what are some of these must pass bills that we could see coming up? host: we think the only thing that will get passed before the midterm is this stopgap spending bill that will carry funding for the government into the new fiscal year starting october 1. guest: the question is how many extraneous issues the appropriators and the leadership are willing to allow into this. will they deal with reauthorization of the export import bank? will they deal with the migrant crisis on the southern border? will they make extra money to address the evil outbreak? -- ebola outbreak? they have put out a wish list of anomalies. there is a strong incentive for republicans to make this a clean continuing-term

resolutions that will expire sometime mid-december. it will be up to a lame-duck session of congress right before congress to take defending that right before christmas to take the funding. host: thanks for the information. is @ twitter handle abettel. midterm elections two months away, the associated press reported today that there will not be an executive action when itident obama comes to immigration. at least not until after the midterms. there continues to be congressional reaction to that news. john boehner releasing a statement that reads "there is never a right time for the president to declare amnesty by executive action.

the decision to simply delay this deeply controversial and possibly unconstitutional unilateral action until after the election instead of abandoning the idea altogether smacks of raw politics." responding to the president not taking executive action. bill nelson tweeting this was the right immigration called by the president even the tea party struggle hold on the house gop. scalise with another take saying the president must abandon attempts to issue blanket amnesty by executive order and focus on securing the border as the house did. , everylexander tweets voter this november should take into account this shameful presidential action. >> with congress returning monday, here is a message to congress from one of this year's

c-span student competition winners. >> the foods most often genetically modified are tomatoes, corn and soybeans. >> according to the usda, approximately 90% of all corn and cotton and 93% of all soybean crops planted in the united states are genetically modified. despite suggestions of noble intent -- >> they are genetically modifying rice to treat vitamin a deficiency throughout the world. >> there are people starving in africa. if we can get them food they need, why not? >> the safety and nutritional value of gmo's is inconclusive and highly disputed. >> there's no difference between if you ate all organic or regular. it will not improve your life or nothing. >> who is responsible for determining whether or not gmo foods should be labeled, band or simply ignored? you decide.

wednesday fort the student cam documentary competition. >> the director of the national institute of allergy and infectious diseases predicted that the ebola outbreak in west africa will soon be recognized as a security issue. it was part of a discussion on political health challenges come specifically in developing countries. hosted by the center for strategic and international studies, this is 1.5 hours. >> the summer is over. we are off to a very good start here. thrilled to come

together as a celebration of and this major opus on global health law that has come out this year. mary raised the idea about having -- larry raised the idea about having a book event. we are honored to be able to do that. he has done so much over the years. -- he hasic output had so much influence over all of us. such a constructive, forward-looking, gracious way that we just thought this was a great occasion. thank you, larry, for letting us picked this up. we are thrilled to be able to do it. this as aand do

conversation around the big question. the big ideas. let's try to bring in some of larry's closest friends and allies over the years who can help in this celebration and a deliberate, proactive, brisk discussion. that and hasto , the leader of any naiad. we will be joined by tim evans from the world bank. the way we are going to go about doing this, we are going to run up to 4:30. we will see how things go. we are going to open up with larry saying a few words about his work.

it is the culmination of many years. large,t just the only comprehensive, encyclopedic, analytic work. he has done this in a bunch of other areas. i wanted to have him offer a few quick reflections. the genesis, the experience of building the book and what it taught him. we will morph from there into our discussion. our discussion will be structured around two big questions. that our very future oriented. pretty much trying to get us thinking about the future. ,he first one is going to be what is the single biggest challenge or problem we need to keep our focus upon, looking ahead over the next 5-10 years? what will that be and why?

we have an international law expert and tony coming at this from the perspective of someone involved deeply in the science, research and development of technology. whose life iseone centered in the science delivery and implementation programs. that firstin with question and then morphed from there into whether we believe to biggest idea will be spur innovation. welcome her to thank you all for being with us. -- welcome. thank you all for being with us.

you are all folks we call upon constantly and debating -- in debating any dimension of health. congratulations. it's a great occasion. >> it is a great occasion. i want to start by thanking you for doing this. there is no place like this in washington. you have built something incredible. friend.a longtime i feel like i'm surrounded by friends. surroundedhat, i'm by two of my heroes that have worked so hard in global health. there is no book on global health law and governance. we tend to think of law as an esoteric field, but in fact the governance of global health is really critical.

think about the tobacco control or ebola. the who declared up government emergency of international health regulations and evoke various powers and the like. what really drew me to the book was the idea of two local health marriages operating out there. one is what you hear from the really great thinkers in global health indicates foundation and who. that is the story of remarkable progress where we were to where we are now with incredible achievements through the millennial development goals of the sustainable development goals.

that is a true narrative, no question about it. if you look at age and mental health and malaria, we have done very well. i also have done work civil society around the framework for mental health so i have talked to people on the ground. their experience is completely different, a different narrative. theirs is a narrative of deep impoverishment. and narrative few can see in west africa today quite frankly of food insecurity, human rights violation, ebola. people are afraid to go to the hospital. we are really facing a crisis there. it turns out both global health narratives are bright.

you have improvements in global health, but those improvements are not equitable across the board. equity and justice is a really major theme in this book. basically i asked three basic questions and then i will move on. the first question is what would a perfect state of global health look like? if we could imagine like what we aspire to, what would it be? for that, i try to place a premium on public health public health services. disease prevention and control are really important. things that we do not think of as global health but it is. clean air, sanitation, hygiene, vector control. all of those things make life

much more livable. the second question is what would global health with justice look like and the third is how we would get there? if you do manage to pick up my book from the outside, i think the best part of it in the best advice from harvard, they said do not get someone like bloomberg or bill gates to write the forward, no one cares what they think. so i did. what we have in the beginning are global health narratives, stories from children around the world in their own words. it is really powerful. it is really important for us to capture the idea of what it is like to live in a poor country filled with injury and disease. without further a due, we can get on to the important part.

>> i did not mention at the outset that over the course of the discussion we will open things up and hear from you. please think about your comments and questions as we move through this dialogue. we will get through this quickly. do you want to begin by offering a few minutes of thoughts about the most important problem and challenge? come on up. we are just getting rolling here. welcome. >> great to see you. >> why don't you kick things off with a few things around what is the biggest challenge we face in looking ahead? >> i think the biggest challenge is equity and justice.

i mean this tobacco guru lipservice is very small. they argue with one another. i do not know how i got part of it, but i was. they talk about and games and tobacco. they are very popular with aids. -- talk about end games. you can get it with all these different areas. i asked them an ethical question. i said suppose you could get to the end game in tobacco, which means you have a prevalence rate of percent or less, but you still have mentally ill, poor, working-class with relatively high rate. would that be ethically acceptable to you? every single zealot said yes, it was acceptable because the main goal

was health improvement. i think the biggest goal was health improvement with justice. trying to look and make the world a place where it does not matter if you were born income paul a or new york -- in apollo or new york or mail or female or with child or an adult or sick or healthy, disabled or not. what matters is that you have equal opportunity and to live in the conditions which are healthy. one thing that really struck me, i came back while i was doing the last chapter of the book from a very typical sub-saharan african city. i came back and i realized i really was not feeling well. i did not have malaria or anything like that but my throat was bad from the fumes.

my tummy was a little bit bad. i just realized when i came back from any of the lower income countries i did not feel well. and that told me something. that's when -- where euclid makes a lot of difference. it was not the doctors i concede that the environment in which i laid in which people live every day of their lives. >> thank you. what i picked out is the single biggest challenge or problem for the next five or 10 years is one that is certainly not new or creative but very real. it really has to do a bit with what i am as an infectious

disease person in dealing with the problem as i stated is the disparities in health and developing versus developed world, which relates very much to the justice that larry was talking about but i am particularly involved in this with the arena of ebola. let me just take my 2.5 minutes that i have left to go over that with you. i always talk about disparities in health. you talk about malaria, malnutrition, lack of clean water -- all of the things related to countries that are not resource rich or are limited in resources -- resources related to health. the thing that has impressed me like nothing else is what i have experienced over the past couple of months with ebola. some of you may have heard me

say, and i always get the question, should we be worried about ebola here? the answer is someone look it on a plane from west africa and end up in west africa or london and be well on the plane get here, get sick, go to an emergency room, get sick, maybe die in infected nurse or doctor and everyone will realize it is ebola. there will be isolation and the proper precautions in the outbreak would end their. in west africa we are dealing with a situation where we are seeing an exponential case with 1500 plus deaths and the projections of going to 10,000 cases is not hyperbole because now the curve is exponential.

the reason it is happening is because of the disparity in health care capability. that is the only reason it is happening because you cannot have infection control, no infrastructure for isolation. no infrastructure for quarantines and properly and no infrastructure for contact tracing. if there were the first two or three cases that were in the united states, it would be very frightening to everyone, all over the newspapers but it would stop. so i was adding prepared to get my three minutes of what i think the granite -- greatest challenge is is just that. there would not be be ebola academic if there were not

absolutely does an -- stunning disparities upheld in the west african countries compared to our country. >> great. this is going to be a bit of a repetitive theme. there may be selection bias at work. let me first apologize for being late. it was something called ebola consuming many of us that are directly or directly involved in the response. i do not think today there is a greater challenge, because i think it is symbolic and indicative of the vast disparities that continue and which not only threaten the country's and the economies and stability and security, but certainly has made it clear the west african context is

increasingly shaky with respect to containment of ebola and the rest of the continent and therefore the rest of the world. but i wanted to first begin by saying congratulations to mary. -- to larry. i do not know larry as many as well of -- as well as many of you but i have always thought from a distance he has been a massive leader and really writes what he talks about so eloquently and that is bringing the discipline of law to global health and i feel this book that i have not read but will give it a glowing endorsement based on your reputation, but congratulations,

i am delighted to be here. having wasted two of my three minutes now or spent them on more important things, add my two cents on this. to me, the biggest challenge is inequality or in equity. in between countries and within countries, the fact that you have major gaps in life expectancy and health achievement in this country with all of the means that it has to is an assault on a fundamental sense of justice. i think it is also one that civilization needs to move increasingly to evaluate equally, no matter where they are based. i think that i -- ethical principle needs to be much more fundamentally ingrained in everything.

the challenge of that is multi-factorial. i think we will have more time to chat about the points of entry to really allow the principle to manifest itself in a meaningful way. i would say, however, that relative to where we were 20 years ago, there has been a massive mobilization and something called global health or around global health that has multiple manifestations, which i think embodies to a significant extent this sense of impatience and intolerance of local inequities in health, and i am personally encouraged we are moving but when you look at the ebola crisis today, it is clear we could move an awful lot faster, and i think we have to look at how we can do that.

>> when ebola first came to our attention earlier in the spring and the initial response was it did not look that different and we moved into april and june and perceptions began to change, there was a certain confidence in the ability at that time to still use the tools we had to address this. there was a recognition that the inequities and gaps were feeding along with distrust, mobility and speed that was happening. inequity was recognized in west africa. but i do not sense people made

the leap from that to say the inequities of that kind were more than and normative consideration, that they were more than something to lament as a reality of life versus something that is normative and ethical. also something that strikes security considerations in a way that would motivate people to see inequities as something that requires much more aggressive action. today, when you look at what is happening with the exponential leap over the past six week's,

one of the stunning things to me is that it is not registered as a security issue. it is competing against some ready formidable geopolitical crises, in which there are no fewer than three major ones. the field is very crowded. when you all raised these issues and reference the ebola crisis as a very poignant and excruciating example to witness and our lifetimes, the backdrop of dramatic gains made in the past years, how do you make the case, the security case? the inequities are the ones that have to be addressed.

i think we are still struggling today as this crisis unfolds. we are still struggling how to make this for not just our government but many others. >> i think you are very insightful. you raise a lot of important questions. undoubtably it is a geostrategic security issue. the whole region that is destabilized. ebola is first and foremost a health crisis but has traveled and cut off food security, employment, the economy, to that he. all of that is down. focused on the whole region of the world. there has been international spread. the who has invoked a public health emergency. and yet government has and

basically left to itself with the u.s. government and others but not at the higher u.n. level that we need. i think it is clearly a security issue. i think my worst fear is this could be another haiti where it mobilizes a huge humanitarian response. then when the humanitarian response gets up and leaves, the same conditions exist. you still have the fragile health systems. you still have enormous deficits and doctors, nurses, midwives. already there are places like sierra lyons and liberia that have something like one 20th of what they would need in terms of health work force. and yet they have lost a lot of nurses and doctors to ebola.

what will happen when we do contain it? we will eventually and then move onto the next thing. this is a development issue as well as a security issue and infectious disease issue. >> scanning back to the point about security humming you said when will this we recognize as a security issue? soon. it will be recognized soon because if you look at the kurds and projections of mathematical modeling, when you have 3000 people infected and 1500 die, that is a humanitarian issue compounded by the fact that people who do not have ebola do not go to the hospitals because they are afraid. many people are dying from bleeding ulcers and automobile accidents and the need for care at birth and do not have it

because they're just not going to the hospital. it has become a security issue when you look at the model that goes from 3000 to tens of thousands and government starts collapsing. i remember in the mid-to early part of the aids epidemic, and it was not that early into it when it became -- that it became very clear in the developing world that there were militaries of different countries of strategic interest that had 30-35% of the people were infected. i remember because i went with colin powell to the united nation special session on aids, and he, for the first time articulated he consider this a security problem.

then all of a sudden everything "and people began to consider that. so i think it will happen and reasonably soon if you look at the curve of where it is going exponentially. >> one is how do you make the case, and i think on that front, the weakest link in the chain is one that is a threat to us all globally. in 2005, when who passed the world will health regulations all countries were supposed to become a client by -- compliant by 2012. any experience in the low income

or more -- or even middle income country after every country signed up for that knew there was not a snowballs chance in a hot place for that to actually happened. because the investments were not being made. the problem is the threat to stimulus, when it disappears, that countries did not make the basic investment in the core infrastructure. lo and behold when you have something like this and no where near the infrastructure you need , then you do not have the ability, which is not complex to really snuff it out he for it essentially becomes endemic. so the rationale for investment needs to be strong, but it has to go beyond the immediate threat and look at the return on investment from investments in

health. here we have tons of evidence. larry summers, commissioner on investing came out to show it is one of the best investments that can be made with respect to economic growth in the economy. ministers of finance really need to understand these sorts of investments are not only ones that help people live and survive, but ones that make abundance of sense in terms of prosperity and economic growth. having said that, in addition to mobilizing, as larry said in, hopefully the commencement level of response, and i would like to make it clear, that we are about 25-30% of the mobilization necessary is the who roadmap of

400 90 million and have not heard it from the u.n. senior warden nader david navarro in terms of what is required above of the immediate health response to respond to the crisis. the price tagged will go up. there is a long way to go to respect of the immediate response. the challenge is that it needs to happen tomorrow, not in three weeks. i was listening to the president of the u.n. this morning. and she said we need a search force capacity at which is paramilitary in character. she was saying the biohazard forced that many countries have has to be deployed in the epidemic if we are going to see

there grate of response necessary to get on top of it. this is coming from the institution that has cared for two thirds of all of the cases to date in west africa. so i think there's sense of the urgency is critical. the feeling we can do that -- assuming we can do that, and that is a big assumption, because i think all of you in the room, in addition to us have 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 on 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 countries -- equipped countries to be able to respond to these challenges. thank you. >> someone mentioned earlier a 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 session on aids and the shock 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. and now making this case for the dire need for introduction at a much higher level of new capacities that have been absent. in a way, a 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 government -- 75 or 80 cdc personnel on the ground. it is becoming increasingly imperative to simply protect them. it is becoming much more difficult than that. so we are at this watershed moment. the 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. shifting 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 -- in global health.

>> 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? i think there are some different places we might .2. -- some really good candidates we might point to. what are the big ideas? i don't i will build off what tim said about international law of international health regulations. 172 countries signed on to the international health regulations. it requires countries to build capacity and international immunities to help old capacity. very little has happened. we have not even begun to meet those standards. even the own independent commission on the functioning of the international health

regulations. they were highly critical and they recommended and even then in 2011 a search capacity. no one did anything about it. what is the answer? i think one of them is the fienberg report to get the standing search capacity so we can go in and help workers really knit these things in the but. the big idea 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.

if that had 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. we've got pepfar.

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. aid assumes you have a wealthy good to work, philanthropist that at their discretion will give money and you have a needy recipient wanting a handout. that is not mobile health justice. what it 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.

so one 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 about? that is a decade-long job if you are talking about the issue of economies, but there is 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 impact is the global health security agenda. the global health security agenda 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. -- readily and effectively. if you look at that and i do not want to take the time to go through the object to its, but 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 global network of emergency operations centers. and how long it took to get an emergency operations center that could essentially handle what is going on in west africa was that if you have this in place it would have hit the ground running. my idea is the global health security agenda implement the agenda.

>> this was launched in february. it has gone through several meetings outside the united states. it was implemented in 27 other countries and a very timely point tony is making because september 26 is when the summit will occur here in washington. at a much higher level. and for the usg one of the problems has been finding, making the case for making it operational. right now via didn't is the $45 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

where real money and political 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. however, 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, he said it is robust to wake up and realized viruses can be as deadly or more deadly than bullets and bombs. what he was pointing to was that the u.n. is an affiliated institution and fonts with specialties is virtually impotent one it comes to mounting the critical response to a health crisis. unlike a tsunami and the tsunami we had almost a decade ago, there were war looking for survivors off the i went. volunteers were moving in from all over the world.

in this situation where there is a bug that is lethal, no one is coming. the u.n. mill put out a call to 53 countries for volunteers. they had one response. out of 53 countries. ok. 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. who is chronically underfunded, has been for decades. everyone has an expectation that who should be and are the go to agency to give us advice on what to do and how to respond, but 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 dimensions, we would have a capacity to respond such that we 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. please put your hands up folks with microphones and we will bundle together a series of comments and questions. please put your hands up and we will get everyone -- we will not get everyone in the first round but we will get several. >> 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? >> hold on that for a moment. the hand over here. come over here, please. please introduce yourself.

>> i am a medical officer. i am stationed at uses. i was stationed in iraq a year ago, and i would love to share my experience about some of the shortcomings related to global health and global engagement. when i get my orders to go, he 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 interior telling me they have 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. according to engage is not there -- authority to engage is not there. then i come back and tell my surgeon general, this is what we

have, we do not have a policy to engage. the bottom line, any global health engagement, we need the 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. more sustainable efforts like a

lot of issues can be sold. that have been my experience, actually. >> right-down in front, please. >> [inaudible] international health law. i have two or three questions. >> please, give us one. >> the first and last. is 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 taking an international approach

>> thank you very much. we will do another round, i assure you. >> the world health organization. i would like to hear a little more analysis of the 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 role of health in the disturbance? 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? >> i would 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 -- in zaire and 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 -- in uganda in 2000 that had 426 people.

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 and the village is isolated, the contacts are not necessarily that widespread. like there was an outbreak in 1995 in uganda 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 extraordinarily so. the longer it goes without containing it and the more exponential it gets, then the previousof outbreaks are no longer meaningful. it is a different ballgame. >> the issue raised by the colonel on how to implement is not simply just do it. it's actually more complex than that and it is worth some of the

articulation that you provided. that, but iove on think attention on how to implement as fundamental. there's a lot we can learn. the other point i respond to is the ncd's. what's think part of going to define the effectiveness and is defining the effectiveness of national responses is the global mobilization. and i'll give you one anecdote. i went to mexico to attend a meeting on the prevention of overweight obesity and diabetes. i learnedeting, about mexico's ncd policy, which they had enacted three months earlier. they launched the policy with the head of coca-cola mexico.

on the stage. ad part of the policy was major value-added tax on all sugar drinks. so i said to the ministry of health, how on earth did you get the big beverage industry to agree to be part of this? and they said, well, it was not that easy. and i said, tell me more. they said, initially, it was lobbied agianainst. but then we looked to the european union and there was a directive on noncommunicable diseases that all the beverage companies had signed up to. including coca-cola. eu so, they drew on this directive, brought it to mexico and said, if you are able to

sign on to a directive in europe, why aren't you able to sign on to a similar directive in mexico? thethat was what mobilize beverage industry in mexico to sign on. aey realized that by having double standard, they would look eyesuffer in the public's enormously. so i'm using that as an anecdote because you say, where is the value of an eu directive? jeez, that is brussels, bureaucracy, god, what is that? but here is the case of the value. others can use this, not only in the eu. this made a big change in the boldness of a strategy to challengessorts of

you are identifying. i think this is what i would call soft law. i think one can use both hard and soft. theory of diplomacy. not everything has to have teeth and sanctions. bme thing by association, dentresident -- by prece can be influential. i am not suggesting that is the only way, but i think we have an instrumentation. when it comes to moving forward in global health, part of what it is going to determine our ur effectiveness is our ability to think creatively on how to draw on these instruments. not just a framework convention on tobacco control and tobacco compounds function -- tobacco consumption. an understanding of what works in different contexts and

recognition that there is really a one-size-fits-all for any problem. >> the colonel's point about how do you get the authority to engage? how do you get the policy and the authority to engage? the fundamental questions on the table today when we are talking about ebola and deployment of exceptional capacity that are military in character to address something that is beyond the scope of humanitarian organizations. my response would be that only happens when there is a strategic decision taken by political leadership. and those strategic decisions have not been taken. you put a request out to 53 countries. was it 53? you get one back. you are going to get deep resistance to jumping in first into this particular situation

a highers matured into level. question around why did we not learn from past cases? there were 25 previous cases. i think it's important to point out that and tony'explained this, that this case in west africa pushed us into this unknown -- the unknown very rapidly when it jumped from one to three. when it jumped from the coastal cases, when the numbers began to take off, when it did things we had not seen before on a scale, speed, a ferocity. and we were slow to get it. where itome around to was going to take us into this next phase. we i think we, in some ways, naturally fall back on go to the things that worked in the past and -- effort. -- and double that effort.

that's true up to a point, but in this case, we are at this very difficult moment of saying it has not worked. the point about governance about the global health institutions is a similar kind of logi c in the way who has governed has not fit this situation. >> that is a very good segue to what i was going to address -- i was going to address the who and the ncd. who is such a wonderful promise. u.n. agency int the world where i, when i wrote the book it occurred to me that 1949 period,o three things happen -- the un charter, the who constitution,

and the decoration of the human rights. but what happened with who? this is a story we need to learn from. because tim mentioned that who has chronic budget shortages. i was there when margaret chan announced they basically have a begging -- the way they dealt with ebola. 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. things that are important, polio eradication and so forth, nonetheless, who cannot do anything about it.

this has to change before who can even begin to meet its potential and govern the way that we would like to see, and that would transition to things like universal health coverage , noncommunicable diseases and so forth, and we have been talking about global health with infectious diseases, but it is across the board, and it is not just what is prominent in the news. and it is not polio eradication. it's not just aids or malaria. it is cancer. it is heart disease, and it is things people never talk about. it is mental health. it is injuries. just go to the developing world and see the level of devastating injuries. nobody talks about it, so you look at the global burden of

disease, and you compare that to budget, it is a complete mismatch. we devote very few resources to ncd's, mental health, and it is a sad situation. it is reversible, but we need that political will. >> let's take another round of questions. lets start on this side, and then there are two hands. let's take these three folks here. s. 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.