emergency department with a fever of 100.1. abdominal pain, dizziness, nausea and of 101. d he was examined and went over tests. in the time his temperature went to 103 and later went to 102. and he was discharged and we provided a time line on the notable events. mr. duncan was transported by

ambulance to hospital. the csc was notified. the hospital followed safety to protect staff, nurses and visitors. protective was water and surgical mask and eye protection and gloves. since the patient had diarrhea shoe covers were added. we notified the dallas county service department and the infectious disease specialist came in. they confirmed the first case of ebola in the united states in dallas. later that day cvc officials were notified and they arrived on our campus. >> doctor, one moment, please. i know we are going way over time and can you wrap up, the

members want to ask you questions on these details. >> in conclusion, i would like to underscore, that we have taken all of the steps possible to maximize the safety and we'll continue to make charges. we are an agent of change by helping our peers benefit from the experience. tex tegs health resources has a long history of excellence and our mission and ministry will continue. thank you for the opportunity to testify and i will be glad to answer questions from the committee. >> thank you. we'll recognize with the five minutes of questions and keep a strict time on this as well. let me start off here with dr. freeden. the second nurse took a flight to cleveland after having

a fever. and the cvc was called and said she could fly. my understanding is that she did contact cvc and we talked to her. >> were you part of that conversation? >> no, i was not. >> was there a pretext for limiting her contact? >> the protocol for movement and monitoring for people exposed to ebola identifies as high risk as someone who did not wear appropriate equipment in the time they cared for a patient with ebola. >> let me ask this. what did she tell you. mr. duncan was wered -- was not under the travel restrictions of people he came in contact with. what specifically was the symptoms and what happen? >> i have not seen the

transcript of the conversation. my understanding no symptoms were reported to us. >> with regard to the new patient transferred to nih, will people contacting with her be under travel restrictions? >> doctor, you perhaps know that? >> according to the guidelines of the people coming in to contact with her, will be physicians, and nurses and others who will be in personal protective equipment and therefore they are not restricted. >> why is she transferred to nih. >> to give the state-of-the-art care in a containment facility. >> has her condition deteriorated or improved. >> i have not seen the patient yet. but from the report we are getting from our colleagues in dallas is that her condition is stable and she seems to be doing

reasonably well. i have to verify that myself. >> and will other people be transported to nih. >> we have a limited availability of beds. we have two beds and she will occupy one of them. >> doctor frieden you are opposed with travel restrictions because it would hurt the flejing democracy. >> did the administration advise oregon agencies, where did the opinion come from that that is of high importance. >> my sole concern is to protect americans, we can do that by continuing to take the steps we are taking here and. >> did someone outside of yourself advise you that that is the position to protect flejing

democracies. >> my recollection is that we stop the epidemic at the source. and so stopping planes and i heard you say this in multiple occasions, we have a thousand plus persons a week coming to the united states from hot zones, coming from those areas? >> 1 to 150 per day. >> thank you. >> and the duncan case impact approximated dallas and northern ohio. if the administration insists on bringing ebola cases in the united states, clearly they have determined how many ebola infection cases they can handle. nih can handle two. how many over the country? >> our goal is no patients. >> i understand that. and as long as we are not

restricting travel and quarentining people and limiting their travel, we have a risk. and so the issues of surveillance containment. the american public are asking, why are folks allowed to come over here with no quarentine. >> our fundmental mission is to protect americans. >> i understand that, doctor, and i have a high respect for you. but even though they are not limited from travel and quarentined for 21 days. and they could show up with symptoms and bypass questions in the thermometer and this is what happened with the nurse that went to cleveland. is this the position of the administration that there are no travel restriction. >> we'll consider any option to better protect americans. >> i now give my five empties.

>> thank you, mr. chairman. dr. frieden and doctor varga. i have a lot to move through and appreciate only yes and no answers. in the spring of 2014 ebola spread through west africa and causing concern in the international public health community. >> correct. >> ebola is not contagious until the person with the virus begins to be symptom. >> 2- 21 days yes. >> ebola is transmitted with the patient's body fluid. vomit and feses and saliva and concentrateds more heavily as the patient becomes sicker, >> correct. >> the cvc developed guidance for the hospitals to follow if patients consistent with the

symptoms of pullbulland distributed them in the summer of 2014, correct? >> correct. >> dr. varga, can you hear me? >> yes, ma'am. >> your hospital received the first health advisory on july 28th and it was given to the the directors of the emergency department and signs in your emergency rooms, is that right? >> yes, ma'am. >> was it given the emergency room personnel and training in texas presbyterian for the staff at that time? yes ono. >> was given emergency department. >> was there actual training? >> no. >> on august 1st, your hospital received an e-mail from the cvc specifying how to take care of ebola patients and how to question people from west africa is that right? >> that's correct.

>> after the first advisory, thomas ericuncan showed up in texas presbyterian with a fever of up to 103 and told the personnel he had come from liberia and despite, the hospital sent him home. right? >> not correct. >> they did send him home, right? >> that's correct. >> he took a severe turn to the worse and brought back by ambulance the hospital and nurses and everybody else wore protective equipment, is that right? >> right. >> do you know how long it took them to put the shoe covers on? >> i don't. >> and now because ebola is highly contagious when the patient is symptomatic protective gear has to shield them from bodily nudes, is that

correct. >> correct. >> i got a sloyd, a photo of the people in the various protective gear, and so the first one on the left shoes what they are supposed to wear when they come in contact when they are not having contact with the bodily fluids and the second one shoes what they are supposed to have with bodily fluids. let me ask you, dr. varga is what they were wearing the first set of protective gear? >> i can't see the picture right now. >> >> i was told you would be able to. >> dr. frieden what should they have been wearing before the ebola was diagnosed. >> i can't make out the details. but the recommend vary at the risk whether there is diarrhea and vomiting and expose health care workers. >> this guy had diarrhea and

vomiting, and so in your testimony people should have been completely covered? >> i would have to look at the details. >> so you don't know if they should be completely covered if the facient approximate diarrhea and vomiting and from west africa? >> that was recommended under the cvc recommendations, yes. >> i am going to have to dr. varga since you can't see my chart. a number of health care workers were put into this protective group and work, is that right dr. frieden, people who were monitored and on october 10th. nina pham was admitted to the hospital with a fever; is that right? >> yes. >> and amber vincent presented

with a fever and told by your agency; is that right? >> that is my understanding. i need to correct that. i have not reviewed what was say, but she contacted our aenls and did board the plane. >> she said she would told to board the plane. your august 22nd protocol say that people who are monit thorred should not travel by commercial conveyance. that's what they say? >> people who are in what is controlled, controlled movement should not board commercial airlines. >> that is people with close contact with the patients, that's what the guidelines say. >> health care with appropriate protective equipment don't need to be. but people without personal

protective. >> chairman. >> i just asked for the record the interim guidance stated october 2nd and august 21st and. cvc dated july to be included. >> without objection. doctor frieden, and the texas doctors. your comments you just made to us, if she was wearing appropriate protective guyer she was okay to travel. and you told us we don't know. we'll recognize the chairman of the committee. >> thank you, again, mr. chairman. most americans realize it is you have 21 days, if you will go beyond 21 days, you are at no risk of ebola.

but it is conceivable after 14 or 15 days, you can get ebola; is that correct? >> yes. >> i want to go back to the restriction of travel by nonu.s. citizens, those 150 folks a day to west africa. and the conditions, exit screening and all folks are exit screened and it is conceivable they can exit screen and they are okay and no fever and in fact, their destination, perhaps to the united states. and have the worst, is that right? >> and so if our fundmental job is to protect the american public. the administration as i understand it. and i have looked at the legal language. the president has the legal

authority to impose a travel ban because of health reasons including ebola. >> i don't have that language. >> i saw language today, we can share with you. and he does, not only an executive order that former president bush issued. and so the legal standing as well. if you have the authority and a number of african countries around west africa and the three nations have imposed a travel ban from those three countries in their country, is that true? >> i don't know the restrictions details. >> it is my understanding they say no and jamaica, as i read in the press earlier this week,

issued a travel ban from folks coming from west africa. are you aware of that? >> i don't know the details of other countries have done. >> i guess the question i have, if other countries are doing the same and the fundmental job of the u.s. now is to protect u.s. citizens, why cannot we move to a similar ban for folks who may or may not have a fever, and knows that the exposure rate, 14 or 15 days is well within the 21 days and knowing that 150 folks coming a day, not 100 percent. 94 percent terms of screening from the united states airports, it seems to me that this is not a fail safe system put in place at this point? >> mr. chairman, may i give a full answer. >> i look forward to it.

>> right now, we know who is coming in. if we try to eliminate travel and they will come in by land and we'll not be able to do multiple things. we'll not be able to check them for fever. >> can i interrupt you, can we not see the passport. >> borders are porous. >> and may i finish, especially in this part of the world we'll not be able to check them for fever when they leave or arrive. and currently to take a detailed history to when they arrive. we'll not be able to impose quarentine. and we'll not be able to detect detailed located information not

only name and date of birth and e-mail and addresses of friends and we can identify and look at them and we would not be able to provide all of that information to the state and local health departments. we would not be able to impose controlled conditional release on them for active monitoring if they are exposed. >> my time is expired and i have a swift gavel to my left. i just don't understand. if we have a system in place that requires any airline passenger from coming overseas with a date of birth and make sure they are not in a aspect terrorist list. and look at their travel list. no, you are not coming here. it needs to be solved in africa and until it is, we should not

allow these folks in period. >> time has expired. >> and thank you, mr. chairman. >> dr. frieden, you have a difficult job and in fact all of your colleagues in this agency have a difficult job and it is a fast- moving issue. you are trying to explain things to people and limit information. and they have to be invited in by the. you are dealing with a fast- moving situation and you have to strike a balance about informing the public on the one hand and keep it from panicking on the other. and so let's go to basics. if people are frightened about

getting ebola, what assurances can we give them that it is not going to be a widespread epidemic in the united states as you have said. >> the concern for ebola is first and foremost for the people caring for ebola. we are concerned about the treatment. and in the health care system as a whole, to think about travel. someone who has a fever and signs of infection needs to be asked where you have been and if they are in west africa isolated and assessed and cared for. >> we have to make sure we monitor health care workers. they are exposed to people with ebola, and what about the people coming in from africa and countries where the ebola episemiic is taking place. why don't we restrict the travel directly or indirectly from

anybody coming in from those countries. i would like to put up on the screen a map to show passenger flows from those countries. that map shoes if you hold it up here. if you are looking at particular countries in africa, they can go to europe, turkey and saudi arabia, and china and india and go to other countries in africa and from those other countries come in the united states, i suppose we could set up a whole bureaucratic apparatus to make sure someone didn't travel from any jerria or cameroon or sierra leon to make sure they didn't get here from those countries. that could be our emphasis, but what you are saying, we want to monitor people before they leave

the countries to see if they have the infection, and we want to monitor them when they come in the countries to see if they have the infection, is that what you are proposing to do? >> that's what we are doing. we screen on entry and get and determine the risk level. and if people came in going over land to another country and entering without our knowing, we would lose that information. currently we have detailed locating information and taking detailed history and sharing information with state and health departments so they can do the follow-up. >> do you agree with dr. frieden at this point? >> i do. >> we say seal off our borders and don't let them come in.

usually an immigration matter and in the a believe health. but certain countries, the epidemic is originating, why not stop them >> i think dr. frieden and yourself articulated yourself. it is understandable that someone meet comto the conclusion that you ought to just seal off the border. if you have the possibility of doing all of those lines you show, that is a big web of things we don't know what we are dealing with? >> this epidemic can spread if there is contact with body fluids of someone showing the symptoms of ebola and exposed to that individual. if we had a travel band, wouldn't we just force these

people to hide their recommending? and wouldn't we also not know where they are coming from and if that are going out the way to fight it and fighting the epidemic in west africa and the worst it becomes in west africa, the greater problem it will be all over the united states; is that your position? >> thank you. and now we recognize the vice chair for five minutes. >> thank you, mr. chairman. dr. frieden, i want to make sure i heard you right. we can't have flight restrictions because of a porous border. do we need to worry about the unsecured south sxern norther border. >> i was referring to the countries of africa >> you are referring to that and not ours? >> sierra leon.

>> would it help if we eliminated illegal entry. >> we are going to read the information in the database and ask them where they are coming from. >> yes or no is sufficient. i need to move on. dr. frieden, i want to come back to you. a week before last and in the cvc. and i thank you for the letting me follow-up on the committee work. i recommended in a quarentine in the affected region. i think we should consider that. quarentine that region and it helps every country. going back to the issue in the subsequent phone call and that is medical waste. you assured me standard protocols were followed for the disposal of the waste.

25 years ago, hospitals could insenerator. and epa regulations prohibit that and the waste has to be trucked. and they outsource the care of the medical waste and it results in that going to central processing centers. and so let me ask you this, is ebola waste as contagious as a patient with ebola. >> ebola waste can be readily decontaminated. the virus itself is not hardy. and killed by bleach and variety of chemiccals. >> is ebola waste more dangerous than other medical waste? >> the severity of the ebola infection is higher. you want to be certain to hand it. >> is cvc assessing the

canability of hospitals eliminating the waste and allow off sight of ebola medical waste. >> the latter question. yes, we worked with the department of transportation as well as the commercial wastes management companies. >> we have an admissibilitied danger in having to truck this waste and move it to facilities? >> and are the employees in the processing centers trained of how to expose of ebola waste. >> we have detailed guidelines for the west of ebola patients! you and i talked about the troops over fort campbell and my constitients have questions. will the american troops come in contact with ebola patients or those exposed to ebola or

included in any of these controlled movement groups? >> as i happen it from the department of defense. there are no plans for paeshts with ebola and that said, we would always be careful in countries. there is a possibility of coming in contact with with symptoms and that's why the department of deputies and careful to desclose. that >> we are relying on self reporting. >> we taking the temperatures and hand washing. >>'s minute you are moving away from self reporting. and i found a quote from december 2011 at the joefrj

comstock lecture and tv result. >> hippocrates. was right. most patients don't take the medication. you can delewd yourself and in tb, we believe they took their meds. dr. frieden, relying on self reporting and making certain that people tell us the truth and we catch the fever in the right time if they have a temperature. we have to do better than this. we are here to work with you. and we expect a better outcome. i yield back. >> i would like to thank the panel for joining us today. dr. frieden, i was happy to hear you say we will consider every option to protect americans. are you familiar with the centinal event reporting.

snshg yes. >> has cvc done a root cause analysis of what happened in texas presbyterian and come up with an action plan on what we learned? and we have the detailed list of ebola preparedness and if there is changes and modified in light of what happened in texas presbyterian. >> we have 20 of the world's top disease detectives in texas. we left for the first day the patient was diagnosed and identified three areas of focus. first prompt diagnosis of people with ebola. and second contact tracing and the graphics outlines what we are doing in the state of texas. they are doing a terrific job making sure every contact of the

first patient is monitored and the temperature taken by the outreach worker 21 days. and so of the 48, none developed symptoms or fever. and we are now looking at contacts health care workers who may have had contacted as the two individuals infekted did. we are delighted to nih is supporting the hospital in texas and emory university is doing that as well. and the third area, after identification and contact tracing effectiveoisealation. we are looking closely at what might have happen. >> and i assume new recommendation based on that analysis and protocol would be updated and redistributed? >> we always look at data to

help protect americans. >> you are kind enough to share with us in graphic and you mentioned new link, which is working on one of the vaccines that went in a clinical trial; is that correct? >> that's correct. >> i talked to two employees and i know they are working around-the-clock trying to help come up with a vaccine and that meets the protocol. and the who. and hhs. and public health agency in canada called the vaccine as one of the most powerful in the world. and they are adding a third site for manufacturing to scientific studyings required. and complete the additional safety study to provide vaccines that are equivalent to the

original vaccines. and companies that work as subcontractors. what is being done to make sure those contracts are moving forward. >> we reviewed the proposal and it looks favorable. we'll finalize the negotiations with them. prior to that, we'll help them with assistance on sight and manufacturing sights and working with them to expand their production with other companies. >> and also, about brailly. the hhs is involved on the other end of it. the trials that were started were in collaboration with the department of defense. it is a phase one trial. not only in the besting but the directions. >> it is my happening that the

ultmeat goal is to expand the clenical testing in to the affected remmingions in africa as well once we have happening of the concerns that were identified earlier in your testimony. >> that's correct. after we get through phase one in the trial. i was talking about both vaccines and the new link. if they are safe and induce the response. we'll expand them in trials in west africa. >> we heard about the issue of travel restrictions and can you walk us through the strengths and weaknesses from your stand point on border security. >> >> we have the ability to use the data that the airline gives us to see where travel is

originating from. they may go to different location but through the review of the passport we can identify they are in the area. and it is more difficult for us to do it, and the possibility is there and greater that we would miss one. i agree with what the experts say. it is easier to control it where we know where they are coming from. >> the key word is vol fairly. >> i recognize dr. burgess. >> the travel restriction, the secretary has the authority to issue a travel restriction. and the president has the ability to issue a travel restriction.

2005 was a mended to enclude hemmereragic fever. that authority exist and why is the executive branch and agency will not exercise that authority? i think this committee should consider a question to the full house we have a vote on full travel restriction. people are asking us to do that. >> and dr. frieden. the first nurse infected is transferred to texas presbyterian. and her condition is that she is stable and improving. the reason she is being removed because the personnel are no longer willing to take care of her? >> texas presbyterian are dealing with a difficult situation. they are working very hard. and they are now dealing with 50

health care workers who may have potentially been exposed. and the management of those individuals making sure if they have symptoms they come in to be assessed. if they develop bullpen, others may be infected. and that mikes it chemicaling to operate. and we felt it would be are caring for patients and health care worningers. >> i don't disagree. and you and i talked about this. i am fully in faf that people diagnosed be taken care of the regular university setting and to dathat.

nviwould haveitability've personnel in the experiences and lob. is it --in have a picture from the dallas morning news and cvc recommended personal protective equipmt. and not only shoes that, but details the in which it should be put on and removed. they are not included in this combrafic and you can see the exposed skin around the eyes and forehead and neck. doctor frieden, this is your picture in western africa and there is head to toe covering and goggles. you were able to be dosed within your toxic dose of chlorine. >> yes. >> that's why you can't have

skin exposed pause it is impossible to do the tis infection after taking care of an ebola patient or war. it is impossible to do the disinfection if skin is. >> we know the numbers in west africa is going up and we know that ten percent of the cases are health care workers. and 56 percent of the health care workers will succumb the illness. that is a dire warning and i would submit that. what kind of stock poil of the personal protective equipment that you have able to the health care workers.

and a patient can present themselves. and are you going to deliver. and so we know from talking to the beenaries, in they are willing to ony what do you know would be a possibility, we had the gentlemen who do ied. what did you think patient 0 going to look like? >> time has expired. >> what is the match up. >> thank you, doctor. there is no single right answer. but there is a balance between

protective equipment and less familiar and less flexibility and that can be decontaminated. the use is something that we are looking at intensively now in dallas and in conjufrpgz of the health care workers there. >> and thank you, mr. chairman, i have so many questions. but i want to begin by thanking the health care professionals. i want like to put in a letter when randy winegarten from the american federation. and i would like to put in the record, the dairy from partners in health. and among other things said that

the fact is, that they are to glam for the we are know that s. how the work force and one doctor in liberia and for one. and in my limited time focus on our infrom you structure here. at any points and community health kers when where people may present themselves. no one better than the united states. do we have the ability to train and equip as we talk about in military terms in syria do we have the ability to train and equip and let me put things on the table.

in terms of the nurses, i still don't feel like we have a good skwr. and why nurse one and nurse two, contracted ebola. was there a problem with not following kro troicals. and how are we going to insure that everyone knows how to use them. the congresswoman showed the various protective gear that nurses are supposed to be. and yet two days went by. they didn't have shoe covered. and the skin was in fact exposed even as we knew he had ebola. and so how are we going to make

sure, te spite how we check in the records. i talked to the airline. and it is a possiblity that someone shows up earlier. >> just to clarify one thing. those days were before his were drawn and he was not yet diing oninosed in ebola. >> excuse me. congresswoman, were you saying otherwise in >> the lady will yield. and he presented with obaebola symptoms. and saying that he had been in

west africa and the centers for disease control said they should wear the out fits. and i certainly hope if a paesht shows up and he's vomiting and has diarrhea. you don't see we don't have the ebola. >> those first couple of days, 28 and 29th. and on the 30 sd we learned hewas there. and there were varabilities. snshlgs and the hospital was trying to implement cv c proto be calls.

>> how are we going to educate the people and the nurses. nurses are saying they have not been involved and trained properly and having the equipment. >> first, think ebola. and any time a patient is suspected. we'll talk you through how to provide care. if confirmed we'll be there. >> my time has exposed. when did you come up with that plan? >> you just did it. the plan in terms of training nurses. what was it decided. >> we look at our preparedness. and awareness is she was asking for the nurses. when was the texas hospital saying you need to follow the

protocol. >> the day the diagnosis was confirmed we sent a team to texas. >> first of all i thank chairman murphy for calling the subcommittee to come to washington and in response of the ebola outbreak. your attendance to the hearing. and since my time is limited. i would like to get to my questions and this is a follow on to what she was asking i don't think we got a question. i direct it to dr. varga and then dr. frieden. we know yesterday a second health care worker that contracted ebola. miss amber vincent and now isolated treatment in emory university containment unit in

atlanta. we must examine the protocol break downs that resulted in the contraction of ebola by two nurses that were in contact treating thomas duncan. doctor varga, in your written testimony, you say that the first nurse, miss pham, who contracted ebola was using full protective measures under the cvc protocol while treating mr. duncan. has your organization in texas identified where the specific breeches of protocol were that resulted in her infection or the inadequacy of the protocol. dr. varga that is for you. >> thank you, sir, we are

investigating currently the source of this obvious exposure and we confirmed that was wearing protective equipment through the whole period of time as dr. frieden already mentioned with the diagnosis of ebola confirmed the level everyone personal protective equipment elevated to the hazmat style. we don't know at this particular juncture what the source or the cause of the exposure that caused nina to contract ebola was. >> i'm going to interrupt you. i want to now go to dr. frieden. dr. frieden, as dr. varga just

stated, health care personnel were following cdc protocols while treating mr. duncan. which includes the use of pce, personal protective equipment. do the cdc guidelines, your guidelines, on the use of p.p.e. mirror current international standards that, by the way, are being adhered to, those international standards, in west africa in those three countries, sierra leone, gunea and liberia? >> the international standards are something that evolve and change. we use different p.c.e. in different settings. there's no single right answer, and this is something we're looking at very closely. our current guidelines are kent with recommendations from the world health organization. >> i would think there would need to be, dr. frieden, and i commend you for the job that you are doing, and i know these are

tough times for all of us, butt we need, and that brings me to my next question and my last question. again, it's to you, dr. frieden. this issue of elevated temperature, you know, is it 100.4? is it 101.5? is it 99.6? i think tldz some great confusion because i think initially when people were screening mr. wagner at the airports in west africa, the temperature threshold was 101.5. then i think now the screens that we're doing at these five major airports including arkville international in atlanta, it's now 100.4. when mr. duncan came for the first time to the texas

presbyterian hospital, his temperature was, what, 100.1, and within 24 hours, of course, it was 103. when mom and dad are out there when their child has a temperature this fall and it's flu season and they're going to the doctor, they're going to demand being checked for ebola. give us some guidelines on what is elevated temperature and when should parents be concerned? >> parents should not be concerned unless you are living in west africa or you are exposed to a victim of ebola. the only people that have been exposed are people caring to the three ebola patients, and i outlined this in sh this sheet. for our screening criteria, we're always going to try to have an additional margin of safety, and so we look at that, and we would rather check more

people and assess, and so we're always going to have that extra margin of safety for our screening. >> thank you. i yield back. >> i recognize -- >> thank you all for tackling this important public health issue of the ebola virus, and i want to thank the centers for disease control and the n.i.h. and medical professionals across the country, especially those at emory university health care who have been proactive in containing and treating the virus. i agree with president obama and all of you. we have to be as aggressive as possible in preventing any transmission of the disease within the united states and get containment in west africa. this is a wake-up call for america that we cannot allow

n.i.h. funding to stagnate any longer. earlier i offered an amendment to the republican budget to restore the cuts to n.i.h. the budget cuts that have been inflekted over the past two years, and repair the damage of the government's shutdown from last year. unfortunately, it did not pass on a party line vote. we will only save lives if we can robustly fund and keep america as the world leader. i would like to turn to some of that research that is going on now. it's going to be research that will be our longer-term response to ebola. it will be the vaccine to prevent a disease and the drug to treat it. i'm going to walk through a basic point here. the development of vaccines and treatments for ebola is different from the development of many other drugs. it's not a large profit margen for ebola drugs. the development requires the

leadership of our country and n.i.h. has been working on a vaccine for many years, and he said today they've moved into phase one clinical trials. dr. fosse, can you explain why it's so important -- >> when you have a product that you want to develop that is not a great incentive on the part of the pharmaceutical companies because of the disease whose characteristics is not a large market, we have the experience when you are dealing with emerge and re-emerging disease via influenza or be it a rare disease that could be deliberately or n bioterror or a rare disease in ebola that if you look prior to the current epidemic, there were 24 outbreaks since 1976. the total number of people in those outbreaks was less than 3,000. it was about 2,500.

we were struggling for years to get pharmaceutical partners ourselves, who were doing the fundamental basic and clinical research, and then we did get some pharmaceutical partners like we have now with glascos-smith klein. the n.i.h. and researchers at this end and then have you to push the envelope further to the product to derisk it on the part of the companies. companies don't like to take risks when they don't have a clear -- >> can you quantify a timeline for an ebola vaccine to be on the market? is it feasible for any vaccine to be approved in time to assist in the current outbreak? >> well, your question has a couple of assumptions. the first is that the vaccine is safe and it works. the second is going to be how long is this outbreak going to last at its levels?

if you look at the kinetics and dynamics of the epidemic, it looks very serious. our response to it, when i say our, i mean the global response is not kept up with the rate of expansion. if that keeps up as the cdc has projected, we may need a vaccine to actually be an important part of the control of the epidemic itself as opposed what the original purpose of it was was to protect health care workers alone, but now if you have a raging epidemic and to be quite honest with you, i cannot predict when that will be. if you have a lot of rate of infection, a vaccine trial takes a much shorter time to give you the answer. if it slows down, it's a much longer time. if you have a lot more people in your vaccine trial, it takes less time. if we have trouble logistically, which we might, of getting people into the trial, it might

take longer. >> in addition to the vaccine of importance is early diagnosis. can you speak to the improved diagnostics that can assist in this outbreak? >> well, there are a couple of us -- when i say us, i mean agencies that are working on diagnostics. dr. frieden's group at the cdc has actually played a major role in leadership. we have several grants and contracts out to try and get earlier and more sensitive diagnostics. >> thank you. >> thank you. i recognize -- >> thank you, mr. chair, and i thank the witnesses who joined us today and the work that are you undertaking. . i want to clarify something you said earlier. i believe you mentioned that there are approximately 100 to 150 people a day coming into the united states from the affected areas? >> that's my understanding, yes. >> to mr. wagner, you had mentioned this we're screening

94% of those people? >> as of today with the expansion to the four additional locations. that covers about 94%. >> so of the 100 to 150, 94% are being covered. that means that somewhere between 2,000 and 3,000 people a year are coming into this country without being screened from the affected areas? >> well, they would undergo a different form of screening. we're still going to identify that they've been to one of those three affected regions, and we're still going to ask them questions about their itinerary. we're going to be alert to any overt signs of illness and coordinate with cdc and public health if they're sick, and we're also going to give them a fact sheet about ebola, about the symptoms, what to watch for, and most importantly, who to contact? >> will you be checking their temperature? >> we will not be checking their temperatures or having them fill out a contact sheet about their -- >> there's 2,000 to 3,000 people entering this country a year without checking their temperature, without having a contact sheet that 94% of those affected people -- >> they're going to arrive at