business. he wants to shut them down in policy after policy after policy. >> that's time. >> thank you. >> dr. trammell? >> point of clarification. not on the ballot. ( laughter ) and for the record, i disagreed with what she said. i happen to agree with you in general sense. in terms of answering this question for our students, and i in theny of you are audience today, let me answer in a specific way first and then in general way second. in a specific way part of how we have to address your future is through student loan reform. i met with a bunch of doctors last week and they told me that many of them will come out of med school with more than $300,000 in student loans. they'll be 29 years old, and i asked them when they'll pay that generally theaid plans that we're on, you pay it off when you're 60.

and i thought about my own student loan coming out of graduate school, which i haven't paid off yet. president obama and michelle obama didn't pay their student loans off until the year before went into the white house. we are shackling our young enormous amount of debt. we're charging them higher interest rates. paying 7.5% interest on my student loan, but my mortgage is 3.87%. why are we doing this? loandressing the student and the rising cost of higher ed is key. but i think we also need to start designing our communities for your generation. some of the towns and communities in virginia are already doing this, like danville is a place that's trying to do this. they're trying to get internet free in all the businesses, they're trying to design their trails sos with bike you can ride your way to work. design theirg to community for the 20 something so that after you go to randolph

to youru come back community and become a productive member of the economy there. so i think there's some wemunity engineering that a worldo help make this where you'll be interested to be in the 7th district after awe from a from college. was our last that question. we'll now move onto closing statements. won the coin you toss on that, so you elected to speak last on the closing statement. so we'll begin with dr. brat. a great you again, what a great

night, students, thanks for coming out and playing a part in the political process. it is important, if you want the american dream, vote for me next tuesday, and you'll get it. history has proven that free markets can turn economies around and produce the american dream. so if i were tied to president obama's policies, i ran against them, right, obamacare is a disaster, illegal immigration is a disaster. the debt and unfunded liability issues that i've covered in detail tonight are a disaster for this country. i think you ought to send an economist up to d.c. to fix the competenced provide once again in our core american institutions and values. go into detail on one example, jack says he want more taxes in other debates and forms, but obamacare

a trillion dollar tax hike on americans. you don likey taxes, but he's for a program which is a trillion dollar tax hike. and that matters. that program is kicking 250,000 virginians off their health insurance policies. after the election, as i covered. not unintended consequences, this is exactly written.aw was i want to repeal obamacare i to commitflat tax this economy moving again, and i sewer programs for seniors going forward owe. >> that's time. >> to protect social security medicare. thank you all very much for having us tonight, it's been a pleasure. you.ank dr. trap el? >> let me -- already dr. trammell? >> let me say thank you for having us here tonight. i look around the room and i see so many familiar faces. i miss this place. i hope i'm not coming back,

but -- ( laughter ) but i thank you all for being of this participatory democracy tonight. i also would encourage us not to act in this time out of fear, and not to act out of a sense of crisis. i think instead we should go back to what i said initially, quoting jefferson that we need to acknowledge our history, acknowledge where we are, and some challenges there. but we need to have the dreams of the future, we need to have the vision. so for me that means two years from now i can come back and i to you about comprehensive immigration reform. can come backrs i and visit you and talk to you about the school climate improving. educators finally getting a break for all the hard work they do. somebody holding the department of education for theble accountability movement. in two years i'd like to come

that a do-nothing something has turned into a do-something congress in two come back and to say that we've made health care work better. in two years i'd like to come doing betterwe're to our vets. we didn't talk about them much tonight, but we need to do some thing to help our vets and to reform the v.a. in two years i'd like to come you that we've got jobs here that we didn't have two years ago. able to tell you that we live in a safer world, and i'd like to be able to tell that we areople stating to rearrange the way we live in our communities, so that a partl come back and be of our communities. the 7th district need you here. again i thank you for being here on the and being part of this shared vision. i ask for your vote november 4th. thank you. [applause]

>> well, gentlemen, these folks appreciated you so much tonight, they didn't even wait for me to to applaud. but we do thank you. you both made us proud, and we wish you the best of luck in the coming week. you --e to see both of actually i don't want to see either of you come back, so -- ( laughter ) [applause] but we're going to welcome one

you back with very open arms. those interested in more debate discussion here tonight, pavilionin us in the in birdsong hall for a post debate town hall panel discussion. and let's give our candidates applause.und of [cheers and applause] >> join us tuesday night on c-span for our live campaign coverage.ion night starting at 8:00 p.m. eastern you can see who wins, who loses which part will control congress. and engage with us on the election results on twitter at or facebook.com/c-span.

cities tour takes book tv of and american history tv on the road, traveling to about theirto learn history and literary life. this weekend we've partnered with coloradoor a visit to springs, colorado. lon montgomeryu pike was sent into the southwest to explore the region, very similar to how and is clark who were sent to the northwestern acquiredhe newly louisiana territory. pike was sent to the southwest the territory. and from his perspective when he here he really walked off the map. wasent to an area that unknown. sees theike first grand, he thinks he'll reach the few days, but it really takes weeks. they reach what we believe is a

mountain on pike's peak mound rose savment he wrote in his journals that given the conditions, given the thepment that they had at time, no one could have summited peak. pike's peak inspired the people that became america the beautiful. written by bates, who came here teach a summer course at colorado college in 1893. down to the plains from the top of the mountain the poetry, and inspired the images that are in that poetry of the united states. our events from springs today. and sunday on c-span 3. >> next, a discussion about

international health and including the ebola virus and chemical warfare. columnist, author and glen greenwalt talks about the effect of government surveillance on democracy. at 7:00 a.m. your calls and comments on "washington journal." next, a panel discussion on international health and challenges. medical and defense analysts discuss the spread of the ebola virus. health concerns related to pie logical and chemical warfare, humanitarian and refugee crisis resulting from the war being waged by the islamic state. by the interuniversity center for terrorism studies, two hours.t under >> i want to welcome everyone to and thank youar, for putting this together with a

great deal of haste really the topic. the health challenges that we fromin securing responses ebola to terrorism. and of course i think it's an extraordinarily timely event. here.e a super panel panel, we're blessed today a loting a panel that has of military experience, a lot of government experience, a lot of medical experience, a lot of all kinds of experience, if you will, that you need to talk topic, along with don and his international legal ofice and all of that kind thing. somebody told me one time when i young guy if you want a good idea, read an old book. that is very timely. for example, here's a book that yona13 years ago, and the title is terrorism and

responses, u.s. lessons and policy implications. says it all.at >> thank you for your kind words. mentioned the book, i would like to calm your extraordinaryhe --k that general we have the information in the you.ge that we provided to if you read this book, you know about.adership is all and we actually after learning what work, what didn't work, and the general made many contributions as we many, many years. onto ourre we move

speakers, i have to deal as an academic with some of my duties. of all, i thank the of this event, of potomacof the and the -- we do have some of the colleagues. where are you? in the back. and i think we do have a few other members here. right here fore many years, professor don wallace. and i do have to mention also colleagues who are not here a longy work with us for time. the center for national security

virginia,niversity of school of law, particularly and owe professor moore and professor turner. my colleague professor brenner who died several years for we worked together, many years, at the center for studies. at the international law institute. me first introduce our panel. make some have to remarks before they speak. dr. robert -- right here. see a veryl the generalio, as mentioned. we do have some former senior thecials, the white house, pentagon, u.s. senate and so on.

read the bios of the speakers. is dr. katani, right here. who is at the potomac institute, also has a rich background and you can see that. is professorelist now with the is near east out of the asia center studies.egic in he also participated government, the u. n. and so .orth now, you do have the program in you, and i would like

few remarks both as an academic, and i think it's my to try to put some and rationalization to our discussion. before that i would like to mention that in general when we issue of security dedicate the, we seminar or the session or all in thefirst of ofory of the victims violence, of both man made and mother nature, which i will come back to. now, of course,s who who died of the ebola disease. by those who were victimized terrorists throughout the world. to keep in, we have

mind that with any challenge which is very serious with implications, globally and all have tod we certainly think about the victims. some specific segments of the society that are targeted by terrorism. for example some of the cover thes, those who events and try to bring us the the way a from dan yes pearl who was assassinated in 2010, and to the islamic state of the execution of james foley. to theis a dedication victims, and secondly also we

ofe to celebrate the work those who serve to protect our ofieties, in this case course the medical community, the first responders. the law enforcement people, the military governments and the society in general. may, we, i think if i seminarull together a that we left two major challenges, in other words one disasters --l do you have the? okay. quickly a fewry slides. --ce men have faced natural disasters

made disasters all the way from earthquakes to ebola. secondly, of course, a man made, economicay from the collapse, technological , piracy, and trim and war. obviously we have to deal with both of them in order to a are some ofh the major challenges that we have to deal with. now, if i may, i think we have the connection between experiences as well times.emporary we're trying to deal with technology.

as we say, nothing is new under except technology. right? wrong thing.the after all, i'm an academic. just have rate, we the publication here on the challenges in africa that was published yesterday and we're releasing it and will provide you with copies, deal with both as the terrorism challengings. so if, for example we look all the way back, even in the bible that,l the books and all it's very clear what happened to that time, and the victimization. to looks interesting during history of what were the

or the blame for some asthese disasters, natural well as man made. and we can look what shakespeare said in king lear, to point the finger, who is guilty of the disasters. but i think the best answer was noah, when he built the arc. sent a he basically message that should be, i think, developing,terms of and he said there is no room for delays or indecision. governments have to move and the society have to move in to deal with the challenges. obviously we back can look back at history, the time of the troubles if you will, and the middle ages

particularly the black death, the thing is that the middle ages and the black death is not history.apter in sometoday we find in contemporary struggle that some anremists, they try to push call --t one can in other words, for example in i think a crisis and war, there were communications that the jews are poisoning some of the waters in order to kill more and more people. now, if we look back at the responses, this is one picture the middleian in ages, protecting themselves from black plague.

see thatally you can he's really wearing a cloth oil cloth, covering his spongeth a mask and a with vinegar. from thehave to learn past. that found in fact i think professor wallace, and i remember we were together at the turkey, and though monuments of the of the turk irk republic, thehe way just celebrated 91st anniversary of the think --epublic, and i in this particular statement art of thequate the

body to the art of the nations was really on the mark. set a valuable standard for in humanity that we cannot be detached from reality look at theto situation as it is. to deal, we're going with the virus and the threat of ebola, and what we learned from history that there are two emotions that drive people. one is fear. hope.e is with fear, obviously we see what even if there were very few cases in the united the west.d interest n and it dead generate a great deal of fear. to discuss the whole ebola, and we do have, i would say the experts to deal

with that. each time we're surprised about the surprise, did not anticipate, a, like in africa we know that there were many cases of infectious diseases all from malaria to typhoid and so on. tonumber one, we're going specifically,ola the roots and what are some of the challenges that we're going andace in the coming months years. to discussre going about also the security issue, which has to do with terrorism, particularly now we have seen isis.appened with the now, i suggest that we look at ase of the other groups well. for example, the hezbollah and we also mark this

october, the 31st second baseof the and french forces in lebanon. have to look at hezbollah as well, because we find that although it's very much engaged in syria and of reportso all kind to upgradeh was able its capacity, and according to there arereports, 100,000 records case of aah, and the third lebanon war with hezbollah going to see,'re , capability. in addition, we have to look at the region, and the alt one of course is

qaeda group. not, we have to look at the affiliate groups. we're going to discuss it with one of our panelists as well. the this is a older map in beginning of the year. obviously we're going to have an upgraded map to indicate what's happening now in the region, and elsewhere. americans, the and we havee region to deal also with the hamas issue and particularly now we

find that the most recent attack sinai that we witnessed, egyptian armythe currently has some connections with the hamas and other external groups in the region, and clearly i think in to develop security, they buffer zone.t a sinai region between the and gaza and israel. and there is no doubt that we have to pay very close attention person of stability in e vipt, which is the most important country in the middle east. stomach state, that discuss in some details, and what is really

islamicing about the state, that they are able to somehow recruit thousands of volunteers from all over the the foreignknow, fighters. from tune eastern a-- tunisia today, there are about 3,000 volunteers, despite tunisia proved that it can somehow develop elections there isn't that we know, but nevertheless for thethose who fight totalitytate and the of thees lambic state is very well-known, but i like to mention not only this, but women so forth it.and so we know that the islamic territories as well, and of course the concern

the islamic state as a in far fearsrategy or 10 years, and i would say we to be concerned about this. to the roleregards linked with, security, we're going to discuss humanitarian crisis in the africa, or god in into some details to countries know if you take, for example, syria, the telephone number of refugees or displaced syria is around 10 millions if you take into refugees, --

think the same thing is in -- so the question is, basically, facing in terms of security? we must to you that discuss not only the ebola, but the biological and chemical and nuclear exal evenings that society is facing, and then of these in order to deal with strike a pal to between the security considerations and human rights hibbities. civil liberties.

>> it a great pleasure and privilege to be here today. play to quoteof a that only the dead have seen the end of war. sayi would amen that to that only the dead have seen the end of war, terrorism, and disease. so on the topic of ebola it really represents, i think, a in time,resting point and i think the historical reference to the black plague is interesting one, because it will highlight some points i'll make later about the risk that we face in the 21st century plagues like not only ebola but other things that will be enabled by things like climate change, things like mingaization and urbanization. but i'll talk about that a little later. issues i'd like to highlight for you is give you a

this of, we enter into circumstance with the great humanitarian crisis and quite frankly national security cries is in western africa, after a bit of work that has been done over the last decade to terms ofur became in health preparedness and health security. so it will be my intent to give sense of what has been done and what remains to be done a policyult lines from perspective exist both for the current administration, who ever is president next, he or show, and certainly the new congress that will begin in january. i think the current ebola crisis at least from a u.s. perspective the great vulnerability of our health care system to a single case of ebola that basically walked through the emergency room door in sents and was immediately out after all the warnings and messages that the centers for control had set, saying that it was possible, more than

possible, that an ebola victim could walk into your emergency room or hospital. worse about this is the argue that you could this has been largely media hype, but i would argue something very different, that there's a very core fear in the predatespublic that the events that happened here in back, andhat go well i have an historical example of it, back to 1946. so many of you may not realize that during world war ii we had manhattan projects that were conducted. one was developing the nuke ther bomb, and we know who oppenheimer was there, right, dr. oppenheimer. biologicalas also a oppenheimer, a gentleman by the merck, his name may sound familiar because there's a billion dollar pharmaceutical company named after him. but he was the american

for --imer quite frankly they never were able to create a functional biological weapon that they intended to use at either japan germany used this is kind of weapons against us. i only make that point because i there's a historical point about the role of intelligence, in 1943 when president f.d.r. was warned about the logical warof buy pair and the u.s. intelligence community basically informed him germany had a buy logical weapons program and japan didn't. after the war the exact opposite was true. probably relate to more recent examples where the hasn't beenunity 100% right on these issues, but i think it's wore any to note case then ande now that in some ways if you

spellings we may be disappointed. andicularly about terrorism disease itself. the point i'm trying to make is merck released a report to the american public about the efforts to develop biological weapons. cases that ihe few know of where a report was undallas filed, released to the public and later reclassified in secret and pulled from all the shelves. why was that, because it scared the americanut of public. it created a firestorm in print perfect of time, and you can recount that if you go to andarchives of "newsweek" tile magazine when they were printed on paper, and actually only the scientific debate but the fear that was invoked by the concept that you create agents that would be invisible, that would be, if totally alien to ultimately that will

kill new a rap i fashion. i would argue that everybody has life, so in their there's some element of what i'd say personal reference to the as it is.lness, few people have had ebola in america, but if you recall robert preston's book, the hot zone, he certainly makes a very case why you should fear such an organizism like ebola virus. so in some ways there's an innate fear by the american public and also a created fear by public press, there have been subject,ovies on the and obviously the immediate where has not missed their print ortizing in today's world. but the point is this represents interesting next us for the potential for terrorism. that is what we experienced around 9/11 with the anthrax attacks. so i would just argue for the august panelhis

that in some ways while we view the ebola crisis as it is today event, it could certainly migrate into a different space, should someone advantage of the availability of a virus like means tod use basically deliberately infect people. new news to you. but i do think in some ways you need to understand the health care system that we have today. a $2.8 trillion activity. and the u.s. government currently spends about, for hospital preparedness, about $225 million. that represents one one hundredth of one percent of what spend in health care. so you can imagine that what we gain out of that federal investment around health preparedness is evident when a single case of ebola basically through a door, or it could be any other disease of

smallpox or like pandemic influenza. affordable health aircraft, and i'm not here to throw stone a it, but does not have thread of preparedness weaf through it to ensure that the willh care system that we develop over time whereverry only access tot by the right to health care is a meetm that's prepared to the challengings of the 21st century. represents the poster child for the challengings ahead of us. just throw out this quick anecdote. the amount of money we spend on is about 3%redness of what the american people chips.n potato so as a society we don't put a lot of investment or priority, or significance on that one. but while i may be doom and monetary side, i need to convey to you that there

is a wealth of things that have been done, beginning back in the mid 90's during the clinton administration that really have, if you will, evolved policy and action to the point where today in some ways i would we we have enough policy, have enough legislation, to do what we need to do. we failed on execution and thattment to do the things have already been established by presidential policy and legislative statute. some examples of that. first of all, as i mentioned, president clinton basically recognized the concern about bioterrorism, and even though wasentional press says it around the book, cobra event, by robert preston, and another book synthetic virus that comes up with. but the point is that much like einstein letter of the 1940's, that was sent to

f.d.r., president clinton got a letter from a yachtguished nobel lawyer by the name of joshua letterman, in that decade did a study for the institute of thatine that indicated emerging diseases were going to be a significant consideration in the future. 1992, before the issues if you change,global climate before the issues of globalization of realized, dr. letterberg and his colleague, basically recognized that we were on a converging path, potentially with disaster of emergingsibility diseases and buy -- bioterrorism. and it was his warning to that -- i'm a great believer in our

attem of government that best we can hope for imperfect increment alism. you could look at any issue in the united states history, whether it be civil rights, policy, or public and weical preparedness that demonstrate imperfect incrementalism. made a few steps forward, one step back. with that there have been a series of, if you initiatives,tive that basically happened after noting.t are worth one is the pandemic preparedness. like to take credit for it because ways a staff member of committee that drafted it, but it was actually senator richard bird from north carolina said ted kennedy who championed that bill. and the significance of that the was it basically used lexicon of national security to

and redefineign the u.s. government's role in repping for these events. interesting enough and i'll make reference to a project that in inl gray was involved his career. but we use the goldwater nichols act as the template for this bill, not because we think health or medical capabilities should an lined d.o.d. access, but it did identify in the goldwater the idea of having joined operations, putting creating a large and command structure overall. so with that a position was created servicesalth and human department for the assistant secretary of preparedness and response. in the crisis at hand you don't hear much about that. but it was their function to do thees in things to a line not governments --

it's also this idea that to the state andn local authorities who are, if you will, the front line ofdiers in the kind --rorist who were soldiers in this kind of activity. ofo hope that as a result this ebola event, somebody will have the wisdom that they had in the 1980's to commission a holloway report that general and we talkedof, about it before these proceedings. did assess why did things fail. that case, desert one, because what they identified in blueprint they laid and the vision they left was one that decades went from the point in time when we had a failure in the iranian hostage rescue to the point in time that we could all

the demise of osama bin laden. that didn't come overnight, that happen because somebody just said let's do it. literally took decades of commitment by the special operations community to do four lengths things. four essential things that i would argue today are the the kind elements of of public health we need to address. best people.t the if you look at the record right now, we have a tremendous brain will, drain of the public health community the people operating at the and local levels to peoplely ensure that abide by their quarantine, that people do the things that lower public tof the disease. we also acknowledge that in the that in manynity ways we don't necessarily train theseip them to manage

events. i think the events in dallas proof, as they did prove in the desert one, there is no such thing as just in time preparedness. the idea that you need to have a trained,t's ready, they need the be trained and exercised. yesterday i spent the day with the institute of medicine on prepareds in and we spent the day looking at what already ebola virus.th the leaders from local atlanta, from nebraska, from new atk, and from dallas, or least indirectly from dallas on their experience so far. said is you know what we really needed to do was make the equipment in hand and that we were well trained. butjust in time training, continue to show that we could

mission. so these are essential elementings of the challenge that we face right now in terms preparing it. you'll hear offed ahoc teams d. c., department of hocnse, those are truly ad gap fillers. but as we look forward to the itnts before us, i think does raise the question, how much are we going to invest in ais space, how much of priority are we going to put in this space. crisis is over, realizing the next one may be on the near horizon. are two major political, policy issues that are outstabbing that need to an dressed. and then i think i'll probably be at the end of my time. i'll leave you with some final thoughts. first of all, one of the lessons we learned in the early 2000 period from the standpoint the anthrax letter events, it could have been a lot worse.

from the commission graham, thatator they recognize that that perpetrator, taking a single envelope with that anthrax and ventilationnto a shaft in the metro, it wouldn't have killed several people, i have infected several hundred or several house people. veryhis points out a important issue of inversion that i think has happened. in the policy towards these events. so we talk about inversion about oversees,nies moving policy --e you a the critical element here is, in events, it wasse always believed that bioterrorism, bio warfare, conducting these kind of infectiousing disease agents, would create a situation that was not seen in

nature. couldhe risk was that you infect millions of people near anultaneously by releasing aerosol cloud. over time, the believe is that prepare for natural events like ebola, which don't have the epidemiology, that somehow we'll get the benefit of health andur public medical incentral truck stur but int a lower cost, some ways that's the more likely concern are no. army toe telling an say, or basically better yet let analogy,football taking the washington redskin play am they're going to local high school teams, as their way to extra when to delay theut delays cowboys or the seattle seahawks. a you design the problem in certain way, and i think we're on the wrong track at the

current time, that we will basically not prepare ourselves address, i won say the worst case scenario, but certainly a scenario where terrorism basically price to use weapons.d of agents as and as i think you can see in the events of the ebola case, we proved their selves necessarily exit to deal with a single case of a naturally occurring disease. that's reported to the united states. issue is, another policy issue is in all the the efforts ofn washouse, that preparedness somehow outside the domain of care.r health kind of an add on, an adjunct, and the answer is it has to be integral with. that's another vor policy issue outstanding.is

think in the construct of my comments today, and athroughing to the points the professor blackder made around death, we to look at the events lifeare going to make our challenging no matter what, whether it disease that is or deliberategin in origin. essential factors, talk about chiement change ally built, globalization, the that someone could get on a plane today and be in the samed states about day or the next day carrying a disease that either or she acquired, that could represent a public health threat, or by peoplely having ten purposely inoculated by a youicular disease being, if will, infiltrating the united states by commercial airplanes. elementink the other here is this idea of

urbanization. the problema wasn't in the past. because it would happen in a somewhere.age would get sick, people would die, and because there was no you are to modern transportation, the outbake was naturally contained into those settings. now there are better road in africa. people living in large urban monrovia whereke there's a million people living. in thatbody gets sick environment, particularly when othertion and conveniences of life that we able,or granted are not it creates a circumstance where these things can prop gait. probably, if anything, went over my time. but i hope i left you with a the landscape that we've down, which again, first is imperfect increment alism, we're two decade into a

to improve thet preparedness of our public health and medical incenter truck stur. many more miles before we sleep, before we get it right. this is not rocket science. experiences and analogies we've done in other areas, that there is a way to rapidly fix this problem. expensive, butly it takes leadership and some so.cum of resources to do and the last thing is we need to define the problem correctly. ways the challenges before us are likely to be more they may represent a deliberate component that entirelys something different than we're dealing with now, and we should have the fortitude toe develop what we need before it is no justause there in time preparedness.

[applause] # >> general gray, professor and distinguished guests, it's always difficult to go after somebody who i respect tremendously, who has been a friend and advisor for many years, doctor. i'm going to focus on some of the facts and the ethical issues related to this particular disease. in africa, ebola primarily inurs in remote villages tropical rain forest in central and west africa. reported inses were democratic republic of congo known asformerly dan, ivory coast, and

and sierraeria leone. and 2012, 2,388 1,519 deaths were reported. when we look at the numbers are amazed. that is something that we want perspective. another important thing to appreciate is how does ebola spread. now, recent studies have clearly that food are a -- freul bats are a residence for fruit bats are a carrier of ebola. transition, humans, so unknown. the first patient becomes withted through contact infected animals such as fruit

primates, which is call a spill over event. can lead tosion large number of people getting a small pastin outbreaks, primates were also alsoted and a lot of them died during these outbreaks. and humans when we consumed the of those primates or touch pri mates, got infected. once the infection comes into the virus did spread in several ways, through direct skin, mucousen membranes, eyes, nose, mouth, body fluids ofnd a sick person. and it's not limited just to urine, saliva, sweat, feces, breast milklso to and semen. canenerals like needles also transmit the virus and from infected and as we've also

and thed the fruit bats primates. past research has established now, and we are still working on it and there are still some questions, but past research has cheerly suggested that the spread does not, that the throughdoes not spread air or by water or in general by food. spread as ebola is the result of, as we mentioned handling of the -- there's no evidence that other insects can transmit ebola. they canone recovers no longer spread the virus. however, ebola virs has been found in semen for up to three months. so that's something also to consider. as of october 29, the current epidemic in west africa caused the zaire strain has resulted in intrafficking over 13,000 and close to 5,000 deaths, which brings the current

case mortality rate to about 36%. the three main countries are liberia, sierra leone and guinea. jeer that had 20 cases and eight deaths and was declared on october 19. senegal had one case that ebolaed and was declared free on october 17. of sierra leone have reported at least one case and ivory coast is at the nextst risk to be country that could get the disease. , the interestingly, the inst outbreak that happened 1976, the case fatality ray was

about 80%, and that was the zaire strain. the lastout break, in 2000, 2001, had a case fatality rate of about 32%. getting close to the personals that we anticipate that are going to be for this strain.ar we all know that in spain there we all know in spain -- two nurses. be declared after 42 days ebola-free. we all know about the cases in the united states. dr. cadillac talked about it in detail. the recognition of diseases big, is something we need to look at very carefully and appreciate. couple of other cases -- there is one case in new york right now that was diagnosed on october 23. in a position who worked for

doctors without borders. and is currently being treated. in terms of the people he was in contact with was being done in new york. there was another potential case in new york, a five year old child was taken to the hospital who tested negative. there was a case in maryland on october 27. then it turned out that was not a positive case of ebola. very interesting things. the things that happened on october 27. the cdc outlined plans to monitor travels. most health care workers woulding from west africa be considered to be at some risk of spreading infection. while health care workers tending to ebola patients in united states facility would be seen as low but no zero risk threat to the population.

these guidelines were short of the mandatory quarantine imposed by some united states states such as new york and new jersey. same day, united states department of defense came up with its own policy well beoyond military protocols. u.s. army isolated a dozen soldiers at a base in italy, including a major general who oversaw the initial response of the ebola outbreak in africa. dozens more would be isolated in the coming days. where the military has been building infrastructure to help treat ebola victims. we have about 3000 boots on the africain rotation in helping with this particular problem. one of the critical problems with ebola is how do you diagnose this disease? we did not have a very effective way of diagnosing it. in response to the epidemic on

august 5, the fda issued the defenser the department. on october 25, the fda issued another emergency authorization for two new tests, which can be done on blood or urine. and give results and an hour. france is developing a tool which is called the ebola d screen. and it can potentially diagnose a patient in 15 minutes. when it comes to treatment, there is no proof treatment available for the disease. clinical management is focused on supportive care of complications. however, multiple therapeutics or drugs are being developed or are in potential process of being developed that could ehhep work on this disease.

there are two vaccines. one being developed by glaxosmithkline. the other one by ulink, a canadian vaccine being produced in aimes, iowa. both of these vaccines, if the test of all the efficacy and safety in humans being done right now comes out ok, then there should be a decent amount of supply in the first quarter populations within the united states or to begin to health care workers and first responders in africa. e other important factors to consider is what is going on in terms of the beds in africa. there are not enough beds for patients per the latest data indicates that only 22% of the the planned ebola treatment beds are now operational, which

leaves a huge void in terms of providing help to the population. the current epidemic is the largest and the most complex on record with an unprecedented number of affected countries. thousands of cases and deaths. in general population, and hundreds of health care workers infected. the scale and mortality of the outbreak has reinforced the need and accelerate development of available and effective medical interventions. subject to the outcome of initial safety studies, we expect that there will be therapeutics and vaccines that will be available to work on this disease. now, all of you have heard that experts have predicted that if appropriate measures are not taken, we can expect a proximally 10,000 cases per wee starting in december in africa. two countries the

opera is going on, we are seeing a little bit of decline in terms of cases. so there is some hope this potential outbreak could be nipped by january if measures are taken. as dr. cadillac had suggested, the world is making this up as we go, and we have become more comfortable with uncertainty. it is a huge problem. the current epidemic, which africa struggles with, is something that we should have thought about. they do not have a health care structure that can deal with the regular issues that go on over there from a health care perspective. now we are adding to the injury by ebola. nature is adding to the countresies with ebola outbreak. data clearly suggest aggressive

intravenous hydration replacing electrolytes and managing nausea, fever, and bacterial infections. they are inexpensive measures that can be part of a package that can be delivered to west africa. there is a critical need of beds. in the most affected country. proper training and protective gear needs to be provided to hospital staff. and the burial staff. there are complex ethical challenges. untestede of interventions, quarantine, special care, and other issues. in the u.s. national institutes of health biomedical research has always played a critical role in physical and mental health of americans and the g lobe, which has yielded significant economic benefits. federal funding has been the theerstone for nih for

american biomedical research sector that leads world innovation. ng stagnant after 2003 and declining after 2010, the cost of conducting biomedical research has rapidly increased at the same time. this was further hurt by the recent budgetary cuts and sequestration. in order to secure america's position in the -- as a global theer in research, for future, congress must pursue investments. there is no evidence in the scientific literature that says closing borders will cause the disease to stop to come to a nation. we also need to deal with some of the other ethical factors in terms of informing health care workers. we should accept those workers. we should make special specialents and

commitments to health care workers that are currently working in these particular countries, frontline, dealing with a disease that is externally deadly. these doctors and nurses must be promised not only high quality of training and protective equipment, but also that if something happens, we must take care of them. someone must take care of the heroes, not just the civilians who are there but the 3000 troops we have in the hot zone when they come back. we have to make sure that they are taken care of. and somebody -- although there are signs the epidemic is slowing down in some areas, it is not met with an effective international response, it will cause a bigger devastation that we could ever think about. i believeccine an is the only hope for containing the outbreak, but the u.s. investment is a drop in the bucket. a non-partisan effort in the

u.s. is needed for funding support to the nih for research and development and advanced development of vaccines as well as diagnostic devices. concertedve to make a effort to develop many faction facilities right here in the united states. for diseases such as ebola and other infectious diseases we might encounter in the future. countries, ngo's and funding agencies must fill their pledges. of pledgesorry, 17% so far have been fulfilled. countries promise and pledge private institutions promise and pledge. those pledges never come through. they need to stand up and fulfill their commitment. remember,ord is diseases do not observe boundaries. could have these diseases

come to the united states or any other part of the world if we are only reactive and not proactive. thank you. [applause] >> thank you. with dr. alexander's permission and our media colleagues' approval, i'm going to speak from the table rather than the podium. i appreciate the opportunity of being here. i have been asked to speak a bit about terrorists and insurgent groups that are operating, not just in africa but also in other parts of the region. and a little bit about how that affects humanitarian, potential for humanitarian disasters in the region. there has been plenty of literature analyzing these groups. some of the best has been done here in this building. i am not going to go into what al qaeda or isis are all about, except for just a little bit. but what i want to do is talk

about activities of these groups and the potential for the development of true humanitarian crises in the region. and that is primarily through the issue of refugees and displaced persons. i have got statistics i will rattle off. the sources of these -- mostly the united nations, the high commission for refugees or the undersecretary general for humanitarian affairs. groupica, boko haram, a that has certainly made headlines recently, there are probably 10,000 nigerian refugees in cameroon. i do not know if anyone would go to cameroon to seek refuge, but there are 10,000 nigerian refugees in cameroon. there are probably 50,000 nigerians in niger. and there are several hundred rnally displaced

persons within nigeria. maybe even up to one million. because these numbers keep changing as things evolve. moving for the north, in the mali situation and in the activities of al qaeda and the islamic magrib. in mali and algeria. there are 300,000 internally displaced people within mali. i mentioned 50,000 in niger. some of those come from mali. in both situations, the u.n. as monitoring not for ebola but for yellow fever, cholera, and this sort of thing. emphasize the humanitarian disasters that can happen are certainly more than just medically related disasters. in libya, which one can argue is kind of the beginning of this whole process, especially in

northern africa, there are 60,000 internally displaced persons within libya, a country of government, the central government or regional governments, their reach does not extend very far beyond the building in which they are meeting. there are 1 million refugees, according to the u.n., in tunisia. the president of tunisia, who will be president for another six weeks, says it's up to 2 million libyans in tunisia. capable medical -- capabilities. a bit of a joke about that if we have time. but this is still, it really taxes the capacities of

countries to handle these people. now, let's talk about isis. i'll talk about the refugee situation which dwarfs these on the numbers. -- these are the numbers. then i will talk little bit about isis itself at the end. the un says there are 3.2 million registered refugees. registered refugees registered with the u.n. from the isis -syrian civil war and sectarian fighting within iraq. more thanrefugees, one million each in jordan from iraq and syria. jordan has seen waves of refugees from 1948 right up until this year. about 1.3 million in turkey. these are registered. 1.2 million in lebanon. 500,000 syrian refugees are in

iraq. the frying pan to the fire. they saw a refuge in iraq. and there are 900,000 internally displaced people within iraq. syria, the number such a, there are 4 million syrians that are displaced. now, some of them go to cities and live with relatives. not necessarily all in refugee camps, but this certainly is a lot more than 3.2 million refugees. about 5.2gets close, says theeople in iraq, united nations, are in need of humanitarian assistance. as winter sets in. fuel, shelter, that sort of thing. syria, this is a

chilling statistic and i will talk about that towards the end, there are now about 10 million people living in areas controlled by isis. that's 10 million people. in s yria and iraq, both countries. that is larger than the populations of most of the states in the region. now, this creates a large refugee population, camps, emergency needs, and there are our previousd by speakers -- i do not mind going after previous speakers. i learned a lot from the folks who have spoken before me. there are a lot of obstacles to governance and international organizations and ngo's. there are obstacles to their providing the necessary humanitarian assistance. ranging from the, well,

seemingly ridiculous. teams that are vaccinating for polio in pakistan are actually there to sterilize her daughters. so do not let them into the village. in fact, several have been killed. medical workers are actually bringing ebola into your part of the country. so stay away from those people pity reminds me of the black plaguecture -- the black picture with the vinegar. it is misinformation and propaganda that we have to counteract. obviously, there are terrorist attacks and resurgent attacks going on in all these countries that i mentioned. and that threaten especially foreign ngo's, but indigenous or native ngo's, also. in niger, the government has

said that any humanitarian teams providing assistance need armed escorts outside of the capital. that certainly inhibits people flocking to help the victims there. there are kidnappings and abductions of humanitarian aid workers in mali. isis has targeted humanitarian workers. we've seen the beheading of two brits that were there for humanitarian purposes. the under secretary general of the united stations for humanity says, united nation's, this is in syria, "we have had 66 humanitarian workers who have lost their lives since the start of that conflicts and hundreds more have been kidnapped and objected." this is what she says. within syria. that is certainly an obstacle to bring the assistance necessary to take care of these people.

and, as we've seen in refugee camps in jordan and probably elsewhere, the war in syria or the sectarian fighting in iraq can spread to the camps themselves. in other words, fighters from each side can infiltrate the camps or go there as refugees and carry on the fight within the camps, which is really stresses the national security services, the u.n., and other organizations. so we have got the situation with millions of people facing, and it would not take much to humanitarianl crisis, but certainly other crises in terms of food, water, shelter in these camps. bit let me talk a little about isis, because this

represent the new situation. isis, that is what our government insists on calling it. i'm no longer part of the government. i'm an ex-fed. not fed-ex but an ex-fed. our government insist on calling it isis. but isis has its eyes on a lot more than just iraq and syria. their map of the world wide caliphatesembles no that ever existed. most of northern africa, south globallyis a very looking -- whether they have the capacity to execute it is another story -- but they have this vision of this worldwide caliphraate. this is the first organization of its kind that has been able

to control territory in the dayt ime as well as the night. this is key territory. these are cities, these are infrastructure, roadways, ribs, that sort of thing. 10 many people live in the area they control. a.q.i.m. and groups like that roam the desert. that's true. but these people control territory. they have displays the governments, both the national governments such as they existed, and the more traditional tribal authorities, that sort of thing, in the they control. but they have not filled the governance vacuum that they themselves created or that had been growing before they even came upon the scene, such as iraq and syria. they are not providing services

the people, these 10 million people that live in the area. they do not even seem to care about providing services to these people or interested. i do not serve the jihad he is goingto see what on. but i have not seen anything from isis that seeks to show how they have made life better for the people in mosul, now that maliki and this corrupt government are gone. all of their propaganda is about beheadings. this is a totalitarian organization. in the classic sense of the word. if you are not one of us, we'll kill you. even if you are one of us and you do not toe the line and believe what we do, we will kill you, too. so this is a very different organization than al qaeda. al qaeda never relalally took that line.

now we are seeing isis sort of e-type organizations in northern africa that are swearing allegiance like they did before to al qaeda, to isis. mali and in northern africa. elements of boko haram are doing it. so, we are getting these almost nihilistic totalitarian organizations that are controlling. a lot of territory getting intos these places that isis is not approve. the red cross says it did manage to provide medical equipment to a hospital in mosul, which isis controls, and c says it has established contacts with some people inside falluja, in riraq, that these are very small efforts. the situation as i

see it. in that particular region. we are facing a very difficult situation, under resourced as our two previous speaker said. thank you. a&a. --n do that during q&a. >> oh, and foreign fighters. i'm a grandfather. young men worldwide find ways to get in trouble. i do not care where they are from. tunisia and other places are no exception. it could be through video games or through drugs or through alcohol. ut forcefully, at least in the west and in europe, the outlets for getting a trouble are much less lethal than they are in that particular -- it is not surprising that young men of that age would see something, everybody wants to be

the person in the video games. a lot of tunisians before the revolution in tunisia were drawn into these groups. when they were in your. they left tunisia to go to europe to find a better life, which they did not find. thereforey were attracted by these groups because they were separated from their real families, they had to find a virtual family which was on the internet someplace and they get sucked into these groups. a lot of them went to syria. now they're recruiting within tunisia itself. said, there is a lot he can blame on the jobs, the economic, the social despair they have, but essentially, there is always a group of young men that are going to find ways for excitement and to get into trouble. would you like to make any

comments now? yes. ok. thesey of you come to programs -- [inaudible] is that ok? is that live? i say, many of you have come to these programs and there's thread thatolden runs through them. i think it is the richness of what is said. i find it difficult to pull it together in my head. today, we have a fairly common set of themes. i thought initially we would be talking about the fear, but i think we are talking about the underlying reality. so we do not have to get into the excessive reaction. someone mentioned the core fear. dr. cadillac.

and i think both -- let me talk about isis briefly. we've had a program on isis before. we can call it isil at the time. i think someone called it terrorism, but i think it is deeper than terrorism. terrorism is simply one of the things its bond. i think this is something we have to be concerned about. i think we have seen the collapse probably of the middle east order. it is interesting. somebody mentioned that yesterday was the 91st anniversary of the establish of the -- the establishment of the turkish republic, roughly the same time as the end of the califphate. but i think there is a real unraveling there. the problems are profound. i think so many of these problems, when america. fear comes from ignorance. but even if you are knowledgeable, it is very hard to get a total grip on the underlying reality that is

evolving. i think that is something we will come back to again and again. ee drawing that picture and then arc keeps deepening. on the other side, i thought it was interesting. i did not see how we would link ebola to this, but now i see. it is the inadequacy of our ability to cope. yes, difficulty in coping with isis, but maybe even a greater difficulty coping with ebola and then possibly bioterror. something veryo deep and american which is our priorities. i'm a republican, but i am not a tea party republican. disc inclination of americans to spend money on public goods, the believe that private life is all it is about. the atriums and buildings, the beautiful houses, the meals. we think there is something wrong with our manhood in wanting to spend money on public goods. and yet, we do at our perril.

-- at our peril. as we cope with security problems, we must not collect or civil liberties. i agree. i'm a lawyer. and lawyers tend to be interested with that. they are not the same. but nonetheless, our regard for our liberties is somewhat related to our regard for our untrammeled freedoms, our unwillingness to sacrifice in the short and long-term. ether we will get serious about it or not. even in the face of emergencies, what we are not is marines. general gray is a marine. the military has a discipline. the civilian publics of the west do not have it. so i think we are going to lurch and lurch and large and do incrementally a little better but we are going to have to put up with it. i hope we do not succumb to fear in the process. a discussion up here. stion of -- the quewstio

fear. it is a question of hope. so, the big issue is that we tend to exaggerate sometimes -- out of proportion the fear and also the hope. we hope things are going to improve. so we have to select some sort --a realistic balance [inaudible] anyway, i think you raise your hands. >> yeah. thanks very much. andent many years counterterrorism at state. more recently, i've been working on the ebola issue with a group called global health response. i think there are some parallels. in fighting terrorism, and one of the things, especially by president bush, was we fight

them overseas before they can hit us here. and one of the efforts in fighting ebola is to try to contain it in africa. the efforts to, help the people there. there are certain ironies here -- terrorism we spent millions of dollars in training other countries to beef up their counterterrorism forces. in fact, in benghazi, jordan and indonesia broke up a couple of rings that try to attack our embassies. in the bio areas, you know better than i do, we have tried to improve the capabilities of other countries. but now we are running into a problem. to encouragerying health workers to go overseas. doctors without borders, the story by reuters today said that there is a chilling effect by

the quarantines imposed in new york and new jersey. and governor christie admitted he talked to health officials. we have two major allies -- canada and australia -- which have good health systems. are reluctant to set health workers because they are worried about how to train them. what i'm trying to get it is we are being counterproductive by imposing quarantines and discouraging people from going overseas. there is another effort that is going on. much publicity trade the only solution is not vaccines. but our proposals to develop sort of a phase two to develop quarantine or develop containment zones in areas, countries already affected around the country's to keep ebola from spreading. the idea is to help educate the villagers to abandon some of their burial practices, which --

person is passed around among the family. leone has made some progress. the basic effort is to try to educate the villagers and put in some teams to deal with the psychological and aspects of phase two. this group which includes mainly a group of public health specialists and some former military people from dhs is trying to put that together. my point is that we have to look not only at the immediate problem of getting enough people and health workers and train them up. of also develop a better way containing it before it spreads further. that's basically it. >> thank you very much. [inaudible] that, i agree with you

vaccines and developing a vaccine is not the only way to problem, but what i wanted to emphasize was that if we really wanted to get rid of this problem for good, we need to have a vaccine. neededmary thing that is is to provide the affected countries with a decent -- the basic needs. some of the basic needs were the ones i identified, which are tom beds to i.v. fluids antibiotics, for example. going from there, we have got to understand and appreciate that we have got a cultural bias that thosegot to deal with in nations, and that has to deal with the way that they deal with food. and the practices. dr. cadillac pointed out clearly that we are clearing the rain forest and deforestation a lot

of land in africa. what that is doing is bringing the food back into close proximity to the population, not only the human population but the primates. once a primate gets it, the food supplies are short in those countries. guess what they depend upon from a food supply perspective? so, they eat the apes and monkeys. theyhat's the meat utilize. if the animal is infected, once they slaughter the animal, they will potentially, if the animal is infected, they will get the disease. and those practices have to change. the burial practices have to be modified. so a lot of work needs to be done. but one of the critical things before and beyond all of that is that we have got to help those nations build their infrastructure. they do not have the bed capacity to deal with the regular issues they encounter on a day-to-day basis. on top of this ebola problem, it

is impossible for them to deal with it. >> yeah. take the mic, please. >> hi. to follow-up on your question. what is your view, the medical dayrts of this 21 quarantine. it is effective in some states, not effective in other states. some health workers defy that. where should we go from there? >> first thing, i think to understand and not to highlight guidelinesat the in cdc has published have evolved. evolved to inve terms of the current setting, and i think it is one of the areas that is causing some concern and maybe a little confusion in states.

because states have authority under the constitution for those things there are not reserved by the federal government in public health falls into that. they have domain over this. so it is their interpretation of how they should take recommendations from cdc. but the shor tpoint is, that right now the two greatest risk groups for ebola transmission are close personal contacts with people with ebola, and health care workers who are treating ebola individuals. i think the difficulty in terms of the guidelines they have instated is that we do not perceive in the current setting the health care workers are at greater risk. face of flies in the what happened in dallas when two nurses became ill. we understand why they became ill. they did not have the right personal protective equipment. they probably do not receive

proper training. they did not know how to take the equipment off. i think that's causing people to w healthuld we not vie care workers who have been in contact with ebola patients as somewhat higher risk? with that a higher risk, what are the considerations? should they self-isolate? for people that are working in the medical frontier, that is the recommendation, that they should go home and stay out of public places for 21 days. self-imposed. obviously in states where there is a lot here -- ignorance to go with it. there seems to be a demand politically for action. obviously, we know in the states of new york and new jersey those quarantine orders did not last very long. so i think that, as the events as guidance is

refined, you may see that politicians will be a little bit less likely to lead with their face. on the other hand you may see refinement by cdc to suggest some kind of maybe higher consideration for health care in directo've been contact with patients. it does not change the nature in maine today, where the governor is thinking of a court injunction to enforce quarantine on the nurse who is up there right now. to be determined, i guess. so, i think as someone told, someone sage said, just wait. it will change again. i think that is kind of like the watchword that needs to be invoked. bit of caution, bit of prudence, but certainly some of the effort so far have veered one way -- quicklyne more thing to

add to that. the first thing is that 21 days is the safe period after which you are not eliciting any symptoms you should not have the disease. that is the number one rule. two, we have to have compassion for the health care workers and we cannot ostracize them. from an ethical perspective, we have to take that consideration and consider the law as well as the ethics we follow. suree have got to make that we follow all of those things and provide them all the support that we need to provide them. one of the critical things that i would like to see is, and as was mentioned that there has be a voluntary executed quarantine that individuals impose on themselves. and i hope that after doing such tremendous work and working with

patients with ebola and being on the front line and dealing with the situation, they will have stay indoorsto for 21 days, because we definitely do not want resources being spent on this particular issue at this point. we need to spend resources on the critical issues needed in africa. i can assure you that after november 4, a lot of this hype is going to disappear. [laughter] >> yes, please? >> thank you. i'm the egyptian consul. i've learned a lot today from this panel. so, thank you so much. some quick comments. regarding what was mentioned. regarding the terrorism in the

region, especially in the middle east. because what they mentioned, professor wallace regarding the cooperation or the international cooperation in fighting an epidemic like ebola still very low. i believe, actually the cooperation in fighting terrorism is much lower than the cooperation in fighting the epidemic, disease and so on. what isis is doing in iraq and syria is not -- not only contradict with islam but also contradicts with human values. the egyptian government, for example, has been calling for an international support to fight terrorism in the region. every single western country few reluctant -- till a months ago when the foreign fighter problem emerged and just to give you an idea, what would

happen -- weeksington times" a few ago published as statistics about the foreign fighters in the middle east in iraq and syr ia. they mentioned a little thing regarding tunisia. they said, they have more than 6000 tunisian foreign fighters in the region. 330 something from egypt. we are wondering if really the regime stays in place. and compare the true -- two populations of the countries, how many tens of thousands of foreign fighters would be there. opinion,ally -- in my like professor alexander mentioned, the situation in sinai. many criticism towards what the egyptian government is doing to fight

terrorism. if we look at the statement, the public statement made by the former government, supporting the mali terrorist group and -- in their trial to seize power. they call for jihad in syria. to a sectarian conflict. i think we still need by you and all the -- we need actually to the opportunity for more cooperation in fighting isis. thank you. >> yes? name is greg childress. just a quick question. we talked about decontaminating

and proper training of health care workers. and the thought just struck me that i haven't heard anyone in the press described how you determine -- you decontaminating health-care worker. seeing as how this is all being taped and presumably going out to a wide audience, i'm sure there are some of us in this room who've actually been to decontamination for a nerve a gent. from full mop 4 down to skin and beyond. it is not a quick process. it is very time-consuming. it is resource intensive. to decontaminate the decontaminating is. so it is not easy, which goes to your point about training.

you describecan how you decontaminate a health care worker that has been treating someone with a ebola? >> thank you. actually the analogy between nerve agent exposure is very similar to what you would be concerned about in the cases of being exposed to ebola virus t hrough human secretions of one sort or the other. so the main ways, the principles are the same. theerms that, though equipment is different in terms of some of the types of equipment available now, but the principle, the principal measure is using bleach. so that is the principle rinse orsome kind of bacteriacide microcide that will render the ebola virus dead.

it is time-consuming. thes a buddy rule like in military. he would start with removing the gown first. retaining the gloves, removing the boots. going through a shuffle pit. then retaining the last thing, the respiratory protection and last pieces ofhe equipment you would take off before you would be clean. in, obviously and settings africa which are different than the u.s., you have people shower out as a final step and change their clothing because they probably wear scrubs. haverica, they do not those opportunities. in africa, they are reusing the gloves. and much of the equipment that we see as disposable. the reuse them because of the short supplyy. so that's a rough description.

>> spray. >> [inaudible] an example.ive you for each individual that needs to be decontaminated, you need 32 gallons of water, 8 gallons of bleach. of gloves.8 change at least two to three complete coveralls, which cost $32 in africa. you also have to have these boots that go over your boots. it is a very expensive and intensive process. dr as dr. f mentioned, y -- had a lack mentioned, you do not have all of those resources available in africa. a lot of things that are happening that should not be happening. but people in those situations have to improvise. thiss why the cost of

epidemic is so high. right now the united states has approximately spent $700 million or is spending $700 million and sending troops over there, etc. you have to put in the numbers that are going to be used for all of thees, and equipment needed. it is a very expensive and tedious and resource intense process. >> yes, not only their but. just started off the equipment list. so, being an ex military guy, i look around and say -- going back to this preparedness and professor wallace's comments about spending for the public good, outside the defense department, how many sets of that exist in the state of texas that could be brought to that

hospital in dallas? >> not enough. that raises the critical thing. amateursilitary axiom, talk strategy or policy. professionals talk about logistics. this is all about logistics. and the answer is whether domestically, internationally, the supply chain for these kinds of materials to address this, in monrovia or in dallas are not sufficient. yes?, >> the statement that you made that said a poem. that poem belongs to a person poet. -- a persian poet. all humanities are made by the same creator. the same body. if any part of the body ahces, a -- aches, and nobody bothers,

you cannot name those people human. >> yes. [inaudible] the globalization of humanity. one quick footnote on the isis. about throfessor spoke e territory, which is true, but we do have some parts of territory are referred to as in libya and so forth. they declare allegiance to isis. but, aside from the territorial elements, which is very important. nk,the financial, i thi , with whatof isis they have -- all the way from kidnapping to oil. that 's capability is very important to them in order to --

people in refugee camps as well as in the slums of casablanca and elsewhere. meaning they've thousands of dollars to allocate to those who would join them, volunteer. those that, by the way, the military background wouuld get m -- would get more funding because of their experience. so number one, when we talk about refugees this grave humanitarian issue that you discussed. greater attention and support. but it is also a potential for future recruitment for many years to come. the children of today can become the terrorist of tomorrow. now, because of the interest of time, let me ask one question. the audience is welcome to

respond. thery to link the issue of disease in this case ebola and canrorism really -- disasters be predictable? in other words, can we do the homework to prepare ourselves? that it would not happen again. this is number one. number two, we refer to it to some extent, can we be prepared to mitigate disasters in the future, and can we have a list of what oworks and what did not? professorou, alexander. that is a great set of questions. i'm recalling a contemporary philosopher, yogi berra, that the future is hard to predict.

so the answer is, i do not know if we can -- i take my page from a book that's called the black swan, which has nothing to do with public health, nothing to do with disasters but certainly economic disasters. it's the whole notion of whether you can predict those things from happening. in retrospect, you can. of course, we can see the recession of 2008 coming. look at all the abuses, look at the loopholes. b the answer isut in some -- the hisr is in some ways, contention is in some ways you cannot predict these things. and really the approach is really about preparedness. and become resilient. there are good black swans and bad. you have to be prepared to recognize either one and take advantage of the good and mitigate the bad. so i didn't that is how i would leave it -- so i think that is

how i would leave it. in some ways, we probably are not going to be 100% accurate in terms of our predictive capabilities. but we certainly know what works. for better preparedness for these things. and it certainly seems in light made in other areas -- and i will use national missile defense as an example -- that investments in these areas which are insurance policies for an uncertain future are probably reasonable and affordable. dr.o, quickly, as dillac mentioned, we cannot predict anything that we can be prepared. what i was pushing for for in when i talked about the resources needed for science and technology in this nation, that have been the switch, which used to be on all the time has somehow bee shut off and the numbersn in terms of funding has

declined. if we continue to do that, we will never have the safety net you talkeddillac about because we will not have those labs. we understand and appreciate that sometimes those labs and those manufacturing facilities that we need to have in this nation are not going to be doing a lot of active work, but if we do not have them when the time comes, they cannot do that active work. inneed to invest a lot looking at the ecology of diseases and -- we have not recognized all the diseases. tf you folks feel that you ge influenza vaccine every year and you will not get influenza, you are mistaken, because what is 70 % of people who will get the vaccine will be protected, but 30% will get the virus. of people that, a lot

who get the vaccine still get something which is similar to influenza. those are other viruses that we know -- havwe have no idea abou. we have not invested enough money to investigate. that is what is needed in the west. if we don't do that, we will never be able to be prepared for anything. >> thank you. this is a little bit out of my -- we certainly could predict hurricane katrina. we knew it was coming. but what brings to my mind the comments that you made about rocket science. actually, this is harder than rocket science. the laws of physics do not change. when hurricane katrina comes ashore, it is like a pinball machine. you pull the handle and hope to get three cherries. if you do not, it is a disaster. you do not know what you're going to get. a combination of human failures, bureaucratic issues and all of these things that affect these

things. berra, alsoi said, i did not say all of those things. [laughter] somebody ghost wrote his boo k. working?till ancertainly just as extraordinarily intellectual here if presentations think we are all.little bit smarter this afternoon then we were this morning. yournk many would say first inclination would be to throw up your hands. it cannot be done. it's too much. i happen to be the eternal optimist. so it hink that something can be done. studye two of the recent on africa, you will notice that

the owner said that what we need for the ebola challenge in africa is some kind of a marshall plan. and that's sort of what i would globalore for this whole topic that we are confronted with here today and will be for a long time. it is going to take a long, long, long, time. a lot of investment. a lot of brainpower, a lot of thinking in a whole bunch of areas, that sometimes seem unrelated before we can come up with a reasonable capability in my opinion to confront these various challenges. on on the other hand we've faced theseber not only in the manhattan projects and things like that. i have to say that the second manhattan project i knew a little bit about, too. i was born in new jersey and over in the eastern