Member mr. Smith. Today we are here to discuss the eradication of ebola, and the medical advancements and Lessons Learned in trying to suppress this deadly disease. Ebola is one of the deadliest viral disease in the world has become a part of the Global Health landscape. The recent discovery up in a bowl of vaccine and better healthcare employee training have helped improve response times to outbreaks and decrease the ability of the virus transmitting to rural areas. However evil outbreaks are often complicated by regional conflicts, lack of trust between local communities and practitioners, and armed groups attacking and burning down treatment centers. This hearing will address the challenges and opportunities to combat the transmission of ebola, and the effort and collaboration deeded by appropriate stakeholders. I look forward to hearing more from our witnesses regarding the ebola vaccines and how they are being used in this most recent outbreak. Without objection, all members may have five days to submit statements, questions, extraneous materials for the record, subject to the length limitation in the roles. I recognize myself for the purpose of making an opening statement. I would also like to thank our distinguished witnesses who are here with us today. The current outbreak in the Democratic Republic Of The Congo began in august of last year. It is the second largest today. As of news reporting from today, may have reached up to over 2000 cases. And almost 1200 confirmed deaths. If we do not collaborate with all stakeholders to combat the outbreak and ultimately eradicate ebola, the disease would surpass the 2014 2016 outbreak, the deadliest in history. Which had 11,000 recorded deaths in and 28,000 cases. That outbreak started in new guinea iberia and sierra leone, and spread to mali, nigeria and senegal and even beyond the continent with cases in italy, spain, the united kingdom, and i think we all remember the cases in the United States. Ebola epidemic has been heightened because it is in a comfort zone in the Democratic Republic Of The Congo. The epicenter of the outbreak is in north kivu which has more than 100 active armed groups in the region. North kivu also shares a border with uganda, and is a hub for travel and trade but also various other types of Movement Across the border. New cases are hard to determine because of the violence and political unrest in the affected areas, it is further restricted the communities access to healthcare. The lack of security in the region is also hindering the Ebola Response by making it difficult to trace context and organize Crucial Community outreach activities. Some Health Centers have been temporarily closed or damaged. Several of the Health Workers have been killed. I know that the people of the drc are frustrated because of the lack of medicine, food, and Foreign Companies extracting the countrys precious metal minerals. But that is no excuse to burn down facilities or attack and kill people who are there to help treat this deadly disease. What this indicates is that we must work to do all that we can to keep these Health Practitioners safe. These are things we have to think beyond providing humanitarian assistance, and medical treatment. Usaid administrator mark green said two weeks earlier that when it comes to ebola the drc is a labyrinth of challenges, government resistance to community leaders. A failed democracy in many ways, it will take more than simply a medical approach. Considering suppressing the outbreak, i look forward to hearing your views and suggestions in your testimony or in the q a and i am interested in hearing the pros and cons of identifying this outbreak as an International PublicHealth Emergency. Why wouldnt we declare that . Those are just a few concerns i want to pose to the witnesses. Finally i am concerned that the administration released a president ial memo last november implementing eight restrictions to most of the tier 3 countrys found in the 2018 report. It clearly states in section 110 the President Shall exercise a Waiver Authority when necessary to avoid significant adverse effects on vulnerable populations including women and children. Not focusing resources on health, education and community outreach, hinders the success of countering the Ebola Outbreak in the drc and i urge the administration to act more diligently now. This administration has an opportunity and obligation to try and stop the deadly outbreak. That is why we are having this hearing and im introducing the trend 19 which would authorize usaid to assist with the efforts in the drc. Lastly i believe it is imperative that we not let ebola reach, because if it does it is highly probable that it will reach rwanda, uganda, ethiopia and south sudan. Oh my goodness. And that would have an effect on humanitarian efforts, peace and security and economic trade. The tier 3 status is something i know the Ranking Member is the author of the report and has worked for many years on this. Presents a bit of a dilemma. Where we certainly do not want to do anything to reward a country that is a tier 3 status. On the other hand, we have the situation where we have ebola in a tier 3 country. So what do you do . Not provide aid . When this disease obviously has international impact. I now want to recognize the Ranking Member for the purpose of making an opening statement. Drug thank you very much madame chair. Its very important. The gentle lady from california is a good friend. This cup somebody was heavily engaged in the summer of 2014, in addressing ebola when we were in the midst of that outbreak. In sierra leone and liberia. And ensuing panic over the disease. We held three hearings, when many around the world thought the bubonic plague was about to jump borders. And overwhelm Health Systems especially of subsaharan africa. It was a. When we thought that nigeria, nigerias most populous country in africa, would suffer from a pandemic outbreak, thanks to a largely unheralded work of a number of key actors including and especially our own centers for Disease Control, the outbreak was contained. But we did have cases in the u. S. , due to highly effective quarantine measures, and state oftheart medical care, we were able to dodge that bullet as well. Perhaps our witnesses, dr. Robert redfield can enlighten us further, and the Critical Role of the cdc, played with regard to global efforts in containing and then defeating the 2014 Ebola Outbreak in nigeria and Lessons Learned. In many ways today we are better equipped to address Ebola Outbreak in terms of vaccines that were not available in 2014, as a practical boots on the ground matter we are worse off with the current outbreak which began in 2018. That outbreak, has now spread in Populated Areas of the eastern drc. It makes the situation more difficult this time, is the security situation. Vicious attacks on healthcare workers. As reported by the washington post, according to the who there been some 119 attacks against Health Workers this year. With some 85 wounded or killed. The presence of expatriots in particular, among healthcare workers appears to have increased the militants who have carried out the attacks. Centers, these dedicated Health Workers put their lives on the line to help prevent and treat ebola. The fact that they should be targeted boggles the mind. The testimony of of one of our 2014 hearings, how he contracted the disease despite taking every precaution. By helping a bowl of patience and liberia. We hope to get an update from Witnesses Today as to what is the security situation on the ground. And whether we are putting our cdc and other personnel further in harms way beyond the threat posed by the virus. Finally i would like to address the issue raised by my good friend and colleague, there is some concerned that assistance to the drc will be cut based on the fact that our state department has designated the drc as a tier 3 country. In terms of Human Trafficking. I certainly hope that this is not the case as it does not comport with the intent behind the legislation. As the author of the trafficking protection act of 2000, it requires that we withhold not humanitarian, foreign assistance to the government of tier 3 countrys. Which means that the country does not fully comply with the minimum standards and are not making significant efforts to do so. I know that the tvp at explicitly excludes humanitarian and trade related assistance from any assistance cut off. Further allows Development Assistance which directly addresses given needs which is not administered by the government. Development assistance can flow to nongovernment organizations, i visited myself, one notices that health and Education Needs are met largely by faithbased entities. As the government and its institutions are viewed with a great deal of suspicion. Moreover section 110 d for of the tvp a invest the president with Waiver Authority with respect to neon battalion non trade related assistance. When such assistance is in the National Interest of the United States. Such as the spread of ebola. Further, the tvp eight mandates, when necessary to avoid significant adverse effects on vulnerable populations, including women and children, if theres any misunderstanding with respect to how it should be interpreted, rental minute, i know the chairwoman and i would be very happy to meet with members of the administration to discuss it. I do want to note that in the fiscal year 2018, the american taxpayers had provided 330 million, humanitarian assistance to the democratic republic of congo, and some 87 million in response to the ebola crisis. We are told additional will be forthcoming. And we look forward to receiving those as well. Thank you madame chair. I yelled back. Truck before introduce the witnesses, i would like to acknowledge, who were in the audience, this is a special day on the hill, when we acknowledge, celebrate and lift up the hundreds of thousands of young people who are in the nations Child Welfare system. For the first time i have been doing this for years, for the first time three of our former foster youth are from the continent of africa. One is from the congo, ethiopia and kenya. I want to acknowledge them. [ applause ] in support of the young people, a very famous actor who is one of, who represents one of my favorite tv shows, blackish, who is here with his father. [ applause ] supporting all of the foster youth. Thank you very much for attending. And now to our panel. Admiral sieber is the acting assistant administrator for the bureau of democracy conflict and humanitarian assistance. And usaid. April 2017 to july 2018, he was appointed by President Trump to be the senior director for Global Health security and bio defense at the National Security council and in june 2006 he was nominated by president bush to lead the president s malaria initiative. Dr. Robert redfield is the director for the centers for Disease Control and prevention. He has been a Public Health leader actively engaged in Clinical Research and Clinical Care of chronic human viral infections and Infectious Diseases especially hiv for more than 30 years. He made several early contributions to the Scientific Understanding of hiv and in addition to his research, he oversees an extensive Clinical Program providing hiv care and treatment in the baltimore, washington dc community. Thank you very much today and we would like to hear a summary of your testimony, we have your written testimony. But if you would present for five minutes. And then we will have questions and answers by the panel. Ranking member smith, members of the subcommittee thank you for the opportunity to speak with you. About the United States government response to the ongoing Ebola Outbreak. You referenced the 2014 west african outbreak and the devastation and the impact it had. The current outbreak in north kivu and in the province has surpassed 2020 k cases the situation is worsening and the numbers of cases will continue to rise. Last month i traveled to the eastern drc. I met with health teams, local community leaders, implemented partners, and saw firsthand the scale and complexity of this outbreak. I traveled extensively in my career, in my three decades in the u. S. Navy and in the roles i have had since, this trip to the drc was one of the most sobering trips i have ever taken. The scope of this virus, Security Threat is changing. And the risk of the virus sleeping the border to other countries is very high. This will further destabilize the region economically and heighten insecurity. In order to control this Ebola Outbreak, and its source, a fundamental shift in a reset is necessary. And ongoing violence and Community Distress tort the response has been summarized by both of the opening statements. On group violence, as well as deeprooted Community Resistance has kept the health teams from doing their Critical Health saving work. And frequently results in the suspension of the response efforts. In february, Community Members and set fire and destroyed the ebola treatment unit, when i was there beside restored. The evening we left, one of the guards was killed and another recurring attack. There been over 70 security incidents this year alone. Cases have been accelerating in areas where the Community Members exhibit deeprooted distrust of the Central Government and foreigners as well as the people from other regions within drc. This widespread distrust has fueled misconceptions about the disease and deep suspicion regarding the motives of the sudden and dramatic International Presence responding to ebola. As well, the feelings of the community, that they are being exploited by this injection of cash. They refer to it as the ebola economy. There is clear consensus among stakeholders that we need to listen better, to the communities, listen to what they are doing, and that should and must inform the trajectory of how we can shift this accelerated increase in cases. The outbreak is not just a Public Health crisis, it is an outbreak in the midst of a complex emergency. In order to contain this outbreak, a more holistic humanitarian approach is needed. Towards this end, usa supported by cdc as the technical lead is leading a government response focusing on six key areas. In order to bring this Ebola Outbreak to an end. Let me quickly review those six areas of focus. First, we are working to improve coordination among the drc government who and our international partners. I am pleased to say that over the last week and 10 days significant change is underway to accomplish that objective. Secondly, we are emphasizing and addressing the paramount importance of Community Engagement in local ownership. Third, we are working with the newly appointed un a bowler response coordinator, mr. David grassley, nonhuman and we are working with the cdc to implement operational improvements in the Public Health response including a forward leaning vaccine strategy. Fifth, we are looking at the ebola readiness along the coma quarter as well as the four countries to the east. And lastly, we are engaged in a longerterm planning scenario for stabilization and development to address the root causes of fragility in the region. This reset is building on the work of our usa funded partners that have been implementing key aspects on this Public Health response. Are partners of help train 1600 community Health Workers and surveillance, prevention control measures, andover 280 health facilities, reached 1. 5 Million People with health messages, and provided enough food to meet the needs of approximately 45,000 beneficiaries each month and much more. There is no Silver Bullet to end this outbreak. But i believe that an adaptable, government response that capitalizes on each agencys unique strengths and expertise, will be successful in containing controlling and ultimately ending this outbreak. I look forward to your questions. Dr. Redfield . Good afternoon. Thank you for the opportunity to