and the urgent need we will here today. i am deeply concerned about ebola. so was all of america. .ut the home and abroad there is a national consensus that agrees that we need to contain the disease and we need to eradicate it. diminish the fear that it generates. 13,000 500 cases of ebola in west africa. here in the united states of america, there are currently no cases of ebola. we look forward for that to be ratified or corrected by our esteemed panelists. the united states of america has ebolad nine patients with , to have contracted it in texas

, a have recovered, one has passed away. there have been nine in america. 13,005 hundred and west africa. the situation is serious. it means that all of government has to respond in a way to do so. my strong suggested principles of this, first we must fight the disease at its epicenter in west andca, in liberia, guinea sierra leone. we also want to look at countries near these areas where it has not spread. we want to use the expertise of the department of state, usaid, nih, fda, any government agency that can play our role in making the world, with africa, and america safe. that is what we want to do. the second principle is we must

protect america. we must do it at our points of entry. finally, we need to utilize the best science and a ploy of public health agencies in a way that is effective. that is for the cdc, our state and local health departments, scientists developing vaccines and treatments at nih and approving their safety and efficacy at fda. as we look at what government will do, i want to thank the people in our own country and all over the world who have been working on this. doctors and nurses, let technicians, disease detectives, a workers, soldiers from our own defense department, working shoulder to shoulder in africa and at our border and ports of entry here. in these important agencies, cdc, and are ever

ready military. been wonderful volunteers who were willing to go to the danger zone. we want to thank them for their work in west africa. we also want to thank those in our own country, who not called american --sity university of maryland, john hopkins, will be ready to deal with. we have witnesses from our major government agencies to present testimony. for the mosts senior cabinet member to testify first. in my out-of-the-box way of thinking, i want to do with the problem rather than focus on protocol. sometimes in the senate there is a lot of compensation stance. i want to dispel with it.

have organized the testimony is to really start internationally to hear from the department of state, and then mr. rockton from the department of defense, and then going to .ur ports of entry we would hear from deborah terry -- deputy secretary of state, usaid, who would tell how we will do this in west africa, and not only in those three countries, but in contiguous countries. we will begin with the assistant secretary of defense, we know that he is the official a bullet coordinator designated by secretary hagel. he is accompanied by major james solitaire. then we will hear from jeh johnson, to discuss america's fourth of entry.

then the secretary of health and human services, silvio correll, accompanied by dr. friedman of cdc and dr. anthony felt she of nih. we will ask you to join us after they testify to be able to answer questions from this robust participation that we have. opening statements will be from the four witnesses. we have before us an administration request to contain and fight ebola. ofrgency spending request $6.2 billion. ,ecause the ebola, in my mind meets the criteria for emergency -- ding terry it is sudden funds from includes the state department and usaid, 2.9 billion. the department of defense to

develop technologies to fight ebola and short and vaccine development -- 100 $12 million. the department of health and human services to contain -- andain ebola in west africa fortify, strengthen domestic capacity to treat ebola with treatment centers available in every state. equipmentiate care for caregivers, like our nurses. we also have money to develop new test am a vaccines, which would be a total of $3.12 billion for hhs. billion -- 112 million four department of defense. homeland security says it is ok, but it needs some flexibility.

about myn i talk colleagues to focus on the money, but on funding an emergency. i say to my colleagues, we faced infectious disease emergencies before. one under president bush in 2006. the other in 2009 under president obama. in 2009, we were faced with the with in one flew epidemic 30 million americans who caught the virus and nearly 3000 died. we provided funding for 6.4 billion and designated that as emergency spending. the bipartisan emergency response in 2009 mirrored what we did to help president bush on a bipartisan basis when we faced , when it that time congress responded with $6.1

billion in emergency funding. we have done this before. i would hope that we would follow the models that we had used in the past. today, we live in a world that smallpox, polio, now we have to tackle the new diseases. vaccines, effort, there are a few tricks to treat diseases, the people in the emperor structure to do that. we have also invited in addition to government, we have asked for the american hospital , andiation, crucial ngos also schools of public thought, like the bloomberg school and john hopkins to submit testimony. we have 56 submissions already. we were definitely pay attention to them. the common themes are sustained

investment is needed in public health, both at home and abroad, and emergency money is needed in the short term. that lays out the framework. i look for to the testimony. i turned to my calling senator shelby. >> thank you. today as the chairperson has laid out we will discuss the administration $6 billion request to address the whole a outbreak, both the mystically and in west africa. ,iven the size of the request the slow progress and detailing plans, how the money will be spent, and some of the missteps made so far, i think it deserves are careful oversight and scrutiny. as we have seen in recent weeks, the vast majority of americans and health care professionals have little or no experience. the appearance of the disease on her shores can have devastating

consequences for our health care system and our society at large. consequently, it is the fundamental responsibility of the federal government to respond effectively to this crisis. step must be taken to protect the american people. responsef an effective , what we have witnessed, i believe, these past few months in various agencies has been confusing and it times contradictory plans. and theire, the cdc guidance to hospitals has been a moving target. this uncertainty has exposed health-care professionals to unnecessary risks. he administration also sends mixed messages on the issue of quarantine. while the president has discouraged strict quarantine roles, the defense secretary sehgal has prudently put into place a 21 day mandatory quarantine for troops returning from west africa.

addition, the administration did not call for enhanced airport screenings for travelers entering the united states from west africa until months after the epidemic became severe. it still remains to be seen whether these cursory screenings will be effective. not surprisingly, americans have been frustrated by the lack of clarity and coordination within the government. even though the president has named a so-called ebola czar to a coordinate our response, all reports indicate that he has no actual authority to direct government agencies here. from the beginning of this outbreak, the administration has appeared to be preparing for only the best case scenario. confident crisis planning must include contingencies for the worst-case scenario as well. think we should not rule out any reasonable options to prevent the reintroduction of ebola in the united states,

including travel and visa restrictions. if the history of disease outbreaks has taught us anything, it is that things can change quickly and without warning. our federal agencies must be ready to aggressively implement a clear and organized strategy. it is my hope that today's witnesses can assure this committee and the american people that the president has a plan and that the funds he is requesting are necessary to execute it. we will wait for the testimony. thank you. >> thank you. ms. hagan bottom, i will ask you to start. we will go down the line. distinction members of the senate appropriations committee, thank you for the opportunity to testify today on the u.s. department of state and usaid emergency request for assistance

to combat the ongoing ebola epidemic. accompanied bybe the assistant administrator for the bureau of this moxie, conflict, and he medicare and assistance. madame chairwoman, i have submitted a detailed statement for the record. in the interest of time, i will briefly summarize. in westa epidemic africa has already resulted in over 14,000 ebola infected persons and over 5000 deaths. while liberia, cre loan, and ginny have borne the brunt of the epidemic, we have also seen cases in malley, nigeria, senegal, and spain. we have also seen isolated cases in the united states that highlight the u.s. national security implications of the epidemic greatly department of state and usaid are working in concert with agencies representing at this hearing today and alongside a global

partners to stop the spread of the ebola virus at its source. usaid strategy to eradicate ebola arrest on four pillars, controlling the epidemic, managing the secondary consequences of the outbreak, building coherent leadership and operations, and in ensuring global health security. state and usaid have taken immediate action within existing resources to begin and lamenting the strategy. usaid deployed a disaster assistance response team to lead the u.s. response on the ground and all three affected countries. secretary kerry created in ebola coordination unit to drive our diplomatic efforts to raise international contributions. over $1 billion in bilateral commitments, and a hundred million dollars in commitments have party been made. efforts,lt of these alongside those of our colleagues across government, we are beginning to see results. it is important to recognize

that the epidemic is not yet controlled and that the number of cases will continue to grow. it is clear that we need to intensify and scale our efforts to eradicate the epidemic. to do so require resources. state andment of usaid are jointly requesting $2.9 billion. that includes two point $1 billion in base funding to meet immediate needs and $792 million in contingency funding to address emerging requirements as the epidemic evolves. billion in state funding will be directed to the first pillar of our response strategy. controlling the outbreak. these resources will support the construction, staffing, and operation of up to 20 ebola treatment units and establish and staff up to 150 community care locations in rural and hard-to-reach areas of the region.

this funding will also be used to scale up contact raising, train and mobilize health-care vitals, and replenish logistics and supplies, including personal protective equipment. our base request also includes 388 million dollars to support the second pillar of our response strategy, mitigating second-order impacts. this -- thecimated infrastructure in the three countries and has reached have it. we are particular concern about food security. the usaid funded famine early warning systems network has issued an alert that a major food crisis is expected to occur and 2015 if the epidemic proceeds through march. our funding request seeks to counter these district of consequences, which if left unchecked, will undermine our efforts to combat ebola at its source and could create instability in the region. our base request includes $77 million to support the third pillar of response strategy,

coherent leadership and operations. these funds are critical to expanding the department's medical support and evacuation capacity in the region and to support key diplomatic operations such as the ebola coordination unit and the usaid staff engaged on the ebola response. finally, our base request addresses the fourth pillar of and includesterry $62 million to support pandemic preparedness and strengthen public health systems in liberia, sierra leone, and ginny. in sum, our emergency request will allow state and usaid does gallup or existing efforts along all colors of response. we have scenes with some promising signs on the ground, but it is clear that the epidemic is not controlled. these resources are imperative to eradicating the ebola a break at its source, which is the most

effective way of protecting americans here at home. thank you for your time and i look forward to your questions. >> chairwoman mikulski and distinct members of the committee, thank you for the opportunity to testify today regarding the department of defense's role in the united states is comprehensive ebola efforts, which is a national security priority and response to a global threat. to the united states military's unique capabilities, the department has been called upon to provide interim solutions that will allow other departments and agencies the time necessary to expand and a ploy their own capabilities. military efforts are also galvanizing a more robust and courtney international effort, which is essential to contain the threat and reduce human suffering. before dressing the specific elements of it the ods ebola response efforts, i would like to share my observations of of the evolving crisis and are increasing response.

after recently visiting liberia, i was left with a number of overarching impressions that helped shape the department's role. first, our government has deployed a top-notch team experienced in dealing with disasters and humanitarian assistance. second, the liberian government is doing what he can with its very limited resources. third, the international response is increasing rapidly due to our government's response efforts. fourth, i traveled to the region thinking we face a health care crisis with the logistics valid's -- challenge. in reality, we faced a logistics crisis. incremental responses will be outpaced by this dynamic epidemic. finally, the obama epidemic we face is truly a national security issue.

absent our governments corrugated response in west africa, the virus spread brings the risks of more cases here in united states. i would like now to turn my attention to dod's role in our nation's ebola response in west africa and here at home. in mid-september, president obama ordered the department to undertake military operations in west africa in direct support of usaid. secretary hagel directed military forces undertaken to for mission. first, support usaid and an overall government effort. second, respond to state of request for security or evacuation assistance, if required. direct patient care of ebola exposed patients in west africa is not part of dod's mission. secretary hagel approved unique military activities falling under four lines of effort, command-and-control, logistic support, engineering support, and training assistance. weeks, dod hase undertaken a number of

synchronized activities in support of these lines of effort. to include, designating a named operation united assistance, establishing an intermediate staging phase. providing strategic and tactical airlift. constructing a 25 bed hospital in monrovia. constructing 12 ebola treatment units in liberia. training local and third country health-care support personnel, enabling them to serve as first responders in a bowl of treatment units throughout liberia. in all circumstances, the protection of our personnel and the preservation of any additional transmission of the disease remain paramount training factors. there are snow higher operational priority than protecting our department of defense personnel. dod has also increased support to the departments and homeland security. the lead agencies for ebola response in the united states --

by activating a response team capabilities anywhere in the country. they are also focusing on longer-term requirements to counter ebola. that is why we have requested $112 million for the defense advanced research process in this emergency funding request. million will support intermediate efforts aimed at developing technologies that are relevant to the ebola crisis. this includes new research focused on utilizing the antibodies of ebola some progress to provide to prorate community for infected to paris community for infected of patience and the accelerated development and testing of new ebola vaccines and diagnostics. these efforts complement existing developments at the national institutes of health and the defense threat reduction agency good with more than 50 years of experience successfully developing technologies to achieve seemingly impossible darpa is uniquely

positioned to contain and illuminate the ebola outbreak. because of darpa's approach to these research and developments come from conventional avenues, they have the possibility of producing real results. in conclusion, we have a comprehensive government response and an increasingly corrugated international response. the dod's interim measures are in essential element of the u.s. response delay the necessary groundwork of the international community demobilized the response capabilities. with that, i would like to , theduce my colleague director for military political affairs for africa. we look for to answering your questions. thank you. >> secretary johnson. >> thank you.

you have my prepared statement. let me mention a couple of things in my five minutes. that the all agree thing necessary to prevent -- the key priority is ensuring the safety of the american public. i agree with term a costly that that means fighting the disease at its epicenter. let me mention a couple of things about screening that we are doing with regard to passengers who may come to the united states from the three affected countries. first of all, we have the authority to issue do not board orders. deter passengers who macy to travel here from the three affected countries that we have an effect used that authority on occasion to prevent people from leaving the three affected countries. we have in fact use that authority already if we have reason to believe the person might be infected with the virus. the second thing i would like to

mention is that in the affected countries, they have put into play screening to screen outbound passengers from the three affected countries, that includes taking temperatures and other mechanisms. fourth, we work with the airlines that fly from those countries to our country. i have personally engage's airline ceos about the ebola virus. i know that cdc has issued guidance to the airlines about flight crews and cleaning cargo and personnel. any directo longer flights from the three affected countries into the united states. there was at one point, but there is no longer. to fly from the three affected countries to the united states, you have to get on one of a handful of flights that go through transit airports, mostly

brussels, paris, and morocco. at one point in may, the number of flights leaving any of those three countries to anyplace in the world was over 400. there is some data to suggest that it was about 600. it is now between 100 and 150 flights in the entire month from those three countries to anyplace in the world. dailymber of passengers those threem affected countries into the united states used to be an average of about 150 per day. it fluctuates significantly day-to-day. as 100,s it is as many 75. is five or six. the average is something now on a handful of

commercial flights. we have set up enhanced screening at the five airports that were receiving approximately 95% of the itinerary passengers coming from those three countries. jfk, doll is,, atlanta, and chicago. training involves a passenger declaration, questioning, taking their temperature, and asking for and looking for symptoms of the ebola virus. that screening has received approximately 2000 passengers. we have also identified through our questions by her customs inspectors a number of people who have flown indirectly from the three countries. they have been submitted for enhanced screening. 22 we used our

authority to effectively final everyone coming from the three affected countries into those five airports that are conducting enhanced screening. the other thing i will say is that at every port of entry at this point, land, sea, or air, we are prepared to engage in secondary screening. if we identify somebody from the three affected countries who may have the ebola virus, guidance has gone out to our customs personnel. we have put into place protocols for people who may be arriving by vessel. we have authority to identify people from the last five ports of call. if those are from the three affected countries, we put into place protocols there. we continually of i you wait whether more is necessary. to evaluateue whether more is necessary. i look for to your questions. thank you.

shelti, thankber for inviting me here today to discuss the department of health and human services response to the ebola epidemic in our request for funding. as you know, we are deeply focused on domestic preparedness. of ebola first cases were reported in west africa and march of 2014, the united states has mounted a whole government approach to protect the american people and to contain and eliminate the epidemic at its source. , this involves close coordination in collaboration of the national institutes of cdc, the fda, the office of global affairs, the office of the assistant secretary for preparedness, and the all this that has the u.s. public health service commissioned corps, which is deployed to the region. joinedeased today to be

by dr. friedman and dr. felt she today. we believe we have the right strategy in place. the first is to strengthen our domestic preparedness, and while we may see additional cases, we are confident we can limit the number of cases in the united states. second, to stop the epidemic at its source in west africa, as my colleagues have discussed, that, in turn, will protect our homeland. third, we need to accelerate the research and development of vaccines, rapid diagnostics, and therapeutics. we work on the crisis right now as well as preventing future crises in the future, and fourth, we need to invest in the

capacity, and this was something that was started before the ebola epidemic. but this is something that i think we see the incredible importance of right now. this will help the u.s.. some of the actions are delivering results. hearingple, we are encouraging news about treating ebola patients, as was reflected in the testimony. second, we see signs that are screening and monitoring system is working. recently in north carolina, oregon, and maryland, individuals were identified with the potential symptoms. this was with the correct protocols. they were therefore transfer through the appropriate protocols, and they did not expose anyone.

thing that kind of was important. we need to continue to support local and state efforts. there was also an important milestone. individuals who have been monitored in ohio and dallas came off of their 21-day incubation period, and they are no longer being monitored. we need to make sure they support state and local health officials to be able to continue to do this kind of work. today, more than one quarter of a million health-care personnel have been trained by the cdc and the assistant secretary for preparedness and response, doctors, nurses, emt's, fire departments, but we need to continue this training and make through that the training is getting through. there are some positive results, mali, and heard

last night, there are more cases there. needed, andunded is that is what we are here to talk about today. it is $2.43 billion in emergency funding. will allow usding to enhance our ongoing preparedness here in the united states and her efforts to ensure that states and localities are prepared. the personal protective equipment, training of thousands of health-care workers. second, the emergency request will further strengthen the department's ongoing work to contain the ebola in west africa. we will continue to work with partners on the ground and in to make sure they are effectively treated, and if they die, safely buried. and manufacturing, production,

and review of the vaccine diagnostics and therapeutics. with an eye towards detecting and preventing outbreaks of this magnitude, it will strengthen our health security around the world. are safe andey secure laboratory and emergency response capabilities. i understand that americans are concerned. is a is scary, and it deadly disease that is new to the united states. we have taken akin -- active gaps year and abroad to protect the safety. is emergency funding request a vital to continuing that work. i want to just conclude of recognizing the health care workers that are on the front lines of this response both here and abroad, as well as the more our department at

aj just left a ploy to either west africa or in the united states. and i also want to recognize the men and women that are in this nation who have treated the and it ishat are here the three west african countries where this is the worst. i look forward to your questions. thank you. >> thank you very much, secretary. now, in order to get to questions, we are limited to the , weer of people testifying do not limit the number of people who can answer questions, so i am going to -- which one of and if they can come up and join the table, the good general, the coordinator from u.s. id, you all want to come up

discussioncan have a and wide-open questions. i am going to go to the first question. we will wait until the general get settled. and everybody has got their names. would like toi thank, again, all of you at this have and at the tables you in your respective agencies in and around the world. i want to say that as we watch this unfold, i know many of you work long days, and i know that many of you work a 10 hour work week, and i think we need to say that as we evaluate what does it

take to be able to respond in an effective way? calls forisis that really maintaining our critical infrastructure and our critical public health infrastructure. i also want to particularly acknowledge those institutions and states that have stepped patients, treat the emory university, the university of nebraska, and, of course, the nih clinical center, all three that were there to work with the american people as they returned home that needed our help, our prayers, and, quite frankly, our medical use, and you know what it shows is, you know, these were not red states or blue states. these were american states, so looking forward to solving this, it has to be looked at in this way. and my question is this. my job as a united states senator is to protect the american people.

it is also to protect the people that are protecting us. render service, or those who were concerned about those doing this work, so let me go to the secretary. in your testimony, you talk about the message of preparedness him and you thanked everyone for their gallant and reallyed work, but i was worried, and i also was not really worried, so was the national nurses united. i received a letter from them that really articulated my concerns. what they said to me, and now i quote them, is that the president needs to invoke his executive authority to maintain uniform national standards and protocols, that all hospitals must follow safety-protected patients or health care workers and the public. they then go on to talk about the personal protective

equipment needed, particularly hazmat equipment, and they identified the actual osha standard number. my question to you, secretary burwell, is do you feel confident that now in the way we are responding, that the doctors and the you were ins who are -- the doctors and the nurses who are actually touching patients have the protective equipment that they need, that these are national standards for not only the equipment but the training so that we have a national response regardless of where someone might appear that needs help? could you share with us and did you respond or did the president respond to the national nurses united request? >> so, with regard to the issue of make something you are that our health care workers were prepared, i think we need to think about it in a number of different levels. the first is in that screening and monitoring and that's what state and local health care workers are doing, with then checking on the people who have come from these countries. second is that that initial front line worker, in a health care institution that needs to be able to detect and isolate,

ask the right question. if off fever what is your travel history? the next is the level where treatment will occur and as we describe in our submission, this will be in a more state by state basis and where the cases are in terms of treatment. the question i think the nurses were posing was on the category that had to do with that front line. as i mentioned in both my oral and written testimony, at this point, we have trained over 250,000 people. what we need to do now, and that's part of what this request is about, is to make sure that that training continues and extends and we need to measure it, what we are hearing when we hear from the nurses, we want to make sure we respond. do they know? is the training working? do they feel confident? right now, we are working with the association of state and tribal health care organizations to make sure that we are going to put in place a measurement so we can understand they have what they need with regard to training much the second part the nurses mention is ppe, protective equipment. >> yes. >> provided guidelines to the cdc in terms of what's needed,

training and what to do, the second issue is access to that and through the assistant secretary assistance and sport, barta, working with the manufacturers, producing 24/7 now, working with them and working with the states to make sure that those who have the greatest need and will most likely treat get that equipment. >> well, madam secretary, let follow up on this. so do you feel confident that we have -- that if ebola appears, you used -- on page four of your testimony, the maryland case example, a young lady came in, she took her temperature, she thought she might have it, she wasn't gonna go to nih, she was gonna go to either mary land or hopkins. that those who would be once identified with the high temperature, et cetera, that they would have the equipment and that they would know how to use the equipment, but regardless of whether they are

at a high-tech urban hospital, like a hopkins or a maryland, an academic center, but could be a community-based hospital in a rural area, that you would be ready to respond to see that they had the equipment and the training? >> that is why we are doing the, aggressive training that we are doing. and we want to continue to do it. >> do we have the -- do you feel confident that we have this now or we are in process? >> right now, what we have seen in all the cases that you articulated and all those that have come through, because we are also providing at the border a kit so any individual that is coming through, which is where the case would originate gets a phone number they are supposed to call. they get a thermometer to take their own temperature. >> what i need to get is for that nurse to feel that if she has got to walk into a room and provide the care that she has taken an oath to do, along with the doctors and others that are the support staff that they're going to have what they need to do the job and that they also

have what they need to protect themselves. >> that is what we are working to do with all the training. at this point we've trained 250,000 and the funds that were -- >> isn't this what your money is for? >> yes. >> really? >> to continue this effort. >> isn't that part of the public health infrastructure? >> it is. it is the basic not just for ebola. >> i have to put their minds at ease, but that we have their back and we cover their back and their arms and legs, et cetera. >> with ppe. >> right. now, i have another question for our constituents that go towards the military. oh, my god we're now sending our , military in harm's way to protect against terrorism but now we're sending them to get ebola. my constituents were deeply concerned that in deploying our military to do the task that you

just identified that they were going to be exposed to ebola and we were putting them in harm's way to get ebola. do you believe in your deployment and if the good general needs to respond, are our military actually going to come in contact with people with ebola and our are military at risk of getting ebola? and are we sending them in harm's way with a disease? in the same way we are doing it with a bullet. for the you very much question. i think one of the key aspects here is what i mentioned in my opening remarks, he which is that dod personnel are not doing direct patient care of those that are infected with the ebola virus. we've taken great steps to ensure that our military personnel receive comprehensive training before we go, that we monitor them while they're there

and we have a controlled monitoring situation. when they return, but i'll defer to my joint staff counterpart who can go into the specifics about it. thank you. >> general, welcome. >> thank you very much. the personnel we are going to be deployed, as the secretary said, will not be doing direct patient care. we've instituted four levels of predeployment training for all personnel who are going for our transient peoples, think about air crews flying in, not getting off the airplane, and flying out. graduating up to personnel who will be in country, who will have to interact with liberian nationals as they go about their day-to-day business. those personnel will receive training in how not to come in close contact with those personnel and will be issued ppe that they will carry with them in the cases necessary. up to higher levels of training

for our health care professionals who will be in country at the two rural hospitals, one in morovia. senegal, who will be there to treat our military personnel for regular injuries and be able to treat them if they somehow do come in -- do contract ebola. and, finally, to the highest level of training for our lab workers who are there now, testing blood samples as part of the support there. so yes, we've got a complete , protection package for those personnel. >> thank you very much. i am now going to turn to senator shelby. protecting our border people and the state department people, and i look forward to you perhaps submitting an answer to that. so we protect those who are trying to protect us. senator shelby? >> thank you, madame chair. on october 17th, president obama named ron clain to a white house post responsible for coordinating our response to the ebola crisis.

the so-called ebola czar. this is a question for all of our witnesses. how many times have you met with him since his appointment, and what has he brought to the table that was missing? madame secretary, start with you. >> i've been in touch with mr. clain every day since he has begun, whether that is face to face, by phone or by e-mail. in terms of what he has brought to bear it's been my experience and my experience last time when i served in government, the importance of policy coordination, i was there at the beginning of the national economic council where we did much consultation. it's a very important role in terms of when a whole of government is occurring. and he has stepped into that role and added value to our policy coordination across all of us. a lot of us have been working with folks before, but it is

important to have people on a day-to-day basis to do that. >> secretary johnson? klain broughttary to the table? >> i have been in contact with him. i believe that the critical value that ron has brought to this is coordinating the federal response. >> ok. >> between and among all the agencies, components you see represented here and having somebody who is dedicated full time to the white house to doing exactly that. >> secretary? >> my first hour with secretary klain was nearly everyday in contact with him, and he has done an outstanding job of doing just that, coordinating and singular focus for the administration of coordinating across the interagency. >> ok. >> i've just been back from maternity leave for two weeks, senator. ron was appointed to his position prior to my returning.

but in those two weeks -- >> you'll be excused. >> since then we've had frequent interactions. it's the policy coordination that's so key to our response. >> to your knowledge, does mr. klain have the authority or power to direct your agencies to perform any specific actions or is it mainly trying to bring you together? >> policy coordination with regard to the execution of the agency's responsibilities, those sit with me and the head of the operating division like dr. freeden. , statestary burwell that issued more stringent rules for returning health care workers, stating we don't just react based on our fears. we react based on facts. as we've all known, secretary hagel has approved mandatory

quarantine for troops who have been deployed to the ebola-affected areas. furthermore, most military personnel, as we have learned, are charged with filling facilities and will have limited, we hope, patient contact while civilian medical workers will have direct patient contact. what facts, that was the word the president used, should we base quarantine guidelines on , madame secretary? >> certainly, i will also -- i will start but then turn to dr.s freeden and fauchy. what we have done is created a system that is actually based on level of risks, so what we have done is create a quarantine base system based on their level of risk. and that's based on the epidemiology, which is years of experience. i think dr. fauchy has been working on this well over 30 years. in terms of the experience that we see.

in determining risk that's how , we determine what's done with each and every group of people and different groups of people. that's how we base the decision. that's an individual basis often which is why we monitor directly and actively every day those health care workers that return. >> is the assessment -- i'll direct this to you, too, doctor, since you'll be in on this. in the assessment of risk difficult when people are coming from various countries and perhaps don't divulge where they've been? i know you can keep up with it to some extent. who has been exposed to all of this? is the assessment tough to come by? >> we do several levels of assessment, first to assess the fever to see if someone is ill and then to determine the cause. >> ok. >> second to see what exposures they may have had working in an ebola unit or are being a health care worker otherwise or having potential exposure to someone who may have had ebola. but for every one of the

individuals who returns, we ask the states to undertake an active monitoring process and we facilitate that process, as secretary burwell said so they're taking their own temperature and if develop fever, they rapidly contact the health department of their state where they can be safely transported to a facility that is ready for them. that system is so important, because ebola, as far as everything we've seen only spreads from someone who is ill. it doesn't spread from someone who is not ill. so if you can find that illness quickly and isolate them, then you can stop them from transmitting it to anyone else. that, essentially, is the way of protecting not only their health but the community's health. >> doctor, you want to add -- >> yes. so in some circumstances when we stratify risk, versus the monitoring and the restriction of movement, that there is sometimes the functional equivalent of a quarantine if someone is at high risk. it isn't as if it's all or none,

but not saying there's a blanket quarantine we're being somewhat reckless of making everyone have the same sort of movement. we do not do that. to do -- give you an example, i took care of nina pham. so i'm in the low if not moderate risk. i had direct, active monitoring every day. if i had to be quarantined i wouldn't be able to be here testifying. because of the fact that i'm low and not zero risk -- >> maybe you would have liked that. [laughter] >> if you are, we're going out the door. >> right. >> doctor, to dr. freeden, head of the centers for disease control, what can you say to the american people today about their and it's widespread of a possible ebola outbreak in this country? >> we certainly understand people's concerns. ebola is scary, deadly.

and the images from africa are frightening. but ebola spreads by direct contact with we know unsafe care -- direct contact with someone sick with ebola, and we know about unsafe care giving in the home or health care facility and unsafe burial practices. the burial practices that are spreading ebola in west africa are not things that we do here, so not to be concerned about. but care giving is. that means for every individual who comes back from a place that may have ebola, very important to be monitored actively for 21 days. and at the first sign of any symptom, even if it's not severe illness, what we're seeing now is, as appropriate. people are coming in, being tested. coming in and being isolated. and as soon as that happens, we reduce the risk of spread. so from everything we've seen the last nearly 40 years working on ebola in africa and from everything we've seen here, no household contacts became infected, ebola doesn't spread

widely. it does not spread like flu or measles or other infectious diseases but it is deadly. and that's why the hospital infection control is so important. but from everything we've seen, we do not think a large outbreak is at all likely in this country. it's just not how ebola has spread either here or in africa to date. >> senator harkin. >> thank you very much, madam chair. i am pleased at the administration's request to address the immediate funding need to end this epidemic, but it also begins to address the reasons why it reached epidemic proportions in the first place. the current spread of ebola in west africa is a major public health emergency but it should not be a cause for panic or journalistically provoked fear among our populous. it should serve as a reminder and a wake-up call.

let me read you something that senator mark hatfield, former chair of this committee said when he retired in 1996. he gave us his farewell speech on the senate floor. and here is what he said, and i quote. it was at the end of the cold war. and this is exactly what mark hatfield said. he said quote, the russians are not coming. the greatest enemy we face today externally is the viruses are coming, the viruses are coming. end quote. 1996. former chair of this committee. a decade later, mike leavitt, ford george h.w. bush, issued a similar warning at the emergence of the avian influenza. and i quote, at another virus will emerge with some point in our nation's future another virus will emerge with the potential to create a , global disease outbreak. history teaches us that everything we do today to prepare for that eventuality will have many lasting benefits for the future. mike levitt, end quote.

both were right. the spread of the ebola virus follows on the heels of other dangerous viruses, h1n1, middle east respiratory syndrome mers. , yet during this time, when new viruses are emerging and new -- old viruses are becoming drug resistant, we reduced investments in nih and cdc and acting short-sighted cut that is have left us less prepared. we have to accept the fact that we don't live on an island with more than airline flights every 100,000 day around the world, every virus is de facto and airborne virus. we must stop chasing diseases after the fact. we cannot be everywhere at once and we will never run faster than a microbe. our only chance lies in building public health systems capable of detecting and stopping diseases before they become epidemics.

we have the knowledge, right here. we have the expertise and the systems to combat ebola and other infectious diseases. our challenge here is to act calmly, based on science and facts and with resolve, double our resources and build that capacity. i say that because there's some talk in this emergency funding that we should only address ebola and not look to future viral outbreaks and viruses. so i looked up the word emergency. this is emergency funding, right? >> we hope so. >> emergency funding. it comes from the word emerge. how about that? emerge. merriam-webster dictionary says it's an urgent need for assistance or relief, so we should not confuse emergency with disaster.

funding, togency stop a disaster. that is what this is. is an emergency, because viruses are mutating. some of them, we know, are becoming more drug resistant and these are not a diseases that we are looking at now, bashing the diseases that we are looking at now, ebola is just one of those. they're now global in their impact. dr. freeden, you and i have spoken many times on our trip to africa, a year and a half or so ago, to stop these diseases where they start. those conversations as well as the work of a group started by your predecessor, jeff copeland, inspired me to create a federal health program in last year's appropriations bill. we must invest in countries with weak public health systems so they can stop these disease before they cross the borders. we only need look at h5n1, southeast asia, to be reminded of the virus threats that are still out there. they're still out there. i've said before if h5n1 starts

really jumping from birds to humans and humans to humans, we better look out. it will make ebola look like a picnic. so the need is not only to a dress ebola now, but the emergency now to keep it from coming on our doorstep at home. by building cdc's in our home and all of these countries. i understand that approximately $600 million at your request would go to doing just that. but considering the need, that seems very low to this senator. very low. $600 million to build the cdc's, to put in the laboratories, get the equipment, train the technicians, train the epidem iologists.

$600 million seems low to me. can you explain that number? what do you hope to accomplish with that investment? and could we use more to address emerging, emergency zoonotic outbreaks? dr. freeden? >> thank you very much. you don't need to look any further than the difference between what happened in nigeria with ebola and what happened in liberia with ebola to see what a difference prepared public health systems make. in nigeria, through extensive effort, because there was an emergency operation center, because there was a laboratory network, because there were trained disease detectives, because there was a public health system that could respond to the outbreak, they stopped it. it took enormous effort but they stopped it. and today, from that importation, nigeria is ebola free. the world would be a very different place today if and sierrainea, leone had those systems in place a year ago.

they could have contained this outbreak. the global health security portion of this request aims to protect not only these countries but ourselves against that type of threat whether it's the next ebola, the next sars or even the next hiv. there are three fundamental areas we work in. they're all very specific, measurable and will leave behind as temporary assistance something that will protect us for many years to come. the first are prevention methods, how to ensure we keep our laboratories safe, that we stop the spread from animals to human whenever possible. and that we're able to immunize with whatever we can to reduce the risk of things spreading. second, and the largest component is detection. putting in place the laboratories, the disease detectives and also the surveillance systems to find problems when they first emerge so we can stop them at the source before they spread. and third third, of course, is the response. emergency operations systems, the ability to work with medical counter measures and to stop outbreaks before they spread. those are the three key

interventions that we would be able to implement with these emergency funds to protect ourselves against these emergencies going forward. >> thank you, doctor. i see my time is out. i'm sure i just think that's a low figure confronting what we have to confront worldwide. and i'll ask a point of personal privilege. this is probably my last -- >> yes, i was going to note that. >> committee meeting after serving on it 30 years. let me thank you all to your commitment to public service and for your great leadership. and if you don't mind i especially want to thank tony fauchy with whom i've had a 30-year relationship. we both came here at the same time. you came there. i came here. you have had the better of it, believe me. and also, thank you for your great leadership at nih and also dr. frieden with who i have had about a decade-long association, first in new york city and later at cdc. thank you for your great leadership.

and for staying calm and targeted and focused when others around you might be losing their heads. thank you very much. thank you, madame chair. [applause] >> i think we could say the same about you. i don't know about the calm part. -- >> i don't know about that. >> by the way, we're going in the order of arrival, so -- >> yeah. let me start with you, secretary burwell. in your written testimony, you mention the contribution that emery made, the university of nebraska made. i think the cdc would recognize the guidelines you're using, significant input was provided by those institutions. as i have looked through the request for funding here, $6

billion request, we have money to reimburse the world health organization. we have money to reimburse civil aviation organization. i could go on and on. i don't see funding that would be available to reimburse any institution in the united states that provides care and treatment and training relative to ebola. i've talked to staff for the relevant subcommittees and talked to some of the members. and it appears to me to be an oversight. and it would seem to me to be logical, because you asked emery to take patients. you asked the university of nebraska medical center to take patients. we were glad to do it. but it seems at this point some

assistance in terms of reimbursement would be appropriate because treating an ebola patient is a world different than treating mike johans who walks in with a severe case of the flu. you know what i am saying? go ahead, secretary. >> so, with regard to, i think there's the issue of the treatment facilities and there is funding within this request to make sure that we have treatment facilities around the country and that there will be funding. but with regard to the special institutions like the university of nebraska and dr. gold and the team there, who have had the opportunity to spend time and talk to, and the emory folks, what we have done is there is funding about the creation of an education training facility and it is our hope that both of those institutions will team with cdc. we will do financing for those

institutions to be part of our training of the other institutions and hospitals around the country. with regard to the specific issue of treatment and the treatment of patients, to date, much of the conversation has been between private insurers and the hospitals themselves. if this is something that the congress -- to date it has not been an issue that has come to us. if this is something that folks want to discuss as part of this funding, we're happy to entertain that. >> great. it's an appropriate discussion because the private insurer, it is through the roof. they will cover a minuscule amount if there is private insurance coverage. it will come nowhere near to cover the cost. and i will tell you what you know already. and that is in the early days of this problem, couple of months ago, you folks were scrambling

to figure out what to do with these patients. we were glad to be there. this was -- this was started when i was governor. we're just glad we have world-class treatment there. we want to be helpful but again i think it's a conversation we need to have. second point i wanted to make here -- and i think this is a very important point. i understand the expediency of putting money in each state. each state will get a certain amount of money. it seems that the formula is based upon population. i think we're going to look back in three or four years. i'm not going to be here to question you about it. but i think we're going to look back and say i wonder what that got us. here is the reason. treating an ebola patient is very, very challenging. and there is risk involved if

it is not done correctly. i don't know that every hospital out there would want to get into this business, to be honest with you. i think some hospitals around nebraska would say they seem to be doing a pretty good job over there in omaha. let's fund them and support them. i think you need a more regional concept than what is called for by this legislation, because there are facilities out there that were way ahead in terms of what was provided here. i would like your reaction, secretary. and then i would like the reaction of the director of centers for disease control to what i've just said. >> so with regard to the question of where we do treatment in the nation and how we do that, what we have started with is certainly we were fortunate that the congress had funded and we had supported the university of nebraska, nih and emory to be bio facilities. those are our anchors.

>> i think those were funded by state dollars. >> i'm not convinced that there were federal funding. maybe a very small amount. but i think it was a state initiative. >> as those then go out from that ring of three, what we've done is we have focused our effort on the five airports that secretary johnson said that's where the cases we believed would come in. so we put in place the training and cdc did that training in conversations with the other hospitals for new york, dulles, o'hare, atlanta and newark. and so that was the next ring in terms of treatment, to your point of the question of a strategic approach. and then beyond that, we have been doing tracking of where the income of the people are coming. that is how we are starting in terms of your question about a focused approach. as we have started this process, though, many states have approached us because of their desire to make sure that they

have a facility within their state. as we were thinking about it, where is the concentration and where is their geographic proximity so that a patient could be within eight hours anywhere in the united states as well as what we're receiving in terms of incoming. that's how we have started to design and are working on where these facilities should be, the treatment facilities, so it is both states reaching out to us as well as the strategy we're seeing analytically and the risk. >> as secretary burwell says, it's really a question of stratifying risk and which hospitals can do what. with the active monitoring program, we'll have a head start on being able to plan for if someone has just come back, where would they go. the issue of ebola is one deadly infectious disease that's complicated to take care of in hospitals. but the more -- the broader issue is hospital infection control for ebola and other deadly infections. and what can we do to strengthen

what each state has in their hospitals? something that's valuable not just for ebola but other hospital acquired infections. >> madden chair, i will not abuse the privilege of my time, but i will just tell you with a , small amount of money that's going to each state, i think what you're going to end up with is double wide units that won't be adequate for the next crisis. i just think that money is going to go out there and it's just not going to be enough to do the kind of work that you're trying to describe to this committee. thank you, madame chair. >> to the gentleman from nebraska, first of all, you sent me a letter on this matter just a few days ago. when i went to acknowledge the receipt of the letter, asking

for consideration and of funds for hospital workers and also for those hospitals that agree to treat and are able to treat these patients, i think the gentleman raises an important point. >> thank you. >> i'm not sure it can be addressed urgently in this supplemental but it could be ebola, or it could be another infectious disease and i think we need to look at this. i want to acknowledge the validity of the issues you've raised because for those of us who faced -- and i don't mean it in a way to say oh, my god, we faced it. but we're willing to provide care as the university of nebraska, we should be committed to support those hospitals. -- should be commended for their superb care. it's costly. it is costly. and in this era of stringent reimbursements from the private and public sector, hospitals are already stretched to meeting

their bottom line and if the generosity of spirit and the technical capability to absorb, your point is we shouldn't add to the fiscal burden while they have to deal with the care burden and also the stringent reimbursement systems that they're already under. is that kind of your issue in a nutshell? >> madame chair, it is exactly. because we want to be helpful. we never had any reservations about this. and i could not be more proud of what was happening there. but the cost in this is just huge. >> so let's talk about this, ok? >> yes, so we will keep working on it. >> ok. senator reed? >> thank you very much, madame chairwoman and thank you, ladies and gentlemen, for your testimony. dr. freeden, one of the major objectives we have is to suppress the disease in west africa. but one critical factor is health care workers.

can you elaborate how internationally we're doing in terms of local health care workers, supporting them and also attracting international volunteers? and the bottom line is do we have enough health care workers to deal with this crisis? >> stopping ebola at the source in west africa requires improving care and burial, two key ways it's spreading. usaid has stepped up safe burial services. the department of defense and others are helping to establish treatment units. one of the things that is encouraging is 90% or more of the health care staff caring for ebola patients in west africa are from those countries but there's still a need for international assistance. one of the things that has been very encouraging is the african union has been willing to send hundreds of health care workers in. and that's in process now. we've also seen an increase in health care workers from other parts of the world. and one of the things that we try to ensure that every step is taken to make care as safe as possible there.

still a gap, as my colleague nancy can discuss to , help address the epidemic at the source. not only to save lives there, but to protect us here as well. >> what are we doing to fill that gap is the obvious question, then? either you or your colleague can respond. >> yes, thank you. as you know, there's a significant need for health care workers and, in part, because it's a very high burnout job. so we have to continue to replenish the pipeline. and there's a significant effort underway to recruit internationally. -- the deputies secretary higginbottomtary

can talk about that. and having them feel comfortable, that if they go and serve, they will be taken care of. to that end, our colleagues from dod have built a hospital, 25-bed hospital that is being staffed by u.s. public health care workers, medical personnel. and we are working with dod, with w.h.o. and others to have a continual supply of protective gear and dod has stood up a training facility in monrovia to ensure the specialized training that's required. >> on that very note, if i may, to train u.s. health care workers going over, cdc began a training course in alabama in conjunction with the fema site there. all the u.s. public health service who were serving their went through that training. it's based on years of experience that doctors without borders have. and that's the type of very intensive training that we're implementing. >> and the resources in this

emerging resolution will support this? >> absolutely. >> and without these resources the gap will persist and the disease will be further beyond our means of suppression? >> these resources are essential to stop the outbreak in africa and protect us. >> let me just -- secretary lumkin, dod is set up there. the question is, that i've gotten, is how do you get to the last mile, dakhar, supplies, personnel trained personnel out? , and the other issue comingeing based on our discussions is the end of the rainy season, what impact is that going to have, and does that give us special urgency in getting this bill done? >> thank you for the question. i would like to address the issue with the end of the rainy season first. because i think that's a temporal issue before us. as you are probably aware liberia gets 200 inches of rain , a year. what's been moving during the

rainy season is people by foot. because many roads are closed and, therefore, carrying the disease. what's hard to do is get supplies to where they need it to be. so that's why it was crucial to build up these logistic networks. as we mentioned in the drying season, you have two things. you have more freedom of movement for people, is one. which means an increase in spread of disease potentially, but also the temperatures go up. the time that health care workers can spend in their ppe, personal protective equipment, is reduced significantly. so that adds another burden. i will defer. >> senator, thank you very much for the question. the intermediate staging base is fully operational at this time with 101st brigade running that operation there. they've established a rotator flights, c-130s down to monrovia. and then from there we have helicopters on the deck that can take personnel and equipment out to the various locations or to

do what they need to do. so we've got the -- starting to get the equipment and the personnel in place, able to transfer that equipment to the last tactical mile. >> my time has expired. quickly, ma'am. >> senator, quickly, part of what this request does is enable us to have the funding so that dod can depart and there's a civilian capacity in place for logistics, including the last mile transport. >> thank you, madame chair. >> senator blount? >> thank you, madame chair. -- chairman. dr. freeden, there was a report november 7th that said that public health experts warned that the actual number of ebola-related cases and deaths in africa was likely much higher than the numbers being reported. do you have an opinion on that report one way or another? >> we have previously estimated that there is probably underdiagnosis and underreporting of cases.

particularly when cases are increasing rapidly. that overwhelms treatment and surveillance systems, so, yes, we believe the number of true cases is larger than the number of reported cases. >> do you have any idea how much difference there might be? >> in september we estimated that for august onward there could be as many as 2 1/2 times more than were diagnosed up to that point. since that point we believe that the monitoring systems have improved and we don't have a more recent estimate of the difference between what's reported and what we actually think may be happening. >> and in -- i think in guinea and -- the numbers have gone up pretty dramatically lately and seem to be heading the other way in liberia and sierra leone, is there a reason for that? >> we see different trends in each of the three countries, and within each of the three countries and different trends

in different areas in each of the three countries. in guinea, waves of disease, increaseing then decreasing, emanating generally from a forested area deep in the country, which is where the outbreak is believed to have begun. and where it has never been completely controlled. that has been the epicenter for not only in guinea , but the other two countries. but in the parts of each of the countries which have implemented the strategy, we have proof of principle. we've seen big decreases in cases in individual areas when we get the safer care contract tracing, safe burial infectious , control and health care systems those standard disease , control methods that have worked for every ebola outbreak and i'm told now have worked for the firestone company and near monrovia, which implemented them as well as in individual communities, so we have proof of

principle, but it is still an enormous challenge. >> to go onto another topic, how long should this money last that you're asking for? and when -- what's the significance of the contingency fund and how long in the future do you think that money will be there? >> so in the context of what we know, as director frieden just talked about, the evolution of the epidemic is something that ebbs and flows. but the current trajectory and based on what we know in terms of what works, we believe that the base amount of funding is the amount of money that we need across the departments. that will stave off the epidemic. the contingency fund was asked for because to the point that was made in opening remarks about preparedness and making sure, when we have elements that aren't predictable we want to make sure that that funding is in place and that would be for different types of things. to give you some examples, if another country, another ring country has a number of cases and starts to be elevated, that

or a sierrainea leone or liberia, that may change the needs. another thing that could change the needs that we would use the contingency funding for would be if we actually get a vaccine and we're still at a stage where we believe you need to do deeper and would do more distribution of vaccines to a broader group of health care workers. so those are some of the things that the contingency fund is about. it is a fund that we have submitted for, because we want to make sure there's a block that funding will not be used unless it is needed but that we put in appropriate preparedness. for things we cannot exactly predict right now. >> and on vaccines you've asked for money for fda here to -- >> uh-huh. >> how would you do that process differently? would you speed it up? bring more people into the process? are there steps in an emergency situation like this where there's a way to go through them more quickly or go around them, to get to the end product

quicker? >> yes, sir. and we've seen that in process right now. the congress gave us emergency use authorization that would allow us to approve diagnostics quickly. we have used that authorization six times. fda has used it six times. we approve friday start to finish in 36 hours. one of those diagnostics. with regard to other emergency authorities that fda has, we have approved drugs. and what happens is when a drug , is not approved if a clinician asks fda for approval for that individual to receive the drug, every patient that's been treated in the united states has received a drug. can't speak to the specifics because of hippa but each one has received a drug. those have been approved. one was approved in one hour. and so right now fda is on a , path. and there are over 300 people working on these efforts because it cuts across therapeutics, diagnostics, vaccines. the team is working across all of those issues to make sure

that we are moving as fast as we possibly can to support and approve across all of those categories. we're supporting the efforts and hundreds of questions have come in from commercial entities. and that's great. because a number of commercial entities are out there and they want to help us find the solutions to ebola. most of those questions are legitimate. it's about speeding their efforts. some of those things, as you know, people are saying there are things that work when they don't. fda needs to watch for that, too, in this important time. that is what this funding is for. it is about that speed and moving things through quickly. >> one last question, on that topic, for anybody who would know the answer, is there anything we need to do or we're doing in this bill to be sure that ebola is clearly defined as one of the things that you can use those accelerated processes for? >> we have not had the authorities that you all have given us, i mentioned, have been in a way that we can use them. and when we have needed to we

, can add to definition when we've needed to. so far, we have not. i will take your question and make sure with the fda that it is answered for all categories. you know, every -- there are a number of categories. we need to make sure. so far we've not had any be issues. thank you for the authorities you have given us. i think you here we are using them and using them as quickly as we can. >> chairman, while everybody else is making a comment i would like to thank you for your really talented and great leadership of this committee. thank you for all you've done. >> thank you. thank you. we're now going to turn to senator kuntz. but i'm going to ask senator shahine to call the superintendent and ask that the air conditioning be turned off. i asked 45 minutes ago. >> i would be delighted to do that, madame chair. i have tried to get him to turn down the air conditioning in this building before. >> now because this committee really doesn't want to waste energy, either that of the

members or of the taxpayer paying for air conditioning that is unneeded, unnecessary and unwanted. so ok? ,[laughter] well better to have heated , discussion than wasted money. secretary -- senator kuntz? >> thank you. i will join senator blood and thanking you. to the many witnesses who have testified today, i want to thank you for the vigorous discussion of the funding request to deal with this global funding crisis. -- global public health crisis, it and to remind all of us that the ebola outbreak has been characterized as among the most severe public health emergencies we've faced in modern times. chairman mikulski, i emphatically agree with your characterization that our first priority is to protect american lives and that the single best way for us to protect american

lives is to engage vigorously in the work against the fight against ebola on the ground in west africa. this emergency funding request provide support for every facet to keep americans safe first by , strengthening and bolstering and principally making sure we can contain it and preventing its spread to neighboring countries. i did want to take a moment to share that i recently had my third recent conversation with president johnson, who i visited several times in liberia in previous years and who wanted to make a point to thank the american people for our generosity and our engagement but urged us not to let off now because just because there is some hopeful news doesn't mean we've turned the corner on this and in the region it still remains a very very dangerous , and difficult time. i visited with delawareans here and liberians who have lost their entire family to this disease. and we need to redouble our efforts. i also want to acknowledge the

remarkable sacrifice, dedication of our uniformed men and women, thousands of missionaries who are on the front line against ebola. americans who go abroad should not be stigmatized when they return. should be honored and supported in their commitment and service, and should have confidence that they can return from their let me turn to the global health agenda. piece of this emergency health is for the global gendas that are designed to around syria and liberia. i was wondering if you wanted to speak to how many total nations will you target with this and what will you do to increase their capacity and why is this phefr lly to ensuring americans are safe from ebola

nd that this is effectively contained? >> our focus is to strengthen that will find problems when they first emerge, prevent ffectively and them wherever possible. and the goal there, if we just could have t happened in rural ginny, if there had been monitoring system r surveillance system that found the initial cluster, that responded to it promptly, we very different outcome today. n fact, over the past 24-48 hours we've been dealing urgently with the situation in molly. as part of our response to the outbreak, cdc sent teams to the countries to ensure a clear through checklist of the things that needed, laboratory systems and public health and a series other things that were needed.

the team was in molly when the came from ginny died but the y team helped organize a response of tracing more than a hundred people. or two, it's aay new situation of great concern individual died probably from ebola in the services, family members died andcted before he other individuals, healthcare affected and were facing a cluster. making ds to end with molly ebola free again. is her or not that happens entirely dependant to have the stems in place in advance to ind problems before they get out of hand to respond effectively and that's what the security aspect of this emergency request is for.ntial it's about understanding that

their vulnerability is ours and we do to find them there and stop them there will protect us. what you're saying the difference in outcomes in versus the other three countries is the difference in public health inextra structure that makes it possible. a legacy of a great investment and part of is a challenge. they coordinate to make sure they are made wisely effectively and that we strengthen the infrastructure. we work hand in glove a. i.d. c.d.c. c.d.c. is essential natural forsetting the policy and the technical and medical expertise and we work it ely with them in

immentiimmen implementing around the issues hat the doctor just outlined and looking forward to the fact that you have increased pressures in areas that were previously forested. increased lity of jumps of diseases from animals is umans is something that looking a part of forward to how to get ahead of in the future. >> my last question will be this -- >> senator, your time has expired. i don't mean to be rough with an ne but we've been here hour and a half and we have 2, 8, 10 more senators to go. o, senator, i'll be a little more strict now. >> madame chairman it's good to haven't lost your touch. >> well, we have a vote, so --

i understand. t l try to be brief here. the -- first of all, thank you for calling the hearing. so much misinformation and dis information and lot of ption and a nervousness and we all had to hearing hat and this gives us better clarity in terms and where we e have been and where we're going. sitting at eryone the table because i remember when secretary johnson called me this is a nd said government wide effort and this is deserving full response and and a lot of eck those hands are sitting at the table and there has been some news here in terms of steps that have been taken and a early struggles couple of bumbles that made all nervous. i think we've clarified some of

that. but i have questions about how to go forward.g point number one as secretary aid, we've got to fight this battle at the source. and i understand that. but some countries and others it you're look, if at the source it you have to contain it at the source. military set one terms of standards in terms of anyone been at the source relative to need to do when they return, that standards stands in contrast to what our current standard is relative to people of course the screening is important, secretary johnson talked about that and so forth. a couple of questions relative to that. is canada and australia and who said, look, if and we're going to fight it at the source we'll close our coming from yone the source. our s the best way to keep

that i was over italy in early september and noticed they were not going to in there.oldiers the president made a decision and and they're sending people in. but general williams came home and immediately the team he was with which i think was about a or so, quarantined themselves. so, what are we to tell people at home about well the military is taking these steps, public is taking these steps. guess i would like some response to that and then i do i have a i have time

johnson.for secretary maybe one person could speak for the group or secretary do you a shot at that. that is done at the request of he service chiefs and the chairman of the joint chefs of staff. because of the scope and the of the number of people in the region it of ed like a prudent course action. colleague over at the joint staff. you for the hank question. s secretary said, we have the youngest population responding crisis.

as the chairman said we have a role and responsibility we decided to take this more approach.ve it's not because we know omething more than everybody else. >> but the question is from the is, okay, my question people are gratified to hear that. our soldiers are doing they can to protect themselves not to be a carrier ack and not spread through and we appreciate that the military is taking those stands. saying,ther hand, we're well, the health workers don't rise to the level of having the standards applied or all those who are courageously in harm's waylves who are not wearing the different there's a standard there. who wants to respond to that?

guess before i let my colleagues respond i would like to point out this was not a decision but an operational decision made by the chairman based on the --ommendations >> but it makes common sense. bent over in an infested area you could be a carrier, why go under quarantine so we know for sure someone is not out with a fever. >> let me jump in here. marchio in. is jumping >> i'm jumping. coats who also chairs security raises a question that is continually asked. military has one have rd and civilians another. though his time is expired because this is a question that continually raised nationally.

'll ask to answer it or call upon the expert to clarify that and then we'll move on. and i the distinction think my colleague from the department spoke, but this was science.d on the this was based on the management of the force and the force desires. as we work through this, that's something we want to respect for regard nd everyone with to the civilian parts of the defense department they are nder the same guidance that we are using and that cdc has issued. i think what's important is that make decisions based on the risk and the science and that's are about.andards i also think it is important that we respect those that are are ng and that those that there and what they actually ask and want to do, there's the science and the standard that we need to set to rotect the nation but the desire of those that have taken the steps to serve and i think that's a part of what my reflecting in terms of what the force was

chiefs.ing of the joint and i think we will want to hear too, when there's a return as people come back there are people who will make choices. we need to do the steps that are science-based to protect the nation. a desire to wish to do others or more, that's something they should do. but the decisions and what we have put in place are based on risk levels and the science related to that. and i don't know if doctor, you want to add. couple of ld make a points. in ebola there is no carrier state. make other people wish to do others or more, that's omething they should ill unless you yourself is ill from everything we have seen how the virus operates. at cdc itself we already more 100 of our top disease people come back and they come back into active work so they be productive and protecting americans in other ways.

monitoring ve program is to work to ensure that every person who comes back is monitored, their temperature is taken every day because the wherever you are, kwar reason teen or your home home or workplace, as soon as any symptoms whatsoever, even if and they on't turn out to be ebola, you get assessed and isolated and that's how we can protect americans most effectively in people coming back themselves. doctor.k you very much, the 21 day monday itering is mandatory. approach of al i the military is precautionary. are a command and control organization. a nutshell.n >> it is true. one is an operational decision

nd another one is decision based on the stratification of risk. as i mentioned earlier in the aspects that there are of what the cdc recommendation s that are the functional quivalent of a quarantine that is based on the stratification of the risk. you're monitored in a direct and if the risk is low you of have a monitoring you and have ay the flexibility of making the decision on the restriction of based on the monitoring. >> madame chairman, if i could have ten seconds to make a point. assumes you know everyone that needs to be screened. you haven't missed anybody. i know we've got five airports, we've got thousands of people coming across the borders. thank you. thnow we will go to

senator murray. > thank you very much, i appreciate you doing this hearing and your tremendous leadership of this committee as well. i'm sure all of us have heard ebola could t how impact them and what we're doing to stop this disease and keep communities safe so today is an important opportunity to make are onr response efforts track and doing everything we can to put an end to this outbreak and i want to thank you for coming and all the agencies. your considering to ask the ebola outbreak being entered into the record as well. you.k i wanted to just mention today that i am really proud that my washington is a global leader in the public sphere.ould

agencies that combat ebola. they've contributed a lot of ime and a lot of effort and a help we're very grateful to that. secretary, i wanted to ask you more about the role of ngo's and the foundation the ebola outbreak and what percentage is coming private non-governmental roups and what more private actors and foundation can do. >> i agree with your statements that have been made by a number organizations and i think i would put it into two buckets in

the type of assistance. one is important and we've been asked about which is health care there are a number of ngo's and community based rganizations and my colleague can speak to that that is essential and important and part what the funding will do to get the people in country in so we can assist hile 90% of the people who are doing the work in care are locals. be eed that 10% to come and experienced. so that's one entire area. and then i think there's the and that's where the melinda gates foundation. it's not only funding and cdc foundation, nih is working closely with the make suredation so we we have the best experts. is not about a

ting agriculturae aspects. and paul allen and his foundation have focused on those issues. so i think -- >> getting the data which they talked to me about. >> absolutely. a range of issues that i think they can be helpful with and are and then there's whole issue of the ngo's have healthcare workers and help and relief on the ground in the country. to ask you secretary in

requestlemental funding funds distribute that funding and how do you expect the states and localities to use that money? > there are two pieces of the money that will go to states and localities. part of it comes from the assistant funds designated for readiness within state and local public health departments and laboratories i wanted to ask how secretary for preparedness and response and our network. and also work with the state health departments to determine who to set up parts of the through cdc and we'll talk about those monies. so there's a portion in one part then there's the cdc money. >> we would provide support for local entities in a variety of ways. t it would be formula based based

on emergency response. in addition we would support etworks like the emerging laboratory capacity grant program that support cutting at infection ook control, training and documentation of how to improve control as well as laboratory networks, laboratory response network which is now 10 years old and why now we have 27 labs around the u.s. able to test in just a few hours for ebola. but that needs to be upgraded as well as our emerging infectious disease programs. work in e to deploy to this area through state and ocal entities and institutions . /*. we're now going to turn to

senat senator. senators who ther wish to ask questions. come to the end hen we're at the end and otherwise we will adjourn -- ecess for the vote and come back after the vote. get this k we can done. senator. >> thank you, madame chair and one ust like to ask question and be respectful of the time. opefully you and leadership ill remember it. i'd like to ask, the senator eluded to omething that i have concern about. you mentioned nigeria and the good they did and liberia on the extent where things have difficult ad such time. can you -- my concern is when or africa ern africa in general, we see many examples

of the $$20 million processing plant that was built to help the locals when they only needed a $250,000 processing plant. we leave and they go bankrupt and it's just sitting there what they t's not needed. liberia's a country where they electricity their output is such it would have the jumbotron g at dallas stadium. are we thinking about that or is we'll put in and it's going to be an on cost for forever? s that the program or are we talki talking about doing something and turning it over. countries where you have less than one doctor people. 000 >> that's a wonderful question nd something we're working closely with both national and ocal governments is to try not

only to respond to the immediate needs of the outbreak but to behind a strengthened ealth system and some of the impacts we've seen and the elements. we need to leave behind a system nd help that country stay more on the pathway of development. out of a u know came decade's long civil war. just seeing the progress. >> not only that country but others. need to move on. i hope we're looking at that in servicing uipment, equipment just basic things that need e or granted, we do to look so when we walk away and e will walk away through the appropriations process, they have something they can maintain good job.ly do a chair. ou, madame

>> thank you to all the for being here today and the hard work you've been ebola o address the outbreak and africa and the cases here. i think this follow-up to secretary burrell and the doctor about just to make sure that i'm clear for what senator murray asking about the impact on state and local public health our ability to build infrastructure. as i understand your response to were suggesting that the support in this legislation go not just to address bola specifically, but also to build capacity for future otential outbreaks or future local and state needs. is that correct? both.will do when we think of the funding prepared go, that is

them spending at the frontlines which was the issue that the chairwoman began with in terms at hat kaoeupb of training the frontline and they'll be facilities that will be able to ebola and other things as well. and so while it's focused on the and now weible it will extend just like the raining that will occur, the 500 people who are being in place hose will be in west africa and our work will be in place here. marchio thank you. relay i've spoken with the nicole murphy public ealth officials and they have been very pressure active of the close working relationship of nih and so, hoeup that will continue and i'm sure it will. talk about the hospitals, one of the things that i have heard from hitchcock which is the designated hospital n nicole murphy to be the

state's ebola critical referral hospital. they have indicated that they're having trouble getting the personal protective equipment available and what is being done to make sure that hat equipment is available to hospitals that need it and therefore personnel. there are three different things we're doing to make sure that equipment is available. with the is working manufacturers to make sure that they are producing as much as can.possibly working actures are 24/7. the second thing in this is part of this package is funding. actually are going to purchase, if there is a case and the treatment hospital doesn't needs cdc can provide it. >> i'm sorry to interrupt. you can tell me what your proposed schedule is for having

that in place? for the strategic national gun to assemble kits that are available today. if there are cases we don't want up all available from the market. secretary burrell was noting, they're at the hospitals as more become available we'll have enough in the strategic to provide for the care of up to -- depending on about unt of use up to two dozen patients for their getre course of illness and that to any hospital within hours. >> great, thank you. and finally, nicole murphy eneral peter cory who is the deputy commanding general for africa is deployed to liberia to assist with the and i want to comprehend him and all another embers of our military who are

working to contain the outbreak africa at great sacrifice to families.s and their as i understand his mission there and the mission of our ther military members is to build facilities and for training. i think that's what people have well.n to today as one of the things that i'm not lear about and i think this is for deputy secretary. hen you were talking about the funding request you pointed out that 1.3 billion in base funding is to go to it, among other things, construction of the units.ent are those the same treatment units that the members of our ilitary are going to be constructing? or is that piece somewhere else request?budget >> so as you know, senator, the mission of the department andonnel is limited in time scope and the resources that we're requesting will build

ebola treatment units and those that the defense department is building, we support resources to the staffing of those and others that we construct. seamless is it's a operation from that perspective the d.o.d. mission will be able to exit as planned and ave the resources ability to step forward and cannot instruct the units. >> i'm still not clear though. is this 1.3 billion a separate d.o.d. requests someplace else? >> i'll let my colleague respond but i believe they have reprogrammed funds to meet that need. we did a reprogramming that was supported at the end of fiscal year '14 to that over it a $1 billion that over it a $1 billion

>> thank you. madam chair. >> senator cochran? caucusstand that if your concurs you will chair the committee in the next congress. is that right? >> i hope so. >> senator cochran, please. >> thank you, madam chair. directed to the secretary and it relates to what was discussing. the concerns about some of the facilities being envisioned by the department and the funding is being requested in this unable toal may be byt the goals established the administration. specifically, i have concerns provided for the creation of more than 50 centers ebola treatment may