advance an agenda that is helpful to iowa. as your next senator i will -- as your next senator i am going to get up every morning thinking about what i can do to make your lives better. i'm going to focus on economic policies that will strengthen the middle class. that is what i was always dependent upon whether it is in agriculture, education, energy, our economy has been based on hard-working iowans who get up every day and do what is necessary to get the job done. as your senator that is what i'm going to do. i'm going to work hard to make sure that your lives are better.

i'm here tonight to ask for your help. i'm here to ask for your vote. thank you. >> thank you to our host this evening. it has been a pleasure. thank you congressman for joining me on the stage. i think you have seen very clear differences in this race. i am not a washington politician. i grew up on my family farm in southwest iowa. woman, i am a soldier. i deeply care about the nation. i don't support congressman braley's policy, obama's policies of higher taxes, more spending. the list goes on and on. congressman braley has a failed record in washington.

because of that he is running the most negative campaign iowans have ever seen. if you trust me with your vote on november 4 i will fight hard for middle-class families so they have better paying jobs. i will work for thousands of iowans facing higher health-care costs because of obamacare. i will protect social security. >> thank you both. >> political coverage did not stop. we are going to be online.

less than 20 days until election day. >> we think those in the audience who have watched this evening. we can continue to contribute by going to those websites. you are on the campus of morningside college. thank you for joining us. >> watch earlier debates and other races from a car us the country -- from across the country. here is a look at the ads running in iowa. >> i'm bruce braley and i approve this message. >> take a closer look at joni ernst. in the state senate, ernst sponsored an amendment to outlaw abortion, even in cases of rape or incest. ernst even wants criminal

punishment for doctors who perform an abortion. joni ernst, radical ideas, wrong for iowa. >> joni ernst promises to shut down the department of education, hurting iowa students, abolish the epa, giving polluters a pass. that's why sarah palin wants ernst in washington. joni ernst. promises to them. too extreme for us. the league of voters is responsible for this advertising. >> i get very upset. are you ready to apologize? >> you're damn right! >> that individual had no college education. >> i find it ironic that there's this big push to shut down the house. >> do you have any advance degrees in economics?

there's hardly anybody working down there. >> there's no towel service. >> a farmer from iowa. you never went to law school. >> we're doing our own laundry down there. >> you don't have a master's or ph.d. in health care policy. >> one of the most important places i go is to the house gym. >> have you published any scholarly treatises in a peer-reviewed journal? >> he never went to law school. >> are you ready to apologize? >> you're damn right! >> i get very upset. >> on friday, our campaign 2014 coverage continues, with the wisconsin governor's debate. scott walker chases mary burke. life coverage at 8:00 p.m. eastern, here on c-span. c-span's campaign 2014 coverage

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like us on facebook. follow us on twitter. e-house hearing on the u.s. response to the ebola outbreak. the defense department briefing on efforts just thought you'd be lot -- ebola. -- efforts to stop ebola. on the next washington journal the bipartisan policy center discusses ebola screening procedures at airports. a look at efforts to fight isis. plus your calls, facebook comments, and tweets. like every morning at 7:00 eastern on c-span. >> c-span 2015 student can competition is underway.

award 155tition will prizes. create a documentary on the topic the three branches and you. videos need to include c-span programming, and must be submitted by january 20, 2015. grab a camera, get started today. >> next, a house energy and commerce hearing on the u.s. response to the ebola outbreak. members heard testimony from cdc director tom frieden and national institute of allergy and infectious diseases director, anthony fouchi. this is about three hours. >> good afternoon. i convene this hearing of the subcommittee of oversight investigation. afternoon. i convene the committee on senate oversight.

we will need to make sure when the witnesses speak, we are clear in the center section. today the world is fighting the worst ebola outbreak in history. the c.d.c. and our public health care system are in the middle of a firestorm. job one is to put that out completely, examine and we will not stop until we do. we must be clear-eyed and singular in purpose to ensure that not one additional case is contracted in the united states. we as congress stand ready to serve as a strong and solid partner in solving this crisis. there is no greater responsibility for the u.s. government than to protect and defend the u.s. people. the stakes could not be higher. the number of ebola cases in africa is doubling in about every three weeks. with no vaccine or cure, we are facing down a disease for which there is no room for error.

we cannot afford to look back at this point in history and say, we should have done more. errors in judgment have been made to be sure, and it is our immediate response on this day to learn from those errors, correct them rapidly, and move forward as one team, one fight. let us candidly review where we stand. when the latest outbreak in west africa confirmed, we thought it would be quickly contained. that turned out to be wrong. by underestimating the danger and and over estimating the ability to handle the ebola outbreak, mistakes were made. the trust and credibility of the administration and government are waning as the american public loses confidence each day with demonstrated failures of the current strategy. but that trust must be restored. it will only be restored with honest and thorough action. we have been told that any

hospital in the country that can do ice legislation can do isolation, unquote. events in dallas have proven otherwise. events for containment have not worked. false assumptions create mistakes, sometimes deadly mistakes. why was the c.d.c. slow to deploy a rapid response team at texas presbyterian? why weren't protocol rapidly communicated? what training have health care workers received? and there are things about ebola we don't know. how long does the virus live on substances? how do health care workers wearing full protective gear still get infected? can it be transmitted from a person who does not have a high fever. the largest study of the current ebola outbreak found 30% of

transmitted cases in africa did not have a current fever. i believe the c.d.c. is the goal. i want to understand why c.d.c. and the white house changed course in 2010 on proposals first introduced in 2005 that would have strengtheneded the federal quarantine guidelines. am here to state my objection that the u.s. fails to restrict travel from ebola hotzones. a month ago the president told us someone reaching our shores with ebola was unlikely. screening and self-reporting have been a demonstrated failure. the administration continues to advance a contradictory position that does not make sense to me, especially if priority one is to

contain the spread of ebola. it troubles me more when public health policies are stated over cutting commercial ties with fledgling democracies rather than protecting public health in the united states. this should not be presented as an all-or-none choice. we can and will continue to transport whatever supplies are necessary to end this deadly disease in africa. we do not lead to leave the door open while ebola is a dangerous and unwelcome stow-away on these flights. the current airline passenger screening at five u.s. airports and temperature taking is troubling. while c.d.c. and n.i.h. tell us ebola patients are only contagious when they have a fever. we know this may not be completely accurate. a fever can be masked by taking ibuprophen. it is -- let me be clear to all

the federal agencies responding to the outbreak. if resources or authorization is needed to stop ebola in its tracks, tell us in congress. i pledge, and this committee joins in pledging, we will do everything within our power to help you keep the american people safe from ebola outbreak. i now recognize the ranking member of the committee. >> thank you, mr. chairman. on monday the director general of the world health organization called the ebola outbreak, quote, "the most severe acute health emergency seen in modern times." she warned, "the epidemic threatens the survival of these governments in south africa." this is no exaggeration. c.d.c. predicts that up to 1.4 million west africans could be affected from debowlia.

this is a humanitarian crisis, and we have a moral imperative to help in west africa. but ending the west african outbreak is also a u.s. national security imperative. doing so is the best way to keep ebola out of the united states. i was alarmed like all of us were when thomas duncan flew to the u.s. while harboring ebola, and even more disturbed to hear he was discharged from the texas e.r. after saying he had traveled to liberia. even worse, we learned two nurses have contracted ebola. i know, mr. chairman, we all join in sending these women and their families our prayers. these new cases raise serious questions. "the washington post" wrote yesterday that texas presbyterian, quote, had to learn on the fly, how to control the deadly virus and the hospital was, quote, not fully prepared for ebola.

we need to find out why this hospital was unprepared and if others are, too. and we need to make sure that the c.d.c. is filling these readiness gaps. we should be concerned about the appearance of ebola in the u.s. and the transmission to two health care workers. but we should not panic. we know how to stop ebola outbrake break by isolating patients and tracing and monitoring contact. the u.s. can prevent isolated cases from becoming broader outbreaks. that's why i'm glad dr. frieden doctor by phone. it would be a mistake to say that the -- it would not be wrong to say that the first case of ebola was mismanaged. i know both of these gentleman will be transparent and forthright in helping me understand why how we can understand our response when

another person, and it will inevitably happen, shows up at the emergency room with these kinds of symptoms. i appreciate the steps taken by c.d.c. and customs. these steps are appropriate. as some call for cutting off all travel, as the chairman said, this will be reasonable to be able to stop anybody with ebola from coming into the united states. we don't want to take steps that would endanger americans by interfering with efforts to halt an outbreak in africa. you know, there is no such thing as forterss america when it comes to infectious diseases. the best way to stop ebola is going to be to stop this virus in africa. efforts from doctors without borders have told us a quarantine on travel would have a quote catastrophic impact on west africa. also, earlier this week, the director of n.i.h., francis collins said had we adequately

funded his agency for over a decade, we would already have an ebola vaccine. his words are a reminder that key public health agencies have faced stag demand funting for several years, hampering ourable -- hampering our ability to handle this crisis. l the scope of this problem in west africa was beginning to come into focus months ago. now the situation is dire. let's work together to make sure we stop it as quickly as we can. with that, i yield back the balance of my time to the gentleman from iowa. >> thank you. our duty today is to make sure the administration it is doing everything possible to prevent the spread of ebola in the united states. our number one priority in combating this disease must be the protection of americans, and we have to figure out the best way to do that. my heart goes out to all those suffering from this horrible epidemic. i am very proud by the hard work

done by american troops, doctors, nurses, and other volunteers to combat this disease. congress must come together, put aside partisan differences, and help stop this outbreak. today i hope to hear what steps the american -- the -- i am greatly krn concerned, as the congresswoman sucked, that they did not act quickly enough in spoppeding in texas. we need to discuss all the options we have in moving in, in texas, and make the changes necessary. >> the gentleman's time is expired. we have a lot to do here, so we'll just keep going. >> ok. thank you. >> i now recognize the gentleman from the full committee, mr. upton, for five minutes. >> thank you. let me first thank all our witnesses, republicans and democrats, for being here today. it is unusual to convene a

hearing in d.c. during the district court parade, but there is no time to wait. i was glad to see the president get off the campaign trail yesterday to finally focus on the crisis. people are scared. we need all hands on deck. we need a strategy, and we need to protect the american people, first and foremost. it is not a drill. people's lives are at stake, and the response so far has been unacceptable. as chairman of this committee, i want to assure the witnesses we stand ready to support you in anyway to keep americans tafe safe. we are going to hold your feet to the fire on getting it done and getting it done right. both the u.s. and world health community have failed to put in place standards to combat the current outbreak. the c.d.c. admitted more could have been done in texas. two c.d.c. workers have become infected in texas even as protocols are being developed on

the fly. none of us can understand how a rse who treated an ebola patient and had herself a fever was permitted to boffered a flight -- board a flight and fly across the country. we are seeking preparedness in the response plan here at home and abroad. it is clear whatever plan was in place was inefficient, but i believe we can and should do better now. >> we need to treat health care workers and safely stop the spread of this disease at home and at its source in africa. this includes travel restrictions or bans from that region beginning today. surely we can find other ways to get the aid workers -- aide workers and supplies in from these countries, and there is air travel used to assure public

safety. why not here? we can no longer be reactive to each day's crisis, we need to get ahead of this terrible outbreak. the american people also want to know about our troops and medical personnel who are courageously head today africa to treat the sick. how will they be protected? we want to be sure americans here have the resources and training necessary to combat this disease as well. it is not just the responsibility of the u.s. the global health community bears the charge to finally get ahead of the threat, develop a clear strategy, train all of those involved in combating this disease and eradicate the threat. we have all heard the grave warnings this will get worse before it gets better. people are scared. it is our responsibility to ensure the government is doing whatever it can to keep the public safety. diana degette and i have partnered to help ensure the research speed and while much attention has been paid on how this affect can help with

diseases like cancer and diabetes, these same reforms have to help us in the development of treatments for ebola. nfections like i yield back the balance of my time to dr. burgess. >> thank you. i think everyone here agrees we must fix this. america's response to the ebola outbreak is not a political issue, it is a public health crisis. we need to guarantee the safety of our health care workers on the frontlines. it has been long known that health care workers have an out-sized risk in africa. they have a 56% mortality rate of those health care workers who catch this disease. two nurgses have contracted ebola in the united states, and indeed, we have to learn from the current situation in texas and youzhny information we can gather to better help prepare

hospitals and better protect health care workers on the frontline. we are hear today because we need answers to these questions. this will past august the director of homeland security issued a response on personal protective equipment and anti-counter terrorism measures. they found that the department of homeland security did not adequately conduct pan democratic preparedness supplies and did not effectively manage its stockpile of personal protective equipment and medical countermeasures. this illustrates how under-prepared we are. we have to get this right. i would yeelyeel to ms. blackburn from tennessee. >> thank you, dr. burgess. welcome to all of our witnesses. everyone has welcomed we are here to work with you to help protect americans, and that includes the care givers. by that i mean the men and women working on the frontlines, the screaming eagles of the 101st from fort campbell.

i will yeelyeel. -- i will yield back my time. >> the gentlelady yields back the balance of her time. to mr. waxman. >> i am pleased to make an opening statement before we hear from the witnesses. i think we have to put all this in perspective and not panic. everybody says "don't panic" and then they say things like "we're going to get tough." well, what are we going to do? first of all, we have a problem in africa. thaze serious outbreak that could spiral beyond our control. the world health organization estimate estimated there could be up to 10,000 new ebola cases each week in west africa. c.d.c. has warned the outbreak could affect as many as 1.4 million people by the end of january. this is a humanitarian crisis in africa.

and we have a responsibility to help. if we don't help there, that outbreak is going to continue to spiral out to other places. and sealing people off in africa is not going to keep them from traveling. they will travel to brussels, as one of the people did, and then into the united states. we can stop the epidemic from spreading in africa or the united states if we isolate the -- ents and contact the monitor the contacts of that patient. if we do that, we can stop it there and we can stop it here. so in africa, we need to know, are we moving fast enough? responders have adequate resources? are we coordinating our responses with other organizations in other countries? here people are scared, and we should not make them more

frightened. put this in perspective. we have had three recent cases of ebola in this country. thomas duncan who entered the u.s. while harboring ebola and who flew through brussels to get here. nina pham and the other nurse who became infected while treating mr. duncan. we need to act urgently, but we need not to panic. what we need to do is learn what we need to do, what mistakes we have made, and not repeat them. we want to find out what happened in texas health presbyterian hospital, how c.d.c., state and local health officials can improve procedures moving forward. we should also use this as a wake-up call to assure the adequacy of our own public health and preparedness safety net. we need to be prepared before a crisis hits, not scrambling to respond after the crisis.

in the past decade, the ability to fund research and public health programs has declined here in the united states. since 2006, c.d.c.'s budget, adjusted for inflation, has dropped by 12%. funding for the public health emergency preparedness cooperative agreement which regulates state preparedness activities has been cut from $1 bhill bill in its first year of 12 million 2, to $6 in 2014. all of these were also subject to the sequestration. so to allow that sequestration allowed - so those who e government to close, sequestration, have to answer to the american pep public as well.

based on what we know, texas presbyterian would have not met c.d.c. standards. although, in fairness, i suspect much hospitals all over the country would have struggled to respond. this is a problem we have to solve. mr. chairman, before i run out of time, i want to go to health care workers and volunteers, those treating ebola victims in the u.s. and those who have traveled to west africa to help during this outbreak. it is a dangerous work they are doing. they are putting themselves in danger to save lives and preserve -- and they deserve our thanks and our praise. i also want to thank all of our witnesses. you have my confidence. i thank you for joining us today to provide answers to help stop the current outbreak in africa and how to improve our public health systems to avoid the next public crisis. i am ending my career at the end of this year. but i have been through so many hearings where when there is a

crisis we have congressmen sit and point fingers. let's point fingers at all of those responsible. we have our share of responsibility by not funding. in africa, they have no infrastructure. we have to help them many build infrastructure, and we should have not these irrationale budget cuts. >> i would like to introduce our witnesses. . tom frieden, c.d.c., dr. fauci, the national institutes of health. dr. robertson, advanced research and development authority within the office of the assistant secretary for preparedness and response at the united states department of health and human services. r. luciana borio, the assistant commission ergs for u.s. counter-terrorism policy at the u.s. food and drug administration.

dr. wagoner, u.s. department of homeland security. joining us today on video conference from texas will be dr. daniel varga, senior vice president at texas health resources. joining us in a moment. i will now swear in the witnesses. you are all what ware -- all aware the committee is holding an investigation and when doing so has the practice of taking testimony under oath. do any of you have an objection to giving testimony under oath? >> no. >> no. >> the witnesses say no. dr. varga? >> no. >> you are entitled to be advised by counsel. advisedf you wish to be by counsel during your testimony today? >> no. >> no. >> everyone answers no. >> that case, please rise, and i will swear you in.

raise your right hand. do you swear the testimony you are about to give is the truth k, the whole truth, and nothing but the truth? >> i do. >> i do. >> i do. >> i do. >> thank you, doctors. you are now subject to the penalties in title 18. of the u.s. code. we call upon you to give a five-minute opening statement. dr. frieden, you are recognized first. >> thank you, committee members. i very much appreciate the opportunity to come before you to discuss the ebola epidemic and our response to protect americans. my name is dr. tom frieden. i am trained as a physician. i'm trained in internal medicine and infectious diseases. i completed the c.d.c. epidemic intelligence training, and i've worked in the control of diseases -- communicable

diseases and others since 1990. ebola spreads only by direct contact with a patient who is sick with the disease or has died from it, or with their body fluids. ebola is not new, although it is new to the u.s. we know how to control ebola. even in this period, even in largos, nigeria, we have been able to contain the outbreak. we do that by tried and true measures of finding the patients promptly, isolating them effectively, identifying their contacts, ensuring that if any contact becomes ill, they are rapidly identified, isolated, and their contacts are identified. but there are no shortcuts in the control of ebola. and it is not easy to control it. to protect the united states, we

have to stop it at the source. there is a lot of fear of ebola. i will tell you, as the director of c.d.c., one of the things i fear about ebola, is that it could spread more widely in africa. if this were to happen, it could become a threat to our health system and the health care we give for a long time to come. our top priority, our focus is to work 24-seven to protect americans. that's our mission. we protect americans from threats, and in the case of ebola, we do that by a system at multiple levels. in addition to our efforts to control the disease at the source, we have helped each of the affected countries establish exit screening so that every person leaving has their temperature taken.

in the two-month period of august and september, we identified 74 people with fever. none of them entered the airport or boarded the plane. as far as we know, none of them were diagnosed with ebola. that was one level of safety. recently we have added another level of screening people on arrival to the u.s. that identifies anyone with fever here. and we have worked very closely with the department of homeland security and customs and border protection to implement that program. i would be happy to provide further details of it later. we've also increased awareness among physicians throughout the u.s. to think ebola in anyone who has fever and/or other symptoms of infection and who has been to west africa in the established laboratory

services. in fact, one of the laboratories in austin, texas, identified the first case here. have fielded calls from concerned doctors and public health officials through out the country. 300 calls,re than and only one patient, mr. ogden, had ebola, but that is one too many. we are open to ideas as what we can do to keep americans as safe as possible as long as the outbreak is continuing. we have established merchants a response teams that will go within hours to any hospital that has an ebola case to help them provide effective care, safety. there is a lot of understandable concern about the cases in doubtless. -- in dallas. i have one slide of the contact

tracing activities, and we provided copies for the members. the two core activities in dallas are to ensure there is effective infection control and to create contact here. you see a timeline of exactly what has happened in the identification of contacts. we have followed each of the contacts. wen any become ill, immediately isolate them so we can break the chain of transmission. that is how you stop ebola. i can go through the details when you wish. we are also working to ensure there is effective infection control there, and i can go through the details of that. cdc works 24/seven to protect americans. there are no shortcuts. everyone has to their part. there are more than 5000 hospitals in this country, more than 2000 500 health departments at the local level. we are there to support, with

world-class expertise, and we are there to respond to threats that we can help protect americans, and we are always open to new ideas. we are always open to data because our bottom line is using the most accurate data information to inform our actions and protect health. thank you. >> thank you. i will now recognize dr. fauci. >> thank you, chairman murphy, ranking members. you just heard about the public health aspects of the ebola virus disease. i appreciate the opportunity to speak with you this morning addressing of th infectious disease. thee events started with /11, whichnts of 9 were closely followed by the

anthrax attacks rate it was in that environment that a multifaceted approach toward irish terrorism was mounted by the federal government, one of which was the research to develop countermeasures. he soon became aware that naturally occurring operates of disease are just as much of a terror to the american and world oflic as a deliberate fire terror. you see on the slide the number one we call category a pathogens, from anthrax, botulism, lay, smallpox, but look at the last bullet, pharrell hemorrhagic fevers. the pharrell hemorrhagic fevers are difficult because they have a high degree of fatality and infectivity upon contact with the fluids. therapy is supportive without specific interventions, and we do not have a vaccine. what is the role of the national institutes of health? we could advance the slide?

the role of the national institutes of health in the research endeavor. we do basic and clinical research and we apply and supply resources for researchers in industry and academia to advanced product development. the endgame of what we do our diagnostics, therapeutics, and vaccines. i'm sorry, could we get the slide back on the last slide? no, the previous one. i am very sorry. right get it back, there, there. this is a multi-institutional endeavor. as you can see on the slide, the nih is responsible for basic research and early concept the moment. something that we did relatively unknown because of the lack of interest on the industrial partners of making interventions. who youered with barda, will hear from short letter, and

then we partnered with industry, as i will tell you, to ultimately get the approval of products through collaboration of fda. next slide. you heard a lot of therapeutic interventions. i would like to spend a moment talking to you about a few of them. it is important to realize that they are all experimental. none of them have proven to be effective. when you hear about getting a drug that has a positive effect, we do not know at this point, a, is it a a positive effect, or is it b, causing harm? that is why we need to study these effectively. the first one on the list is -- it looks very good in animal models. it needs to be proven in the humans. there are others such as the biocryst product. you heard about the tekmira d

rug, which is being used in the others you will hear about,. these are just a few of those that will be going into clinical trials and are being used in an experimental way with compassionate use with approval from the fda in certain individuals. b turn to this slide is an important one. slides regarding a vaccine. we've been working on an ebola vaccine for a number of years. he did the original studies shown in animal models to be favorable. we are now at the stage where we are in phase i trials, started september, when a second vaccine was started a couple of days by the u.s. military in collaboration with nih. when we finished those trials, namely asking is it safe, and doesn't induce a response that you would predict would be protective, it is important to make sure it is safe, if this

parameters are met, we will advance to a much larger trial in larger numbers of individuals isdetermine if it actually effective as well as not having a paradoxical negative ella terry is effect. the reason we think this is important is that if we do not until the epidemic with pure public health measures, it is entirely conceivable that we may need a vaccine and it is important to prove that it is safe and effective. i would like to close by making an announcement to this entity, because i am sure you will have a her about it soon in the pressprich this evening, tonight, we will be admitting to the clinical studies unit, the special clinical studies unit at the national institutes of am, otherwiseh known as nurse number one. to nih. be coming we will be supplying her with state-of-the-art care in our high-level containment facilities. thank you very much, mr. chairman. >> thank you.

dr. robinson? >> good afternoon, chairman durfee, chairman upton, and others of the subcommittee. thank you for the opportunity to speak today by the efforts on the ebola. i am dr. robertson, a former vaccine developer, and i have been working on pandemic and bio threats. is the government agency responsible for supporting advanced development and procurement of novel countermeasures such as vaccines, drugs, diagnostics, and medical devices for the entire nation. barda exists to address consequences of violence rates best of bio threats. it supports development for man-made threats on a routine basis to respond to emerging like h1n1.

today we are responding to ebola . said, when it comes to ebola, the best way to protect our country is to address the current epidemic in africa. barda works with partners to transition the countermeasures from early development into advanced the moment towards ultimate fda approval. since 2006 we have built an advanced pipeline of more than 150 countermeasures for threats. have of these products been fda approved in the last two years, and today we are transitioning several promising vaccines and candidates from ihrly development under an

in ensuring these candidates are available as soon as possible. barda eliza's partnerships with utilizes public and private partnerships. barda has worked a flexible and responsive infrastructure to develop and manufacture medical countermeasures. pandemic, and the approved framework has been afforded to federal and industry partners. last year we made five new vaccine and the dates in record time. currently we are working with a wider array of partners, including canada, the u.k., rican countries to make and evaluate these candidates.

barda has established a counter measure infrastructure to respond to immediate public health emergencies. we are using a number of our to make these products available as soon as possible. are on-site at the manufacturer, to provide technical assistance and oversight to expedite availability. we are working with cdc and others in the government and internationally with modeling efforts to look at the ebola out rate as it -- outbreak as it becomes epidemic and other impacts that may occur. barda supports production of medical counters. -- countermeasures. today we are assisting ebola vaccine manufacturers with scale

the production, and we are supporting development and of z mapp, expanding capacity of z alternativerking on antibody candidate to expand production capacity. pending the outcome of animal challenge studies, barda will support additional development to treat ebola patients. under the vaccine front, barda is working to scale up manufacturing of vaccines to commercial scale for clinical studies in africa next year. in addition to efforts in the barda supports other activities and including develop and guidance of patient movement, standards of care, andort and guidance,

ongoing coordination and communication with national and international communities. we face challenges as have been discussed in the coming weeks and months with the ebola and asc continuing, these countermeasures are evaluated. bottom line is my colleagues here and our partners will use all of our collective capabilities to address today's ebola epidemic and be better prepared for future outbreaks. i want to thank the committee for your generous and continuous support and the opportunity to testify. thank you. >> thank you. >> good afternoon. >> will you please all the mike close ashe mike as possible. >> thank you for inviting me to testify today on the ebola

epidemic. my colleagues are determined to do all we can to help end it as quickly as possible. the desire and need for safe and effective vaccines and treatments is overwhelming. fda has taken steps to be proactive and flexible. they're leveraging on our authorities and working to expedite the government, manufacturing, and availability of safe and effective products for ebola. the provided fda advised companies to guide their submissions. we are reviewing data as it is received. these actions help advance the on ofopment of investigativ products as quickly as possible. result, the vaccine candidates being developed by the companies began phase one critical testings on september

2, and the vaccine candidates began similar setting on october 13 the er partnering with u.s. government agencies that support medical product development, including barda and the department of defense. fda was able to authorize the use of the ebola the agnostic test under our emergency authorization within 24 hours of request. of two authorize the use additional tests, and these tests are essential for an effective public health response. we are supporting the world health organization. we are providing technical advice to the who as it worse to assess the role of convalescent asthma in treating patients with ebola. i participate in a consultation focused on vaccines in geneva which included dozens of experts as well as from affected

countries in west africa. participants agreed continued investigation of vaccines must be evaluated in clinical trials and in the most urgent manner. fda is working closely with government colleagues and the vaccine helpers to support this. it is important to note that while we all went access to orediate therapies to cure prevent ebola, the scientific fact is that this investigation of products are in the earliest stages of development. there's tremendous hope that some of these products will help patients, but it is also some may hurt patients and others may have little or no effect. torefore, access investigation of products should be through clinical trials when possible. they allow us to learn about product safety and legacy, and they can provide an adequate means for access.

we are working to develop a protocol to allow conference -- companies to evaluate most products under a common protocol. the goal is to ensure a pool of interpretable data and generate actionable results in the most expeditious manner. it is important for the global community to know the risks and benefits of these products as soon as possible. trials are established, we will continue to enable access to these products when available and requested by clinicians. we have mechanisms such as compassionate use which allow access an investigation products outside of clinical trials when we assess that the expected benefits outweigh the potential risks for the patient. ebolatell you that every patients in the u.s. has been treated with at least one investigational product. acause ebola is such

serious disease, fda has approved such requests within a matter of a few hours and often times in less than one hour. fdae are more than 250 staff involved in this, and everyone has been proactive, thoughtful, and adaptive to the complex situation that has emerged. we are committed to sustaining our engagement to support a response to the ebola epidemic rate thank you, and i will take your questions later. >> thank you. you recognize for five minutes. >> thank you for the opportunity to discuss the efforts of u.s. customs and border reduction in deterring ebola. each day about one million travelers arrive in the united states. cdc is responsible for travel in the airports.

within this broad responsibility, our mission remains to prevent terrorists and weapons from entering the united states. we play an important role in of disease inductionn into our countries. cdp officers assess each cover for signs of illness. in response to the recent virus outbreak in west africa, we are working to ensure that front-line officers are provided information and equipment needed to identify and respond to international travelers who may pose a threat to public health. all cvp officers are provided training to addressing any transmission of the fires. healthcludes public training to identify through observation and questioning the symptoms of ill travelers.

cvp also provides training for how to respond to travelers with potentially illness, including referring people for secondary screening as well as training with implementation of quarantine protocols for it provides training for its personnel of blood-borne n, other preventive measures. we are committed to ensuring our field personnel have the most accurate information regarding this virus. information sharing is critical, and cvp engages with health and medical authorities. has station and officer at

our national carding center to provide expertise and facilitate requests for information. cvp beganctober 1, providing information notices to travelers entering the united states. provides the travel information and instruction should he or she have a concern of possible infection. in addition to screening all passengers for wellness, starting october 11, cvp and cdc began enhanced screening of travelers of the three countries, and we have expanded efforts at dulles, atlanta, newark. in coordination with cdc, these travelers are asked to complete a cdc questionnaire, provide contact information, and have their temperature check. based on these efforts, cdc quarantine officers will make a

public health assessment. since the measures went into effect, cdc has done enhanced screening at on travelers for individuals known to have traveled through the one of these three affected countries. 13 travelers were identified by officers as needing additional screening applied on all ports of entry. a total of eight of these travelers have been sent to tertiary very screening by cdc and it is important at all passengers were examined and released. receivep training, if they identify a traveler believed to be ill, they will isolate the traveler and contact the local cdc quarantine officer, along with local public health authorities. cvp officers are trained to employ universal precautions in infection control when they encounter individuals with overdose and tons of illness or

contaminated items in examinations of baggage and cargo. when necessary cvp will take the appropriate measures based on the level of potential exposures. these are designed to minimize risk to the public and have been utilized collaboratively on a number of occasions. cvp will continue to monitor the ebola outbreak with information to our personnel, and we are working with partners to evolve measures as needed to deter the spread of ebola in the united states. thank you for the opportunity to testify today. speak with dr. varga. >> good afternoon, chairman murphy, ranking member degette. i'm the chief clinical officer texas health resources.

i am board certified in internal medicine and have more than 24 years in medical education and health care administration. i'm truly sorry i cannot be with you in person today, and i appreciate committee plus understanding of our situation and how important it is for me to be in dallas. texas health, presbyterian hospital is one of 13 acute-care hospitals. we are an 898 bed hospital treating some of the most complicated cases in north texas in terms of -- texas health dulles is recognized as a magnet facility for excellence in nursing. texas health resources is one of the largest state-based centers, not-for-profit health systems in

the united states and the largest in texas. our mission is to improve the health of the people and the communities we serve, and we care for all patients regardless of their ability to pay. community anderse we provide one standard of care for all, regardless of race or country of origin. as the first hospital in the country to both diagnose and treat a patient with ebola, we are committed to using our experience to help other hospitals and health care providers, protect public health against this insidious virus. it is hard for me to put into words how we felt when our patient thomas dunkin lost his n lost his- dunca struggle. it was devastating to the teen 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, best intentions and a highly

skilled medical team, we made mistakes. we did not correctly diagnose his symptoms as those of ebola and we are deeply sorry. also, in her effort to communicate to the public weekly and transparently, we inadvertently provided information that was inaccurate and had to be corrected. unsettling towas a community already concerned and confused them and we have learned from that experience as well. a nurse from our hospital family who courageously care for mr. duncan was also diagnosed with ebola. our team is dedicated to help her win that fight, and on tuesday her condition was upgraded to good, and as mentioned earlier, nina's care continues to evolve. prayers ofl you the the entire texas health system are with her. yesterday, we identified second can giver with ebola, and i

also tell you our thoughts and prayers remain with her as well. a lot is being said about what they are may not have occurred amber to nina and contract ebola. we know they are both extremely skilled nurses and were using for protective measures under the cdc protocols, so we do not know how and when they were infected. anis clear there was exposure somewhere sometime, and we are poring over records and observations and doing all we can to find the answers. you have asked about the sequence of events with regard to our preparedness for ebola and treatment of mr. duncan. events from our timeline are attached to our statement, but here is an overview. as the epidemic in africa worsened over the summer, texas health hospitals and facilities begin advocating propositions and risksms

associated with the virus. there was an advisory received about the disease and it was shared with other personnel. the health care advisory and courage all providers in the u.s. to consider ebd and the diagnosis of the onus, in other words, a fever, in person to it recently traveled to affected countries. the cdc adviser was sent to all directors of our emerging departments and signs were all posted in the e.d.'s. all regional hospital leaders and leadership across our system received an e-mail directing all had at a policy in place to address how to care for patients with ebola-like systems. the e-mail also drew attention to the fact that our electronic health record documentation in

emergency departments included a question about travel has treat to be completed on every patient . attachments to the e-mail included a draft emergency policy that specifically d, a poster, and a cdc advisory from 7/28. of u.s.st 1 guidelines patients suspected to have the disease was the ship is to staff, including the physicians and nurses on august 1 and august 4. over the last two months, the dallas county health and community services department indicated with us for a possible case of ebola. we have also provided the august 27 thousand county health department, rhythm and screening questionnaire. at 10:30 p.m. on september 25, texasncan, presented to health, emerge with a fever

and1,0 with nausea headache. he was examined and underwent numerous tests over a time of four hours. hisng his time in the e.d., temperature spike to one of three. it later dropped to 101.2. he was discharged early on the morning of september 26 and we provided a timeline on the n's initialr. dunca emergency department visited on september 20, he was transported to hospital on the ambulance. he met several criteria of the ebola outdoor them. the cdc was notified, hospital in texasall cdc department of state recommendations in an effort to ensure the safety of patients, hospital staff, volunteers, nurses, decisions, and visitors. perfect if equipment into the water-in per meal counts, high protection and gloves.

since the patient was having diary, shoe covers was shortly thereafter added. we notified the dallas county services department and their infectious disease personnel arrived shortly after. 30, ebola wasth diagnosed. later that day, cdc was notified, and they arrived october 1. >> doctor, one moment please. we are going way over time. we want to hear some details, but could you wrap up, because a lot of members want to ask you questions. >> ok. >> thank you. >> thank you. i would like to underscore we have taken all the steps possible to maximize the safety of our workers, patients, and community, and we will continue to make changes. we are determined to be an agent

of change across the u.s. health-care system by helping our peers benefit from her experience. lo has a long history of excellence. thank you for the opportunity to testify. each will be recognizing person on the committee for five minutes of questioning. we will keep a strict time on this. let me start off here with dr. frieden, a second nurse took a flight to cleveland after she registered a fever. we have reports she said she told she cdc and was could fly? >> my understanding was she contacted cdc. >> were you part of that conversation? >> no, i was not.

>> was there a plan that limited the her contacts with other citizens? >> the protocol for people moving and monitoring people who are exposed to ebola identifies as high risk someone you did not wear appropriate her some protective equipment during the time they care for a patient with ebola. what specifically did she tell you? uncan's team was not under the same observation, so what did she tell you her systems were? seen the not transcript of the conversation. my understanding is she reported no symptoms to us. >> another question, quickly. regard to the new patient being transferred to nih, will people come into contact with her be under travel r

restrictions? >> according to the guidelines that the people who will be coming into contact with her will be physicians, nurses, and others who will be in personal protective equipment. therefore, they are not restricted. >> why is she being transferred? >> to get the state-of-the-art care in a containment facility. conditionr deteriorated or improved? >> she has not paid at this point from the report we are getting from dallas is her condition is stable and she seems to be doing reasonably well. i have to verify that myself when my team goes over there. >> if other people come to dallas, will they also come to nih? >> we have a limited vast database of being able to do this level of care in containment. our total right now is to bed. she walked by one of them. phone, we spoke on the

you remained opposed to travel restrictions, he said cutting commercial ties will hurt these fledgling moccasins. is this your opinion, or did someone advise you, someone within the administration, where did this opinion come from that is of high importance? >> my sole concern is to protect americans. we can do that by continuing to take the steps we are taking here as well as to-- >> did someone advise you on that, someone outside of yourself? >> my recollection of that conversation is that that discussion was in the context of our ability to stop the epidemic at the source. >> but we can get supplies and medical personnel into the ebola hot zones, so stopping planes, and i have heard you say this in multiple occasions, we have

1000-plus persons per week coming out of the united states from hot zones, am i correct on that -- coming from those areas? >> there are approximately 100 to 150 per day. impactsuncan case dallas and northern ohio. my understanding is bringing ebola cases into the united states, clearly, you have determined how many infection raises the u.s. public can handle. nih can handle two of these beds. do you know how many across the country? >> our goal is no -- >> i understand. as long as we are not partying people, we still have a risk. these issues of surveillance and containment i do not understand. this is the question the american public is asking. why are we still allowing folks to come over here and once they are over here no quarantine? >> are fundamental mission is to protect millions.

right now we are able to attract everyone who comes in. >> [indiscernible] my concern is the american people say they are not limited from travel, not 14 421 days because they can still show up with symptoms, still bypass questions. and this is what happened with the nurse who went to cleveland. so i'm concerned here, is this maintainbe a position of the administration that there will be no travel restrictions? >> we will consider any options to better protect americans. degew five minutes to ms. tte. >> thank you. i have question for you and i would appreciate yes or no answers because i have a lot to move through and only a short time. dr. frieden, and the spring of 2014, ebola again spreading to west africa causing concern

within the international public health community, correct? >> correct. >> beginning often with a fever, correct? >> between two and 21 days. through is contracted bodily fluids, and the virus concentrate more heavily as the patient becomes sicker, presenting increasingly greater risks to those who may come into contact with them, correct? >> correct. >> the cdc has developed guidance if haitians consistent with ebola symptoms and has distributed them to hospitals in 2014, correct? >> correct. varga, your hospital received the first health advisory on july 28, and this advisory was given to the

directors of your emergency departments and signage was posted in the emergency room, is that right? >> yes. >> was this much information given to your emergency room personnel, and was there any training at texas respiratory and for the staff at that time? yes or no? >> it was given to the emergency department. >> was the actual training? >> no. hospitalust 1, your received an e-mail from the cdc specifying how to care for ebola patients, and advising intake or smelled asking question about travel history from west africa him is that right? >> is correct. >> on september 25, almost two months after the first advisor received by the hospital, thomas duncan showed up with a fever that spiked up to one of three and he told the personnel that he had come from liberia. despite this, the hospital sent him home, is that right? >> not completely correct. >> they did send him home,

right? >> >> that is correct. three days later on september 28, he took a severe turn for the worse. the hospital staff and everybody else wore protective equipment, is that right? >> correct. >> eventually put shoe covers on. do you know how long that took? >> i do not. >> because ebola is highly contagious when the patient is symptomatic, the protective gear has to shield them from any contact with bodily fluids, is that right? >> correct. >> i have a slide i would like to put up, and i got it from the new york times, the photo of the people in the various protective gear. the first one on the left shows what they are supposed to wear when they come in contact, when they are not having contact with bodily fluids.

the second one shows what they are supposed to have with the bodily fluids. i want to ask you, dour . varga, if what they were wearing at first, the first set of protective gear? >> i cannot see the picture right now. >> i was told you would be able to. after frieden, what should they have been wearing of that protective year before the?ebola was diagnosed >> i cannot make out details, but the recommendation vary as to the risk him including whether the patient is having fiery or vomiting and they exposed health-care workers -- had diarrhea and vomiting. in your testimony, people should have been completely covered, is that right? >> i would have to look at the exact the deals to know what the answer is. >> so your position is they should not be completely covered

if -- >> if they had diarrhea and vomiting, additional coverage is recommended, yes. >> my other question i want to ask him and i am going to have to get dr. varga's testimony since you cannot see my chart. subsequently, a number of people, health-care workers, were put into this group, this particular, is that right, dr. frieden, people who were being monitored? phan wasr 10, nina admitted? >> yes. >> october 13, amber, was ted with a fever and told she could board the plane. >> she did contact our agency and she did board the plane. >> she said she was told to

board the plane. say evilst 22 protocol who are being monitored should not travel by commercial conveyance. >> [indiscernible] >> that is what they say. >> people who are in what is movementntrolled should not board commercial airlines. >> and that is people who have had close contact with these patients, right? that is what your guidelines say? >> it says health-care workers with appropriate equipment do not need to be, but people without personal protective equipment do need to travel by control transfer -- >> mr. chairman, i just asked for the record the interim guidance dated october 22, august guidance dated 1 -- >> without objection.

we need you to get back to the committee to follow up with her question, because your comments you just made to us was that if she was wearing appropriate protective gear, she was ok to travel. if she was not, she did should not have travel. and you told us we do not know. we need to find that out. you, mr. chairman. i think most americans realize you have 21 days. if you go beyond 21 days, your virtually of no risk of ebola. is conceivable that after 14 or 15 days you in fact can still get ebola, as i crept? >> yes. >> i want to go back to the restricting of travel, particularly by non-u.s. citizens, these 150 folks a day into the u.s. from west africa.

the conditions as you talked about, exit, screening, all there are exit screens, so it is perfectly conceivable that someone after 14 days can exit screen, they are ok, no fever, and in fact get to their destination, perhaps in the united states, and have the worst, is that right question mark >> -- is that right? >> yes. >> the fundamental job, to protect the american public, the president does have the legal banority to impose a travel because of health reasons, including ebola. is that not correct? >> i do not have the legal expertise is a question. >> i selling which earlier today. we can share that with you.

he does, from what we understand, and not only an executive order that former president bush issued when he was present, but also the legal standing as well. if you have the authority, and it is my understanding again that a number of african west africa,und around these three nations, in fact have imposed a travel ban from those three countries into their country. is that not true? >> i do not know the details of the restrictions. there are some restrictions. >> it is my understanding they and including jamaica, as i understood in the press, has issued a travel ban from folks coming from west africa. are you aware of that? >> i do not know the details of what other countries have done. i know some of the details and some of them have been in flux. >> i guess the question i have is if other countries are doing the same and as you said the fundamental job of the u.s. now

is to protect american citizens, why cannot we move to a similar ban for folks who may or may not have a fever knowing in fact that the exposure rate 14 days or 15 days is well within the 21 knowing the 150 folks coming a day, not 100% -- 94% in terms of screening from me. airports >> it seems to this is not a failsafe system has been put into place >> thus far. may i give a full answer? >> i look forward to it. >> right now we know who is coming in. eliminateto do travel, the possibility that some will travel over land and come from places and we do not know they're coming in on meaan we will not be able to do awful things.

we will not be able to check them for fever when they leave -- >> can we not have a record of where they have been before, i.e., at passport from a travel status, as they travel from one country to another? ous,orders can be por especially in this part of the world. we will not be able to check them for fever when they leave, when they arrive. you'll not be able, as we do currently, to take a history to see if they were exposed in a arrive. when they arrive, we would not be able to impose quarantine as we now can you have a high-risk contact. we will not be able to obtain information as he do now, including not only name and date of birth, but e-mail addresses, cell phone numbers, addresses, addresses of friends so we can locate them. we would not be able to divide all the information as we do now to state and local health departments so that they can monitor them under supervision. we would not be able to impose conditionalelease,

release on them, or active monitoring if they are exposed -or- two >> my time is expired. i just do not understand. if we have a system in place that requires any airline passenger coming in over seas to make sure they are not on the antiterrorist list that we cannot look at one's travel history and say, no, you're not coming here, not until this situation. be're right, it needs to solved in africa, but until then, we should not be letting these people in, period. >> i recognize mr. waxman. >> thank you. dr. frieden, you have a difficult job. in fact, all of your colleagues who are involved from the different agencies have a difficult job, because this is a fast-moving issue.

to explain things withople and educate them limited information and partial authority. the cdc cannot even do anything in a state. they have to be invited in the state. you cannot tell the states to follow your guidelines. you can give them guidelines read your dealing with a fast-moving situation, you have to strike a balance about informing the public on the one hand and keeping it from taking on the other. 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 academic in the united states come as you have said, on numerous occasions? >> concern is first and foremost caring for people with ebola. that is why we are so concerned with infection control and where

-- anywhere in the health-care system as a whole, to think about travel, because someone who has a fever or other signs of infection needs to be asked where have you been in the past one days, and if they have been in west africa, immediately isolated, assessed, and cared for. >> we have to make sure we monitor health care workers about because they are exposed to people who have ebola. the question has been raised, what about these people coming in from africa, from the countries where the ebola epidemic is taking place? you have been asked why don't we just restrict the travel eith er directly or indirectly from any one coming into those countries. i would like to put up on the screen a map to show the passenger flows from those countries. that map shows -- if you hold it up here -- if you're looking at those particular countries in africa, they could go to any

country in europe, they could go to turkey, egypt, saudi arabia, china, india, other countries in africa, and then from those ther countries, come into united states for it i suppose we could set up i hope your credit card rattus to make sure somebody did not travel from nigeria or cameroon or senegal or any or sierra leone to be sure they do not really get here from any of those countries. that could be our emphasis, but it seems to me what you are saying is that we want to monitor people before they leave his countries to see whether infection and we want to monitor them when they come into these countries to see whether they have these infections. is that what you are proposing to do? >> that is what we are doing. we are able to screen on entry. we are able to determine the risk level if people were to

come in by going over land to another country and then entering without our knowing that they were from these three countries. we would actually lose and that information. currently, we have detailed locating information. we are taking detailed histories and sharing information with state and local health departments so they can do the follow-up that they decide to do. with. fauci, do you agree dr. freeman on this point -- dr. point?en on this >> i do. we know certain countries, where the epidemic is originating, why not stop them? >> i believe dr. frieden and yourself just articulated very clearly, it is understandable

how someone might come to the conclusion that the best approach would be to just seal off the border from 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 of those lines that he showed, that is a big web of things we do not know where we are dealing with. >> so what we know, is this epidemic can spread if there is contact articles from someone who is showing the symptoms of ebola or someone who has been exposed to that individual. if we had a travel ban, would we to hidece these people there are jen, and wouldn't we also not know where they are coming from if they are going out of their way to hide it, a ban, with reference to fighting the epidemic in africa, and the worse the epidemic becomes in west africa, the greater it is

going to become in the united states -- is that your position, dr. fauci? the vice recognize chairman of the full committee for five minutes. >> thank you, mr. chairman. to frieden, you just said chairman upton that we cannot have flight restrictions because of a porous border. worry abouto having an unsecured northern and southern border? >> i was referring to the border of the three countries in africa -- >> you're referring to that border and on our porous border. would it help if we eliminated legal entry? >> we are going to ask them their travel history, where they are coming from, how they arrived -- sufficient.no was

dr. frieden, i would remind you a week before last at the cdc, and i thank you for allowing me to follow-up on some of our committee work, that i recommended a quarantine in the affected region and hold people there. i still think that is something that we should consider. daysntining people for 21 before they leave, it helps every country. i want to go back to an issue that you and i have talked about at the cdc and in a subsequent phone call, and that is the medical waste. u.s. shortly that standard protocols were being followed for disposal of this waste. we know that 20, 25 years ago, hospitals could incinerate their waste. epa regulations now prohibit that in the waste has to be trucked, and they outsource the care of the medical waste, and it results in that going to central processing centers.

so let me ask you this. is it ebola waste as contagious as a patient with ebola? >> ebola waste, waste from ebola patients, and be readily decontaminated. the virus itself is not particularly hardy. is killed by bleach, by a variety of chemicals. ebola waste more dangerous than other medical waste? >> the severity of the infection is higher, so you want to be certain when you're getting rid of it -- >> is the cdc assessing the capabilities of hospitals to manage the waste of ebola patients, and does the cdc allow off-site disposal of ebola medical waste? >> my understanding is the latter question, yes, we work closely with the department of transportation as well as the commercial waste management companies to ensure that capability.

inso we have an added danger having to truck this waste and move it to facilities. are the employees at the processing centers been trained and how to dispose of ebola waste? >> we have detailed guidelines for the disposal of medical waste from the care of ebola patients. >> all right. you and i talked about my troops from fort campbell that are going to be over there, and i have some questions from some of my constituents. are the american troops going to come into contact with any ebola patients or with those exposed to ebola or included in any of these controlled movement groups? >> as i understand it, from the department of defense, their plants should not include any care for patients with ebola or any derek contact with patients from ebola. bet said, would always

careful because there is always the possibility of coming into contact with symptoms and being exposed to their body fluids, that is why the dod is being careful to avoid that possibility. >> we are still going to rely on self-reporting? we are taking temperatures applications in many countries. we have handwashing stations -- >> you're moving away from self-reporting, because originally used said your was based on self-reporting. i found a quotation from december 2011 on the george comstock lecture. have cartridges was right. pocrates was right. you can either delete yourself in whether patients are taking their medications or not but if people say they are taking their

meds, we believe they are taking their meds for it to lying on relying on self reporting, and if they catch the fever at the betterime -- we can do than this and we expect a better outcome. i yelled back. >> mr. braley for five minutes. i was happy to hear you say we will consider every option to protect americans. but i do want to ask you about texas. are you familiar with the concept of sentinel event reporting? >> yes. >> has cdc done a root cause analysis of what happened at texas presbyterian and, with an action plan on what we learn from that incident? we have a checklist for ebola preparedness, which we have heard here today. have there been recommendations

on changing or modifying this in light of what happened at texas presbyterian? >> we have a team of 20 of the top specialists in texas now. we have identified three areas of particular focus. first is the prompt diagnoses of anyone who has fever or other symptoms of infection with a travel history to west africa, and dr. vargas spoke about that issue. the second is contact tracing, and the graphic i provided earlier outlines what we are doing very intensively in the state of texas in the county doing a terrific job along with our stuff making sure that every single contact with mr. duncan is monitored and the temperature taken by an outreach worker every day for 21 days good most of the way through that risk period. of the 48, none have developed symptoms, none have developed fever. --are looking at the contact

the health care workers who may have had contact, as well as the 2 individuals who became affected, our thoughts are with them, and we are delighted that nih is supporting the hospital in texas and at emory university is doing that as well. the third area is after identification and contact tracing, effective isolation. we are looking closely at what might have happened to result in those exposures. i assume if there are any new recommendations based upon that analysis, the protocol that was sent out will be updated and redistributed? >> we always look at it data to see what we can do to better protect americans. >> thank you. youfound -- dr. fauci, share with us this graphic and you mentioned a company in ames, iowa working on one of the vaccines that went into clinical trials this week, correct? >> that is correct. >> i had an opportunity to talk

to two of their employees and i know they are working around-the-clock to help, with a vaccine that will meet the protocol and the standards for scalability that i think everyone is looking for. defense,department of hhs have called this vaccine one of the most advanced in the world and they have requested to expandwith hhs manufacturing, to add a third site for manufacturing, to complete the scientific studies required for manufacturing, and to complete the safety study to provide newly manufactured vaccines equivalent to the original vaccines, and they have also identify companies to work with subcontractors. dr. robinson, can you tell us what hhs is doing to make sure that the 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. 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. that the dr. robinson, 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 ride in a fight earlier in your testimony's death that were identified earlier in your testimony 00

--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. 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 checd 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. >>