keep this virus outside of the united states. already, there has been a vigorous response. we hope to hear more today about exactly what has been done, and what needs to be done going forward. two weeks ago, thomas r duncan traveled here from liberia. by way of brussels and dulles airport. he fell ill, and presented himself for treatment at texas health presbyterian hospital in dallas. mr. duncan's diagnosis set in motion an extensive public health operation involving federal, state, and local officials to identify and assess any individuals with whom he may have had contact. a process called contact tracing. that contact tracing effort continues today. our prayers are with everyone who is currently being monitored as part of this incident. we are thankful that to date, there been no additional cases of ebola standing from this case. it is difficult, but it is one of the few ways to contain the disease. containment also requires swift coordinated action. in this hearing, and investigations into the boston marathon bombings, we heard about the importance of the incident command system. the system is a vital tool for making sure first responders at all levels engage quickly and decisively, rather than argue about who is in charge. the importance of such a response mechanism was highlighted in the 9/11 commission report. it has since saved countless lives. i was encouraged to learn that officials here in texas instituted the structure, and today, state and federal officials are located in the dallas county emergency operations center, enabling vital information sharing and coordination. to be clear, the situation here is far different than what is happening in west africa. we have a strong public health infrastructure in place, particularly here in texas. it enables us to work to contain this virus more effectively. dallas is not the only area that we must be vigilant. we need to ensure that state and local responders nationwide are prepared to move quickly if the virus is detected anywhere else within our borders. hospitals are recognizing this, and have made nearly 190 inquiries with the cdc about cases they believe could be ebola. thankfully, testing was only wanted in 24 of these cases. only one case was confirmed as ebola. public health and medical personnel must remain vigilant, ensure all hospital personnel are informed, followed protocols to identify the virus, and take appropriate quarantine measures. we must reinforce the importance of taking travel histories and sharing that information with all relevant personnel. protecting the homeland from the ebola virus also requires us to put measures in place at our airports. i am pleased the president announced earlier this week additional entry screening efforts that are being launched. beginning tomorrow, enhanced screening measures will be activated at jfk airport, and soon after at dulles, o'hare, newark, and atlanta. his airports received more than 90% of all travelers from liberia, sierra leone, and guinea. the department of homeland security has been involved, and i commend secretary johnson for his leadership. we must also closely monitor the situation overseas, and continue our global response efforts. i've spoken with the homeland security adviser numerous times to ensure we are doing all that is necessary. we discussed exit screening procedures that have been put in place by cdc trained personnel. the screening has stopped 77, out of a total of 36,000 individual screened. fortunately, none of those 77 have been diagnosed with ebola. there have been many positive aspects of this response, there have also been missteps. for instance, here in dallas, mr. duncan's travel history was not communicated to all relevant medical personnel when he first sought treatment, which led to his release from the hospital, and the potential that additional people were exposed to the virus. there were also problems removing hazardous biomedical waste from the apartment where mr. duncan's family was quarantined. the soiled materials remained in the home for days after the ebola diagnosis was confirmed. we must learn from the steps, and ensure the proper procedures are followed. going forward, we must consider all policy options for stopping the spread of this disease. i have heard many ideas. everything from stopping inbound flights from specific countries to additional screenings at home and abroad. we hope our witnesses will discuss options that are being considered in the trade-offs that we have to confront. we also have to ensure unnecessary government red tape does not slow down the response. in fact, we passed -- an appropriation was made in the house seeking $750 million towards response efforts. i would urge the senate to follow the lead of the house and approve the pentagon's request to transfer additional resources to this fight. now is not the time for politics. congress has been loath to get anything done this session. if there has never been a time to come together and put pettiness aside, it is now. we must get this right, and make sure that federal protocols are put in place, and communicated to our state and local partners when a situation is critical occurs. my hope today is that we don't focus on politics, but instead, here from our panel, and focus on solutions. we are all in the same boat. we need to work hard to make sure our nation is protected from this threat. i want to thank the ranking member for being here today in my home state of texas, and the showing of support for the shared goal. before i turn it over to him, i would also like to commend our first responders, our medical personnel and public health officials who have responded courageously to the case here in dallas. most importantly, our thoughts and prayers are with the victims and the families affected by this crisis. i look forward to hearing from the witnesses, and hear from them what more can be done to keep americans safe. with that, the chair recognizes the ranking member, mr. thompson. >> good afternoon. want to thank the chairman for holding this timely hearing on our efforts, both domestic and international, to contain and prevent the spread of the ebola virus. also, i think the witnesses for appearing here today. i look forward to the testimony. additionally, i want to thank the chair and the board of directors of the dallas-fort worth airport, and their executive staff, for hosting the committee today. i want to extend my condolences to the family of thomas eric duncan, the first person diagnosed with ebola on american soil. we are not here to dehumanize mr. duncan. unfortunately, his diagnosis, and the procedures that followed, raised critical questions about our preparedness for highly infectious diseases such as ebola, and how federal, state, and local authorities coordinate in their aftermath. as ranking member of this committee, i often urge my colleagues not to use opposition of influence to promote fear in the public. hence, i want to clarify that while it is proper to have serious concerns about the ebola virus, it would be irresponsible for us to foster the narrative that an ebola epidemic in the united states is eminent. rather, this searing provides us an opportunity to review state, local, federal, and global public health infrastructure, learn where there are inconsistencies and gaps, and lay the foundation for eliminating these disparities. while the ebola virus has caused the united states to institute new screening procedures at airports, it is incumbent upon us to work with our international partners to eradicate the virus at its origin, in west africa. the current ebola outbreak is the deadliest outbreak on record. according to the assistant secretary general of united nations, it is also impairing national economies, wiping out livelihoods and basic services, and could undo years of effort to stabilize west africa. eliminating this virus at its source is a surefire way to prevent more ebola cases in the united states. as citizens of the global community, it is not only our responsibility to limit this virus, but help them recover. the united states'response seems as though the international community did not act aggressively soon enough. in march, the world health organization issued a notice of an ebola outbreak in guinea, after the outbreak in liberia. in june, doctors without borders, a nongovernmental organization, declared the outbreak out of control. the world health organization and the international community did not improve on its efforts until august. according to a chart that i have here. we had a lull until the spike started in august of this year. mr. chairman, i submit for the record this chart. earlier, i stated an ebola outbreak is not imminent. what should be discussed is the value of public health infrastructure, and the cost of maintaining it. many times, it is used for a pawn. viruses do not know political parties. preparedness grants from the cdc, and office of the surgeon general hit already struggling state and health departments hard. we can use our platforms to restore funding, and support the federal cost of maintaining a public health and for structure. i hope that our discussion today can yield a step in this direction. i also support the chairman's, comment that this disease does not see party. it is an american problem, the world needs our best minds to address. i look forward to the testimony of witnesses. i yield back the balance of my time. >> i thank the ranking member. dr. tobin merlin is the director of the department of preparedness and emerging diseases. in this role, he is responsible for the cdc's laboratory response network, infectious disease and emergency response coordination, and emerging infection epidemiology and laboratory capacity programs. next, she serves as the acting assistant secretary of health affairs and chief medical officer for the department of homeland security's office of health affairs. she began her service in july 2008, previously served as the associate chief medical officer and director of the division of workforce health and medical support. prior, she served on a detail to the national security staff as a director of medical preparedness policy. thank you. mr. john wagner, i want to thank you for the tour you gave me, and how you would deal with potential ebola victims. mr. wagner overseas employees and specialists that protect our borders. his annual budget provides operations that support national security and customs and commercial trade. the full written statement will appear in the record. >> good afternoon. i appreciate the opportunity to be here today to discuss the current epidemic of ebola in west africa, as well is the work the cdc is doing to manage the global consequences of this epidemic. i have been particularly involved with colleagues here in dallas, addressing the first u.s. diagnosed ebola case. like you, our hearts go out to the family and friends of mr. duncan. as the cdc director noted, mr. duncan puts a real face on the epidemic for all americans. the ebola epidemic in guinea, liberia, and sierra leone is ferocious. it continues to spread exponentially. the current outbreak is the first that has been recognized in west africa, and the biggest and most complex ebola outbreak ever documented. as of last week, the surge past 7900 cumulative reporting cases. we believe the numbers could be two to three times higher. fortunately, the u.s. and others in the global community are intensifying the response in order to bring this critical situation under control. from the time the situation in west africa escalated from an outbreak to an epidemic, we have anticipated that a traveler might arrive in the united states with the disease. the imported case of ebola in dallas required the cdc and the nation's public health system to implement rapid response protocols that had been developed in anticipation of such an event. within hours of confirming that the patient had ebola, cdc had a team of 10 people on the ground in dallas to assist the capable teams from the texas state health department and local authorities. we have worked side-by-side with state and local health officials to prevent infections of others. together, we assessed all 114 individuals who might have possibly had contact with the patient. we narrowed down the contacts to 10 who may have been around the patient when he was infectious. 30 others with whom infection could not possibly be ruled out. these individuals are being tracked, and will be tracked for 21 days for any signs of symptoms. they will quickly be isolated if symptoms develop. we are also working to identify and learn lessons from the initial patient encounter. and other events that cop located our response, and to apply them in other responses. we are cop it we can prevent in ebola outbreak here, and that congress has put us in a strong position to protect americans. to make sure we are prepared as the epidemic has example five, the cdc has done the following -- instituted layers of protection starting in affected countries where our staff work intensely on airports running. they provided guidance on how to manage sick passengers. along with partners and dhs and state and local health agencies, we continually assessed and improved inbound passenger screening and management. as the president announced, the cdc is working with dhs to intensify screening at united states airports. this is something my colleagues from dhs will be discussing. we have worked with american hospitals to reinforce and strengthen controls. we have intensified training and outreach to build awareness. we have expanded lab capacity across the united states to test for ebola. we have developed response protocols for the evaluation, isolation, and investigation of symptomatic individuals. we have instances of extensively evaluated suspected cases. we remain confident that ebola is not a significant health threat to the united states. it is not transmitted easily, and it does not spread from people who are not ill. it is possible another infected traveler might arrive in the u.s. should this occur, we are confident we can prevent the kind of significant transmission of ebola that would lead to an outbreak here in the united states. it is important to remember that the only way to protect americans is to end this ebola epidemic and to continue intensive focus on west africa. we are determined to stop this one. it will take meticulous work, and we cannot take shortcuts. thank you for the opportunity to appear before you today, and for making cdc's work on this epidemic and other health threats possible. >> thank you, dr. merlin. >> chairman, ranking member, distinguished members, thank you for inviting me to speak with you. i appreciate the opportunity to testify on the department of homeland security's role in the management of ebola. i'm honored to testify along with my colleagues. i want to thank the texas state and local officials who will testify later. dhs works closely with the state of texas on a number of important issues. we appreciate their work. dhs is responsible for securing our borders and safeguarding the american public from communicable disease. the dhs office of health affairs is at the intersection of homeland security and public health, with a mission to advise, promote, integrate, and enable a safe and secure nation. we achieve this by enhancing the health and wellness of the dha working force and protecting the nation. in my role, i provide medical and health expertise. in this capacity, i'm helping to coordinate with components and provide them with medical advice regarding the department's efforts in repairing for an d responding to ebola. this is the largest a bowl outbreak in history. it has had devastating impacts. on september 30, 2014, cdc confirmed the first travel related case. sadly, he has since passed away. the patient did not have symptoms when he left liberia, nor when he entered the united states. but developed them approximately five days after his arrival. the public concerns surrounding this event and possible future public exposure to ebola from international travelers is understandable. although it is important to member that the cdc has stated that the risk of an ebola outbreak in the united states is very low. the president has been focused every day on the government's response. he has stated to senior health, homeland security, national security advisers that the epidemic in west africa is a top national security priority. dhs takes this issue very seriously. we have been closely monitoring the ebola outbreak since april. we are actively engaged in ebola response, working with federal and international partners to develop multiple mechanisms to allow screenings. we are closely monitoring the situation. actively engaged with state and local partners and adjusting processes as needed. dhs has unlimited methods to eliminate risk. take a layered approach to make sure there are varying the points through which an ill individual could be identified so there is no single point of failure. to this end, we are also focused on protecting those traveling by air and taking steps to ensure that passengers with communicable diseases like ebola are screened, identified, isolated, and quickly and safely referred to medical personnel. we have been working with the cdc to implement an additional layer of screening for travelers entering the united states, which is scheduled to begin this weekend. these additional screening protocols are just some of the many actions the federal government has taken in our layered approach to help ensure the risk of ebola in the united states remains minimal. assistant commissioner wagner will go into more detail. but i would like to highlight other key actions that we have taken to date and will continue to take. they have posted messages from the cdc at select airport locations that provide awareness on how to prevent the spread of infection. typical symptoms of ebola, and instructions to call the doctor if it traveler becomes ill. tsa engages with industry partne\rs and domestic and foreign air carriers to provide information, reinforcing the cdc's message on ebola and providing guidance. oha, through the national center, continues to monitor the outbreak and is producing tailored ebola products. the u.s. coast guard is monitoring vessels known to be inbound from the bowl in affected countries, and is providing information to the captain of the port. we provide personnel with health advisories, including impacted regions, symptoms of the virus, and mode of transmission. the department of homeland security has worked closely with its interagency partners to develop a layered approach to ebola response. dhs is always assessing the measures we have in place, and will continue additional actions moving forward of appropriate to protect the american people. i look forward to working with you to address any concerns or questions. >> mr. wagner. >> thank you for the opportunity to discuss the efforts of u.s. customs and border protection's. each day, we process more than one million people into the united states. 280,000 of them enter at international airports. cbp is responsible for securing the nation's borders while facilitating the flow of legitimate trade and travel that is so vital to our nation's economy. within this broad responsibility, our mission remains to prevent terrorist and terrorist weapons from entering the united states. we also play an important role in limiting the introduction, transition, and spread of serious diseases from foreign countries. we have had this role for over 100 years, and is travel and threats change, cdp has changed as well. we have had modern protocols in place that guided response to a variety of signal to get health threats over his and years. cbp officers assess each traveler for overt signs of illness, in response to the recent ebola outbreak, cbp is working to ensure that frontline officers are provided the information, training, and equipment needed to identify and respond to international travelers who may pose a threat to public health. all cbp officers provided guidance and training on addressing travelers with any potential illness, including communicable diseases. cbp officer training includes public health training, which teaches officers to identify through visual observation and questioning, the overt symptoms and characteristics of ill travelers. cbp also provides operational training and guidance on how to respond to travelers with potential illness, including referring individuals to cdc quarantine officers for secondary screening, as well as training on assisting cdc with implementation of isolation and protocols. we provide web-based training covering key elements of blood-borne pathogen exposure control plan, protections from exposure, use of personal protective equipment, and other preventive measures and and procedures to follow in a potential exposure incident. we are committed to ensuring field personnel have the most accurate updated information regarding the ebola virus. since the operative again, cbp field personnel have provided guidance. with numerous and regular updates since then. we provided information on regions of importance, symptoms of virus, and modes of transmission. operational procedures and precautions for processing passengers showing signs of illness will continue to provide our officers -- >> is your mic on? >> we will continue to provide information on ebola preparedness and response we've also provided guidance to the field on baggage inspection travellers on impacted meatries and problem itted products and exposel of garbage inbound international flights. they continue to engage with ealth and medical authorities at the state, national and local level. migration and kwar enteen has stations a liaison manager provide subject matter, expertise and facilitate requests for information between organizations and ctively engaged with the air career industries. the current o -- starting y october 1st, they began cdc ebola health alert process. this information notice provides traveller information and instruction. in addition based on these enhanced screening efforts they will make health assessment. and they'll roll out next week atlanta and newark and combine 94% of all travelers the affected countries states.g the united they'll continue to screen on all skpaerpbgz also provide tear sheets to travelers at all locations who come in infected countries. while cdc officers receive they identify an individual to be ill, we'll from the he traveller public and contact public health authorities to help with the medical assessment. they'll continue to monitor the outbreak and provide guide ense and work closely with dhs to develop or adopt measures that is needed. thank you for the opportunity to testify today. for the attention you're giving to this very important issue. to answer questions to help stop the spread of this disease. but many of my constituent and many americans are asking the we banning y aren't all flights from west africa the united states? so doctor i want to give you a not opportunity to answer that question. why shouldn't we ban all flights to the stphuts it is a concern of many people. liberia,se outbreak in and sierra leon is we may be able to stop it. in order to uninhibit need out of the nd if we don't do anythi -- disease from spilling from those countries into neighboring countries and out into the rest of the world. to getopportunity now is the disease at its source and is to not -- i that. iate we would through an agency process through this. prepared to make any necessary. >> doctor, you said that this is ot a significant health threat to the united states, i believe, in your testimony. and doctor, said the risk is very low. wanted to see if you could elaborate on that and explain deadly wicked virus is actually transmitted. mr. chairman. the -- as you say, the virus is horrible virus because it causes horrible disease and infected it has a high mortality rate. this know a lot about virus and we know from 40 years experience how to stop outbreaks of this virus. the virus is acquired by people direct contact from infected individuals who are symptomatic. from on't get the disease contact with people who are asymptomatic. it is often contacted by people an individual for who is infectious and sick. is an cquisition there inch basing period ranges 8-11 days and can be longer. and can be i would also point out as the s a i.d. director has stated this is a disease that preys on poor public health and infrastructure. public health nt infrastructure in this country. contact than airborne? >> that's correct. bio ey had a senior defensive person and that was eliminated in the current administration. do you know why that was and who was responsible for coordinating at state level.nd >> we have a robust agency been meetinge have regularly on this and we believe hat the varied expertises available are all necessary. thank you very much mr. chairman. when i left the jackson, mississippi, airport this morning. talked about this hearing and a number of people they wanted to know is it safe and what do i have to have. needless to say it's on the minds of a lot of people in this country. id to that extent dr. merlin, think it's important that to the can soeufpbg the ame page of music as we push information out, the better off we are. you can provide this committee that process works from standpoint and notification to state and local around the country? mr. thompson, i will -- i the process how works for identification of cases. is that what you would like me -- >> that's fine. worked with our federal partners and our state to distributeners health ion to departments to health department to onnel as well as hospitals and physicians on the ebola, thesymptoms of travel history that is there for ebola and how to detect ebola infections. we on our website have provided facilities and guidance on how to do this and how ded guidance on facilities and physicians should who they individual think is suspected of ebola and how they can place them in so they immediately don't infect others and we have testing for ebola diagnostics around the country offer 24/7 consultative services for people who have uestions about how to handle suspect suspected and /* >> and the public is trying to what happened? and i we have to somehow provide level of confidence to the the difference is still part of the system. other help me if not members of the committee with the response for that? will. ebola untreated ebola 50-90% more talt of including a number of factors including the age of the person. to -- we have d treatingxperience with our developedtern and the outcomes are did he pen tkabt on a number do actors and a lot have to with preexisting illness with the patient and how quickly on of symptoms the patient received therapy and so it's -- wish we had the assumption that every person who comes down ebola who gets western style medicine would survive, that's the think case. thank you. r. wagner i call to order the public health crisis from the virus outbreak. in my letter i have i avid navarro and mr. brief the bury to membership on this pressing matter. take this opportunity and his of cabinet nd chief our stkeus tinge wished invite invitees. we have 20 locations where have e located at but we contact information at all our ports of entry. a travellerncounter that has overt signs of illness cdc. contact >> you'll hold those people until cdc shows up. >> we potentially could. of what on the nature it is if they're showing up and the port walk through less what are you going? >> i think we would contact cdc. that's the end of the day going to be the medical professionals that make those determinations. >> i guess the encouragement is up how we need them to come with some teachable standards so the people actually want to know for and then what to actually do. don't have that information we'll make this job impossible. i thank you for this hearing. clarification, you said there is a division devoted to --s >> yeah, there is an entire that is devoted kwor /* kwor ran teen. what i would do if the question were asked of me, i would touch with get in someone who knows the answer to this question. chair recognizes the gentlemen from texas. chairman the reigning member you very much. i thank my colleges for their presence. particularly again as i note thank my chairman and ranking several members that are from this region and thank hem so very much for their engagement and participation in this on going challenge. also thank i know that we will see some of our local panel ls on the second but i want to take knowledge of them now and appreciate all the ounty and all the first responders have done in this community. we need to express our appreciation to them and i thank all of you for and thesence here today very valiant work that you have done. days ago i raised the red lag not the historical flag as i was able to be escorted by totoms and border protection look at the very fine men and there.that work i visited the containment unit by cdc. on the day that we visited my team was here in dallas. saw the equipment that was there. i went down to the sub base look at the amount of epheuplt. hen i say the elimit i think it's the suits that are there to nsure that cdc and others had it. it's important before the american public to know that airports many of the this kind of equipment but i aise the red flag to ensure that there was this kind of screening. publicly tooted i'm going to request and the there was not designated bush intercontinental airport enhanced screening. i made the request to the and secenters for disease control that this will be responded to. trapls not based upon the that comes into continental airport. let me also say that it is not and all of us must e restrained in how we define it. but it's particular skpreuz this headline that says leader, please for ebola aid. i want to thank the president the hundred 30 civilians and the units and the containment been set up, the teams and 3,000,700 million that i hope that the congress and all convince the congress to support and i especially want men and women of the military that are on their soon to be on their way. let me raise this question as i to talk to some of and edical professionals -- let me ted that enjoy my colleague by exresting sympathy to mr. duncan's pray for them as they passing.s to you and i te don't think we're practically prepared. indication of you patient i would think clear out any hospital. going to come.t put units together. i hear from my health season onals in the flu that hospitals are saying when similar ave those symptoms and they're the average pushed they're getting by the ambulances to bring those symptoms. do you think it would be to have those kinds of units? i know you're seeing them in hospitals. need to be they separately placed? i understand the question and, no, i think that all to be able to care for people who present to facilities for care and we individuals to present to selected facilities. let me go on to the next question and i want to ask one to mr. wagner. question goes to the persons.al i am told they are telling me 80% have e country, aid that hospitals have not communicated to them. 85% said that their hospital has provided any education on ebola. says their d hospital has insufficient supplies of eye protection and et cetera.s, your answer on how to get all prepared and airports that are not in this scheme of several airports, what are your and women doing and where do if theye these patients find they're infected. answer. >> that is concerning. our e will reach out to state and local health things nts to see those addressed. nurses need to feel they can patients if they're potentially infectious whether ebola or simple as influenza. >> where are these -- what are ou doing in airports that are not in this five member? the question we need to keep rule. five minute >> any location outside of the five. travel as ify the of the ed from one areas. >> the chair now recognizes mr. sanford. >> thank you. holding this hearing and thank the ranking members as well. hearing back home is that people are really concerned about the disconnect between they see and hear. eople relatively safe but meanwhile they're seeing pictures of people coming out of wearing space suits and people back home are saying, i don't have a space suit. safe? i there is a disconnect in terms of imagery and what they're hearing. would also follow up on the chairman's point. it was your words just a few this disease at fer ferocious. i asked our staff look at how we these things in the past. one of the big benchmarks they spanish flu of 1918 which killed millions around the world and the different new york city en and at that time pittsburgh which were two of the bigger east coast and implement mediately and different results in terms of death in respective se cities. and so, what people have been home is wait ack veer , if this thing is lent as some people suggest, why world of kwor ran teen are going to let those people of the world part part of the world? what you said just moment ago we need uninhibit travel. time i checked 101 airborne hey don't fly on dealt tafplt military air can get resources. people, health professionals in civilians going in and out. then the second thing you said we wanted to prevent these countries from collapsing economically. i think that overstates the case. from a u.s. standpoint what economically won't drive the american come and vice versa travel embargo from cuba and not crippled the country. what a lot of people back home chairman's o the point in question, if you're over there, we won't issue a we get this thing sorted out because going back to my colleague from utah's it tion just a moment ago seems to me there's a real --match those are very good questions and understandable questions. have to admit that i wince images me i see the tv with people in space suits gives an impression infect teuft of the virus that is not realistic. overreaction and i hink it flames people's fears ebola is a and how spread. doctors without borders has care of ebola patients for established g personal protective equipment that doesn't include nose sort see on suits that you elevision without acquiring infection in their workers and a little of this -- some of media nfortunately driven. between thefference nfluenza epidemic in 1918 and ebola there are major differences. >> understood. i see we have gone to a yellow light. a couple of seconds left. on not again prohibition travel? there you don't come here. >> we neil feel that would cause the disease to grow in that area and to spill over into other countries and then spill over into the u.s. and the real opportunity now is to put out disease there and every travel restriction that's been area on travel into that has interfered with people who are trying to help not being get there. travel restrictions or reduction not r travel and it's he just the u.s. military but andle from china and europe cuba who are trying get there to make doing would what we need to do harder. we ask the people's understanding of that. >> my time is expired. thank you. recognized.er is people back home are con kerpbed and i came here to ask kpwez on their behalf as well as to get answers. ut before do i, that i just want to extend my condolences to mr. duncan's family. and to all of the people in the affected, i at are think the video we've seen on suffering in the heart. just touches or inch the united states is mobilizing to help. men and woman r in uniform for taking this mission on. i now they will do an credible job building facilities to help care for those who are sick. and i also, commissioner wagner want to commend your men and oman because you're on the frontline when it comes to how did 'do we make sure we control who might be in bringing this disease to our country. what the chairman said earlier about this not political issue. this is an american issue for of the people we represent. and it's an american issue for is we do so well and that elp other countries who aren't able do what they need to do for themselves. as we look at what's needed here today that we, as members of will return fully committed to providing the funding that's necessary to resources that are necessary for our men and woman protect the g to nation and address this disease. i want to go to the question has come up now a couple of times, commissioner wagner, we control is that or manage travelers coming from are most ies that affected today. concern about e stopping flights. let me suggest another possible and get your reaction. be helpful to require individuals who are not u.s. permanent o are residents traveling from the countries that are affected to them to go to the local consulate or embassy at implement some screening that location before people embark for the united states. could you comment? to have a visa already to come here. part of process does make a person inadmissible to the you have any if umber of kphaoupbicable did he saoeus z /* -- diseases. miss act theed a questioning and questioning process we'll be alert for signs --illness of a person >> could i interject though. i appreciate that people have to have a visa. i guess what i was going at, implement the same kind of screening procedures hat you're implementing and beyond what you're implementing as people come into the country. the disease atch before it actually embarks we a better place to protect the united states and the citizens. would have to defer to the department of state if everyone new have to apply for a visa subject to condition. >> let me turn next to the doctor. commend the cdc for taking on this incredible challenge. i have a lot of confidence in for our country but also cognizant that the cdc has been impacted heavily by budget cuts. and i hope when we return you'll take a look at what you need to make sure this job is done with resource that are needed. doctor, oned earlier that we have known about this years.e for 30 i have one question. perhaps possible and to understand the nature of the individual before we wait 21 days. person ot examine that in another way rather than the apparent?o be >> congressman that's an xcellent question and it comes up repeatedly. no diagnostic ly ebola at will detect before an individual is infected. fact, our current testing may not detect it in the first three days of illness. is a patient who is suspect of having ebola and the is negative we often test at 72 second hours. i think that is a good challenge. and it would be very helpful to have a test like that developing test to perform on asymptomic is very difficult find a you need to target that's present in -- you need to find distinctive t is and present enough in the infected individual and non-infected individual and that's hard to do. >> our time is up. our sed we out to double efforts to do such testing and t would be very useful to our efforts to control this disease. appreciate your service to our country and i know how hard you all are working now to keep safe. thank you to the ranking member chairman for doing this committee meeting particularly dallas. good job. responders.t having large parts of my life overseas it's not comparable to that i've seen and i want to congratulate you and say it's a good job. 'm worried now about our first responders that are going to africa. so my first can he question to are we going to have 3200 troops that are not medical as rts in these mobile labs i understand it doing testing and so forth. o my first question is to you all regarding that. re good samaritans going to be okay here and safe? and that's the first thing that popped into our mind. in my so many veterans district. are our first responders going go to africa? second thing that i wanted to how long until we have a vaccine? what will it take to get there? this morning you were saying this is the highly doctor, thatsease, is right? fatal up to 90%. you right, not ecessarily contagious like influenza. sounds still pretty deadly. how far out is a vaccine? then my question to mr. agner, you talked about the enhanced efforts and you'll get more information on what those what that means. it took usafter 9/11 a while for ts a to get up to speed and they're a lot better they do now then right after the disaster. you think that you are confident that there are holes in the security wall. answer these questions i really appreciate it. congressman. of anyone who we epidemic like this sefrpblt we con harm's way by in putting them someplace where might be affected. provide ining and personal protective equipment or use of equipment from keeping people being infected. our military forces will not be providing providing direct care but it's a cal work but concern and we'll do everything prevent people. >> i think the goal here is zero. agree. i agree completely. forgetting your second question. >> vaccine. uhm, you know i would prefer national institutes of health which is responsible for overseeing the vaccine development speak to the tables for development. ortunately there are vaccines available that have shown ets in non-human primates but before administering them to people you need to be sure that when o no harm to people you administer them to people. those trials are going on now. know the right dose to administer and to have the manufacturing capability. i know that the agencies are working simultaneously to do and ramp up the capability, but both are better to testify than i am. those trials go to the top of the heap because there is as you know?og >> they have gone to the top of the heap. you of that. >> thank you. wagner? >> today we screen all travelers of communicable including symptoms of ebola. what we're kicking off saturday j.f.k. is extended procedures about taking people's asking them and very specific questions about contact with people who have ebola. working closely with c.d.c. to get those people who ave a temperature in getting them into some professional medical care to address that. locations will continue to -- then we have four will kick ions that off following saturday at some point next week. 94% of allover about coming from those thr three regions. >> that means you're doing face o face training right now in those airports with those officers so we'll have an upgraded procedure starting immediately. >> we have on going training. we have an annual certification all officers about blood diseases.gens and protocols for happening those people off for medical care. all three. >> the chair recognizes mr. o'rourke. chairman.ou mr. for country merlin, my understanding is that there are treatments for ebola and that mr. did you know ant was diagnosed on the 30th of september but did not receive treatment until the fourth of october. on that our thoughts and whether or not that his death. to >> in other words, the delay in receiving the treatment. >> yeah. the people who understand best he decision making process around weather and when to experimental therapies to the patient are care team providing care for the patient and the family.s we at c.d.c. our job is to make officials and th the team aware of what therapies are vailable and how to go about acquiring them. sometimes we facilitate that but we don't actually-- > you don't have authority to order a specific treatment. that would be better asked to the care team? >> exactly. let me then move on to my next question. we talked a lot what we're ts and doing to screen there, capacity, training, protocols. public health perspective and i'll ask mr. agner from an operational perspective what are the threats at our other ports of entry, sea ports from a perspective?h number ofad already a cargo ships that come in -- they people all the time with ho are sick on the ships, and is the e coast guard first line of defense on. that they engage with the coast usually with i believe with c.p.p. and with us to determine what the best of action is with the on a ship. so these are harder cases to deal with and also harder ecause often the person who is sick on the ship is gravely ill. it's a more difficult situation to deal with. and mr. wagner, what capacity at these other ports to handle potentially infected travelers? so, again, we would be alert for any overt signs of illness through our routine questioning -- > they're receiving that training? >> absolutely, yes. all our officers get that. processing normal of a traveller if they see the ign of illness they have the contacts with cdc on what to do follow-up. tuberculosis and measles we see the border. cross public . administrators health emergency preparedness stkpwrapbts $640 million that all states. what concerns or questions do for us aboutnswers accountability for how that money is spent and used given ome of the mistakes made in dallas with the handling of mr. duncan's case. what recommendations if any do terms e going forward in of additional accountability and you feel those are needed? question, very good congressman. we need to assure -- steps have been taken in this that .h.e.p. grand and the hospital preparedness programs are well coordinated and that both grants not only health department but facilities are for potential and infectious disease emergencies a that we sort of have system.s prior to two years ago the administered endly and now they're better coordinated. there are things that people know how to do. >> we'll submit for the record questions that try to get to the root of this, whether spent money being well right or whether we have the appropriate accountability to the training in place especially given some of mistakes that were made thompson are holding a good hearing and i'm want o be part of it. i to feed off the very first question that you had. i think this is a serious issue. it's obvious that people are affected by it. it's very that people are concerned by it. here in the it's real.s region we've had an ebola case, an individual not from the area who s traveling to the area has contracted the disease and has died so it's not academic. this should emost be treated i think as a public issue. international diplomacy issue or foreign or civil rights issue but public health issue. in the community i live in about years ago a teacher contracted tuberculosis and was class and one of is students contracted the disease. when that became known, the public partment of health which will testify on the next panel came into the school district, interviewed all the in the immediately lass, kwor ran teened some and monitored some and came down and held a public hearing that i helped facilitate. immediately as a public health issue and dealt such a dealt with in way that there were no other cases contracted of t.b. paeurp doesn't appear right now that we're treating this public health issue. have to commercial nights to send nights into a country. if we were treating this as a issue why would we not immediately stop these lights and then on a case-by-case basis send as pment and people necessary and on a case-by-case basis allow people to come out. do we have to have commercial flights that, under procedures screening that you've talked about, you're mathematicallyed to miss some people? with due respect i don't accept that answer. flights simply because we need to get people in. i understand. our experience has been that interruptions in impedes the t response.alth although there might be work military transport, it's -- andicult and right now time is of the essence. -- who makes that decision? is that a presidential decision a secretary of state decision? that is a secretary of homeland decision? makes that decision about banning flights? sir, i'd just like to point out and i'll defer to chief direct here are no flights from those areas so that it's more an issue of what flights coming airport. intermediate a couple of e people on a single flight of 300 people. >> you can still ban it. if the from liberia came through i believe brussels he in d have been stopped brussel. or not even allowed a visa to go brussel. >> i think's the most important coordinationa good around those questions. >> my question on the table is, decision? he is it the president or the state or homeland security? who makes the decision? i would refer to the process that's on going > so it is the president if >> i would say there are many different actions that you've is relayed re. one to visas and one relate to landing. >> i know my time is expired. could a governor of a state or an airport authority ban particular region federalo be done at the level? >> sir, most of the airports are airports and request permission to land. i think it's more for the and airport authorities on what business they choose to do. r not >> theoretically the airport to passenger t from a coming -- >> i would have to defer on them decisions tosiness make and where to fly to and to. h airlines they go texas. r recognizes >> i'm trying to understand -- what's the scientific explanation for the response ban would actually make things worse thank you for asking that question. a disease now that we rangetand how many -- the of how many people are infected. how many people will be infected next month if nothing how many people will be infected by the end of the year if nothing is done. we know the size and the scale of the international effort that it's a remarkable nternational effort that is it. and we top have good projections on how deaths will be caused by delay and we're very afraid that that are done that impede the l will delay nterventions that prevent the progression of the disease. disease progresses into the point it can't be stopped it will spill over and create a threat for the u.s.. by delaying you create a much epidemic that is impossible to control. disease becomes endemic in africa and we're dealing with for the foreseeable future and we can't stop t what we want do is stop right now -- we know how to do it. we just need resources there to do want to do n't things that would impede that. are all seems to me there two great risks and that is spread of the disease outside and those three countries following up on a point mr. wagner was making from the from people oint who are traveling from those three countries anywhere else, kind of international coordination are we seeing and i wondering if you could maybe who else is ea helping us out? what is the international the nity doing to stop spread of the virus into the other adjacent countries and going to airports like brussels and any other point in between? you from all >> cbc regard this as a high priority. -- youa 40 individuals have a 140 individuals employed in neighboring countries involved in creating the ministries of health and training individuals to his in increasingge of disease. what we want to happen in those countries is went an ember of the disease lands and goes countries, they are able to push the disease as quickly as possible. that is the public health approach. i do not know about the air travel issue and i differ to my colleagues. they may know about the coordination of air travel. the response is well coordinated under the united nations and has been for several weeks. there are different questions on the follow-up. >> let me ask you this question. aside from the hemorrhaging, the symptoms of the virus appear very similar to any severe flu . are there distinctions? >> in early clinical presentation, no. it is unfortunate that it has its name and, because only a minority of patients develop symptoms, bleeding and that is late in the course of the disease. the first three days, it is a flu-like illness. fever, malaise. there is nothing about the clinical presentation that would make you know what is ebola. after about three days, it is usually profound nausea, vomiting, diarrhea. that is what, when my colleagues and i hear stories about that presenting, that is what raises flags that it might be ebola. the travel history and exposure history are very important to include with the early symptoms to understand where someone might have ebola. you can't tell just on the symptoms alone, you need more information. >> thank you. >> the chair recognizes dr. burgess. >> thank you, and i think our panel for being here. i appreciate you spending time with me on the telephone, it was very helpful. i am sure we will continue to have discussions as the story evolves. we are appropriately respectful of the passing of mr. duncan. i think we also ought to a knowledge the passing of patrick sawyer at the end of july. mr. sawyer was an individual who worked in liberia, commuted there from his home in minneapolis. after attending his ill sister ,n liberia, he flew on to lagos and before he could board the plane back to minneapolis, he .ied he could have been patient 02 months before we had the experience there. two monthszero before we had the experience here. did you do any studies about th at? >> i am not aware of that. >> the reason i ask the question , and they put it very clearly. you had a situation in presbyterian, they did not take an evaluation. and some travel history has given that perhaps provided an important clue that was subsequently lost in the activities involved with treating the individual. from the cdc standpoint, are you concerned at all with the issives andand m action alerts you're been putting out for months, somehow they were not getting to the front line of the triage desk? it is really, there was only one response -- i am here for a fever and stomachache, i traveled from africa. go through that door where the two men in that movie suits will meet you and put you in suits will-- in moon meet you and put you in isolation. -- asgree with you someone who was working a hospital and emergency room, i am sure that you know that things in retrospect are often a lot clearer than they are when patients present -- perspective,c/dc you put all these directives to the hospitals, to the front lines. this is not the usual flu, you have to be thinking about this. , i will from the cdc be concerned that this did not get down to the frontline -- not to be critical, not to be accusatory. what are you going to do different to make sure the message does get to the frontline, because that is the critical part that was missed. >> i think what we need to do is to work with regulatory organizations like the joint commission to be sure that ispliance with preparedness a higher priority, and that when facilities are accredited, it is something that is what that critically and then look at whether the frontline staff -- looked at critically. >> business as usual might not get it. airlines and stopped going to monrovia in the summer, in august. they decided they would stop service there. i know that people have asked me, the president suspended air operations through the fda to the airport in israel for a to the airport enters role in the summer for a while as there were bombings going on. so we know that the authority exists. this is a graph, it is a classical growth curve. the log phase, the exponential phase. countries, zero the own and my barrier, they are in the logarithmic phase. leonne and-- sierra liberia, they are in the logarithmic phase. is the threat matrix such that you would recommend to the president, we have to do something different and we have to stop as disease and not allow it to be imported to our country? because this does not come into fluyway, it is not like the . you can only get ebola if you go get it and bring it home. where is the point on this graph or that would occur? -- where that would occur? \ >> we are already at the point where we believe that all stops need to be pulled out in preventing the growth of the disease in africa. and that is what we need to focus on, because the wrist in this country will not be eliminated -- wrist in this country will not be eliminated until we stop the spread in africa. that comes down to the crucial point, which is that we will not we stop the growth of the disease. because it has now infected so many people, and it is reproducing so quickly, that it will inevitably, unless we stop endemic and inevitably be a greater threat. so i think that the president has already taken the message out to the american people and to the u.n. that this is the time, the opportunity spaces right now. >> i know my time is up, but i disagree. i do not think the president has put a significant amount of importance. i have not heard him say that this is the time of zero defects and we have to do things perfectly. dr. without borders -- doctors without borders, that is under experience, they have a low infection rate because they do everything by the book every time. we need to develop that same attitude here. >> mr. thomas. the united nations general assembly also met today to discuss the international response to the ebola up rick. -- out break. earlier this week, they approved preliminary funding. this is an hour. >> i called to order the formal meeting on the public health because of the ebola outbreak. as noted in my notebook of october 14th i have invited a special envoy of the secretary general on ebola and special representative and head of the united nation mission for ebola emergency response to brief the membership on this pressing matter. i take this opportunity to warmly welcome the deputy of secretary general, the chief of government from the civil trade general, and our distinguished invitees to this media. anthony is joining us through a video conference. the resolution 9/1 on september 2014, the general assembly welcomed the secretary general to establish the united nations mission for ebola emergency response and court appointed member states of the united nations and the united nations system provided their full support to the mission. , secretaryency's distinguished elegance, ladies and gentlemen. we gather this morning for a briefing on the ebola outbreak and the global epidemic. let me begin by thanking the deputy secretary of general for joining us today. also a special thanks to dr. david nabarro, secretary envoy, and the special agent for ebola who will be briefing the assembly on the latest crises. as you recall in the first meeting of this session, exactly three weeks ago, we looked at a resolution and it was the secretary general's initiative to establish the mission for ebola emergency response. the resolution said the united nations entities to provide full support. yesterday the assembly approved the funding required. and yesterday, global government leaders met in washington, d.c. to discuss the critical issues, needs and possible solutions for addressing the health and economic impacts of the crisis. in that meeting, leaders underscored the potential consequences if the outbreak is not quickly contained. excellencies as you well know , the situation on the ground remains extremly precarious. the humanitarian workers are doing amazing work but despite their heroic efforts the epidemic continues to ravage the communities with the death toll rising with each passing day. in light of spread of the disease, we are concerned that the outbreak evolved from a regional to an international crisis as we have witnessed it in today's world. ebola can be at your door step. i am therefore pleased to see the international community has wasted no time to answer to the call of action. many member states have come forward with support in terms of financial and in-person contributions. for these efforts, never states deserve thanks. -- member states deserve thanks. furthermore, teams have been deployed to the mission in ghana. in this situation where each day potentially means lives lost the rapid response supports the implementation of containment measures and support. yet, when the initial response from the international community is commendable, much more needs to be done to stem this public health crisis. in this context, i urge you to follow through on your commitment and pledges of support. as we have said all along, addressing the crises requires action on international communities. your pledges of support are a vital component of the global response. the commitments -- beyond the commitments already made i have , proposals on how the global community can support the community with financial, humanitarian and other requirements. requirements. the international community must work together to come up with a practical solution to contain the further spread of ebola. in this regard, i urge people to remain aware of the evolving situation and share proposals on how to improve or streamline response efforts. even for those members who have already made contributions more is needed. use the opportunity of this briefing to make more pledges. i thank you for your kind attention. i now give the floor to the secretary general of the united nations. >> mr. president, ladies and gentlemen, first of all i want to thank you, president of the general assembly for creating this crucially important and timely meeting which i have the honor to represent the secretary of general while he is on travel. let me state from very beginning our response to the ebola epidemic must be swift and effective to mask the scale and emergency of the challenge. now is the time for action. we must catch up for the curve of the virus. the crisis is multi dimensional with serious effects not only on public health but food security, economic and social and political stability. hard one development progress is in jeopardy. neighbors are at risk. none of us are insulated from this threat poised by ebola. it is a global concern and demands a global response in compassion and solidarity with those affected. that is why we formed the global ebola response action to galvanize international reaction to emergency response and coordinate action on the ground. the secretary general and i thank the general assembly and also the security council and member states for decisive and generous support for these initiatives. this morning i presided over the first meeting of the global air response coalition. we noted a wide range of actions and commitments for the epidemic and discussed how we can most effect only -- effectively capitalize action. but let us be clear. ,while the un stepped up to play a coordinateing role we cannot do the work alone. no country, no organization can. this crisis requires collective mobilization outside and inside of the affected countries, as the president just stated. here i would like to play tribute to the courageous aid workers since the onset of the outbreak in march. many international health workers have lost their lives . many others working for organizations like doctors without frontiers and red cross workers are selflessly risking their life and many colleagues from u.n. agencies. defeating ebola is going to take the best efforts of all of us working together. governments, banks, international and non-government organizations, and many others. we must work to support the countries to implement their response strategy to ebola. to that end, we are rapidly deploying people and assets and working with unprecedented collaboration and speed. we are guided by five simple commands. one, stop transmission. two, treat those with ebola. three, ensure essential services. four, preserve stability. and five, prevent further spread. the u.n. peace keeping mission in liberia and other countries have been providing critical assistance for many months and continue to partner with the unified framework provided. on the 29th of september an advance team arrived and they just finished a week long assess assessment visit to the three most affected countries, sierra leone, guinea, and liberia, to assess how we can best implement programs without duplicating them. the secretary has appointed crisis managers for each country , and he is in regular contact with the president's of the three most infected countries. we remain engaged in efforts to forge strategic partnerships to through the global coalition to achieve to massive scale of resources that are so urgently needed. there are now over 18 newly deployed missionary members with more on the way but many more needed to reach the areas where support is most needed, especially at the district level. speed is of the essence. a contribution within days is more important than one within weeks. recent cases of the virus outside of the region is showing this is a global crisis. but the answer is not to close borders or to propose travel bans. that will isolate the countries not the disease and prevent , urgent aid from reaching those in need. we need international solidarity in the face of an international threat. the secretary and i are grateful for the number of financial and in-kind contributions flowing in. over $20 million has been raised in the last week but we need more. much more of the $1 billion needed. only one quarter has been funded. we need a surge in trained health care personal that can do deploy to community states. we need to make medi vack available to health care and provide the necessary necessary necessary things for surgeons to be deployed. and we need dedicated facilities for health-care responders in country who continue to work at great risk. and we must achieve quality care for all citizens in the affected countries. guinea, liberia, and sierra leone. we should always recall that with the crisis in the health sectors in these three countries now, there are so many people who are not getting normal medical help. the hospitals are overburdened and people are worried to even go to the hospital. so you can imagine imagine the number of people suffering and even dying from other diseases we would normally treat. that is not part of our statistics yet. we must also work to generally stregthen the health sector and make sure they have food security and stronger regional preparedness. in closing, ebola is an unforgiving and frightening disease but it can be defeated if we work together in solidarity with affective -- and with effective coordination. every hour counts. every contribution counts. the people of the world are watching. the people of west africa, now to a great deal, depend on us , although national ownership is absolutely crucial. let's give them hope. let us be at their side. and let us end this crises swiftly and decisively. i thank you, mr. president. >> i think the secretary of the united nations for his statement. i not give the floor to david, the special envoy of the secretary-general on ebola. >> mr. president of the general assembly, mr. deputy secretary general, excellencies, ladies and gentlemen, first of all, i would like to acknowledge the really important role of this global body in focusing attention on and leading the support for the response for the current outbreak of ebola. in my remarks, i would like to cover six points. i would like to talk about the history of the outbreak, i would like to focus on its significance, i would like to reflect on some of the actions being undertaken now to scale up the response, i would like focus -- to concentrate on the different partnerships being built, the leadership of different bodies in particular the president's of the countries and the coalition that is being referred to in the deputy secretary general's remarks. i will be followed by anthony who will give a more specific presentation on the work of the united nations and mission -- united nations mission for the ebola outbreak response. let me start with history a little bit. i worked as a public health doctor for 35 years. and i have been involved in many disease outbreaks and indeed some pandemics. but i have never encountered a challenge like this one in my professional life. the reason is that this outbreak has moved out of rural areas and come in to towns and cities. it is no longer just affecting a very defined location. it is affecting a whole region and it is now also impacting on the whole world. and this outbreak is advancing quite rapidly ahead of the control effort and the rest of us are having to work really hard to catch up and overtake it. but we know what has to be done. and together we are going to do it. and our commitment to all of you is to achieve it within a matter of months. a few months. rather than going slow and letting the outbreak cause a lot more harm and misery. so my second point is about the significance of the outbreak. it has gotten into societies in west africa in a very deep and worrisome way. for many of the communities that are currently affected, the day a person dies is the most important day of that person's life. that is the day when the spirits move from the person into friends, relatives and the community. the day of death must be treated with proper respect and ritual . otherwise it undermines the very fabric of society. yet people who are dying of ebola are very dangerous and if they are touched and if they are held at that moment of death , they can infect large numbers of other people because their bodies are toxic. their bodies contain the virus. it is often on the surface of their bodies. so unfortunately the time of death has proved to be a time when the virus tends to spread very widely. and in order to get control over the virus, people are having to change the ways in which they handle illness and handle death , and to move away from traditions that are centuries old. this has been a major difficulty for many of the societies that are affected. it is really only in the last few weeks, thanks to the courage of the leaders of the country's concerned, that there has been a much greater emphasis on people coming to terms with and owning the disease and changing their behaviors so that they are less likely to spread the disease. another phenomenon