>> news about the u.s. response to the ebola outbreak from "the washington post" online. secretary of state john kerry has appointed nancy powell to be ebola coordinator for the state department. l will lead the ebola coordination unit. "lead new role, she will the state department's outreach to international partners, including foreign governments, to ensure a speedy and truly global response to this crisis." declared thema has outbreak and national security priority. the president will be addressing the oboe outbreak in a speech to the united nations general assembly. his -- will be addressing the ebola outbreak in a speech to the united nations general

assembly. in nebraska'sates second congressional district face-off tonight. lee terry is running against brad ashford. -- thehow the coverage race is very close to it we have some ads we will show you the candidates are running -- polls show the race is very close. will showme ads we you the candidates are running. >> we would go to battle and give our lives if it is necessary. about homelessk veterans, the va hospital, the veterans sarah terry -- veterans cemetery, you hear lee terry's name. thank you for caring about our veterans and giving us an opportunity to state -- to serve them. >> i'm lee terry, and i approve this message. >> my dad flew a bomber over france on d-day.

my disagreements with congressman terry are not personal, but his votes against veterans sure are. congressman terry shut down the government, defended his own paid while the soldiers were andl on the battlefield, defended his perks while catering veterans care. i'm brad ashford. our promises to veterans are thisnal and why i approve message. >> lee terry is fighting to keep our neighborhoods safe and he secured grants to strengthen community policing and he fought for the violence .gainst women act he passed a law in neighboring neighborhood activists to start a new fm radio station, giving voice to a community working to stop street violence. lee terry, working hard to keep us safe. >> i'm lee terry, and i approve this message. >> i'm running to make a difference for nebraska.

reducing partisanship in washington is not one easy step am a one single day, or in electing one new member. i'm going to work from day one to create a coalition of 25 members of congress who set aside part -- partisanship and focus on solving problems, just like i've done for 16 years. i'm brad ashford, and i approve this message. >> brad ashford, working together, changing congress. >> tonight's live debate in nebraska's second congressional district is one of over 100 house, senate, and governors debates we will be bringing you during the campaign season on the c-span networks. on the c-spand networks, friday night in prime time on c-span, the values voter summit. speakers include senator ted cruz and senator rand paul. saturday night at 8:00 p.m. eastern, a national town hall on the critical and historic impact of voting. sunday evening at 8:00 on "q&a,"

columnistn post" sally quinn. 2, saturday night at 10:00, pulitzer prize winning reporter matt richtel. sunday at 1:00 p.m. eastern, the ninth annual brooklyn book festival. friday at 8:00, on c-span 3, former chiefs of staff's and advisors to recent presidents talk about their relationship with the commander in chief and how he makes important decisions. night, author jonathan wight on the role of the union army in abraham lincoln's 1864 reelection. dunlaphor annette explores the evolution of first ladies' fashion.

let us know what you think about the programs you are watching. or send us ail us, #comments.n, twitter. on >> yesterday, the head of the cdc updated congress on the ebola outbreak in west africa, comparing a treatment center in liberia to a scene out of said thatferno, and any delay in u.s. assistance could triple the number of ebola cases. according to a new report from the cdc, there could be 1.4 million ebola cases in liberia and sierra leone by the end of january if the outbreak cannot be effectively controlled. >> as people come in, grab your lunches. i am the senior foreign-policy advisers for senator kunz.

i would like to welcome everybody today. we have a remarkable panel. we are very excited to have so many people interested in this critical issue. ciceroe to thank anita for her effort to pull together this event. i would also like to recognize upmc center for health security for hosting this event. i would like to turn it over to tom, our moderator, who will introduce our distinguished panel. >> thank you so much. thank you to senator coons, se senatelake, and the foreign relations subcommittee on african affairs for hosting this event today.

welcome to my guest, who i will introduce in a moment, and thank you all for joining us for this very important discussion. we are very glad to have c-span here as well so others can take part in this. for those of you who don't know our center, the center for health security of you mpc -- of nonprofitre a dedicated to protecting people's health and preventing disasters. we are here for the discussion of the urgent ebola crisis in west africa. there have been estimates that project as many as 20,000 cases of ebola by november and as many as 1.4 million cases of ebola by the end of january, massivean immediate and response. in the affected countries, there is a terrible consequence and academic hardship on the ground and epidemic hardship on the

ground. ebola combines an extraordinary case fatality rate with the capacity to spread by contact, an inability to treat with medicines or prevent with time as and dublin short as 20 days. there's no other infectious disease like this. a disease once relegated to remote villages is now threatening to take hold in major cities in africa. but there are also major new efforts underway the u.s. government and by the who, and other governments in the world. cdc is making its largest international response in history. more than 100 people on the ground in west africa. hundreds of people in the cdc emergency operation center. is providing hundreds of thousands of home protection kits and training and information. its people are moving 100,000 units of personal protective equipment to west africa.

the u.s. to farming of defense is providing 3000 u.s. forces for the response, establishing a regional staging base to facilitate the arrival of equipment and supplies and preparing to trains hundreds -- to train hundreds of health care providers. we know who has provided a roadmap for response and is providing expertise in africa and is seeking funding from governments around the world. ngos like doctors without borders are heroically leading the efforts on the ground. we williscussion today, hear about the situation on the ground in west africa by people who have been there quite recently and to our leading the effort. we will learn about what the u.s. government is doing in more detail and, perhaps most important me, we can take to end this crisis -- perhaps most importantly, we will discuss what measures we can take to end this crisis.

, who we are today so fortunate to have, given all that they are doing in this response -- the usaid director of office of u.s. foreign disaster assistance. rieden, director of the u.s. center for disease control. joseph, cofounder of the well known organization -- the assistant secretary of defense for nuclear, chemical, and biological programs. we are sorry not to have keiji -- kejii fukada. his boss said she needed him in new york today. feel free to make your comments from there or come to the podium.

>> thanks for the opportunity to speak. it is great to see this level of interest on the hill. this is a remarkable challenge. -- ink it will take it is taking the whole of government and it will take a whole of society response for us to fully support the liberians -- the liberian, sierra leone, and guinean governments. this is a crucial piece to our ultimate success. i will talk for just a few minutes about the over arching u.s. strategy that the president laid out last tuesday and usaid's specific pieces of that, then turn it over to my colleagues to go into more depth on their respective pieces. as the president laid out on

-pillar, we have a four strategy that the u.s. government is pursuing across all of its many capacities to try and control and ultimately defeat this outbreak, but also to look beyond the immediate outbreak at the longer-term and the health systems toilience of these countries what will be a likely future outbreak of this as well now that this is in the environment in other countries such as uganda and drc. we don't want this whole episode to result the next time that happens here we do know from those other countries that it can be controlled when there are measures in place to do so. the first pillar of the strategy is to focus on controlling the immediate epidemic and the immediate outbreak. the second pillar focuses on mitigating second order impact,

things like food security, economic and political stability , and ensuring that as these countries struggle with the immediate outbreak, that we don't see second order impacts that are equal to if not greater than the outbreak itself in terms of human out -- human impact. the third pieces to coordinate an effective global and u.s. government agency response. coordination will be critical to the success of this, both at a country level and at a global level. there are many, many countries that are looking to play a role here, and in any major response that we undertake, there is a , thatcoordination element hundreds and hundreds of ngos that famously showed up in haiti are a well-known example of. in this case, it's even more critical, because this is something that none of us have ever done on this scale before. having cord did action is all the more important for that reason -- having coordinated

action is all the more important for that reason. it is also critical because there is an ability to prevent future outbreaks of this magnitude. it is critical for the long-term future of these countries, but also critical in the immediate term that some of the neighbors do not see outbreaks on this scale. and i think the fact that cases have popped up in a few of the neighboring countries so far not triggering any major outbreaks is an indicator both of the risk but also of the potential to keep this managed with swift and decisive action. just to speak briefly about usaid's role. has thece that i lead standing role in the federal government as the lead coordinator for international disaster response. and so, in that capacity, we m to thet a dart tea

region that has representation from across the interagency, works closely with the larger cdc team that is also there on the ground, also has cdc representation on the dart as well. the focus of the dart team is both to coordinate the agency input and also to deliver and execute on usaid's pieces of the response. our current focus, and i won't reiterate everything that president has already announced, but our current focus is along five lines of effort. the first being effective in country management and leadership of the response. we are very policed -- please to that the liberian national emergency operation center has opened officially. all of the elements of the liberian government coordination now sits under one roof after a great deal of u.s. government support. the second element is to focus on scaling up isolation and treatment.

so we are focusing heavily on getting etu set up and working closely with dod in that effort. the ebola treatment unit, excuse me if i use acronyms that you all don't recognize. please just raise a hand. it's hard to think about. fairly ingrained. the third piece of that is safe burial. we are on track to have -- we are on track -- i think that's one where we've seen the most rapid process. it is one of the more easily scalable pieces of this. we are on a good track there. the fourth element of this is infection control. more broadly within the country and a big piece of that will be the community care strategies that the president announced last tuesday. that will focus on beyond the etu's, enabling communities and safelyry households to isolate and provide care when etu treatment is not available,

because that takes time to scale. the protective kits that tom referenced in the opening remarks are an important part of that approach and we're happy to talk more about that. and then the fifth element is communications and social mobilization. this is a new disease in all of these countries. there's a lot of misinformation and misunderstanding about it, and ensuring that there's accurate understanding, accurate information, and that people know the basics on how to protect themselves is a critical piece. underpinning all of that is a huge logistical effort that both we and dod are working on very intensively to ensure both adequate procurement, adequate transport, as well as adequate supplies and supply chain management within the country, because the volume of personal protective equipment, chlorine and other supplies, that are required to run a medical operation on this scale is just enormous. so, that's a huge piece we are focusing on. thanks. >> tom?

>> so, thanks very much for bringing us together and senator -- to senator coons' office and to all of you for your interest. i've been doing public health, running public health agencies for a few decades on a few continents and i became a doctor working in new york city in the 1980's where i cared for literally hundreds of people dying from aids with a limited ability to do much other than help them die comfortably. and that experience was searing for me personally, and i've never seen anything like that until i was in monrovia recently. and went during ebola treatment unit run by doctors without borders who are working really with just incredible effort, their largest response ever, exceeding the capacity, stretching the limits of their operations. but we went into a treatment

unit and we saw really a scene out of dante. it was patients who were in all stages of the disease, from those suspected but maybe didn't have it and maybe might get it there if they weren't effectively separated from others. and our lab next door was working more than 12 hours a day confirming within a few hours whether people had disease or not. people who were just getting in and being cared for and desperately needed rehydration to survive. patients who were recovering, including one guy who was healthy enough to complain about the food. i thought he should probably be helping to make the food if he could complain about the food. [laughter] but also, tragically, three patients who had died in the past few hours, and the staff

was so overwhelmed, they could not remove their bodies. and this is the facility in which there are 14 to 20 beds per tent. tent who had one died was next to the other patients who were struggling to live. and that kind of situation is the real world example -- exemplification of what it means to have an exponentially increasing outbreak. it's a very hard term for all of us, myself included, to get our minds around, that it is doubling in 20 to 30 days in the region. that facility had had 60 bodies removed that day. so, the situation right now in west africa is an absolute crisis. it is moving faster than it is easy to understand, particularly

in liberia, and we've already seen exports to both senegal and nigeria. we now have a field team in ruralote d'ivoire -- in cote d'ivoire looking at cases there. if i were to just summarize for a minute, what we need is an immediate response that is , and then make sure that this doesn't happen again. and if i can just outline those three concepts for a moment. i've never seen a public health situation with this much need for immediacy. as i've explained to people, and response today is much better than a great response in a week. it is that urgent. case, really, in all three countries that are

affected, even though liberia has, by far, the most out of control situation. but there are districts within liberia that are having relatively few cases. they have the opportunity to stop it before it spreads widely there. and where there are many cases, we are intensively trying to scale so we can reduce the spread. in sierra leone, where cases have not increased quite as we haveas in liberia, the opportunity to prevent a liberia-like situation. , where cases have had three consecutive waves where it has expanded and been controlled, they have the potential of keeping it under control. or the bestlogy metaphor is a forest fire. we see the forest fire raging in many districts of both sierra leone and liberia, especially that tri-country area. there's a three-border area where the three countries come together.

it a deeply forest did -- deeply forested region. it has very poor infrastructure, has very poor relations with the rest of each of the countries but is the crucible of this epidemic. and other capital cities of freetown and monrovia which are -- the world's first extensive urban spread of ebola in the context of the world's ebola epidemic. so an immediate response is critically important and that's why president obama's announcement at the cdc last week is of critical importance that the department of defense , is already on the ground. usaid and the dart process is there. and the needs are extraordinarily large. and that's what's really hard to get our minds around because not only are the needs large today but they will be twice as large in less than one month. and if we're going to be successful we have to build to where they're going to be in a month. and we're going to have to sustain this, because once we

tamp it down -- is somethingbola that cdc has done for decades with who, with other countries. in 2012, in uganda where work on ebola many times, tragically a 12 year old girl died from ebola. what was striking was that she was the only one who got ebola. that's the only time in history we've seen a situation like that that i'm aware of, other than a laboratory incident, where there is someone who got it but people thought immediately, this might be ebola, they immediately isolated her, tested, and confirmed it was ebola. they confirmed that when she died she was safely buried and they ensure that any contacts were tracked. theyey had gotten ill, would not have spread it further. if that kind of core public health service, finding problems quickly, responding and preventing were possible, if that had been in place a year

ago in these three countries, the world would be a very different place today. but the fact is we now have an outbreak that is likely to continue for a significant amount of time, and to protect other countries, we need to surge. so, when one individual went to lagos, city of 21 million as the about the same three cities in west africa -- the three countries in west africa, we got on the phone with the governor of lagos and health minister of nigeria. we sent a team of experts within 48 hours to be there. we brought in 40 people who we -- who were trained in the polio eradication effort and working effectively -- now they are not completely out of the woods but it does look like they have controlled the outbreak in both lagos and port harcourt. that involved more than 1000 health care workers doing among other things more than 19,000 home visits to measure temperature of nearly 1000 made -- named contacts.

that was to address one case of ebola. so, we need to have a response that is immediate, that is sustained, and that prevents future events like this. because we could have prevented this in the first place. sars cost the world $30 billion in just about three months. the economic implications of ebola in west africa, not just west africa, not just for africa, but for the world are quite substantial. who, in the publication yesterday, raised the possibility of ebola becoming endemic in africa, and that would mean, for those of you who are not in the public health world, that it would continue on an ongoing low or medium level indefinitely. we think that's not inevitable. we think if that were to happen, it would be an enormous problem, not just for west africa and africa, but for the world, because we would always have to be thinking about the possibility of ebola.

anyone who had been in any region that might have a case of ebola -- i would reiterate the approach that president obama has outlined is exactly what we need , and we need to get to scale and speed that will match the exponential growth of the outbreak to ensure that we have an immediate response, sustained , and prevent this from happening both where it is not happening now and from happening again anywhere, whether it is ebola or any other health threat. thank you. >> thank you for the invitation to talk today. let me start -- sorry. let me start by saying i completely echo director frieden's comments. we happened to see each other in sierra leone while he was there. i'd like to preface my remarks with the fact -- with the understanding that i am mostly speaking from my experience in sierra leone and liberia. by remarks tend to be skewed towards those countries which

are currently experiencing the worst parts of the outbreak. and when we say the situation is dire in sierra leone and liberia, we just can't emphasize that strongly enough. what we are facing is an end- ofdays scenario locally, biblical proportions. and the people of those countries largely feel abandoned by the international community. however, that response is now starting to trickle in and there is hope, there is a light at the end of the tunnel, hopefully, although it is going to get worse before the it's better. i'd like you to keep in mind when we're talking about at least those two countries, we are talking about two countries that have endured almost a decade of civil conflict. we are approximate 11 years out from the end of the civil conflict and considering build a public health care infrastructure in just 11 years is an enormous task. we were dealing with regions which are almost on the brink of not being able to offer sufficient health care on a normal day.

what we've seen since the onset of the outbreak is a complete breakdown in the public health and the health care infrastructure. schools are closed. hospitals that haven't even experienced ebola are closed. and i think from that we may never know the toll of deaths that resulted from non-ebola cases, from very normative infections that occur every day in sierra leone. there was a headline today on cnn that you have ebola unless proven otherwise, and that is indeed the case. before this outbreak i could argue the case would be you have malaria unless proven otherwise. we have complicating this factor that ebola is now occurring in the highly mobile environment, that is well connected by roads. we are dealing only with colonial borders. these are not tribal borders. the tribal languages amongst these three and four countries are all the same, so it is considered much as we would consider going to canada from the united states. it is a very easy and thorough transport through that region.

we are still very much experiencing an upward trend in the number of cases in liberia especially, but also sierra leone, less so in sierra leone. and while i truly applaud the move to reach out for support, the building of treatment centers is something that i do not want us to put faith in stopping this epidemic, because we could build treatment centers for the next 12 months. at this point, we are over for treatment centers. scenes.horrific , there was ah ago situation being described where we had 10 persons that had passed. gs had no body boaa because flights had been stopped

. as the director mentioned him as a patient you can imagine that you are trying to survive this disease and your mentality in trying to survive the disease is very important. however, you are looking to your side of people who were lying to you, alive just the day before, and you can only imagine you are going to be next. you can see why there is the tendency, which we have read about, of people fleeing, running, not coming into the treatment centers, and that is partially because treatment centers are considered a house of death. we are turning the corner in that opinion. much of the messaging that we did early on in the epidemic, which was accurate, but not locally understood, was there is no licensed treatment for the ebola virus. what we had as a result of that rtion of theo

population did not believe in the virus, but why report to a treatment if there is no treatment? what they heard was there is no treatment for ebola, so that led to almost half the population to see cap traditional healers. a lot of that involves bloodletting, which is probably the worst thing you could do, and that is also greatly enjoy reading to the spread of the virus -- greatly contributing to the spread of the forest. the priority has to be stopping transmission of the virus, and we are doing that with roots on the ground, with aained epidemiologists, and sustained effort. as we saw in guinea, we thought the outbreak was o ver, but we missed two or three contacts.

concurrent with that is this construction of the treatment centers that are already infected, that speaking as a public health professional, our number one priority has to stop the transmission, save the people not yet infected, and also treat those that are currently infected. that the caution phenomena that we have seen since the introduction of things like -- and the experimental vaccines, what that has resulted in is the belief that that is going to be the answer to the outbreak. improving our infection control and treatment centers, and in the long term, at this will

require is a rebuilding of the public health infrastructure of these countries. this has set these countries back in that regard five or six years. we are also going long-term dealing with the derivative ebolats of the outbreak. food security. airlines, and a lot of the commercial trade that those countries are doing. tankers, including oil tankers, have threatened to stop talking in sierra leone and iberia, and that would create another set of problems. we're still working on getting mobility and transport in place. those are things we are going to have to deal with concurrently. lastly, we are facing a unique situation, especially in sea erra leone and light beer, this is the first time we have fever in aneak of

area where we already have a lots of fever. last week we are starting to enter the dry season. the areas which have been most affected, the areas of liberia that have been affect, those happen to be our areas for this fever. very shortly, and we have already seen this, we are going to have multiple hemorrhaging fevers at the same time, and there is not a place to put all the ebola patients. that we will think about how we separate the fever patients in the ebola patients because that is not something we want to mix. the chances for surviving with the fever is much better than ebola. those are my comments. >> thank you.

>> thank you. thank you, tom. thank you for the center for health security and the senate for organizing this meeting. there is a lot of interest in this very important and urgent crisis. this is a national security imperative. is a human tragedy and an international health emergency on a scale that we have not seen before. one thing i want to stress is see hers team that you today, we did not just meet because of the ebola crisis. we have been working together on dan andssues, tom frie i, regularly for the last five years. we have a strong relationship between the department of defense and hhs and cdc that

goes that many years. dod is not new to global health. ofng back to our tradition walter reed and the work he did on the yellow fever virus. week we established operation united assistance, which will be dod's support to this global effort that is led by the united nations and their special mission established this ofk, and we are in support our civilian agency counterparts and working with allies, including the united kingdom, france, and others that have a lot of reach into the affected countries. dod will focus our contribution our uniquength, capabilities and capacities, including command and control, logistics, training, and

engineering support. we established the joint forces command under u.s. africa command, and the major general round doing the g the assessment. he is also the commander of the u.s. army africa, and the command headquarters is being established in monrovia, liberia, in addition to a regional intermediate staging senegal, which will provide support to ensure the flow of personnel and equipment and material supplies for this very, very large area of west africa. statestion, the united

will send this week two more diagnostic laboratories. some of our best scientists and microbiologists from the naval medical research center will deploy with those units to liberia. one in monrovia, and one in another city, and they will be associated with ebola treatment units, so we can have rapid eye gnostics -- diagnostics. department is providing a 25-bed staffed byat will be international health workers and public health service medical personnel. the department of defense will not be involved in direct patient care as part of this operation. 17are going to construct 100-bed ebola treatment units in

liberia, and the planning and preparation contracting for that act of the is underway, and that should to show results on the ground in the next few weeks. byse units will be staffed local and international health care providers. again, the department will not be engaged in direct they should care, but we will provide training based on the infection control training that msf has established in belgium and cdc at aeplicated in alabama facility there. we are going to establish a similar training center in liberia with the goal of training 500 health workers per week.

and the focus of that will be on infection control. the department of defense is prepared and has requested up tot from congress for one $1 billion to commit to this ever. there are two major reprogramming actions that are pending here on the hill, and the nunn-lugar cooperatives biological engagement program is over $60g to invest million in strengthening the global health security capacity and laboratory capacity, both in the affected countries and also in the neighboring countries. the department of defense through our bio defense program has been involved for many years in the development of medical

therapeutics,s, vaccines, as well as diagnostics, and we have sent over 10,000 diagnostic test kits for ebola to the affected countries as well as personal protective equipment. note that ino just february, february 13 of this year come on the day the federal government was close, the u.s. government launched a global effort called the global health security agenda, and that has grown. it was not in response to ebola, but we are glad we initiated that, and on friday the white house will be hosting an event of 44 countries at the ministerial level that is cross-sectoral. we have health ministers, home affairs ministers of defense ministers, crossing different

sectors, which is necessary for the whole of government response eventsese types of ricardo and the goal is to build those capacities which had an in place in west africa -- which it had been in place in west africa could have prevented this from becoming an epidemic. prevent,acities are to detect, and respond to infectious disease outbreak as your heart under the international health regulations. will participate in the global health security agenda event at the white house on friday, together with secretary burwell, secretary kerry, and that will be hosted by ambassador rice with the participation of president obama. finally, i would just like to thank people like joseph and aid cdcers on the ground, 100

experts on the ground, like jordan, who just returned from re, for their truly heroic efforts. we owe them a deep debt of gratitude for the heroic work they are doing on the ground every day in west africa. thank you. >> thank you, andy. thank you all for really setting up this discussion and so much insight and information to start the discussion. we are going to now turn the discussion for those of you following along on the web or twitter, you can submit russians #ebolaonthehill. before we get too specific questions about the response, because people want to understand the new once as of the response from the leaders here, i want to ask one more question about the consequences if we get this wrong, if we do not rise to the occasion, and you begin to paint that ensure

here of what is at stake, but we hear things in the media or along the way, along the lines of this country has enough on its plate, we are trying to deal with isis, we have national security threats. why is it important to invest so much of our time and talent on this problem, and what happens if we get this wrong? today" headline, could the ebola epidemic go on forever? what are the consequences for us for africa security, for health if we get this wrong? career, i spent three years living in guinea, working with refugees from sierra leone and liberia. are onlyseph said, we about 11 years out from the end of the civil wars in these countries. the u.s. invested large amounts

of effort, political capital, resources to bring peace to these countries, particularly liberia, where we have strong historical ties. if unchecked,ak, could undo a huge amount of effort both in terms of strong investments athe u.s. has made, but at a human level as well. it just threatens to devastate -- it is already devastating these countries, and there is a strong humanitarian impulse in the american body politic. it is the reason why we are a leader. i would say the global leader on international humanitarian action and disaster response, and any time there is a disaster on this magnitude, the u.s. is on the front lines. for humanitarian

reasons and for u.s. interest reasons, an absolute national security purdy, and the president has articulated this -- priority, and the president has articulated this. if you look at the interest level in the american public and the media, there is a clear desire to beat this thing, and we know we can. think the sad fact is that the worst-case scenarios are really bad. --terday cdc outlined in our what would happen if the exponential growth were to continue at the rate it was going a few weeks ago. we do not think that will happen because of the response of the u.s. and others. but the worst-case scenario tops 1 million cases within a relatively short time, and not

only would affect west africa, but would inevitably spread to other countries. disease exportation events with the first couple thousand cases. how many events are we going to have if there are tens, or as the president said, potentially hundreds of thousands of cases? think, it iswe may not possible to seal borders. it just does not happen in today's world. if it did, control of drugs and diamonds and people would be much easier, but it does not, and it is not going to here. and what that means is that we really are all connected. so while we do not think that if ebola continues to spread, as we believe it has been spreading all along, it will present a significant health risk to people in the u.s.. it could absolutely change the way we work here and it could change the economy of the world.

it could change the way we assess anyone who has traveled to anywhere that might have had ebola. we do not think that will happen. that is why president obama highlighted the whole of government response to each part of government intruding what they can do to stop this as quickly as possible among recognizing, as the doctor said, that it is going to get worse before it gets better. we have to recognize that although we have to work immediately, it is going to take time to show the around. but the other key findings of the report we released yesterday is progress is possible. when you isolate and of people, the disease begins to stop spreading, and then can decline in numbers almost as rapidly as are exponential growth we seeing now. but what the model found that i wasd particularly striking

the mathematical documentation of the urgency we all feel, that of one month in scaling up the responsible result and a tripling of the size of the epidemic, and that isd of shocking increase very hard, as i said, to really get our minds around and to act in a way that we are trying to make sure that we are anticipating what are likely to be the next problems, even though we recognize that the situation on the field is fluid almost beyond description. it changes day to day, but our response has to be with the urgency that will turn it around, and i think we can do so, the risks are not just west african africa, they are to the whole world. >> sure. first of all, i would like to draw attention to something we've mentioned several times. there were two cases of exportation of a virus to other

nations, nigeria and senegal, and we look at the response in those countries and how they contained it very quickly. we cannot ignore the fact that the gdp of nigeria is approximately $530 billion a year. senegal is approximately $16 billion a year. you cannot ignore the fact that the socio-economics of this disease, so like most tropical diseases, it is disproportionally affecting the poor. i would argue, as jeremy mentioned, that we are experiencing a level of mental and social trauma not seen since the civil conflict in this area. and a lot of us may question why we have never seen this run and clean mentality with the ebola. this is a direct result of this complex, because that was the mentality developed at those times, though the only way you are going to stay alive is to

run, hide, to stay with her family, and that is what we are seeing right now. and i believe we are turning the corner in the psychology of that in convincing families that by hiding somebody, keeping them in your home, not only are you greatly increasing the chance that that person will pass, that you also will infect your whole family. that is unfortunately had to happen many, many times for that message to come through. we are likely to see major impact on the government of these countries. just example, liberia. the president was one of the most popular presidents in africa, and africa will altogether. now you have seen a tremendous amount of negativity flowing towards the current administration. in sierra leone, we face a similar circumstance. not widely publicized, but the current epicenters in sierra leone are in eastern sierra leone, and if you look at sierra leone, its political is divide

is like it is in the u.s., with a two-party system, and where the current epicenters of the virus are currently occurring is the opposition party stronghold. the rate of infection, the percentage that is all being used as political fodder against the current administration and office desk in office and although they have improved conditions in sierra leone in the past 10 years. everyone on this panel is at least familiar that we have spent much of the last 10 years focusing on bioterrorism since 9/11, and another term which we use, bioerror. this is somewhat of a worst-case scenario and the sense of we literally have thousands and thousands and thousands of samples of ebola virus. i did not have exact numbers on how many of those are positives, going into very low resource labs, taken by technicians that are baseline phlebotomists, so we have seen a number of infections occur just because of

needle sticks, etc., and there system fortracking the samples. all the clinical laboratory services that are needed on a normal day in any of these countries for the typhoid, malaria, common infections people have have all but stopped, and that is understandable because now as a lab tech mission, when you receive a sample, it is safe to assume it is ebola. to echo the comments of the panel, i think we are going to have a lot of long-term effects which we are also going to have r. address and to echo df. frieden's comments on every single day we delay we are potentially going to be seeing an exponential number of increased cases. >> you want to say something? one more question, and we will open it up to questions. if anyone has a question, on the webcast, and it relates to one of the pillars of the response

rate it is clear we are going to need doctors and nurses in numbers that are not available now, and there is an element of training going on in the planning, and an element of her crew. how do doctors and nurses get involved in this, in our country and elsewhere in the world if they are willing? >> that is a critically important question, and it is that preoccupation of us now, because one of the things that has made this such a challenging response is that prior to this there'll are was no standing global reserve capacity for large-scale ebola resounds. -- response. it did not exist. he did not think it was modest scale at the time, but it was modest in terms of the swing, and contained rural settings. respondal capacity to and treat ebola was premised on that sort of response scale. and we are now faced with a situation where we need a response scale that is orders of

magnitude larger, and that involves finding institutions, organizations, nonprofits, medical teams who are able to come forward. it identifies -- it involves identifying staff who can identify ebola, and one thing that is important underscore is the treatment unit model is 5% towidely applied, only 10% are professionals. the vast majority of the people who are taking the risks and putting themselves on the line to control this are nationals of countries. and we are working furiously to set up training models. dod will have a role in this. cdc in the world health organization are organizing training in the countries themselves. and working with ministries of health and local institutions to identify nationals of the country so we can put them through trainings.

which was opened recently in monrovia, has a large, meant of train the library and staff. we are also looking for medical professionals to join in the response. been set up, and it is reachable where we are collecting contact information of people who are interested who respond,teering to and we are making that available to partners were looking for staff to step up their responses. as we are getting new grants out resource fors is a them that they can draw on to help the consummate their staffing. -- complement their staffing. interestis an a lot of

in assisting, despite the fear that ebola natural causes. the african unit, with cdc in the department of the state, is now on the ground in the countries helping out and providing care. this is a great example of what is needed. there are some barriers that we need to break down some people are more willing to help. one of those is being able to go back to their home country, because some african countries have put up travel restrictions to those returning to the area, even from their own citizens, but we are seeing a lot of interest. oureremy said, 90%-plus local staff, intensively trained, and willing to work in these areas, so the numbers become a little but more men's will when you think about it that way, but are still very large and needed very clearly. that is why actually this week cdc completed the first training course ever for ebola outside of the msf model, based on msf

training, and that will train trainers and we will scale that up. >> great. we will take russians from the audience. dirksen questions already. i see some questions already. >> from the foreign relations committee. that roughlying, 75% of the current victims are women and children. do you is true, what think the particular socioeconomic impacts are and psychological impact are in these communities would be as a result, and how does it change or alter your spots? --the who response yet petition yesterday, said that although was an impression of a female predominance, what we have seen in the past, because females do more caregiving can we have seen a 50-50 response in the data that the who published yesterday. children tend to be less affected directly because they do not tend to be caregivers.

but we are seeing just horrific implications of this. i will mention 34 children. one, i was speaking with once reiber in her home -- one survivor, and her never you was bouncing off the walls, and they said their neighbors do not let him go outside to play because they are afraid of him. the second one, i held a child in a survivor, his parents died. aunt, but weth an are seeing horrific problems. and, three, i saw one of our staff at cdc who has done that post-employment screening of iron staff as they have come the stories they tell are searing. for example, one of our staff described on the street seeing babies left by parents who were afraid of infecting them, so to try to save their child's life,

they were abandoning their child hoping that someone would pick them up. the implications are enormous for the societies themselves. >> i would add to that that in probably something you have read about them about once a person does show thrive, if they are fortunate enough to survive the disease, there is intense stigmatizing of them once they enter the community, even if they are allowed. as the director said, the majority of caregiving at the local setting is from women. women are primary farmers for cassava the with

main consumable. often children have survived because parents were this themselves from them. , we have untold numbers of orphans. you're coming into a system where the social networking site was alreadyorphans under developed. again, going back to the civil conflict, we are seeing numbers now that are not exactly equivalent to what they saw during that conflict, but is reaching that category of a number of orphans we are seeing, especially in the most affected areas. add, theuickly to second pillar of u.s. strategy, focusing on the second order impacts, is exactly that. that is an element of exactly that, and that is why we are focusing on that, because we know that even getting impact, the immediate outbreak under control, there are going to be many knock on social and economic effects that are going to take years to address. so we are building that from the beginning. >> next question. i global.

i had a question about the evolution of the virus. the virus has seen more human hosts than ever before. there was an article published at the end of august that documented the evolution of the forest to 99 human hosts. the question is, what is the current and ongoing effort to understand the direction in which this virus is going to evolve now that it has seen more hosts than ever before? >> as you point out, we are in an unprecedented situation. we have tracked the genome of ebola for 40 years, and we have genetics than 5% change, which is small for most pathogens. i think the fact that we have different10, 20 generations, and we're seeing it in thousands of people, does put us in a different environment than before. we have had groups looking at tos, and there is the need track the genetic changes in the virus over time, and there are

institutions working on doing that. there is also a need to try to track the epidemiology over time, because we know so little about the genome and what the different expressions are, that we are more likely to pick up the change by that court public health epidemiological monitoring that should be going hand in hand. gary, from senator rob portman's office. following up on your comments about containment and response and the response to a potential expansion of the virus, it is my understanding that cdc is working with dhs on development for points ofe entry, and currently that it is past the surveillance. elaboraten, can you

when you see elevating the threshold for surpassing the surveillance, and how that does correlate for training to cdc officers at point of entry? >> i think of us and having three lines of defense against ebola, and thinking carefully about how to do that most effectively and most practical. the first is to try to stop it at the source in africa, and we have been talking about that, and that is going to be the most effective way of doing it, but it will be continuing for a while, so we need to do more than that. the second is stopping people who may have ebola from departing the country. searched andhave have put people in each of the airports in each of the affected countries, and they are doing multiple temperature readings on every person boarding a plane leaving, as well as a

questionnaire, and they are removing from the departure line anyone with a fever or who may have ebola. that clearly is not a perfect way of eliminating ebola, because someone could have just been exposed, and the incubation period is usually eight to 10 days, but can be as long as 21 days. that does not mean we will keep you ball in these countries because people travel over land, as the individual who went to senegal to come in because there may be an incubation period, but it is an important thing to do to keep the travel safe, and one of the things that has kept some of the airlines that have kept flying flying, because they have been having a reasonable expectation that nobody is going to get very sick on a plane. the third area is within our tontry -- and we really need recognize that with ebola spreading this widely, it is not impossible that someone will come in to one of our hospitals or health centers with symptoms of ebola who may actually have

ebola. we have already had 13 people come in symptoms that were considered potentially consistent with ebola, who were from the area in the past 21 days, they have been tested, and they have all been negative or ebola. we have rolled it out more than a dozen times. close toinquiries from 100 different health care facilities that we have been able to assess, and we have provided more than a dozen labs around the country with the ability to test for a bullock so that public health labs can do that quickly. in terms of border protection, we have a very close working relationship at cdc. we have staff in quarantine stations throughout the u.s. suspected disease, ebola or otherwise, we work very closely. we have worked with order production of protocols we would follow if someone were to come in with symptoms that might be consistent with ebola. so that we would be able to respond effectively. thatf the challenges is

what we might hope would be magically knowing that somebody has ebola, it is just not possible. so understanding what is best done and how we can manage more effectively is something that ande always considere continue to dynamically reassess at dhs and others. microphone. sorry, i was handed a microphone, so i assumed it was the logical purpose. i'm here with the armed services committee in the senate. we heard from panelists at the effort that the response will need to be sustained. go at it hardief for three months and we are done. we heard a lot about the u.s. which is whatnse, you're representing largely today, including the billion dollars of the defense department funding, but my understanding is that is

intended to cover up about a six-month period to build up the effort. can you give us a sense of what you mean by a sustained come in terms of length of time, and the response that you believe is needed from other countries, besides the united states, because obviously we are doing a whole life, but this needs to be major international response? thanks. >> i will say a couple of things, jeremy. basically, give them a number and we will give it a date, but do not give them both together. we do not know what the future is going to hold. you know the sooner we get out there, the sooner we are going to control it, and the penalties for delays are extraordinary. so surging now is critically important. i will say we have seen a wonderful global collaboration here, and just take laboratory services. parts of theeveral department of defense running labs. we have nih, cdc, the south africans, ned and, chinese,

russians, french, and italians all running laboratories in these regions. there has been a robust mobile response. the african union, a health is already once, the ground. there is a robust capacity on the ground, but the us has unique capabilities in terms of speed, skills, and scope. pie cce,ernational the worst affected countries rcl sierra leone and liberia. is stepping up now in sierra leone in a similar manner to what the u.s. is doing in liberia. of thee taking the role

foundational or principal donor partner to the sierra leone government in a way we are doing in liberia. guinea, there is not a single lead donor there, but it is a smaller outbreak. the french are increasing their involvement. it looks like other european partners will be going in a larger way into guinea as well. the third pillar of the strategy that i mentioned focusing on building the coherent international response to the u.s. interagency response is focused on that very question, because we know that the u.s. government cannot and should not have to carry this entire response on its own. in a verysetting up substantial way, that is a huge piece of that. as tom mentioned, many other international partners are stepping up. we are doing very regular calls.

in the past half a day i have been on ones with u.k. and other international partners. that is an important part of the effort. isinternational outreach a big part of this ever. is a part that president obama emphasized in his announcement in atlanta at cdc. one of the u.s. objectives is held mobilize the international community and improve the coordination among the international community. next week the u.k. will host an event focused on sierra leone, to coordinate donor contributions. the public-private partnerships are a big part of this. the bill and melinda gates foundation has pledged initially $50 million to this ever, and around thengo's

world our country. there is a lot of outreach this week in new york, and as i mentioned in my opening remarks, this friday the global health security agenda, we are going to leverage that to get real commitments, real commitments for action for funding, for in-kind contributions, to global health security around the world, but also specifically for the current crisis in west africa. and the state department as named ambassador nancy powell, former head baath city to india, to help lead this effort for international outreach and owner coordination. >> i forgot to mention the world bank come and i would not want to leave them out. they have been terrific. they have leaned forward in a receipt. they have arty put over 100 million hours in the field. there is more than $100 million

they're put into the field, and they not just get the emergency response, but put into place the laboratories, disease detectives, and emergency response capacities that would have prevented it in the first place, that can prevent similar events in the future, and that will be discussed in the white house of friday on global health security, which has been a top priority for us at cdc. whatwould like at i do not want to speak the timing of sustainability. that is dependent on how fast we get a handle on the outbreak and we start seeing a decrease in numbers. but for me, sustainability is going to equal building human and technical capacity so that we prevent this from happening again. that will take time. there is going to be short-term term training, medium-term training, and there's going to be long-term training coupled with investments and locally sustainable technologies, and that will take time and effort, and it is things we are currently introducing and will continue to introduce

throughout the lifespan of the outbreak. regarding the international coordination, i think the governments, the african union -- >> you can watch the rest of seminargressional syste anytime at www.c-span.org. >> thank you for bringing us together today to address an urgent threat to the people of west africa, but also potential threat to the world. dr. chan, heads of state of government, especially african ladies and partners, gentlemen come as we gather here today, the people of liberia and uinea are in and gi crisis. as secretary-general ban and dr. an, have already indicated,

the ebola virus is spreading at alarming speeds. thousands of men, women, and children have died. thousands more are infected. if unchecked, this epidemic could kill hundreds of thousands of people in the coming months. hundreds of thousands. ebola is a horrific disease. it is wiping out entire families . it has turned simple acts of love and comfort and kindness, like holding a sick friend's hand or embracing a dying child into potentially fatal acts. if ever there were a public health emergency deserving an coordinatedng, and international response, this is it. but this is also more than a

health crisis. it is a growing threat to regional and global security. guinea, sierra leone, public health systems have collapsed. economic growth is slowing dramatically. this epidemic is not stopped, this disease could cause a humanitarian catastrophe across arearegion, and in and where regional crisis can become global threats, stopping ebola is in the interest of all of us. the courageous men and women fighting on the front lines of this disease have told us what they need. they need more beds, more supplies, more health workers, and they need all of this as fast as possible. right now patients are being left to die in the streets because there's nowhere to put

them in there is a witty to help them -- there is nobody to help them. one worker compared this to fighting a forest fire with spray bottles. but with our help, they can put out the blaze. last week i visited the centers for disease control and prevention, itches mounting the largest international response in its history. i said that the world could count on america to lead and that we will provide the capabilities that only we have and mobilize the world the way we have done in the past in crises of similar magnitude. and i announced that in addition to the civilian response, the united states would establish a military command in liberia to support civilian efforts across the region. today, that command is up and it is running. our commander is on the ground

in monrovia, and our teams are working as fast as they can to move in personnel, equipment, and supplies. where working with senegal to stand up and air bridge to get health workers and ethical supplies to the west africa faster. we are setting up a field hospital which will be staffed by personnel from the u.s. public health service a training facility where we are getting ready to train thousands of health workers from around the world. we are distributing supplies and information kits to hundreds of thousands of families so they can better protect themselves, and together with our partners, we will quickly build new treatment units across liberia, guinea, and sierra leone where thousands will be able to receive care. meanwhile, in just the past week, or countries and organizations have stepped up their efforts. and so has the united nations. the secretary-general, the new u.n. mission for emergency

response announced last week u.n.'sring all of yo resources to bear. we thank you for your leadership. it is encouraging, but i want us to be clear. we are not moving fast enough. we are not doing enough. everybody has the best intentions, but people are not putting in the kinds of resources that are necessary to put a stop to this epidemic. there is still a significant gap that we where we are and where we need to be. we know from experience that the response to an outbreak of this magnitude has to be fast and it has to be sustained. it is a marathon, but you have to run it like a sprint. and that is only possible if everybody chips in.

if every nation and every organization take this seriously. everybody here has to do more. international organizations have to move faster and cut through red tape and mobilize partners on the ground as only they can. more nations need to contribute resources, or treatment. more foundations can cap into the -- tap into the networks they've have to raise funds for businesses, especially for those who have a presence in the region, who can provide their resources from access to critical supply trains, to telecommunications, and more citizens of all nations can educate themselves on this crisis, contribute to relief efforts, and call on their leaders to act. so everybody can do something. that is why we are here today. theiren as we meet,

urgent threat of ebola, it is clear our nations have to do more to protect and defend against future biological threats before they erupt into full-blown crises. tomorrow in washington i will host 44 nations to our global help security agenda, and we are interested in working with any country that shares this commitment. emphasize the issue of speed again, when i was down at cdc, and perhaps as has already been discussed, but i want to emphasize this, the outbreak of point, more at this people will die. but the slope of the curve, how fast we can arrest the spread of this disease, how quickly we can contain it is within our control, and if we move fast,

even if imperfectly, then that could mean the difference 20,000, 30,000 deaths versus hundreds of thousands or even a million deaths. should haveone that a lot of wrangling and people waiting to see who else is doing what. everybody has got to move fast in order for us to make a difference. and if we do, we will save hundreds of thousands of lives. stopping ebola is a priority for the united states. i have said that this is an important a national security priority for my team as anything else that is out there. we will do our part, we will continue to lead, but this has to be a priority for everybody else. we cannot do this alone.

we do not have the capacity to do all of this by ourselves and we do not have enough of workers by ourselves. we can build the infrastructure and architecture to get help in, but we are going to need others to contribute. to my fellow leaders from liberia, sierra leone, and guinea, to the people of west africa, to the heroic health workers on the ground as we speak, in some cases, putting themselves at risk, i want you to know that you are not alone. we are working urgently to get you the help you need, and we will not stop, we will not relent until we halt this epidemic once and for all. i want to thank all of you for the efforts that are made, but i hope that i am properly to mitigating a sense of urgency here. do not stand by thinking that somehow because of what we have done that it is taken care of. it is not. and if we do not take care of this now, we are going to see if all out -- fallout effects and

secondary effects that will have ramifications for a long time, above and beyond the lives that have been lost. i urge all of you, particularly those that have direct access to your heads of state, to make sure that they are making this a top priority in the next several weeks and months. thank you very much. [applause] ,> you can watch this speech you in general a semi-speeches. yesterday's security council meeting, chaired by the president, all at www.c-span.org . according to the associated press, attorney general eric holder is resigning. white house official says president barack obama will make a personal announcement on the whiteeparture at house at 4:30 eastern today. we will have that announcement live right here on c-span.

the phoenix da medical center held a town hall meeting last friday. e was at thelar sit center of an inspector general report about long wait times and systematic problems in delivering patient treatment. we will show you that tonight on c-span2 at 8:00 p.m. eastern. here's a preview. >> it took me three years to get an apartment after i got up. i just serious, the general reason the whole v.a. is in trouble, is because you had the secret waiting lists? and that is because we put these people on secret waiting lists because there are too many people, not enough providers, relatively correct? >> yeah. >> i came in here june of this year. i got seen for three minutes by a doctor who did not ask me any single question about any service-related disability that i got put out for, and then i

got her letter in the mail saying my disability was cut in half. they spent three minutes asking up, which is disrespectful, and sent me on my way. since i got out of the army, my wife left me. i moved out with my parents and i cannot get a job. you that, itng made them think that my issues are all better. he scheduled me for a primary lateprovider appointment august. i get a phone call saying it has been canceled, and they scheduled me in september. i get another hose cart it has been canceled, and i get one in early october. i get a postcard saying it has been canceled, so i start calling, and surprisingly i cannot get a single human on the phone. i can get an operator who i'm sure has been cussed out more than anybody on the planet because she is the only point of contact as a human. i decided, screw it, i'm going to the clinic.

i walk in, tell them i had f four canceled appointment. they said, talk to this site over here. he spent an hour answering the phones. don't you think is ironic that the reason i had to go to a clinic to talk to someone was because i cannot get in he won on the phone, and then i had to wait an hour for a guy to stop answering the phone? i cannot get his number. they would not give me his number. i get an appointment, i sit to talk to one of these african people, and they said i canceled all my appointments for i canceled some appointments and and here i am? you guys got in trouble because you are canceling and putting people on these bogus lists, but now you're just being open about it and you are doing the same damn thing. the -- theing i got only reason i get care was because i went down there and raised hell. >> this airs tonight on c-span2

and contains language that some viewers might find offensive. >> here are a few of the comments we received from our viewers. >> i watch c-span almost every morning, and you guys do a great job with the programming, and i think that the people you have on our really good at and the topics that you choose are really good, but what i would like to see is somebody from both sides of the opinion. i think a lot of people have commented. i've been watching the debate between two of the people is so much more informative for the public, and you guys have done it a couple times, and i will turn it on and i will go, wow, they have both sides here, and that is what is really awesome. you guys are great, but you could be awesome. >> c-span needs to get more , smart commentators that are familiar with world affairs. one that comes to mind is dr.

jeffrey sacks. he would interviewed to a liberal point of view of our government and the world. i think could be a fine computer at c-span to give it a little more balance. >> i want to thank c-span for their c-span for their balanced coverage and for letting everybody have their say on tv. i very much appreciate it in our so -- i amnd >> im so disappointed since you change your format. i can no longer see who is getting out oft bed and going in front of the tv. i am really upset about that and i really do like c-span. >> call us at -- e-mail us.

send us a tweet. >> the white house national security council elizabeth cameron says the ebola outbreak isn't just one countries fight, the world's because we are interconnected. good morning and welcome. i want to say it is an honor to be here with you this morning. we are in for a very long battle against ebola. not only in west africa. i'm afraid elsewhere in the world, quite possibly in the americas.

we have four speakers and we had 10 minutes but we are down to nine minutes each now. we will move quickly. we have dr. jesse boehm from georgetown university and dr. beth cameron from the white house. i would like to show just a few slides from the time i spend in august and sierra leon and slides with strongly held opinions based on the experience of everything i've learned and done over the last 35 years in clinical medicine and research and public health and what i think is happening and what needs to happen to the response of the ebola crisis in west africa but soon may be elsewhere. this is a sign from sierra leon that sierra leon that you find everywhere come the signs and symptoms of the ebola virus. the early clinical verse of the illness are nonspecific fever and. that means they are very much imitative of common diseases, much more common diseases like malaria or typhoid

or gastroenteritis so it's hard to know if someone has ebola or a much more common diseases such as malaria. perhaps you can see it but the symptoms are fever and which may be bloody and which may be bloody. and muscle pains. the bleeding hemorrhages very late in the disease. early on, it is a big problem to differentiate ebola from some noninfectious diseases. these are signs you see everywhere not only in sierra leone but in west africa. the statement is ebola israel, it not political. let's fight against ebola. you see it in hospitals and clinics found buildings on the street and airport so there's initially a perception that ebola is not real and it's not a virus that causes a contagious

infectious disease and rapid death in the majority of people who are infected with it. from yesterday's w.h.o. organization update on the number of people with a minimal estimate the people with ebola liberia has found more than 3000 sierra leon 2000 guinea is more than 1000. in nigeria, everyone is hoping they're there won't be an outbreak in portable eras. there is one patient who traveled from guinea. this is a map from yesterday's world health organization. this is a map of three countries in west africa where the outbreak is the most intense. in the north in sierra leone and the capital of freetown and liberia printed out here and where morobe as which is the most impacted impacted and the

most devastating part of the epidemic right now. the outbreak started at the confluence of the. -- confluence of the rural area, in the confluence of the three countries and unfortunately it's spread through multiple areas. almost every district except for one in sierra leone and one not having any cases as well as most places and liberia in the majority and guinea. also the capitals conakry freetown in monrovia. in a 25 outbreaks of ebola in the past in africa it's always always been in always been in rural areas never in big cities and certainly not capital cities but it's different now. that is why i am emphasizing the federal. urban and rural but it's not just ebola that you have known for 25 plus years since it was discovered in 1968 in sudan.

it's something different. it's different in terms of our way of controlling outbreaks in the past which were very effective. isolation of people who are ill and quarantine of people who have been exposed always effective in stopping the outbreak in humans and back into the reservoir where it lives with gorillas and chimps and african envelopes. -- african antelopes. this time the methods are not effective and in my opinion they are not going to be effective in monrovia and freetown and perhaps other cities. yesterday's numbers from w.h.o. 348 health care workers in west africa have become infected with ebola virus in more than half have died. i want to emphasize that almost half have survived. people who have survived have been cured of ebola to their own immune system and the help they have received in terms of rehydration is very important and very under precise.

-- marriott underemphasized. -- very underemphasized. people who are survivors once they fully have recovered can provide care wearing personal protective equipment potentially donate antibodies against the virus from their own blood and most of all they should be no longer stigmatized as as having ebola but they should be honored. in terms of personal protective equipment i'm going to have to wrap up. personal protective equipment, this is what you need to wear and perhaps even more. doctors without borders, it's more complete than what we adhere. that each -- than what we had here. this is a training exercise i was privileged to be able to participate in as a trainer along with colleagues in sierra leone and from the u.k. we train each morning and afternoon for three and a half hours each in this type of personal protective equipment. this is the largest ebola testing isolation unit in the freetown hospital. it's one of the three most precious and memorable hospitals i have ever worked in.

this is the one large pediatric hospital in sierra leone in a -- and it closed. everyone is discharged in the patients were discharged to home. children were sick with typhoid. some people were exposed and they decided to close it. many children and adults don't have access to medical care for diabetes and for malaria and complicated childbirth because of the ebola outbreak. this cascading effect is that the devastating effects across the society. it's beyond the virus itself. i was tested on as i was leaving. this gentleman is taking the temperature. people were tested place. -- tested twice. but i came into the airport and when i was leaving and i had to

fill out a questionnaire that i didn't have any symptoms. this is just a few of many that could be shown but it's very important there's original campaign across west africa where the virus is to stop it. we can't only stop it in one country and expected to be -- expect it to be stopped in region. it won't happen. control methods as i mentioned quarantine and they're not working in monrovia and freetown. there's a lack of enough good high-quality personal care. i can't emphasize to survivors is very important. there's an op-ed or document in the post two days ago with regard to the situation in sierra leone and he's he is an -- and the first allies emphasize that he is not a helped work or himself. he is an author.

the many important aspects of survivors they should be transformed from being stigmatized to being honored. they can provide care to people who are sick including young children of whom there are many. they can offer antibodies from their blood against the virus and they are living proof that ebola can be cured. my last slide in my last-minute ebola crisis looking ahead, i think it will be a long time, more than a year before we have sufficiently large amounts of effective ebola vaccines and anti-viral vaccines. this epidemic is likely to last until her greater than 2017 will spread to more cities outside of africa. that's my strongly held opinion. it's important to act now as if these are going to be facts in the near future.

we have clinical trial units. for ect is based on 30 plus years of clinical trial experience for anybody's vaccines and drugs against the virus. if theo poll book becomes endemic in west africa and that's a real possibility in my opinion that in my opinion we need is a campaign like the global smallpox eradication program which dr. joe bremen sitting in a car or participated in as was the first ebola outbreak stopped in 1976 in zaire by the drc. also i would ask if i have in multiple media interviews last week and i will continue to do for my own experience i think there's a huge gap that can and must be filled soon. in other words we need to have an authoritative ebola expert in a global health crisis leader someone who is very experienced in both for the health crisis outbreaks and ebola outbreaks . the rapid what i call command-and-control like the success of the world had against sars in 2003. the person who read -- let that global response against sars and has extensive experience with ebola outbreaks

who is now head of public health england was with w.h.o. for many many years and prior to that with the cdc dr. david heyman. he would be my first pope my first vote that certainly there are other candidates. i would like to stop here. i'm out of time. thank you very much for your time. [applause] >> our next speaker is luciano barrio. a was the director of office of counterterrorism and emerging threats that the fda. she also leads the fda's medical countermeasures

she has been instrumental in recent responses to mers in the 2008 and 2009d bird flu that has become a major concern in east china. [applause] >> thank you. inviting me today to discuss the actions to the response to the ebola epidemic in africa. this outbreak is the most heartbreaking and tragic we have witnessed in recent history. there are many complex challenges we are facing.

specifically the minimal health care infrastructure within the effective countries have made this very difficult. as just mentioned, the primary approach for containing epidemics like this, the standard, tried and true methods are not working. it is very difficult to implement them in such a large-scale in this limited infrastructure. about identifying patients, confirming patients, taking care of haitians, learning about their contacts, providing personal protective equipment to health care workers and burial teams, educating the population about the mission, being able to detect secondary infections in a timeframe that you can continue now to break -- all of this has been extraordinarily challenging. the infrastructure has made it

impossible to provide a standard of care, electrolyte replacement, things that we take for granted in most of the world. it ebola kills twice. it kills people who are infected and kills others with other diseases and cannot access medical care. childcare,e of people die of a broken bone, people die of malaria, and other things. we have not seen vaccines that have been safe and effective for ebola. as to say, a safe and effective vaccine will be a total game changer. we know from history that a vaccine can really change the infectious diseases evolve. smallpox, for example. polio is another example.

in the case of malaria, we still do not have a vaccine for widespread use. energy needs to be prioritized to develop a vaccine to roll out to countries. i cannot say enough how that will be a game changer. i am here to tell you that oftentimes fda is detected -- is foricted -- is depicted situations like this. they talk about fda's regulatory hurdles which delay product development and causes unnecessary delays in public asks in its investigation of products. but fda is a catalyst for product development. we were to facilitate the development, to facilitate manufacturing, to scale up manufacturing, do -- to fill a sale -- to facilitate the ability to manufacture products.

we have a very large professional staff. expertise in all elements. we provide that expertise to all our colleagues in government agencies who are working to develop products with the private sector are. we support hhs agencies and department of defense agencies. and work very closely with them in tandem as we move these programs forward. we also work interactively with the medical developers to to maketheir products, sure their products move as fast as possible. this is a very resource-intensive process but the fda is dedicated to that. we do not want to see any delays. we reviewed data in a situation like this as it becomes available. whenever there is misinformation, the companies

will submit to the fda and submit it -- and review it in real-time. product development is often seen as rigid and linear because that is how it is depicted in textbooks. developmentects of can be done in parallel and that is where fda plays a big role because we can guide the developer roles -- the developers to do things in parallel and where they can expedite studies again with the idea of moving things as quickly as you can. we also collaborate , health canada, with the the german -- three agencies as well as the u.k. add all of the african -- the west african counterparts. fda is seen as a leader in product development. we have one of the most flexible regulatory frameworks in the world. we have a lot of authority to be

able to make decisions based on the best available science and with the goal to promote public health. often times, our framework is adopted by other regulatory agencies after we do some consultations. i like to stress that we are talking about to the rio vaccine candidate -- about two to be all drug therapies. they are a nearly stages of development and only small amounts are available. when productsble are at this stage of development. there is no impetus to manufacture it in large-scale. options fores large-scale trials and to distribute a product. commission there needs to be efficacy. to do that, we normally will do clinical trials. to do clinical trials in the affected countries right now seems like a daunting, daunting endeavor.

the announcement by the president last week is really critical to not only take care of patient care but also be able to begin to study these products in the affected countries here . we do hope we will be able to conduct trials in the coming months. we have a gun discussions with the developers on how they can do that. we are talking with them about civil trial and design that can be implemented and can be extraordinarily informative. if this capacity is built in the coming months, we will be ready to go. the companies are already planning to do this. a geneva, we will meet with representatives from the affected countries. is --ally, thereby in

buy-in is critical. the availability of these products in west africa on multiplendent parties working together, not only the companies who actually make these products, the health authorities, the regulatory authorities and the u.s. government ability to establish this kind of infrastructure. this is all extremely challenging but i think failure is not an option. we do have to find ways to overcome the challenges. failure is not an option. thank you again. fda is highly committed. we have over 200 scientific staff involved in this response and we are committed to doing all we can to respond to this epidemic of ebola. i will answer your questions at the end. thank you. [applause]

quirks our next guest served in national healthcare all sick. research focuses on they local economy in developing countries, community directed programs, health systems design, health services delivery in social science theory. [applause]

>> thank you very much. thank you for coming. we have about 10 minutes. in 10 minutes come i will tell you something about the historical and political dimension of the ebola crisis. it is about how do we get here and where are we going to go. does anybody know what this is? this is not a trick question. this is the ebola virus. what we do about it is the question. just hold onto it for a second. this is the measles virus. about measleslk as a problem of low vaccine coverage. i will give you a couple fat pigeon's more as a way to talk about the way people think about health problems around the

world. these are tb bacilli. so these are bacteria. this is a quote from the who stopped tuberculosis program. it is conceptualized as an access problem. problem tocess high-quality diagnosis and patient centered treatment. this is plasma of malaria. thread to malaria that is drug-resistant. here is another malaria aspect. this is a mosquito that transmits malaria. in the global malaria action plan, their art two approaches, long-lasting insecticide nets and indoor residual spraying. these are three diseases and there are four approaches.

here is a quote from one of the fact sheets identifying very weak systems. here is charles kinney writing ina book of business week -- "business week." the three most affected west african countries share weak health care systems. the world bank in a press release last week identified weaknesses in the health sector and suggested that limiting ebola and it's economic impact and be done in investing in the

health sector. and why don'ttems we talk about it with other diseases? is not that we don't talk about it with other diseases. we do not focus on it. one reason is that we are at the limit of what we can do at ebola. there is no specific treatment or cure. there are no specific preventative technologies and there are no vertical solutions. the things that we are good at at mobile have are things like disaster relief. there tend to be specific interventions. the with ebola, we don't have any of those options. we are left with do health systems. in fact, health systems are thus azeri for all kinds of things. but there are cultural patterns that health care does not go near.

been spread byas the handling of deceased ebola patients. burial practices. there's also the consumption of bushmeat. sanitary practices also byron transmission. preventing and controlling ebola largely realizes -- relies on state authorities and trust in addition to these other factors. ebola in this is not exceptional. health systems have what benefits. roughly 300,000 women per year die of maternal causes. many of those can be prevented with a functioning health system. diarrheal diseases cause us a thousand children a year. most of those can be prevented with a functioning health system. malaria, 600,000 cases a year.

hiv-aids, 1.6 million per year. we have done lots of things. we have made tremendous congress with narrow interventions for specific diseases. however, you always reach a point where you need to have a health system. in hiv-aids, for instance, it is a continue of care for patients have decades of treatment. now that we are good at it, it is not just one thing that we are worried about even in vertical programs because health systems are such a limiting factor in our ability to promote health. so why are west african system so weak? if they are so useful, if they're one of the most fundamental building blocks of a healthy and safe society, why don't we have functioning health systems? view.s a historical in west africa, rural health search or so is -- rural health

services are composed of mobile teams that went from village to village doing surveillance where they found signs of the disease. samovar four spinal tap punchers and then mandatory treatment. they have a single disease focus, which was sleeping sickness. they did not build any capacity. i would like to tell you that that is a colonial pattern that we left in the past but it is more the template of one of -- to put of what we have done. the 1960's, the countries themselves try to do better. in the 1960's and 70's, the world health organization try to improve systems. but in the 1970's, commodity price collapses and the oil prices hurt both countries and donors. in the 1980's, to try to rebalance the economy's that

were totally out of whack, structural adjustments were promulgated by the washington institutions. one artifact is the company stopped investing in health systems. the ebola outbreak is one way of talking about the consequences of three decades of neglect in health systems. donors prefer things that are short term have easily defined simple linksave between input and outcome that can be somewhat easier to implement. they are wary of ongoing commitments and urgent tasks usually take accident over others. so here is a calculus for your very think of how you would conceptualize malaria versus health system investments, the annual death toll in a specific diseases clear. it can be measured.