>> president obama continues his overseas trip today, attending the nato summit in wales where he is participating in meetings with other world leaders and focusing on the alliance role in afghanistan and the conflict in ukraine and the growing global threat from isis. he returns to washington tomorrow. we will bring you live coverage of ralph nader and grover norquist. they are both speaking on the topic of bipartisanship and will

be at the national press club. , formerernoon counterterrorism officials outline terrorist threats to the u.s. and whether the u.s. efforts to fight extremists can only lead to more attacks. c-span's campaign 2014 coverage continues tonight. we will be taking you live to california for a debate in the governor's race. jerry brown is facing off against his republican counterpart neil cash kari -- kashkari. firstight's debate is the and likely only debate between the two in this general election. is ang us on the phone veteran political columnist dan walters of "the sector meant to be." >> you're welcome. -- "the sacramento bee."

>> you're welcome. we are looking for any ri to putty for kashka anything on jerry brown. jerry brown is a skilled wordsmith. he uses latin and greek references, for example. he has developed a little bit of a short fuse. it will be interesting to see that --kashakkari can do get under his skin. >> a brief biography of jerry brown's career in california politics. >> he has been in politics forever. his father was the governor of california for two terms in the 1950's and 1960's. brown ran time, jerry for the los angeles community college district board. he became the secretary of the

state and then governor in 1974. 1976, for president in reelection in 1978. then again in 1980. the u.s. senate in 1982 and lost. he dropped out of politics for a number of years. he came back in a state party chairman and then dropped out again and became a radio talkshow host, ran for president again in 1992, then ran for mayor of oakland in 1998 and one that -- won that. he ran for attorney general again. then back into the governorship in 2010. ri?who is neel kashka son of indian immigrants. he is a hindu, which is unusual for anyone in politics, especially a republican.

he is a banker by trade. he worked on wall street. he was the director of the bank bailout program under president bush and president obama. andame back to california dabbled in banking again. there are no party primaries. he beat out another republican to get the right to challenge jerry brown in the fall election. he has waged a kind of geurilla campaign. but he is young and articulate. he does a lot of radio talk shows. he is up and down the state all the time. he is on twitter. he is everywhere he can to make himself visible. on nothiding jerry brown doing enough to relieve poverty in california. california has the worst poverty

situation in america, almost a quarter of the states population is in poverty. wente point, kashkari underground and spend a week in fresno as a homeless person experiencing the plight of the homeless and the poor and wrote about it extensively afterwards. it has been a guerrilla campaign. he has very little money. he put some of his own money into it. he is not wealthy in any super terms, but he has a few million dollars. he hopes that he can kind of make a slash. >> california is the most extensive media state in the country. how much will be spent? about $30rown has million and is not going to be hurting for money. as everyone knows, he is leading in all the polls. the consensus is that he is a slam dunk to win reelection and that unless he does something to

undermine his own campaign it is probably going to be a fourth term. it is probably going to be a very light spending campaign. jerry brown does not like to spend money. if he does not have to spend it, he probably won't. there is no much else going on in california to attract big-money. it is likely to be a very light spending election in california and a light turnout election, as well. that has some democrats worried about some of the congressional offices. ashkari campaign called for 10 debates. camp says this will be the first and only debate. >> that is in keeping with most incumbents. they do not like to debate. why give your challenger an opening and a free platform? because he wants to say, you can't say i didn't

debate. the state was chosen to be the opening night of professional football. that is one thing that will limit the audience. event, butteresting probably not a very significant one. >> dan walters is joining us from sacramento, a calm -- columnist for the "sacramento bee." thank you for the preview. >> you're welcome. >> that debate comes up tonight at 7:00 p.m. pacific. ahead of that, we will take a tok at the latest efforts combat rising childhood obesity by improving the nutrition in school meals. the president-elect of the school nutrition association is part of a panel that testifies before the senate agriculture committee. next, doctors and global health experts discuss the ebola out right and the recent estimates that say as many as 3000 people in five west african countries have been infected by the disease.

this event was hosted by the georgetown university institute on national and global health law. >> i just returned from sierra leone 40 hours ago. -- 48 hours ago. i did not shake a single person sand. -- person's hand. that there are three primary things i tried to focus on. i had many opportunities to do many good things. the first thing was the compassion and care and evaluation of patients at any boulevard testing center in testing -- and ebola

center in freetown. workedtor from spain there for two months and is there now still. another 27-year-old british physician from kings college london. ,t had a profound effect on me to be able to help provide care and evaluation of patients with the ebola virus disease. , i participated in the training in how to put on the personal protective equipment and then most importantly is how to take it off safely. when you take it off, that is when there is virus on your gowns and gloves and goggles and face shields and you have to take it off in a very sequentially important manner, washing your hands between each step. i worked with the minister of

help -- health. and a u.k. physician sierra leoneian colic. -- colleague. together, we trained trainers. who then went on to train more people after we left. in freetown and in other hot spots. our goal was to organize a working group. the major hospital closed well i was there and it has not reopened as of august 18. there are many children with terrible diseases who are not able to get medical care as a result. just briefly, i did bring handouts on the pediatric situation in a publication called the program for emergent diseases.

there is a second article that i had a small role to play in. this is an article i wrote and i take full responsibility. it may be controversial, but many people read it and distributed it to colleagues, more than 30 professional colleagues in freetown. simply 18 problems and 18 solutions for how the ebola solution could be much better and provide better care for individual patients and citywide. i would like to say that this ebola outbreak has a more profound impact on me personally and i think it should on many of us because it is going to get much worse. that a largerced outbreak is going to occur in a

large oil city in nigeria. links to a physician who died and had many close contacts. , it is certainly controversial, but i truly believe that after three weeks of being there and sierra leone, this is the first urban outbreak ever of ebola. personally, i don't believe our traditional methods of being able to control and stop ebola , contact tracing, isolation, quarantine, is going to be effective perhaps in most of the cities. if this outbreak is on longer than a year, we are going to have to have vaccines, drugs, antibodies, and first exposure prophylaxis to stop it. we should do everything we can to slow it down, to stop it, to

start to decrease, but i'm not confident we will be able to stop it without therapies and vaccines. this is much worse than anything i remember from aids in san francisco in 1982 or anthrax in 2001 or sars in hong kong, bird flu in indonesia and egypt, and murs last year. i'm very happy to go back to liberia to work with doctors for sixborders ince -- weeks. >> thank you for those remarks. thank you for your service. want to start with the human picture. this is a particularly terrible virus and disease. let's step back and try to get a situation analysis of where things stand. i'm going to ask marty who has been tracking these issues

across all of the affected countries and populations, if you could give us an overview of where we stand. i think we know we are not at the end. are we at the beginning of a control of the kinds of individualr epidemics? if you could give us an overview, that would be great. >> sure. thanks for the invitation and i appreciate the opportunity. i do need to provide a disclaimer to the heaping introduction. i am one small part of this response in an agency that has mobilized several hundred people and more70 deployed will be deployed internationally by the weekend. it is an unprecedented response for our agency. brilliant minds and talents dedicated and

engaged, not just from cdc. in terms of context, i really appreciate the opening comments about perceptions on the ground. is whatould like to say are the characteristics of this epidemic? this epidemic is very much out of control in some areas. what are the characteristics that make it unique in that regard compared to the other ebola outbreaks of the past since its discovery in 1976? one of them is the location. profound. pretty we are seeing painfully the face of poverty and disparity and so on and the impact of the intersection of poverty with a

devastating, merciless virus. it is staggering in that regard. systems fragile health that have been suffering in states that have only recently emerged from years of civil war and infrastructure challenges. another unique aspect. compared to the original outbreak in 1976, it is very isolated, this was unconnected. the tools of detecting an outbreak, isolation, contact tracing, and beginning to alter unsafe practices in burial, which cause a huge amount of transmission, happened in a very remote area -- it was not very connected or globalized. the success and/or failure in the trajectory of the outbreak -- the outbreak gets contained.

here we have an outbreak that probably emerged at the intersection, at the boundary areas of three countries that are highly connected culturally zoneshnically, with many of commerce and exchange, with community practices that involve marriages across boundaries and burial practices that are often distant from the original religion and so on. the degree of human mobility is a factor that plays into the spread. this outbreak is unprecedented, both in geographic spread, scope, and magnitude. this outbreak is occurring in urban areas, which is unprecedented. the strategies and thinking about how to control dents, crowded urban slums like west cities, the capital whole concept of how to deal

with a lethal outbreak in these urban settings with large population centers and connectedness, both regionally and through other places on the continent globally is a very unique circumstance. the health infrastructure was fragile at its start. but epidemics of disease like this, horrible diseases like bys, are often followed epidemics of fear and epidemics of stigma. combats and the stigma and conflicts the attempt to get the epidemic of disease under control. misperceptions, lack of understanding about means of ofnsmission, suspicion, lack trust in government, suspicion of outside folks not understanding how the disease is spread or who was bringing it.

these things contribute to a level of resistance in ismunities and anger, which often the mask of that fear and former ability. -- vulnerability. is axtent to which this fresh ebola outbreak in west africa contributes to that. a lack of understanding of the disease and where it came from. that context is really important to understand how we got to where we were. some people refer to it as being caught off guard. it is more important to think about where we are going and not finger-pointing or blaming. massive public health emergency of international concern and a humanitarian crisis which risks civil society. we're seeing the collapse of some of the key aspects of civil society to keep it functioning in areas hard hit like liberia and the capital.

in those areas, when you ask about the trajectory, we have not turned the corner. the virus is winning the battle. it has outstripped the human resources. the numbers treatment centers that are needed, the number of health-care workers that are needed, the degree of personal quantity effective equipment, the quantity of body bags, the people and the stuff that are needed to be able to get an outbreak of this magnitude under control are just not there. to be aally needs wake-up call to the global community that this is going to require a coordinated international, all hands on deck , not just the health sector response, but a full response. it represents a significant global health security threat, as new countries become introduced and have a single like nigeria.

we are still trying to snuff out one chain of transmission from one introduced case since july 27. you think about the possibility or intomic in lagos one of the world's largest mass gatherings coming up in saudi arabia. the consequences and the concept of having introduced ebola into these other types of settings, mass gatherings, or mass communications is hard to fathom. larry's comments are very poignant. i think it is a long road ahead. i think the who roadmap is very much welcome. hope we are there. in the best of circumstances maybe. right now, we have not seen the band did not epidemic curve. . fear it could be much longer we really are going to need all of civil society to be fully engaged.

have got awe sobering picture on the human-patient level. thank you for that overview. if we are in a situation where the epidemic, we have not turned the corner, it is growing exponentially, at least in some of the key areas. -- as we to ask steve think about a crisis like ebola growing, particularly in capital cities and on a regional basis, you might want to reflect more generally, if you would, on the impact on politics in africa, global politics. a little bit of the larger frame. this has moved beyond the public health sector issue to a much potential set of issues around security. >> i was also hoping to talk implicationsurity

and the role of the united nations and the security council. weekshink in the last six this epidemic, the surge of this epidemic has forced us to recognize that it has moved beyond being a public health crisis. it has become fundamentally a security crisis. it has triggered, for the states in question, particularly liberia and sierra leone, it has triggered an agate -- existential moment. the states which were acutely week before hand, the functionality of their civilability to worsening conflict is magnified tremendously. they have seen their already marginal health systems eviscerating and overwhelmed.

they have seen in security touch well over one point 5 million people. they have seen their markets, their production, their economic integration disrupted. they have seen their integration into global airline systems disrupted. pretty much halted. they have seen the sudden exodus ,f talent out of the states across multiple sectors. they have seen in the health sector and the emergency response sector, they have seen a worsening of the risk environment, a deterioration of the risk environment reaching such a point that medical personnel simply cannot be effectively protected in many of these situations, whether they are at work in these protective clothing or they are outside of work in what is supposed to be a more normal situation. would you are seeing is the insertion of teams that get

exposed and they get suddenly and immediately pulled back. my first point is that this is not a health crisis, this is a multidimensional security crisis within this region that now threatens neighboring and nearby states. it threatens another 10 states. likelihood of the transmission. the second point i would make is that while this crisis has mushroomed in this last period, it has not penetrated the level of world leadership and come to be recognized and the knowledge -- acknowledged as a global security problem. it has not been brought forward to the un security council. why is that? why is that? if you have the kind of implosion that i have described

and the implosion that now threatens the surrounding region and the human magnitude of the crisis on a skyrocketing trajectory, where we were told dead, 1500hat 3000 , 3000 cases, 1500 dead, but we think it is probably 2-4 times that level and we think it could hit 20,000, there is no confidence whatsoever that 20,000 is a stop point. you are now in a world of great unknown. of trying to think about what the two deck three -- trajectory will be. you can see this lots of bullets going to 40,000 or 100,000 or plausible ofng going beyond 100,000. this has been a very hard set of

lessons for public health experts. why have political leadership not grabbed onto this? a couple of answers. this is the unknown. we did not know that there would be this cascade of catastrophe. know that this perfect storm would appear and ignite in this region with the speed and ferocity that we have seen. that in the earlier days there was an overconfidence in public health officials that the methods that have worked in earlier settings could be applied and would work in these settings. there was excess confidence in those tools. s were made to political leadership, those went unmet. there was overconfident and an inability to penetrate the higher levels.

summer that in this last it has been a terrible environment to get a virus driven security crisis onto the agenda of the security council when you have the atlantic state in syrian iraq, you have the israeli-palestine war, you have the russia-ukraine war. it is an exceptionally crowded environment to push this through. the last thing i would say is that it is very hard to walk the sovereignty minefield here. until the states in question are prepared to come forward and plea for a higher level of commitment, how are you going to win consent to deploy peacekeepers into this setting? the model of responses failed. there needs to be another model of response that treats this as an emergency, humanitarian catastrophe that requires the deployment of protected authoritative forces into this

setting. to get to that point requires consent. it requires sovereignty. it requires sovereignty be respected and it requires political leadership. there has not been political leadership on this matter. toear that what is going happen is that we are going to do with the who is suggesting, which is draw up a list of 12 things and ask people to do more of those 12 things, versus seeing the big picture and coming up with a response to address -- we need to transform this exponential crisis, this escalating runaway epidemic and we are not going to transform it by doing more of the same. thank you. now we have aired all three. -- individual country level individual, country level, geopolitical. before we turn to a couple of the issues that have emerged so far, i want to invite anyone from the panel who wants to

comment on steve's point. i want to emphasize the point that marty made in its relation to steve's. in the middle of a public health crisis, there is a lot of information and a lot of people the really important point is given we are today, one of the things we can attract attention and the actions of the players in the world that can make a difference in this dynamic, because i would argue this is a maybe not unprecedented, but a rare place for us to be in as a global community. i would like to turn to a couple issues that have received attention in the bd, particularly around his quarantines and access to medicine. let's start with both larry and dan mentioned the issues around treatment of vaccine.

i'll ask kevin to kick us off. yesterday hhs announced they will accelerate their contract to get more of the vaccine available for clinical trials. nih has mentioned, announced we started yesterday going forward with the first trials of the ebola vaccine. hasink this stark situation raised a couple of really critical, ethical issues, and one of them is that debbie a joe can be on a panel

like this come and does it make sense to provide medications in a context that the who recommended. how do you allocate what will be in variably scares resources in the context of the catastrophe we are talking about? i guess i would ask kevin to kick us off with the conversation. larry has written about this. will,o, if you differentiate between drugs that have not undergone safety or efficacy trials with vaccines, because you have a compassionate use of a drug when somebody is potentially dying. but vaccines are given to otherwise healthy volunteers. this raises a whole set of ethical questions. if you could reflect on those things, that would be helpful. >> absolutely.

we have heard about the humanitarian crisis from the position,d as a especially if physician who spent much of his career treating children, it is devastating to hear about this. i cannot imagine what it must be like to be living through that. we heard about the public health response, the in adequate health response and how we will have to be able to do much more. that will raise a bunch of ethical questions. but i think we have to remember that this is also about people, about the people involved. and there is a tremendous urge to say if we can treat people, even with experimental medications, why are we not doing that? that is one of the foremost fickle questions. i think there are several that and weth thinking about,

may be able to cover some of them today. that is number one on the list. the other would be when we are considering the application of those scarce resources, the most pressing question would then become, who should be treated, because we have a whole lot more people who might be candidates for treatment than we have treatments available. and also i think that one of the questions i would like to hear discussed before we are done is if the ebola virus has been known as the cause of disease since 1976, why is there no preventative vaccine or effective therapy? i have my own opinions on that, but i would like to hear everyone talk about that. now, first off, what about experiment treatments being offered? i think we have to consider the pros and cons of giving external drugs.tal they are for the dangers and

adverse effects that can neither be known or safety predicted. it is entirely possible they may --in effect or even harmful ineffective or harmful. in america all studies have to go through a first age where the likelihood of harm can first be assessed followed by subsequent phases to look for additional side effects and evidence of efficacy. so far, these therapies have been tested only on a handful of monkeys and not even the first fore that has occurred human beings. the monkeys are getting better, you will be happy to know. but so far six people have received one candidate experimental therapy. two of them have died. this does not prove it is effective and does not prove it is safe. we do not know what harm's it may do long term or even short term, and the guiding principle to any use of new medicine is in the first place do no harm. research is designed to answer

questions about possible harm and possible effectiveness. but what has been done here is not research, but rather it is scary, experimental treatment. it was done because ebola is a deadly, scary disease. but if we were to keep approaching this in an uncontrolled way, we may never know if these therapies are safe and effective or at least not know until a great deal of harm may occur. especially that part of the world now suffering most tom ebola, desperately needs know if there can be an effective treatment as well as an effective prevention in the form of a vaccine. all possible victims, current and potential, to get this right. there have been examples in the past of untested and under tested therapies being rushed

into service and ultimately doing the patients a disservice. some of these misadventures occurred on the african continent. pervasive distrust of western drug companies using africans as their experimental guinea pigs. so i think that is really an important issue, but then when we hook it to the issue of who should be treated, the civil answer is that all the questions, ethically very important and complex, it will remain moot until therapies are made available. as we have already heard, no tested or approved therapy exists, and we are at least months away before any therapeutic drugs could be even produced again for testing, much less know that they are safe and effective. the happy news is, if there is any, is that, as larry pointed

out, vaccine testing has begun. vaccines may be able to be rushed into service sooner. we would hope. but vaccines will not take anybody who is infected, and will only be effective if large numbers of the population can be vaccinated, which presupposes two things. first, the sufficient amount of safe and effective vaccine can be produced, and, secondly, that we induce the threatened populations to accept this vaccine. you have to understand in these areas we are having people still do nine that ebola is real, and those who do get it or are at risk of getting it are hiding from the medical establishment for a variety of reasons, what is making the entire control of this epidemic much more problematic. was just going to follow up

on that, but for the whole panel, as well as you, kevin, i know this is a horrible thought, but it is occurring to be, and i wanted to ask the question. in ou think about 1ni1 which was a direct threat to united states and australia, we rapidly got a vaccine within months. toe, we are going back essentially a regional tragedy since 1976. i think public health experts said it one day will come to the united states, but we will quickly contain it. it does not represent the same kind of threat to us. what is the reason why we have not seen the investment to scale

up for well-tested vaccines and drugs? >> the temperate answer is there is an arduous process of developing therapies, developing vaccines. only one out of 10 prove successful, which mean 90% of the candidate drugs and vaccines are not going to be usable for one reason or another. i think there's more to it than that. i think the stark reality is the pharmaceutical companies are a business come and the business has to have a market. and there are twofold problems there. the first is, as scary as this is and as tragic as a number of deaths -- as the number of deaths are, this represent a small market for pharmaceutical

markets. >> and and unpredictable one. >> and the other problem, it is a poor one. if thisvinced it i epidemic were happening in other than poor countries in west africa, we would be seeing the attention we have heard should have been given to this a long time ago. >> others? there's no question we are in a different dynamic than a global flu pandemic. >> just to get some contacts. not saying i disagree with all the issues that play, but to be fair, if seasonal influenza influenza comes every year. this is something that is a familiar, recurring threat on the frontline of everybody, knowsody globally

somebody who gets the flu, and somebody who has succumbed to the flu. and that level of our violence and that level of frequency year in and year out, as well as memories of pandemics past, like 1918, and the devastation of an evolved we dated strange to which the whole world is susceptible is a powerful influence, and we should not underestimate the difference in frequency of occurrence. it is easy to see, and there are many explanations behind this, but i do not want to -- >> but in a pushback, you're totally right, but even with h1n1, and one could imagine this in so many areas, even though you might tell up some good reasons a vaccine, the distribution of a scarce resource still resides, and even for seasonal influenza, the

low-and middle-income countries do not have the supplies, do not use them. so you have seen much greater depths. >> but let's take neglected tropical diseases and sort of parallel and look at malaria, tuberculosis, etc.. there has been scale. than weave been later would have wished. but things that are more common that are more recognized and daily routine every year in and out killers have also been addressed. there needs to be more done to combat neglected tropical diseases. so i think when we still look at ebola, we're still talking in the scores of outbreaks, not over a year thousands, millions of cases like neglected tropical diseases like malaria. in twoink we are

different markets. >> it is important to remember prior to the ebola outbreak in west africa the total number of cases from the previous two dozen outbreaks was 5000. the total number of deaths was under 3000. you contrast that to the 39 million estimated deaths from hiv-aids and a current population of 34 million living with hiv. those are rather disparate market numbers. and if you are going to apportion resources, scarce resources towards the development of treatments and possible vaccines, then where do you put your money? realityink that cruel is with us today, and we are playing catchup. together think i would say is this has not deterred in this context, has not returnedgsk

fro partnering. there has been a willful -- i think this is been a wake-up call across audible sectors for folks. there is now an urgent moment withrying to accelerate all of the provisions around preserving safety and the like come up at trying to change the conditions and move towards treatments and therapies and vaccines. see somenk we will results. whether we will see results in time to address the immediate urgent crisis is of course totally up in the air as a question, which gets to my second point about about ethics, which it seems to me, the biggest ethical challenge in front of everyone with respect to the response today is how to go about providing low-tech

treatment to the large affected population in west africa on a safe basis that is ethical, because the more high-and treatment options are getting washed out. hospitals are closing. personnel are leaving. personnel are not on the ground. tothat ultimately leads you inquire about what are the options going to be for low-tech palliative care can that be provided to people who are suffering from a bowl and the other threat from a bullet in text, which would be different from what we would do in a normal circumstances. it will raise ethical issues, issues of race, and that is the predicament. that is the biggest predicament we face on the ethical grounds right now. >> i think you're absolutely right. i think what we really have to be focusing on are not the questions that made the headlines initially, which were

great, because they made us all pay attention to what was going on over there, but in fact if we are going to make a difference in the immediate future, it is glovesings as simple as and gowns and. antiseptics and the public health measures and those are things we need to focus on. soon we will have a vaccine and maybe there will be an adequate market for it. the sad truth is there's probably another reason that we are on theng as we vaccine, and that is it was also realized that this might be a recognizable infection. itthat presents another -- is both a risk and opportunity, right, because it does speak out -- to take a second for my -- weus stint at hhs moved quickly from identifying

vaccine, buting a that was not a given. it did work out in that sense. but i hope as much as i think we are all incredibly hopeful about the prospects for an ebola vaccine can i do not think we can assume anything, and certainly it is a very competent a situation that does not have flubenefit of a pandemic context of an annual process of developing a vaccine. we are not eating -- e toe are not evfe effectiveness testingn. >> and makes an argument for the kind of investment, whether security, and to deal with man-made threats and natural threats. it is an argument for thinking about why you need to invest now for what may be something coming down the road. let me ask others on the panel

-- dan had mentioned this set of issues. does anyone want to jump in? >> in 2011 -- we're coming back h1n1, harvey fienberg -- feinberg chaired a committee that was an independent and sanitation -- an independent examination of there's lots of international health regulations during the first to clear public health emergency of international concern. one of the recommendations that he made at his commission made, that was prescient, was to have an ongoing health contingency emergency response fund, something that provides surge capacity early on that you do not have to now five months

later be asking for funding. as marty said, it should be there on the ground and quickly mobilized. marty and others will know berg report.in what can we do now to make that a reality? >> i was on that committee with harvey, and it was a year-long process, and i think there were many good recommendations which was a reflection of how the world responded to the pandemic as well as how -- what can be done to strengthen the international health regulations and position the globe at the ready to deal with these what -- become particularly

predictable -- unpredictable and timing -- current and emerging threats. the committee report and the committee unanimously felt strongly about the need for such a global emergency fund that could be called in quickly. in addition, i would point out over the last year there has been a tremendous effort to develop a global health security agenda that reframes this up. we could put a lot of -- have a loud conversation about the speed and fairness with which medical countermeasures are developed, but there's really nothing like primary are mentioned, because no matter what there is a lead time for a newly emerging threat to come into the countermeasure arena and we need to invest in prevention up front, where it is possible, primary prevention, the ability to detect rapidly and respond swiftly. all three pcs come all three

pillars of the global health security agenda are critical, and sadly this is bullet epidemic -- this ebola epidemic an example of the need for a global set of partnerships so that when these inevitable things are merged in our highlyzed, interconnected, an interdependent world, we have the capacity to find them quickly, we have the infrastructures and health systems to respond, and we have the ability, even if we had a vaccine, we have the ability to preventive services and a quick time. those are key aspects. his is one example. seven, there will be more. i hope we will heed the call and the lesson and we invest with some look toward the future. >> steve, let me recognize you, and then dan. >> thank you. marty raises a critical point for what can be done here in

washington, and that is around the global health security agenda. this wasemind folks, launched by the white house in february of this year. tom friedman played a critical freedan played a critical role. it involved a consortium of 27 other countries, and a number of other organizations. it was driven with an awareness of the antimicrobial resistance, fire security threats, and emerging infectious threats, that like we are seeing today with ebola. it has resulted in the aspiration to create a network of emergency operations centers around the world, but it is being done on a paltry budget, a paltry are budget. free $5 million a year. million a year. there is no funding mechanism

that is robust, reliable, durable, sustainable, in the u.s. security budget beyond our borders. and there is no institution that is the sole repository of expertise and responsibility for leading on this. we are very fragmented. to the extent that this crisis stimulates a rethink on that hill and a rethink within the administration, the global health security agenda provides a very good model or set of pilots which could be expanded, built upon, quite aggressively. the summit for this is september 26 here in washington. so that moment will arrive, and i guess ebola will figure prominently in the discussions about why it is you can have crisis in ated place that really has not looked -- hasof the capacity not built up any of the capacity of international health relations. >> dan, please.

>> i want to speak up about the issue of taxing. of vaccine the moment. we can put money and effort and resources and minds into the vaccine, but an there's no guarantee that work. the most glaring examples is hiv, hepatitis c. there are no licensed vaccines against any parasitic disease. those are some examples. a lot of brilliant minds and research has been put forward, for example, to developing an hiv faxing, but we are not there. i say that because there is no will be a there safe vaccine. hopefully it will be safe. hopefully there will be an immune response.

using the model, trying to learn from the past, one thing we have tried to do for 30 years with hiv vaccines is up for a particular immune response. that almost never occurs with hiv. but with ebola, it seems that it does. in this outbreak, approximately of people have survived. they're not feeling really good -- they are feeling really bad when they survived, but some are feeling better than others. point 16 the points, out of 18, people are short of ebola, but from multiple points of view, one of which is the scientific point of view. i would argue it would be a value to vaccine in the element if we were able to better understand the immune response induced by the natural ebola

virus infection itself. and then trying to mimic our vaccines to reproduce the natural protective immunity. >> let's hope the virus does not mutate. a differentlmost species, a different strain of the species. >> that is another question about whether a vaccine for this species would be effective across the range. en beforei just -- ev figuring out the immune issues around the survivors, now engaging the survivors in their control and response. having survivors be part of the social mobilization and telling the story of ebola, having the survivors play an important role in providing care in areas where there are limitations

until ppe can be scaled up. that is an underappreciated -- >> just scientifically, for the audience, once you recover, is there a complete immunity to re-exposure? >> it is thought that recovered persons are immune to reinfection. in the short run. the duration and the species variation on that maybe effort, but there's no reason to believe that people will be repeatedly infected in the same pop wreck or epidemic. >> thus far what we have talked about in terms of response to the outbreak, we have talked about the importance of a therapeutic response, both in terms of vaccine element -- development and drug development. we have talked about the sanitary and public health trying ton terms of

make sure we have adequate personnel protective equipment, safe and secure and hygienic isolation rooms, and public health infrastructure to do the contact tracing, which is like.e, and the we have also talked about the idea of just lower-tech caring, hydration. nursing care. those are all -- and then to back that up, i think the panel has almost been unanimous in which we would like to see a surge capacity, a standing surge investing in relation to emergencies. but what we have not discussed a more ancient response, but one that we have seen here, nitaires, basically a guarded area where people can

go in and come out of. in many cases, it has been and , andd through the military there had been discussions about food security shortages and clean water, viable employment, travel, commerce, all of that. but let's -- i would love to hear the panel's view about what role there is, not just for unsanitaires, as it has been used, and it was just lifted yesterday from west point -- yeah. smart unsanitaire

might look like, what role it would play in relation to all these other pub health interventions. >> to ask maybe marty in particular to share with us, the current public health recommendations in the space in your experience come as i think that is -- >> this is an area where there has been a lot of inking about in terms of preparation for a devastating pandemic and many other things. i think the public health measures are based on the principles of isolating the sick , quarantining those who are exposed, but not yet ill, and filling separating the unexposed or the well and creating that space under the principle of breaking transmission. two primary goals in this epidemic is to stop his

mission inside the zone and prevent spread, or vent seeding of new division. >> and prevent spread within the hospital. >> but to stop transmission inside. and so we have highlighted how much we are a globalized world and how much mobility and interdependency there is. so that is a formidable challenge in contrast to off-century leaving a ship venice for 40 days. that part of the modern challenge as well as the ethical challenge. thankfully, we do not live in a world where we sacrifice the victims for the benefit of everybody else. the question you asked, larry, is what are the ethical principles behind using that tool in an effective way. and i think some of them that have been read about by others

as well as some papers that i published on this involved proportionality, making sure that the measure is proportional to the threat, that the -- to create that goal, and dialing that back and minimizing the duration as the need for exists.longer i a process that inside the ring, the most important thing, the infecteds need to be outlined between the victims and communities being protective. they have have a common set of incentives. and there is nothing that could propel an instinct to flee more quickly than armed guards and wire blocking someone into a space. echoes against her primal instinct that if it is so that i have to be locked in here, i need to get up quickly. thosecannot confuse

incentives. and i think part of what is essential in a modern context is delivering effective goods and services inside, not joking an area off from food and nutrition and medical care. the treatment centers have to be adequate and sufficient. the work services, the compensation, the permissions that all of what would need to happen to align a community to voluntarily in some ways -- if the incentives are designed right, you do not need a primitive card. what you need is a compelling government, trust, and community engagement to violent terry participate. and it is not impossible to create that. we saw the vast majority of quarantines hopefully that were applied during sars were voluntary quarantines and recommendations -- we did not have a direct medical countermeasure, did not have a vaccine, did not have a treatment, but there was a compelling argument and alignment.

circumstance,rent absolutely, but the principle of that obligation, and in addition, inside the area do not want to create a hyper transition zone. you still have to identify the sick as they might be exposed and need to be pull it out and separated, so you need a safe space within a community or village where the sick can be isolated, where people can be provided safe care, where food and water and nutrition and other incentive structures can be in place. .nd those are the concepts those are not easy to do, and the risks of doing it wrong i think are exactly what we saw in west point, that the simple military cordon and forced with wire and and -- barbed communities that have a distrust of authority has the potential for real -- >> i wanted to follow up and have steve come in with this, because one of the things that

affects me, most of the things we have said today, there seems to be great unanimity among the public health community. but i have heard some discord and see about the role of the cordancy abouts the role of the military. some say the military is the only group that has the operational capacity to deal with something this big. the others have talked about securing a bullet treatment centers, -- securing ebola treatment centers, securing other centers, people working in the field, but yet from a public health point of view, having a military involved is trying. >> my comments were about military, armed military enforced cordons -- >> i was not referring --

i wanted to get a wider discussion. >> i think those are different roles. >> what is the appropriate role of the military? >> [indiscernible] >> i think particularly in the context of a post-conflict states, but what the international -- so there are several questions or dimensions to this. keep in mind in liberia and sierra leone these are countries which went through decades of internal war that were -- that involved particularly heinous abuses of civilians at the hands of armed entities, some of these official army into the skim others, malicious or oppositional ones -- militias or operational ones. it is hardly surprising that sanitaire in aon

remote area where 70% of transmission -- that that has that it is permeable, and people do not trust it, and they flee. i think the idea that the militaries can win the trust and confidence of their a pretty dubious proposition, and we have seen it in west point where what looks basically creating a death zone or a tomb and saying inside, good luck, and outside, thank your stars. it is sort of the militarized thing. what i meant about militaries was the fact that there needs to be some kind of mobilization that can bring into -- that can create the list capacity -- the which hasity,

disappeared on the civilian side in terms of air, and it is highly disrupted. and we know from countless natural disasters and postwar situations that blue helmet deployments are critical to restoring security and making it possible for all of the civilian-based things to go forward. and this is a situation that genesis is a virus, but it has morphed into a multi sectoral crisis, and there has to be security restored, and it would make sense to return to that model in the first instance providing you have the will to put troops into that or a request was put out, as we heard yesterday, 53 countries, a quite request to the u.n. channels as to who might be willing to troops in andting one country of 53 said possibly they would consider it to keep in mind also you have today 4600 new helmet trim its deployed in

library and that were part of an original peacekeeping force, that was at its peak 15,000, and that is in a phase down. it is supposed to be down to zero in 2016. the filipinos have said they want to get out for the safety of their forces. you have a force there that if you could hold that force and build upon it within liberia and rethink its mission and give them confidence that they will be protected, you can begin to move in a direction that i am talking about. but it is going to be hard. it is going to take an enormous political investment to make this work. >> you're thinking of international peacekeeping forces? >> it could be white helmets. they would have had a different look. why is it that the president of msf is out saying that this has to happen? is saying that joanne that is because msf is shouldering 2/3 of the burden today of delivering of service

today in three countries. one ngo. this is a gritty, determined, disciplined, and remarkable institution that does not shy , violent,brutal broken places. they are in eastern syria, myan mar, and in west africa in the center of ebola, but they have reached the outside limit. they have a thousand employees. ine other force has to step to take things to the next stage. >> if you could say just two enceences for the audite in distinguishing roles that peacekeepers can play. >> i was making up the white hat thing. [laughter] >> it will be quoted. >> blue helmets, blue is the color of the u.n., is troops

that are on a volunteer pieces placed under a you and flagged and you and command in order to play under the geneva protocols to play effort functions, and the precise functions are negotiated with the countries in question. and the duration and the rules of engagement and the deployments and command getsture, and all that negotiated out carefully. it is not easy. at any one time of the last decades, the u.n. has to put up missions ineeping conflicted sites. there's no reason we should not be looking at that option and asking the leaders of these countries why this would not be acceptable. >> it is important that every one of those steps has a history and a process that has to go through with the countries, countries that are in crisis by all the things we've talked about here. i'm going to take liberty here.

we had about a half an hour left. panel the things -- this has been amazing and we have identified what will issues. we have talked about quarantine and issues related to that. we have talked about various kinds of medical treatments and vaccines, and we have talked a lot about public health interventions. we have got a crisis of extraordinary portion. it is not clear the trajectory, although, as marty has laid out, there are things we can do, but we are at the tough part of beginning the control at a minimum, and as steve notes, we do not know that. there have been a lot of unknowns here. my question for the panel, a number of you had said things from the very specific, the lessons we have learned in the first five or six months of this, one, what could we apply in the countries right now? have think marty and dan

alluded to things -- let's not make the same mistakes twice. what have we learned, what can you do differently? and second, looking on a global stage and steve has identified several ideas, using peacekeepers, taking advantage of the global health security agenda meeting that is coming up . i ask people to think in both the near and longer term, what can we do, and the kickoff to that being who has put its role ad map out. $490 million. >> and that is their first guess. does anyone have the sense of that happening, and how does that fit in? both near-term and long-term, anybody who wants to say something in the next few minutes for we turn to the audience. steve? who roadmap, it was hastily concocted.

million, up to $600 according to the statement this morning. it is not clear where the world bank $200 million might fit. is not clear where the african development banks, 60-billion plus might fit. it is not clear who is in charge, and it is not clear how to raise the money. how are you going to fix that? the big question is what do you do from here? who in the midst of this crisis has been enfeebled by staff and budgetary crises, and this has been a terrible, terrible episode in history of the who. it has put forward this plan. the question it begs is who is going to make this happen, who is going to the operational details together and be authoritative in directing this and raising the money and getting us forward. i do not feel that many people

are confident who can do that. so what does that lead you to? suggest the un security council needs to take this up and create a mechanism, a body charged with doing this, and of course who would be part of that. as i said earlier, what has failed is not going to get us out of this mess up to now. and it was a good step to lay out in that $489 million plant the number of personnel needed by countries, the number of -- plan, the number of personnel needed by countries, and all the technical pieces and the person all caps that exists, and they were staggering. but to get to operational lies that is not yet clearly defined. and that i think is what we need to focus on.l >> kevin, marty, anybody else want to add? marty? >> i think that -- i'm going to stay away from that specific

that right nowst in the setting of a crisis there will be plenty of time to look back and do an after-action, but right now in the setting of what is needed to move ahead and get things under control is a coordinated international effort with a lot of partners. and i think one of the areas that has been perhaps underutilized is the importance community-level engagements, messaging, and communication, the use of survivors, even community mitigation and community control strategies that are better aligned with the cultural acceptability in the areas where the control has to go on. i think that increasing roles for a medical anthropologist --

we need to define clearly the ager drivers of the epidemic. and this is not just one hammons this epidemic. this multiple -- one, to epidemic.ogenous it is one thing that it is deployed into a country and you can stamp it out, where you have the numbers and the capability to recognize, protect, and stop it. it is a different strategy when you are on the exponential growth phase in an urban area. this as a look at multifaceted epidemic and identify the major drivers and engage the understanding, public trust, community support to help break the chain of transmission. as many have said repeatedly, it is not that we do not know how

to control a disease like ebola. we know how it spreads, and we know if you can reduce contact and you can use personal protective equipment and safe means of interacting with one another for those who care for patients, we know that war, and we need to engage it and engage community-level involvement in building that support. >> kevin, did you have one -- >> you were talking about the drivers, and you're absolutely right. one of the things we have not emphasized very much is the fact that one of the drivers is the population's response to ebola epidemic. the reason it is spreading in fact in some of these areas is because people who suspected they were infected fled the treatment centers and brought the infection elsewhere. and that will make it extremely difficult for us, above and

beyond the usual health -- >> it is a challenge, but the antidote to the anger and recalcitrance which is a mask of fear and vulnerability is education and empowerment, and that is the vaccine that can help turn around behaviors that are clearly not only individually counterproductive, but socially counterproductive. and we really have to do a lot more in understanding the cultural context in which this epidemic is spreading and engage solutions rather than trying to from the outside how to impose that. >> that is a point well taken. i think the panel has given us a rich number of questions. so we have got about 25 minutes. so the way we typically do this is we first take questions from students who are enrolled in the colloquium.

here. not self-identified i am trusting everybody. i know a couple people in the front rows are not students. but beyond that i do not know who is. so let me see if we have questions from -- >> what we should do is take several questions before we get to the answers. >> let me try with three. we have won three and one in the back and one over here. one, two, three. >>hi. i noticed for the last two months and right on the top of personal was the protective equipment. what is logistical write-down and getting this -- breakdown in getting this? budgetary? >> let's take a couple more. i cannot see her face -- yes, please. >> hi.

one of the questions i have, i think a theme that has been alluded to a loss here is in countries that have the resources to keep going and help deal with these crises, there is not a sense of urgency, either with the public or with their elected officials. so how do we go about trying to change that tone in the public discourse? >> excellent question. in the back there? yes. >> the question would be, why does, despite the historical nature with that with diseases, why are we seen as --ying to reinvent the wheel [indiscernible] >> those are all good questions. but he suggests, if i could,

maybe marty you could help us question.e ppe steve, on the sense of urgency in terms of -- and everyone can jump in on the answer. i am just thinking in terms of's just starting. and the last question i think everybody, bute dan, in particular, from your experience. marty, you want to talk -- >> i think the ppe issue is about logistics and scale and supply, and in the areas where it is needed most urgently, the supplies are desperately short. i think that can and is being scaled up, and i think that getting that stuff in and providing logistics, some of the response is being hampered and choked by the reduction of commercial movement. basedt may take u.n.- support to continue to move

services and people into the areas to make sure there is adequate supply. the other quite frankly is just figuring out how much is it that you really need and based on what strategy, and i think a lot of thinking has gone into that a number of agencies, including who and cdc. that should be an achievable result. that is not where it stops, because it not just about -- i think and said in his opening, having the stuff is one thing, and distributing it is another thing. but training in its proper use and most important in training ppehow to take off the in a way you do not disseminate yourself and scaling up infection control practices is an ongoing effort and that is something that is going to take more time than simply buying it. >> i cannot emphasize enough that i do not think it is a money problem. it is logistical, but beyond in thehere is ppe

capital of sierra leone, but it did not get to where we needed it. more than 240 health care workers have been in tech to the virus. more than 120 have died. largest testing and isolation facility in freetown, we did not have gloves that i felt safe with. we had flimsy gloves that broke easily. shieldsot have face until two days ago. we had goggles that have been washed so many times, washed through each that you cannot see to them. you, use what my crazy -- sweat like crazy. it is so hot. like crazy. it is very hard to see. it is very hard to see out of your goggles.

you cannot really see and you have gloves that you do not feel confident in. why is that? i could talk to everyone i could in the sierra leone hierarchy colleaguesy and see who were very helpful. one of them took him to his hotel room and said you can have anything you want. masks.ake some face [laughter] back and you could see through them, the surgical gloves, so you could draw lead safely. now there are some face shields. they are not ideal because the have ties that are tied back are going tobe you get some fires in your scalp, and there is no shower, etc. personally i think there needs to be something below the emergency operation center, some kind of federal public health manned center that makes sure

that people that need the equipment and appropriate training, that needs to be just me so people are protected. otherwise, they are not going to put their lives at risk. >> anyone want to comment on the personal protective equipment? also some thoughts, how the creative sense of urgency, given where we are now. >> it is a great question. the first thing i would say is othersericans and outside of west africa have been certainly imparted with news accounts around this, right? media every day, our media coverage has focused on this in great detail and considerable depth. we have seen a lot of very important voices. the secretary-general ban-ki

moon speaking. margaret chan has made some eloquent statements. has beenan indefatigable in his powerful way. others from the u.n. joann, constantly. there is no shortage of people try to rake the barrier and bring this to people's attention. and i think for a lot of the polling data shows people are scared, they are alarmed by this. they are less clear i think in their minds of what we should do. choices the strategic that powerful governments face in this. -- in this period. and in that sense i think bring

forward a next lay her of communication from the president, from samantha power at the un security council, and from other like minded personalities, including the nigerian head of state and minister of health, including many others would be very valuable at making clear what needs to happen and why does that tie to u.s. national interests at this moment. we are having obviously, when you look at isis, when you look at the other crises area, with ukraine,with yo with putin, there is a debate about projection of military power. well, that debate has not happened in this case. we have not had that debate around what is at stake in terms of u.s. national interests, what are our assets, what we can do,

what should happen during this next period. >> i think you're right, and i think it is difficult to have a clarion call when we are still i think in fact what is we're realizing the scope of the problem in getting a clear idea of how the world needs to respond, not just our country. you always -- also pointed out an important issue in that is we have to believe it is in our self-interest. we are wonderful and generous company -- country but we will mobilize when we are threatened. i think the unfortunate infection of two american missionary health care workers was the relevant thing that brought this to the front page. ande have been hundreds hundreds of people infected and hundreds of deaths including the

health care workers who are african and have been taking care of them from the beginning. a couple of americans to bring it to our attention. that is understandable. more peoplen't see getting infected and bringing it back to this country. that would be worst-case scenario. would bring it to everyone's attention. a fair question about community-based education. the point is well taken. so long?it take i do not know the answer but i think it is a very important when there is widespread transmission that is community-based and hyperendemic and educated in and empowering and providing kids and speaking how that is measured.

it is not a substitute and i do not think it is an either or. for allwhen we scale up the traditional approaches to fighting ebola and we need a level of preparedness for leveling new areas and creative community engagement in hyperendemic areas. some of those other things are just too hard or cannot be accomplished quickly enough. it is in all of the above. i think unicef is playing an important role as a partner in the effort and has been amplified. there is encouraging things going on. engaging someone you do not really think israel on a social that were. the hero story. in occurred and is a glimmer of

hope and inspiration that many crises have buried within them. theeed to be able to tell stories and tell the stories of survivors and the courageous and all of that because it is part of the social fabric of the response and a limit -- elevating those people rather than sticking -- signifying them . elevating them as heroes that they are rightfully so can help change the community diet blog and think it is really important. should we be thinking of community in that location in the same sense that we think of it here? there may be people in this room who may not react well if there was a knock on the door and said i am from the government and am here to help you. seems even there it is much less likely.

i do not know it is the government needs to do the knocking. think it is a grassroots evolution inside out rather than top-down. alsodesperately needed. controlling ebola at the septic -- epidemic for decades has always pointed out if there is not community participation and engagement commit those epidemics are hard to control, in particular, because there needs to be education around very sacred things. in some belief systems, and properly honoring the dead could bring on the scourge. so we need to understand from a medical perspective and figuring out how to meet the deep seated

internal needs in a way that is safe. i think it can be done. it has been done effectively in uganda in terms of controlling the ebola epidemics and altering practices to include safe burial . this is happening in an area where that level of community education has occurred. >> i would only add that in a crisis listening is one of the hardest things to do. so i think that is true for comedic -- political leaders at all level. not see any other hands in the earlier round from students in the class. i see more. to do a couple more students and then two more to the open group and then we will have to bring it to a close. are you a student and then bring it back here.

taiwan.a student from i noticed many of you have mentioned international globalization effort. taiwan,e president of have materialto manpower to join, what would you suggest we should do to get started? label.tional ?> your question you go >> my name is vicky and i am a student at georgetown law. my question is in the region

where this epidemic is happening. the issue of mobility and human traffic. i know some airlines have stopped buying into this country . how do you think that is being treated, considering the nigeria?of take twos wise, i will more questions from the larger audience and then will invite the panel to reply. i think we will be at the end of the time. this is not fair at all. one from the left side. the lady in the middle there. i have one on the end. will bethat is all we able to do between now and then. let's go ahead with the questions from over here. i am a student in global

health ball. -- law. approach toside out the treatment of this epidemic. i am wondering why if we are not already doing it, we are not going from the already existing that we havee have had in africa. i watched a lady yesterday on mediarculating in social were how the medical staff

recapturing a patient that had escaped. approach needshe to be implemented, because you could see the patient did not to betand why they have inside the facility. if people do not understand it, they do not realize how much of a detriment they are to the community. it is a loss. a loss that we cannot win the war. hiving with experience with for instance. so it made me think about the human rights aspect.

right to decide whether to be subjected to treatment. they have a right to be subjected to treatment, or because of institutional problems, the government should engage. >> the human rights engagement of the intervention. i think that is exactly right. gets to theon sovereignty issue a little bit. how do you measure the risk of controlling the epidemic and countries like liberia asking for assistance and being growth -- so grateful while not undermining the great work that has been done. naturee has the fragile and they have often had tremendous games. they have set up financial

mechanisms and suddenly are concerned international donors will find international ngos for the response. shell of the be a ministry left. how do you balance controlling the epidemic with maintaining a small but important gain that has been made since the end of conflict in these countries? >> we have four questions. i am not sure we will be able to touch them all. the one thing i would ask is if maybe marty could talk about the borders and travis -- travel restrictions. maybe you could say a word about the human rights dimension. the issue of human rights and capacity, the end goal is to have a strong functioning state and that is where we need to end up. we have three or four minutes. i think we can do this pretty

quick. >> the point is well taken. connectivity, unfortunately -fromthe three epidemic darius is relatively speaking more limited. it is a whole different story if you have an epidemic in another big hub area. i think the reduction in capacity of commercial airlines for a whole bunch of reasons, dollars, logistics, safe place for crew, many things we have been trying to combat, down 50% or more in others. need an alternative way to respond. i think your point is a really important one and understanding the poorest nature and potential reintroduction, especially in the manual river area, the introduction needs to be

addressed but i think it needs to be addressed again through more creative approaches. lex i do want to say a word about the human rights. i think human rights are really critical here. they are critical because i think when you have significant human rights violations, it is really the antithesis of the public response. it is our instinct as people to inflate. there has been violence and fleeing. those of the two opposite things we want. the other thing is human rights includes the right to health, the food security on the clean water and all of those things that are part of a government

public health community. we cannot forget about those in the midst of the disease crisis. as we know from so many hundreds of years back, i were worst comesct as human beings forward when we feel threatened by an epidemic and we have to overcome that. >> i think that is what larry was saying. one of the remaining questions is how do we help without creating individual harm for the structures that are in place? i would like to address the points around protecting and balancing those accomplishments and programs and achievements

that have been made as we get to this urgent requirement. we have seen, of the 3000 cases, 240 health workers infected and 120 killed. i have seen the disruption of services have huge applications for childbirth, treatment of any health meanser where there have been these games. so how do you take action to further erosion. that has to do, i believe, with protection. the risk environment has become .ervasive in many of these area particularly in sierra lyons, and how do you push back in order to preserve these games?

issues, we arer moving towards a de facto for the region. that is what is happening here. as they cease and government put have put up giant -- fans on land, sea and air traffic. more remote.es, we're moving into that. the question is, how do you push back on that in a constructive way in order to preserve and maintain the flow of goods and people that are so essential to the response. simply appealing not to do this has failed. that willhe measures

do that? i think it has been an amazing two hours. believe we in some ways are where we are at the beginning, a crisis that has a very real human dimension. we have seen this epidemic out of control in many places. as steve outlined in the comments, the regional global dynamic share is extraordinary. to think ask everyone the panelists for joining us. we at georgetown want to thank all of you who came here and are watching either on the internet or on tv. cannot takessue we off the screen. countryone that our plays an important role and all

of you do, too. thank you for coming. >> a few quick news items to tell you about. circuit court of appeals granting a request by the obama administration to have the full court rehear a challenge to the health care law provision allowing certain americans to purchase health insurance to receive subsidies. this comes after a three judge against the federal exchanges. so the full court is scheduled to rehear the case on december 17. were this our that eric holder is holding a news conference this afternoon to provide an update on the justice department efforts in ferguson, missouri. we will have a life for you on c-span. ahead of that, remarks by consumer advocate and former candidate ralph nader along with americans for tax reform president grover norquist talking about the topic of bipartisanship of the national

press club said to get underway at 1:00 eastern. later, counterterrorism obamaals in the bush and administrations outlined terrorists and whether the u.s. effort to fight extremists leads to an attack. eastern.ive at 5:00 a senate hearing taking a look at the latest efforts to combat childhood obesity by improving nutrition in school meals. here is a preview. of course kids do not like whole grains. they like sugar even more. a choice, theyd will pick sugar. that is what they like. their taste buds love it. them thedo not give food they want and teach them how to eat well for their whole lives and that takes leadership, determination and creativity. i love the fact that you told

your school district picked three colors every day. my children when i was teaching them about nutrition, that is how we did it. how many colors can you put on your plate? they loved that. because i fed them steamed vegetables as children, they only like steamed such bubbles. -- vegetables. they have been eating fruit at every meal since they were babies. my kids because they were introduced has -- healthy choices at every meal paper for healthy foods. a lot of these kids are not getting healthy foods at home. they are getting refined carbohydrates at every meal. a typical meal would be a burger and fries. a coarse paper for that, that is what they have been fed since they were little. it is easy to have flexibility. not serve refined foods at

lunch. let's push them to eat something healthy that makes them healthy and reach their full potential. he cannot concentrate in class. he is often made fun of. he has low self-esteem. he does not reach full potential. she does not reach full potential. so i am grateful all of you have talked outside the box figuring out how to meet nutrition standards. it out.igure >> watch more from that hearing, including testimony from the president-elect and the school nutrition association tonight at 8:00 eastern. next, more campaign 2014 coverage. off against her republican challenger in the first debate for the senate seat. they talked a lot about education and the health care law. republicans who need to pick up six seats to take control of the

senate are eyeing north carolina are indicating a tight race. the hour-long debate is courtesy of the north carolina association of broadcasters. >> good evening and thank you for joining us for the first of two association of broadcasters educational foundation senate debate. i am nora o'donnell from cbs news and i am delighted to be here as your moderator. is speaker tom tillis, the republican candidate for the united states senate. he currently serves as the speaker of the house in north carolina state the just later. welcome. on your left is kay hagan, a democratic candidate for the united states senate. currently a u.s. senator from north carolina. welcome to you. great to have both of you here. he here are the rules for the debate. we will start with opening

statements. following those, the candidates will respond to questions that have been provided by the news media, along with media from me. for the next part hum of the candidates will have a chance to directionsher directly. finally, it will conclude with closing statements by each candidate. we want you to know the order of the opening and closing statements and which candidate gets the first question were determined and agreed to by the candidates and their campaign. speaker tillis will make the first openings eight meant and received the first question. let's begin. >> thank you. it is time for someone in north carolina to cross party lines. and does not work here in north carolina. in 2008 andid that then she got elected and spoke

with president obama 95% of the time. by her own standard, she helped the people. she failed the people of north carolina. i know what it is like raising a family, struggling to make ends meet and go to college at night. as a speaker of the house i cut spending, regulations and cleaned up some of the mess k b high and in raleigh. as your u.s. senator i will washington and go and get things done and make america great again. k promise she would be different but she broke her promise. >> thank you. >> thank you. thank you for tuning in tonight. tonight is about presenting voters with a choice on how to move our state forward. i approach this job with common sense. solving problems and how we can

put the middle class first and make the economy work for everyone. differenteaker has priorities, the wrong priorities and at every opportunity he has fought for policies that are taking our sports -- our taxes backwards. he is cut for big corporations before students, women, middle-class amah and ultimately before the future. tonight he will be able to examine the true priorities. please listen to whom we are fighting for. speaker tillis feels those who have the most should get the most help. i believe our middle class and small businesses come first and the economy should work not just for the wealthy but for through one. tothe first question goes speaker tillis. in a new video service of the second american be executed by

isis otherwise known as the islamic state of iraq and syria. this morning, the president about to degrade and destroy the terrorist group. he has already authorized airstrikes in iraq. the focus is now on syria. how do you think the administration should perceived? -- proceed? >> we have to go back and realize just months ago president obama was calling isis the jv. last week after the beheading of he came andurnalist expressed regrets and a few days later said we do not have a strategy for isis. how can you not have a strategy for an organization almost 10 years old? they have roots in syria. they are taking over a country that men and women of the armed forces of the united states fought for and held ground and now we're are seeing a backward

trend. this is an example of where president obama has failed the people of the country and kay hagan has allowed it to happen or has been silent. we have to make this country and world safer. should thefollow, u.s. strike isis in syria? >> i >> i think the u.s. needs o take all actions to protect american citizens and protect freedom loving people all over the country. i think the president, to certain extent, now, trying to solve a problem that his inaction created. i think the president, who is responsible for foreign policy has failed on for a variety of places around the united states, needs to start acting and showing some leadership. i think senator hagan needs to demand he do, particularly in a state that has one of the largest military presence is in the united states. >> does the u.s. need to strike isis in syria to protect america's national security? >> i think one of the issues here is that the president

should have weaponize the moderate syrian rebels earlier. without doing that, that helped allow isis to grow. i believe isis is the most serious threat to our national security since 9/11. i have never seen a more evil terrorist group than this entity. the fact they have just recently beheaded the second american journalist -- this is a direct attack on the united states. time's up. action must be taken. the president needs to bring a resolution. he needs to bring a plan to congress. and i am at the point where, yes, i want him to do that. i want to look at it and i want to take action. >> so you do believe there should be strikes in syria? >> i believe we need to work with the moderate syrian rebels. i think the fact we are the most capable air surveillance groups in the country -- this is an

issue that is really a threat not just for syria, but to iraq. look what is going on in iraq right now with this caliphate that isis has put forward. we need to work with our allies. be the strongest military in the world, i do believe -- i want to see the president's plan and i'm ready to take action. >> would you like to reply? >> yeah, i think his extraordinary that senator hagan says, now that isis is one of the greatest threats globally and have a president that doesn't have a strategy for it. we've seen the beheadings of two americans over the last couple of weeks. the president announced his regret for the beheading and then played a round of golf. a couple of days later, he said that they don't have a strategy. the american people deserve better than that and kay hagan should be pounding the table for this president versus rubberstamping a failed policy that is not working. >> you also get a reply. >> i have said that i think one of the faults is the president

did not arm the moderate syrian army earlier in order to prevent isis from having the ability to grow and recruit, to use the social media that they're doing. they are the most serious terrorist threat facing the country today. we need to take action. time is up. the president does need to bring a plan and i'm ready to support -- first, i have to see what it is, but i'm ready to support and do what needs to be done to take isis out. >> the next question goes to you, senator hagan. health care has been a big topic in the senate race. the affordable care act and also known as obamacare, is currently the law of the land and the problems with its implementation has been will talk minute. senator hagan, you voted for and -- have been well-documented. speaker tillis, you said you wanted to repeal it. what would you do to improve the quality of health care north carolinians receive?