Thank you all. Today on cspan3, the Senate ForeignRelations Committee authorizes a measure to use military force against isis. Beginning at 10 00 a. M. Eastern time. Then at 2 00 eastern, former, current and future chairman of the Republican Study Committee talk about conservatives in the newly elected congress. Watch live coverage from the American Enterprise institute here on cspan3. The white house ebola coordinator around head of the National Institute of allergy and Infectious Diseases gave an update on the west africa update and funding for the u. S. Government response. They spoke at georgetown university. This is an hour. Thank you very much. Thank you all for being here this morning for a very important conversation regarding an urgent challenge that we face as a Global Community. Over the course of the last year weve been engaged here at georgetown in a very significant conversation regard region the future of the university. How in the face of a whole set of new disruptions that are really changing the ways in which Higher Education is understood and perhaps even delivered, weve been wrestling what does it mean for us, what is it we need to protect and embrace and what is it that we need to respond to in terms of some of the new challenges. As weve thought about our 225year history and our mission and purpose of the university, weve identified three interlocking elements. Three characteristics that serve as the underlying framework in which we do all of this work. Theyre inextricably linked, interlocking, mutually reinforcing elements. Were committed to the formation of our young people, to the inquiry, the scholarship and research of our faculty, and as a University Community, to contributing to the common good wherever and whenever we can. The issue were going to discuss this morning, the ebola crisis that has unfolded over the course of the last 12 months, is one that has engaged our University Community in each one of those dimensions. Weve sought to ensure that our young people have the opportunity to understand the implications, background, history, the ideology of the disease, and also to understand what kinds of responsibilities do we have in moments like this our faculty engaged in a wide variety of efforts in exploring and research and scholarship, the nature of this disease. Then of course as the University Community, we gather here in moments like this. We have throughout the fall trying to understand that ever deeper levels, the nature of our shared responsibilities to one another. We have know extraordinary opportunity to morning to be with two Exceptional People who more than any in our country are responding to this challenge, and it is a privilege for me to be in conversation with them. Im going to start off the conversation and go about a half hour with questions that i will ask, and then well bring a microphone to the center aisle and take another halfhour or so of questions from all of you. Lets get started. Tony, this is a disease weve known about since 1976. We have seen other iterations over the course of these last roughly 40 years. Nearly 25 different experiences that weve had dealing with this as a Global Community. Over 12 months, we have seen a particularly intense weve had a particularly intense experience. Can you give us a sense of the arc, the narrative that were engaged in now as it relates to ebola . Thank you, jack. Ebola is fundamentally a disease in animals that its called a zooanatic disease. It fundamentally is in animals, then jumps to humans and spreads by very well defined ways. In 1976 and it likely existed long before 1976, it was first recognized almost simultaneously in zaire and in the former zaire, currently the democratic republic of the congo, and. Sudan, in which there was an outbreak that was controlled by the way we are still controlling it, namely identification, isolation, Contact Tracing and keeping sick people away from other individuals or if you are doing it in a way where you are protected. Every one of the epidemic, all 24 of them up until now, ranging in size from two people to the second largest in uganda in 2000 which had about 400 people. They were all able to be put down in the sense of controlled. The arc that jack is talking about is something that is unprecedented because of what i refer to when i talk about this as the perfect storm. The perfect storm is, you have a disease thats an emerging infection, that characteristically jumps to humans, that has been able to be controlled because prior outbreaks were fundamentally geographically restricted in areas that the bad news is that it was remote and it was tough to get people there, but the good news is that it was remote because it was easy to isolate. The perfect storm of the current arc is that you have now an outbreak in an area of africa, west africa, that has not historically seen ebola in a highly populated area with porous borders where even though the artificial borders that years ago were made, that people have relationships across borders so theyre constantly going from one country to another. When you look at the map of west africa, guinea wraps itself around sierra leone and liberia. And also you have the issue that weve never seen before, is in big cities. We now have an outbreak that percolated a bit in the early part of the spring and then started to explode to the point where we now have an extraordinary situation. 17,800 cases. 6,700 deaths, likely a bit of an understatement with waves of epidemic. It looked like liberia was the worst a month ago, got some better control of that now. Even though dont claim victory because there may be outbreaks in the rural areas. Now we have sierra leone, which there are more cases now in sierra leone last week than there had been in liberia ever. The issue of the arc now is doing this in sierra leone, this in liberia. Guinea is kind of like this. Thats the way ebola works. It comes in waves. Even though we are making progress, we are still in a very critical, serious situation. The thing about ebola just finally is that unlike other diseases, when the trajectory goes down, almost by itself it will disappear. Ebola, if theres one case thats out there, one case can ignite another explosion. Its one of the unusual diseases that you have to put every ember and every spark out. We are far from that right now. Thank you. Ron, tony has spent his entire career engaged in addressing Infectious Diseases. In november you were minding your own business when the president called you but he said we need you to help us develop our national response. What was it like in those early days . How did you come to terms with the challenges that you faced in this new role . Tell us about the learning curve and how you were able to close. Close some of that curve. What have been your experiences in roughly six weeks on the job . So when the president asked me to come do this, i was minding my own business and teaching a course here in georgetown. I see several of my students in the front row. It is good to see them again. I think that the president asked me to do this based on my experience coordinating other complex interagency projects weve had in the federal government. Most recently when we did the recovery act, nearly a trillion ondollars of spending in the first two years of the admission. He said to try to coordinate. We have every single federal Agency Working on some element of fighting ebola here at home or overseas. For me, i have been able to climb the learning curve thanks to great experts like tony fauci and others at the cdc, Sylvia Burwell at hhs. My major objective in the job is just to make sure that all of our agencies are working together, that were identifying problems, reallocating resources that need it, getting decisions quickly to the president for him to make about our response and making difficult policy choices that need to be made. The thing that has been not just surprising to me but humbling to me every day is the vast array of people who are acting selflessly to fight this disease every single day. We are sitting here in one of my favorite spots on planet earth and while we sit here, there are hundreds of volunteer Health Care Workers in Ebola Treatment Centers in sierra leone, Government Employees who have taken voluntary leave, reassignment to go fight this disease right on the front lines, putting themselves at risk doing the most important work that can be done to battle this epidemic and the chance to meet with those folks, talk with those folks and do whatever i can to facilitate their work is the most humbling part of the job and the most important part of the job. Maybe you can take us deeper into the perfect storm. Why west africa. Why are things appearing to stabilize right now in liberia but look like theyre on the increase in guinea and sierra leone. What is it that we can understand about the nature of this that explains some of the phenomenon . What this brings out and i hope if there is something good that comes out of this is a realization of how when you do not have a minimal modicum of a health care infrastructure, how vulnerable you are to so many things. N and then when something as cataclysmic as a highly lethal disease inserts itself into the community do you realize how that lack of infrastructure and ability to do just minimum health care type delivery can be so destructive to a society. What i hope comes out of this is a realization by the countries themselves and the world that wealthy countries and the organizations to realize how we can build sustainable infrastructure. You heard ron and i and tom frieden and Sylvia Burwell and others say not in a cavalier way that it is highly unlikely you dont say impossible, because you never say that in biology highly unlikely that we would have an Ebola Outbreak of any significance in the United States. The reason is because we have a Health Care System that wont allow that to happen. So one of the things that is so important for the world to realize, that we will end this outbreak in west africa in collaboration with our west african partners. But this would be a terrible thing if we let the opportunity go by without saying we need to then leave an infrastructure there, or the beginning of a direction to an infrastructure, to not only prevent ebola, but what about malaria . What about tuberculosis . There are things there that can i wouldnt say easily, but that can be addressed just with a modest turning of the knob. It is amazing how many people who we are following that we want to make sure they dont have ebola that have malaria. It really hits you right between the eyes that malaria is taken so for granted, and yet it kills close to 700,000 people each year, almost all of which are african babies. So this has got to be a shakethecage moment for us to realize that. If you just add two things to that. Building on what tony said, one of the other tragedies of the ebola tragedy is the level of immunization has plummeted it to near zero. I had the honor and sad duty of speaking at the funeral of dr. Martin salia last week who was a missionary physician in sierra leone who was not treating ebola patients but died from ebola because the level of the infection in the Health Care System is just so high. So when we count the number of deaths from ebola in these countries, we need to count the other kinds of human loss in these countries from the rise of other Health Care Problems. Thats one point. The other thing is im sure we will talk about this more, but the president smithed a emergency fundsing request to the congress which were very grateful for both democrats and republicans for their response but part of that request is an investment in a Global Health security agenda to build the capacity to detect outbreaks like this earlier in other countries and to get on top of them a bit earlier so we dont see the kind of escalation hopefully that we saw in these three nations. This is building on that point. The first death i believe was a year ago tomorrow. As we were describing through the course of the spring and the summer, the numbers really began to climb. What have we learned about the our capacitieses for Global Governance on issues like this . Because it did take some time for us as a Global Community to respond effectively. Well, ron just mentioned the Global Health security agenda. If we had a functional Global Health security agenda to be able to recognize those first cases in guinea in december of 2013, i would say with some degree of confidence that we would not be where we are right now. We would have been able to do the kind of identification, isolation and Contact Tracing that could have actually put that out. Let me ask you, what are the tool it is we have available to us for constructing a Global PublicHealth Security agenda . What kind of resources, what kind of institutional structures . Where do we go to put this in place . I think clearly we have to work with the 9uw. H. 06o. And International Organizations that are an important structure for all of this. But i think that in this case, america has to lead, and it has led. I think its led for three reasons. This is a Health Problem for the United States too. As long as people are getting ebola in west africa, we are from time to time going to have people get ebola in the United States. Not an outbreak or epidemic, but occasional works. Well have Health Care Workers come back to the United States infected so this is a Health Care Problem for us. Secondly, its a geopolitical and National Security challenge for the United States to see this kind of devastation and loss in west africa, thats something we have to respond to. Its a humanitarian crisis to see this kind of loss and devastation. Were seeing great response from the united kingdom, france, even nontraditional partners. China i think has mobilized its Largest Global let response in response to this crew sis. We have doctors from cuba working in sierra leone right now. It has been a global response, but i think our leadership has been critical and i think it is something the American People can take a great deal of pride in. If there were other elements in the current structure for addressing a challenge like this from a global perspective, are they needed, or are there existing elements in the structure that just need to be used more effectively or efficiently . Well, we need to expand what we have. You cannot underestimate what it it means to have a country be able to do it themselves ultimately. The classic example of that and it was really almost the foundation for so many other things, including what we developed pepfar. There are many people who do this well. But what they did in heat with being rwanda, you dont just go in, help people and get out, but you go in, you train people and you make a situation there where they will stay, they will teach others and it will become a selfsustaining issue where you do it, you train someone, they do it, they train someone. We had that experience in a very positive way 30 years ago when i first became director. We set up a unit of exchange back and forth in mali. We had trained people who were Global Health students who came from mali to the nih, and then we went there. That turned out to be an interesting model because it started is off focusing just on malaria. Now the people who were trained there and who trained people who trained people, and on and on, that in that area, they have an infrastructure there that made it very easy when the case went to mali to all of a sudden Contact Trace 300, 400 people. They never would have been able to do that if they didnt have that. We need to continue to make it sustainable in the countries that are involved. There is a bit of a mismatch, 17,000 cases in west africa and 11 in the u. S. Yet the Public Discourse than unfolded here in the u. S. In the days shortly before your appointment, what have we learned about how difficult it is to communicate, to engage in public communication about risks like this . I think, jack, its understandable when people hear about something thats new and dangerous that weve never experienced in our country before, to react with trepidation about that. I think the best thing we can do in the face of that anxiety is to respond promptly with an aggressive response. But a response based on science, on medicine, on the best possible learning that we have about this. And so i think our country was very, very lucky to have someone like tony fauci who has great experience. This is a person who won our nations highest civil honor six years ago and is still fighting this fight every day. And to have his leadership and expertise and wisdom and voice i think has been a critical part of that. I also think we simply had to people had to experience our success in managing this disease to have confidence that we can successfully manage this disease. The fact that all eight of the patients with ebola who have been promptly diagnosed in our country have been treated, all treated succes