should -- yes or no? >> we are learning new things about ebola. ebola has never been in this hemisphere before. we are developing procedures as quickly as possible. >> to the extent the virus is transmitted in the same way when we look at the logistics, the acquisition management, the answer would yes. >> this is outside our purview. >> with that, i will go to the gentlelady from new york. >> thank you. i would first like to thank all of our distinguished panelists for coming today during what is a critical time in the federal government's response to an urgent global crisis. first, i would like to take a moment to commend the health care professionals in new york city for their outstanding response yesterday to our first

new york city has been working with new york state come in the center for disease control prepare for this in our nation's largest city, based on what we know now, i believe they have responded and done absolutely everything right. a young physician had returned from west africa 10 days ago where he had been working on the ebola crisis with the dock or is -- doctors without borders. upon arrival into the united states, the doctor was flagged by the cdc and the customs and border patrol and reported to new york city health authorities. yesterday when he reported he had a 103-degree temperature and was experiencing pain and nausea among the new york city health care system spring into action. the patient was immediately transported to a specialty

trained unit wearing protective equipment to bellevue hospital. the hospital has been designated for the identification of potential ebola patients by the city and state officials. governor cuomo has designated a special hospitals in new york city. earlier this week, a specially trained cdc team visited bellevue and determined that the hospital has been trained and proper protocols and is well prepared to treat patients. i must say that i respond to your concerns about nurses and at the hospital there were clear protocols in place established by the health department to ensure that nurses and all staff caring for the patient follow the strictest safety guidelines and protocols. contact teams are ready to quickly identify, notify and if

necessary quarantine any contacts the patient may have had on history tips on the subway visit to a restaurant and a ride in a taxicab. the health department is now working with the hh the leadership, bellevue's clinical team and the new york state department of health. and the cdc is assisting us daily in this effort. they are in close communications at the new york city health department, bellevue hospital. i would say all elected officials and they are providing technical assistance and resources. the cdc already had a team of ebola experts in new york city. they were already there to help. members were flown and last night for the cdc leave the so-called cert team to join colleagues already on the ground

and we are told that for cdc professionals will come in if needed. the cdc at ebola response team will arrive within 24 hours to any location in the united states where he cases reported and so far this is absolutely true. it is what has happened in new york city. this week on the cdc named new york city as one of six states who will begin active post-arrival monitoring of travelers whose travel originates in either liberia, sierra leone or ginny and arrive -- guinea and arrive at one of the five airports in the united states doing enhanced screening. active post-arrival monitoring means that travelers without fever or symptoms consistent with the ebola symptoms will be followed up daily by state and local health departments for 21 days from the date of their departure from west africa.

an active post-arrival monitoring will begin on one -- monday, october 27th. i want to reiterate that ebola is not airborne. someone affected can only transmit the virus as they are experiencing symptoms, bodily fluids in direct contact, vomiting, blood, saliva. there are over 9000 reported cases in over 4000 ballots. i am told that the american health system is now actively reviewing to vaccines. they are in clinical trials and are responding. my question really is to you, dr. lurie about the hospital preparedness program. first i would like to request a this statement prepared by the trust for america's health, a nonprofit. >> without objection placed in the record. >> it talks about the need for enhanced funding, that are

funding is not up to the threat our country faces. i would like to ask you, how does the program help ensure that our hospitals that are so designated across america are prepared to respond in a health emergency. i would like to thank your program for the help you gave to the great city of new york via -- thank you. >> a gentlelady's time is expired, they of course can answer. >> thank you so much. we were very gratified last night to see the kudos to the program and the kudos to new york city for their tremendous job in responding. our program gives money to states and in the case of new york city, directly to new york city to help the health care system become prepared. it is defined as a set of a basic things that every health care facility needs to do and provides the funding for training for exercising were -- for planning for other things

necessary for hospitals and other health care facilities to be prepared. it is in fact that bellevue and other hospitals in new york city have to do such a tremendous job getting ready for this and we will continue to support them through this program and others as they move forward. >> thank you. the gentleman from florida, mr. mica. >> first, i have to take a point of personal privilege. i apologize for being on a plane. the committee should know, you know, the country faces to the credible threats right now. one is isis, the threats we've seen that threatens not only the united states, but the world and our allies.

but i accompanied him and we had a democrat member from the foreign relations committee was in iraq. we were in iraq last night as we left there at 6:00 in the evening and flew all night. this is how dedicated he is to make sure that we are prepared over there. in general to get called to do some test status. -- tough stuff. but i saw some men and women and they are just awesome and we had a chance to meet with some of our allies to get them to step up to the plate. but we face that threat nationally, domestically and internationally. we face up to, a very serious threat, dr. torbay, this ain't going away anytime soon, is it? >> all the steps being put in place, it would be contained. >> here's a report i read on the

plane last night that says experts warn the infection rate could reach 10,000 a week by early december. is that semi-accurate? the way things are going now. this is a report i got on probably the people that are most at risk are health care workers, whether they are or here. correct? pretty high fatality, right? >> that's correct. >> thank you, ms. burger for representing the nurses. do we know how those nurses were infected or exposed, how they caught ebola for sure? >> tanks to the whistleblowing

efforts of briand, we know that the nurses did not have optimal standards for personal protection. >> so we know that they weren't properly protected. >> or trained. >> dr. lurie, you said we are putting additional protocols in place, right? what is the most recent? >> the most recent personal protective equipment has been in the last couple of days. it was changed in response to the situation. >> so when the last couple of days. he said airport screening. when was screening. when was that instituted, the new guidelines? >> i can't recall exactly. but the funneling into the airports within response in the last week. >> i can tell you it is not working, okay? all we got to do is look at

craig spencer. he was tested there. it is not working. now he is a medical professional. he reported himself. and then you see cases where again, we are not prepared still. part of this hearing is all about mr. roth report. right, mr. roth? we spent millions of dollars getting prepared. didn't you just testified that in fact, on page seven year, 200,000 of our pandemic respirators have gone beyond their five year manufacturer warranty? >> ones the tsa -- 84% of the hand sanitizer is

expired. is that right? how do i tell the american people that we are prepared, we spent millions of dollars. you were just in your testimony talking about how it's important that the right protection. almost all the equipment in this report in fact it's either out of date. it was the purchasing made no sense, we don't know who is going to get it. isn't that right? >> you are correct. >> the gentleman's time is expired. >> your report is correct. >> thank you. >> thank you. the gentleman from massachusetts.

>> nina pham is ebola-free. is thatgood bit of news the united states has taken a lead in the international response to this and we don't often give credit where it's due i'm not and we should all be proud this country at this recognize that we have issues with our own country or that we have to deal with in terms of people that may be exposed or come down with the disease in this country or be here treating somebody but that we to have to go to the source with the shock and awe kind of approach. so we need all the things that mr. torbay talked about. are the people that are supplied and trained and equipped sufficiently to get the job done.

so my first question might be to mr. lumpkin and dr. lurie and mr. torbay, is the international effort now large enough? is it well enough coordinated? what remains to be done and by whom? mr. lumpkin. >> in west africa, u.s. leadership is galvanizing support on the international front. we have gone in with speed and scale so they are coalescing in order to fight the epidemic. >> are the people well-trained and equipped enough? is the responsive sufficient enough and who should he

responsible in what remains to be done if anything? >> the situation west africa has taken time to get the resources in place there. u.s. leadership has been important. as a result of that, we're finally seeing many other countries of the world step up to put resources in west africa. is it well enough coordinated to start containing the situation and bringing it around? >> the u.s. and the u.k. have stepped up. now it is time to the rest of the world to follow suit. we are starting the training in sierra leone. in the next few weeks the training would be up to speed, which is critical. supplies are coming in.

the different levels are coming in and we hope the pipeline will continue. i think the other countries need to step up. we cannot forget about guinea and containment of the ebola in guinea. this is where you started. the economical -- the economic toll is just phenomenal. we need to think about technology as well. the development of vaccine is critical, but also the companies need to start thinking about creative ways when they come back and monitor instead of having to rely on patients checking the temperatures twice a day. i think if the international interventions continue at the same pace that it is now, i think it will be contained within the next four to six months. i would also like to thank the

department of defense for putting a lab next to our [indiscernible]. and this has cut down three to five days to five to seven hours. >> thank you. last question. this is not new. ebola has been around for a while. people think we could've done a lot further along in terms of either treatment or medicine on that. there is that no profit motive sufficiently involved on that. what are we doing anything along the situation in the chairman's question earlier. what do we do to make sure we

have the forward thinking that the free market and profit motive, what are we going to do as a public policy? >> that's a great question and i thank you. were it not for the investments in getting going with vaccines and therapeutics, we would be nowhere near where we are now with the safety testing of two promising vaccine candidates going on and soon to be testing some therapeutics. so we need to think about emerging diseases. we need to think about developing countermeasures and we appreciate the support for the biomedical advanced research and development authority and they have helped us to ensure

and they have helped us to ensure there is a market and ensure product developers and manufacturers will work on these threats. >> you talk about public financing being used to establish markets as opposed to the private industry on a going out and trained to work with the free-market aspects? and tremendous models we develop -- >> it has been about bio threats are about pandemic flu that i really make it not possible, yes. >> thank you. gentleman from north carolina. >> thank you, mr. chairman. my questions are for the assistant secretary and for the general. our men and women in uniform are in regions affected by ebola. to their parents, their mothers and fathers of these men and women, do you have every confidence that they have every bit of equipment they need to be protected, to be safe and return healthy?

>> the safety of our servicemembers. >> the right answer is yes. >> is absolutely paramount and you can never mitigate and we've taken all the steps. -- risk to zero, we have tkaen all the steps to mitigate the risk. my answer is yes. >> we are making every effort to ensure that the troops of the -- have the training and equipment so they can return home safely. >> mr. lumpkin, you said in your opening statement that if in fact they, if someone contracts ebola in country, they will be returned to the united states. is that correct? >> i did not say that in my

opening statement. >> you mention the cdc facility where treatment will be given. if somebody comes down ill in country, how will they be cared for? will they be cared for in country or will they be returned to the united states? >> returned to the united states. i defer to my staff counterpart on the specifics. >> thank you for the questions. to take care of the groups in country, there'll be two hospitals. one established in sierra leone. the medical personnel there will be trained in how to treat ebola .ictims if a u.s. uniform military person does in fact contract it. disaster? they are treated in country. if they identified for some reason it's having high-risk exposure and exhibits sent tons -- symptoms, they will be cared for initially in country and

moved home. if they are age symptomatic, on a dod aircraft. >> how many aircraft are outfitted to move these individuals out of country in the event this happens? controlled movement, any aircraft can do. so any aircraft, at the present time, the only aircraft that can move the symptomatic patients is the phoenix air contract to use a moving. >> how many patients can the aircraft told? >> one at a time, four movements a week. >> is that sufficient? >> given the number of ebola patient the united states is the united states has had total at the present time, it is sufficient. >> so at this time the department of defense has a statement worked through the system to put together an

isolation pod that can carry multiple persons for aircraft testing and -- i'm sorry, development will begin in october as testing in december procurement will begin in january. >> in january. >> how many individuals will be able to transfer? >> 15. >> 15 at the time of the turnaround. >> we hope to procure a number of these systems so they can be put on any c-17 so we could move multiple c-17's. >> so we can take less than 10 people out of country in a weeks time. >> if they are symptomatic. >> so this is not at all sufficient. >> at current time, we will not be doing direct patient care and

so we anticipate -- >> i understand. how many american troops will we have in the region by the end of the year? what is our maximum? >> 3000. >> 3000. this is very disconcerting. mr. lumpkin, is it a question of resources? does congress need to appropriate funds that we can get more planes, more logistical support here so that we can have the capacity if something absolutely horrible happens to our fighting men and women in country? >> we clearly have an identified requirement. >> i think you should get familiar with that position process. if we currently have one plane controlled by the state department, i am asking the department of defense at the mass number of airplanes come equipped in a training capacity

we have, nearly expending half a trillion dollars annually on the department of defense if you need it, we look at it. we will demand it. if we are putting men and women in harms way, potentially where they contract ebola, the idea we have one airplane in the united states to get these men and women out of country in a safe manner if they contract what is absolutely horrible, which we want to control, which we absolutely want to control. the idea that you come before us and giving us this type of testimony raises great concerns. i know you have been asked to do a lot and i absolutely respect that. though we are asking you in the legislative branch to tell us what you need and we look at it. because we don't plan to put our men and women in harms way without any capacity to care for them. our veterans, our fighting men and women deserve the best health care and training in the world and they have it.

but it means the proper protocols are there to make sure they are protected and a something that happens they are immediately taken out of harms way, cared for and return back to their normal state. >> i yield back. >> i think the gentlemen. we now go to the second gentleman from massachusetts, mr. lynch. >> thank you, mr. chairman. i thank you and mr. cummings for holding this hearing. the panel, you've been very helpful. there has been some contrast between the testimony this morning and i want to drill down on that because sometimes that is helpful when people in the panel disagreed. dr. lurie, you testified in the written testimony that we are better prepared than ever and you have one of those comprehensive response on the ground. on the other hand our inspector general, you were commenting on how the analysis you to the dhs

-- done by dhs, how the equipment purchases are not adequate and in some cases the usefulness of the equipment, drugs beyond the expiration date. dr. lurie come you testified you have a very aggressive system in place in the other hand, president burger for national berkshires united said it they've done a survey. they have done a survey of 3000 nurses.

from every state in the union and the district of colombia. they have not been trained to deal with ebola, and preparedness is woefully insufficient and dangerously inadequate. so, those are two different stories of what's going on here. i understand we don't want to panic people, but we also don't need happy talk in terms of what were dealing with. when they come before this especially and there's nothing to worry about. we've got this. that's when i start to worry. now as to who to believe, i think the nurses and the massachusetts association as well and they are on the ground. they are in the battle against ebola. they are the ground troops, doing this work everyday. they are exposing themselves in her haps their families, perhaps their families if things go wrong, if they don't have the adequate equipment. so when they tell me that they are not prepared, i tend to believe them. i think those are facts.

and we need to make sure that we get the equipment and training they need to protect themselves and protect our communities and protect their families. there are a couple of facts that we've gotten in the briefings from the various panelists. one fact is that the cdc estimates by this january there will be up to 1.2 million people in west africa afflicted with ebola, 1.2 million. the estimate by dod is 1.2 million, 1.2 million in january. now they were done at different times, so the difference might be just a period of time that they were taken if things go as they are right now, 1.4 million. we've got a real and present danger to the people of west

africa and the people of the united states who i am pledged to protect. now i understand it is a post-arrival approach. we are gonna have these hospitals as people arrive from west africa, we are going to begin an analysis in making sure they are not carrying ebola. it seems to me and mr. torbay, yet powerful testimony, a lot of written it quite frankly and you have had a chance to talk about it, the u.s.a. -- you were saying that the focus should be on west africa. what we are setting up here right now with this post-arrival in the u.s. approach is we are going to set up these hospitals, all of this equipment, everything here in the united states and wait for those folks

to arrive. and i believe we should be doing the opposite, but we should also be doing something else that matters predeparture. instead of the restriction here in the united states, there should be a 21 day preapproval. they need to present themselves and report in person until they get on that plane. we can take the temperature in a -- and a blood sample is necessary. so 21 days later when they appear to travel, we test them again. now we've got to contact points on a person before they fly to the u.s. and we can also do the post-arrival check as well.

we are not taking this seriously enough. we are not. we need to help our brothers and sisters in west africa absolutely. but we've got to have a fact-based approach to this. this can't be just about ideology and happy talk. we have to look at this very seriously and have a scientific-based approach to what we are going to do about this problem. i don't think it helps to say we've got an aggressive thing on the ground. everything is good. i've got a feeling you'll come back again as a whole different story. we've heard that before. we've got to post this in a very -- approach this in a deliberate manner and take a much more seriously than what i am hearing here today. we owe that to the citizens they -- we represent in the united states as well as the individuals in west africa who want to support as well.

mr. torbay, let me ask a question. think about this. if we are putting our folks all over the world, medical personnel on the ground, in monrovia or freetown, wouldn't it be better, wouldn't it strengthen the infrastructure there on the ground in west africa as opposed to just having a post-arrival process here in the united states? >> thank you for your question, mr. lynch. as i mentioned, it needs to be contained at the source in west africa. this is where the majority of the investment needs to take place, this is where equipment and supplies need to take place and this is where most of the

investment needs to take place. that said, we cannot just focus on one without the other. we are treating the symptoms of the outbreak of west africa. we need to deal with the root cause of the problem and that is actually at the community level of west africa. i believe there are some temperatures being taken being before they take the flight. >> they do on the plane. i'm talking about doing something 21 days before steve got two contact points that you cannot measurements on. it is not foolproof, but having two contact points there in west africa. >> okay, mr. chairman. thank you for your indulgence. >> quick response, mr. torbay.

>> we are having difficulty recruiting health personnel. wait 21 days, that is nine weeks and it's extremely difficult to allow doctors and nurses after nine weeks before they come back. we cannot completely wrap ourselves in a bubble here. people will go from guinea or sierra leone and wait a couple of days and come here and there's not much we can stop for doing that. so the preparedness needs to take place at both ends. >> so there's only a few flights. >> we've got to move on. i thank the gentleman for his good points. dr. lurie, when you are in front of congress in 2011, the reauthorization of the pandemic act, that created your agency in

your position, you had an exchange with mr. rogers, colleague of ours. he said this. there is somebody that makes the decision, somebody absolutely in charge. not cdc, not nih, not fda or anyone else. it is here. his response was, that's right. you're the key person, right? >> my role is to be the principal at pfizer to the secretary, yes. >> you are the keepers of the government for medical preparedness public health emergencies. >> in hhs. >> got it. >> i want to put up a couple slides. just to be clear, you are the person, your agency in response to lead the nation in preventing, preparing for public health emergencies and disasters. further down, the secretary of hhs delegates to the leadership role of all health, medical services support, function and health emergency and public health events. you are the key person. correct?

>> that's what the legislation said, yes. >> your website confirms that. you are the key person. have you met with the new ebola response coordinator? >> yes, i met with him his first day and had several conversations. >> we expect that to happen. the story that says 39 million worth of nih funding that could have gone to an ebola vaccine. are you familiar with that story? are you familiar with the

$275,000 on a restaurant intervention to develop a new menu was spent at nih dollars? $2000 to encourage seniors to join choirs, are you familiar with that? $39 million of nih funding was spent for all kinds of things. i guess, just cut to the chase. one of the things you learn in your first economics, not that i was a great student, but i did study economics. one of the things they tell you is opportunity cost. when you spend and allocate resources for one thing come you by definition can't use those resources for something else. why in fact did we spend so much money on, for example, $374,000

for preschoolers when in fact some of those money as cadillac -- as catalogued by the press account could've been used to help with treatment for something like ebola and potentially vaccines. are you involved in the decision that nih makes when they decide how to allocate money? >> i'm involved in the decisions related to bio defense and preparedness programs. , d.o.d., dhs, allrtment of agriculture work together on these issues. >> are you the point person and coordinating all of that? >> yes. >> at some point you have to sign off and say it's ok that $374,000 is used for puppet potentiallyd of

being used, losing the opportunity to use that money to develop a vaccine to deal with something like ebola. >> at like to do a little bit of clarification here. there's misunderstanding about how it's allocated, but that is not my responsibility. >> let me go back to the exchange you had with mr. rogers when we were reauthorizing the act that created your position. mr. rogers says this. you said this when you responded to mr. rogers. you are in fact in charge. >> yes. >> you are the key person at hhs. you said i have found through experience that indeed i have the authority that i need to be in charge. you follow up by saying i find that the collaboration with sister agencies and hhs, i don't think it has never been better. we're working extremely close

together. i think they recognize and respect the fact we provide policy direction and are in charge. all the efforts we've undertaken across hhs have done that. you told mr. rogers when we were discussing whether we would have the key position that in fact everything was working great. you were the person in charge within hhs cordoning policy, direction and you were in charge of working closely together. >> and i would stand by that statement. >> back to the key question. might we be closer to having a vaccine today if you aren't allowing all this millions of dollars, $39 million to be spent on what many americans view as questionable uses for tax dollars, particularly when we have the outbreak in the united states. >> thanks to the investments we've had in bio defense and our focus and department of defense on this critical issue over the past decade. we now have two vaccines in

safety testing and at the nih and walter reed. >> dr. lurie, that is my point. might they be further in testing if you had not wasted $39 million on things most taxpayers think they're ridiculous. in fact, can we put up the second slide. the second slide specifically mentions, ebola, you were you were supposed to be getting ready for this. might be more ready if you hadn't spent $39 million of hard-earned taxpayer money and puppet shows for preschoolers and invested in vaccines for ebola. yes or no. might we be the further along if the money had not been spent someplace and could've been applied to the question at hand. >> the develop mint is a long and complicated. >> is a complicated.

$39 million could've been used for it. you work closely for policy direction. those are your words not mine. >> i am not in a position to comment on the overall nih budget. >> the gentleman is recognized. >> i thank the chair. i think the main public health message of this hearing is probably counterintuitive that at least for u.s. citizens, we face probably more risk from the flu. so hopefully everyone will be getting their flu shot after hearing this hearing. there are many other public health precautions we should be taking such as handwashing at -- and things like that which are too often neglected. back to ebola, the public is concerned that we are doing too little too late. so i would like to explore some of the gating factors that might limit an appropriate response. mr. torbay was very specific in

his testimony, mentioning that obviously manufacturers are 35% of the estimated demand for the appropriate type of cover all. and you could explore what you can do to augment the supply of those essential coveralls. >> i like to clarify this manufacturers with a specific type different than other organizations used. i do not remember the manufacturers, but i'd be more than happy to provide comments in writing after the testimony for the record. >> of course we all hope on the committee that we don't get the point where we need augmented emergency flights by dod to shift our soldiers back home. but mr. mchenry asked appropriate questions. those are men and women in uniform and their families want to know they will be sufficient capacity to get them back home.

one of the concerns of the public is three health workers have been infected in the u.s. and one actually oversees returning. i think we're all looking for the right sort of response. this doctor in new york, we all hope and pray for her safe recovery, but when he felt sluggish on tuesday, perhaps it would have been more appropriate to limit his contact with others, since he had been exposed to some of the worst infections in africa, but from tuesday to thursday was taken extraordinary taxpayer effort, tracing, all sorts of things to try to limit the risk of exposure. what is the proper protocol for these people during this 10-day period to limit contact? everyone would have to feel sorry for his fiancee or

girlfriend or the other folks he was close to when he is a skilled medical professional who presumably should have known it is a little dicey here. 103all in when he has degree temperature -- is there a better response than that from any of the panelists? it is unrealistic to expect any health care professional working under extremely stressful situations, including mber and several doctors -- you have to remember that they are human. you can't expect them to use their common sense at that point. they are patients. they need a team they report to the checks on them as mr. torbay indicated that follows them and makes the decisions for them so that they are no longer health-care workers, they are patients that need our protection and care.

and so to that end it would make sense to have a professional team monitoring them and making the recommendation recommendations so they can actually relax and not have to worry that they are contaminating or exposing anyone to the infectious disease. that would help in making sure that everyone that volunteers to take care of these patients and puts their own families life at risk actually is well taken care of after their service. >> so you're suggesting doctor spencer should have been viewed as a patient earlier than thursday and should have had a team of counselors to advise him because his judgment could not really be trusted? >> exactly.

>> as far as international response mr. torbay mentioned that we had some individuals in america paul allen and mark zuckerberg have given more than any nation. what can we do to get more nations involved? these other nations what should , we expect of them? >> an all hands on deck approach is necessary. i think the realization that this is not a west african problem but a global problem that could take any country anywhere around the world especially with travel being the way it is. people need to realize the threat and realize any contribution that they can make will make a difference. as you mentioned it contributed more than some countries did, and i think the u.s. government should continue to put pressure on those countries.

>> i see that my time is expired. >> i now recognize the gentleman from michigan, mr. wahlberg. >> general, thank you for your service. the number one question or concern i've been getting on this issue in the past several weeks comes from family members of our the military, active national guard troops, a concern that what they seem go on in places where they expect their family members to have a death sentence as a result being proud members signing onto that and committed to their efforts yet there are concerns that their loved ones haven't been given the necessary tools and rules of

engagement and all the rest to handle what they've been trained for. the biggest concern on the phone calls or meetings in public is that this is a death sentence being sent in to combat a virus and with great uncertainty because of the multitude of changes in protocol, coming from what they hear in the news and in this administration with responsibilities and also the lack of information coming from the military on what they are doing. let me ask if you would just briefly walk us through a daily routine of one of the soldiers that have been sent over to west africa. >> i've spoken to the commander on the ground and the folks at africom.

the protocols for an individuals on the ground for an average soldier and again, i would emphasize first none of the military personnel are providing direct patient care. we have four lines of effort, command and control, logistics, engineering and training as protocols for treating patients isn't something that -- >> but they do come in contact with contractors with -- >> absolutely. >> there is a three feet separation when you are talking to local nationals over there. your average day for a soldier over there would be getting up,

eating chow, doing the morning routine, getting your temperature taken first thing in the morning, going out to whatever task you were going to do. if you are in the command center that involves the command center terminal working on the generators or whatever it is you're doing in the command center. it involves eating only fruits from fruit sources, drinking from bottled water and washing your hands in chlorine solution virtually everywhere you go. at the end of the day every time you come back into the compound at the end of the day where wherever you're going to get your temperature taken again to ensure that you stay ebola free. u.s. military personnel have zmapp or other

experimental drugs on the ground? >> i'm not aware there will be any zmapp available on the ground. the equipment will be issued to them depending on their level of expected exposure. for the vast majority of people that will include gloves, boots, a suit. for the medical personnel would be more along the way for lines for the health care providers. >> doctor lurie, in 2005 the bush administration proposed a change that would allow the cdc power to confine individuals believed to be infected with deadly pathogen mike pandemic flu. >> thank you for the question.

i think with every situation we are always reviewing and taking a look at whether we have the authorities we need to do the job. our system now that it rests with the states and they have authority to do that when they think it's necessary. >> the cdc should have that authority and it should be flexible. don't you think that would be a valuable authority to have? >> >> we are always learning and based on our experience that is what we will be looking at going forward. >> i hope so. i'm not sure that we are adjusting as rapidly as possible and i'm certain we are not giving any type of security to our medical workers, nurses including our citizens out there that we have a solid policy in place that is first and foremost protecting our citizens against these type of problems and i think it's evidence of either

hearing today and hearings that will go on but you're not bringing a sense of security and as a member of congress representing a district i'm expressing the point of view who believe that we are less secure than we ought to be if we could use the policies that we could put in place. mr. chairman and i yield back. >> i will now recognize the gentleman from virginia for six minutes. >> i thank the chair. it seems to me based on what we know in the hearing that united states objectives have to be twofold. domestically it is to protect and prevent. that goal cannot be successful if we don't address the second goal which is to deal with the disease at the source and west africa. -- in west africa. and especially given the fact that we are potentially looking

at an explosion of infection that is exponential in a very short period of time in the next two months it seems to me there is enormous urgency in the latter not to diminish at all the need to address the former. we have some good news today. ms. pham has been declared a ebola free. but dealing with the first part to protect, it wasn't thanks to the protective gear and the guidelines that were in place at her hospital. while the cdc was giving us assurances of how hard it was to contract the disease we are pretty confident we have things in place and so forth. two of the health care workers including ms. nina pham came down with it.

doctor lurie, do you think that perhaps the cdc missteped? >> they said some missteps have been made that they've taken a quick look at the experience and -- >> doctor lurie, i'm asking a public information health question on how to deal with event when i was the head of my county. never reassure the public when you don't know. never do that because it is your credibility. as you've heard from some of the questions on the other side to -- gave them an opening to attack the credibility of the administration by extension. because the cdc wasn't capable of saying not yet. we don't know. it's a work in progress. what's so horrible about doing that? >> i think right now as we look at the situation we see that it is a work in progress and we can see that it's taking constant steps to just a just as we learn

more. >> ms. burger, you indicated he would welcome a law establishing if not executive order preferably a wall that codifies establishing uniform guidelines, uniform protocols so we don't have this up and down. is that correct? >> excuse me, you left out one critical word which is mandatory optimal standards for the personal protection created the cdc guidelines are merely guidelines and all 5,000 hospitals in the usa gets to pick and choose what part of the guidelines they implement. >> i take your point. doctor lurie, would the administration welcomes such legislation and is the president contemplating such executive action? >> one of the things to keep in mind is the federal government

does not license or regulate hospitals in this way. they are regulated primarily by states but i think it's fair to say at this point no hospital wants to see its health-care workers infected. the cdc guidelines provide options for safe protective equipment in large part because there's probably not a one-size-fits-all solution. it's important for people to be able to practice in the equipment that they are using comfortably day-to-day provided that it meets the safety standards the cdc has articulated. >> not sure what that means in terms of whether the administration is contemplating executive order or you would welcome the legislation that would make it mandatory as suggested, but we will be in touch i'm sure. final set of questions mr. torbay. in the united states there are 245 doctors per population and in liberia, 1.4.

in guinea one, sierra leone, 2.2. health spending per capita, $8,895 here in the united states and $65 in liberia. $32 in guinea. cdc says if we don't achieve 70% of the isolation of existing ebola victims in the affected countries, the number of victims you or people with ebola in these areas could reach 1.4 million by january 20. roughly around when the president gives the state of the union address. that is astounding and whatever problems we've got with the relatively limited number of ebola patients in the affected regions obviously becomes enormously magnified when you're

looking at that kind of a number . how in the world do we contain this before it becomes explosive? it's already the largest ebola epidemic ever recorded to but to go from roughly 10,000 or so to 1.4 million in the next two and a half months is job dropping. -- is jaw dropping. >> thank you for the question. there are steps that could be taken and that are being taken and to hopefully never achieve that 1.4 million number and that includes isolation of patients -- for the ebola treatment such as the one at the international running in the county. >> mr. chairman i promise the cdc says if you isolate trey

-- 77% now, you would achieve complete the basement of ebola in the affected regions. in other words, then we are on a path to the complete reversal. >> also we cannot forget the need for the regional preparedness outside of those countries. we know one patient and mali was taken to a hospital. regional preparedness is critical and that includes training the teams and that could also treat ebola, detect contact tracing and it includes community messaging so not the conflicting messages that go out as well as the stalking of supplies needed in case of an outbreak.

this is critical as well and this is an area that is being ignored in terms of preparedness. >> thank you. >> now the gentleman from south carolina mr. gaudi. >> i want to start by thanking the nurses and dr.s, hospital workers, soldiers and others for their courage and their sacrifice. most of us run away from danger and disease and risk and very few people are willing to run towards it so i want to start by thinking that group of people. i want to read you a quote and you tell me if you can tell me who the author of the quote is beginning with the development of a strategy might roll could be to help find the country to be ready for any kind of adverse public health events including a response to any challenges the future may bring. do you know who said that? >> you did. in your page it says you are the secretary for preparedness and

response and your work has included evaluating public health preparedness conducting 32 tabletop exercises on the hypothetical crisis such as smallpox, anthrax, pandemic influenza. another story on you and your career which is an incredibly commendable career said your job is to plan for the unthinkable a global flu pandemic. a bioterror attack, she's on it, massive earthquake, yes she has a plan it commissioned that includes both science and a communication strategy. so i was sitting there thinking here we have a dr. with an incredible background in medicine who also happens to plan for crises like ebola whose job description also includes communication strategies. so why in the hell did the president pick a lawyer to be

the ebola czar and not you? >> can i take one moment to verify my answer about the question because i think that i didn't understand it fully. the cdc has ample authority to do but it needs to do. and it's use to those authority many times. the proposed regulation would have refined the process but the underlining statute already gives the authority that is needed. >> the record is now complete with respect to door position on the quarantine. now i want a record to be complete on why in the world of the president pick a lawyer to head the ebola crisis instead of somebody with your varied background. >> and i appreciate the confidence. the role of the coordinator in the white house is a whole of

government coordination role. >> i appreciate that, dr. lurie, but he's not a doctor, he is not an osteopath come he's not a nurse come he's not an epidemiologist, he doesn't have a background in communicable disease, he doesn't have a background in infectious disease, he doesn't have a background in west africa so how in the world is he the best person to be the ebola czar and not you -- and i don't want to hurt the secretary's career and i fear that i will by complimenting her but she is an incredibly bright person, one of the more capable people i've met in the last ten years is your boss, the secretary of hhs. we disagree on fairness on a lot of policy, but she actually has a background through her work in the foundation in global health.

you're a doctor. if this were an outbreak of people that don't have a role in west africa or if this were an outbreak of the contested elections in west africa, then i would say yes go higher mr. claim. but it's not. it's a medical crisis. so why not you? >> right now i have a full-time job in the the department of health and human services. i appreciate the vote of confidence and i have a lot of confidence in him. >> how about another dr. who's an expert in infectious disease or an expert in west africa or the delivery of healthcare? god forbid we pick somebody with a background in medicine instead of a lawyer. and in the interest of full disclosure, i am one. >> with respect i think the will of the coordinator role of the coordinator of the white house

doesn't require a doctor it requires someone that is able to bring part of the government together to enhance the covert nation. >> i'm going to make you this promise and i want you to hold me to it. the next time there's an opening on the supreme court i want you to see whether or not the president considers a dr. or a dentist for that job. and we actually are about to have a vacancy for the attorney general. and i want you to consider or be mindful of whether or not he considers may be like a tattoo artist to be the next attorney general. i promise he will not. he will pick a lawyer for the supreme court and to be the head of the attorney general department of justice. i'm just lost why he wouldn't pick someone with a medical or healthcare background to be the ebola czar. can you understand why people might possibly think that this could perhaps be a political pick instead of a medical

science health pick? can you understand how people might be a little bit suspicious spinner i can understand a whole variety of issues. >> despite the medical background. i was going to but you.> you will and will >> i'm going to take that answer that he has none. he has me, dr. frieden, dr. fauci. we could go on and on. >> we had access to those people before we had mr. klain. so why pick a lawyer to head up the response for ebola?

color me cynical it just appears to be political. but but with that, mr. chairman i would yield back. >> with my friend yield? >> of course i will yield to the gentleman from virginia. >> i just want to join my friend and colleague from a nonlawyer it's the healthiest thing we've had in the last 50 years. thank you. >> are you applying? are you interested? i thank the gentleman. now recognize the gentlewoman for five minutes. >> i thank the chair. dr. lurie are you trying to say someone needs to be good at coordinating and managing and cutting through a lot of the bs? >> that is exactly right. i thank the panel for meeting with your committee today to our committee today to discuss this issue and i want to let you know my thoughts and deep appreciation are with all of the health care professionals dealing with this crisis and those in the audience and

because i represent illinois a special shout out to those from the chicagoland area. my questions are about the role in west africa. secretary lumpkin i know some commented that there is no reason to involve the u.s. military in this kind of humanitarian crisis. why is the u.s. military so critical to getting that but they are under control in west africa? >> thank you for the question. again we are in direct support in the whole of government efforts. usaid came to us because of our speed and scale of response. we can mobilize quickly, we can and still command and control but we have to keep in mind think about 200 inches of rain a year.

when we were there it was raining six to eight hours a day sometimes and many of the roads are impassable except by foot and what goes by foot is the ebola virus as well so there was an accessibility to the various areas. we have the ability to reach and get those areas and to support usaid. we have the ability to do construction and to build the ebola treatment units. when i was there i had the chance to get on the ground to talk to some u.s. navy's building the monrovia medical unit and working through the rain with the equipment to get what looks to be impossible they make it possible. the final piece that we can do is scale to training for up to 500 workers per week to staff these treatment units. so we bring the capacity in order to do that.

so, again, we are an interim solution to support usaid into the international community to mobilize in order to take over our efforts. >> so you feel you have extensive experience in conducting the humanitarian efforts like this? >> we supported usaid on numerous occasions. we've done it in places like japan several years ago, the philippines most recently, the team on the ground we worked with from the disaster assistance response team has extensive experience working with the department of defense and we are very tightly lashed out and i would say that it's seamless. >> thank you. general can you provide general can you provide a status update on the operations in the region and let us know what your biggest challenges are? >> yes ma'am, thank you for the question.

as mr. lumpkin said we were asked to do this mission because of our unique capabilities. as we are here today we have 698 personnel on back split between liberia and senegal. we are expecting the next 24 hours to 121st airborne division will complete its move in the country and we will begin a rotation for them to take over the command and control piece of this equipment continues to flow through the staging base and. as mr. lumpkin said, we were asked to do engineering. usaid asked us to be prepared to build up the 17 ebola treatment units and we've been asked to build a 12 since we are currently under construction and as for the training effort, we have identified the national training center in monrovia where we will bring in the military trainers to begin training healthcare workers in the next couple of weeks.

>> if this epidemic is not contained and it spreads over a continent do you agree that this affects international security? >> to reiterate my comments, this is a national security priority for the united states that truly has global impacts. so, we have an opportunity right now to flood the zone to make sure we have the capabilities in the country working as a whole of government to mobilize the community to respond. while it still is at a point while it is dire if it gets worse it is good to be hard to manage, so we need to take this opportunity that we have right now. >> thank you both for your testimony and again, a deep appreciation to all of the health care professionals. thank you.

>> i thank the gentlewoman and i will now recognize myself for five minutes and i want to thank the six of you for your continuation and your efforts in the united states of america and the men and women that serve on the front lines of the workers and first responders i join in thanking all of those that run to the sound of the guns into the graces that have been that they are amazing individuals and have our thoughts and prayers and hearts behind them. on the military side of things i don't know whether to start with mr. lumpkin or the general, but help me understand the proximity to the challenge how many usaid personnel are they supporting? >> i don't have the number above my head. >> do you have a range? is that hundreds? >> it is so integrated -- my

understanding, doctor, is there is a 21 day window in which a person who may have been exposed to ebola will actually potentially come down with ebola and starts to show signs of having this virus is that correct, 21 days? >> that's correct. stack why do we only hold the troops for ten days before we release them to bring them back to the united states? >> thanks for the question. i can understand the confusion on this but let me see if i can make it clear. to start the 21 day period for monitoring has to take place outside of the infection zone. for us, that would be in the united states.

out of an abundance of caution, prior to departure in order to reduce the risk, commanders will be about two renew their personnel from whatever jobs they were doing for up to ten days prior to the departure from liberia in case of to limit their exposure and provide an extra layer of protection. >> i'm going to need further explanations because i don't understand about ten days the science is 21 days. >> that the 21 day monitoring for the military personnel will take place stateside after they've left in order to ensure that they are ebola free just as it was described previously for other healthcare workers. >> of the written material that i see out there, talked about talk about fever which is monitored twice a day and other symptoms.

what are the other symptoms? >> they might include nausea, diarrhea, red eyes, muscle aches, fatigue. >> so anyone of the symptoms could be happening and not have a fever and you could have the virus, correct? you could have fatigue for instance before you have a fever. >> that is correct that you only transmit the disease when you are. >> if you have one of these symptoms and your coming through customs and border patrol for instance we have about a million people a day that come through the united states border. we have these custom order patrol agents and officers that are wonderful people. they are dedicated and committed in the tough and difficult job and we are asking them to make an assessment of somebody in about a minute or so as to

whether or not this person potentially has ebola. how would the world are we going to train them so they have these assessments? >> let's be clear about what's happening. first they are funneled to five major airports where people are specially trained to do tight screening. if in fact they have symptoms of ebola or they have a fever, then they get referred to secondary screening. >> are you telling me that it worked? did it work in the case of dr. spencer? >> the reason we moved active monitoring for people to come back to the countries from the united states is exactly for this reason. if people don't have a fever when they come through customs and border patrol stations we still believe they need to be very actively monitored for 21

days. dr. spencer took his temperature at the earliest moment as i understand it. he called authorities and was isolated expeditiously. >> so you don't think he was contagious in the 48 hours before blacks >> from what we understand, people are infectious and they have a fever coming up before him. >> so why did you close the bowling alley? why did they come and you know, put other people in the quarantine? if he isn't contagious, he barely showed a fever and he's a doctor and he said he didn't have a fever until the morning, why did you have to shut down the bowling alley? >> it is a good question and we want to move it in an abundance of caution. the bowling alley is closed for so that it can be cleaned and decontaminated out of an abundance of caution and i expect that it will be open in the not-too-distant future. >> you can transfer this through

sweat. that secretion can hold the virus for some time, correct? >> it is being cleaned out of an abundance of caution, yes. >> i just don't have the confidence that we are dealing with people who have a no contact with ebola patients why we wouldn't hold them for a 21 day period to make sure that their loved ones, the people of this country and i don't understand why we wouldn't put that travel restriction in place and why we don't get a little more strict. the self quarantine didn't work in the case of dr. spencer and she's one of the great people in this earth he went to go help save people's lives and he's an emergency room physician >> will the gentleman yield?

i would like a clarification on one of your responses to the chairman's question. you said that the quarantine cannot happen in the country of origin or of infection and that you would quarantine for ten days and save liberia before you would allow them to come to the united states. my first question is why can't you? clarification, why can't you quarantine the country particularly if we are sending over the military that could build a unit. >> i will teach her to the doctors what our infectious disease fellow us to be absolutely certain that everybody is ebola free it has to be outside of the infection zone for all intensive purposes the entire country of liberia is an infection zone but i would be for the dr. for further verification.

that guidelines indicate if you have no risk and if you've not been exposed to other people, you haven't touched other people -- >> the question was about military personnel. >> you haven't cared for the sake of ebola patients and if you are in personal protective equipment you haven't had a breach of personal protection that depending on the category you are at low or no risk. >> i'm not buying it. >> my time is expired. has expired. we will go to the gentleman from pennsylvania. >> i want to follow up on that and thank you for joining us today, secretary lumpkin and major general lariviere. the abundance of caution has been used in this room today and what i'm wondering specifically

and i will invite will open that up to either of you gentlemen is there any reason why this proposal -- mr. connolly and mr. maloney brought it up is there any reason we went and want to just into want to just use the 21 day waiting period in west africa before we bring people back to the united states? >> our 21 day monitoring process is done at the unit. it's done twice a day to have direct contact with a healthcare professional for everybody that comes home and it is commensurate with guidelines that other organizations are following the soviet are same guidelines

that the cdc and others recommend. >> when you say in the unit you mean whether it is in west africa or the united states trade >> while there is an country monitoring and monitoring when they return home. when they return back to the continental united states were a point of origin so to speak they will go through a 21 day process where twice a day for 12 hours apart they will refer to their unit and do positive discussions with a healthcare provider and have their temperature taken to see if, to make sure they do not show any symptoms but keep in mind going back to the risk of the department personnel is because we are not providing direct healthcare to the ebola patients. our risk is much lower than those that do to begin with. >> you're answering my question with what we are doing and i'm asking why couldn't you do it a little differently? why couldn't you do the 21 day

waiting period in the country just to be extra careful that we are not bringing this virus back to the united state's? >> again everybody will be monitored twice a day for the temperatures over all intensive purposes we are basically doing what the cdc recommends every single day while we are in the country by having their temperature taken twice a day immediately prior to the departure we will have the personnel go through a questionnaire to find out if in the last few days before they left if it possibly could have come into contact as anything other than a low risk category before we transport them home to start for 21 days. the ten day period which is causing all of the confusion that is an additional period in which they would be removed from whatever jobs they were doing if

they were out and about on the town to further reduce the possible risk. >> thank you for that answer but again the answer but again you're telling me what the plan is right now and i'm asking you why couldn't you be a little more careful with the plan, go overboard with the protection and extend the wading period to -- extend the waiting period to 21 days? and it seems to me you are deferring into the cdc on this. >> it's also the u.s. military infectious disease with interagency partners. >> may i ask you gentlemen to please consult with those sources and ask them to consider a 21 day in country wading -- waiting period just to be in

an abundance of caution? cynically will people do that. >> i also want to ask you know we heard about this terrible potential for the spread of the disease in west africa were depleted by january a million infections or more. the suffering, and one question i have is number 13200 american american servicemen and women enough to properly trained to defeat this enemy. >> based on the requirements that have been asked of us from usaid who were supporting in country the answer is yes. >> the next question is are there enough trainees so that we can train enough people to take care of the problem? spinnaker that is a question i i would have to divert the expertise on the ground.

>> with anyone on the panel like to take that question? >> there are health workers not necessarily from sierra leone that from but from the u.s. and other african countries from asia that would bring to the country as well to help the treatment and the containment and we are hoping with the training that's been provided into the supplies and development on that actually that should be sufficient. that being said it is difficult to encourage people to go and work in west africa given the conditions on the ground but also given the conditions that they might actually stay for a longer period as well so this is why we try to balance it in terms of going at the same time making sure that they can actually leave and go back home. >> my time has expired. thank you. >> are there any united states personnel that have any symptoms of ebola?

>> not to my knowledge. >> i recognize the gentleman from texas. >> i want to follow up before i go to my line of questioning. you talked about an overabundance why we closed the bowling alley and it's why the airline took out the seeds and -- took out the seats and reupholster. we are hearing a lot of the caution. from the purely held standpoint wouldn't it include an air travel ban complete to the affected countries like we've seen in some of the european countries? >> i don't believe it would. >> i'm going to disagree. i'm glad we are having this hearing today. this is my second hearing on ebola and i was disturbed in the first hearing that the homeland security committee had in dallas to see the cdc pointing fingers at the cbp and the national institutes of health. it's one of the reasons i said we needed it needed to appoint

somebody to be the point person, somewhere the buck stops. the president chose -- and i'm going to join with being of us got to go putting a lawyer instead of a dr.. josh earnest told reporters ultimately it would be his responsibility to make sure all the government agencies who were as possible for aspects of this response but their efforts are carefully integrated into key will also be playing the role making sure decisions get made. one of the key things is working with congress and i think that he should be here today or at a hearing today called very soon. we are the ones that signed the checks. i think that he needs to be here and also part of the finger-pointing that we saw was that the nurses in texas book called following to the best of their ability with a variable to do it think that it was entirely inappropriate they threw the

nurses under the bus. my wife is a nurse and she and i were both individually hurt and offended by that and i think that these nurses were doing the best they could. a ebola patient isn't always going to present. they will show whether their local hospital when they show symptoms. every hospital needs to be trained. am i correct in saying that your testimony -- what was the percentage that were not prepared? >> i believe it is 85 to 86% but you have to remember these are voluntary guidelines. they are not mandates and until there is a mandate from congress or the president, we will continue -- >> i'm not a big fan of government regulation. maybe the joint commission for the states. i would also like to enter they were also thrown under the bus and this is one of their responses to that.

since we do have mr. lumpkin and general here i wanted to ask a couple of quick questions about our military involvement. general, why did you join the military? >> to serve my country. my dad was a marine. >> traditionally the job is to serve and protect the country with guns and bombs. i understand the mission is expanding and you are out now building health facilities. very laudable but is this really what the military was designed for? it seemed if you wanted to build healthcare facilities you would join the peace corps and not the military. >> this is a national security threat and as it has been stated previously the idea has been to

fight this overseas so it doesn't further come back. >> is the military the only organization that can build hospitals and treatment facilities? aren't there thousands if not hundreds of thousands of contractors worldwide that can do that? >> absolutely that we were asked to use our capabilities to jumpstart the process getting it in place so we could turn it over to those organizations. >> are these facilities going to be near existing facilities are they going to be greenfield facilities or brownfield facilities or other locations nearby where patients are going to be congregating? >> we've been asked to build a treatment units and locations that were coordinated between usaid. >> so you could be working on an expansion in an existing hospital treating ebola victims within those guidelines? >> the ones we have been asked to construct none of those were

expansions. they were all unique. >> what's personnel would be wearing ppe? you have 80-degree plus conditions in these countries and the natural inclination is going to be why do i need to wear this type of suit? >> that is a great question. of the protocols that will be followed or that the u.s. military personnel will be issued a basic set they will have with them in the country but because quite frankly the jobs they will be doing they will not be required to wear -- >> i have one quick question. there's been a lot of confusion about this ten days and 21 days. they will come back to the united states and go to the unit and monitor the unit. between the 12 errors if they are not being monitored are they going to be able to ride the subway can see their girlfriend,

go to a bowling alley? >> on the military facility they will be allowed to go home but having to refer to the unit every 12 hours will limit their ability to travel not sure they're off base. >> my time is expired. >> now the distinguished gentleman from illinois mr. davis for five minutes. >> thank you mr. chairman and i want to thank the chairman issa for calling this hearing. it's an instructive and helpful and i want to thank all of the witnesses for a hearing and being with us. with o'hare airport being one of the busiest in the world and with chicago where i live being absolute transportation hub

where millions of people come into and through our city each and every week, first of all i want to command our public health officials under the leadership of the illinois department of public health and our city officials and homeland security for what they have done in terms of preparation to screen individuals as they come and have places that they can go should anything be detected. our hospitals have been fully cooperative and i commend all of them. i also want to commend all of our health workers who are the frontline individuals because while others can stand and cheer from the sidelines, you are in the arena. you are actually there.

you are not the spectators. i've heard a great deal of information and i'm delighted to live in a country that is willing to use some of its resources to be available in such a way that it does play and understands an international role so i want to thank our military for being in west africa. i agree with those that recognize that we don't have enough resources there to actually do all that we can and all that is needed to be done but i commend us for the effort and for what we are indeed doing. i think i have a little more confidence in the cdc and our

health professionals because every day as i understand it, our protocols are under review that whatever has been established with every incident we are learning new approaches, new techniques and we are putting those into place. so i'm not sure that i have as much gloom and doom because we have had the crisis before and we found a way and we will find a way to stay ahead of this one. dr. lurie let me ask you notwithstanding the advances that we've made in medical science and infectious disease continues to cause millions of deaths every year throughout the world and we know that the primary strategy has been to

vaccination, developing vaccines. what we ask are there other strategies and other approaches that are being used relative to human behavior activity? i always remember to my mother who didn't have any medical training but she always told us that an ounce of prevention was worth much more than a pound of cure. are we able and are we doing things that can help prevent and arrest the impact of these infectious diseases? >> i appreciate your question, congressman. as a primary care doctor. every time i see a patient and how important communication is both with my patients and with my

community one of the challenges of dealing with this outbreak in west africa has been that there are a lot of deeply held beliefs. there hasn't been sufficient information about how one contract this disease or how to prevent one from getting it and i believe that there's been a tremendous effort in public education and i expect that's going to continue in the days and weeks and months ahead. here at home as well there have been efforts to educate the public but many of them have centered on the populations whose heritage is in west africa and in the areas of the country where the populations exist in the state and local health departments have been have shown tremendous leadership in reaching out to those populations, helping them understand how to recognize and how to protect themselves here and importantly helping them provide information for their

families in west africa whether it's on the internet, whether it's by skype or text, whatever. there is certainly much more public education and outreach to do both in west africa and likely here but i really applaud your observation because it is important to anything we do in medicine or public health. >> thank you very much. >> to my colleagues that are concerned about the czar it occurs there were those of us are those of us that know things and then there are those of us that know how to make things happen and get things done and i think that the president may have had that in mind as he made the appointment. him in theand tell question is u.s. response to

ebola the effective? pundits have weighed in with their comments, including donald, who says this administration is allowing 100 people in this country daily from affected areas. the neighboring african countries closed their borders. and diane posted the jury is still out. we're just not going into winter. ask again in april. now we would like to hear from you. /c-spano facebook.com post your thoughts. earlier today, nina pham, the dallas nurse who contracted ebola from again brief reporters to announce she is free of the disease. she was transferred to the nih clinical center and bethesda, maryland, for treatment. this is 15 minutes. and answer a few questions, and then we will get texaso get back home to to resume a normal, healthy, and happy life. nina? [cheers and applause]

good afternoon. i feel fortunate and blessed to be standing here today. i would first and for most like family, and, my friend. throughout this ordeal, i have put my trust in god and my medical team. i'm on my way back to recovery, even as i reflect on how many others have not been so fortunate. of course, i am so incredibly thankful for everyone involved in my care. and the moment i became ill was admitted to texas health presbyterian hospital dallas, up to today, my discharge from this clinical research center. i would especially like to thank hiskent brantley for selfless act of donating pa lasma.

i have a special appreciation of the care received, not just doctors and nurses but the entire support team. i believe in the power of prayer, because i know so many people all over the world have been praying for me. thankot know i can ever everyone enough for their prayers and expressions of concern, hope, and love. prayer never the recovery of others, including my colleague and friend amber craig spencer. i hope that people understand that this illness and is a spirit has been stressful and challenging for me and my family. no longer have ebola, i know it may be a while before i have my strength back. so with gratitude and respect for everyone's concern, i ask for my privacy and for my family's privacy to be respected as a return to texas and try to get back to a normal life and unite with my dog. thank you, everyone.

[applause] you.ank before you open up her questions, i want to recognize two people who really helped us in linking with nina and getting to know her as essentially a member of our family as nih. and that is nina's mother and her sister. [applause] so, questions? that she isu know virus-free? what did you do for her while she was at nih? >> we know she is virus-free because we now have five negative pcr's on her. now, i do not want anyone to take from that that that is the that youthat standard,

can only guarantee someone is virus-free if you do five. five because this is a research institution. we provided her with supportive care, and that is something i have been saying all along that one of the most important things anbringing back ane bola -- ebola patient back to health is to give them the kind of medical general support to allow their own body to then be able to fight off the virus and essentially get rid of the virus. up to her,d leave that but that is not for me to answer right now. >> [inaudible] should americans or others returning from the ebola zone be forced into a mandatory quarantined? >> that is something that is under active discussion and you will hear shortly about what the guidelines will be, but i want to point out to remember that it

theot just the cdc and federal government but the states have an awful lot to say about what happens in people come in, but you will be hearing more about that. >> [inaudible] there are concerns that he went to the bowling alley -- [inaudible] repeat what wen have been saying all the time, that the way you get ebola is by direct contact with the body ill individual. if you do not have that, you do not have to worry about ebola. i think that is important to point out, that you must separate the issue of the risk to a general public with the and with people like niana her colleagues. they are two different things. ana put herself in situation where she knew it was a risk but because of her character and her bravery and that of her colleagues, she happened to get infected. that is a different story from

the general public. she was with a very sick person. >> what have you learned by treating nina pham? and what experimental drugs did you use and what can you teach other doctors such as dr. spe ncer in helping him recover? >> first of all, we did not anynister to nina experimental drugs while she was under our care. we followed her. we have a considerable amount of laboratory data here at this is only one patient. we are in contact and discussion with our colleagues at emory and at nebraska. we continually compare notes back and forth. i think it is important for people to understand that there is a public-health issue, and there is the scientific issue of understanding what is going on. and that is essentially what we do here. primarily, it is the care of the patient first. but together with that is to learn information that might help others.

that is easy to do when you have a whole bunch of people that you could collect data on, but when you have one or two or three, you have got to focus very much and tried to get enough information where gradually we will be able to say things that will help others. that's the reason why we may have done different kinds of lab tests or more of them. that does not mean that everybody has to do that, but we are trying to learn from that. >> why has it taken so long to get a vaccine? reports that there was one ready for human testing a decade ago. >> there are a lot of reasons why to say what went to get of that team you have to make sure you separate that from the candidate. if you are saying attack scene, something you can distribute, first of all, since ebola is a disease that has outbreaks and disappears, it is very difficult to be able to prove something except in the setting of disease, which we are actually trying very hard to do right now when we go from face i studies to show its stakes and it

induces a response. we are planning a larger trial, a controlled trial, to be able to do that. in direct answers your question, you might recall that we started on this 10 years ago. and we have done different iterations of improvements. one must appreciate that the incentive for a pharmaceutical company to get involved in putting a major investment to develop a vaccine for disease that up until this outbreak had less than 2500 people infected. we did not have the kind of an centralization on the part of industry. we certainly have that now. not essentially a scientific obstacle, and it was not an obstacle of wanting to have one. it was the ability to bring all of the cards together to get that. >> the ability to get funding for it? theell, first of all,

funding one is a very complicated issue. i think you should put that off the table, because we are really talking about what we're doing right now. and we are on the way, in the sense of we have the capability and the resources to do the trial that hopefully will start in the beginning of 2015. >> [inaudible] can you pinpoint a turning point in her care? [inaudible] >> well, you know, i do not want to make an absolute statement on that, because remember, she was taken care of by very good people in two separate hospitals. so, when she was in texas presbyterian, she was in the process of actually doing better. she came to us and she continued to do better. we both supported her. so i cannot pinpoint and one patient what was the turning point. the only thing that we're really happy about, that the turning point occurred. >> [inaudible] but youis conceivable,

cannot prove that here the question -- you may not heard is -- was if the plasma transfusion from dr. kent bradley. certainly, that could be the case. when you have so many separate factors at the same time, going into the care of the patient and patient,s won for this it is impossible to say that this is the thing that did it and this is the thing that did not. it is impossible to do. i'm not trying to evade it. that is the reason why he wanted to clinical studies and where you can actually get that information so that the next time we have in our rate,-- an say this is can the recommendation because we know it works. at this point, everything is experimental. we are trying to take the experimental and make it evidence. >> first of all, nina, since we have not said it, we are so happy you're well. congratulations. we wish you well. i want to ask about the

experience. that 70% of those with people in west africa die because of this virus. what explains the speedy recovery of someone like nina pham and amber vinsen. >> again, i wish i could to be the answer, but we do not know. but i can tell you that things as a physician what goes into a patient getting better. if anything from -- she is young and very healthy, number one. number two, she got into the health care system that was able to give her intensive care early. was theno, she transferred to another health care system which was able to give her everything she needed. that is one of the reasons that youst common sense tells that that contributed. how can you relate that to 70% versus this percent? it's impossible. >> what is nina's prognosis? 100%, she's cured?

any long-lasting effects? >> she is cured of ebola. let's get that clear, ok? that is for sure. now, long-lasting effects? example. you an a few years ago, i had that influenza. and influenza is trivial compared to ebola. even though i got back up and went to work, i was feeling tired and worn down, so i would not be surprised if over time anyone who has had the experience of recovering from ebola will take time to get the full strength back. she will. but she gets back next week or two weeks, i don't know. that is her. she's such an incredible lady, she is going to do it quickly. >> along those lines, are there any restrictions right now on her travel, where she can go, she cancan talk to, who see, and how to she traveled back to dallas? will this be a private charter? >> that's -- i would have to

leave that confidential right now. because that is something personal and private, because i do not want to have hordes on her. she asked for her privacy, we will give her her privacy. >> can you talk a little bit about the communication with nina's family throughout the process? was she allowed to talk to them? how closely did you relate the condition to them? >> we have a system in there that is easy to communicate. phone, family talks by by face time, and things like that. so when i am not going in the room, i'm just coming by to say hello, she taught me how to say son. -- facetime. [laughter] anything else? one more and then we have to get her off and home. >> as a public health professional, how confident are you that hospitals are getting the proper information so that other health care professionals like nina will not end up in the same situations, as we see more

ebola patients entering hospitals and being exposed? there is have noticed, a strong, aggressive educational effort going on that is led at the federal government, the cdc playing a major role in that. we are doing telecoms, doing a rewrite of things that are trying to educate more people. not only educate them but also make sure we have people trained, free trade, practice. people who have the capability of recognizing, identifying, and isolating. all of that is really getting scaled up. thank you all very much. we appreciate your being here. >> are you going to miss nina? >> i gave her my cell phone number in case i get lonely. [laughter and applause] you, nina! [applause] [captions copyright national cable satellite corp. 2014] [captioning performed by national captioning institute]

on our facebook page, we have been asking the question has the u.s. response to ebola been effective? we would like to hear from you. log onto facebook.com/c-span and post your thoughts and opinions. tomorrow on "washington journal," stephen shepherd discusses the current political landscape leading into the final days of campaign 2014. after that, alex smith of the college republican national youngtee and the democrats of america look at young voter issues in the midterm elections and the impact young voters could have cared less, your phone calls, facebook comments, and tweaked. "washington journal" is live saturday at 7:00 a.m. eastern on c-span. >> be follow us on twitter and mike is on facebook to get debate schedules, video clip, debate previews from the politics team.

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