Chairman for his tireless efforts on behalf of the weekend vulnerable. Week and vulnerable. I like to thank my good friend for pulling todays hearing together amid the escalating outbreak of ebola across west africa, countries including liberia, sierra leone, guinea, and now nigeria. Although i am not a member of the Foreign Relations committee, i do serve on the state and foreign operations appropriations subcommittee which funds the state department and foreign aid programs. I would also say to the witnesses that if you need extra money, ask for reprogramming. You should not wait for september, october you should ask for it immediately and him confident the appropriate committees will allow it. But if there is any doubt, there should be request for reprogramming. The current ebola epidemic has claimed over 900 people. It was detected earlier this year and is proving to be the worlds worst outbreak of the virus ever recorded. It now appears this alarming, contagious disease could be on the verge of spreading. On july 28, i received a call from ken isaacs. Let me say samaritans purse and Doctors Without Borders have done more to help the poor and suffering in many faces than almost any other group around. So i want to commend samaritans purse and Doctors Without Borders. Wherever you go in africa, they will either one other groups have long gone. Samaritans purse is on the front line, working to curtail the Ebola Outbreak. The outlook via absence of the United States was bleak. The Obama Administration underestimated the magnitude and scope of the epidemic. Despite wellintentioned efforts by local and International Aid workers, actors and nurses working on the ground, it seems the International Community in the u. S. Had been noticeably absent in helping these west african countries to get out in front of the spread of this epidemic. For the first part of the epidemic, the International Community led three of the most impoverished countries in the world deal with it ebola essentially on their own. It should be no surprise the Health Systems and night in liberia, guinea and sierra leone do not have the resources or capacity to deal with this epidemic on their own. Despite early warnings from ngos working on the ground, there was little action taken to get in front of this problem and now we are seeing the consequences. Nothing can bring back the lives that were lost and money and personnel deployed to help may not be enough to contain the epidemic. I spent much of last monday on the phone with the white house, state department, cdc, and aj just trying to understand what, if anything the u. S. Is doing to contain the out rate and prevent the spread of ebola to the u. S. I was concerned no one could tell me who was in charge within the administration on this issue. No one could explain what actions would be taken to ensure the u. S. Was prepared to respond. Although more progress has been made over the last week since these conversations, it is clear the government is still trying to catch up. This requires efforts from agencies and countries, france, great britain, many of the countries in europe who are experienced in africa should be brought in. It has also come to my attention that there seems to be deficiencies in the planning procedures and protocols in response to the ebola threat will stop as mr. Isaacs will share today and i have read his testimony when the Health Care Workers confirmed with ebola, getting guidance for returning Health Care Workers soon became apparent there were significant gap in existing procedures for dealing with this. The cdc had no available registry of medical facilities capable of treating ebola patients in the United States. There are no quarantines or travel restrictions in place and there was concerned the gaps in the protocols and how do you deal with them . I appreciate them very much. I appreciate dr. Frieden he took the cold call when his getting on the airplane. I hope you will talk about any deficiencies and how they can be addressed by the government and the congress of stop and the congress. I want to thank chairman smith for calling this hearing during the august recess and i also want to recognize the men and women of the cdc and other International Response groups who are on the ground and soon will be on the ground in africa as well as the doctors and nurses helping the two patients in atlanta. I want to thank them because this is very dangerous, what a will be doing all stop and people we do not know their names, will be doing. We nk we should tell them appreciate them. I want to thank the state department and department of defense for their invaluable assistance as this thing is taking place. This is important and serious work and i knew if the American People if they knew what was being done would appreciate their efforts. This should be a very top priority of the white house, the Political Leadership of the nation. You know with the career people are going to do, but the white house, the American People deserve to know what their government is doing to prevent the spread of this epidemic and keep the country safe. With that, mr. Chairman, thank ou and i yield back. I would like to now introduce our first panel of two panels. The getting first with dr. Tom frieden, who has been the director of the centers of Disease Control since june of 2009 and has worked to control Infectious Diseases in the United States and globally. He led new york citys program to control tuberculosis and reduced the multidrug resistant cases by 80 and worked in india for five years, helping to build a Tuberculosis Control Program that has saved nearly 3 million lives. Dr. Frieden founded programs that increased life expectancies and is the recipient of numerous awards and honors and has published more than 200 scientific articles and has previously testified before this committee on drugresistant diseases as well as other very Important Health topics. Thank you, dr. , for being here. We would like to introduce ariel pablo mendez, the assistant administrator for Global Health at usaid. Hes been in that position since 2011. He joined usaids Leadership Team to shape the bureau for Global Healths efforts to accomplish scalable, sustainable, and measurable impact on the lives of People Living in developing countries. He developed on mobile Health Strategy in the transformation of Health System and africa and asia and served as the director of Knowledge Management at the World Health Organization. He is a Board Certified internist and until recently was practicing as a professor of clinical medicine and epidemiology at columbia university. We will hear from ambassador williams, career member of the Senior Foreign Service with the of of minister consular Foreign Service and deputy of affairs at the department state. She serves as ambassador to the republic of niger and has served t the u. S. In montana france and guinea. Her postings have included director for International Organizations in National Security council at the white house and advisor at the u. S. Mission to the United Nations in new york. Ithout objection, fuller but they will be entered as part of the record. Dr. Frieden, the floor is yours. Inc. You very much for your interest in Global Health, your interest in ebola and calling this hearing at this critical and pivotal time. First, lets are member the lives and faces of the men, women and children who are affected by the Ebola Outbreaks in the four countries currently affected, especially the Health Care Workers who account for a substantial proportion of cases. Those are the people we must focus on. Those are the people we must support, and it is in africa we can stop this outbreak and protect not only this country but ourselves as well. We focus on what works and im incredibly proud of the staff of he centers for Disease Control and prevention. And i think every american who would know the expertise, dedication of the disease detectives, laboratory experts, disease and intervention specialists who have an on the ground in the past few weeks and months and you are now searching for our response would be proud to know what we are doing there. I want to start with the bottom line. Three basic fact. First, we can stop ebola. We know how to do it. It will be a long and hard fight and the situation in lagos, nigeria is particularly concerning, but we can stop ebola. Second, we have to stop it at the source in africa. That is the only way to get control. Third, we have to stop it at the source through tried and true means the Core Public Health interventions that work and i will go through in a few moments. By way of background, ebola is one of several viral hemorrhagic fevers. There are others, but ebola is the most feared in part because it had a movie made about it. There are others that are just as deadly. The first ebola virus was identified in 1976 in what is now the democratic republic of congo. There have been sporadic outbreaks since the natural reservoir is not known but is believe to possibly be that which pass it to primates and other forest living mammals and humans may come into contact with them by eating bush meat or contact with bats. That is a theory. Theres increasing evidence for but we are not certain of it. What we are certain of is when ebola gets into human populations, it spreads by two routes first, two people who are getting care to individuals who are sick with ebola. Ebola does not spread from people who have been infected but are not yet set. Its only sick people the transmitted. Second, its transmitted only by close contact with exchange of body fluid. So a Healthcare Worker or Family Caregiver who comes into contact with a patient who is very ill, maybe leading or have body fluids on the individual, that is how ebola spreads. In the outbreak in africa, there have been two main Drivers Health settings and other caregiving settings, including the family, and burial practices, where there may be practices that involve contact with the recently deceased person. Those are the drivers of ebola in africa. Ebola only spreads from people who are sick and only spreads through contact with infectious body fluids. It does not spread through asual contact. It is not an air borne disease, does not spread through water or food. And incubation time is usually between eight and 10 days from exposure to onset of illness. It can be as short as two days and possibly as long as 21 days. But in that time, it is essential any contact he closely monitored to determine if they have developed the symptoms of ebola and if they have, are followed up. We do know how to stop ebola. Meticulous case finding, isolation, Contact Tracing and management. We with our partners have been ble to stop every Ebola Outbreak to date. And i am confident that if we do what works, we will stop this one also. But it wont be quick and it wont be easy. It requires meticulous attention to detail. If you leave behind even a single burning ember, its like a forest fire. It flares back up. One patient not isolated, not diagnose, one Healthcare Worker not protected, one contact not traced, each of those lapses can result in another train of another chain of transmission. To control the outbreak, we have to work effectively. The challenge is not the strategy, its the mplementation. Mr. Chairman, we have provided how this can be controlled. Because il permit me, think it is important to get the fundamentals out there. First, to find the patients and diagnose them. That means fever or other symptoms. The only way to diagnosis ebola is with a laboratory test. We working with partners from the department of defense from the past with france, and from countries where the disease is present are scaling up the ability to diagnosis patients. So the first diagnosis is, suspect is with fever, test with blood, get it in the lab. Thats the first step. The steckedsfep is to respond to those cases. We do that by i getting them in isolation, eliciting their contact, and by following each and every contact every day for 21 days. If a contact develops fever, begin that process all over again. Isolate them. Find out who their contacts are. It is hard. It requires local knowledge and action, but it is how ebloa is stopped. Third, prevent it. Prevent it through Infection Control, health care, safe burial practices, and producing the consumption or unsafe consumption of bush meat and contact with bats. The Current Situation is a crisis and unprecedented. It is unprecedented in five different ways. First, it is the largest outbreak ever. In fact, at the current trend, within another two weeks, there will be more have been more cases in this outbreak than in all previous recognized together. Of ebola put continent. Is multi cases have moved between countries. One country gets control, and patients come in from another country. So that tricountry area is a particular challenge. Third, this is the worst outbreak in africa. This is a disease that was unknown in that area before. Because of this it has been a particular challenge. This also has been a challenge. Fourth, many of the cases have been in urban areas and there has been spread in urban areas. This is something we have not seen spread from this work before. This doesnt appear to be a change in the virus, but it is a new development in how and where the virus is spreading, and it makes control much more difficult. Fifth, it is the first time we are having to deal with it here in the United States. Thats not merely because of the two people that became ill caring for ebola patients and were brought back to the u. S. By their organization. Thats primarily because we are all connected. Inevitably there will be travelers who go from these countries or from lagos, if they dont get it under control, and appear here with symptoms. Those symptoms might be ebola or something else. So we have to deal with ebola in a way we have never had to deal with it before. The u. S. Is working to support partner governments and the World Health Organization. I have activated the c. D. C. Emergency Activation Center at level one for this outbreak. It doesnt mean there is an increased risk for americans, but it does mean we are taking an extensive effort to do everything we can to stop the outbreaks. E cant do it alone. Governments around the world as well as most importantly people in country will be key to stopping the outbreak. We will send the next week or two will have reached that 50 number. We are supported at our home base in atlanta by a much larger group. Even today before the full surge of activation, we have more than 200 staff working on this outbreak response. We will increase that number substantially in the upcoming days and weeks. We will hear more about the agency for development where we are using an unprecedented model to Work Together and rapidly identify and call in for reinforcements and assistance. I think it is important to we rstand that if didnt do this, we wouldnt we have more than 200 staff working on this outbreak. We dont have we have medications to care for it. You may have seen press coverage about experimental treatments. The plain fact is, we dont know if that treatment is helpful, harmful, or has any impact. We are unlikely to know from the experience of two or a handful of patients whether it works. We do know that Supportive Care for patients with ebola makes a big difference. Supportive care gives people saves peoples lives. Making sure they are not under their fluid balance. Treating other infections that occur, providing good Quality Health care. We are currently coordinating with n. I. H. , f. D. A. , the department of defense and others to see whether there can be new treatments and whether these treatments can be effective and treatable thrfment is a lot we dont know about that yet. It is important that we keep in mind that we do know, even without medicines specific to ebola or a vaccine, we do know how to control it and we can stop it. I want to spend a moment to discuss what we are doing to protect people in this country. First off, the single most important thing we can do is stop the outdaybreak break, stop it at the source. The second thing we are working on is to help these countries do a better job screening people who are leaving their countries so they will screen out people who are ill or who may be incubating ebola. Third, because we do recognize that we are interest connected, we are working with state and Health Workers throughout the United States