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 HealthEmergency 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