>> >> if it comes to that and my opponent is not doing that and that is one of the important issues of this race. >> paul davis is ahead of brownback of 42% why is this so close? >> a very different dynamic with the senate race on national issues but the reason is built around competency or execution. and is of very aggressive program. and the effect is to blow a sizable hole in the state's budget without the boost he suggested. for that reason is because people are worried about education or transportation they have gotten a lot of traction out here. but the governor is also a fixture of kansas politics just like roberts known each other for a quarter century it would be a very republican state with a bill to the advantage but search of the unrest with some voters in kansas that you can see the types of campaigns we looked at that has a very dramatic effect on the futures. >> for the kansas city star from kansas city we appreciate you being with us give it great to be here this minute conversation on the outbreak of ebola and the first case in the u.s.. >> this cdc confirmed the first case of ebola in the u.s. this week. up next and dr. bill takes part of the discussion in the help break of the ebola virus. from milan to a council, this is 90 minutes. [inaudible conversations] >> good afternoon i am the director of the effort to center here at the land to the council. on behalf of the chairman it is my pleasure to welcome all of you and those joining us around the country including c-span about combating the ebola outbreak lessons learned from the international response. o i would like to welcome among those present several people who have links to the region that are most affected. most to his excellency from the the of republic of sierra leone who honors us. your excellency's our thoughts emperors' m. best wishes go to the people love your country as well as liberia and new guinea and i would think sierra leone from the beaches they'll have a special place in my history. also representative of the community here in town with the republic of south africa. we're also honored to be joined by the first u.s. ambassador following the civil war's for every u.s. ambassador to the african republic and rwanda at the embassy. before introducing our panel , and better deeply grateful let me say a word about the atlantic center. the african center established september 2009 with a mission to help transform u.s. and european approaches to africa by emphasizing strong geopolitical partnerships and strengthening the economic road to prosperity on the continent. engage with former -- formal policy makers throughout africa globally and americans and europeans in particular. within the context with the leadership and engagement international affairs with the authentic community meeting international challenges the africa center collaborates with public and private centers with a practical solution to the challenges and opportunities in africa and in spirit of this mandate i am pleased we're able to host this discussion. during this leaders' summit the largest and he has held with african heads of states organizing 11 high levels with cabinet ministers and business leaders as they celebrate the strengthening between the united states and the fastest growing regions. now to do our part to tackle the challenges of the ebola virus not just economic prospects but those as obama noted last week as a growing threat to regional and international security. much has already been done and i suspect there analyst will highlight the response for u.s. and international including the group's second been to earlier today in london but there's still a significant gap between where we are and where we need to be. i'd like the situations we found ourselves in the recent past including a response to haiti and the ongoing refugees from syria a number of issues related to the ability of national and international actors the complex fight in the shortcomings with respect as they continue to have contact. with epidemiology or public health to noted experts of both subjects are here but from what we need for what we need to learn so please join me to welcome our panel. biographies are available if you are present so apologies for the brevity for national discussion. first fidelity coordinator of people live response that the u.s. department of state most recently served as united states embassy in didn't new delhi and was appointed people love coordinator for the state department. he began his career in denver service as the peace corps volunteer in sierra leone. the deputy director for policy and communication at the cdc prevention and global whole center with extinguished the dash distinguished experience in the legislative branches. and the assistant secretary of defense for humanitarian affairs with the civilian they'd in the pentagon response. and the commission officer from the medical corps with military hiv research programs a leading authority on he epidemiology. to show the possibilities for the vaccine of the hiv virus. finally the managing director and chief executive officer wrote the current crisis of monrovia i it have known her as of personal privilege to has a personal commitment i can testify to the effort she undertook to take on too literally try to save one life. and we're delighted for you to partner with aspin. now let's turn it over to use the panel. >> ladies and gentlemen, good afternoon. says many, many years served as peaceful volunteer i am no medical expert i don't have a military background i don't know much about ebola but i know the strength i have great confidence that we will get through this terrible epidemic and the rest of us can help. we will talk about the u.s. response with this crisis and i will talk about president obama when we spoke at the cdc headquarters said the ebola epidemic is a global crisis requiring a truly global response. since the first cases were identified in west africa pursuing a whole government approach focusing on five discrete areas. coordinating with other countries with support from the u.n. relief effort provide research to health care workers to encourage u.n. leadership of the ground abroad and well-informed. after the earthquake in haiti and the tsunami of the coast of indonesia the u.s. government shows the capability to react to the international crisis. in the same way the u.s. military and civilian funds and government on the ground but it is our belief that the rest of the international community would take increasing roles over time for u.s. secretary general has greeted the un commission for a response which includes a command center that will provide logistics' and overall coordination for the efforts with the individual special representatives and last week that obamacare participated with this true coalition. the white house or the state department with usaid has worked tirelessly to sign countries that for the global coalition. we are at 35 countries with the fight against the bullet and five international institutions. with bilateral and multilateral has increased significantly. two day seem more than 200 million. in terms of the international financial response with over $400 million to the effort the imf is the assistance of millions of dollars and add to that private-sector response from the gates foundation the paul allen foundation and others. we will also see a lot of progress in terms of commitments to build. the critical list is from these far-flung corners get built quickly. the british government has committed to building 700 including the hospital specifically for the health care workers that are infected. that the military will build a system for all ebola patients and forest regions and the german government treatments contribute to a heavy cargo aircraft plane to build the air bridge with supplies of personnel. even contributing $1 million to find ways to contribute. with the international health care workers to provide peace and care but also to train workers. to prevent them to step up in greater numbers is the need that should they become infected they receive a high level of medical care. with the state department it has entered into several partner countries to provide medivac coverage for other people working on this crisis. to date united states and several european countries out of west africa in retry to ramp up that capability united states working together. but those people being evacuated the cost is paid for by the sponsoring organization. those with financial support health care workers and strategic airlift into west africa. but as the president has said where we are today a to head off a crisis. thank you. >>. >> thank you for the state department leadership on this issue. with our own employees i know you called yesterday with the global community and that confidence makes a different. so now i turn to west africa and a few comments about global whole security. but it is unprecedented rapid scalable is essential to reverse course. i would also say we have the unprecedented opportunity to control future infectious disease threats to implement the agenda that president obama so just briefly as many of you know, , along with texas health officials the conference as started at 1:00 today for those questions that you have and i am not directly involved in the domestic response and could not respond to inquiries you have about that but with the involvement of the united states we have 10 people dispatched to work with texas health officials contact tracing and infection control. more broadly working with public health and officials from around the country on preparedness and guidance from managing ebola patients. with those issues related to screening with airlines and other federal partners. but may turn out to west africa. for more than 7,000 reported cases in west africa but is in liberia alone 3700 reported cases health care workers have been disproportionately impacted with significant consequences what was already a week -- and need to recoup health care workers. right now the epidemic is doubling in scope every three weeks and the exponential increase is not slowing. the epidemic is likely to get worse before it gets better. despite the efforts by the global community. and there will be large consequences including economic and social. but there is news that together we put in place a response that can occur most importantly of the isolation and control practices with this epidemic. the one to say a few words about what cdc's specifically is doing and i have been with the cdc almost 20 years and watching them respond to the hiv epidemic to natural disasters to the flu and liz has a unique flavor. cdc has more than 130 staff deployed to west africa. but watching heliports they come to volunteer but we also have several hundred people around the world supporting staff to provide services. everything we do to be clear is in service to response of the home countries we are not working separately it is critical the country is charged it is essential that we support all the. includes laboratory and diagnostic or epidemiology which means to really understanding and characterizing effectively and smartly respond. with the communication that means to get culturally appropriate messages out to people protested messenger. and their infection control it is the area that is neglected and the highlights the importance. also there is the clear structure to manage the outbreak. them perhaps most importantly to work are mannar with the u.n., ed who comment world bank and private sector all have come forward with extraordinary commitment. with the role these entities have played and how important to the medium and long term with rebuilding. the collaboration has been excellent. with the usaid and in hhs all of whom have critical roles. despite the bleak news and potential of the crisis to get worse this hope and i want to mention a few of them. one is the in country leadership is committed to action and open to input and eager to assess. more than 90 percent of responders and health care workers and local staff. this really has been deeply appreciated at all levels with pockets of resistance they can readily overcome with better communication. ebola is not bred easily we can stop the spread with the burial practices and the ways in which the virus spreads. but it will require not just commitment scale of isolation and treatment capacity. but just a word about global health security the current ebola epidemic is a tragic illustration of the important improving global health security and the necessity to an advance the agenda. meeting with the global leaders last week the agenda aims to put every country in a position to stop before they become emergencies with better infection control and safety practices. now with the use of disease detectives to respond rapidly when they rise it is that management systems. as the cdc director has stated as components of this agenda in place already had read detected earlier to control. in closing i want to reiterate that rapid scallop is essential to bend the curb we do have an unprecedented opportunity to implement the measures from last week. thank you. >> ladies and gentlemen, figure for the opportunity to be at the atlantic center panel with interagency colleagues. we at department of defense are now working so closely from dallas reinforcement this epidemic is not something from which the united states will be able to isolate itself to support what we knew already the need for a coordinated government and private-sector response has become all the more urgent. those exposure not new but the interconnected world they are intensifying. i would like to take a few moments to share the idea for its with a epidemic in the context of the whole of government under way i would emphasize the department of defense undertakes its efforts of the civilian agencies with the accord meet the response of the epidemic in the field as well was closely with the department of state. and identifying the epidemic as a national priority for the united states. the department of defense is engage because it has unique capabilities to provide interim solutions but it can have more international efforts to have terrible human suffering that we see in west africa. it deploys u.s. troops in the unique capabilities including command-and-control in addition the program has unique resources and expertise for surveillance in the region. secretary hagel has approved activity and let me take you through these. the first line is command and control on september 15 secretary hagel wanted united assistance that efforts to the ebola outbreak. the commander of u.s. army africa u.s. africa command is the official commander. and to be in monrovia approximately two weeks coordinating with u.s. embassy team and end working closely with officials on the ground and the government. on tuesday the department and now secretary hagel will have to plan a 700 soldiers from the first airborne division from kentucky to become headquarters staff from the joint forces command in monrovia. and for those of various engineering units of the ebola treatment units by that expertise in those deployed to the region as a joint task force was formed with said dot element of the overall response to to the outbreak. close coronation with the usaid disaster assistance and with the usaid response management team. recording of the international level for the emergency response and partner countries that contribute to the response. the second line of beverages logistic support the department has initiated assistance with the commitment of the 25 bet hospital providing a local treatment facility for health care providers should they become ill or injured last weekend it is being prepared for construction. in respect the results in the coming weeks it will be manned by a health care professionals the public health service team is on the ground in bavaria. more than the ebola patients that have come out with protective equipment and other medical supplies. in concert with other international partners up possible establishment to support u.s. government and efforts that will include the development of their chance rotation and capabilities and the further provision of other supplies planning up 2/6 months for those facilities maintained by the region and the third line of beverages engineering support we have the joint force headquarters in monrovia so to support the construction of that et you to deliver care. as you may have seen already in liberia to view the etu and the construction military engineers are working with engineers of the armed forces of liberia who are committing their efforts to etu construction as well. the first will be0nk >> >> we are working hard but we cannot do this overnight and responding as quickly as we can but it will take time to get people on the ground to support this mission. with that i will yield to the next speaker and be more than happy to take your questions. >> no return to colonel michael. >> ladies and gentlemen, i am speaking to today someone who has spent his entire professional life those of stigmatizing disease and i will tell you that in my experience there is always room for hope there are epidemics of disease but ebola and hiv are epidemics of the year ended is time to concentrate hard on what we can do with public health responses and to look at things as newsworthy and infection control to understand this disease has struck east africa multiple times. there is a public-health response that i think we will get there again. ultimately to bring of pandemic to with neece to be effected a preventative vaccine. something that we have achieved partial success who was sitting in the second row is our person in thailand who made the trial work over 16,000 individuals in thailand and i would get back to that at the end of my discussion because amateurs like to talk about tactics but professionals talk about logistics'. at the end of the data's statistics to make the public-health response and counter measure efficient. so i will talk briefly about what is being done in the context of developing vaccines. for well over 10 years there has spent an effort in the field with many stakeholders that has brought us to the point where we are today. because of the nature of the central african and epidemic the pace of development has been steady but not accelerated. because of the nature of the public health emergency you have heard. the two vaccines and want to tell you about that gives you the impression fuel from monday and tuesday and was in geneva where there was of world health organization consult on the ebola vaccine where the consensus summary is sorted posted on the duration a website so there are two vaccines that are the farthest forward in development. one has come from the public health agency of canada working with stakeholders that include academic groups from all around the world the u.s. national to -- nestle institutes of health. this particular factor has been modified to a produces a portion of the ebola fiber is that the vaccine itself cannot give the individual ebola a that is an easy concept to accept then don't underestimate how difficult it is to get to that message. they do not cause the disease but contained a portion of the virus that we hope will provide effective immunity. the other vaccine developed largely by the national institutes of health and most specifically by my very good khaled colleagues that the vaccine research center working with that group since 2008 because my program is all over africa and we tested earlier generations of the vaccine and uganda. there is now a new prototype we expect to start testing again in uganda in march of next year now we will start that steady and about four weeks. once again the pace of this development which was steady has been accelerated. now choose to tell you about each of those vaccines the most important thing i can tell you is they have not yet been tested to be shown they are safe and effective in humans. both vaccines have been shown to be effective in what we call the animal models when you test these vaccines in monkeys were their vaccinated, and then exposed to very high amounts of ebola virus, even giving very large doses could be shown in animal groups of six to be 100 percent protected. but the question is whether or not whether wave vaccinate ourselves of that goes to a national exposure. i can tell you that the initial studies began initially at the vaccine research center at the nih and i refer you to their web site for full description. additional studies in the united states as well as around the world. and the steady that we would be doing in a few weeks in uganda but the idea to get to understanding the vaccine first and foremost, is safe. i will remind you of the hiv vaccine natalie shows it did not work but it increased the chances you to become hiv infected. but as a note of caution how does one do these kinds of studies overseas? have they do days ago kinds of trials with the placebo or others to see how that works in some individuals. i will tell you that the end of the day to be absolutely certain to get the quickest results the a who continues to explore what we call a randomized controlled trial. so that kind of environment where all kinds of ways to test the vaccine and not give it to others. many issues of bioethics. this is critical input from our partners the safest way to understanding is to do these studies in africa. i will tell you there is a very large pharmaceutical company in belgium working closely with the research center and a company called new links genetics in ames i was also working on this. billing back to the comedy of interagency efforts to be ready looking to get -- working together people forgetting which uniform there where or who pays the paycheck both our government and outside of the united states these our position sarah the most involved with the control efforts in the country. but let me get back to two critical issues. and speaking powerfully to this logistics' with the epidemics of fear. in order to do these controlled studies rekeyed to get to places where people are at risk and secure the integrity of the vaccine and kept at a very low temperature and areas of the world to collect quality information and to bring people back including colonel kim the came down to fixing those logistics' those unheard done on a very large number of people for the quality for a good logistics' not just for the discipline countries i think that we have to think very hard about. the last thing i want to leave you with is the issues of epidemics of fear we have learned over a generation that it is not just a platitude publishing a document of a good bridge is the tory guideline practice to look at the 89 days document shows a way forward those that tested with complete immunity involvement during the entire life cycle from sitting on the study teams to make sure when the volunteers are given informed consent the best of the understanding a compact and transparency with these individuals and the volunteers. to do the studies despite how well you think you can do community engagement you cannot do enough and that is incredibly helpful to go forward to say i got the vaccine from the westerners now i had a bullet it did not work for us. maybe they gave it to me these are critical questions working continuously so i would discourage all of us to take a deep breath going forward to develop countermeasures we need to be extremely diligent about community engagement. thank you. >> finally christie rogers. >> i do want to thank peter and atlantic center to show such great readership to commend this panel while the crisis is ongoing and the international aid effort continues to unfold. talking about a coordinated effort and lessons learned that for everybody in the audience to highlight what we're doing to identify those areas to make improvement and what we have not focused on yet while the effort is unfolding you need to be commended. thank you. i am here today to offer a unique perspective i want to thank my colleagues and friends for their ongoing efforts in response we have been on the ground in liberia since june. we enter the country working to improve with they were getting. we ended up to take over and rescue a clinic and to the strength of the team able to stabilize the clinic and improve services and upgrade the equipment and keep the doors open. i would not recommend this in terms of a business model to takeover of clinic while the ebola crisis is unfolding. but because we have such a dedicated group of professionals and intensive care paramedics we were able to do it because of commitment. just call little a bet -- a little bit about our company with a growing footprint in africa we provide a whole range of medical and health services to companies companies, governments and ngos working with the communities so the full range of health care services ranges from delivery to training of specialized staff training of the first-aid responders or to staffing and managing and operating any size clinic whether merger care or special care to provide indoor services and aeromedical evacuation which i will highlight momentarily. while that ebola crisis has unfolded for the countries affected it is also the economic crisis that will go beyond the public health crisis once ebola is contained we will have these impact on the local economy to be deep and long-lasting. one of the things that i think the international aid effort which is very generous has overlooked, the involvement of companies who are operating their. x pats' or those that employ local nationals that have a unique skill sets to be rapidly mobilized. once we're on the ground if you recall ebola was not on the front page of every paper we did contact of all the local and international organizations operating their. we knocked on every door to say we are here we have western trained doctors and nurses and we continue to say that we currently served 900 individuals now offering care right now to ebola victims focusing on an urgent care and general health care. that is critically important as well because right now most of the public health care facilities in monrovia and are shutting down. focus 100 percent of the overwhelming crisis. what happens to those individuals who have appendicitis or those mothers giving birth in the st.? that is a problem and a travesty we can quickly mobilize with our current capacity. we can mobilize with those letters similar and remote medical facilities to focus on the remainder of the population and also to ensure public awareness is increasing and those individuals who work to try to keep the company's open to try to stop the exodus of those that are there to give them workers a you are fine don't leave now they need you now more than ever. and we say we're there to help. i see my colleagues in the audience. we are their. we have people on the ground as well but we also understand it is even more of a travesty. we can rapidly mobilize. death from today was convened to talk about and highlight the coordination and a effort but also lessons learned. i have been involved almost two decades the stabilization efforts in disaster relief efforts that we embarked upon in this country. one thing that is similar is what about the private sector? where they involved in the planning stages? not takeover but what can they do to be a force multiplier to mobilize? they do have a unique skill set and they are generous but to coordinate the corporate social responsibility programs. a lot of these companies have huge public social responsibility programs to give back and train health care workers and cancer screenings and increasing public awareness. without coordination a lot of companies don't know where to focus their efforts with the international aid efforts aside from just donations i think it is happening to an extent. but the choosing several highlight regarding the dedication, we are partnered with a local library and dr. , extraordinarily well trained and incredible human being. he was one of the first doctors to contract ebola while taking care of his very good friend working at jfk hospital. one of the first doctors to die. . . we do aromatic evacuations as well. one of the things that peter highlighted in the beginning was we had an extraordinarily unfortunate case early in august where we had a 24-year-old u.s. citizen who had an infected shunt in his head, had an ebola test and tested negative. he needed a neurologist. he didn't have one at the clinic and there was one available because the public facilities had shut down and library so we were trying to get it out. i had a plane ready and i had a pilot ready. i had everybody ready but because we couldn't secure landing rights in a neighboring country unfortunately our patient died. i have been an outspoken advocate on the coronation effort and working with the local neighboring companies and the state department and the department of defense to make certain that while we are taking care of folks -- that we are not forgetting about everybody else who may not have ebola to have another urgent case and to make certain in our effort we can continue to take care of them and provide for the avenues of success. with that i'm going to leave it open and thank you again very much for being here tonight. >> thank you christiane thank you to all our panelists. i will exercise the moderator's prerogative and throughout two related questions and invite any members of panel who want to comment. recently in the last 24 hours we have had a relatively senior prominent leader in one of the countries go on france 24 and denied and refute -- tried to refute the worst-case scenario of the cdc model of how the spread of the disease -- on the one hand and on the other side of that is the question of speed up ramping up our speakers have all highlighted the difficulties that are being overcome with still the effort is taking time and that is on one hand stepping back on what happens on the other hand we need to move if we are not going to get the worst-case scenario. if any of our panelists would like to comment both on the modeling of extreme cases perhaps our experts on epidemiology lightweight in on why that's a valid point that was raised in the study and simply -- is not the right thing are also balancing that with the question of timing as a response so open for anyone who wants to jump in on the scientific side or the implementation side. >> i will just say -- we are all looking at cdc. >> on the model the critical point in the model was the need for rapid action and what the costs are of moving slowly. it's less important whether the worst-case scenario is precisely right. it's a sufficiently concerning devastating number that if we get even close to that number it will be an awful outcome. i think the modelers are quite correct in their assumption that we need to move quickly and that every day, every week and every month that passes is an opportunity for the disease to spread in a way that it would require us to more than redouble her efforts that do things we are not prepared to do right now. >> i would just say addressing the issue of modeling is very difficult because small changes in a whole variety of parameters is a mathematics exercise. a very small change in assumption is going to be a huge outcome difference in models. if you look carefully at what models have published or the w.h.o. meeting you see a range and you have the best and worst case scenario. every week as you actually get real epidemiologic data and this is something that dr. shriber emphasized and i can't emphasize enough the ability to track the attack rates to really understand that the subnational level where the disease is, how bad is it is critical because it allows you to track where the logistics go and where the resources should go in designing a vaccine study where the best balance between where you can logistically do a study and where the attack rate is going to be high enough you can get the answer the most rapidly. therefore make a decision than about public health rollout of the vaccine. i think the issue to me isn't so much the modeling, it's the need for hard logistics and hard epidemiology. you can't separate the two. the last thing i would say something we have learned from the relatively small amount of epidemiologic data is actually a good news story. if this were respiratory disease something that may be a disease like sars those kinds of diseases or any one person has a disease you can in fact up to 17 people. and epidemiology they would call that the arc of zero. when that number gets to be less than one it means the epidemic is on the way out. that's all vexing people thing. the number from the hour zero number for ebola is around to so for every person that's infected that person usually can infect up to two. it doesn't mean it's the only way we'll go but on average. so this should be the kind of epidemic with the right public health responses in terms of putting in this basic prevention package as well as effective vaccines and therapies that should be an epidemic that would be easier to control than some others. it's less to me the issue of what anyone model data gives you any results but they need for having data to best inform the response. >> i want to open it up to questions. i would ask you to wait for the microphones to come to you and then to please identify yourself. i think it's only proper to give the first word to his excellency the ambassador of sierra leone. >> just to make a short contribution to this, the question one would want to ask and several people asked the question is -- for this kind of epidemic. one is it correct to assume that the. [inaudible] so the question was was it prepared? from what i know, from what i have been reading you weren't prepared for it. a year or two ago their budget was slashed especially in public health area and there's a lot of red tape from the time they are informed early on. the epidemic was discovered and the first thing they did was to inform the population. we think they were underresourced and not ready so maybe there's a paradigm shift to get the w.h.o. perhaps to be ready for these kinds of emergencies. one would have assumed that they were ready but what a surety is there? they didn't have the money to do it. that is when i started going to their various -- asking them for money and that's my contribution. >> thank you ambassador. the gentleman in the second row. please identify yourself. >> my name is peter connor and i'm from texas. i'm a national security consultant with a focus on science and health and cyber. my question is to dr. nelson michael. he talked a great deal about vaccines and i'm sitting next to your vaccine expert here but i didn't hear in the address by the panel much about therapies and i do represent a company that has a therapy that set the fda right now looking for an emergency exemption for it. what anybody on the council or dr. michael care to address that question about potential therapies? >> the reason i didn't speak to that specifically is because it's neither my field of expertise nor is it anything currently right now that the institutes i'm associated with in research is actually doing. i do know there have been developments obviously of a wide variety of therapeutics to include antibodies and in the field right now i know my colleague from liberia is testif taking plasma from individuals that survived which is rich and antibodies that might be protective and giving that individuals that become ill. there are more interesting and novel technologies come interesting from the standpoint of me as a scientist like small interfering rna's. that may drive some of you to wikipedia but there are small molecule inhibitors much like the drugs were used to treat other diseases especially hiv. there's a panoply of therapies being developed and i can tell you they are newsworthy but there is not a lot of information that i have seen yet that would lead us to quickly coalesce to go forward. this is usually the province of pharmaceutical companies that do this better than anyone and i would tell you that i know there are active efforts along those lines. again to reiterate specifically i did not speak to those because it isn't something i'm directly involved in. >> i think we have limited information about new modalities that we do know that basic treatment can make an enormous difference in survival rates, so these are basic things like hydrating a patient, balancing their electrolytes in treating infections as they occur. >> i think we are really hitting on a critical point. i would refer you to a "new england journal of medicine" article by jesse goodman, a physician who recently stepped down as the chief medical officer of the food and drug administration and he refers to another outbreak of a deadly disease that occurred in this country with anthrax in 2001. it carefully shows that we thought at the time that inhalation of anthrax in the 90% fatality ratio. you have a 90% chance of dying even with effective antibiotic therapy. in fact that rage was more like 45% because you could do good intensive care. with ebola you need to take care of the interop with the bit you get. body salts especially potassium and magnesium and oh by the way you can't fix potassium and lesson you have magnesium to replace it. there are things that intensive care nurses would know about that in stricken areas these are more difficult. as you improve the clinical care just the basic clinical care without some of these more novel therapeutics you will see the case fatality rate drop. why is that important? is important for the intrinsic reasons of protecting human beings but it's also important to recognize when you're testing therapeutic's if you assume the case fatality ratio for anthrax was actually 90% and it was 45% giving the time you feel that the therapy actually kill 20% of the people you end up with a 65% mortality you would have thought you were doing a great job unless you had an active contr control. i think it's important as we talk about countermeasures being therapeutics or countermeasures helping otherwise healthy people using vaccines. we need to be very careful going forward. >> my name is robert griffin and i'm a retired ambassador. i was most recently the surgeon of affairs in sierra leone in august and part of september. i would first like to say a word about embassies. it embassies or the u.s. platform out there and we focus our efforts on relocating families. we focused on our mission. we have become an essential platform for the cdc and usaid activities and presumably for the military. i had to ask where has africom been for the last six months? this should be something they were focusing on and there was no military focus until two weeks ago and i they think it's a johnny-come-lately and something of a shame for the policymakers to have neglected getting involved earlier on. but on sierra leone itself there is no question that the population is traumatized. they are scared that they are also very accepting. their societies collapsing. there are no schools. the health infrastructure is close. there's no place to go to have your appendix taken out or get a malaria pill. all of those things that close. the internal constraints, there is not food coming into the cities the way it used to because of roadblocks and other concerns. there has been a massive education effort on the part of the government with its international partners to teach people about ebola, about what to do. don't touch somebody that's sick. don't touch anybody that is dead. call the numbers. get the help and report the cases. people are quite aware i think of the immediacy of this and if not in sierra leone they had a national shutdown and everybody had to stay home and was visited by health workers to find out about this. i think the people are getting the message and that got the message. the rumors about who started it and why it started and what was causing it and who is responsible, have all pretty well faded away. people understand that this is a terrible disease and it's a tragedy that they have to face and work with. i have confidence in me government of sierra leone and the organization that is out there now is well-established and doing the right job. and the question as you mentioned is getting enough people there doing enough training. we have the money and all the equipment coming in so the question right now is really trying to get ahead of the cur curve. when dr. frieden was out there he used to say this is the rise of ebola in west africa. liberia is a peer in the top of this curve and sierra leone is only halfway up. it's time for sierra leone to hault that curve and i think the international community is bringing those resources into place. i think from the perspective of the field i think we are getting a better handle on what's going on. that was my comment. sorry there's not a question. >> thank you. >> i just have one comment. there's no room for complacency. we are all hungry for good news but at the first sign of good news it doesn't mean we can give up our efforts. it's absolutely essential that we pursue this with the same figure. >> that provides a good jumping off point for my question. i am judith kauffman formerly of the state department, now independent consultant working with lm pie which has robust medical supply chain and logistics practice which i work with. and i thank all of you for the work you are doing and for the passion. ms. rodgers you correctly pointed out to the effect this is going to have on the economy and we are all i think worried also about the impact on an already fragile health care system and the private sector can't make up the difference. so my question particularly to the government people is what are you doing now? how are you thinking, who is responsible for ensuring that this emergency response which is vital. he can't do without it but that it doesn't do further harm to existing systems and in fact works to build better and stronger systems against ebola. >> i can try a couple of words. there are four primary goals of the u.s. administration in terms of its efforts on ebola. one of them is trying to blunt the second order effects on economics, on the social fabric of these countries as well as on the political systems. what we are seeing already and you can read it in any paper the absolute collapse of almost every kind of infrastructure that you need to sustain life in these countries. the wftu has been a leader in trying to ensure that people are not going hungry, bringing en masse quantities of food. the world bank and imf have made enormous commitments to try to stabilize the economy's. it is not nearly enough. over and over you hear that message but whatever we are seeing on the ground and the ambassador spoke of his experience in sierra leone there are tremendous things in the pipeline heading towards this region. they haven't gotten there yet so the one thing i want to leave everyone with is the sense that for the u.s. government we believe it's absolutely essential the borders remain open, the ports remain open, the commercial airlines remain open. i was on the phone with john hoover our ambassador in sierra leone. he arrived last night. it's really hard to get to sierra leone right now. it was hard years ago when i was there but it's really hard now. it will get harder as the world shuts down to this part of the world. we need to flood this area with supplies, with people and with our systems and the only way to do that is to keep these channels open. >> there have been a couple of questions about the military response and this is an implied question as well. it's important to understand that what the department of defense is doing is first of all at the request of our civilian agencies so the questions about when we got there and what scale we are operating at relates to what we are being asked to do. we are asked to come and suppo support. we respond and we are responding with all due speed and we do have the joint force command setting up on the ground. we do have some 200 military personnel already in monrovia. we are engaged in this as intensively as we can be but as i said in my remarks this isn't an overnight process and this is going to take some time to get our personnel and equipment into place. in terms of the type of respon response, the dimensions of the response in which we are participating again responding to the question that we just got, again in support of usaid and at responding to what it is that we are being asked to do to create a kind of an interim solution if you will so that these other kinds of resources can come in behind and can help to shore up infrastructure and capacity which is so critical for the long-term. >> thank you. i want to thank you peter pham pham on atlantic council and each of the panels and also the obama administration. our country was the first to respond in this coordinated effort and that's something we should all be very proud of. i think you know colonel michael you talked about fear and how this spreads and i think akers in in terms of technology is very important. west africa is everything fro from -- to cape verde. two other countries senegal and nigeria where one or two cases have been reported and a half 11 others which leads to my question. this morning it was reported that "cnn" said that a member of congress is requesting that fights the banned from quote unquote west africa and you talk about economic growth that is taking place on the continent, this is just very unfortunate. so my question to all of you is, i think that isolation in this regard would also be completely decimating these three countries that are at the mall significantly impacted and i would like to know your views. thank you. >> i'm actually just going to jump in. i have been working very closely on my team in the ground closely with library in particular but also working in sierra leone. with the government of liberia and the ministries of health and customs by the customs agency i should say plus a u.s. embassy there to ensure that our supply-chain remains open and we can actually get equipment and health supplies into the country. one of the casualties and fatalities of closing the borders was a patient -- so we take it extraordinarily seriously. it's not just the economy but it's why you can't close the borders. i would say our contact into an indication of usaid in dod and the state department has been very helpful and as we are working hand-in-hand with ambassador headquarters to ensure the lines are open. >> i would just add to that, many of you know some of the training that's going on with health care workers from west africa is in the united states. it was in europe and in places beyond. then we'll have our full effect in terms of our ability to be successful in this crisis. i would add to that the u.s. customs and border patrols a set of protocols to protect the american people from the potential visitors to this country. we are refining this every day to make sure we keep ourselves safe. >> we are running short on time so i would like to maybe go in reverse on and invite members of panel to make final remarks or final comments or observations. >> i would just say in the closing remark again thank you for your attention on this. it's an every day in the headlines now so it's hard to avoid it. but i would say that there are individuals, there are companies outside of the international aid in geos and governments respond who are willing and ready to go. we have not, not been able to staff any for jobs with u.s. doctors, nurses, paramedics. it's important to remember and it's important to know that we can mobilize very quickly and the big giant way, the companies that are outside of aspen medical in aspen health care so thank you very much. >> i would like to thank the atlantic council -- atlantic council for fulfilling an important need for us to have open and transparent discussions that are data-driven so i think that is the ultimate antidote to get away from the distractions of the epidemics of fear and concentrate on infectious diseases. >> likewise. i think the atlantic council for allowing us to get the audience a better understanding of at least some dimensions of the u.s. government response and how it is and are playing with the private sector response. i think it's important as you just said to increase the level of understanding on what it is we are doing in the challenges we are facing and how it is we are working together to address the response. >> thanks also and it's been a pleasure to serve on this panel. a couple of quick points. first just personally i've been struck by the heroism of individuals and organizations. i think nsf has served as not just a force on the ground but a conscience for the world. jim kim at the world bank has shown vision and leadership and generosity beyond what any of us could ask and many front-line health care workers in the affected countries have also shown extraordinary courage. we have seen incredible resilience from people in affected countries. there was a brief comment about w.h.o.. i think one of the many lessons to learn from this is that with relatively modest investments we can prepare most countries around the world to prevent to prevent epidemics and manage those that they can prevent and we need to look carefully at moving quickly to do the things that are necessary to make that happen. >> we all learned if you meet someone on the street in a person greets you you often say in response, i fell down but i get up. i think our friends at sierra leone will pick themselves up after this but hopefully they will do it anyway with the support of friends from all over the world. >> i would like to conclude by thanking all the panelists for their valuable time especially during this. of crisis when there are so many demands on all of the responsibilities and the office for media me and others, taking the time to help inform our deliberations, our discussions here. i also saw a theme emerging. we were talking with panels about lessons learned or prospects. in many respects i can't promise when scheduling issues but i think we need to reconvene to talk about the longer-term impacts. the united states under the leadership of the president and others in the agencies represent an incredible as was the private sector incredibly generous and responding. what is good about us as americans we respond well and the sustainability of the long-term, not just the economic and health care for structure but i think the social fabric of these countries. i think there's a lot to do there and even the basic government shortfalls. the world bank came out a week ago with a percentage point they were shaving off economic growth in these countries and doing a budget shortfall of already restrained budgets and a vicious cycle and how we can sustain this not just this year but in the years ahead. please join me in thanking our panelists. [applause] [inaudible conversations] [inaudible conversations] >> naaqs, the head of the international monetary fund discusses the global economic outlook. christine lagarde also talks about the ebola virus and warns if it isn't contained it could pose a significant risk for the global economy. this event from georgetown university is an hour. [applause] >> well good morning. it's my pleasure to welcome all of you to gadsden hall. i want to thank you for joining us this morning. for more than a century this hall has served as one of the most important places for public discourse and discussion here in washington and today we deepen that history as we come together to engage in conversation on the most pressing issues facing our global economy. to provide insights we are to have with us interim director of the international monetary -- christine lagarde. madam lagarde a steward of the imf during a period of great challenge in our global financial environment. she is here today to talk about a way forward. and in the world the imf is playing to promote financial stability and growth around the world. there's great urgency to this work from how we respond to issues of poverty and inequality to our assumptions about growth and our economies. as a university it is our role to imagine anew how we can better care for one another and build our societies so they can be more inclusive and how together we can address the challenges that confront us whether through the formation of our students as women and men for others to the inquiry of our faculty and in the responsibility that we have been promoting the common good, it is the ethos, the characteristic spirit of the university to seek the betterment of humankind. you can see this work, life in settings like this and in the context of the global economy and the worker programs like our masters and global human development, our masters in applied economics and r. marquart school of public policy where we recently announced that the 2001 nobel prize winner in economic economics sciences currently senior resident scholar at the imf will be joining our faculty in november. in today's lecture we seek to gain a deeper understanding of the financial challenges and opportunities of this moment and to engage in conversation on the policies and approaches that contribute to global prosperity and economic opportunity for all people. an experienced government minister, an expert in antitrust and labor issues, the first woman to serve as finance minister of the g7 nation in and the first woman chairperson of the american law firm baker and mckenzie adam lagarde offers an unparalleled prescript -- perspective into the global system. she is held many posts including finance employment as minister of agriculture and fisheries in 2000 the financial times named her the best minister of finance in the eurozone. she also served as chair o of te two g20 one friends assumed his presidency for the year 2011 and in that world launched a wide-ranging agenda on the reform of the international monetary system. in her role as managing director of the imf oppose she has held since 2011 she has sought to bring stability to the global economy, dance economic opportunities for women, strength women, strengthen member state representation and promote inclusive and effective economic growth policies. her recent address in mexico at the international forum for financial inclusion she described the economic imperative of developing and inclusive economic system. she said in a quality is not just a moral issue, it is a macroeconomic issue. she continued, our research tells us that countries with higher inequality tend to have lower and less durable growth. inequality chokes the prospects for individuals to realize their full potential and could choubey to society. whether it's through personal experience or empirical evidence one thing is clear, growth has to be more inclusive and for this finance has to be more inclusive. we welcome madam lagarde to campus day today at the moment of significance frye as they approach their annual meetings here in washington. we are grateful for her presence and the insights that she will share with our community. ladies and gentlemen it's an honor for me to welcome to the podium, christine lagarde. [applause] >> good morning to all of you and president i would like to thank you very much for introduction i would like to especially thank you for having quoted the speech that i gave in mexico. it is definitely a country that epitomizes some of the points that i will try to make and they caused my remarks this morning as the country that tries to include particularly those that did not have access to finance, those that do not have access to the job market and i mean by that often the poorest and frequently women. madam ambassador, delighted to see you here. mr. dean i am pleased to look forward to you handing the questions from the many of you who are here today and it's very very nice to be here at georgetown university. i'm really honored to be hosted by one of the finest schools of foreign service. i looked at your mission statement and correct me if i get that wrong but i read that the mission is to contribute to global peace, prosperity and human well-being by educating future generations of world leaders. now the founders of the school back in a year that is very famous for me, 1789, the founders of this school had a very ambitious and sustainable vision. they were inspired by some of the writers and in what happened in france around the bus deal in 1789 but i'm sure they had no idea that only 70 years ago in 1944 the bretton woods institutions including the imf would be founded with pretty much the same purpose in the same mission only using of course different means. the focus of your institution is education. our focus is stability around the world using all the means that were then available and which i will tell you later on has evolved over time. so we are in the same boat. and as i look at the gray and blue colors of georgetown university, the colors that adorn your beautiful campus and the colors i have tried to replicate with my scarf -- [applause] i am actually reminded of the things that i would like to touch upon today. because essentially what i will focus on is the gray clouds that we have on the horizon and the blue skies that most populations around the world aspire to. we have that integrity at the moment between the aspirations of the blue sky and the gray clouds that are coming out. before i do that because those will be the topics addressed as you said mr. president next week by the 188 governors of central banks from around the world. that's the management of the imf. they will be focusing on data they will also discuss how the imf can could choubey to pushing out some of these gray clouds. let me just tell you a little bit about the imf on the occasion of that 17th anniversary are celebrating. it was founded as i said in 1944 as a world war ii was coming to a close in new hampshire bretton woods. and for the last 70 years we have been doing quite a few things. we have been fighting many crises around the world starting in europe moving over to asia focusing on latin america and then we have helped many developing countries integrating into the global economy. we have provided enormous technical assistance, capacity building around and historically we have are very much a referee of variation of currencies. that hasn't faded away as the monetary system has evolved which was predominantly a fixed exchange rate to predominantly a floating exchange rate. the surveillance activity in the monitoring and support, that is still with us. in the recent years, we have provided financial support through programs to many countries around the world predominantly in europe. in recent months we have extended support to countries like ukraine, countries in the middle east and most recently the three african countries that are the victim of ebola. we put together in next to no time literally a financial package of 130 million to give them additional budgetary support so that they can face the shortfall of revenue and additional spending that they have to engage. our main job is as i said earlier on is to try to push the clouds up because you will see numbers and you will hear about numbers. there is some economic recovery but as we all know and as we can feel it because we have family members, friends, relatives, people we know who are looking for a job who do not have the means that they would like to have. that growth is not enough to respond to the challenges that the world is facing. so what should be done? we believe that the clouds can be pushed provided that all policymakers actually aim high higher, try harder, do it together and country specific and i will touch on all of that. so what do i mean by that? aim higher, try harder, do it together. there has to be a new momentum. a new momentum that will consist of putting a set of bolt of policies together in order to overcome what i would call the new mediocre and that is a risk. if it stagnates as such, if we have this horizon of new mediocre. so what i will focus on his first of all the state of the global economy as we see it at the moment and the risk that the world gets stuck in that new mediocre. and second i would like to describe for you how all policymakers can generate the policy momentum that is needed to power up the global activity and overcome that new mediocre horizon. of course i will conclude really that comes back to us in to us and away what to us in a way what i regard as essentially leaning forward and this is the new multilateralism which requires increased cooperation amongst policymakers and amongst countries. so let's have a quick look at the state state of the global economy as it is at the moment. i'm going to give you very specific numbers because they will be released next week when we bring all the finance ministers and governors of central banks together but suffice it to say at this point the global economy is weaker than we had hoped only six months ago so there is recovery. don't get me wrong but it's weaker than what we had thought. and we forecast a modest pickup in 2015 and that's an important factor. the outlook for potential growth has been pared down. now as i said earlier its country specific and the prospects are different depending on where you sit or where you look out. among the advanced economies clearly the united states of america and in europe the united kingdom are leading the charge and expected to be strong. the recovery is much more modest in japan and its the weakest in the euro area where there are disparities with the same currencies. the emerging and developing economies, they have been doing all the heavy lifting in the last five years. they have contributed roughly 80% of global growth of the last five years and led by asia predominantly given the size on the growth particularly china they will continue to contribute but then too i would like to do that at a slightly slower pace because we are all interconnected. if some of the players are a bit slower they will be affected too mad. for the low income and developing countries including sub-saharan africa the economic prospects are rising. i will come to the risk in a minute but the economic prospects are rising and remain however because some of them have been borrowing quite extensively and issuing in the markets their debt level has increased so they should be watching. finally in the middle east the outlook is clouded by difficult economic transitions and of course by an intense tension and political strife. the bottom line of all that, six years after the financial crisis, we continue to see weakness in the global economy. countries are still dealing with the legacies of the crisis and what do i mean by that? a much higher debt level both in sovereign and quite often corporate and private sector levels in general and unemployment is still a major major difficulty in many of those crises. those are the legacies. in addition to the legacies that they are still struggling with and have difficulties addressing, there are those gray clouds on the horizon. now let's look at those clouds. we have different categories. we have the economic clouds, we have the financial clouds and we have the geopolitical clouds. i don't pretend the imf can push all the clouds. it will require collective effort and that's my final point. the first economic club that we see is that risk of low growth for a long time. now, how is that characterized? will if you expect growth to b be -- you are going to refrain from investing in new capital expenditure. you are going to refrain from consuming possibly in this dynamic seriously impede the recovery. so it's not sort of a vicious circle into which the economy could find itself and as i said this is the circumstances where you have a combination of low inflation and high unemployment. that is currently the case within a euro area and in some countries more than others. the second cloud is still economic although more monetary. the second cloud we see on the horizon is that of unsynchronized -- who has studied latin and greek hear? everybody. it means they are not going to be all synchronized together and it might apply to the same monetary policy with different moments of the cycle. the monetary policy normalization in advanced economies and the spillover effect that will have on other markets. and this bill back affects that it could have been the domestic market where the normalization is taking place. those impacts could be of three kinds, interest rates, variations which we haven't seen much of lately because they are all rock bottom and variations of exchange rates. the second category of clouds that we see, financial clouds. there is a concern that the financial sector excesses may be building up especially in advanced economies. asset valuations are at the highest. spreads and volatility in almost all sectors, not quite all but almost all are at their lowest. further worry is the migration of new markets and liquidity risks outside the banking sector in what we called the shadow banking sector. which is a nonregulated, non-bank sector which is growing rapidly in some countries. in the united states for instance the shadow banking sector isn't now considerably larger than the banking sector. in europe it is roughly half the size of the banking sector and in china about 25 to 35% of gdp, it is the fifth-largest in the world. so it's growing and it's not all bad. shadow banking can be just fine in some cases ended needed -- is needed in some economic space to actually finance economy growth but the problem about it is we don't know enough about it. when i say 25 to 35% it gives you the range of what we now but also what we don't know about it. so that requires particular attention and probably an expanded type of regulation that will embrace larger and broader than just the banking sector. it also emphasizes the fact that we need to complete the financial sector reform and he may have heard a lot about the financial sector reform over the last six years because it was described in the objectives of the g20 back in washington and then london. i was there, i remembered that there are still areas where we have not made the progress that we have to make. that's the case for the too two important they fail institutions and be regime that should apply. that is the case also for the derivative markets that need to be safer and more transparent and require exchange of information between those places that actually have a very active derivative market. so, we have talked about the economic clouds. we just talked about the financial clouds. i want to talk briefly about the geopolitical clouds. we have quite a few of those. we have to have them on our radar screen because they have an impact on economic and financial stability as well as prosperity. the first one that i would mention is any escalation that could take place in ukraine where it would cause disruption both in the immediate vicinity would also possibly disruption on commodity prices for instance and trade. the second area of possible disruption clearly the middle east. and also in some parts of asia. the third category that i would think of ukraine middle east in some parts of asia is obviously the development of the ebola virus. if it is not contained, if all the players that talk about it don't actually do something about it to try to stop it and contain it and help those three countries deal with it it might develop into something that would be a very serious concern and could cause significant risks. so all those risks, and some of them are materializing just a little bit. we have to be careful that they did not develop and we cannot put them on the back burner. we have to have them on our radar screen all the time. that is the reason why we must adopt collectively that new momentum that i told you about in order to avoid that raising of the new mediocre. i hope you have noted something. it's just for you to remember my speech. mediocre and momentum m, multilateralism and so i am on my second m which is momentum. that momentum is quite special because it requires a better balance in our policy toolkit using both the demand and supply-side of the economy. those of you who study the economy know about this confrontation, controversy, debates between those that up like supply-side measures and those that are in support of -- the canadian on one hand and many others on the other supply. what we are saying is it has to be a mix of both and we have to use all the tools that are available. you have a good basketball team here. it's about the same thing as la jolla is. you have to use all the players. it's not just about attack. it's about defense. it's about moving the ball around so all players have to play their part in order to score. and it's exactly the same with the economy. each policy instruments must play its part in order to achieve this momentum. i will start with the first one which is the one that is the most visible and has been most effectively lately and that's the monetary policy. it has provided important support to demand and that has been the case when the fed decided to start quantitative easing measures and it has proved efficient. it has done a lot to push recovery. the ecb has done quite a lot as well. there are different moments of the cycle. the bank of japan is doing a lot. the bank of england, so all the major central banks of advanced economies have pushed that tool. but monetary policy alone does not suffice. it's as if you had a great defense play but that's it. you don't score. plus the longer easy monetary policies continue the greater the risk of fueling financial excess so this needs to be monitored and managed. equally important as i mentioned earlier are the prospects of exiting from that new monetary policy. because it will have implications for other parts of the world. these implications, that's what they call the spillover effects and the peel back when in boo boos -- back to the domestic market that needs to be monitored, that needs to be managed. they need to cooperate and talk to each other extensively. ..

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