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call us on the number on the screen. officials discussed attempts the hearing bola. that a d news reports doctor was diagnosed with ebola

new york city. last week a dallas nurse was officially declared ebola free. this of the hearing is three hours. turn your cell phones them in airplane mode. you are welcome to take not ures as long as you do the k other people. this is is not ce where applause with that, the committee will come to order.

oversight committee exists for two fundamental principles. deserves an public efficient, effective government works for them. it is our solemn responsibility to hold accountable to tax want to know ayers we government is prepared. in l leave no stone unturned is wing that america planning tomorrow. in the west nation of ghana, the a new case of of

possible that the disease began late last year and spread to neighboring the cdc s. according to it he 14 ebola virus largest in history. is rapidly on and loping and changing americans are understandably their d, about government's response and the taking to contain fda approved o a ccines or medicines, it is

serious threat to public health the world. an outbreak contain and tly to have major economic impacts. it is particularly distressing in new york r no new positive. but cases have been reported in nigeria in 46 days. those in thomas eric duncan passed the have now period wihout new perhaps that means

our response mechanisms are see , though as we shall today, not perfect. as long as response is well use dinated and officials will be ense, it to contain this disease. public health has been eroded infected sponse. an traveler from liberia passed a homeland security screening and in dallas. when that showed clear symptoms, to hospital turned him back

community. the cdc director a nurse became because she must have protocol". ch of medicine is not done over the talking to a ss measuring and at ient. a separate nurse a at hospital was cleared for despite having symptoms of ebola.

questions have been raised about risks to americans responding in the affected we need to know if there breakdowns that our response mechanism is working properly. i think we all know that the system has not been refined to the adecuate levels. equipment aining and that front line health care personnel d military airport ? is an

screening reliable? are government agencies doing they can to foster the development of ebola situation when a this arises, government is on prior to rely government d response. congress has considered the possibility of an outbreak on a bipartisan the bumbling we have from attempts to these mistakes. president obama's appointment

ebola czar shows that has on one tration recognized the missteps, and on the other hand is not to put a leader or medical professional in charge. ask, and will ask, today whether coordination is already in place or whether we expected the czar to put organization together, sifting through conflicting did invite him to are very nd we

disappointed that he was not to. we understand that he started and expect this in a not be repeated follow up hearing. i have visited the world heath organization, which says pandemics have already been planned for. as americans we have invested billions of let me say, before anyone pulls the trigger medicines, that this a new problem. in 1818,

spanish flu killed more in ple than any outbreak history, killing 20 million the world. in a military base riley, kansas, was the the "big red sly, being sent ldiers away on ships, not recognizing were adding to disease and asian flu of e

flu of and hong kong 1968-9, also caused thousands deaths. it would be a to underestimate what further uld do. any fumbles or missteps, or reliance on estimates not based certainty, can no longer be forward to i look hearing forward from this panel witnesses to take this appropriately seriously, recognizing that kill we do not know could this. with that, i recognize ranking member for his opening statement.

you for your statement. reason why we have to oversight committee is address these problems. yesterday a doctor working for borders was out tested positive.it appears clear that health care authorities have come a long way since thomas duncan first texas hospital last month. new york had been this possibility for weeks and about 5000 health care workers were drilled on procedures e and

just past wednesday. a special protective gear transported to bellevue hospital, which is specifically designated to handle ebola. they placed him directly in isolation unit and began as soon as m tracing his contacts immediately. as new york officials said last night, they would not have face an ebola case, but they did. they worked diligently and professionally over the last themselves to hurt for this day. there many questions about this new case assume it will be the last. i remind all of us this is our watch of continue to be

vigilant and continually reevaluate our protocols and training procedures to protect our health care workers, many whom are here today. to those health care workers on of a grateful congress and a grateful nation i thank you for what you do every day. to express our thanks to and to amber times benson, two nurses from texas -- contracted a bullet when they treated mr. duncan. they were too brave young woman who risked their lives to their jobs, just like across this country single day. 24/7, 365

i understand that mr. duncan's condition has been now clear of he is the virus. we thank them for their bravery and commitment. we can no longer ignore the crisis in west africa. we can ignore it. nearly died from ple have this disease or are battling in h it as we speak. many most gruesome conditions imaginable. i firmly believe that we have a fundamental moral and humanitarian obligation to address the crisis in africa. we are the nation in the world and have the resources and make the biggest difference. however, for those have ay not agree that we

a moral obligation, they must addressing the ebola crisis in africa is also interest. public health officials say that we need to address this outbreak the source in africa. the longer the outbreak continues the more likely it will spread of the world, including more cases right here states. if we did not take strong action now and course cause much more in the long run. the encouraging news is that health to fight rts know how this disease. this week the world health organization senegal nigeria and

free of ebola. this was a tremendous accomplishment due to a combination of early control s,infectious burial. that we still face severe challenges in sierra leone and guinea. when a health infrastructure is at ufficient, cases increase a resolution s. was unanimously adopted saying was an international health crisis. the u.n. passed a dozen mission critical and provided a budget million. however they millions of of dollars short. they need of

funding for treatment beds, for health care supplies to prevent infections. they need resources for things as basic as food and vehicles and fuel. head of united nations council said just last week, we need to stop ebola now or face an entirely unprecedented situation for not have a plan. there have already been several congressional hearings on how here in re ourselves united states. today i intend to ask witnesses what they the expert you could be the most significant concrete and constructive steps our nation could take to address this outbreak at its particularly grateful to the international medical here today to g provide on the ground his group s for what

and others need to stop the of ebola. mr. torbay, i must feel great who thy for the worker tested positive yesterday. i have asked my staff to place your testimony on our website, going on in hat is africa, the things that work. i think the public should have an read all 10 to he was one of the ebola in west ing africa. it is a situation all of your workers must fear on a group and s. your many others is doing one of the things that will truly in short the world will be free of to support you as we urgently can. we

need to convince the rest of world to do the same.two this rs of the congress, not a time for conflict. we higher ground. e with that, i look forward to your testimony. our panel at we go to of witnesses. assistant secretary of defense for low intensity conflict at united states department of defense. james lovari, head of

military affairs in west africa. hon. jon roth, general for united department of homeland security. assistant secretary for preparedness and response the us department of health the ices. copresident of and mr. nurses united. ravine torbay, senior vice of international operations at the international corps. ladies and gentlemen, according to the rules of the committee, will you please all cries and raise hand for the oath. do solemnly swear that your testimony will be the truth, nothing e truth, and the truth?please be seated.

but it be noted that all answered in the affirmative. today we will have a lot of questions, so please realize that your entire be on g statement will the record. and we ask that you limit your oral testimony to five minutes. members of the d committee, thank you for the be here this o regarding the department's role on ebola response, which is a response to a global threat. two to the us military's unique capabilities, of the department upon to provide interim solutions which allow other departments the time to deploy their own

abilities. this is essential to reduce this thread and before uffering. addressing the d.o.d's response let me say that after visiting liberia, i was left with a number of overarching impressions that have shaped our department's role. our government has deployed a top-notch team experienced in national g to disasters. liberian government its oing what it can with very limited resources. response is l our easing regionally to to governments response efforts. i

thinking to the region we would face a health care with a logistics challenge. in reality we have a with a cs challenge care element. limited resources will be outpaced by speed of the epidemic spread. is increasing its spread, bringing the risk of more cases in the united to tes. now i would like turn to the dod role in the response in west africa. obama authorized military response, and a

directed a agel it would mission. respond to department of state evacuation. direct not part of is mission. secretary hagel four lines of response. six weeks the dod number of aken a synchronized activities, designating a named operation, establishing intermediate state basis, strategic and tactical airlift, establishing

a hospital in monrovia, constructing up to 17 ebola treatment units also known as -- etus in liberia, and training personnel to serve as responders in these ebola treatment units. i would reiterate that the us personnel will not provide care to african patients. the department programs in the region. we are expanding the regional efforts of the operative s biological enhancement program robust biological for ncements

biosurveillance systems. preventing further spread of the highest importance. in conclusion, we a comprehensive government response and an inclusive international response. the us is laying the groundwork the international community to respond. with that i would like to from the my colleague joint staff maj. gen. revere. we are ready to answer your questions. i appreciate the opportunity to be here.

>> mr. roth? inviting me to r -- dhs must must have the opportunity to prepare train against the epidemic. a report of our audit is attached to our testimony which submitted to this our audit in short, concluded that dhs mismanaged program in three ways. it did not adequately conduct a

assessment for antiviral not s. as a result we could determine the basis for dhs about what kinds of supplies to store. as a result in a have too much of some too little of others. for example, it has a stockpile of many suits and surgical masks but has not been to demonstrate how either their pandemic preparedness plans. it has a significant quantity of antiviral drugs but again, understanding of department needs we have no assurance that the quantity of drugs will be appropriate. purchase much of its equipment without thinking need to be hey would

replaced. material it purchased shelf life. for example, pandemic protective equipment stock includes respirators which are beyond five your usability dates guaranteed by the manufacturer. in fact the department believes entire stockpile of personal protective equipment be usable after 2015. likewise the antiviral drugs the dhs purchased are nearing of their effective life. it is attempting to extend the shelf life through a testing program but the results that are not guaranteed. dhs did not readily know how much protective equipment and drugs it was on hand or where being stored. trucks and gone missing and conversely equipment has been thought at department

had been destroyed. we visited multiple sites and found drugs that were not being stored in a temperature controlled environment. because dhs could they were ured properly stored, they are in of recalling a significant quantity because it be assured that they are taking epartment is to implement 10 recommendations. will continue to keep this committee informed department progress. mr. chairman, that concludes my statement and i welcome any questions. a primary care

doctor. i appreciate the talk to you to steps agencies have taken. we are working 24 control the epidemic that we are prepared. thank you to the foresight of congress this and prior work istrations, dedicated of the interagency, we are ever r positioned than before to respond to ebola as range of other serve as assistant secretary on all matters applied to public health.

i have strengthened our ability better decisions and after an g, emergency. our response allows us to be nimble and respond to known and unknown threats. our family of out to the mr. duncan, the nurses who have been detected as well as the position in new york. we are pleased to nurses have been them a o well and wish speedy recovery. we are extremely serious in our focus on protecting america's health. that is to y to do prevented the epidemic in west are ca. the same time we against g our system any potential cases.

thank you to past investments we have leveraged government assets to urgently speed the development and testing of therapeutic drugs for ebola.these advances allow us to create countermeasures in record time that we have we ducts to use as soon as have the necessary proof of efficacy. our strategic investments and infrastructure including centers for innovation and advanced in elopment, established 2012, will be used to get therapeutic drugs into use. are strong aring a relationship with private addition rtners. in our public health system must prepared to deliver safe care at a moments notice.

the public health emergency meant that health care and local health departments are prepared to since the epidemic these after using programs. we developed an to promote program the effective isolation and treatment of ebola patients. we have in place has adjustments, led including heightened guidance for personal protective equipment, aggressive national education, screening active patients entering funneled through

five airports. we have been working with our partners to ensure effective medical worker and workplace safety. mr. chairman members of the committee, i understand why you and your concerned. we re take domestic preparedness seriously. i ensure you that my team and partners have been working and continue to work our nation preparing for threats, with lessons new challenge his we have made efficient use of the investments provided and made tangible meaningful progress since you first created this office in 2006. as a result of the department has been able to provide efficient health to our states and

communities. i welcome your questions. >> members of the committee i burger a registered copresident of the national nurses united which represents 190,000 members of the largest nurses in on of united states. the ebola pandemic and exposure of health coworkers to ebola in texas and the real threat that could elsewhere united states represents a clear and present danger to public health. a health orking in care facility is in danger, just as he nurses who contracted ebola while treating duncan in a dallas. to

one death ected and so far. in our survey of over 3000 nurses from over 100,000 hospitals in every state, 85% of the nurses say that they are not adequately trained and level of preparation for ebola facilities is their icient. many say hospital has not conveyed any kind of response plan to ebola with ay that no education opportunity to interact and asked questions has been insufficient supplies insufficient and fluid resistant impermeable gear are also problems. there to equip isolation

rooms in many hospitals. who ially those nurses mr. duncan did not wear impermeable gowns. this is what happens when guidelines are inefficient and cdc ntary. the new guideline that protects a direct testament to brianna aguirre, who first on pres. us and called obama to invoke his executive and have congressmen mandate equipment that meets international standards.

purifying d respirators were approved. at least two direct care units for required. nt is continuous on site care is important to to the changing nature of the disease. the must be onary principle utilized while developing public health policy designed to protect patients public nurses and other health care be exposed to potentially infectious of exposure e risk to the public at large starts with the public health givers

does not stop there. as is in public school closure, inadequate protocols and lead to public exposure. the response to ebola from us hospitals and government health agencies has dangerously inconsistent and inadequate. the lack of mandates and shifting guidelines from agencies in voluntary n compliance has led to caregivers being severely the case of n infection. the new c d.c. guidelines represent progress with improved standards for training been demanding for

months. the cdc guidelines are on it the most effective protective equipment specifically allowing hospitals to select protective equipment availability and other first line ll your of defense and no nation would ever contemplate sending soldiers into the battlefield without armor and weapons. kill all we tools we need and ask -- give us the tools we all we ask from president obama is no more infected nurses. members of the d the ittee, on behalf of international medical corps, one of the two nations in the world to treat ebola patients, for uld like to thank you inviting me to testify today on

this critically important hearing. we would like to express our appreciation for the us government for the pivotal action a generous support in the response. our outbreak has a been robust. by the end of the lumbar anticipate will have a total of about 800 cases these will ly 70 of be expatriates. international medical corps has been west africa since 1999. our ebola response june. in a july after realizing that the epidemic had reached out of control levels we deployedemergency response sierra leone and one hour emergency teams arrived in august what we found on the ground confirmed urgent action was a few short months

the fallout from the outbreak had brought the already fragile health care system in the country to the break of and apse. many were dying many were afraid. previously busy hospitals and clinics were staff and both potential patients too frightened to go for the fear infected with the rather than risk infection mothers shunned life-saving vaccinations for children and if their children became ill many believed that the safer option seek treatment at 70 bed opened our first liberia on september 15 currently have 53 beds occupied of 70 d by a team and 71 liberian nationals. with the next six

weeks we expect to open three units one and liberia, and to gain sierra in the northern province. we hin the next two weeks expect to open a training center in both counties to on case her ngo staff management protocol. the center which will be adjacent to our units will also offer 7 to 12 day training for involved on ll be treatment of ebola patients. who open a similar center in the ria as well. this is key to a training health care workers who are working in an which ebola is must nt. strong guidelines be combined with on the ground to be truly effective. that may share what we have works in order to show is needed going forward.

first and foremost he must contain the disease at its to happen need t factors e that seven are in place. treatment units health care ional doctors. limiting the spread of the community is essential. therefore a focus on trinity sensitization including awareness is critical. finally, safe burial teams are required to limit like to sion. i would offering some considerations. more detailed recommendations can be found in of the testimony. one is t important conclusions

-- t we need printer effective training. to ensure ed availability of supplies. third, protocols for evacuating health care professionals. and th, open airspace to from the ebola infected needs to be maintained. limiting travel only shuts off those countries the outbreak wing to continue. we need to support

production of vaccines and finally, developing and preventing efforts needs to focus on building stronger systems in the region. mr. chairman, there is will stop this outbreak. if done correctly, we will also have the tools to prevent another outbreak of similar proportions. you mr. in thank chairman for allowing me to present this testimony. i would be glad to answer any questions the committee might have. >> thank you to all the witnesses. >> the gentleman from ohio is recognized for five minutes.

hagel is eve that sec. very concerned with the effects on the american public. if i only get one question it is to be about that. i am skeptical of dod had ocols. we have basically to threats. one is the other is here. a dividuals falling ill as are health bola. we care providers.the american public is very concerned that individuals who have been to the ebola virus have access after ublic

being exposed. this is during a falling hile they were ill to ebola. on october 10 came to visit ohio. a nurse traveled from dallas to cleveland visiting local nurses. almost 300 people had contact with her while she was falling ill to ebola. fortunately ohio does not have a report of the case. on the entire congressional delegation on a bipartisan basis sent a letter to the cdc challenging their protocols with respect to to ple who have been known have been exposed. none of the trying on wedding dresses. bowling. riding the of these issues are personal responsibility but to questions of protocol.

has authority and may, although they do not have to, quarantine somebody. that no known say exposure was seen. there was a monitoring. but it suggests that individuals routine daily activities including going on bowling, and riding the subway. i am concerned with the multiplier effect. i that both the cdc rules guidance ps the dod

should be revised. the three health care providers had significant health care contact while falling into the ebola to believe that the october 10 dod guidance should be revised? >> the first thing i would like to say as i mentioned in my statement is that we patient doing direct operations ica. our support are limited to supply chain issues. nobody does not mean will be exposed. the gentleman a o flew her first was not health care provider. >> we have different categories of risk and i would like to turn over to my joint staff

colleague to explain the risk categories and mitigation strategies for each one of them. you for the question. we put in place will involve testing of personnel twice a day when they temperature . their will be taken so that they can if they ted effectively are exposed. the timeline you discussed is what will take place in each country. >> general, as you note from york, his new occurred at 11 days. monitoring period once out place only

of the affected area. >> no sir. the 21 day timeline will start once they are back in the united states. >> i am highly skeptical and need to be se revised. the american public is concerned that people who are exposed to too much contact with the american public. thank you mr. chairman. >> i would like to make sure that you are clear in what mr. re saying and what turner was asking. if someone the doctor tested positive, and leaves after 10 days on a commercial airplane, arriving in new york, and on 12th day goes positive, your 10 days will

will done positive and you not have that opportunity to that is the quarantine does not matter. the example he gave the doctor just is terday shows that 10 days not long enough if that person on a commercial airline where they then can infect other passengers on the airline. i'm not being clear. the 10 days is to attempt to limit their possibility for while they are in a country in liberia. they will then be screened for temperature and possible exposure prior to getting on a government contract for us military aircraft to return to to the united states. once they have flown back they will be given a 21 day monitoring. where they will

be required to come into the unit twice a day for medical us military medical personnel, but he will have their temperature taken and looked in the eye by a medical professional to see how they are doing. if they do exhibit symptoms once they're back during a medical check they will merely taken through to a treatment facility and begin the isolation process. want you to remember what was just stated they want to to on that in a minute. i know your organization is input ibly busy but your

is very crucial. in addition to your very detailed written he provided some pictures and i'm hoping you can what we are seeing. believe this picture is an ebola treatment center. can you briefly describe what we and where it is? >> this is in our ebola is the nt unit. this isolation unit. what you see are two health workers in yellow suits with a hood and a mask actually inside the restricted areas. nobody's in there without full personal protection equipment and training. outside a supervisor take notes that proper protocol is taken. >> you said you need about 840 of these suits every week. also said the current demand far exceeds supply. there are two

main manufacturers for the acceptable overalls and they producing at full capacity.is that right? >> what can we do to help provide more protective gear? >> for so i would like to a 60 fy that 840 is for bed hospital. that is for one unit not the entire operation. is to e need to do encourage those manufacturers increase the supply line. a lot of them are in stock in areas that are not actually endemic and need to be released for those that are treating patients. go to another picture. here is little truck with some kground

kind of flat board there. can you tell us what this truck is used for. a make shift ambulance. there is a lack of took a truck so we and put a board on it. said and i quote, we need three things. people, commodities and money. by i mean everything from ppes to disinfect meant to and bedding and clothing. is this what you are talking about? to transport . to ients additional vehicles transport to burials as well as treatment units.

picture from sierra leone. there's a team of people in full protective suits that moving a dead body. can you please explain have t is so important to proper burial procedures. >> the viral load in a dead body is actually at its when it is at its most contagious. will he about it is that we spray a person with disinfect we put -- disinfectant. would put and spray body back them again. it is extremely important that proper burial procedures are followed all the time. >> would more resources help?

need more burial teams. they constitute about one third we need body nd for the burial teams. >> let me play a brief video.

thank you mr. chairman. right now there are a lot of people watching this hearing. may be not a lot of them know crisis in west a microphone ve right now. what would you tell people? >> wwe need to deal with ebola virus at its source in west steps can be taken. we need to immediately increase treatment capacity and training

for health personnel. weed we modities as we discussed. we d financial resources. at the community together need to work end to team to put an this outbreak. once we do so would need to rebuild the health care system in west as prepare other countries so that this outbreak occur again. the us is playing a pivotal role and am is ud to say that the us to t the wayand that is answer the call. other countries are following the lead of the us. >> mr. turner asked a great chairman tried to

clarification. what was your reaction. we have workers in the back here. do you feel this is an appropriate way to address this? clarify one ike to thing. no symptoms, no transmission. monitoring temperature is as the l because as long patient is asymptomatic there is no risk of transmitting the disease.

day we monitor people. not le with risk we do allow to travel on commercial airlines. we ask them to stay risk area for 21 days. high risk individuals will be quarantined and they ored, and the minute develop symptoms they will be for ebola and admitted. follow up on that point. the 10 day waiting period has only utely no value. the real way to ensure that somebody does not become ensure they s to are out of the risk are for 21

days. >> i think the 10 days comes of m is that the majority cases have an incubation period >> again, known exposure. that's correct. general, you are going to be operating some seven months. anyone who works in those labs takes materials out of those labs, has secondary exposure to review bell, liquids and so on. in fact, is in direct risk, aren't they? the testing labs, because we party had that in dallas is in fact a point of transmission. it is not just the individual, but in fact the materials that come under the individual. is not correct? >> said the military personnel working in labs are infectious disease specialist.

>> i don't want to know who they are. i want to know where they exposed. >> they are considered low risk because they have the entire suite of protective equipment and extensive training. >> one of my problems come in general, very little time and i want to be pleasant through this whole thing, but we have the ahead of cdc, supposed to be the expert and he's made statements that simply aren't true. dr., you can get ebola sitting next to someone on a bus if they throw up on you. that's reasonable? >> the way you get a bullet is by exposure to body fluids, yes. >> okay, when the head of the cdc says you can't get it from somebody on the bus next to you, that is just not true. when the head of the cdc says we know what we are doing, but in

fact health care professionals wearing what they thought was appropriate protective material got it and that means it's wrong. when the head of the cdc goes on television and says sometimes less protection is better and then has to reverse the protocol so we no longer have nurses, these burger, who had their necks exposed. that was wrong, wasn't it, ms. burger? the cdc gave false information, basically saying it was okay to have your neck area exposed when in fact if someone threw up on you, that could be -- >> i don't honestly know that those nurses were instructed that their next word exposed. >> the head of the cdc when asked whether you had full body suit versus simply the mouth said sometimes more is not necessarily better. said the head of the cdc was wrong.

we are relying on protocols coming from somebody who has been proven not to be correct. it's not true? >> those nurses were not protected. >> mr. roth, i don't want to belabor waste fraud and abuse them although that is a lot of what this committee looks for. if i understand correctly, your report shows they didn't know what they were buying and why particularly well. they bought large amounts without a recognition that it is going to essentially expire and without a plan to rotate or in some other way put those materials to good use the way dod normally do in order to prevent items from expiring the secondary use. is that a correct? >> that's correct. >> in the u.k. at reach every conclusion. did you discover, for example, the facemasks benefit of buying them, they simply had a rotating

inventory they could've drawn from that would've allowed the vendor to maintain a stockpile said they would only take possession which is almost done on occasions. they would only take possession when they needed and in fact wouldn't have to buy it or rather rent the availability of it. did you look into that at all or did they look into that at all? >> they did not look into it all. we make our recommendations, we explore the options you talk about. >> all of those options need to be looked at, evaluated and available to members of congress before we start riding checks for large stockpiles. would not be correct? >> that is obviously up to congress to decide. now the department is doing the cleaning we had recommended. >> i will close with mr. torbay. the pictures that the ranking member showed in the situation in africa is certainly desperate. i know my constituents are most worried about what comes here.

but realizing the 4000 air versus less than one handful here certainly shows us where the problem is that i think you said that very well. but in fact, medical personnel that are dispatched from here, go there and in more than a few cases, find themselves infected. it's not true? >> correct. >> so, i want to ask, it might be both, but is not primarily because of the conditions under which those doctors and nurses and other health care professionals find themselves working or is it for lack of training? is it more of the other? >> mr. chairman, is a combination of both. our medical staff are heroes, doctors and nurses. they work in probably 95-degree temperature wearing in those videos you've seen. our rotations are every hour. we get them out of them every hour because they are

dehydrated. >> they are capable of not getting affected if they are in a good facility with one patient rather than questionable facilities and monthly for 24 hours a day, trying to deal with an onslaught of patients. is that correct? >> in our facility is a 230 staff members and their only job is actually to look after the patient. >> to the greatest extent possible, i will ask one last question that i would like to have people say yes or no. ebola is a 35 euro disease. it is not new. it is discovered a long time ago it would've spent money looking into it, planning for it. the various flus come into one set going back to 1918 are not

new and they have this illinois should we be looking at an infectious disease he -- diseases, training, the handling, the emergency, should we be looking at this as a failure of not just ebola but infectious diseases of this entire sort that we could have and should have been more prepared for? i would appreciate a yes or no. >> yes. it's a somewhat more complicated question.

ebola and flu are spread very differently. the isolation and maintenance and so on, i was not saying those which could be aspirated or transmitted, but the point is it an lot -- aid and lots of , we have hads these for a long time. are these failures to a certain extent the fact that we said we were planning to deal with these disease and prepare our health care system and it appears as though we have trained them but not train them to the level we should? >> i think our failure relates to the fact that we are learning new things about ebola. ebola has never been in this hemisphere before. things,e learning these we are tightening up our policies and procedures as quickly as possible. isto the extent the virus transmitted in the same way, we

have looked at the logistics and acquisition management, i would say the answer is yes. >> this is outside of our purview. >> with that, i will go to the gentlelady from new york. >> thank you. i would like to thank our distinguished panelists for coming today during what is a critical time in the federal government loss response to an urgent global crisis. to take a moment to commend the health care professionals in new york city for their outstanding response yesterday to our first case of ebola. has been working with new york state, the center for disease control to prepare for this and our nations largest ,ity, 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 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 as tacky and that, weren't erstwhile protective equipment to bellevue hospital. the hospital has been designated for the identification of potential a bowl of 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 staley and ms. affaire. 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 18 of ebola experts in new york city. they were already there to help. remember his name told 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 lullaby within 24 hours to any location in the united states where he cases reported in 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 at one of the five airports in the united states doing enhanced screening. active post-arrival monitoring means that travelers without fear northampton consistent with the uvula 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 day, 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 statement prepared by the trust for america's health, a nonprofit. >> without objection placed in the record. >> attacks about the need for enhanced funding, that are funding is not to the threat our country 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 glad inside 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 to find a set of a basic things that every health care facility needs to do and provides the funding for training for exercising were planning for other things necessary for hospitals and other health care facilities to be prepared. it is in fact that bellevue another 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. you would be so proud of our troops that we saw incredible in general to get called to do some test status. 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. without the correct? this is not today, the unit 404 cases of a bulla and health care workers. 200 ready to die. pretty high fatality, right-click >> that's correct. that 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 were properly protected. >> or train. >> were trained.

>> dr. lurie, you said we are putting additional protocols in place, dating, rate? what is the most reach like a >> the most recent and some 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? always got to do is look at craig spencer. he was tested there. it is not working. now he is a medical professional. he reported his elf. and then you see cases where egad, 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 of the tsa. >> on page six woman to testify this is a bottle of hand sanitizer and you tested it. 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, we don't know who is going to get it. >> mr. roth, but yes. you are correct very >> the gentleman's time is required. >> your report is correct. i thank you. i have additional questions. thank you. >> thank you. the gentleman from massachusetts. >> .2 anchor the members of the panel for their testimony and the work they do on a regular basis. the united states has taken the

lead in the international response. should be proud this country recognizes not only do we have issues within our own country that we have to deal with in terms of people who may be exposed to the disease and be here when they are treating somebody, but you do have to go andhe source with a shot all kind of approach. mr.eed all the things torbay talked about. do we have a large enough response? is it coordinated accurately? are the people trained sufficiently to get the job done? question is is the international effort large enough? is it being well enough coordinated? is there sufficient training and equipment for those involved in

it? what remains to be done and by whom? africa, u.s. leadership is galvanizing support on the international front. we have gone in with speed and scale, the international community is coalescing to come together to fight the ebola epidemic. >> is that coordinated enough? is the response sufficient enough? with thed agree assessment of the situation in west africa. it has taken time to get the resources in place there and u.s. leadership has been incredibly welcome and as a result of that, we are finally seeing many other countries of to putld step up

resources in place in rest -- in west africa. >> is the response adequate enough? are the people involved trained and equipped enough and is it coordinated to start containing the situation and wrestling into the ground? >> the usn u.k. have stepped up. now it's time for the rest of the world to follow suit. up.training is picking we started our training and the minister of defense is starting training and i think in the next three or four weeks, the training will be up to speed. ppe's are coming in. we hope the pipeline will continue to come in. i think other countries need to step up. any andt forget about the containment there.

that is where it started. businesses need to get involved. the economic toll of this outbreak, we need to think about that. we need to think about technology and developing a vaccine is critical, but we need to start thinking about creative theyto monitor people when are coming back, to monitor their temperature rather than lying on patients -- relying on patients checking their temperature twice a day. if the intervention continues at the same pace that it is now, i think it will be contained in the next four to six months. i would like to thank the department of defense and u.s. navy for adding a lab right next to us will stop this has cut down the testing time from three days to five to seven hours. we are accepting patients, testing them and envoy date --

and avoiding infection by them staying in the isolation ward. >> thank you for your work. don'tways amazed agencies go to the general accountability office to learn how to set up a getsl until late until he audited later and find out they did not do it correctly. last question. this is not new. ebola has been around for a while and people that we could have an further along with has beenon, but there no profit motive sufficiently involved on that. ebola orwe doing with anything along the line with the chairman's question earlier -- what are we going to do to make sure we have that kind of forward thinking? what are we going to be able to do as a public holiday? exit the great western and were it not for the investment in bio defense and getting going with ebola vaccines, 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 therapeutic will stop we need to think about emerging diseases and think about developing countermeasures for them now. we have appreciated the support through its direct funding and the project bio field fund that has helped us there is a market and product developers and manufacturers will step up to the plate and work on these important rats. publicre talking about financing doing that as opposed to just private companies doing it on their own? >> we have been talking about some very positive public-private partnerships we

have developed whether it's about bio threats or pandemic flu or now with ebola that are making that possible. >> thank you. >> my questions are for the assistant secretary and general. uniform arewomen in in regions that are severely affected by ebola. to their parents, the mothers and fathers of these men and you have every confidence they have every bit of equipment and training they need to be protected, to be safe and return home healthy? >> the safety of our servicemembers -- >> the correct answer is yes. >> it's absolutely paramount and while you could never mitigate

risks to zero, i think we've taken all the steps to mitigate the risks. my answer is yes. combatant command services are making every effort to make sure the troops have the proper training and equipment they need for this mission so they can return home safely. >> you said in your opening infected, ift if someone contract ebola, they will be returned back to the united states and cared for in ac/dc facility, correct such mark >> i did not say that in my opening statement. >> you mentioned ac/dc facility where treatment would be given. -- if ask a question someone comes down ill in country, how will they be cured?

>> 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. one established in liberia. the medical personnel there will be trained in how to treat ebola victims. the question is if they will be treated there or at home, the question's answer is both. if a u.s. uniform military person does in fact contract it. they are treated in country. if they identified for some reason it's having high-risk exposure and symptoms they will

, be cared for initially in country and moved home. if they are asymptomatic, they come back on a dod aircraft. >> how many aircraft are outfitted to move these individuals out of country in the event this happens? >> for 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 week's 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. as we develop the capacity, i would like to say that for the record, i am not familiar with the process -- >> 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 will get 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. but we are asking you in the legislative branch to tell us what you need and we look at it. we will get 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 at the top level 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. and with that, mr. chairman, i

yield back. gentleman.the 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 done by dhs, how the equipment purchases are not adequate and in some cases the wrong equipment, or 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 nurses 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. maybe it is just me, that lately usn an agency comes before

and says that they've got this, and they say there's nothing to worry about. 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 and perhaps their families if 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. so 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 that the current approach is to use 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, you have given some very 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. when they say they want to travel to the united states, they need to present themselves and report in person until they get on that plane. we can take the temperature and a blood sample if 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. you know? 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 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 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. wrapping up her.

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 training 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. >> at the time of the flight, yeah, they get tested before they get 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. response,have a quick mr. torbay? >> we are having difficulty recruiting health personnel. if we wait 21 days, that is nine weeks and it's extremely difficult for any hospital or university 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 to senegal 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. >> with all due respect though, 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, a colleague of ours. he said this.

"there is a point person, 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 says, yes. not what the is

legislation says, that is what your website says. >> yes. >> your website confirms that. you are the key person. >> yes. >> 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? >> i am not 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? are you familiar with that? with $2000 toar encourage seniors to join choirs, are you familiar with

that? >> i am not familiar with grant programs. >> $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 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. the nih, the cdc, the fda, my offices, the d.o.d., the dhs, the department of agriculture, all 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 shows instead of potentially 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 congressman rogers when we were reauthorizing the act that created your position. mr. rogers says this. you said this when you responded to mr. rogers. how can we improve functions at are in fact inu 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 agencs 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 's focus 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 on 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. >> i don't believe that would have been the case. >> you don't believe that would've been the case. >> the development is a long and 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 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 only going to be able to meet 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. >> first of all i would like to clarify that this manufacturers with a specific type different than other organizations in use. 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 ship 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 his 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, contact tracing, all sorts of things to try to limit the risk of exposure. what is the appropriate protocol for these people during this crucial 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. to call in when he has 103 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 tina and amber and several doctors -- you have to remember that they are human. you can't expect them to use their common sense at that point. because they are patients. they need a team they report to the checks on them as mr. torbay has 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

unduly to the infectious disease. i think 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 on thursday and should have had a team of counselors to advise him because his judgment could not really be trusted? >> exactly. exactly. >> that is a pretty bold recommendation. 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. so that is an astonishing response. but what can we do to get more nations involved?

i was thinking about france that has had involvement in that region traditionally, these butthese -- traditionally, 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, private foundations and corporations 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. probably 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've seen 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. trained to do. that is a concern for them. but 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. >> congressman, thank you for the question. i've spoken to the commander on the ground and the folks at africom. this question comes up quite a bit, actually. 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 individual soliders will be doing. >> but they do come in contact with contractors and aides? >> 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. again 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 comman