and memories. susan page of usa today, nancy reagane the personal touch and usa today.com. this time it is riverside california, ginger. looks like we lost ginger. the final thoughts with funeral this afternoon of the nancy reagan's legacy? gu sshe channeled that toughness into taking care of him. one of the most celebrated instances is she did not get with the former treasury secretary, the former ceo of merrill lynch.

reagan came from the treasury to the white house chief of staff. nancy reagan decided early on that reagan thought that was chief, not staff. a very powerful job, but it is still staff. she thought reagan was not serving her husband's interest. she was enraged after a comment about cleaning up her husband's loopers and gas. - and gap -- husbands bloopers and gaffes. thought he was not serving her husband well. one of my favorite quotes from eight years of the reagan's came from a senior aide. the senior aide said to me it is reagan --me, nancy

save for me nancy reagan -- safer for me nancy reagan doesn't know who i am. very exclusive a club, first ladies of the united states. >> thank you for sharing your experience. details ahead on our coverage plans. that will do it for this morning's washington journal. until then, have a great weekend.

>> just a short time ago dr. ben carson, former rival of the republican presidential nomination gave his endorsement to donald trump. it happened in a remark to -- the newsat conference just wrapped up. life for you on c-span2. go to c-span.org. coverage of live that u.s. response to the zika virus. experts discuss the likelihood of more cases in the u.s. and what the government is doing to prepare the spread -- to prepare. secretary johnn king will speak down about k-12 education. you will be able to watch that conversation live on c-span2. join c-span today at 1:30 p.m. eastern for the funeral service

of former first lady nancy reagan at the ronald reagan presidential library in steamy county, on you. michelle obama, former president george w. bush and laura bush, will be among the dignitaries attending the funeral. mrs. reich and will be buried next to her husband at the library. live coverage on c-span, c-span radio, and c-span.org. white house national security adviser now on efforts to combat isis. she spoke at the council on foreign relations here in washington. after her speech she took questions from the audience, monitored by attorney kevin weinstein. a former advisor forge. -- advisor for george w. bush, this is about an hour.

>> good afternoon. pleasure to be here to preside over today session with lisa monaco. everyone tolcome today's meeting. memorialart of the lecture on homeland security and counterterrorism series, which honors the memory of cabinet -- of kenneth a moscow. for details about his life and professional accomplishments can be found in the book for today's meeting. i would like to ask that -- like to extend a special thanks. lisa, besides being an old friend is a tremendous public servant. andassumed the duties

deputy national security advisor on march 8 2013. in that capacity she advises the president in all aspects of counterterrorism policy, as well as this -- as well as the coordination throughout the executive branch. prior to that she served as the assistant attorney general for national security in 2011 through 2013. prior to that she was the principal associate deputy general, what is an important -- which is an important function. she was chief of staff to director robert mueller. from 2001 through 2007 she served as a federal prosecutor. she was appointed to the enron task force where she was involved in the trial of four executives. her work in that task or's, she received the attorney general's award for exceptional service,

the highest award given by the justice department. prior to being a federal prosecutor she was counsel for the attorney general janet reno, providing law enforcement budget and oversight issues. prior to joining the doj she cleared the honorable -- -- honorable jane roth. i would like to welcome lisa to the stand. lisa: thank you so much. can was referring to his prosecutor days when he welcomed me to the stand. reverting to his prosecutor days when he welcomed

me to the stand. he served as the u.s. attorney to the fbi, where he was also chief of staff to director mueller. attorney general for national security. he is also one of my predecessors in my current job. so it's good to be here. it is good to be back with an old friend. it is also very good and a real pleasure to be delivering the kenneth moscow memorial lecture. i had the opportunity to visit with keith backstage. we shared a number of stories about our common roots. for those of you who are not aware, ken moscow, in addition to being the kind of guy who likes to run with the bulls in pamplona, was a talented cia operative. he hailed from my hometown of

newton, massachusetts. and he died tragically and far too young near the summit of mount kilimanjaro. his life and his work was like that of so many other intelligent men and women, military men and women, homeland security, diplomatic and law enforcement members. they all put their lives on the line every single day. they do so to keep our country safe. today, i want to talk about the preeminent security threat that we face, the threat of terrorism, and how isil represents a new evolution of that threat. and how we are waging a new campaign. it was only three months ago that a married couple, sayed

farouk and tashfeen malik, walked into an office gathering in san bernardino and opened fire. they had assault rifles and a veritable armory with them and in their home, including pipe bombs. they also had a six-month-old daughter who they left with their grandmother, with her grandmother, before they began their murderous grand -- murderous rampage. 14 people were killed. 22 were wounded. sigh he farouk was an american citizen. like the recent attacks from paris to chattanooga, the san bernadino attack was a stark reminder that, for all of our vigilance, for all of our focus, the specter of terrorism persists both for americans and for our allies. instability from syria to somalia provides fertile ground for extremism and sometimes tragically the attackers are homegrown.

but i mention san bernadino, not just because it was the worst terrorist attack on the united states since 9/11, but because it was a starkly different kind of attack. simply put, the terrorist threat we confront today, almost 15 years after that terrible september day, the terrorist threat has evolved and it has done so dramatically. what distinctions the threat today is that it is broader, more diffuse, and less predictable than at any time since 9/11. where we once spoke of hierarchical networks and sleeper cells, much of the threat today is online, distributed across the globe. while we continue to see planning for sophisticated and coordinated attacks, such as those in paris, terrorism today is increasingly defined by small cells or loan actors, sometimes with little or no direct contact with terrorist organizations.

those people have succumbed to violent extremism. it is what you might call opportunistic or a do-it-yourself terrorism. the primary example of this new type of terrorism is the cancer of isil. isil has eclipsed al qaeda. the world has been shocked by the butchery and depravity of these twisted fanatics. from their stronghold in iraq and syria, isil has displayed unprecedented brutality. they crucify their victims and brutalize others. they enslave women and children and teach that rape is an expression of gods will.

they behead in his -- they behead innocents and broadcast it to the world. what keeps me up at night is that this threat is unlike what we have seen before. al qaeda focused on launching catastrophic attacks against the west. the so-called far enemy. they used the internet to post grainy videos in pdf form. isil is different. a recent report was subtitled from retweets to rock up. i think that underscores the scale of our challenge. these fanatics are online and on the ground. they are at once terrorists, insurgents and bureaucrats attempting to control a territory that was at one point

larger than the united kingdom. i still supporters have -- isil supporters have shown an ability to have broader tax, but they also direct foreign fighters to attack soft targets, like they did in paris. they deployed crude but deadly chemical weapons, which pose an imminent threat to syrians and iraqis. and they -- and through their use of social medium, isil has distributed the threat locally. they can inspire sympathizers and adherence air in -- adherence anywhere. they turn lost souls into soulless killers and they do it whether it is in bangladesh or in san bernardino. so even as we focus on isil, we can't take our eyes off of al qaeda, its affiliates or its adherence. from north africa to south asia, their desire to strike at american interests and citizens warrant our continued vigilance.

the most active of these affiliates remains al qaeda in the arabian peninsula and it has attempted to attack the united states multiple times. american airstrikes and international pressure have forwarded -- have thwarted external plots and targeted their leadership. we are paying very close attention to groups like al-shabaab and al qaeda and the islamic maghrib, which has shown brutal attacks and that it, too, remains dangerous. taken together, these all form a toxic group. and the different threat that isil poses is a danger that we cannot ignore nor underestimate. this is not an entity we can accommodate. so i will say it again. today, i self come -- isil, and all of its manifestations, insurgent army, foreign magnet, social media phenomenon, external operations contract, isil is the principal terrorism

threat we face as a nation. against this backdrop, we are applying lessons learned to a new and adaptive enemy. thanks to the brave military and intelligence personnel that we have, we have disrupted al qaeda's finances and training camps. we have hunted down their leaders, including osama bin laden and many others. him and al qaeda of 15 years ago has been decimated. al qaeda's remaining leaders in afghanistan and pakistan spend much of their time plotting their attacks. this is the result of the transformation our security apparatus has undergone over the past 14 years.

after 9/11, we implemented a series of legal, structural, and cultural reforms to break down the barriers that had grown up between law-enforcement, the intelligence community, the military and the functions not named at the time that we now call homeland security. i've seen first at the fbi and then at the department of justice and now at the white house how we brought intelligence and law enforcement tools together to confront this threat. we adopted new normals in anything from airline travel to our interactions with partners overseas. and the courage and dedication of counterterrorism professionals across two administrations has succeeded in

averting further large-scale catastrophic attacks on our homeland. so just as we are doing with al qaeda, we will degrade and ultimately destroyed i sold -- isil. as president obama told the nation, we will prevail by being strong and smart, resilient and relentless, and by drawing upon every aspect of american power. as always, whether confronting al qaeda, isil or another threat, we are guided in our counterterrorism efforts by a several core principles. we will always take every appropriate, lawful action to protect americans at home and abroad from terrorist threats. we will protect our values by continuing to conduct our counterterrorism efforts as transparently as possible with clear guidelines, strong oversight, and accountability, and in full accordance with the rule of law.

we will build and sustain effective multilateral coalitions and work with those partners to anticipate and annihilate terrorist organizations before they require an outsized military response. and we will integrate our counterterrorism actions with efforts to undermine the forces that few will terrorists, like political oppression and lack of opportunity. in recent years, we have taken clear and specific steps to institutionalize our counterterrorism approach so that our military, intelligence, and law enforcement communities have the tools and the authorities they need to sustain the fight for years to come. this includes putting in place a durable legal and policy framework to guide our counterterrorism actions consistent with our values. isil specifically, first, we are protecting the homeland. second, we are engaging our partners. third, we are taking direct action to target isil on the battlefield. fourth, we are disrupting the factors that enable them, like financing.

fifth, we are taking creative steps to counter the extremism that fuels and swellsisil's ranks. the first pillar is part of my job title and will always be our first responsibility as the u.s. government -- protecting the homeland. every day, i meet with the president to discuss the threats we face, whether it is terrorism, cyberattacks, or deadly viruses like ebola. his first question is always are we doing everything we can to protect the american people? he does not take his eye off the ball ever. is and i can tell you that the president and those of us on his national security team are focused every day on preventing future attacks at home or abroad, whether the terrorists are home-grown, isil-directed or isil-inspired.at disease it will be, we need to

start preparing. there are a series of things we need to do to get going. the time to do that is now. we say we, it's very much a collectively. it's just not the u.s. government proposition at all, it takes partners -- partnerships with the civil society and have it sector to create a comprehensive strategy. i would love to ask you about these partnerships, and how they complement government programs. what you've seen from your work in the field of how we can do it better and what is the right mix of partnerships? >> thank you everyone for being here today. hish laid it out copper handsomely. we shouldn't underestimate the scale of the challenge that you articulated. what we're talking about in the case of west africa is the part of the world where every

institution is weak. weak, institutions are private ossetians, civil society, tremendous strain on every answer to the society. i think the fact that we're talking about the zika by currents in the western how mr. makes it somewhat different. obviously it's a place with stronger institutions and stronger leadership. obviously, the two viruses are different. and represent themselves in different ways. i think we have a better shot in the current context than the context of ebola. but partnerships -- from my perspective, when we look at an effort to mobilize all the actors in a particular geography or market to respond to a public health challenge, we tend to look at this through the lens of a we call the total market approach. we try and understand where the failing exists in each market

place. we could be in terms of government policy, or in terms of the health sector. it could be in terms of civil society actors within the health sector. it could be in terms with what the private sector is doing to be engaged. everyone of those is subject to failure, market failure if you will as we try to orchestrate all of those actors to respond to a public health challenge like this. i said, in the context for zika is much more promising in terms of all of the different players that can be brought to bear. that said, one of the perpetually challenging faultlines in that environment is between the range of public sector access, society, governors, donors, and the private sector. the private sector can have a huge role to play. in the immediate context for zika virus, we know that even as all the research is underway, and a day doesn't go by where we don't learn something new about what this really means, right?

we select to focus on in particular, the women who are pregnant now, who are considering becoming pregnant, remembering the fact that half of all the pregnancies in latin america and the caribbean are unintended. what are the practical steps that can be taken right away to help protect them? we know insect repellent as part of that, private sector is the one that is manufacturing insect repellent and marketing in all of these markets in latin america and the caribbean. that is a conversation that needs to take place rapidly as we talk about practical steps to help women deal with the consequences of this threat right now. ms. plack: i want to ask you about the report that he mentioned, the report of this strategic diplomacy. can you tell the audience what you mean by this? what it is, and how it can be used in terms of the response to zika?

>> thank you for that question. it's great to be here. the concept of strategic health diplomacy is essentially that by addressing global health, we can also advance our national security interests. it is trying to bring global health and national security closer together. when we do global health work, differentom perspectives. we tried to see if that far, which was a tremendous global health success, supported in a bipartisan way i started by president bush and continued by president obama, we know that it in immensely successful terms of reducing morbidity and mortality, increasing education for health care workers, but we wanted to see whether there were any second order effects that

were related to the global health initiative. we compared recipients to non-recipients. we looked at public opinion and found that in these countries, public opinion of the united states was significantly higher than the rest of the world. when surveys were done and residents in those countries, they were asked if this hasn't come in, what would your perception be of the united states, it was always lower. we also looked at social economic status, or religion average output for worker, and a macro economic perspective to look at human development. in both instances, these countries are performed over the course. and then we looked at state stability and governance, which in vulnerable populations and the prevalence of hiv in military personnel. we looked at aids and orphans and found significant reductions versus non-participants.

and then we looked at rule of law, absence of terrorism and also found substantial improvements. is conclusion of the report essentially that we weren't trying to prove or demonstrate causation here, but that there is a correlation, there's something here, an important healthion between improvement and global health initiatives. and our national security interests. i think the lessons learned from ebola for strategic health diplomacy initiatives and for toa, r 1 -- initiatives need have clear goals, and these need to be understood by all partners. they need to be to find, going back to clear goals. i think the focus here is really on ensuring that pregnant women andot get infected by zika, also childbearing women of the information, education and

resources they need for family planning. there have to be clear goals. the need to be defined interventions. we need to be implement it in a way that is sensitive to local contacts and culture. thisnk he will talk about in perspective ebola, but understanding local context is critical for the success of any initiative. we need to be in it for the long term. you need to build capacity, and you need to be transparent and accountable. think these are all lessons learned, which we will probably talk about. these are things that when we looked at this to demonstrate why was successful not only from a global health perspective, but also these potential second-order impacts -- these are the things that bubbled up. i think these will also be important for zika as well. ms. plack: i want to follow up on your lessons learned, particularly with the regional and international responses and some of the international partners. someone said that the speed at which the who declared zika a

public health emergency was a direct reaction to the chris's and they received over the response to ebola. as of now, what do you think about the international response , does it reflect our lessons learned, and if not, what war needs to be done? dr. jha: great question. if you think about the timeline, in the end of march 2014, doctors without borders said we are overwhelmed, this is obviously in the context of ebola, they said we are overwhelmed, this disease is out of control, we need help at the end of march 2014. that the until august who declared a public health emergency of international concern. by the end of march, about 300 people have died. the who finally responded, the disease have become far more widespread. that delay is what a lot of us have focused on. i have asked hard questions about why was there that delay and how do we make sure that doesn't happen again. i do think, as a response, who

has been far quicker. there have been some people who said it was too quick to declare this time, it's not the same disease, it doesn't spread in the same way, it's not clear. who did a very narrowly, in the context of microcephaly. they said this is a public health emergency of international concern. i don't think they have overreacted, i think it's a personally reasonable call. it doesn't reassure me, i will tell you why. right now, there's a spotlight on who. real question about whether who can play the role that we all needed to play. of their being far more responsive, this is not the stress test that we are looking for. the question is what happens two years from now when the spotlight is off and people aren't paying attention. will who have put in the kinds of changes it needs to respond to the disease when it is not in the headlines? that is what we need to the way

joe to do. we don't need them to tell us where problem when it's in the headlines every single day that we have a problem. i think it was a perfectly reasonable thing with who did. it has not offered me reassurance. there are important structural reforms that who needs to go through that it has not gone through yet, including being far more transparent, having a lot more accountability -- we layout specific things, which i'm happy to get into. but until those things happen, i'm not going to sleep any better at night knowing that who has learned its lesson from ebola. they are doing what any of us would do, which is if you mess up the next time in the spotlight, the same question comes up, they're going to get it right. but it's not clear the you've learned the lessons for the long run. youplack: and when asked about this idea of international cooperation. we spent a lot of time at the department of health and human services, and now at bipartisan policy center, what are the critical areas of international cooperation? what are we doing well, what do we need to do better in terms of

the international response? hhs fromh: i was at 2005 to two dozen 15, four h-one, h1n1 at 2014, and ebola. the pillars of what people think about, this is the global security agenda, that every country in this world ought to be able to prevent, to detect, and to respond to outbreaks as emergencies. when you think about the key areas that we need international cooperation on -- i think we are seeing into a certain extent here with the zika response, first, surveillance and laboratory capacity, which is critical. there has been good cooperation here thus far, you have u.s. scientists in brazil right now running case-control studies to better see the association between zika and severally. the ability to detect is

critical. cooperation in vaccines of seeingutic -- we are some positive signs in terms of sample sharing right now. that's a critical piece of responding to outbreaks. provider training is critical as well, making sure that health care workers all around the protocols access to and the best level of evidence and care for whether it's women with zika, whether it's children with microsoft fully. in this particular instance, for diseases that are mosquito borne, vector control is absolutely important as well. i think there's cooperation their own techniques to reduce that in the water or limited breeding grounds. i think one of the most important areas of international cooperation however, is education, communication, and public messaging. making sure the general public understands the nature of the outbreak, what is causing the outbreak, that this isn't

something that is made up. making sure they understand how to protect themselves, focusing on prevention. i think this is one aspect where -- i think the who is leaning forward with respect to zika, , thehe importance of this importance of reducing stigma, the importance of meeting countries where they are and giving facts and information to the general public i think is a critical piece in really entire international community needs to work together on that piece. mr. hofmann: i agree with that. and the importance of communication in general as quickly informed. i love the opinion of these to help put -- public health physicians about how you think we are doing so far in terms of the zika communications? how is it going?

i will give a quick one. one thing that's clear, we didn't do a good job with ebola. we can begin with that. one of the key lessons on these things is trying to tell people not to worry is one of the most ineffective things you can do when people are worried. acknowledging the fear, understanding the fear, and walking people through it -- my general sense is that it has been much better under zika. people have not downplayed it, i've heard early from the cdc, from other leaders in government about windows the guys coming to the u.s., and now we know it's here, it's going to be even more substantial. being very clear about what we know, not overhyping it. ebola crisis, there was a sense of we know how to manage this, we have a great health system. this will not spread here. it the first nurse who got in dallas kind of blue that

whole story up. the bottom line is, it wasn't that badly handled. we did a good job, but the key medication did not work for a well. he gets going much better. i would be serious if you disagrees. dr. parekh: i agree. we of the difference was were focused on three countries. the zika, we had transitioned and 31 countries and these are very different. you start with a country like brazil, there are hundreds of thousands of health workers trying to educate people. the public health of a structure is more robust. another, we are allies, ally of the u.s., perhaps. if you look at other countries, el salvador, haiti, venezuela or we don't have excellent diplomatic relationships, we don't know. i think is an excellent question. some of these countries -- we just don't know how the public health communication and messaging is going. i think that is a key point as well.

trying to meet countries where they are. there are some countries like brazil and colombia where we can be a little more confident in how things are going. there are other countries where we don't know a lot. there is some reports that we are not really getting good reporting back from some of these countries in terms of new cases of things like that. it's unclear what messages are getting filtered to that population. ms. plack: i think one of the lessons with not just what you were saying, but how you are saying in his twos -- is it who is saying it in terms of local context. i don't know if you have a comment on what the lesson was in terms of local context. i know you all work in central america, how you ensure that we don't have a one-size-fits-all approaches can indication problem? -- one size fits all approach to >> a bigunication issue is understanding the local context. even understanding the individual context.

we look at that as consumer insight. understand what drives the individual and helps what is good for them and public health? in made a similar point terms of fear not being a good motivator. me, i things, a lot. i have something here with me. no salesman should be anywhere without something to show. that we havetotype developed over the last few weeks. we're talking about a zika kit or a safe pregnancy kit.

they context of trying to motivate healthy behavior, sometimes they need a product. sometimes we need something more than a message. we have used human centered design concepts. cloth used to demonstrate how you apply repellent. of ae, we have the concept kit that will include various things. it might include repellent. i cannot bring it into the capital. we had some cans of off. repellent could be use it a trimester of pregnancy.

the idea would be that a pregnant woman would have access backkit like this and come to a health center for a regular checkup every few months. she gets the content three filled. you might have condoms. transmissionsexual has been well-documented. do we help women ensure safe pregnancy? then, we might have something like a multivitamin. ae cdc has also suggested mosquito net. --se mosquitoes do not buy buy at night. that coming up with that will help people add something meaningful to pregnant women a way that they

can respond to the danger. this is prohibited because of the repellent. we talk about what the private sector might be able to do. condoms are not a significant cost. even mosquitoes are not a significant cost. the repellent is. we have to figure out the cost. with a subsidy you can use some bank this. we have the individual reality for the health consumer you are trying to reach with the correct approach. , i will keepo add harking back to ebola. the lessons do apply.

to discuss ation response. the we have the one response over and over again. you can have the best public message in the world. but, if people do not trust you, it will not work. the truth is that trust is not billed during a crisis. trust is built over a long run. what they describe was by the time these countries have a plan is for people in the community. who said we carl have weak institutions and west africa across the board.

some became, you have a spouse who is sick. some ratios up and said we will go to a hospital. they take them away and the person dies. , youat continues to happen avoid public health officials. you do not trust them. so, a part of communication that is contextualized during a crisis. it does not work. that was a major part of the failed response. i think you're right. we do not know how well it is happening in venezuela. we are not sure how it is happening in many places. i think zika has gone much better.

my only fear is that somehow we will think we will figure this out after ebola and then be done. i think we got lucky after ebola. this happened in a much better place with a much better system. the next when we may not be so lucky. >> i want to ask one more question. kit, it is ahis prevention kit. paradigm change the from dealing with emergencies to preventing emergencies. to do we go from reactive proactive on these issues. what is the political will that it will take for u.s. policymakers with the global community to shift how we think about these things swear not fighting the current emergency, but planning for the next one. --? will turn it over. to, we do we have have to understand the context of what is happening here. we spend enormous amount of resources and do it over the long run. things like preventing nuclear

weapons from getting into the hands of terrorists. why do we do this? we have never had this. it is because we understand that if that were to happen, that will be a nightmare scenario. where perfectly willing in making the investment. i think we have not seen pandemics as posing the same kind of threat to the people of this country into people around the world. yet it does. again, i'll go back to ebola. the average ebola person spread it to two other people. the average person who gets measles spreads it to 18 other people. if you imagine a disease or spreads quickly and is fatal and lands on the u.s. shores. it can be quite devastating. yes, it requires a long-term

sustained effort. how do you create the political we havedo that go figured it out in other arenas. my idea is that we have to think of a pandemic as a national security risk. if we do that, i think will be much more open and ready to make good investments. panel through the school with another panel at the institute of medicine. it was the global health framework. it cost billions of dollars to make the world a safe place. i'm not sure if that number is completely correct. it is a trivial investment if you think about this as a national security risk. much as $4.5 billion. we are lots of partners in europe and other places who can pay for it.

i think we need to get started and get moving. this is not about ebola or about zika come it is about keeping people safe. >> these are things we will face as individuals and as a society, the problem of convention. it is something we do personally to prevent these problems in the future. that said, i'm an optimist. because i camet to global health through the foreign policy national security avenue. started working in africa 30 years ago as a foreign service officer or i realized then in the american embassy roast stationed realized that issues around hiv were clearly important to national security.

when you look at reports they demonstrate when you look at the success of malaria and the , is the really tremendous progress we have seen with global health over the past , your reason to be optimistic about our ability to get this right. we are getting better than we would have 30 years ago. so, i look at the glass half-full. ofan important principle public health preparedness is from a health perspective and a cost perspective. to be inays better front of the curve rather than behind the curve. if we think is -- preventing an outbreak will cost this much money, it will cost more if we wait for the crisis to occur. ensuring that political leadership and understanding that it is critical. tohave an important mindset

instill amongst the political leaders. outbreaks and pandemics, they do not necessarily just come and go. it is important to continue the ebola investment to ensure that the public health infrastructure is strong. otherwise, it will just come back. it is not we are done with that and move on to the next one. we do not just treat outbreaks one at a time. the point of diplomacy is that you need to be invested in the long term. you need to invest in a capacity building. that is what establishes the bilateral ties. it is on for so many other topics. that builds the trust were talking about as well. i think that prevention is critical. not looking at individual outbreaks one at a time. -- is important

for us to remember. >> do we have microphones? there is one. let's take at least two questions. then, we will have panelists respond. say your name and organization. >> i am a leeza waxman. i work with the a bullet case. i am working to develop a joshegy for our ordination coordination across the effort. one thing that is important for me and my team is to have the lessons implement into policy and how we structure ourselves in the future. what would be the key things to to draft these recommendations so that they do not get shelved.

they are used to tactically influence a higher level. >> i saw a few other hands. we will go here and make our way forward. >> hello. my name is lauren weir. question about diplomacy. we all know that in global health, money is frequently siloed. this money is for hiv. this is for malaria. this is for ebola. we also know that human beings can have ebola and hiv. so, one of the lessons that came out of west africa was coordination and collaboration between different programming. i do not anticipate we will fun things in different ways. my question is, and not to pick on haiti, but i will. how do we collaborate as donors?

whether it is the usa, cdc or these countries to ensure that an area we are already working in control or condos for hiv that we are not re-creating the wheel or adding a complex program. haiti has a big condom investment program. how do you leverage that with zika investment? >> we have practical recommendations and the importance of the collaboration with the international governments. >> let me take the second one. -- i agree time for with what they said about the phenomenal success of fars and the malaria initiative. i think the times for malaria

initiatives is behind us. they were right for the time. they need to keep going. there are several reasons why that time has passed. a lot of which you articulated. one of them is that we cannot protect -- predict what will happen. it is not an effective strategy. for the writer reasons, not the least of which is that you start building parallel infrastructures. with countries like rwanda that and taken their resources other vertical programs and started building broader systems. that is doable. we have to figure out ways of encouraging that make broader investment health systems. this is a phrase that on one hand is right. people say what does that mean? ther building health in

long run. the answers that there are important ways in which we can be helpful. companies will only be safe and effective if they have health systems that work. so, i think that is a shift in global health. i should stop there. >> i did say i was an optimist. on these questions of vertical programs and the logic of horizontal approach, i have to confess i'm a pessimist. having moved inside the bureaucracy for some time, i have to say why these things grow in vertical fashion. this is probably the prime example in a public health context. we all know that you could get of did get in the offices the pharmacy center is a great

regional congressional facility. because, the humanitarian and the national security and all the other aspects are brought together in bipartisan fashion. it has been sustained and funded. if the approach had been the president's emergency program, it would have failed. we know that. and, i think that is a political reality that we have to reckon with. efficient. it is regrettable. it is the way we have mobilized many of the resources that we global deal with the health challenges. it has delivered a lot of success. i would rather take the vertical program that has resources in a horizontal program that does not.

and, just a point on condoms, we condosponsible for the market in 80 such as it is. i totally agree with you that it is important to have a functioning condo market in every country. have multiple benefits. yes, certainly with zika as well. lots of different actors have roles to play in ensuring that the market functions well. involves both donors and a private sector. a private sector. social marketing, commercial marketing. >> i will add that i'm not an with state department and global health programs, but in an ideal world, we should be .ble to be nimble

one it comes to zika and we understand there is a need of family planning realize a lot of these countries are graduated from receiving court dollars, there should be a way to see whether resources, if this is a bigger crisis than it is could potentially be channeled to the countries where there is a need. >> talk about malaria. there is a crisis. the mosquito might be difference. there could be comes troll -- allowingtrategies resources in one area where there is a crisis to allow us to combine them. think as carl said, there are some realities here. i think being nimble when we can is very important. >> ok. i apologize if i cannot get to everyone.

i have some on this row. we will try to get to you. i'm sure panelists will have some time to. curtis with the coca-cola company. in regards to public and private partnerships, we would like to get their thoughts about the global security agenda. thank you. >> linda gaudi, i am retired from the department of agriculture. i only heard about this problem. does this makeck someone who gets it. and, maybe it could spread more because they do not go to the doctor. >> i am jeanette roberts. i'm with senator markey. this year, we have mentioned the

condoms and the kids, and family planning. the concept of zika, we have the sexual transmission abilities. they are all now pretty tight. zikathe complications of being president and a largely catholic country really complicates that conversation. i'm wondering if we are making any headway on women's reproductive health and light of the zika epidemic. what's -- >> let's let you guys pick and choose. beenka, like ebola, has proportionately disinfecting the poorest people. those kits require a primary health care system along the continuum of care and community health workers who can get to

the people and provide this service. i like to hear more about investment in that platform that becomes the security that we seek. >> what i might recommend is that we have a few questions on the table. if you can go down the line, we are running out of time. we will start with you. oneet me take the second about zika. a couple of issues. this is more medical than policy. you know, we talk about the alleged connection. it is true that we have not nail this down. it is pretty convincing that there is a clear relationship between zika and other neurologic factors. there is a pretty clear connection between the disease people can get after zika. the thing that has been the biggest surprise with the latest data coming out, number one, you

do not have to be that sick. you could have a high fever and a bad rash. finding thatsingly a lot of women have a very mild disease. they might not be aware that they are sick. they are sick for a day then they get better. they will have quite substantial and their logical effects. most of the time these issues are pretty devastating. if you think about how widespread zika can be across 31 countries, this is a very substantial human toll. i want to make one other point. i completely agree with our colleagues from arts and health. these things always impact of the poor the most. this is the nature of the illness. people who are wealthier with moreresources can respond

effectively and have more ability to fight their way through the system. health in of global would argue over the last two decades is the notion that we are only a safe as the most vulnerable people. , i completely agree and understand the argument that the president has had emergency programs for building community health workers. it does not have quite the same cash. we have to be creative and think about how do we be sure that the resources we have help invest in things like community health workers. you can the best technology and diagnostics, if you cannot get it to the people who need it, it does not work. we have to solve that end of the problem. i agree. we know what the right thing to

do is. it is politically challenging, but it is certainly the right thing to do. i feel like i have been on a mosquito tour this week. on monday and tuesday i was dealing with the context of malaria. mosquitoes use different buying patterns. they're talking about the zika mosquitoes. just the sobering facts in terms of health care investment that is needed. but, astounded by this, the democratic republic of congo with a 70 million people be total government expenditure for all purposes in the congo this year will be $5 billion. all but the government of congo spends on everything. we see the scale challenge. building up a primary health manysystem will cost multiples of $5 billion.

so, to get back to this point about a week infrastructure and weak institution, it is sobering. coca-cola, we have collaborated with different places around the world. gives usy chain yield the ability to move products. we have the world-class ability to influence behavior. that is what marketers like coca-cola do. obviously, you have a workforce that is impacted by many global challenges. it is important to try to figure out the private sector in the context, it is the case. i think it is too soon to say, i hope it is the case that a public health emergency like for opens up a wider space women's reproductive issues. it is a hope at this point. it is not a reality. quickly,d like to add in terms of private partnerships, we have had tremendous success and the needs

of water sanitation and hygiene. we have stagnant water and water related issues. it is a bad area where we need better partnerships. it helps us on the vectorborne disease side. put in onel just plug there. have the issue that we have to deal with reproductive health. when involuntary family health planning. i will end on primary health care in terms of the physician. one of thedamentally most important things for any health care system. country, if there is anything we can do to help support the primary health infrastructure, it is tremendous.

as about a smart global health. this could be one of the best. make boths we could short-term and long-term. >> away wanted to turn it over to wrap up. >> we have the practical recommendation request. we also have both reports over on the side table. >> thank you. thank you for doing such a good job moderating. with such brilliant minds that i thinkon the panel, about the take away is that we have the tools and experiences in the lesson from past examples. we have to avoid the next pandemic. we'll keep thinking on that. definitely, we, in conjunction with others want to think the doctors and lindsay for their

work today. thank you all for coming. [applause]