This committee that we are go. We know we have to build that. Concerned that weve seen we will work on the financial pieces of it. And our hope is that together protocols have to be adjusted, that we wish we had better training, that we are concerned with the Global Community we can about hospital responses. I would just add particularly set something up that will work like this. So lets Say Something even after the last statements, and i dont disagree that we want the worse than ebola, deadly highest standard of response, but a multitude of responses that are not based on scientific pandemic flu for example, breaks out somewhere. Evidence and that best practices billions oft dollars moving right away, then we can bring that, the emergency if they are not, the art sound, Health Worker core into fighting those academics those then we create even more confusion and more panic by academics epidemics. Individuals, and we cant really our hope is that it would work for an advance market signaled manage Public Health court and emergency systems response. For vaccines. Right now vaccine makers would those are clear lessons that are like to go full but it is hard learned as secretary of health to find financing because they are saying it in if there was an dealing with, i wasnt there to outbreak, would there be an interest in your product . Who would pay . Deal with virus in mexico but we this could take a step towards had those experts surely there answering that question. But i was there for sars, for the Immediate Response . Yes. Potential pandemic and for not the link between health and having enough flu vaccine. I am still there do with one of the worst hepatitis c issues in economic development, no question. But even protecting from the United States. Downside risk to the economy, unfortunately, in new mexico we this is one of the things we have to do. Let me just followup quickly. Not important it is to have a how much money did the world bank pony up right at the good, solid, strong public beginning . , before anyone health and Emergency Response system. To that and i know we have been else steps up, we pledged 200 both critical and we recognized whether or not congress invests million. And then afterward what we saw that it was much more serious epidemcic we did 200 million sufficient resources in the cdc, more. And the nih on oliver of the usually this takes months to partners that have a response to emergency preparedness, we disperse. Expect that there is still in months is an incredibly rapid disbursement, but once we place a robust response. But i want to be clear that had we the problem from the time the fact that these policymakers took it to our board to the time have failed congress to invest it was in the three countries was nine days. Abruptly and have cut funding, normally we do not work like that, but this was so crucial have that had a negative impact that we did it. And this is going to the on our ability to respond, not is on the million only to ebola that all Public Health crises . Ground. And it is paying for everything know. From supplies, detective i think we have seen an erosion protective gear, to health in support for Public Health, worker salaries. Becauset ambulances several times in her country, ambulances were needed to carry the patients. And each time that happens well so we are really doing anything look back through the that is needed right now. Retrospective scope and wish we but a big chunk of that money had done something different. Also has to be for holding back im not sure understand your those Health Systems. Answer to get a think having and also trying to get the reduced resources targeted at economy is going. These issues has had any arm hasrivate sector negative impact . So, we actually just had the opportunity because i will tell you that my Public Health team will say now committed to increasing its activities. This. My Hospital Association says it Economic Impact in these is. Individual hospitals around the country say it is. And the fact that you the three countries has already been devastating. And we now have to really think decentralized Public Health system, so even if you had the about rebuilding those authority to mandate you dont economies. All three of them have come out have a system that you demanded. Of conflicts over the last decade. I dont know that i agree, and the last thing we need is although i really respect my intohis epidemic to lead colleague, mr. Connolly, that you want to mandate here but we another situation where they have enough issue in this move back into conflict. Country which is we do not have so we are trying to do many things at once, but right now a centralized Public Health the focus has to be on putting the fire out. Guy . System. Thanks so much for being your ability to manage state by state by state by state, and i have a poor state with a here, mr. President. Centralized system fairly my name is guy taylor from the effective, but i can tell you even there it was hard for us to washington times. Manage all of our county and im going to be that guy. Emergency response partners in a i want to bring the conversation crisis. You are actually correct, and inside the world bank for a minute. Certainly we are hearing a lot there have been a lot of articles, some i have written from states. They are very concerned about and a number of others here the reductions and support for about unrest among the staff inside the bank. Public health, and for Public Health preparedness. And many of them are really memo circulating among rankandfile economists. Looking hard at how theyre going to have to cope with the latest rounds of reduction. There is one out now that is calling for people to hold a bank in the lobby of the are you prepared now to really think about best practices and more centralized every thursday. There have been several such approaches and requiring maybe a rallies. Some of these people, mostly will not give their names, but are accusing you on paper of different protocol for our gross mismanagement of a Public Health Emergency Response systems in this country . I think if we did that even when restructuring of the bank. I wanted to give you an congress doesnt do its job to opportunity to respond to that publicly, but i specifically adequately fund these public wanted to ask, one of the Things Health issue so that we only that has, out of this sense of a read when theres a crisis instead of, and i appreciate someone talk about precautionary culture of fear inside the bank. Principles that we out to be people complain about this to reporters. And i wonder what you are doing proactive and in as many cases to address that, because budget as we can with the evidence is found about being proactive in cuts or reforming on that particular manner. Restructuring are one thing, but but, in fact, i do expect that when a culture of fear takes the federal government even with a difficult limited resources does everything it can to identify thing. What is best practices are when they took the job in antiregularly identify what the risks are if you dont adequately fund and what the july, 2012, the questions that i was getting in a pretty pointed impact is two states also find way was what is the relevance of themselves without adequate resources to prepare and be trained to effectively. The world bank today . I so much appreciate your passion for Public Health and the issues that kept coming up were, are you relevant for for the resourcing of Public Health. Its so important. Middle Income Countries anymore . The way Public Health is one of the things that was organized in this country by law is the federal government by and large can provide guidance and worrisome is that we were reaching a single borrower tools and best practices by the limit. Were runnings, we implementation of other aspects of Public Health is either out of state or local level. As i think you know well, its on of space to support middle Income Countries. The other issue that came up was organized differently in a knowledgeat as different states. Thats my point. Is it may be time to think about whether or not that in of itself institution we had fallen backwards. That we werent providing is an effective strategy in this stateoftheart knowledge to all of the countries who are our country. I think its a very interesting idea. Clients. What we did, we did a survey of i yield back. Thanks it gently. The entire staff. I ask unanimous consent that and the survey was extremely critical of the bank as it was. Page 172 of the report entitled s we try to issue funding of the hhs secretary for prepared is in response in millions of dollars be place in tackle, how can we continue to the record. Additionally, ask without be relevant for middle Income Countries . We are we ensure that objection. Additionally i ask the wall street journal article in the moving the best Global Knowledge opinion section entitled theres to every country . And one of the things we foudn plenty of money to fight ebola wee t found that when be place in the record. Without objection. Lastly i would ask that the fy asked technical specialist, how much debt the time do you spend dividing your expertise to other 2014 hhs appropriations overview regions . It came back around 1 . By crs be placed in the record at this time. We knew we needed to do a couple without objection, so ordered. We now go to the gentleman from of things. We talk to everybody and we decided that we needed to make michigan. Some pretty fundamental root and branch changes. Thank you very much, mr. When we decided we were going to chairman. And thank all of you for coming do that, i told everybody this is going to be really hard, today and testifying before this committee on a very important because it had not happened for 20 years. Subject, a great deal, a great there had been really know structural change for 20 years. This talk of moving toward a deal of importance to the people in my district. Global knowledge system, talk of trying to increase our lending mr. Rauf, quick question. What is the federal governments capacity, all of this was on the table, but nothing had happened present witnesses to address to have a pandemic or other literally since 1997. Emergency whether its a surgeon so when we started in, we tackle michael needs in a specific the very robust agenda. Region . And we did it in a time of low i can only speak to the dhs component which is what we studied. Are you familiar with, do you Interest Rates. So historically low Interest Rates affect us. Our income is lower. Have any idea how many mobile hospitals are in inventory to be the only way we would have been able to do that, to grow our deployed at, welcome reasonable capacity, to lend to middle amount of time meaning one day Income Countries and to have Global Knowledge was at the same to three days to revision that review of a is experiencing a surgeon medical needs . Thats for any reason expenditures. It turns out that an expenditure whatsoever. Another katrina, hazmat review had not been done for a long time. I suspect that all of your emergency, pandemic, earthquake, organizations have gone through reviews. We had not for more than a decade. So, what the board told us was, tornado. We did not look at that in we will work with you and let the audit. In 14 months been in office, since ive been in office the you increase your lending last 14 months, my office has capacity and we support the move to go to Global Knowledge groups, but you really have to been investigating that need. Do something about efficiency so first responsibility is to and your expenditures. Protect this country. So, the complexity of this as we and i havent found any in the inventory. Did it all at once. So theres no mobile hospitals the reason we did it all at once available, no mobile isolation contingenteach was units deployable that can be deployed within hours or days of on the other. An emergency. You can expand your lending to middle Income Countries, but you have to go to the expenditure ms. Burger, either question. Review. Your interest. How long have you been a nurse if you can expand your lending, at . The only reason they would want more lending is if your fortythree years. My wife has been a nurse or knowledge was significantly better. So were in the middle of this, 37 years, so thank you very much for your service. And people are absolutely now i have a question. When a person has any type of understandably worried about their jobs. They are worried about the wha infection disease, whether its ebola or the flu, i know they what the system will look are transmitted differently, but for each step that an infected like. And big bureaucracies like ours, when people get used to a way of person makes, does it or doesnt not increase the risk of its doing things, no matter how much they may be critical of it in a survey and tell you that there spreading, potentially . Are steps etc. , when you its unsettling. I just give you an example. If somebody came down with the flu, its quite possible, well, we knew there would be many course corrections we would have if they stay in the home the to go through. And we are in the middle of a course correction right now. Only people that are probably rallies have going to get sick or infected from the flu is those people that are in the home. Happened. Rallies, ine of the that if any member of the household leaves the house, goes to the drugstore, does to the had a town hall meeting and we supermarket, whatever the case talked about specific issues. May be, does the potential to there were some issues that i had, i was aware of. Then there were others that were infect others increase . Well, if its of the flu, as you know brought to my attention in a very clear way at that town hall. The next week he had another and airborne. Made policy changes. And they also have good hand washing. So if you are not in direct iwould put it this way contact with the airborne virus have great empathy and sympathy gor the people who have to going into your eyes by yourself putting her hands into your eyes through this and are still uncertain about their jobs. Or something, thats not likely. But the only thing we can do is but what we are talking about to keep going, and make sure here today is the ebola changes happen. Preparedness in this country. Then everyone will know soon enough whether or not they have a job or how the process of i understand. And its completed different in this country because theres making decisions around jobs will go forward. You know, i have learned a lot about 5000 hospitals in this country and 5000 ways to manage from this process. One of the things that is most this disease. How many of those hospitals important is that when you have havent Isolation Unit that is 188 governors, a livein board. Works withines and capable of containing the ebola virus speak whats according to what the hospitals report on a the institution. Daily basis in the newspapers, 25 executive directors. People for 100 Different Countries. That there already and they can english is a light to washington isolate patients at a moments but there are many different languages. Notice. But what which is cub reporter with this much cultural to us yesterday was a nurse complexity, with an organization that is so complex that has not thats not, from kansas city who gone through a change in the long time, it is tough. Has a quote negative pressure so i know there is no doubt it rooms which was not operable. Is tough. But there are things that are happening already that i think thesecause we made okay. Thats one negative pressure rooms. Very important, special with ebola, correct, to have that changes. For example, the response to ebola has not been a regional capability . Response at all. It is been a response that has correct. Evolved all kinds of different if a patient walks in with expertise in the bank. Now we are structured so we can flulike symptoms, first thing they would do in a good hospital is they will visit an do that. We recently were able to put administrative clerk does together a price on carbon, a statement on a price on carbon u. N. General assembly. Triage, ask interest questions, is that not correct . If they have the flu, most of the time they are at home in b anin, that was a cross bed. Well, thats not always the case. They could be experiencing fever your they do come to the institution wide effort that really would not have happened emergency rooms. Before. Optimisticextremely if they are seriously ill. Seriously ill with flulike and confident that this is going to get better. Real quickly because we have symptoms. So is it possible, what is the protection that the an got a lot of other people in. Other people waiting. Administrative clerk that meet you at the hospital, the i appreciate your answer. Receptionist that asks what are your symptoms, why are you here, you did hold these town halls. Whats your insurance . Whats the chances of them being in one of them, the issue of the infected by an ebola virus . Cfos bonuses came up. The gentlemans time has expired. , but she can answer but i just, im curious to know. Youre not talking con your same this is bertrand flulike symptoms bu but you are he was given a signing bonus. Assuming the person has ebola . You announced to the staff that correct. The lady can certainly answ he would renounce his bonus. Bank presse world answer. Again, as i say several, 5000 office then came out and said he had artie received 70 of his hospitals all have different bonus, and he was going to be keeping that, but for going the protocols on how they handle last part. Could you clarify that . Ebola. Some cpd officers are not asked because this is going to be to step in. They are given little ebola gets broadcast. Im sure there are people inside the bank that know you are the person has the answer. That have a gallon, some gloves is he giving his bonuses back, or hes keeping him and not and a surgical mask. Getting them Going Forward . Hes not giving what he artie a gallon. Down. I think thats a we are talking received back. That would be very difficult about is that everybody, Everybody Needs to be trained and prepared and educated on how process to go through he is not giving what he already to handle a potential ebola received back. The premium is because we are patient so that the clerk is also not exposed to unnecessary virus from ebola. Organization, and salaries for staff in Different Countries are based on local salaries. Very difficult for thank you very much. We now go to the other gentleman from michigan. Us to attract the kind of talent thank you, mr. Chairman. And thank you to this medal for we need in many places in the world if we do not have a being here today. Premium. In the case of bertand he was earlier this month several airlines including kenya airways, british airways, and the, cfo of one of the most important and largest banks in france. We were trying to help meet nigerias air suspended flights to and from certain affected the salary cut that he was countries in west africa. Taking. Greatk bertrand did a our own state department issued travel warnings to our citizens urging them to delay take in refusing to nonessential travel to liberia and sierra leone. Anymore, but we are not asking and recent reports suggest that more than two dozen countries him to give back what he or he had. Have restricted entrance to persons of traveled west africa. Thanks for coming and talking my question is to dr. Lurie. About this again. Under what circumstances, if i am going to go back to the a little louder. I wanted to ask you about the any, do you think a travel ban or increased top travel research would be safeguard to chance of, how the disease is protect american . Spreading or not in west africa. Experts looking so i thank you for that question. Over the past week we have increased and tightened up our at the number of cases in the screening measures for fact that even in nigeria, as we talked about the response, was individuals traveling from the three affected countries. Huge for just a small number of cases. They are all now being funneled enoughen we dont have through five major airports. They get screened before they workers, the expectation is that leave. They get screened when they this is going to spread with neighboring countries. What does that mean for the come. Every passenger coming from an affected country now has the strategy for how to deal with this . What does it mean for the u. S. Response . Information given to the state because the u. S. Has come in, and local health authorities, and so far theyve said their and they will be actively troops will not be coming near monitored for 21 days. So weve really tightened up the disease, but do you think quite a bit and i believe it should be sufficient. That is a realistic strategy and what is the exit point for that . What happened in nigeria how about a travel ban . Is there any circumstance would was really a model. You support a travel been . But it was a model that was we think a trouble been would be incredibly unproductive or counterproductive. In what ways . Workable because there was one crossborder case that led to 20 cases. Well, first of all right now so, just to give everyone the we have a really good mechanism to identify and track every numbers. It was over 200 physicians. Single person coming up from over 600 other Health Workers. Infected country. If youre to put a travel ban 10rds of, more than and the fact you will have people coming to visit this country who we wouldnt know. We wouldnt even know how to find and or monitor them. Million of cost. They did almost 19,000 home visits where they took peoples that would become a serious problem. But if someone is why temperatures. This was during the contact. Commercial and they dont it was a textbook Public Health exhibit symptoms, they been in response. But if you can imagine if there the region thats infected, how are you going to know that they were 100 cases or 1000 cases are infected . Or that they might have been that came over the border, it infected . I think the whole point of would challenge even nigeria to doing the exit screening and then the screaming when they be able to respond effectively. Come to the United States, and so right now the strategy is to then following them for 21 days, taking their temperatures, twice a day is exactly so we can see focus on what are the critical things to do to make sure you can somehow knock down the speed them through the end of the incubation period. Of the growth. And if necessary be on top of the two things that people have that within hours of in identified are safe burials and exhibiting a fever. Then identifying the people who are sick. Then, at the same time, trying mr. Torbay, same question. Which is what a travel ban under any circumstances . To provide them both treatment no, we dont. In preventing further infection. A travel ban, first of all, we 70 i think the goal now is have to recognize that there are no direct flights from those three west african country studios. The majority of people actually Prime Minister through europe. So travel ban will have flights coming from europe, which i safe aerials and 70 detection of cases. That is not the classic public dont think it would be Health Response because whether they are saying is that its feasible. Going to be difficult to find but even with that we cant every case right now and because if were talking about difficult to do all the contact fighting ebola at its source, we tracing. Are being they need Health Professionals to be able to travel in and out of the practical and try to take that first major step knocked down country. We need supplies enable to be the growth by going at the those where, going after flown into, into the country in order to the predominantly travel problems that are spreading the virus the most. Then after that, you may be able through commercial airline . Absolutely. Would be prohibitive to to then bring in the classic require that travel through Public Health response. But right now that is the reality. Ideale now using not the charter jets and . It will be very expensive. Theniques but it is because the question, followup question. You said earlier, and the doctor said if theres a symptoms, epidemic in those three theres no risk to other people. Countries is too big. Now if we had thousands of what if someone were to get onto Health Workers going in, we an airplane with no symptoms but you have an eight hour flight, could get all of that done and United States from european then get to the classic Public Health responses, doing the country, lets say, and did in west africa, europe to the contact traces. That is what you would like to do. United states, could exhibit symptoms on the flight . In a situation where you do not have enough workers, you have to isnt that a risk . Focus on what are the highest impact things you can do right now. I very much appreciate your think it is going to question and concern, and i think that is exactly why now spread to neighboring countries, and what does that mean for the all of the planes are being strategy of how to fight it . Routed through the fighter the world also planes to the airport. Why, by the time the plane lands health organization, the whole Global Response is working with on the ground both customs and each of the neighboring Border Patrol and the cdc countries to put their response quarantine officer notified in place. So i think there is no doubt about whether there are any six passengers on the planes. That the neighboring countries are much better prepared than when they get off the point that as the the same questions again and given information about liberia, sierra leone, and guinea were, but it is going to symptoms of ebola and what to do if they have any. Be a chalice. Im going to yield my remains if it is one case at a time, into the gentlemen from florida, there are systems that will respond. Mr. Mica. Thank you. First of all, what youve got in if we do not get it under control and hundreds or thousands of people start coming place has failed. Across the border, then i think we are going to have a very serious problem. The doctor, the new yorker doctor just came through and he we are going next to the got the temperature thing and l. A. Times. All of that, but it failed. He selfreported. News. Llas morning the journal. I think its basically what you mr. Lee . G20 coming up, what have is a 21 day period from where they have been subject to are you expecting physically, or the infection, and people need maybe what are you looking for to be quarantined coming out of those countries. You dont need a travel ban. You need to go to the people who in terms of their response to post the risk. Ebola . And secondly, on a nonebola i understand its only 80150 coming out of those countries question, there have been reports about the u. S. Actively right now entering the United States a week, is that right . Thats what im told. Opposing chinas efforts to build a development bank. But you quarantined them. The worldould rival my grandparents when they came in the ellis island were subject working. We quarantined lots of people. I will take you out to where we bank, and i wonder what you think of that effort. Talksuspect there will be did. Or the self quarantine themselves. They pose a risk, every traveler about a bowl at the g20 doesnt. But people need to be about ebola at the g20. Identified. We just came to the airport today at dulles, and again can we didnt come from one of those countries but we didnt have to. I think president obama and Prime Minister David Cameron have been very loud about asking someone you just a transited. They can Prime Minister other countries to make donations and to do their part. Ill certainly give the same the gentleman to yield its message, that we still need time is expired if you could wrap up. Again, just commonsens commot resources and we still need Health Workers. So i will surely give that doesnt prevail a brandnew or message at the g20. Anywhere. 21 days. Look at this guy again, learned at the g20, the topic of by his example. Discussion will be global the 14th he flew out, the growth. This is what, the two items that 12th was his last day there. You count 21 days forward. The australians have focused on for their hosting of the g20 so he shouldve been subject to has been target for global quarantines not exposing itself growth, and that is the 2 local on the subway and other places. Your guidance finally target. Interesting thing is when the oecd and imf did a survey of all im going but i didnt i will come back. Let me just finish because the different Economic Strategies that are, that are the gentlemen will have additional minute. Currently being carried out, just an additional minute. I dont know if this is true, that if everyone did what they its new york. Workers and i spread this stuff. Said they were going to do, there is a possibility to get to and nurses were either taken ore 1. 8 global growth. Sense, it is a things off our exposure of the skin. We dont know. Do you know . No. We dont know. Heres the picture i saw. Relatively positive picture, but my wife told me about this. Then the question is will these are new york police first everybody implement all the Structural Reforms that they need to reach that target . Responders. That is going to be one of the the you have a memo to first discussion items. Responders and how to do with yeah, yeah. So the other issue of this stuff . We do. We put up guidance to this is a press account. I dont know if its true but it shows in putting their gloves infrastructure gets right to and other stuff from the area in your second question. Theof the things that new york into a public trash been. Australians have identified is ivet there is a mass so again, what youve got to do, market failure right now. Make certain First Responders, there are a lot of great Infrastructure Projects that growth of boost the nurses, all the protected things in place where we have exposure, and we have exposure and the economies, especially in developing countries, and theres lot os of capital sittig testing at the airport is not working. We need a quarantines in place, on the sidelines earning low period, for those coming out of returns. Situation could their, or youre not going to stop this to the doctor was a be that we find some way of mobilizing that capital that is very responsible, educated individual. Sitting on the sidelines and get thank you. I thank the gentleman. It invested in these vital Infrastructure Projects. And so, the australians have i ask unanimous consent the Ranking Member have one minute. Without objection. Really focused on building esther corbett, the something called the quarantined, can you talk about that . I know your interest in whats alfrastructure center, glob happening in africa but your interest in whats happening here. Can you comment on that . Infrastructure center, that will be a clearinghouse of as i mentioned one of the information and opportunities to bring capital on the sidelines and Infrastructure Projects together. Now, thats exactly what the main things are fighting people in west of kosovo ability to take steps to bring the backhoe. Aging Asian Infrastructure we cannot recruit from use or anywhere else in the world if Investment Bank is going to do. Theres a chance they might not be able to come back home to the it was launched yesterday in china. Families and to the duties, to you would have to ask the United States government what their take on this is. Their other duties. I will tell you are view. Putting people in quarantine actually goes against our the Chinese Government began ability to recruit and to retain talking with us very early on, and, therefore, it would go really immediately after they against our ability to fight had this idea. That especially ebola in west africa. Now the children from florida for five minutes. Thank you, mr. Chairman. In asia, there is nowhere near enough money for infrastructure. The estimate is that there is 1 dr. Lurie, as i understand, trillion in additional investments that were needed in congress in 2006 passed a infrastructure in developing countries alone. So if you put all the pandemic all hazards preparedness act. We review that and reauthorized multilateral banks together, we in this congress, and one of the key points in that was are 45 billion. If you look at the private 2013, some from 2012 to establishing an assistant secretary for preparedness and response, which is of course you, and this is supposed to be the focal point for these private Sector Investment in responses. Infrastructure in developing you were quoted previously sang countries went down. And so, the figure in 2013 was around 160 billion. You have responsibly forgetting the nation prepared for Public Health emergencies, whether naturally occurring disasters or all of the Infrastructure Investment does not begin to meet the need in developing manmade, as well as for helping to respond and recover, a pretty countries for infrastructure. Our perspective is that any significant undertaking come into quote. It occurs to me im glad to see institution that comes to the you here but i have not seen you table to try to make these investments in infrastructure, we welcome. Out front. We have been working very i know too many occasions is closely with them. Supposed to be part of what you and they want to utilize our do. Technical expertise. Have you been appearing at Public Meetings over the last we have been doing everything from project preparation to implementation support, to several weeks in conjunction with ebola . Have you been participating in any briefings for the public . Let me start by saying, and bringing multiple different groups together to finance projects. So the Asian Infrastructure repeating something i said in my testimony, back in the spring Investment Bank should be a very welcome addition to the current when we first learned about ebola in west africa, our whole situation, which is a woeful office activated to start taking lack of financing for action on behalf of the country, infrastructure. Now, the politics of it we are on behalf of west african i appreciate that but can you not a political organization. Speak census has become heightened with the American People in the last three or four it is actually get our articles weeks . It seems like your protocols of agreement that we do not get been a lot northern summit of involved in domestic politics. The folks even though your so well have to ask the u. S. The position on it. Office is a key one, so how my sense is that we could work would you respond to that . With them very well. One of the things we know [inaudible] budget with Public Health emergencies is the public does better if there is one or two the u. S. Efforts consistent spokespeople. I have not heard. Dr. Frieden has played a major from chinese officials. Role in that because the cdc has not at all. The lead for the Public Health aspects of the response. What i can tell you i appreciate that. Let me ask you this. We, without question know that the president had what was there are many more billed in the press as emergency Infrastructure Projects that are bogeys at the white house. Worthy of investment that we can invest in. We know that for sure. The critical thing one last friday and then a week ago tomorrow on saturday after agassi played a round of golf. For us would be to make sure our efforts are well coordinated. Did you attend either of those i can even see one of the meetings . Our second to attend this outcomes of the australian g20 meeting and ive met with her every single day since we got involved in this response. Was that we establish the Global Infrastructure facility for just did you attend a . This purpose. No, i did not. Because we know that, we did a and so has the white house or lmost 30 billion last year in the secretary of hhs instructed infrastructure spending. Your office to stand out as again, that is not nearly being the point office in favor of this new ebolas are . Enough. So what we did is we built, we not at all. Just launched a facility that we will put some of her own money so heres an issue. In, but we will do all of the Thomas Eric Duncan brought people to the u. S. Preparation, we will use our safeguards. Then were going to try to your office excluded what was envisioned in this legislation, attract money from other did he was able to bring it is sources. For example, sovereign wealth easier. Funds that would not take from europe or the u. S. That so what we do, where you guys prepared in your office for would not think of investing in infrastructure in developing countries. If we are involved and make it ratiothat the riskreward thomas duncan, or did you drop the ball and could youve done some things that are . Makes sense, then we can bring so what happened with some of that capital into building roads and highways and mr. Duncan required a whole system to work, right . Sources of energy in africa. From mr. Duncan, the it required the federal components to be in place. It required state and local Health Departments to be in place but it required hospitals to be in place and it required individual health providers, first case of ebola diagnosed, doctors or nurses all to be able to do the job. The record of treating patients has been good so far in the u. S. With the two nurses who were certainly there were some breakdowns in links in the chain. Do i think that weve done a good job preparing hospitals and infected they clear the virus Health Care System in our before an average person show symptoms. Are there specific early country for disasters . Yes, i do. Do i think we are being very interventions that we are aggressive now about preparing learning about here that might Health Professionals and Health Care Providers and institutions be able to be applied in africa to be able to recognize, treat tickets to that stage of catching it early enough . Or is it just General Hospital and isolate patients with ebola . Care . So, the ebola virus is a very i think were being very, very aggressive about that. Explained to me than, the interesting virus in the sense that its really not pandemic act seemed to have your welladapted to exist in the office a point person. Now we have this ebola czar. World in the sense that, in a how did the chain of command work in terms of how we are developed country, if you prevent any further infections confronting ebola at this stage . Is the hhs as they come in and it gave intensive care to several reporting iran and is the people who are sick, you can direct reporting to the stop it spread very quickly. President . What is your understanding of it is, the reason it has spread this . His role and responsibility in those three countries is because its opportunistically is to coordinate all the taking advantage of the fact different aspects so that we are that their Health Systems were increasingly working in a whole of government response. Not developed to detect, treat, or prevent further infections. It to make sure that all the parties are working together on so it only can spread if youre a daytoday basis to make isnt that in your Job Description anyway . Falling down on the job in terms of providing services. Arent you kind of a czar to do ll recognize that with these pandemics . The next thing we have to really do is to commit to putting in so i have responsibility for data with medical and public place Adequate Health services Health Emergency, particularly in every country in the world. Domestically, and the other thing i think its important because it is going to be the recognize is the bulk of this country that does not have the response is global Health Services that is going to be the accelerator of future epidemics. Response, not a domestic response. We now understand that we have my office has been active along got to get better at it. But the treatment is really with the cdc, the nih, fda in supportive care. Being with the secretary at the so there are some candidate beginning of this as i said drugs, vaccines. But supportive care, meaning almost everyday. I know the chairmen invited that what happens is when the virus gets into cells and they ron klain you. I wish he wouldve comes we leake, you lose fluid. Could ask some people as mr. Gowdy put out may have some reason to question whether this your electrolytes is the right individual to actually execute the medical potassium alexa lets get out component of this or whether of balance. This is more for political what you need to be able to do is replenish those fluids. Theres a great story. Reasons. I wouldve liked to been able to a doctor fr library andom ask them some questions to try who survive. To prove that further. Speed would the gentleman yield . Yes. For the record we get invited. He forced himself to drink 12 we hope you would be but we also liters of fluid a day. Invited the world health he forced himself to eat by Organization Representative and holding his nose. As you know we find about half woulddern hospital, you of their entire budget and their answer to us was that basically not have to do that. You would provide intravenous they dont do congressional fluid. If needed, you would provide orher gastric feeding hearings. So im sending a letter to the appropriators letting them know intravenous feeding. They dont do congressional in other words, all the tools hearings about how theres been a our money and other going to that we need to get survival fight Something Like this. But it is in the concert as you rates up very high, we have. Say. Youve got an attorney who has one of the efforts we are trying been hired to do this as a czar to make in these three and you have the World Health Organization and neither one in countries, and this is a. Especially the focus of my i yield back spent we now go to former car legs at partners in health, is to try to increase the gentleman from georgia for the capacity to do things like five minutes. Monitoring and managing mr. Collins. Electrolytes and providing thank you, mr. Chairman. I appreciate you each being here. Intravenous hydration, because for the doctor who survived, i theres a lot that concerns me from the searing. I came into this hearing hoping think just about all of his in some ways got some assurance colleagues died. Because it is really hard to but also im very concerned that drink 12 liters of fluid a day, and hold your nose to eat. Some the answers that were given. I make it to the demo by want to any modern Medical Center would muchgiven those nurses a focus on being from georgia i want to focus on a positive note. I want to focus on something, better chance of survival. So what we are trying to do is because back, when theyre to argue that we have put in countries a high brought United States, came to really the constituent to my level of care, intravenous fluids, electrolyte management, so that the incentive is for constituent started feeling they are, this is something we dont understand and how you get it. People in those three countries been in the weeks and days after to stay where they are. They want to stay in their home that the conflicting and i could public statements that followed country. They want to go back to work in the arrival from cdc, others. Their field. They want to go back to their jobs. But if youre in a situation where those things are not have caused even more. Available and you know that survival is much higher in fact, today in one of mine elsewhere, the incentive is to local press outlets there is leave. So this is something i just cannot stress enough. Weve got to get beyond basically an opinion poll, people can click its of 75 nihilistic notions that nothing believe the cdcs information can be done. The only way to put it out is to from the beginning was just an actor and not helpful. You have a level of trust that put in as high a quality of is gone with many people. Services as we possibly can. Do the things quickly that we but what happened was really know will slow things down. Time to switch gears and say frankly from my perspective identifying who they are. Georgia got it right. But if you tell patients, we are going to isolate you. We are not going to give you any emory got a right to nebraska has got right to the are some feeds, but we are places that have got a ride to ottawa to know is we continue this process, look at the going to make sure you do not precautions, the things going on, focus on the protocols for infect anyone else. That going into ms. Burger and the nurses and the folks are coming to the very front stages, they do it in a isolation is a death sentence, then unfortunately, the way that they follow protocol, incentive is to go somewhere where it is not a death they have the protocols in place sentence. So thats the challenge. And have the equipment in place. This is what i want to commend that is why we need health in the reagan diversity in workers so badly. Atlanta for being able to be the michael . Dallas morning news. First hospital to successfully what were the mistakes and what treat ebola. The fourth is still recovering were the learnings that you at emory and is declared ebola didnt see, that you saw taken advantage of new york in new free. Emory do this because theyre set up with the cdc on those york . First of all, we now have a levels that weve heard about, dr. Lurie come on the table much, much higher level of topic they work with the cdc. Suspicion. And were paying much closer theyre one of those outlets in case something happened which, attention to travel history. A trainedncer is most of which i am so proud of, except so the public statements by the director who is really professional, so he was taking his temperature twice a day from lost confidence of many in the field and many in the country by the time he came. The statements are made and the fact that he made the call actions he took for him to be and got the care literally the the face is really a concern. Of this. Morning when his temperature so the question that i have is a looking at this, emory has put out a lot of great stuff. Spikes suggest to me that the i would like to add the chance, just as everyone said, editorial from the president and chief executive officer of emory the chance of infecting others before that was as the health care. Without objection the entire department of health said, almo article would be placed in the st nil. Record. I do appreciate that because just was notere i think this is a national response. You said something a moment ago, you said youre looking for this is not a domestic, a global the level of heightened awareness that this might come. Handts on the one issue. Art with part of global . So what part would you be missing and understanding of how unfortunate that that happened that would affect us . To dallas, but fortunate that we learned from it. When youre me concern was if it my understanding is that because was something overseas when we of that experience, health have places like emory and systems all over the u. S. Are now at a level of preparedness nebraska doing it right, doing that they simply had not been before. The repair this, the protocols that were not forced upon them, they had a ready to go. Thinking ahead. Was it, should it not a been a there is no miracle drugs. No magical or surgical procedure part of your job . That stops it. May be used as to what i was trying to convey, what i was trying to convey is very quickly and lightly. It is highlevel suspicion so i have domestic that when you know someone might have ebola you isolate them responsibility for preparedness. Right away. Then when they get sick, you in fact, one of the things that i was reflecting on when i was provide the care they need to survive. What thenow exactly listening to comments is that prior to taking this job i had an opportunity to go around to every county in georgia and do number will be, but i suspect that for a case cup early for a case caught early. Those tabletop exercises. For bio preparedness. Died, but it was i spoke to the leadership at emory yesterday and were very grateful for their incredible probably because we were late in response in their leadership, getting the treatment. If we treated him early, the chances of him surviving would not only taking care patients at have been much higher. Emory but now helping us at if thats the story. I hope that will become the helping the rest of the country story. As we build out and develop a that went cases are caught early and in a prepared Health Care Regional strategy for taking care of i appreciate because i do want to at least extend with the system like the United States, that not only do we prevent infections but survival is very positive Health Care Workers are getting it right but i share high. Any other questions mentioning the importance of ms. Burgers concerns and there getting Health Care Workers. Was discussions lately is lets given the cases that have made say they did switch planes. The most attention in america, theres not tracking the they dont fly into one of the five hav center dot healthcare workerse. How are you going to convince airports. They present at an emergency room which by the way in my area thousands of folks to put themselves at risk . A lot of times for areas they do its a great question. Go to the emergency room with flulike symptoms all of the time. All the time. Thats why i started by saying that dr. Spencer is a hero. Part of the problem weve got it is going to get worse. So it is the people, having dr. Spencer understood this trained, have adequately prepared and i think this is the epidemic. He understood that the only way part that concerns me. To protect americans in the you made this statement is going medium and longterm was to to india because the concern out there is for the people to treat, in his case, guineans. Understand what is done right, emory hospital, nebraska those kind of things that are done what it took to follow protocols he understood that. That is the case. Spencer camer dr. And be prepared. Thats number one. From the cdc level and the spokesman level theres been a disastrous failure of that. Theres been now with mr. Klain back with ebola, i would still say that what we need now is for physicians we take various forms of oath. A disastrous. The oath is we ll do everything not just an image system that we needed someone else that has the credentials that you have for we can to protect ourselves, but others. And heres my problem. Our job is to treat those who are sick. If you have a global epidemic after we discussed everything on when it actually got it, a doctor in new york, which i was raging in three countries, i in new york, just get back next think it is extremely noble that also very much in the spirit of just came back last night. Take in of the oaths we heres your response. Its the response that the becoming physicians. American people cannot hear and so, i wish him the best. Anymore, and that is after it i hope he gets better quickly. Happened, out have an abundance i would not be surprised if he of caution we cleaned the Bowling Alley to out of an abundance of caution we went goes back and continues to treat back to the American People need people in those countries. To see the abundance of caution before him. That is your job. And i would urge others to seriously consider going and helping. The journal. That is the job of the cdc and the chopper preparedness. Monrovia hasue in they wanted to see the abundance of caution before our Health Care Workers were put at risk, before system thats what abundance of coalition you to said that there are numerous anecdotal cases of workers who come, and for that from a very positive statement from emory arent getting paid the cash hospital and nebraska and others who didnt right there i want to that, including yourself, the highlight an abundance of bank has provided. Caution should have started a while back, not after the fact of accountability to with that i yield back. We now go to the gentleman from florida, mr. Mica. Structure do you have an a perfect leadin. Assurances do you have that the cash is being spent as intended you told us you responsible for and isnt being siphoned off both domestic prepared his and the Global Response. Into some accounts . No. My responsibility is a domestic nobody has mentioned responsibility primarily. So you have nothing to do with a Global Response. More from this article about w. H. O. And wouldnt come here this. Im just curious whether there has been any mention of sick on today. The. To overseement first of all this is the worst Ebola Outbreak in history, is that right . Global efforts on this. You constantly seem to be saying okay. And asses he says the world heah organization said today it would that there is a shortage of probe complaints it had been too supply, a shortage of action. Slow to wake up to scale of ebola. And this has critics have you seem to be pushing, questioned why dont you w. H. O. Knowledgeable of what is going on. Theres been criticism of other will be declared an international Health Emergency in august, eight months after efforts. The epidemic began. Finally, if you could, can did the administration or anyone you elaborate just what your in a position of authority from understanding is on the shortage the United States where we spend millions of dollars in w. H. O. Of healthcare workers . What are we talking about . How many thousands are we short . Asked them to proceed . So let me as you know, we have no. Let me put a finer points because you do you know if they did . You can say you dont know. I dont know if they did been aggressively trying to lead the fight against corruption in what . Anything. Did we go after w. H. O. . Developing countries since 1996 this is a global when Jim Wolfensohn it was we have been working with w. H. O. Theown for people like where and this isnt my stuff. Im just reading you what im telling you that people are coming after. President of the world bank to use what they call the cword. Okay. Corruption. This isnt a panic. Him not to say is to be prepared. Are you in charge of being prepared . I am in charge of being prepared. Corruption. He then went out and did the okay then i think you need to turn your resignation in. Speech called a cancer of corruption. Ever since that time, people have you read this report . Have you read this report about like paul volker and others have preparedness that the ig d. Been working with us and all the other institutions to follow the have some authority over money as carefully as we can. Preparedness at dhs because i every single project is audited. We have people on the ground who have no authority over in utah the authority to do the job. Are following the money. Who has the authority to do the our understanding job of . Just prepared for this committee. Is that a lot of this is just the day is known for. Tlated to the inefficiency in he said the stuff they bought nobody, even the inventory where its gone, youve got come you got equipment to protect people he system. On the other hand, if there are people siphoning off these funds, we have about as robust thats out of date. System as one can imagine in and while protecting the they even put a hand sanitizers a settings like this to follow it look at 84 of them are expired. Afterwards. So i think it is really, as i said, Margaret Chen this morning is that your job or somebody way,d me at 6 15, by the else . Without iif it isnt your job, isnt the new sars job . Whose job is to to protect the to tell me that one of the things they are trying to do is American People . First let me clarify that dhs to put Electronic Payment Systems in place. We know there are great examples has responsibly to by personal protective equipment for of Electronic Payment Systems that are working in africa. Have you been over there to in kenya. See what they have . And have you been over there to so it is one of the things were see what theyre doing . Have you seen this report . Going to work on over the next staff, make sure she gets a copy literally days to weeks to get of this report. This is a scathing report, page that system on the ground. If we can do something that is more automated, that people get paid on a a card with a cell after page. The inventory outdated, stuff we thought we spend millions of phone, we will put it into dollars and we arent prepared. Place. I have ad ay day job, ian. Let me ask you another question. Having been a while i was through the blued the bird by the response is being led flu. This is transmitted by an individual. Take and continues comforts while you should arent in the all the appropriate people. Health care workers. You are wrong, mr. Torbay. So the secretary general is very they are the most exposed to personally involved in the response. This. And you know, as i said, so anyone has been exposed for 21 days coming into the United States must be quarantined. Margaret is 24 hours a day, Margaret Chen, the head of the i dont care if its in continues. They should recognize their own World Health Organization is working on this issue. Risk, and we should watch those they are the ones who can people. You had one guy come in convene a meeting on vaccines yesterday. And come up with the protocol. They got to what come his 18th day or something, came down with they are the ones who can it. Okay . Convene all the right people to so i think, and it may not be have the kinds of that many Health Care Workers but they are the most exposed conversations that need to be unless youre burying the people had about where to go. Like you just saw with a photo from him. It is interesting. They prod in the person the if youre burying people are in person who is running the response is probably the person the medical, you quarantined those people for the own risk. Has the most experience in doing things on the ground. Even if we pay for it to keep friend. An old this thing from spreading. Right now we are lucky. We dont know what infected the he has been running the polio nurses. We dont know, again, if there eradication response. That is a huge effort. Now that he is involved, there will be other cases. Is something you have not heard of the global outbreak alert you have to take steps in an and response network. Goarn. Emergency situation like this. She claims she doesnt have the authority to see what dhs have they have 300 people that were to keep us prepared. Somebody needs to see that we brought together around previous are prepared. Again this isnt panic. Epidemics, and they were critical in managing the sars spent last question. Epidemic. Bird flu. Now just about everybody from that network is in those i was involved with bird flu. Countries. So i think there are a lot of these people are coming by plane. Theres a lot of activity and when some plane comes in from africa or Prime Minister, passengers from there, what are organization. I do not feel like i need to, i we doing with it . The plane. Would need to, and i havent been asked to step in. With the plane itself speak with yes. Margaret and i are old friends. I hired her as part of a they might be screening. There may be vomit. There may be body fluid. Transition team in 2003 when i we dont know if those nurses was leading the transition for the new director general. I have known her for a decade. And i know these players so well guided from taking off equipment incorrectly or for touched their skin. You testified earlier that it has been really helpful for me to be in this position perspiration would do it spent being able to put resources in there are protocols i want to know the protocols various places in collaboration in place but ive seen the with the others. Equipment that we have answers for Disease Control actually i think that is not the issue right now. The issue is continuing the got, and we could bring up a risktum and at the heating device that heats the plane to 140 degrees to kill the repeating myself too often, germs and thats what we used in getting the people in place who can actually make it happen. We have got five minutes the bird flu. We doing anything like that to left. We go to mark and then the make sure those planes arent general lady from figaro. Little ebola transporters . The npr. You have talked about the you sound upset advance our im not upset. Importance of russian resources im happy. To the west african region. Will make sure you get the ushing resources to the protocols. Im not happy with, again can you tell me me you are west african region. Responsible for preparedness. We have our hands full trying to do that and get Health Systems at home in the u. S. Ready in if thats not your responsibility, isnt the new guy . Does have the ability to go in cases like new york, but is and make certain that we are there also a need to get going prepared . On the wider Public Health what you want to do is be system . Prepared to the boy scouts could this crop up in other marching song, be prepared. We spend millions of dollars, and Inspector General of the developing countries that are not ready and are resources United States has gone at our request and look at when agency being mobilized for that and how so . Is doing to be prepared and its great question. Let me answer the health a scathing report we are not question the Health Workers prepared. Question. It is thousands. So you go back to the other guy who didnt show up today, the more than that, it is thousands who rotate. Its really hard to do this kind new czar. We want to work with you. You. We wanted working people at of work for a year. So the nsf has rotations. Risk. Weve already been through this as i said with bird flu. Are those planes being properly we need literally thousands and sterilized . Thousands of Trained Health this can spread, okay . It hasnt spread. Morers who will need we arent at risk right now, then the protocols, you get to training around ebola to step up and volunteer. The committee and give to the we would love to see hospital record the gentlemans time has expired. Systems in the u. S. In volunteer the First Responders direction. I will put these pictures of the videos from new york disposing numbers. We would love to see countries all over europe. Of the clubs and the masked cuba has stepped up impressively. Wed like to see more countries without objection. Would be happy to get you do just that. The answer is yes, could another those protocols and protocol for cleaning the plane and a very much looking forward to working with you and other members of epidemic, top of this . Congress as we move forward with this. Thank you. Yes, absolutely. Could another epidemic crop up . Im not going spee space i havea plane to catch. All those answers are yes. Thank you, have a safe flight. I think this is a wakeup call. I hope it is. Ons is why im so focused about your 12th in four days. I do want to ask just one getting this global facility put together. Because if we go out and say you question then well go to mr. Cummings for his clothes. Of dollars billions there was a statement made to seeseems like an eternity ago bt into a fund, i think that is maybe 15 minutes ago about going to be a negative response. If we say that we need to set up following people for 21 days an instrument that youd only after they land. Have to pay back if it dr. Lurie, currently in there is disperses, and it would only no visa restriction or law that disperse in the face of a terrible emergency, that i think gives you specific authority. We have the beginnings of a discussion. I actually began the discussion at the g20. Do you believe you have the authority under existing public there has been a lot of health laws to force followup interest. So we are Going Forward. We are going to put something together. Now, but you also need basic Public Health. Infrastructures daily, temperature checks and the like . Lets assume for a moment we in place in every country in the world and its really not that take the gentleman from floridas analysis that a plane expensive. Its affordable and youll. Comes in, a person tests unless you said elevated temperature and dobable. For a moment, whether they test im is a conversation positive later or not. For othefor the other people one having with tom friedman at the centers for Disease Control all the time. Plane, do you have the authority we are having that conversation as we go, but for now, the focus then to compel them to be tested, or is it just hope for is has been on the immediate the best that they were recognized High Temperature and response. Is that important for ebola report . I believe that we have the or just for the future . Authorities at wendys but we ebola. Are constantly looking at in ebola is not an airborne updating our policies based on infectious disease. The situation at the time, and if it was, it would be an issue for ebola. But ebola, because it moves she would continue to look and make sure we have the authorities that we need. Relatively slowly, outside in addition to asking for those protocols which of our city went to give us, im going direct contact, we are focusing to direct committee to, in fact, on the countries in the region. Planes and go to ask questions of you and other europe and the United States, i think awareness is so high that areas and, of course, our new the systems are more prepared czar asked a specific now than before. Authorities that would support in the medium and long term, we have got to get on this task. [inaudible] regarding people. Theres been a lot of discussion little louder, please. About restrictions on peoples travel, and i agree quite frankly many of the people here i was wondering about how is that it sounds like a great [inaudible] idea, its a great sound bite but then when you actually try to figure out what stop somebody from leaving sierra leone going about the importance of having Health Workers on the ground. Whats the u. S. Military are to paris, spending a day there, then booking a flight here, the doing now . Is it balancing the lack of practical reality is it would be Health Workers . Thehow are you thinking circumvented to come over the question of a plane load of people coming in, and i came in today into washington, d. C. Your response in terms of the guy came in with a marine major. Rotation, when these Health Workers go back to the u. S. From news doctor a marine major who has a cold and to as many of the symptoms york. Is it imaginable that they would come and she did not go through a check. Theyre not doing temperatures are if he later reports, the wait in the country to make sure they do not have ebola before going back . In thet not imaginable whole question from a Public Health standpoint of are we prepared to locate and to way that youre going to organize their rotations . I think the rules now, and mandate surveillance on people the new rules coming up, are if so that after the fact we can youve been to this countries, actually do a containment is one depending on your level of risk, that im directing that went as cases of questions, and doctor, the cdc is going to ask you to take your temperature on your own four times a day and call in your organs it would be a part of it. Would you give me a moment to report what your temperature sent you talked about the guy with the cold to do a quick is. Educational sound bite . The reason that is so important this will be your closing in whatd its reflected statement, doctor. Anybody who has a fever or flulike symptoms during this happened in new york city is that the minute your temperature goesu up, you have season out to be asked to provide a travel history to look to report yourself and go into at whether theyve been out of the United States in the past 21 quarantine. If thats possible, if that days and whether they have been in one of the infected system is in place, that i think countries. I couldnt agree with you it is still possible for health more. If i get a fever, having been in workers to go and come back. Notfact that youre iraq, kuwait, saudi arabia, uae and, well, additional places infectious until you have symptoms is an advantage for us in this epidemic, which means meeting with people, many of that people should be able to come back and forth as long as whom have traveled to africa recently, i will be the first to we have a system in place that detects symptoms the minute they happen. Thats what the cdc and usaid rush to the hospital to report. With that we go to the gentleman from maryland. Has put into place now. Thank you very much mr. Chevy. First of all of what you think last question, scott . All our witnesses for being here [inaudible] today. I must tell you that i can i know this is something you have wrestled with in other context, and i wonder if you can understand the emotion of the American People. Talk more broadly about the challenge of trying to convince people that the first rule of medicine can make a difference when there is an issue of life outside the first world. Or has experienced rate is any and death, and when you have better at that . I think, my own experience in this is that we encountered an people who put their lives on the line to take care of the epidemic, an outbreak really of sick, not knowing whether they will become sick themselves, multidrugresistant work. Multidrugresistant thats serious business. When you have our military going tuberculosis. Large numberally across the sea to try to make a of cases in one community in a uatter settlement in lima, difference, as i always say, change trajectory of somebodys destiny, and the idea that they may come back with a disease peru. I have treated patients with that could possibly kill them, deadly diseases, and they could actually cough it on you. Thats serious business. What we knew is that the only way and it is the same story so, you know, as i listen to the only way to stop this thiseak of t. B. In you, mr. Lumpkin and you, major general, i have absolute the no community was to treat the people who were wick. Doubt that you will do everything in your power to one should treat them, they stopped becoming infectious. They knock out the infection in protect our military. I have no doubt about that. Their lungs, todays top transmitting it. And i think that if you find you have to treat them over 18 that as you go through the months. It is the only way to stop an procedures that you have in outbreak. So, when we said, we have got to place if you feel those treat it, everybody in the procedures need to be changed or Public Health community said it is impossible to treat. Either tweaked so as you might too collocated. Be more effective and efficient then we kept saying, what do you in that goal, you will do that, expect us to do . Turn your head. Is that correct . We knew this was going to become that is correct. An even bigger problem in other and you, doctor laura, i want to thank you for what you are areas, especially in africa. We fought for years to convince doing. And one of the things i just dr. Lurie. When i looked at all of the world for feminization dr. Lurie, and i saw all those World Health Organization and Health Workers, nurses i guess other Public Health bodies to it was, and then i see say ok we have to treat this in developing countries. What happens here was the sense ms. Burger sitting next to you, gee, these countries do not and then i hear about people not have any of these capacities. So, gosh, can we do this . Being properly trained in the instead of saying, this is hospital to i think would be almost legislative malpractice happening. What is the adequate response to this epidemic . Safe burials. For me to not ask the question, identify people right away. Enemy been asked before when i was out of the room, how we make provide treatment, so that you are not putting them into sure that those folks receive quarantine to die. I think it took time to get over the training. They are not just running around saying, you know, im just the sense that you could not do it in these countries. Complaining to be complaining. They want to be the best. They dont mind, they dont mind putting their lives in danger. There is no sense we cannot do it. Er but they want to know that Everything Possible to make sure that they are safe, they want to make sure those things are in place. And i am so glad that nurses i am has been found to be able to free now. But how do we make sure that they know that. And ms. Burger talked about an executive order in the nature was asking you about, dr. Lurie, whether you had all the things you need them to do what you need to do. I just got to ask you, when you listen to ms. Burger, and ms. Burger i watched you on television, i know your passion. No, im serious. I feel that. Its contagious. And it is strong, and i know you care about the people that you represent, no doubt about it. So how do we do that . I mean, dr. Lurie, help me. Sure. First let me say, ms. Burger and i and probably every nurse in america share the same goal, to keep them safe, to be sure that they are trained, to be sure that if there frontline providers that they have the education, the knowledge, the adequate training and exercises to stay safe. So i can tell you a little bit about what weve been doing. We have been reaching through the top. Weve got a very comprehensive now National Education Program Going on. We reach for the top for all the hospital to all the hospitals for the nursing associations. I was on the phone with 10,000 nurses the other night and they were more that wanted to get on the phones. We have said to them all, please, if youre a hospital, conduct a medical and a nursing grand round. To first patient training. To first patient drills and exercises. Make sure your nurses are trained and to frontline nurses have to practice putting on ppe to proficiency. Okay, have policies, plans and protocols in place and drill and exercises. We have said to the nurses and other Public Health professionals, here is the guidance. Please be sure that the check was in of the things are posted in your places of frontline care. Please ask your hospitals and your administrators to be sure that there are plans, practices and policies in place, and that you have the pte required to do your job. We sent to state and local Health Departments, we would like you to call every hospital in your jurisdiction, find out if they put those plans in place. Find out if those exercises are in place. Find out if the pte is in place and report back to us. And we will continue to to be reaching out with material, with training come with Education Opportunities until weve got this done. Ms. Burger, this is your moment. This is your moment. Dr. Lurie just talked about, i hope you dont mind, this is important. Dr. Lurie just talked about what they going to do, what they are doing. Those ladies that were behind you today, im income they want to know. Some of them have left now, but they want to know that theyre going to be protected. Now, you just heard what she said. Maybe you want to give her some advice as to what you all and im not trying to be smart. Im serious. This is a critical moment. Go ahead. And nurses that were here had legislative visits. They are fully engaged in this hearing and they appreciate the opportunity to be year. But, and what i would like to say is that until the cdc guidelines and training and education and personal protective gear at an optimal level are mandatory, no matter how good the guidelines are, no matter how good the intentions are, we need to ask congress to step up and do whats right for the United States of america and its citizens by making sure that frontline caregivers have mandatory optimal standards for protective gear, and training and education. So there is a gap, dr. Lurie, am i right . Basically what she just said, in other words, you may be saying all these things but then its a whole other thing for the hospital, hospitals to provide the things that you tell them they need to go and get. Am i right . I think ms. Burger and i share the same goal, and i share the same goal, as i said, with most nurses and nursing workstations around the country, and look forward to working with the moving forward so that we can be sure that nurses across this country to pu who put thems on the line of fire every single day with other frontline Health Care Providers are safe. As i close i just want to thank you, mr. Torbay, for your testimony. And i want to say, it goes back, we have to address the issues in america. No doubt about it. But we also to go back to the source. Weve got to do that. And i think, mr. Torbay, your testimony about some basic things that are needed, such as food vehicles, fuel, staff, supplies, resources, things that can be, that will allow us to try to stop this in africa so that it does the continue to come to our shores is so very, very important. And i just hope that, that the congress is listening to you. And i realize that we need more International Partners but i think thats what you just told us. People coming in and helping this, because this does not just affect africa or the United States. In fact, it affects the world. And so i dont know how we convince folks, that is, other countries, to do more, to get up to the 988 million figure, but we got to figure out a way to do that. Would you agree . And then i will close. Absolutely. I fully agree with you. I think the whole world needs to realize that were all in this fight together. And the resources need to be available until we get this virus under control. And at the same time id like to thank the committee for its leadership on this issue, as well as the u. S. Government and its agencies for taking the lead in responding to the ebola crisis. They have been doing tremendous job and we are very proud to be part of it. Thank you, mr. Chairman. Thank you. Want to thank all of our witnesses here today. In closing, im going to make a comparison and i think its an important comparison for the American People, put it in perspective. As was alluded to earlier i just came back from what has become a theater of operation in iraq where isis now, like an ugly, resilient virus or infection has shown up again. Islamic terrorism is murdering people far away. While i was there there was a murder in canada, and around the globe, small but significant events occur in which we realize that terrorism does not stay in the country that we think it begins in or is predominately an. In the war on terror, we rely on the department of defense and our u. S. Military as our primary way to eliminate those actors in faraway places like iraq, afghanistan and syria. Its only good if everyone takes it. The idea that we are going to find a shot in a continent of a billion People Living in mostly poverty means that even when we find it it may in fact be there for generations. And like smallpox, tuberculosis and others, they never seem to be completely gone. Our effort and the effort that all of you articulated a very well today has to be first of all in africa at the source. The World Health Organizations coming usaid and once again the United States military have and are taking up the fight against this threat of disease. Mr. Roth, your testimony and the testimony that we will have following best that the department of Homeland Security has an obligation, unique obligation one in which they were formed to deal with are things that threaten the home front, ebola and particularly of the movement of the movement of people that may be infected. Fullstop where lee within their jurisdiction and they seem to have not been prepared. So as we conclude here today it is my view that we will be doing both public and nonpublic investigation in the weeks and months to follow. Looking for transparency, and doctor lurie you said this very well transition to the American People. What we tell nurses and doctors and Healthcare Professionals we need to tell the public because unlike some things where the First Responder is in fact the greatest threat the First Responder with ebola is not the first to come into contact with the infected individual. Almost in every case there will be a cab driver or bus driver, family, friends and others who will already have had unprotected contact by the time he First Responder is aware that there may be a problem. By the time that persons who thought that he or she already will in fact be exposed. So as we begin looking at the protocols, i think we have to understand one thing. There is no perfect solution. There is no way that every american is good to place themselves in a hazmat suit from morning until night to deal with this disease we will have to go to its source and Work Together with our partners around the world to eradicate it in africa because ultimately like terrorism has been to the American People for more than a decade this disease will not be eradicated if we wait until it comes to our shore. So i think you and i believe this was a worthwhile hearing and i think mr. Cummings and the tremendous turnout of members that came back on the up their elections for this hearing and with that, we stand adjourned. [inaudible conversations] tonight at 10 00, this morning beginning at 11 00 a. M. Eastern on book tv, live coverage of the texas book festival and sunday, our coverage continues live starting at noon. On American History tv on cspan 3. Tonight it 00, on luscious and history, the modernization of his nieces and households in the 20th century. And sunday afternoon at 4 00 on a, Ronald Reagans 1964 speech. Find our schedule at cspan. Org, and let us know what you think about the programs youre watching. All us, email us or sent us tweet at cspan comments. Join the conversation. Like us on facebook, follow us on twitter. Here are just a few of the emails we have recently received from our viewers. Cspan provides the most valuable service to the American People by providing focus and coverage on the most important issues facing our nation. Our government needs constant watching and monitoring that is only available on cspan as other networks will not provide coverage. Book tv is also great for the serious reader. Your Video Library captures history as it is made. Best of all, there are no commercials interrupting the programs. Thanks to the cable providers. Christine sent this email. I wanted to say thank you for the West Virginia Senate Debate that aired last evening. I also like that you allow your viewers to air their opinions on edited. It is important to know what the American People are concerned about. And robert joan from massachusetts wrote. Im wondering if your emails get read. Im a regular follower of cspans washington journal. Boringfileclerk seems to get 20 of attention with her emails being broadcast all the time. Email us or you can send us a tweet. Join the cspan conversation. Like us on Facebook Follow us on twitter. Ungld Bank President jim j kim described International Efforts to fight ebola at the Christian Science monitor breakfast in washington, d. C. The world bank has pledged 400 million to address the problem. This is an hour. Our guest this morning is world Bank President dr. Jim yo ng kim. We are honored to host a number of his predecessor starting with Robert Mcnamara in 1971. We appreciate dr. Kim taking time to be with us today. He was born in south korea and moved to iowa with his family when he was five. He earned a bachelors degree from Brown University and a medical degree and a phd and at apology from harvard. Degrees,nishing his our guess cofounded the nonprofit partners in health which provides health care on four continents and was a leader in tackling hivaids in developing country. He joined the staff of the World Health Organization, becoming director of its hiv department. The same year he won the macarthur genius fellowship. He held overriding a professorships and chair department at a number of distinguished medical institutions, including Harvard Medical School and its school of Public Health. 012 he was the president of dartmouth college, a position he left when he was elected world Bank President in july 2012. Of on to the recitation ground rules. As always, we are on the record. Please, no live blogging while the purpose is underway to give us time to listen to what our guest says. There is no embargo when the session ends. To help you resist the selfie urge, we will email several pictures of the session to all reporters as soon as the preface and. As regular attendees know, if you would like to ask a question, please do the judicial thing and send me an nonthreatening signal. And i will happily call on one and all the time we have available. We will offer our guests to make some the opportunity to make opening comments. Then we moved to questions around the table. Thanks for having me. It is a great honor to be here. This price list has a long tradition. And we do know that starting with president mcnamara many president s have been here. I am open to talk about anything you might want to talk about, but probably something that is on the top of peoples minds is ebola epidemic that is going on right now. First of all, let me start by saying that i have been watching very carefully about what is going on in new york city. A couple of things are very striking. This is a system that was well prepared. We learned a lot from dallas. And looking at the response from both the governor, the public frieden, itials tom was very impressive. They did everything in just the way that you would want a government or system to respond. The other thing that i would like to stress, and we can talk more, as we all have to understand that dr. Spencer is a hero, that he is doing exactly what is needed to actually bring the academic to event the epidemic to an end. He is a hero in that he went and did the one thing that we need to do in order to stop more cases from coming not only hear everyone else. We need to have Health Workers, experienced Health Workers. He is a fellow in International Emergency medicine, which is good training for Something Like this. Thing that we now we know in these three countries is that we need Health Workers. Work beingemendous done, especially by the u. S. And the u. K. , on building facilities, but it is still not clear where the Health Workers are going to come from to the treatment, the isolation, the Infection Control that we need right now. The epidemic is still growing. It is really hard to get exact numbers on where we are in the three countries, but we know it is still growing. And i think any number that you might hear, most of them are about are oriented around thinking how big could it get . It does not make many sense for me to tell you it is going to get bigger. We do not know. If we do not improve our ground game quickly, lots is being done. I look back a month and a half, there is so much going on on the ground now that there was not before. But the biggest concern this is why dr. Spencers story is so the biggest concern is that we will build facilities and we will not have the workforce. With that, let me stop and hand it back to dave. Then we will talk about anything else you would like to talk about. Im going to do one or two. To me take you back something that you said at a reuters events. In terms of the Global Response to ebola, we are not close in terms of getting it right. Has that assessment changed . We are closer now than we were last week. So things are moving quickly. Facilities are getting built. Facilities are getting built. We are looking at every single option. I just spoke with Margaret Chen. She calls me whenever she needs to tell me anything. She called me to tell me a couple things. First, they had a very successful meeting on vaccines. Because there are several vexing candidates. Let me stress that there is no proven vaccine. Into thinkinglled a vaccine will solve the problem. We would need Health Workers to administer them. Was notone thing that clear is how a vaccine trial would be worked out. Just yesterday, they had a meeting with the u. S. U. K. Officials from the private sector and they worked that out. So things are moving day today. She just told me that one of the big issues how do you pay Health Workers . Theyre working on Electronic Payments for Health Workers. All this tells you that the speed and the momentum of the response is growing. But what she told me this morning and what still remains true is that we do not have enough Health Workers and we are not quite sure where theyre going to come from. My guess is youre going to get asked about the u. S. Aspect by other people, celeb me ask you something that may not come to mind, and that is what you see is the role of fear and the medias behavior in dealing with all of this. Oped in the washington post, the crisis were watching unfold derives less from the virus itself and more from deadly and misinformed biases that have led to a disastrously inadequate response to the outbreak. So what is your sense of how the media has behaved, what is your sense of the role of fear in dealing with this . The media has very tremendous has varied tremendously. Ive seen highquality reports that go into detail about how the virus is transmitted is transmitted. Then i have seen sensationalist media reports. Veryke this fear seriously. From the perspective of economics, what we have learned thehat 80 to 90 of Economic Impact of these outbreaks has to do with fear, what we call aversion behavior. Fear than it does with the virus. So the virus can have a limited impact, and then fear has a huge impact. That is what happened during the sars epidemic. One of the things that is really critical is to explain and be really accurate and specific about how these things evolve. That is what they did in new york. In watching at least part of the press conference, i thought that the very clear explanations both on the part of the Public Health people, but then having political leaders there clearly knowing what the facts are and then reassuring the population was very important. We will see what happens today in new york, but i thought that their handling of the information piece was extremely good. Finally for me, there is a study from the world bank on Economic Impacts. And several different cases. Billion, the high case 32 point 6 billion that assumes it is contained in southwest africa. Has yourour sense sense of the Economic Impact of this changed at all in the last week or two . It all depends on whether we can get the response in place. The perspective of the virus, the most important thing right now is to stop it where it is spreading quickly. Of there still parts three countries where it is spreading quickly. So there is really only one way to stop this from continuing to export cases all over the country all over the continent all over the world, and that is to read double and redouble our efforts on the ground. So the agencies that are supposed to be working on this the World Health Organization, the u. N. , funding organizations like ourselves, the United States government, the u. K. , france, and all the other governments they have stepped up their response. But unfortunately we were late, so instead of having a few dozen cases, the largest outbreak to date has been 425 cases. There are more health beenssionals who have infected than the number of cases of the largest epidemic previously. So were behind because it is moving so quickly. Is optimismere about what has happened, there is still a long way to go. If we do not solve the health effortsroblem, all the to date will simply not have the impact that we need to have. Mark . Anyou come to this with interesting expertise in your sitting in an interesting position now. What do you see as the world banks role . And do you find organization suited for the vision you have of how it might benefit the situation . E world bank is very involved in financing health. There is a good reason for that. Studysummers just did a innow 11 months ago january of 2014, Larry Summers published a study that shows that in low to middle Income Countries, fully 24 of the Economic Growth in low to middle Income Countries from 2000 to 2012 was due to improved health. The fact that Life Expectancy went up, Maternal Mortality went down, that infant mortality went down those interventions that led to longer life accounted for 1 4 of Economic Growth. We are involved in health because it is so important for growth. In this case, we have a Crisis Response window. And it is one of the only sources of readily available cash we can movve. Because the other traditional funders werent stepping up and because there was not a fund that immediately disperses when you have outbreaks like this, we had to become that organization. Here is what we are focusing on now. Thesee, weve developed very interesting instruments almost like insurance instruments. We call them catastrophic drawdown bonds
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