action by the executive, legislative or judicial branch has affected you or your community. there are 200 cash prizes for students and teachers totaling $100,000. for a list of rules and how to get started, go to studentc a,.org. >> next, a senate hearing on the ebola outbreak in west africa. then a debate between the candidates running for governor of iowa. later, "q&a," with jenny beth martin, president of tea party patriots. americanbrantly is an who survived ebola. on tuesday, he said the time to act against the disease is now. 's comments came as testimony before a senate hearing. according to the world health organization, the outbreak is in five countries. guinea, liberia, nigeria, sierra leone and congo.

the hearing is just under three hours. >> committee on health, education, labor and pensions, and the appropriations subcommittee on labor, health, human services, appropriations will come to order. in march of this year, public health officials reported an outbreak of ebola virus in guinea. unlike past ebola outbreaks that it have been efficiently and effect if there stopped, this outbreak has spread in ways that are potentially catastrophic for the world. due to the gravity of the situation, the danger poses not only to the affected region but also to our country, i have taken the unusual step of calling together this joint

hearing of both the authorizing committee i chair and the appropriations subcommittee which funds it, which i also chair. we have come togetherred to to learn what can so we can work together over the coming weeks to stop this daysly plague. the extent of this epidemic is tragic and grows more serious with each passing day. the death toll is already far greater than all other previous ebola outbreaks combined. the world health organization estimates 20,000 people may become infected by dem if current control efforts north strengthened and we know the mortality rate is close to 40 to 50 percent. we have other estimates that are much higher. and of course, the constant concern that that's virus spreads it can also start to mutate and become even more deadly. or have other means of transmission other than through

badly fluids. ebola is just an example. others include avian flu. me rs, and health threats easily crisscross the planet. that's why i worked hard to strengthen, all of us on both completeeyes, to strickennening investments in public health preparedness and responsibility capabilities at home. last year the bipartisan pandemic and all hazards preparedness reauthorization act was signed into law. that came through this committee and, of course i see senator bur r here, who led a lot of effort on that. on his side, senator alexander, senator casey, all worked very hard on this bill. it strengthens cdcs response capables and ensuring the

biomedical advance research development committee has the authority it need to spout the attempt of critical dreams and vaccines. the appropriations committee has worked together for years to curtail fundings at cdc to set up a network of disease detection nevers across the globe. we now have ten, including three in africa. we need one in every country africa. it is these centers that are now deploying trained epidemiologists and other staff to help in areas and we'll have more discussion on that when we get to our witnesses with the cdc. i hope and expect that in the ex-day for two the senate will vote in favor of the $88 million we are trying to secure. this is a crucial investment that will enable 100cdc scientists to continue working inest africa. it will keep the zmap and

vaccine candidates moving quickly through clinical trial us but it's just a first step. i hate to say this but ebola will not be conquered in at the ten weeks of the continuing resolution. when we come back to negotiate the fiscal year 2015 appropriations bill the fight to contain ebola must continue be an urgent priority. the subcommittee passed a senate labor hhs bill that includes a new $40 million global health security initiative. you must carefully consider the size and goals of this initiative in light of the ebola outbreak, while maintaining our commitment to cdr staff in the field. as this crisis illustrates, we must stop chases diseases after the fact. and start building public health systems around the globe, capable of detecting and stopping diseases before they cross borders. last year, with the help of senator mr.an, we were able to

start a new global initiative called the national public health institute to do just that. this program needs to be expanded, in light of this epidemic. with these big challenges ahead of us, today's hearing is absolutely critical. we have a distinguished group here to educate us and advise us. ask i will now turn to senator alexander and senator moran. before before that i request the record be kept open for ten days. i recognize senator alex anywhere. >> thank you, mr. chairman, and thanks the birdie coming here today. we must take the dangerous deadly threat of ebola as seriously as we take isis. let me say that again. we must take the dangerous, deadly threat of the ebola epidemic as seriously as we take isis. i think i have a reputation as a senator who is not given to overstatement. the spread of this disease

deserves a more urgent response from our country other countries around the world than it's now getting. this is one over most explosive, deadly epidemics in modern time if we do not do what we know how to do to control it. it will require a huge and immediate response. there's no known cure. there's no vaccine. half of those who get sick, die. each sick person, accord together center for diseases control could infect 20 or more others, including caregivers, friends and family. samantha powers, the u.n. ambassador, said to me earlier this week, she is trying to get other countries to view this with the same urgency that we do. this is an instance she said when we should be running toward the burning flames with our fireproof suits on. ...

>> >> a doctor who has contracted ebola and has recovered and is here to talk about it. it is the like of flu italy

spread by bodily fluids of did through burial practices are carrying for someone who was sick but only one airplane ride away from a person exposed to ebola getting on the plane in the united states than once they arrive. but human tragedy in africa it affects the united states and dr. brantly will testify as the ebola patient and is graduates from the university in like many americans go on a mission trips around the world to help people. level support the administration request that senator hart did talk about

with biomedical research advance treatment and there is a request to address $500 million of reprogramming so why should our military be involved? they have to. there is no way for doctors and nurses and health care workers to do it. i am pleased double sides of the aisle to recognize the severity of this epidemic. and to learn about the severity and what we must do control it. i will endorse started. we must take that deadly and dangerous threats as seriously as we take isis. >> senator thank you i appreciate your leadership

from the senator of tennessee it is interesting to see what is taking place in africa but we have the ability to make a significant difference in the outcome of what is occurring. sometimes we don't know what to do and while i realize we have not discover of skiers and treatments we do well will save people's lives and the spread of ebola around the globe so the encouraging fein is from the united states senate. and so i appreciate the leadership today we need to declare war on ebola it is real but something with that campaign we have the ability

to change people's lives did diminish the number of people that is effective the future it is a global response to provide necessary of leadership that the war was one. thank you chairman. >> we have a distinguished panel and now we will move ahead with the statements. first director of the national center for the emerging e factious diseases that cdc. dr. bell is responsible for the efforts to respond to a of a broad range of emerging and established threats and to help lead the response to the ebola outbreak in west africa. serving in multiple leadership roles including during the response of the 2001 anthrax attacks and

h1n1 influenza epidemic. dr. brantly deposition held since the team 84 providing outstanding leadership. receiving a portfolio of applied research to improve our understanding of infectious diseases to apply this knowledge with prevention and treatment they and strategy. serving as one of the key advisers to the white house and d.h. us on the initiative to you pollster prepared this is against the emerging infectious disease threats. i will extend the committees will come to a director of the biomedical advanced research authority and about office of the assistant secretary preparedness' response that vhs. dr. robinson is responsible for france development and

acquisition of innovative medical countermeasures including vaccines and diagnostic tools to protect against man-made and naturally occurring health threats. played a key will to ensure the ongoing research and development of experimental ebola treatments. i would just ask consent all statements be made a part of the record and dr. bell give us a summary for the we will have a lot of questions so i just set up we would appreciate it. >> good afternoon chairman market. ranking members and members of that committee. i a director of the national center for infectious diseases at the cdc and i appreciate the opportunity to be here today to discuss

the current epidemic of ebola in west africa that shows of a tragic way that need to strengthen global health security and i have been asked to send sincere regrets to the doctor to not be here in person but also your continuing support to will be able us to build this sustain a capacity to respond to health threats like ebola. this epidemic is ferocious and spreading exponentially. the first is recognized and west africa of the biggest and most complex ever documented as of last week it surpassed 4400 pripet cases including 2300 documented deaths although we believe there is considerable under reporting and expect the actual numbers would be two or

three times higher. we have now seen cases imported into nigeria and senegal and other countries are at risk as the outbreak grows there is the urgent need to help border countries to help prepare for cases now in st. the detection of response capabilities and africa. this includes the collapse of the underlying health care system with the inability to treat malaria has led as non healthful impacts such as economic instability. these are intensifying and not only signally growing humanitarian crisis but also impact on the ability to respond to the ebola epidemic itself. there is a window of opportunity to control the spread of this disease but

it is closing. if we do not act now we could be dealing with it for years to come affecting larger areas of africa is currently an epidemic the worst outbreak in history, but we have tools to stop it and accelerated global the spots is urgently needed. it is important to note we do not view ebola as a significant public health threat to the united states the best way to protect the u.s. is stop the outbreak in west africa but is possible that infected traveler could derided the u.s. and if it occurs your confident our public health systems can prevent any outbreak here to recognize the authorities in investments provided by your committee have put us in this strong position. many challenges remain since there is no fair pure vaccine shown to be saved

and effective. we need to strengthen the global response which requires close collaboration with the who and additional assistance from international partners and a strong and coordinated government response. cdc has over 100 staff currently and hundreds of additional staff are supporting the effort in atlanta. we will continue to work with our partners elsewhere to focus on the five pillars of response. establishing effect the emergency operation centers. rapidly ramping up isolation facilities. helping to promote safe burial practices. strengthening infection control and other elements of the health care system and improving communication of the disease and how we can be contained. controlling the outbreak will be costly requiring sustained effort by the u.s.

and world community. with hhs the administration recent proposed congress provide $30 million for a response during that continuing resolution period a and counter measures in the president indicated a logistics' and capabilities of the military would be engaged and we work across united states government to assess the full range of resources to change the trajectory of the epidemic. working with our partners we have been able to stop every outbreak and we're determined about this one. it will take meticulous work and we cannot take shortcuts. as cdc director has noted fighting ebola is like a fire if you leave behind one case and the epidemic could

reignite. this tragedy highlights the need for stronger public health systems around the world and there is a worldwide agreement on the importance of global health security but the ebola epidemic demonstrates there are much more to be done and legal liability could have widespread impact if not stopped at the source. as you are aware that fyi 15 president budget includes an increase of $45 million to strengthen the fundamental health around the globe. if there currently battling to leaven their early outbreak would not have grown to what we are facing today. stopping the outbreak where they occur is the most effective and least expensive way to protect people's health. i and many of you have traveled to africa to see our work and we come away

with an appreciation of the challenges that people face. these may be or not more evident than the current epidemic each day i was impersonal, the - - contact with people in the field to have a desired need to put real faces on the tragedy that cannot simply be reduced to numbers or fax but these also reinforce the role that cdc and partners play with the intensified global focus to make a difference. think you for the opportunity to appear before you to make cdc were, the epidemic and the health threats possible. >> thank you very much mr. chairman ranking members and members of the committee i appreciate the opportunity

to speak to you about the role of the national institute of infectious diseases and research addressing the ebola virus disease. i have some handouts with the visuals. the involvement of nih and ebola dates back to the tragic events of 9/11 2001 followed closely by those anthrax the tax through the mail to the senators as well as members of the press because this led to a broad smaltite agency in denver of by a defense against threats not only deliver it but unexpected naturally each emerging threats. as you can see on the right-hand side there was a research agenda of category

agents they are listed there and anthrax, botulism, and on the bottom you can see as a category called those fever viruses which are ebola. the reason why they were so important and deadly and in need of counter measures is as you named in those introductory remarks they have a high degree of lethality. unfortunately this mostly supportive without specific anti-viral drugs directed against the microbes in question and as we know, a a vaccine for any is not

available at present. the tea levin fibrous given the name of the appearance one has when they look at it , the countermeasure research and development program is ongoing and has been but before i even mentioned that underscore something that dr. bell said. right now today the best way to contain this epidemic is by intensifying intensive control capability to isolate and identify and protect the health care workers with personal equipment. but to be prepared we need countermeasures. what we do is basic clinical

research but provide the resources to get to that end game that is better diagnostic and therapeutic and vaccine. that product development pipeline for developing that concept tooling preclinical studies which i will mention. we partner with our colleagues who are involved in the advanced development to hand the baton over to industry for commercial manufacturing with the ultimate regulation and approval by the u.s. fda among other agencies if you will hear from dr. robin since shortly. let me have those promising therapeutics. you have heard of a

combination of artificial the produced anti-buddies against ebola virus and has been shown to be promising in the animal model and as you will hear it was given for the first time to humans is very important to re-enter stand how well it works and if it is safe and what it looks like it could be beneficial but we don't know that. it is our job to prove it to have their readily available. but among those interventions one of those drugs with the reproductive process then one company has

a drug of the small and had it molecule but as i mentioned it as bennett ministered to seven individuals. would be at that animal model very encouraging results but this has the potential because it could block the virus that we could capitalize on with research ahead. then the issue of vaccines. this is that effort to protect people we have been working on the ebola vaccine in the process we have improved upon. we have favorable results with those civil models

using one of two candidates that is that glaxo smithkline candidate that was developed at the nih in collaboration with glaxo smithkline and looked very good with that animal steady. but the proof is in the pudding to show scientifically that it works. on september 2nd in bethesda we started the first phase one study of this vaccine but so far 10 of 20 were vaccinated and so far no red flags. we will expand these studies to try to prove the fact we have a safe and effective vaccine. in closing of a like to

reiterate as the dual mandate of nih research with infectious disease. but to have that microbiology infectious diseases but also that mandate to respond rapidly and efficiently with those counter measures that prevent mortality to have the citizens and clearly ebola is the most daunting of those infectious diseases and it is our aim that we do have those countermeasures to prepared to address the problem. thank you very much. >> good afternoon.

think you chairman heart can and ranking members and distinguished members of the committee to speak with you today about our response everett's. i am dr. robinson and secretary of hhs. created by the pandemic of 2006 is the agency responsible for providing advanced development and countermeasures and therapeutic drugs and diagnostics for the entire nation. exist to address the consequences of by of threats and on a routine basis responding to your emerging threats and the etf outbreak last year.

today we face ebola that is up by a thread with the department of homeland security and the emerging infectious diseases. when it comes to ebola the best way to protect their country is address the current epidemic. florida works with federal court in to transition to a early development into a finance development toward ultimate fda approval since 2006 we have built a pipeline of more than 150 measures chemical biological nuclear threats. we are having therapeutic candidates with advanced development in concert with the federal partners to have

counter measures to protect -- over the past five years n.i.h. and cdc we have bill of flexible and rapid response superstructure to develop and manufacture counter measures. as a result of the preparedness it has been afforded to federal industry partners. to design and develop and manufacture with those in record time we're working with the of a wider array of canada and u.k. and western africa and the country's navigates foundation and others to make these candidates. forbade established infrastructure and to assist

developers of a daily basis to respond immediately but today we use in animal studies network centers for innovation to expand production and our manufacturing network to put the vaccines into files. the computer models of the consequences of man made threats is coordinating international efforts of the current ebola epidemic of medical or not medical intervention. lastly large-scale production of the public health emergencies so that containment outbreak of 2013 to day the therapeutic manufacturers that

specifically support the development of the antibody therapy for clinical studies for one manufacturer. and with those other refractors to seek other candidates to expand the production and additionally working with nih and partners to scale of manufacturing of to promising candidates for a clinical studies. fyi 2015 appropriations are needed now to fund investment with a counter measures. the challenges of the coming weeks and months with the manufacturing of these countermeasures' but bottom line to use the collective capabilities to address today's epidemic to be

better prepared for future outbreaks or biotech's -- by a terrorism going forward with thank you for your support and the opportunity to testify and i look forward to your questions. >> thank you dr. robinson and for your statements. i will try to it here we also have dr. brantly who is a survivor also a worker of the ground in western africa so we would like to get to that panel this afternoon. i will start first. dr. bell comedies disease outbreak seem to be coming more common because the proximity of humans and animals can travel is common. what happens in west africa i believe is the failure of

the public health system or the nonexistence of one. years ago traveling with dr. friedman it occurred to me they need the cdc or entity that is culturally sensitive to involve people of that country to detect the news early to do the work to isolate and control to be connected with ours as well so we can work together. last year the senator and i put money into the appropriations bill ted million dollars or something like that to start expanding can you speak to this? how important is it for them to create their own version of the cdc so they could be dealt with - - controlled

from the beginning? >> thank you. you make some very important points there are fundamental capabilities that we at the cdc take for granted because they are so fundamental that absent in these countries like basic laboratory capacity rapid response teams, and understanding of what it takes an emergency operations to understand the structure to identify control the outbreak. telecommunication systems and this is what we agree that every country these days of that is what the agenda is about. one example from another country in africa, we're in the midst of the extremely

challenging and outbreak but the cdc has been investigating and stopping that outbreak for a longtime. one of those countries is uganda. some of the largest ones we thought was a lot it over the last decade working with uganda and the ministry of health to build capacity that now have a laboratory that allows them to do their own testing to detect ebola and other fevers and transportation networks that allows them to move specimens around the country to get to the laboratory and rapid response teams and consequently what we have seen in you got that is more outbreaks and they are much

smaller to the point where one year ago there was an outbreak of ebola that vault one person and they could stop after one person and they are small close -- clusters stopped quickly. this is building the capacity that is a benefit to the country solve the fundamental health problems that they have. this is an example that these to be built into every country. >> i hope the congress that follows will take this up. we have spent lots of taxpayer dollars to shore up military operations around the globe so people could defend themselves. but yet we have spent

inadequate just like we expect our cdc to do everything. it can do of what but we need falco stealth there where people can defend themselves from that rapid transmission so thank you very much. i hope the next few years the cdc could be replicated in countries around the globe. >> dr. bell, you and the other witnesses carefully explained we know what to do about ebola to demonstrate it can be controlled. but talking with you and dr. friedman i can tell you feel this epidemic or

outbreak is a very serious problem that we ought to do jump all over. you said of moments ago a few hundred cases would be a big outbreak but today the official report says you have identified a little less than 5,000. but it might be higher? what if that is under reporting? >> quite likely. >> it is also a true those cases and they were reported the last three weeks? >> more or less. >> of the number was 10 or 15,000 instead of 5,000 perhaps half of those would have been reported? >> quite possibly. >> the danger is the rapid infection. why is it that spreads more

rapidly? but why such a grim outlook about this epidemic? why is it the most dangerous epidemic of modern times? >> thank you. but ebola is not easily transmitted it is not to the air and requires a direct contact with bodily fluids of dead bodies. but what we see in this outbreak because of right now is sufficient capacity to icily patients with ebola greasy then trades of transmission in you can imagine as the cases grow the number of contacts for each case continue to propagate that is how those

cases grow and continue to grow faster as the number of cases increase it is that matter of arithmetic pretty me to the point what is the critical issue right now especially in liberia? we must come up with ways to effectively isolate and treat ebola patients. >> peppers to have to chase down every infectious person? >> right now in liberia you could have patients so we must do meticulous contact to isolate and check the temperature every 21 days

bad right now especially in liberia the problem is we don't have measures to isolate case is that we do identify that is the limiting factor. >> so those cases appear or double every three weeks and have those infected die? >> it appears that is the mortality rate right now. >> dr. bell you don't catch ebola by breathing on someone but it is bodily fluids usually when someone is infected or dead? in those are most of those infections bayou reported to say it is not likely it will change how it is transmitted

which produces an even more serious set of possibilities. are you tracking the virus as it affects more and more people to see if this is mutating so we're not deceived? >> that is an important question that i will tell you what we're doing. right now that ebola virus is not transmitted through respiratory tracts there is us discussion since it replicates a lot the greater the up possibility of it mutating. most mutations are irrelevant not associated with the biological change or function. said even though you see a lot of nutation it is

unlikely there will be a change but there is a possibility usually if you have a change of function it to be more or less virulent or spread the way usually is are less efficient in is the unusual situation were of mutation would change the way it is transmitted not possible that unlikely so we follow it carefully and to it a direct answer we have an arrangement with one of the best microbial sequencing groups in the world in boston getting samples looking at the evolution of the mutation in to make sure that they are not occurring that would have an important impact on

the biological function. i want to make sure that people understand that changing the transmission rate is something that could be frightening and want to make sure people under state and that we watched that carefully but it is not impossible but of likely. what is likely if we don't do what we're doing now of the major ramping up of infection control capabilities including getting the military heavily involved it is very likely if we don't stop this epidemic it will just get worse and worse that is why we concentrate kiddie get under control to not give it

that opportunity to mutate of virus that does not replicate cannot mutate if we put the lid on it then that is it. >> so now in order of appearance senator warren isaacson casey johann's and those man and empire and senator durbin. >> dr. bell 84 the visit to atlanta of few days back and visit this week i had expressed at that time to express gratitude for the efforts of the people that work at cdc to contain and

change the lives we are very grateful for what you have undertaken. let me ask that question first, it was just indicated about the potential response of the of military. is something you can say to the american people to ensure military men and women are safe and secure from ebola with the new tasks they are being asked to undertake? >> the key for those kind words. we already have more than 100 people in the field the question thus it safety and security of our own staff or any staff or members of the u.s. government the safety and security is our number one priority as we have been paying a lot of attention to this issue to make sure the

us staff understands what the situation is like on the ground before they go to understand clearly what are the intervention is that they need to take the they have the right equipment to understand basic strategies to distancing to know what to look for if they start to feel ill. that is the bottom line it is a dire situation. we are concerned about safety and security and have taken a lot of steps to do what we can to minimize the risk. bin is a difficult situation i where about this with my own staff. >> i will give my a

expression of gratitude to those organizations working globally with significant risk to themselves. what type of coronation education retreating to you understand has taken place with our military and the preparation for their assignment? >> at all have specific information that i will say that this is one of the areas we have been working quite closely in training. next week we host a course in alabama that is the three day safety trading for health care workers planning to deploy a to work for the ngo in liberia or sierra leone a.

and the precise purpose is to explicitly teach them about the important principles they the turgot to care for those ebola patients and we hope to have this course weekly the first is completely full and that the trading is pivotal event to your point to make sure they can care for patients safely. >> the broader question, dr. bell. what is the best case scenario with ebola with the spread of consequences and the worst case scenario and

what makes the worst case scenario not happen? >> over the coming months we can effectively isolate and treat patients and follow the contacts and do something about those save burial practices to not have bodies in the street and people could bury the dead over a period of the coming months to interrupt transmission tuesday that increase of cases that senator alexander was talking about. worst-case scenario to see

this exponential biting and the corollary is exhortation to other countries we already have that to nigeria and seven call. they do really worked extremely concerned you could imagine if we have ebola get out of control how incredibly dangerous but it was the enormous effort to get to that situation to where it is today we do not think there is uncontrolled transmission that this involves following up on thousands of contacts working in the emergency operations center. so one exportation requires the an enormous amount of

work so we can expect many more to other countries and each requires a huge amount of work and we have no guarantee we would be successful you can imagine that outbreak spreading around those borders that are affected. >> i just have one clarification doctors said on respiratory communicable? what if somebody sneezes? >> mr. chairman there is no evidence over multiple outbreaks that respiratory spread ochers or if it does it is extraordinarily rare. never say never in biology but people in situations if that would have been noticed

clearly indicate that is not the case. >> hq senator for your extraordinary service to the nation and to the world. we have a large library and - - liberian community they are hard-working and read about their families dr. bell and dr. rowe those that participated in a conference call we were both involved to set that up. also also to salute those volunteers who have dr. flanagan in the country giving their skills courageously on behalf of

the people of liberia. and the emperor are here on the status deferred departure that expires september 30th that i would hope he would do so because to send people back would be inappropriate to. but i will last dr. dr. fauci day you have this sense how fast this could be deployed? have you reached a point to that you say it is said huge risk but it has to be done? >> excellent question. the standard way to

implement a vaccine goes through a series of steps is it safe for does it or doesn't have the hypersensitivity reactions and then to find out the right dose of the right to give you a response. then you go to larger numbers of people that is called phase to. then depending on the disease they you don't want to deploy a vaccine but it doesn't '01 that is more terrible or one that makes it worse. you have to consider that the with the emergent situation with the desire to get people protected, there

are ways to get the answers. not as definitively but to employ a the people who'd be that backseat as part of the clinical trial to compare one and against another set you try to determine if it is safe or effective but at the same time by getting people in these trials you make it available. so right now with this situation we know it is safe to have that expanded trial to get that opportunity to get vaccinated clear the that is directed to the

health care workers were emergency response they put themselves at risk as is dr. brantly. >> if you prove it is safe but not effective you could inoculate those health care workers but it is not definitive. >> so leave knowing you'll not get a definitive answer but in the of urgent situation if you have to do the best you have. >> commensurate with these trials the vaccine has to be available to make sure we can go to partial scale so the studies could be done

and there is more backseat available. >> thank you for your extraordinary work and all of your colleagues. >> senator? >> the key to this panel and the next panel all those called into action over the next weeks and months but hopefully not years. you said if we don't not now what is that for the timeline? at which point do we reach our opportunity? >> i wish i have a crystal ball to tell you that answer but the situation is fluid it is hard to predict with any type of precision. i can say speed and scale is of the essence. >> is controlling the

outbreak of us save you use that the same way as containment? >> yes, sir. >> had you achieve containment on the disease that is already broken and containment? >> is the matter as bending a kurd in one direction everyone to make it go in another direction of the week at two -- we have to break that trade of transmission to isolate patients so they cannot transmit and with health care facilities. >> taking liberia as an example we search through dod that capacity in the country that is the road now

my math is not great but my maths as we are behind the eightball on to a number one because of that but said today is or individuals ride with their families then ride home so how long can that virus survive and in fact, somebody? >> there have not been definitive studies. it is not a durable virus is fragile but people get infected by touching those dots -- dead bodies. it is did the time frame of the funeral because that

isn't people are documented i don't think we could go beyond giving you days or weeks but clearly is not instantaneous once the virus is out of the body is gone because real people have been affected at funerals by touching the the bodies be back we have seen generations of transmission by how many have we seen so far and how many have fleecy the chain of transmission in? >> i cannot give you a number of that but if you have the virus it notoriously is the bad reproduce or in makes mistakes and the tapes most don't read anything it is just irrelevant. sometimes that means it kills the virus may be it

has modified its functions i cannot tell you how many generations but that could mathematically be figured out of the paper that kim had a couple weeks ago over 78 people the virus was taken from them you could say how they replications and you could determine that. >> if you could get that to us. but in recent-- isis modeling says we could see 20,000 cases per month the outbreak of last as long as 18 months that would be 360,000 cases. i think we continue to be a step behind that one -- what projected number is the

response strategy based to date with those actions announced today? >> there has been a number of models out there and it is certainly true a number of these models predict without additional interventions we could see hundreds of thousands of cases. so all of those mottling exercises have been taken into account as we call for additional intervention that the critical point is those models are based on not scaling up and in addition to what it is doing there

are many other international partners that are also scaling up like the did you rachel and other countries some of the colleagues that will testify in the next panel so the financing that has become available from the world bank. the lead is involved so it is fair to say there are forces and what they predict is not what we will see. >> i follow that closely and i know the mobilization of most other countries is not the time frame hours is why it scares me to death. let me to say to you have

the resources you need?

the, a it's important to mention one of the reason is fought to hard to role back sequestration in the >> to provide -- which have had to deal with this steep and harmful budget cuts. i believe it's going to be very kit cal that we continue to focus on rolling back this trend of disinvestment in research and development so we can ensure that our country continues to produce the kind of life-saving, world-changing research that we know we're capable of. but i am very concerned. i just need to say this -- that fiscal awe state and the return of sequestration next year will continue to weaken our ability to respond to needs like this. so, dr. fast -- disaster facci

he talk about how the sequestration has impacted the u.s.' able to respond to the ebola situation? >> thank you for the question, senator. i have to tell you honestly, abeen a significant impact on is, as you well know -- i know you've been fighting for us for a long period of time. our bug has been flat since the end of the doubling in 2003 with the two-plus percent inflationary index that over a ten-year period we lost 22% in our purchasing power. that was the left hook. he right cross what the sequestration that came in and pulled out a significant amount of money. 1 359 billion. of which we got reconstituted, not all of it. we try to preserve the fundamental basic research of the investigators, the bright ideas that people have, and if you want to preserve that, the money you have are in

initiatives such as the development of vaccines and the development of drugs, suffered because it's a balance. there's prom initiatives and investigator initiated rewards, and when you shrink the budget or don't give even an inflationary increase, all of that whittles away and you get secondary fakes, like disincentives of getting bright people involved, from your state or any state, who feel there's a disincentive to get involved. so it has been both in an acute and chronic sinneddous way eroded our able to respond in the way that i and my colleagues would like to see us be able to respond to these emerging threats. in my institute particularly, that's responsible for responding on the dime to an emerging infectious disease threat, this is particularly damaging. >> i hope all of us keep that in mind moving forward.

again, i'm proud of the folks in my state, bill and melinda gets gave $50 million to scale up emergency operations. another 9 mine has been contributed. dr. robinson, director bell, i know that gates foundation has stepped up that way, and the money that is going to be included in the cr, thank you four appropriations chair who is sitting next to me, is that enough money? and global support to stop this outbreak? >> i'll answer, center, for the cdc. we appreciate the $30 million in the cr. that amount of money is enough to keep us operating through the end of the continuing resolution on december 11th. it allow us to keep our people in the field to pay for our staff, and to begin to scale up in a way that we think is necessary. we are -- will be kind of

considering over the time period of the cr, what additional resources we will need for the rest of the fiscal year in order to fulfill our responsibilities and respond to the ebola brought break in the way we know we need to. >> dr. robinson. >> the $58 million we requested will get us through this fall. we want more than vaccines and more therapyityics, there will have to be more funding for us to go forward. >> thank you, mr. chairman. >> thank you, senator murray. senator isisson. >> thank you, mr. chairman. dr. bell, i want to echo what has been said about how proud we are of cdc. at one of georgia's two senators, however, i want to add how proud we are of emory university and dr. jim wagner and the staff. i now dr. brantly would feel the same way, as well as phoenix

that's brought the patients back from liberia to the united states. that was a tremendous effort. and saxby was gone when this happened so i was the only senator reachable by the press they day it was announced they would come to emory university. the press immediately looked for the wisdom of bringing an ebola patient back to the united states and whether we had the capable of preventing the disease from spreading. in emory university and the cdc did a marvelous job of making those transfers seamless and complete, and prove though media that was truth their best to start a riot, think, that the ebola virus will be safely con find they were in the best place in the world. so y'all deserve a tremendous amount of credit. i want teed say that publicly to you. >> thank you, senator. >> tell me, you said this is by far the worst ebola outbreak you have ever seen. what was the next worse before it, in terms of numbers? >> let's see.

-- [inaudible] >> about 400 some cases here's me question. what makes this one so different. >> a number of factors, senator, that have made this one quite a bit different. first of all, this is the first time we have seen ebola in a large urban setting. our previous experience with ebola outbreaks has been primarifully rural areas, and there are many, many different sort of factors that come into play when you have a ebola in a situation with people packed very closely together in a large city. so that's one thing. another issue that has been challenging is that the area, this sort of three-country area where the outbreak sort of began, and has been propagating from, is an area with communities that are sometimes not very receptive to intervention by the government

or public health officials. a third point is these are countries with very, very weak infrastructure start with. they've been just been emerging from decades of war. they have very weak health systems, and very little capablessities to senator harkin's point about public health capables and even healthcare capabilities, so very little with which to battle the outbreak from the beginning. >> i've traveled extensivefully west africa and seen first hand what you -- they're almost bereft of health care facilities of anything we would consider to be reasonable. when you described containment, you described a very labor intensive process. you talked about people taking temperatures for 21 days to see if somebody had been exposed. you talk about monitoring. talk about isolating. we're sending 3,000 american troops to west africa, and we have 100cdc personnel. we have ngos and other volunteers.

seeks like it's going to take a lot bigger labor force just to contain the disease at its current level. aim creek? >> yes, sir. there's lots of different settings we can talk about. but for example in the ebola treatment units, 90% of the staff are local. i think it is important to remember that the governments, the people in the countries and the governments themselves, are stepping up, and with assistance, from both of us that have the technical capabilities, are really able to fill many of these roles and responsibilities. as i say, some of the work in the treatment units, much of it going out into communities every day and checking in with contacts to see how they're doing. these are roles that the people themselves, local people themselves in these countries, can undertake, with some technical guidance from some of us that have this experience. this is not minimize the scale of the human resources that will be needed to contain this.

but as i say, i think that there are many of these sorts of functions that we're already seeing the local people help with. there's also other groups around africa, the african union, many of our field training programs, from around africa, that are also stepping up. so it is an enormous job. but it's a job, as i say, where i think there are lots of different sectors and parts of the local community in addition to the international community that can work together to address this. >> i know my time is up. i want to make a comment. the africa summit which was here, participated and some of that was west africa leaders. they were begging -- not begging but wanting so much american knowledge, cdcnih, all the technology, but seemed very -- even the bordering countries seemed like they were willing to provide manpower but badly

needed leader palestine terms of health care. >> yes, sir. we have made quite a bit of progress in that regard over the last month or so, and are working very closely with the african union to have them deploy staff to the area. >> thank you very much. thank you, mr. chairman. >> thank you. before i recognize senator casey, you mentioned all these different entities now addressing this. cdc, usaid, state department, world health organization, doctors without borders. can you tell white house is in charge of coordinating our government's response? effort in africa? >> yes, sir. in terms of the u.s. government, in each of the countries, there is the disaster assistance response teams, the dart. this is the usaid umbrella under which all of the u.s. government efforts are coordinated, and we are quite well coordinated with all these different -- with the usg organizations. in the larger sort of

undertaking in each office these countries people are getting organized generally speaking with the government taking -- go ahead. >> usaid is in charge intracountry. but overall, who is in charge of coordinating -- >> the dart -- there is actually the three countries together unthe umbrella of the usaid umbrella. >> i guess i'm just -- >> well -- >> i'm startled to find that out. usaid would be in charge of coordinating -- >> it's a disaster. when the disaster is declared -- i don't know as we scale up, i'm sure there will be other mechanisms for the various parts of the government to collaborate and coordinate with each other but there is this kind of

structure on the ground, which is meant to -- >> i think this requires further looking into by this -- by both commitees, senator casey. >> i would concur, mr. chairman. >> mr. chairman, thank you very much. i want to thank the members of the panel, for being here, and i also want to note the good work that's been done by this committee and members of this committee for a lot of years. the chairman, chairman harkin, senator mccull ski as well, with her experience, and grateful to work with them. senator byrd, who has become such a leading voice on this. i don't want to plow ground that's already been plowed through. i apologize for having to juggle two hearings, but i wanted to ask dr. bell -- i know that one over fundamental questions you're asked is what is the

threat to the united states, if any? and how you articulate that. let's just for purposes of process and the mechanics of confronting this kind of a threat were it to arise here, i'm just thinking -- just pick a town in pennsylvania, won't pinpoint one, but if there was someone in pennsylvania that was a patient at a hospital and they tested positive for ebola, what would be the steps that would be undertaken at that point? >> thank you, senator. we have been working quite closely here in the united states to prepare for this sort of eventuality you described. as we mentioned, ebola really is not easily transmitted. and i think in terms of helping to understand the context of answering this question, just want to say a word or two about

what a hospital in these countries in africa looks like. as a way of contrasting. so, when we think of a hospital, we think of a shiny, clean, lots of equipment. most of the hospitals in this region, as many of you that have traveled to this area are aware, often times there's no running water. there's no soap. there may not even beds. may be mattresses on the floor. every healthcare worker is caring for large number of patients. there will beds all around. the may not have the appropriate person -- personal protective equipment like gowns and gloves and masks. that's the environment in africa where ebola is currently raging. in the united states, by contrast, we have many, many protocols in place, and with these protocols, most hospitals that can isolate a patient in a private room, with their own bathroom, and can follow very

strict and meticulous infection control practices, which have been well outlined and which health care workers are quite aof, can safely take care of ebola patients, and while we haven't taken care of any ebola patients prior to this outbreak here in the united states, we have safely cared for at least five patients in recent years who have had other viral fevers. so, what we call -- each of these circumstances, these patients were cared for quite safely in our hospitals around the country and we didn't see any transmission. while this is something certainly to be taken quite seriously, and we're doing a lot to educate healthcare workers and laboratory workers and to answer people's questions to sensitize them to these issues, most hospitals in the united states with these basic capables should be able to safely care for ebola patients.

>> thank you, doctor. limited time but i want to ask dr. fauci one question. you noted in your testimony a number of ebola therapeutic and vaccines in development. recognizing that all these products are still rather early in their development, do any of them have clear advantages or disadvantages over the others? can you make that assessment yet? >> i don't think, honestly, senator casey, we can say that, because apart from zmap and one other perhaps, they have not really been in humans we have experience where things look good in the animal and then they get into the human it doesn't work or is too toxic. i can say there are a number of candidates that look favorable enough in an animal model we're

enthusiastic about moving them into face one and beyond that. so there are number of candidates that have a favorable profile in an animal model but i think it would be unsize are wise to -- unwise to say this one looks better than this one, because it's too premature to do that. >> i hope there's nothing that congress has not done that would be an impediment for you to be able to answer that question down the road and to be able to make the progress you want to make on these developments, because we have an obligation, i believe, to fund nih and fund these -- this research in a manner that leads to this, the result we hope. so i think that's a bipartisan obligation. i say it for the record. thank you, doctor. >> thank you. we appreciate it very much, sir. >> thank you. >> senator bowsman. >> thank you, mr. chairman, and thank you, very much, for having

this hearing, hearing you and rest of the leadership on both sides. this is so important to y'all. we appreciate you being here. our all have sterling, excellent reputations and we we appreciate the fact you're working so hard to keep us safe. from what i'd read, seems like speed is important, education is important, coordination is importantment we have the cdc involved, the nih, the dod, the department of state, samantha powers is calling the security council for to the first time ever in an event like this. i would like to get into a little deeper, we heard that usaid was distributing sufficient -- stuff over there, who is in charm of all of that at the washington level? who is taking this on so that we can get coordination so we can get speed, and get the education component done? is that cdc?

are you doing that, miss bell? or mrs. bell? i'm sorry. >> that's okay. we at cdc have the lead on the public health aspects of the response. the dod and the usaid have the lead on logistics and materiale. the national security council is coordinating certainly from washington, and it's really important that we draw on all of our assets from all different agencies working in our particular lanes, and coordinating, as i say, all together. there's a lot -- there's very strong interagency coordination, as i say, the nsc is deeply involved in bringing all the agencies together, and we at cdc, as i say, take the lead in the public health aspect. >> i hope we get that worked out, where we actually have somebody we can point to and -- an individual that is kind of in

charge of coordinating because the same thing is going on the ground that needs to be going on over there is simply not going to happen without that happening here. one thing that has happened, dr. bell, dr. fauci, there's an ebola outbreak going on in the democratic republic of congo. is that related to this or separate? >> i'll say something i'm sure dr. fauci can add. this outbreak is not related to what we're seeing in west africa. as you say, senator, this area of the drc is an area in which we have seen many ebola outbreaks in the past, and this outbreak is of the strain that is quite similar to those outbreaks. so while we are taking it very seriously and we at cdc have sent a team into that area, we don't think that outbreak is at all connected. we're actually, i think, aware of the individual case that began that outbreak and had no

relationship to what has been going on in west africa. >> you can actually go and -- i agree with dr. bell that will be determined. it does not look like it's the same. the extraordinary ability to do rapid deep sequencing of the genome of these viruses can actually pinpoint whether or not they're relate and it's very interesting that the study that was done and published very recently, showed the exact point introduction of what we're anything west africa and how it went from guinea to sierra heown to liberia, and doesn't look like the strain in the democratic republic of the congo is in that lineage. even though it's the same general strain. >> very good. dr. bell, can you reassure the dish know the public is concerned about bringing it into the country. can you talk to us a little bit about the steps with the --

helping those that are at the airports, identifying people that possibly have the virus? >> yes, senator. it's certainly quite understandable why people would be concerned. the images we're seeing are quite alarming. as you know, we have been working with the -- in the countries to improve their able to do exit screening. we have teams in each country, and we have really been able to help them improve their capable to do exit screening, considerably over the last month or so, and are quite pleased with the progress in these countries. they have equipment, they understand what they're supposed to do, they have the protocols in place. and they're really moving forward. in addition, i'll mention that we also have been doing a lot of work with our own border agencies, so with the tsa and with the cdp to train them so they understand what to look for

and they understand when they need call on us, as you know, cdc has quarintine stations in major airports around the country. and then the final point i goods i would make on this topic, to senator casey's point, is that we have done a lot of work here in the united states with healthcare providers, even with just citizens, so that they know what to look for, to remember to ask for a travel history. we have -- there are number of our laboratory response networks, of laboratories around the country who now have the capacity to test for ebola. and then the healthcare facilities themselves are very tuned into the appropriate isolation methods that would be needed should they have a suspect ebola patient. >> thank you, mr. chairman. thank you. >> senator bennett. >> thank you, mr. chairman. thank you very much for holding this area. dr. bell, you messengered in your opening comments a

particular problem in liberia, there being a lack of isolation capacity. i wonder, if you could describe for us -- if everything actually worked the way it's supposed to work, make the decision -- what the experience of somebody today who is infected with ebola is in lie beer yeah when they don't happen an isolation chamber, and what you expect to the the progress points we need to see in order to know we're actually creating an infrastructure that can -- that really can change the outcomes, the course of this disease. >> thank you, senator. as you mentioned, there are not enough treatment facilities, isolation facilities in liberia right now to take care of all of the cases, and because of that, there's ongoing transmission that is occurring because we can't isolate them. we are working on this in a number of fronts. first, as many of the senators

have mentioned, we will be building more ebola treatment units and in addition, a number of other entities, including the government of liberia, are also building ebola treatment units. so there will be a scaleup of ebola treatment units. there's a number of groups actually working to scale it up. in the meantime, there are -- i'm sorry. in the meantime there are interim measures we're taking so people can be isolated safely, not in a treatment unit. so there's a number of ways to approach that. there are community sort of holding centers for lack of a better term, where people can be isolated safely with one caregiver, and that caregiver can be provided with the appropriate personal protective equipment that they need to prevent transmission to themselves. there's also some efforts afoot to do that in households. so, where households --

caregiver in a household would be given a kit which provided all the equipment that the person would need to protect themselves, and also some of the medications, such as oral rehydration, for example, tylenol to help with fever -- that the patient themselves could use during their illness. so there's a number of different kinds of interim measures that we're working to scale up now at the same time as we're working on building additional isolation facilities. >> how are you -- women who are you working to make sure that work is actually happening rather than just being thought about? >> there's actually quite a bit going on right now, actually usaid has been working with a number of nongovernmental organizations, including msf -- they've actually produced tens of thousands of these kits and have a machine in place to scale them up to hundreds of thousands in the near future.

>> thank you. one of the first questions the chairman talk about the need to have a cdc or something like it in every country, and that is something i think we ought to aspire to. we have a long tie go to get him just wonder if you could talk a little bit about theert you're making to create a more global and operable network of real-time detection of diseases and collaboration among these various countries in our response. >> yes. part our response here is to build up these basic capacitiness these countries in addition, right now, asen urgent matter, we're working to build up these capacities in the bordering countries. so, laboratory capacity, emergency operation centers, rapid response teams, beginning planning on what they would need to do in terms of isolation should they need to do that, working on culturally appropriate burial practices so in those bordering countries,

that is sort of an urgent priority for thus. then across the rest of africa we are also working to kind of harden the country's ability to be able to recognize imported cases, to know who is the incident manager, how is their emergency operation center going to work and what are the steps they take in order to respond to an additional case. do they know how to do contact tracing, who would be responsible for contact tracing, where to isolate the patient. these are all things we're working on now in the context of theout break. these are basic cameabled the global health security agenda have -- we have been calling for, and as you probably know, we at cdc have been working with the number of countries in a pilot kind of way over the last couple of fiscal years, to show the proof of principle, of what global health security can mean, to detect, to respond, and to

prevent these outbreaks, with basic capabilities around laboratory capacity, around communications strategies, around emergency operations centers, basic epidemiology... ... >> >> ifs and -- if we have the

appropriations bill but an understanding of course, you cannot do it all at once. to trade them in laboratory procedures to get us a jump-start. >> i appreciate that. >> they need the money. that is right. >> not inexpert of epidemics i dunno if there are excepted stages wiggles from

full epidemic to it be out of control forest fire. what are the bad fly eggs we should be looking for with the threat that it presents? >> there are some key indicators that depends on the situation there are some basic indicators as senator alexander has discussed like the number of cases of health care workers we should not see those if intervention is working but after that we work to track fame's whether patients that need to be isolated could be

appropriately isolated equivalency bodies that could be picked up in a timely fashion are other indicators to help understand if we bend the curb and if it goes to the right direction. >> consider that exist seeing effort that is heroic but not keeping get from accelerating how many multiples of the existing level of effort are required to get ahead of this touche be in control? ten times? one hundred times? >> i would say a very large increase of that effort and also with a sense of urgency so that have been quickly. it is hard to say how many multiples there needs to be.

>> every close to meeting the threat now? >> the intervention is that we have heard about in recent days is the sort of scale that we need to address this outbreak and epidemic. >> dr. fauci is this up virus capable of being manipulated by humans? could one and go into it and meddle with the portion of that dna strain? kids someone try to make something that is more transmittable? >> theoretically you could manipulate almost did a virus the way that you wanted issa question to raise red flags but yes the

trouble is it would not be easy for somebody to do that in their laboratory backyard there would probably kill themselves that would be a state type thing that i mentioned our getting involved in those fever viruses is part of the agenda because way back during the cold war it was clear from intelligence and proof been the soviets were stockpiling those fever viruses so hasted we the state not just throw person. >> we would love to work with you on that to explore that further. think you very much.

>> is cdc werke with the who? but i guess. very closely. >> it is lighter standing the president submitted the name of dr. friedman to be our representative to the who in july of this year and it is still lost somewhere in the united states senate. i would hope before this weekend's and we return home might consider pass this on of bipartisan basis on who we know well so he could be with the who now waiting to months or more to return to consider that nomination of a bite to suggest that to see if we could get that done. the second question to dr. fauci following up senator casey said i hope there has

been nothing done on a budgetary basis to slow down development of the ebola and taxied the talk about 22% decline of funding and sequestration has there been to your knowledge said a shortage of funds leading to a delay of testing or development of the ebola vaccine? >> honestly senator everything over of the last several years with few exceptions has been at a level less productive than we would have been purely on the basis of significant constraint we cannot say there is us serious delay in this tax see that would be ideal for exaggeration but under the umbrella of the entire effort we put forward

had to be muted by of budget that is shrinking by real dollars. >> it is minder standing -- my understanding about the of physician per capita is expected to be 240 physicians in sierra leone for 100,000 people or one position for but hundred thousand? that is the indication in for a snapshot of the scarcity of medical professionals at the highest level. we included in the immigration of bill that passed a provision that provided if you are medically trained in africa

and promised to serve for a certain period of time we would honor that and respect that not allow all people to come to it is states to they have an obligation to their country of the doctors could serve in the crisis situation overseas about jeopardize saying their immigration and status but that was never called for consideration of the house. speak to not just that terrible infrastructure with hospitals but the medical professionals that is available. >> you are right. the number of doctors and liberia and sierra leone are extremely small i think before it numbered in the hundreds and tragically

because of a lack of infection control mcorp conditions of the health care facility and the inability of the workers to recognize cases when they come up with the fever they think it is malaria but the workers could not protect themselves tragically a lot of these health care workers have died and many facilities that were already rudimentary are closed so we paid to trade and provide protective equipment to get those facilities back up and running safely so we don't continue the spiral of that ebola outbreak of other conditions not being treated right now.

>> we learned the hard way they have very few of medical resources when they face this challenge with soviet 10 hour played right away to the united states. >> senator ivan say when you talk about dr. freedman's nomination i don't know how lee dropped the ball on this but it does not come to us. >> mr. chairman the affirmation rehab is a u.s. nominated the end of july every run on an august this dash this meeting with him tomorrow and a bipartisan way i urge senator mcconnell the he supported the proposals sled out all why the majority leader and the whip could now work to get that done before we leave.

i would hope so and would support that as i imagined the chairmen would. >> i would the meeting but with those little committee meetings to get the job done in a hurry. [laughter] >> they q very much mr. chairman. they q4 organize saying this hearing and to my colleagues for such job bipartisan in participation. first of all, i want to think - - take the people for all their outstanding jobs they're doing to organize the american government's response to this and also to dr. brantly

and teeeighteen people trying to help people with the terrific challenges facing the workers to or are under incredible stress. that are under such a grip and horrific proportions. so too will acknowledge that but mr. charles it is great to have you but dr. brantly is great to see you. but it is great that you are well enough to be here a hunt travel here and that we're not afraid to have you here but this is a stunning

accomplishment ice said what it is a matter of hours doing this to city into dr. brantly? you look so much like her. we're glad you are here. first of all, of the issue of who is in charge from senator harkin i think usaid is it in charge of responding it a disaster and their to be acknowledged for their ability to do that but the size and scope of watching government agencies this the day higher authority to command personnel on a bipartisan

basis to the kinda of resources to do this because what we're doing today just go to use the appropriations we will need dod and hhs and cdc so i think mr. chairman across the aisle you should ask the president we gave up point person to do this. >> i just want to make sure i did not have of this conception. i've met on the ground coordination in the middle of that area but i take your

point. >> here is my point as the bipartisan group we have the republican party we of work together to create if we wanted to me with any person in charge who would be that person in charge? aid? dempsey? >> i take your point senator >> so let's do that to maximize the leverage to also create that sense of urgency. talk about resources. so if you see the so we can

have on a bipartisan basis but what i am looking ahead to december of 11 this see our is said down payment to keep the body functioning the year cody to respond in africa to prevent it and my correct? >> yes. it will allow us to continue field operations through the end of the cr. but the situation is very fluid and we are assessing what we need for the rest of the year. >> host: when did you have to submit fiscal 60 request? >> ups ran out of the answers. >> let me tell you. >> i thought you might be able to.

>> a few months ago. whenever dr. friedman told the white house he needed for the cdc is three-year five months behind soviet courage omb to go back and say what is it that you need for the cnr and omnibus as we can usually find a way to cancel the sequester so i would say let's get back and revisit that to get the latitude to come back now

dr. fauci you have been tried to find solutions and we're so lucky to have you but you spoke to us eloquently a few years ago about a pandemic they'd had a global infectious diseases crisis to have that infrastructure to respond. and my correct? >> correct. >> this pertains to one continent in one part of a continent are we headed to a pandemic? >> no. because as we have mentioned, the spread of this in the west african and countries is a reflection of that extraordinary disparity of lack of infrastructure to handle the help break -- outbreak to get the people taking care of.

n the country like united states and it is entirely conceivable to have someone get off the plane to be a symptomatic to land in washington or new york or paris or london get sick thing go to the emergency room and in fact, a person or two because someone did not take a travel history. but at that point the capabilities we have would make almost impossible to have the help break the ec and the country that it is driven by a lack of ability to handle infection control and we have that. >> if the disease mutates is that of concern to you? ended those treatments deep

effective because it is new or become airborne? >> get a hypothetical you say we have to say it is not impossible but as a person dealing with irises for so long is it likely? no. you never rule anything out and we are following the genetic mutation of this very carefully. when people ask me the question i say what i know will happen is not hypothetical that of less lee get control of this it will continue to not only devastate but much more difficult to get control in the back of the mind we concern ourselves with irritation but today it is

not the problem but the full court press to get this under control by standard classical control that it spirit that is public health infrastructure. >> quite correct. >> date you senator wearily up running late it has been very informative thank you very much for your leadership and the record will remain open for 10 days i hope we can continue to call upon you for advice and consultation. >> now we call the second panel teeeighteen and dr. brantly served as a medical director for this of meriden first care center in monrovia