Good afternoon, everyone. And thank you for having me here today. Id like to thank the u. S. Global Leadership Coalition for welcoming me and for convening this important gathering about how the United States can and does lead in healthcare around the world. This is not necessarily the kind of stage i expected to be on when i was a young washington lawyer two decades ago. Before my first job at hhs. Many of you may never have expected to need to attend gatherings like this one in your professional roles either, but were united here by the shared recognition that American Leadership on the world stage is indispensable to american prosperity and peace at home. When i was first asked to serve at hhs in 2001, as general counsel, i didnt imagine that National Security and Foreign Policy would become a significant focus of my work at the federal governments largest domestic department. But i was confirmed in august of 2001. One month before 9 11, when everything changed. The day of 9 11, i quite literally experienced how much hhs needed to start thinking of ourselves as an integral part of the National Security establishment. On 9 11, hhs had no Central Command center to keep us linked up across the government, to track the Public Health threats that could arise from a terrorist attack or other significant event, natural or man made. Our main phone system had gone down, so our only way to communicate with other agencies was actually on our personal cell phones. Im sure a few people in this room had that same experience here in d. C. Or in new york and experienced the same kind of realization about the need for better preparedness. Hhss role in National Security and Foreign Affairs became more prominent when we suffered the anthrax attacks shortly after 9 11. Our first real bioterrorism attack on this country. We had to come up with countermeasures, and we had to procure and develop the anthrax vaccine. Anthrax was far from the last infectious threat we had to handle in my first tour of duty at hhs. There was pandemic flu, sars and many more. All of this was a reminder that Infectious Disease threats are not just a health issue, but a National Security and Foreign Policy issue. Sometimes the threats we faced were so foreign as to be almost comical. I remember waking up and seeing the New York Times one morning was talking about monkey pox getting into the United States. Well, how was it getting here . Through collectors importing giant rats, and how was it spreading . It was spreading by prairie dogs and people who collect prairie dogs. So we immediately banned the importation and interstate sale of giant rats and prairie dogs. Just so you know, there is and remains a very active prairie dog lobby in the United States. I had no idea those little animals could generate so much hate mail. In any case, hate mail can be a fact of life in public service. But once youre dealing with hate mail involving this, you have definitely entered the realm of Foreign Policy. So i knew when i returned to hhs last year that my position would demand thinking about how to keep america and the world safe from all kinds of health threats, especially Infectious Diseases. During president obamas administration, the 2014 Ebola Outbreak in west africa, the deadliest Ebola Outbreak in history was a serious wakeup call about our global preparedness. Thanks to groundwork and huge levels of support from generous americans and other part ners, eventually that outbreak was brought under control. In its aftermath, we recognized that the International Structure that we had for responding to these outbreaks including the World Health Organization needed reforms. And needed to place its primary focus on infectious threats that can cross borders. We also needed further investments in all countries ability to respond to these threats on their own, and we needed better biomedical tools to respond to ebola in particular. Thankfully trials were launched at the invitation of local governments and Health Ministers as the outbreak was still raging in west africa. By the time of the next major outbreak which lasted several months last summer, in the northwestern democratic republic of the congo, these efforts had already begun to bear fruit. Thanks to the work of hhs components including the president s Emergency Action plan for aids relief, the drc government had the ability with some International Help to bring that outbreak under control. There are 150 disease detectives in the drc for instance who have now been trained by the cdc to detect and identify outbreaks, but now weve been reminded how far we still have to go, by the Ebola Outbreak that is raging in the eastern part of the same country. We have a perfect storm of factors in the eastern drc. The outbreak is not far from the borders with burundi, rwanda, uganda, and south sudan. Even more worringly the outbreak is occurring in one of the worlds most unstable conflict zones. Theres almost no place on earth where it could be more challenging to respond to an Infectious Disease outbreak than the eastern drc. More than 2,000 ebola cases have been reported. More than 1400 congolese have died and the outbreak shows no sign of slowing. As many of you have recently heard, last week we had our first confirmed cases and the first confirmed deaths outside of the drc. The first victim to die outside of the drc was a 5yearold boy of uganda who had crossed the border to attend the funeral of his grand father who died of ebola. His grandmother also died of ebola. Because of the sheer scale of population movements between the drc and its maybes we knew the first its neighbors we knew the first cross border case was certainly a matter of time. But uganda deserves credit for containing this particular situation and working incredibly hard with this outbreak to work with cdc experts and others to monit monitor crossings. I was encouraged that my fellow Health Ministers and whos leadership recognized the threats we face and understood very well that this outbreak is not under control. I was extremely pleased that the whos director general was highly engaged on this issue, understood the need for even more comprehensive response and had begun to lay the groundwork for future action. Im immensely grateful for his leadership at who, where he has their work on the infectious threats and closely tracked this outbreak. I will highlight on a couple key challenges we still face and some of the efforts we have undertaken with who, the drc and partner nations to tackle them. One troubling issue is the security situation, which requires careful decisions about how to provide security for whos Health Workers without impeding their work or disturbing the local communities they have got to reach and build confidence in. Another is the importance of sound Financial Management because donors are most supportive when they can be confident that their dollars are being used wisely and we have been pleased to see that the who understands this as well. Were also encouraged that the who has recognized the need for better relations with the communities in the eastern drc who are sometimes skeptical of a massive surge in International Aid to combat on outbreak when they have already suffered so much from conflict and the lack of Economic Opportunity and stability. Responding to the outbreak should mean lasting, useful investments in the drcs ability to keep its people healthy and we look forward to working with the who on that goal. Addressing these challenges will allow better use of the response tools that we have already developed and deployed. As of june 1, more than 129,000 people have received an investigational vaccine a product we didnt have when the 2014 outbreaks began. Late last year the drc government, the u. S. National institutes of health, the who, and other International Partners began a new Clinical Trial in the drc for new investigational ebola treatments, bringing the total number of investigational treatments we have to four. Think about that. Just a few years ago a few years after Ebola Research really ramped up, there were hundreds of congolese patients able to receive investigational treatment in a Clinical Trial run by scientists from the drc, america and elsewhere in one of the most challenges places to work one of the most challenging places to work on earth. That along with so much else response to this outbreak. All need to do more to bring this epidemic to an end including more support for vaccines. We were pleased at a recent meeting in geneva, germany announced a new commitment for the purchase of vaccines but we may all need to step up further. As the outbreak continues there may be an urgent need to buy significantly more vaccine doses. It is important to remember for all of our efforts this will not be the last Ebola Outbreak so investing in vaccines today will either help defeat the outbreak or be vital to beginning the response to the next one. The United States has so far provided approximately half of the governmental and nongovernmental funding to confront this outbreak. And were committed to seeing this battle through to the end. The Ebola Outbreak is one of our top Global Health priorities, and it will remain so until its been stopped. But even once its been halted, we will continue our work to help places like the drc build even better capacities to respond to these challenges on their own and stop outbreaks before they have a chance to steal so many innocent lives. Ebola is far from the only Global Health threat on our radar today. I have also spent a significant amount in the last year or so engaged on a Public Health crisis in our own hemisphere caused by the illegitimate maduro regimes destruction of venezuelas Healthcare System. The countrys economic collapse has sent venezuelans fleeing to neighboring countries often with Infectious Diseases that could not be prevented or managed by the countrys failed Healthcare System. Diseases like measles are seeing resurgence because venezuelans havent been able to Access Healthcare service as basic as vaccines. The Trump Administration has taken a leading role in this challenge providing more than 200 Million Dollars in aid to neighboring nations which are hosting huge numbers of venezuelan refugees and preparing to help rebuild venezue venezuelas Healthcare System when the time comes. I hosted a meeting of healthcare meetings last fall and helped support a meeting led by the peruvian government at the beginning of may. In august we will attend the next Regional Health meeting on this topic hosted by columbia. Until venezuelas legitimate government is able to begin rebuilding the country, i expect to continue this work with our regional partners, supporting venezuelans and the countries around the region in meeting these health needs. As i mentioned at the beginning, when my career led me into the healthcare industry, i didnt expect that it would lead to so much exposure to the vital role america plays on the world stage. But it is a little surprising that on Public Health and Global Health, america is an indispensable leader. Our institutions at hhs like the cdc, nih and fda have been a model for every nation that seeks to stop Infectious Disease and improve their Public Health. Our scientists and universities have laid the groundwork for so many of the tools that all nations need to prevent and cure disease. We built these resources in part to keep our own country safe and healthy, but generously sharing those tools and offering our expertise to every nation in need will help keep us safe and healthy too as we see today from south america to central africa, america will always be willing to lend a hand, lead where necessary, to help every nation work toward a healthier future for their people and for the world. Thank you for your role in making network possible and thank you so much for having me with you here today. [applause] thank you, secretary. That was a very thoughtful and your remarks about the Global Health security, your work already and welcome to all those that are here today. I have the opportunity to raise a few questions and to dig a little bit deeper. Gathered here before you are hundreds of our state leaders as we were talking about earlier. These are business leaders, faith leaders, nonprofit leaders that really care deeply about what you just talked about, about americas leadership in the world, particularly on Global Health, on development, on diplomacy and they are really grateful for your leadership. Thank you. Lets dig a little bit deeper into some of the issues you raised. Theres been a lot of progress but you touched on some pretty tough issues. I want to pick up on ebola, an area you have been working hard on. One of the most difficult parts about this is the comment that you made around the security situation. It is creating a situation where the medical personnel you said to me earlier, weve had lunch recently where you talked about you cant send the cdc workers in there because of the security situation. We literally have had medical personnel forced to withdraw from the region. Or killed. Or killed. So secretary, can you comment on two things . One is, what can the u. S. Do to try to address this situation when your medical personnel cant get there . And second, how do we help countries that are having such difficulty advance their weak Health Systems because ultimately thats how we not only deal with it from the humanitarian point of view but also from preventing diseases from come eight cross the borders from coming across the borders. We have the u. N. Peacekeeping forces. The United States is the biggest contributor for the peacekeeping efforts in the democratic public of the congo. We support that, but it is a challenge because your healthcare workers dealing with ebola, theres a certain image that comes with coming in as part of a package of armored land rovers and security teams and everything else, and that can be off putting to a local community. You know, youre trying to build trust in an area that is effectively in a civil war, has 174 different rebel groups. The National Government does not exercise complete territorial control in that area. So trust is a scarce, scarce commodity there. You need people to believe that those coming in to help them are there to help them and actually not coming to spread ebola. There are literally people who believe the vaccine spreads ebola or is part of a conspiracy. Obviously its hard for the people in this room to imagine that, but people who have been living in a war zone with that kind of conflict for so long, you can see that. So thats why its so important for the u. S. And the World Health Organization and our other major partners to work on really Building Trust through Community Engagement there, working with village elders, working with community leaders, religious leaders, to convince them of the authenticity of the response and the genuine International Concern for them. It also means taking people where they are at it means if somebody has ebola, obviously you get them into a treatment unit that we have there, but it also means if they have malaria, you treat them for malaria. It cant be ebola inc. , as they say. Yes. A tremendous amount of work. The u. S. Has done a great thing through the Global Health security agenda. I talked about the last outbreak which was in the spring to early summer of 2018. Well, that was in the western drc. And the democratic republic of the congo themselves identified the outbreak. They did the diagnosis. They reported it in. They ran the front line response. Thats actually historic change. That is a Historic Development to have a country like the drc with all that its been through have that level of Public Health infrastructure and education, and thats thanks to the United States, where that was. Were going to keep doing that. While i cant send people from the cdc directly into some of the most immediate areas, we can do a lot of training. We can do support of drc. We can help with the World Health Organization. We are fully engaged right up to the limit of putting our people in harms way beyond whats appropriate. Thank you for what you are doing. Let me pick up on something else. A year ago on this stage, we talked about it. I led a conversation with a group of people who are all involved in the original creation of it. I asked them whats the secret . How does something endure over multiple administrations, democrats, republicans, both ends of pennsylvania avenue, and there were a couple things they said. They talked about the fact that they had rigorous monitoring evaluation. Countries were invested in it. Private sector was engaged in it. And one of the things i want to ask you about and some of it you just started to talk about is that theres a big youth in a lot of parts of the developing world. One of the concerns thats been talked about is if we take our foot off the gas pedal and we dont focus on the youth and make sure they are involved, we could lose some of the gains we have made. A program thats saved 17 million lives. How is hhs working with the other agencies in the government to make sure that were still addressing this just as you started talking about it . You have met the ambassador, you know nobodys foot is off the gas pedal. Thats for sure. The administration has a deep commitment. That doesnt mean though it will always be run the same way as in the past. I think the ambassador has stated quite clearly its very important for us to bring countries up to levels of selfsufficiency so that we can redeploy our assets, our scarce assets to those areas or those populations most in need. Part of it is about that quest of independence and selfsufficiency by different governments, that it is not a permanent kind of running of the system. I think that where hhs comes to play, obviously were very tightly aligned around it with the state department and usaid, but also the Global Health security agenda which is almost an outgrowth i think of the mentality, helped to build up the compliance capabilities of developing countries for the International Health regulations which came about after the sars catastrophe globally, and we saw just how weak some of the Public Health connectivity was around the world and local domestic infrastructure, so we support that, again, like in the democratic republic of the congo, thats really the backbone of it. One last question for you, you mentioned that the last time you were at hhs, it was 9 11, you were there at you talked about anthrax. Take us back to that time. And take us back to your personal reflections and how that impacted your view of why this Global Health security agenda is so important. Again, the first time that we met, you gave some personal commentary about how that impacted you. Very dark days for all of the u. S. , but had to be particularly for somebody who was in hhs, feeling the weight of the country, the weight of the world. Can you share some of those experiences with us . Sure. I think its good to have somebody who lived through those fairly dark days in this role because it causes one while i do sleep at night, i dont sleep well because i know all the things to worry about. I remember on 9 11 worrying about a potential smallpox. Could we face a smallpox attack . You didnt know what was coming. We didnt it was the fog of war. We didnt know what was coming at us. And just the notion of collecting up all the existing supplies of smallpox dry vax in the United States in case we needed to vaccinate people. That notion of countermeasures, the anthrax attacks and needed to procure massive amounts for that. Thinking about if we faced a broader attack of anthrax. The countermeasures is my worry of thought constantly. Thanks to the work of the Previous Administration with the ebola crisis in west africa and the Public Private partnership, we have two vaccines. We have four investigational treatments in Clinical Trial in the eastern drc right now. That is a Public Private partnership. We couldnt invent vaccines on our own or bring them through development or investigational treatments. We played a Critical Role through nih and others and the private sector to make that happen but that shows the Public Private value of all of this. We face an era of such connectivity of people, its cliche or trite, but the simple fact is somebody in the eastern drc can get on an airplane and be in the United States the next day. Okay . So we have Ebola Treatment Centers here in the United States. In fact, i was just meeting with the leadership of one of them today. We are very well prepared. We have vaccine here in the United States. I think the American People should feel very confident in the preparedness of their government and of their Public Health infrastructure here. That doesnt mean that we should not be very focused on the situation there in the eastern drc. But weve worked very closely in more stable areas, for instance, with uganda work the fantastic minister of health, the minister in uganda who they have done they have only had the three cases initially so far, but they have done a wonderful job of being prepared for it and handling the Immediate Response to it. So while its good for me to worry about the threats, i think having people like me and the rest of our team worrying about it can let the rest of the American People not have to worry about it. Because you dont sleep at night, what does keep you up at night when you think about the future . You have been in the business community. You have been in government. What gives you hope about the future, under the rubric of the Global Health security agenda . So people often ask whats the number one threat that you worry about . And they think it is going to be some deep dark classified thing there are cameras. Go into a secret room to talk about. I tell them, i say the same thing every time, flu. Flu is what i think almost every Public Health official in my department worry the most about. Its so changeable. Its so spreadable. We lost 80,000 americans just last year from the annual flu. I mean, imagine pandemic. Now, we are so much more advanced than we were when we started down on the pandemic flu preparedness efforts under secretary thompson and levin in the bush administration. We have capacity to manufacture vaccine. We have cell based. We have technologies. We have Public Health preparedness infrastructure for pandemic flu. That being said, a rapidly modifying pandemic flu highly virulent is still going to be a massive Public Health challenge for us. Whats your hope . What gives you the hope is how much were advancing. I mean, just in the 12, 13 years of that effort, its been a remarkable level of change. Just our countermeasures program, we now have a smallpox treatment. We have licensed the first ever smallpox treatment. So you need to know that at hhs, we have an entire massive enterprise dedicated to the discovery and the development of countermeasures against the threats that we face. 42 fda approved products already sibs we launched that since we launched that just in the second bush administration. So we are harnessing technology. We are harnessing Public Private structures, financial structures and development structures to keen you safe. Keep you safe. Ladies and gentlemen, please join me in thanking secretary azar for keeping us safe. [applause]
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