Test. Captioning performed by vitac other questions . Yes, sir. My name is zumerisan, the executive director of Public Health for harris county. I just flew in from houston so i missed almost the entire day. Anything i say, if its completely off, i completely apologize. Just wanted to say that up front. I actually have a question for you. Im also associated with the National Association of county and city house authorities which represents close to 3,000 local Health Departments across the u. S. And we are very much interested in really this really Global Learning that really impacts domestic local Public Health, domestic Public Health practice here in the u. S. As were going through this process were learning that a lot of organizations that were getting to are very much very interested in the Global Health space, so they are doing Global Health work, but not interested in Domestic Health, or theyre doing Domestic Health work and not interested in the Global Health aspects. So as we talk about pandemics it seems this is that gulf between as the three of you have been speaking about between Global Health, Domestic Health and how they come together. Do you have ideas about how to really bridge that gap in terms of models at practice and practice at that local level, not at that national or federal level, but really at that local level where we can really share across the system that would help us for pandemics and beyond . Thank you. Let me just tell you something that started in the early 1980s, its still going on, its a school run by the office of foreign Disaster Assistance called ofdanaid to train First Responders in latin america. Its a train the Trainer Program and its been going on for, what, almost 40 years now and it has dramatically reduced the need for the United States to do Emergency Response in latin america. There are a couple exceptions, without mentioning countries, there are a couple countries that are so dysfunctional that you need Emergency Response from the outside. Most latin american countries dont need the help anymore and i tribute it to this very quiet program, almost unknown outside of ofda to run and fund this center. Its all done at the local level. Theres people who participate at the National Health ministries and the police and all that, but its mostly at the Community Level and it was a 40year effort to do it. I dont know why we cant do the same thing in africa. You set up the school in africa, you dont have it in the west, and you fund it over a very long period of time and you do a train the trainer approach. So weve done one thing, now, they dont train for pandemics, they do it for first on set natural disasters like earthquakes and storms and all that, but there is no reason it couldnt be expanded to this larger community. I went down there and saw it 30 years ago when i took over the directorship of that office under bush 41. So there are models. Let me just if i could just very quickly say andy introduced me as the ebola czar. Can i tell you theres nothing as unczarlike as being in charge of a response that involves the u. S. Healthcare system. You know, when we had one case of ebola in texas where we had under the texas system most of the key decisions were being made by a state court judge, clay jenkins, a great man, but he was the commissioner essentially that oversaw the county in a county that was in a state with governor perry as the governor and a state Public Health director and county Public Health director and, you know, very, very unczarry in washington is how this worked. So one thing that i took out of that was one great way for local and i think the plurality, the pluralism in our Healthcare System in the u. S. Is a great strength and a great weakness. Its a great weakness in that there isnt that kind of command control that you really love to have in a crisis. During the Ebola Response every week i did a call with my counterpart in the uk and every week we bench marked who was bending more healthcare workers to west africa to respond and i would report on the 52 calls i had done to 52 different Healthcare Systems begging them to send people and he would tell me that he called the National Health service and they were sending 60 more people and it had taken five minutes. I got envious of a unitary health system. Until at christmastime one of those nurses came home with ebola and the union decided not to send other people and we were sending other people in the u. S. I think one thing i took away from the Ebola Response was that it would be great if people on the local level organized exercises where you put everyone in the room, the local Public Health people, the local providers, the private providers, the public providers, the First Responders, the community leaders, the political leaders, the state political leaders and you saw what would happen in the event of one of these of some kind of incident like this in your community. Nothing is going to make the people this that room more connected to Global Health than going through that exercise, understanding that by the time it gets to houston its too late. The kind of problems youre going to have are too late. At the end of every one of those sessions everyone says we need to get on a plane, go to washington, get engaged in Global Health. If we kind of got i think its one of those things, you know, think local, act globally in the sense that when you see how hard this is to manage, city by city in the u. S. , county by county, town by town you realize how we need to take all these different players and plug them into some kind of Global Health awareness. One of the concepts we use is what we call one health and by that we talk about the interrelatedness of health of wild animals and Domestic Animals and domestic crops and the Global Health community and the Domestic Health community because, again, as the world shrinks and as its increasingly interconnected the ability of pathogens to travel across all of those boundaries is greater than ever. I think all Health Planners and administrators, managers, have to think that way. Its a lot of thinking to do and its hard to get out of why you are local responsibilities, i understand that, but a number of us have to be thinking that way about all of that and all of those interconnections. Another question here. Thank you. Im with the miter corporation, i had the privilege of working for dr. Parker for nine years. Im going to ask you to envision a world where we have these trusted relationships and Effective Communications and a Healthcare System that works for us and i want to focus on the am he had cal counterpressure component piece and ensuring that we have that asset we are going to need to save lives. I will ask the question if we could view the suppliers of that asset as a critical element of our Industrial Base, the way we think about the Defense Industrial base and all the components that make the jet fighters and the aircraft carriers, it doesnt seem like we view it that way. Its a series of transactions, we have a threat, we have a requirement, we enter into a transaction, but we dont have Industrial Base policy, we dont have Industrial Base assessment, we dont look at the fragile nature of some of these companies and supply chains. So i would ask you sort of your sort of perspectives on that lens on the medical countermeasure enterprise and also this idea, mr. Klain, you just remarked on. Exercising. Can you imagine exercising making a vaccine, actually making having a system where that Industrial Base in the bio pharmaceutical sector is tested and evaluated on a regular basis so that if we establish that capability even if that event doesnt emerge into the next outbreak, major outbreak or pandemic, that weve tested and evaluated that capability. Thank you. By the way, we have we did a simulation at our conference in october of last year by students ph. D. Students, master students across the texas a m and they wrote a paper up thats in your folder in addition to the white paper, frankly its as good as the white paper s its very well done by our students who went through this simulation and recorded after they did it more research on what their conclusions were. I actually think simulations are very valuable. Just one little story, i went on a simulation, this is about ten years ago, in north korea and there was an admiral who was a friend of mine, retired admiral and i said how many of these have you been through . He said 22. I said, how do they all end . He said everyone of them ended in nuclear war. I said, really . He said, do you know why were in south korea . Its because of these simulations. They are so scary that the policymakers who see the results of the simulation prevent the two countries from going back to war again because of what its going to mean. Its going to escalate. It escalated in the one i participated in, there was a nuclear war. I mean, no at real one, but obviously in the simulation. So i have to say one thing we could do that is not politically impossible is to do what dod does all the time, is to do simulations of wartime training exercises. I think ai d c dc ought to manage t frankly, because they both have roles in this and do it on a regular basis with the community, but also in the developing world and in the u. N. System on a regular annualized basis with a regular budget and get the reporting out to policymakers what comes out of these simulations. I would respond that just as i said early on, that the federal governments responses as well as the State Government responses are siloed and not interconnected and not coordinated. The private sector, the companies that are members of my organization, do a grand job, but what is needed is a level of coordination that is bigger and bolder to create new platforms to have the capacity to surge, to have the capacity to share manufacturing facilities and turn around in realtime and very quickly to have a more unified system of diagnoses capabilities around the country and around the world. And on the bioterror thing, you know, we have these systems that were developed right after 9 11 where we had these sensors all over the place that are supposed to be able to pick up when events are occurring. In complete shambles, virtually useless. No matter how many times you have all been banging on the heads of the federal government to modernize and update those systems, they are woefully neglected and incompetent. The only thing i will add to that is i agree, i mean, we need to think more strategically about this. I agree with the idea that thinking of these medical countermeasures as a critical seconder and thinking about what should we be do to increase responsiveness. I think barta is kind of supposed to have this role in some respect, but i think they need more funding and they need more strategic leadership and more strategic empowerment to really do that. Again, thats why i do think there should be someone at the white house whose job sever day, you know, seven days a week, ten hours a day to get up in the morning and think about how to build a plan for doing this and how to make it happen. You know, i had a lot of Great Teachers when i took over this Ebola Response. One thing tom always emphasized was that youre going to respond to these crises by flexing up your existing system and if you want to be ready what you really shouldnt do what you really cant do is hope youre going to build some magical capacity in the emergency moment. Youve got to have strong, robust Healthcare Systems with a lot of capacity, doing well and then, you know, try to amp that up in the event of a crisis. It really starts what the day to day looks like. And theres things about our Healthcare System right now that are very strong on a day to day basis, things that are less strong on a day to day basis, but investing in those core Healthcare Systems i think is the best way to have the capacity you can flex up in a time of crisis, but capacity is a critical issue. I mean, you know, everyone says to me, well, why dont we have hundreds of hospital beds someplace that we could put people who had this Infectious Disease and isolate them. I said can you imagine building hundreds of beds and keeping them empty just indefinitely . Can you imagine having vaccine manufacturing capacity and just not using it so its sitting there . I mean, we have so many healthcare needs that you would have Spare Capacity is a hard thing to imagine, its a hard thing to consider. If thats true in our country, think how true that is in other countries. Double and triply true in other countries. I think its about investments in the core system, making a stronger Healthcare System and having that ability to dial it up and amp it up in the event of a crisis. I would like to thank the staff of the Scowcroft Institute and of the Veterinary School and dr. Parkers leadership and our staff for their efforts and the texas a m students who are here, checked everyone in for all their work. Please. [ applause ] well, we have come to 1700 and thats 5 00 and this has been an outstanding day. We have, i think, learned a lot. Unfortunately some of these issues are not new issues, like i said in my opening remarks, and we have simply got to find a way that we can turn these longstanding lessons observed into lessons learned. Our nation and the International Community deserves it. I want to thank our last panel for getting into some of the strategic issues. [ applause ] and everybody thats made this possible, the scowcroft team, everybody back at the bush school, college of medicine and of course our federal Relations Office here in washington, d. C. This concludes the third annual pandemic and bio security forum. We will keep in touch and continue this dialogue. Thank you very much. [ inaudible ]. November 11 to 12th, please join us at the president ial Conference Center at the bush school of Government Service at texas a m university for our panned mick and bio Security Summit that will begin our policy process once again. Thank you very much. Tonight American History tv looks at the 50th anniversary of the stone wall riots. Historian mark stein joined us from the Stonewall National monument in new yorks Greenwich Village to talk about the six days of protest starting in june of 1969 that became a turning point for gay rights in the u. S. The stone wall riots starting at 9 00 p. M. Eastern here on cspan 3. This Holiday Weekend on American History tv, saturday at 10 00 p. M. On real america the 1970 film honor america day the july 4th celebration of the National Mall featured bob hope and billy graham. She has never hidden her problems and faults. Without freedom of the press and open Communication System we dont sweep our sins under the rug. If poverty exists, if racial tension exists, if riots occur, the whole world knows about it. Instead of an iron curtain we have a picture window. And sunday at 6 00 p. M. Eastern on american artifacts, living history hobbyist craig hall portrays a soviet calvary officer and skriebts the soviets role in world war ii. One month before dday we had been occupying 65 maybe of the best german troops fighting us. If we hadnt done that, if we had failed at moscow or stalin grad, all of those troops could well have been on the normandy beaches and it could have been a different outcome. So the story that has to be told is that thats a significant contribution to winning the war. Watch on American History tv on cspan 3. Next a hearing to review the state of the farm economy. Four farmers testified about the financial and trade issues facing their agriculture operations, including access to credit, International Trade tariffs and finding farm labor. This house agriculture subcommittee hearing runs 90 minutes