lethalness. therapy is mainly supportive without specific interventions we do not have a vaccine. and so, what is the role of the national institutes of health? if we could advance the slide. of the national institutes of health, in the you can endeavor, as see on the slide, we do basic and clinical research. andimportantly, we apply supply resources for research in academia to advance product development. the end game of what we do are diagnostics. could we get the last slide back? there, right there. a multiinstitutional

endeavor. the n.i.h. is responsible for early concept development, something we did relatively alone, because of the of interest on the industrial partners of making interventions. we partnered with someone, who you will hear from shortly, with dr. robinson, and then we partnered with industry to ultimately, in collaboration with the fda, get the approval products. next slide. you've heard a lot about therapeutic interventions. momentt like to spend a talking to you about a few of them. first, it's important to realize experimental.all none of them have proven to be effective. if so when you -- so when you giving a drug that has a positive effect, we do not know at this point, a, is it a effect, or b, is it causing harm? and that's the reason why we carefully at these the same time we rapidly can make them available to the people who need them. the first one on the list is

z-map. to dr. brantley and nancy. it looks very good in animal model. still needs to be proven in the human. there is over products. about the drugs which were developed in support defense,partment of which is also being used and others that you'll hear about. these are just a few of those, again, that will be going into clinical trials and that are actually being used in with compassionate the fda inproval of certain individuals. slides regarding a vaccine. an ebolaeen working on vaccine for a number of years. we did the original studies, animal model to be quite favorable. we are now right at the phase phase 1 trials. some of you may have heard of it. onstarted at the n.i.h. september 2nd. a second vaccine was started

just a couple of days ago by the u.s. military, in collaboration with the n.i.h. when we finish those phase 1 asking, is it safe? and does it induce a response would predict would be protective? it's important to make sure it's safe. parameters are met, we will advance to a much large -- trial, in larger number of individuals, to determine if it is actually effective, as well as not having a paradoxal negative effect. think this is important is that if we do not control the epidemic with pure public health measures, it is entirely conceivable that we may a vaccine and it's important to prove that it is safe and effective. to close by making an announcement, because i'm sure you'll hear about it soon in the press. tonight, we will be admitting to the clinical studies unit, the special at thel studies unit, national institutes of health,

pham, otherwise known as nurse number 1. she will be coming to the national institutes of health will be supplying her with state of the art care in high-level containment facility. thank you very much, purchase. >> i now recognize dr. robinson minutes. >> good afternoon, chairman upton, rankingn members and other distinguished members. thank you for the opportunity to about our you today efforts by the government on ebola. dr. robinson. a former vaccine developer in the industry. for the last ten years, a public working on pandemic preparedness and many other biothreats. it was created, the government agency responsible for supporting advance developments of medicalent countermeasures such as vaccines, therapeutic drugs, the entire nation.

it exists to address the medical consequences of biothreats and emerging infectious diseases. we responded to emergency h1n1, pandemic in 2009, and avian influenza in year.last today we are immersed in responding to ebola, which is withtaneously a biothreat a material threat determination. infectiousging disease. as you have said, when it comes andbola as a biothreat emerging infectious disease, the best way to protect our country the currents epidemic in africa. we work with our federal to transition the federal countermeasures from early development and to advance towards ultimate fda approval. since 2006, we have built an advance development pipeline of more than 150 countermeasures threats and pandemic influenza.

seven of these products have been fda approved in the last two years. and today, we are transitioning promises ebola vaccines and therapeutic candidates from early development under n.i.h. and d.o.d. support and to advance development, in ensuring manufacturing capacity for these products is available as soon as possible. in concert with our federal publics, we utilize partners to ensure we have countermeasures to protect our citizens. the past five years, we and rapid a flexible responsive infrastructure to develop and manufacture medical countermeasures. and result of the pandemic, the preparedness authorization framework hased been afforded to federal industry partners. year, we made new vaccines.

currently we're working with a partners,y of including both small and large company, canada, the u.k., the world health organization and others to make evaluate the safety and ebolacies of these product candidates. we assist product developers on basis to respond immediately in a public health emergency. of oursing a number assistance programs, the network, andtudies our manufacturing network to these products available as soon as possible. additionally, our staff are on site, people in plant to provide technical assistance and expedite product availability. additionally, we're working with cdc and others internationally our modeling efforts to itk at the ebola outbreak as becomes epidemic and also what possible impacts, interventions

may occur. we support large-scale production of medical countermeasures, for public health emergencies like the h1n1 pandemic. today we are assisting with ebola vaccine and therapeutic scaled-upers with production. specifically, we're supporting z-map, one oft of the antibody therapies. expanding overall manufacturing capacity by enlisting the help others and working on candidates antibody to expand production capacity. pending the outcome, we are prepared to support advanced development of additional promising candidates to treat ebola patients. on the vaccine front, we are working with industry partners manufacturing of three promising ebola vaccine candidates. make anhich we will announcement on today, for

clinical studies in africa next year. the efforts in the ebola response, we're supporting a number of other -- activities, including developing policies guidance on patient movement, standards of care, supporting the logistical aspect u.s. public health service officers to west africa and ongoing coordination and communication with national and international communities responding to the threat. face significant challenges in the coming weeks and months with the ebola and as these medical countermeasures are manufactured evaluated. bottom line is that my ofleagues here will use all our abilityings here and a-- abilities here and abroad to be prepared for future ebola outbreaks the. i want to thank the committee and subcommittee for your and continued support over the past decade and the opportunity to testify. thank you.

>> good afternoon, chairperson. >> please pull the microphone as close to you as possible. >> good afternoon, chairperson, ofking members and members the subcommittee. thank you for the opportunity to appear before you today to fda's actions to respond to the ebola epidemic. a tragic global event. my colleagues and i at the fda are determined to do all we can to help end it as quickly as possible. the desire and need for safe and andctive vaccines treatments is overwhelming. the fda has taken extraordinary proactive and flexible. we're leveraging our authorities diligently to expedite the development, manufacture and availability of effective medical products for ebola. uniqueroviding fda's scientific and regulatory advice to companies to guide their submissions. reviewing data as it is received. thee actions help advance development and investigation of products as quickly as possible.

for example, in the case of the that the previous gentleman mentioned, the fda few days to review the applications and to allow the studies to proceed. as a result, the vaccine candidate being developed began on september 2. begane vaccine candidate similar clinical testing on october 13. we're also partnering with the government agencies that support medical product including niaid and the department of defense. fda was able to authorize the ebola diagnostic tests under our emergency authorization within 24 hours of the request. authorized the use of two additional diagnostic tests developed by the cdc and these tests, of course, are essential for an effective response. addition, we're supporting the world health organization.

our scientists are providing technical advice as it works to assess the role of convalescent treating patients with ebola. i recently participated in a consultation focused on ebola in geneva, which included dozens of experts from as fromhe world as well affected countries in west africa. participants agreed that promising investigation of vaccines must be evaluated in valid clinical trials and in the most urgent matter. fda is working closely with our colleagues and vaccine developers to support this goal. note, though,t to that while we all want access to to cure orherapies prevent ebola, the scientific fact is that these investigation products are in the earliest stages of development. there is tremendous hope that products will help patients. but it is also possible that may hurt patients and others may have little or no

effect. therefore, access to investigation of products should be through clinical trials when possible. they allow us to learn about product safety and efficacy and provide an equitable means for access. the fda is working with our to develop agues flexible and innovative protocol to allow companies and clinicians to evaluate multiple investigative ebola products under a common protocol. is to ensure accrual of interpretable data and generate actionable results in the most expeditious manner. it is important for the global know the risks and benefits of these products as possible. until such trials are established, we'll continue to enable access to these products when available and requested by clinicians. we have mechanisms, such as compassionate use, which allow access to investigatal products outside of clinical trials when we assess that the expected

benefits outweigh the potential patient. the i can tell you that every ebola patient in the u.s. has been treated with at least one investigatal product. because ebola is such a serious approvedthe fda has such requests within a matter of a few matters and oftentimes in less than one hour. there are more than 250 fda in this response. and without exception, everyone thoughtfuloactive, and adaptive to the complex issues that have emerged. fully committed to sustaining our deep engagement to support the robust response the ebola epidemic. thank you. >> thank you, chairman, of theuished members subcommittee, for the opportunity to discuss the efforts of u.s. customs and protection in deterring the spread of ebola by means of

international travel. one millionout travelers arrive in the united states. about 280,000 arrive at our international airports. are responsible for securing our nation's borders while facilitating the flow of legitimate trade so vital to our nation's economy. our priority remains to prevent terrorists from entering the united states. however, we also play an important role in limiting the communicableious diseases from foreign countries. 100e had this role for over years. we've had modern protocols in place for over a decade. officers at all ports of entry traveler for overt illness. in close collaboration with cdc, we are working to ensure that frontline officers are provided trainingment, necessary. all officers are provided

guidance and training on identifying and addressing travelers with any potential illness, including diseases such as the ebola virus. the training includes cdc public teachesraining, which officers to identify the overt characteristics of ill travelers. we also provide operational how tog and guidance on respond to travelers with potential illness, including referring individuals who signs of illness to quarantine officers for well asy screening as implementation of the isolation protocols.ine additionally, we provide training for frontline personnel by covering key elements of blood-borne pathogens exposure control plan, protections from exposure, other preventive measures and procedures to follow. committed to ensuring our field personnel have the most accurate information regarding virus, since the outbreak began. field personnel have been

ofvided a steady stream guidance, starting with initial information on the current outbreak, with numerous and updates since then. information sharing is critical withe continue to engage health and medical authorities. since january of 2011, the andsion of global migration quarantine has stationed a liaison officer at our targeting to provide expertise and facility requests for information between the two organizations. 1, this year,er we began providing ebola information notices to travelers entering the united states from guinea, liberia and sierra leone. travelert provides the information and instructions should he or she have a concern of possible infection. to visually screening all passengers for overt signs of illness, starting 11, we began enhanced screening of travelers from the affected countries entering at jfk airport. today we've expanded these dulles, chicago o'hare, atlanta and newark.

94% of travel lers enter the united states through airports. these targeted travelers are asked to complete a questionnaire, provide contact and have their temperature checked. based on these enhanced officers willrts, make a public health assessment. since the additional measures we haveo effect at jfk, conducted enhanced screening on who werelers identified in advance as being known to have traveled through of these three affected countries. additionally 13 travelers were needing additional screening during the course of our standard interview process that's applied at all ports of entry. a total of eight of these travelers have been sent to tertiary screening. all passengers were examined and released. receive training in illness recognition and response, if they identify an ill,idual believed to be we will isolate the traveler from the public and contact a

cdc quarantine officer, along with local public health authorities. officers are trained to employ universal precautions in control, developed by cdc, when they encounter individuals with overt symptoms. when necessary, personnel will take the appropriate safety measures, based on the level of potential exposure. procedures, designed to minimize risk to our officer and to the public, have been utilized by both agencies on a number of occasions with positive results. continue to monitor the ebola outbreak, provide timely information and guidance to our personnel, work closely with our partners to deter the ebola in the united states. thank you for the opportunity to testify today and the attention to this very important issue. i'll be happy to answer any of your questions. going to recognize

dr. daniel varga, chief clinical us from texas. dr. varga? >> good afternoon, ranking members and members of the committee. dr. daniel varga. i'm the chief clinical officer executive for texas health resources. internal certified in medicine and have more than 24 years experience. i couldly sorry that not be with you in person today and i deeply appreciate the ourittee's understanding of situation and how important it is for me to be here in dallas andng this very challenging sensitive time. texas health presbyterian one of 13allas is wholly owned acute care hospitals and -- in the texas health resources system. hospital,898-bed treating some of the most complicated cases in north texas. texas health dallas is magnanted as a

desiccated facility. it is one of the largest faith-based centers, and the largest in north texas in terms of patients served. our mission is to improve the the people in the communities we serve. and we care for all patients, regardless of their ability to pay. we serve diverse communities and as much, we provide one standard of care for all. regardless of race or country of origin. in thefirst hospital country to both diagnose and treat a patient with ebola, we using ourted to experience to help other caretals and health providers protect public health. into hard for me to put words about how we felt when our patient, thomas eric duncan, ont his struggle with ebola october 8.

it was devastating to the nurses, doctors and team who tried so hard to save his life. and we keep his family in our thoughts and prayers. unfortunately, in our initial despitet of mr. duncan, our best intentions, and a highly skilled medical team, we made mistakes. we did not correctly diagnose his stomachs as those of -- his ebola.s as those of and we are deeply sorry. also, in our effort to communicate to the public quickly and transparently, we inadvertently provided information that was accurate and had to be corrected. no doubt, that was unsettling to a community already concerned and confused, and we have learned from that experience as well. last weekend, nurse nina pham, a member of our hospital family, courageously cared for mr. duncan, was also diagnosed with able. our team is doing everything possible to help her win that fight. and on tuesday, her condition to good, and as the

doctor mentioned earlier, nina's care continues to evolve. can tell you that the prayers of the entire texas health her.m are with yesterday, as has been noted, we second caregiver with ebola. and i can also tell you that our remain with prayers amber as well. a lot is being said about what have occurred to cause nina and amber to contract ebola. we know that they are both extremely skilled nurses and protectivefull measures under the cdc protocols, so we don't yet know precisely how or when they were infected. but it's clear there was an andsure somewhere sometime we are poring over records and weervations and doing all can to find the answers. you have asked about the sequence of events with regard preparedness for ebola in our treatment for mr. duncan.

ourevents are attached to submitted statement. but here's a brief overview. epidemic in africa worsened over the summer, texas health hospitals and facilities our physicians, nurses and other staff on the symptoms and risk factors associated with the virus. on july 28, an infection prevention nurse specialist received the first centers for disease control health advisory ebola virus disease and began sharing it with other texas health personnel. the health care advisory encouraged all health care providers in the u.s. to consider ebd in the diagnose of illness, in other words, a fever, and in persons who had recently traveled to affected countries. the advisory was also sent to all directors of our emergency departments. 1, texas health leaders, including all regional the edpital leaders, and leaders across our system,

received an e-mail directing that all hospitals have an emergency policy in place to patientsow to care for with ebola-like symptoms. the e-mail also drew attention that our electronic health record documentation in departments included a question about travel history to be completed on every patient. a draft eepincluded deem logic -- epidemiologic policy that specifically addressed this. guidelines, cdc evaluation of u.s. patients suspected of having ebola, was distributed to staff, including physicians, nurses and other 1ontline caregivers on august and august 4. over the last two months, the and human -- hel health and human services department communicated with us as plans were put in place for a possible case of ebola.

august also provided the screening questionnaire. mr. duncan presented to texas dallaspresbyterian emergency department with a fever of 100.1. pain, dizziness, nausea and headache, symptoms that could be associated with many other illnesses. he was examined and underwent numerous tests over a period of four hours. his temperature spiked to 103 but later dropped to 101.2. he was discharged early on the of september 26. timelineve provided a tim on the notable events of his visit. on september 28, mr. duncan was the hospital by ambulance. once he arrived at the hospital, criteriaveral of the of the ebola. at that time, the cdc was notified. the hospital followed all cdc

and texas department of state services recommendations in an effort to ensure the safety of hospital staff, physicians nurses, and visitors. protective equipment included water impermeable gowns, surgical masks, eye protection and gloves. havinghe patient was diarrhea, shoe covers were shortly thereafter added. we notified the health and human services department and their infectious disease specialist the site shortly thereafter. 30 -- we confirmed the first case of ebola virus diagnosed in the united states. later that same day, cdc officials were notified and they on our campus october 1. >> doctor, one moment, please. hold on one moment, please. way over timeoing here. we do want to hear details, but lotd you wrap up, because a of members want to ask you questions as well on some of

these details. >> okay. thank you. >> in conclusion, i would like to underscore that we have taken the steps possible to maximize the safety of our workers, patients and community we will continue to make changes. moreover, we are determined to be an agent of change across the u.s. health care system by benefit fromeers our experience. texas health resources has a long history of excellence. and ministry will continue and we will emerge from these trying times stronger than ever. opportunity tohe testify. i'll be glad to answer any questions from the committee. >> thank you. recognizing each person on this committee for five minutes of questions. time on thisstrict as well. here withrt off dr. frieden. a second nurse infected with ebola took a flight to cleveland after she registered a fever. that says shert contacted the cdc and was told

she could fly. call the krbdt and ask for -- the cdc and ask for guidance on boarding a flight?al >> my understanding is she did contact cdc and we discussed her her reported symptoms. >> were you part of that conversation? not., i was >> was there a plan suggesting limiting her contact with persons? movement andol for monitoring of people potentially to ebola identifies as high risk someone who did not appropriate personal protective equipment during the time they cared for a patient ebola. on -- >> let me ask you this then. what specifically did she tell you? we know mr. duncan, the medical same -- waser the not under the same observation hevel restrictions as people came into contact with. what specifically did she tell you her symptoms were? the have not seen transcript of the conversation. my understanding is that she

reported no symptoms to us. >> all right. let me ask another question here quickly. patientard to the new being transferred to n.i.h., will people who come into >> under travel restrictions? becoming intowill contact with her will be physicians, nurses, and other people who will be in personal protective equipment, therefore, they will not be restricted. >> why will she be transferred to nih? >> so she will be in a facility with people who can take care of her. >> issue getting worse? -- is she getting worse? well, i hear she is doing

however, i have to verify that with my team. we have a limited capacity of the beds of being able to do this level of high-level care, our total is two beds, and she will occupy one of them. >> you said that cutting these commercial ties will hurt these fledgling democracies. is this the opinion of cdc, is this your opinion, or do somebody else advise you, somebody within the administration, somebody with other administration agencies, is it somebody from high importance? is to protectcern americans. we can do that by taking the steps that we are taking here, as well as -- >> did somebody advise you on that? did 70 advise you that we need to protect fledgling democracies -- did somebody advise you that

we needed to protect fledgling democracies? >> we need to get supplies and medical personnel into the a the ebola zones -- hot zones. approximately 100 to 150 per day. >> if the administration insists -- ebolang -- bringing cases into the united states, nih can handle two of these, you know overall how many our country can handle? >> our goal is to not handle any -- >> i understand, but as long as

we are not stopping travel, there is a risk. don't understand. this is the question of the american public is asking. why are we still allowing these people to come over here, and why once they are over here there is no orenstein. -- quarantine? >> our goal is to protect the american people. that thecern is american people are not limited to travel, they are not quarantined from 21 days, they can still show up with symptoms, so this is what happened with the nurse that went to cleveland. so i am concerned here. is this going to be -- is this what to maintain the position of the administration that there will be no travel reductions? restrictions? dr. frieden, i have questions

for you, and i would appreciate yes or no answers because i have a lot to move through in only a short amount of time. dr. frieden, in the spring of 2014, ebola began spreading through west africa, causing concern within the international community, correct? >> correct. an abilitynot have to spread inside the incubation. of 21 days, correct? >> correct. >> the virus is only spread through bodily contact, and it as the more contagious virus continues. correct? >> correct. >> if patients present symptoms consistent with ebola and then

tose flyers were submitted hospitals around the country in the summer of 2014, is that correct? >> your hospital received -- correct. hospital received these directions, and it was given to ector of your emergency department, correct? >> yes ma'am. >> was there any person to person training at texas presbyterian at that time? it was given to the emergency department. >> was there actual training? >> no. on august 1, your hospital received information regarding symptoms of ebola and restrictor of -- strict of travel

advisories, is that correct? >> correct. >> then thomas eric duncan showed up with a fever of 103, and he told your hospital staff that he had come from liberia, is is that correct? >> that is not entirely correct. >> but they did send him home? >> that is correct. the hospital staff wore protective equip it he returned, is that right? >> that is correct. youhen they eventually put covers are, and unit along it took them to put shoe covers on took you know how long it to put shoe covers on? >> i don't know. slide that i would

like to put up. i got it from the new york times today. inis a photo of the people various protective gear. the first one on the left shows what they are supposed to wear --n they come in contact when they are not having contact with a bodily fluid, the second one shows what they are supposed to have with the bodily fluids. so i want to ask you doctor, what they were wearing at first when ebola was diagnosed, were they wearing in a first set of protective gear? >> i am sorry, i cannot see the picture right now. >> ok, i was told you would be able to. dr. freeing, what should they have been wearing -- dr. frieden , what should they have been wearing? details,t make out the but it varies depending on the risk of diarrhea or vomiting. guy, he had

diarrhea and vomited. so in your testimony, people should have been completely cover, is that right? >> i would have to look at the exact details to know the answer to what that exact question would be. >> so you don't know if they should have been completely covered if the dire -- if the patient had diarrhea and was vomiting? >> under the cdc recommendations, yes. want other question that i to ask, and i'm going to have to get your testimony, because you cannot see my chart, now, subsequently a number of people -- health care workers -- were group, thiss protective work. is that correct, dr. frieden? , shetober 10, nina pham presented with a fever and was admitted to the hospital, is that correct? >> yes.

>> and then the second nurse presented with a fever, and then she contacted the cdc, and she was told she can fly, is that correct? >> she did contact their agency and she did board the plane. >> and she said she was told to board the plane. protocol said 22 that people who are monitored should not be traveling by commercial conveyance. that's what they say. >> people who are in what is called controlled movement should not board commercial airlines. >> and that is people who have had close contact with these patients, right? that is what your guidelines say. people and health care workers who have appropriate equipment don't need to be, but people without the appropriate personal protective equipment do

need to travel by control travel. >> you need to -- >> i just need to ask for the record, that this was stated on and that these be included within the record. you tofrieden, i need get back to the committee, to because that is a follow-up question. if she was wearing appropriate protective gear, she was ok to travel, but if she was not, she was not ok to travel. you just said you don't know. we need to find that out. thank you again: mr. chairman, i think most americans thank youat it is -- again, mr. chairman, i think most americans realize that you are virtually at no risk of ebola if you go that far, but it

is conceivable after 14 or 15 days you can in fact still get ebola, is that correct? >> yes. >> i want to go back to the restriction of travel, particularly by non-us citizens, day from150 folks a west africa. you talked about exit screenings, so it is perfectly conceivable that someone after 14 days can exit screen and they are ok, no fever, and in fact get to their destination, perhaps in the united states, and have the worst, is that right? fundamental job is to protect the american public, the administration as i understand it, because i have looked at the legal leg with, the president does have legal authority to

because ofavel ban health reasons including a bola, includingt correct -- ebola, is that not correct? >> i don't have the legal language. was one issue by former president bush, but there is the legal standing as well. it was my understanding before that a number of african countries around west africa, around these particularly -- these three nations, have imposed a travel ban from these three countries into their countries, is that not true? >> i don't know the details of these researches, there are some restrictions. that theyrstanding is said no, and even jamaica, as i read in the press earlier this week, has issued a travel ban

from folks coming from west africa. are you aware of that? >> i don't know the details of what the countries have die, i know some of them have been in flux. the countries have done, i know some of them have been in flux. >> as you say, the fundamental government is to protect citizens, why can we not moved to a similar band for -- fever, folks with a knowing that the exposure ray of 14 days or 15 days is well within the 21 days -- rate of 14 is well within the 21 days. this is notme that a failsafe system that has been put into place at this point. >> mr. chairman, can i get a full answer?

>> i look forward to it. >> right now we know who is coming in. we know that some will come from overlay, and we do not know that we will not be able to do multiple things. we will not be able to check them for fever when they leave -- >> i am going to interrupt you for just a second, do we not having a record of where they , ae been before, i.e. passport, a travel record? >> borders can be porous, we will be able to check them for fever when they leave, we won't be able to check them for fever when they arrive. when they arrive, we would not be able to propose quarantine as we now can if they had high risk contact. we would not be able to find locating information,

like date of birth, cell phone numbers, addresses, addresses of friends, we would not be able to provide all of the information as we do now to state and local health department so that they can monitor them under supervision. we wouldn't be able to impose controlled room lease on them. --other words >> i just understand. if we have a system in place any airlines passenger from coming in that we can't look at one's travel history and say no, , notre not coming here until the situation -- you are right, it eased to be solved in africa -- but intel is, we should not be allowing these

folks in. period. >> the gentleman's time has expired. mr. waxman? >> you have a tough job. in fact, all of your colleagues in these agencies have a difficult job because this is a fast-moving issue. you are trying to explain things withople and educate them limited information and partial authority, in fact the cdc can't even do anything in this day, they have to be invited in by the stay, you cannot tell the state to follow your guidelines, but you can give them guidelines. so you are dealing with a fast-moving situation, and yet you have to strike a balance tween informing the public on one hand, and keep them from panicking on the other. so let's go to basics. if people are frightened about getting ebola, what assurances

can we give them that this is not going to be a widespread epidemic in the united states, as you have said on numerous occasions? isthe first risk for ebola amongst those who are people -- is amongst those people who are carried for those with ebola. travel, people who have a fever and who have an infection need to be asked where they have been in the last 21 days, and they need to be assessing cared for. so we have to make sure that we monitor health care workers because they are exposed to people who have ebola, but the question has been raised, what about all of the people who have been coming in from africa and where the epidemic has been taking place. you have been asked why don't we just restrict the travel either directly or indirectly and keep

those people from coming into the country. i would like to put up a screen -- on the map, pastor flows from those countries. i willp shows that -- hold a peer -- if you are looking at these particular countries in africa, he could go to any country in europe, they could go to turkey, egypt, saudi countriesina, other in africa, and then those other countries come to the united states, so i suppose we could set up a whole bureaucratic apparatus to make sure that somebody didn't really travel nigeria or cameroon or senegal or ginny or sierra leone leone,uinea or sierra is used to me what you are saying is that we want to monitor people before they leave those countries to see whether

and weve this infection want to monitor when they come into these countries to see whether they have this infection. is that what you are proposing to do? >> that is what we are actually doing. we are able to screen upon entry, we are able to get detailed information, we are able to determine risk level, if people are going overland to another country and entering without our knowing that they were from these three countries, we would actually lose the information. currently, we have detailed locating information, we have detailed history, and we are sharing a information and staying informed with the help departments so that they can decide what to do. >> do you agree with dr. frieden on this point? >> i do. about travelere bans come about sealing off our borders, don't let them come in, now that is another immigration matter, not public health

particularly, it might be a tangential issue, but we know certain countries where the this is originate, why not stop it? >> i believe dr. frieden and yourself articulated it very clearly, it is easy to understand how someone could come to a conclusion that it would be easy to seal off the borders to those countries, but we are dealing with something now that we know what we are dealing with. if you have the possibility of doing all those lines that you showed, that is a huge web of something that we do not know that we are dealing with. know that this epidemic and spread if there is contact from bodily fluids of people showing symptoms of ebola, or somebody who has been exposed to that individual, if we had a could we just force these people to hide their

origin, and would not we also not know where they are coming from and if there was a banner a africa -- an west ban or a quarantines in west africa? >> the gentleman's time is expired. >> is that your position? >> now we recognize the committee for five minutes. >> thank you mr. chairman. i want to make sure that i heard you write. you just said that we cannot have flight restrictions because of a porous border. need to worry about having an unsecure southern and northern border, is that a big part of the problem? >> i was referring to the borders of the three countries a, here lyons,uine

sierra leone, and -- or no was sufficient, i need to move on. dr. frieden, i need to come back to you, i want to remind you the week before last i was at the cdc, and i want to thank you for doing the follow-up. quarantine and the affected region, and they still think that that is something that we should consider. quarantine people for 21 days before they leave that region, it helps every country. i want to go back to an issue that you and i talked about at the cdc and in the subsequent phone call, and that is medical waste. certainred me that protocols were being followed for the disposal of that waste, agowe know that 20-25 years

, hospitals could is iterate their ways, and now the epa prohibits that, and the waste has to betroth, and they outsource the care of this medical waste, and as a result, it it is going to central processing centers. is ebola as contagious as a patient with ebola? and waste from is not particularly hearty, and it can be destroyed by autoclaving and by combination of different chemicals. >> is it different from other medical wastes? >> you want to be certain when you are getting rid of it that -- >> is the cdc assessing the medical waste of ebola patients

and does the cdc allow off-site disposal of ebola medical waste? with thek very closely department of transportation and the commercial waste management companies to ensure that capability. danger inave an added having to truck this waste and move it to facilities. in theemployees processing centers being trained in how to dispose of this waste? >> we have detailed guidelines as to how to dispose of this waste from ebola patients. >> you and i talked about the troops from fort campbell who are going to be over there. and i have questions from some of my constituents. are the american troops going to come in contact with any ebola patients or with those exposed to ebola or those included with

any of those movement groups? from thenderstand it department of defense, their plan is to not include any care with patience with -- patie nts with ebola and to avoid contact. said, the department of defense is being extremely careful to avoid the possibility. >> so we are still going to rely on self reporting? takingwe are temperatures within many locations in the country, we are having handwashing stations -- >> so you are moving away from self reporting? yournally you said structure was built on self reporting when i visited with you earlier. i found a quote from you from december 2011 at the george comstock george

lecture of research, and you right,at hippocrates was themselves,n delude and if we see people take thei r meds, we believe they take their meds." caning on self reporting have proms, we have got to do better than this, we can do better than this, we are here to work with you, and we expect a better outcome. expired,dy's time is and now on to the next. >> i was happy to hear you say that you will hear any options to protect american people, but i do want to ask you about texas. are you familiar with the concept of sentinel event reporting? >> yes. done an analysis

of what happened at presbyterian and come up with an action plan for what we have learned on that? do we have a checklist on hospital preparedness, have there been any recommendations on changing at texas presbyterian? >> we have a team of 20 of some of the world's top experts, and we left the first day the patient was diagnosed. identified three areas of particular focus. the first was the prompt diagnosis of anyone who has fever or other symptoms of infection and travel history from west africa, and dr. vargas spoke of thatarga issue. state of texas and the county are doing a terrific job along with our staff making sure they have made contact with

every single contact with mr. duncan. temperatures have been taken by outreach workers every day, so of the fortier, none have developed symptoms, none have developed a fever. 48, none have developed symptoms, none have developed a fever. for those who have been affected, our thoughts are with them, and we are delighted that nih is supporting a hospital in texas and that also emory university is doing that as well. and the third area is after the identification is effective isolation, and we are looking very closely at what might possibly have happened to result in these two exposures. there i assumed that if are any new recommendations based on that analysis, that protocol will be redistributed? the data to look at

see what we can do to better protect americans. >> thank you. dr. frieden, you mentioned a iowa that is working on a vaccine that just went into phase one clinical trials this week. is that correct? >> that is correct. >> i just spoke with two employees there and i know that they are working to come up with a vaccine that will meet the protocol and meet the standards for scale and accountability that everyone is working for. the who, the department of defense, hhs, and the public health agency in canada have called this backseat one of the most advanced in the world, and contractsrequested with hhs to expand manufacturing and two at a third site with manufacturing and to complete scientific studies with manufacturing, and to complete the additional safety study to create additional vaccines, and

they have also identified companies to work as subcontractors. dr. robinson, can you tell us what hhs is doing to make sure that those contracts are moving forward as quickly as possible? >> >> thank you, sir. we have renewed their proposal. it looks very favorable. we will be finalizing negotiations with them. prior to that we are helping them with submissions to the fda, providing assistance on site and also at the manufacturing sites to help them expand production with other large companies in the united states. >> also, mr. braley, hhs is involved out the other and because the files started were not only in collaboration with department of defense, but we admitted our first patient in bethesda in the phase one trial. it is not only in the testing

but in the production. >> it is my understanding, dr. fauci and dr. robinson, that the ultimate goal is to land his clinical testing into the affected regions in africa as well once we have an understanding of some of the concerns that were identified earlier in your testimonies. >> if they are safe and reduce the response we feel is appropriate, we will expand both of them into larger trials in west africa. the response we feel is appropriate, we will expand both of them into larger trials in west africa. bama mr. wagner, we have heard a lot about the issue of travel restrictions. can you walk us through the strengths and weaknesses of that approach from your standpoint in border security? >> time is expired so if you could give a quick answer -- >> we have the ability to use the data the airlines give us to see where travelers originating from. there are instances where

travelers may go to different locations and we might not see that, but through our questioning and view, we can identify safe and duties affected regions or if they come through one of the borders, if they fled to canada or mexico. it is more difficult for us to do it but the possibility is greater -- i do agree with what the experts say. it is easier to manage and control when we know where people are coming from voluntarily. "voluntary."s dr. burgess for five minutes. >> the secretary of health and human services has the authority to issue a travel restriction under the pandemic plan that was 2005, the president has the ability to issue a travel restriction. 2005 was geared towards the pandemic avian influenza but it

was amended in july of this year to include hemorrhagic fever. i believe that authority very clearly exists. the question is why the executive branch or why the agency will not exercise that authority. mr. chairman, perhaps this committee should consider forwarding to the full house a request that we have a vote on travel restrictions because people are asking us to do that and i think they are exactly correct to make that request. , the first nurse who was infected over the weekend is being transferred away from presbyterian. and yet her condition has been serially reported in the news media as she is stable and she has been improving. the reason she is having to be removed because personnel are no longer rolling to stay at presbyterian that's willing to stay at presbyterian to be with her? >> they are working very hard and because of the events of the past week they are dealing with

at least 50 health-care workers who may have potentially been exposed in the management of to make sureuals they develop any symptoms whatsoever from even the slightest, they come immediately to be assessed so if they develop ebola -- we hope no more well but know that is a possibility, since two individuals became infected and others may -- that makes it challenging to operate in the hospital and we felt it would be more prudent to focus on caring for any patients who come in, any health-care workers or others who come in with symptoms. >> i don't disagree, and you and i have talked about this, and i'm fully in favor of individuals who have been diagnosed, that they be taken care of in centers and dr. fauci, you know if somebody wants to do research on the ebola virus, they can't just go to a regular university setting a new that.

-- and do that. they have to go to one of the laboratories were the applicability of protecting the personnel. -- where they have the capability of protecting the personnel. there was a picture in the "dallasorning news -- morning news" where the cdc recommended personal protective equipment. it also details the order in which it should be put on and remove. i would note that shoe covers are not included in this graphic . you see a fair amount of exposed skin around the eyes and the ehead and, of course, the neck. dr. frieden, this is going to be hard to see, but this is your picture in west africa. gogglestoe, covered in and i believe if you, understand the circumstances currently, you are about to be dosed with a new toxic dose of chlorine, correct? >> yes.

>> that is why you cannot have been exposed because it is impossible to do the disinfection after taking care of the ebola patient or being in tenable award. it is impossible to do the disinfection if the skin is exposed because exposed skin would be killed by the chlorine and that one of the good for the person delivering the care -- that would not be good for the person delivering the care. we know the numbers in western africa are going up on ebola. we know the case rate is going to increase. we know that 10% of those cases are health-care workers. and we know that 56% of those health-care workers in western africa will succumb to the illness. that is a pretty dire warning for anyone who is involved in delivering health care. i would just submit -- dr. robinson, let me ask you, what kind of stockpile of this personal protective agreement you have available to the health-care workers online" patient could come in

tonight and go to any hospital in this country and present themselves. are you going to be able to quickly deliver a stockpile of personal protective equipment like this? >> we know from talking to the manufacturers right there that there are no shortages right now and they're willing to deliver 24 hours or less. >> let me ask you this question, dr. frieden. what did you think the first patient was going to look like? you knew you would have patient zero at some point or it was a possibility. who diedhe gentleman in nigeria at the end of july who could've gotten off the plane in minneapolis. what did you think that was going to look like? what was patient zero going to look like? what is the match of their? >> go ahead and answer quickly. thank you, doctor. >> our goal is to get hospitals ready. the protective equipment used is not simple but there is a

balance between equipment that is more familiar, less familiar, more flexible, less flexible, can be decontaminated more easily or yes -- less easily. itiously, we're looking at very intensively now in dallas in conjunction with the health-care workers there. right, represented it -- representative schakowsky for five minutes. >> i would like unanimous consent to put into the record randi weingarten from the american federation of teachers, which represents many nurses come into the record. i would also like unanimous consent to put into the record the diary of paul farmer from partners in health who has among other things said that the fact is that weak health systems are

to blame for ebola's rapid spread in west africa, and we know that west africa has 21% of mobile disease burdens, 3% of the world health workforce, one cracks -- one doctor in liberia for 90,000 people. i would like to focus on what we are going to do to help that infrastructure, but in my limited time i want to focus on our infrastructure here. ,e have a vast infrastructure hospitals and community health centers, where people may present themselves. aides. nurses no one better than the united states. but do we have the ability to train and equip, as we talk , do wen military terms have the ability to train and equip -- let me put a couple things on the table. , i stillof the nurses

don't feel like we have a good answer of why nursing one and nurse one and nurse two contracted ebola. is it because there was a problem with not following the protocols or is it because of the protocols? how do we ensure that even if we have the best protocols in the world everybody knows how to use them? degette showed the protective gear that our nurses are supposed to have, and yet two days apparently went by when they were not wearing shoe covers, that an act -- their necks were not covered, as dr. burgess said, may have been exposed even though they knew he had ebola.

how do we make sure when we check at the airports -- i am from chicago, cuts to our health director today -- i talked to our health director today, but there is still a chance anywhere -- how are we going to make sure that everybody can be protected? >> just to clarify one thing, those first love days, the 20, 29th, -- first couple of days, the 28th, 29th, 30th, were before his likenesses was known. the tests had been drawn and assessed but he had not yet been diagnosed with ebola. in our team's review -- >> excuse me one second. congresswoman, were you saying otherwise? ield.e gentlelady will y he presented with ebola symptoms, he had been to the emergency room just a couple days earlier saying he had been from africa, and i believe the cdc protocols that were given to the dallas hospital said that

people should be wearing a protective covering even before the official diagnosis. i would certainly hope -- thank you for you think -- thank you for yielding, ms. schakowsky -- i would hope going forward that if a patient shows up saying he's from africa and he is vomiting and has diarrhea, you wouldn't say "we don't have the lab results in yet,k" you would start treating a person as if he has ebola. >> absolutely. those first couple of days comes he was being isolated for ebola. the diagnosis was confirmed on the 30th and on the 30th we sent the team there and when we look at -- to answer your question -- those first couple of days there was some variability in the sub protected -- in the use of protective equipment. the hospital was trying to implement cdc protocols -- >> going forward how do we make sure that just trying -- how are we going to educate people,

saying-- the nurses are across the country that they have not been involved and they have not trained properly. any time a patient is suspected, isolate them and contact us and we will talk you through how to provide care while we get the tests done and we will be there within an hour. >> when did you come up with that plan? the plan in terms of training, when was that decided? >> we look at our preparedness continuously, so awareness has been something that we have been promoting an extensive ways -- she was asking specifically for nurses -- when was the plan would interface -- put into place for the texas hospital?

>> the data diagnosis was confirmed we sent a team to texas. rey is confirmed for five minutes. >> i want to thank the chairman for walking main the subcommittee back to washington in response to the ongoing outbreak, and commend my colleagues on both sides of the aisle, the near unanimous attendance for this hearing. since my time is limited i would like to get to my questions. this is kind of a follow-on to y was asking.kowsk i don't think we ever got around to an answer on that. i will direct my question to dr. frieden and maybe first two dr. varga. as we know from reports yesterday, a second health-care worker has contracted ebola, ms. amber vinson. now that she has received treatment at emory university in

atlanta, we must examine the protocol breakdowns that resulted in the contraction of people of by these two nurses -- contraction of ebola by these two nurses who were treating, stumping -- treating thomas duncan. written test your them in a you say that the first two contracted, ebola was using full protective measures under the cdc protocol while treating mr. duncan. has your organization in texas identified where the specific breaches in protocol were that , orlted in her infection alternatively, the inadequacy of the protocol? dr. varga, that question is for you. >> thank you, sir. we are investigating currently

of this exposure and the contraction of the illness. inhave confirmed that nina, care with mr. duncan, was wearing protective patient equipment through the whole period of time, and as dr. frieden already mentioned, with the diagnosis of the ebola , the full hazmat style , we don't know at this , what the juncture source or the cause of the toosure that caused nina contract the disease was -- >> i will interrupt you because of limitation of time. i want to go to dr. frieden. just stated,

health-care personnel were following cdc protocols while treating mr. duncan, which include the use of so-called ppe, personal protective equipment. do the cdc guidelines on the use of ppe mirror current international standards that, by the way, are being adhered to, those international standards, in west africa in those three countries -- sierra leone, guinea, and liberia? >> the international standards are something that evolved and changed. we use different ppe in different settings. there is no single right answer and there's -- this is something we're looking at closely. our current guidelines are consistent with the world health organization is my understanding. >> i would think there need to be, dr. frieden -- and i commend you for the job you are doing.

i know these are tough times for all of us. but i think some consistency is what we need. and that brings me to my next , andion, my last question again it is to you, dr. frieden. the issue of elevated temperature. it know, is it 100.4, is 101.5, is it 99.6? confusionere is great , because initially when people were screening, mr. wagner, at the airports in west africa, the 101.5,ture threshold was and then i think now the screening we are doing that these five major airports, atlanta, it is 100.4. when mr. duncan came for the first time to the texas presbyterian hospital, his

temperature was, what, 100.1, and within 24 hours it was 103. when mom and dad are out there -- when a child has temperature and it is flu season and they are going to the doctor, they are going to demand being checked for ebola. give us some guidelines on what is elevating the temperature and when should parents be concerned ? >> parents should not be concerned about evil unless you are living in west africa or the child has had exposure to ebola. the only people who have had exposure to ebola in the u.s. are people who are providing care to ebola patients or the contacts of the three ebola patients. for our screening criteria we are always going to try to have additional margins of safety. we look at that and we would rather check more people and assess -- we are going to always

have that extra margin of safety. >> thank you, and i yield back. castor forize ms. five minutes. >> thank you for tackling this important public health issue of want toa virus, and i thank the centers for disease control and the nih and medical professionals across the country, especially those at emory university health care, with been proactive in containing and treating the virus. i agree with president obama and all of you, we have to be as aggressive as possible in preventing any transition of the disease within the united states , and boosting containment in west africa. but i also think we need to pause here. this is a wake-up call for nihica that we cannot allow funding to stagnate any longer. earlier this year in the budget

committee i offered an amendment to the republican budget to restore the cuts to nih. the budget cuts that have been inflicted over the past two years, and repair the damage of the government shutdown last year. unfortunately it has not passed, on a partyline vote. wewill only save lives if can robustly find medical research in america and keep america is the world leader. i would like to turn to some of the research that is going on now, because it is going to be research that will be our .onger-term response to ebola it will be the vaccines to prevent the disease and the drugs to treat it. anddevelopment of vaccines treatment for people is different from the development of many other drugs. there's not a large private market for ebola drugs. the development requires leadership in our country, and

testified, hasci been working on a vaccine for many years, and he reported today and has moved into some phase one clinical trials. you explain why government support is so important for developing ebola vaccines and treatment? >> well, when you have a product that you want developed, there is not a great incentive on the part of the pharmaceutical companies because of a disease whose characteristics is not a large market. we have the experience when you are dealing with emerging and reemerging disease, the influenza or a rare disease that could be used deliberately in bioterror or a rare disease like ebola that if you look fire to the current epidemic -- prior to the current epidemic there were 24 outbreaks since 1976 and the total number of people in those outbreaks were is less than 3000, about 2500.

we were struggling for years to get pharmaceutical partners -- ourselves from doing the fundamental basic clinical research. and then we did get pharmaceutical partners, like we have now with glaxosmithkline, which is the reason we are moving along. that is one of the reasons that i showed that slide -- i showed that slide where the nih and the research is at this end and you have to push the envelope further to the product and de-r isk it on the part of the companies. companies don't like to take risks when -- >> can you quantify a timeline for the ebola vaccine to be on the market? is it feasible for any vaccine to be approved in time for the current operation? >> your question has a couple of assumptions. the first is that the vaccine is safe and it works. the second is going to be how long is this outbreak going to last that the level?

if you look at the kinetics and the dynamics of the epidemic, it looks very serious. our response -- when i say "our, " i mean the global response has not kept up with the rate of expansion. if that keeps up, as the cdc has projected, we may need a vaccine to actually be an important part of the control of the epidemic itself, as opposed to what the original purpose of it was, to protect health care workers alone. now if you have a raging epidemic -- to be quite honest with you, ms. castor, i cannot predict when that will be. if you have a lot of rate of infection, the vaccine trial gives you a much shorter time to get the answer. if it slows down, it is a much longer time. if you have a lot more people in your vaccine trial, it takes less time. if we have trouble adjusting lee, which we might, of getting people into the trial, it might take longer. i would like to give you a firm

answer but we can't right now. vaccines,tion to the part of controlling the virus is early diagnosis and treatment. i know there are some diagnostic tests that are being developed. can you speak to the prospect of improved diagnostics that can assist in this outbreak? >> there are couple of us -- when i say "us," i mean agencies working on diagnostics. dr. frieden's group at the cdc has played a major role in leadership. we have several grants and contracts out to get earlier and more sensitive diagnostics. >> thank you. recognize mr. gardner for five minutes. todr. frieden, i want clarify something you said earlier. i believe you mentioned there are approximately 100 to 150 people a day coming in to the united states from the affected areas? >> that is my understanding, yes. >> mr. reiner, you mentioned we

are screening 94% of the people? spansion toay, with the four additional locations, that covers about 94%. >> 94% being covered, that means somewhere between 2000 between 2000-3000 people a year coming into this country without being screened from affected areas. a they would undergo different form of screening. we are still going to ask them questions about their itinerary. we are alert to any overt signs of illness and chlorinated with cdc and public health of they are sick. we are also going to give them a fact sheet about ebola, about the symptoms, and most important link, who to contact. >> will you be checking temperatures? >> we will not be taking temperatures. >> so there are 2000-3000 people a year entering the country without taking temperatures, contextfilling out a

she. >> they're going to arrive at hundreds of different airports throughout the united states. >> i want to talk about travel restrictions. non-us military commercial flights are currently going into the affected countries? >> i don't have the exact numbers. >> does anyone on the panel know? from the united states or from anywhere? >> from the united states into those areas. >> there are no direct flights into the united states. >> or into west africa? >> there are direct flights into west africa? >> how many? does anybody on the panel know how many? back to the united states? >> there are no direct flights coming back to the united states from those affected areas. what about from europe?

>> there are hundreds of flights coming from europe. >> and people from west africa throughhrough their -- there. and there is 94% screening. >> we would have to get back to numbers, butof huge quantities of supplies are needed. >> if you could get back to me with that number, i would appreciate it. are you aware if nigeria has a travel ban on countries affected by the outbreak? >> they do not. the areas brought up regularly to me when i go home, what should i tell my local hospitals and local doctors that they need to do to address ebola? >> make sure if anyone comes in with fever or other symptoms of , they need to ask

where they have been for the last 21 days and whether they in west africa. >> and the training the small local district hospital would receive, is that the same kind of metropolitan hospital would receive? >> there are override the of forms of training. hospitals are usually supported by the state. >> what do we need to do to make sure people understand that there could be similar conditions, similar circumstances, so we don't have a situation where people are panicked. >> the key issue as you point out is that we are going into flu season. by all means, get a flu shot. for health-care workers, anytime someone comes in with fever or other infection, take a travel history. that's really important.

>> you mentioned that we can't have a travel ban because you are afraid of the impact it would have, but you don't know how many personnel or flights are currently in use. >> my point earlier on was that of passengers are not allowed to come directly, there is a high likelihood they will find another way to get here, and we will not be able to track them as we currently can. talking supplies and personnel. how many? how much equipment? not able to track people coming directly, we will lose the ability to monitor them for fever, to collect information and share it with local authorities, and to isolate them if they are ill. you.ank we now recognize mr. wilshire for five minutes.

>> first, i want to understand this. u.s. andn came to the infected to health-care workers in dallas, correct? >> at this point, none of the 48 contacts he had prior to haveoping symptoms developed anything and they of all past the point -- >> we have had two incidents in the united states, but this is such a highly contagious disease, we are on full alert, correct? >> it is as severe disease. it is not nearly as contagious as other diseases, but any infection in a health-care worker is unacceptable. >> and there is an enormous amount of public concern about this, so we appreciate the effort you're making. there has been some concern

about what happened in dallas, the efforts made. and now you're telling us that there has been information provided to all of the hospitals in the country about what protocols to follow, correct? >> that's right. >> is it feasible that all of our hospitals are going to be in a position to provide state-of-the-art treatment or as a practical matter does it make sense for hospitals to contact you when they have a potential infection, for you to come, and then for there to be centers where an individual can be treated. >> every hospital needs to be able to think it may be ebola, call us -- we have had hundreds of calls, and then we will determine what treatment is best for that patient. -- this isalso heard absolutely a public health infrastructure issue where he gets out of hand, correct? >> public health measures can control ebola.

>> they have effective measures in nigeria where they have been able to contain it, but they have no public health infrastructure in the three countries where the epidemic is now gaining headway, correct? >> right. >> and in the u.s., we are fortunate to have a pretty good infrastructure, but we do have to have an answer, i think, to this question that is being asked about travel. a concern people have because it is seen as a "easy answer. co i want to understand what the answer." "easy it seems like a debate within the medical community, but it may be a psychological answer but not necessarily in effect of medical answer. all of us have been asking you to give your explanation as to why, from a medical standpoint, you have concluded that a total

travel ban is inappropriate and not effective. >> first off, many of the people coming to the u.s. from west africa are american citizens, american passport holders, so that is one issue to be aware of. way, i don't have much time, but if we're going to encourage people to go and do important work, including military personnel, we have to take them back and make sure we can treat them if they do get the illness, correct? >> people travel and people will be coming in for it >> you say there is basically a trade-off. if there is a full ban, there are ways around it and then you lose the benefit of being able to track folks who may be infected and that could lead to a greater incidence of outbreak. it is a trade-off. is that essentially what is going on? >> we are open to any possibility that will increase the safety of americans. >> are there midpoints that

makes sense to you in coordination with your colleagues, particularly mr. wagner? >> we would look at any proposal that would improve the safety of americans. >> this is not about funding so i am not going to ask you because i think we know what your answers would be, but i just want to share the concern expressed -- mr. chairman, we may want to have a hearing at some point about funding requirements to make sure the emperor's structure this country needs to be in place before thishing -- infrastructure country needs to be in place before something happens is robust that we have people who are strong and trained and ready to do the job. that is not today's hearing, but i think it is a question we should address the cause with 20% across-the-board funding and nih, i find not to be a reckless decision. 12% at cbc i think is reckless.

we have to revisit our priorities and making sure we have the emperor structure in public health to protect the -- infrastructure and public health to protect the american people. >> we do have a hearing scheduled on that. >> i now recognize mr. griffith. >> thank you, mr. chairman. i believe we should have reasonable travel restrictions. i am submitting a letter for the a prominentcites medical and travel security services country with more than 700 locations in 76 countries that reports that africans have imposed air, land and travel

bans by persons from countries where ebola is present. south african development community members only allow highly restricted entrance from ebola affected regions with monitoring for 21 days and public gatherings discouraged. i find that interesting because some of those countries have had a previous ebola outbreaks themselves. >> i will take your word for it. >> i will tell you that this is a concern to a lot of our constituents and mine as well. recently, a father from virginia prayers for his daughter because she lives in the complex with the first nurse and was very concerned.

while i think i know the answer, i would like to get your answer. he asks, if i get to 21 days and is nothter is in fact -- infected, can i exhale and breathe a sigh of relief? >> he can do that now. the first nurse only exposed one contact in that was in the very early stages of her illness. at most, one person from the community was exposed. >> i appreciate that. he said there were some concern coming out of dallas that the patient's dog may be infected. by the virus be transmitted dogs? i did some homework on mess because i thought it was an interesting question and i found a publication from march of 2005 the did a study on dogs in and dogs in france as a

control group. they showed that while dogs have antibodies for ebola, they are asymptomatic, but the study went further to say that there are a lot of questions about how ebola is transmitted. there is a question as to whether or not or how the ebola outbreak occurred. it wasn't in normal ways, human human, and the report indicates the dogs might be -- might be -- i don't want to scare folks -- might be suspect. isn't it true that we don't know a whole lot about the outbreak of ebola and when we are trying to a sure american people -- just like previously we didn't think it would come to this country and then if it did get to this country we wouldn't have

any problems controlling it and now we have all kinds of people being monitored. aren't there a lot of questions about how ebola is spread? >> although we are still learning a lot, we have a lot of information about ebola. we have a good sense of how it .s controlled we have looked at exposure to animals. we don't know of any documented ,ransmission from dogs to human but we will be looking to help assess that situation. seenthough we have not transmission, we have a lack of evidence as opposed to evidence that it cannot be transmitted. we have no restrictions on travel of human beings. how about the dogs?

i called customs. they said experts are there. called the usda. they said that would be cdc. i understand all of your reasons -- while i don't agree with them completely, i understand about humanitarianism in all of that, but don't you think we should restrict travel on dogs? legs we will follow-up on what is recommended -- >> we will follow-up on what is recommended. >> i like to start by mentioning "will americaled meet the ebola challenge?" i would like to submit that for the record. this has been a very enlightening hearing. i would like to acknowledge that

the kentucky international guard, which is taste in my district, is in senegal providing help for the 101st. so into the ink them for their effort. displaying my ignorance, we know that you cannot do text ebola until it -- until itagious becomes symptomatic, at which point it is contagious. is there any way to detect going on? >> at this point, we don't have a test that would identify it before someone has symptoms. the test only turns positive when they are sick. the test is for the virus itself. that is another reason we are confident that it doesn't spread -- we can't even find tiny amounts of it in people's bodies until they get sick. is there any research been

done on a possible test for this? >> there's a lot of research being done to understand, diagnose, prevent and treat better. sensitive to have a media treat situations like this. certainly, the media can be a very important part of providing public information about a potential threat to public goety, but they can also .verboard i see comments in the media the threat oft ebola and the spread of ebola. while it has spread to two health-care workers, i know the public may perceive that differently. like, for instance,

in the washington post today, a picture of a woman at the dulles airport who looks mummified because of her concern about contracting ebola. one survey showed 98% of the american people are aware of the ebola situation and not even 50% know there is an election coming up in three weeks. media has certainly alerted people that something is going on. my question to you is has the helpful orage than harmful in having the public have an appropriate level of concern as to what the situation is. workersimes health care become infected and ill it is unacceptable and our thoughts with those health-care workers and hoping for their recovery. it is certainly understandable that there is media interest.

it is new to the united states. it is a scary disease. there was a movie made about it. it is important that we pay attention and the doctors, hospitals, community clinics in health care practices stop it at the source to make is completely safe. i thinkthe coverage, many would agree, may exaggerate the potential risks or confuse people about the risks. we know about ebola. cdc has an entire group of professionals who spend their entire careers working on ebola. they stop outbreaks all the time. outbreaktopped every except the current one in africa. there is zero doubt in my mind that are in a mutation there

in thet be an outbreak u.s.. it warrants attention but it's important to put it in perspective. >> i agree. additionaly authority that cdc would find helpful in conducting your responsibilities. specific authority that would make it easier to do your job? >> we are looking at a variety of things, procurement, for example, to see if there are changes that might allow us to respond more quickly and effectively. >> thank you. i yield back. fore recognize mr. johnson five minutes. >> thank you for being here. thank all of you on the panel

for being here today. politics orabout international diplomacy. this is about public health and protecting the safety of the american people, particularly our health care workers who are some of the high risk folks to be exposed. as of my main concerns though we don't know what we don't know. throughout testimony and questioning today, i have heard you say multiple times i don't know the details of this, i don't know the details of that. i think what the american people , is some assurance that somebody does know the details. salome us your question. do we know yet how the two -- so

let me ask you a question. do we know yet how the two health-care workers contracted the virus? was it a breakdown in the protocol? was it a breakdown in the training of the protocol? do we know of the protocol works? >> the investigation is ongoing. we have identified possible causes. >> so we don't know. we don't know. i get that. we don't know. you know, the people in ohio are , especially now that we know that one of those health-care workers traveled through ohio, even spend some time in akron with family members. kasich's governor immediate actions to try to address the situation. in my experience as a military

war planner, 26 and a half years in the military, and i know we have the military engaged in this process overseas, we don't wait until the bullets start flying to figure out whether our war plan is going to work. when did the cdc find out their was an outbreak of ebola in west africa? >> late march. >> one of the things we do in the military is conduct operational readiness inspections. scenarios inworld controlled environments, no notice, so that those who are going to be responsible for whatting a war plan know to do when the first shot is fired. no panic, no second-guessing, they know what to do. ebolae plan to address an

outbreak ever been tested by the cdc in a real-world environment? >> not only has the plan been tested, that outbreak control has been done multiple times in west africa. >> i am talking about in america. >> in america also. >> do you know of any hospitals in southeastern ohio that have participated in any kind of real world scenario of an ebola outbreak? >> i can speak to that -- cannot speak to that specific example. >> let me go further. daymentioned that 150 per roughly are coming in from west africa. let me give you a scenario. in tosay a person comes

the country from west africa, and let's say that everything in the screening process works right. they may be on day 14 of having in westosed to ebola africa. symptoms andwith go through the screening process and then go to wherever they may go. day 17 or 18 they start getting ill and start seeing a spike in their temperature. if they want into any emergency room in appalachia, ohio, and start throwing up and having planoms, does your identify that can tell that hospital emergency room what to do and then scenario? don't know that person came

from liberia or any other place. >> we have detailed checklists and down rhythms we have provided widely two health-care workers throughout -- algorithms we have provided widely two health-care workers throughout the country to determine if there is an outbreak of ebola and if they do, to call for help, and we will be there. mr. madison is next for five minutes. >> thank you, mr. chairman. a number of questions. i will try to move through them quickly. dr. friedman, it strikes me that controlling the outbreak in west africa is really one of the real of to keeping americans safe. the reports indicate we may be losing ground in liberia. what would enhance the

international community's ability to gain some ground in africa in terms of actions and resources? that itwe're finding is is moving quickly and there is a real risk it will spread to other parts of africa. therefore, the key ingredient to progress there is speed. the quicker we surge in a response, the quicker we blunt the number of cases and the risk ,o other parts of the world including the u.s., decreases. angress has provided agreement to use money from the department of defense. received $30e million for the first 11 weeks of this fiscal year, which we appreciate. has an unprecedented

number of people in the field right now in west africa and texas. how many people do you have doing airport screenings? >> i would have to get back to you with the exact numbers. we are overseeing screenings to make sure they are done correctly and to screen individuals here -- >> make sure you get that ifber, and also find out those resources are best used there or elsewhere with your limited number of people. is there progress in developing test to determine if somebody has ebola? >> a more rapid test would be helpful. we are currently testing one in africa that is simpler and quicker and would be more aspful even if it is not thorough.

to me that when it comes to infection control and prevention and hospital standards, i think he very wisely from hospital to hospital in this country. what regulatory or legislative actions could strengthen these systems? how can we reduce this variability among hospitals in ?ur country >> infection control in our country generally is a challenge cdc worksing that hard to improve. hospitals are regulated by the states in which they operate and the issue of what could be done isimprove infection control complex. cdc has a large program of ofpital prevention infection. we share new efforts in new ways to do things better. that center of excellence model is an important one. suggesting that while

you can provide guidance, implementation is more of a state function than a federal function. do you think we should be looking at that issue? we have a federalist system. the cdc provides information and input that roughly 5000 hospitals in the country were not regulatory. >> one other line of question. there is no good news about ebola, but at least it is not , it does not transmit as an airborne identity. it is clearly that we do not want to underestimate the trent -- the ability to transmit it. the focus is on ebola and rightly so, but there are other airborne transmittal pathogens that ought to be of great

concern. birds being one of them. is this experience we have had with ebola, how do we learn from it to make sure we are prepared for other, human to human that mayible pandemics have a higher rate of transmission van ebola? >> two major lessons. prevented at the source. either go to find it, stop it, and prevented, it would be over already. country, tor continue preparedness and public to find and stop public health threats. >> recognized for five minutes. >> thank you. today, we have referred to , referred to nurse one

and nurse two. these are two young women who dedicated their lives to helping other people, sick people. nurse oneo them as and nurse to does not sit well with me. it is reminiscent of dr. seuss, thing one and thing two. these are not things. i would like to think -- first nurse and the second nurse -- these are young women with families. one particular has a fiancé. i think it would serve us well are humanr these beings, young women, who have dedicated their lives to help people. i would like to open with that. dr., he said in your testimony earlier, only by direct contact can you contract ebola. you contest that statement?

and it is not airborne? you agree? >> it spread person-to-person not by the airborne. >> if you need personal contact fluids, why is it scrubbed four times? aren't they wasting money? contact,n have bodily why -- >> it is a scary disease. >> so it is just for public perception. they do not need to be doing that. >> we have detailed guidelines. you need to be sick and generally, the first symptom of illness is a fever. >> do you need a fever to be

contagious? >> later in the disease when people are deathly ill, they may not have a fever but they would be able to walk at that point. >> you need to show symptoms within 21 days of exposure. are contagiousu at that point? time, anywhereon from 0-21 days. question early within the first 21 days or so. >> you said there were 121 people from west africa to the united states. you are opposed to -- constituents are in favor of traveling -- i predict you or the president will put on traveling restrictions. i think they are coming and i think sooner rathean