Having me here today. I would like to thank the u. S. Leadership Global Coalition for welcoming me and convening this important gathering about how the United States can and does lead in health care around the world. This is not necessarily the kind of stage i expected to be on when i was a young washington lawyer two decades ago before my first job at hhs, many of you may never have expected for me to attend gatherings like this either, but we are united here by the shared recognition that American Leadership on the world stage is indispensable to american prosperity and peace at home. When i was first asked to serve at hhs in 2011 as General Council i didnt imagine that Foreign Policy would become significance important of my work of domestic department. But i was confirmed in august of 2001, one month before 9 11 when everything changed. The day of 9 11 i quite literally experienced how much hhs needed to start thinking of ourselves as an integral part of the National Security establishment. On 9 11 hhs had no control command center to keep us linked up among government and track Public Health that could arise or other significant event natural or manmade. Only way to communicate with other agencies was actually on personal cell phones. Im sure a few people in this room have the same experience in dc or in new york and experience the same kind of realization about the need for better preparedness. Hhss role in National Security and Foreign Affairs became more prominent when we suffered the anthrax attacks or shortly after 9 11 first real bioterrorism attack on the country. We had to Counter Measures and cure and develop anthrax vaccine there was pandemic flu, many more. All of this was embracing reminder that Infectious Disease is not only health issue but Foreign Policy issue, sometimes the threats we faced were so foreign as to be almost comical. I remember waking up and seeing New York Times one morning was talking about monkey pox getting into the United States, how is it getting here . Through collectors importing giant gambian rats, how is it spreading, prairie dogs and people who collect prairie dogs. We immediately stopped importation of gambian rats and prairie dogs. I had no idea the little animals could generate so much hate mail in any case, hate mail can be a fact of life in public service, but once youre dealing with hate mail involving the word gambian you definitely enter the realm of Foreign Policy. So i knew when i returned to hhs last year that my position would demand thinking about how to keep america and the world safe from all kinds of Health Threats especially Infectious Diseases. During president Obamas Administration the 2014Ebola Outbreak in west africa, the deadliest in history was serious wakeup call about our global preparedness. Thanks to hard work on the ground, heroic west africans and huge levels of support from generous americans and other partners eventually the outbreak was brought under control. In after math we recognize that the structure to respond to outbreaks including World Health Organization needed reforms. And needed to place its primary focus on infectious threat that is can cross borders, we also needed further investments in all countries ability to respond to threats on their own and better biomedical tools to respond to ebola, thankfully trials on experimental treatments were launched at invitation of foreign governments and ministers as outbreak was still raging in west africa. By the time of next major Ebola Outbreak which lasted several months last summer in North Western democratic republic of congo, in part thanks to the work of hhs components including through the president s Emergency Action plan for aids relief, the drc government had the ability with some International Help to bring that outbreak under control. There are 150 disease detectives in drc, for instance, who have now been trained by cdc to detect and identify outbreaks, but now weve been reminded how far we still have to go, Ebola Outbreak thats raging in the eastern part of the same country. We have a perfect storm of factors in the eastern drc, the outbreak not far from the borders rwanda, uganda and south sudan, even more worryingly the unstable conflict zones. Theres almost no place on earth where it could be more challenging to respond to an Infectious Disease outbreak than the eastern drc, more than 2,000 ebola cases have been reported. More than 1400 congolees have died and outbreak show no sign of slowing. As many of you recently heard, last week we had our first confirmed cases and first confirmed deaths outside of drc. The first victim was 5yearold from uganda who would cross the border to attend the funeral of his grandfather who died of ebola. His grandmother had now also died of ebola. Because of the sheer scale of population movements between drc and neighbors we knew that the first crossborder case was only a matter of time. Uganda deserves credit to work incredibly hard work with cdc experts to monitor border crossings. I was encouraged that fellow Health Ministers recognized the threat that is we faced and understood very well that the outbreak is not under control. I was extremely pleased that the general director was highly engaged on this issue. Understood the need per response and began oh to lay ground work for future action. Im immensely grateful for leadership at whf where they have work on infectious threat and track outbreak. Highlight a couple of key challenges that we still face and effort that is we have undertaken with who, partner stations to tackle them. One troubling issue is the security situation which requires careful decisions about how to provide security for whos Health Workers without impeding in work. Another importance is financial management. Donors are confident when dollars are being used wisely and we are pleased to see that the who is doing as well. Better relations with the communities in the drc, sometimes skeptical of massive surge and International Aid to combat outbreak when they have suffered so much of conflict and lack of opportunity and stable. Responding to the outbreak should mean lasting useful investments in the drcs ability to keep its people healthy and we look forward with working with who on that goal. Addressing these challenges will allow even better use of the response tools that we had already developed and deployed. As of june 1st, more than 129,000 people have received investigation ebola vaccine, product that we didnt have in 2014 outbreak begans, late last year, institute of health, who and International Partners began Clinical Trial in drc for new ebola treatments, total number of investigation of treatments to four, think about that. Just a few years ago, a few years after Ebola Research really ramped up, there are hundreds of congolese patients in one of the most challenging places to work on earth, that along with so much else about the response to this outbreak is a tribute to american generosity and leadership. All of the actors involved still need to do more to bring this epidemic to an end including through more support of vaccines, we were pleased that at recent who meeting in geneva germany announced new commitment for the purchase of vaccines but we all may need to step up further as the outbreak continues there may be an urgent need to buy significantly more vaccine doses. Its important to remember that for all of our efforts this will not be the last Ebola Outbreak and so investing in vaccines will either help outbreak or be vital to beginning response to next one. The United States has so far provided approximately half of the governmental and nongovernmental funding to confront this outbreak and we are committed to seeing this battle through to the end. The Ebola Outbreak is one of our top Global Health priorities and it will remain so until it is stopped. Even once its halted we will continue the work to help places like the drc build even better capacities to respond the challenges on their own and stop outbreaks before they got chance to steal so many innocent lives, ebola is far from the only Global Health threat on radar today. I also spent significant amount or so engaged in Public Health crisis in own hemisphere caused by maduro regime destruction of venezuelas healthcare system. The countrys economic collapse is set more sent more than 3 million venezuelans to other countries, cannot be managed by countrys failed healthcare system. Measles are seeing resurgence. The Trump Administration is taking leading role in the challenge providing more than 200 million in aid to neighboring nation which is are hosting huge number of venezuelan refugees and prepare to go help rebuild Health System when the time comes. In august will be attending the next Regional Health minister along this topic hosted by colombia. Until government is building country i expect to continue the work with regional partners supporting venezuelans and countries around the region Meeting Health needs. As i mentioned at the very beginning when my career let me in healthcare industry, i didnt expect it would lead to so much exposure the vital work the United States plays in world stage. America is indispensable leader. Model for every nation to seek Infectious Disease and include Public Health. Scientists and universities have layed the ground work for so many tools that all nations need to prevent and cure disease. We built resources to keep country healthy and offering expertise to every nation in need will help us keep safe. As we see today in south america to central africa, america would be willing to lend a hand, help every nation to work for their people and the world. Thank you for your role in making that possible and thank you so much for having me here today. [applause] well, thank you, secretary, that was a very thoughtful and your remarks about the Global Health security, your work already and welcome to all those that are here today, i have the opportunity to raise a few questions and to dig a little bit deeper, gather here before you are hundreds of our state leaders as we were talking about earlier, these are business leaders, faith leaders, nonprofit leaders that care deeply about what you talked about, americas leadership in the world particularly on Global Health, on development, diplomacy and they are great for leadership. So thank you. Lets dig deeper in issues raised, theres been a lot of progress made but you touched on pretty tough issues and i want to pick up on ebola, an area that i know youve been working very hard on, one of the most difficult parts about this is the comment that you made around the security situation, its creating situation where the medical personnel, you said to me earlier, we had lunch recently where we talked about you cant send the cdc workers because of the security situation. Youve literally have had medical personnel force today withdraw from the region. Or killed. Or killed. Secretary, can you comment on two things, one is what can the u. S. Do to address the situation when medical personnel cant get there and second, how do we help countries that are having such difficulty advance their weak Health Systems because ultimately not only deal with humanitarian point of view but also from preventing diseases from coming across the border. So obviously weve got the un peace operations. We support that but its a challenge because your healthcare workers dealing with ebola, certain image with armored land recovers and security security teams and that can be off put to go off putting to community. Trust is a scarce, scarce commodity there. You need people to believe that those coming in to help them are there to help them and actually not come to spread ebola. People living in war so for that kind of conflict for so long, you can see that. Community engagement there, working with village elders, working with community leaders, religious leaders u to convince them of authenticity of the response and genuine International Concern for them and also mean taking people where they are at means somebody has ebola, you get them into Ebola Treatment Center that we have there but also means if they had malaria you treat them for malaria, it cant be ebola, inc as they say. Yeah. Tremendous amount of work. The u. S. Has done a great thing through Global Health security agenda, i talked about the last outbreak which was in the spring, early summer of 2018. Well, that was in the western drc and the democratic republic of congress identified the outbreak, they did the diagnosis, they reported it in and ran front line of response. Actually historic change, thats a Historic Development to have country like drc with all of whats been through, have the level of Public Health infrastructure and education and thats thanks to the United States and we will we will keep doing that. So while i cant send people from the cdc directly into some of the most immediate areas, we can do a lot of training, question do support of drc people, help with ngos, World Health Organization, we are fully engaged right up to the limit of putting people in harms way beyond whats appropriate. Thank you for what youre doing. A year ago we talked about i asked them whats the secret sauce, how does something endure over multiple administrations, democrats, republicans, both ends of pennsylvania avenue and a couple of things they said, they talked about the fact that they had rigorous valuation, private sector was engaged in it and one of the things i wanted to ask you about and you started to talk about is that the theres a big youth in a lot of parts of of the development world, we dont focus on the youthful to make sure their involvement, we can lose advancements we have made. How is hhs working with state, working with usad and working with other agencies to make sure that we are addressing just as you started talking about . [laughter] thats for sure. Deep commitment, the administration has deep commitment. Doesnt mean that it should always be run the same way like in the past. The ambassadors have stated quite clearly its very important for us to bring countries up to levels of selfsufficiency so we can redeploy assets, those areas most in need. Part of it is selfsufficiency by a different government thats not a permanent of the system. I think that where hhs comes to play, obviously we are tightly aligned around state department and usaid, the Global Health security agenda which is almost mentality and capabilities of developing countries for the International Health regulations which came about after the catastrophe, globally, we saw how weak Public Health connectivity was around the world and infrastructure, we support that, again, like in the democratic republic of the congo, thats really the backbone of gsha. One last question for you, you mentioned that when the last time you were at hhs, it was 911, you were there at you talked about anthrax, take us back to that time and take us back to your personal reflections and how that impacted your view of why this Global Health security agenda is so important, again, the first time that we met you gave some personal commentary about how that impacted you, very dark days for all of the u. S. , but had to be particularly for somebody who was in hhs feeling the weight of the country, the weight of the world, can you share some of those experiences with us . Sure, i think its good to have somebody who lived through those fairly dark days in this role because it causes one while i do sleep at night i dont sleep well because i i know all the things to worry about. I remember on 9 11 worrying about a potential smallpox, could we face a smallpox attack. You didnt know what was coming . We its the fog of war, we didnt know what was coming at us and just the notion of collecting up all of the existing supplies of smallpox drive act in the United States, in case we need today needed to vaccinate people. Anthrax attacks, massive amounts for that and be thinking about if we face the broader scale attack from anthrax, the counter measurements development is a major focus of effort and worry and thought constantly and thanks to the work of the previous administration, the ebola crisis in west africa and the publicprivate partnership. Thats a publicprivate partnership. We couldnt invent vaccines on our own, we played a Critical Role through nih and others as well as private sector to make that happen but that really shows the publicprivate value of all of this. We face an area of such connectivity of people, the simple fact somebody in the eastern drc can get in an airplane and be in the United States the next day, so we have Ebola Treatment Centers here in the United States, we in fact, i was leading with leadership of one of them today, we are very well prepared. We have vaccine in the United States, i think the American People should feel very confident in preparedness of government and Public Health infrastructure here, that doesnt mean that we should not be very focused on the situation there in eastern drc but we worked closely in more stable areas, for instance, with uganda, minister of health, minister in uganda, theyve only had the 3 cases initially so far but theyve done a wonderful job being prepared for it and handing the Immediate Response to it, so while its good for me to worry about the threats i think having people like me and the rest of the team worrying about can let the rest of American People not worry about it. Because you dont sleep at night, what does keep you up at night when you think about the future . Business community, youve been in government and what gives you hope about the future and under Global Health security agenda . So people ask number one threat, they think deep, dark go to secret room to talk about and i say the same thing every time, flu, flu is what i think almost every Public Health official worry the most about. Its its so changeable, its so spreadable, we lost 80,000 americans just last year from the annual flu. Imagine pandemic, now, we are so much more advanced than we were when we started down on the pandemic flu preparedness efforts under secretary thompson and bush administration. We have capacity to manufacture vaccine, technologies, we have Public Health preparedness, infrastructure for pandemic flu, that being said, rapidly modifying pandemic flu is is still going to be a massive Public Health challenge. Whats your hope, what gives you the hope is how much we are advancing. Just in the 12, 13 years of that effort its been a remarkable level of change, we just our countermeasure program, we have a smallpox treatment, licensed first smallpox treatment. So you need to know that at hhs we have an entire massive enterprise dedicated for the discovery and the development of countermeasures against the threats that we face, 42fda approved products already since we launched that just in second bush administration, so we are harnessing technology, harnessing publicprivate structures, financial structures and development structures to keep you safe. Ladies and gentlemen, please join me in thanking secretary azar for keeping us safe. [applause] thank you