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tv   Politics Public Policy Today  CSPAN  November 14, 2014 9:00am-11:01am EST

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ebbs and flows. in terms of what works we believe that the base amount of funding is the amount of money that we need across the departments. that will stave off the epidemic. the contingency fund was asked for because to the point that was made in opening remarks about preparedness an preparedness and making sure when we have elements than aren't predictable, we want to make sure that that funding is in place. and that funding would be for different types of things and to give you some examples, if another country, another ring country, has a number of cases and starts to be elevated like a guinea, a sierra leone, or a liberia, that may change the needs. another thing that could change the needs that we would use the contingency funding would be is if we actually get a vaccine and we're still at a stage where we believe you need to do deeper and would do more distribution of vaccines to a broader group of health care worker.
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those are some of the things that the contingency fund is about. it is a fund we have submitted for because we want to make sure there is a block that the funding will not be used only as needed, but we want to plan for things we can't exactly predict right now. >> you've asked for some money for fda for vaccines. would you speed it up, bring more people into the process, are there steps in an emergency situation like this that there is a way to go through them more quickly or go around them to get to the end product quicker? >> yes, sir. we have seen that in process right now. the congress gave us emergency use authorization that would allow us to approve diagnostics quickly. we've used that authorization six times. fda has used it six times. we approved from start to finish in 36 hours. one of those diagnostics.
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with regard to other emergency authorities that fda has, we have approved drugs. what happens is when a drug is not approved, if a clinician asks fda for approval for that individual to receive the drug, every patient that's been treated in the united states has received a drug. can't speak to the specifics because of hipaa, but each one has received a drug. those have been approved. one was approved in one hour. so right now fda is on a path and there are over 300 people who have been working on these efforts. because it cuts across therapeutics, diagnostics, vaccines. the team is working across all of those issues to make sure that we are moving as fast as we possibly can across all of those categories to support, and approve. we're supporting the efforts -- and hundreds of questions have come in from commercial entities. and that's great because a number of commercial entities are out there and they want to help us find the solutions to ebola. most of those questions are
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legitimate. it is about speeding their efforts. some of those things, as you know, there are people who are saying things work that don't. fda needs to watch for that, too, in this important time. that's what the funding is for. it is about that speed and moving things through quickly. >> one last question on that topic. for anybody who would know the answer, is there anything we need do or we're doing in this bill to be sure that ebola is clearly defined as one of the things that you can use those accelerated processes for? >> we have not had the authorities that you all have given, as i mentioned have been in a way that we can use them. when we've needed to, we can add to definitions. so far we have not. i will take your question and make sure though with the fda that it is answered for all categories. every -- there are a number of categories and we need to make sure. so far we have not had any issues and thank you all for the authorities that you have given us. i think you hear that we are using them and using them quickly as we can.
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but thank you for raising it. if we are, we can come back. chairman, while everybody else is making a comment, i'd like to thank you for your really talented and great leadership of this committee. thank you for all you've done. >> thank you. we're now going to turn to senator koontz but i'll ask senator shaheen to call the superintendent and ask that the air conditioning be turned off. i asked 45 minutes ago. >> i would be delighted to do that, madam chair. i have tried to get him to turn down the air conditioning in this building before. >> now because this committee really doesn't want to waste energy, either that of the members or of the taxpayer paying for air conditioning that is unneeded, unnecessary, and unwanted. okay? well, better to have heated discussion than wasted money. senator koontz. >> thank you, chair mccullsky.
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i'll join senator blunt and thank you for your tremendous leadership in this committee. to the many witnesses who have testified today i want to thank you for the vigorous discussion of the administration's emergency funding request to deal with this global public health crisis and remind all of us that the ebola outbreak in west africa has been characterized as among the most severe public health emergencies we've faced in modern times. chairman, i emphatically agree with your characterization that our first priority is to protect american lives and that the single best way for us to protect american lives is to engage vigorously in the work and the fight against ebola on the ground, in west africa. this emergency fundsing request provides support for every facet of what's needed to keep americans safe, first but strengthening and bolstering our readiness here in the united states but principally but ensuring that we contain ebola in liberia, in sierra leone, in guinea, and preventing its spread to neighboring countries. i want to take a moment to share
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that i recently had my third recent conversation with president sirleaf johnson who i visited several times in liberia in previous years and who wanted me to make a point of thanking the american people for our generosity and our engagement, but urged us not to let off now because just because there is some hopeful news doesn't mean that we've turned the corner on this and in the region it still remains a very, very dangerous and difficult time. i visited with delawareans of liberian heritage who have lost their entire family to this disease and we need to redouble our efforts. i also want to acknowledge the remarkable sacrifice, the dedication of our uniformed servicemen and women, of the thousands of volunteer health professionals and missionaries on the front line of the work against ebola. americans who go abroad should not be stigmatized when they return, should be honored and supported in their commitment and service and should have confidence that they can return from their service and be supported when they do so. let me turn to the global health
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security agenda, if i might. a piece of this emergency request is for the global health security agenda within ideas in the cdc and nid designed to strengthen the whole health security systems of a ring of countries around guinea and sierra leone and liberia. dr. frieden or deputy secretary higginbotham, if you wanted to speak to how many total nations will you target with this funding request, what will you do to increase their capacity, and why is this essential to ensuring that americans are safe from ebola and that this outbreak, this epidemic, is effectively contained. >> our focus stro strengthen the systems that will find problems when they first emerge, respond effectively and prevent them where it ever possible. and the goal there, if we just think of what could have happened in rural guinea if there had been a monitoring system or surveillance system
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that found the initial cluster, that responded to it promptly, we would see a very different outcome today. in fact, over the past 24 to 48 hours we've been dealing urgently with a situation in mali which is a real illustration of this. as part of our response to the west african outbreak, cdc had already sent teams to each of the surrounding countries to ensure that they went through a clear checklist of the things that were needed. laboratory systems. surveillance systems. isolation capacity. emergency response capacity. contact tracing and public health and series of other things that were needed. the team was actually in mali when the 2-year-old child came from guinea there. sadly, died in mali. but the team helped organize a response of tracing more than 100 people. over the past day or two we've learned of a new situation which is of great concern where an individual died probably from ebola in the funeral services, family members were infected.
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in the care of that individual before he died and other individuals, health care workers, were probably infected. we're now facing a cluster in mali. the challenge is to make sure that that cluster ends as the nigerian cluster did with making mali ebola free again. but whether or not that happens is entirely dependent on the ability to have those systems in place, in advance, to find problems before they get out of hand, to respond effectively. that's what the global health security aspect of this emergency request is essential for. it's about understanding that their vulnerability is our v vulnerabili vulnerability. what we do to find problems there and stop them is up to us. >> the difference in outcomes in nigeria versus the other three countries is the difference in having a had a robust public health infrastructure that made it possible to do the contact tracing and do the immediate response. part of this is a legacy of pet
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far. how will cdc and usaid coordinate to make sure these investments are made wisely and effectively and that we strengthen the whole region's public health infrastructure. >> thank you, senator. we were hand in glove, aid with cdc. cdc is essential for setting the policy for bringing the technical and medical expertise forward. we work very closely with them in implementing these approaches, these policies. we've been jointly conducting workshops for the 12 countries in the region, for example, around the issues that dr. frieden just outlined. we're also looking forward to the fact that you have increased population pressures in areas that were previously forested. so the possibility of increased jumps of diseases from animals to humans is something that is
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very much a part of looking forward to how to get ahead of these kinds of outbreaks in the future. >> i appreciate that. my last question will be this -- >> senator, your time lass expired. >> thank you, madam chair. >> i don't mean to be bruvg squo anyone but we've now been here an hour and a half and we have ten more senators to go. senator coates, i'm going to be a little bit more strict now. >> madam chairman, it's good to see that you haven't lost your touch. >> well, we have to vote, so -- >> yes, understand. i'll try to be brief here. first of all, thank you for calling the hearing. i think there's so much misinformation, disinformation and misperceptions and a lot of nervousness out there among the public. we've all had to address that and i think this hearing gives us a better clarity in terms of
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where we are, where we've been and where we're going. so i think all that is helpful. i commend teeveryone sitting at the table there. remember when secretary johnson called me weeks ago saying this is going to be a government-wide effort. this is a crisis deserving of full response, all hands on deck, and lot of those hands are sitting here at the table. and there has been some positive news here in terms of some steps that have been taken despite some early struggles and couple of bumbles that made all of us nervous. i think we've clarified some of that. i think all of that is positive but i do have some questions about how we're continuing to go forward. point number one, as secretary burwell said, we've got to fight this battle at the source. and i understand that. but some countries, and others, have said look, if you're going to fight it at the source, you need to have it contained at the
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source. and while the military has set one set of standards in terms of anyone who has been at the source relative to what they need to do when they return, that standard stands in contrast too what our current standard is relative to people coming back, and of course, the screening is important. secretary johnson talked about that, so forth. so i have couple questions here relative to all that. is canada and australian and these countries that have basically said look, if we're going to fight it at the source, we're going to close our borders to anybody coming from the source, that's the best way to keep our country free of that. that may or may not be the right thing to do, necessary thing to do. but nevertheless, it certainly assured their public that, yeah, okay, they're fighting it at the source. then when you add that together with what the military has done, supported by the secretary of defense, relative to anybody going to the source -- i was with general williams over at
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africa command in italy in early september and then noticed at that point they were not going to send any soldiers in there. the president made a decision, they did send people in and they're sending people in. but general williams came home and immediately the team that he was with, which i think was about a dozen or so, quarantined themselves. and so what are we to tell people back at home about, well, the military's taking these steps. the rest of the public is taking these steps. and so i guess i would like some response to that and then i do have, if i have time, a question for secretary johnson. maybe one person can speak for the group. >> yes, if i may. thank you, sir. as you mentioned, secretary hagel approved the 21-day controlled monitoring program at the request of the service
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chiefs and the chairman of the joint chiefs of staff. the military is a unique entity and because of the scope and the scale of the number of people that we have. the region, it seemed like a prudent course of action. i'll defer to my colleague over at joint staff who can tell you about the formulation of that recommendation. >> senator, thank you for the question. as secretary said, we've got the youngest and largest population of personnel responding to this crisis. as the chairman said on 30 october, we've got a unique role and responsibility for the u.s. military personnel due to the scale of the deployment and the responsibility to the health of our service personnel and to their families. we decided to take this more conservative approach. it is not because we know something more than everybody else. it is just this is the way we chose to redeploy our personnel.
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>> but the question from the public, to me, and my question is -- okay. i mean people say -- are kind of gratified to hear that. our soldiers are doing everything they can to protect themselves not to be a carrier back and not to have this spread through it. and we appreciate that the military is taking those stands. on the other hand, we're saying well health workers, they don't rise to the level of having the same standards applied. or all those who are courageously putting themselves in harm's way who are not wearing the uniform, there is a different standard there. who wants to respond to that? >> i guess before let my colleagues respond, i would like to point out this was not a med kay based decision. this was operational decision made by the chairman based on the recommendation. >> but it kind of makes common sense, doesn't it? if you have just been over in an infested area, you could potentially be the carrier, why not take the extra conservative step to go under quarantine so
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we know for sure someone's not out bowling with a fever? >> let me jump in here. >> who's jumping? >> i'm jumping. ♪ coat senator coates who also chairs the homeland security -- or is the ranking member on homeland security, raises a question that is lynnly asked. why the military has one standard, and the civilians have another. though his time is expired, because this is a question that is continually raised nationally, i'm going to ask you, miss burwell, to answer or call upon the scientific expert to clarify that. then we'll move on. >> so the distinction -- and i think my colleague from the department of defense spoke, that this was not based on the science. this was based on the management of the force and the force's desires. as we work through this, that's something we want to respect for anyone and everyone. with regard to the civilian
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parts of the defense department, they are under the same guidance that we are using and that cdc has issued. i think what's important is that we make decisions based on the risk and the science, and that's what the standards are about. i also think it is important that we respect those that are serving and that those that are there and what they actually ask and want to do. there's the question of the science and the standard that we need to set to protect the nation. but there's also the desire of those that have taken the steps to serve. i think that's a part of what my colleague was reflecting in terms of what the force was requesting of the joint chiefs. i think we will want to hear that, too. when there's the return, as people come back, there are people that will make choices. we need to do the steps that we believe are science based to protect the nation. if there are those who have a desire or a wish to do other, or more, that's something that they should do. but the decisions and what we have been put in place are based
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on risk levels and the science related to that. i don't know if dr. fauci or dr. frieden, you want to add. >> if i can just make a couple of points. in ebola, there is no carrier state. so you cannot make other people ill unless you yourself are ill. from everything that we've seen of how the virus operates, 'til date. at cdc itself, we've already had more than 100 of our top disease detectives and public health specialists go to fight the outbreak, and then come back to cdc. they come back into active work at cdc so that they can be productive in the response and protecting plerns in oth ining ways. but our active monitoring program is to ensure that every person that comes back is monitored, their temperature is taken every day, because the key is that wherever you are, quarantine or your own home or workplace, as soon as you develop any symptoms whatsoever, even if they don't turn out to be ebola, you immediately get assessed and isolated.
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that's how we can protect americans most effectively in terms of people coming back themselves. >> thank you very much, dr. frieden. but to dr. fauci, i think did you have something to add? because as i understand the statement is the 21-day monitoring is mandatory. the 21 -- the residential approach of the military is precautionary. and they also have our command and control organization. is that it in a nutshell? >> it is true. one is an operational decision and another one was a decision based on the stratstratificatio risk. there are aspects of the cdc recommendation that are the functional equivalent of a quarantine but that's based solely on the stratification of the risk. as you lower down, you're
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monitoring in a dredirect activ. if the risk is low you have a monitoring every single day and you have the flexibility of making decision on the restriction of the movement based on the monitoring. >> madam chairman, if i could have ten seconds just to make a point. i flow i don't have time to have it answered. that assumes you know everyone that needs to be screened. that assumes you haven't missed anybody. and i can't -- i know we've got five airports but we've got thousands of people coming across the borders. zbll ok >> okay. thank you. i think this clarified a very important national question. now we will go to senator murray. >> well, thank you very much, claire woman mckolsky. i'm sure we've all heard concerns from our constituents about how ebola could impact them and how we can stop this
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disease and keep our communities safe so today really is an important opportunity to make sure our response efforts are on track and we're doing everything we can to put an end to this terrible outbreak. i want to thank all of our witnesses for coming, for all you are doing for fall the the people in your agencies. i would like to ask unanimous consent that the comments of american federation of teachers concerning the ebola outbreak be entered into the record as well. thank you. i wanted to just mention today that i am really proud that my home state of washington is really a global leader in the public health sphere. in the seattle area alone we have over 40 public health organizationses that are working to combat ebola. bill and melinda gates foundation. they've contracted a lot of time, effort and money to help scale up some of the emergency operations to control this
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outbreak, including providing some critical support for the centers for disease control and prevention. i think i speak on behalf of the entire nation that we're very grateful to that. secretary burwell, i wanted to ask you specifically more about the role of ngos and the foundation support and the ebola outbreak, and even like what percent of funding would you say is coming from private non-governmental groups to support this fight and what more private foundations and actors can do. >> i agree with your statement about the efforts that have been made by a number of organizations. i think i would put it into two buckets in terms of the type of assistance. one is very important and we've been questioned about, which is health care workers. there are a number of ngos and community-based organizations. and my colleague from usaid can speak to that is essential. that is specific. that is important. that's part of what the funding will do to support the people to get people in country in west africa so that we can assist.
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while 90% as mentioned by director frieden, of the people who are doing the work and care are locals. we need that 10% to come and be experienced. so that's one entire area. then i think there's the other area. that's where the bill and melinda gates foundation, paul g. allen, and that's helping in the areas where they have expertise. the gates foundation is not only funding at helping with the cdc foundation. nih is working very closely with the gates foundation so that we make sure we have the best experts, zmapp, one of the drugs, it's not just about a drug. it actually is an agricultural product because it comes from tobacco. so gates agricultural experts are part of our conversation to make sure we're speeding that along. in addition, people like it the paul allen foundation found places that they could help us. one of the critical issues is medevacing health care workers out. paul allen and his foundation have focused on those issues. >> and getting the data which they talked to me about. >> absolutely.
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so there is a range of issues that i think they can be helpful with, and are. then there's the whole issue of the ngos that have health care workers and help and relief on the ground in the country. >> i want to ask one other question. i know my time's going to run out. but i think it's really important that we recognize those groups that are doing that and look forward to hearing more from you about that. but i did want to follow up on how the money was going to be allocated in hospitals in particular and for all of us to think about that. i wanted to ask you, secretary burwell, in the supplemental funding request you have funds designated for readiness within state and local public health departments and laboratories. i wanted to ask how you're going to distribute that funding and how do you expect the states and localities to actually use that money. >> so i think there are two different pieces of the money that will go to states and localities. part of that money comes from the assistant secretary for
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preparedness and response and uses our preparedness networks that we have traditionally used and that were basically set up post-9/11. we will use those networks and we will also work with the state health departments to determine who wants to set up treatment facilities. so that's one portion of it. parts of the money though go through cdc. i'll ask director frieden to talk about how those monies. so there is a portion that's in one part of hhs, then there's the cdc money. >> at cdc we would provide support for state, local entities and for coalitions in a variety of ways. the public health emergency preparedness fund would be formula based, based on improving infection control and emergency response. in addition, we would support networks like the emerging laboratory capacity grant program that support cutting-edge work and prevention epicenter to look at infection control, training and documentation of how to improve infection control, as well as laboratory networks, the laboratory response network which is now 10 or 15 years old,
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and is why now we have 27 labs around the u.s. able to test in just a few hours for ebola. but that needs to be upgraded and extended. as well as our emerging infectious disease program. so a variety of programs we're able to deploy to work in this area through state and local entities and through leading cutting-edge institutions. >> so you are kf dernt you have a system in place already so that those funds are distributed in the best way to use them? >> yes, we are. >> thank you, madam chair. >> thank you. we are now going to turn to senator boseman. i just want to remind everybody, we have nine other senators who wish to ask questions. i asked people to kind of come to the end when we're at the end. otherwise, we will adjourn -- recess for the vote and come back after the vote. i think we can get this done.
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>> thank you, madam chair. i'd just like to ask one question and be respectful of the time. hopefully you in leadership will remember it. something i have concern about, you mentioned the difference in nigeria and the good job that it did. then we've got liberia on the other extent where things have really had such difficult time. can you -- my concern is when you go to western africa or when you go to africa in general, we see many examples of the $20 million processing plant that was built to help the locals when they only needed a $250,000 processing plant. we leave, they go bankrupt, and it's just sitting there because that's not what they needed. liberia is a country where they
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tell me their electricity output is such that they would have trouble powering the jumbotron at dallas stadium. so are we thinking about that or is this going to be something that we put in and it is going to be an ongoing cost for us, forever. is that the program or are we talking about doing something and turning it over to them? again, in situations where you have countries that maybe have less than one doctor per 100,000 people. >> he that's a wonderful question and something we're working very closely with, both national and local governments, is to try not only to respond to the immediate needs of the outbreak but also to leave behind a strengthened health system and some of the other impacts that we're seeing in terms of food security and economic impacts of this outbreak. it's absolutely essential that we leave behind a system that can be sustained and that can help that country stay more on the pathway of development.
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they, as you know, were coming out of a decades-long civil war. >> i understand. >> so they were just starting to see the progress when this outbreak -- >> well, not only that country, but others. again, we need to move on. but i really hope that we are looking at that. in terms of equipment, servicing equipment, just basic things that we take for granted, we really do need to look so that when we walk away -- and we will walk away through the appropriations process or whatever, that they have something that they can maintain and actually do a good job. thank you, madam chair. >> thank you, madam chairman. thank you to all of our panelists, both for being here today and for the hard work that you've been doing to address the ebola outbreak in africa and the cases here. i think this question is a follow-up to secretary burwell and dr. frieden about just to
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make sure that i'm clear for what senator murray was asking about, the impact on state and location local health authorities and our ability to build infrastructure. as i understand your response to her, you were suggesting that the support in this legislation will go not just to address ebola specifically but also to build capacity for future potential outbreaks or future local and state needs. is that correct? >> it will do both. when we think about the hospital preparedness funding that will go, that is preparedness funding to the front lines which were the issue the chairwoman began with in terms of that type of training for the front lines. in terms of hospitals that will be treatment facilities, they will be able to do ebola but be able to do other things as well. while it is focused on the effort here and now we believe
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it will extend just as the question about the training that's going to occur, the 500 people that are being trained -- the defense department can speak to -- those will be in place in west africa. similarly, our work will be in place here. >> thank you. i will just relay i've spoken with the new hampshire public health officials and they have been very appreciative of the close working relationship with cdc and nih and so i hope that will continue. i'm slure it will. >> when you talk about the hospitals, one of the things that i have heard from the dez fl designated hospital in new hampshire hto be the state's critical ebola referral hospital, they indicate they've had trouble getting the personal protective equipment, that it is not available. what is being done to make sure that that equipment is available to hospitals that need it and therefore personnel? >> there are three different
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things that we are doing to make sure that that equipment is available. the first is working with the manufacturers to make sure that they are producing as much as they possibly can. the manufacturers are now working 24/7. we are working directly with them through the assistant secretary for preparedness and response. the second thing -- this is part of this package's funding -- we actually are going to purchase ppe that will sit with cdc so if there is a case and a treatment hospital doesn't have what it needs, cdc can provide it. the third thing we are doing is -- >> i'm sorry to interrupt but can you tell me what your proposed schedule is for having that in place? >> for the strategic national stockpile, we've already begun to assemble kits that are available today if they were cases and we needed to provide them to hospitals. we don't want to soak up all that's available from the market. so as secretary burwell was noting, we're encouraging the manufacturers to provide it first to those hospitals on the front lines.
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as more becomes available we will have enough in the strategic flasnational stockpil provide for the care up -- depending on the amount of use, up to about two dozen patients for their entire course of illness and to get that to any hospital in the u.s. within hours. >> great. thank you. finally, new hampshire brigadier general peter corey, the deputy commanding general for u.s. army africa and a member of our new hampshire national guard is deployed currently to liberia to assist with the effort there. i want to commend him and all of the other members of our military who are working to contain the outbreak in africa at great sacrifice to themselves and their families. as i understand his mission there and the mission of our other military members is to build facilities and for training. i think that's what people have spoken to today as well.
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one of the things that i'm not clear about -- i think this is for deputy secretary higginbotham -- when you were talking about the funding request, you pointed out that $1.3 billion in base funding is to go to, among other things, construction of ebola treatment units. are those the same treatment units that the members of our military are going to be constructing, or is that piece somewhere else in this budget request? >> so as you know, senator, the mission of the department of defense personnel is limited in time and scope. resources that we're requesting will build additional ebola treatment units. those that the defense department is building we've also requested resources to support staffing and operations of those and the others that we construct. the answer is, it is a seamless operation from that perspective and hopefully it the dod mission will be able to exit as it's planned and we'll be able to have the resources and ability
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to step forward and construct those units. >> i'm still not clear though. so stis this $1.3 billion a separate request? is the dod request someplace else in this emergency? >> i'll let my colleague respond but i believe dod has reprogrammed funds to meet that need. >> okay. >> yes, ma'am. we did a reprogramming that was supporting by this committee of obligationed operations contingency funding for fiscal 2014 to move that over to a $1 billion reprogramming to support dod's effort. would encourage the support of congress to make that happen. >> thank you. >> senator cochran. i understand that if your caucus concurs, you will chair this committee in the next congress. is that right? >> i hope so. >> senator cochran, please. >> thank you, madam chair. i think this is directed to if
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the secretary. and it relates to what senator shaheen was discussing. the concerns about some of the facilities that are being envisioned by the department and the funding that's being requested in this supplemental may be unable to meet the goals established by the administration. specifically, i have concerns that the amount provided for the creation of more than 50 regional ebola treatment centers may be totally inadequate to accomplish the administration's goal. what is your reaction to that? >> thank you, senator. let me take an initial response and ask my colleague to jump in. first, the request that we're making sheer is to support a u.s. government funded total number of 20 ebola treatment units. there is a larger number in a
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global strategy and one of the things we've been doing at the state department is to encourage and ask for donations from partner governments around the world. it is the view of the experts that that number of fixed unit treatment beds is critical to controlling the epidemic but we're also requesting community -- resources for community care centers that can go into more rural places and basically be mobile to go where there are spikes in the disease for immediate isolation and containment. then follow patients to the etus. but let me ask nancy to join here. >> simply that, that we're looking at a strategy that is care and isolation, it is also the safe burials and it is also intensive social outreach so that people change their habits. all taken together is what we're seeing in some of the highly affected areas is beginning to yield some results. we need to keep at that in a way that is nimble so that as the virus changes and moves we're
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able to put the right strategy element against it. >> madam chair, thank you very much. let me commend the panel. i think the quality of the discussion and exchange we've had today is excellent. certainly to inform -- better inform the members of our committee. it is a serious responsibility that all of you have. i understand that you do take it seriously and i commend you for your efforts. >> thank you, madam claire. i've been following part of this from my office and part running from other things. secretary burwell, you've always been available and i appreciate our talk we had earlier this we week. secretary johnson, you have, too. of course, dr. fauci i've known forever and ever. his hair was dark and i had hair when we first met.
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but i might ask this question of dr. fauci and anybody else that would like to try, go ahead. today, as i understand it, zero americans have died of ebola. even though we see headlines every day. . but thousands of americans die every year of other contagious disease. i'm thinking influenza, especially, something that we can curtail greatly. but less than half of our population ever even gets vax fl vaccinated for the flu. is there avaccinated for the fl. is there a disconnect here? should the news be putting up a big chart saying zero ebola, 2,253 flu deaths.
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would that make people start paying attention? >> you bring up an excellent point, senator, that when you have something that is new and when you look at what goes on in west africa, it's rather cataclysmic. when you look at what has happened with ebola because of our capability, as dr. frieden has often described, to do the kinds of contact tracing to prevent an outbreak here, you're absolutely correct. from the standpoint of the control, we've done very well. often we forget when you have something that year after year after year has a terrible burden of illness and disease, you kind of get used to it and you take it for granted. but i'm very glad you brought up the issue of influenza which is an extraordinarily important disease that we face constantly season after season after season with always the looming threat of a pandemic. . so there are things that we can
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do about it. you brought up one of them. we need to make sure that everyone from 6 months of age or older gets vaccinated for influenza. we could decrease dramatically the burden of disease, death and hospitalization for influenza. so that's not at all to diminish what needs to be done and what we're doing with ebola. but when we do that, we shouldn't forget other important diseases in our society. >> the reason i use that as an example, i agree with you, i'm not downplaying ebola at all, but i'm looking at -- tends to vary from state to state, sometimes almost draconian measures taken on health care workers who come back from liberia or place with ebola. i realize people are trying -- oftentimes people have no medical knowledge are trying to protect everyone. and i understand that.
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but do we have a counterbill or anything that might happen that we're going to make it more difficult to find health care workers who are willing to go from the united states, to follow it the commitment united states government has made to help countries like liberia? >> that's one of the reasons why several of us have said it's very important to respect the health care workers and to develop policies that are based on fundamental science to protect them when they go, to protect them when they're there, and to protect and respect them when they return. so i take your point very strongly because i feel very strongly myself being a health care worker and having so many of my colleagues who have actually volunteered and now have come back and want to resume their regular lives and their duties. >> i think about my wife is a medical surgical nurse. when she was working she was
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sometimes highly, highly infectious patients and they would do all the things that now i see on television, putting on the suits and all the rest that they did. we follow these things. one last question, i might ask. anybody wants to answer it, feel free. the president requested hundreds of millions of dollars for the development and testing of an ebola vaccine. knowing the amount of time it takes to develop a vaccine and test it, what are we talking about in time? anybody care to -- >> sure. well, as you may have heard, we have fully enrolled phase one trial at the nih that started on september 2nd. i just reviewed the data that came in from that. it looks good. we're going to move on towards the end of this year to a phase two-three trial to determine ef quasi. one trial will take place in liberia, and one will take place
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in sierra leone. the one sierra leone will be a step wedge trial that the cdc will be responsible for. if in fact this is an effective vaccine, senator -- which we hope it will -- and if the infection rate remains at a high level -- because that's how you get your data more quickly, we could know by the middle of 2015 whether or not we have an effective vaccine. so we're hoping that that will be the case. but we fully are now already geared to start this towards the end of the this year and the very first month of 2015. >> i appreciate that very much. the chair is back. i yield to -- >> senator collins, who's been remarkably patient. we're just going to go straight down the republican aisle which they'd like anyway.
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is senator -- senator collins, why don't you get started. then we'll go to senator kirk and see who else is here to ask questions. >> madam chairman, let me first thank you for your leadership of this committee. you may no longer be our chair, but i know you're still going to be a powerhouse on this committee. dr. frieden, all of us are grateful to the health care workers who have traveled to western africa to help control this epidemic and treat the patients there. but a major reason that the american public is alarmed about washington's response to ebola is that the cdc seemed to be reacting to events rather than getting out in front of them. let me give you some examples.
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first of it all, the cdc and cbp did not begin enhanced entry screening of individuals arriving from west africa until after the diagnosis and subsequent death of thomas duncan. second, the cdc did not issue updated guidance on the use of personal protective equipment until after the diagnosis of the two dallas nurses. third, the cdc did not issue revised guidance for monitoring and the movement of individuals with potential ebola exposure until after it had told one of those nurses that she was free to travel on two commercial airline flights, and until after dr. craig spencer, who,
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fortunately, has recovered from ebola, rode the subway, went tout dinner, and even went bowling. all of those activities could potentially have exposed others to the virus. then the department of defense implements a totally different protocol for military members despite the fact that they are not involved in direct patient care. so from my perspective, it's not surprising that the american public is concerned about whether the response from washington is the correct response. it is also no surprise that so many state governments, including major states, large states -- new york, new jersey, california, georgia, illinois, virginia, florida, and my home
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state of maine -- have lost confidence and have used their authority to implement policies that go beyond the cdc guidelines. so i guess my bottom line question to you is, are you sure that the cdc's guidance is correct and the best way to protect the american people? >> cdc bases its guidance and its actions on the best available data and experience. we have faced now the first case of ebola in the united states. the guidance we have provided was based on decades of experience in africa, and had been effective in protecting our own staff and others. when it did not work here, we changed that guidance. we will change our guidance based on the experience and based on what the science and data shows us to be most protective of health care workers and most protective of americans. what we know clearly is that we need to adjust our approach
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based on experience. right now we're dealing with a cluster in mali. that cluster has to be controlled or we're going to have another front in the battle against ebola and we have staff on within the u.s., we're intensively working with health care workers to increase training and the resources in the emergency funding request would allow us and other parts of hhs to scale that up even more. >> dr. fauci, first of all, let me commend you for taking care of one of the nurses who was infected. in your experience, should we be worried about the ebola virus mutating into a virus that could be more easily transmitted the way the flu is, for example. >> senator, thank you for that question. the ebola virus continues to mutate because it replicates very rapidly.
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that's not surprising. all viruses, particularly rna viruses, do that. the question that's the important question, are the mutations associated with significant functional changes in the virus? and by functional change, the question everyone asks, can it all of a sudden go from a virus that is not transmitted by the respiratory route like flu, where it does not now. could do it that? and the answer it it would be extremely unlikely that there that's the case i say "extremely unlikely" and the reason i say that, because with viruses you never say never and you never say always. but the reason i can comfortably say extremely unlikely is that this would be unprecedented because of all the viruses that replicate and mutate, there really no examples of a virus that has completely changed its method of transmissibility. it can get a little more virulent, a little less
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virulent, a little bit more readily transmitted, a little bit less. but to completely change its method of transmission would be unprecedented. that doesn't mean we're not following it carefully to make sure it doesn't do that but it would be an unprecedented situation in virology. >> thank you. >> thank you, i have one question for dr. fauci. could you describe your opinion of the technical expertise in academia and medicine of the canadian government? >> canadian government? they're very good. i mean, we have many colleagues in canada. we deal with them almost on a continual basis. they're as good as you can get. >> let me follow up. if they're very good, why were they wrong in shutting down their visa line in the source countries of ebola? >> senator, i wouldn't say they were wrong. i would say that they made a decision based on what their
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judgment was for the best -- for their citizens. when it comes to what we do, we make our decisions based on the scientific data which might be different from people who in good faith are trying to do the best for their citizens. so i don't say they're wrong and i don't criticize them. >> and yet we made a different decision. we have insisted on keeping the visa line open in the source countries. i would say that is likely a mistake. we should probably follow the direction of our canadian allies. >> may i comment on that, please? this specific question is one i've thought a lot about myself and, in fact, the number of flights that are coming from west africa that would enable you to get here have been dramatically reduced and on those flights, only about 30% of those passengers are
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non-immigrant visa holders from those three countries. a number of visa applications are denied by our state department already. my biggest concern with limiting the number of visas is that if the united states of america does that, a lot of other nations are going to follow us. which will have the effect of isolating those countries which i don't think we want to see happen. i'm proud of the fact that our military, our health care workers, are leading the international effort there. i don't want to see thises country become a leader in isolating those three countries. and so the reality is, given who we are as a nation, what we do is followed by other countries in the world. and so, that's -- that's my overriding concern with taking that action. >> dr. fauci, let me have you characterize the scientific and medical expertise of the australian government. >> again, similar to canada. they're excellent. they're as good as you can get internationally.
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>> in their case they made a similar decision to the canadians, on, i think it was october 28th. they shut down their visa line in the source countries. if they're so excellent, why would we ignore the action they have taken? secretary johnson? >> well of course i pay very close attention to what our friends in the canadian government do. in fact they have limited the number of visas, they haven't banned them entirely. and it's what i said before. this country is leading the international effort there. and i'm concerned that if we talk the same action it would have a cascading effect on other nations in europe, most prominently that you have with the effect of isolating those countries and making it harder for health care workers to go in and out of those countries. i think we have to pay very
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careful attention to what the airline industry would do in reaction to limiting visas because if you -- if the airlines start cancelling flights, there's no way to come and go. >> and i would just like to add, senator, in terms of one of the most important things to us is protecting the homeland. when we know and we've had this conversation through most of it, there are four things we know about this disease -- detect, isolate, contact trace, and treat. our ability to do that and as the secretary said there are no direct flights here. anyone who's coming here is coming indirectly. right now our ability, because we funnel, and not only we had five airports that did 94, now we funnel all. and we funnel through, and we create a monitoring mechanism, both at the point of departure, where everyone who leaves that country is checked. their temperature is checked, they are questioned. when they come to this country three things happen, they get
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their temperature checked, they're questioned and they write down their contact information so we make sure if they need to be referred the next step is they go to cdc for a further effort there. then we do the monitoring. that's an important part and that's what we've seen work. and whether that's what we've seen in the cases in oregon, oklahoma, across the country, when we can be on top of it because we know and get ahead of it as dr. fauci and dr. frieden have both said before someone is symptomatic and can spread. so it is our judgment that that is the best way, especially when a large percentage, as the secretary said, of those returning, are actually american citizens from these countries. >> senator, if i might add just one thing about our visa operations. we have taken steps to ensure we're asking the same questions of visa applicants that are asked when they are transiting -- when they're departing, when they're transiting. >> can i follow up here? i have sent a letter to you on october 17th, i wonder if the state department could respond to the letter? >> absolutely.
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>> thank you. >> i would just conclude by saying if any of the questions are answered affirmatively, we deny the visa, it's not issued and we refer to cbp and cdc to ensure that person can't travel. >> senator moran? >> thank you very much. as you can see, there continues to be a lot of interest in this issue about quarantining people who return from west africa. it was indicated earlier in the testimony about the difference between the department of defense and others and there was a comment that was made that says well, that's been clarified now. i'd like to say it's been explained, i don't think it's been clarified in the distinction between or the rationale for how we're going to treat troops versus how we're going to treat others. here's what i'd like to ask. who is present at the table if i wanted to ask a question about how successful we are in our coordination efforts among the
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various agencies and departments? and what strikes me is that the president's ebola coordinator is not part of the panel and maybe that's the committee choice and not yours but one i would think as a member interested in this topic, i remember our hearing on september the 16th in which the question was asked, i think it was mostly about coordination abroad, in africa, and the answer was usaid and more senior members than me on this committee, had this kind of, wasn't an audible gasp, but like that doesn't make sense, there's got to be more to this story, or are we really trusting usaid to coordinate the activities in west africa? the president has now appointed an ebola coordinator and that person isn't part of the witness panel today and that strikes me as odd. >> the chair would like to take the opportunity to respond. i reached out to mr. klain through the office of the white
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house, his employer, the white house declined his participation saying that he had no operational role, his role is that of a coordinator and was an employee of the white house and the president. the white house rather than us getting into a lot of arguments back and forth, because i had some -- you know, you and i think a lot alike. on many of these practical matters. >> thank you for that compliment. >> that really going back to presidents -- we've looked all the way back to ronald reagan and whenever there was an employee of the white house that had an important role, it was the right of the president to decline there. so president obama didn't do this, but they felt that the people who had the real responsibility for doing the actual governance of response, and the ones who would be in charge of the money from this committee should be the ones to testify and i think by all
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accounts this is a pretty solid group. >> certainly, madam chairman, you and i agree with this being a solid group and i appreciate the testimony and education i've had today. but i did notice among committee members on our september hearing this concern about coordination and i'd like to follow up and find out what's transpired since we met, ask that question and how the coordination has changed and been altered since then. dr. fauci, what developments have occurred? in some ways you've answered this question, i think, but what's different today than the last time we met? when you were here and testified in september, i think september the 16th, what's changed in the care, treatment, protocols, i guess this may be a dr. frieden question, as well, what's transpired that is different today than it was when we met a month and a half ago in regard to treatment and the
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prospect of hope in this battle against ebola? >> i'll take a shot at it first. the first thing is that at the time we met last time we were still in the stage of doing contact tracing of people who were exposed in this country. and as it turns out now when you look at the contacts of the infected individuals they are now beyond the 21-day period. so we can now comfortably say that the united states of america is ebola-free. and that's something i couldn't tell you at the last hearing because we were not sure at the time. the next is that we've made a significant progress on the road to the testing of a vaccine for its efficacy because we had just started the phase one trial at the time of the last hearing and now the results look good in that trial and we're all set to go at the end of the year into the efficacy trial in west
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africa. then the other thing is that the downturn in liberia is encouraging. we're not saying that the ball game is over by any means but the downturn there is encouraging which means that the prevention and contact tracing and funeral issues have worked. >> dr. brantly who testified on september the 16th, indicated that he was unable to say whether his treatment improved his condition or not. can we answer that question today? >> no, we can't. and i'm glad you asked that because that is the real important argument for doing the controlled clinical trials that we are now planning, we had a meeting last evening at the nih where we brought together all of the people who had taken care of ebola patients in the united states. we had nebraska there, we had emory there, we had the nih there and we had others and when we looked at the data, the cdc presented all the data and it
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was clear that we have no idea what works or doesn't work because it was just given on an impeeric basis, which is a very strong argument for clinical trials. >> thank you. >> madam chairman, thank you very much. >> thank you, madam chairman. my first question is for assistant secretary lumpkin. in your statement you mentioned $112 million of the president's recent request for emergency fund willing go to darpa to develop technologies and provide temporary immunity. i understand the defense threat reduction agency has been looking for rapidly available ebola vaccines and treatments. so first can you elaborate on what darpa will be looking for with the requested funds, and whether there are technologies in the pipeline that show promise in the short term? >> first of all, i don't propose to promise anything. this is a research capability we're trying to fund to
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accelerate development programs and i think the key to look at that is that this is in conjunction with nih efforts in conjunction with ditra efforts and i think the key is we have to pull out all stops as we look at doing ground breaking new innovative technologies to address the treatment and ultimately a vaccine to prevent ebola. so darpa has unique capability and methodologies, how they look and do problem solving that's led to many of the capabilities that we have today from everything from gps to the mouse that runs your computer. they look at -- they have innovative technologies as the way they look at the problem solving. so we'd like to resource them to look at this problem set, and to add just one more set of eyes to move this forward as fast as possible. >> and then to coordinate that effort with ditra. >> absolutely. and with nih as well. >> we generally think of it as the continuum.
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ditra and darpa, many times in the earliest stages. though ditra is not just the earliest stages. then nih is the next level and then barda at the next level when we're getting to that stage of manufacturing in terms of thinking about the continuum of getting product from that initial idea through production and use. >> madam secretary, i see that the hhs request for biomedical advance research development authority is specifically requesting an additional $157 million to manufacture vaccines, and synthetic therapeutics for use in clinical trials. in the upper midwest region there's very promising therapeutic but as i understand it it's not necessarily synthetic. meaning it's developed outside the lab. this has proven effective with mers and the flu so how is your request flexible enough to take advantage of new technologies like this?
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>> what we want to do is work and we have been working on zmapp which is tobacco-based currently, one of the things in terms with getting enough production even that we can do trials. this is a therapeutic. why we've turned to synthetics is because we think we can get volume. with any of these issues we want to work to what will get us there faster and to the level of production and so as we're reviewing and with the finances we were given earlier, we have been working on zmapp in a non-synthetic fashion. >> give than many early vaccines fail, how many candidates will barda be able to support with this $157 million request? >> i will turn to dr. fauci to talk about the number of different -- there are two main vaccine candidates that are there, but there are a number of others on the list. but i'll let dr. fauci -- >> does the funding allow for
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scale out for manufacture when you find something that works? >> so the answer to the question is that as the secretary correctly said, there are two major ones but there are three right behind them that barda has their sites on. so if you're asking what can barda do with regard to pushing it forward in the development, we're talking about five. >> i would just add depending on where and how quickly the issue of the distribution of those, there's the manufacturing and production, which barda is focused on but there's also distribution and that's why we have put in the contingency fund. a part of the contingency fund is if we get something and at that point believe we need to support further distribution, that's something that we would do, as well. so distribute a successful vaccine. >> that allows for large scale manufacture and distribution? >> right now we have put in funds that will help us get to the manufacturing. that is what we are focused on in the barda element. >> thank you. >> thank you very much, senator
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hogan as we wrap up today's hearing i'd like to thank these witnesses here today for their cogent testimony. i think we've learned a lot. i think it gives us great insight into the president's request and why that significant amount of money is needed and why even though it might not be a headline the urgency continues and i would like to follow the model established under president bush and then with president obama when we had an infectious disease situation before. before i wrap up i want to comment about dr. frieden and dr. fauci who spent a lot of time both dealing with the
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disease and dealing with the fear the public had around the disease and you did a great job while you were trying to do several other jobs. so secretary burwell do you think you work would have been facilitated while these two fine doctors -- because the question is who is america's doctor? should we move rapidly to confirm a surgeon general which in no way minimizes the work that these men have significant operational responsibility and in many ways they acted as america's doctors. and they did a great job and we're grateful. >> it would be helpful. this is scary to the american people. so having an additional voice that would be a voice that is a trusted doctor voice about how to think about this, and how to understand it is certainly something that would be helpful in ebola. but it would be helpful also in things that the department does like opioids and other things that are problems throughout our nation. so the answer to that question is it would be very helpful to us, and thank you to dr. frieden and dr. fauci, who did take that
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responsibility on. because they are physicians. >> and they did do that job. >> and they did do that job. >> but they had a lot of other jobs. >> that's correct. >> from clinical trials to whatever. well we're going to wrap up, but i just want to thank everyone in our civil service. all of our federal employees. from the administrative support team all the way up to the top level. and also, of course, for our military personnel. but for our civil service, our federal employees, often trashed and bashed i would like to say thank you. and i think we need to acknowledge this. that in a democracy, we need to be able to have a civil service that is reliable and continue to do the job. you just can't dial up a civil service. you can't order it on and i know that in every single one of the agencies that they face sequester, they face the a shutdown.
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just one year ago they were told they were non-essential and now we want them to risk their lives or spend night and day trying to protect america. so i think we need to respect them and the way we show that respect is making sure they have the resources to do the job that they were. and this also cautions us when we make unnecessary travel restrictions, our federal government doesn't -- we're not talking about taking a lavish trip to an exotic foreign capital like many of us do. that this is really on the job. so i want to say thank you and we want to thank every single one of them that we need to do our job so we have what they have to do their job. thank you very much. in addition to this -- thank you. we've heard need the committee has also received 60 written submissions from 116 organizations that will be made part of the hearing record. if there are no further
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questions, senators may submit additional questions for the committee's official record. we asked the agencies not to take their usual 30 days. we asked the agencies to respond in two weeks. the reason why is this committee is going to be moving on this request and the senators have a right to have their questions answered. so if everyone could make sure any additional questions are and then senator shelby and i working with congressman hall rogers under the guidance of our leadership intend to be moving on the urgent request but also our responsibilities for fiscal 2015 for which we need to do our job so others can get on with theirs. having said that, the committee now stands in recess subject to the call of the chair and i thank everyone very much.
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coming up at noon, live on c-span2, a hearing on the future of energy in africa. officials from the state department, agency for international development, and energy part are among those testifying. 30% of global oil and gas discoveries over the past five years have been in sub-saharan africa. and at 2:00 p.m., also live on c-span2, a forum on opportunities for fiscal reform the next congress. specialists from the committee for responsible federal budget, the bipartisan policy center, and the concord coalition offer their views. this weekend on c-span, author and president of arabs or israel. >> i had arrived late at night, almost september 11th morning. i arrived in my home in los angeles and i woke up at 6:00
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a.m. l.a. time to seeing the second airplane hitting the tower live. and i was traumatized, because that was when i knew that this is terrorism. it's not one airplane accident. so i ran to the phone, and i called many people in egypt. i wanted them to comfort me. especially after i learned that mohammed atta, the leader of the 19 terrorists, was from cairo. the same city i came from. i called around eight people and they all said the same thing, even though they -- some of them don't know the other, they told me how dare you say that this was done by arabs or muslims, don't you know this was a jewish conspiracy?
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the jews did it. and i hung up the phone and wept. i suddenly felt i cannot relate to my culture of origin anymore. and this is a very hard feeling. when you -- when you can't relate to how the people you love, and you are brought up with for many, many years of your life, that they don't see the reality as it should be. >> her entire interview sunday evening at 8:00 p.m. eastern on c spans's q&a. on book tv we're featuring new releases. best-selling author karen armstrong and religion and conflict. president george w. bush on his biography of his father. and john mccain on unsung military heroes. and on american history tv, on c-span3, our all-day live coverage of the world war i centennial symposium from norfolk starting at 9:30 a.m. eastern.
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find our complete television schedule at and let us know what you think about the programs you're watching. call us at 202-626-3400. e-mail us at or send us a tweet @c-span, #comments. join the c-span conversation. like us on facebook. follow us on twitter. president obama continues his asia trip today. he's in murre ba, also known as myanmar, for more economic meetings. he has already held meetings with the president and the opposition leader in that country. president in australia tomorrow and sunday for the g-20 leaders summit and is also expected to deliver a foreign policy address there. the president this morning talked about the keystone xl pipeline that's before the house today. and the senate next week. this article from the hill, lawmakers shouldn't short circuit the existing process for evaluating the key stone xl
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pipeline. president obama told reporters on friday, i've been clear in the past, and my position hasn't changed, that this is a process that is supposed to be followed. president obama said at a press conference in burma, the president said that until an ongoing court case in nebraska was settled, that could affect the root of the pipeline, it will be difficult for his administration to conduct an accurate study of the effect of construction, and obama reiterated that he personally would be evaluating the pipeline on whether or not it accelerating climate change. again, that from the hill today. the house vote to authorize the keystone xl pipeline project is scheduled to occur during the noon hour today. c-span will have that live as part of our coverage of the u.s. house of representatives. a look at what states and local governments are doing to integrate immigrants into their communities now. the commissioner with the new york city's mayor's office of immigrant affairs, and a
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california state senator as well as the director of the group called global detroit all offer their views. this discussion was part of an all-day conference hosted by georgetown university law school. >> we're going to get started. we're a little bit behind schedule. i'm going to try to get us back on track. my name is jeanne atkinson. i'm the executive director at clinic. catholic legal immigration network. i'm delighted to have you all here. and i'm delighted to follow director rodriguez because he really set up this panel i'll be moderating this morning. he spoke of a broad spectrum of organizations that play a role in this issue. and how immigrants energize our economy. he also mentioned how the federal government how the administration's looking at stepping into the void created by the lack of congressional action. and that is essentially what we're going to be speaking about this morning. since 2007, state legislatures
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have introduced laws and regulations related to immigration each year. last year, lawmakers in 45 states in the district of columbia enacted 437 laws and regulations covering a wide range of issues, including higher education, enforcement and migrant and refugee programs. at the same time, civic organizations are focusing attention on integration on the economic, social and cultural value that immigrants bring to their communities. it is my privilege to introduce three distinguished panelists who will speak about how state, cities and local entities have filled the void of congressional action. they represent three different sectors engaging in immigration issues outside the purview of the federal government. in the interest of time, i'm not going to read their bios, you have them in your programs and i encourage you to look at them. but i would like to introduce to
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nishaing aar wall, commissioner of the new york city's mayor office of immigrant affairs. and senator ricardo lara represents the 33rd district in the california state. and steve tobocman is the director of global detroit leading the city's economic revitalization. i'm going to stand. because we're going to do this in kind of a question and answer format so that we can look at some issues from these different sectors. and i will save time at the end for you all to have questions. so nisha i'd love to start with you. can you talk about the role of the mayor's office plays, and your commission plays in helping to fill the gap in benefits and gaps in new york city? >> sure. so, first of all, thank you so much for having me and for the conference organizers for having new york city represented here today on this panel. i guess one thing i'll say to start is some context, which is in that in new york city, one out of three individuals is foreign born or immigrant.
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that's more people than the city of chicago. when you add their kids it's 60% of new york city. so there's not of aspect of life in the city that isn't impacting immigrant families and vice versa. so it's really something front and center for city government for a long time. my office is essentially the bridge between city hall and new york city's many immigrant communities. and we have a very simple mission, which is to promote programs and policies that improve the well being of immigrant communities. and in mayor de blasio's administration we have three broad goals which think we sort of fulfill that mission. and the first is really to think about how to embed immigrant inclusion throughout the city's dna in a way. so it's not just the mayor's office of immigrant affairs that's thinking about immigrant well being, but it's really a part of the code of the city overall. and i think one good example of this that the mayor announced in january when he first took office is the city's municipal i.d. program. this is creating a government-issued local
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identification that's available to all regardless of immigration status and is really meant to function as a key to the city to open doors that were closed before to people who didn't have i.d. but also really to kind of equalize access to many of the services and amenities in new york. and i'm happy to talk more about that later. another broad goal of ours is access to justice and whether it's sort of on one end of the spectrum, needing adequate representation to defend themselves in those cases all the way to naturalization and citizenship. the city has invested a lot of resources, has a number of different programs available to help people sort of move down that continuum and we're currently thinking about how we'll prepare for that at the local level, as well. it's a major goal. and then the third is where my background comes in is advocacy. and how does the city as new york serve as an advocate at the state level. right, new york has somewhat shamefully failed to pass the dream act still. and how do we function at the
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federal level for eventual immigration reform and certainly to support the president when he announced his executive action. that's really how we think about our role and happy to talk about those initiatives in more detail. >> senator, can you tell me what the california legislature's been working on regarding immigration. and also how do you look at what's happening in cities such as l.a. and san francisco? >> great, thank you. great to be here. buenos dias. as we in california continue to address the fact that congress' complete failure to enact any type of comprehensive immigration reform, california has to lead. given the fact that we are the most diverse, most populous state in the country. and our legislature feels compelled to continue to serve as that kind of role model in terms of how can we affect positive change and ensure that we incorporate all of our immigrant communities into our society. and so in california, we've
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continued to pass legislation after legislation, with the hope that one day we get comprehensive immigration reform. but until then, there's families in california that continue to be torn apart. and we see it on a daily basis when we go back to our districts, when, you know, we're in our community, when we're in our churches. we see the struggle that people are going through. and the fact that we can't come up with some sort of comprehensive immigration reform. and so the -- the responsibility falls on the different states and city governments and local organizations. and so what we've done in california is continued, you know, we continue to lead where congress has continued to fail. and when it comes to driver's license bill, we finally got that passed. but we got that passed with the safeguards to ensure that we protect the individuals identity and then we protect the human
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and civil rights to ensure they're not victims of any discrimination. and likewise, we've seen case after case, and i'm sure you guys are aware of how professional students that are now graduating and our dream act students are graduating, finishing law school. finishing their professional studies, yet lack the opportunity to actually pursue a career. and so this year, instead of doing it by piecemeal like we were doing it in the legislature, we decided to do just a blanket bill that would cover the different professions. that require a professional license. and no longer just require a social security, but an item number to be able to qualify for that. and to allow the students or the professional to pursue the career and act as an independent contractor. again, understanding that the more folks have an opportunity to economic prosperity, the better our state is in. and california being a nation state and being the eighth largest economy in the world. continuing to promote that
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amongst residents remains a priority. we've just surpassed russia in italy's economy. we're on schedule to surpass france and the uk putting us back as the sixth largest economy. so our legislature wholeheartedly believes we need to ensure that everybody has that opportunity for that economic prosperity. and that includes our undocumented community. >> thank you. steve, i will mention that steve was a former michigan state legislator. so as we talk about the interaction in these, i think he brings us back a layer to the conversation. can you tell us about global detroit and what your role is in interacting with the city of detroit as well as the state of michigan? >> sure. so, again, also want to thank the sponsors for inviting us and having a voice from the midwest, the heartland. we have a very different demographic make-up than either of our coasts, where most immigrants enter. i think a critical and important place where i think we're trail blazing new concepts and new
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ideas about immigration and what it means for our communities in the heartland. so, global detroit is a regional economic development initiative. we are not an immigration per se initiative. we're certainly not an immigrant rights or advocacy organization. and we came together in the height of michigan and detroit's metro detroit's economic crisis in 2009. and i could get into some really woeful statistics, but really no state has ever had a decade as bad relative to the other states in the country as what michigan had in the 2000s. and so at the height of this economic depression in michigan, the detroit regional chamber of commerce foundations and other community leaders began to ask a number of questions about what does the future look like. and one of those questions was, what role do immigrants play in the economy? and what are the opportunities? and what are the challenges?
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and so out of that, we found a number of really powerful statistics that actually are shared all across the rust belt and the industrial heartland of this country where immigration is -- really make jobs and really power the economy. in i would say largely untold ways here in either national media or federal congressional debates. and so, just to briefly, you know, i'll try to throw two of what is probably about 30 something factoids or statistics that we commonly use at global detroit. from 1995 through 2005, according to research at duke university and uc-berkeley, 32.8%, about a third of michigan's high-tech firms had an immigrant founder or cofounder. and this is a state where there's only 5% to 6% foreign born, which means you're about six times as likely to start a high-tech firm than those born in the u.s. who live in our state. and it's -- i could get into all
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kinds of statistics on -- we happen to have an immigrant population that's more educated that our native born population and frankly educated in the right fields. international students play a really powerful role in our universities and colleges. but it's not just high-tech immigrants, and it's not just the stem and the h1bs and the things that you see the tech entrepreneurs trying to get. frankly, we are the only state that lost population, and our city, the city of detroit read lots of headlines of a large municipal bankruptcy in the history of america. you know, there are lots of reasons for that. and there's been a lot -- one that i don't think it's published often enough or very rarely. it's that we are still the 18th largest city in the country with about 700,000 people in the 2010 census. but we actually have the 135th largest foreign born population
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with only 35,000 immigrants in the city of detroit. the region, metro detroit has 400,000 immigrants and compares fairly well across the midwest. but the city really struggles. in fact, there's no other of the top 25 largest cities in the country that fall outside the top 100. and only one other that falls outside the top 50 in terms of the size of the foreign born population. in a state that is rapidly aging like much of the midwest like pennsylvania and ohio, frankly, immigrants across the board from working class immigrants who work in agriculture industry, which is our second largest industry after manufacturing to powering our research universities and medical complexes and tech firms and automotive design information technology. really probably the most powerful economic development strategy we have going for us. and so i lead a initiative that seeks to capitalize on that that has launched between 6 and 10 depending on how you want to count, independent initiatives
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like the country's first international student retention program. and i'll just conclude with this. as i mentioned, we're part of a growing movement in the midwest that has come to this reality. so in just the last four years, st. louis mosaic initiative similar to ours was launched. welcome dayton was launched in the city of dayton. the chicago office of new americans. vibrant pittsburgh, global cleveland. and similar intshives are being formed in senate it, toledo, buffalo, and all across the midwest. and there are literally almost a dozen. we worked collectively on the global great lakes network. it's exciting work and important work and it really is focused on national and regional and local economic policy. >> great. i'm going to follow up with you again, steve, for a minute. director rodriguez said that absent federal action, congressional action, we cannot do it all. so in -- with employment-based visas, you can't create them. there are other types of visas.
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what strategies do you use to overcome those types of challenges? >> sure. well, make no mistake that the biggest economic boost would be a more sensical and higher performing federal immigration policy that works for local economies. and maybe even is localized. because clearly the challenges that we face in detroit are very different than in long beach or new york city. and our skill sets and needs are very different and probably one-size-fit-all policy might not work as well. but absent that, we're trying to do everything we can to take advantage of the opportunities that we have. and frankly those. a lot of those would prepare us well. if some kind of immigration reform policy was passed. what do we do. one is i mentioned international students. we launched the michigan global talent retention initiative. i keep saying at conferences i'm waiting for someone to contradict that would be the first and maybe only international student retention program in the country. we have three full-time staff. we have agreements with 31
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colleges and universities in the state of michigan that represent most if not all of the 28,000 international students studying in our state, which by the way is an $800 million export product for our communities. and what we do is inform the students of the opportunities under the law to use their curricular practical training of their optional practical training under their visa to work both while they're in school and after graduation. and we highlight the opportunities as a gate way to investing more in-depth. and we can't answer long-term employment needs for this talent pool. but we can certainly create some gateways and opportunities. and we do a lot of education. we have 60 what we call go or global opportunity employers who have agreed to look at international student talent. and when you consider the fact that between 40% and 50% of all
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the masters and p.h.d.s and engineering, life scientists, computer sciences, physical sciences, are given to international students, it is sane that we don't have more policies to connect this incredible talent pool. we have the world's most talented people coming to this country. in fact, i mentioned the statistic about 32.8% of our high-tech firms. follow-up research suggests the average high-tech entrepreneur, immigrant entrepreneur starts their company 13 years after they come to the country. and the number one reason they come to the country is to get an education. so we see our international student retention program as the pipeline to becoming the silicon valley of the midwest. and we also look at how do we better connect skilled immigrants. who are underemployed and unemployed. the so-called brain waste syndrome that a lot of national players, we happen to have the fourth office of upwardly global nonprofit that has offices in san francisco, new york, and chicago.
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we're very connected, now they're opening up in maryland, i believe. we're very happy to have their fourth office in the city of detroit to work with skilled immigrants and refugees when we're getting about 2,000 or 2,500 middle eastern refugees a year. and while they -- from just anecdotal experience, i don't have the statistics, i think some of the first people that are able to get out of the conflicts of syria and some of the issues in iraq frankly are the most affluent and educated. and so they come to the metro detroit. frankly, we have one of the highest in raw number than anywhere in the country. certainly the highest concentration of middle eastern americans, and they're working restaurant jobs. they're working menial labor jobs. and these are engineers, these are accountants, these are people with i.t. backgrounds. and so what we're doing is recredentialing them, looking at our state laws and licensing guides and helping them. so those are just a couple of
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the ways we're trying to connect talent under the existing broken immigration system. >> thank you. so can you tell us about new york's workforce initiative programs? >> sure. so right now new york's workforce system is going through a rethink. a big rethink. under the office of a new task force called jobs for new yorkers. and this comprises both sort of city leaders as well as advocates in the field. and other stakeholders. and what's notable about it is one of the kind of facts that obviously jumped out at me in the first meeting of the task force was that one out of two of the unemployed or underemployed are foreign born in new york city. and so it's clear and i hear this every time i'm meeting with groups that our workforce system is really not working for immigrants. so one of the things we've been doing with the jobs from new york's task force is really convening groups to understand how the workforce system can respond better to immigrant communities in particular, some of it is low-hanging fruit, right? the fact that recipients are now eligible for some of the title i
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workforce services which they weren't before. i don't think our workforce system has been trained on that making sure that people are connected to the 16ss that they are entitled to now. but then also thinking about learning from places like michigan and detroit. thinking about how we can do better by our high-scaled workforce, how we also look at the low wage workforce, and connect them to the economic system as a whole so it's functioning better for them. we had a convening that was co-sponsored by us, the ford foundation, and i think the kind of big reality check for the workforce folks in the room was that there's a huge, informal economy, right? where largely, undocumented immigrants are working. if executive action happens and folks get work authorization suddenly that invisible workforce which is huge in new york city is no longer so inchrisible, and is the workforce system prepared to be able to work with that population? and i think the answer is no. not yet. and so we're really trying to think about at the system level
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what we can do about that. and it's somewhat daunting. but i think we're moving in that direction and we'll learn from others who have done a really great job in this area. >> thank you. senator, you've championed initiatives including california's driver's license bill, which passed, and a measure that would extend health care for all. which go not. what role do ud think the state should play in connecting immigrants to social and other services? >> i think it's the state's complete role to help its residents. and all its residents. and so, as we talk about, for example, the health care, health for all bill, which will reintroduced next year, and i'm very we're going to get that signed, we look at the fact that our own experiences, working with folks as we were signing people up to the aca, we realized that a large group, a large group of folks will live in mixed households. so, when people would come and try to sign up for the aca, then
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they would realize that wait, my spouse, my two children can't apply because they're undocumented, so none of the family is willing to register. because they didn't want to leave anybody out. so we realized that we needed to do something about that, again. and either whether it's creating a state exchange, very similar to what the aca does, or expanding our med account so we can cover those folks that can't afford to pay becomes a necessity for us. because if a person is sick, or you know their child is sick, then they don't go to school, they don't go to work and it impacts our economy directly. the other thing is california spends $1.7 billion annually on emergency room care. and this is where we know where our undocumented population are going. and that threatens everybody's health care, especially in a life or death situation, where our emergency rooms are completely booked for issues that can be treated by, you know, just having a doctor or
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access to a doctor. we in the legislature feel that this is the next step in terms of immigrant rights, of human rights, and we're going to continue to work on this issue. we've put a task force together. the thing is, you guys have heard from our governor, is like how are we going to pay for this? and this is what we're working on right now. is how do we create a funding mechanism to help the population which everybody is trying to work for. and so you're going to see some creative ways that might not -- that some of our immigrant rights groups nationally might not agree with. but they're ideas that we're looking at on how we cover this population. because we know that if we have access to health care, again, it's about incorporate them into our society, and ensuring that they have the wherewithal for some sort of upward mobility and access to affordable health care is part of that. >> you've also recently provided funding for representation for unaccompanied children?
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>> very proud of the fact that california is the only state that actually provided $3 million from our budget to help these children. we met with some of the biggest law firms in southern california with our attorney general, and we realized that the nonprofits, the legal aid folks that are working on these cases don't have the resources to be able to tend to all case loads. that's coming up, understand the fact that the united states is responsible for what's happening, has to take responsibility for what's happened in central america. so we were debating what we were going to do to help these refugee children. we decided that we needed to do and understanding also that the cases of a child is represented by an attorney, the chances of them actually gaining a stay is much greater than having, you know, a 10-year-old or a
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5-year-old go before a judge on their own. and we've known, we've heard, anecdotally of some of the children that have been returned. some of them have actually been murdered already. and so it just broke our heart. and it is just the drop in the bucket of what we could do for the kids in california. so we gave we portioned $3 million that are going to go to help these organizations to ensure that when they partner with the legal team that the cases actually prepared for doesn't take that much longer to take the case before a judge. and, again, instead of, you know, shunning these children understanding they're in need. nobody leaves or flees their country because they just want to on a whim. these are children that are in dire need. and if this was happening anywhere around the world, in europe, or anywhere else, we would do the same thing. and so we're very proud of the fact that we were able to do
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that. and we're going to monitor it and continue to see if we can give more money to the effort. >> that's great. nisha i'm sure you're proud of what new york city is doing also for unaccompanied children? >> yeah, we both the city council, the administration and then private philanthropy really came together in new york to respond to the child migrant issue. the city administration, we've formed an internal task force of mainly city agencies to figure out how we can best coordinate resources for the kids, specifically focused on things like educational and health resources. and so our city agencies are now actually located at the immigration court which, i think, in new york we have great immigration judges and they're really excited to have us there connecting the kids both to school enrollment as well as to child health class and other health benefits they may be eligible for. and we're running a series of community clinics connected to the schools, where the children are sort of most concentrated in new york city. and then the city council along with two foundations the new york community trust and the
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robin hood foundation funded close to $2 million to essentially provide universal representation for the kids coming through the new york surge docket. so that's really exciting. i hope more than just a response to the child migrant issue that it becomes then a stepping stone for us to think about how to use our school system as a way to connect kids, immigrant kids, to legal resources and other services like that. it's part of the mayor's platform, and i think also something that teachers and guidance counselors were hearing from them and are saying our kids have complicated immigration issues, how do we connect them to the right resources and how do we structure referral system that actually works for the schools, as well as for the kids and the legal services provider. so we're thinking about that now. >> you mentioned the municipal i.d. could you talk a little bit more about that? >> sure. where the municipal i.d. started, the first program was launched in new haven in 2006 or 2007. and i know san francisco, oakland a few other jurisdictions around the country have these programs. i think for new york city, and for the mayor, the notion was
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really simple. we have half a million estimated undocumented people in new york city who cannot get identification because we don't have a driver's license that's available for all. and so, the notion was starting with them, you know, we really need to provide a government-issued local i.d. so that interactions with law enforcement are better. so if you're riding your bike on the sidewalk instead of getting arrested because you don't have an i.d. you can show your municipal i.d. and be able to get a summons like everyone else. to access city buildings, my own building, you have to show an i.d. before you get in. things like that. also seeing it really as a sort of vehicle for equalizing access to a number of different services and amenities in the city. so a few weeks ago we announced a partnership with 33 of the city's leading cultural institutions, the metropolitan museum of art, lincoln center, the bronx zoo, all of whom will provide one year free membership to municipal iemplt d. card holders. this is part of the idea of opening the doors of places like
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the met and others, they're very interested in actually diversifying their audiences. but really opening the doors to a broader cross-section of new york, and frankly i think it makes the card very appealing to people who may already have a driver's license but don't get a free membership with their driver's license. and so we'll hopefully make this a card that all new yorkers are carrying and not just the undocumented and therefore removing some of the stigma associated with it. so the card launches january 1st. it's a bit of a hair-raising schedule to get this off the ground. and folks can sign up mainly through the libraries. you basically have to be able to show some other form of photo i.d. and establish residency in new york city and you can get your municipal i.d. so expect to hear lots more about that in the coming months. >> i'd love to hear how each of you sees the role of your sector in preparing for federal changes to immigration laws and policies. so the global detroit's out there. not just global detroit if you feel like you can speak about
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the mosaic project and others more broadly. we'll start with you, steven. >> the interesting thing, listening to the commissioner and the senator is that i'm just struck by how pragmatic and sort of commonsense these policies are. they're asking questions about their own communities, and what's in the best interests of their economy, of their quality of life in terms of delivering government services, in terms of alleviating poverty and suffering. and they're coming to very commonsense answers. and i think some of these issues have been foisted upon them by broken immigration systems, and we're stuck in this obsession about the undocumented, instead of what people in michigan are very concerned about, which is their economic future and their quality of life and their education systems. if we would actually just have a commonsense, you know, conversation about what are the impacts that immigrants are having in terms of the average
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quality of life, in terms of our local communities, and our economies, and our safety, i think we would have very different both state and local policies, as well as federal policies and certainly new york city and the state of california of the high presence of immigrants, but too often what we're seeing is this -- you know, the issue of the undocumented being demagogued to prevent commonsense approaches. what we're doing in terms of preparing is we're trying to prepare a welcoming, functioning community in southeast michigan and across the state of michigan. we frankly, and it sometimes pains me as the former democratic majority foreleader to say this, particularly three weeks before an election, but we probably have the most -- or we probably have the most -- or we definitely have the most pro-immigration republican governor in the country and maybe even arguably one of the most pro immigration governors in the country and that's
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because governor rick snyder understands the economic opportunity and is often quoted saying immigrants make jobs, they don't take jobs. when you bring a new lens and just ask the question, what's in it for our economy, what's in it for our public systems you get to all kinds of new solutions. and the reality is that global detroit was founded upon bringing a lot of parties from the city to universities to health care systems to workforce development agencies to businesses together and sort of saying how do we create jobs, how do we poster growth? and so we end up working on issues like trying to create better language access in our city and we just completed a report of our detroit city council will convene its first immigration task force and completed kind of a rough planning document and the city announced itself as the 41st welcoming city in the welcoming cities and welcoming counties program county, which is home to the reagan democrats,
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working-class whites, union, catholic, fairly socially conservative county of a little less than 1 million people. they've created the one macomb initiative that looks at the county's mental health systems and health services and how those get delivered to a very rapidly growing middle eastern bangladeshi and bosnian population in that community as well as latino. so, we don't have a grand plan, and this is happening on many levels, from county government to city government, and all of this began out of a private sector nonprofit convening and study of asking the question that was on really taking the issue of immigration or immigrants in our community and asking the question of what was at the core of michigan and metro detroit's concerns in 2009, which is what's in it for our economy. and we end up working on a lot of issues that frankly immigrant rights groups, social service agencies have worked decades on and sometimes with that new
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energy, those new partners, i think we're bringing new solutions or we're championing old solutions, frankly, and giving them new energy to be successful. so i'll just say that there's a lot of things i don't want to talk about that we've avoided on the state level because of governor snyder's promises. if they knew what was happening behind the scenes they would try to capture and figure out how to introduce it in the state legislature and then we would have a hot button issue on our hands. so there's a lot of opportunity, and it is happening in other places as well as i mentioned from st. louis to chicago to, you know, dayton, which is a very small immigrant population, has really embraced immigration as a revitalization and quality of life tool. >> do you see yourself kind of jumping into action if and when the president announces administrative reform? >> absolutely. yes. so we've built a welcome mat
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network which is an online searchable databases from esl to citizenship that is cross tabulated by culture and by language. would he have one of the most robust welcoming america state affiliates when welcoming michigan which received a white house champion of change award a couple of years ago. we are talking through everything from community colleges to local school systems to health care workers. i mean, there's just a myriad of aspects to integration and, again, i think that when we get off this sort of obsession, i think, of, you know, undocumented people, who's here legally, fear of refugees and you get to what do most communities on a day-to-day basis -- how do immigrants impact them? the reality is that words like integration and economic opportunity and solutions that really not only have profound impact in immigrant and refugee populations but, frankly, create
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opportunities for receiving communities and host communities and new players and partners from all sides of the aisle seem to be embracing these once we get beyond this hot button issue. >> i think for the record, california is ready for california immigration reform. we've been ready for a while. wanted to put that for the record. you know, one of the issues that we've been trying to deal with as we prepare for one day comprehensive immigration reform is this issue of fraud prevention and the idea has been floated around of creating at a state level of office of new americans, kind of the things that we're all on the same page on. again, in california there's kind of a patch work of different things that are going on throughout the state. cities have office of immigration relations, office of new immigrants, but there's not really one kind of hub where we're strategizing on how do we do outreach, how do we do
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education, how do we do fraud prevention. language courses, civic courses and things of that nature. the main focus of that for us is fraud prevention. we've known -- you know, we've seen since the passage in 2001 of 8540 which was a bill to allow undocumented students to pay in-state tuition, we saw these little businesses pop up saying give us $1,000 and we'll help you pay in-state tuition at your local college or university when it's completely free. and so that continues to be a problem for us and even now i'll tell you we're scheduled to send out our -- start providing our licenses for everyone january 1st, 2015. there's still a lot of hesitation from the immigration community, from the immigrant community saying is my information going to be shared. what happens if we have a couple of rogue sheriffs, that they're not going to adhere to the law, and what happens if i get stopped by one of those cops in one of those counties? and all these different things. and rightfully so, right? immigrants are survivalists.
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they've learned to kind of adapt and modify, but now this kind of shift. government's embracing. if you look at the immigrants that are coming to the united states and i use my parents as an example, they don't tend to go to government for help. they actually flee their government or they're fleeing from their government. so it's kind of mind shift that we have education that we have to do with our immigrant population. even if we ask them for one more document, they're like, why do you need this document? what if we don't have this document to get a license? it's a constant education, constant reaffirming to them that at least in california we're not going to share your information with the federal
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government. and so we need some sort of kind of central hub that does this work 24 hours basis because they need to feel -- our immigrant community needs to feel that there's somebody there, some sort of agency that's looking out for their best interests. and so as we continue to wait and hopefully one day we get immigration reform, we're thinking an office of this nature under the governor's office would help not only continue to help integrate our immigrant populations but give them the assurance that we are not collaborating with the federal government. >> and, yeah, in new york we've started thinking -- we're not quite as ready as california but we're getting there. i guess sort of we see the city as having four different levers. one, we're a big funder of the services that have to kick in to connect people to whatever executive action happens so we're starting to think about from the very simple level of making sure whatever legal services and other providers have contracts with the city, that they're actually able to pivot and serve the need that will emerge with executive action to really thinking how do we create a system, right, rather than kind of don't wait now, millions of dollars of funds to think about whether we're creating a system where
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you have legal services taking the hardest cases, community based providers able to do the outreach and real connections to the community, the share information about what is and is not happening. with executive action. that's one lever. we're a good convenor. this goes to the point of needing a central hub. we're neutral among the different nonprofit providers in the field organizing around this. we can convene our agencies, right? our department of education, different agencies have to provide documents to people to establish their presence, to establish just like in daca any number of different things. we can actually help prepare them to do that job so it's easier for those who are applying for whatever kind of deferred action comes down the pike. we have a lot of assets at our disposal. when the daca renewal came up one of the things we did was launch a large scale campaign around the renewal but also just
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about daca itself using our transit system to have ads using community ethnic media contacts. we saw a several hundred percent increase around daca as a result of some of that increase. i think thinking about that experience and using it for executive action will be one strategy. and then of course we can be an advocate where there are a lot of negative voices that will emerge when the president announces something when immigration reform has been on the horizon. as a city we can stand up and say this is not only a good idea for the country, but this is how it concretely helps new york city and it's not a bad thing. the last thing i'll say is, you know, i agree completely with what steve said about most of these policies are really common sense. some of them we probably shouldn't even have to do and it's not really revolutionary work, but i do think that one of the other things that's made possible at least in new york


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