response teams. globally, we are seeing new threats with a clus of cases in mali. cdc surged. we have 12 staff on the ground today in mali. we were there before their first case. they are tracing more than 400 contacts. we are helping them do that and test any who may have symptoms that could be ebola. we are also aware with the end of the rainy season, other parts of west africa may experience an increase in travellers from the affect ed countries and may be at increased risk. the metaphor of a forest fire holds here with the center burning strongly with a series of brush fires around the region and with sparks with with the potential of united statesing new challenges in the struggle against ebola. the funding request also addresses the security aspect so we can, with an emergency focus, look at what keeps other countries vulnerable and us.

three quarters of the cdc component is to strengthen the warning systems detection, laboratory networks and others. there are funds to respond r57dly and prevent where possible. covering the u.s., we have made progress. we are doing it through a series of levels. each requires significant investments. stopping it at the source. screening travellers when they leave africa, when they arrive to the u.s. tracing each traveller for 21 days in all of the 50 states. the states are doing an excellent job. with excellent participation from custom and border protection which has electronically collected data in hours. we are seeing most states reaching 100% of travellers regularly according to the information they are reporting to us. this is a relatively new program. it's going smoothly. it is working on borrowed

dollarsmedollar s. we need funding to support this and key measures of prevention, ke text and response in the u.s., public health systems, hospitals, laboratory networks, active monitoring and more. finally, i would emphasize that intensive public health action can stop ebola. in nigeria they were able to surge and stop a cluster from spreading. mali is in the balance. whether it become it is next nigeria having successfully contained a cluster or sierra leon with with wide transmission. the shifts and changes in the epidemiology in africa are just emphasis for the need for rapid response and the only way to protect us is to stop us at the source and build systems in africa and the u.s. that will find, stop and prevent ebola and

other infectious disease threats. thank you very much. >> thank you. dr. lurie, you are recognized for five minutes. >> good afternoon, chairman murphy, member caster and other members of the committee. i'm the assistant secretary for preparedness response at hhs is. i appreciate the opportunity to talk today about actions that asper has taken to enhance national preparedness and strengthen our resilience to public health threats. while it is essential we continue to focus on controlling the ebola outbreak in west africa, we also have a critical responsibility to protect our country from this disease. today i will highlight three areas this which as per's work is critical to the domestic response. first the biomedical advanced e reor barta building on counter measure development is speeding the development, testing and manufacture of oh ebola vaccine and treatments.

second, the hospital preparedness program has since the beginning of this outbreak been preparing hospitals and first responders to recognize and treat patientses with suspected ebola. third, our federal resources and responders,s whether the national disaster medicalle system, the medical reserve core, or the public health service staying ready to support a comprehensive response should it be needed in the coming months. barta with other medical partners hases a great track record in expanding the medical counter measures pipeline and building needed infrastructure to do soment in addition to developing and procuring 12 products since project bioshield's inception over a decade ago the centers for innovation and and advanced development and manufacturing are being used to produce, formulate and fill vaccines and treatments for ebola. complementing our

emergencies and disasters, asper is responsible for services and coordinates assistance to supplement state and tribal resources and response to public health and medical care needs during emergencies. i would like to close with an overview of the recent emergency funding request from the administration. it includes 2.43 million dollars

for hhs. barta's product development efforts and hpp's preparedness. funding will support development of an ebola vaccine and therapeutic candidates, clinical trials and commercial scale manufacturing. funding will ensure communities can purchase additional protective equipment that health care workers will receive additional training and patient detection, isolation and infection control. and we further build preparedness for the future by ensuring that all states have facilities that can handle an infectious disease as serious as ebola. mr. chairman and members of the committee, the top priority of my office is protecting the health of americans. i can assure you my team, the department, and our partners have been working and continue to work to ensure our nation is prepared to respond to threats like ebola. thank you for the opportunity to address these issues. i welcome your question s.

>> thank you. now, you are recognized for five minutes. >> thank you very much for the opportunity chairman murphy, members of the oversight & investigation subbing committee. thanks for something us here to testify about the u.s. public health commission core and its role in responding to the ebola outbreak in west africa. i am here to provide frvegs about what the office of the surgeon general and the united states public health service corps has contributed to the wide effort to stop the spread of ebola virus disease. in essence where it began in west africa. the commission core of the u.s. public health service is made of 6700 uniformed officers assigned to 26 departments and agencies of the federal government serving in 800 locations worldwide. i'm proud of this group. they are highly trained, mobile, medical and public health professionals, operating under the departmental leadership of the secretary of health & human services and the oversight of

the surgeon general and assistant secretary for health. commission corps is one of seven university forled services of the nation. the only service of its kind in the world. it is an unarmed unifor service dedicated to a public health mission and medical care for under served and vulnerable populations. the mission is to protect, promote and advance the health and safety of the medication. for 125 years this is an anniversary year for us, corps officers have been the dependable resource for public health emergency services working with closely with the asper in times of war in the past and national or oh international agencies. corps officers like others of our sister services can be deployed at a moment's notice anywhere in the world to meet the needs of the president, hhs, address the needs related to the well-being, security and defense of the united states. we have had a long history of doing this, protecting the health and safety of the nation by addressing infectious disease

over sea s. smallpox, polio, now ebola. to ensure we can meet the mandate to respond rapidly to urgent or emergency public health care needs around the globe there is a tiered response system composed of 41 different general and specialty response teams. we have deployed in the past to events ranging from terrorist events, 9/11, the boston bombings, anthrax, natural disasters, hurricanes, haw humanitarian assistance in haiti, reare construction stabilization in iraq and afghanistan, public health crisis, h1n1, suicide clusters on indian reservations, hospital infrastructure rescue in the mariana islands. over the past ten years the corps has over taken 15,000 officer deployments this in support of nearly 500 missions and events. corps officers are operating in the united states and in west africa in clinical, education,

management, liaison roles supporting the department of health and human services and working under the auspices of the centers for disease control & prevention. we have 900 officers with the cdc. one critical element of the plan for combatting the ebola outbreak targets the ongoing need for health care personnel in the ebola affected countries. united nations estimated at 1,000 international health care workers would be needed on the ground in west africa to bring the outbreak to an end. there is a wide consensus that in order to create conditions to encourage both west african and international health care workers to contribute, yes, the time and skill to contain and end the ebola outbreak, it is essential to establish a dedicated facility to provide high level care for those health care workers should they become infected with the virus. in support of this objective the corps deployed trained clinicians, physicians, nurses, behavioral health specialists,

infection control officers, pharmacists, laboratory workers, management, personnel to liberia to staff the mmu. this is a u.s. government funded 25-bed hospital that has been configured to function as an ebola treatment unit. it provides advanced ebola treatment to liberian and international health care workers. and to nongovernmental organizations and u.n. personnel involved in the ebola response. d.o.d., the state department, u.s. aid have prorided invaluable support for the missionment it ises being carried out with the full cooperation of the liberian government and its ministry of health. corps officers -- i'm sorry. the first team of the commission corps officers completed one week of advanced training in alabama in october. they arrived in liberia october

27. the full complement is staff thing of 70 core officers, each of whom voluntarily accepted the assignment to provide direct care for ebola patients. additional training was completed in liberia with support of ngos such as doctors without borders and the meddle call corps. we have the commitment. have gone through management protocols. on november 12, the mmu accepted its first patient, a liberian health care worker. the fourth patient is soon to be admitted. four overlapping teams of 70 officers will be scheduled for rotations to approximately 60-day deployments for an estimated six months of operations at the mmu. in conclusion the safety of the personnel is the highest priority. we are making every effort to ensure that all core officers on the ground are working in an environment to minimize and the risk to personal safety and security following guidance from the cdc. to ensure the safety of the officers, familieses, friends, co-workers and the communities in which they live, work and

play upon return officers will undergo exposure risk assessment and, as indicated being monitored by pub p lick health authorities. we look forward to welcoming home the personnel providing support and thanking them for the extraordinary efforts on behalf of the thags that people of west africa. thank you, mr. chairman. other members and members of the subcommittee. i will be happy to answer questions at this time. >> thank you, doctor. i will authorize myself five minuteses for questions. dr. frieden, so in the weeks you have been dealing with this in the united states can you highlight the lessons learned and modified that could give the public assurances that you are adapting as need be? is. >> the most important principle we are following in ebola control is to find out, as quickly as possible, as definitively as possible what works and implement that on the

ground in west africa and the u.s. we found that treating ebola in the u.s. is difficult. the two infections in dallas were an indication of that. we immediately moved to add a margin of safety to our guidelines for infection control and personal protective equipment. we also have put into place multiple levels of protection. our top priority is protecting americans. we do that through control at the source in africa, screening on exit, screening on entry, and the active monitoring program as well as work with individual hospitals and health departments. we have something called rapid ebola preparedness teams that have now visited more than 30 hospitals in more than ten states to get the hospitals ready for the next ebola case, if one occurs and a team had been to bell view before dr. spencer became ill. so the rapid response is key and rapid adjustment as we learn

more about ebola in the u.s. >> on august 2014 under the food & drug cosmetic act secretary burrwell declared circumstances exist justifying emergency use of in vitro diagnostics for detection of the ebola virus. did you help advise of the declaration? >> yes. >> she declared ebola to be an emergency for the purpose of the fda law she has not declared it a public health emergency under this. the world health organization in august declared ebola to be a public health emergency. do you agree or oh disagree? is in a public health emergency in the united states? >> in order for the drug to be used in the united states the secretary has the authority to declare that the conditions of a potential pub p lick health emergency exist. as i think dr. frieden and others highlighted, fortunately

we have been successful in the united states in detecting and controlling the disease. we had two unfortunate cases of transmission of the disease in the united states, but no others. we believe all of our efforts are effective in controlling the disease at this time. >> we want to make sure we are doing everything we can. on page six of the testimony, you mentioned the response coordinating the support function using domestic or emergencies. is that an operational responsibility that you have? >> my responses are policy advice and operational response, yes. >> that's been activated under the response to ebola? >> yes. the secretary's operation sent er is activated. all components are hard at work. >> you're still the coordinator for emergency support function? is it now mr. clean? >> mr. clean is the ebola

coordinator for the country, yes. >> okay. let me look at this. >> whatyou modeling or have you done data modeling to determine the number of cases we may anticipate. >> one of the things we have done, as a lesson learned from h1n1 that brought together modelers -- subpoena. >> -- >> how many cases are you planning for? >> the model suggests if we continue to be aggressive about exit skreeng from west africa, entrance screening, tracking travellers with direct active monitoring that we might expect a handful of cases in the united states, potentially in an unrecognized cluster. but we don't ant 'ticipate a widespread outbreak. >> you are looking for $6.2 billion and you expect a handful

of cases. senator schumer said we have to track all those who came in contact with someone. you don't believe in self-isolation though many of the ngos do. there is a disconnect here. expect a handful of cases. don't expect more. but asking for 50 hospitals to be prepared throughout the united states. help me understand. >> i don't think there is a disconnect at all. our strategy for hospital preparedness first looks at being sure that beyond the biocontainment facilitieses at emery and nebraska and nih we have good strong hospital capacity to recognize and treat through the entire course of illness. first in the five cities where all passengers are being funneled. a next ring of hospitals is needed for geographic dispersion around the country to place where is travellers are most like willy to go. and that's a pretty good range of states now throughout the country. one of the things we have learned and you asked dr.

frieden about lessons learned is mother nature always has the upper hand. that means we have to think about what's next after ebola. ebola taught us that we really need high containment facilities. so far our planning has been for pandemic preparedness on something airborne like the. the infection control needs for something like ebola are very different. part of the emergency request is being able to meet our needs now by having a broad geographically disperse network of hospitals to treat ebola p. it's building toward the future because we don't know where the next cases or next travellers will uh show up. we need to be prepared not only for today but for the next decade and century. >> i'm way over my time. >> thank you very much. on november 5 the president requested #.2 billion from congress to enhance the u.s. ebola response. the president's request focuses

on stopping the outbreak at its source in west africa. in your testimony you said you were focused on detext and response. 603 million to cdc for international response efforts. discuss how the funds would be used. >> thank you very much. our approach would be on the prevention side. to implement screening procedures so they could be continued long term and individuals with ebola or potentially exposed to ebola would be isolated traced and isolated p if they were ill. second on the prevention side is infection control. this is a challenge for west africa. each of the facilities caring for patients needs to think of ebola in a country and countries

where malaria is endemic and the symptoms aren't easily distinguishable. that's infection control, quarantine. on the detection side laboratory and related services to find infections and find illnesses as soon as they occur. that relates to some of the u.s. funding which would allow us to work with companies and other parts of the u.s. government to optimize testing modalities and surveillanc surveillance. we are tracking what's going on. and training of health care facilities to identify cases so they are found, isolated, cared for and don't cause outbreaks. then response. the core pub p lick health activities of contact tracing, training of health care workers, surveillance, public health education and outreach, rapid response teams and support to ministries of health so we don't need to be there long term. >> what, if any, public health

infrastructure was in place in west africa. >> there were weak systems in place prior to this. public health or health care. a shortage of trained workerers. part of the effort is to build up systems so they can continue it for years to come. >> the budget request also would direct 1.98 billion to u.s. aid, 112 million to the department of defense and 127 million to the department of state. can you go through how funding to those agencies would assist in the broader effort? >> i would have to refer you to them for details. in general, u.s. aid is coordinating under the dart or disastrous assistance response team. they are recruiting partners in countries. for example for burial team which is s exist all over liberia and are rapidly, safely and respectfully collecting human remains of people who may have died from ebola.

we are addressing the critically important areas of supporting development in areas like the guinea forest region. there is a lot of resistance and resentment. services in the region will be important in allowing us to get in and do ebola control. >> doctor, how would the funding assist in the work in west africa? >> certainly running the monrovia medical unit supported by multiple agencieses in the department of health & human services. certainly it will assist in that endeavor. d.o.d. plays a key partnership role. they are supplying us with equipment, supplies, logistics support on the ground. u.s. aid is really out there also pushing ahead. from our perspective to have a continuous presence, if we believe the mission is important providing the medical care to health care workers.

>> we have heard from doctors without borders and other organizations about the need for flexibility and adaptability in the response. in the budget request. what measures are built into the supplemental budget request that would give us the flexibility and adaptability. >> first there is the contingency fund requested by the president split equally between the state departme department/u.s. aid. that would be available if the disease breaks out in another part of africa that we need to surge to or if we have an effective vaccine to implement the campaign will be challenging. second, within the budget request there is transfer authority. that's extremely important so we can adapt the response to what's needed. third, within the cdc budget in particular it would be a single budget line so we would have flexibility within cdc to spend resources specifically for ebola control as they will be most

efficient and effective. >> thank you very much. i yield back. >> now recognizes ms. blackburn. >> thank you, mr. chairman. let me come to you. as i mentioned in my opening, keeping america safe, this is where the focus ought to be. you said in your testimony 621 million would be used to fortify domestic public health strategies. you didn't mention the managing of waste products from patients with ebola. according to the institutes of medicine report from earlier this month a patient with ebola generates 30 to 40 times more medical waste than another patient. the report states there is limited ability to handle ebola, medical waste in the u.s. i have a couple of questions. i can take a yes or no answer and that will help us missouri

quickly. part of the 621 million will be directed to managing medical waste products from treating ebola patients or will hospitals be expected to build on site incinerators or auto claifs to decontaminate waste? >> funding will go to support hospitals to strengthen waste management systems. >> do you have plans for sterilization of waste including ebola waste on site or as close as the source -- to the source as possible. >> cdc provides guidelines to the waste potentially contaminated with the ebola virus. we would continue to recommend the same guidelines. >> does this include on site? >> decontamination could be done on site or could be moved off

site. >> where is it going to go. >> we are supporting hospitals to deal with ebola. we would want it done on site. >> all right. kind of got a little skirting the question there. do you plan to procure and utilize mobile medical waste sterilizers? >> that would be one option that could beer considered. >> do you plan to do it? >> it depends on whether it made sense for the facility. >> what about the waste in africa? where are your supporting efforts? >> incineration is used in general. >> on site? >> generally on site, yes. >> dr. lurie, i would like to come to you for a moment. the funding request includes 157 million for barta the to support the manufacture of vaccines and synthetic therapeutics for use in clinical trials. would the funding be slated to support manufacturing at one of the three centers for innovation

and advanced development and manufacturing that were established through previous funding for barta or are you looking at other potential manufacturing partners? >> right now funding is being used. it would be anticipated to use to support both vaccine development, vaccine manufacturing and fill and finish vaccine cap is it city. also the continued capacity and fill and finish of therapeutic products such as z-map. we are actively engaged both with the centers for innovation and advanced manufacturing and with a fill finish network components to look at the role they can play. >> so you were engaging other partners? >> we are engaging the range ofs -- >> private sector. >> the range of partners it takes to get vaccine and therapeutics. >> okay. we read secretary burrwell's testimony last week as i'm sure you have from the senate aprops

committee and it seems it would go to manufacturing quantities of products that under go successful early development at nih. we know there are several private companies who have committed significant resources to develop treatments or vaccines for ebolament we want to make certain those companies are involved in processes going forward. so it is my understanding, you're saying you plan to include and invite them. >> any company with a promising product is welcomed into barta. we have a system to sit and talk with them, determine whether they have promising candidates and for them to submit proposals that are evaluated. what i can tell you is it is generally nih's role. bart that's role to support advanced development of

products. barta is and will support the advanced development of vaccines and therapeutics and get them scaled up so that if they work they can be used in a mass vaccination campaign or in therapies. >> thank you. i yield back. >> now recognize mr. wax man for five minutes. >> thank you, mr. chairman. dr. frieden, you and other experts have said numerous times the key to protecting americans from ebola is stopping the disease at its source in west africa. can you explain the approach in west africa to contain the spread? >> in brief to identify patients with ebola promptly, get them isolated and cared for safely. and in the event that individuals die, have them buried respectfully and safely without spreading disease. to turn off unsafe care and

unsafe burial. that's what ef we have done until now. instead of dozens or a handful of cases, thousands of cases to deal with. >> would you say the epidemic is moving too quickly to keep up? >> the decrease of is some cases is proof of principle that the approach works. we are stiller far from the finish line. >> what are the consequences of failure in africa? >> if we are not able to stop the ebola epidemic the risks are high that it would spread because of travel within africa. if that were to occur it could be a matter of years before we would be able to control it and the threat to the u.s. and other

countries would be proportionately greater. >> some people say if that's the concern why not seal off africa and not let other people travel from africa. would that solve the problem? >> from the standpoint of public health we look first at protecting americans from risk. protecting americans from threats. we have systems in place that trace each person who leaves one of the three affected countries, each person who arrives to the u.s. and follows them for 21 days. we have had people who developed fever, called the 24/7 number provided and have been safely transported and cared for and have been ruled out for ebola. the systems rely on knowing where people are coming from and how they are getting there. >> the president asked for more money in the supplemental

budget. a big budget goes to our efforts in africa to stop and contain the disease. some of the money will be used here in the united states to en hans u.s. government response to the ebola outbreak. can you give a brief summary of what initiatives are covered by the funding? >> thank you. these would allow us to work with states so all travellers are traced on a daily basis. if they become ill, they are promptly and safely taken to a facility ready to care for them. it would result in safer hospitals and other infectious disease threats. there is a small research component the to allow us to implement a vaccine trial, probably in sierra leone. others would ep help with diagnostics to detect more rapidly if someone became ill. we woul support all

jurisdictions to be better prepared for ebola and other infectious disease threats, have safer hospitals, more rapid response and work closely with the state -- between the state and hospital systems within the state on infection control generally, ebola and other deadly threats specifically working closely with the funding for asper and other parts of hospital preparedness. >> it seems to me that it shouldn't be partisan in any way for us to give a grant of money the president requested to deal with the terrible epidemic in africa. and request is balanced in helping us deal with the situation as we now have it. we have always had bipartisan support. talking about here in the united states, what if we had a pandemic flu. that would be more dangerous

because of how fast it could spread. would these funds help us to deal with that? secondly, are we prepared for a pan demic flu? do we have a stock pile of the medications. are we ready -- as you said we don't know what will come next. but are we ready for it? >> we always work to be better prepared today than yesterday and better prepared tomorrow than today. a pandemic of influenza remains. one of the most concerning possibilities, the funding in the emergency funding request would assist this country, health departments, hospitals, the health care system, the public to be better prepared for ebola and other infectious disease threats such as the pandemic influenza.

>> without objection. >> dr. frieden, the administration's additional funding request states money will go toward 50 ebola treatment centers throughout the united states. some states, texas, has already start started on their own. will it be includeded in 50 or in addition to? >> i will comment and dr. lurie may want to continue. our approach is to strengthen the statewide systems. it would be the states responsible for -- in collaboration and determining which hospitals would be used. what we have asked each state to do is four things related to the active monitoring program. first, establish the program including information flow from the state health department to local health departments. second, establish a 24/7 hotline

for any traveller who thinks they have ebola to call so they can be safely managed. third, establish safe transport between wherever the person calls from and the facility that the state decided would be the facility to assess or treat them for ebola. the fourth is to work with their hospitals to identify facilities that are able to do that assessment and treatment. >> let me add it would be great if you got a -- let me ask you the same question. the 50 centers designated in the president's budget request is that in addition to the state designated centers or would those state designated centers in texas fall under the purview of the 50 centers president obama is describing? >> as dr. frieden said, our process and plans have been to work through the states to identify facilities. the process works --

>> make it simple. the two centers governor perry designated in the state of texas. do thosele fall under the parameters of what president's budget request as it exists today. >> the funding will go to the states and the states in conjunction with the hospitals will determine which of the hospitals will serve as infectious disease containment centers or the ebola treatment centers system i guess that's as close as i will get to an answer. let me ask you a question. do you report to ron clane? is that someone in the hierarchical reporting structure you have? is he a person to whom you report? >> i report to the secretary. i interface with mr. clane on a regular basis. >> in your testimony you say that under the national response framework, my office, your office, is responsible for coordinating the emergency support function number 8 response which is listed here. so where does mr. clane's

responsibility fall in the emergency support function number 8? >> so during different event this is the united states whether they are national disasters or other kinds of emergencies, either fema is activated and as it is for hurricanes and floods and i know we have worked together in texas on a number of things. fema is has activated an emergency support system number 8. ser vises are activated under that framework. in other -- >> let me interrupt you. that's under the coordination and control of secretary burwell. is that correct? >> emergency support function 8, yes. >> does mr. clane have a role? >> in this situation we have not had a declared national emergency. fema has not been activated. however, we have a very serious situation in the united states and mr. clane is the national coordinator -- >> my time is going to run out.

it's not fair to say you have an emergency plan, but do you have a serious situation plan you are working under? >> we are doing aggressive planning both for what we have in the here and now and for the what-ifs. we work across hhs and the rest of the components of the federal government on the what-if planning. >> i will assume you will be able to make the details of the plan available to the committee staff? >> it is -- continues to be in draft. we continue to work through what ifs with the partners across government, yesment. >> yes was the answer. >> yes, when we have the rest of the plan together. it's something that's a whole of oh oh government plan, not an hhs plan. >> it's time. dr. frieden, i have to ask. we had two nurses at presbyterian hospital infected. i have to tell you. when you get the call at 2:00 on a sunday morning that a nurse is infected you don't have confidence that things are working the way they were outlined. do you have insight as to how

those nurses became infected and what we can do to protect our health care workers going forward? >> we don't know how those infections occurred. the evidence points to them having been infected in the first 48 hours after mr. duncan was admitted to the hospital, before his diagnosis was confirmed. that's consistent with the period of time between on set of similar. toms and exposure. it's consistent with the observations of the ta s team o from cdc that arrived and found in the intense efforts of the health care workers to protect themselves they may have increased their risk by some of the ways they were working with personal protective equipment. that's why cdc strengthened the martin of safety and established new guidelines for personal protective equipment that in collude as two critical components practicing repeatedly so the health care workers have comfort with the equipment they

will be using and direct observation of oh every step of taking on -- putting on and taking off the protective equipment. >> this just under scores why it is important to have treatment centers available around the country. because i could just tell you the average icu is not set up for that type of activity of the donning and dof f'ing of protective commitment. i have a problem with the time frame. mr. duncan's family never became symptomatic. i would suspect it is later in the course when he was throwing off massive amounts of viral particles where the greater risk for exposure to those health care workers occurred. i'm sure you and i will have future discussions about that. i will yield back. >> just to clarify, during that time mr. duncan, at what point did he disclose he was in western africa e posed the to ebola? >> my understanding is he disclosed that he was from west africa on the earlier emergency department visit on the 25th of is september.

he was admitted on the 28th of september. >> thank you. now mr. green is recognized for five minutes is. >> thank you sh mr. chairman. to follow up my colleague from texas i know our state has designated two locations. two months ago i was at texas meddle call a center in houston and there was interest in trying to do that, too. that may not be one of the two locations that the governor has designated. but i have a question later for dr. gold from the university of nebraska. how it was unique that the university of nebraska created the facility there and how it happened. let me get to my question for you dr. frieden. what is the process and timeline for updating and communicating changes for protocols to local health care providers. we know there was an issue about that last month. what is the process or have the processes changed at the cdc from what we did, say, in october? >> with respect to cdc

guidelines we used the latest data, information and experience. we consult widely with affected parties for input. when we have a clear set of guidelines we then disseminate those through a wide variety of networks. >> what we have learned is personnel protection from the experience at texas presbyterian and how the lessons are shared with other hospitals. again, the feeling somebody shows up at 3:00 at one of my not for profit hospitals in an urban houston, how are they going to deal with that? >> we are dealing with this from both sides of the equation. first, the patient side. what we have done is for every single person coming from west africa, they are greeted, asked detailed questions, the temperature is taken and they are provided a care kit that includes a thermometer, a log for taking their temperature, a wallet card with 24/7 number to call. we have already had multiple

times in the past few weeks individuals take their temperature, find they had an elevated temperature, call the number, be safely transported to and safely cared for in a facility. they all ruled out for ebola. but the system worked in those cases. we can't guarantee guarantee it in every case. that's why we are working very intensively with hospitals throughout the u.s. to prepare them for the possibility that they could have someone with ebola. at least guidelines which are in conjunction with the rest of hhs training sessions. we had hospital visits by rapid preparedness teams to more than 30 hospitals and ten states and continue to work intensively with the system so that they are increasingly well-prepared to address a possible case of ebola. >> how can you provide clarity over the cdc's authority and responsibilities and setting and enforcement? do you have authority and enforcement over hospital settings? >> cdc provides guidelines and

information and tools and feedback to facilities. we do not regulate in that area. that would be up to other entities within the federal and state governments. >> okay. without a commercial market, many counter measures like those against ebola and infectious diseases require skpbl private partnership. they recognized this when it created a drive by providing a stable source of funding so that a reliable market was in place. that can take the urge urgy was that was not enough. can you provide a dollar figure on what you think is needed for ebola, vaccines and drugs to get to the chance of successfully

developing a product. >> i didn't hear the last part of the question. >> can you provide us a dollar amount on how much investment you received as needed for ebola vaccines and drugs to allow us the best chance of successfully developing these products. like i said earlier, the research program and ebola has been going on for a decade. are there resources and how much would we need to do to get that drug. >> absolutely. one of the reasons we now have two vaccines that are finishing safety trials is because of prior investments made across the u.s. government in trying to develop an ebola vaccine and also with ebola therapeutics. as you may know, the vaccines are finishing those early trials and thanks to money provided in the cr. they work on vaccines and

therapeutics. whether they work we will learn over the coming months. at the same time we have now gone ahead and invested in the advanced development of three other vaccine candidates and making the therapeutics so that we never put all of our eggs in basket. we want to do better and we will continue to do that through the investments. we support the support from congress. >> i'm all out of time and i want to thank the panel today. >> i yield back and recognize the chairman for ten minutes. >> congressman green department want to brag, but he has a family member who is active at nebraska we appreciate them on

the frontlines. we will welcome our witnesses from texas and glad you are here. my first question i'm going to ask, the rear admiral and surgeon general. i believe we should treat this as a health issue and not as any other issue. it puzzles me that we have not really effectively put in a travel ban from west africa. i know we have alerted people and all of that, but when we had the hearing down in dallas at airport, the answer we got is we need to send personnel over there. we don't want to prevent people traveling to here. as a pure public health official

and the surgeon general, why would we not put in a true quarantine and flat prevent any travel from west africa. >> certainly as stated and have a strong belief in this, is that currently as we have it, the idea of having a travel ban prohibits all travel. there is that sense of travel of health care workers to western africa and i stated earlier, the real resolution to this issue is solving the problem. at the same time instilling a travel ban has a total loss of control of who enters and how they enter this country. as the doctor stated earlier, we set up the systems. the systems in place right now allow us to know where people are coming from. it allows us to track them appropriately through the public health endeavors at the state and local level and to be able ultimately to follow them appropriately and to be able to

intervene if symptoms appear and direct them and detect them appropriately and instill the right response for that. as the system works, as the surgeon general, i find that the appropriate course of action. >> okay. it puzzles me if we were to have a health outbreak like tuberculosis, there wouldn't be in question that the texas department of health would put a true quarantine in place. i understand some of the external reasons, but if you are trying to contain an epidemic, a quarantine does work. when i asked dr. friedin, there has been concern that perhaps we don't know how this disease is transmitted. unless something came out recently some of the individuals

in texas that were potentially infect and put on a watch list had no means. do you have any way of finding out the methods of transmission than we do today. >> we do research specifically on ebola and spread of it. the two infections are the two nurses at texas presbyterian occurred at the time when mr. duncan was highly infectious with large quantities of highly infectious colors of diarrhea and vomiting. they were most likely to have been infected although we don't know for certain. we describe what we see in africa. people become infected by caring for or touching someone who is

either very ill or died from it. we analyzed the amount of virus in a patient's that goes from undetectible to small quantities when they first become ill and as they get sicker, they increase enormously. they are quite large. >> as a medical professional yourself, what's your confident that there is no other method of transmission than we know about today. are you 100% certain there is no other way. they spread from a vearlt of ways. but the way it is spreading by and large. they are the two main mechanisms of touching body fluids. i will mention one of the things

we looked at in the new guidance is what is done in u.s. health care facility facilities. there is more ventilation somewhere. that may generate the particles and the respiratory equipment guidelines. >> thank you, mr. chairman. my time is expired. >> i recognize mr. braley for five minutes. >> thank you, mr. chairman. i want to clarify the questions that congress person blackburn was asking you. at the 50 hearing on october 16th, the doctor was kind enough to present us with materials to walk us through including this product development pipeline which i think you described in your testimony, talking about early concept and product development being the province of nih and the advanced development being the province of barta and commercial

manufacturing by the industry and regulatory review. the next page was therapeutic development. the treatments for the symptoms of the ebola virus as opposed to a vaccine that would hopefully prevent the virus from spreading, correct? he had a slide that talked about the vaccines that were in or approaching phase one trial. the first is the glaxo smithkline. the second was new link genetics. i asked him questions about that at the time. i questioned doctor robinson. in this particular slide, it appeared there were only two companies, glaxo smithkline and a new link that had phase one trials ongoing. has there been a change to that since the hearing? >> since the hearing on october 16th, the phase one trial has

been under way. they are almost complete and they are very optimistic that they start next phase of the trial with both of those vaccines in west africa. >> this slide indicated that there was a third company, but they were not expected to engage in phase one trials until the fall of 2015 which is a substantial ways away from where we are today. >> there other potential vaccine candidates in the pipeline. we are supporting some of those. they are behind this timeline and we are right now focused on trying to figure out if these vaccines are and effective and if they are, get them into use to control the epidemic in west africa. part of the emergency funding request will be $157 million for barta to continue to accelerate the development and manufacturing of vaccines and therapeutics for the outbreak.

>> my understanding from talking to the folks at new link genetics is these clinical trials that have been ongoing at walter reed and the national sn institute of allergy and infectious disease, there is good rapport against the agencies and the company involved. that there is continuing to be ongoing interactions with the department of defense sponsors as well. that would be the defense threat reduction agency and the joint vaccine acquisition program. is that your understanding as well? >> that is in fact every week once or twice a week i run a call with all of the parties. so that we are all joined at the hip through every step of the process. we know what's going on and we share information and we know what to anticipate. fda has been a key partner as well. because of the fact that it's their regulatory authority.

it is going to determine what moves forward and what doesn't. i never thought i would find myself in this situation, but we are racing to catch up with fda. it's a great situation to be in. everybody is working extremely effectively. >> great. >> doctor, mr. barton asked you a question about trying to contain an em demmic with an absolute quarantine. is there an ebola epidemic in the united states right now? >> there is not. and that's why they are trying to contain it there. >> one of the things we talked about during these hearings is the importance of focusing on facts and science and medicine. in 1900, the two leading causes of death in this country were influenza, pneumonia and tuberculosis. neither is a leading cause of

death because of the response of science and medical health. when you look at the fact that in 2012, there were 25 million people living with hiv around the globe and the case of ebola, with the proper application of science and medicine and public health, we should be able to manage this crisis if we devote the necessary resources on a global basis. would you agree? are. >> yes, i agree. >> thank you. >> you are recognized for five minutes. >> thank you and i appreciate you having this second hearing on ebola and i want to thank the panelists for coming. we would like to see mr. kline be a part of this. the committee made a request for a new one here. they will have transparency to

talk about it. they would be focussed on working with us to get solutions to this. the last time you were here, we talked about a number of things. one was the comments that we heard from samaritans to groups that will be on the second panel. one of the things is the comments you previously made. they were blown off by the agency and i asked a few about that. you said you heard about it. have you looked into it to see what's going on? can you follow-up on that last conversation we had about those complaints? >> i am not familiar with suggestions or complaints or concerns that have been raised that we have not addressed.

>> one was a quote that kind of blue me off and made others that implied they were not being taken seriously. you said you would look into it. do you agree with that statement or have response? >> we are certainly still learning about ebola and the best way to fight it. that's a critical component of

activities and a component of the emergency funding request as well. is it still going on and you think it was being under estimated and not being under estimated to that level? >> the cdc publications estimated the degree of under reporting could be as high as 25 back over the summer. our sense is that is likely to have decreased in areas. including systems to track the disease and they don't have a place to come in. they are less likely to be accounted for. >> is there new conversation that we had especially the white house about what has been talked about by a lot of members having a travel ban for those having

direct contact with people in west africa and come back into the united states to have them to make sure we didn't come back with ebola? >> my top priority is to protect the american people. i have said and others have said that we will look at anything. we don't want to interfere with the system that allows us to track people when they leave and arrive for 21 days after at 100% follow-up for most people who come into the country. if we don't have it, it could result in a greater than a lower degree of risk. >> let me ask you about ron kline. we did ask that he participate in this. he is designated as the ebola

czar. have you had contact about strategy and how to deal with this? >> i have frequent contact with him. he advances. >> the two had disagreements on how to approach this. >> we have not. if you felt he ought to go that way, is there a hierarchy right now? >> he has been clear and specific decisions that are at the cdc. >> i appreciate your questions and answers and thanks for coming in. >> thank you to our panelists for dedicated work. we heard that the key to keeping the united states is to e

raticate them at their course. while we had early indications of momentum begin to emerge, it seems as if the situations in sierra leone and guinea are not showing the promising signs. what additional resources are they doing? >> the emergency funding is essential to our ability to protect ourselves here at home and stop ebola. too many blind spots and weak links in places in africa and elsewhere. we have large amounts of travel and animal human interface and large members of people. all three of the cdc components and all of the components are so important. the cdc-related components are domestic and stopping ebola and preventing the next ebola

through the global work. >> i know it's a few weeks ago and they are four individuals from cdc in guinea. france is taking the lead on ebola response in this country because the united states needs to take a more leadership-active role or does it have the capacity to do so? >> excuse me. for the cdc specific response, we provide a comprehensive public health approach in each country. as of today, we have approximately 175 staff on the ground. we have the most staff in sierra leone. we also have more than 20 staff or roughly 20 in guinea. we get the french speaking staff and we have 12 as of today

dealing with that cluster and trying to stop it at the source. >> what are about engaging on a more international impact. how does the community get engaged to devote the resources for this world health crisis? >> it's a robust global response. my understanding is that contributions from other countries total more than $1 billion. they have been active and effective. they have been stepping up in sierra leone and french and eu support to guinea and other areas. >> we keep hearing that there is a great need for medical volunteers to travel to west africa. do you have a sense of how many medical personnel are needed and how would one get involved? >> for american health care workers with the u.s. agency for international development maintaining a website.

you can go and volunteer. we ask that americans who want to be involved do so through another organization. they are not going as individuals, but part of an organized approach. not just clinical care, but public health measures. >> that's reaching out. is there activism in terms of recruiting personnel? >> there is quite a bit of effort by individual organizations within the u.s. for our own part. we are looking at epidemiologists not only among the staff, but they may be able to deploy. this is going to be a long road and take many months. we need people who are willing to go not just for a week or a month, but several months or longer so they can get that max mall effect by being there. although for the clinical interventions where you are working in the isolation unit,

we like to limit that to to six weeks so people can be well rested and minimize the chance of taking a risk. >> we heard that hospitals across the country are having difficulty sourcing ppe. what is the cdc's and the allocation of these and could the u.s. ramp up manufacturing needed to contain a domestic ebola outbreak. >> the doctor addressed the manufacturing aspects from the cdc perspective. we operate the strategic national stockpile and we stockpiled ppe to enable to us rapidly within hours deploy to whatever hospital in the u.s. that's one of the components and in addition, we conducted what are called rapid emergency preparedness visits to more than 30 hospitals and ten states. one component of that is

addressing whether they have sufficient ppe. we prioritized reports near airports where those airports where people come in or where a large number of the africans live. we understand that not all of them get what they want. they have been working to ramp up manufacture and prioritize the facilities most likely to need it and we have been working with the national stockpile. the ppe that we can deploy quickly. >> thanks to each of you for being here and shedding light on this situation. both for you and you, you have told us that this emergency

funding request supports nonspecific funding. not all would be directly for ebola, would it? >> i would disagree. it is divided into two components. all of it is addressing ebola. it addresses it with respect to the cdc and in ways. domestic preparedness for ebola and other threats. we think it would be most responsible to not only address them and strengthen the system, but addressing the risk that there will be another outbreak and the spread of ebola or a disease like ebola elsewhere through the security component. >> could not some be handled through the traditional appropriations process? >> the situation is urgent with respect to earthquakes ebola. they indicate for the control,

the size can triple. as the director, i am not going to address the mechanism, but i can say the need for urgent funds with flexibility and the use of funds is crucial. you commented that 2,000 travelers are being monitored. how many are being monitored this moment. what is the number? >> roughly 1500. the number is lower than it had been previously. >> what maintains the list of who is being monitored? >> everyone comes through the process customs and border protection. we work in conjunction and that is collected and opinion hours we provide it to each department and monitor with the state departments and resolve challenges if someone is hard to find and moves from state to state. >> are there any being monitored that you lot of track of?

>> a tiny fraction. less than 1% have been monitored and not found. they were later found to have left the country to go back on travel or otherwise. the program is relatively new and started about a month ago. what we are finding is excellent participation from the states and the travelers, but it is challenging and one of the things that would be supported in the funding request are funds from the departments to operate. >> how many are told to seek medical attention? if you have 1500 adults and some from west africa, more. malaria is common. for example, in the past several weeks, four individuals used the care kit for ebola we provided at the airport.

took their temperature and found it was elevated and called the number they were provided with where it was safely transported and cared for. they were ruled out and cared for in a safeway. >> let me ask and we talked about waste management. what to do with the ebola patients. are any of those being transported across the country? >> my understanding is that some are auto claving it. that the decision of the waste management companies was then to take that auto claved material which is sterile and move it for consideration. >> that is meaning that the waste is being transported across the country? not only auto claved, but anything not being auto claved is being transported? >> i am not aware of anything at

present. are the states notified of that transport? >> i am not familiar with the details. they have been looking at different measures. they had a meeting with the medical waste industry to get input from them. we worked with the department of transportation and what we have done in the individual cases. that's from the federal level and the state for the management of waste. >> i yield back. >> you said a travel ban, i think i'm quoting you would cause us to lose contact of how many people travel to the country. what do you mean by that? >> well, right now we have a

system. the system is an open system. we know when people are entering. we know where they are coming from. we know through our cooperative efforts with border protection, of when they are arriving. they are arriving through five funnels and airports right now. we have that connectivity. with a travel ban, the essence is what? no one moves. however -- >> it's from those countries. >> at the same time there is this potential that people move from country a to country b. from b to c and c to the united states and they can be from western africa. in my assessment of this, in essence it's what we have right now and the system that works following these individuals who are coming from western africa or the affected nation. >> if they were not coming and we had a travel ban, how can we lose track? >> through multiple routes going

from one to another to another. >> they won't have a passport that said where they started some. >> again, that system can be worked around, if you will. right now we have a system is allowed to follow people. we know where they are coming in from that allows us to follow them. >> i'm from missouri and you have to show me. that doesn't make sense with a travel ban from the hot zone countries. if they were not coming in, how we could lose track. if they are not coming in the first place. if they want to do a work around on their passport where they started, correct. >> let me ask you. you were talking about the travel ban also. you said less people coming in now. the last one was october 16th, i

think. the number was 100 to 150 people. >> it has been closer to 70 to 80 per day. cut by about 50. >> that's my understanding. >> and some seem to think if we gave you an unlimited check, do you think enough money would fix the problem? >> we have the ability to stop ebola, but that will require what the emergency funding request asks for. stopping it at the source and preventing another ebola situation where the world is most vulnerable. i'm sure you have seen the story of a nurse that was diagnosed with ebola in mali.

she was diagnosed after she was deceased. some people would call them the 1%. also un peace keepers that have been injured and after she was deceased, they found out she had ebola. the first ebola death is eight days after the last hearing in here, the 24th of october was the first death. they found out there was a 70-year-old item who came from sierra leone or guinea. he came from guinea. he apparently was the person who

brought him to deceased. instead of kidney disease he deceased from ebola. in the area, they didn't know she obviously had symptoms before she passed away. the other side of the aisle, they said he self quarantined and took care of himself. was he not misleading? he didn't answer where he had been. he said he was home in the apartment and they checked the subway passes. they have the bowling alley and the pizza parlor. did he not? in new york? >> in terms of the mali situation, we have 12 staff on

the ground there now. >> they have been there how long? >> we had staff there since before the first case helping them with ebola preparedness and the 2-year-old who died who you mentioned was unrelated to the current case. the 70-year-old gentlemen who died lived in a town on the border. >> i'm talking about a nurse, not a 2-year-old. >> the source case for the nurse is the 70-year-old. he lived on the border between mali and guinea. his ebola diagnosis was not recognized. people thought he died from the other problems and there is a cluster of cases there and we are working intensively to stop it. even the challenges of mali, if ebola gets in, it will be hard to get out. we are hoping to stop that. >> i went back weeks later and tried to sanitize the mosque he had been prepared for burial in, correct? >> that is my understanding. >> i would like to see as i said

on the 16th, a travel ban and i don't understand how you can lose track of people who never came in the first place. i yield back. >> you are recognized for five minutes. >> thank you, mr. chairman and thank you to the panel. dr. friedin, i have been reaching out to the hospitals in north carolina and i have a number of reports that are saying that they receive the protective equipment and where they need. specifically a short supply and 95 masks. what does the cdc play this this and why would there be a delay in this equipment? >> we looked at three levels of

hospitals. first the hospitals around the airports and we want to make sure they have ample supply. also the specialty facilities like nebraska and emery and nih. second is the facilities where large numbers of people from africa live where we might have another case and third is all of the other facilities. given the number of facilities, there is not enough on the market for some of the products to give every hospital as much as we like. we have a national stockpile and that stockpile already has enough ppe to distribute to hospitals that urgently need it within hours. we also have worked through the rapid ebola preparedness teams or rep teams with several dozen hospitals to get them ready. when we work with them, we found although they might have shortages, they have been able to meet the shortages.

they are most likely to need the facilities. we have ample supplies to the national stockpile. >> do you want to comment on that as well? >> sure. one of the things my office has done since the very beginning is reach out and work with them. i personally have spoken to the leadership at each of the companies and each of them now have gone to 24-7. >> the manufacturing. >> three shifts a day. they made a commitment to work with them and we are doing this so if a hospital is on our first list of being really ready to take care of ebola patients or needs them urgently, they will prioritize the orders. what they said is because a lot of people are frightened, many hospitals are they think double and triple ordering ppe from

different distributors and manufacturers. they want to be sure they get some. part of our job is to be sure working and they get what they need. as the doctor said through the stockpile, we are confident that they can get enough ppe to any any have enough. the manufacturers and distributors have developed training material. they don't have to train on them. they will go out to a facility and let you use other kinds of samples to practice. >> to practice. >> dr., in relation to travel, i have been raleigh durham international. that is not one of the five designated airports. and the first line.

they are not health care professionals. with this increased threat of ebola. is the cdc prepared or has dedicated funds to the airports to help with training and personnel issues. >> part is to ramp up and working with the funneled airports now and we worked closely with customs and border protection. it has been an excellent partnership and provided training and information. there is a entire for more information. we ensure that almost all go to the airports. >> one last question. is the cdc working with osha and department of labor helping hospitals to be trained for the prepared readiness? >> they have been part of the teams and offers services and information to hospitals that are working on preparedness.

>> great, thank you. i rich that he was here with us today. i think the new ebola czar provided the new information. >> my home is texas 22. it's a suburban district. many folk who is live there work down at the texas medical center. they may live in rural parts. cotton is still king. it spooked them badly. shut down for days because two students coming back from

cleveland with a nurse who had been exposed. cleveland is not as close to houston as it is to dallas. texas had a cruise ship docked there and came up early because a nurse self imposed far an teen in the cabin. 55 gallon drums. 1,800 degrees fahrenheit burned them from treated them in dallas. it comes through texas 22. the deluge of information coming from cdc and awful y'all. it's confusioning and overwhelming. i heard it from big hospital systems and 1345u8 providers. the mercy centers from my

hometown of sugarland, texas. i'm worried about the other guys like st. michael's. i have a question for all three panelists. the first is for you. what is your organization doing to ensure that small guys like st. michael's are ready if an active ebola patient shows up at 2:00 in the morning on thanksgiving night? >> three things. first, we are working with the travelers themselves so that they know where to go and have a number to call. they are checking their own temperature so they can identify if they have symptoms and they are cared for before they become infectious. second, we are providing information through our website and webinars and demonstration and training and practices to hospitals throughout the u.s. as well as hands on training through our rep teams and team fist there were to be a case.

we are working with the state health departments that are key here. one of the components of the emergency funding request is strength eping and providing more resources to state health departments exactly for this to strengthen infection control for ebola, other deadly threats and things that are daily endangering the threats throughout the country. the departments and hospitals have a critical roll to play and maximize the impact of that. it will require the resources that it will require taking an approach that addresses ebola as well as other deadly threats and strengthens the systems of infection control. >> how about yourself? >> one of the things we have done is reach out to all of the hospitals around the country. they are organized into coalitions which are community

level collects of hospitals and dialysis and nursing homes and others. texas has a well organized system of this and reaching out through them, they are able to reach st. michael's and say if they needed personal protective equipment. if they needed help with dper size and training, they could get it. number two as i mentioned, we had a very aggressive outreach and education campaign. it has been open to health care providers including health care providers from st. michael's and anywhere else. people can take advantage of numerous phone calls and webinars. they reached nurses and doctors and hospital administrators and ems professionals. at this point we reached over 360,000 people across the united states with this. it is our goal that every hospital like st. michael's as they say they recognize a case and safely isolate a case and to

be able to get help. finally through the health departments, you know you will hear from them in a while. they called the state health department and if they have questions or concerns, this is a good position. >> one more question for you. you were quoted on october 2nd. essentially any hospital in the country can take care of ebola. do you stand by the quote today? >> clearly it's much harderly in the country as we recognized. every hospital in america should be ready to recognize ebola, isolate someone safely and get help so they can provide effective care. that's why we established the team ebola response team that will fly in at a moment's notice for a highly suspected or confirmed case to help hospitals

throughout the country. >> thank you, i yield back. >> i recognize mr. jones for minutes. >> want to thank the panel for joining us today. thank you very much. >> have any other states applied stricter standards than the cdc has in terms of how to handle ebola? >> cdc guidelines are just that. the states are free to be stricter than that. we are gratified that most have followed standards and what we say is clear. >> do you know if any states have stricter standards? >> some do. >> all right. >> why do you think the states are adopting stricter standards than the cdc? are you confident that your standards and the guidelines and standards are strong enough? >> we believe our standards if followed are protective of the public. they require that people who may

be at any elevated risk or some ri risk, they have temperature monitored every day. that is something that allows us to interact with the person and talk with them and to determine on an individual basis if they should stay home that day or if they might be reasonable to allow them to do other things. >> have you talked to the states that have stricter standardards to find out for the stricter standards? >> i had communications and understand some of their thinking process. the number of individuals who are subject to those stricter standards is small. all of those individuals by our standards should be in direct active monitoring. someone watches them take their temperature and and they don't have the fever. >> the last time that you were with us, we talked about having

tested the standards. have the standards been fully tested across the country back to what my colleague from texas mentioned so that every hospital knows what to do? have they been tested? >> the standards in monitoring travelers are being implemented by every state in the country or virtually every state in the country. tracking people coming back and monitoring them. >> have they been tested? >> i'm not sure i understand your question, but with respect to the -- >> then let me explain the question. going back to my military experience and i think some of the gentlemen here can understand that, we do things called operational readiness inspections. we don't wait for the bullets before we know what they will do when they do start flying. you come to appalachia, ohio. there lots of community

hospitals. they dot our region. are those hospitals fully up to speed? have they tested and signed off on any guidelines that they have tested their ebola process? >> in terms of hospital preparedness, many hospitals have undertaken drills. we have also -- >> has cdc mandated some. >> they don't mandate that hospitals do drills. we have guidance and resources for hospitals. >> have you recommended? 35r. >> directly involved with doing that and reviewed for the visited hospitals. those most likely to receive a case. we visited those hospitals and have overseen the drills and preparedness and worked with them on advancing their preparedness. >> it's my understanding that there several ebola centers

scattered across the country referred to as infectious disease centers. most have a capacity of to two people treated in the united states have been transported to one of these centers to better manage the illness. in the event that a larger number of cases were to show up in the u.s., how do they plan to treat the load that exceeds the available bed space in the centers? >> the challenge of a cluster would be substantial and a matter of using all available -- >> define a cluster. >> it could be or ten cases in a practical scenario. this could be seen. in this case we would use all available local resources. if need be, surging health care workers in and transport patients to facilities around the u.s.

they could be treated. >> they are set up to handle one or two patients to handle the requirements of the disease. the virus. do we have transportation systems that are capable of transporting ebola patients if that outbreak were to be bigger than one or two that we are talking about. >> we are working with the state department and others to increase the capacity to transport patients. >> what about being transported to other places. would they receive lower quality care than one of the infectuous disease centers? >> the quality can be provided and it's an intensive care unit care. they consulted on the care of every patient cared for in the u.s. and provide it to each one.

he is going to get you at this point. >> we will try to it's able to get closer to what i am. they take it somewhere else. and when that happens, are you notified and is she required to tell you as far as i know? >> the infectious disease.

i believe that that and that division would be part of the response. i'm correcting that. >> that is correct. do you know whether or not the secretary transferred money from the cdc's global health programs? >> i would have to get back to you. >> likewise on the cdc's preparedness and public response division. >> i have to get back to you. >> both of those are part of the ebola response. >> you indicated what you don't know and do you know if they were transferred at all? >> they are the secretary's transfer and i don't know the details of what has been done. >> okay. >> so you don't know the details. you would not know if any of this was transferred to help support the financial underpinnings of obamacare?

>> i don't know. >> likewise, do you know of any transfers made to the administration by the administration for children and families to care for increasing numbers of unaccompanied children arriving in the united states? >> i am not familiar with that. >> would you give us the answers to all of those? >> i can get you the fair amount of money. part of that is a 5.4 billion and funding. some of that is supposed to go to hhs. they said in his letter to make resources and domestically and internationally. and that goes hhs. it then talks about transferring the funds over to homeland security to increase customs and border control operations. do you know what money they are

getting? >> we work closely. the ebola required a very extensive response. the plexibility is a critical component of the funding request. >> that are funding request is as was pointed out in an editorial by david and hope i pronounced that right. a former surgeon general. isn't that correct? >> i don't know. the funding details. >> in regard to mr. claim, have sat down with them? i greatly appreciate that. that would be very, very

helpful. some of the outbreaks in the past in the outbreak and i don't know where the disease came from. it may be bats, but we have not determined that. we determined it for a similar virus from research. >> the meat, i understand from the deputy from excrement? are they eating that as well? >> it may be saliva. >> i'm not sure the animal reservoir we had spreading from unsafe care or unsafe burial.

it couldn't have come from human contact. we are not sure what animals carry it. what else? we do know that it's transmitted if you eat it. >> it may not be the consumption of the push meat, but the consumption and handling where you are exposed to other bodily fluids. >> i yield back. >> thank you, mr. chairman. i want to apologize to you and the panel for running in and out. the democratic leadership is working on who our next ranking member of this full committee is going to be. it's not going to be me. thank you for your vote of confidence. so i just wanted to ask a few

questions and leave you in the capable hands. the first thing is the what exactly is the purpose of that fund and what would it be used for? >> the contingency fund is to deal with the unpredictable nature of ebola. the possibility that it might spread to countries where it is not currently in place and might require very extensive, expensive control measures there. also we might have new interventio interventions, such as a vaccine and need a largely and potentially expensive program to implement a vaccine program for health care workers. >> why would you need to do that through a contingency fund and not an emergency supplemental if that situation -- either of those situations presented themselves? >> in the words of one of my

staff at cdc in the case of ebola, it's the lack of speed that kills. we need to be able to respond very quickly to changing conditions on the ground. >> and we're seeing that right now in africa s that right? things are changing quickly in africa. >> absolutely. we're responding to a cluster in mali. we're moving out with disease didn'ts into a remote. rural area to address clusters of disease before they become large outbreaks. >> do you have a sense of why the number of cases in liberia has recently dropped? >> we believe this is proof of principle, that the approach that we're recommending can work. but we're still seeing large numbers of cases in at least 13 of the 15 counties of liberia. we have seen that decrease taper off so that we have seen a leveling off of cases that have been reported. every one of those cases needs intensive follow-up contact, monitoring of contacts and we're still having perhaps between 1

and 2,000 new cases per week in west africa. this is still a very large epidemic. >> and that kind of leads me to my final question, which is you have said repeatedly, and frankly there's been a lot of pushback on this, not just from this committee but from lots of other folks. you've said repeatedly that you don't think that travel bans and quarantines are the way to go about addressing this. and i'm wondering if you can tell us whether that's still your view and if so, why, and if it's not, why not. >> we're willing to consider anything that will make the american people safer. any measure that's going it to inkre increase the margin of safety. one of the things we have done is implement a travel system so people leaving these countries are screened for fever, arriving in the u.s. are monitored for fever, are linked with the local health department. we're now working with state and

local health departments to monitor each of those individuals each day and we're seeing very high adherence rates to that. so we have a system in place now. the risk to the u.s. is directly proportional to the amount of ebola in west africa. the more there is, the higher our risk. we have to reduce the risk u there by attacking it at the source. but whatever we can do to reduce the risk to this kocountry, we' certainly willing to consider. >> so you would still consider a travel ban if that it seemed like the only solution? >> if there were a way to ensure that we didn't lose that system of tracking people through every step of their travel and once here, we would consider any recommendation. but it's not cdc that sets travel policy for the u.s. government. >> right, and what i'm concerned about is if ebola goes to other count countries in africa in general,

it will be harder and harder to trace where people came from. >> the spread of ebola to other places in africa is one of the things we're most concerned about because it would make it harder to control. we were able to work with nigerian authorities to stop the cluster in nigeria. right now mali is in the balance of where we'll be able to stop the cluster before it gain. s a foothold. the longer it continues, the greater the risk it will spread to other countries. >> thank you very much, mr. chairman. >> mr. terry is recognized. >> unanimous concept to be able to ask questions. >> yes, you're recognized. >> dr. frieden, from nebraska, i'm really proud of the efforts of university of nebraska med center. at least we're top in something. it's not football, but it gives us a sense of real pride despite the last patient outcome, which

they did heroic efforts. but also in that regard, they seem to have been the ones that, especially in comparison to the dallas baptist hospital, we're kind of the -- that they were setting the standards on the practi practices. so that begs the question or at least we should ask the question of whether the cdc should develop an accreditation type of program on infectious disease programs to ensure that these hospitals maintain a level of competency in readiness. is something. like that ongoing? >> first, we really appreciate the facility in nebraska and their willingness to step forward in a phenomenal care they have provided to all of the patient who is have come to them. despite the outcome of the physician recently, we know that heroic measures were undertaken and the staff there really

deserve the gratitude of all of us. we appreciate their willingness to consult with other facilities and share their experience because that's critically important. >> which they have done, and again, hospitals like johns hopkins is asking them how to do it is a source of pride. >> what we have approached is something called the rapid ebola preparedness team where we send a team in to work with the facility to outline every aspect of their preparedness and to see how ready they are and to provide recommendations for what more they can do. e we also worked with state health departments so they can determine which of the facilities within their state that are most appropriate to take patients with ebola or other infectious diseases, because they are best prepared for that. in terms of accreditation, that's something we have discussed with the joint commission. whether that makes sense in the long run or not is something we're open to exploring.

>> as a layperson, it seems to make sense you would have an area where there is one hospital that has that level of accreditation. and then it begs the question that if they are going to be that go-to hospital in a region or a state, whether there should be maintenance funding behind that. what do you think? >> we certainly believe they should receive resources. there's funding within the emergency funding request both from cdc and from asper to support such facilities. >> the question is just to clarify, would that be part of the president's requested dollars? >> yes, it is. >> doctor? >> e yes, it is. >> very good. and again, dr. frieden and dr. laurie, one of the experiences here is that we know that, let's see umc has 11 units but the reality is they could only have three patients at a time because

all the collateral circumstances. so do we need more biocontainment units like what emory has, dr. frieden? >> we think we need some increase in the number of facilities that can safely care for someone with ebola or another deadly infection. we have been working closely with hospitals throughout the country to increase that capacity and the emergency funding request would enable us to get to the level where we would have a greater degree of comfort with the facilities out there in the kmaft. >> just to clarify that some of the dollars that would be in the emergency funding, the president's request would be to expand the number of biocontainment units. >> yes. >> very good. one of the questions about having three patients at unmc, these folks don't have any insurance and they are hold iin

the back for the funding of those patients. is there anything with hhs, dr. laurie, or cdc that can reimburse facilities for health care costs? >> i believe the secretary indicated in the hearing last week that we're open to mechanisms that would make them whole for the expenses they have had. >> open to it and doing things, there's a big gap between those two. is there any further discussions to reimbursing? >> i think we understand that the cost of caring for these patients is quite substantial and the secretary indicated that she would look forward to working with congress on this issue, yes. i might also just add in terms of the emergency funding that is necessary. it is clear that hospitals that are going to take care of ebola patients need additional training and we very much appreciated the fact that university of nebraska and emory have been now working side by

side often with the rep teams to help with that. part of a funding request would also establish something that would look like a national education and training center that would move to another level, i think, of preparedness for hospitals that really wanted to attain that and get help with doing that. >> okay, thank you very much, my time is expired. >> that concludes the questions for this panel. we thank you and also members may have some additional questions. we do appreciate the availability of all of you in responding to us. thank you very much. >> thank you. >> as this panel is moving out, i'll begin to introduce the second panel so we can move forward here and i'll introduce to the panelists and ask mr. terry to introduce one as well. we'll start off here first mr.

ken isaacs is the vice president of program and government relations for samaritans purse. also dr. david is the commissioner of the texas department of state health services, but is here today testifying on behalf of the association for state and territorial health officials. and mr. terry, if you'd like to introduced the other panelists. >> i would be honored to introduce the chancellor of university of nebraska medical center in nebraska medicine. he is recent to nebraska, but certainly making a huge impact, especially with the biomedical containment center where they have hosted three ebola patients and they are setting the standards for how to treat the ebola patients and setting the standards for the employees that come in contact and work with those. unmc is a great facility. they are very forward thinking.

there are probably ranked very high in a lot of areas of care, but it's probably the research that is making them known internationally so i'm proud to introduce dr. jeffrey gold. >> thank you. when doing so has the practice of taking testimony under oath. do any of you have objections of taking testimony under oath? the chair that advised you that you're entitled to be advised by counsel. all the panelists have said no. in that case, please rise and raise your right hand. do you swear the testimony you're about to give is the truth, the whole truth and nothing but the truth? all have answered affirmatively. you are under oath.

we're going to ask you each to give a five-minute summary of your written statement. we'll begin with mr. isaacs. >> thank you, chairman and teemed members of the council and guests of the committee and are letting me testify. it's a privilege to be before you in regards to the ebola outbreak in west africa. since ebola entered in march through its explosion on to the international spotlight in july and even now when it appears the disease has crested in liberia, but i want to stress today that we have discovered that there are many important questions we simply do not know the answer to and need to know the answer to them. i want to run through them quickly. i will say that going last means you have to reshuffle everything you're going to say because it's all been said before. but i think that a good question to know the answer to is how are the doctors become infected. some of those doctors have been our staff, some of those doctors

have been our co-workers that were treated at nebraska. and even recently the gentleman in new york, they were all wearing level four gear. how did they get infected? can the virus live in other mammals besides primates, bats, rodents and humans? i have worked and lived in africa for about 25 years and i have eaten my share of bush meat. it's something like a groundhog. and so what does it mean, where does the virus live? the point is that can it jump into the animal population here, we need to know that. as with other viruss, is it possible that ebola can be asymptomatic? we know for a fact of three situations where blood were drawn on patients who were nonsymptomatic and all three tested positive one of the problems that exists today in liberia where