thermonuclear weapon. fission weapon. it could be one of these things and still be tactical. you don't have to design the thermonuclear weapon so that it produces negative -- megaton yield. this whole make it lost. think it's an important thing for you to focus on when you think about deterrence and where you are talking about it. important for security of nuclear weapons and nuclear weapons technology. there was a time, 1979, when i was minding my own business working in the department of the state and i was approached by the mayors council and somebod others about an article that was going to be published in the progressive magazine.

the question was, should the united states for the first time in history attempt prior restraint publication? someone who believes he has good civil liberties, my instinct was absolutely not. i looked at what was going to be published. -- we had what we called tickets. i would not have had clearance for this kind of stuff and thermonuclear weapons and it was going to come out in a magazine. we knew how long it took the french to go from fission diffusion. -- fission to fusion. this was an arm's important. -- this was enormously important. thermonuclear

weapons was put out in the open literature. hear that's whenever i hear that a country has claimed that it has successfully detonated a thermonuclear weapon and you read that our judgment is, no, not really. i'm happy about that. because the level of destruction damaging, ith more makes a difference. in the terms of deterrence theory, i would say not much. not much. thank you all very much. [applause] today begins the open enrollment for those wanting to purchase health insurance online the government's marketplace. federal health officials say

healthcare.gov is significant was stronger than when it first rolled out in october of last year. efforts were made it to make the application process more user-friendly and there were security upgrades as well. and 9.9 million will sign up for coverage in 2015. endsyear's enrollment february 50th. the open enrollment is the topic on tomorrow's newsmakers. the president of enroll america talks about the nonprofit organization and its goal of getting people signed up for coverage. this year, we have to be able in and talk about it. we need to get the word out to millions of people who did not enroll the first time. it's a harder to reach population than those that we were able to last her. we need to help those that enrolled last year and make sure they have the facts you need to renew their coverage.

it's easy when you are doing this work to stumble on that. how does our messaging need to be different between the two audiences? america'sl perspective, it does not need to be that different. what we are encouraging partner organizations to do is use a simple framework, get covered and stay covered. the financialn to assistance available to. that is true for those enrolling the first time and important for those renewing their coverage. if their income has changed or the there have been other life havees, they can -- you the chance to shop around for plans. that is true for those enrolling for the first time and for those renewing. this year, there is a 25%

increase in the number of insurance companies are offering plans on the marketplace this year. for folks who have coverage, they might find a better option. the third step is to choose your plan and enroll. if you are happy with the plan you have, you have a chance to renew that and stick with it. if you like a different one, you have the chance to do that as well. when you frame it that way, it helps people understand that we can talk about this similarly in a way that does not confuse consumers but does not complicate things. we are encouraging people to make sure that how we share information with consumers stays very straightforward. >> you can see the entire newsmakers interview tomorrow at 10:00 a.m. and 6:00 p.m. eastern on c-span. thanks for your comments about our programming. here are a few we received about washington journal. , firstington journal

thing in the morning, absolutely wonderful. very informative. i really appreciate you guys letting people such as myself actually call in. sometimes even talk to people who are running our country. >> i would like to make a suggestion that instead of dividing the country between democrats, republicans, askpendents, c-span should the question and have callers either call in as agree or disagree. this would take a lot of partisanship out of their. thank you. thank you. this morning, today, the best show i've seen. that's what we need.

please have more shows like the one today. have a democrat and a republican on there so people can ask them questions about what they are going to do. this was a great show. we need to have them explain what the policies are and how they differ. they give their reasons. we need to know how they think, how they vote and how we should vote. have one every day with their ideas, their policies and what they plan to do for the people. and have us call in and question them. thank you so much. >> continue to let us know what you think about the programs you are watching. us, e-mail us or send us a tweet. join the c-span conversation. like us on facebook, follow us on twitter.

>> health and human services and they sylvia burwell jeh johnson testified on capitol hill this week about efforts to protect americans from the evil outbreak in west africa. the hearing came shortly after a new york doctor who worked in west africa was declared free of the virus and released from the hospital. other witnesses include the cdc director and national institute of allergy and infectious diseases director. this hearing is a little less than three hours. [ gavel bangs ] >> good afternoon,

today's hearing is on the united states' government response to fighting ebola and protecting the united states of america. today, we will hear what we are doing and we will hear what resources are needed to do that fight. first of all, the -- congratulations are in order to some of our checks who have won we want to acknowledge senator reid and senator con's victory and on this side, we want to acknowledge the victory of senator cochran and senator collins and we want to congratulate them and note the -- note their victory. today is a day where we really have to pay attention to an

international and national challenge that we are examining. a look at an infectious horrific disease that is wasting a key continent in west africa and also threatening the united states of america. but for me, this will be the last full committee hearing that i will chair. before we go into the substance and i make my statement, i want to thank senator shelby and his staff for the wonderful way that we have been able to work together and though we will exchange gavels, we will also continue to exchange the views in the way we have. i have found in senator shelby and on the other side of the aisle, always a tone of civility and candor and an ability to, in

this committee, to try to try to work together and find common ground to deal with america's problems in a way that achieves sound results and to do it in a way that's affordable. i think that's characteristic of our committee and i hope that as we move ahead, that we will continue to do so. i would also particularly note senator cochran, who chaired this committee before and who also, during the time of senator inouye's passing, was a very important bridge to help me as senator shelby and i both moved into new rules and senator, i'm going to acknowledge your graciousness and wisdom. so, we are about to, on january 3rd, change who controls the united states senate. but until now, this committee's chaired my me and i look forward to working with my colleagues to deal with really moving what i hope will be an omnibus and that

we, on december 11th, will not be voting on a cr, but be voting on an omnibus that meets our fiscal 2015 responsibilities and also deals with the urgent need that we are going to hear today. i'm deeply concerned about ebola and, of course, so is all of america, both at home and abroad. i think there's a national consensus that agrees that we need to contain the disease and we need to eradicate it. and also, face very clearly the fear that it generates. now, the epidemiology tells us that there have been 13,500 cases of ebola in west africa. here in the united states of america, there are currently no cases of ebola and we look forward for that to be ratified or correct by our esteemed

panelists. however, the united states of america has treated nine, n-i-n-e patients with ebola, two have contracted it in texas, the west africa. eight have recovered, one, regrettably, has passed away. so, there have been nine in america, 13,500 in west africa. the situation is serious. and it means that all of government has to respond in a way to do so. my strong suggestive principles are this, first, we must fight the disease at its epicenter in west africa, in liberia, guinea and sierra leone. we also want to look at the countries contiguous to these three areas that has not spread beyond these three countries. we want to use the expertise of the department of state, usaid, cdc, dod, nih, fda, any

government agency that can play a role in making the world, west africa safe and us safe is where -- what we want to do. the second principle is we must protect america and we must do it at your points of entry. and finally, in looking at our country, we need to utilize the best science and employ our public health and public health safety agencies in a way that's effective that's the center for disease control, state and local health departments and scientists developing vaccines and treatments at nih and approving their safety and efficacy at fda. as we look at what government's going to do, i want to thank the people, both in our own country and all over the world, that have really been working on this. doctors and nurses, lab technicians, disease detectives, aid workers, soldiers from our own defense department, working

shoulder to shoulder in africa and also working at our border, and our ports of entry here and in our own country. in these important agencies, usaid, state, cdc, hih, fda, ever and of course, our ever had-ready military. there have also been very wonderful volunteers that were willing to go to the danger zone and we want to thank them for their role that they played in west africa. we also want to thank those in our own country who though not called upon places like university of maryland and johns hopkins in my own community were ready to be able to deal with this. i'm glad today to have witnesses from our major government agencies to present testimony. ordinarily, protocol calls for the most senior cabinet member to testify first. in my usual kind of out-of-the-box way of thinking, i'm going to deal with the

problem rather than focus on protocol. you know, sometime in the senate, there's a lot of pomp and circumstance. i'm gonna dispel with the pomp and get to the right circumstances. so the way we have organized the testimony is to really start internationally to hear from the department of state and then mr. lumpkin from the department of defense, then going to our ports of entry, then with silvia burrell, who will be here to talk about hhs. we will hear from deputy secretary of state heather higgin bottom, accompanied by nancy anymore berg of usid who will tell us how are we going to do this in west of a nick ka and how are we going to do it not only in those three countries but in the contiguous countries. we are then going to turn to assistant secretary of defense, mr. michael lump kin. we know that's the official ebola coordinator designated by

secretary hagel and he's accompanied by major james laravair. then we will hear from secretary jeh johnson to discuss america's ports of entry. then from secretary health and human services, silvia burrell, accompanied by dr. freiden of cdc and dr. anthony fauci of nih. and then we say to drs. fauci and friedman, mr. lindberg, vet good general who's here, we will ask you to join us after they testify to be able to answer questions from really this robust participation that we have. opening statements will be from the four witnesses. now, we have before us an administration request to contain and fight ebola. an emergency spending request of $6.2 billion. because the ebola, in my mind, meets the criteria for emergency spending. it's sudden, unanticipated,

unforeseen, urgent and temporary. the request includes funds from the state department and u.s. id for $2.9 billion. the department of defense to develop technologies to fight ebola and shorten vaccine development, $112 million. the department of health and human services to contain ebola, both with cdc in west africa and remember, cdc is both here in our country and also in west africa. to also fortify, strengthen domestic capacity to treat ebola with treatment centers available in every state and the appropriate personal protective equipment for caregivers, like our very valued and treasured nurses. we also have money in here to develop new tests for treatment and vaccines, which would be a total of 3.12 billion for hhs. so, state is talking about 2.9 billion.

hhs 3.12 billion. 112 for department of defense and right now, homeland security says it's okay but it needs a lot of flexibility. now the reason i talk about my colleagues to focus on not only the money, but on funding in an emergency, i say to my colleagues, we face infectious disease emergencies before. one under president bush in 2006 and the other in 2009 under president obama. we worked on a bipartisan basis to do this. in 2009, we were faced with the h 191 -- h1n1 flu epidemic. we provided 6.4 billion and designated that as emergency spending. the bipartisan emergency response in 2009 mired what he

we did to help president bush, again, bipartisan basis, when we faced avian flu when at that time, congress responded with 6.1 billion in emergency funding. so, we have done this before when we have been faced with an emergency related to infectious disease. i would hope that we would follow the models that we have used in the past. today, we live in a world that's free from smallpox, that cut polio cases by 99%. now we have to tackle the new diseases and we have to have a strong worldwide public health effort, vaccines to prevent diseases, therapeutics to treat diseases, the people and the infrastructure to do that. we have also invited, in addition to government, we have asked for the american hospital association, crucial ntos, and also schools of public health, like the bloomberg school and

may own state of johns hopkins to submit testimony. i want to acknowledge that we have got 56 submissions already and we will definitely pay attention to them. the common themes are sustained investment is needed in public health, both at home and abroad and emergency money is needed in the short term. so, that kind of lays out the framework for the hearing. i look forward to the testimony and now i turn to my colleague, senator shelby. >> thank you -- thank you, madam chair. today as the chairperson has laid out, we will discuss the administration's $6 billion request to address the ebola outbreak, both domestically and in west africa. given the size of the request, the slow progress in detaining plans for how the money will be spent and some of the missteps made so far, careful oversight

and scrutiny. as we have seen in recent week, the vast majority of american health care professionals have little to no experience with this virus. the appearance of the disease on our shores can have devastating consequences for our health care system and our society at large. consequently, it is the fundamental responsibility, i believe, of the federal government, to respond effectively to this crisis. every prudent step must be taken to protect the american people. instead of an effective response, what we have witnessed, i believe these past few months from various agency has been confusing and at times contradictory plans. for example, the cdc's guidance to hospitals has been a moving target. this uncertainty may have exposed health care professionals to unnecessary risks. the administration also has sent mixed messages on the issue of

quarantine. while the president has discouraged straight quarantine rules, defense secretary hagel has prudently put in place a 21-day mandatory quarantine for troops returning from west africa. in addition, the administration did not call for enhanced airport screenings for travelers entering the u.s. from west africa until months after the epidemic became severe. it still remains to be seen whether these cursory screenings will be effective. not surprisingly, americans have been frustrated by the lack of clarity and coordination within their government. even though the president has named a so-called ebola czar to coordinate a response, all reports indicate that he has no actual authority to direct government agencies here. from the beginning of this outbreak, the administration has appeared to be preparing for only the best case scenario. competent crisis planning must

include contingencies for the worst case scenario as well. therefore, i think we should not rule out any reasonable options to prevent the reintroduction of ebola in the u.s., including travel and visa restrictions. if the history of disease outbreaks has taught us anything, it is that things can change quickly and without warning. therefore, federal agencies must be ready to aggressively implement a clear and organized strategy. it is my hope that today's witnesses can assure this committee and the american people that the president has a plan, that the funds he has requested are necessary to execute it, but we will wait our testimony. thank you, madam chair. >> mr. shelby, thank you. ms. higgin bottom, i'm going to ask you to start and then we will go down the line. >> chairwoman mikulski, ranking

member shelby and distinguished members of the senate appropriations committee, thank you for the opportunity to testify today on the u.s. department of state and u.s. aid emergency request for assistance to combat the ongoing ebola epidemic. i'm pleased to be accompanied by nancy limb bourg, usaid assistant administrator for the bureau of democrat circumstance conflict and humanitarian assistance who is helping to lead usaid a response on the ground. madam chairwoman, i have submitted to the committee a detailed statement for the record and in the interest of time, i will briefly summarize my statement here. the ebola epidemic in west africa has already resulted in over 14,000 ebola infected persons and over 5,000 deaths. while liberia, sierra leone and guinea have borne the brunt of the epidemic, we have also seen cases in mali, nigeria, senegal and spain. and of course, isolated cases in

the united states highlight the u.s. national security implications of this national epidemic. the department of state and usaid are working in concert with agencies represented at this hearing today and alongside our global partners to stop the spread of the ebola virus at its source. the state and u.s. aid strategy to eradicate ebola in west africa rests upon four pillars, controlling the epidemic, managing the secondary consequences of the outbreak, building coherent leadership in operations and ensuring global health security. state and u.s. aid have taken immediate action within existing resources to begin implementing this strategy. u.s. aid deployed a disaster assistance response team or a darth team to lead the u.s. response on the ground in all three affected countries. secretary kerry create and ebola coordination unit to drive our diplomatic efforts to raise international contributions.

over $1 billion in bilateral commitments and near lids 800 million commitments to the u.n. have already been made as a result of these efforts, alongside our colleagues across those of government, we are beginning to see results but it is important to recognize that the epidemic is not yet controlled and that the number of cases will continue to grow. it's clear that we must intensify and scale our efforts to eradicate the epidemic and to do so will require additional resources. the department of state and usaid are jointly requesting $2.9 billion to end the epidemic at its source in west africa, including $2.1 billion in base funding to meet immediate needs and $792 million in contingency funding to address emerging requirements as the epidemic evolves. $1.3 billion in base funding will be directed to the first pillar of our response strategy, controlling the outbreak. these resources will support the construction, staffing and

operation of up to 20 ebola treatment units and establish and staff up to 150 community care locations in ruralal and hard-to-reach areas in the region. this funding will also be used to scale up contact tracing, train and mobilize health care workers and safe burial teams and remen nish vital logistics and supplies, including personal protective equipment. our base request also includes $388 million to support the second pillar of our response strategy, mitigating second order impacts. ebola has decimated the health system's infrastructure within these three countries and has wreaked half vong on local economies. we are particularly concerned about food security. the usaid funded famine early warning systems network has issued an alert that a major food crisis is expected to occur in 2015 if the epidemic proceeds through march. our funding request seeks to counter these destructive

consequences, which if left unchecked, will undermine our efforts to combat ebola at the source and could create instability in the region. our base request includes $77 million to support the third pillar of our response strategy, coherent leadership and operations. these funds are critical to expanding the department's medical support and evacuation capacity in the region and for supporting key diplomatic operations, such as ebola coordination unit and the usaid staff engaged in the ebola response. finally, our base request for the fourth pillar of the strategy, ensuring global health security in west africa includes $62 million to support pandemic preparedness and strengthen public health systems in liberia, sierra leone and guinea and 278 million to prevent the spread of ebola to other vulnerable nations through the global health security agenda. in sum, our emergency request will allow state and usaid to scale up our existing efforts across all pillars of the

response strategy. we are seeing some promising signs on the ground, but it is clear that the epidemic is not yet controlled. these resources are imperative to eradicating the ebola outbreak at its source, which is the most effective way of protecting americans here at home. thank you for your time and i look forward to your questions. >> mr. lump kin? >> chairwoman mikulski, ranking member shelby and distinguished members of the committee, thank you for the opportunity to testify today regarding the department of defense's role in the united states comprehensive ebola response efforts, which is a national security priority in response to a global threat. due to the united states military's unique capabilities, the department has been called upon to provide interim solutions that will allow other departments and agencies the time necessary to expand and deploy their own capabilities. the united states military efforts are also galvanizing a more robust and coordinate

international effort, which is seeming to contain this threat and reduce human suffering. before address the specific elements of the dod's response efforts i would like to share my -- and increasing response. after recently visiting liberia, i was left with a number of overarching impressions that are shaping the department's role as we support usaid. first, our government has deployed a top-notch team experienced in dealing with disasters and humanitarian assistance. second, the liberian government is doing what it can with its very limited resources. third, the international response is increasing rapidly due to our government's response efforts. fourth, i traveled to the region thinking we faced a health care crisis with a logistics challenge. in reality, we face a logistics crisis focused on a health care challenge. fifth, speed and scaled response

matter. incremental response -- responses will be outpaced by this dynamic epidemic. finally, the ebola epidemic we face is truly a national security issue. absent our government's coordinated response in west africa, the virus spread brings the risk of more cases here to the united states. i'd like to now turn my attention to dod's role in our nation's ebola response efforts in west africa and here at home. in mid-september, president obama order the department to undertake military operations in west africa in direct support of usaid. secretary hagel directed the u.s. military forces undertake a two-fold mission. first, support usaid in an overall u.s. government effort and the second is respond to department of state requests for security or evacuation assistance if required. great patient care of ebola exposed patients in west africa is not part of dod's mission. secretary hagel approved unique military activities falling

under four lines of effort, command and control, logistic support, engineering support, and training assistance. in the last eight weeks, dod has undertaken a number of synchronized activities in support of these lines of effort to include designating a named operation, operation united assistance, establishing an intermediate staging base into senegal. providing strategic and tactical airlift. constructing a 25-bed hospital in monrovia. constructing 12 ebola treatment units in liberia. training local and third country health care support personnel, enabling them to serve as first responders and etus, ebola treatment unit, throughout liberia. in all circumstances, the protection of our personnel and the preservation of any additional transmission of this disease remain paramount planning factors there is no higher operational priority than

protecting our department of defense personnel. dod has also increased support to the departments of health and human service and homeland security, the league agencies for ebola response in the united states, by activating a medical support team that can rap midly augment the centers of disease control convention and capabilities anywhere in the country. we have longer term assignments to combat ebola, requesting $112 million for the defense advance research project agency, darpa, in this emergency funding request. the $112 million for darpa will support intermediate efforts aimed at technologies relevant to the ebola crisis. this includes new research focused on utilizing the antibodies of ebola survivors to provide temporary immunity for infected patients and the accelerated development and testing of new ebola vaccines and diagnostics. these efforts complement

existing development at the national institutes of health and the defense threat reduction agency. with more than 50 years of experience successfully developing technology to develop seemingly impossible goals, darpa is uniquely positioned to fulfill a critical role within the whole of government response to contain and eliminate the ebola outbreak. because darpa's approaches to these research and developments die verge from conventional avenues, they have a real potential to produce game-changing advances in the prevention, diagnosis and treatment of ebola. in conclusion, we have a comprehensive u.s. government response and increasingly, a coordinated international response. the department of defense's interim measures are an essential element of the u.s. response to late necessary groundwork for the international community to mobilize its response capabilities. with that, i would like to introduce my colleague behind me, major general jim laravair, the joint staffs director for political military affairs with

regard to africa. the general and myself look forward to answering your questions. thank you. >> secretary johnson? >> thank you, chairman mikulski, senator she will business you have my prepared statement. let me just mention a couple of things in my five minutes. first, we all agree that the thing necessary to -- that the key priority is ensuring the safety of the american puchbl i agree with chairman mckulski that first and foremost that means fighting the disease at its epicenter. let me mention a couple of things about screening we are doing with regard to passengers who may come to the united states from the three affected countries. first of all, we have the authority to issue do not board orders to air passengers who may seek to travel here from the three affected countries. we have, in fact, used that

authority on occasion to prevent people from leaving the three affected countries to come to the united states. we have, in fact, used that authority already if we have reason to believe the person might be infected with the virus. the second thing i would like to mention is that in the affected countries with our assistance and advice, they have put in place screening to screen outbound passengers from the three affected countries. that includes taking temperatures and other mechanisms. fourth, we have worked with the airlines that fly from those countries to our country. i have personally engaged airline ceos about the ebola virus. i know that cdc issued guidance to the air lines about flight crews and cleaning cargo and cargo personnel. there are no longer any direct flights from the three affected countries into the united

states. there was at one point, there is no longer. to fly from the three affected countries to the united states, you have to get on one of a handful of flights that go through transit airports, mostly brussels, paris and morocco. at one point in may, the number of flights leaving any of these three countries to any place in the world is over 400. some data to suggest that month to month, it is about 600. it is now down to about somewhere between 100 and 150 flights in an entire month from those three countries to any place in the world. the number of passengers daily that fly from those he affected countries into the united states used to be an average of about 150 per day. that is it fluctuates significantly day to day, some days, i look at the numbers daily, some days, it's as many

as 100 or 75 or a little over 100. some days, like today, for example, it's just five or six much the averagesing? now about less than 100 on handful of commercial flights. we have set up enhanced screening at the five airports that were receiving approximately 95% of the itinerary passengers coming from those three countries. they are newark, jfk, dull less, atlanta and chicago. that enhanced screening, as you probably know, involves a passenger declaration, enhanced questioning and taking their temperature and asking for and looking for symptoms of the ebola virus. that screening, to date, has received approximately 2,000 passengers. we have also identified through

our questioning by our customs inspectors, a number of people who have flown indirectly from the three countries. they, too, have been submitted for enhanced screening. and on october 22nd, we used our authority to effectively funnel everyone coming from the three affected countries into those five airports that are conducting the enhanced screening. the other thing i will say is that at every port of entry at this point, land, sea or air, we are prepared to engage in secondary screening. if we identify somebody from the three affected countries who may have the ebola virus, guidance has gone out to our customers personnel. we have put in place protocols for people who may be arriving by vessel. we have authority to identify people from the last five ports of call if any of those are from the three affected countries. we put in place protocols there.

we continually evaluate whether more is necessary. so i look forward to your questionings. thank you very much. >> thank you. secretary burwell. >> chairwoman mikulski, ranking member she will business thank you all and committee members for inviting me here today to discuss the department of health and human services response to the ebola epidemic and our request for funding. as you know, we are deeply focused on domestic preparedness and since the first cases of ebola were reported in west africa in march of 2014, the united states has mounted a whole of government approach to protect the american people and to contain and eliminate the epidemic at its source. at hhs, this response involves close coordination and collaboration of the national institutes of health, the centers for disease control, of the food and drug administration, of the office of global affairs, the office of

the assistant secretary for preparedness and the office that has the u.s. public health service commission corps, which i think everyone knows has deployed to the region and i'm blessed today to be joined by both dr. freiden and dr. fauci today, who will join me as part of the questioning. we believe we have the right strategy in place, both at home and abroad. and the strategy is designed around four core principles. the first is to strengthen our domestic preparedness and while we may see additional cases, we are confident that we can limit the number of cases in the united states. second, to stop the epidemic at its sources in west africa, as my colleagues have discussed, that, in turn, will protect our homeland. third, we need to alaska sell rate the research and development of vaccines, rapid

diagnostics and theraputics so that we work on the crisis right now as well as think about preventing future crises in the future. and fourth, we need to invest in our public health capacity around the world through the global health security agenda. this is something that was started before the ebola epidemic but it is something that i think we see the incredible importance of right now. this preparation, in turn will help prepare the u.s. as part of the strategy, the administration is taking a number of actions and some of these actions are delivering results. for example, we are hearing encouraging news from the hospitals that have treated ebola patients, as was reflected in the chairman's testimony, eight of nine individuals treated so far have survived. second, we have seen signs that our screening and monitoring system is working. recently in oklahoma, north carolina, oregon and maryland, individuals were identified with potential symptoms.

those were reported to local authorities through the correct protocols. they, therefore, were transported through appropriate protocols that did not expose anyone. we are very fortunate. those cases have all been negative in the past weeks. but this is the kind of thing that is part of this emergency funding. we need to continue and support the local and state efforts as well as cdc and efforts to do. last week, there was also an important milestone. those sides will have been monitored in ohio and dallas came off of their 21-day incubation period. and they are no longer being monitored. we need to make sure that we support state and local public health officials to be able to continue to do this kind of work. to date, more than a quarter of a million health care personnel have been trained by the cdc and the assistant secretary for preparedness and response, doctors, nurses, emts, fire departments, but we need to continue this training and make sure that the training is

getting through. in west africa, the strategy is showing some positive results but as we saw in mali and learned last night there are additional cases there. while the u.s. government's response to ebola outbreak to date has resulted in progress, additional funding is needed and that's what we are here to talk about today. our department request is $2.43 billion in emergency funding. first, the funding will allow the department to enhance our ongoing preparedness here in the united states and our efforts to ensure that states and localities are prepared. for example, it will be about the purchase of ppe, that personal protective equipment, training of thousands of health care workers. second, the emergency request will further strengthen the department's i don't going work to contain the ebola in west africa. we will continue to work with communities, governments and other partners on the ground in west africa to ensure that people are promptly diagnosed, effectively treated and if they

die, safely buried. third, this request will expedite the research, development, manufacturing, production and regulatory review of the vaccines, diagnostics and therapeutics to combat the virus. finally, with an eye toward detecting and preventing outbreaks of this magnitude in the future, the emergency request will strengthen our global health security around the world. and this means providing that there are safe and secure laboratory capabilities to fight the diseases and emergency response capability in countries if these diseases occur. i understand americans are concerned. ebola is scary and it's a deadly disease that is new to the united states. we have taken active steps here and abroad to protect the public health and safety of the american people and this emergency funding request is vital to continuing that work. i want to just conclude by

recognizing the health care workers who are on the front lines of this response, both here at home as well as abroad, including the more than 650 department -- from our department at hhs who have deployed to either west africa or served here in the united states. we are proud of these brave and dedicated men and women across our department. i also want to recognize the men and women who are health care workers in this nation who have treated the parents that are here. and also recognize those who are suffering right now in the three west african countries where this is the worst. members of the committee, thank you for inviting me. i look forward to your questions. thank you. >> thank you very much, secretary burwell. now, in order to get to questions, we limited the number of people testifying we don't limit the number to people who

can answer questions. each one of have you been accompanied by really experts and esteemed witnesses, so if they could come up and join the table, doctors freiden and fall chill, the good general, the coordinator usaid, ms. lind berks you-all want to come up and get there so that, you know, we can have wide open discussion and wide-open questions. i'm going to go to the first question, wait till the general gets settled. and everybody a he is got their names. before i get to actually to my question, first of all, i'd like to thank, again, all of you at this table and at the tables you have in why you are respective agencies here and around the world. i really want to say that as we have watched this unfold in both west africa and here, i want to thank you, because i know many

of you worked a 36-hour day. and i know many of you worked a ten-hour workweek. so think we need to say that as we evaluate what does it take to be able to respond in an effective bay? it was a crisis, which calls for the need for maintaining a critical infrastructure and our critical public health infrastructure. i also want to particularly acknowledge those institutions in states that really stepped forward to treat the patient, emory university, the university of nebraska and of course, the nih special clinical studies center, all three that were there to meet the needs of the american people as they returned home that needed our help, our prayers and quite frankly, our medical advances. so, we want to thank them for that. you know what it shows was, you know, these weren't red states or blue states, these were american states so as we look forward on solving this, it has

to be looked that the way. now, let me get right to my question, which is this. my job as united states senator and i know at this table is to protect the american people and also, protect the people that are protecting us. and this, therefore, goes to the people who render hands on service or those that were concerned about doing this work. so, let me go to secretary burwell, to you. in your testimony, you talk about domestic preparedness and thank everyone for the gallant and generous and dedicated work of health care workers here. but i was also really wore rained wasn't only really worried but so were the national nurses united, i receive adler from them that really articulated my concerns. what they said to me, and now i quote them, is that the president needs to invoke his executive authority to maintain

uniform national standards and protocols, that all hospitals must follow safety-protected patients or health care workers and the public. they then go on to talk about the personal protective equipment needed, particularly hazmat equipment, and they identified the actual osha standard number. my question to you, secretary burwell, is do you feel confident that now in the way we are responding, that the doctors and the you were ins who are actually touching patients have the protective equipment that they need, that these are national standards for not only the equipment but the training so that we have a national response regardless of whether where someone might appear that needs help? could you share with us and did you respond or did the president respond to the national nurses united request? >> so, with regard to the issue of make something you are that our health care workers were prepared, i think we need to think about it in a number of different levels. the first is in that screening

and monitoring and that's what state and local health care workers are doing, with then checking on the people who have come from these countries. second is that that initial front line worker, in a health care institution that needs to be able to detect and isolate, ask the right question. if off fever what is your travel history? the next is the level where treatment will occur and as we describe in our submission, this will be in a more state by state basis and where the cases are in terms of treatment. the question i think the nurses were posing was on the category that had to do with that front line. as i mentioned in both my oral and written testimony, at this point, we have trained over 250,000 people. what we need to do now, and that's part of what this request is about, is to make sure that that training continues and extends and we need to measure it, what we are hearing when we hear from the nurses, we want to make sure we respond. do they know? is the training working? do they feel confident? right now, we are working with the association of state and

tribal health care organizations to make sure that we are going to put in place a measurement so we can understand they have what they need with regard to training much the second part the nurses mention is ppe, protective equipment. >> yes. >> provided guidelines to the cdc in terms of what's needed, training and what to do, the second issue is access to that and through the assistant secretary assistance and sport, bart ta, working with the manufacturers, producing 24/7 now, working with them and working with the states to make sure that those who have the greatest need and will most likely treat get that equipment. >> well, madam secretary, let follow up on this. so do you feel confident that we have -- that if ebola appears, you used -- on page four of your testimony, the maryland case example, a young lady came in, she took her temperature, she thought she might have it, she wasn't gonna go to nih, she was gonna go to either mary land or

hopkins. that those who would be once identified with the high temperature, et cetera, that they would have the equipment and that they would know how to use the equipment, but regardless of whether they are at a high-tech urban hospital, like a hopkins or a maryland, an academic center, but could be a community-based hospital in a rural area, that you would be ready to respond to see that they had the equipment and the training? >> that is why we are doing the, aggressive training that we are doing. >> do we have the -- do you feel confident that we have this now or we are in process? >> right now, what we have seen in all the cases that you articulated and all those that have come through, also providing at the border a kit so any individual that is coming through, which is where the case would originate gets a phone number they are supposed to call. they get a to take their own temperature. >> what i need to get is for that nurse to feel that if she

has to walk into a room and provide the care that she has taken an oath to do, along with the doctors and others that are the support staff that they're going to have what they need to do the job and that they also have what they need to protect themselves. >> that is what we are working to do with all the training. at this point we've trained 250,000 and the funds that were -- >> isn't this what your money is for? >> yes. >> really? >> to continue this effort. >> isn't that part of the public health infrastructure? >> it is. it is the basic not just for ee eebl. >> i have to put their minds at ease, but that we have their back and we cover their back and their arms and legs, et cetera. a question for our constituents that go towards the military. we're now sending our military

in harm's way to protect against terrorism but now we're sending them to get ebola. my constituents were deeply concerned that in deploying our military to do the task that you just identified that they were going to be exposed to ebola and we were putting them in harm's way to get ebola. do you believe in your employment and if the good general needs to respond, are our military actually going to come in contact with people with ebola and our are military at risk of getting ebola? and are we sending them in harm's way with a disease? >> in my opening remarks, dod personnel are not doing direct patient care of those that are infected with the ebola virus.

we've taken great steps to ensure that our military personnel receive comprehensive training before we go, that we monitor them while they're there and we have a controlled monitoring situation. i'll defer to my joint staff counterpart who can go into the specifics about it. >> general, welcome. >> thank you very much. >> we've instituted four levels of predeployment training for all personnel who are going for our transient peoples, think about air crews flying in, not getting off the airplane, and flying out. graduating up to personnel who will be in country, who will have to interact with liberian nationals as they go about their day-to-day business. those personnel will receive

training in how not to come in close contact with those personnel and will be issued ppe that they will carry with them in the cases necessary. health care professionals who will be in country at the two rural hospitals, one in morovia. senegal, who will be there to treat our military personnel for regular injuries and be able to treat them if they somehow do come in -- do contract ebola. and, finally, to the highest level of training for our lab workers who are there now, testing blood samples as part of the support there. yes, we've got a complete protection package for those personne personnel. >> i look forward to you perhaps submitting an answer to that.

we protect those who are trying to protect us. senator shelby? >> thank you, madame chair. on october 17th, president obama named ron clain to a white house post responsible for coordinating our response to the ebola crisis. how many times have you met with mr. clain since his mo appointment and what has he brought to the table that was missing? madame secretary, start with you. >> i've been in touch with mr. clain every day since he has begun, face to face, by phone or by e-mail. in terms of what he has brought to bear it's been my experience and my experience last time when i served in government, the importance of policy coordination, i was there at the beginning of the national economic council where we did much consultation. it's a very important role in terms of when a whole of

government is occurring. and mr. clain is doing a -- >> what has mr. clain brought to the table? >> i can't say i've been in touch with him every single day. i've been in touch with him countless number of times. >> okay. >> i believe that the critical value that ron has brought to this is coordinating the federal response between and among all the agencies, components you see represented here and having somebody who is dedicated full time to the white house to doing exactly that. >> secretary? >> nearly every day in contact with him and he has done an outstanding job of doing just

that, coordinating and singular focus for the administration of coordinating across interagency. >> i've just been back from maternity leave for two weeks, senator. ron was appointed to his position prior to my returning. >> you'll be excused. >> since then we've had frequent interactions. it's the policy coordination that's so key to our response. >> to your knowledge, does mr. clain have the authority or power to direct your agencies to perform any specific actions or is it main ly trying to bring yu together? >> with regard to the execution of the agency's responsibilities, those sit with me and the head of the operating division like dr. freeden. >> secretary birdwell, states that issued more stringent rules

for returning health care workers, stating we don't just react based on our fears. we react base d on facts. as we've all known, secretary hagel has approved mandatory quarantine for troops who have been deployed to the ebola-affected areas. furthermo furthermore, we have limited, we hope, patient contact while civilian medical workers will have direct patient contact. what facts, that was the word the president used, should we base quarantine guidelines on had, ma'am secretary? >> certainly, i will also -- i will start but then turn to dr.s freeden and fauchy. we've determined level of risks. quarantine base system based on their level of risk. and that's based on the

epidemiology, i think dr. fauchy has been working on this well over 30 years, in terms of the experience that we see. that's how we determine what's done with each and every group of people and different groups of people. that's how we base the decision. that's an individual basis often which is why we monitor directly and actively every day those health care workers that return. >> is the assessment -- i'll direct this to you, too, doctor, since you'll be in on this. in the assessment of risk difficult when people are coming from various countries and perhaps don't divulge where they've been? i know you can keep up with it to some extent. is the assessment tough to come by? >> several levels of assessment, first to assess the fever to see if someone is ill and then to determine the cause.

second to see what exposures they may have had working in an ebola unit or are being a health care worker otherwise or having potential exposure to someone who may have had ebola. but for every one of the individuals who returns, we ask the states to undertake an active monitoring process and we facilitate that process, as secretary burwell said so they're taking their own temperature and if develop fever, they rapidly contact the health department of their state where they can be safely transported to a facility that is ready for them. ebola, as far as everything we've seen only spreads from someone who is ill. it doesn't spread from someone who is not ill. if you can find that illness quickly and isolate them, then you can stop them from transmitting to anyone else. that, essentially, is the way of protecting not only their health but the community's health. >> doctor, you want to add -- >> sure. so in some circumstances when we

stratisfy risk, there is sometimes the functional equivalent of a quarantine if someone is at high risk. it isn't as if it's all or none, but not saying there's a blanket quarantine we're being somewhat reckless of making everyone have the same sort of movement. i took care of nina pham. i'm in the low if not moderate risk. if i had to be quarantined i wouldn't be able to be here testifying. because of the fact that i'm low and not zero risk -- >> maybe you would have liked that. >> if you are, we're going out the door. >> right. >> doctor, to dr. freeden, head of the centers for disease control, what can you say to the american people today about

their and it's widespread of a possibly ebola outbreak in this country? >> we certainly understand people's concerns. ebola is scary, deadly. and the images from africa are frightening. but ebola spreads by direct contact with we know unsafe care giving in the home or health care facility and unsafe burial practices. the burial practices that are spreading ebola in west africa are not things that we do here, not to be concerned about. but care giving is. that means for every individual who comes back from a place that may have ebola, very important to be monitored actively for 21 days. at the first sign of any symptom, even if it's not severe illness, what we're seeing now is, as appropriate. people are coming in, being tested. coming in and being isolated. as soon as that happens, we

reduce the risk of spread. so from everything we've seen the last nearly 40 years working on ebola in africa and from everything we've seen here, no household contacts became infected, ebola doesn't spread like flu or measles or other infectious diseases but it is deadly. that's why the hospital infection control is so important. but from everything we've seen, we do not think a large outbreak is at all likely in this country. it's just not how ebola has spread either here or in africa to date. >> why it reached epidemic proportions in the first place.

a major public health emergency but it should not be a cause for panic or journalistically provoked fear among our populous. it should serve as a reminder and a wake-up call. let me read you something that senator mark hatfield, former chair of this committee said when he retired in 1996. he gave us his farewell speech on the senate floor. here is what he said, and i quote. it was at the end of the cold war. this is exactly what mark hatfield said. quote, the russians are not coming. the greatest enemy we face today externally are the viruses are coming. the viruses are coming. end quote. 1996. former chair of this committee. a decade later, a similar warning at the emergence at the avian influenza.

another virus will emerge with the potential to create a global disease outbreak. history teaches us that everything we do today to prepare for that eventuality will have many lasting benefits for the future. mike levitt, end quote. both were right. syndrome, mers. yet during this time, when new viruses are emerging and new viruses are becoming drug resistant, we reduced investments in nih and cdc and acting short-sighted cut that is have left us less prepared. we have to accept the fact that we don't live on an island with airline flights every day around the world, every virus is de facto and airborne virus. we must stop chasing diseases after the fact.

we cannot be everywhere at once and we will never run faster than a microbe. our only chance lies in building public health systems capable of detecting and stopping diseases before they become epidemics. we have the knowledge, right here. we have the expertise and the systems to combat ebola and other infectious diseases. our challenge here is to act calmly, based on science and facts and with resolve, double our resources and build that capacity. i say that because there's some talk in this emergency funding that we should only address ebola and not look to future viral outbreaks and viruses. so i looked up the word emergency. this is emergency funding, right? >> we hope so. >> emergency funding. it comes from the word emerge. how about that?

emerge. merriam-webster dictionary says it's a need for e mechlt rgent relief. this is to stop a disaster. that's what this is. viruses are mute ating. some of them, we know, are becoming more drug resistant and diseases that we are looking at now, ebola is just one of those. thglglobal in their impact. dr. freeden, you and i have spoken many times on our trip to africa, a year and a half or so ago, to stop these diseases where they start. those conversations as well as the work of a group started by your predecessor, jeff copeland, inspired me to createl health program in last year's appropriations bill. we must invest in countries with weak public health systems so

they can stop these disease before they cross the borders. we only need look at h5n1, southeast asia, to be reminded of the virus threats that are still out there. they're still out there. i've said before if h5n1 starts jumping from birds to humans and humans to humans, we better look out. it will make ebola look like a picnic. so the need to address the emergency now to keep it from coming on our doorstep at home. approximately $600 million at your request would go to doing just that. but considering the need, that seems very low to this senator. very low. $600 million to build the cdcs,

to put in the laboratories, get the equipment, train the technicians, train the epidem yolgss? it seems low to me. can you explain that number? what do you hope to accomplish with that investment? and could we use more to address emerging, emergency outbreaks? dr. freeden? >> thank you very much. you don't need to look any further than the difference between what happened in nigeria with ebola and what happened in liberia with ebola to see what a difference prepared public health systems make. in nigeria, through extensive effort, because there was an emergency operation center, because there was a laboratory network, because there were trained disease detectives, because there was a public health system that could respond to the outbreak, they stopped it. it took enormous effort but they stopped it. and today, from that importation, nigeria is ebola

free. the world would be a very different place today if liberia, gui nechlt a and sierra leone had those systems in place a year ago. they could have contained this outbreak. global health portion of this request aims to protect not only these countries but ourselves against that type of threat whether it's the next ebola, the next sars or even the next hiv. there are three fundamental areas we work in. they're all very specific, measure measurable and will leave behind as temporary assistance something that will protect us for many years to come. the first are prevention methods, how to ensure we keep our laboratories safe, that we stop the spread from animals to human whenever possible. and that we're able to immunize with whatever we can to reduce the risk of things spreading. second, and the largest component is detection. putting in place the laboratories, the disease detectives and also the

surveillance systems to find problems when they first emerge so we can stop them at the source before they spread. thi third, of course, is the response. emergency operations systems, the ability to work with medical counter measures and to stop outbreaks before they spread. those are the three key interventions that we would be able to implement with these emergency funds to protect ourselves against these emergencies going forward. >> thank you, doctor. i see my time is out. i'm sure i just think that's a low figure confronting what we have to confront worldwide. and i'll ask a point of personal privilege. this is probably my last -- >> yes, i woos going to note that. >> -- committee meeting after serving on it 30 years. let me thank you all to your commitment to public service and for your great leadership. if you don't mind i especially want to thank tony fauchy with whom i've had a 30-year relationship. we both came here at the same time. you came there.

i came here. you have had the better of it, believe me. also, thank you for your great leadership at nih and also dr. frieden with who i have had about a decade-long association, first in new york city and later at cdc. thank you for your great leadership. and to staying calm and targeted and focused when others around you might be losing their heads. thank you very much. thank you, madame chair. >> i think we could say the same about you. i don't know about the calm part. >> i don't know about that. >> by the way, we're going in the order of arrival, so -- >> yeah. let me start with you, secretary burwell. in your written testimony, you mention the contribution that emery made, the university of nebraska made.

i would think the cdc would recognize the guidelines you're using, significant input was provided by those institutions. as i have looked through the request for funding here, $6 billion request, we have money to reimburse the world health organization. we have money to reimburse civil aviation organization. i could go on and on. i don't see funding that would be available to reimburse any institution in the united states that provides care and treatment and training relative to ebola. i've talked to staff for the relevant subcommittees and talked to some of the members. and it appears to me to be an oversight. and it would seem to me to be

logical, because you asked emery to take patients. you asked the university of nebraska medical center to take patients. we were glad to do it. but it seems at this point some assistance in terms of reimbursement would be appropriate because treating an ebola patient is a world different than treating mike johans who walks in with a severe case of the flu. do you know what i'm saying? go ahead, secretary. >> so, with regard to, i think there's the issue of the treatment facilities and there is funding within this request to make sure that we have treatment facilities around the country and that there will be funding. but with regard to the special institutions like the university of nebraska and dr. gold and the team there, who have had the opportunity to spend time and talk to, and the emory folks, what we have done is there is funding about the creation of an

education training facility and it is our hope that both of those institutions will team with cdc. we will do financing for those institutions to be part of our training of the other institutions and hospitals around the country. with regard to the specific issue of treatment and the treatment of patients, to date, much of the conversation has been between private insurers and the hospitals themselves. if this is something that the congress -- to date it has not been an issue that has come to us. if this is something that folks want to discuss as part of this funding, we're happy to entertain that. >> great. it's an appropriate discussion because the private insurer, when they look at the cost of care for an ebola patient, i mean, it's through the roof. they will cover a minuscule amount if there is private insurance coverage. it will come nowhere near to cover the cost. and i will tell you what you

know already. and that is in the early days of this problem, couple of months ago, you folks were scrambling to figure out what to do with these patients. we were glad to be there. this was -- this was started when i was governor. we're just glad we have world-class treatment there. we want to be helpful but again i think it's a conversation we need to have. second point i wanted to make here -- and i think this is a very important point. i understand the expediency of putting money in each state. each state will get a certain amount of money. it seems that the formula is based upon population. i think we're going to look back in three or four years. i'm not going to be here to question you about it. but i think we're going to look back and say i wonder what that got us. here is the reason. treating an ebola patient is

very, very challenging. and there is risk involved if it's not done properly. i don't know that every hospital out there would want to get into this business, to be honest with you. i think some hospitals around nebraska would say they seem to be doing a pretty good job over there in omaha. let's fund them and support them. i think you need a more regional concept than what is called for by this legislation, because there are facilities out there that were way ahead in terms of what was provided here. i would like your reaction, secretary. and then i would like the reaction of the director of centers for disease control to what i've just said. >> so with regard to the question of where we do treatment in the nation and how we do that, what we have started with is certainly we were

fortunate that the congress had funded and we had supported the university of nebraska, nih and emory to be bio facilities. those are our anchors. >> i'm not convinced that there were federal funding. maybe a very small amount. but i think it was a state initiative. >> as those then go out from that ring of three, what we've done is we have focused our effort on the five airports that secretary johnson said that's where the cases we believed would come in. so we put in place the training and cdc did that training in conversations with the other hospitals for new york, dulles, o'hare, atlanta and newark. and so that was the next ring in terms of treatment, to your point of the question of a strategic approach. and then beyond that, we have been doing tracking of where the

income of the people are coming. that is how we are starting in terms of your question about a focused approach. as we have started this process, though, many states have approached us because of their desire to make sure that they have a facility within their state. as we were thinking about it, where is the concentration and where is their geographic proximity so that a patient could be within eight hours anywhere in the united states as well as what we're receiving in terms of incoming. that's how we have started to design and are working on where the phils should be. states reaching out to us as well as the strategy we're seeing analytically and the risk. >> it's really a question of stratifying risk and which hospitals can do what. with the active monitoring program, we'll have a head start on being able to plan for if someone has just come back,

where would they go. the issue of ebola is one deadly infectious disease that's complicated to take care of in hospitals. but the more -- the broader issue is hospital infection control for ebola and other deadly infections. and what can we do to strengthen what each state has in their hospitals? something that's valuable not just for ebola but other hospital acquired infections. >> with a small amount of money that's going to each state, what you're going to end up with is double wide units that won't be adequate for the next crisis. i just think that money is going to go out there and it's just not going to be enough to do the kind of work that you're trying

to describe to this committee. thank you, madame chair. >> to the gentleman from nebraska, first of all, you sent me a letter on this matter just a few days ago. when i went to acknowledge the receipt of the letter, asking for consideration and of funds for hospital workers and also for those hospitals that agree to treat and are able to treat these patients, i think the gentleman raises an important point. >> thank you. >> i'm not sure it can be addressed urgently in this supplemental but it could be ebola or another infectious disease and i think we need to look at this. i want to acknowledge the validity of the issues you've raised because for those of us who faced -- and i don't mean it in a way to say oh, my god, we faced it. but we're willing to provide care as the university of nebraska, we should be committed to support those hospitals.

it's costly. >> yeah. >> it is costly. and in this era of stringent reimbursements from the private and public sector, hospitals are already stretched to meeting their bottom line and if the generosity of spirit and the technical capability to absorb, your point is we shouldn't add to the fiscal burden while they have to deal with the care burden and also the stringent reimbursement systems that they're already under. is that kind of your issue in a nutshell? >> madame chair, it is exactly. we want to be helpful. we never had any reservations about this. and i could not be more proud of what was happening there. but the cost in this is just huge. >> so let's talk about this, okay? >> let's keep working on it. >> okay. senator reed? >> thank you very much, madame

chairwoman and thank you, ladies and gentlemen, for your testimony. one of the major objectives we have is to suppress the disease in west africa. one critical factor is health care workers. can you elaborate how internationally we're doing in terms of local health care workers, supporting them and also attracting international volunteers? the bottom line is do we have enough health care workers to deal with this crisis? >> stopping ebola at the source in west africa requires improving care and burial, two key ways it's spreading. usaid has stepped up safe burial services. department of defense and others are helping to establish treatment units. one of the things that is encouraging is 90% or more of the health care staff caring for ebola patients in west africa are from those countries but there's still a need for international assistance. one of the things that has been very encouraging is the african union has been willing to send

hundreds of health care workers in. that's in process now. we've also seen an increase in health care workers from other parts of the world. and one of the things that we try to ensure that every step is taken to make care as safe as possible there. there's still a gap, as nancy can discuss, to help address the epidemic at the source. not only to save lives there, but to protect us here as well. >> what are we doing to fill that gap is the obvious question. either you or your colleague can respond. >> yes, thank you. as you know, there's a significant need for health care workers and, in part, because it's a very high burnout job. we have to continue to replenish the pipeline. there's a significant effort to recruit internationally. i would just add that ensuring

that they have the training and equipment that they need is an important part of the equation. and having them feel comfortable, that if they go and serve, they will be taken care of. to that end, our colleagues from dod have built a hospital, 25-bed hospital that is being staffed by u.s. public health care workers, medical personnel. and we are working with dod, with w.h.o. and others to have a continual supply of protective gear and dod has stood up a training facility in monrovia to ensure the specialized training that's required. >> on that very note, if i may, to train u.s. health care workers going over, cdc began a training course in alabama in conjunction with the fema site there. all the u.s. public health service workers went through that training.

it's based on years of experience that doctors without borders have. and that's the type of very intensive training that we're implementing. >> and the resources asked for in this legislation will be. >> absolutely. >> and without these resources the gap will persist and the disease will be further beyond our means of suppression? >> these resources are essential to stop the outbreak in africa and protect us. >> secretary lumkin, dod is set up there. the question is, that i've gotten, is how do you get to the last mile, dakhar, supplies, trained personnel out? and the other issue comiing basd on our discussions is the end of the rainy season, what impact does that have? does that give us special urgency in getting this bill done? >> thank you for the question. i would like to address the

issue with the end of the rainy season first. i think that's a temporal issue before us. liberia gets 200 inches of rain a year. what's been moving during the rainy season is people by foot. many roads are closed and, therefore, carrying the disease. what's hard to do is get supplies to where they need it to be. that's why it was crucial to build up these logistic networks. in the drying season, you have more freedom of movement for people, is one. which means an increase in spread of disease potentially, but also the temperatures go up. the time that health care workers can spend in their ppe, personal protective equipment, is reduced significantly. so that adds another burden. i will defer. >> senator, thank you very much for the question. intermediate staging base is fully operational at this time with 101st brigade running that

operation there. they've established a rotator flights, c-130s down to monrovia. from there we have helicopters on the deck that can take personnel and equipment out to the various locations or to do what they need to do. we've got the -- starting to get the equipment and the personnel in place, able to transfer that equipment to the last tactical mile. >> my time has expired. quickly, ma'am. >> senator, quickly, part of what this request does is enable funding so that dod can depart and there's a civilian capacity in place for logistics, including the last mile transport. >> thank you, madame chair. >> senator blount? >> thank you, madame chair. there was a report november 7th that said that public health experts warned that the actual number of ebola-related cases and deaths in africa was likely

much higher than the numbers being reported. do you have an opinion on that report one way or another? >> we have previously estimated that there is probably underdiagnosis and underreporting of cases. so, yes, we believe the number of true cases is larger than the number of reported cases. >> do you have any idea how much difference there might be? >> in september we estimated that for august onward there could be as many as 2 1/2 times more than were diagnosed up to that point. since that point we believe that the monitoring systems have improved and we don't have a more recent estimate of the difference between what's reported and what we actually think may be happening. >> i think in guinea and -- the numbers have gone up pretty dramatically lately and seem to be heading the other way in

liberia and sierra leone, is there a reason for that? >> we see different trends within each of the three countries and different trends in different areas in each of the three countries. in guinea, waves of disease, increasing then decreasing, from a forested area deep in the country, which is where the outbreak is believed to have begun. and where it has never been completely controlled. that has been the epicenter for sources receding other parts of the forest area. not only in guinea but the other two countries. in the parts of each of the countries which have implemented the strategy, we have proof of principle. we've seen big decreases in cases in individual areas when we get the safer care contract care, infectious control and health care systems those standard disease control methods that have worked for every ebola outbreak and i'm told now have

worked for the firestone company and near monrovia, which implemented them and individual community. we ha >> how long should this money last that you're asking for? and what's the significance of the contingency fund and how long in the future do you think that money will be there? >> in the context of what we know, as director frieden just talked about, the evolution of the epidemic is something that 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 and making sure, when we have elements that

aren't predictable we want to make sure that that funding is in place and that would be for different types of things. to give you some examples, if another country, another ring country has a number of cases and starts to be elevated, that may change the needs. another thing that could change the needs that we would use the contingency funding for would be 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 workers. those are some of the things that the contingency fund is about. it is a fund that we have submitted for. we want to make sure there's a block that funding is not used unless needed. but that we put in appropriate preparedness. >> and on vaccines you've asked for money for fda here to --

>> uh-huh. >> how would you do that process differently? are there steps in an emergency situation like this where there's a way to go through them more quickly or go around them, to get to the end product quicker? >> yes, sir. we've seen that in process right now. congress gave us emergency use authorization that would allow us to approve diagnostics quickly. we've suesed that authorization six times. we approve friday start to finish in 36 hours. one of those diagnostics. with regard to other emergency authorities that fda has, we have approved drugs. 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 hippa but each one has received a drug. those have been approved.

one was approved in one hour. right now fda is on a path. there are over 300 people 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 to support and approve. we're supporting the efforts and hundreds of questions have come in from commercial entities. and that's great. a number of commercial entities are out there and they want to help us find the solutions to ebola. most of those questions are legitimate. it's about speeding their efforts. some things as you know, people are saying there are things that work when they don't. fda needs to watch for that, too, in this important time. the funding 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 to 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 us, i mentioned, have been in a way that we can use them. we can add to definition when we've needed to. so far, we have not. i will take your question and make sure with the fda that it is answered for all categories. you know, there are a number of categories. we need to make sure. so far we've not had any be issues. thank you for the authorities you have given us. we are using them as quickly as we can. >> chairman, while everybody else is making a comment i would 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 kuntz. i'm going to ask senator shahine 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, madame 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? better to have heated discussion than wasted money. secretary -- senator coons? >> thank you. to the many witnesses who have testified today, i want to thank you for the vigorous discussion of the funding request to deal with this global funding crisis. and remind all of us that the ebola outbreak has been characterized as among the most severe public health emergencies we've faced in modern times.

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. first by strengthening and bolstering and preventing its spread to neighboring countries. i did want to take a moment to share that i recently had my third recent conversation with president johnson, who i visited several times in previous years and who wanted to make a point to thank the american people for our generosity and engagement but urged us not to let off now because just because there is some hopeful news doesn't mean we've turned the corner on this and in the region it still

remains a very dangerous and difficult time. i visited with delawareans here and liberians who have lost their entire family to this disease. i want to acknowledge the remarkable sacrifice, dedication of our uniformed men and women, thousands of missionaries who are on the front line against ebola. americans who go abroad should not be stigmatized when they return. should have confidence that they can return from their service and be supported when they do so. let me turn to the global health security agenda, if i might. a piece of this emergency request is for the global health security agenda, activities within cdc that are designed to strengthen the whole health security systems of a ring of countries around guinea and sierra leone. i wondered 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? why is this essential to ensuring that americans are safe from ebola and that this outbreak, this epidemic is effectively contained? >> to strengthen the systems that will find problems when they first emerge, respond effectively and prevent them from wherever possible. and the goal there, if we just think of what could have happened in rural guinea, if there had been a monitoring system 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 the situation in mali, a real illustration of this. so 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, public health and a series of other things 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 to organize a response of tracing more than 100 people. over the past day or two, we've learned of a new situation of great concern where an individual died probably from ebola in the funeral services, family members were infected. in the care of that individual before he died and other individuals, health care workers were probably if he can'ted and now we're 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. 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 their vulnerability is our vulnerability. that what we do to find problems and stop them there will help us. >> if i hear you right, dr. frieden, the difference in outcomes in nigeria versus the other three countries is the difference in having 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 a great investment in public health across the region. part of this is a challenge. how well cdc and usaid coordinate to make sure that these investments are made wisely and effectively and that we strengthen the whole region's public health structure? >> thank you, senator. we work hand in glove, aid with cdc. cdc is essential for setting the

policy for bringing the technical and medical expertise forward. and we work very closely with them, implementing these approaches, these policies. we've jointly been 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 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 has expired. >> thank you, madame chair. >> and i don't mean to be brusque to anyone. we've now been here an hour and a half and we have two, four, six, eight -- ten more senators

to go. senator coates, i'm going to be a little more strict now. >> madame chairman, it's good to see that you haven't lost your touch. >> well, we have a vote, so -- >> yes, i understand. i'll try to be brief here. >> sorry. >> 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 where we are, where we've been and where we're going. i think all of that is helpful. i commend everyone sitting at the table there, because when madame secretary johnson called me week ago saying this is going to be a government-wide effort. this is a crisis deserving of full response, all hands on deck and a lot of those hands are sitting here at the table. there has been some positive news here in terms of some steps

that have been taken, despite some early struggles and a couple of bumbles. that made all of us nervous. we've corrected those and that's positive. we do have some questions as to how we're going to continue to go forward. as secretary burwell said, we have to fight this battle at the source. i understand that. some countries and others have said if you're going to fight it at the source, you need to have it contained at the source. and while the military has taken -- 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 to what our current standard is relative to people coming back and, of course, the screening is important. secretary johnson talked about that and so forth.

couple of questions here relative to all of that. is canada and australia and these countries that have basically said 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 necessary thing to do. nevertheless, it certainly assured their public that, okay, they're fighting it at the source. general williams over at africa, then noticed at that point they weren't -- they were not going to send any soldiers in there. the president made a decision. they did send people in. they're sending people in. swren williams came home and immediately the team that he was with, which i think is about a dozen or so, quarantined themselves and so what are we to tell people back at home about

the military is 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 could speak for the group. or, secretary, you want to take a shot at that? >> 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 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 in the region, it seemed like a prudent course of action. i'll defer to my colleague over at the joint staff who can tell

about the formulation that have recommendatio recommendation. >> senator, thank you for the question. as the secretary said we have the youngest and largest personnel responding to this crisis. as the chairman said on 30 october, we have had a unique role and responsibility for military personnel due to the scale of the deployment and the responsibility to the health of our service personnel and to their know -- this is the way we chose to redeploy our personnel in the question to me and my question is -- okay. ofean, people are kind gratified to hear that. our soldiers are doing everything they can to protect a carrier, not to be back and not to have this spread through. we appreciate that the military taking those stands. on the other hand, we're saying, they the health workers, don't rise to the level of having the same standards areied or all those who courageously putting themselves in harm's way, who are not

uniform, are -- there's a different standard there. to respond to that? >> i guess before i let my colleagues respond, i would just to point out this is not a medically based decision. this was an operational decision. >> it kind of makes common sense, doesn't it? if you've just been over in an infested area, you could potentially a carrier. why not take the extra coffin to go underive step quarantine, so we know for sure someone is not out bowling with fever? >> let me jump in here. >> who is jumping? >> i'm jumping. senator coats, who also chairs the homeland security, the ranking homeland security, isses a question that continually asked, why the military has one standard and another.ians have though his time is expired,

because this is a question that continually raised nationally, i'm going to ask ms. burwell, to answer it or call upon the scientific expert to clarify that. on. we'll move >> so the distinction -- and i think my colleague from the defense spoke, but based on thebased to science. this was based on 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 department,efense they are under the same guidance that we are using and that cdc has issued. what's important is that decisions based on the risk and science, and that's what the standards are about. also think it is important that we respect those that are serving. and that those that are there they actually ask and want to do -- there's the question of the science and the that we need to set to protect the nation.

but there's also the desire of those that have taken the steps serve. and i think that's a part of what my colleague was reflecting waserms of what the force requesting of the joint chiefs. and i think we will want to hear the too, when there's return, as people come back, there are people that will make choices. need to do the steps we believe are science-based, to protect the nation. those that have a a desire orh the -- wish to do more, that's something they should do. but the decisions we have put in place are based on risk levels and the science on that. >> if i can just make a couple of points. in ebola, there is no carrier cannot make other people ill unless you yourself we have from everything seen of how the virus operates till date. itself, we've already had more than 100 of our top disease detectives come back to cdc.

they come back into active work at cdc so that they can be productive in the response and in protecting americans in other ways. but our active monitoring ensure is to work to that every person who comes back is monitored. their temperature is taken every day, because the key is that wherever you are, quarantine or workplace, asor soon as you develop any symptoms whatsoever, even if they don't out to be ebola, you immediately get assessed and isolated. can protecte americans most effectively this interms of people coming back themselves. much,nk you very dr. frieden. dr. fauci, did you have something to add? the 21-daytand, mandatory.is the residential approach of the precautionary. >> right. have a commando

and control organization. is that it in a nutshell? is true. one is an operational decision. one is a decision based on the the -- there are aspects of what cdc recommendation is that are the functional equivalent of that's based but risk. on the as you lower down, you're monitored in a direct, active way. if the risk is low, you have a monitoring every single day and you have the flexibility of theng a decision on restriction of the movement, monitoring. >> madam chairwoman, if i could have ten seconds just to make a point. that assumes you know everyone screened. to be that assumes you haven't missed anybody. and i can't -- i know we've got airports but we've got thousands of people coming

across the borders. >> okay. thank you. i think this clarified a very national question. now we will go to senator murray. much,nk you very chairwoman mikulski. i really appreciate you doing your tremendous leadership of this committee as well. heardre all of us have concerns from our constituents about how ebola could impact them and what we're doing to keep our disease and communities safe. so today really is an important ourrtunity to make sure response efforts are on track and we're doing everything we can to put an end to this outbreak. i want to thank all of our for alls for coming and the people in your agencies. before i begin, i would like to unanimous consent concerning outbreak be entered into the record as well. i want 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, which have over 40 public health are workings that to combat ebola. gatesnd melinda foundation, i had a chance to talk with some of the folks here. before i came back we all owe them a great deal of gratitude for what they are doing. they've contributed a lot of time and a lot of eviden efforta lot of money to help scale up some of the emergency operations to control this outbreak, providing critical support for the centers for disease control. speak on behalf of the entire nation that we're very tbraitful for that. grateful for that. i wanted to ask you specifically and thee role of ngo's foundation's support in the ebola outbreak. even like what percent of funding would you say is coming from private, nongovernmental groups to support this fight, what more private foundations can do? >> i think i agree with your

the efforts that have been made by a number of organizations. and i think i would put it into buckets, in terms of the type of assistance. one is very important, which is health care workers. and there are a number of ngo's in community-based organizations. and my colleague, ms. lin lindb, to that is essential. that's part of what the funding people in get the west africa so that we can mentionedile 90% was by director frieden, of the people who are doing the work 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. and that's where the bill and melinda gates foundation, the paul allen. gates foundation is not only funding and helping with the cdc foundation, n.i.h. is working closely with the gates foundation so we make sure we

have the best experts. zmapp, it's not just about a drug. it actually is an agricultural because it comes from tobacco. so gates agricultural experts to part of our conversation make sure we're speeding that along. in addition, people like the paul allen foundation found they could help us. one of the critical path issues medevacing health care workers out. there's -- >> and getting the data. >> absolutely. a raping o range of issues i helpful with. be then there's the whole issue of have help and relief on the ground in the country. >> 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

senator johan. to think about it, i wanted to ask you, secretary burburwell, in the supplemental you have funds, kes naited for ready -- designated for readiness. wanted to ask how you were going to distribute that funding and how do you expect the states localities to actually use that money in i think there are two different pieces of the money. part of that money comes from the assistance secretary for response andand uses our preparedness networks set upre basically post-9/11. we will use those networks and with the state health departments to determine who up treatment facilities. so that's one portion of it. part of the money go through cdc director frieden talk about those monies. >> at cdc, we would provide support for state, local

entities and for coalitions in a of ways. the public health emergency preparedness fund would be based onased, improving infection control and emergency response. in addition, we would support like the emerging laboratory capacity grant program that supports cutting-eledge work. prevention epicenters on how to improve infection control as all as laboratory networks, laboratory response network, which is now ten or fifteen is why now wech have labs all over the u.s. able ebola. for but that needs to be upgraded and extended. so a variety of programs we're able to deploy to work in this area through state and local leading,and through cutting edge institutions. >> so you're confident you have a system in place already so those funds are distributed in the best way to use them? >> yes, we are. you, madam chair.

>> thank you. turn to theing to senator. remind everybody, we have nine other senators who wish to ask questions. i ask people to kind of come to end.nd when we're at the and otherwise, we will adjourn -- recess for the vote and come back after the vote. i think we can get this done. senator? after the vote. >> i'd just like one question and be respectful of the time. hopefully u.n. leadership will remember it. i'd like to ask the senator has eluded to something i have that concern about. you mentioned the difference in nigeria and the good job that it did and then we've got liberia

on the other extent where things have really had such difficult time my concern is when >> we see many examples of the $20 million processing plant help thebuilt to locals when they only needed a $250,000 processing plant. we leave. go abrupt. and it they go bankrupt and it's just sitting there, because what they needed. liberia is a country where they their electricity output is such that they would the trouble powering jumbotron at dallas stadium. is this something that we're in and it's going to be an ongoing cost for us, program, or are we talking about doing something and turning it over to them? situations where you have countries that may be have 100,000n one doctor per people.

a wonderful question. and something that we're working both nationalith, and local governments, is to try not only to respond to the the outbreakds of but also to leave behind a strengthened health system and some of the other impacts that of foodeing in terms security and economic impacts of this outbreak. it's absolutely essential that we leave behind a system that can be sustained and help that the pathway more on of development. they, as you know, are coming out of a decades-long civil war and so they were just starting progress when this outbreak occurred. >> and, again, we need to move on. that we'rey hope looking at that, in terms of equipment, servicing equipment, that we takeings for granted. to know, we really do need 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 it actually does a good job. you, madam chair. chair.k you, madam and thank you to all of our panelists, both for being here that and for the hard work you've been doing to address the ebola outbreak. in africa and the cases here. i think this question is a to secretary burwell about -- just to make sure that i'm clear for what senator murray was asking the impact on state and local public health authorities and our ability to build infrastructure. as i understand your response to thatyou were suggesting the support in this legislation to address just ebola specifically but also to for futureity potential outbreaks or future local and state needs.

that correct? >> it will do both. the hospital about preparedness funding, that is preparedness funding to the is the issuewhich that the chairman began with in terms of that type of training lines. front in terms of the hospitals that diseaseinfectious treatment facilities, those will be facilities that will be able ebola but be able to do other things as well. so while it's focused on the we believe and now, it will extend, just as the question about the training 00at's going to occur, the 5 people being trained, the defense department can speak to that. those will be in place in west africa. similarly, our work will be in here. >> i've spoken with the new hampshire public health officials and they have been very appreciative of the close working relation shcship with te thatnd n.i.h., so i hope will continue and i'm sure it will. let me ask, when you talk about

thingspitals, one of the that i have heard from hitchcock, which is the designated hospital in new hampshire, to be the state's ebola critical referral hospital, they have indicated troubley're having getting the personal protective equipment, that it is not available. to make is being done sure that that equipment is available to hospitals that need it and therefore personnel? differentre three things that we're doing to make sure that equipment is available. with the is working manufacturers to make sure they are producing as much as they possible can. are nowfacturers working 24/7 and we're working directly with them through the assistant secretary for preparedness and response. the second thing, we actually going to purchase ppe that if therewith cdc, so is a case and a treatment hospital doesn't have what it needs, cdc can provide it.

thing we're doing is we're working -- >> i'm sorry to interrupt. what youru tell me proposed schedule is for having that in place? strategic national we've already begun to assemble kits. allon't want to soak up that's available from the market. so as secretary burwell was theng, we're encouraging manufacturers to provide it first to those hospitals on the front lines. as more becomes available, we will have enough in the stockpile to provide for the to, 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 brigade general peter cory, who is the deputy commanding general u.s. army africa and a member of our new hampshire national guard is deployed

to liberia to assist with the effort there. to commend him and all of the other members of our military who are working to contain the outbreak in africa great sacrifice to themselves and their families. as i understand his mission of ournd the mission other military members, it is to build facilities and for training. i think that's what people have spoken to today as well. i'm not clearngs about, and i think this is for higginbottom,ry when you were talking about the request, you pointed out that $1.3 billion in base go to, among other things, construction of ebola treatment units. same treatment units that are the members of our military are going to be constructing, or is that piece somewhere else in this budget

request? you know, senator, the mission of the department of defense personnel is limited in time and scope. that we'reources requesting will build additional ebola treatment units. those that the defense department is building, we've also requested resources to support the staffing and those and the others that we construct. so the answer is that it's a thatess operation from perspective. and hopefully the d.o.d. mission ai able to exit as is be able to have the resources available to construct those units. >> i'm still not clear, though. this $1.3 billion a separate request? d.o.d. requesting someplace else in this emergency -- >> i'll let my colleague respond. believe d.o.d. has reprogrammed funds to meet that need. >> ah. okay. >> yes, ma'am. did a reprogramming request that was supported by this overseas for an contingency funding at the end move thatyear '14 to

over to support d.o.d.'s effort. we appreciate the support of the make that happen. >> thank you. cochran?r i understand that if your caucus chair thisu will committee in the next congress. right? >> i hope so. >> so we should have -- senator cochran, please. you, madam chair. i think this is directed to the secretary. and it relates to what senator shaheen was discussing. the concerns about some of the beingties that are envisioned by the department, and the funding that's being this supplemental meet the goalso theblished by administration, specifically i have concerns that the amount

ofvided for the creation more than 50 regional ebola may be totallyrs inadequate to accomplish the administration's goal. reaction to that? >> thank you, senator. an initial response and ask my colleague to jump in. first, the request that we're making here is to support a u.s. government funded total number of 20 ebola treatment units. in a is a larger number global strategy. one of the things we've been done at the state department is ask forrage and donations from partner governments around the world. the expertsew of that that number of fiked unit fixed unit- treatment beds is critical to controlling the epidemic, but we're also requesting resources for community care centers that can go into more rural places mobile to go be where there are spikes in the isolationr immediate

and containment. let me ask nancy to join in here. that we're looking at a strategy that is care and isolation. also intensive social outreach so that people change their habits. all taken together is what we're highlyin some of the effect areas. it's beginning to yield some to keep at we need that in a way that is nimble, so that as the virus changes and to put thee able right strategic element against it. chair, thank you very much. and let me commend the panel. theink the quality of discussion and exchange we've had today is excellent. better inform -- inform the members of our committee. it's a serious responsibility iat all of you have, and understand that you do take it seriously and i commend you for efforts. thank you. chair.k you, madam

secretary burwell, you've always been available, and i appreciate had earlier this week. and secretary johnson, you have too. and ever. you forever his hair was dark and i had hair met, so -- but i question ofis dr. fauci and anybody else that would like to try to go ahead and answer. as i understand it, zero americans have died of ebola, though we see headlines every day. americans dieof every year of other contagious disease. thinking of influenza weecially, something that

can curtail greatly. but less than half of our vaccinatedeven gets for the flu. here?re a disconnect should the news put up a big zero ebola, 2253 flu deaths? would that make people start paying attention? >> well, you bring up an senator, thatt, when you have something that is new and when you look at what in west africa, it's rather cataclysmic. has you look at what happened with ebola because of capability, as dr. frieden has described, you're absolutely correct. from the standpoint of the well.l, we've done very

often we forget, when you have that year after year after year has a terrible burden of illness and disease, you kind taket used to it and you it for granted. but i am very glad you brought up the issue of influenza, which is an extraordinarily important constantly, we face season after season after season, with always the looming threat of a pandemic. so there are things we can do about it. you brought up one of them. need to make sure that everyone from six months of age older gets vaccinated for influenza. we could decrease dramatically disease, death and hospitalization for influenza. diminish not to at all what needs to be done and what we're doing with ebola, but when we shouldn't forget other important diseases in our society. >> and the reason i use that as and i agree with you -- i'm not downplaying ebola

all. but i'm looking at trends that vary from state to state. sometimes almost draconian on health care workers that have come back from liberia or places where there's ebola, and i realize people are whong -- oftentimes people have no medical knowledge are trying to protect everyone, and that.rstand but do we have -- are we going tomake it more difficult find health care workers who are willing to go from the follow thees to commitments the united states government has made, to help countries like liberia? >> that's one of the reasons why several of us have said it's important to respect the health care workers and to policies that are based on fundamental science to

when they go, to protect them when they're there and to respect and protect them return.y so i take your point very feel verybecause i strongly myself, being a health care worker and having so many have colleagues who actually volunteered and now have come back and want to resume their regular lives and their duties. wife, ank about my medical surgical nurse, and when she was working, she was sometimes working in highly infectious patients, and they things that all the now i see on television, putting on the suits and all the rest that they did. follow these things. one last question i might ask, and anybody who wants to answer, free. the president requested hundreds of millions of dollars for the testing of and ebola vaccine. knowing the amount of time it to develop a vaccine and test it, what are we talking time?in

anybody care to -- >> sure. well, as you may have heard, we fully enrolled the phase one trial at the n.i.h. that started on september 2. data thatiewed the came in from that. it looks good. we're going to move on towards of this year to a phase to determineial efficacy. there will be two trials. in that will take place liberia and one that will take place in sierra leone. leone will berra controlled trial by the n.i.h. if in fact this is an effective senator, which we hope it is, and if the infection rate a high level, because that's how you get your data more quickly, we could know by of t 2015 whether or not we have an effective vaccine. thee hoping that will be case. but we fully are now already geared to start this towards the veryf this year and the

first month of 2015. much.ppreciate that very i yield to -- senator collins, she's been remarkably patient. we're just going to go straight the republican aisle. is senator moran coming senatornator hoeven and alexander? senator collins, why don't you get started. to senator kirk and see who else is here to ask questions. memadam chairwoman, let first thank you for your leadership of this company. you may no longer be our chair, i know you're still going to be a powerhouse on this committee. dr. frieden, all of us are grateful to the health care

have traveled to western africa to help control and treat the patients there. that theor reason american public gets alarmed washington's response to cdc seemed tothe be reacting to events rather than getting out in front of them. and let me give you some examples. cbpt of all, the cdc and enhanced entry screening of individuals arriving from west africa until andr the diagnosis subsequent death of thomas duncan. second, the cdc did not issue use of guidance on the personal protective equipment diagnosis of the

two dallas nurses. not issue cdc did revised guidance for monitoring the movement of individuals with untilial ebola exposure after it had told one of those toses that she was free travel on two commercial airline flights and until after dr. craig spencer, who has recovered from ebola, rode the subway, went out dinner and even went bowling. activities could potentially have exposed others to the virus. the department of defense a totally different protocol for military members, 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. also no surprise that so many state governments, states, larger states, new york, new jersey, illinois,, georgia, virginia, florida, and my home have lostaine confidence and have used their to implement policies that go beyond the cdc guidelines. so i guess my bottom line question to you is, are you sure the cdc's guidance is correct and the best way to american people? bases its guidance and actions on the best available data and experience.

caseve faced now the first of ebola in the united states. provided waswe based on decades of experience in africa and had been effective protecting our own staff and others. when it did not work here, we changed that guidance. will change our guidance based on the experience and based on what the science and shows us to be most protective of health care ive ofs and most protect oif americans. what we know clearly is that we approachdjust our 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 .gainst ebola and we have staff on the grouped doing that there. we're the u.s., intensively working with health care workers to increase inining and the resources the emergency funding request would allow us and other parts hhs to scale that up even more.

>> dr. fauci, first of all, let you for taking care who wasf the nurses infected. in your experience, should we be worried about the ebola virus mutating into a virus that could be more easily transmitted the is, for example? >> senator, thank you for that question. the ebola virus continues to it replicates rapidly. that's not surprising. that.ruses do the question that's the important question, are the mutations associated with significant functional changes in the virus? theby functional change, question everyone asks, can it all of a sudden go from a virus is not transmitted by the like flu,y route, where it does not know, could it do that? the answer is it would be

extremely unlikely that that's the case. the reason i say that -- and i unlikely, but of course with viruses you never say never and you never say always. the reason i can comfortably unlikely is that this would be unprecedented, because of all the viruses that and mutate, there really are no examples of a virus that has completely changed its method of transmission. bit moret a little virulent, a little less, a readilyit more transmitted, a little less. but to completely change its behod of transition would un-- transmission would be unprecedented situation in virology. >> thank you. i have one question for dr. fauci. could you describe your opinion of the technical expertise in

of thea and medicine canadian government? government,ian they're very good. we have many colleagues in canada. a deal with them almost on continual basis. get.re as good as you can >> let me follow up. if they are very good, why were downwrong in shutting their visa line in the source countries of ebola? senator, i wouldn't -- >> senator, i wouldn't say they were wrong. decisionay they made a based on what their judgment was for their citizens. do, we comes to what 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. don't say they're wrong and i don't criticize them. made a different decision. we have insisted on keeping the line open in the source countries. i would say that is likely a

mistake. 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. fact, the number of flights that are coming from that would enable you to get here have been dramatically reduced. on those flights, only about 30% of those passengers are nonimmigrant visa holders from those three countries. a number of visa applications our state by department already. concern with limited of visa is that if the united states of america does that, a lot of other nations are going to follow up, effect of have the isolating those countries, which i don't think we want to see happen. ourproud of the fact that military, our health care workers are leading the international effort there.

want to see this country in isolatinger those three countries. given who we are as a nation, is followed by other countries in the world. that's my overriding concern with taking that action. >> dr. fauci, let me have you scientific ande medical expertise of the australian government. canada., similar to they're excellent. they're as good as you can get internationally. they have madee, a similar decision as the i think it was october 28. visa linedown their in the source countries. if they are so excellent, why we ignore the action they have taken? secretary johnson? >> well, of course i pay very close attention to what our friends in the canadian do.rnment in fact, they have limited the

visas.of they haven't entirely. it's what i said before. this country is leading the effort there. and i am concerned that if we the same action, it would have a cascading effect on other mostns in europe prominently, that would have the 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 what thettention to airline industry would do in reaction to limiting visas, if the airlines start there's justights, no way to come and go. >> i would just-like to add, senator, in terms of one of the to us isrtant things protecting the homeland. we've had this conversation. there are four things we know disease.s detect, isolate, contact trace,

and treat. as ability to do that -- and the secretary said, there are no direct flights here. anyone who is coming here is coming indirectly. right now our ability, because we funnel, and not only have we had five airports that did 94, now we funnel all. we funnel through and we create monitoring mechanism, both at the point of departure, where everyone who leaves that country checked. their temperature is checked. they are questioned. when they come to this country, three things happen. their temperature checked. they are questioned. and they write down their contact information, so we make sure, if they need to be theyred, the next step is, go to cdc for a further effort there. then we do the monitoring. and that's an important part. that's what we've seen work. and whether that's what we've seen in the cases in oregon, the country,oss when we can be on top of it, because we know and get ahead of and dr. frieden have both said, before someone

spread.omatic and can so it is our judgment that that is the best way, especially when as the percentage, secretary said, of those returns areactually -- returning actually american citizens from those countries. >> if i might just add one thing our visa operations. we have taken steps to make sure we're asking the same questions applications that are asked when they're departing -- >> could i follow up? sent a letter to you on october 17. i wonder if the state department could respond to the letter. >> absolutely. >> thank you. >> i would just conclude by saying if any of the questions are answered affirmatively, we deny the visa. it's not issued. cdc to insure that person can travel. >> as you can see, there lot ofes to be a 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 well, that'ss, been clarified now. i'd like to say it's been explained. i don't think it's been clarified in the distinction 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 the question about how successful we are in our coordination efforts among the various agencies and departments? and what strikes me is that the president's ebola coordinator is panel.t of the and maybe that's a committee choice and not yours. but one, i would think, as a member interested in this topic -- i remember our hearing september 16 in which the question was asked -- i think it was mostly about coordination africa.n the answer was usaid and more

me on thisers than committee had this kind of -- it gasp, but thatle gaps doesn't make sense. tore's not got to be more this story. are we really trusting usaid to coordinate the activities in west africa? president has now appointed an ebola coordinator. person isn't part of the witness panel today and that strikes me as odd. to takehair would like the opportunity to respond. i reached out to mr. klein, thely through the office of white house's employer. the white house declined his that heation, saying had no operational role. his role is that of a was an employee of the white house and the president. the white house then -- rather than us getting into a lot of back and forth, because i had some -- you know, you and i think a lot alike on of these things. >> thank you for that compliment. back to --lly, going

we 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 their presence. president obama didn't do this. but they felt that the people had the real responsibility the actual governance the ones whond would be in charge of the money from this committee should be the ones to testify. think, by all accounts, this is a pretty solid group. >> certainly, madam chairwoman, you and i agree with regard to this being a solid group. appreciate the testimony i've had today. but i did notice, among committee members on our september hearing, this concern about coordination. i'd like to follow up and find out what's transpired since we met, ask that question, and how has changed,ion improved, been altered since

then. dr. fauci, what developments have occurred? answeredays, you've this question, i think, but what's different today than the last time we met, when you were and testified in september? i think it was september 16. care, changed in the treatment, protocols? i guess this may be a as well.en question what has transpired that is different today than it was when a month and a half ago in regard to treatment and the of hope in this battle against ebola? itwell, i'll take a shot at first. the first thing is that, at the werewe met last time, we still in the stage of doing contact tracing of people who were exposed in this country. and as it turns out, now when contacts of the infected individuals, they are 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 the last hearing, because we were not sure at the time. that we've made significant progress on the road testing of a vaccine for its efficacy, because we had 1 trialrted the phase at the time of the last hearing, in now the results look good that trial and we're all set to go at the end of the year, into efficacy trial in west africa. and then the other thing is that in liberia is encouraging. we're not saying that the ball over by any means. but the downturn there is encouraging, which means that prevention and contact tracing and funeral issues have worked. >> dr. brantley, who testified september 16 indicated that hisas unable to say whether treatment improved the condition or not. can we answer that question today?

can't.we and i'm glad you asked that, because that is the real for doing thement controlled clinical trials that we are now planning. a meeting last evening at the n.i.h. where we brought whother all of the people have taken care of ebola patients in the united states. nebraska there. we had emory there. we had the n.i.h. there and we had others. at the data,ooked tim from the cdc presented all of the data. we had no ideaat what works or what doesn't work, anause it was just given on empirical basis, which is a very clinicalgument for trials. >> thank you very much. >> thank you, madam chair. forirst question is assistant secretary lumpkin. in your statement, you mentioned that 112 million of the president's recent request for the emergency funding will go to

develop technologies and provide temporary immunity. defensetand that the threat reduction agency has been looking for rapidly available treatment.nes and so first, can you elaborate on for darfa will be looking with the requested funds and whether there are tech nothings in -- technologies in the pipeline that you'll promise for the short term? >> first of all, i don't propose to promise anything. this is a research capability. tore trying to fund it accelerate development programs. and i think the key to look at in conjunction with n.i.h. efforts, in conjunction with ditra efforts. i think the key is we have to pull out all stops as we look at doing groundbreaking new technologies to address the treatment and ultimately a vaccine to prevent ebola.

darfa has unique capabilities. how they look into problem solving has led to many of the capabilities we have today, everything from gps to the mouse runs your computer. they have innovative technologies. resource them to look at this problem set and to eyes to one more set of move this forward as fast as possible. >> and then to coordinate that ditra? with >> absolutely and with n.i.h. as well. >> all right. we generally think of it as a continuum, in the earliest ditra is nottimes always just the earliest stages. then n.i.h. at the next level. barta at the next level, when we're getting to that stage when we'reuring, thinking about the continuum of getting product through that initial idea, through production and use. >> madam secretary, i see that hhs's request for biomedical

advance research authority is specifically requesting an additional $157 million to manufacture vaccines and synthetic therapeutics for use in clinical trials. in the upper midwest reason, promisingvery therapeutic that as i understand it is not necessarily synthetic, meaning it's developed outside the lab. withhas proven effective m.e.r.s. and with the flu. request flexible enough to take advantage of newer technologies like this? to do is, and we have been working on zmapp, which is tobacco based, currently one of the things in terms of getting enough aoduction, this is therapeutic. why we've turned to synthetics can getse we think we volume. with any of these issues, we ust to work to what will get there faster and to the level of production. reviewing, and with the finances that we were given earlier by the committees, we have been working on zmapp also

in a nonsynthetic fashion. stage how many early vaccine -- given that many of the early stage vaccines fail, many candidates will become to supportly be able with this request? turn tol actually dr. fauci. there are two main vaccine candidates there but there are a others on the list. but i'll let dr. fauci -- >> and does the funding allow scaleup for manufacture when you find something that works? >> so the answer to the question, there are two major ones, but there are three right barta has their sights on. barta're asking, what can do with regard to pushing it forward in the development, we're talking about five. add, depending on where and how quickly, the issue of the distribution of the manufacturing and production, which barta is