impact of the president's immigration proposal. the iranianst on nuclear program negotiations, which have a deadline this monday. as always, we will take your calls and you can join the conversation on facebook and twitter. "washington journal," live at 7:00 a.m. eastern. -- an update on ebola. he recently spoke at the national press club about u.s. response efforts. this is one hour. >> good afternoon. i and an adjunct professor at the george

washington university school of media and public affairs. former international bureau chief for the associated press and the 107th president of the national press club. the national press club is the world's leading professional organization for journalists committed to our profession's future through our programming with events such as this while fostering a free press worldwide. for more information about the national press club, please go to our website at press.org. on behalf of your members worldwide, i would like to welcome our speaker and those of you attending today's event. our head table includes guests of our speaker as well as working journalists who are club members. and so if you hear applause in our audience, i note that members of the general public are attending, so it's not necessarily evidence of a lack of journalistic objectivity. i would also like to welcome our c-span and public radio audiences. you the follow the action on twitter using the #npclunch. after our guest's speech

concludes, we'll have a question and answer period. i'll ask as many questions as time permits. now it's time to introduce our head table guests. i would like each of you to stand briefly as i call your name. and then i will begin by saying, from your right, adam spencer, washington, d.c. corespondent for news beat social and new national press club member. jared rizi, white house corespondent for serius xm satellite radio. marilyn thompson, washington bureau chief for thompson rotors. paul shingman, national reporter third generation member of the national press club. virgil dickson, reporter for modern health care and another new member of the national press club. david evans, executive

director of the national science teacher's association. jerry, washington bureau chief of buffalo news, chair of the speaker's committee and former national press club president. skipping over our speaker for a moment, doris, president of editorial associates and the national press club member who arranged today's luncheon. thank you, doris. diena, editor of health and medicine, scientific american. todd gillban, washington bureau chief for the washington morning news. carolyn block. vince. combat news chief for air force. [applause] dr. anthony fauci is an authority on ebola. the health crisis that has devastated parts of west africa,

sickened or killed many health workers and called into question america's preparation for an epidemic. dr. fauci is director of infectious diseases part of the national institutes of health where he has spent his career. he became a public figure for his role in understanding hiv and aids and for his involvement in developmenting an hiv vaccine. he received a presidential medal of freedom for his work on hiv. of late, development fauci has been swamped with requests from the medical community, media, legislatures and the public for his guidance regarding the ebola outbreak. typically he does not sugar coat his assessment. last week he said, quote, the war against ebola is far from over, unquote and cautioned that outbreaks can come in waves, recedeing and then resurging. the virus continues to make

headlines, such as nurses strike to demand better training and safer clothing for dealing with ebola patients. congress is considering a multi-billion dollar boost for ebola prevention and treatment. scientists and governments debate the development and testing of vaccines. infected health care workers in africa are being flown to the u.s. for treatment. public disputes about mandatory isolation rules. we've asked dr. fauci to address these and other issues of the ebola outbreak. ladies and gentlemen, please join me in a warm, national press club welcome, for dr. anthony fauci, director of the national institute of allergy and infectious diseases. [ applause ] >> thank you very much, myron. it's a great pleasure to be with you here this afternoon to discuss this extraordinarily

important global health topic that has captured the imagination, fear, concern and mobilization of people throughout the world. i want to spend our time -- and i'll be relatively brief because i know one of the best things about all of this is giving you the opportunity to ask me questions -- so i want to break up my remarks into four major areas. first of all, some background on ebola. i know you've heard a lot about it. i want to point out features. the status of the current outbreak in west africa, ebola in the united states and finally what we're doing in the form of countermeasures for the development of therapeutics and potentially and hopefully a vaccine. so let's start off first with some background on ebola. as some of you may know, ebola was first isolated and recognized in 1976 in the former

zaire, current democratic republic of the congo. very soon there after, within days from sudan, since 1976 there have been 24 outbreaks not including the current outbreak. these have been of varying sizes with the totality of the outbreaks put together about 2,400 people, which means that the current outbreak in west africa is more than all of the other 24 outbreaks combined. and we can talk about why that's the case. these outbreaks have been anywhere from two people to several hundred people all of whom have been contained and eliminated and suppressed by public health measures of identification, isolation and contact tracing. i'll get back to that in a moment and why the situation now in west africa is very different from those previous outbreaks.

so, what is ebola? ebola is a virus member of the a family called filo viruss. f-i-l-o. if you look at it in a micro scope, it's an ugly looking virus. they have these filaments that look rather intimidating from someone who has looked in the microscopes for viruses over so many years. it's one of the ugliest ones that i've ever seen. the transmission cycle, we know what happens from human to human, but there are still some unanswered questions. it exists in fruit bats and certainly infects non-human primates. it kills off these non-human primates intermittently. it jumps species as some, if not most of emerging microbes do. it's fundamentally an animal virus. it's not fundamentally a human virus that stays in the human

population. it bleeps up in these outbreaks that i told you 24 of them and we're in the middle of a massive one right now. and the way it gets there is really not clear. eating animals, touching them, slaughtering them, preparing them for food. but once it gets into a human, it's transmitted only by direct contact with the bodily fluids of an individual that is sick. we'll get back to this. this is all the concern, the argument, the debate about who can and cannot transmit ebola and why health care workers are the people who are at the absolute most risk as are people in a family who take care of an individual as are people who handled bodies because the actual burial ceremonies when people touch bodies are one of the most important ways it's transmitted.

so, we want to keep in mind unlike influenza, which is transmitted across parts of rooms by airosol, that you can't even see, ebola is transmitted by direct contact. when you say bodily fluids, it's diarrhea, vomit, blood when people cough up, that's what we talk about when we say bodily fluids. its incubation period is anywhere from 2 to 21 days. the mean is right around 8 to 10 days. and by incubation period means that if i get infected now by working with a person, somewhere between 2 and 21 days i'm going to get sick, very likely around 8 to 10 days. once i get sick, i start to feel flu-like symptoms. at that point, it is unlikely that i'm infected. 90-plus percent of the times you

get a feever, then you start vomiting, coughing, bleeding, diarrhea and it's that that causes the trance misability. that's the background of ebola. it's a very serious disease. the mortality depending on the strain, there are five separate strains. the one we're dealing with now is ebola zaire. there are other names to them, sudan, et cetera, et cetera, not important for the purposes of our discussion. if you get infected with one and you recover the fact is that you are protected against that strain forever. so let's focus in on the outbreak in west africa. it started likely from contact with an infected animal. if you do molecular tracing, the first case was probably in a child in guinea in late december of 2013. we started to notice it as an

outbreak in march of 2014. now, the thing about this that makes it different and why we had the explosion of cases -- i wrote a paper a few months ago in the -- actually last month in the "new england journal of medicine" and the title of the paper was "ebola in 2014, a perfect storm" and a good example of the discrepancy and the disparity of health care capability in these countries. you wouldn't get an outbreak in a country if you could do good contract tracing, if you could isolate people. what happened is somehow this child infected people in a cluster of countries that was very different from the far out geographically isolated areas of the previous 24 epidemics where you can actually isolate very easily. if you look at a map of west

africa, guinea wraps itself around liberia and sierra leone. the tribal relationships are very close, so people go across the borders. the borders are very easy to go across because people work in one country and live in another. also, it got into the big cities. and when that happens, you have a problem. so we had an explosion. they were about 14,000 cases, 5,700 deaths. that's probably an underestimate. when we were talking about the changing demography of it the number of cases are going down in liberia, but they may actually flair up in the outskirts because monrovia is where most of the cases were. as that's happening, the cases are going up in sierra leone. so when you look at the epidemic as a whole, one can say, without a doubt, the cases particularly

in monrovia are going down. likely because of the effort that has been put into that. however, i have said and was quoted by myron is the fact is that it is not over and we should be very careful to think that we are going in the direction of it being over. there's still a long way to go. so, that's where we are at that. something that comes up in questions, is this virus changing. all viruss that are a virus tend to mutate. most mutations have no functional relevance. it doesn't change anything about the virus. potentially, however, there are rare mutations that do change the function, namly, make it a little bit more virulent, or little bit less. however, in the history of viology, it's unprecedented that a virus will mutate so much to change the way it's transmitted.

is it possible? yes. is it likely? extremely unlikely. yet you probably read in the papers about the concern that it's going to change into a respiratory virus, spread over and destroy the world. now, as a scientist and as a physician, i cannot say that's impossible, but i can say it's very, very unlikely that that would happen. it may change a bit, but unlikely to change so much. now, when you talk about how it's transmitted and the proof of transmisability, when you look at the history, we don't want to say we know everything about the virus, but when you look at household contacts of people during outbreaks, for example, a famous one in 1995, in the households of people who were infected, the only people

who got secondarily infected were people who actually touched the person who was very sick. everybody else in the household, they didn't get infected. now, that is strong evidence that you don't get it by casual contact in the sense of being in the same room with someone without necessarily touching them and coming into contact. now, is that 100%? nothing is 100% in biology, but the evidence is pretty strong. okay. so now let's talk about ebola in the united states. when you think about ebola in the united states, you should think about it in five separate issues because it gets very confused and i believe strongly that's the reason for the concern and what i have called the epidemic of fear in the united states. the first situation where you

can have ebola in the united states is when you deliberately air evacuate someone to take care of them in the united states. and we've done that with dr. brantly, with salia and an unidentified person. we put them on a plane and brought them to a hospital here. it was either at emory or it was at nebraska or other places. the second is the inadvertent importation of someone who gets sick some place else, doesn't know they're sick, and comes here and the illness is manifested here. we have two examples of that. thomas duncan who went to dallas and craig spencer, the new york physician from columbia who got sick over there, came back here and when he realized he was sick, he got admitted to bell vue.

the third is secondary spread from an inadvertent case. there isn't any. so craig spencer didn't spread it to any, so there's no cases. the other, health care workers in the united states who have taken care of patients. and we have two of those. nancy pham who i had the privilege of taking care of myself at the nih and amber vinson who was also infected and taken care of first at dallas and then at emory. and then lastly is the secondary spread from those health care workers. and there's been none. nina pham did not spread it to anybody nor did amber vinson. you have to be careful when you talk about ebola in the united states. you have to be talking about do you bring it in or is it spreading insidiously, and it's not. i would be happy to discus that

in the questions that we have. so, what about the issues of how do you protect america? do you ban travel? do you do airport screening? do you quarantine people who are over there? or do you quarantine all health workers who have come into contact? that's a debate that's going on. as we've said and i've said publicly decisions are made based on scientific evidence and experience. let me tell you what's going on. there's both exit screening from west africa. someone comes up to get on a plane in liberia, sierra leone or guinea, they are questioned as to whether or not they feel sick, their temperature is taken and then they are asked if they've come into contact with anyone who has had ebola. when they get on the plane and they get off the plane at one of the five airports which are the only airports that people from that part of the country can

come to, they have what's called entry screening, same thing. temperature taken, questioned if they have any symptoms. if there's any question, they get put in a separate facility. watched. let me give you an idea of some of the numbers. is there a large influx of ebola people infected with ebola who are trying to get in the united states? the answer is no. if you look at august and september of 2014, 36,000 people went to the airport in one of those three countries to get out. of those, 77 were denied because of a health reason. of those 77, none had ebola. most had malaria. so, yes, duncan got into the country, but that was a very rare event because of what we know now when we do screening.

so the question is, how do you balance the issue of keeping america safe at the same time as you don't do something that might be so draconian, for example, as to cut off a nation from help, namely isolate them which we know from talking to the leaders in those countries, that to them would be devastating to do that. what do you do about the many, many health care workers that we need to volunteer to go over there to help? what do you do when they want to come back? do you quarantine them or do you institute a system where, as we've discussed it publicly many times, where you stratsfy the risk of that person having gotten infected with the way you monitor and/or restrict their free movement? so let me explain what we've done. we being the government in the sense of the cdc, nih, fda, the department of homeland security,

et cetera, are all working together. you divide it into four levels of risk -- high risk, some risk, low but not zero risk, or no risk. an example of a high risk, health care worker is one who accidentally sticks themselves with a needle that was contaminated. that's a high risk. or someone who was working with an ebola patient, didn't have the right equipment. that's a high risk. if you're a high risk, you are directly monitored. someone will take your temperature every day for 21 days. someone will question you how you feel and your activity is restricted. you can't get on a plane. you can't get on a subway. so we're already implementing some form of quarantine on certain people who are high risk. i don't think many people appreciate that. what happens if you have some risk?

namely you took care of a person, you had the proper equipment, but you still can make some mistakes. the same thing, direct, active monitoring. someone takes your temperature, records it, questions you and your restriction will be made on a case by case basis. not everybody gets restricted. the next one is a low but not zero risk. i used to be now but i'm past 21 days, i took care of nina pham. what did i do for 21 days? i took my temperature in front of someone. i showed them the thermometer. they recorded it. if i felt well, then i could go out into society, which i did. low risk, there's obviously nothing there to do. so, let me now just move to the last part and we'll open it up for questions because i want to stay on time.

what are we going about it? there are no therapies that have been approved and there are no vaccines for ebola. the reasons for that are complicated. we haven't had good industrial partners who would be willing to invest in developing a vaccine or a drug that barely exists. remember, from 1976 until this epidemic, there were less than 2,500 cases in the entire history. so there's not a lot of companies that want to invest hundreds of millions of dollars to develop a vaccine or a drug. but we do have some important advances. what's happened is that we started a phase one trial with a vaccine at the nih up in bethesda on september 2nd. we enrolled the full component of people. it looks good. there aren't any adverse events. we've shown the immune response looks good. we're now planning that some

time at the end of december the beginning of january we will expand that into what's called an ethicacy trial in west africa, in other words, to determine if it works. and that's in the process. i can't guarantee you it will work because you never can guarantee that a vaccine will work. but at least we have one that's ready to go into advanced trial. in addition, finally, we have drugs that are still experimental. you read about all these people that had these experimental drug. there isn't a single drug that's been proven to be effective. i hope that one or more of them will turn out the be effective, but we don't know that yet unless you do the clinical trials. that's, in fact what we're doing. so let me just close by saying looking ahead, what do we need to do?

what we need to do is first, make sure we keep our eye on the problem. and the problem is west africa. they are the ones that are suffering. they are the ones that have the disease. the best way to protect americans is to completely suppress the epidemic in west africa so there isn't any risk of it going anywhere else. prepare for future outbreaks. we're trying to build up the infrastructure in other countries so that they can identify these outbreaks much earlier before they wind up getting out of control. then again the last is what i said i wrote about in the "new england journal of medicine ""where we spoke about the disparity of the health care systems in developing nations. as a rich country, as one of many rich countries, i feel we have the responsibility as a

global community to help those countries build sustainable infrastructures that not only are beneficial to their own health but actually have an indirect benefit for the rest of the world to frechbt outbreaks that then wind up having a dispersion throughout the world leading to the kinds of fear and kinds of situations that ebola has brought to the united states here. i'll close with that and be happy to answer any questions. thank you. >> thank you, dr. fauci. if containment of any communicable disease is isolation with the use of stringent medical treatment and protocols, why is ebola not contained and treated in the african locals? >> when you say not contained and treated, you mean it is? >> the question is why is a

highly communicable disease not contained and treated in african locals. >> i'm not sure what they were -- what point they were trying to make. i'll give you a couple of versions of that. i think they were trying to say if you want to live in africa, why would you want to bring someone over here? is that what they're saying. >> i think so. >> the people we brought over, if you're an american citizen and you get sick, you have the right as an american citizen to return to your country of origin and that's what we've done with those individuals. >> nigeria in particular was quickly able to put a halt to the spread of ebola. why was nigeria so successful in its containment efforts when neighboring countryies were not? >> very good question. that relates exactly what i told to you about the infrastructure to be able to handle an epidemic. and nigeria, as a country, as a relatively good infrastructure to deal do that.

much better than guinea, sierra leone and liberia. what happened in nigeria when a case accidentally, eric sawer, mr. sawyer went from liberia to nigeria and inadvertently, unfortunately infected a number of health care workers, several of whom died. what they did in nigeria was very effective contact tracing and isolation when someone is shown to have ebola. so the halmark of containment is identify, isolate, and contact trace. and when you do that, you can suppress an outbreak. nigeria did it very well. the other countries were unable because of their resources to do that. >> what is your assessment of the weakest points in the u.s. health care infrastructure to deal with ebola and to deal with other future outbreaks or buy biological weapons?

>> well, what we have learned, first of all, is you need awareness. remember, when duncan first came, he was not recognized as a person with ebola even though he was from liberia and it was sick . that should not have happened we have to have the capability of education, equipment, and the health care system which is actually pretty good, to be able to handle outbreaks. and that is the reason why when we started this officially and in earnest, it was after the 9/11 attacks followed by the anthrax attacks. we developed a system of trying to be able to have better surveillance and the better capability to respond to emerging microbes. that was to a deliberate attack . but we expended that to say that nature itself is probably the

worst bio-terrorist when you think about it because of things like the emergence of influenza. so we expanded our capability to be able to respond in the united states to outbreaks of emerging infections. but since we live in a global community, the weakest link globally is the weakest link that might be someplace else and that's the reason why we need to build a global health security agenda so that almost -- or hopefully all the other countries that have the capability of doing that. >> you said that the president's ebola response coordinator is an excellent manager and supported the white house. what significant way has he changed all of the government response fighting ebola in the united states and in west africa? >> ronklain is the official ebola response coordinator. he is terrific. i work with him daily. the reason it was important to have a coordinator is that there

are multiple agencies involved in the ebola response. there is hhs, there is the department of defense, there is homeland security, there is the state department with usaid among others. when you have multiple agencies involved, you need some sort of coordination at the white house level. doing that prior to the appointment of ron klain was lisa monaco and to some extent susan rice, both of whom have very, very important day just to do in addition to that. it was felt that you needed a person who is devoting their time to nothing else but coordinating the ebola response. and that is exactly what mr. klain is doing an excellent job at right now. >> the president is asking for $6.5 billion for the fight with ebola. what are the u.s. medical priorities? and what will the spending on

ebola do to those medical priorities? >> the president is asking for $6.18 billion, not $6.5 billion. let's not get carried away. i had the opportunity with my colleagues from other agencies to defend that budget before the full senate appropriations committee chaired by senator mikulski from maryland. and it is divided, again, into multiple agencies. so the nih, and i just mentioned our work with vaccines and therapeutics. our share of that was $238 million. the cdc which has a much broader role in surveillance and trying to get the hospitals up, they had a much larger -- the defense department was smaller, they moved money around. the department of homeland security had some and others had some. it was a combination of multiple agencies, each of which had a line item request.

>> now that the estimates for the potential number infected, loss of life, and financial burden have been revised downwards by the world bank, will the response effort from naiad decrease as well and is this a wise decision in trying to get the united states prepared for any type of a biological outbreak? >> this gets back to what i had said during my former presentation that just because numbers are going down in a particular country is no reason to think we have won this battle. so we have not, and nor has the cdc or any of the other agencies lessened our efforts to try to contain this. we are going full speed ahead with our vaccine work and their work to develop therapeutics. even as the numbers go down in liberia, remember they are going , up in sierra leone. and maybe we will see other waves.

so the down tick in numbers has not diminished our efforts. >> there is a sense of fear a few weeks ago bordering on panic about ebola among some americans. why do you think that was? and was the fear justified? >> i always respect fear and concern on the part of the american public. i mean, that is us, the american public, so you cannot disparage it and say it was crazy to be afraid but you can understand why. ebola is a very dramatic, cataclysmic disease as it occurs. when you look at what's happened in west africa and particularly not so much now -- because things have toned down a little bit over the last couple of weeks -- but remember, it was every single day that ebola was on the front page of the major newspapers throughout the country. and what the american public saw and what they saw on television was this terrible situation as it existed in west africa.

so when we had the first case here with duncan and then we had our two nurses getting infected, there was this understandable but not justified extrapolation of, this is what will happen in the united states exactly what happened in west africa. it's an understandable extrapolation but there is no evidence that that would or could happen for the simple reason -- i get back to something i said just a few minutes ago -- the reason you have an outbreak in the three countries were that they'd did not have the medical or health care infrastructure to be able to do the identification, isolation, and contact tracing. someone asked a question about nigeria. nigeria did. there was no outbreak in nigeria. so even though you can think this might happen and the united states, it is extremely unlikely

that you would have that outbreak. yet the american public understandably made that extrapolation and connection. now that we have a case in a hospital and two nurses got infected, we will be like west africa, and that is just not the case. >> you mentioned the media. this is a media related question. liberal groups like media matters have criticized what they say has been overblown television news coverage of ebola. but this week, this past tuesday, president obama noted that the news coverage has subsided even though the epidemic rages on in parts of africa. he thinks it is still an important story. what is your assessment of the media coverage? >> in general, i think the media coverage has been commensurate with the interest in the american people in this. and people get very interested in this and they hear it.

so the media covers it. i think the media coverage was actually quite good. there are sometimes for you have the problem is, and we all know, and people interested with media know it more than i do, when you have 24 hour news coverage come you can make something that looked -- that looks much bigger than it is and i think that's what happened. i would not say that is bad media coverage for it is just an effect of the 24-hour media coverage. >> thank you. what are your suggestions for education and training, best practices for the u.s. health-care system as a result of the ebola outbreak? many health-care workers are required to take a basictpe and -- basic tpe and blood one rne pathogen training as part of their employment. beyond that, what do you suggest? >> that's a very good question.

one of the positive things that will come about from all the attention been paid to ebola in the united states is that we really need to have regional capability of being able to handle outbreaks that require special kinds of medical attention like ppe's. stands for personal protective equipment. you don't just put on ppe. you have to learn how to do it and more importantly, you have to learn how to take it off. if you look at people getting infected, it is more likely that when people take off ppe's that if you get something on you with ebola, that's how you do it. you inadvertently -- you are careful when you put it on your -- on and you are taking care of patient and taking care of them for an hour or so when you're tired when you walk out of the room and you say a have to get the stuff off. you take it off and you may not take it off properly. in fact, there is a terminology

called a wat san named after water sanitation, a historical issue. when i took off my material, i had a trained person watching me to make sure i did it correctly. they have the authority to stop you when you do it and sayoops, you're making a mistake. it's not just going ahead and taking care of a patient. you have to be trained. bottom line answer, you have to train people. >> what can local laboratories , i.e. clinics, hospital labs, physician office labs, due to prepare for processing any samples from suspected ebola patients? the cdc revised guidelines to to send all suspected samples to cdc. even in preparing samples for a transfer to cdc, are there any suggestions from niaid for the pre-analytic and post-analytic phases for the lab? >> that's a good question.

and they are not suggestions that i have. there are clear protocols about how to do that. the cdc spells out very clearly how you have to handle specimens that you are suspected are infected and how you would handle that in the testing. there are preliminary tests that do not need necessarily have to go to cdc. the second level when you want to confirm it have to go to the cdc. >> there has been a good deal of public concern regarding risks associated with ebola-related waste including medical waste as well as the belongings of the individuals afflicted. with high-ranking officials across the country stumping politically against this transport and taking legal action to stop it. is there any merit in fearing infection from the treated medical waste and how do we alleviate mass public concerns if not? >> so i have to be careful on

this answer. the reason is i'm not making policy. i can just tell you from a scientific standpoint that when you do the kinds of contaminations that we do with waste, it kills the ebola. if you do decontamination and incinerate, it kills ebola. what you do with waste after that is obviously a matter of contention. but from a scientific standpoint, the kinds of decontaminations that are done in hospitals like my own in the kinds of things you do when you autoclave decontaminate or incinerate are enough to kill all the ebola. >> you have had extensive experience in the research of aids. has that experience been applicable to your work with the recent ebola crisis? >> scientifically, not. because they are different diseases. i mean, you learn about virology

and things, so there is some experience there. but i think the thing that is the real lesson is how to make sure that you make policy and you make recommendations based on the science. and to get the american public to understand the relationship and difference between probability and risk. the american public understandably -- this is not a criticism -- really wants to live in a completely risk-free life. yet every day, we live a life that is full of risks. the issue is, the risks have been with us for so long that we don't pay attention to it very much. when a new risk comes in, no matter how small the risk is, it captures the attention of the public and they worry more about

a risk that is very, very low than they do about a risk they have been living with forever that is much higher. i give you an example that's out of the situation of ebola. and i think you can understand it. so years and years ago, in the 1980's, i think it was on ted koppel's "nightline" show. when he was on. and i was asked by someone who said -- we should ban gay waiters from waiting in greenwich village because the infection rate is so high there. and what if a waiter has a cut on their finger and brings to your table, your dish of calamari and you happen to have a cut on your finger and pick up the plate that he puts in front of you? is it possible you could get hiv?

and the answer is biologically , yeah, it's possible, but what is the likelihood of it happening? well, i can say with confidence that the likelihood of it happening in that greenwich village restaurant is less than the likelihood of you walking out of the restaurant and getting hit by a bus. so it depends on probability and risk and that is the thing we need to keep educating people on. you cannot be 100% risk-free. >> do you worry that the growing human population combined with climate change will create an environment where outbreaks of ebola or other deadly pathogens will be more common in the future? >> theoretically yes, probably the only thing that significant climate change might impact is the range of certain mosquitoes

for example. there may be malaria. for example, if you take kenya as a nation, there are parts of kenya that have high elevations. and when you get above a certain elevation because of the temperature, you don't have mosquitoes so you don't have malaria there. you can imagine that if you get a one degree increase, the malaria range would increase so much. but i don't think that is that important because if you really have so much of a climate change that would have mosquitoes be all over the place through every season, there would be enough melting of the ice cap that you would not have any coastal cities anymore. so that is what you should really worry about. >> beyond the ebola epidemic, there is growing concern among many scientists that the overuse of antibiotics in farm animals

could lead to infections that are antibiotic resistant and therefore dangerous to humans. how do you feel about this issue and what should the federal government do about it? i realize you are not the policymaker. >> i have no problem addressing that. antibiotic resistance is a real and present danger as it gets worse and worse in the situation of having microbes that could be resistant to all antibiotics. we have reasonably good examples of that now. one of the things, there are about four or five major factors that are involved in the evolution of antibiotic resistance. one is our own inappropriate use of antibiotics among humans and -- when people take antibiotics when they don't need them they take antibiotics without the full course, giving the opportunity for emergence of resistance. another is the inappropriate use of antibiotics in animals for the purpose of growth as opposed to the purpose of treating a sick animal. if you just empirically give it for growth, you absolutely have

a danger -- i don't know exactly how that gets transmitted to the reality -- but there is the danger there of propagating resistance when you do that. and the fda has already taken steps to try to diminish that. they did that last year, actually. >> is the use of public health monitoring proving to be an effective way to track specific drug-resistant medical situations? >> well, certainly, hospitals now have much more sophisticated tracking system for resistance and sampling people who come in, particularly hospitals that have problems with things like mersa and others. for example, i know in my hospital, we do tracking and isolation as we have a patient that has a resistant microbe. we isolate them and have strict protocols about washing hands and putting on gowns and putting on gloves. i do it all the time i make -- time when i make rounds on

patients. >> move away from ebola for a second and i have more questions to come back to it. but peanut allergy, nobody had it when we were kids. now it is very prevalent. do you foresee a cure any time or even a turnaround in the spread of this allergy? >> we are working on this very intensively. my institute is the national institute of allergy and infectious diseases. infectious diseases are much more dramatic and cataclysmic so you generally identify me with infectious diseases but we do allergy as well. and peanut allergy is an important situation. that we have now. and you are right, it is growing in numbers. we are doing a considerable amount of research and one of es is to try to essentially desensitize children before they develop the full allergy. there is a big study going on now to see if you can actually

prevent the emergence of peanut allergy in children. it is a relatively high percentage. >> as i mentioned, we could go on for a couple of hours but i succinsix and three -- ctly get the best questions and more keep coming in. the ebola outbreak has highlighted the danger of all sorts of infectious diseases. that being the case, what do you recommend as a regimen for every american to avoid common and dangerous infections? >> wash your hands. [laughter] [applause] >> you touched on this in one of the questions. i just want clarification. coughs orbe spread by sneezes both of which contain small particles? >> that's a good question and a source of confusion. so ebola is spread in bodily fluids when the level of viruses -- virus is very high. in order for the virus to get into a cough, it has to replicate in the lungs.

by the time ebola replicates in the lung, a person is so sick, and we know that, and that's the reason why you have someone who is very sick with ebola and they are in extremis and you want to intubate them the way you do when someone cannot breathe on their own, when you intubate someone, i hate to say this after lunch, you intubate someone and you stick a breathing tube in, a whole bunch of sputum comes out on you and that's a dangerous time if you don't have the personal protective equipment. but that happens when someone has very advanced disease. someone who might be infected with ebola that feels well enough to walk around and costs, -- walk around town and does, that,hat, -- goes, like that is not ebola in the sputum. ebola gets in the sputum when you have it in the lungs and when you have it their commute advanced disease.

is there the possibility that a one in a million situation will occur, of course, but from our extensive experience, with ebola, it is not spread unless someone gets into direct contact with those bodily fluids. >> how did the initial treatment of eric duncan go so wrong? was it just lack of preparation and staff training at the hospital or was he to advance to be treated? -- too advanced to be treated? and what was learned about treating ebola in the united states from that case? >> the situation with mr. duncan was very unfortunate. because as we all know, since it was blasted over the media and it was true -- he came to the emergency room on a certain day saying that he felt sick. and mentioned he had come from liberia. mistakes happen. that was a tragic mistake.

that it was not -- the dots were not connected. sick african man just got back from liberia where there is a major ebola epidemic -- you would think you would want to put the person in the hospital or at least isolate them. he went home for two days and then came back to the hospital in an ambulance very sick. could that have impacted his ultimate course? of course it could. we know the sooner you treat someone and the sooner you get them under care the better. those things happen and it's unfortunate. perhaps, hopefully, that will be a lesson learned. right now, we learned that in medical school as part of the physical diagnosis. one of the important things you ask somebody is a travel history. have you traveled out of the country lately or where have you been lately? it's just a natural part of asking them if they smoke or if they are on any medications. travel history is a very important part of the physical diagnosis.

>> japan has received inquiries about the influenza drug known under the brand name of asavignon and some sciences think this could be helpful against ebola. do you think it would be helpful against ebola and if so, are there plans to move forward with testing? >> i have no idea whether it's going to be effective. it is put up as a potential ebola drug. and as i mentioned during my formal remarks, there are at least five and maybe more therapies that have been tested empirically and under compassionate use by the fda. we do not know if a, any of them are affected or b, if any of them are quite toxic. so i cannot tell you right now until we put it into clinical trial and ask the question in an appropriate way. >> has the presence of u.s. military troops changed the atmosphere on the ground in west

africa? >> certainly, the department of defense has been extraordinarily helpful. they have sent over teams of engineers, logistics, command and control, engineering. and they have set up their -- the plans of 17 100 bed hospitals and have already put several of these up and that has been helpful in making available the capability of taking care of patients in what is called ebola treatment units or etu's. the military has been extremely helpful. >> we will switch to the lariam for one question. there are reports that genetic data can be obtained from barcodes. can the data obtained be used to locate the geographical origins for malaria if a malaria is active in a number of countries and regions of the world? >> a barcode for malaria? i'm sorry. [laughter] .> it says

>> ok, all right. to locate the geographic origins of malaria -- i don't know if it's a barcode. i will have to change the question. i have never done barcode with malaria. can you track malaria's location by genetic analysis of it if you want to make the metaphorical barcode be a genetic analysis? the answer is yes. we have capabilities right now that have been developed over the last several years of extraordinary ability to sequence microbes, even big parasites like malaria. malaria is pretty big compared to a bacteria or a virus. and you can actually track the evolution and location of where tracking they genetic evolution of the micro. microbe. if that's what the questioner was asking about, that's what you can do. >> a quick penultimate question .

your interest in science? is it a chemistry gift early in use or was it experience? i teach my students to try to find the spark that led to a person's profession. what was that spark for you? >> i am not sure i can pinpoint the actual spark that i can tell -- spark thought i can tell you how i got interested in medicine and science. i was as interested as dealing with people as i was in science as an abstract discipline. probably my first year in high school, i realized that i liked science and i was good at it but i did not want to divorce myself from a profession on a daily basis interacting with people. so to me the most natural thing was science in the form of people is medicine. so i went into medicine. >> if you could just wait here for a moment, dr.. -- doctor.

we're almost out of time but before asking the last question, we have a couple of housekeeping matters to take care of. first of all, i want to remind you about two upcoming lunches. monday, december 1, teresa sullivan, president of the university of virginia will discuss trends in higher education. on friday, december 5, gary betman will discuss the growth of the nhl and that 2015 winter classic. and i believe, jerry, they might even bring the stanley cup? that's the plan. next, i would like to present our guest with the traditional national press club mug. dr. fauci, you might have some other ones so add this to the collection with their deep appreciation. >> thank you. >> for the last question, as you have dealt with so many crises over your outstanding professional life -- i know in october, you must have gone

weeks with minimal sleep -- how do you remain so calm? [laughter] >> the alternative does not work. well, i learned a long time ago that when you are dealing with a crises, that if you be consistent in making your policies and statements and how you deal with situations based on facts. be consistent. don't be afraid of saying that you don't know something when you don't know something. because otherwise you get yourself into trouble. and all of that leads to, i think, a common approach toward -- a calm approach toward crisis situations. >> thank you so much. [applause] thank you all for coming today. i would also like to thank the national press club staff including the journalism institute and broadcast center

for organizing today's event. finally, a final thank you. we are adjourned. [captioning performed by national captioning institute] which is responsible for its -- [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. >> next republican governors discuss a range of issues, including immigration, partisanship, and the congressional race. then the state of race in america. after that chuck grassley marks the upcoming retirement of tom harkin. on wednesday, governor rick perry said texas might sue president obama over his plan to take executive action on immigration. perry spoke during a panel at the republican governors association annual meeting in boca ron