right now on "andrea mitchell reports," nina pham, the first health care worker to contract the virus in the united states is expected to be transported to the national institutes of health isolation unit in maryland. demanding answers, the nation's top health experts on capitol hill now, and in a few minutes, they'll be grilled how ebola spread in the u.s. and how we're going to contain it. >> it appears our hospitals were not ready, workers were not trained adequately. >> we have a fragmented public health system. i think there's legitimate questions about how the cdc is hap handling this. >> who is in charge? the alphabet soup of washington, searching for a way to coordinate its response. meanwhile, sprawling allegations raised by one of the nurses who works in the hospital in dallas. >> i just flat out asked several

infectious disease nurses. i asked the cdc, why? why wear two pairs of gloves, three pairs of booties, a plastic suit covering my entire body, and leave my neck hanging out this much? ♪ >> good day, i'm andrea mitchell. the government's response, the lack of preparation in hospitals, the impact on public transportation, all big questions for top policymakers from the president on down, and top officials will be testifying today. we have the story covered from all of the angles with our nbc team. gabe is joining me from the hospital in atlanta, and john yang as chicago o'hare

international airport, but we begin with craig melvin out texas presbyterian hospital in dallas. you have breaking news on nina pham. >> reporter: she's going to be moved from here later today. i spoke with the county executive here in dallas, and he told me that he did not want to see this hospital, texas presbyteri presbyterian, did not want to see the hospital house more than one ebola patient at a time, explaning why amber vincent was sent to emery yesterday. as of 15 to 20 minutes ago, he told my colleague, kate snow, essentially, she's in good condition, but being moved, just in case they get more ebola victims here in dallas. again, as we have reported over the last day or so, it is something they are expecting here. they are essentially sending

pham to make space here in dallas at texas presbyterian, andrea. >> let's go to gabe at emery university. gabe, are they prepared, first of all, they have now another nurse from dallas, so the situation now is a patient at emery a patient that is going to be coming to washington, d.c., suburban washington, d.c. at nih? >> reporter: hi, andrea. well, here at emery, the isolation unit can handle a maximum of three ebola patients. they have this nurse that came here late last night, amber vincent, and they have an unidentified third ebola patient that was brought here several weeks ago after dr. kent bradley. here's what we know about amber vincent. she was described as ill, but clinically stable making the trip from dallas to atlanta yesterday. however, emery university hospital officials are not commenting on her condition this

morning because of patient privacy. now, we know that vincent traveled to ohio over the weekend to visit her family and to plan her wedding. she did call the cdc on monday and self-reported a fever of 99.5 degrees. however, federal government officials say that she was not told not to board this flight back to dallas because the risk threshold was 100.4 degrees andrea, again, she's treated here in the isolation unit in emery. >> clearly this is not a bode of confidence for the hospital in texas. john yang at chicago o'hare where screenings have begun at now four more domestic airports. >> reporter: that's right. started here, going on since this weekend at jfk. today, it starts here in chicago at dulles and outside washington, atlanta, and newark. so far this morning, most of the

flights that have arrived or all flights arriving this morning have been from asiament up likely you have passengers coming from west africa, but within the last hour, two flights from london, a flight from frankfurt, more likely to have connecting passengers from the three countries involved that they are looking for. they are looking for travellers from liberia, guinea, and sierra-leone. if people are from the countries, they will be taken aside, temperatures taken, and asked about their health, how have they felt within the last week or so, have they been around people with ebola. they'll be asked about travel details over the past week or so, and they'll also be made sure that they get their contact information here in the states so that they can reach out to them if necessary. if they don't show any symptoms, if they don't have a fever, they'll be sent on their way. if they do have symptoms, they'll be taken into an isolation room that the cdc has at every international gateway airport in the united states, just in case.

this is all the enhanced screening that begins today, andrea? >> john yang, and briefly at the white house, preparing to join the hearing, a lot of kquestion about the cdc, that the nurse called the cdc and was not told not to fly. >> that's right, andrea. as you know, president obama cancelled travel plans to campaign for a second day in a row to address the situation with ebola. this comes after meeting with the cabinet secretaries yesterday and announced s.w.a.t. teams are dispatched within 24 hours of getting diagnosed. the president will follow-up on that today. >> they'll watch the hearing, chairman murphy now speaking. let's join the hearing. >> for the more than 1,000 travelers entering the united states each week from ebola hot zones. the president said someone with e ebola reaching the shores is unlikely and we've taken necessary precautions to

introduce screening at airports so someone with the virus does not get on a plane for the united states. screening and self-reporting in airports are a demonstrated failure, yet the administration continues to advance a contra kick ri position for the failed policy that does not make sense to me, especially if priority one is to contain ebola and protect public health. troubles me more when public health policies are based upon a stated condition concern like cutting ties with democracies rather than protecting public health in the united states. this should not be presented as an all or none choice. we can and will create the means to transport whatever supplies and goods are needed in africa to win this deadly battle. we do not have to leave the door open to all travel to and from hot zones in western africa while ebola is an unwelcomed and dangerous stow away on the flights. i'm confident we'll develop a reason and successful strategy to meet the needs. the current airline passenger screening at five u.s. airports through temperature taking and

self-reporting is troubling. the ebola patients are only contagious when having a fever, but we know this may not be totally accurate. a determined infected traveler can evade screening can mask the fever with ib profin, and it's nearly impossible to conduct tracing on flights going all around the globe. let me be clear to those responding to the outbreak, if resources or authorization is needed to stop ebola in its tracks, tell us in congress. i pledge, and i believe the committee joins me in plemging, we'll do everything we can do keep the american people safe from ebola outbreak in west africa. i recognize the ranking member of the committee. five minutes. >> thank you, mr. chairman. on monday, the director general of the world health organization called the ebola outbreak, quote, the most severe, acute health emergency seen in modern teems. she warned that the epidemic, quote, threatens the very survival of societies and

governments in west africa. this who assessment is no exaggerati exaggeration. cdc predicts up to 1.4 million west africans could be infected with ebola, and many more die from treatable illnesses due to the collapse of the country's infrastructure. this is a humanitarian crisis, and we have a moral imperative to help in west africa, but ending the outbreak is also a u.s. national security imperative because doing so is the best way to keep ebola out of the united states. i was alarmed, like all of us were, when thomas duncan flew to the u.s. harboring ebola and more disturbed to learn of his discharge from the texas presbyterian er with a fever after reporting he reported from lie be liberia. what's worse, is the two nurses treating duncan contracted

ebola. i know, mr. chairman, we join in sending the families our prayers. these cases raise serious questions. the washington post wrote yesterday that texas presbyterian, quote, had to learn on the fly how to control the deadly virus, and the hospital was, quote, not fully prepared for ebola. we need to find out why this hospital was unprepared, and if others are too. we need to make sure that the cdc is filling these readiness gaps. we should be concerned about the appearance of ebola in the u.s., and the transmission to two health care workers, but we should not panic. we know how to stop ebola outbreaks by tracing contracts and monitoring. the u.s. health care system can prevent cases from becoming broader outbreaks. that's why i'm glad dr. frooeden is here with us because i -- because it would be an understatement to say that the

response to the first u.s. based party with ebola has been mismanaged causing risk to scores of additional people. i know both of the gentleman will be transparent and forthright in helping me to understand how we can improve our response when yet another person, and will happen, shows up in the emergency room with the kind of symptoms. i appreciate the steps taken by cdc and customs to begin airport screenings. these steps are appropriate, and as some call for cutting off all travel as the chairman said, this will not be reasonable to be able to stop anybody with ebola from coming into the united states. we don't want to take steps that would endanger americans by interfering with efforts to halt the outbreak in africa. you know, there's no such thing as fortress america when it comes to infectious disease, and the best way to stop ebola is going to be to stop this virus in africa.

experm experts told us a quarantine on travel would have the, quote, catastrophic impacts on west africa. also, earlier this week, the director of nih, dr. francis collins, said had we adequately funded his agency for over a decade, we would already have an ebola vaccine. his words are a reminder that key public health agencies have faced stringent, stagnant funding for several years, hampering our ability to respond to the crisis. mr. chairman, six weeks ago when i sent you a letter to ask for the hearing, the scope of the problem in west africa was beginning to come into focus. now the situation is dire. let's work together to make sure that we stop it as quickly as we can. with that, i yield the balance of my time to the gentleman from iowa, mr. brailey. >> thank you. our duty today is to make sure

the administration is doing everything possible to prevent the spread of ebola in the united states. our number one priority in combatting the disease must be the protection of americans, and we have to figure out the best way to do that. my heart goes out to all those suffering from this horrible epidemic, and i'm proud of the hard work done by american troops, doctors, nurses, and other volunteers to combat the disease. congress must come together, put aside partisan differences, and help stop the outbreak. today, i hope to hear what steps the administration is taking to prevent the spread of ebola and respond to the outbreak. i'm greatly concerned as congresswoman degette expressed that the administration did not act fast enough in responding in texas. we need to look at all the options available to keep our families safe and move quickly and responsibly to make necessary changes at airport. >> the gentleman's time expired. >> okay. >> we have a lot to do here.

we'll keep going. >> okay, thank you. >> thank you, i recognize the chairman of the full committee. mr. upton, for five minutes. >> i want to thank the witnesses and all members, republicans and democrats, for being here today. unusual to convene a hearing in d.c. during a district work period, but there's no time to wait. i was glad to see the president off the campaign trail yesterday to focus on the crisis. people are scared. we need all hands on deck. we need a strategy. we need to protect the american people. first and foremost. it's not a drill. people's lives are at stake, and the response so far has been unacceptable. as chairman of the committee, i want to assure the witnesses that we stand ready to support you in any way to keep americans safe. we're going to hold your feet to the fire on getting the job done. getting it done right. both the u.s. and the global

health community so far fail to put in place an effective strategy fast enough to combat the current outbreak. the cdc admitted more could have been done in texas. two health care workers have become infected with ebola as nurses and other personnel suggest protocols are developed on the fly, and none of us can understand how a nurse who treated an ebola infected patient and herself developed a fever was permitted to board a commercial airline and fly across the country. it's no wonder that the public's confidence is shaken. over a month ago, before ebola reach the shores, we wrote seeking details for the preparedness and response plan here at home and abroad. it's clear whatever plan was in place was insufficient, but i believe we can and must do better now. we need a plan to treat those who are sick to train health care workers, to safely provide care, and to stop the spread of the disease here at home and add its source in africa.

this includes travel restrictions or bans from that region beginning today. surely we'll find other ways to get the aid workers and supplies into the countries and from the terrorist watch list to quarantines, there are tools used to manage air travel to assure public safety. why not here? we can no longer be reacting to each day's crisis. we have to be aggressive and finally get ahead of the terrible outbreak. the american people want to know about our troops and medical personn personnel courageously headed to africa to care for the sick. how are they protected? we have to have the resources in america to safely combat that threat as well. it's not just the responsibility of the u.s. the global health community bears the charge to finally get ahead of the threat, develop a clear strategy, train all of those involved in combatting the disease and eradicate the threat. we have all hear grave warnings this is going to get worse before it's better. people scared.

it is our responsibility to ensure that the government is doing whatever it can to keep the public safe. degette and i partnered together in the cures initiative to help improve the research and speed, the approval of life saving medicines, and how this affects cancer and diabetes, same reforms have to have treatments for ebola. we are part of the effort to save lives. i reserve my time to dr. burgess. >> thank you. we all agree we must fix this. the response to the outbreak is not a political issue, but a public health crisis and dire at that. the frightening truth is we cannot guarantee safety of our health care workers. they have a risk in western africa.

56% of the -- they have a 56% mortality rate of the health care workers who catch this disease. two nurses have contracted ebola in the united states. indeed, we have to learn from the current situation in texas and use any information we can gather to better help prepare hospitals and protect health care workers on the front line. we're here today because we need answers to the questions. this past august, the inspector general, the department of homeland security, issued a report on personal equipment and anticounty measures finding that in quoting here the department of homeland security did not adequately conduct needs assessment prierp to purchasing pandemic supplies and did not manage the stockpile of personal equipment and antiviral medical counter measures, showing how unprepared we are. we have to get it right. i want to yield the balance of the time to ms. blackburn from

tennessee. >> thank you, dr. burgess, and, yes, indeed, welcome to all of our witnesses. everyone is mentioned we are here to work with you to protect americans, and that includes the care givers, and by that i mean the men and women working on the front lines, the screaming eagles of the 101st from fort campbell. i yield back my time and have further questions. thank you. >> the time expired. i would now like to introduce the witnesses -- sorry, first i go to mr. waxman. i apologize. >> thank you, mr. chairman. pleased to have this opportunity to make an opening statement before we hear from the witnesses. i think we have to put all of this in perspective and not panic. everyone said not panic, and then they made statements like we'll going to get tough, we're going to do something about it. what do we need to do? first of all, we have a problem in africa, and this is a serious outbreak that could spiral beyond our control. on tuesday, the world health organization estimated that soon

there could be up to 10,000 new ebola cases each week in west africa. cdc warned that the outbreak could infect as many as one in four people by the end of january. this is a humanitarian crisis in africa, and we have a responsibility to help because if we don't help there, that outbreak is going to continue to spiral out to other places. they'll travel from brussels, and then into the united states. we can stop the epidemic from spreading in africa or the united states if we isolate the patient and contact -- and monitor the contacts of that patient.

if we stop it there, we can stop it here. are we moving fast enough? do we have the resources? are we coordinating responses with other countries and international organizations. but here, people are scared. we should not make them more frightened. in perspective, we've had three cases in the country, thomas duncan entering the country who flew through brussels to get here. nina pham and amber vinson. we have to be concerned, act urgently, but need not panic. we have to learn what we need to do, what mistakes we have made and not repeat them. we have to find out what happened in texas health presbyterian hospital, how cdc, state and local health officials of hospitals can improve

procedures moving forward. we should also use this as a wakeup call to ensure the adequacy of our own public health and preparedness safety net. we have to be prepared before crisis hits, not scrambling to respond after the crisis. in the last decade, the ability to fund research decline here in the united states. since 2006, cdc's budget adjusted for inflation dropped by 12%, funding for the public health emergency preparedness cooperative agreement supporting state and local health department preparedness activity cut from $1 billion in its first year of funding in 2002 to $612 million in 2014. all of these were also subject to the sequesteration and those

who allowed sequestering to happen by closing the government have to answer to the american people as well. we need to commit adequate funding to public health department infrastructure. we have to hold public health systems accountable to standards of preparedness. based on what we know, it appears that texas presbyterian would have not met those standards, though, in fairness, i suspect that many, many hospitals all over the country would also have struggle to respond. this is a problem we have to solve. mr. chairman, before i run out of time, i want to indullening the health care workers and those who help during the outbreak. it's a dangerous work they are doing. they are putting themselves in danger to save lives they deserve our thanks and our praise. i also want to thank all of our witnesses. you have my confidence, and i

appreciate you joining us today to provide answers about how to stop the current ebola outbreak in africa and how to improve our public health systems to avoid the next crisis. i'm ending the career at the end of this year, but i've been through so many hearings where when there's a crisis, we have congressmen sit and point fingers, we have our share of responsibility by not funding the infrastructure. in africa, they have no infrastructure. we have to help them develop to deal with the crisis, but shouldn't leave ourselves vulnerable by the irrational budget cuts. >> the time expired. thank you. i would now like to introduce the witnesses on panel for today's hearing. the director of the centers disease control and prevent. dr. anthony fauci doctor of the allergy and infectious diseases in the institute of health. dr. robert robertson is

development authority and office of the assistance secretary for preparedness and response at the united states department of health and human services. dr. borio, assistant commissioner for counterterrorism policy at the u.s. food and drug administration, mr. john p. wagner, assisting commissioner of u.s. field operations in border frictions at the u.s. department of homeland security. joining us today on video conference from texas is dr. daniel varga, a chief clinical officer at texas health resources. i'll swear in the witnesses. you are all aware that the committee is holding an investigative hearing, and when doing so, had the practice of taking testimony under oath. do any of you have objections to taking testimony under oath? the witnesses say no, and dr. vargo? >> no. >> thank you. the chair, then, advices you

under the rules of the house and rules of the committee, you are entitled to be advised by coup. do any of you prefer that today? >> no. >> dr. vargo? >> no. >> okay. thank you. everyone answers no. in this case, rise and raise your right hand and i will swear you in. do you swear the testimony you are about to give is the truth, the whole truth, and nothing but the truth? >> i do. >> i do. >> yes, i do. >> thank you, doctor. you are now under oath and subject to the penalties set forth in section 18 and title 18 of the united states code. we'll call upon you each for a five minute opening summary of your written statement. dr. freifreiden you are recogni for five minutes. >> thank you. i appreciate the opportunity to come before you to discuss the ebola epidemic and our response

to protect americans. i'm dr. tom frieden, trained as a physician, trained in internal medicine, infectious diseases, completed the cdc epidemic intelligence service training, and i worked in the control of diseases and others since 1990. ebola spreads only by direct contact with a patient who is sick with the disease or has died from it or with body fluids. ebola is not new, although it's new to the u.s. we know how to control ebola even in this period, even in lagos, nigeria, we've been able to contain the outbreak. we do that by tried and true measures of finding the patients promptly, isolating them effectively, identifying their contacts, ensuring if any

contact becomes ill, they are rapidly identified, isolated, and their contacts are identified. there are no shortcuts in the control of ebola. and it is not easy to control it. to protect the united states, we have to stop it at the source. there's a lot of fear of ebola, and i will tell you as the director of cdc, one of the things i fear about ebola is that it could spread more widely and africa. if this were to happen, it could become a threat to our health system and the health care we give for a long time to come. our top priority, our focus, is to work 24/7 to protect americans. that's our mission. we protect americans from threats and in the case of ebola, we do that by a system at

multiple levels. in addition to our efforts to control the disease at the source, we have helped each of the affected countries establish exit screening so that every person leaving has their temperature taken. in the two month period of august and september, we identified 74 people with fever, none of them entered the airport or boarded the plane. as far as we know, none of them were diagnosed with ebola, but that was one level of safety. recently, we've added another level of skreeping people on arrival to the u.s. that identifies anyone with fever here, and we've worked very closely with the department of homeland security and customs and border protection to implement that program, and i'll be happy to provide further details of it later. we've increased awareness among physicians throughout the u.s.

to think ebola, and anyone who has fever and/or other symptoms of infection and who's been to west africa in the previous 21 days. we've established laboratory services throughout the country so that not all laboratory tests have to come to the specialized laboratory at cdc. in fact, one of those laboratories in austin, texas identified the first case here we have fielded calls from concerned doctors age health officials throughout the country. we found more than 300 calls and only one patient, mr. duncan, had ebola, but that's one too many. we're open to ideas of what we can do to keep americans as safe as possible as long as outbreak is continuing. we established emergency response teams from cdc that go within hours to any hospital

that has an ebola case to help them by defective care safely. there's a lot of understandable concern about the cases in dallas. i have one slide, if we can show it, of the contact tracing activities there, and i think we provided copies for the members the two core activities in dallas are to ensure there's effective infection control and trace contacts. here you see a timeline of what happened in the identification of contacts. we've followed each of the contacts, and when in or if any become ill, we immediately isolate them to break the chain of transmission. that's how you stop ebola. i can go through the details when you wish, and we are working to ensure there's

effective infection control. i have the details of that. in sum, cdc works 24/7 to protect americans. there's no shortcuts. everyone has to do their part. there are more than 5,000 hospitals in the country, more than 2500 health departments at the local level and we're there to support, world class expertise, and we're there to respond to threats to help protect americans and always open to new ideas, open to data because our bottom line is using the most accurate data information, inform our actions, and protect health, thank you. >> thank you. now for a five minute summary of your statement. >> thank you. you just heard about the public health aspects of ebola disease. i appreciate the opportunity to speak with you this morning for a few minutes on the infectious

diseases. of note is that our activities actually started with the tragic events of 9/11. if i could -- of 9/11/2001, followed closely by the anthrax attacks, which many remember, against the congress of the united states and the press. it was in that environment the approach to bioterrorism was mour mounted by the federal government, one to research couldn't measures. we were aware that naturally occurring outbreaks of disease are just a much of a terror as deliberate terror. there's a number of category a pathogens from anthrax, botulism, plague, smallpox, but this last one, fevers like ebola, and others, the viral fevers are dlififficult because

they are a high degree of lethality and body fluids. therapy is supported without specific interventions and we do not have a vaccine. what's the role of the national institutes of health? we could advance the slide. role of the national institutes of health in the research endeavor, as you can see on the slide, we do basic and clinical research and importantly supply and supply resources for researchers in industry and academia to advance product development. end game of what we do are diagnostics, therapeutics, and vaccines. i'm sorry. get the slide back on the last slide. no. the previous one. very sorry. can we get it back? there, right there. this is a multiinstitutional endeavor. as you can see on the slide, the

nih is responsible for fundamental basic research and early concept development, something we did alone because of the lack of interest on the industrial partners of making interventions. we partner with bahter who you'll hear from shortly with dr. robert robertson, and partner with those in collaboration with the fda to get approval of products. next slide. you've heard about therapeutic interventions, and i want to take a moment to talk about a few of them. first, it's important to realize we are all experimental, none proven to be effective. when you hear about giving a drug with a positive effect, we do not know at this point, a, is it a positive effect, or, b, is it causing harm? that's the reason why we have to study these carefully and at the same time, make readily available to the people who need

them. first on the list is those given to dr. braptley and nancy, looking good, needs to be proven in the human. there's other like the biocrisp product. you hear about the drug developed in support by the department of defense, which is also used and others you'll hear about. these are just a few of those, again, that will be going into clinical trials and actually used in an experimental way with the compassionate use from approval from the fda and certain individuals. i'll turn to this slide here, an important one. slides regarding a vaccine, we have been working on an e e mole ba vaccine for a number of years. did original studies shown in animals to be favorable. we are now right at the phase where we are in face one trials, some of you may have heard of, started at nih september 2,

second vaccine started days ago by the u.s. military in collaboration with the nih. when we finish phase one trials, asking, is it safe? does it induce a response that you predict would be protective? it's important to make sure it's safe. if those parameters are met, we will advance to a much larger trial in larger numbers of individuals to determine if it is actually effective as well as not having a paradoxical negative deleterious effect. the reason we think it's important is if we do not control epidemic with pure public health measures, it's entirely conceivable we'll need a vaccine and it's important to prove it's safe and effective. i'll close by making an announcement to the committee because i'm sure you'll hear about it soon in the press. this evening, tonight, we'll be admitting to clinical studies unite, the special clinical studies unit at the national

institutes of health, nina pham known as nurse number one, coming to the national institutes of health, supplying her with state of the art care in the high level containment facilities. thank you very much, mr. chairman. >> thank you, doctor. now recognize dr. robertson for a five minute summary of your statement. >> good afternoon, chairman murphy, upton, ranking members degette and wax man and other members of the committee. thank you for the opportunity to talk about ebola. i'm dr. robertson, developer of industry, and ten years public servant working on panic preparedness and other threats. ba barda was created in 2006, to have advanced development in countermeasures for vaccines, diagnostics, and medical devices

for the entire nation. barda exists to address threats and emerging infectious diseases and supported development for manmade threats on routine basis and responded to threats like h1ns 1and other outbreaks. we are responding to ebola with a material threat determination issued by want department of homeland security and emerging infectious disease. as said and my colleagues said, when it comes to ebola as a threat. best way to protect our country is to address the current depp deppic in africa, worse on record. we work to transition medical countermeasures from early development as was said into advanced development to ultimate approv approval. since 2006, we built a pipeline of more than 250 countermeasures

for chemical and others influ ens, seven approved, and today, we are transitioning several promising and maturing vaccines and therapeutic candidates from early development under nih and dod's port into advanced development and ensuring that commercials manufacturing capacity for the product is available as soon as possible. barda utilizes public-private partnerships with industry to have countermeasures to protect our citizens. over the past five years, barda with nih, cdc, and nia and industry partners built a responsive infrastructure to develop and have countermeasures. as a result of the pandemic reauthorization act and counterdevelopment afforded to industry partners. last year, we made five candidates in record time for

the outbreaks. currently, working with a wider away of partners including small and large companies, canada, the u.k., western africa countries, world health organizations, and others to make and evaluate the ebola product candidates. barda established an infrastructure to assist product developers on a basis to respond immediately to a flick health emergency. using a number of our core service systems, programs, nonclinical services network, centers for advanced develop of manufacturing, and finished manufacturing network to make these products available as soon as possible. additionally, our staff, on site at the manufacturer. people in plant to provide oversight to expedite product availability. working with cdc and others across the federal government and internationally with our modelling efforts to look at the ebola outbreak and as it becomes

e epidemic, and what impacts and interventions may occur. they support measures for public health measures like the pandemic and h7 and 9 outbreaks. we are supporting manufacturers with scaled up productions, specifically development of production for clinical studies at one manufacturers, expanding overall capacity by enlisting the help of other tobacco plant manufacturers and working on candidates to expand capacity. if any of the studies, barda will support advanced development of additional promises therapeutic candidates talked about to treat ebola patients. on the vaccine front, barda is working with partners to scale up manufacturing of three promising vaccine candidates, one of which we'll announce

today from pilot to commercial scales in after are ka next year. 24 effort for the response, supporting the number of other response and activities, including supporting the health care system preparedness, guidance on patient movement, repatriati repatriation, clinical guidance, supporting lo gisty call deployment to west africa, and ongoing coordination and communication with national and international communities responding to the threat. finally, we face sigtd challenges as have been discussed in the coming weeks and months as the epidemic continues and countermeasures are manufactured and e evaluated. bottom line, colleagues here and our industry partners use all of our collective capabilities here and abroad to address today's ebola epidemic and be prepared for outbreaks and events going forward. i thank the committee and subcommittee for the generous and continued support over the past decade and opportunity to testify. thank you. >> thank you, dr. robertson.

dr. borio, you are -- >> thank you. >> pull the microphone close to you. thank you. >> thank you for the opportunity to appear before you today to discuss fda's actions to respond to the ebola epidemic, a tragic, global event. my colleagues and i at the fda are determined to do all we can to help end it as quickly as possible. desire and need for safe, effective vaccines and treatments is overwhelming. fda's taken extraordinary steps to be proactive and flexibility, leveraging our authorities and working di inin ining diligentl safe and effective medical prur products. we are providing unique and scientific advice to companies to guide submissions. we review data as it is received. these actions help advance

development of products as quickly as possible, and, for example, in the case of the two vaccines mentioned, fda took days to review applications and allow studies to proceed. as a result, the vaccine candidate developed in the phase one clinical 2 and developed by new genetics begins testing on october 13. we are partnering with agencies that support medical product development like iaid, barda, and the department of defense. because of fda's long standing clan ration with the dod, they were able to authorize the use of the ebola diagnostic test under the authorization within 24 hours of request. we thorsed the use of two additional diagnostic tests developed by the cdc, and the tests, of course, special for a public health response. in addition, we're spothing the

world health organization. scientists provide advice to the bhr as it works to di veers verse treatments with ebola. i focused oven focus on ebola vaccine, including experts from around the world as well as affected countries in west africa. it was agreed that promising vaccinations must be must be va clinical trials and in the most urgent matter. they are working closely with government colleagues and developers to support this goal. it is important to note, though, that while we all want access to immediate therapies, to cure o and prevent ebola, scientific fact is investigational products in the early early stages of development. there's tremendous hope these products help patients, but it's possible some may hurt patients

and others have little to no effect. therefore, access to investigation of products should be through clinical trials when possible allowing us to learn about product safety and ethics and provide an equitable means for access. fda's working with nih colleagues to develop a flexible protocol to allow companies and clinicians to evaluate multiple investigation ebola products under a common protocol, and we'll have interpretable data and generate actionable results in the most expe dirks p -- expeditious manner. it's important to know the risks of the products as soon as possible. until trials are established, we'll enable access to the products when available and requested by clinicians. we have mechanisms such as compassionate use that are used outside of clinical trials when

we assess the expected benefits outweigh risks for the patient. i can tell you every patient in the u.s. has be treated if at least one investigational product. because fda is -- ebola is a serious and offerly fatal disease, fda approved such requests within a matter of a few hours and less than one hour oftentimes. there's more than 225 staff involved in this response, and without exception, everyone has been proactive, thoughtful, and adaptive to the complex range of issues that emerged. we'll fully committed to sustaining deep engaugement and aggressive activities to support a response to the ebola epidemic. thank you, and i'll take questions later. >> thank you. mr. wagner, you are recognized for five minutes. >> thank you, ranking member, sub committee for the opportunity to discuss efforts of u.s. customs and border kut

ms by der touring the spread of ebola by the means of travel. each day, 1 million arrive in the united states, 28 0,000 through the airports. cdc is responsible for securing borders and securing the flow of travel and trade vital to our nation's economy. within this broad responsibility, our priority mission remains to prevent terrorist and terrorist weaponing from entering the united states. however, we play an important role in limiting the introducti introduction, transmission, and spread of diseases from foreign countries. we had this role for over a hundred years, and in coordination with the cdc, we had protocols in place for well over a decade that guides response to a variety of specific health threats. cbp officers at all ports of entry search travelers for illness. in west africa, we, in close collaboration with cdc, works to ensure front line officers provide information, training, and equipment neated to identify and respond to travellers who

pose a risk to health. we identify and address travellers with any potential illness such as ebola. cbp officer training academies health craning, which reteaches officers to identify in abs vags and questioning. the systems of ill travelerings. they provide operational training and guidance how to respond to travellers with potential illness including referring things with signs of illness and tech dare screening success assisting cdc as well as quarantine protocols. they cover key elements of cbp's blood born pathogens exposure control plan, protections from exposure, use of personal protective equipment, other preventative measures and procedures to follow in a potential exposure incident. we committed to seeing our personnel has the most updated information in regarding the

virus since outbreak began. the personnel provided gieps starting with knew ral information of a current outbreak in prim of this year with updates since then. sharing is critical, and we continue to engage with help and medical authorities. since january 2011, division of global migration and quarantine stationed liaison officer at national targeting center to provide expertise and facilitate questions for information of the two organizations. starting object 1 this year, cbc provides ebola notices to travelers entering the united states from africa. this sheet provides traveller information and instructions should they have a concern of infection. in addition to screening all passengers from overt signs of ill vrns, starting object 11, beginning enhanced screening from the thee effects countries at jfk, and today, expand

efforts at dullse chicago, atlanta, and newark. 94 of the travelers enter in these five airports, and these travelers are they to complete a cdc questionnaire, provide accountant information, and have temperature checked. based on the screening efforts, the quarantine officers make a public health assessment. since the measures are in effect at jfk, we conducted enhanced screening on 55 travellers identified in advance as known to travel through one of three affected countries. additional 13 travelers were identified as needing additional screening in the course of the standard interview process applied at all ports of entry. a a total of eight travelers sent to cdc, and all passengers were examined and released. while cbp officers received training in illness recognition and response, if they identify an individual believed to be ill, cbp isolates traveler from

the public in a designated area and contact the local quarantine officer and local public health authorities to help with further medical assessment. cbp officers trained with precautions and effective controls when they encounter victims with symptoms and examination of baggage and cargo. when necessary, cbp personnel takes safety measures based on the level of potential exposure. these procedures designed to minimize risk to the public utilized collaboratively by both agencies on a number of occasions with positive results. continue to monitor the outbreak, provide information and guidance to field personnel, work closely with the interagency partners to develop or adopt measures as needed to prevent spread in the united states. thank you for the opportunity to testify today and attention you give to the important issue. happy to answer any of your questions. >> thank you. we'll recognize dr. vargo, chief

clinical officer joining us from texas from video conference. >> good afternoon, chairman murphy, vis chair burgess, ranking member degette, and other members of the committee. i'm the chief clinical officer and senior vice president for seconds health resources, board certified in internal medicine, 24 years of combined experience in patient practice, medical education, and health care administration. i am truly sorry i could not be with you in person today, and i deeply appreciate the committee's understanding of our situation and how important it is for me to be here in dallas during this very challenging and sensitive time. texas health presbyterian, and acute care hospitals, and the resources system. we are an 898 bed hospital treating some of the most complicated cases in north texas in terms of -- in north texas.

texas health dallas recognized as a facility for excellence in nursing services bit the nurses credential center, leading nursing program. texas health resources is one of the largest faith based centers, non-for-profit health systems in the u.s. and largest in north texas in terms of patients served. mission is to improve the health of the people in the communities we serve, and we care for all parties regardless of the ability to pay. we serve diverse communities and provide a standard of care for all regardless of race or country of origin. as the first hospital in the country to both diagnose and treat patient with ebola, we are committed to using our experience to help other hospitals and health care providers protect public health against this insidious virus. hard to put into words how we felt when our patient duncan lost the struggle with ebola on

october 8. it was devastating to the nurses, doctors, and team who tried hard to save his life, and we keep the family in our thoughts and prayers. unfortunately, in our initial treatment of mr. duncan, despite best intentions, in a highly skilled medical team, we made mistakes. we did not correctly diagnose the symptoms as though of ebola, and we are deeply sorry. also, in our effort to communicate to the public quickly and transparentally, we inadd ver tently provided inaccurate information and had to be corrected. no doubt, unsettling to a community already concerned and confused, and we learned from that experience as well. last weekend, pham, a member of our hospital family who care for mr. dun can was diagnosed with ebola. the team is doing everything possible to help her win that fight, and on tuesday, her condition was upgraded from good

and as the doctor mentioned earlier, nina's care continues to evolve. i can tell you that the prayers of the entire texas health system are with her. yesterday, as has been noted, we identified a second care giver with ebola, and i can also tell you our throughououghts and pra remain with amber as well. a lot was said what may other may not have caused amber and nina to contract ebola. they are both extremely skilled nurses using full protective measures under the protocols so we don't yet know precisely how or when they were infected, but it's clear there was an exposure somewhere, sometime, and we are pouring over records and observations in doing all we can to find the answers. you've asked about the sequence of events with regard to the preparedness for ebola in the

treatment of mr. duncan. key events from preparation timeline are attached to the submitted statement, but here's a brief overview. as ebola in africa worsened over the summer, texas health hospitals, and facilities educated physicians, nurses, and other staff on symptoms and risk factors associated with the virus. on july 28th, infection prevention, health advisory about the disease. begun sharing with with other texas health personnel. the health care advisory encouraged all health care providers in the u.s. to consider ebd in the diagnosis of the illness, in other words, a fever, in those who travelled to other countries. the cdc advisory sent to all director of the emergency departments and signs posted in the eds. august 1, texas health leaders

including regional and hospital leaders and e leaders across the system required they have and end deem logic policy this place to address how to care for pashlgts with e hole la-like symptoms. the e-mail drew attention to the electronic health documentation in the emergency departments included a question about travel history to be completed on every patient. attachments including a draft thr emergencies policy that specifically addresses this, cdc based poster posted in the ed and cdc advisory from 728. the august 1 cdc guidelines and evaluation of patients suspected of having ebola first disease was distributed to staff including physicians, nurses, and front line care givers on august 1st and august 4th. over the last two months, dallas county health and human services department communicated with us for plans with a possible case

of ebola. we provided the august 27th dallas county health algorithm and screening questionnaire. at 10:30 p.m., september 25, mr. duncan presented to texas health presbyterian dallas emergency department with a fever of 10 0.1, pain, nausea, and headache. symptoms associated with many other illnesses. he was examined and had numerous tests over a period of four hours. during his time in the ed, the temperature spiked to 103 degrees fahrenheit and later dropped to 101 preponderate 2. he was discharged early in the morning on september 26, and we have provided a timeline on the notable events of mr. dun can's initial emergency department visit. on september 28 th, he was transported to the hospital by ambulance. once arrive at the hospital, he met criteria of the ebola algorithm. at the time, cdc was