty good infrastructure of health, where you're able to have your teacher tell you, study, and everything will be all right. that is totally different from a situation where there is terror and fear that is going on right now. it is really a horrible they are in. >> we have gotten to the close, and there are further discussions in other parts of town, so i think we want to close. i would like to ask our three speakers to leave us with just a quick parting thought, and let's

start with tim and close with larry. and point your comment really to this audience. audience.on-based what is the message you want this audience to take away, looking to this next phase? we have spent a lot of time on ebola. we do not need to make it central, but we have talked about the challenges and big ideas. tim, what is your last word of ?dvice >> well, i am not sure i have any advice, other than, perhaps, to say that there are realities in the world that we live in, which are such that we increasingly need to think about global health as intimately

linked to our health locally, and i think that means that you not only have to be concerned with the issues that confront us directly and proximately, close to our neighborhoods, but we also have to be as concerned elsewhere,onditions because we are increasingly therefore,ted, and our role in trying to make sure we move towards that principle of valuing equally the lives, wherever they may be lived, is extremely important, a value to see embodied in all forms of governance, and thank you. >> tim? as you said, this washington, d.c. sophisticated audience, because something may seem

insurmountable, do not give up. just because it cannot be done not bet mean it will done. back in 2002, everyone thought africa would be the fall off the face of the earth with hiv aids, and the program was put together, and people were saying you can never ever get africans to take medicines. you will never get them to lives aate into their daily medication that could save them or prevention, and then they came along and has completely transformed the lives of millions of people throughout health andso global addressing the disparities is something that will take a long time, but if you use that as an example, i think we should be is possible.at it >> this is a celebration of your

work. you get the last word. >> it is always a good place to pick up on. some days i get up and am more inspired, but other days i get up and say it is overwhelming. it is useless, but i am saying what you just said. never give up. we actually can do it. end with we would just camu, and i am paraphrasing, but he said pathogen's just come in common, us -- just come and come us, and we are wildly surprised. why do we jump from crisis to crisis, from haiti to the

to ebola? sars isn't it obvious? it is affordable. it is doable, so let's just do it. [applause] all for joining us. i want to thank all of the speakers, and i particularly want to congratulate larry, so please join me. so thank you. [captions copyright national cable satellite corp. 2014] [captioning performed by national captioning institute]

>> in a few moments today's headlines plus your calls live on "washington journal." at 10:00 a.m. eastern secretary f state kerry on u.s.-muslim relations. then the brookings institution hosts a discussion on the threat of the militant group known as isis and al qaeda. and alive at 7:00 p.m. eastern with the debate between the candidates for senate, north carolina kay hagan and her republican challenger. in 44 minutes a look at the militarization of police forces. our guest is tara dan ski. at 8:30 eastern we'll discuss

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