To govern ourselves will stop the adoption of smartphones is faster in minority communities than suburban and affluent white communities. Fantastic news for america. You see the developing world about such technologies very rapidly. Thats fantastic news for improving the human issue and allowing people to have the benefit new information. Lyrical ando change Economic Expectations of a positive way. That monday night on the communicators on cspan2. But now a look at the ebola out break in the Resources Available for fighting these which has affected more than 2000 people in west africa. This discussion with doctors and Global Health experts was hosted by the Georgetown University law center. Its an hour and a half. Think you. It is an honor to be here. It was one of the latest honors of my life to work in sierra leone. I just returned from sierra leone 48 hours ago. I did not shake a single persons hand. Let me say that there are three primary things i tried to focus on. I had many opportunities to do many good things. The first thing was the compassion and care and evaluation of patients at any boulevard Testing Center in freetown and ebola Testing Center in freetown. One doctor from spain worked there for two months and is there now still. Another 27yearold british physician from Kings College london. It had a profound effect on me, to be able to help provide care and evaluation of patients with the ebola virus disease. Closely related, i participated in the training in how to put on the personal protective equipment and then most importantly is how to take it off safely. When you take it off, that is when there is virus on your gowns and gloves and goggles and face shields and you have to take it off in a very sequentially important manner, washing your hands between each step. I worked with the minister of health. In the u. K. Physician and a sierra leoneian colleague. Together, we trained trainers. Who then went on to train more people after we left. In freetown and in other hot spots. Our goal was to organize a working group. The Major Hospital closed well i was there and it has not reopened as of august 18. There are many children with terrible diseases who are not able to get medical care as a result. Just briefly, i did bring handouts on the pediatric situation in a publication called the program for emergent diseases. There is a second article that i had a small role to play in. This is an article i wrote and i take full responsibility. It may be controversial, but many people read it and distributed it to colleagues, more than 30 professional colleagues in freetown. It is simply 18 problems and 18 solutions for how the ebola solution could be much better and provide better care for individual patients and citywide. I would like to say that this Ebola Outbreak has a more profound impact on me personally and i think it should on many of us because it is going to get much worse. The who announced that a larger outbreak is going to occur in a large oil city in nigeria. Links to a physician who died and had many close contacts. In my opinion, it is certainly controversial, but i truly believe that after three weeks of being there and sierra leone, this is the first urban outbreak ever of ebola. Personally, i dont believe our traditional methods of being able to control and stop Ebola Outbreaks, contact tracing, isolation, quarantine, is going to be effective perhaps in most of the cities. If this outbreak is on longer than a year, we are going to have to have vaccines, drugs, antibodies, and first exposure prophylaxis to stop it. We should do everything we can to slow it down, to stop it, to start to decrease, but im not confident we will be able to stop it without therapies and vaccines. This is much worse than anything i remember from aids in San Francisco in 1982 or anthrax in 2001 or sars in hong kong, bird flu in indonesia and egypt, and murs last year. Im very happy to go back to liberia to work with Doctors Without Borders ince for six weeks. Thank you for those remarks. Thank you for your service. I think we want to start with the human picture. This is a particularly terrible virus and disease. Lets step back and try to get a Situation Analysis of where things stand. Im going to ask marty who has been tracking these issues across all of the affected countries and populations, if you could give us an overview of where we stand. I think we know we are not at the end. Are we at the beginning of a control of the kinds of epidemics or individual epidemics . If you could give us an overview, that would be great. Sure. Thanks for the invitation and i appreciate the opportunity. I do need to provide a disclaimer to the heaping introduction. I am one small part of this response in an agency that has mobilized several hundred people engaging 70 deployed and more will be deployed internationally by the weekend. It is an unprecedented response for our agency. There are many Brilliant Minds and talents dedicated and engaged, not just from cdc. In terms of context, i really appreciate the opening comments about perceptions on the ground. What i would like to say is what are the characteristics of this epidemic . This epidemic is very much out of control in some areas. What are the characteristics that make it unique in that regard compared to the other Ebola Outbreaks of the past since its discovery in 1976 . One of them is the location. Poverty is pretty profound. We are seeing painfully the face of poverty and disparity and so on and the impact of the intersection of poverty with a devastating, merciless virus. It is staggering in that regard. Weak and Fragile Health Systems that have been suffering in states that have only recently emerged from years of civil war and infrastructure challenges. Another unique aspect. Compared to the original outbreak in 1976, it is very isolated, this was unconnected. The tools of detecting an outbreak, isolation, contact tracing, and beginning to alter unsafe practices in burial, which cause a huge amount of transmission, happened in a very remote area it was not very connected or globalized. The success and or failure in the trajectory of the outbreak the outbreak gets contained. Here we have an outbreak that probably emerged at the intersection, at the boundary areas of three countries that are highly connected culturally and ethnically, with many zones of commerce and exchange, with Community Practices that involve marriages across boundaries and burial practices that are often distant from the original religion and so on. The degree of human mobility is a factor that plays into the spread. This outbreak is unprecedented, both in geographic spread, scope, and magnitude. This outbreak is occurring in urban areas, which is unprecedented. The strategies and thinking about how to control dents, crowded urban slums like west point in the Capital Cities, the whole concept of how to deal with a lethal outbreak in these urban settings with Large Population centers and connectedness, both regionally and through other places on the continent globally is a very unique circumstance. The Health Infrastructure was fragile at its start. But epidemics of disease like this, horrible diseases like this, are often followed by epidemics of fear and epidemics of stigma. The fear and the stigma combats and conflicts the attempt to get the epidemic of disease under control. Misperceptions, lack of understanding about means of transmission, suspicion, lack of trust in government, suspicion of outside folks not understanding how the disease is spread or who was bringing it. These things contribute to a level of resistance in communities and anger, which is often the mask of that fear and former ability. Vulnerability. The extent to which this is a fresh Ebola Outbreak in west africa contributes to that. A lack of understanding of the disease and where it came from. That context is really important to understand how we got to where we were. Some people refer to it as being caught off guard. It is more important to think about where we are going and not fingerpointing or blaming. This is a Massive PublicHealth Emergency of International Concern and a humanitarian crisis which risks Civil Society. Were seeing the collapse of some of the key aspects of Civil Society to keep it functioning in areas hard hit like liberia and the capital. In those areas, when you ask about the trajectory, we have not turned the corner. The virus is winning the battle. It has outstripped the human resources. The numbers Treatment Centers that are needed, the number of healthcare workers that are needed, the degree of personal quantity effective equipment, the quantity of body bags, the people and the stuff that are needed to be able to get an outbreak of this magnitude under control are just not there. There really needs to be a wakeup call to the Global Community that this is going to require a coordinated international, all hands on deck, not just the Health Sector response, but a full response. It represents a significant Global Health security threat, as new countries become introduced and have a single introduction, like nigeria. We are still trying to snuff out one chain of transmission from one introduced case since july 27. You think about the possibility of epidemic in lagos or into one of the Worlds LargestMass Gatherings coming up in saudi arabia. The consequences and the concept of having introduced ebola into these other types of settings, Mass Gatherings, or Mass Communications is hard to fathom. Larrys comments are very poignant. I think it is a long road ahead. I think the who roadmap is very much welcome. 69 months, i hope we are there. In the best of circumstances maybe. Right now, we have not seen the band did not epidemic curve. I fear it could be much longer. We really are going to need all of Civil Society to be fully engaged. I think we have got a sobering picture on the humanpatient level. Thank you for that overview. If we are in a situation where the epidemic, we have not turned the corner, it is growing exponentially, at least in some of the key areas. Im going to ask steve as we think about a crisis like ebola growing, particularly in Capital Cities and on a regional basis, you might want to reflect more generally, if you would, on the impact on politics in africa, global politics. A little bit of the larger frame. This has moved beyond the Public Health sector issue to a much broader potential set of issues around security. I was also hoping to talk about the security implications and the role of the United Nations and the Security Council. I think in the last six weeks this epidemic, the surge of this epidemic has forced us to recognize that it has moved beyond being a Public Health crisis. It has become fundamentally a security crisis. It has triggered, for the states in question, particularly liberia and sierra leone, it has triggered an agate existential moment. The states which were acutely week before hand, the functionality of their vulnerability to worsening civil conflict is magnified tremendously. They have seen their already marginal Health Systems eviscerating and overwhelmed. They have seen in security touch well over one point 5 million people. They have seen their markets, their production, their economic integration disrupted. They have seen their integration into Global Airline systems disrupted. Pretty much halted. They have seen the sudden exodus of talent out of the states, across multiple sectors. They have seen in the Health Sector and the Emergency Response sector, they have seen a worsening of the risk environment, a deterioration of the risk environment reaching such a point that medical personnel simply cannot be effectively protected in many of these situations, whether they are at work in these protective clothing or they are outside of work in what is supposed to be a more normal situation. Would you are seeing is the insertion of teams that get exposed and they get suddenly and immediately pulled back. My first point is that this is not a health crisis, this is a multidimensional security crisis within this region that now threatens neighboring and nearby states. It threatens another 10 states. Where you have the likelihood of transmission. The second point i would make is that while this crisis has mushroomed in this last period, it has not penetrated the level of world leadership and come to be recognized and the knowledge acknowledged as a Global Security problem. It has not been brought forward to the un Security Council. Why is that . Why is that . If you have the kind of implosion that i have described and the implosion that now threatens the surrounding region and the human magnitude of the crisis on a skyrocketing trajectory, where we were told last week that 3000 dead, 1500 i mean, 3000 cases, 1500 dead, but we think it is probably 24 times that level and we think it could hit 20,000, there is no confidence whatsoever that 20,000 is a stop point. You are now in a world of great unknown. Of trying to think about what the two deck three trajectory will be. You can see this lots of bullets going to 40,000 or 100,000 or beyond being plausible of going beyond 100,000. This has been a very hard set of lessons for public Health Experts. Why have Political Leadership not grabbed onto this . A couple of answers. This is the unknown. We did not know that there would be this cascade of catastrophe. We did not know that this perfect storm would appear and ignite in this region with the speed and ferocity that we have seen. I think that in the earlier days there was an overconfidence in Public Health officials that the methods that have worked in earlier settings could be applied and would work in these settings. There was excess confidence in those tools. When pleas were made to Political Leadership, those went unmet. There was overconfident and an inability to penetrate the higher levels. I think that in this last summer it has been a terrible environment to get a virus driven security crisis onto the agenda of the Security Council when you have the Islamic State in syria and iraq, you have the israelipalestine war, you have the russiaukraine war. It is an exceptionally crowded environment to push this through. The last thing i would say is that it is very hard to walk the sovereignty minefield here. Until the states in question are prepared to come forward and plea for a higher level of commitment, how are you going to win consent to deploy peacekeepers into this setting . The model of responses failed. There needs to be another model of response that treats this as an emergency, humanitarian catastrophe that requires the deployment of protected authoritative forces into this setting. To get to that point requires consent. It requires sovereignty. It requires sovereignty be respected and it requires Political Leadership. There has not been Political Leadership on this matter. I fear that what is going to happen is that we are going to do with the who is suggesting, which is draw up a list of 12 things and ask people to do more of those 12 things, versus seeing the big picture and coming up with a response to address we need to transform this exponential crisis, this escalating runaway epidemic and we are not going to transform it by doing more of the same. Thank you. Now we have aired all three. The individual country level individual, country level, geopolitical. Before we turn to a couple of the issues that have emerged so far, i want to invite anyone from the panel who wants to comment on steves point. I want to emphasize the point that marty made in its relation to steves. In the middle of a Public Health crisis, there is a lot of information and a lot of people may look back and wish you had done things differently, faster, or sooner. The really important point is given we are today, one of the things we can attract attention and the actions of the players in the world that can make a difference in this dynamic, because i would argue this is a maybe not unprecedented, but a rare place for us to be in as a Global Community. I would like to turn to a couple issues that have received attention in the media, particularly around his quarantines and access to medicine. Lets start with both larry and dan mentioned the issues around treatment of vaccine. Ill ask kevin to kick us off. Yesterday hhs announced they will accelerate their contract to get more of the vaccine available for clinical trials. As larry mentioned, nih has announced we started yesterday Going Forward with the first trials of the ebola vaccine. I think this stark situatio