[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
GLOBAL EFFORTS TO FIGHT EBOLA
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HEARING
BEFORE THE
SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH,
GLOBAL HUMAN RIGHTS, AND
INTERNATIONAL ORGANIZATIONS
OF THE
COMMITTEE ON FOREIGN AFFAIRS
HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
SECOND SESSION
__________
SEPTEMBER 17, 2014
__________
Serial No. 113-239
__________
Printed for the use of the Committee on Foreign Affairs
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COMMITTEE ON FOREIGN AFFAIRS
EDWARD R. ROYCE, California, Chairman
CHRISTOPHER H. SMITH, New Jersey ELIOT L. ENGEL, New York
ILEANA ROS-LEHTINEN, Florida ENI F.H. FALEOMAVAEGA, American
DANA ROHRABACHER, California Samoa
STEVE CHABOT, Ohio BRAD SHERMAN, California
JOE WILSON, South Carolina GREGORY W. MEEKS, New York
MICHAEL T. McCAUL, Texas ALBIO SIRES, New Jersey
TED POE, Texas GERALD E. CONNOLLY, Virginia
MATT SALMON, Arizona THEODORE E. DEUTCH, Florida
TOM MARINO, Pennsylvania BRIAN HIGGINS, New York
JEFF DUNCAN, South Carolina KAREN BASS, California
ADAM KINZINGER, Illinois WILLIAM KEATING, Massachusetts
MO BROOKS, Alabama DAVID CICILLINE, Rhode Island
TOM COTTON, Arkansas ALAN GRAYSON, Florida
PAUL COOK, California JUAN VARGAS, California
GEORGE HOLDING, North Carolina BRADLEY S. SCHNEIDER, Illinois
RANDY K. WEBER SR., Texas JOSEPH P. KENNEDY III,
SCOTT PERRY, Pennsylvania Massachusetts
STEVE STOCKMAN, Texas AMI BERA, California
RON DeSANTIS, Florida ALAN S. LOWENTHAL, California
DOUG COLLINS, Georgia GRACE MENG, New York
MARK MEADOWS, North Carolina LOIS FRANKEL, Florida
TED S. YOHO, Florida TULSI GABBARD, Hawaii
SEAN DUFFY, Wisconsin JOAQUIN CASTRO, Texas
CURT CLAWSON, Florida
Amy Porter, Chief of Staff Thomas Sheehy, Staff Director
Jason Steinbaum, Democratic Staff Director
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Subcommittee on Africa, Global Health, Global Human Rights, and
International Organizations
CHRISTOPHER H. SMITH, New Jersey, Chairman
TOM MARINO, Pennsylvania KAREN BASS, California
RANDY K. WEBER SR., Texas DAVID CICILLINE, Rhode Island
STEVE STOCKMAN, Texas AMI BERA, California
MARK MEADOWS, North Carolina
C O N T E N T S
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Page
WITNESSES
The Honorable Nancy Lindborg, Assistant Administrator, Bureau for
Democracy, Conflict and Humanitarian Assistance, U.S. Agency
for International Development.................................. 15
Anthony S. Fauci, M.D., Director, National Institute of Allergy
and Infectious Diseases, National Institutes of Health, U.S.
Department of Health and Human Services........................ 24
Luciana Borio, M.D., Director, Office of Counterterrorism and
Emerging Threats, Office of the Chief Scientist, U.S. Food and
Drug Administration, U.S. Department of Health and Human
Services....................................................... 42
Beth P. Bell, M.D., Director, National Center for Emerging and
Zoonotic Infectious Diseases, Centers for Disease Control and
Prevention, U.S. Department of Health & Human Services......... 51
Kent Brantly, M.D., medical missionary, Samaritan's Purse
(survivor of Ebola)............................................ 81
Chinua Akukwe, M.D., chair, Africa Working Group, National
Academy of Public Administration............................... 92
Mr. Ted Alemayhu, founder & executive chairman, US Doctors for
Africa......................................................... 101
Dougbeh Chris Nyan, M.D., director of the secretariat, Diaspora
Liberian Emergency Response Task Force on the Ebola Crisis..... 108
LETTERS, STATEMENTS, ETC., SUBMITTED FOR THE HEARING
The Honorable Christopher H. Smith, a Representative in Congress
from the State of New Jersey, and chairman, Subcommittee on
Africa, Global Health, Global Human Rights, and International
Organizations: Prepared statement.............................. 5
The Honorable Nancy Lindborg: Prepared statement................. 18
Anthony S. Fauci, M.D.: Prepared statement....................... 27
Luciana Borio, M.D.: Prepared statement.......................... 44
Beth P. Bell, M.D.: Prepared statement........................... 54
Kent Brantly, M.D.: Prepared statement........................... 84
Chinua Akukwe, M.D.: Prepared statement.......................... 94
Mr. Ted Alemayhu: Prepared statement............................. 103
APPENDIX
Hearing notice................................................... 118
Hearing minutes.................................................. 119
Dougbeh Chris Nyan, M.D.: Material submitted for the record...... 120
Questions submitted for the record by the Honorable Mark Meadows,
a Representative in Congress from the State of North Carolina.. 124
GLOBAL EFFORTS TO FIGHT EBOLA
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WEDNESDAY, SEPTEMBER 17, 2014
House of Representatives,
Subcommittee on Africa, Global Health,
Global Human Rights, and International Organizations,
Committee on Foreign Affairs,
Washington, DC.
The subcommittee met, pursuant to notice, at 10 o'clock
a.m., in room 2172 Rayburn House Office Building, Hon.
Christopher H. Smith (chairman of the subcommittee) presiding.
Mr. Smith. The subcommittee will come to order and good
afternoon, or good morning, I should say, to everybody. We are
here today to hold our second hearing in just 5 weeks on the
Ebola crisis in west Africa to underscore just how serious a
crisis they are facing and I would say we are facing--an
international pandemic which threatens to balloon unless
confronted head on.
I spoke yesterday to Dr. Tom Frieden, director of the U.S.
Centers for Disease Control and Prevention and the lead witness
at our August 7 emergency hearing during recess on Ebola, and
he said that this is the worst health crisis he had ever seen.
He said, I have never seen anything like this in my life,
and coming from the head of the CDC that was an extraordinarily
powerful statement.
Since our August emergency hearing, we are seeing a
constant movement upwards in the number of actual cases as well
as the predictions of how many people may contract the disease
and what potentially the number of fatalities might indeed be.
The numbers range. Yesterday the President was talking
about hundreds of thousands. I read a German doctor who said
something on the order of 5 million.
That, hopefully, is way overinflated but it underscores
that nobody really knows and we are talking about a pandemic
that even if it stays contained in the west African countries
is doing unbelievable damage and imposing unbelievable sorrow.
The World Health Organization estimated we would see as
many as 20,000 cases of Ebola before it has ended and, again,
the numbers have now begun to exceed that in terms of
estimates.
We are holding this hearing to take stock of where our
intervention efforts stand, particularly in light of the
President's decision to commit U.S. Military personnel to
Liberia to fight this disease.
Liberian President Ellen Johnson Sirleaf, with whom I spoke
yesterday, has conceded that the Ebola epidemic has overwhelmed
her country, her ability to treat.
She said this in a letter that she sent to the President:
``The virus is spreading at an exponential rate and we a have
limited time window to arrest it.'' She pointed out that well
over 40 percent of the total cases have occurred in the last 18
days alone.
She said the treatment centers are overwhelmed and that at
this rate we will never break the transmission chain and the
virus will overwhelm us--an ominous statement from the
distinguished President of Liberia.
We are also holding this follow-up hearing this morning to
determine if there is a reasonable hope for vaccines,
treatments, or detection strategies in time to help with this
health emergency.
I hesitate to provide figures for the number of people who
have died but I think the estimates are something on the order
of 2,500 people who have passed away and that is probably an
underestimation of the actual number.
Ebola, which was mostly unknown in west Africa until now,
presents itself early in the infection like usually non-fatal
diseases such Lassa fever, malaria, or even the flu.
The temperature seen in the early stages might even be
brought down with regular medicines. Therefore, many people may
not believe or may not want to believe that they have
contracted this often fatal disease.
If someone is in denial or unknowledgeable about this
disease, they may not seek treatment until it is too late, both
for them and for the people they unknowingly infect. Families
in Africa tend to help each other in times of need, an
admirable trait that unfortunately increases the risk of
infection.
The sicker a person gets with Ebola, the more contagious
they are and never more so than when they die. So burials that
don't involve strict precautions to avoid direct contact with
highly contagious remains of victims make transmission of this
deadly disease almost inevitable.
Burial traditions make avoidance of infection problematic.
The porous lightly-monitored borders in west Africa lend
themselves to cross-border transmission as people go back and
forth along well-traveled roads and into marketplaces where
hundreds of people also travel and make contact with those who
are infected.
Patrick Sawyer, a Liberian-American, reportedly was caring
for his dying sister a few weeks ago. After she died,
apparently of Ebola, he left Liberia on his way to his
daughter's birthday party in Minnesota. He collapsed at the
Lagos airport in Nigeria and died within days.
Had he left Liberia a week or even days earlier, he might
have made it home to Minnesota but he likely would have
infected people along the way, including his own family.
We can say that because Sawyer infected several people in
Nigeria, which led to Ebola being transmitted to health care
workers and then to dozens of other people.
We will never know now if Mr. Sawyer realized that he had
contracted Ebola and just wanted to go home for treatment or
whether he thought his symptoms were from some other illness.
Many people are just like him, however, and they are
spreading this disease even to places where they have been
brought under control. For example, the Macenta region of
Guinea on the Liberian border was one of the first places where
this disease surfaced.
But by early September, no new cases had been seen for
weeks. Doctors Without Borders closed one of its Ebola
treatment centers to focus on harder-hit areas. Infected people
leaving Liberia for better treatment than Guinea have once
again made Macenta a hot spot for the disease.
The U.S. Centers for Disease Control and Prevention has
established, as we know, teams in Guinea, Liberia, Sierra
Leone, and Nigeria to help local staff do fever detection and
to administer questionnaires on potential troublesome contacts.
The agency also was helping to establish sites at airports for
further testing and/or for treatment.
Liberia and Sierra Leone are the hardest hit so far by this
Ebola outbreak. This is undoubtedly partly because of the weak
infrastructures of the two countries emerging from long
conflicts.
However, post-conflict countries also have significant
segments of the population who don't trust the central
government. The unfortunate mishandling by the Liberian
Government of an attempted quarantine in the capital
demonstrates why trust has been so difficult to come by.
The Liberian Government, as we know, established barriers
to block off the West Point slum area where, after a holding
center for Ebola victims was ransacked and contaminated
materials were taken.
This quarantine was done without fully informing its 80,000
inhabitants or consulting with the health care workers. Not
only did this prevent people from pursuing their livelihoods or
bringing in much-needed supplies, this move created great
suspicions of the motives of the Liberian Government.
This suspicion was heightened when the official in charge
of the area was called to a meeting and was seen leaving just
as everyone else was trapped behind barriers. The furor over
the quarantine forced the government to abandon it 10 days into
its planned 21-day term.
Liberian officials assured us that they have learned from
their mistakes, that of the quarantine, and has alerted
Liberians of the reality of the Ebola epidemic. I read many of
the newspapers from west Africa every single day and it is
front-page headlines, sometimes a little bit exaggerated, but
certainly front-page headlines, so people are becoming more
aware through that medium.
Despite the fact that the drug ZMapp appears to have saved
some lives including Americans Nancy Writebol and Dr. Kent
Brantly, who we will hear from in our second panel, there are
no proven readily available treatments for Ebola.
The death rate for this disease, once more than 90 percent,
is now down to 53 percent despite the number of cases growing
exponentially.
In Africa, a few patients apparently have been successfully
treated with ZMapp and Dr. Fauci, I am sure, will give us
additional insights in this, and some others may have been
saved using other treatment methods, especially when the
disease was identified early.
Yet there is not now nor will there be in the short term
large quantities of this medicine or any others. There are
other several Ebola therapeutics under development but if this
outbreak cannot be brought under control soon, even the most
optimistic timetable for the testing and production of these
drugs will not be sufficient to meet the ever expanding need.
ZMapp was used with the informed consent of those to whom
it was given. But how can we guarantee that the many Ebola
victims, whose most likely salvation would be to use an
experimental drug, truly understand the risk of using a drug
that has not been fully tested?
Lack of faith in national and international systems
fighting Ebola has impeded the replacement of many Africa
health care workers who have died from this disease. That is
one of the untold problems, that people on the front line are
dying, as well as their families.
I was talking to a friend who runs an NGO in Sierra Leone
who works with obstetric fistula and a nurse at his clinic
died, and so did her six children. So health care workers have
borne a disproportionate share of this horrific disease.
As of late August, 164 Liberian health care workers had
contracted Ebola and 78 had died and that number no doubt has
increased. African health care workers face an epidemic that
threatens to defy control.
The lack of diagnostic techniques and insufficient supplies
of safety equipment have put these health care workers at
extreme risk. These health care workers know that the lack of
treatment centers and medicines means that those on the front
lines of this epidemic are most at risk, as I indicated
earlier.
And finally, without objection will put my full statement
into the record. I will just point out that yesterday's
announcement that some 3,000 American service personnel will be
deployed. Nancy will remember that I traveled right after the
typhoon hit in the Philippines and if it wasn't for the
military providing food, water, shelter, and medicines working
with USAID and NGOs like Catholic Relief Services, many more
Filipinos would have died as a result of Dengue fever and other
terrible diseases might have manifested in large numbers.
Same goes for the tsunami. I will never forget a number of
us went and we saw what was being done in Banda Aceh. Again,
USAID, working with CDC, NIH, and the military. But this is a
little bit different and perhaps our witnesses could elaborate
on this either during the Q and A or in their statements about
what precautions might be provided to those service members.
I know they will be likely building beds, which are
unbelievably lacking, particularly in Liberia. People can't
find a bed when they are sick to get treatment or at least to
live in until they pass.
And so it does raise the question of what kind of
precautions those military personnel will take, whether they
will be properly suited, what their mission will be, and when
will they be deployed. A number of questions have arisen, I am
sure, by many of us concerning it to ensure their safety.
I would like to yield to Ms. Bass and then to the chairman
of the full committee, Mr. Royce.
[The prepared statement of Mr. Smith follows:]
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Ms. Bass. Thank you, Mr. Chairman, as always for your
leadership and for calling today's hearing to give us an
opportunity to examine the scope of global efforts to address
the ongoing Ebola crisis in west Africa.
This is the subcommittee's second hearing on Ebola in the
past 6 weeks and I look forward to getting updates from our
witnesses today on how their agencies and organizations
continue to combat this deadly outbreak, what trends they are
seeing both positive and negative, and what additional support
is needed as they coordinate with the governments of the
impacted countries.
I appreciate their efforts and outreach to help keep
Congress informed on this evolving and devastating epidemic.
Yesterday, I was very pleased to see President Obama's
announcement at the CDC headquarters in Atlanta where he
provided a comprehensive outline of the U.S. support for
Liberia and other west African nations impacted by the crisis.
The President's commitment totals, as I understand it, over
$700 million over the next 6 months and will include sending
3,000 American military personnel to the region, AFRICOM's
establishment of a regional intermediary staging base to
facilitate the transport of medical equipment, supplies and
personnel to affected regions, and the command's establishment
of a medical training site to train up to 500 health care
providers per week.
It has been an honor to work with the various U.S. agencies
seeking sustainable solutions to the Ebola outbreak including
the CDC, USAID, the Departments of State and Defense,
respectively.
I also want to commend the steps being taken by the
Governments of Liberia, Sierra Leone, Guinea, and Nigeria and
the great work of the many health professionals from throughout
the world who are doing everything they can to help people who
have contracted this disease.
The U.S. commitment will address the unique nature of this
outbreak that has made combating the disease particularly
difficult. West Africa has not faced this before and
communities and governments and health professionals in Guinea,
Sierra Leone, and Liberia don't have the expertise and capacity
to address the scale, spread, and proper treatment of the
outbreak alone.
The crisis is not just about obvious health concerns, and
this is a major concern to me and why I was happy with the
President's announcement about military support because I am
really concerned about the stability of the countries, with
post-civil war conflicts.
These countries have weak institutions and a crisis like
this could actually lead to a complete destabilization.
Although they have elected democracies right now, we know that
in many of these countries, as I mentioned before, you could
actually have a collapse of the governments.
Yesterday, I also had the privilege to speak with Liberian
President Johnson Sirleaf on the impact of the outbreak in her
country and the work they have done to fight the spread of the
diseases.
She called to thank me and to express her deep gratitude
for U.S. assistance and stated that with essential support from
the U.S. Government, the World Bank, the African Development
Bank, she actually feels confident now and she sees moving
toward a health recovery, and I will say that this was markedly
different than the telephone conversation I had with her a few
weeks ago, and I am sure the chairman and ranking member and
Mr. Smith had the same type of calls, where she seemed to be
particularly desperate. So it was nice to have the call
yesterday.
It is in America's and the world's interest to continue to
assist in this crisis and to continue to support nations as
they fight this outbreak and work to develop and strengthen
their health care systems.
Health care is a human right. We must ensure that countries
have the ability to address this outbreak and are able to move
forward and prevent future health epidemics from occurring. In
Congress, there has been consistent activity related to the
recent crisis.
Prior to the August recess, 100 bipartisan members
introduced House Resolution 701 expressing the sense that the
current outbreak is an international health crisis and is the
largest and most widespread outbreak of the disease ever
recorded.
On August 7, the Foreign Affairs Committee's Africa
Subcommittee held an emergency hearing on the crisis and 77
members have signed a letter to the Committee on Appropriations
to fulfill the President's $88 million funding request to fight
the crisis.
And there is also going to be a member meeting tomorrow
that we are all doing together to brief members who don't have
the opportunity to sit on this subcommittee or the full
committee.
I look forward to your testimony and I am interested in
hearing from all of you about what more Congress can do to
assist your efforts to combat the disease outbreak and support
international efforts to improve health care systems around the
world.
Thank you, and I yield back.
Mr. Smith. Ms. Bass, appreciate it.
We are joined by the distinguished chairman of the full
committee, Mr. Royce.
Mr. Royce. Thank you, Mr. Chairman. I just guess I would
start by thanking and welcoming Dr. Kent Brantly who is with us
and to say that I am very glad that ZMapp is in trials and I am
glad you are here.
Our heart goes out to the families of your colleague who
also tried the ZMapp and did not survive. But we are encouraged
by the fact you are with us today. We have seen this pandemic
in the past in the Philippines, in Uganda, in Congo, different
strains, and over the past in each case the strain has burned
itself out. I mean, we have had about 2,300 deaths worldwide
since 1976 as, time after time, different strains of Ebola have
been put to rest.
But in this latest chapter in west Africa, primarily in
Liberia and the neighboring states, we see a situation where we
have already had 2,300 deaths, as many as in all the previous
cases combined.
And I spoke yesterday also to President Sirleaf, who
contacted me about the situation in Liberia. She acknowledged
that the health system of Liberia has virtually collapsed under
the strain of this Ebola crisis and she correctly pointed out
that this is not just a health catastrophe affecting her
country.
It affects the region. It affects the security of the
region, threatens the economic growth and food security but,
beyond that, affects the security of the United States.
The entire global health community must come together and
put in place a coherent strategy to stem the tide of new
infections and my hope is that some of our effort here will
encourage this in terms of the entirety of the world health
community.
We do not have the luxury of time. Infectious diseases like
this one, they do not recognize borders, they do not
discriminate, and the time to act is now.
And I spoke recently with Raj Shah, the Administrator of
USAID, who shares our concern on this subject. But I really
want to thank the witnesses for appearing today and we look
forward to working with them to ensure that the U.S.
contribution to the global response to Ebola is robust and is
effective. And thank you again, Mr. Chairman.
Mr. Smith. Thank you very much, Chairman Royce. I would
like to now yield to the ranking member of the full committee,
Mr. Engel, of New York.
Mr. Engel. Thank you, Mr. Chairman--Chairman Smith, Ranking
Member Bass. Thank you for holding this important hearing on
the devastating Ebola outbreak in west Africa.
I want to say at the outset I am very happy that Betty
McCollum, our colleague from Minnesota who is a former member
of this committee is here with us as well.
Without exception, the global health leaders from around
the world continue to sound the alarm about the terrible threat
posed by this Ebola outbreak. It is almost impossible to
overstate how dire the situation has become in Liberia, Sierra
Leone, and Guinea.
The World Health Organization has called this outbreak
unparallelled in modern times. Almost 2,500 of the 5,000
individuals infected by Ebola have died. NGOs and humanitarian
organizations have shouldered most of the burden in fighting
this epidemic for months but their passion and dedication is no
match for the speed with which this disease is spreading. More
government involvement is desperately needed.
The World Health Organization has also said that if the
response is quickly scaled up, only tens of thousands of
individuals will become infected by the time the outbreak is
contained. That is the best case scenario, believe it or not.
The alternative is simply unacceptable.
The need for more well-trained health care personnel,
personal protective equipment, and adequate health care
facilities is immediate. So I am pleased to see the CDC, USAID,
and Department of Defense are rapidly scaling up their efforts.
I am also glad that President Obama has decided to send the
U.S. Military to help.
It is my belief that our response must be well coordinated,
sustained, and nimble enough to meet the needs as they evolve.
However, the United States cannot contain this disease alone.
It is a threat to the entire international community and
requires a truly global response.
I will be interested to hear from our panelists about what
our other partners around the world are doing to help with the
response and what significant gaps remain to be filled.
I would also like to take a moment to applaud the courage
and selflessness of the health workers on the front lines
trying to help those afflicted to survive.
They put themselves at significant personal risk and are
bearing the brunt of the infection's spread, as one of our
witnesses, Dr. Kent Brantly, can attest to. Their bravery and
dedication is simply appreciated and a true inspiration to all
of us.
So let me say as the ranking member of the House Foreign
Affairs Committee, thank you, Chairman Smith and Ranking Member
Bass, for convening this hearing and thank you to our witnesses
for coming to talk about this urgent issue. I yield back.
Mr. Smith. Thank you very much, Mr. Engel. Mr. Stockman.
Mr. Stockman. I just want to say a brief note to those that
are here in attendance today, I was in South Sudan and one of
the organizations, Mr. Chairman, that I saw there, of all the
other nongovernmental organizations that were there, was
Samaritan's Purse, and wherever I travel around the world they
are a shining light and example of true compassion and
sacrifice and it is done in silence that most Americans aren't
aware of.
And Kent's sacrifice is not just in Africa, but your whole
organization is to be commended for the compassion and the
heart you have and I know Franklin Graham and others have
worked tirelessly and has not broadcast that.
But wherever I went Samaritan's Purse was there and it is
really a testimony to the work that you and others have done on
behalf of the United States and I just want to send a thank you
for that.
Mr. Smith. Thank you very much, Mr. Stockman.
Mr. Cicilline.
Mr. Cicilline. Thank you, Mr. Chairman. I want to thank you
and Ranking Member Bass for holding today's hearing on this
very serious outbreak of Ebola in west Africa.
I also want to acknowledge and send thoughts and prayers to
all of the families who have already been affected by this
outbreak and I know in my home state of Rhode Island, which is
the very proud home to a wonderful Liberian community, it has
caused considerable heartache and concern.
I want to particularly offer my gratitude to the witnesses
today for your testimony and for the really important work that
you are doing and to the government panel in particular for
keeping Congress so well informed with regular updates on the
situation on the ground.
In particular, I also want to acknowledge and thank Dr.
Kent Brantly for joining us on the second panel and for sharing
with us the work that he has been doing in Africa to fight
Ebola and, of course, his own personal experience surviving the
virus.
The United States has both a humanitarian responsibility
and a national interest in doing all that we can to fight this
outbreak, and in addition to obviously protecting against Ebola
within our borders, we also have a responsibility to work to
help save lives and strengthen the economies of our trading
partners and maintain political stability in the region that
has been affected by this outbreak.
We must all be concerned about the serious issues of civil
unrest, food insecurity, and the collapse of national health
care systems in the African countries impacted by this
outbreak, and I hope our witnesses will share with us ways that
we can address this crisis more effectively and what are the
things Congress might do to support an effective response to
this crisis.
And with that I, again, thank the witnesses and yield back,
Mr. Chairman.
Mr. Smith. Thank you, my friend. I would like to yield to
Dr. Burgess.
Mr. Burgess. Well, thank you, Mr. Chairman, and thank you
and Ranking Member Bass for allowing me to be part of your
committee's activities today and I am anxious to hear from the
witnesses that you have assembled and to learn more.
I am on the Energy and Commerce Committee and we do have a
healthcare footprint. But, Mr. Chairman, let me just say you
have taken an outsized role in providing leadership in the
Congress in having the hearings on this very important
outbreak.
Certainly, Dr. Fauci, for the last 12 years you have been a
resource for me whenever infectious disease threatens and,
unfortunately, it does and I have always looked to you for your
expertise and your leadership in this area.
Dr. Brantly, I just had a chance to meet you for the first
time today. You are from my part of the world in Fort Worth and
I appreciate your service at Samaritan's Purse and certainly
grateful that you are with us and I really mean that you are
with us today.
Others have said it so well but more people have died in
this outbreak than all of the previous outbreaks of Ebola going
back to 1976. No one expected the outbreak to reach the
proportions that it did, but it did.
No one expected it to last the length of time that it has,
but it has. Now, certainly, whatever criticism there may be for
lack of action in the past I am pleased that action is
occurring now.
Just also feel obligated to note that an obstetrician is
recovering today in Omaha, Nebraska--Dr. Rick Sacra--who was
not actually treating Ebola patients but was exposed through
his work in labor and delivery, and it just underscores part of
the risk--the accelerated risk that healthcare providers
experience in this illness and in the countries that are so
affected but also the fact that the rest of civil society and
the healthcare infrastructure is really put under strain by
this.
And you can really scarcely devote the resources that are
needed to treating malaria and accident victims and mothers in
labor when everything else has to be diverted to taking care of
people with Ebola.
So, Mr. Chairman, I thank you for the opportunity to be
with you today. Thank you for your leadership on this issue and
I will yield back my time.
Mr. Smith. Thank you very much, Dr. Burgess.
I would like to yield now to the gentlelady from Minnesota,
Ms. McCollum
Ms. McCollum. Well, thank you, Mr. Chair. That is an
unexpected surprise. Thank you very much.
I would also like to extend my thanks to the panels that
are here today who reflect all the healthcare workers around
the world, especially those in Africa who are working so hard
and the researchers who are trying to find ways in which to
defeat this disease.
Minnesota is my home state. We are a state that is blessed
to have so many wonderful, wonderful people from all over the
world who call Minnesota home including a large Liberian
population, one who is mourning the loss of their own, as
Chairman Smith pointed out.
We are also the home to my first state epidemiologist, Mr.
Osterholm, who sometimes gets accused of talking fire but he is
saying look where the fire exits are.
So in my work on the Appropriations Committee and the
Department of Defense I am pleased that we are putting boots on
the ground to fight this disease. Thank you, Mr. Chairman.
Mr. Smith. Thank you very much, Ms. McCollum.
I would like to now introduce our very distinguished panel,
beginning first with the Honorable Nancy Lindborg, who is the
Assistant Administrator for the Bureau for Democracy, Conflict
and Humanitarian Assistance at USAID, and she has testified
before our subcommittee several times and provided very
valuable input and leadership for her respective portfolio but
also great input to this subcommittee as to what we ought to be
doing to be of assistance.
Since assuming her office in October 2010, Ms. Lindborg has
led DCHA teams in response to the ongoing Syria crisis, in the
Horn of Africa in 2011, the Sahel 2012 droughts, the Arab
Spring upheaval, in the aftermath of Typhoon Haiyan in the
Phillippines, and numerous other global crises. Prior to
joining USAID, Ms. Lindborg was the president of Mercy Corps
where she spent 14 years.
We will then hear from Dr. Anthony Fauci, who is Director
of the National Institute of Allergy and Infectious Diseases at
the NIH.
Since his appointment as NIAID Director in 1984, Dr. Fauci
has overseen an extensive research portfolio devoted to
preventing, diagnosing, and treating infectious and immune-
mediated diseases. Dr. Fauci has made numerous discoveries
related to HIV/AIDS and is one of the most cited scientists in
the field.
Dr. Fauci serves as one the key advisors to the White House
and the Department of Health and Human Services on global AIDS
issues and he was one of the principal architects of PEPFAR.
We will then hear from Dr. Luciana Borio, who serves as
Assistant Commissioner for Counterterrorism Policy and the
Director of the Office of Counterterrorism and Emerging Threats
in the Office of the Chief Scientist, U.S. Food and Drug
Administration.
In this capacity, Dr. Borio is responsible for providing
leadership, coordination and oversight for FDA's national and
global health security, counterterrorism, and emerging threat
portfolios.
She serves as FDA's point of entry on policy and planning
matters concerning counterterrorism and emerging threats,
collaborates across U.S. Government and internationally on
actions to advance global health security and U.S. national
security.
And our fourth witness in Panel I will be Dr. Beth Bell,
who is the Director of the National Center for Emerging and
Zoononic Infectious Diseases.
Most recently, Dr. Bell served as the Associate Director
for Epidemiologic Science in the National Center for
Immunization and Respiratory Diseases.
Dr. Bell has served in leadership roles during CDC
responses to several major public health events including the
2001 anthrax attacks--and she will recall one of the post
offices hit was my own in Hamilton Township where we had a
number of people who contracted cutaneous anthrax--Hurricane
Katrina, and the 2009 H1N1 influenza pandemic.
As a member of the senior leadership team for the 2009 H1N1
influenza pandemic response she provided oversight of policy
and scientific direction. So four extraordinarily important
and, I think, great leaders in the field.
I would like to now go to Ms. Lindborg and then to Dr.
Fauci.
STATEMENT OF THE HONORABLE NANCY LINDBORG, ASSISTANT
ADMINISTRATOR, BUREAU FOR DEMOCRACY, CONFLICT AND HUMANITARIAN
ASSISTANCE, U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT
Ms. Lindborg. Thank you. Thank you, Chairman Smith, Ranking
Member Bass, members of the subcommittee and other members.
Thank you for inviting me to testify today on the U.S.
response to the really unprecedented Ebola epidemic in west
Africa and special thanks for your continued support and vital
interest in these issues.
I think as a number of you have very articulately laid out,
this is the largest and most protracted Ebola epidemic in
history. Thousands have already been sickened or killed and for
the first time ever it is being transmitted in densely
populated urban areas.
So we are now seeing a near exponential increase in the
transmission of the virus with the potential for a regional
spread beyond the primary countries of Guinea, Liberia, and
Sierra Leone.
The United States began combatting the epidemic when the
first cases were reported in March and what began as a public
health crisis began morphing into a multidimensional public
health, humanitarian, and security crisis this summer.
And so we then significantly expanded our efforts and on
August 5 USAID deployed a Disaster Assistance Response Team, or
a DART, to the region to oversee and coordinate the U.S.
response, drawing on critical assets and resources from across
the U.S. Government including CDC, USAID, HHS, DoD and the U.S.
Forest Service.
We developed a clear four-part government strategy that
supports the U.N. and country-led responses. That was first and
most urgently focused on controlling the epidemic. Next, we are
working to mitigate the side effects of the crisis. This
includes blunting the economic, social, and political tolls.
Third, we are helping to coordinate with the U.N. and
enable a broader effective global response, and finally, very
importantly, we will work to fortify the global health
infrastructure.
So we had deployed 120 experts to the region and began
airlifting urgent supplies, personal protective equipment for
healthcare workers, disinfectant backpack sprayers, water
treatment, chlorine, body bags, et cetera--the kinds of
supplies that are absolutely critical.
The team is providing technical guidance to strengthen the
local response systems, do the contact tracing, and upgrade
laboratory testing facilities. We have supported the U.N.
humanitarian air service and we funded those organizations
willing to step forward to run Ebola treatment units.
However, we very quickly ran into the reality that there is
simply not the global expertise or capacity in the humanitarian
or health world to respond to this kind of crisis at this scale
at the rate that it is continuing to increase.
With the disease transmission rates nearly doubling each
week there is little time to spare, and as President Obama
announced yesterday, we are now significantly expanding the
response with the deployment of the unique capabilities of our
military to respond with the speed and the scale that is so
essential to get ahead of this disease.
So those efforts will essentially provide the backbone for
an expanded regional effort that will enable the entire
international community to contribute.
It will include the establishment of a joint force command
headquartered in Liberia, very importantly, a training facility
in Liberia that will have a tent city and the training
facilities to train 500 workers a week so that we can have a
vital pipeline of health and management personnel.
They will include a regional base with lift and logistical
capacity to expedite a surge of urgently needed equipment,
supplies and personnel, and include command engineers to help
construct the Ebola treatment units.
This is the critical infrastructure, coordination and
logistics to provide the foundation for an ever greater
response as needed so that we can bring all our resources to
bear and set the lead for our international partners.
The President also announced the launch of our community
care campaign. This is focused on getting vital information and
support to families and communities so they can protect
themselves and their families.
We will work with local communities and international
partners to initially target 400,000 of the highest risk
households with intensive outreach, information, and important
tools for those unable to access a bed in a healthcare unit and
we will simultaneously work on broad information campaigns to
reach all of society and every household.
We recognize that a significant number of people in this
region don't seek formal healthcare which is why ultimately the
virus will only be controlled if people have a better
understanding of what this is and how to prevent transmission.
We are hearing stories of ordinary west Africans who do not
believe that Ebola is real. Show me Ebola, they say. So we are
challenged to reverse deeply-ingrained cultural practices even
as we help the affected communities.
Cultural funeral traditions, such as washing the body where
family members touch and clean the body of the deceased, are
contributing to the spread and women are especially vulnerable
as even those who sometimes know they shouldn't continue this
practice are pressured to do so.
Our partners are already saying thank you for the public
messaging campaigns, that now people know that this is harmful
and can spread the disease, even though it goes against their
traditions.
This is a region of fragile states just emerging from
decades of conflict and poverty, so we are also looking at how
to help with economic help, food support, and salaries for
health workers. We know that tough months lie ahead.
It will take a coordinated effort by the entire global
community to stem this terrible crisis, but past outbreaks have
been stopped and we are confident with this concerted effort we
can stop this one.
I want to just add my commendation for the extraordinary
courage of the health workers, including Dr. Brantly and the
many, many west Africans who have sacrificed to provide help
for their families and their neighbors.
We are remaining focused on outreach efforts to get
additional medical workers willing and able to go to west
Africa. So we encourage those who are interested in joining
this historic response to go to our Web site at www.usaid.gov/
ebola and we will continue to work together and across the
international community to stem the tide on this disease.
Thank you very much.
[The prepared statement of Ms. Lindborg follows:]
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Mr. Smith. Thank you very much, Nancy.
I would like to now ask Dr. Fauci if you would proceed.
STATEMENT OF ANTHONY S. FAUCI, M.D., DIRECTOR, NATIONAL
INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES, NATIONAL
INSTITUTES OF HEALTH, U.S. DEPARTMENT OF HEALTH AND HUMAN
SERVICES
Dr. Fauci. Ranking Member Bass, members of the committee, I
appreciate the opportunity to discuss with you today the role
of the National Institute of Allergy and Infectious Diseases in
the research that addresses the Ebola epidemic.
There are some visuals, I believe, on your screen in front
of you and I will speak from them if you see them, if we can do
that.
It is very interesting that we became involved in this in
an unusual way dating back to the tragic events of 9/11
followed by the attacks by mail of anthrax to United States
Senators and to the press because that triggered a multi agency
effort in what we call biodefense involving the CDC, the FDA,
the NIH, a variety of other agencies--including Homeland
Security--to develop an agenda to be able to be prepared not
only against deliberate attacks but against natural emerging
and reemerging infectious diseases.
We developed a research agenda against what we call
Category A agents, which is shown on this visual, including
anthrax, botulism, plague, smallpox, tularemia, and notice on
the last bullet is what we call the viral hemorrhagic fever
viruses including Ebola, Marburg, Lassa and others.
These were of particular concern because, as we are
painfully witnessing now, these viruses have a high degree of
lethality and infectivity. Unfortunately, therapy consists
mainly of supportive therapy with no specific anti-viral drugs,
and a vaccine, as I will get to in a moment, is not yet
available.
This is an electron micrograph of the Ebola virus, a
particular deadly character, as you know, as we are
experiencing. It is a member of the filovirus family because of
the filamentous look that you see on this image.
Just a very brief word as to what we were referring to as
the kinetics or dynamics of the epidemic. This visually shows
you the 22 previous outbreaks, some of which were so small that
they don't even fit on the scale.
If you will look at the far right, the current outbreak, as
we have all mentioned several times, is more than all of the
others combined both in numbers and in deaths. And if you look
at the map of west Africa, this is a few days outdated but,
indeed, even the underestimated numbers show about 5,000
infections and about 2,500 deaths in the countries involved.
Now, without a doubt, the approach to this is an
intensification of the effort of infection control. This next
slide is a bit frightening because if you look at the red line
under Liberia that is a mathematical manifestation of what we
call exponential increase.
Linear and incremental is not a steep slope. When you go up
like that what you have is an exponential increase at the same
time that we might be incrementally increasing our response. As
we know in public health when you put incremental against
exponential, exponential always wins and that is really the
problem and why we are so gratified and excited about the
President's initiative about really ratcheting up the response
in infection control.
But also supplementing and complementing that is the
development of countermeasures and let me just take a minute to
outline this because we at NIH and NIAID are involved in
everything from basic to clinical research and also supplying
the research resources for academic as well as industrial
partners to develop the three main interventions--diagnostics,
therapeutics, and vaccines.
So a moment on therapeutics. You have heard a lot about
ZMapp. It is a combination of three artificially-produced
antibodies directed against the Ebola virus.
The results in an animal--in this case, monkey model--have
been really quite striking, and as I will get to in a moment it
has been given to seven humans, the first time it has been in
human.
It is the responsibility and the mandate of the NIH when
more of this becomes available to strike the delicate balance
of getting it to people who need it and at the same time
proving that it is safe, that it really does work and if it
does, how well does it work and does it, in fact, hopefully not
have any paradoxical harm.
Also shown on this slide are a couple of other
interventions that you will be hearing about or have heard
about again. All did well in an animal model and now are either
in or getting ready to go into Phase I trials--things like
novel drugs that interfere with the reproductive process of the
virus or small molecules that interfere with the replication of
the virus.
This is a series of press releases regarding the ZMapp and
you know there have been anecdotal data that it works. We are
very, very pleased and gratified to have our colleague, Dr.
Kent Brantly, with us today who received this.
Whether or not that was the deciding factor, we hope so and
we hope to be able to prove it, but we don't know that right
now and that is why a clinical trial is important.
And then, finally, the issue of vaccines. We have been
working on vaccines for Ebola for several years and
incrementally have done better and better in an animal model
and even gone into Phase I. The most recent one is shown on
this first bullet. It is referred to as the NIAID/
GlaxoSmithKline candidate.
It is not the only vaccine candidate but it is the one that
we have actually just started now, and as I know I have
mentioned to this committee before, you go from an animal
preclinical to a Phase I in human. If it is safe and it proves
to be immunogenic, you then expand the trial to be able to find
the important information--A, is it safe, B, does it work, and
C, does it do no harm.
And, again, it will be the delicate balance of determining
that at the same time that we actually make it available to the
best extent that we can, and in this regard on September the
first human received this at the NIH in Bethesda, Maryland in a
20-volunteer study. This is a little bit outdated.
We injected the 13th volunteer about 1 hour and 45 minutes
ago up at the NIH, and we are hoping to get to 20, and the data
will be available by the end of November or the beginning of
December.
So in summary, members of the committee, the NIAID research
has a dual mandate. For years and years, we continually do
robust and basic clinical research to be able to fulfill and
determine pathogenic mechanisms and microbiology in infectious
diseases.
Despite this effort every day, every week, every month, we
still stand prepared at a moment's notice to respond to
surprising emerging and reemerging infectious diseases and this
is exactly what happened with the reemergence of Ebola in west
Africa.
So we stand prepared for this pandemic and, hopefully, for
anything in the future. Thank you.
[The prepared statement of Dr. Fauci follows:]
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Mr. Smith. Dr. Fauci, thank you so very much for your
testimony and your leadership.
Dr. Borio.
STATEMENT OF LUCIANA BORIO, M.D., DIRECTOR, OFFICE OF
COUNTERTERRORISM AND EMERGING THREATS, OFFICE OF THE CHIEF
SCIENTIST, U.S. FOOD AND DRUG ADMINISTRATION, U.S. DEPARTMENT
OF HEALTH AND HUMAN SERVICES
Dr. Borio. Good morning, Chairman Smith, Ranking Member
Bass and members of the subcommittee. Thank you for the
opportunity to appear before you today to discuss FDA's actions
to respond to the Ebola epidemic in west Africa.
This epidemic, with so many lives lost, is heartbreaking
and tragic. My colleagues and I at the FDA are fully dedicated
to doing all we can to help end it as quickly as possible.
The primary approach to containing this epidemic remains
standard, tried and true public health measures, but
effectively implementing such measures on a broad scale has
proven challenging, and I know the professionals caring for
patients with Ebola are doing all they can under very difficult
conditions.
They are operating in a setting of very limited healthcare
infrastructure which has made it almost impossible for them to
provide supportive medical care, such as intravenous fluids and
electrolytes, for the large number of patients who need them,
and this response is further complicated by the lack of
specific treatments or vaccines that have been shown to be safe
and effective for Ebola.
In situations like this, the FDA plays a very critical
role. We have one of the most flexible regulatory frameworks in
the world and we are working diligently to facilitate and speed
the development, manufacturing, and availability of
investigational products such as vaccines, therapies, and
diagnostic tests.
We are providing FDA's unique scientific and regulatory
expertise to U.S. Government agencies that support medical
product development, agencies such as Dr. Fauci's at NIAID,
BARDA, and the Department of Defense.
We are working interactively with companies to clarify
regulatory requirements to help expand manufacturing capacity
and we expedite the review of data as it is received so there
is no lag between receiving data and reviewing data.
As a result, the vaccine candidate being co-developed by
the NIAID and GlaxoSmithKline began Phase I testing on
September 2 and a second vaccine candidate is expected to begin
clinical testing very soon.
We will continue to work closely with all of these
companies, again, to speed development of their products. In
addition, we are collaborating with the WHO and working with
several of our international counterparts, including the
European Medicine Agencies and Health Canada, to exchange
information about investigational products for Ebola and
considerations for their deployment in west Africa.
It is important to note, though, that these investigational
products are in the earliest stages of development. For most,
only small amounts have been manufactured for early testing.
This constrains options for assessing their safety and efficacy
in clinical trials and for wider distribution and use.
Access to limited the supplies of investigational products
during an epidemic like this should be through clinical trials
when possible because they provide an ethical means for access
while also allowing us to learn about product safety and
efficacy.
FDA is working with developers to encourage the conduct of
practical, ethical, and informative trials so the global
community can know for sure the risks and clinical benefits of
these products.
But until such trials are established, we will continue to
facilitate access to these products when available and when
requested by clinicians.
We have mechanisms such as compassionate use which allow
patients to access investigational products outside of clinical
trials when we assess that the expected benefits outweigh the
potential risks for the patient.
This epidemic has posed incredible demands on FDA. There
are more than 200 staff at FDA involved in this response and
without exception everyone involved has been proactive,
thoughtful, and adaptive to a complex range of issues that have
emerged.
Developing these products for Ebola is highly complex and
will, unfortunately, take time. I once again stress that public
health measures remain the cornerstone of curbing this epidemic
and improving the medical infrastructure in the affected
countries is critical to save lives.
Such infrastructure is also essential for advancing product
development to meet the global access to vaccines and cures.
FDA is fully committed to sustaining our deep engagement and
aggressive response activities.
Thank you so much.
[The prepared statement of Dr. Borio follows:]
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----------
Mr. Smith. Thank you very much for your testimony.
Dr. Bell.
STATEMENT OF BETH P. BELL, M.D., DIRECTOR, NATIONAL CENTER FOR
EMERGING AND ZOONOTIC INFECTIOUS DISEASES, CENTERS FOR DISEASE
CONTROL AND PREVENTION, U.S. DEPARTMENT OF HEALTH & HUMAN
SERVICES
Dr. Bell. Good morning, Chairman Smith, Ranking Member
Bass, members of the subcommittee and members of other
committees.
I am Dr. Beth Bell. I am the director of the National
Center for Emerging and Zoonotic Infectious Diseases at the
CDC. I appreciate the opportunity to be here today to discuss
the current epidemic of Ebola in west Africa, which illustrates
in a tragic way the need to strengthen global health security.
I will be updating you on testimony that CDC Director Tom
Frieden gave before this subcommittee in August when you played
an important role in calling attention to this emerging
epidemic.
The Ebola epidemic in Guinea, Liberia, and Sierra Leone is
ferocious and it is spreading exponentially. The current
outbreak is the first that has been recognized in west Africa
and the biggest and most complex Ebola epidemic ever
documented.
As of early September, there were more than 4,500 confirmed
and suspected cases and over 2,500 deaths, though we believe
the actual numbers could be at least two or three times higher.
We have now also seen cases imported into Nigeria and
Senegal from the initially affected areas and other countries
are at risk of similar exportations as the outbreak grows.
There is an urgent need to help bordering countries to better
prepare for cases now and to strengthen detection and response
capabilities throughout Africa.
The secondary effects of this outbreak now include the
collapse of the underlying healthcare systems resulting, for
example, in an inability to treat malaria or to safely deliver
an infant as well as non-health impacts such as economic and
political instability and increased isolation of this area of
Africa.
These impacts are intensifying and not only signal a
growing humanitarian crisis but also have direct impacts on our
ability to respond to the Ebola epidemic itself. There is a
window of opportunity to control the spread of this disease but
that window is closing.
If we do not act now to stop Ebola, we could be dealing
with it for years to come, affecting larger areas of Africa.
Ebola is currently an epidemic, the worst Ebola outbreak in
history, but we have the tools to stop it and an accelerated
global response is urgently needed and underway, as the
President announced yesterday.
It is important to note that we do not view Ebola as a
significant public health threat to the United States. The best
way to protect the U.S. is to stop the outbreak in west Africa.
But it is possible that an infected traveler might arrive in
the U.S.
Should this occur, we are confident that our public health
and healthcare systems can prevent an Ebola outbreak here and
recognize that the authorities and investments provided by the
Congress have put us in this strong position.
Many challenges remain, particularly since there is
currently no therapy or vaccine shown to be safe and effective
against Ebola. We need to strengthen the global response which
requires close collaboration with WHO, additional assistance
from international partners and a strong and coordinated United
States Government response.
CDC has over 100 staff in west Africa and hundreds of
additional staff are supporting this effort from Atlanta. CDC
will continue to work with our partners across United States
Government and elsewhere to focus on five key strategies to
stop the outbreak: Establishing effective emergency operations
centers in countries, rapidly ramping up isolation and
treatment facilities, helping promote safe burial practices,
strengthening infection control and other elements of
healthcare systems, and improving communication about the
disease and how it can be contained.
Controlling the outbreak will be costly and require a
sustained effort by the U.S. and the world community. Within
HHS the administration recently proposed that the Congress
provide $30 million for CDC's response during the continuing
resolution period and for efforts to develop countermeasures.
Yesterday the President was briefed at CDC on the epidemic
and announced that the unique logistics and materiel
capabilities of the U.S. Military will be engaged as part of an
urgent and intensified U.S. Government response.
As my colleagues can attest, we are working across United
States Government to assess the full range of resources that
can be leveraged to change the trajectory of this epidemic.
Working with our partners, we have been able to stop every
previous Ebola outbreak and we are determined to stop this one.
It will take meticulous work and we cannot take shortcuts.
As CDC Director Tom Frieden has noted, fighting Ebola is
like fighting a forest fire--leave behind one burning ember,
one case undetected, and the epidemic could reignite. Ending
this epidemic will take time and continued intensified effort.
The tragedy also highlights the need for stronger public
health systems around the world. There is worldwide agreement
on the importance of global health security but the Ebola
epidemic demonstrates that there is much more that needs to be
done.
In Dr. Frieden's previous testimony, he outlined new
investments we are seeking to strengthen fundamental public
health capabilities around the globe. If these people,
facilities, and labs had been in place in the three countries
currently battling Ebola, the early outbreaks would not have
gotten to what we are facing now.
Stopping outbreaks where they occur is the most effective
and least expensive way to protect people's health. I know many
of you have travelled to Africa to see our work in global
health, as have I, and we all come away with an appreciation
for the enormous challenges many people and countries face.
These may never have been more evident than in the current
Ebola epidemic. Each day for the past months I have been in
personal contact with our teams in the field. Their experiences
reinforce the dire need and put real stories and faces on a
tragedy that can't simply be reduced to numbers and charts.
But these stories from the field also reinforce the unique
and indispensable role that CDC and our many partners are
playing and the sense that with an intensified global focus we
can make a real difference.
Thank you again for the opportunity to appear before you
today and for making CDC's work on this epidemic and other
global threats possible.
[The prepared statement of Dr. Bell follows:]
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Mr. Smith. Thank you very much, Dr. Bell.
Let me just begin the questioning and then I will yield to
my colleagues for their questions. I will throw out a few
questions and if you wouldn't mind jotting them down because I
do have about 100. I exaggerate a little bit.
There has been a lot of criticism about who is in charge.
Is it the health ministers in country? WHO puts out a lot of
press releases.
Dr. Brantly made an observation, and I think it is a very
good one, that
``Agencies like the World Health Organization remain
bound up by bureaucracy. Their speeches, proposals, and
plans--though noble--have not resulted in any
significant action to stop the spread of Ebola. The
U.S. Government must take the lead immediately to save
precious African lives and protect our national
security.''
You know, I know that you might be loathe to criticize WHO but
we need to know who is actually in charge on the ground.
Secondly, if I could, the deployment of 3,000 members of
the U.S. Military obviously, that was weeks, certainly, days in
preparation. Interagency coordination had to have been a part
of that for that announcement to be made. I am just wondering
if you could tell us who will be deployed.
I will never forget making a trip to the border of Iraq and
Turkey immediately after the Kurds flocked to that border, and
many were dying from exposure and disease and Operation Provide
Comfort was established.
Within about 5 days a group of us went over there to take a
look at it and to talk to people, and if it wasn't for the
Special Forces and the work they did, and they handed the baton
eventually to NGOs and others who helped those individual
Kurds, but for about a month had it not been for the Special
Forces, particularly the military doctors and others that were
there, hundreds if not thousands would have died. So my
question is how that force will be configured.
Will it be made up of a significant portion of MDs, nurses,
and others? I know that we have heard that they will be
constructing or, I believe, that is one thing they are going to
do in Liberia, you know, hospital beds or at least places where
people can find refuge and get help.
But what will that configuration look like? Dr. Brantly,
again, in his testimony makes an excellent point, ``For too
long, private aid group have been confronting this Ebola
epidemic without adequate international support.'' Then he says
these organizations cannot go it alone.
``A significant surge in medical boots on the ground must
happen immediately to support those already working in west
Africa'' . . . and he goes on in his testimony. How many
medical personnel are needed?
How many have been deployed and will this deployment of
3,000 of our service members be significantly made up of
medical personnel? On force protection--and Dr. Fauci, you
might want to speak to this as well--obviously, when you are
dealing with an epidemic and people can contract this disease
it gives new meaning to force protection, you know, all the
usual. How many protective suits will be needed?
Do you have adequate access to those suits and gear? You
know, as Dr. Brantly points out, he took every precaution and
he still got Ebola. So the question would arise, and I am sure
for the individual service members being deployed and their
families: Will there will be adequate protections?
Is more money needed? You know, as my friend and colleague
pointed out at the Rules Committee the other day, $88 million
is in the supplemental: Is that enough?
You know, we should leave no stone unturned to make sure
that people are protected and hopefully safe from this hideous
disease but when putting many more Americans into harm's way,
no stone should be left unturned in making sure they are
protected as well.
If there are any gaps there, please speak to that. Let me
also ask you: How do you attract medical personnel to be
deployed? You know, if they are ordered by way of military,
that is one thing.
But how do you incentivize it? Many of the faith-based
groups go there and risk their lives, as do the non-faith
based, out of pure love of African people or wherever it is
that they are deployed.
But now they are dealing with a pandemic. How do you
incentivize and are people coming forward to go? The range of
the estimates of infections and, Dr. Fauci, I want you to speak
to this, is there a possibility or probability that this could
mutate into an airborne, you know, infection?
Right now we are told that is not the case but is that a
possibility and, again, if you could put any kind of number on
how many medical personnel are needed to be deployed. You know,
I have been trying--I read everything I can on Ebola, talk to
people nonstop about it.
I still don't know how many people--because so much of the
infrastructure, as we all know, in west Africa for healthcare
has been decimated as well as the NGOs that were there early on
where their personnel have been hurt as well.
And finally, to Dr. Borio, if you could, at our last
hearing I raised the issue of TKM-Ebola and the FDA's
suspension of the trials. Has that changed?
I remember reading the company's information and they were
kind of surprised. But has that been reversed on that
particular drug? Ms. Lindborg.
Ms. Lindborg. Yes.
Mr. Smith. Okay. Dr. Fauci, if you could.
Dr. Fauci. No. Actually, Ms. Lindborg was going to, I
think, take the first question. There were several you asked me
for which I will be happy to answer but I think Ms. Lindborg is
going to take the first question.
Ms. Lindborg. Let me also offer, Chairman Smith, that it
might be helpful to come and do a more--even more detailed
walk-through since that seems to be something that is of great
interest.
What I will say is that there is a two-star, General
Williams, from AFRICOM who arrived in Monrovia yesterday and is
already beginning to work closely with the DART on detailing
out the exact configuration of the mission. It will come out of
the African Command.
There will be a large contingent of logisticians and
engineers, medical planners, planners, that will be setting up
the fundamental nerve center that will be able to support this
overall response.
There will also be 60 medical trainers who will be
operating the training facility and critical barriers in moving
forward a more robust response have been several key
constraints.
First is there has not been confidence that people could
get in and out of the region. Therefore, we are looking at
laying down the significant lift capacity that will serve the
entire region.
Secondly, people are worried because they have been
uncertain about Medevac in the event that they are ill, and so
we are working to increase the reliability and availability of
Medevac services for health workers.
Thirdly, they have been concerned about lack of healthcare
for the health workers, which is why the military is bringing
in a 25-bed hospital for healthcare workers.
It will be staffed by public health workers, teams of 65 at
a time out of HHS, and the first of the 13 plane loads bringing
that hospital in arrive on Friday in Monrovia. So that will be
set up.
Then finally is the lack of training. It is not so much
that you need high-level medical expertise so much as there
needs to be rigorous, very disciplined infection control.
Most urgently is a large cadre of basic care workers and
part of what this training will seek to do is create a pipeline
of healthcare workers who understand how to minimize the
infection and how to run a clinic that is absolutely rigorous
in following the right kind of procedures, and we will be
working with MSF to adopt their training so that that is
available to a larger cadre.
Finally, there are doctors needed both for the Ebola
treatment units but also for the larger revitalization of the
health systems.
As Dr. Bell mentioned, this is a problem throughout the
country and it is training those healthcare providers and those
clinics also on rigorous infection control because of the
stories that we have heard of people coming in and being
treated for other problems and end up you have transmission of
the Ebola virus.
So there is that whole package of issues that when we
address those, the goal is to unlock greater capacity of
organizations and healthcare workers who can come in, augmented
by this extraordinary capability that the U.S. Military is
bringing.
Mr. Smith. And we do have sufficient moneys allocated? I
mean, is there----
Ms. Lindborg. DoD has requested a $500 million----
Mr. Smith. Reprogramming?
Ms. Lindborg [continuing]. Reprogramming previously and I
believe today they will be submitting an additional $500
million.
Mr. Smith. Now, is that request being based on what they
think can be gotten or is it to really get the job done?
You know, we know that U.N. agencies notoriously
underestimate what the cost will be because they think when
they put out their request to other nations--donor nations--
they think that is all they are going to get rather that what
is the need and then we fight like the devil to get that money
allocated.
I have had that argument with them for 30 years in Geneva.
Ask for what is really needed even if we don't reach it so we
know the true need. Is what you are asking for what is needed?
Ms. Lindborg. Well, that is for the military's budget.
Mr. Smith. Yes, I mean--but also, like, the $88 million----
Ms. Lindborg. The $88 million, and USAID has allocated $100
million from our budgets. We think so for at least the initial
response but this is unprecedented. This is new territory for
all of us.
And so as we lay down this urgent scaled response we will
be closely monitoring to see what impact it makes and what else
we might need.
Mr. Smith. Gotcha. Dr. Fauci.
Dr. Fauci. So let me answer the question about this
potential scope, which is important because there is a lot of
confusion about that.
So the issue is--the question that is asked and that
sometimes frightens people: Is it possible that this virus
would mutate and then by the mutation completely change its
modality of transmission, mainly going from a virus that you
get by direct contact with bodily fluids to a virus that is
aerosolized, so if I am talking like this I can give it to Ms.
Lindborg or to Dr. Borio? So let me explain to you how that
possibly could happen and why I think it is unlikely, but not
impossible.
Ebola is an RNA virus and when it replicates it replicates
in a sloppy way. It makes a lot of mistakes when it starts
trying to duplicate itself. Those mistakes are referred to as
mutations.
Most mutations in this particular situation are irrelevant.
Namely, they don't--they are not associated with a biological
function that changes anything.
They just mutate and it is meaningless. Every once in a
while, rarely, a mutation, which is called a nonsynonymous
mutation--that is what scientists call it--does have a change
in biological function.
That change, if it occurs--if you historically look at
viruses that mutate, it generally, if it changes the function,
modifies an already existing function. It makes it either a bit
more virulent or a bit less virulent.
It makes it a little bit more efficient in spreading the
way it usually spreads or a little less efficient. What it
very, very rarely does is completely change the way it is
transmitted. So although this is something that is possible,
and I need to emphasize because whenever I try to explain it
people might think I am pooh-poohing it.
I am not. It is something we look at very carefully and we
actually have grants and contracts with organizations like the
Broad Institute in Boston which very carefully follow the
sequential evolution of the virus to alert us if in fact this
is happening.
So A, we take it very seriously, B, it is something that we
look at and that we follow closely. But we don't think it is
likely to happen. So I would rather that I lose sleep and Dr.
Borio and Ms. Lindberg and Dr. Bell lose sleep over that, but
not the American public lose sleep over that because we are
watching it very carefully.
Having said that, what is likely, and this gets to
everything we are talking about, is that if this virus keeps
replicating and keeps infecting more and more people, you are
going to give it more of a chance to mutate.
So the best possible way that we can take that off the
table is to actually shut down this epidemic and if we do, as I
always say, a virus that doesn't replicate doesn't mutate. So
if you shut it down then that thing is off the table. I hope
that was clear.
Mr. Smith. And your best case estimate on September 17th,
what this could evolve into? I mean, exponential was used
several times during your statement.
Dr. Fauci. Well, Mr. Chairman, the estimate is going to be
directly related to our response because it is kind of a race.
If our response is like this and Ebola is going like that,
as I said, this is going to win all the time and that is the
reason why we are excited and pleased to hear that the
President came out and said what he did and we are going to see
the things that Ms. Lindborg and others have been talking about
because once you get over that curve then you start to see the
epidemic coming down.
Now, that could be within a period of a few months if we
really put a full court press on. If we fall behind, it could
go on and on. So it is almost impossible to predict without
relating it to the degree of your response.
Mr. Smith. Dr. Brantly calls for a surge of medical boots
on the ground. How many U.S. medical personnel are now in the
impacted areas and how many do you think will be there in the
next month, how many the next several months? I have been
trying to get a handle on that for some time.
Ms. Lindborg. So one of the things we are doing is
supporting a worldwide call, this is really going to be an all
hands on deck response.
The African Union has mobilized 100 health keepers, which
is doctors, nurses, and other health clinicians, and the U.S.
is supporting their mobilization. Their advance team is on the
ground right now led by a Ugandan doctor who led the Ebola
response in Uganda.
The Chinese have mobilized medical personnel and the U.K.
and EU are both contributing facilities, labs and funding. So
we will continue to mobilize. One of the questions is how many
of these Ebola treatment units we will need.
Each Ebola treatment unit, according to the MSF model,
takes about 216 people, the majority of whom are basic
healthcare providers, basic care providers, augmented by, you
know, a chief medical officer, a lot of infection control
logistics, water sanitation--those kinds of management
capabilities.
So what we are seeking to do is to create a pipeline of the
trained medical care providers with this 500-a-week training
facility augmented by additional support, training and direct
provision of that management infection control piece because
ultimately the most important thing is it is rigorous,
disciplined, almost command and control of the----
Mr. Smith. All right. If I could just get back to that. How
many medical boots on the ground do we have as of today--U.S.?
Ms. Lindborg. We have--we are focused right now not on the
direct care but rather on providing the system that can enable
a full-throated response.
We have supported organizations like International Medical
Care and we are in discussions with several other organizations
that will bring--International Medical Care has a 60-bed unit
that they have stood up and it is a combination of medical and
other personnel that are needed to make each one of these Ebola
treatment units functioning.
Mr. Smith. But we do have doctors and nurses on the ground?
Ms. Lindborg. Correct.
Mr. Smith. Could you get back to us if you can find that
number? Because, you know, I understand the training component
and that is extraordinarily important.
But we know that there must be, including in the military
deployment, a number of doctors and nurses that will be a part
of that. Just to know what our commitment is on that side of
it.
Ms. Lindborg. Yes. And it is part of a much larger number.
We will get you--we will get you the break out of what the 25
percent are, the 115 people already in the region and the 3,000
who are being mobilized.
Mr. Smith. And anyone else? Yes, Dr. Bell.
Dr. Bell. I was--thank you, Chairman Smith, and I actually
just wanted to mention that I led the field team in New Jersey
during the 2001 anthrax attack so I know your district,
actually, quite well from the old days.
I just wanted to say a couple of other things about this
training pipeline, to build on what Nancy was saying and to
make a couple of these important points--that the majority of
the workers are local workers but there is a need for some
nurses and doctors and more higher-trained healthcare workers
and we have at CDC, working with MSF, established a training
program which will be held in Anniston, Alabama, every week.
It is a 3-day program which is meant to build a pipeline of
U.S. healthcare workers that are getting ready to deploy to the
region. Our first training, will begin next week and is already
full at something like 40 healthcare providers.
So, as Nancy says, we need sort of a very multifaceted and
multi disciplinary approach to addressing the problem and at
our end here at CDC we have had the--we will have these series
of classes every week for the foreseeable future to help build
that pipeline.
Mr. Smith. Just two final questions. The deployment of
3,000, when will the full contingent be actually in theater
and, again, to reassure not only those who will be deployed but
their families, will they have the protective gear in adequate
numbers from masks and the like to ensure that they do not
contract the disease?
And, Dr. Borio, if you could, speak to the issue of the
TKM-Ebola and whether or not the suspension has been lifted so
that the trial can continue.
Dr. Borio. So, Mr. Chairman, I am unable to discuss the
specific product today but what I can tell you is that clinical
hold issues it is based on our assessment of the benefit risk
profile for a proposed clinical study.
So whereas a product may be on clinical hold for a specific
study, it may not be on hold for different types of studies.
For example, sometimes the dose or frequency proposed in a
study does not allow us to believe the benefits will outweigh
the risks. In addition, sometimes we put a study on hold
because of adverse events that are identified immediately
after, you know, using the drug in the first few volunteers.
Another reason for a study to be on hold has to do with the
patient population that is being studied on that particular
proposed study. So there are many reasons for a study to be on
hold.
It is rare that we are not--well, in situations where a
study is on hold we will work the company very closely,
especially in a situation like this with Ebola, to be able to
make sure that we can design the studies where the benefit-risk
balance would be more appropriate.
Mr. Smith. Again, are there cross conversations? You
mentioned how flexible FDA is, like with NIH and others. I was
shocked when that hold was placed because I read a lot about
the drug.
It doesn't make me an expert, but there were some
encouraging signs and when you only have three or so drugs in
the pipeline that is not a large universe.
Dr. Borio. We are working very closely with our colleagues
at the NIH, at BARDA, DoD, as well as all the different
companies that have products of interest to the U.S. Government
to do all we can to move the development programs forward as
fast as we can.
Mr. Smith. Okay. Again, Ms. Lindborg, do we know when the
3,000 will actually be there? You know, I know they will be
going in components but when fully will they be deployed?
Ms. Lindborg. They are going in components and I will just
quote General Dempsey, who said they will move as fast as they
possibly can until they hit the laws of gravity.
Mr. Smith. Okay.
Ms. Lindborg. So they are fully seized and deployed.
Mr. Smith. And fully protected?
Ms. Lindborg. Yes, and if--I just want to underscore one
other point in response to your questions and that is we are
continuing to conduct outreach efforts so that we can find
other medical workers--doctors, nurses, and physicians
assistants--who are interested in working with organizations
who are responding and that is the Web site, usaid.gov/ebola,
and with the training that is available and the pipelines of
this critical gear that the response will provide of PPE, et
cetera.
Mr. Smith. Thank you. Dr. Bell.
Dr. Bell. Mr. Chairman, just to your point about will the
force be adequately protected, I just wanted to say that, you
know, at CDC we have over 100 young trainees, many of them in
the field, and so we have worked very hard on the sort of
information people need ahead of time--very, very clear
delineation of the sorts of protective equipment, things to do
to protect yourself, and what to do when you are in a situation
that you think is perhaps not as safe and secure as it should
be.
And so this is the sort of information that I think we have
spent--actually, quite a while now we have had people in the
field sort of perfecting and it is the sort of thing, I think,
that can be used with the military.
We all want to make sure that people are as safe as humanly
possible. The other thing I see off of my list of questions I
just wanted to address your question about the funding and to
just say from the CDC perspective that the $30 million is
enough to get us through the continuing resolution and allow us
to keep our people in the field but that we are going to be
considering during the period of the CR, what additional
funding we might need for the rest of the year.
Mr. Smith. Thank you, Dr. Bell. You know, in a conversation
I had with the President of Guinea, who has deployed his
military, I was concerned about how well-protected they were,
you know, when they rush in to be of assistance and then all of
a sudden they find themselves contracting the disease.
So and I am very concerned about our military as well. I
would like to yield to Ms. Bass.
Ms. Bass. Thank you, Mr. Chair, and I would like to begin
by asking a question on behalf of my colleague, Mr. Cicilline,
who had to leave and in his opening statement he mentioned that
many of his constituents are from Liberia.
So his question is the current extension of deferred
enforced departure for Liberians living legally in the U.S. is
scheduled to expire at the end of the month and apparently this
summer several Senators sent a letter to President Obama asking
him to end the uncertainty, especially given the current
crisis.
And so even though this is an issue under the jurisdiction
of USCIS, he was wondering if you know whether the
administration is really taking into account the health crisis
if many of these individuals would have to return home.
Dr. Bell. Thank you, Congresswoman Bass. As I testified
yesterday before the Senate HELP Committee and Senator Reed
asked a similar question, as you say, this is an important
issue in Rhode Island and other parts of the country as well,
and actually my deputy participated in a number of briefings
and town hall meetings on this topic.
This is a humanitarian issue, we agree, but we don't have
any further information about what is happening from the
perspective of the Immigration Service on this topic. Do you
have any information, Nancy?
Ms. Lindborg. We will take that question. We are
coordinating closely across the interagency that is a State
Department question. We will take it and get back to you.
Ms. Bass. Okay. All right. Thank you. And then I, in
speaking to a number of my colleagues yesterday as we were
preparing for this member briefing tomorrow, several of them
mentioned to me their concerns about the virus mutating and
becoming airborne, and I am not sure if those came up in the
questions before. Oh, they did?
Mr. Smith. They did.
Ms. Bass. Yes. You raised it? Okay. Well, maybe you could
explain why that is not a concern.
Dr. Fauci. Well, I wouldn't say it is not a concern but it
is not an overwhelming concern.
Ms. Bass. Okay.
Dr. Fauci. As I mentioned, and I will just very briefly
summarize what I said when you were out, Ms. Bass, that this is
a virus that continually replicates and makes a lot of
mistakes.
It mutates, and the overwhelming majority of the mutations
are irrelevant. They are not associated with any change in
function of the virus. Rarely, occasionally, you will get a
mutation that actually does have a biological function.
Now, that could be that it evades the diagnostic or the
mutation makes it a little bit more virulent or a little bit
less virulent. It makes it a little bit more efficient in being
transmitted or a little bit less efficient. But it would be
distinctly unusual, underline, not impossible----
Ms. Bass. Right.
Dr. Fauci [continuing]. For it to completely change the way
it is transmitted. In fact, of the many, many viruses like HIV
that replicate in millions and millions of people and mutate a
lot, you don't see a change in the way it is transmitted.
Now, having said that, we have contracts and grants with
organizations that do continuing phylogenetic sequencing which
means they trace the evolution.
So we are looking at that very, very carefully and thus far
with all of the infections and all the mutations we have not
seen any indication of any modification of biological function
associated with the mutations.
So, again, although it is not something you can completely
rule out, it is not something that I would put at the very top
of the radar screen and say this is something that is occupying
all of my concern. Having said that, the easiest way to avoid
that is to stop the infections which will then stop the
mutations and then you won't have to have the discussion we are
having right now.
Ms. Bass. So it is safe to say that in previous outbreaks
that has never happened?
Dr. Fauci. Right. Right.
Ms. Bass. Okay. Thank you very much. I yield back my time.
Mr. Smith. Dr. Burgess.
Mr. Burgess. Thank you, Mr. Chairman. And Dr. Fauci, along
those lines, now 10 years ago in the language of avian flu I
remember the discussion was genetic drift and genetic shift--
genetic drift being why we have to have a new flu shot every
year because there are little changes that occur and then
genetic shift would be one of those major changes that would
occur in--say avian flu, the transmissability from human to
human where it hadn't been occurring before.
Is that the same sort of thing you are talking about here?
Dr. Fauci. A bit different, Dr. Burgess. It is a bit
different because when we talk about a drift we are talking
about the immune response that the body has made to previous
viruses and when it drifts a bit it doesn't change much in its
fundamental way that it is transmitted.
How it changes is that it evades your already existing
immune response or the immune response that a particular
vaccine might induce. A little bit it drifts. It doesn't
change.
A shift is that it is so different than the previous virus
that you don't have any background immunity to it. So when you
have a new pandemic like the H1N1 2009 influenza, except for
people who were alive and well back in the late 1960s, early
1970s, mid-1970s, most of the young people never had seen a
virus like that.
So they didn't have any background immunity. Did that mean
it changed the way it was transmitted? No. Flu is a
respiratory-borne virus whether it is a pandemic flu or a
seasonal flu.
The actual shift means that it was so different than
anything else that you experienced that you don't have any
background immunity which makes it much easier for it to turn
into a pandemic.
Mr. Burgess. Okay. Thank you for the clarification.
Now, we have got CDC, FDA, NIH, and USAID today because we
understand from yesterday's speech by the President, Department
of Defense is involved and we have heard Department of State
mentioned today.
So I guess my question is, and this may be fundamentally
naive as far as the function of government, but who is in
charge? Who is in charge of our response to what is happening
in Western Africa?
Is it the CDC? Is it the State Department? Is it now going
to be Department of Defense? Who is our go-to agency as far as
who is in charge?
Ms. Lindborg. So the U.S. Military is working in support of
USAID on the ground. This is very similar to the approach that
Chairman Smith noted. We worked in the Philippines just
recently.
There are task forces in each of the critical agencies that
are enabling CDC, HHS, State Department, USAID to organize
across our agencies to mobilize for the best response.
USAID is leading the U.S. interagency response as part of
the worldwide efforts led by the U.N. in support of sovereign
nations--Liberia, Guinea, and Sierra Leone--working very
closely across those task forces and with the NSC.
Mr. Burgess. So things are already--things are already
tough. If they get a lot tougher USAID is who we call? If
things go really bad, who do we pick up the phone and call?
Ms. Lindborg. Yes.
Mr. Burgess. USAID? All right. So noted. I will put you on
speed dial.
You know, we heard through some of the discussion--I guess,
Dr. Fauci, this will be to you is that, you know, previous
episodes this virus has burned itself out. Is there still a
possibility, even with your rather frightening exponential
graph that you showed us, is it still possible that at some
point this episode will burn itself out?
Dr. Fauci. It is more than possible. That is what we are
all striving for. The escalation--it was very clear that the
rate of increases of cases that we were seeing, particularly in
the densely populated areas where instead of two or three
contacts you have 30, 40, 50, 70 or 100 contacts, that the
growth of it was outstripping even our ability to increase it
at incremental levels.
So that is the reason why, as I mentioned, Dr. Burgess,
when the President made this announcement that it is going to
be a sea change. It is not going to be an increment, it is
going to be a major change in how we approach this with a
considerable amount of resources--not only direct resources of
healthcare but home kits, home care components, education
components.
It is a very comprehensive package that the President
announced at the CDC yesterday. So if we implement that, which
I believe we will--I hope we will--I think there is a very good
chance that it is not going to happen tomorrow and it is not
going to happen next month but that we are going to turn this
around. But it is going to require that really accelerated
effort that the President spoke about yesterday.
Mr. Burgess. Well, Dr. Fauci and Dr. Borio, let me ask you
as well, being representatives for the Food and Drug
Administration, Dr. Fauci, I have been to the Galveston
National Laboratory.
I remember right after Hurricane Ike going down there to
make certain they were okay and hearing about the work they
were doing on Ebola. Then I was down there I think it was less
than a year ago.
So there has been ongoing work. I mean, this--you have
known of the risk and there has been ongoing work. I guess I am
just a little disappointed, Dr. Borio, to hear about a clinical
hold--I don't know that I had heard that term before.
I mean, we knew this was out there. We knew this was
percolating. U.S. taxpayer resources were being put toward the
research and development and I guess my question is what does
it take to get us over that obstacle to where we can put these
things in the field and begin--and begin clinical trials.
Instead of talking about clinical holds let us talk about
clinical trials. Let us talk about breakthrough designation.
Let us talk about making things available. Can either of you
speak to that?
Dr. Borio. Absolutely, Dr. Burgess. So for the vaccines,
for example--I will give an example--you know, even though they
have been in development for a number of years when this
outbreak--epidemic began we did not have any of the INDs filed
with the FDA for the vaccines.
So I think what you are hearing is really an unprecedented
level of engagement by the FDA to facilitate the applications
for these vaccines and to be able to begin clinical trials in
record time.
I can tell the reviewers review the applications in a
matter of a few days and in addition prior to the application
being received we work intensely with the sponsors to be able
to get them ready for this--for the submission.
So I hope that I conveyed that, you know, so that there is
no doubt that we are doing all we can to be--to exert not only
maximum flexibility but also to speed development and to engage
very actively with all the developers, government partners, and
the companies.
So the clinical hold that--the clinical hold situation that
I was asked, again, all of our decisions are based on the
science we have available and with the interest of public
health in mind and we are working with every one of the
developers to move their programs forward.
But there are situations where if the risk is believed to
outweigh the benefits based on the available science we--it is
called a clinical hold. We basically tell the sponsor that the
study cannot proceed in volunteers at this moment until some
adjustments are made and the benefit-risk profile is more
favorable.
Mr. Burgess. There is a broad understanding at the Food and
Drug Administration that this is no ordinary time, correct?
Dr. Borio. Absolutely. I think, as I mentioned in my
testimony, there are more than 200 people at the FDA who are
engaged in this response and working very actively with the
developers. There is no question in my mind that it is all
hands on deck and everybody is very aware of the gravity of the
situation and very determined to do all they can to help
mitigate it. There is no question about that.
Mr. Burgess. Mr. Chairman, I realize that I am a guest on
your committee and I wasn't going to bring this up but you
did--you said you were loathe to criticize the World Health
Organization but then you went ahead.
So, Dr. Bell, not really a criticism but observation and
then, of course, this goes back several years--if it were not
for the CDC the global outreach and response network of the
World Health Organization would be pretty thin.
Now, I talked to the folks at the CDC right at the end of
July. Someone there told me you had 30 people that were getting
ready to deploy to western Africa.
I believe I have that number correct. And Chris Smith
talked about, you know, the surge of people that are needed in
the healthcare field. But we also recognize healthcare
personnel are under special risk in this outbreak.
Are you all the go-to people for that preliminary training
for people who are going to western Africa to mitigate that
risk somewhat and to minimize that risk to the extent that it
can be minimized?
Does that fall to CDC or is that actually a World Health
Organization jurisdiction?
Dr. Bell. Thank you, Dr. Burgess. I think, as Nancy
mentioned, the scale of this problem is such that we are going
to need many, many different partners assisting.
On the topic of training and infection control, I think,
first of all, the good news is I think because of the
leadership of MSF we have actually a very clear and very tried
and true protocol or method for minimizing risk to healthcare
workers when they are treating Ebola patients.
I believe that there is something like 450 MSF workers who
have been working in west Africa and we have seen no infections
so far, thank goodness, in those healthcare workers.
So it is impossible to drive the risk to zero, obviously.
There are extremely difficult conditions but we do have, I
think, a good framework for training. As I mentioned, we at CDC
we sort of have the public health lead, as you well know, in
this response and in many others and given the importance of
infection control as part of the public health response we have
been ramping up our efforts in many spheres around infection
control as we work to stop the outbreak and one of them is to
have taken a leadership role among others to build this
pipeline of training in safe--how to work safely in an Ebola
treatment unit.
As I mentioned, we have this course that we have put
together in collaboration with MSF which we think will help
with building a pipeline of U.S. healthcare workers who are
going to be deploying to the region.
But as Nancy said, there are many other groups that I think
will be helping to gather people together to sort of bring to
bear the resources that we need to bring to bear in the region.
I do think that we have the sort of training that is
necessary in order to minimize that risk and that is a training
that can actually be sort of spread and propagated in any other
venues where training might occur.
The same is true in-country. As Nancy mentioned, there is a
very large need for basic infection control in healthcare
facilities. As I mentioned, the healthcare system is really
completely collapsed and this was largely because healthcare
workers were seeing patients who turned out to have Ebola. They
didn't realize that. They have no protective equipment.
They have no understanding of infection control. They don't
know what safe triage means and therefore, tragically, many of
them got infected and the facilities closed. So this is another
large priority on the topic of infection control that we and
many other groups are working together.
We would like to see an infection control practitioner in
every facility in Liberia, for example, similar to the way we
deal with infection control here in U.S. hospitals.
Mr. Burgess. Mr. Chairman, fascinating panel. You have been
most courteous. I will yield back.
Mr. Smith. Thank you very much, Doc. Ms. McCollum.
Ms. McCollum. Thank you. We hopefully will have someone
from the Department of Defense who can maybe inform members
more at the co-briefing we are doing with the Global Health
Caucus along with you and Ms. Bass to have maybe some of those
questions answered.
But my understanding is, first and foremost, we need
staging areas. We need, you know, places where people can be
treated and so the DoD is bringing in a wave of engineers and
those engineers for the most part will not be coming into
contact with patients or people who are ill, and the DoD has a
great medical staff.
I mean, infectious disease is something that they are--they
have their own research. They collaborate with the CDC, the
NIH, everybody--the Department of Health. They all work
together on this.
So I am fairly confident that AFRICOM has a good handle on
the first wave that is going to come in because if we don't
have the infrastructure, and that is the boots on the ground--
it is building, the framing up the hospitals and all that will
be really, really important and then our soldiers will get
really excellent training before going in.
But the first wave going in for a lot of what we are
talking about they are not going to be coming in contact, and
you are all kind of shaking your heads yes. So I just wanted to
kind of say that DoD knows when it is trained to this.
And so one of the things that I think you pointed out as,
you know, you all kind of have a hierarchy. You have your own
special responsibilities. You are getting together. This is an
emergency and you are talking amongst yourselves quite a bit.
But I want to just kind of talk about some secondary
impacts. We touched on a little bit about what is, you know,
happening with maternal-child health, what is happening with
people who maybe have been diagnosed with cancer, tuberculosis,
HIV/AIDS--all of those critical resources in healthcare systems
that we have been working to make better in these countries.
Now people are not being able to access that kind of a
treatment especially in some of the countries where the Ebola
has gone. So, for example, in Guinea, Sierra Leone, and Liberia
are large poor populations, limited access to clean drinking
water, basic infrastructure, other public health services.
One of the things that has come up time and time again--how
farmers are not out in the field, how we are expecting a major
food crisis--this is already--many countries, as I pointed out,
with some of the very poor people whose health is fragile as it
is what are some of the things we should be looking from the
international community to supplement the work that you are
doing from the World Bank, from the African Development Bank,
from the, you know, World Food Programme? What are some of the
things that we should be thinking of next step?
Ms. Lindborg. Great. Thank you. And I would just fully
agree with you and reiterate that what DoD is fundamentally
bringing is their unique capability of having a scaled, fast
response that sets that framework up, as you said.
On the second order impacts, this is very important to pay
attention to and we are coordinating closely with the World
Bank, IMF, African Development Bank, all of which are preparing
economic support packages.
We are also looking at ensuring that health workers'
salaries are paid during this critical period where you need
people to continue to come to work at a time where there is the
threat of total collapse. We are working throughout the region
on preparedness.
Countries that border throughout west Africa are
increasingly concerned and so we have teams working to help
them strengthen their health systems and be more prepared in
the event that there is a case that appears.
Malaria, especially as we come into the rainy season, is a
particular threat so there is an increased effort among all of
the agencies--UNICEF, USAID, CDC--who participate--WHO--who
participate in the stop malaria efforts to ensure that there is
a redoubled effort and a coordinated effort to get bed nets
into the most affected areas.
One of the most important issues is, first of all,
controlling the outbreak and as a part of that enabling people
to have the kind of information that can reduce the fear level
because they are better equipped to protect themselves.
Since it isn't an airborne disease, there are measures that
families and communities can take to protect themselves so that
commerce and regular activities can resume, borders can stay
open, and economic activity is not brought to a standstill.
So these are all part of that secondary impact piece of the
strategy that we are very focused on, working with these global
partners.
Ms. McCollum. Thank you.
Mr. Chair, much has been said about vaccines and having a
vaccine is critically important. But making sure that we go
through the same clinical trials that we would for anyone in
the United States or in Europe, for that matter, before a
vaccine is widely disbursed is critically important.
To rush into this and not have it tested by sex, age,
health condition, and blanketly using a vaccine that is not
ready to go will discredit and make people more fearful of some
of the vaccines and preventions that we currently have in the
field and there is--there is grave concern from some in Africa,
and I have heard it from some of the population here, that
Africa not be a testing ground, that their African brothers and
sisters and relatives have stuff that has been safely vetted to
the best of scientific ability.
There is always going to be, you know, human error and
things that don't go the way we quite planned. So I know that
there is a lot of pressure but I, for one, think it is really
important that we follow the science and that we do this safely
so it could be done effectively. Thank you, Mr. Chair.
Mr. Smith. Thank you very much. Before yielding to Mr.
Wolf, I would just point out that TKM-Ebola is a treatment and
we have such a limited universe of treatments available. Even
Dr. Brantly took a risk in taking ZMapp. I am not suggesting
that we bypass the safety, and the efficacy remains an open
question, but I am still bewildered as to why TKM-Ebola has
this hold. I would like to yield to the distinguished chairman
of the Subcommittee on Commerce, Justice, Science, and Related
Agencies Congressman Frank Wolf.
Mr. Wolf. Thank you, Chairman Smith.
One, I want to thank Mr. Smith for having this hearing and
being really one of the first here in Congress doing it at the
end before the Congress went away. The other thing I just felt
like saying as I was listening at the other hearing too, two
groups--MSF, every time they travel everywhere you go they are
there.
They are in little villages, they are in places and
Samaritan's Purse, which is a Christian group run by Franklin
Graham who, quite frankly, I think at one time was even
disinvited from an event that this administration had somewhere
because he might have wanted to pray at a prayer breakfast--I
forget what it was--two groups, MSF and the Samaritan's Purse,
have been out in the front before our Government was and I want
to personally thank MSF, all of their people.
They--and I think we should be thanking them, all of them,
and also Samaritan's Purse and all of their people for what
they have done because they have been out in front of everyone
and, Mr. Smith, and Samaritan's Purse people calling and having
a hearing back in the summer and I think we should recognize
them.
I know you kept referencing MSF. Thank God for MSF. Thank
God for Samaritan's Purse. I think Dr. Burgess made an
interesting point. I think you need one person--I want to thank
all of you for what you do--I think you need one person in the
administration so that there is a central point.
You have the State Department. You have the Health
Department. You have the Defense Department. I think Ms.
McCollum was right--Agriculture would be involved. It would be
very difficult if you don't have one person who is the person
that they can--not that they will do it all, but one place to
go to call.
I also think, and that leads me to the question, you
probably need someone to travel the world the same way that
Secretary Kerry is, to his credit, asking for people to support
the effort that is going to be taking place with regard to ISIL
and Syria and places like that. When I listen to the testimony
and read all the articles, I only have America and reference
periodically to one or two other countries.
Are the other countries giving commensurate with what we
are giving based on their size and population? China, the
Saudis, Qatar, Germany, France, England--are they stepping up
the same way that President Obama stepped up the other day?
Is Cameron stepping up in England doing that? Is the French
Government stepping up? Are the Scandinavians stepping up? Are
the Saudi princes stepping up? Is the Chinese Government
stepping up?
Are they stepping up to the same degree, and I am not going
to try and embarrass each and every country but are they all
cooperating and have they all been asked to do as much as we
are?
Ms. Lindborg. This is a very important point and what we
know is that when America leads it sets the frame for others to
make a bolder and more aggressive response as well. So on the
heels of yesterday's announcement there are calls this morning.
Secretary Kerry has been having meetings as a part of his
Paris conversations. There will be a U.N. meeting tomorrow on
Thursday and during the U.N. General Assembly next Thursday
there will also be a meeting on Ebola. The hope and the goal is
that, inspired by the response that the U.S. announced
yesterday, there will be a ramped up response from a large
number of international actors.
We are already seeing some additional more forward leaning
responses from the UK. We expect them to make an announcement
any day now that is quite larger.
As I mentioned earlier, the African Union has mobilized
what they call health keepers of 100 health workers who will be
travelling to Liberia and we are supporting that effort. The
European Union has pledged $180 million and there will be more.
There will be more efforts as a part of the mobilization.
So over the next week watch for the global response, which we
anticipate will continue to ramp up.
Mr. Wolf. Okay. And I would assume, unless you differ with
me, that you all agree with me with regard to MSF and
Samaritan's Purse.
Ms. Lindborg. Absolutely, and, you know, we support
Samaritan's Purse in many countries around the globe and are
very aware of the heroic efforts of Samaritan's Purse and of
MSF, who are on the front lines of so many crises globally.
What is particular about this outbreak is that Ebola has
not been this kind of a challenge before. There have been
small, relatively contained outbreaks so there hasn't been a
requirement for large-scale global capacity to address Ebola
and that has been one of the challenges as this particular
outbreak jumped borders and went into urban areas in countries
that were absolutely ill equipped to deal with that level of
transmission.
So this will--this will be a sea change in how the global
community understands and responds to Ebola.
Mr. Wolf. Thank you, and I want to thank all of you and
your people, too, the CDC that are on the front lines, and
thank all of your people for what they are doing and what I
know they will be doing.
With that, Mr. Chairman, I yield back. Thank you very much.
Mr. Smith. Thank you very much, Chairman Wolf. Just one
final very brief question. Whose idea was it for this surge?
Did it come in from an interagency recommendation or was there
one person who said this is what has to be done?
Dr. Fauci. There have been intensive discussions going on
at various levels and it became apparent to us all that we
really needed to have a sea change and that is how it evolved.
Ms. Lindborg. So I would say that, as I mentioned earlier,
USAID through our DART and our Office of Foreign Disaster
Assistance is responsible for coordinating the U.S. Government
response to disasters overseas.
Each of the critical agencies here in Washington has a task
force and we are using that whole of government approach to
draw from critical resources from across the government and
there has been a concerted effort working together to identify
both the need and then the kind of response that is necessary
to get ahead of the transmission, which has resulted in
yesterday's announcement.
Mr. Smith. Thank you for your leadership. Thank you for
spending time this morning with us, now afternoon, and we look
forward to work with you going forward. Thank you.
I would like to now welcome our second panel, beginning
with Dr. Kent Brantly, who is a family medicine physician who
has served since October 2013 as a medical missionary at a
hospital in Monrovia, Liberia.
In the spring of 2014, Dr. Brantly found himself fighting
on the front lines in the battle against the deadliest Ebola
outbreak ever to occur and was appointed as medical director
for what would become the only Ebola treatment unit in all of
southern Liberia.
On July 26, he was diagnosed with Ebola, became the first
person to receive the experimental drug ZMapp and the first
person with Ebola to be treated in the United States. Thank
you, Doctor, for being here.
We will then hear from Dr. Chinua Akukwe, who is an Academy
Fellow and chair of the Africa Working Group of the National
Academy of Public Administration.
The Africa Working Group is the leading NAPA's effort to
forge lasting partnerships in governance and public
administration reform efforts in Africa with the U.S. and
African stakeholders. Dr. Akukwe was the technical advisor in
the design of two continent-wide initiatives in Africa, the
Communicable Disease Guidelines for the Africa Development Bank
and the Framework for Achieving Universal Access to HIV/AIDS,
Tuberculosis and Malaria Services for the African Union. He has
written extensively on health and development issues and we
welcome Dr. Akukwe to the subcommittee.
We will then hear from Mr. Ted Alemayhu, who is the founder
and executive chairman of U.S. Doctors for Africa, a non-profit
organization that is dedicated to providing support to the
continent of Africa with regard to volunteer healthcare
professionals, donations of medical supplies and equipment, as
well as hosting high-level healthcare seminars involving
African First Ladies and pan-African medical doctors. He is
also founder of the African First Ladies Health Summit as well
as a key contributor to the formation of the African Union
Foundation.
Then we will hear from Dr. Dougbeh Chris Nyan, who is a
medical doctor and a biomedical research scientist of Liberian
origin.
He specializes in infectious disease diagnostics and his
expertise focuses on developing simple and rapid diagnostic
tests for detecting blood-borne infections and pathogens. Dr.
Nyan is currently a scientist at the FDA but he is testifying
here in this capacity as the head of the Diaspora Liberian
Emergency Response Task Force on the Ebola Crisis, a
conglomeration of Liberian professionals and Diaspora
organizations in the fight against the Ebola outbreak in
Liberia and in the region.
If you could begin, Dr. Brantly, and then we will go to
each of the distinguished physicians.
STATEMENT OF KENT BRANTLY, M.D., MEDICAL MISSIONARY,
SAMARITAN'S PURSE (SURVIVOR OF EBOLA)
Dr. Brantly. Thank you very much, Mr. Chairman. Chairman
Smith, Ranking Member Bass and fellow guests of this committee
and fellow witnesses, thank you for allowing me to testify here
today on behalf of those suffering in west Africa as a result
of the Ebola outbreak there.
I would also like to take this opportunity to express my
deep gratitude to the U.S. Government, particularly to the
State Department, and everyone else involved in my evacuation.
Thank you for bringing me home when I was sick.
I am a little torn because I have this prepared testimony
and my personal story and there are so many questions and
issues that were just raised in the previous panel that I want
to address. But let me first present my prepared testimony here
for you today.
I began work as a medical missionary, a missionary doctor
at ELWA Hospital in Monrovia, Liberia in October 2013, as you
said. Even before Ebola came to our area we worked long hours
in challenging conditions to provide quality healthcare to
support the country's struggling medical infrastructure.
Missionary facilities like ours provide between 40 and 70
percent of healthcare in sub-Saharan Africa. So it is easy to
see why we were one of the first to join in the fight against
Ebola as it made its deadly march into Monrovia.
In June, we received our first Ebola patients and the
numbers quickly and steadily increased from that time on. My
organization, Samaritan's Purse, took over responsibility for
direct clinical care of Ebola patients for all of Liberia the
following month.
MSF had been present in Liberia but because of the growth
of the outbreak in Guinea and Sierra Leone their resources had
been stretched and they were unable to provide personnel at
that time for the outbreak in Liberia.
Ebola is a scourge that does not even allow its victims to
die with dignity. Most of them suffer a lonely horrifying
death. I came to understand the extreme physical and emotional
toll that Ebola inflicts in an even more personal way when I
was diagnosed with Ebola virus disease on July 26.
I had isolated myself 3 days earlier when I first felt ill.
I had a dedicated team of medical professionals who cared for
me in Liberia. But even their best efforts could not prevent
the virus from racking my body with sustained fever,
excruciating pain, and vomit and diarrhea filled with blood.
Like the dozens of Ebola patients I had treated, I found
myself suffering alone, and the men and women who cared for me
were wearing protective personal equipment that looked like
space suits and all I could see were their eyes through their
protective goggles.
The only human contact I had came through double layers of
medical gloves. While in Liberia I became the first human being
to receive the experimental drug ZMapp. Shortly after receiving
ZMapp, I was evacuated to Emory University Hospital in Atlanta.
As a survivor of Ebola, it is not only my privilege but my
duty to be a voice for those who continue to suffer devastation
from this horrible disease in west Africa.
When Nancy Writebol and I were diagnosed with Ebola at the
end of July 2014, the global media began feverishly reporting
on the grave situation in west Africa.
I am grateful for that coverage but it is unfortunate that
thousands of African lives and deaths did not warrant the same
global attention as two infected Americans. Even after this
attention, when my colleague, Rick Sacra, arrived in Liberia 2
weeks after my diagnosis, it was impossible to buy a box of
medical gloves in the city of Monrovia.
Agencies like the World Health Organization, as has been
mentioned, remained bound up by bureaucracy. Their speeches,
proposals and plans, though noble, have not resulted in any
significant action to stop this Ebola outbreak.
I was honored to meet with President Obama yesterday and I
am pleased that the U.S. has now committed to take the lead and
provide military and medical resources to fight against Ebola.
Now we must make those promises a reality if we are to
accurately represent the compassion and generosity of the
American people and reduce the suffering and death in west
Africa.
Just this week, I saw a report that the 160-bed isolation
unit at my hospital in Liberia is turning away an average of 30
infectious patients every day because they don't have beds.
Those with other life-threatening diseases are also
suffering, as Liberia's already substandard healthcare
infrastructure continues to collapse under the weight of this
epidemic.
The military assets that have been committed must be
mobilized as quickly as possible to set up larger treatment
facilities, to send in skilled personnel and provide logistical
support.
It is also imperative that our Government response be
conducted in close partnership with nongovernmental
organizations that have been on the front lines of this
epidemic as well as other governmental organizations like the
health ministries of the countries that are affected and other
countries who wish to join in the fight.
These NGOs that have been involved in the fight, as was
mentioned by the Congressman earlier, specifically MSF and
Samaritan's Purse, are now taking the lead in finding creative
interventions to halt the spread of Ebola.
Past outbreaks have been contained through the
identification and isolation of infected patients and the
tracing of their contacts. But the rate of transmission for
this current outbreak has rendered this approach nearly
impossible.
A large part of the problem is that Ebola-infected people
are choosing to stay at home because of overwhelming fear and
superstition. Family members are caring for these sick
individuals at home and therefore contracting the disease
themselves.
We now have to educate and equip these home caregivers for
their own protection. They must be trained in safety measures
and supplied with basic equipment to protect themselves.
Ebola survivors can be instrumental in reaching their
communities with critical information and resources. As the
number of survivors increases, employing them as educators and
community health workers can make them champions in this fight
and help restore their dignity while tearing down the walls of
fear and stigma attached to this disease.
Admittedly, home-based care is less ideal than treatment
provided in an isolation unit. However, Ebola treatment units
are overcrowded and unable to take new patients at this time.
If we do not provide education and protective equipment to
caregivers now, we will be condemning countless numbers of
mothers and fathers and brothers and sisters to death simply
because they don't want to let their loved ones die alone.
There is no time to waste in implementing this home-based
care strategy in addition to the deployment of the resources
the President has promised.
As the current outbreak is on the verge and maybe already
over the edge of becoming a significant threat to our national
security, in societies where fear and distrust of authority are
the norm many still deny that Ebola is real and they actively
seek other explanations for the deaths of their loved ones.
I had one patient in early July who died after 2 days in
our isolation unit. As we tried to explain to the family the
cause of her death, some of her family members, with the help
of a witch doctor, determined that her death was caused by a
curse placed on her by her best friend. The family was bent on
getting revenge and that meant the death of the person they
believed had caused the curse on their loved one.
There is a palpable sense of tension on the streets that is
priming the pump of society for skirmishes that could quickly
lead to war. The world cannot afford to allow more conflict in
this region that is home to dictators-in-hiding and terrorist
groups.
This epidemic must be brought to a halt as soon as possible
to regain order and reestablish confidence in local
governments. This is a global problem and the U.S. must take
the lead immediately. The longer we wait the greater the cost
of the battle both in dollars and in lives.
We must act immediately and decisively to bring healing and
stability to the people of west Africa, the African continent,
the United States and the world.
Thank you, Mr. Chairman, for allowing me to testify today.
[The prepared statement of Dr. Brantly follows:]
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----------
Mr. Smith. Dr. Brantly, thank you for providing this
committee the honor of hearing your testimony and for your very
significant recommendations, particularly in the home
healthcare, which has not been focused upon enough.
During Q and A hopefully you will elaborate on some of your
answers to some of the questions raised early.
Dr. Akukwe, thank you for being here.
STATEMENT OF CHINUA AKUKWE, M.D., CHAIR, AFRICA WORKING GROUP,
NATIONAL ACADEMY OF PUBLIC ADMINISTRATION
Dr. Akukwe. Thank you, Chairman Smith, and Ranking Member
Bass and other members of the subcommittee. I think that this
is a great honor and a privilege to be part of this hearing in
the global fight against Ebola, and I must say that it is also
a honor to share this podium with Dr. Kent because when I saw
him walk out of that ambulance and into the hospital, I knew
that he had sent a very powerful message that you can actually
survive from Ebola. So thank you, Dr. Kent, for all your
wonderful efforts.
While I listened to the first panel I think a lot of what I
had intended to discuss have been touched in various ways
because my discussion is around the idea that we can use this
threat of Ebola, the global outbreak of Ebola, to strengthen
health systems in Africa.
I think for many of us who spent more than 20 years working
on HIV/AIDS in Africa, one of the things we learned within the
first decade is that you cannot really make any dent in the
effort against HIV/AIDS without addressing some parts of the
healthcare system and the thing about Ebola, as I have already
mentioned, is that if you look at the three main countries, two
of them just came out of war.
But if you look at all indices of health, Liberia, Sierra
Leone, and Guinea are always dominate the laggards. They are
always among the worst ranked for the past two decades, even
before the wars started, and it is getting worse since the
onset of civil war and now they are trying to emerge from the
civil war.
And if you look at other indices of human development,
Liberia, Sierra Leone, and Guinea also have very poor rankings
and if you look at indices of health systems, Africa really has
multiple challenges.
Liberia, Guinea, and Sierra Leone have very difficult
challenges, always coming up among the worst ranked, and we do
know that WHO about 5 years ago indicated that Africa has 24
percent of the global burden of disease with only 3 percent of
the global workforce.
So we are dealing with 25 percent disease burden and you
only have 3 percent of the global workforce. So what you have
in the situation in Africa is that we have Ebola today. We have
HIV/AIDS.
Tomorrow we are going to have another outbreak. So no
matter what you are doing now, you know, send in people, boots
on the ground, trying to contain the epidemic, if you don't
address some of the lingering issues of a poor health system
then you are going to come back again with this kind of
emergency response within the next few years as other epidemics
come up.
And we do know that in the late 1970s and 1980s the global
coalition that included USAID, U.N. agencies, World Bank, they
came together and from that infrastructure development had a
primary healthcare system.
In many African countries, physically, the only existing
health systems that you find are those health systems that were
built as primary healthcare centers, medical centers in the
1970s.
Not much has changed, and I think what I am calling for is
to use the opportunity of the Ebola outbreak to reevaluate how
we can assist Africa to become part of this global health
architecture that both the Obama administration and the Bush
administration have actually spent significant amounts of money
trying to have a situation where all regions in the world are
part of this global health architecture taking care of emerging
diseases and other outbreaks.
And I agree with what has been expressed today that we need
to go beyond WHO. We need to make sure that we put together a
coalition that includes African governments, multilateral
agencies, global foundations, the academia, organized private
sector to look at the best ways to address healthcare systems
in Africa.
In my book on healthcare services we did find out that it
is not easy for Africans on their own to deal with this
problem. You probably need a lot of technical assistance--not
just money but technical assistance to change the sort of
health systems.
Let me use an example. Technical capacity at continental
and regional level--we are happy that the Africa Union set up
the health keepers program.
But we do know that Africa needs a lot of leadership at the
continental and the regional economic levels to provide
technical assistance for some of these very poor African
countries that will never have the capacity to manage some of
these outbreaks like we are seeing in Sierra Leone, Guinea and
Liberia.
And in closing, I think that in 2000 the U.S. Congress, the
106th Congress, when we were all paralyzed by the response to
HIV/AIDS, came up with the Global AIDS Trust Fund that
jumpstarted the global response to HIV/AIDS. It wasn't a lot of
money, about $50 million.
But what it did was that it now allowed the World Bank and
other multilateral agencies and other stakeholders to begin the
process of looking at HIV/AIDS from a totally different
perspective from the regular way of doing things.
And I think that this is what we probably need at this time
from the Congress in order to help African health systems be
rebuilt in such a way that they could become part of the global
health architecture.
Thank you so much.
[The prepared statement of Dr. Akukwe follows:]
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----------
Mr. Smith. Dr. Akukwe, thank you very much for your
testimony and your leadership.
Dr. Alemayhu.
STATEMENT OF MR. TED ALEMAYHU, FOUNDER & EXECUTIVE CHAIRMAN, US
DOCTORS FOR AFRICA
Dr. Alemayhu. Thank you, Mr. Chairman. First and foremost,
I would like to thank you and Congressmember Bass. You both
have been the true soldiers for the continent of Africa.
Every time there has been a pressing need you have been on
the forefront calling for hearings and showing mutual
leadership. So I am truly grateful for that. Also, I want to
thank my colleagues here at the table. Let me read my
statement, Mr. Chairman, if you don't mind.
Members of the United States Congress, it is my deepest
honor and privilege to come before you this morning in order to
show, in order to share what I know and what should be done to
assist Ebola-affected nations in west Africa.
I, first, wanted to express my sincere gratitude to you,
Members of Congress, and to the entire Government of the United
States for giving your fullest attention for this deadly
crisis. I would also like to thank Dr. Kent Brantly for his
extraordinary service for the people of Africa. We are
delighted to see him well and alive.
Mr. Chairman, Members of Congress, I have come before you
this morning as a son of Africa and a proud citizen of the
United States. As a son of Africa, I am deeply concerned and
heartbroken to see my people once again suffer from another
deadly virus.
As you may recall, the HIV/AIDS virus has murdered millions
of Africans across the continent. I am terribly scared and
terrified as to what could happen now if we do not act rapidly
and decisively to stop this deadly virus.
Mr. Chairman, the Ebola virus does not discriminate. It is
killing babies. It is killing mothers. It is killing fathers,
doctors, and nurses and anyone else that is in its way.
The World Health Organization reports that over 2,400 of my
fellow Africans have been murdered by this disease. If we do
not act rapidly and decisively we could potentially witness
tens of thousands of dead bodies across west Africa and
possibly even beyond.
What is happening on the ground, particularly in the
Republic of Liberia, Sierra Leone, and Guinea is simply
heartbreaking. The governments of these nations are screaming
for help and we must respond to their call immediately.
We must still deploy some of our basis healthcare resources
and accessories, medical supplies, and equipment immediately
because they are needed and needed badly on the ground. Items
such as protective gears, hospital beds, gloves, and masks and
gowns are in dire need.
Local healthcare workers are threatened to quit their
service if their safety is not ensured with the delivery of
these items. And who really can blame them? According to the
World Health Organization, approximately 301 healthcare workers
were infected by this virus and half of them are dead.
There is a severe shortage of healthcare professionals in
most African nations and particularly those nations that have
been affected by this virus. I am speaking averaging one doctor
per 50,000 people or more. This is what I call a perfect remedy
for massive disaster.
Once again, the World Health Organization has called for an
additional 500 healthcare professionals to be deployed on the
ground in order to assist effectively with this crisis.
Mr. Chairman, I can tell you that U.S. Doctors For Africa
and our partners are ready to help. In partnership with the
AFYA Foundation of America--the president and chairman is right
behind me--and many other strategic partners we are able to
mobilize medical supplies and equipment worth tens of thousands
of dollars and ready for shipment.
We are also looking into actively recruiting medical
doctors and nurses to be deployed to Africa. U.S. Doctors for
Africa has access to medical clinics, telemedicine technology,
emergency care units, and other personnel. They look to do all
of this and can deploy them to Africa.
Mr. Chairman, we need strategic assistance and the sponsors
to deliver these units on the ground. Thank you, sir.
[The prepared statement of Dr. Alemayhu follows:]
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Mr. Smith. Dr. Alemayhu, thank you very much for your
leadership as well and later on I will ask you about actively
recruiting doctors and how well that is going.
I would like to now ask Dr. Nyan if you could present your
testimony.
STATEMENT OF DOUGBEH CHRIS NYAN, M.D., DIRECTOR OF THE
SECRETARIAT, DIASPORA LIBERIAN EMERGENCY RESPONSE TASK FORCE ON
THE EBOLA CRISIS
Dr. Nyan. Thank you, Mr. Chairman, and members of this
august committee, distinguished panelists, specifically Dr.
Kent Brantly, to whom on behalf of the people of Liberia and
also Sierra Leone and Guinea we pay you our deepest respect and
to other healthcare workers who did not make it through as a
result of the infection.
Members of the fourth estate, ladies and gentlemen, I would
like to thank the organizers of this hearing for the invitation
extended to Diaspora Liberia Emergency Response Task Force on
the Ebola crisis to testify on the situation of the current
Ebola epidemic in Liberia and the subregion.
We in the Liberia task force from the Diaspora believe that
through this medium U.S. policymakers will have the first
opportunity of hearing about the outbreak from the Liberian
perspective primarily.
The Diaspora task force is an umbrella organization which
conglomerates Liberian healthcare professional organizations,
community organizations, individuals of varying professional
expertise including medical doctors, nurses, public health
practitioners, pharmacists, biomedical research scientists and
engineers, journalists, et cetera.
From the inception of its nationhood in 1847, Liberia has
always maintained a very special link to the United States of
America and have always played a major role on the world stage.
Also, Liberia was always a trusted Cold War ally of the United
States.
Cognizant of this relationship, Liberians have always
turned to the United States for rescue in times of problems be
it economic, social or political, now medical. Today, Liberia,
along with countries of the Mano River subregion find itself in
a situation that is occasioned by the current Ebola outbreak.
This epidemic is dissipating lives, breaking up families as
well as stigmatizing and traumatizing the country and its
people. It is no secret that the Liberian healthcare system, as
has been discussed over and over, completely collapsed under
the pressure of the Ebola outbreak while also the leadership
and local health authorities demonstrated an incapability of
dealing with the outbreak.
Most hospitals are still closed due to the lack of basic
medical supplies. Healthcare workers lack the necessary
protective gear to go in the field to perform their duties.
Although there have been massive input of medical support
and supplies from countries of the global community like China
and India and the United States, we have yet to see a logistic
plan put in place for the proper distribution and delivery of
materials to intended clinics and hospitals.
There is also the issue of mistrust and confidence between
citizens and government authorities, as have been discussed
over and over, and a total breach of confidence. The crisis
have been deepened also by the appointment of unqualified
personnel, particularly nonmedical personnel, as spokespeople
to lead government's fight against the Ebola outbreak.
And this has led to wrong decisions of government grossly
contradicting public health disease control measures. Also, the
unprofessional utterances from some nonmedical officials have
engendered widescale disbelief in the general population that
the Ebola virus is not real.
Additional challenges include the lack of trained medical
personnel in specialized areas of epidemiological infectious
disease control.
On the side of the Diaspora efforts, coordination of
logistics across the United States has been difficult due the
lack of financial resources. In Liberia, reduction of air
flights into the country and the lack of clear policy on duty-
free process for Ebola equipment and supplies have hampered
anti-Ebola efforts from the Diaspora community.
These are among a few examples of the looming challenges in
the fight against Ebola in Liberia and the subregion as a
whole.
Notwithstanding, Diaspora Liberians and, as we have met
with others from the subregion, Guineans and Sierra Leonians,
have since embarked on massive mobilizations of medical
supplies and materials as well as food, and continue to send
these items to Liberia and the other countries on a revolving
basis.
For example, partnering with other organizations and
foundations, the Diaspora Liberia Emergency Response Task Force
recently airlifted about 4,000 pounds of medical supplies to
Liberia on August 27, 2014, set up its own distribution
mechanism that was very much independent of government's
control, and effectively delivered directly to healthcare
facilities that were serving impoverished communities.
One of those communities was the West Point community which
was locked down, and in this service we utilized organized
community involvement. It is important to note that Guinea,
Liberia, and Sierra Leone were ravished by civil wars and this
damaged the little infrastructure that these countries had.
Yet, at the onset of the prevailing crisis there were some
miscalculations also on the part of the international
community. First, the international community should have had
the inclination that these three Mano River Union countries of
Guinea, Sierra Leone, and Liberia did not have the professional
and technical capacity to control the outbreak of Ebola virus,
a WHO-classified risk group four or biosafety level four or
category A virus.
Second, the international community failed to understand
the cultural and traditional ties that exist among the people
living in the common geographic region that connects Guinea,
Sierra Leone, and Liberia.
In that geographic triangle resides common ethnic groups,
example the Kissi and Mandingo, that cannot be separated by
political or colonial boundaries.
Third, the response of the international community was
seemingly uncoordinated. After looking for a while, the French
Government quickly went into Guinea with scientists, doctors
and medical supplies to help out.
Then the British Government followed suit, helping Sierra
Leone alone. Liberia was left alone for a little while, left
alone, and by the mercy of Samaritan's Purse and Doctors
Without Borders--we take our hats off to you again--Liberia was
being cared for.
As if British and the French Government were saying to
Liberia, well, you have got America--let America come to your
aid. True to this, in the last several days the U.S. Government
has begun taking significant steps toward helping Liberia fight
the Ebola crisis.
As the WHO has since declared the Ebola outbreak as a
humanitarian crisis and called for a coordinated response, in
this regard the Diaspora Liberia Emergency Response Task Force
on the Ebola Crisis will kindly call for the following.
One, that Britain, France, and the United States create a
triangular coordination of their assistance to the region for
Guinea, Sierra Leone, Liberia, and Nigeria.
Two, that the international community, mainly the United
States of America, with the WHO should take immediate control
of the healthcare system of Liberia and the subregion in order
to resuscitate its capacity building.
Three, that the fight against Ebola be conducted through a
community-based approach and community empowerment through
nongovernmental institutions as civic groups, churches, and
community organizations have demonstrated competence and
experience in service delivery during the war crisis at a time.
An example will be the Catholic Church through the Catholic
Relief Services and now we can make the Diaspora task force as
an example and civic society groups that have already organized
themselves in Liberia presently. Their acronym is called CASE.
These will be viable partners for U.S. Government and
international donors.
Four, that the U.S. Government actively and practically
supports the proposal of the Diaspora Liberia Emergency
Response Task Force for the establishment of a national
institute of disease control and prevention in Liberia to
conduct disease surveillance and prevent future outbreaks of
Ebola and other related diseases and establish a west African
institute for disease control and prevention so as to create a
network of infectious disease professionals again in Liberia,
Nigeria, and Sierra Leone as well as the subregion to conduct
disease surveillance and prevent future outbreak of Ebola and
other related diseases.
Six, that the United States Government or its aid agencies
kindly provide assistance to the Diaspora Liberian, Guinean,
and Sierra Leonian initiatives that are aimed at sending
Diaspora healthcare professionals among whom are doctors,
nurses, public health practitioners, et cetera, to their
respective countries on a revolving 6-week basis.
Seven, that the United States Government kindly increase
its civilian medical expertise at about 1,000 in the region in
Liberia to augment the 3,000 soldiers that will be sent. And
this we are currently requesting should come from the Centers
for Disease Control, the National Institute of Health, and the
Food and Drug Administration.
On this note, we would like to thank the Government of the
United States of America and the Obama administration for the
concrete steps it is taking in fighting against Ebola outbreak
in Liberia and the subregion.
Thank you, Mr. Chairman.
[A prepared statement was not submitted by Dr. Nyan.]
Mr. Smith. Dr. Nyan, thank you very much and for your very
specific recommendations to the subcommittee and hopefully by
extension to the administration and to the rest of Congress.
Just a few questions and, Dr. Akukwe, when you talked about
watching Dr. Brantly walking on his own and what a sense of
hope that sent to you, that sense of hope is felt here on
Capitol Hill in a huge way that Ebola isn't necessarily a death
sentence, that some intervention may work.
And my first question to all of you and to Dr. Brantly
maybe in particular since he was on the ground dealing with
Ebola patients: How do you incentivize doctors and healthcare
personnel, other than those who might be ordered to be there as
part of a military deployment, how do you incentivize people to
take up that huge, not only responsibility, but to incur that
risk that comes with it? I know for you, and I watched your
press conference when you were with the doctors who had
assisted in your recovery, and I was awed by your statement of
faith in Jesus Christ, your sense of that motivating you to do
what you did in helping those who were suffering so immensely,
especially when the Ebola crisis hit, and you might want to
elaborate on that because I think it goes unrecognized that
even people in governments, even people who are a part of a
military deployment, very often it is their faith that is the
prime motivator for their tremendous acts of love, compassion,
and altruism. If you could maybe elaborate on that.
Dr. Brantly. Thank you, Mr. Chairman. I think there are a
lot of practical things that people want if they are going to
respond to a situation like this.
They want to know that they are going to be safe, that they
are going to have the support they need, they will have all the
protective equipment they need. But none of that provides
motivation.
I think the only way to get volunteers to go serve in these
situations, to go serve the people of Liberia and Guinea and
Sierra Leone in the midst of this terrible Ebola outbreak, is
for people to have some internal motivation and for a lot of us
that is our religious faith.
You know, Jesus instructed us, taught us to love your
neighbor as yourself, and he told ``The Parable of the Good
Samaritan'' and when he was asked the question: ``Who is your
neighbor?'' the answer is ``Whoever is in need; that is who
your neighbor is.''
So for a lot of people that is and could be and should be
their motivation. But even for people who don't hold a close
religious faith, for medical professionals--I spoke to the
Senate yesterday and said healthcare workers take oaths such as
the Hippocratic Oath and all of us from the time we write our
application essays for medical school we want to save the
world, we want to help people, we want to serve people--
everybody's application essay says that--but it has to be true.
You have to have a sense of compassion on your fellow man
and an internal urge to serve your neighbor, to serve people in
need, and I think healthcare workers in this country and other
countries need to remember that that was their motivation for
getting into the practice of medicine in the first place, and
when they have that assurance that they will be supported and
provided with the necessary protective equipment that they--
many people don't want to make a personal sacrifice--so if they
can be compensated for their lost work or they can have someone
fill in in their practice to be sure that their patients don't
suffer because of their service to others, those things are all
helpful. But people have to be motivated from their hearts to
go serve.
Mr. Smith. In your service would you, others--yes, Doctor.
Dr. Akukwe. Thank you, Chairman Smith. I agree with what
Kent said. But there are a couple of other things that we have
learned because I served as the first executive chairman of the
Africa Diaspora Health Initiative is that there are a series of
things that are very critical when you are talking of
professionals going into ``what they may consider hardship.''
First one is about, in addition to faith and commitment, is
logistics. They want to be sure that they are going to be safe
and that there is an organizing platform. You were asking this
morning who is in charge. That is one of the first questions
that a typical professional will ask.
Who is, what is the coordinating authority or coordinating
body and then while they are in the host country the issue of
safety and then, are they going to have basic supplies in order
to do their work?
We found out a lot of people, when they do not receive very
specific assurances of that, they will not like to deploy. And
then, of course, the issue of compensation. Not necessarily
getting paid for what they are earning in United States but
some form of compensation so they can take care of their
families.
And I think also the issue of nonprofits MSF and
Samaritan's Purse. The more people get to know what they are
doing and they are successful in deploying people in some of
these countries, the more you are going to get volunteers.
And then finally, with respect to Africa, the issue of
Africans and the Diaspora, when we see what the Indians are
doing, what the Chinese are doing in China, the issue of
Africans and Diaspora, there are thousands of healthcare
professionals.
The National Medical Association has over 25,000 medical
doctors. I know they have a program on the Diaspora but that is
not well funded. So you do have to help prepare professionals
within the Diaspora who with some kind of incentives, perhaps
they will be more inclined to deploy to Africa.
Mr. Smith. Excellent point. Yes, Doctor.
Dr. Alemayhu. Thank you, Mr. Chairman. I guess the short
answer to your question is really what is the mission of being
a medical professional.
I think most doctors and healthcare providers that I know
of their mission is very simple. It is to save lives. It may
have been in different very, very difficult situations in the
past with the war zones, floods, earthquake disasters, you name
it, and every step of the way they go they take a huge risk.
And this is just another challenge and it is not so much of
what is in it for them but I think it is so much of what they
can do for others and that is--actually that is their mission.
With regards to Africa for a moment, just 1 second, Mr.
Chairman, the African Union is doing its best, you know,
despite all these tremendous challenges and a lack of resources
and everything else.
Currently, they are assembling volunteer medical
professionals from across the continent. Apparently, there are
about 100 of them are being mobilized and being trained in
Ethiopia at the African Union headquarters and supposedly they
will be deployed in the next 48 hours or so.
So the African Union does need a lot of help because
ultimately I certainly don't want to come before you, and I am
sure none of us want to come before this subcommittee, 5 years
or 10 years from now.
What we would like to see is hopefully an Africa taking
care of Africa's business and challenges, and I think the work
could be done as despite what we think about the situation on
the ground, the African Union and the African governments
should be supported in every effort they are out to accomplish.
And so such as the African CDC is something that the
President of the United States mentioned and the African Union
is pursuing and the Ethiopian Government introduced this, and I
think they are doing fantastic work but they do require a lot
of supports. Thank you, sir.
Mr. Smith. Let me just ask--we are going to have to leave
at 1 o'clock because there is another hearing that will have to
be convened. But let me just ask the question--Dr. Brantly, you
pointed out that a significant surge of medical boots on the
ground must happen immediately and I asked that question and it
was right from your testimony to our distinguished witnesses in
Panel I and I, frankly--I still don't have a sense--the
subcommittee members don't have a sense: What is the critical
mass that is necessary?
It is hard to build up and build out capacity if you don't
know what is needed. You also make an excellent point. I read a
couple of articles about how people are getting in taxis and
they can't find a bed anywhere and the taxis are actually
getting hot--at least that is the way the author of the article
put it--you know, potentially putting people at risk who get
into the taxi.
And you mentioned that your 120-bed isolation unit in ELWA
is turning away as many as 30 infectious disease individuals
every day. Where do they go? And again, this idea of home
healthcare--can that be set up?
Do you think that is part of the plan? I wish I would have
asked that of the earlier panel but I didn't but I will because
that ought to be incorporated and integrated, I would think, to
a response.
Dr. Brantly. Thank you. Let me answer this in an orderly
way. The Ebola treatment units are absolutely necessary for
handling this outbreak but right now they are insufficient.
That is where the home care comes in.
People are staying at home. There are not enough beds and
it takes time to construct new units and put beds in them and
provide adequate staff.
A unit with beds but without the staff is just a place for
people to die and that is more incentive for people to stay
home where at least they are with their family. So we have--
also have to have the staff, which is--goes to your question as
well.
The home healthcare strategy, I believe, has been addressed
by the President in his plan when he--I think he committed
400,000 home care kits to be delivered and they have to be
delivered without delay and those kits--I am not sure what is
contained in them but it has to be not only things like oral
rehydration solution and Tylenol to help treat the patient with
that supportive care--and there are other types of supportive
care that are not possible at home like intravenous fluids and
other more technical medical interventions--but we can do some
basic things like try to keep people hydrated with oral
rehydration and ease their pain or their fever with small doses
of Tylenol.
But the more important part of that kit is the equipment to
protect the caregiver and that is going to require education of
those caregivers as well and that is where I think
implementing, employing survivors to help reach their own
communities.
You know, survivors are stigmatized and many times can't
return to their communities safely. But if they can return to
their communities with the support of the authorities with some
safety and security to be able to do this lifesaving work of
educating their communities, of helping those caregivers
provide good care to their patients, their family members in a
safe way, I think that is very important and that can be
mobilized more quickly than we can build new units. The two
have to happen together. But I think the home healthcare needs
to start immediately.
As for numbers of medical boots on the ground, Mr.
Chairman, obviously I can't give you an exact number but let me
give you an idea of what is required to run a unit.
The treatment team is made up of a doctor, two or three
nurses or PAs or paramedics and two or three what we call
hygienists. The hygienist does not have to be a medical
professional.
They have to be safety conscious people who are able to
follow instructions and who are willing to do dangerous and
difficult work. Those are the people who spray the unit with
the chlorine to keep everything sanitized. They take care of
the bodily waste of the patients and they deal with the dead
bodies when patients pass away.
So if you have this team of five or six individuals it
would be one doctor, two or three other healthcare
professionals which can be nurses, physician's assistants,
paramedics, and then two or three of the hygienists, those
people can care for maybe ten patients before--maybe not even
that many--maybe five patients before they have to leave the
unit because of the difficulty of wearing the personal
protective equipment in the heat and you can't drink when you
are wearing that equipment; there is a time limitation for how
long you can stay in the unit.
I think MSF has or WHO has estimated that for a 100-bed
unit you have to have 200 personnel with that breakdown of, you
know, six nurses, PAs, and paramedics for every three
hygienists for every one doctor.
So if you had 1,000 patients that needed to be cared for
you would need roughly 600 healthcare workers, 100 physicians,
and 300 hygienists and that is for people that work 12-hour
shifts with no days off.
It requires half of that again to work 12-hours shifts and
give people a day off every once in a while. So we are talking
about for every 100 patients, 200 personnel or 300, if you want
people to be able to take a break and not be burned out after a
few days of working.
So it is large numbers but it is not that we need 10,000
doctors. It is that we would need 1,200 nurses, 600 hygienists,
and 200 doctors for 2,000 patients. Those are roughly the kinds
of numbers we are looking at.
So if we are looking at 10,000 patients in the next few
weeks you can see the numbers of healthcare professionals and
other volunteers that we would need to treat them.
Dr. Akukwe. Let me say--in Guinea, Liberia, and Sierra
Leone there are lots of trained community health workers who
are either out of work, have retired, or have left the
healthcare industry.
So as part of work Kent is talking about on home health. It
is easy to remobilize these individuals who benefited from very
rigorous training 10, 15, 20 years ago--hundreds of them.
Dr. Brantly. And Mr. Chairman, may I also say I am not
suggesting that all of these people would have to be deployed
from the United States of America. There are lots of Liberians
in Liberia who can help in this response and in fact there are
units--isolation units, Ebola treatment units--that are being
run entirely by Liberians.
There is one on the ELWA campus, which we refer to as ELWA
II, being headed up by Dr. Jerry Brown and they are having
phenomenal success by providing supportive care to patients,
nutritional supplementation, vitamins, and providing
compassionate care to them, and just in the last couple of days
they had 50 patients and they have released 19 survivors.
In the month of August they released 51 survivors. So
supportive care works but you just have to have the personnel
to provide it.
Mr. Smith. Before we conclude, is there anything else you
would like to add? Any answers to the questions that might have
been posed earlier to Panel I that you think you would like to
address? Anybody? Yes, Doctor.
Dr. Alemaywu. Just quickly, Mr. Chairman. What one key
piece that I have not heard us talking about is the
psychological part of this whole thing. I am delighted to be
joined by Dr. Judy Kuriansky from Columbia University--she is
also a board member--it is unthinkable what is going on now
with regards to the psychological challenge and the fear, and,
of course, we have forgotten one huge piece in this which is
the traditional healers--the traditional doctors, if you can
call them that--because the locals, whether we like it or not,
they believe who they know and who they trust, not so much of
the outside forces coming to save them.
And I think getting those elements in place and letting
them be a part of the solution making process is absolutely
key. Thank you, sir.
Dr. Akukwe. And you need to know, from the earlier
discussion--the problem is that I think in long term beyond the
immediate response to Ebola, the next few years you are going
to have another outbreak. So what is the best way to assist
African countries and manage these outbreaks on their own in
the future?
Mr. Smith. I would like to thank all four of our
distinguished panelists for your tremendous insight, your
recommendations. I think it will help not only Congress but it
will help the administration with your guidance and your
wisdom.
And, again, thank you for your leadership. It is
extraordinary. The hearing is adjourned.
[Whereupon, at 1:01 p.m., the committee was adjourned.]
A P P E N D I X
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Material Submitted for the Record
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Material submitted for the record by Dougbeh Chris Nyan, M.D., director
of the secretariat, Diaspora Liberian Emergency Response Task Force on
the Ebola Crisis
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