ebola is scary because of its case phi at that time rate which is generally in the 50% to 70% range. we think with meticulous clinical care we should be able to get that down substantially addressing hydration and fluid management. it's still a very deadly disease. compare that with sars which is 10% or mrsa, or the pen democrat democratic. that doesn't mean it has anything like the epidemic potential of influenza because one of the fundamental facts about ebola is that from everything we have seen, it only spreads from someone who is ill and only spreads from direct contact with body fluids of someone who is ill or someone who has died. so the spread has been primarily by these two routes, unsafe care giving, whether in the home or in health care facilities. in africa, unsafe burials, where burial practices may promote the widespread transmission of disease. the bottom line with ebola is despite recent progress, the epidemic remains severe, poor public health interventions can stop it and that success requires speed and scale deploying effective prevention and control resources. i think there are three overarching principles to success. the first is speed. the second is flexibility and the third is keeping the front lines first. just to mention speed for a moment, models constructed by cdc epidemiologists indicated that even a one-month delay in scaling up services to respond to ebola could result in a tripling of the size of the outbreak. that's why we've been working around the clock for the past four to six months. that's why we've been working around the clock for the past three days surging people intimally to deal with the cluster there which i'll talk about more in a minute. flexibility is very important. the incubation time of ebola is two to to '21 days. the usual incubation time is about eight to ten days. that means every week and a half there's another generation of cases. you've got to be ready to respond wherever it's most needed. the front lines first is a key concept, staff who are working in west africa continue to be frustrated by the lack of simple things that would be very helpful in response. cdc has 170 staff on the ground now in west africa, the largest global response in our history. be eve been aided enormously by our partnership with the d.o.d. and the disaster response team process. despite all the good wishes, still we deal with things like the need to get into a village that's so remote that not even helicopters can get us there or to take dugout canoes to get to a place where there's a cluster of cases or to hike four hours to a forested area to get to a diamond mine where we find not just a cluster of ebola, but 20,000 people living and working around that diamond mine and if we don't get in and get speci n specimens out we may have a cluster of hundreds or even thousands of cases. those are the three key principles that we try to ensure adherence to. the way to think about the ebola outbreak, i think, is as a forest fire or analogous to a forest fire. at the center are liberia, sierra leone or giwhich have bu fires wild spread. the first time the world has ever had an epidemic of ebola, spreading to multiple countries. around them are the sparks that emerge from that forest fire. that might land in nigeria or mali or senegal. each of those sparks has the potential to create another set of wildfires, another forest fire unless it's rapidly extinguished by intensive effort. just to give a sense of how intense that effort needs to be in nigeria when an ill traveler went from liberia to lagos and was so ill he had to be carried off the plane, he went to a local hospital. his ebola diagnosis was initially not suspected. pretty soon there was a cluster of cases in lagos. cdc had staff on the groundworking on polio eradication in nigeria as well as the malaria work. we could bring staff from other parts of africa. within 48 hours we put ten of our top staff on the ground. we were able to help the government repurpose their polio infrastructure to manage the lagos outbreak. we were able to take 40 of the trainees that we had helped become disease detectives to deal with polio, nigerian doctors and reallocate their work to ebola control. over the following weeks, they identified 899 contacts. they did 19,000 home visits to monitor for fever. they constructed an ebola treatment unit. they trained more than 2,000 health care workers in ebola prevention and control. they got more than 95% of their contacts monitored every day. they missed one. that one contact went to another city called port har court and started another cluster of ebola there. they had to create another emergency operation center, training staff, creating treatment facilities. with all that intensive bourque they were able to stop the outbreak. nigeria is now ebola free. that's the effort it took to prevent one case of ebola from becoming an outbreak or epidemic. given how central nigeria is to african travel and transit it was crucial to do that. that's the struggle we are today n gauged in in mali. and then beyond that second ring of countries that may have an immediate ember or spark that ignites an outbreak, every other country that has the potential to have ebola or other deadly infectious diseases needs to become more fire resistant. fire resistance in the case of infectious disease control means detection systems. you find things early, response systems so you can respond effectively and prevention, those same three principles. in ebola control we have five basic principles, incident management, organizing our system to it's efficient last week we ensured that mali had a pointed incident manager. we are scaffolding around that individual to provide as effective incident management as possible. treatment in mali, the government of mali created an ebola treatment unit to provide isolation and care. now they have one confirmed and two suspected patients in that ebola treatment unit currently staffed by doctors without borders from spain. burial support. in parts of africa, burial traditions are very different from here and involve washing the body, touching the body, sometimes whole villages touching bodies, it's their way of grieving. it needs to change to protect people from ebola. means change in communities that are widely dispersed which don't have a lot of trust often of the government and society. which may be cut off without internet, cell phone, even radio coverage with the rest of the world. it's a challenge. fourth is infection control in the entire health care system. we have to ensure that the whole health care system in these three west african countries is ready to consider ebola. that's not easy because it initially presents quite a bit like malaria. these are countries that are hyper endemic for malaria. the rate of malaria infection in these countries is in the range of 20, 40, 50, 60, even 70% in different communities. you have something that's a lot less common but more deadly to the health care workers, you have to have an overarching change in the way infection control is done. finally, communication. get all this through to health care workers and to the public. cdc has, as i mentioned, the largest global response in our history. it's addressing all aspects of t the -- that includes addressing the needs in each of the countries. though many of the u.s. efforts are focussed on liberia, we have more staff in sierra leone than in liberia because the needs are greater there at the moment. in sierra leone the british government has come in in a big way with assistance. we're working very closely with the uk to provide the information and need back and guidance and partnership that is most effective. but everything from laboratory testing to communications expertise, to contact tracing, outbreak control, to logistics are things cdc along with doh and others and the department of defense which has come in in a very helpful way are doing. there have been encouraging trends in some parts of each of the three countries. i believe those encouraging trends are fundamentally proof of principle that we can still stop ebola. but i've heard at times some sense of the problem is over already. i'm very concerned by that perspective because it's nowhere near over. it's going to be a very long, hard fight. because every single one of those cases that's emerging and they're now many hundreds, probably more than a thousand cases a week, emerging in west africa, every one of those cases needs that kind of response that i described for lagos, nigeria. that is going to be incredibly difficult. we have a long way to go. to give a sense of how far we've had to go, a reminder that cases are still growing, despite some progress. there were more cases in west africa in october than there were in september. though the numbers decreased somewhat in liberia we believe, there are still so many cases that we're not able to do the kind of outbreak control that's needed. there are so many communities that have not yet had cases and that need intensive control measures. in fact, in october west africa had more ebola cases than all other recorded ebola outbreaks over the last 40 years combined. we have a long way to go, but we have proof of principle and tremendous commitment to society. my team was describing how many communities themselves were taking action. they're remote. services haven't gotten there. isolating care with ebola. they track the contacts so they would be rapidly isolated and wouldn't further spread disease. there's a lot of progress. i did want to share with you -- this is actually outdated because it's from yesterday. i have an updated slide from this morning. one additional case has been confirmed. this is just an example of the kind of rapid assessment we're doing for the malian cluster. one individual, 70-year-old man, the grand imam became ill and died. it was not understood that he had ebola. in all likelihood he did. in all likelihood he may have gotten it by performing some of the funeral rites that were mentioned. he was the grand imam of a large town literally on the border between guinea and mall lee. someone said, you mean like kansas city? kind of but in other ways. it's a town that straddles two countries. he was taken to three different facilities. he had a large funeral service. in those facilities he was cared for by individuals who have since been confirmed to have had ebola. the team there has now identified more than 450 contacts. and they've undertaken contact tracing to track those individuals, ideally every day for 21 day sos the moment anyone gets sick, they get isolated. we expect people to get sick because there's flu, malaria, typhoid, other febrile conditions. an indicator of this system working is that people will be brought in to the ebola treatment unit and tested. we had two tested negative. when you have a negative test, you have to repeat it 72 hours after similar tom onset. early on the individual is not infectious but also can't be diagnosed in some cases. this is just a map of what happened. you can see on the border, and then the travel. one of the things we do is to help countries establish exit screening so every person who leaves is screened. their temperature is taken. they're asked a series of questions. in this process over the past few months we've identified more than 80 people who have had fever. they've not flown because they had fever. in many cases they didn't even enter the airport. that temperature is often retaken several times by the airlines or others as a way of keeping febrile people off airplanes. now, we also have looked at that second and third and ring of preparedness. this is a slide created i believe before the malian cluster. you can kind of see that there's, roughly speejing, some green. we've got laboratory capacity in most of the countries, some of them it's challenging. but there's a whole lot of red. emergency response capacity. there's even more yellow where we're not there yet. that's why the emergency funding request is so critically important. today or yesterday or tomorrow there could be another exposure, likely exposure in mali and we'll be dealing with another potential outbreak. every one of these countries has the risk of either being like lagos and controlling that spark or like the next liberia or sierra leone with widespread transmission throughout the society. that kind of widespread transmission doesn't just harm people from ebola. it really cripples the health care system. the health care system is basically closed. people don't come in for vaccines. they don't come in for treatment of malaria. women who need emergency obstetrical care don't come forward for it. people who have car crashes and are bleeding are not cared for in some circumstances because people are afraid it might be ebola. the effects on society more generally are also devastating. schools are closed. the economies are suffering severely. crops are either not being planted or harvested to the extent they could be otherwise. the ebola epidemic in west africa has impacts far beyond ebola and far beyond the health system. but there's also progress. this is a woman i met in liberia. she lives on the firestone rubber plantation. firestone had a cluster of ebola. they went to the government and said help us. they said we can't. they said where can we learn to do it ourselves. they said you better talk to doctors without borders. they created a treatment unit, monitored all the contacts and stopped the spread of ebola for their population of 50,000 living on the largest rubber plantations in the world. this is one of the survivors of that effort. in the u.s. there are a series of things we're doing to strengthen our preparedness against ebola. screening and monitoring of travelers when they leave affected countries and when they arrive in the u.s. when they arrive, their temperature is taken again. detailed information is taken about their contacts so local and state health departments can monitor them for 21 days in case they become ill and they're provided with a care package. check and report ebola. that care package has a thermometer, a fever log, health information, a wallet card, a number to call if they get sick. over the past couple of weeks at least four people have gotten sick. they've taken their temperature, they've had a fever, they've called that number. the state health department has arranged for safe transport of the individual from where they are to a hospital that's ready and waiting for them, and all four of them ruled out for ebola. but they were cared for safely in that system. yesterday we notified people that starting today we'll be doing the same kind of active monitoring for everyone arriving from mali. not because we believe there's widespread transmission in mali today, but because there are so many contacts there and we're not yet confident those contacts are all being identified and monitored daily. so if one comes here, we don't want to take the risk that they become ill and the health care system would not bay wear of their illness in time. we don't know we have the perfect response. but like everything in public health, everything in clinical medicine and everything in science, we use data to continuously improve practices. that's the approach we take and we'll continue to take. we've also worked with the health care system to strengthen infection control, to provide assistance in what are called rep teams or rapid ebola preparedness teams which have visited more than three dozen hospitals all over the kun country to assess whether they're ready to care for an ebola patient. we've now got more than 30 laboratories around the kun they that cdc has supplied with partnership from the d.o.d. which provided the as says so they can do defendants for ebola. the rep team will look closely at whether the hospital is ready and what more they need to do to get ready. now, in the emergency budget request the funds requested are divided into, on the one hand, immediate and on the other hand contingency. the immediate request is divided into three parts, domestic, ebola and a broader global health security component. for the cdc aspects of that request, it's a request of $1.83 billion divided almost equally between those three components of domestic preparedness, ebola specific work in west africa and global health security work. this is absolutely critical. we have currently a $30 million stopgap funding that expires on december 11th. that money is all committed. it allowed us to keep going at the level at which we're going, but not to ramp up through the outbreak control needed or to stop and make all those yellow and red boxes green. we don't do that, we can't with confidence say we'll be able to make the next outbreak, the next lagos and not the next liberia. global health security is something we've been working on for a long time. it has clear parallels with the ebola work. in fact, there's tremendous synergy between preparing for ebola and preparing for other health threats. i think it would be irresponsible of us with scarce dollars not to ensure we stretch them as far as possible so we're addressing ebola. but also, if we happen to get lassa fever next time, we've prepared for that as well oovps. the approach really is prevention through, in the case of ebola, things like infection control, bio safety more broadly, in terms of detection laboratory disease surveillance and a trained workforce who can find ebola or the next health threat that may be unexpected from an unexpected part of the world and to respond effectively. i want to, before closing, talk a little bit more than just about ebola. although ebola has been pretty all done assuming for all of us, there's a lot else going on. in 2014 congress approved our top priority asing at cdc. that was something called advanced molecular detection, funding to do something that's quite exciting, to be able to go into what it's called sometimes, next generation sequencing. next generation sequencing, instead of growing an organism in the laboratory and analyzing its genetic code, we take the sample itself, sputum or blood, we can look at it to understand in a much different way, a much deeper way what's happening with that infection. we don't know what's going to come out of this. we think we can get more rapid diagnostics of infections, of drug resistance, perhaps identify what are the strands that are spreading more. it may change the way we understood certain infections. there may be co-infections of multiple organisms or the sub strain that grows well in the laboratory may not be the strain that's actually making someone the sickest when we get that actual specimen data. that's all interesting theoretically, but what does it mean practically? it means we can save lives, money and time. we can cut time out of outbreak detection response and make outbreaks smaller. that's the promise. we need to continue to invest in it, work hard and work smart. i had the pleasure of walking through a poster session at cdc where we had dozens of laboratories and epidemiologic groups at cdc thinking of how toop ply this to their work. perhaps there are cases that were considered to be unrelated but actually are part of a cluster. or another disease, something we assumed was one outbreak and it turns out it was multiple different outbreaks, each of which had different sources and needed different interventions. this is a very exciting new way of combining traditional epidemiology with genetic sequencing, bio informatics that needs to be incredibly powerful to achieve this advanced molecular detection. one of our rapid sequencing machines in one two-hour run can create enough data to overload 100 commuters. the amount of data is mind-boggling. we think over the five years of this initiative, we'll transform the way we do genetic epidemiology and epidemiologic investigations for some conditions, being able to identify things sooner, finding diagnostics that can make a diagnosis in a shorter period of time, helping states implementing sustainable systems and developing more predictive modeling measures. new technologies don't take the place of careful analytic work. they may point in other directions but don't take the place of that thoughtful complicated work. fundamentally that will lead to better detection, better surveillance. one of the things we need to look at closely is anti buy kroeb y'all resistance. in the u.s. and globally, we're seeing an inexorable rise in drug resistance, faster for some organisms, faster in some parts of the world. last year for the first time cdc did an overarching report on drug resistance. we identified there were more than 2 million drug resistant infections in the first year, even conservatively estimated. and more than 23,000 deaths. in addition, 14,000 people died related to c difficile which is a complication of antibiotic use. this is a serious health problem. as an infectious disease physician myself, i've treated patients for whom there are no modern medicines it's a horrible and helpless feeling for physicians, patients and families. and it reflects the fact that for some patients and some organisms, we're not in the pre anti buyic era, we're in a post antibiotic era. unless we take urgent action, a greater portion of infections will be difficult, if not impossible to treat with modern medicines. it's not just anti treatment of infections because routine infections like pneumonia, urinary tract infections might become very difficult to treat. we've tracking one particular organism called crb and that organism can be resistant to all antibiot antibiotics, currently mostly in hospitals but spread to the community. routine urine tear tract infections may become extremely difficult to treat. it's not only the infections themselves, treatment of infections has become an integral part of modern medical care, transplant, treatment of arthritis, joint replacement, complex surgery, all these things depend on the ability to rescue patients when their immune system is low with effective antibiotics. more than 600,000 americans will get cancer chemotherapy this year. about 60,000 of them will be infected with -- will be hospitalized with a serious infection that's a complication of their chemotherapy: one in 14 of those may die from that complicati complication. the more resistant organisms we get, the higher the proportion and the greater risk of cancer treatment. that's just one example. we've identified seven particular threats. i mentioned c dif. i mentioned cre. there are others as well. we think we can actually substantially reduce the burden of these risks. in fact, you'll see this looks quite familiar to what i said earlier, detection, response prevention and innovation for knew diagnostics and new treatments swrechlt a proposal in fy '15 to accelerate detection and to improve infection pre vejs and antibiotic prescribing. we think between about a third and half of the antibiotics used in this country are either unnecessary in the first place or inappropriately broad spectrum. we have a long way to go to improve our own prescribing practices. we can begin to address the gaps that can reverse drug resistance. in fact, we think we can make significant progress. we think we can cut c dif and cre by 50% over a five-year period. that's not just a guess. that's what the best performing systems have already done. that's what other countries have already done. we know how to do that. what we don't have are the resources to do it at scale. in fact, we estimate that if we have this kind of multisectoral intervention, over five years we can prevent over 600,000 multidrug resistant infections and over 37,000 deaths and save nearly $8 billion in health care costs. these are two lines. one, if we keep going as we've always done. one if we are intensive and aggressive. antibiotic stewardship is one of the key area. it requires commitment, leadership, tracking, we recommend every hospital in america have an anti microbial stewardship program. we think it has tremendous benefits for the facilities. it's a win-win. it saves money and lives. the national health care safety network operated by cdc includes virtually every hospital in the country plus dialysis facilities and outpatient surgical facilities. an increasing number of facilities report electronically. we have a very productive collaboration with the center for medicaid and medicare services to use this information to feedback to hospitals to encourage rapid progress. anti microbial resistance is a time bomb. we've got to stop it before it gets too late, before the routine infections we all could get tomorrow are not easily treatable. we've got to preserve the anti boot buy ot ticks we've used for our kid and grandkids. the pipeline is not full of new drugs to come out. we hope so. unless we improve systems of using the antibiotic agents today, we could lose those as quickly as we've lost these. with that i'll stop and look forward to taking any questions you have. [ applause ] . >> [ inaudible ]. dr. frieden, we're honored you're with us. your time is so valuable. we have a packed house both here and outside. we'd love to take a little time to have engagement with the audience. if people could raise their hands. we have microphones. this is being recorded. wait until the mic comes to you. >> we have a question right here. >> hi, i work for senator casey's office. i have ha question about hospital preparedness in america. i remember the last briefing you discussed ppes and mass production of that as well as hospital preparedness and staffing. could you just briefly describe a little bit more about how ready do you think these individual hospitals are all over america? >> i think you have to divide hospitals into several categories. there's a highly specialized group that needs to be able to care for a person who may have ebola. for those hospitals, cdc sends a rep team, the ebola preparedness assessment team to see if they're ready and to help them get as ready as possible. in fact, any time there would be a highly suspected or confirmed case, we would send a ebola response team with a team of specialists, environmental waste management, communications to deal with the situation that the team went to bellevue before dr. spencer was diagnosed when he first was admitted and was ill. there's a specialized smallest group of hospitals that have to be ready to deal with serious infectious disease threats such as ebola. more broadly, there are hospitals around the country that may be need to be ready to assess patients that may have an infectious disease such as ebola. we expect travelers from parts of the world that have had ebola outbreaks get sick. they're going to get flu. if they didn't take their malaria prophylaxis, they may be assessed safely. every hospital in the country needs to be ready and thinking about what do i do if someone comes in and there might be concern for ebola. that's why cdc issued guidelines for emergency departments of what to do if someone comes in. that's why there's such appropriate interest in ensuring there might be training an drills and information for health care officials on the front lines. >> i wonder if you wanted to make any comments at this point. would you want to -- >> we're grateful you're here with us. let's see. questions? -- >> i'm an emergency physician in maryland. needless to say, ebola has changed the way we do business over the last couple months. i work in several hospitals across maryland. one thing that struck me is the variety of approaches each hospital has taken on how to prepare the employees for ebola. for example, i've gone through pep training, protective equipment training. the equipment i use, how i apply it, how i remove it. how i'm cleansed afterwards is entirely different depending upon the facility. i wanted to ask you about that. it's surprising to me there's not more consistency. the second thing, i've also been surprised by how available the cdc has been. there's a 24-hour hotline. not infrequently we call it with a patient with a fooefer in the middle of the night who rules in from a risk perspective and how available they are. within two hours i think is the response. they'll appear in our remote lopts. people from the cdc will come in and see these patients. that's very impressive to me. >> well, i hope it doesn't surprise people that cdc is there 24-7 but we can't be everywhere. what we do is provide information, resources, consultation, not just for ebola but for infectious disease and other health threats. there is not sufficient pce for every hospital to have unlimited quantity. what we've done is allow several options. different facilities use different formats of ppe. our guidelines allow different confirmations. the principals of the guidelines are very clear. that's what every hospital should ensure. one is health care workers should practice and practice and practice so that they're comfort nl putting on and taking off the protective equipment. a second is that the putting on and taking off, particularly taking off of protective equipment needs to be protocolized in a very standard way, directly observed. providing a checklist as each step is taken so it's done with consistency, not because ebola is so terribly infectious but because stakes are so high. you're monitoring every aspect of care from beginning to enter, from entering when you're in the treatment area and as you leave the treatment area. all of those are critical control points. all of those are places where we want to ensure that there's everything done to minimize the risk of infection. >> in the back there. >> dr. frieden, thank you very much for coming today. i'm melissa goldstein, a professor of medical ethics and public health law at george washington university. both of my fields are excited in not so great ways about this. i wanted to ask you a question specifically in the ethical field in following up on hospital preparedness. on october 20th a prominent bioeth sift published an article questioning whether individual hospitals should perform cpr on ebola patients and recommended that they perhaps automatically be categorized as do not he sus tate patients. i'm wondering if you have any comments on that. >> wow. >> obviously all individual hospitals are struggling with this. >> i think you sometimes have to go back to first principles. we want to get the risk of ebola to zero in the u.s. the only way we're going to do that is by controlling it at the source in africa. if we control it at the source in africa, we're not going to have to face that kind of very difficult dilemma here. if we don't control it at the source in africa and it spreads to mali and other countries, then we may have a real challenge in the future. that's why we'll want to make sure that when patients who may have ebola are admitted, we can rapidly assess them and then treat them appropriately. in the u.s. we've had patients severely ill with ebola. as you know, two of them have died, one today, despite maximal treatment. we've also had patients who survived with very intensive support including kidney replacement therapy, including mechanical ventilation, including very, very substantial support. so we want to provide the best possible care in the safest possible way. >> there was a question over here. >> thank you, dr. frieden. two questions for you. the first is, as you know, medical countermeasure development and production is in high gear. what role do you see any successful candidates that are fielded playing in the current outbreak or do you see this outbreak finally being solved through the more traditional public health nez yurs you described. secondly, i'm a veterinarian. i'm interested in your opinion on an issue that those of us who are policy minded veterinarians are discussing now which is the relative lack of attention being paid to the zoo nottic nature of ebola, potentially sew nottic nature of ebola. wet don't tend to think about that in our preparedness planning. if you could speak to that as well, idea appreciate it. >> first, in terms of technological innovation, we have potential to have innovations important in the current outbreak. we can't prom 34is that. we can't count on them. we have to assume they won't be there and maximize our current tools. there are at least two or three things i think are quite promising. the one that may be closest to within reach, though you can't predict the future are rapid diagnostics. there are at least half a dozen companies fairly far along. the navy has a product that's encouraging, where we might be able to do in africa a test in the field at the point of care and have results within half hour to an hour. that would make a really dig difference. we've got a good test for ebola. but it's a realtime pcr. you need to cross contaminate it. it requires a laboratory that's highly specialized. we've been highly creative in deploying those in africa. but that's a far cry from being able to hike in four miles to a diamond mine and take something out of your pocket that can confirm or determine something isn't ebola in less than an hour. that would make the outbreak, detection and control measures we need easier. i'm guardedly optimistic in a few months we may have sting that works well to use in the field. it may not be as sensitive as the realtime pcr. even if it had even a moderately low sensitivity, a negative test wouldn't rule it out. it would be very helpful for the management of outbreaks. diagnostic tests for symptomatic infection at the point of care i think can be brought to bear in the current outbreak. second is a vaccine. we have two vaccine candidates, both of them work well in animal models. we've now assessing implementation of two different clinical trials of vaccines. nih has the lead on one, most i likely to be done in liberia which will be a randomized clinical trial. the cdc has the lead on the other, most likely to be done in sierra leone, an adaptive trial called stepped wedge design. it can get the answers quicker but aren't as definitive as the randomized controlled trial which may take longer. i think these are two very complementary approaches. they're both necessary. i'm hopeful that we might be able to find effectiveness of one of the vaccines perhaps by the middle of next year. that might still i'm afraid be in time to be used in this outbreak. we're also looking at their putices. it's important to think of therapeutics to improve outcomes in the setting where most of the patients are treated and getting those settings upgraded and provided with effective care as rapidly as possible. >> let me take a moment to ask a question -- i see one in the back. go ahead. >> [ inaudible ]. >> i'm just curious to piggyback on that conversation, that question, if and when we do get a viable vaccine, what actions and thoughts is the government putting into getting that manufacturing out at a large scale so it can have an impact, maybe on this epidemic but future ones as well. >> in particular, the agency responsible for bringing new vaccines and other technological advances to the field is working very actively on this issue as is the defense department and others. i think if we had a vaccine, if it were effective, we would consider using it in at least two different contexts. one of them would be providing for health care workers so they would have a reduced risk of infection themselves. the second would be vaccinating where there are clusters, communitywide, to try to kind of observe blaet the cluster, stop the spread in individual areas. our staff working for many months in liberia say in many ways the response reminds them of ow r other outbreak response brs you're not seeing a wildfire, but many, many bush fires. be able to go in and control it and save people's lives and prevent spread to others. there may be a role for a vaccine there. we don't know that. early on in vaccine work there are things that are promising that don't pan out, things that are promising but may potentiate infection. we don't know what role they have. we're trying to get them off the ground as fast as humanly possible. i'll say we've been very en cornealed by the reception we're getting in sierra leone and liberia with countries moving fast and forward on this as quickly as possible. >> let me take a moment to ask you a question about health workforce. i think the statement a health threat anywhere is a health threat everywhere. perhaps many are shocked by the lack of access in liberia and sierra leone. various efforts around health workforce and health systems strengthening that frankly are very, very underresourced. you've had tony blair himself working in sierra leone for almost seven very incentively to build the capacity there. yet the capacity is not there because the level and density of health workers is so profound. do you think this crisis has woken up the world to a need to move more resources towards that. what is the cdc doing in that regard? >> i hope it wakes the world up. i hope at least we get commitment from congress over the coming months to support the kind of efforts we want to do at cd krfrmts. we have a par ram tall model that has three levels. at the most basic level we can train any health worker to recognize and report illnesses, infections ebola or other so we're beginning to get more accurate information in a more timely way. at the middle level, we can train over a several-month period people who are working at the district or county level so they can understand those reports coming in and take appropriate action based on them. at the apex or highest level, there's the two-year epidemiology training program where we're training people to work independently. each of the three countries in west africa, particularly sierra leone and liberia not only started out with many fewer health care professionals per capita and an underdeveloped health care system but has had to suffer through the deaths of hundreds of doctors and nurses and other health care nurses from ebola. they're greatly challenged. responding there, building human cassity, understanding we won't have as many doctors as nurses as we wish. we'll continue to create them and train them and support them, but use a wide range of community health workers, lay health workers, midwives and upgrade their skills and knowledge and capacities so they can respond at the community level to what's most needed. >> let's bring you a microphone right here. one second. would you mind standing for a sec? >> i'm prompting you to talk about another of your favorite topics. you might talk a little bit as a followup to peggy's question what you feel about the knowledge that anybody has about in country capacity and how helpful it might be to have some sort of global measurement so that, as something happened from afar, the world bank or who or somebody else could say that country is equipped and ready and this country clearly isn't. >> with global health security, there are a clear set of capacities. can a country find the five most serious infectious disease threats in at least 80% of the country? does a country have syndroming surveillance for things like viral hemorrhagic fever or other conditions? do they have one trained ep deem oth for every 200,000 eem people? do they have an emergency operations center that can marshall and operate within two hours? those are knowable things, but they're not currently known systematically. we've now worked with a coalition of plor than 30 countries on the global health security agenda to agree on a set of action packages in each of the areas of prevention detection response and to ensure that we are putting into place a system that can objectively monitor them independently. whether that's the world health organization or non-governmental organization is not yet determined, but i think the world a lot of them have march berg. the guy said the bats didn't scare us because we had our moon suits on and the python didn't scare us either. assistance, when the disease first emerged. animals living the forest and the people who hunt and kill bush meet and get affect ed fin out how it happened and stopped it. the fao has worked on that, it's one of the critical components of the global house work, and that's why it's so important that the congress houses all three of the components in the funding request. . not only in stopping ebola in west africa, but the global health security work more broadly. >> we'll take one more question, rachel. >> rachel striker. there are a lot of cdc workers who are being pulled away from other projects to fight ebola. and i was wondering what on some legal you saw this as a net loss for these other infectious diseases that are happening because attention is being taken away, or whether perhaps there's increased health in infrastructure because of this. >> well, it's both, actually, it is true, we usually have about 20 or 30 people working on ebola at the cdc, today we have 850. the other 800 were doing other things before. that's why the emergency funding request is so important, so that we make sure we can do both that we have to do for all of the diseases, for flu or mers or anything else in our portfolio, so the long if this goes on, the more challenging it is to keep all parts of cdc, protecting the public for what we're committed to doing, the more it goes on, the more we are able to build the capacities in west africa, in other countries, that will be useful for not only eeebowl la the next sars, think of what the world would be today if decades ago we would have had basic detection techniques and basic treatment techniques, even without treatment we could have contained it and we wouldn't have 30 million people already infected. we have so much that we can benefit from this. the systems that could have found and stopped this outbreak in west africa cost a tiny fraction what the response is going to cost and it would be very unfortunate if we didn't at this moment both stop ebola and prevent this country from having vulnerability, but also put in place the laboratories, the disease detectives, the response capacity, that will find, stop and prevent the next health threat. thank you all very much. thanks for your comments about our programming, here are a few we received about q and a. >> i have just viewed your program of question and answer, i find it very offensive to put someone online for an hour on air who knows very little about islam, very little about sharia, very little about the koran in history, she misquoted the koran. misquoted the life of mohammad and historical facts that absolutely are not accurate and one can refute on very -- i find it very offensive and completely shocked as someone who watches and respects cspan to see this program, i'm completely, completely shocked and i dare to say the worst program i have seen on cspan in 20 years. >> i wanted to comment on the q & a on c smspan with the author noni darwich. she has given the complete and precise, articulate explanation of the muslim religion in the modern world that i have heard of and i am a religious scholar of over 65 years, she should be commended just for this speech. thank you very much cspan. >> and continue to let us know what you think about the programs that you're watching. call us at 202-626-3400. or join the cspan conversation, like us on facebook, follow us on twitter. with live coverage of the u.s. house on cspan and the senate on cspan 2, here on cspan 3, we complement that coverage by showing you the most relevant public hearings and public affairs events, and then on the weekend, cspan 3 is the home of american history the. american artifacts, touring museums and historic sites to discover what artifacts reveal about america's past. history bookshelf, with the best known american history writers, the presidency, looking at theal policies and legacies of our a ni nation's commanders in chief, and our new series, featuring archival videos from the 1960s and 70s. watch us in hd, like us on facebook and follow us on twitter. here's what's ahead tonight, thanksgiving eve on cspan 3, next the new president of the kennedy center for the performing arts in washington, d.c. then the history and politics of tourism in the colorado rockies. later, a discussion on public private partnerships from the american bar association, more on the ada with a look at transportation security issues. now the new president of the kennedy center for the performing arts, deborah rutter, outlines her u future plans and emphasizes the importance of arts and education and cultural diplomacy, from the national press club, this is an hour. good afternoon, and welcome. my name is myron delkheim, the washington school of media and public affairs and former international bureau chief with the associated press and the 107th president of the national press club, the national

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