passports, birth certificates, government ids military discharge papers, a lot of different ids. thinks it wouldn't think about. medicare cards have a gender marker on them. host: what protection specifically applies to the transgender person? guest: more and more, we are getting -- we are hearing courts interpret sex discrimination laws to say that if you discriminate against a transgender person, it is because of their sex. you don't think they are the right kind of man or right can of woman. so we believe it is legal to discriminate against trans people. i think we have a little more work legislatively and administratively to do and litigation wise to do before that is actually cemented in your -- in. host: what is happening on the state and local levels tackle -- levels? guest: when we started, about 4%

of the country's population lived in jurisdiction that had state or local protection. we have almost 20 states that have stayed exquisite loss that protect gender identity -- have stayed explicit -- state explicit laws that protect gender identity. host: if you want to ask our guest questions, the four mines are available. transgender viewers can call and get the experiences. we divide the lines partisan, but is this a partisan issue? are the people on both sides of the aisle working for this tackle -- this? guest: absolutely. one party has been more favorable towards us than the other, but that is becoming increasingly less true as more and more families have transgender kids or even gay or bisexual kids.

that is how families are really learning about this. and that is how we are teaching people who go to school with us, who go to the school -- church or the mosque with us. host: when it comes to the rights issue, one of the things i read over and over was the issue of -- what is going on? guest: it is kind of puzzling. i think people kind of think we are -- forget we are human. we had to use public restrooms. it is just that simple. and the easiest way to do that -- and the right way to do that -- is for me, for instance, to use the women's room. and for a transgender man someone born female and becomes a man or becomes identifying as a man and may have a beard, we want him in the men's room. we, as a society, want him in the mentor. i don't mean me personally.

it is something that i think people aren't yet familiar with, but it has been going on for decades. we have had city and local laws that protect trans people's writes. host: but there are lawsuits considering -- concerning this. guest: sure. but we are waiting all of those. you know, nothing in any of these laws would allow anybody to do anything in the bathrooms. anybody who does anything illegal in the bathrooms, they have done something illegal. if they haven't done anything illegal, i think everybody should just leave everybody alone in the bathrooms. host: and talk about the work about the agency that deals with work. guest: the eoc has been a really important part of the trends toward clarifying sex discrimination laws to protect transgender people. the logic is pretty simple.

you wouldn't expect the judge to say, you were fired for converting from catholicism to judaism, so that is not religious discrimination. but judges used to say that. they would say, you are fired from converting from a man to a woman. and judges and now the eeoc and the u.s. department of justice and other agencies have said yes, that doesn't make any sense. if somebody fires you or discriminates against you because of your sex, it is sex discrimination. and they have come up very clearly on that. host: (202) 748-8001 for republicans. (202) 748-8000 for democrats. (202) 745-8002 for independents. (202) 748-0003 for for transgender people. on our republican line, you are on with our guest. caller: your guest mentioned in the open that there was no apparent reason for gender to be

on a license. that is, like, ridiculous. it is for cops to identify physically the person that they are looking at. it is just amazing to me that because you decide you are not the gender got made you born with -- god made you born with, nobody is gender. guest: well, thanks, tony. i think you miss her me. i said there is no reason for gender to be on the medicare card. in another few years, i will have a medicare card and it will have an f on it. there is no reason why a doctor's office needs to see that. it doesn't help anything on the card. it has always been there because they were never pictures before. that is why there is a gender marker on drivers licenses. when i got my first license there was no drivers license. so a person -- police officer

would need race, age, height and sex on the license. that is not true anymore. the real id that was passed a little more than 10 years ago require states to keep the gender marker on the drivers license. it doesn't really do any good at eventually that will come off. host: let's hear from wayne next. wayne is in nebraska. go ahead. caller: i am wondering who made the law that taxpayers have to pay for sex changes were people in prison? guest: well, i believe it was, step percent. let me clarify what i mean by that. the eighth amendment to the constitution, which probably jefferson didn't write, it disallows cruel and unusual punishment. over the history of our country we have always always been committed as a country to the notion that denying health care to prisoners was, in fact, cruel

and unusual punishment. so if somebody breaks the lake while they are in prison, we set a leg. and more and more, it is unanimous in the medical community that transition related care, including transition related surgeries is, in fact, good, smart, necessary health care. and as such, our constitution says it is cruel and unusual punishment to deny that to prisoners. that's our constitution. i am a big believer in our constitution. host: are there federal programs that cover transitional surgeries? guest: so, the main federally controlled health care of medicare -- controlled medicare no longer has a national coverage determination that disallows coverage, but in fact, people are not getting medicare currently to pay for surgeries.

the same in the veterans administration, there is a regulation that this allows them from conducting or paying for transition related surgeries. and the federal employee health benefits program the office of personnel management is done that telling insurance companies that they must cover this. so there is not a lot of federal money in use for this at all. if at all. host: employers health insurance, does it covered? guest: 10 years ago, no health plans did. now, more and more are. they know that in order to keep good people, they have to have good health care plans. so, people who do not rely on government funded health care are now more and more a lot better off than people who rely on government. host: what is the cost of transition surgeries? guest: well, it varies a lot. i think a lot of americans think

there is something called sex reassignment surgery, when in fact there is a whole array of surgeries. it is different for everybody. there are what we call top surgeries that happen from the top up. there are bottom surgeries which you can figure that out. and then there are a range of them. but we are in a situation now where we still have, for instance, a transgender man who may need a hysterectomy for not transgender related reasons. a doctor may say, you need a hysterectomy. if the doctor says, the transgender man needs a hysterectomy and his non- transgender female coworker needs a hysterectomy, she may get hers pay for and he may not just because of transgender. and that is discrimination. host: our next call, john. john is from florida. caller: good morning. first question is -- how many

transgender citizens are there any united dates -- united states? and if caitlin jenner does not proceed completely with the transgender process, don't you think this is going to be a huge setback? guest: so, we think there is about one third of a percent of the u.s. population is transgender identified. probably somewhere around 800,000 to one million people. as for caitlin jenner, i don't know what her plans are. i don't think -- well -- i mean i know there is nothing called completing one's transition. it is different for everybody. some people elect to transition socially. jenner has clearly transitioned socially and let everybody know she is a woman, she has a new name, etc.. some people transition legally.

some people change medically. but that is also not a clear line all the time. i do not know what medical treatments caitlin jenner has had or does half, and it doesn't matter to me. i think most of america will make their assumptions about what medical treatment she has accessed. and that is between america and caitlin jenner. host: what has caitlin jenner done for the issue though? guest: oh, what she has done has really been amazing. right after the diane sawyer interview, one of the most amazing things is that news outlets all over the country have been inviting trans people in to tell their story. while caitlin jenner story is just one story, she has created this moment where hundreds or thousands of people are telling their story. and more and more people in america are leading a trans person who they think they knew. obviously, host of us don't and

jenna, but a lot of america thinks they know her through her sports life or through her kardashian life. i think it has been an amazing gift she has given us. and i hope it runs a few more months. host: a columnist makes two points. i want to -- want you to respond to both. the first point, what concerns me here is the media's treatment and the assumption that we all need to be a part of this. guest: yeah, you know, i have personal problems with the whole idea of celebrity culture, but that is actually where we are. my job, as i see it, is to take this cultural moment, which is only happening because of caitlin jenner. if it was just some random person off the street like me, it wouldn't be a big deal. vanity fair wouldn't have put me on the cover. because we live in this celebrity culture, which is

vapid and probably harmful in lots of ways, that is what they do. and caitlin jenner is in the middle of that. is intentionally in the middle of that. and i think there are some real positives to that. you know yeah, i don't know why all of america have to be dragged into every celebrity's everything. host: and the other point goes to your point, saying in stark contrast, all gussied up like some 1940's girl. it seems a mockery of her new womanhood as well as the human dignity. guest: well, i am not, as you can imagine, who they call for comments on fashion magazine culture. so i don't know that i want to comment on that, but what i will say is there are all different kinds of transgender people. there are some glimmers transgender people, and there

are some people who can barely eat. we have a germanic -- dramatically high poverty rate. we are four times more likely than the non-transpiration to live on less than $10,000 -- non-trans person to live on less than $10,000 a year. we are more likely to be homeless. a survey we did five years ago said that 19% of us have been homeless at some point. so caitlin gender -- jenner is not a typical transgender person. but we are just people like everybody else. and so some of us are celebrities. not me. host: mara keisling is with the national center for transgender equality. fred, you are up next. caller: yes, hi. i have a question. i have a son who is transgender. born female. well, we thought.

[indiscernible] -- surgically and legally. and has turned out to be a very happy person and we support the heck out of him. love him and support him. but while i was thinking he was extremely happy and well-adjusted, when we had a conversation, he said, dad, it is not -- well, he said it is not perfect. and not just him, but other people. my question is -- i want to be sensitive and i want to learn. i am old and what things should i stay aware of two best support him? guest: fred, thank you so much. first, let me say i am from harrisburg, right across the river from you. i grew up there. and it is good to hear from somebody from back home. you know, there is a really great group and central

pennsylvania. that i would suggest you get involved with. but actually, the most important thing you could possibly do is what you are doing. you are saying, this is my child. this is somebody who i am attached to for life. this is somebody i care about. this is somebody who i am going to support. is transitioning going to solve all of anybody's problems? no. it is still really hard to be anybody in this life right now. if you are transgender, it is hard to not transition, and it is hard if you do transition. but it makes a really big difference, as you are saying, in your son's life. i would just suggest, meet some good people locally. there is a great lgbt center in harrisburg. with support groups and i think meeting people and getting to know people can help put your situation and your family and

better context for you. but the most important thing for everybody, whether they are transgender or not, his family acceptance and family support. host: this is al in las vegas. go ahead. caller: hello. i'm -- i read a book several years ago. but it goes into the life of a -- a young girl that is -- that she doesn't know, you know, when she becomes an adolescent, she discovers that she doesn't feel like a girl. but she knows she is ago, but the thing is that -- that she doesn't wake up one morning and say, hey, i think i will be a boy or the other way around. a young grow -- or a young boy

could wake up -- i mean, he just doesn't like up someday and say hey, i want to be a girl. a person -- and most people don't realize this -- but a person is born with this problem. it is not like -- it is not like they want to be different. but anyway, let me get back to the book. the title of the book is, "middlesex." guest: absolute -- absolutely. caller: are you aware of that book? guest: yes, i sure am. host: i will let our guest respond. guest: i sure am. it is really a good book. there is artistic license that goes into anything like that, and you are absolutely right. for most people, this isn't a suddenly i woke up when i was 32 years old, you know? using caitlin jenner as an

example, she has done a really good job over the last month or so explaining how when she was a kid and this is how it manifested itself been. and when choosing teenager and went to his young adult. she started going out and meeting transgender people to try and understand it when she was in her 30's, but it wasn't until her 60's when she could execute a transition. it sounded very clinical, to execute a transition, but i have now met kids and doctors of kids who get at 18 months, 36 months five years old would just know. i did. i have thought about this every day of my life and i don't know why, i don't know what causes it, i just know every conscious they of my life since i was three years old i have known this to be absolutely true. and i have known that what

society was telling me was my amazing, loving, well-meaning parents were telling me because we didn't know any better in the early 1960's. you know, we know better now. and it is really improving a lot of kids' lives. and books like that do a good job of -- of educating people about certain aspects. host: what happens when miners want to go through a transition? what laws govern that? guest: again, there are different kinds of transitions. so, i know lots of folks who you know, their children will say, i am a boy or i am a girl and they will let them live that way. you are not going to do a medical transition on a three or four-year-old. i am not an expert on the medical stuff, but that is true. when kids start getting towards

puberty, that is when you have to start thinking about what that is. what should be done. but kids very young -- on the bruce jenner interview, they interviewed a friend of mine who is saying she has seen 18 months old just say, no, not girl. boy. and we know. we know when we are kids. additives -- and it is interesting. society doesn't think to ask how kids are sure about their gender. most little boys and little girls are absolutely sure. and that the arts different than what their parents said. we don't challenge that. we don't say, how does the four-year-old not trans kid know they are not trans? but yeah, kids generally won't -- they will socially transition

young, but they won't medically transition. host: from indiana, hello. caller: high. -- hi. my aunt was born a boy and she had a surgery young. i told -- totally support her. even though i don't talk to her that much, you know, unfortunately. but -- you know -- i see a lot of my own family and friends and stuff who -- who not just with the transgender, but with the lgbt community, just in secret or, you know, in this little family-friendly network, they see a lot of that stuff about those people who live that type of lifestyle. i mean, what does the guest think can be done about that,

not just from a public -- you know -- from a public thing, but what can be done for, you know, -- host: we got your point, day. guest: yes, dave, thank you. the most important thing that happens is what happened to you. you had one in your family. and it has made you more understanding of what transgender is. not that you experienced it yourself, but you know somebody. it is not some abstract thing that some athlete reality show star in hollywood is experiencing. it is something that your family is experiencing. right now, we saw a survey a month or two ago showing that about 20% of americans say that they know a transgender person. that means 80% of people don't either know somebody or they

don't know that the know somebody, but what it means is that it is not a real thing for them. so people still have an understandable -- still have understandable, and doubt that my experience is real, that somehow i am trying to make it up or pull some political agenda on somebody. when you are my family and you know that i have always been in good -- a good and reasonable person and now i am saying this, you can hear it better. and you can be willing to learn. when we heard from the father from pennsylvania, that is not something he was expecting. but now, i bet he doesn't go to work and make fun of transgender people because his son is one. that is the most important thing and the most important thing -- i think the policy work we do at our organization is very important. the most important work that is being done as people every day educating people at work, educating their families and the people they go to a synagogue

with and their classmates. so, i think that is how we do it and it is going to take some time. host: your organization is the national center for transgender equality. mara keisling clark and urban talks about the report on the verio tsa screeners and detecting explosives and weapons. david shepherdson has the latest on the toccata airbag recall. it will take your calls and you can join the conversation at facebook and twitter. "washington journal" live at 7:00 p.m. eastern on c-span.

[indiscernible] >> they are both good, but they are different. [indiscernible] and the only difference that i have found between the democratic leadership and the republican leadership was that one of them was scared from the neck up and the other from the air down. >> that was a perfect example of appealing to the masses with a good yar, but ultimately, i think like a lot of characters he became concerned with his own

power and was consumed by that. >> billy long was a maverick and gave just as much grief that his own party leadership as he did to the opposition. -- huey long was a maverick and gave just as much grief to his own party leadership as he did to the opposition. if they were all mavericks nothing would get done. we were fortunate to some degree that huey long was in the distinct minority of the institution. >> don ritchie and former house historian ray smock on the history of the house and senate its leaders, characters, and scandals. sunday night eastern and pacific on c-span's "q&a." >> the heritage foundation recently hosted a discussion on the u.s. military's response to the recent outbreak of the ebola virus in western africa. the talk focused on the behind-the-scenes work that defensive department agencies did in response to the outbreak.

this is about one hour and 20 minutes. >> good afternoon and welcome to the heritage foundation. we join and welcome everyone on the heritage.com website and we ask if you would use of kind to make that last courtesy check that your cell phone something turned off. it is always appreciated. we will post the program on the heritage homepage following today's presentation for everyone's future reference and our internet viewers are always welcome to send questions or comments by e-mailing speaker at heritage.org. this mr. simpson is manager of

our national security law program. he is also a senior legal fellow in the kathryn and shelby --: davidson institute for security and foreign policy. he is a nationally recognized expert on homeland security and writes and lectures widely on these issues as well as military detention and commissions intelligent of criminal law immigration, and war on drugs. before joining us in 2000 seven, he served as deputy assistant secretary of defense for detainee affairs and he has also worked as a prosecutor at the local state and federal levels. he has served three tours on active duty and in the general core as well. please join me in welcoming collie simpson. [applause] mr. simpson: thank you very much, john. i want to welcome all of you to heritage on this second day of the summer 2000. dean.

-- the summer 2015. a couple years ago, my colleagues at the heritage formed any bullet task worst to look at the policy decisions -- forms and ebola task forces to look at the policy decisions and outbreak. the task force's mandate was to identify and make certain findings on how the u.s. can better respond to future crises. they issued a heritage paper these are scholars in and out heritage which was published on the 24th of april this year. three days later, we hosted a panel event entitled "ebola outbreak and response: assessment of initial u.s. actions." we heard from dr. daniel cousin risky from george washington university peter them, director of the african center at the

atlantic council and our very own dr. john, senior fellow at the center for health policy studies. they shared their thoughts on state quarantines step -- federal and state preparedness, who preparedness and process to deal with ebola, the role of u.s. doctors in the centers for disease control, and other related domestic issues. that is not the whole story and what brings us to today's panel. i think it is altogether hitting that on the day after memorial day, when we highlight dod's critical medical research and development role in fighting the ebola virus, there's is a story not well known and has not been well publicized. one which is, nevertheless, impressive and was critical to stemming the tide. we have assembled leaders of

four key dod organizations who are dedicated who -- to protecting our war fires and our country against injury and disease, to include ebola. i am not a doctor, but as a 23-year-old veteran as -- from the navy, i have a respect for dod can bring to the table and almost -- analyst every area of national defense. i followed their work closely and in civil society, i happen to know one of the key in the dod medical research field who when speaking with them and the social of that, we thought that we needed to tell the dod story a little better and heritage is delighted to do so. the format for today's event is simple. i will sit down and be quiet and we will turn to the experts and go in the order in which they are speaking. each will make remarks assisted

by some powerpoint slides. at the end of their collective talks, i will moderate a q and a. carmen spencer is the joan program officer for biological defense. jp eeoc bd. in that position he provides acquisition management on complex management issues related to join service chemical and biological defense programs. he directs, plans, manages, and correlates the execution of that mission and is responsible for the development of deployment. the highly specialized and joint chemical and biological defense devices as well as drugs and vaccines. he also manages oversight for the demilitarization program and a program for the assistant secretary of the army and army acquisition executive.

he received his bs degree from shaman on university. colonel russell, phd is the joint program manager of the joint project management office for medical countermeasure systems headquartered in lovely for dietrich, maryland. he leads the dod organization responsible for the development acquisition, and fielding of food and drug administration approved medical countermeasures to chemical, biological radiological, nuclear threats. he is the author of over 85 peer-reviewed scientific publications and has been the primary investigator on nih health organization and dod grants. in 1995, colonel deployed as part of a who team responding to any bowl of virus outbreak and in 2003, he was deployed for operation iraqi freedom as the chief of preventative medicine section of the 200 -- 520th army

medical laboratory. in 2008, he became deputy commander of the u.s. army medical material development activity. he was selected as the 10th commander of that organization in 2010 and served in this position until 2013. he received his bs in biology from the state university of new york and you can tell by his accent, a new yorker. a master's degree in medical entomology from the university of tennessee and a doctorate in -- from the massachusetts. colonel steven j is the deputy commander for operations in ebola response management team lead at walter reed army institute of research. u.s. army medical research and material, he also serves as the infectious disease consultant to the army surgeon general. he is the chief operating

officer for that enterprise which encompasses over 2000 military u.s. government civilian, for national, and contract employees. and laboratory facilities in yukon, pay con and nationally reignites rolla just an fax knowledges knowledge is and spend more than five years of his early career living and working in thailand and other areas in south east asia. he, too, has authored more than 55 articles and seven book chapters and represents army medicine expertise by speaking at national and international scientific events. he sits on expert scientific committees for the dod nih, the bill and melinda gates foundation, and numerous pharmaceutical companies of u.s. military development priorities. he took his bachelor's degree with honors in biomedical ethics from brown university and a medical degree from college. finally, colonel woolen the

director of by a security at u.s. army medical research institute of infectious diseases. this is one army ackerman i did miss -- did i get that right? >> yes. >> a biological defense laboratory part of the medical army research and material command. during his first tour of duty, he participated in ebola outbreak investigations and animal outbreak investigations and field studies in the northwest territories of canada and montana for anthrax, plague and other diseases. in 2010, he returned when he served at his current position and completed senior service college for the education program at the army corps college. he received his doctorate in veterinarian medicine in 1985

and a doctorate in bed tonight pathology and 1980 nine, both from kansas state university. he also received a masters degree in strategic studies in 2012 from the u.s. army war college. mr. spencer, all yours. mr. spencer: thank you. first off, thank you forgiving dod the opportunity to tell its story. it is kind of rare for us. we tell folks that your job in life is preparing the armed forces for chemical, biological, and radiological events and you and you not the most popular guy in the department. most people just run away, so we do appreciate the opportunity. our mission is pretty simple, actually. what we do at dod, we develop a medical countermeasure to combat chemical and biological,

radiological and there is that. the threats are real. when we look at the last four years and what we have experienced in global crisis around the globe, we have had three major events. in march 2011 wednesday or six nuclear generators went down creating a global crisis, dod was there for the response. in august of 2013, the use of chemical weapons in the country of syria and the u.s. was called upon as part of a you and effort in support of that effort and we -- and part of the u.n. effort in support of that effort to destroy. we were here to talk about that in april of last year for the ebola outbreak and then we had the biologic. three of the last four years, major global threats the dod has had to respond to. despite numerous smaller scale outbreaks, we still do not know the origins of the natural

vector or carrier of the ebola virus. it is highly contagious on its own, we all know that, it is a pathogen that poses a risk of deliberate mis-use and significant potential for mass casualties or devastating effects. the dod has been engaged in research and countermeasure developments for many years and during that time, we have developed a number of unique tape abilities. -- unique capabilities. this outbreak poses unique challenges. sierra leone, new guinea have never experienced a widespread epidemic of this kind. moreover, the public health infrastructure presented challenges. a lack of trained medical professionals was a pretty good problem. for example, before the epidemic started, the cia reported for that every doctor in liberia they went -- there were 100,000 patients. in the u.s., that ratio is 242

doctors for every 100,000 patients. the affected population is large, global, and urban. local funeral customs included prolonged exposure to the infected diseased of the deceased personnel. in responding, there is a limited -- very limited incentive for private industry to proactively develop a response tool, whether they are diagnostic therapeutic vaccines or other related equipment. even with their pewter aches and vaccines in development, largely with the support of the u.s. government, the past fda approval is somewhat unclear. and no mass production capability for these materials is readily available. in the response, dod did not lead the response. we were part of the massive pool of government response and support of a whole government response. it really was a great example of the inner agency working and

pulling together for a common cause. our government is a bureaucracy. in a time of crisis, a is amazing what we can accomplish the short order. this certainly was a time of crisis. even with dod there was a team approach, you see these gentlemen here. not only was my office responsible for the life development of these products we also have medical countermeasure systems that leaves the effort to develop and require safe, effective, and innovative medical solutions. the medical institute of research of -- conducts biomedical research that is responsive to needs and delivers life-saving products that sustain the effectiveness of all war fighters. of course, the united states army institute for infectious diseases is believed laboratory for medical biological defense research.

let me talk just for a few minutes and give you an overview of the response. the response was prayer -- identify the causes of agents, providing diagnostic tools treating the infected, and preventing further infection. the diagnostic therapeutic vaccines and quarantine protocols developed -- developed by the department of defense provided a corporate response. others will the dod partner to respond to the outbreak. mcs under colonel coleman's leadership provided diagnostic surveillance efforts and accelerated production efforts. it also accelerated that development of two experimental drugs that the credit will discuss in his presentations. lastly mcs also funded medical trials for ebola vaccines. the planning and executing of the state employment of u.s. forces relied on where

pre-deployment training and global while surveillance. the results of the training speak for themselves. while diploid, no american servicemembers contracted ebola or for that matter, a disease which infected 44 of 100 deployed marines in 2003. supported training and consultation on training care -- patient care, transport, and dead body management. they closed health management gaps and in conclusion, giving the advance of the four last years, we know that these threats are not academic and surprise has become routine. repairing response requires mask flexibility and preparation from file surveillance to intelligence research development, planning and coordination is key to minimizing or containing the next major event. the u.s. department of defense

is leading the way in each of these areas. thank you again antiwhite to the heritage foundation or hosting this event and i really looking for to the clue -- the q and a. thank you very much. now i will introduce colonel wallin. colonel wallin: thank you, sir. ladies and gentlemen it is a real pleasure to be here with you this afternoon and be able to represent u.s. medical army of infectious diseases and talk to you about the contributions of that organization. as it has been pointed out, i've a veterinarian and serving as director by a security. you salmon's mission is to provide solutions, provide capabilities to servicemembers in the way of medical countermeasures to counter a bio threat. the hallmark of believe from this outbreak in response is if you see the bottom line of this slide where it says medical and biological defense insurance policy, this is what our

commander wants us to be. everyone that walks into that building daily, this is what he wants us to be. the irony of this is that solutions built for bio defense will readily and easily transfer to a world were outbreak of infectious disease. if that is one of the hallmarks of this current outbreak response. the next slide shows you what we consider to be our mission essential task list at usamrid. core capabilities that organizations must excel out to be successful. in its contribution to the global efforts. these are what the commander has established for usamrriid, providing world-class expertise to identify biological agents, educate the force and daily and everywhere we go established biosafety, bio security, and bio a surety capabilities and protocols and develop and

evaluate medical countermeasures. most importantly, the last one is to prepare for tomorrow's problems and uncertainty. usamriid has a legacy research program that has given us a wealth of knowledge and experience in working with the ebola virus. usamriid has a basic size program as the four fundamental elements or contributions to where it works on both discovery and development of medical countermeasures and it has done that with ebola for several years. it leverages this in field activities as well. the outbreak in 1995 was one of my first experiences with ebola and one that i will bring to your attention today. usamriid's presence in outbreak investigation predates the 1995 outbreak.

and again, this was a very unique field situation because the concern was that the virus may be high up in the canopy and never looked at species high up in the canopy and we partnered with other nations in this effort to develop catwalks through the canopy and trap and collected bugs and species that live high up in the canopy rather than on the forest floor. we brought an element of experience to these and coupled with inter-agencies and international partners, built strong teams. and this is a pretty busy slide. this shows our entire portfolio of areas we are currently working on of research development and testing evaluation. i wanted to draw your attention to quadruple did . -- four bolded bullets.

joint biological identification of infection system, ebola virus diagnostics. vaccines and therapeutics, usamridd 32 characters here in -- i think there are only four of -- two of the four that don't pass through usamriid. and they have a lot invested and looking at these therapeutic vaccines. the joint detective system is heavily tested and one of those field trial test we did when we were talking in the introduction about the northwest territories and looking at natural outbreaks. we would take those into the field and try to field test them. most importantly the ebola diagnostic for this outbreak provided a real-time diagnostic capability on the ground.

i want to take just a moment to highlight that because when i was a kid whipped in 1995, one of the critical things missing was the ability to diagnose real-time on the ground because every patient after the first patient was diagnosed as ebola and any patient after that looked like ebola went into the ebola room. during this outbreak, this real-time diagnostics on the ground, we were able to setup screen capabilities to where patients could be tested and then sent to a different treatment facility if they were not positive for ebola, so this is critical. this was also approved by the fda emergency authorization to get samples from u.s. citizens underground. we talked a little bit about rapid diagnostics already. usamriid has years of experience of operations on where to deploy the laboratories and is part of the cooperative

biological program. we were actually in west africa or had been in west africa since 2006 helping nations develop diagnostic capabilities for fever, fever viruses, a channel toward ebola as early as march in sierra leone and april in liberia to combat the current outbreak. we also put to know the capabilities on the ground in liberia. the attempt for that was to be able to monitor the virus and to be able to track any genetic changes in the virus because it was genetically mutate during the outbreak while the vaccine and therapeutics might not work so we wanted to be able to track that. trading education on a number of standard publications were used as reference materials for training forces, but i want to highlight other operation. this is where usamriid personal

stood up to the challenge at additional training to stop heart of the core elements. they provided and trained over 4000 deployed personnel on how to don protective equipment and invested thousands of man-hours to do that. they also consulted with various agencies on dead body management and patient transports to minimize the spread of ebola infection throughout the course. field identification of dialogical agents was leveraged heavily by laboratory capability that was going on in library to assist. -- in liberia to assist. i won't run through these, but you can see how each of the commanders central task lists or core capability were able to be brought to bear on this outbreak. uthey stand to do that with any other agents we have an mandate

to work on in the future, and therefore, have the training knowledge and expertise to do so. bottom line is that usamriid has provided and can continue to provide nonstandard skill sets and solutions to operation problems that deal with infectious diseases of high consequence type organism. usamriid isn't uniquely prepared to support infectious disease outbreaks and we must be prepared for uncertainty of tomorrow. thank you for listening to my presentation. i will be followed by the kernel. -- by colonel. less: -- >> i can still remember clear as day, my wife who was seven

months pregnant at the time and i was coming home and she heard that the army would give me a thermometer and it i got the temperature, they would throw me in the slammer. the slammer, the isolation ward at usamriid where you come down with -- when you come down with something bad and nasty. my wife knowing they were note therapeutics vaccines, and concerned about her own health and the health of our unborn child said, the heck with that, you go him in the slammer right now. [laughter] you flash forward from 1995 to now, about 30 years and you look at where we are. there were complaints, we have all heard them, but i think the story we are telling is we really have come a long way and i will highlight some of those issues. i am a advanced developer -- what does that mean? i've got to put that in contact

-- in context. you heard from kernel -- from colonel wallace everything and they look at potential ways to block the virus from developing in a person. but that is basic science and that does not get you a fielded drug or vaccine or therapeutic. that is where my organization and joint project management office and medical company assistance comes into play. there is the hand off that occurs and it appears they have got a potential therapeutic product for ebola. it transitions to my group and we bring it in with an entirely different set of skills because my job is to take that science and work with a commercial company and somehow spit out a fielded product at the and that is approved by the fda, that we know is safe, effective and it

is manufactured consistently. it is a different skill set that exists in my group from the one that exists in colonel wallace group and cap research -- and the army research. what i'm going to talk to you now are some of the areas we have been involved and as mr. spencer said, nothing that we do takes place in vacuums. i may talk about what occurs in my organization but the reality is we partner with centers for disease control, the nih. it is a collaborative effort on so many different levels. i am going to really highlight now a little bit about the history and how we got involved in the outbreak. as i just mentioned, the whole government approach that it really took. for example, we worked with rare. they were doing critical trials -- clinical trials to see how safe was this vaccine and we had a role in partnering with them. we worked with usamriid on

different screens, aspects of testing that were going on in their facility. really, what you hear of the story we are telling here is that throughout this will be able outbreak, we remained agile and flexible so as mr. spencer had mentioned, our mission in the joint program executive office is chemical and biological threats. various use of an agent -- nefarious use of an agent to some evil purpose but the reality is that the conference that have been weaponize occur naturally and we got the capability to provide, respond when the natural outbreaks occur. in this chart, i don't know how clear -- i would gather you cannot see that at all from right you say, but this really highlight the key areas that organization was actively involved in and it ranges from detection of the virus -- we get into the treatment of the virus

and vaccine development. i will not -- this was a timeline that shows how when, and where we were involved. i have more detailed slides i will use to highlight some of these points. when it comes to ebola virus protection, our team with partners that usamriid, we really identify the first cases in west africa in this outbreak. our assets that were on the ground there were used to detect the first cases. you have heard a lot about the cases here in the u.s. -- the number of personnel who came back and were infected. that was all conducted by the cdc. the story that is not really told is that all dod developed assays were existing members of the department of defense and the department of health and human services and they allowed us to provide our dod assays to -- because there was a gap there and we would support them in

their mission. you may have heard about the ebola easy one assay -- what i will talk about, and you will hear from me, the challenges of developing these medical countermeasures. when i say that, what i mean is we are developing products that we hope will never be used. that is a fundamental fact. we are developing products to threats that we do not know what, where, or when will occur but we know something will happen as mr. spencer highlighted, over the past three years, we have seen via opera use of chemical weapon and nuclear. we were not predicting any of those. when it came to buyer, it could've been ebola, it could've been ebola, it could have been something else and we have to be prepared for all of it. the challenge is that my group faces though, when it comes to developing these countermeasures , we do this in partnership with commercial companies.

these are companies that are driven by return on investments and they've got to make money. the business model that exists is tremendously challenging. hey, we once you make these countermeasures, but you will probably not make any money doing it. that's the reality of the business that we're in, and it's extremely difficult. so when you hear an outcry from the folks in the west africa hey, where were the drugs and vaccines? they should have been here. we absolutely agree with that. however, it's incredibly challenging. and the fact is that over a number of years it's the u.s. government, department of health and human services with nih and barta, and it's been the dod

with our laboratories and our advance developers who are conducting the research that goes into the development of these products. and that's really a fundamental point that is important to understand. i'll get back to it at the end with my comments about the challenge of getting these countermeasures actually commercialized and available. so back to virus detection. we've got a couple of assays here, and with diagnostics we're trying to be prepared to respond to upwards of 20-30 different threats out there. it would be cost prohibitive for everything in the near term, and we haven't been able to do everything in we want. but we had assays that were prepositioned with the food and drug administration that had data that showed they were safe and effective. and when this ebola outbreak hit in less than 30 days, we were able to get fda approval under an emergency use authorization to use these assays. and that was a tremendous accomplishment, and that allowed us to move our assays forward throughout the u.s. working with the cdc where they were

available to detect ebola in those patients. when it comes to ebola treatment, obviously there are no currently fda-approved therapeutics. that's a widely known story. they just don't exist. it is a hard business when you take a virus like ebola -- which is highly lethal, 50%, 90%, it's difficult to say, but we know it's highly lethal. and so seeking out, and this is where usamriid comes into play. they've been working on ebola for many, many years and working, trying to find therapeutic products. the challenge comes, as i said how do you get those approved by the fda with a commercial partner onboard? story that is frequently lost is, they had funded the development of a number of promising candidates. they had commercial partners. they had some data that showed these products were effective and safe but not enough to get full fda approval. and so by working with the fda we were able to take some of these compounds, and they were put into patients here in the

u.s. on an emergency use basis. and with the full support of our fda. and so two compounds listed here in the portfolio -- one is a compound that was developed by the japanese for influenza, but it's effective against a wide range of viruses, so our team has been working on getting the data to show this works against influenza and also ebola. so we were able to work with the fda. and this went into, i believe, a total of 13 patients here in the u.s.. now, at this point we can't say for sure did this product work in those patients because they were getting a whole smorgasbord of cocktail of treatments, which this is one of them. the second compound is something that's interesting because it's what's called a platform technology. and so what this means is you have a platform that's capable of spitting out a product on pretty short notice. so you could have a platform

established, and if something pops up like ebola, in short order you're able to identify the thread, sequence the genotype, and produce a compound that will hopefully be able to treat it. and in this case we had a product that was really for ebola zaire that was found in kikwit, and it turns out it's different than the one circulating in western africa. so working with our commercial partner in a span of i want to say two or three months, they were able to identify the sequence and develop a product that was specific for the virus in west africa. now, there are some ongoing tests of this compound in west africa. not done with us, but done with the european consortia. and, again, this highlights once again the fact that the relationships that are needed to keep these products under development and keep them moving forward, it's just not dod can

it's not even just u.s. government. in many ways they're international efforts. and the last tier of our three areas to work on is prevention some of the vaccine work. so we began working on ebola vaccines back in 2010. and so that's our group in advanced development. but in the textbased -- tech-based louisiana laboratories, they've been working on it far longer than that. we had a turbulent to trial -- had a trial vaccine effort going, and that was intended to treat not just ebola zaire, but ebola sudan and marburg virus as well. and at the start of this outbreak when it became clear, hey, we're dealing we with ebola zaire, there were efforts to identify is there a vaccine candidate that could treat the

disease circulating in west africa, and you've all heard about, i believe, the vfv delta g vaccine candidate. and that -- the testing has gone on at r.a.r.e., our group was involved,nih was involved, i think, colonel thomas, you'll touch upon that in your talk. so what i've tried to highlight is that when we talk about medical countermeasures, it's much more than just the science that has to take place. it's getting the commercial partners, it's a business model that exists. i don't know if any of you are familiar with the fda priority voucher programs. so a number of years ago it was recognized that we were not delivering medical countermeasures for some of those threats that occur in the less developed parts of the world, you know? where diseases occur that there's just not a commercial market. and so the u.s. congress established fda priority voucher system that would incentivize industry to work on diseases these neglected diseases that were seen of minimal importance. but what i would like to highlight is we face the same situation when it comes to

chemical, biological, nuclear threats. we recognize they're important, but there's a lack of incentives, and that makes this business incredibly challenging. so at that point, you know, key points here, you've heard about how our organization has a long history working with other partners. you've heard about and will continue to hear more about working with the other government agencies and our ability to deal directly with this outbreak. and my final point here is the need to really be proactive about looking at medical countermeasure development whether it's for ebola or other threats that face our nation. and with that, i'm going to turn it over to colonel stephen thomas. col. thomas: ok, good afternoon. i'm really glad to be here thank you very much.

i'm going to talk to you about the walter reed army institute of research. i'm going to tell you who we are, what we do and how both of those were leveraged to participate in the ebola response. this is a picture of the r.a.r.e.. it's located in silver spring maryland, just inside of the beltway. we were established in 1893, so just over 120 years. a very long time. we have the dod's largest biomedical research facility. as you've heard before, we have around 2100 u.s. government military foreign service national and contract employees working not only in silver spring, but a number of locations around the world. and we work in two main areas. the first area would be behavioral health and brain health. so we work on issues like traumatic brain injury post-traumatic stress disorder we work on sleep and the interface between sleep and performance. and then we work in areas of infectious diseases, and that's what i'm going to highlight for you today. as long as we have had an army and a nation, infectious diseases have posed a threat not only to the u.s. service member, but also to the citizen. and that occurs in peacetime and

at war. and it occurs both here locally as well as overseas. and it's been the organization that i work for, our charge to try and develop countermeasures to mitigate or to eliminate that threat to the service member and to the nation. and we have done that successfully for a number of years, and i list a couple of examples of just the vaccines that we have developed. and these make a difference not only in military recruits, but those people that deploy overseas into harm's way. we have done that successfully in the past, working on and figuring out solutions to past problems, but we're also looking at current threats and what the future threats may be. and you see a couple of examples there, things like hav, david weber, -- dengue fever, malaria and ebola as well.

we do that because we are an institution of competencies and capacities and research platforms. we have people that know how to do research and development, and to combine those two things is important and very strategic. and in addition to the expertise that we have and the domestic platforms that we have, we also have a large network of overseas research capabilities. we have a behavioral health unit in germany which is currently in the process of transitioning to washington state, we have a relatively new unit in the caucuses just outside of georgia, and then we have a longstanding presence in africa and southeast asia. and these are very deep and enduring partnerships with host nations where we identify common threats and common interests and then work together at government level, at the civil society level and at the community level to try and come up with countermeasures that serve both of our needs. and as you'll hear, these platforms are incredibly important for the u.s. military

and our countermeasure development activities. so that's who we are, and that's where we are, and that's what we do. how is this all leveraged for the ebola response? the first you've already heard alluded to was testing of vaccines. so when these vaccines complete their early development testing at places like usamriid, they eventually need to be tested in humans. that is a core competency that we have. we do that both here nestically as well as overseas. so when the defense threat reduction agency came to us and asked if we wanted to participate and we were able to do the first human trial of this ebola vaccine candidate, we were very pleased to be a part of that, and we did that. and we did it very quickly, and we were able to do that because we can -- we're agile and we're able to redirect personnel and other resources to acute needs that arise. so in a very short period of time and in a small number of volunteers, we're able to demonstrate that the vaccine was safe and produced the immune response that we wanted it to.

but we didn't do that in isolation. we worked with dr. fauci and dr. lane's team at the nih at the same time with the same vaccine candidate. and we jointly published those results in the last couple of months. but it didn't stop with the u.s. government. we were also working with the world health organization because there were other groups that were also doing these small safety trials. and together we were able to take all the blood samples, send them to usamriid, and they were able to generate the data that was required to make informed decisions what about vaccine dose needed to be use inside west africa. and you've probably seen the lay press, those trials are ongoing right now. so as colonel coleman mentioned, it's not just dod, it's not just whole of u.s. government, it's an international effort. and our vaccine trials that we were doing here in the u.s. were

also being done overseas. and, in fact, the vaccine trial we did at the the r.a.r.e. this past year, it wasn't the first time we had done an ebola vaccine trial. building on military hiv research program which has had a presence in you uganda for many years and collaborations, we did the first -- that i'm aware of -- human vaccine trial on the continent of africa back in 2008, and those results were just published as well. they just finished enrolling in a second ebola vaccine trial in uganda, and we are scheduled to start an ebola vaccine trial in nigeria. so i think this is a prime example of how the dod is very good at expeditionary medicine but more than that expeditionary research and development. and i think that is a unique characteristic of our organization. so that was the vaccine testing story. but we responded in other ways

as well to support operation assistance and to support domestic ebola preparedness. this was a different kind of operation than the 101st airborne and other operational groups had been involved in before. so it was very important to provide them predeployment training so that they understood what the threats and the risks were. and in my mind, ebola was not the number one infectious diseases threat to the deploying force, it was malaria, the most severe form of malaria. so we conducted a lot of predeployment infectious diseases threat briefings with the southern regional medical command and brooke army medical center to all the deploying troops. you remember me telling you about the behavioral health side of our institution. we also sent behavioral health teams to deploying troops, to gain their understanding and perspectives about the operation they were about to undertake and to understand what the specific mental health stressors may have been on that group.

we also looked at controlled monitoring for that group. and that data is coming in, and we're analyzing it now. and then if you remember back to that map, that large presence we have in africa and the large presence we have in southeast asia, those nations had travelers returning from west africa that they needed to test. and they needed to understand if ebola was being imported into their borders. we've had 50 or 60 years of collaborating with some of these nations, and so we provided technical assistance to them. again, the mutually beneficial relationship we have had, again, in some cases for over half a century. now, what you've heard is activities at the lab level and maybe at the program level, but i can tell you this was being tracked at the highest levels of the government. so the dod ebola working group which was occurring in assistant secretary logos -- the assistant

secretary of cos's shop, they were responsible for coordinating the dod response in west africa. and so they coordinated dod activities in support of the primary responder, they got all the different stakeholders together in dod, and we ran through on a weekly basis all the issues that were confronting us and confronting the agency. they represented dod with the joint staff at white house-led meetings, and they worked with congress to make sure that people were remaining informed of what we were doing and why we were doing it. the point here though is that they were tracking very, very closely, on a weekly basis, all of this work that we were just telling you about. they wanted to know what were the vaccine trials, what were the results, what were the drug trials, where are they, when can they be deployed? and all this information was going up to the president. so that's a summary of what the

walter reed army institute of research, what their contributions were to supporting operation united assistance and supporting domestic ebola preparedness. and i think taken with all the other talks that you've heard it gives you a pretty good idea of what department of defense was doing. so i thank you for your time, and i'm going to turn it over to our host. >> well, thank you very much. first, i want to commend you on not devolving into military acronym speak. [laughter] which i know is easy for folks to do. a few questions and then i want to open it up to the entire room. and this term may not be a term you have in the army, but in the navy we have a term -- you may know this because you served in the navy -- hot wash. hot wash is when after you do something, after you have an evolution, after you do a deployment, etc., you get all the stakeholders together, and you sit around a table or a room or a conference, and you figure

out what worked, what didn't work, what went wrong, how to sort it out, how to figure it out and the best way forward. i assume you had some version or multiple versions of hot wash not only within your various components but across dod. and i was surprised to learn that solwick really played the role they did. i think that's interesting. i would think it would be health affairs, but it makes sense. and i'd like, i'd just like to go down the row here and ask you what are the one, two, at most three top lessons learned from your perspective through the ebola response crisis management way forward? i'll start with you. >> i think the biggest lesson for us as dod was no one agency

within the federal government has all the answers. it is a whole-of-government response to any type of global crisis and when it comes to something like a biological incident like ebola, there are no borders. and it's not a dod issue, it's a public health issue. and dod has resources and assist, but we don't have all the answers, and we must work as part of the whole-of-government team to provide capabilities that we can provide. >> colonel woolen? colonel woolen: one of the phrases you hear almost to the a point where you get tired of hearing it when you're a student at the u.s. army war college is the term jimm, joint interagency, intergovernmental

multi-national, is what it talks about. and students there are encouraged to start thinking in that area if they haven't already before they come in. this outbreak rolled all that together. this has to be a joint interagency, intergovernmental multi-national type of solution. there can be no single agency that can respond to this type of an outbreak and bring to bear the resources that are needed to really be able to render a positive solution rapidly. the other thing that i -- and i talked a little bit about this in my presentation -- is that we cannot be stovepiped in our thinking. you know, as we develop solutions in the name of biodefense, we have to be thinking about how else can those be used and how else should those be used. and an infectious disease outbreak is a classic example of how something that is being developed for a relatively specific intent and purpose has

tremendous ability to be cross-leveraged for other purposes as well. >> good point. colonel coleman? colonel coleman: on a similar thread, by training, i'm a preventive medicine officer, and i think most people know it works, but it's also unappreciated and sometimes, you know, physicians, for example, more time is spent on treating rather than preventing. but we know that prevention works, and in this case i think we saw the value of the investments that have been made over a many year period where we're trying to be prepared for any contingency that might occur whether it's naturally occurring infectious diseases or a bioterrorrism event. and we saw the benefits of that investment, that prevention that people had the foresight for and that we really were well

positioned to provide support to this outbreak when it came to the r&d investments that resulted in whether it was diagnostics, vaccine or therapeutics. stephen thomas: i guess the lesson learned for me is that once again it's been proven that the world is a really small place. and when you can get anywhere from one location to another in less than 24 hours, it is very possible for what is a west africa issue to become a global issue. and that can have incredible certainly morbidity and mortality ramifications and financial ramifications and political ramifications. so to me, i think the requirement to enhance our biosurveillance networks globally are of incredible importance. and it is not just the ability to identify and detect and characterize the pathogen, but when you build biosurveillance you are building public health

infrastructure. it's dual purpose. which i think, of course, the west african nations had not been so challenged in those areas, there may have been a different, a different outcome. so that's the main lesson that i've gotten from it. charles stimson: so before i open it up, the last question i have is so let's assume for the sake of the question that there is a verifiable outbreak in a west african country of what people highly suspect because of biosurveillance is ebola. it happened this morning. this is a hypothetical, of course. but not beyond the realm of possibilities. walk us through, to the extent you can share, what each of your organizations does day one. what happens? dod in your lane --

mr. spencer: in my lane the first thing that would happen is russ and i would be on the phone together for a nice long phone call and getting the best and the brightest minds that we have together and basically war gaming it. what do we know, what don't we know, what are the capability gaps, what do we have on shelf where do we need to put investment in the short term to get the biggest bang for the buck. and strategizing what's going to happen over the next few weeks and how are we going to be prepared and ready to meet that challenge. in the kernel -- and the colonel right here would be one of those guys, because he's guy that's making it happen. and that's what my organization would be doing.

mr. stimson: but i assume that in addition to phone calls, what not, there's going to be personnel eventually put in that area, american military personnel or doctors or civilians or somebody. because i think the public especially people who aren't experts like you guys, assume -- and they could be wrong -- that we're going to have people on the ground here, there pretty quickly to figure out what it really is, how important, how widespread it is, etc. so -- they are going to be asking a lot of questions. at that level that's going to emanate within the office of the secretary of defense, within the office of the joint chiefs of staff, and we will react to the

warning orders that they produce. that's why we get the best minds available to respond to their questions to include what would it take to provide a response. and in the case of ebola, one of the first things we're going to want to know and why we're going to want smart people on the ground as soon as possible is, as has been mentioned twice already, is to get a dna sample to determine what strain we're dealing with. dr. woolen: i've been through this three times now with ebola and it's basically been the same each time. and that is until we get a request for assistance, we are not doing anything. the current people operate with a little bit different. i say we not doing anything meaning we are not pushing

people out of the door. what we are doing is having meetings, discussing that task that i talked about, what capabilities we possess that could be brought to bear on the problem is asked to assist. that's a standard whenever the news of an outbreak hits, our commander starts convening those meetings, and it doesn't even sometimes take a commander to initiate that. people that have a vested interest work in that day to start thinking about what we have available that could be brought to bear if asked to do that. but it all hinges on the request for assistance before we can engage. this one was different because we had a presence in west africa. we had people on the ground as part of a cooperative biological engagement program to build host nation capability capacity for these types of diagnostic. we were already there doing that. when it hit they rapidly transition specifically to ebola diagnostic both in sierra leone and then in liberia.

col. coleman: i think i will build upon colonel woollen's comment. our mission really is for dod operation. if an accident like this occurs in west africa that's not a traditional dod mission that's how it initially evolved before became operational assistance. i've got to look at what mikey goes on and what can be brought to bear as colonel woollen said but i've got to figure out a way to publicly provide that support. we have to look at who our partners were another would be operating. so, for example, cdc responsible for homeland defense the many ways, diagnostics. we have the mechanisms in place that allow us to provide cdc with things that we've been working on.

my advisor came to the u.s. come how we provide our therapeutics that are u.s. government owned respond. look at those mechanisms and figure out how can we provide the support. these are conversations that took place with ms. spencer and levels higher. colonel thomas: you've heard a couple times it's not just the desire to go but it is the ask. that ask us to come through usually diplomatic channels into the department of defense. if the ask is coming from africom or africa command, in my particular organization, what we can do again because we did expedition research and development, we can take the drug candidates or the vaccine candidates and we can relatively quickly deploy, if you will, to start doing trials to demonstrate in the population of interest safety and potential for clinical benefit.

my organization is a research organization. that's one of the things we could bring to bear. and again in the process of doing that you are setting a public health infrastructure setting up surveillance systems. you are educating the local communities or them force multiplier scum if you will, in helping you achieve your mission mission. >> anything anyone else wants to add on the panel or to add anything any of the other panelists have said? negative response, all right. do you have a question? simply raise your hand and what my colleagues with a microphone will come to you and please identify yourself by name and organization and ask your question. lady in the front, please. >> victoria from the commerce department. thank you so much for your work. i feel a lot safer. thank you very much. my question is going to be more on the r&d and commercialization that you're working on. i would assume that in addition

to the voucher and a fast-track system where you are probably going to get fast review and extension of patents, either considerations on agency which are advanced market commitments guaranteeing these companies a certain market, like a certainty for contract with the commercialization? and also once these products are finished, are they subjected to compulsory licensing under the trips agreement? and bonus question, a lot of these diagnostics and a lot of the drugs you use probably are not approved in west africa. during crises do you get a blanket consent to use on

the west african population? col. coleman: between the two of us we can handle that one. yes we talk to commercial companies about their ability to provide us long-term with the products. it's important to understand the dod requirements are relatively tiny. so, for example, when we're developing vaccines we may require 400,000 doses, and depend on the shelf life we may only need that every couple of years. very small number. when you talk about the cost and investment that companies that make, as i said there's a lot of reluctance to say this is something we are going to take

our resources. so even the small licensing commitment is in many cases not enough. so i'm glad you mentioned they have to have your doctors, patent extension of that sort of thing. those are the discussions i believe we need to get into because if you truly believe that this is a strategic and national priority, our ability to respond to these outbreaks, whether they are naturally occurred among people or a chemical or biological weapons event, we've got somebody going to crack the code on a. right now most difficult aspect of this whole process, we have great scientist doing great things coming up with potential technologies. it's getting them across the finish line. the second part of the question was related to what is our desired end state? we want fda approved products. that is the gold standard and that is what we strive for. in this case we did not have fda approved products. the fda has mechanisms that

allow not cross the finish line products to be used, like emergency use authorization, like expenditures protocols and so during this outbreak we took full advantage of those. eua was used with the diagnostic products. emergency imgs were used for taking some these experimental compounds and treating individual patients here in the u.s. those did involve informed consent. there's a whole spectrum of tools potentially available that we've got to adhere to those requirements established by the fda to ensure patient safety first stephen thomas and foremost. that will turn over to the physician. -- to ensure patient safety first and foremost. i will now turn it over to the physician.

colonel thomas: entrance of us-based trials, we were able to move faster than usual but it was not because we skip any regulatory steps for any ethical steps. we just focused a lot of resource and were able to do things in parallel versus sequentially which is how that normally works. my organization is not involved in the vaccine trials that are ongoing in west africa now. i cannot comment from a first person view, but what i can say from the experience we have had with field trials in other parts of the world, informed consent is always a component of that. actually children are able to understand basic concepts are, is that the population that's involved, that is also always a component above what we do. so my assumption is, and i would be very surprised if it was not the case, that that is ongoing in west africa now. and these countries have their own ethical review committees and own regulatory frameworks as well so these are not being done in a vacuum. col. woollen: your question in multiple parts, can we touch upon all the parts? colonel thomas: did we get the bonus? col. woollen: one thing i will

add to what my colleagues just commented on is what we are talking about is a low-frequency but high impact disease. you kind of get on the subject already about how do you commercialize? so one of the things that has been looked at at by several other scientists are working on a therapeutics, not so much of the vaccine site because it's more difficult to do, on the therapeutic side is repurposed in drugs that have another intended purpose and has significant potential merits to also treating ebola virus. you also get a leapfrog type of start with reproducing other types of drugs that are also being researched for another type of disease because you can leverage those early clinical trial data on the safety testing that can help propel that forward towards a solution. that's another area that a lot of scientists are looking at. col. coleman: we mentioned 30 doctors and i thought it was great that the fda come on the should you do specifically but we got legislation that award ebola was added, eligible for vouchers. that's terrific but it occurred in the middle of an outbreak and

that's not the optimal time to be thinking about these things. when you look at drug or vaccine development cycles which are many, many years, in order to be prepared we've got to be doing the thinking far in advance. this is great that we are able to respond actually and fairly flexibly but we could've been better position if we have some of the tools in place in advance. those are the incentives. i like the fda priority vouchers. mr. spencer: that's what we're looking at now, the preparedness piece.

when a crisis hit hits that's the worst time to exchange business cards. we've got to be prepared, rehearsed and ready for any eventuality anytime anywhere on the planet. that's going to concentrate our efforts on now. colonel thomas: i do think this speaks to why the department of defense needs to be involved in infectious diseases are indeed countermeasure development. because a lot of the problems that would work on do not necessarily have a large market share. it's not necessarily going to be the case but there is a corporate entity or pharmaceutical entity that will be willing to take it on. but the u.s. servicemember still needs a countermeasure. still need that drug or the vaccine to protect them when they deploy parts of the department of defense in some cases has to be the one taking the initiative to develop it. and in all cases needs to have a seat at the table. to ensure the military gets what it needs. >> other questions? the gentleman in the middle. >> thank you. thanks to the panel by the way. this is not a great session i think i'd like to build on the question, comment that colonel thomas made. given you can get from monrovia to uganda to calcutta in 24

hours, the host workers in this country, given that the world health organization and other institutions fail to respond in a timely manner on interesting issues about the about the need for global team occasions of warning systems, the civilian or the military. mr. spencer: i will talk about surveillance. a number of the panel numbers have stressed the importance of bio surveillance. that's a global capability because it is a public health issue. and we are doing a number of things around the planet now to increase our bio surveillance capabilities because that is the early warning and the indicators. we can say anything we want but the human is going to be the early warning signal. and then it's a question of time. so our biodefense efforts right now and dod is leading the way is going to be the cornerstone

of that early warning system and we are expanded to assess as we rapidly can. you can learn more about it. it's called the global bio surveillance system. colonel thomas: so the department of defense has the global emerging section surveillance and response system led by colonel jim cummings is also an infectious disease physician. they are in approximately 70 countries and that's both dod academic and host nation government facilities. but it's not enough. the network in west africa is not as robust as it should be or needs to be. and so that's an issue for the people who allocate resources and to prioritize programs, but i am a staunch believer that that network needs to be larger. and again because of the secondary and tertiary effects of building bio surveillance networks. col. coleman: i personally believe, just the notion come an example. there are literally hundreds of

outbreaks occurring on a daily basis. most of them are well within the needs of the local population to respond to. the concern is what if the outbreak is larger when the local entity government, whether district, whether it's a nation can respond effectively or what it's got to pandemic potential. and how you separate that out, the one that is the 990 day daycare versus the big one. so the networks that have been described are truly fundamental to allowing us to get that information. i think was a long way to go but there's been tremendous progress made in recent years. >> the only comment i will add to that because this is not, my area of expertise but but the point has been raised we don't know -- [inaudible] we don't know what it is. we don't know what the risk factors are for people to contact with. we do not know whether it will

pop back up again. it reemphasizes the point you're making and my colleagues have talked about, about the urgency of the need for something like a mobile surveillance system. thank you. >> this the gentleman in the middle, please. >> r. i am robert malone, a physician scientist and they specialize in facilitating the interface between industry and government, particularly dod at hhs. personally i think you guys are being way too modest. i saw in mr. spencer's shop and colonel coleman's shop risk-taking advanced risk-taking to expedite product development. and i saw flexibility in contracting that i have never seen before. and i think the fact that we have millions of doses of potentially potent vaccine available in the fall, reflected that risk-taking and that forward thinking. the question i have, and this

surprise to me is someone who specializes in this, is what happened to the whole logic of that entity was to address this kind of problem and the intergovernmental interface issues were quite abundant. i have not had anybody explain to me where that broke down. i would love to understand that. >> your question, what happened to the fencing, your voice kind of dropped. that's the question on the table. col. coleman: want to try and tackle that or you want me to take a stab at? >> and i will follow on.

col. coleman: public health emergency medical countermeasure here it's intended to ensure that u.s. government as a whole is working collaboratively with each other and not competitively to make best use of limited resources that we have. because of public they are -- very active. there is bodies tend to facilitate this. so although you were there at the phemc, i was at thousand there were discussions occurring at the phemc level look at the candidates that were unavailable, accelerated to be able to respond and they were decisions made with phemc but if killers take it to a higher level i will. so decisions such as the map which is probably the most bio therapeutic what agent most advanced and resources there that the vaccine was the one that had been a true that could

be explored most rapidly. so some of those decisions were made. additionally, i don't know whether it originated at phemc that they can we understand how to develop is a risk it to be. even though we may prioritize is the map of the vaccine, look at the other things in your portfolio and consider how you can accelerate those. so those sorts of discussions were taking place and discussions were sent back to phemc for their awareness. mr. spencer: i'm a member of the phemc we did have discussions and in the early phases it was what came each in agency partner bring to the table, if you will. i don't think it broke down.

i do not think it was defective -- as effective as it could then and i would acknowledge that. but it was because we are working in crisis mode and we attend a lot of meetings but it was about doing and not about meeting. so we from a dod perspective which is trying to port everything we could into the fight and get there as quick as we could. and we may have left some people behind in the process, and that maybe one of our lessons learned that come out of this. but the phemc has been a very good tool for me to ensure that i'm not duplicating what barda is doing a what department of homeland security is doing, a what the cdc is doing. if the deconflict so we are not all that spending money on the same problem. >> what is barda? >> the acronym escapes me. >> spoke biologic advanced research development agency. >> department of health and human services.

medical countermeasures. >> thank you. we get a lot of money from you from the taxpayers to do this business. and i want to spend why can get the biggest bang for the buck. i want to leverage what they're doing to take it to the next level if i needed. i want them to know i'm spending money on so they can leverage the great research that's been done, and they can expand on that. we get the biggest bang for the buck, it is very good. col. coleman: i gave an example. it's easy to say this fell apart but things that were in place, many people don't know, phemc, a lot of activities going on. animal nonclinical working group and this is really for a number of years has harmonized efforts among those like dod and not just hhs but i like this as well, standardizing. what type of pathogen will use? that's provided tremendous value to all the organizations and in many ways best positioned as to be able to respond as effectively as we did. >> but --

>> hold on. rephrase your questions or internet and c-span and other audience can hear. please speak louder. >> i had understood that phemc by directive, by their charter were to play a key leadership role in a situation like this. hence my question. in an operational sense, tactical and operational sense. that was the gap i was referring to. >> understand. >> other questions for the panelists? well, please join me in thanking this excellent group of experts, and thank them for keeping us all safe. [applause]

[captioning performed by the national captioning institute, wiich is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national cable satellite corp. 2015] >> today, live coverage of the funeral service or the sons of vice president joe biden. president obama will deliver the eulogy during the mass. that begins at 10:30 a.m. on c-span. >> the new congressional directory is a handy guide to the 114th congress with color photos of every senator and house member. order your copy today.

>> republican senator, tom cotton speaking about foreign-policy challenges raising the united states. he criticized president obama's policies, combating isis, and the ukraine, russia conflict. this is about an hour 10 minutes. >> everyone take their seats and we will get started. i think the microphones are

mainly -- i hope you can project. this is the fourth in our series this week for the issues forum. we have gone from senator bernie sanders who announced on wednesday. lincoln chafee announced. i do not think our speaker will be announcing for president. maybe in four years will have him back when he decides to announce. along with the financial times in the fall we will be putting -- hosting most of the presidential candidates and we have the chairman of the senate foreign relations committee, bob corker, coming in in the fall. let me have your cards whatever, i will put you on the list. today we are honored to have the senator, the youngest senator in the senate. tom cotton from arkansas. he is a harvard graduate, a harvard law graduate. he is on the banking committee the intelligence committee, the armed services committee. he served in iraq and

afghanistan. he has also served at the old guard at the arlington cemetery and has been awarded several awards, the bronze star medal. he served in the house of representatives. if he does decide to run for president he is been in the house, the senate, the next step up. he is the youngest u.s. senator. he is a new father. senator cowan: five and half weeks. >> i give you senator tom cotton. [applause] senator cotton: thank you for inviting me. it is an honor to come speak at the invitation of george mason and johns hopkins and "the financial times." it is not just because all three are important and laudable institutions but that is true.

george mason school of policy and government and international affairs should be proud, it teaches in the tradition. he did much to plan our unions roots firmly. the johns hopkins center should take pride in their benefactor. johns hopkins devoted much of his energy to supporting all americans of all races. it is important to recognize these do not run out of the water's edge. america may vindicate these rights that they belong to every man and a woman. and our closest and dearest allies abroad, the want to fight with us in the trenches and stand with us in the common defense are those that share and will fight and die for the self-evident truth.

the powers and strategic competition with us take a different view. the regimes in beijing and to tehran and moscow adopt strategies to delay and his -- and discredit worldwide progress for a constitutional government, the rule of law free trade and civil and political rights in their own nations and the nations they see as their spheres of influence. they protect and encourage autocratic, authoritarian systems that prize one-party rule, nationalized industry, and mercantile trade policy, and subjugating of religion and ideology. they sometimes gussy up their strategy on the principle. non-interference in the internal affairs of other nations but they interfere with the affairs of other nations when it serves their interests and expands their influences.

sometimes the interferences swift, dramatic, and brazen as when russia invaded georgia in 2008 and ukraine last year. sometimes the tactics are more akin to the slow militancy of a cancer. when these regimes refer to the principle of non-interference what they are saying is they want to reap every economic and security they can. at the same time, they want to dodge the responsibilities inherent in a system which calls for peaceful cooperation and respect for civil and political rights. it is worth taking stock -- under our current commander-in-chief and compare it to the position of these revelations. amidst the global,, it is not an encouraging picture. in no region of the globe is the u.s. influence greater today

than it was six years ago. in fact in many regions it has greatly diminished. one of the challenges of our time, we're hard-pressed to identify any major achievements not eclipsed by failures. these are the fruits of a policy based on strategic retreat. the president has stated powers despite the consequences and our friends and allies. the motivation was in part practical. driven by belief that america cannot as a structural or historic manner maintain its lone superpower status and must accommodate the rise of the rest. the motivation is also ideological. our president exhibits a certain humility when it comes to america's moral authority, implying that american exceptionalism is not all that exceptional. at the same time, he seems preoccupied with america's

perceived historic failings, invoking sins from america's past [indiscernible] two tyrants in the present. the lack of confidence potentially in our economic power and diffidence about our foundational values inform foreign-policy. the systems -- symptoms manifest themselves in ways large and small that at all times detrimental. the president has been made much of his so-called pivots with that part of the world. our new military and diplomatic commitments to the region have been lackluster. we do have new agreements to operate additional military resources out of singapore south korea, and australia. these moves are largely symbolic amid the overall reduction of our military forces. they pale in comparison to the massive ramp up in military spending we have seen in china. in fact, china has established the material capability to deny

our military access to and freedom of movement in the western pacific. the u.s. has failed to prove -- press our advantage with china had a moral level. hillary clinton declared that beijing's records on human rights would not be able to interfere with our relationship. that was a mistake. backing away from our founding principles on foreign soil telegraphs weakness and surrenders the moral high ground particularly with the chinese government sensitive to international embarrassment. instead we should point out beijing's abuses and encourage reform. standing with our allies, it is a powerful diplomatic lever. we have also seen numerous instances of retreat in the president's middle east policy. the media has obsessed lately on whether knowing what we knew then, knowing what we know now about saddam hussein's program.

whether we should have entered the iraq war in 2003. this question obscures that by 2011 the war was essentially one won in iraq. iraq was sovereign and stable. the better question is whether president obama knowing what he knew then in 2011 should have pulled all of our troops out of iraq without leaving a small residual force to solidify her gains. the military commanders warned against the sectarian tendencies and outsized iranian influence. they rendered iraq vulnerable to the rise of islamic state. the president's policy of retreat also mirrors his negotiating strategy with iran over its nuclear weapons program.

at the outside of the t5 was one -- p5 plus one talks, the american position demanded that iran halt all enrichment develop its facilities and explain the military dimensions of its program and never obtain nuclear weapons capability. on each and every one of these demands, the obama administration has retreated. if their current proposal holds, iran will be allowed to continue research, continue limited enrichment, keep its fortified compound, and after 10 years of collecting billions of dollars worth of sanctions relief, it will be in a position to go for full nuclear breakout and that is assuming iran does not cheat. the presidents had long pursuit of a nuclear agreement has disfigured his response to the crisis in syria. the defeat of the regime would have vindicated strategic inte