[House Hearing, 113 Congress]
[From the U.S. Government Publishing Office]
COMBATING EBOLA IN WEST AFRICA:
THE INTERNATIONAL RESPONSE
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HEARING
BEFORE THE
COMMITTEE ON FOREIGN AFFAIRS
HOUSE OF REPRESENTATIVES
ONE HUNDRED THIRTEENTH CONGRESS
SECOND SESSION
__________
NOVEMBER 13, 2014
__________
Serial No. 113-240
__________
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
C O N T E N T S
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Page
WITNESSES
The Honorable Rajiv Shah, Administrator, U.S. Agency for
International Development...................................... 7
The Honorable Bisa Williams, Deputy Assistant Secretary, Bureau
of African Affairs, U.S. Department of State................... 17
The Honorable Michael D. Lumpkin, Assistant Secretary of Defense
for Special Operations and Low-Intensity Conflict, U.S.
Department of Defense.......................................... 29
Major General James Lariviere, USMC, Deputy Director for
Politico-Military Affairs (Africa), Joint Chiefs of Staff, U.S.
Department of Defense.......................................... 50
Major General Nadja Y. West, USA, Joint Staff Surgeon, Joint
Chiefs of Staff, U.S. Department of Defense.................... 51
LETTERS, STATEMENTS, ETC., SUBMITTED FOR THE HEARING
The Honorable Rajiv Shah: Prepared statement..................... 10
The Honorable Bisa Williams: Prepared statement.................. 20
The Honorable Michael D. Lumpkin: Prepared statement............. 31
APPENDIX
Hearing notice................................................... 70
Hearing minutes.................................................. 71
The Honorable Gerald E. Connolly, a Representative in Congress
from the Commonwealth of Virginia: Prepared statement.......... 73
Question submitted for the record to the Honorable Rajiv Shah
from the Honorable Ami Bera, a Representative in Congress from
the State of California........................................ 75
COMBATING EBOLA IN WEST AFRICA:
THE INTERNATIONAL RESPONSE
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THURSDAY, NOVEMBER 13, 2014
House of Representatives,
Committee on Foreign Affairs,
Washington, DC.
The committee met, pursuant to notice, at 10:11 a.m., in
room 2172, Rayburn House Office Building, Hon. Ed Royce
(chairman of the committee) presiding.
Chairman Royce. The committee will come to order. We will
ask all the members to take their seats.
We have had Ebola crises in the past. We have seen this
situation in the Philippines, in Congo, Uganda, but never have
we seen it on the scale, with the reach that this current
epidemic has in Guinea and Liberia and in Sierra Leone. There
are 14,000 cases on record, there are 5,000 people who have
died, there are thousands of children at this time who have
been orphaned, and these numbers are very shocking, and the
numbers are growing.
What has worked in the past to block Ebola, obviously, is
breaking the chain of transmission. But without us doing that,
Ebola will continue to spill across borders, and economies will
be devastated in Africa. Governments will fail. Tens of
thousands will die. And that is no exaggeration, and that means
that this isn't just a problem for west Africa, but a problem
with far-reaching health and economic and security consequences
for the globe.
And I would like to recognize Chairman Smith for convening
an emergency hearing we held together during the African
summit, African Leaders Summit in August, despite concerns by
the administration that it would be a distraction. President
Sirleaf, Ellen Johnson Sirleaf of Liberia, called to thank the
committee for standing by Liberia.
Chairman Smith, who has been working closely with our
ranking member, Karen Bass, on that subcommittee, will convene
a hearing next week with the key nongovernmental organizations
engaged in the response.
Unfortunately, we are paying the price of early failures.
The World Health Organization, which is the U.N. agency charged
with leading the response to health emergencies, downplayed the
crisis. Inept country office directors ignored warnings by
Doctors Without Borders. As a matter of fact, they wrote a
rebuttal to the concern raised by Doctors Without Borders. They
refused assistance early on from the Centers for Disease
Control and from USAID, and they blocked entry for teams of
experts. By the time that the World Health Organization finally
sounded the alarm on August 8th, the outbreak was out of
control.
Of course, the United States has generously provided
support to the WHO. This was a failure of policy, not
resources. Our director of the Centers for Disease Control
serves on WHO's executive board, and we need to be pushing to
reform the organization. Improving accountability would be a
very good place to start, and having country directors that are
not cronies but, in fact, are ready to stand up and deal with
the problem instead of trying to deny it, is a very good place
to start.
In contrast to the WHO's failures, USAID immediately
activated a disaster assistance response team. It immediately
got people to the region. And, today, USAID, supported by the
Department of Defense and CDC, is leading a robust disaster
response. As we will hear from Administrator Shah, who
contacted myself and Mr. Engel after his trip to each of these
countries, treatment units are being opened; lab capacity is
being expanded; medical workers are being trained; and burial
teams are working to reduce transmission.
Reports from Liberia indicate that this is having an
impact. None of this could have been done without the
commitment and sacrifice of the brave men and women of the
doctors and nurses and civilians, both civilian and uniformed
personnel, in all of this who have answered the call for help.
But we cannot afford to let up, and we cannot afford to do
this alone. Containment will fail in the absence of a robust
international effort. Other donors and the U.N. need to step
up, just as we are stepping up. They need to step up
particularly in Guinea. The WHO needs to be part of the
solution, rather than a hindrance. And our Embassies need to
put in place additional prudent containment measures that will
add a layer of protection while not impeding the Ebola
response, including the temporary suspension of visas for non-
U.S. nationals coming from the region.
We look forward to learning more about the international
efforts to help contain the epidemic at its source and
evaluating the administration's request for additional
resources in this fight to address one of the most pressing
health emergencies of our time.
And I now turn to our ranking member, Mr. Eliot Engel of
New York, for any opening remarks he might have.
Mr. Engel. Mr. Chairman, thank you for holding this
important hearing. Let me say it was good spending time with
you this past week.
And to our witnesses, thank you for your service and for
your testimony here today. I want to single out Rajiv Shah, the
Administrator of USAID, with whom I have worked closely during
the past several years.
We appreciate your efforts, Administrator Shah, and the
efforts of all the good people who are testifying here today.
Thank you, Ambassador Williams and the others, thank you so
much.
Since our Africa and Global Health Subcommittee held a
hearing on Ebola in September, the number of cases has nearly
tripled. The World Health Organization is reporting over 14,000
Ebola cases as of November 12, 2014, and a total of 5,147
people have died. The United States has now seen the
implications of this outbreak here at home. Several heroic
healthcare workers who gave their time and skills to treat
Ebola patients in west Africa have contracted the disease and
have been successfully treated here in the United States. We
are grateful for their selflessness and for their sacrifices.
Just as the doctors volunteering to help combat Ebola overseas
deserve our recognition, so do our health workers and border
and transportation officials who are working tirelessly to
prevent an outbreak in the U.S.
As a New Yorker, let me say how proud I am of the staff of
Bellevue Hospital and all of the New York public health
officials who were involved in successfully treating Dr. Craig
Spencer, who was released on Tuesday Ebola free. No matter how
diligent we are here at home, there is always a chance of Ebola
reaching our shores as long as the disease is thriving in west
Africa. To prevent this from happening, we need to stamp out
Ebola at its source. Most importantly, this Ebola outbreak is
causing tremendous suffering. Our country has a proud tradition
of stepping up in the event of a major crisis, and that should
continue. That is why I support the strong commitment the U.S.
has made to combating and eradicating this outbreak in west
Africa.
The United States has been a leader in the response to
Ebola, particularly in Liberia. To date, more than $414 million
has been disbursed. Our soldiers are building treatment
facilities across the country, a high quality 25-bed hospital
for healthcare workers who contract Ebola, and providing vital
air and logistical support. The CDC has helped establish
laboratories that reduce the time it takes to get an accurate
diagnosis from days to mere hours. USAID is supporting more
than 50 burial teams and more than 2,200 workers, who are doing
vital contracting work.
As I have said, the U.S. cannot meet this challenge alone.
Ebola is a global challenge, requiring a global response.
Fortunately, international efforts to control the epidemic in
Liberia, Sierra Leone, and Guinea have increased, both in terms
of financial support and on-the-ground assistance. Our partners
in Europe and Asia have stepped up their commitment to the
region. NGOs and humanitarian organizations, which shouldered
most of the burden in fighting this epidemic for months, now
have more robust and sustained support from donor countries.
However, despite these positive signs, much work remains
before this epidemic is under control, and unfortunately, the
significant financial commitments we have already made will not
be enough to control this outbreak, but we cannot become
complacent. All it takes is one unmonitored and untreated Ebola
patient to cause another flare up.
We have all seen the emergency funding request that the
administration sent to Congress on November 5th. Given the dire
humanitarian impact Ebola is having on west Africa and the
global health threat this disease poses, I strongly support
this request. Like my colleagues, I would like to get more
details from our witnesses: How will this funding be used? Why
is it critical not only for the Ebola crisis but for our
campaign to respond to emergencies globally? I hope we can shed
a little more light on those issues, but Congress should
quickly approve this request so that our efforts to end this
outbreak aren't derailed due to a lack of financial resources.
Finally, while controlling the epidemic is our first
objective, we cannot lose sight of the fact that the three most
heavily affected west African countries have significant long-
term needs for assistance. The World Bank estimates that the
regional financial impact could reach $32.6 billion by the end
of just 2015. This would be catastrophic for a region just
getting back on its feet after a prolonged period of conflict.
So while the international response must be swift, it must also
be sustained.
I also want to mention my gratitude and appreciation for
all of our U.S. Government personnel in the region, the men and
women who represent and support our missions abroad in west
Africa. I thank the military who are here. This is a
challenging time for everyone involved, and we appreciate all
of their hard work in dealing with this crisis. I know how busy
all of our witnesses are, and I appreciate the time that all of
you are taking to give us this valuable update.
So, Mr. Chairman, thank you again for convening this
hearing and thank you to our witnesses for being here today.
Chairman Royce. Thank you.
And I will say to the committee, I agree with Mr. Engel's
assessment here.
Let's go to Chairman Chris Smith, chairman of the Africa
Subcommittee and Global Health.
Mr. Smith. Thank you very much, Mr. Chairman, for putting
together this very important and timely hearing on the Ebola
crisis, and I want to thank our distinguished witnesses for
their extraordinary efforts to combat this disease and help the
victims and their families.
I especially want to thank Dr. Shah for the work the USAID
is doing and for the interest he has taken personally, the
leadership he has provided. It has been herculean.
The unprecedented west African Ebola epidemic has not only
killed more than 5,000 people with nearly 13,000 known to be
infected, and that is probably a significant underestimation,
it has also skewed the planning for how to deal with this
outbreak. As we all know, in the past Ebola outbreaks have
occurred in isolated areas that were much easier to contain. In
this instance, the disease quickly spread from a rural area to
an international trading center and people from Guinea,
Liberia, and Sierra Leone took the disease home with them.
This disease, in early stages appears to do less. It is not
recognized as quickly than other diseases, such as malaria,
which means initial healthcare workers have been unprepared for
the deadly nature of the disease that they have been asked to
treat. This has meant that too many healthcare workers,
national and international, have been at risk in treating
patients who themselves may not have known that they had Ebola.
Hundreds of healthcare workers have been infected, many have
died, including some of the top medical personnel in the three
affected countries.
What we found quickly was that the healthcare systems in
these countries, despite heavy investment by the U.S. and other
donors, remained quite weak. As it happens, these are countries
coming out of very divisive conflicts or they experience
serious political divisions. Consequently, citizens have not
been widely prepared to accept recommendations from their own
governments. For quite some time, many people in all three
countries would not accept that the Ebola epidemic was even
real. Even now it is believed that, despite the prevalence of
burial teams throughout Liberia, for example, some families are
reluctant to identify their suffering and dead loved ones for
safe burials, which places family members at grave risk because
they often touch the body and show great affection for the
recently deceased. The porous borders of these countries have
allowed people to cross between countries at will. This has led
to problems of people obviously carrying the disease with them.
I want to announce today the introduction of a bill. We
have been working very closely with Chairman Royce on this as
well as the ranking member, Karen Bass, called the Ebola
Emergency Response Act. We have also shared it with the
administration, trying to get a best practices bill moving that
would affect the three countries but also the total response.
This includes recruiting and training of healthcare personnel;
establishing fully functional treatment centers; conducting
education campaigns among populations in affected areas; and
developing diagnostics, treatments, and vaccines. It confirms
U.S. policy in the anti-Ebola fight and provides necessary
authorities for the administration to continue or expand
anticipated actions in this regard. The bill also encourages
U.S. collaboration with other donors to mitigate the risk of
economic collapse and civil unrest in the three affected
countries. And we look forward to input from all members on
this important bill, and again, I want to thank my friends on
the other side of the aisle for working so closely on its
creation.
I yield back, and I thank you, Mr. Chairman.
Chairman Royce. Thank you very much, Mr. Smith.
Ranking member Karen Bass of Los Angeles, ranking member on
this Subcommittee on Africa and Global Health, for 3 minutes.
Ms. Bass. Thank you, Chairman Royce, Ranking Member Engel,
and Chairman Smith, as always for your leadership on this
important issue and for calling today's hearing. I also want to
thank Dr. Shah and the other members of the panel today, not
just for taking the time for your testimony but for your
aggressive response and leadership on this issue. I look
forward to getting updates directly from you today on how your
agencies and organizations continue to combat this deadly
outbreak, what trends you are seeing, both positive and
negative, and what additional support is needed as you
coordinate with governments of impacted countries and the
international community.
We all know this crisis has been the largest and most
widespread outbreak of the disease in history, creating a great
burden on the governments and bringing a greater awareness to
the international community about global health security.
Striking west Africa for the first time, Ebola quickly
overwhelmed the extremely limited healthcare systems of these
nations, and quickly spun out of control. Since the beginning
of the outbreak, the United States has made a significant and
sustained effort, and all of what we are doing was described by
Ranking Member Engel.
The question that I have that hopefully the panel will
address is, with all of the infrastructure that we are putting
in place from the treatment centers, training healthcare
workers, burial teams, all of that, after we are past this--and
I believe we will get past it--will any of it be left in place?
Because I think that what we have all learned from this
outbreak is the fact that many of the countries, the reason why
it has been so bad is because they lacked a healthcare
infrastructure. So do we take out of this tragedy and see an
opportunity to begin to address this in the long term?
I think that Ebola has shown us that this isn't about
charity, but that a health care crisis in one part of the world
can directly affect us. And I am also particularly concerned
about the fragile governments and a breakdown in the rule of
law.
On the African side, African business leaders pledged to
help the African Union train and deploy healthcare workers. And
I know the African Development Bank has provided over $44
million to date to assist the global efforts. I understand that
more than 2,000 healthcare workers have been pledged from
African countries to help fight the outbreak.
I know that the administration has asked Congress for over
$6 billion in emergency funds in order to sustain the progress
that has been made and to ensure an end to this crisis. I
believe that this request will expand assistance to continue to
contain the epidemic and safeguard the American public from
further spread of the disease.
I look forward to your testimonies, and I am interested in
hearing from all of you about what more Congress can do to help
you in your efforts to combat the disease. Thank you very much.
I yield back.
Chairman Royce. Thank you.
We begin this morning, our first witness will be Dr. Rajiv
Shah. He is the 16th Administrator of the U.S. Agency for
International Development, and previously he served as Under
Secretary of Research, Education, and Economics at USAID and as
chief scientist at the U.S. Department of Agriculture. And we
welcome him back to the committee.
Ambassador Bisa Williams is the Deputy Assistant Secretary
of the Bureau of African Affairs, and previously she served as
U.S. Ambassador to the Republic of Niger from 2010 to 2013.
Mr. Michael Lumpkin is currently the Assistant Secretary of
Defense for Special Operations and Low-Intensity Conflict. He
previously served as Deputy Chief of Staff for Operations at
the Department of Veterans Affairs.
Major General James Lariviere is the Deputy Director for
Political Military Affairs for Africa for the Joint Chiefs of
Staff. Previously he worked on Capitol Hill as a military
legislative assistant, a professional staff member with the
House Armed Services Committee, and as both staff director and
minority staff director of the House Veterans' Affairs
Committee.
Major General Nadja West is the Joint Staff Surgeon. She
serves as the Chief Medical Adviser to the chairman of the
Joint Chiefs of Staff and coordinates all issues related to
health services, including operational medicine, force health
protection, and readiness among the combatant commands.
And Mr. Lumpkin will give oral testimony on behalf of the
Department of Defense. Major General Lariviere and Major
General West are available to answer our members' questions
here today.
And, without objection, the witnesses' full prepared
statements will be made a part of the record. Members will have
5 calendar days to submit any statements or questions or any
extraneous material for the record.
And so we go now to Dr. Rajiv Shah.
STATEMENT OF THE HONORABLE RAJIV SHAH, ADMINISTRATOR, U.S.
AGENCY FOR INTERNATIONAL DEVELOPMENT
Mr. Shah. Thank you, Chairman Royce, Ranking Member Engel,
and members of the committee. Mr. Chairman, I want to recognize
and thank you for your leadership on behalf of America's
efforts to promote our national security and economic
prosperity through developmental and humanitarian investments
made all around the world, particularly at times of crisis and
recognize the historic role you have played in helping support
these efforts and reform, in particular the way we provide food
assistance around the world.
Thank you, Congressman Engel, for your unwavering
leadership and support and friendship, and I value the support
you have offered for our global health efforts in this crisis
but also all around the world.
And special recognition, of course for Representatives
Smith and Bass for your extraordinary and consistent leadership
in global health for so many years, which we draw upon now as
we face this crisis.
As the chairman noted, today we face the largest and most
protracted Ebola epidemic in our history, with more than 14,000
infected and more than 5,000 already deceased. I have had a
chance to visit these countries and meet those who have been
affected. And I can tell you that the most tragic part of the
Ebola crisis is that it strikes those who offer the most care
and the most love to those who are affected, a mother who holds
a sick child or a son or daughter who kisses a deceased parent.
In Guinea, Liberia, and Sierra Leone, we are facing a
crisis of epidemic proportions, and the President has directed
us to lead a whole-of-government response in west Africa that
can help ensure America's security and safety from this tragic
disease. I am proud here to be with members of our team across
the interagency who have offered extraordinarily important
leadership. You will hear from Assistant Secretary Lumpkin
about the really herculean efforts the military has taken, and
I hope he will share with you how important it has been to
have, amongst other things, the Navy labs in place, greatly
accelerating the time it takes to do diagnostics, from 7 or 8
days down to 5 or 6 hours, thus allowing us to accelerate the
performance of the response. You will hear from Deputy
Assistant Secretary Williams about the more than $800 million
in commitments that our State Department has helped to
encourage from other countries so that the United States is
not, in fact, pursuing this effort alone. And while you won't
hear today from the Centers for Disease Control and Health and
Human Services, I can tell you that on the ground, our teams
operate in an absolutely integrated manner, and in fact, our
disaster assistance response team, which is leading the effort,
is co-led; the deputy director of that team is a member of the
Centers for Disease Control.
President Obama is requesting $6.18 billion in emergency
funding to enhance our efforts to urgently address this crisis
right now and for the coming year. These resources are
essential to rapidly scaling up activities to control the
outbreak at its source, to support recovery in west Africa in
health and agriculture and food and other sectors of work to
prevent civil unrest and governance collapse, and to strengthen
global health security in the region, so, as we just saw
yesterday, cases appearing in Mali don't get beyond that area
and are effectively controlled.
I would like to share with you just a few quick
observations from my trip. In Liberia, I had a chance both to
meet first responders and to see the extraordinary results of
American investment and effort. As just one example, the 65
burial teams that we now have up and running have tackled this
crisis at its most aggressive point of transmission. Seventy
percent of all cases get transmitted through the bodies and the
handling of the bodies of the deceased. Today, more than 95
percent of dead bodies are disposed of in a dignified manner,
but in a safe manner with the proper burial team handling the
disposal of that body. That is just one example, but that has
clearly helped to bring down the number of new cases so that
today we believe the transmission rate has been greatly reduced
in Liberia.
In Sierra Leone, I had a chance to visit trainers who are
training hundreds of healthcare workers, mostly African and
mostly local, in effective protective equipment and performance
so they can be on the front lines of the response. Together
with the World Health Organization and other countries, we will
in fact train thousands of local healthcare workers who are on
the frontline of taking on risk and who will be the legacy we
leave behind so that there is, in fact, to answer the
Congresswoman's question, a legacy of support for global health
efforts throughout the region.
And, in Guinea, although they have the fewest number of
cases out of the three, perhaps current active cases of 500 to
600, we are working aggressively to scale up efforts in the
difficult to reach forest region, difficult to reach rural
community, where most of these cases currently exist.
Finally, I just want to highlight that in order to be
effective in this response, we have had to do some things very
differently across our team. First, we have had to invest in
real innovation and science, and just in the next 2 days, we
will be reviewing proposals for new protective suits that can
help reduce the infection risk when health workers take them
off and put them on because the current protective equipment is
not designed for tropical disease control. We are sending a
real time data team that has already gotten more than 8500
ruggedized android devices, hand-held devices so we can get
better real-time data on where the cases are and respond even
more quickly and rapidly to meeting those needs. And we are
using our efforts in agriculture and food in particular to make
sure that the backbone of the rural economy in all three
countries, which is agriculture based, can be up and running
again as soon as possible, using our Feed the Future program to
help accelerate performance in that sector.
These efforts taken together and led by our disaster
assistance response team leader, Bill Berger, on the ground in
Monrovia, is making a tremendous difference at changing the
path of this epidemic. If we continue to provide support at the
level the President is requesting, we believe we can overcome
this crisis by tackling it at its source.
And I want to thank everyone on the committee for your
ongoing support of the risks and the leadership being shown by
our teams in country every single day. Thank you.
Chairman Royce. Thank you, Administrator Shah.
[The prepared statement of Mr. Shah follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
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Chairman Royce. We now go to Ambassador Williams.
STATEMENT OF THE HONORABLE BISA WILLIAMS, DEPUTY ASSISTANT
SECRETARY, BUREAU OF AFRICAN AFFAIRS, U.S. DEPARTMENT OF STATE
Ambassador Williams. Thank you. Thank you, Chairman Royce.
Ranking Member Engel, and distinguished members of the
committee. I thank you for this opportunity to testify today
regarding the Department of State's role in the U.S. whole-of-
government response to the Ebola outbreak in west Africa.
The ongoing Ebola epidemic in west Africa has already
resulted in over 14,000 infected and nearly 5,500 deaths. While
Liberia, Sierra Leone, and Guinea have borne the brunt of this
tragic epidemic, we have also seen isolated cases in Nigeria,
Senegal, Mali, Spain, and the United States. This reminds us
that Ebola can be a threat anywhere until we end the epidemic
at its source in west Africa.
The Ebola epidemic has inflicted human, economic, and
social costs across the affected countries in west Africa and
has stretched existing health systems to the breaking point.
Beyond the epidemic's immediate effects, fewer children are
being vaccinated; an increasing number of people lack adequate
food; an increasing number of orphans require care; and
economies have been badly damaged. All this has occurred
against the backdrop of countries still recovering from civil
war. In short, the Ebola epidemic is not only a health crisis;
it is a potential global security crisis.
The United States Government has stepped forward as a
global leader to stamp out this scourge at its source. However,
a challenge of this magnitude requires global cooperation. The
Department of State therefore plays a critical role in
mobilizing international resources and coordinating with
partner states, regional organizations, nongovernmental
organizations, and the United Nations to build capacity in the
affected countries and beyond to respond to this crisis.
In this respect, we are working particularly closely with
Dr. David Nabarro, the U.N. Secretary General's Special Envoy
on Ebola, and the U.N. Mission for Ebola Emergency Response or
UNMEER to identify resource shortfalls and those international
donors best placed to contribute needed financial support,
manpower, and in-kind contributions. The U.N. has sounded a
call for $1.5 billion to finance the U.N. response to the
epidemic. And the State Department continues to conduct
intensive bilateral and multilateral outreach to urge countries
to contribute to the U.N. funding appeal.
In September, we launched a broad outreach strategy at the
U.N. General Assembly that raised global awareness of the
emergency and emphasized the high priority the United States
places on addressing it. In mid October, we followed up with
targeted outreach calls from the President, Secretary Kerry,
Secretary Burwell, CDC Director Dr. Frieden, National Security
Adviser Rice, and U.S. Ambassador to the U.N. Power to their
counterparts in a subset of key donor countries, and it worked.
Since October 10th, those countries have pledged an additional
$793.2 million to the global Ebola response in addition to
significant nonmonetary contributions and bilateral
contributions approaching $1 billion. Those numbers continue to
grow.
We are heartened by this growing support of countries
around the globe, from tiny Timor-Leste to giant China. Despite
these gains, we know that the fight is far from over and that
much more must be done. As the President continues to say, we,
the global community, need to do more and do it faster.
Therefore, we will continue to push forward over the coming
months. This means reinforcing our message at major
multilateral events, including the summits of the G20, APEC,
ASEAN, and the EAS, to drive action and seed contributions from
a larger pool of donors. We are also looking at our partners in
the Middle East as well as rising global economic powers, such
as India, Indonesia, and Brazil, to do more. We are working
with the African Union to bring their pledge of healthcare
workers to the affected countries, matching needs on the ground
with the skills and numbers of their volunteers. We support the
African community's leadership in this response.
Healthcare workers are the linchpin of the fight against
Ebola, and recruiting these incredible heroes and removing
disincentives for them to volunteer are a key facet of our
outreach. So we are working with UNMEER, the World Bank, and
our partner governments to provide the logistical support these
volunteers require, as well as the laboratory capacity, airlift
resources, and personal protective equipment they need to
operate Ebola treatment units and other care centers.
I would like to turn now to our work with the private
sector in this response. The State Department has focused on
three aspects of private sector mobilization, urging businesses
to contribute their resources to the Ebola response, urging
companies that are doing business in the region to stay, and
engaging U.S.-based businesses to consider investing in the
region. The State Department has collaborated with groups, such
as the Corporate Council on Africa and the Business Council on
International Understanding, to convene companies interested in
providing specific in-kind donations that would benefit the
response. These groups as well as private American medical
institutions, such as Morehouse Medical School and the Harvard
Medical School, are focusing not only on responding to the
short-term needs to combat Ebola but also on providing the
infrastructure support that we know is necessary for the long-
term economic and social recovery of the affected nations.
One example of such collaboration is the State Department's
partnership with the Paul G. Allen Family Foundation, which has
not only donated $100 million to the response effort but has
offered to pay for the manufacture of new specialized medical
evacuation pods on behalf of the State Department.
As another example, we are partnering with American
technology firms to bolster information communication
technology or ICT infrastructure in conjunction with UNMEER.
Coordinating the response in west Africa is a massive
logistical undertaking that requires adequate ICT to be
successful. The efforts of the State Department and USAID in
conveying the substantial ICT needs in affected countries have
raised awareness of the need for better ICT infrastructure both
to fight the Ebola virus right now and to make future disaster
responses more effective.
At the same time, Assistant Secretary Linda Thomas
Greenfield has been working to keep diaspora groups informed
and to encourage business interests in the region to stay the
course through this current crisis. The U.S. Chamber of
Commerce Foundation, the Corporate Council on Africa, the Ebola
Private Sector Mobilization Group, the Business Council for
International Understanding, and many private sector entities
with substantial long-term business and investment presences in
the affected regions have coordinated closely with the
Department of State and USAID. We have advised them how they
can not only employ their infrastructure and financial
resources in support of this effort but also use examples of
their positive partnership to encourage additional corporate
engagement within their respective sectors in support of the
Ebola response.
As you can see, there are a multitude of actors involved in
response efforts. As we recruit and convene them, the State
Department is also focused on channeling their efforts to fill
known resource gaps, which really brings us back to the U.N.
Chairman Royce. Ambassador----
Ambassador Williams. Oh?
Chairman Royce. It has been like 8 minutes.
Ambassador Williams. I am over time.
Chairman Royce. I think what I would like to ask the
witnesses to do is if you will just give 5 minutes of
testimony, we have got your written report here, and we will
have an opportunity to ask you questions afterwards. So maybe
we should go to Mr. Lumpkin now.
Ambassador Williams. I appreciate it. Thank you.
Chairman Royce. Thank you, Ambassador.
[The prepared statement of Ambassador Williams follows:]
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STATEMENT OF THE HONORABLE MICHAEL D. LUMPKIN, ASSISTANT
SECRETARY OF DEFENSE FOR SPECIAL OPERATIONS AND LOW-INTENSITY
CONFLICT, U.S. DEPARTMENT OF DEFENSE
Mr. Lumpkin. Chairman Royce, Ranking Member Engel, and
distinguished members of the committee, thank you for the
opportunity to testify today regarding the Department of
Defense's role in the United States' comprehensive Ebola
response effort, which is a national security priority in
response to a global threat. Due to the United States
military's unique capabilities, the Department has been called
upon to provide interim solutions that would allow other
departments and agencies the time necessary to expand and
deploy their own capabilities.
United States military efforts are also galvanizing a more
robust and coordinated international effort, which is essential
to contain this threat and to reduce human suffering. Before
addressing the specific elements of DoD's Ebola response
effort, I would like to share my observations of the evolving
crisis and our increasing response.
Like Administrator Shah, I recently traveled to the area
and I was left with a number of overarching impressions that
are shaping the Department's role in direct support of USAID.
First, our Government has deployed a top notch team
experienced in dealing with disasters and humanitarian
assistance.
Second, the Liberian Government is doing what they can with
their very limited resources.
Third, the international response is increasing rapidly due
to our Government's response efforts.
Fourth, I traveled to the region thinking we faced a health
care crisis with a logistics challenge. In reality, we face a
logistics crisis focused on a healthcare challenge.
Fifth, speed and scaled response matter. Incremental
responses will be outpaced by this dynamic epidemic.
And, finally, the Ebola epidemic we face truly is a
national security issue. Absent our Government's coordinated
response in west Africa, the virus spread brings the risk of
more cases here in the United States.
I would like to now turn to DoD's role in our direct
support in west Africa. In mid-September, President Obama
ordered the Department to undertake military operations in west
Africa in direct support of USAID. Secretary Hagel directed
that U.S. military forces undertake a twofold mission: First,
support USAID and the overall U.S. Government efforts; and
second, respond to the Department of State requests for
security or evacuation if needed.
Direct patient care of Ebola-exposed patients in west
Africa is not part of the DoD mission. Secretary Hagel approved
unique military activities falling under four lines of effort:
Command and control, logistics support, engineering support,
and training assistance. In the last 8 weeks, DoD has
undertaken a number of synchronized activities in support of
these lines of effort to include designating a named operation,
Operation United Assistance; establishing an intermediate
staging base in Dakar, Senegal; providing strategic and
tactical airlift; constructing the 25-bed hospital in Monrovia;
and constructing 12 Ebola treatment units in Liberia; training
local and third-country healthcare support personnel, enabling
them to serve as the first responders in these Ebola treatment
units throughout Liberia.
In all circumstances, the protection of our personnel and
the prevention of any additional transmission of the disease
remain paramount planning factors. There is no higher
operational priority than protecting our Department of Defense
personnel.
In addition to the activities of United Assistance, the
Department will continue to support the Liberian Armed Forces
through Operation Onward Liberty and expand the regional
efforts of DoD's cooperative biological engagement program. DoD
has also increased support to the Department of Health and
Human Services and the Department of Homeland Security, the
lead agencies for Ebola response here in the United States, by
activating a medical support team that can rapidly augment the
Centers for Disease Control and Prevention and capabilities
anywhere within the country in a 72-hour notice.
In conclusion, we have a comprehensive U.S. Government
response and increasingly a coordinated international response.
The Department of Defense's interim measures are an essential
element of the U.S. response to lay the necessary groundwork
for the international community to mobilize its response
efforts, and as mentioned earlier by the chairman, I am joined
by Major General Jim Lariviere and Major General Nadja West
from the Joint Staff, and we look forward to your questions.
Thank you.
Chairman Royce. Thank you.
[The prepared statement of Mr. Lumpkin follows:]
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----------
Chairman Royce. Let me ask some questions here, and if I
could start, maybe I will ask this of you, Administrator Shah.
In the early days of the response, the World Health
Organization really I think failed their donors and failed the
people of west Africa, but as I went down those arguments that
we heard coming out of the region, that these were politically
appointed country directors, and they were downplaying the
crisis. They had warnings from credible organizations, and they
ignored them. They failed to submit reports back to
headquarters in Geneva. They obstructed travel by experts, and
they resisted offers of assistance from the Centers for Disease
Control as well as from USAID. And you add to that that it was
the WHO guidelines on prevention and containment, which our own
CDC clung to for far too long in my opinion that proved wholly
inadequate. So, today, the WHO continues to serve as the lead
agency in the U.N.'s Mission for Ebola Emergency Response, and
the administration is seeking more funds for the WHO.
We understand the funds for tackling this problem, but
without reform at the WHO, I would just ask, do you have
confidence that they are up to the task here, if they are going
to be the lead organization? And how has the WHO corrected
course over the past several weeks? Are they making changes,
especially considering the situation you had on the ground
there?
Mr. Shah. Thank you, Mr. Chairman. I think the most
important response to your question is that, yes, there have
been very significant changes made at WHO to the quality, the
personnel, and the focus on this response. That is true in all
three countries. Part of my assessment and my trip was to
assess all of our United Nations partners. Most of the
investment reflected in the request are personnel, logistics,
commodity purchase, like protective equipment, and
distribution. Those main cost drivers will end up being
deployed by partners like the World Food Programme that
actually manage the logistics response over the medium to long
term in the region.
WHO plays a critical role on technical issues, on training
support, in some cases running Ebola treatment units, and they
are working with our NGO partners, like the International
Medical Corps, Mercy Corps, Save the Children, and others to
execute that function. So they play an essential role. We have
worked hard with them to scale up their capacity, and right
now, we need them to perform. And we are going to help them
perform, and we are going to measure results. And when we have
challenges, I am on the phone with my counterpart, the director
general there, very often in order to make sure we have an open
line of communication about what has to be done to succeed.
Chairman Royce. Well, the argument that I understand is
that they have the experience, but the people at the helm, the
country director for Guinea, the outgoing regional director for
Africa in particular demonstrated deadly incompetence in this
situation. So the United States is on the executive board. We
should figure out a way to reform the personnel process so that
cronyism at the U.N. isn't a big part of the problem and, at
the same time, perhaps figure out a way to have them bring more
doctors and personnel and experts around the globe into this
region, into west Africa to confront the crisis. And I would
just ask you about that besides management reform. Can we push
for such a directive?
Mr. Shah. Well, thank you for the suggestion. I think we
will take both of those suggestions on board. The new executive
director from the United States is Dr. Tom Frieden to the WHO.
He is very focused on those and other issues, and right now,
you are right to point out that the World Health Organization
is leading the mobilization of international medical support
for this mission overall, and your points are well taken, and
they are important, and we will continue to push to make sure
that function is implemented well.
Chairman Royce. Thank you, Dr. Shah.
Another thought we had was that we have, you know, with
UNMIL's role, you have 6,000 U.N. peacekeepers deployed in
Liberia, and their mandate there is to solidify peace and
stability. And prior to this outbreak, they were winding down.
But what role is UNMIL playing in the Ebola crisis, and does it
have the engineering capabilities there to play a role? The
mission's U.N. mandate will be renewed again I think in
December. Will we see any changes in the mandate? Are any
needed with respect to addressing this challenge?
Mr. Shah. I will just say, you know, keeping UNMIL both
together, well-resourced, and operationally contributing to the
response has been a major priority. When Ambassador Power made
her trip, that was a point that she really drilled down on. We
do believe they have important assets that include logistics
support, helicopter lift, some degree of engineering. They are
working with the main United Nations logistics provider, which
in this case is the World Food Programme, to scale up their
contribution to the Ebola response, and we are very hopeful
that all of UNMIL's contributing partners will maintain a
commitment to keep that entity going and strong into the
future.
Chairman Royce. And, lastly, Dr. Shah, you spoke of the
supplemental request, but leaving the question of resources
aside for a minute, and I am supportive on that, are there any
additional legal authorities that would improve USAID's
mission, and do you have all the authorities you need? What
should we do legislatively in terms of policy that would
strengthen your ability to tackle this challenge?
Mr. Shah. Well, thank you, Mr. Chairman. I think there are,
in addition to the resources identified in the request, a few
specific congressional authorities that we would seek. One is
the broad transfer authority that would give us the flexibility
to use funds across various foreign assistance accounts as
needed over the course of the year. This will allow us to, if
the, you know, if the crisis moves to Mali and we need to be
responsive there, it allows us to be responsive. This would
allow us if the crisis is more intensely on food security and
governance and the number of new cases is down, it will allow
us to make balanced and appropriate judgments and transitions.
Second, the notwithstanding authority for economic support
funds in this context will allow us to move fast and
effectively, and so we request that.
And the two priorities, sir, that you have been a champion
for in food security around continuing to, you know, allow us
to have more flexibility to do what saves the most lives most
efficiently and to promote agricultural investments through
Feed the Future will also be helpful, and I know those are in a
separate process, but I very much value your leadership and the
committee's support in those areas where we have proven that
these investments can deliver the kinds of results that then
avoid these crises in the future, which ought to be our goal.
Chairman Royce. Thank you, Dr. Shah.
We go to Mr. Engel of New York.
Mr. Engel. Thank you, Mr. Chairman.
For the first question, I would like to ask a quick
question to Administrator Shaw. As I mentioned in my opening
statement, I am very pleased to see that the administration has
required additional funds to fight this epidemic. Could you
please explain to us how fast you are drawing down existing
funds, and if Congress fails to approve this budget request in
a timely manner, at what point will we lack appropriate
resources for the response?
Mr. Shah. We are drawing down funds faster than I have ever
seen us do, and we have had to do that because we know that
resources spent now will avoid the kind of catastrophic case
numbers that would require far higher resource levels in the
future. In just the last few months and going into at the end
of the year, USAID alone from its disaster assistance account
will expend nearly $500 million. To put that in perspective,
the entire annual budget of the disaster assistance, or IDA,
account, is $1.1 billion. Right now, we are dealing with
massive crises. We are averting a famine in South Sudan. We are
supporting 7 million people in Syria and in neighboring
countries. We are dealing with an upcoming winter in
Afghanistan, where I was just a few days ago, and we are not
going to be able to sustain this effort unless we have relief
on the resources.
So thank you for your question, sir.
Mr. Engel. Thank you very much.
It was very encouraging to see that Africa's most populated
country, Nigeria, was successful in containing the recent
outbreak of Ebola.
Administrator, could you describe how our foreign
assistance programs, particularly those focused on health, have
helped to contain Ebola in Nigeria. And tell us what lessons we
can learn from their success.
Mr. Shah. Well, sir, I think your championing, global
health investments at USAID and the PEPFAR program have helped,
especially in Nigeria, create the capacity to be responsive. In
this case, there were a few cases. They quickly spread. I think
there were 18 total cases. They had to do almost 18,000 contact
tracing activities to make sure that they could identify all of
the people who would potentially be affected in Port Harcourt.
They were able to quarantine I think more than 80 individuals
through the period and, through that very effective response,
were able to eliminate Ebola from Nigeria, which as you know if
it took off in some of the urban settings there, we would be
looking at an even more catastrophic situation.
So our ability to continue to make the investments that we
have made over the past several years to build health systems,
to train health workers, to make sure that their medical
supplies--they have basic supplies for oral rehydration and
malaria control and those types of efforts, make a huge
difference in preparedness. They made a difference in Nigeria.
They make a huge difference in East Africa, which we are not
talking about because of the effectiveness of those existing
investments. And I want to thank you and other members of the
committee for ongoing support for these global health programs.
Mr. Engel. Thank you.
I want to raise an issue that is bound to be raised by
others here and that we have heard being raised time and time
again since we have had the outbreak of the Ebola crisis. And
that is travel bans. There has been a great deal of discussion
obviously relating to implementing travel bans or visa bans
from west African countries being impacted by the Ebola
outbreak. Several Governors, including in my home State of New
York, have instituted a mandatory 21-day quarantine period for
individuals returning from west Africa. I understand there is a
desire to obviously protect Americans from Ebola, and I want to
do everything I can to ensure that my constituents are not
exposed to the virus, but I want to know what is really
happening.
So can you tell me what the impact would be on the Ebola
response if travel bans, visa bans, or a mandatory quarantine
period were to be instituted? And what do you believe should
Congress be doing to best protect Americans? I don't know who
would like to take that. Administrator or Ambassador?
Mr. Shah. I can start, and then I will ask Ambassador
Williams to add to this. The President has been very clear that
keeping Americans safe is our top priority, and the only way we
will do that is tackling this challenge at its source where
there have been more than 13,000 cases. We as a team have
looked very carefully across a broad range of options and
ultimately have determined that a science-based approach to
making decisions would allow us to mount the most effective
response and keep Americans safe.
When we saw the actions taken in New Jersey in particular,
for example, a number of USAID implementing partners
immediately had to withdraw their proposals and say instead of
building or staffing two or three Ebola treatment units, we can
only do one because so many doctors have backed out of going
because understandably if they don't know what the situation is
going to be like when they return, it is hard to make that
commitment.
I and Ambassador Williams and others have spoken to a lot
of our international partners, and I think we are convinced
that America is the signal decision maker. If we isolate these
countries, the rest of the world will isolate these countries.
And that will create a much different epidemic curve, and we
will all have to come back here and discuss how are we going to
handle many, many, many additional cases than what we are
looking at now.
The Ambassador may want to add to that.
Ambassador Williams. Thank you, Mr. Engel, for also raising
this. This is an issue that has been under discussion for quite
a while, and it is really, really important that we put these
things in context. What we are really talking about when you
talk about a travel ban, that would mean people are thinking
about banning flights and banning persons. In fact, there are
no direct flights from the affected countries to the United
States, first of all. So we are really then talking about
banning people who come through a visa, through a visa process,
more than banning actual flights. And the data shows that
basically 60 percent of the persons entering the United States
from that region, from the region, are either U.S. citizens or
they are green card holders. They are lawfully permanent
residents. So now we are looking at a 30 percent portion.
If we ban a visa, our experience shows that preventing
access, legal access, really forces people to choose illegal
methods. And once you do that, you are then losing the ability
to use all the protocols that we have in place that we know
work. How do you trace people? Where are people going? What is
the contact information? How do you monitor? So one of the
reasons that we are really urging that there be no
implementation of any kind of a visa ban or travel ban is that
we want to know where people are going. First of all, we are
talking about a relatively small number of people, and we are
talking about implementing the strategies that we know work.
The other aspect of getting the actual healthcare
professionals to the region, getting the ability for pilots to
be able to transport, to be able to get supplies and healthcare
workers in and out of the region, all those kinds of things are
impacted by a notion of denying access or denying visas to
travelers. So what we have tried to emphasize is that we need
to keep the science first and foremost, and we need to watch
and see what is working, and so far, our strategies have been
working.
The other thing that would happen, we are trying not to
isolate. We talked about the secondary effects of this crisis,
and there are deep economic effects. So we are trying to use a
strategy that helps us to, first of all, stop the spread of
this disease and also reinforces the capacities of the people
in those places to be able to respond to the spread of the
disease.
Mr. Engel. Thank you.
Ms. Ros-Lehtinen [presiding]. Thank you so much, Mr. Engel.
The Chair recognizes herself.
Thank you, ladies and gentlemen.
Last year, State and USAID spent more than $52 million on
global health efforts in Liberia, Sierra Leone, and Guinea
combined, but I know, in my constituency, they ask where did
all that money go? It has become apparent that these countries
did not have the healthcare infrastructure in place to handle
or contain the Ebola disease. And as we have seen, it can
spread to Europe and North America. And with the communist
dictatorship in Cuba sending hundreds of forced labor
healthcare workers to Ebola-impacted countries, we have got to
ensure here in the United States that we are taking every
possible precaution. It is appalling that the Obama
administration officials are praising the Castro communist
dictators for forcing these workers, forcing them, to go to
Ebola-impacted countries in Africa. These healthcare officials
do not have a choice. Their families face retaliation on the
island if they don't go. They are forced to go as part of a
coordinated PR campaign orchestrated by the regime for its own
political agenda, and it is disgusting and shameful that we
should be congratulating Cuba for forcing people to go to these
countries and ask the regime what happens to those workers if
they are found to be impacted with Ebola. They are not allowed
to go back to Cuba.
Here are some facts about Cuba and its healthcare
apparatus. In the 1980s, that same Cuban regime, the same
people, sent HIV positive patients to concentration camps. The
regime has taken out life insurance policies on behalf of its
workers, but instead of naming the families as beneficiaries,
any insurance dollars right now go to the regime. The regime is
not exporting its workers for free. It receives approximately
$8 billion per year that it uses to oppress the Cuban people.
Cuban healthcare workers receive less than 25 percent of the
money from donors that is supposed to pay for their salary. The
rest is confiscated by the regime.
Finally, Dr. Shaw, I have a question for you staying on the
subject of Cuba because, earlier this year, in April, you
testified before this committee, and I asked you if USAID will
remain committed to reaching out to people suffering under
closed societies and dictatorships. Your answer was yes. And,
in September, President Obama spoke at the Clinton Global
Initiative and stated that the administration ``will oppose
attempts by foreign governments to dictate the nature of our
assistance to civil society and oppose efforts by foreign
governments to restrict freedom of peaceful assembly and
association and expression.'' That is a good quote.
Yet, this week, there is a column in the Associated Press
that says everything to the contrary. According to news
reports, USAID is planning on rolling out new regulations that
seek to prohibit USAID from working in closed societies. By
coincidence, it seems that the new regulations are in line with
a certain Senator who has been pushing to normalize relations
with Communist Cuba, and these attempts by Castro apologists
may be a backdoor deal to secure the release of Alan Gross. I
certainly hope not because Alan Gross is innocent and should be
released immediately, unconditionally, without concessions to
the tyrants who have held him unjustly for over 5 years.
So, Dr. Shaw, is it true that USAID would consider dropping
programs wherever USAID was denounced? And if true, it would
only benefit thugs like the Castro brothers and Nicolas Maduro,
Rafael Correa. They will use this as an opportunity to gloat
that they got USAID to cave and run away from its mission. Why
is USAID calling and running away from democracy programs in
Cuba and Venezuela and Ecuador, Iran, and Russia? And if not,
will you come out and set the record straight, Dr. Shah?
Mr. Shah. Certainly. Thank you, Madam Chairwoman.
And I just want to highlight, I do want to stay focused on
Ebola in this context, but I can assure you that I am standing
by the answer I gave you previously, that we are going to
continue to work in difficult environments on democratic
governance programs as we have for years. The framework to
which the article refers is one that we are eager to discuss, I
know have been discussing with your team, and I am eager to
discuss in more detail with you. I do not in any way believe it
diminishes our commitment to that objective, and I can discuss
how it is being implemented in that context. I appreciate your
comments about Alan Gross. And as you know, we work continually
on behalf of articulating why he should be released through our
colleagues in the State Department.
I would like to just make reference previously to your
comment about the $52 million spent in Liberia, Sierra Leone,
and Guinea on health. It is quite worth noting that over the
last 5 years in all three countries we have seen rapid
reductions in child mortality and maternal mortality because
primarily of expanded access to bed nets for children who would
otherwise get malaria. Those reductions have saved a lot of
child lives. And, in fact, just over the last 8 weeks we have
had a massive bed net distribution throughout the region
because malaria patients present with the same symptoms as
Ebola--fever, nausea, vomiting--and so we want to make sure we
keep that under control as we are tackling Ebola.
Ms. Ros-Lehtinen. Thank you, Dr. Shah.
Mr. Shah. One thing I will say, what did happen is the
healthcare workers got infected early in this response. And
that did decimate their healthcare systems, and that is why I
think we are dealing with a much more complex situation than we
otherwise would.
Ms. Ros-Lehtinen. I appreciate your answers.
Mr. Connolly is recognized.
Mr. Connolly. Thank you, Madam Chairwoman.
Mr. Shah, the President appointed a Ebola czar, Ron Klain.
What is your relationship, and Ambassador Williams, what is
your relationship to that Ebola czar?
Mr. Shah. Ron Klain has come into the administration and is
carrying out the function of coordinating policy and oversight
of a very complex domestic and international Ebola response. I
talk to Ron almost daily, and we are in meetings together quite
often. I think he has done a very effective job of helping the
President frame decisions and gather the right data and make
the right calls over the last--since he has joined, and I know
that it is a difficult task, and we are trying to do everything
we can to support him in a very important role.
Ambassador Williams. Thank you. I, too, have spoken with
Mr. Klain. I spoke to him actually just yesterday. His role is,
as Raj just explained, coordinating the overall U.S. Government
interagency interaction while we do the implementing.
Mr. Connolly. Is there a need for coordination,
coordination that apparently was not occurring before Mr.
Klain's appointment?
Ambassador Williams. Our view is there is a need for the
kind of overseeing coordination that he is providing because
this emergency has so many moving aspects to it. It is really a
whole-of-government operation. We are used to in the
interagency context to meeting together, talking together, and
focusing on accomplishing our mission. But we are finding the
logistical challenges, the health challenges, and the secondary
and third, tertiary effects of this really are quite complex.
And so I welcome the insurance that he is giving by making sure
all these little pieces are really talking. I can focus on my
aspects at State. But it redounds to others. So, yes, I think
it is necessary.
Mr. Connolly. The chairman provided a pretty devastating
critique of WHO in the early stages of the crisis, in terms of
both their competence, their timeliness and an organization he
characterized as rampant with cronyism. Do you agree with that
critique, Mr. Shah?
Mr. Shah. You know, I have been very focused on ensuring
WHO has the right people, processes, and resources to carry out
a function we need them to carry out in the region right now. I
can tell you on my visit, I spent time with all of their local
staff in all three countries, and I was impressed with--these
were technical people, very sophisticated, helping to train
hundreds of local healthcare workers on how to use protective
equipment, how to carry out their function. I do believe there
is going to be room after this to look back and make reforms as
to how WHO can be more effective connecting its leadership in
Geneva to its on-the-ground eyes and ears and capabilities. And
I think there will be time for that, but right now, my focus is
making sure we have the right WHO folks in country, they are
carrying out their function, working in a team with us and
others. And it is working statistically and we are seeing some
results.
Mr. Connolly. Do we have the right folks on the ground?
Mr. Shah. I wish we had more of their capacity to have
trainers and disease control experts there. I have communicated
that to Margaret Chan, who leads WHO, and we are in constant
communication with. Yes, now, I think you are looking at a
substantively improved WHO response in all three countries.
Mr. Connolly. Well, it just seems to me--I can appreciate
your diplomatic answer, and there will be time after the crisis
to try to improve WHO, but if the chairman is right in his
critique, we have no reason to be confident in WHO. In fact,
WHO contributed to the spread of this virus and to a high
mortality rate, frankly, because of its incompetence and
cronyism and its lack of focus and its lack of timeliness.
There is a big difference between we can tweak it to make
it better and more effective, and it is incompetent to begin
with and simply collapsed in the face of this pressing crisis.
And it seems to me the American people and the Congress are
entitled to know the difference here, Mr. Shah.
Mr. Shah. We are, in the first instance, the focus for us
is making sure that they have the right talent, focus and
process, and I can assure you they do now in these three
countries. I have learned that that institution ought to have
some additional capabilities and more connectivity in terms of
command and control. Those were some of the missing early
elements that the United States stepped in to provide. And I
know as Dr. Frieden and others take forward a process of
reform, they will focus on those items.
Mr. Connolly. Well, I would just end by, again, I think it
is a fairly dispositive issue. If WHO is going to be the
primary international agency with which we need to partner in
this kind of crisis, which will not be unique--there will be
others--we have got to have confidence that that international
partner is competent and has the resources and the talent to
respond in a robust and timely manner. Otherwise, lives are
lost. And, furthermore, we start from way behind where we
needed to in trying to catch up and get ahead of the curve of
this terrible disease. So I look forward to hearing a lot more
about it later on.
Thank you, Madam Chairwoman.
Ms. Ros-Lehtinen. Thank you, Mr. Connolly.
I am honored to recognize Mr. Smith of New Jersey, a
champion on all of the issues of the subcommittee that he
chairs. He is chairman of the Africa, Global Health, Global
Human Rights, and International Organizations Subcommittee.
Mr. Chris Smith.
Mr. Smith. I thank my good friend and the distinguished
chair for yielding. Thanks again to our distinguished witnesses
for your past and ongoing leadership. In response, and it has
been mentioned before but it bears underscoring, to the Ebola
outbreak, in March, the World Health Organization fewer than
200 people were infected and that approximately $5 million was
needed to contain it. However on October 17, Maria Cheng of the
Associated Press wrote a story, headlined ``U.N.: We botched
the response to Ebola outbreak,'' and cited a report that
blamed incompetent staff and quoted Dr. Peter Piot, one of the
co-discoverers of the Ebola virus, who said that the regional
office in Africa is ``really not competent.'' Now, in light of
that, what role is UNMEER actually playing on the ground? We
know about WHO, what they are doing now, but what is UNMEER
doing, again, another U.N. initiative?
Secondly, Dr. Frieden testified at my emergency
subcommittee hearing on August 7 and laid out the prudent steps
that were being taken to detect and to try to mitigate this
crisis. When we had the second hearing on September 17, Dr.
Fauci said that now this terrible disease had gone exponential.
He said in public health, when you put incremental against
exponential, exponential always wins. Nobody on the panel has
used the word exponential. And I wonder if you could update the
committee on what has happened, what have been the game
changers, and what are we talking about in terms of numbers,
immediate, intermediate, and long term in terms of and
projected number of cases of Ebola?
Thirdly, Dr. Brantly testified at our September 17 hearing
and talked about home isolation. And thankfully, the military
is doing a yeoman's work in building up isolation and treatment
units; 1,700 I believe are contemplated. But he pointed out
that family members and sometimes neighbors are caring for
these sick individuals at home and therefore contracting the
disease themselves. We now have to look at interventions that
involve educating and equipping these homes and caregivers for
their own protection, and he talked about the safety measures.
Are we training home healthcare workers to help their loved
ones so, one, they do help their loved ones but also so they,
too, don't get sick?
General, if you could touch on the issue of protecting our
servicemembers. What kind of protective measures are in place?
Are they adequate to the task?
You talked about labs, Dr. Shah. What is the goal in the
labs? Where are we now in terms of the goal capability? Good
news about the 5 to 7 hours, but what is the endgame and how
much lab capacity are we looking to establish? I have other
questions, but time probably doesn't permit. On the quarantine
issue, where are we on quarantine? We know the military talks
21 days. Is that still the situation? What is the quarantine
issue as you see it today if somebody is in west Africa?
Mr. Shah. Okay. I will start very briefly, and thank you,
Chairman Smith, for your just unwavering support for global
health over decades. We are proud to be associated with your
work.
First, on UNMEER, I would note that I think the U.N. in
recognition of its need to improve operational performance on
the ground, created this mission, resourced it, put Tony
Banbury, a former Department of Defense emergency response
official, in charge in Accra, Ghana, and has--in fact, since
then, we have seen improvements in how UNICEF, the World Health
Organization, and the World Food Programme, have organized
themselves to do the logistics and operations of this response
in those three countries. So that is on UNMEER.
On data and exponential versus incremental, I think our
concern is always exponential growth. And what we now see
throughout the region is about 3,000 current active cases,
roughly evenly split across with 1,300 to 1,500 in each,
depending on the numbers, in Liberia and Sierra Leone and with
a few hundred in Guinea. Our concern is--we have seen a big
reduction driven, as I mentioned, by burial teams, community
behavior change, the fact that people are bumping elbows
instead of shaking hands, and washing their hands with
chlorine. And because we have built out already more than
doubling the capacity of Ebola treatment units so that we have
enough capacity now in places like Monrovia.
The reality though is we are now seeing micro epidemics
throughout the countryside, and any one of those could become
exponential if we don't have an adaptable and flexible
response, which this funding request and our strategy going
forward will support. And that then addresses your question
about home healthcare workers and the lab end game. The
strategy really is evolving to focus on rapid response
capabilities, so when you see that there is a case in a rural
community, you can quickly get there with lab support, with
personnel, with protective equipment, the ability to quickly
set up a community care center or mini ETU that might be 5 to
10 beds and deal with that cluster before it gets to be an
exponential problem. And if we are effective at doing that, we
will avoid the consequences of exponential growth that Dr.
Fauci has spoken about.
Mr. Lumpkin. If I may, before I turn it over to General
Lariviere here, just to reemphasize the protection of DoD
personnel is our number one priority as we are continuing to
support USAID in west Africa. So we have a robust training
program for our service members and DoD civilians prior to
going over to the region to serve. We have a very thorough
monitoring program while they are there, and then we have a
controlled monitoring program when they redeploy back to the
United States or their home station.
And as you are aware, the service chiefs as well as the
Chairman of the Joint Chiefs of Staff made a recommendation to
Secretary Hagel to support a 21-day controlled monitoring
quarantine-like situation upon return. The Secretary approved
that because of the unique nature of the military, the scope
and the size of our footprint over there, and the operational
needs on howreintegrate our forces back into home station. So I
will turn it over to General Lariviere, who can answer the
specifics.
General Lariviere. Thank you, sir.
Mr. Smith, as Mr. Lumpkin said, we are taking measures in
all phases of the operation, pre-deployment, during deployment
and post-deployment. Before deployment, all personnel will
receive a medical threat briefing covering all health threats
and measures. In addition, they will receive special training
on the EVD safety precautions, prevention and protection
measures, personal protective equipment use, symptom
recognition and monitoring. As Mr. Lumpkin said, they will be
monitored continually throughout the deployment with their
temperature taken twice a day and obviously with medical checks
throughout.
Upon redeployment, as was also mentioned because of the
special nature of the military's deployment, the use of our
population, et cetera, on the recommendations of the Joint
Chiefs, the chairman did recommend to the staff that personnel
be put in controlled monitoring once they return. So, again, we
are taking measures throughout the deployment to ensure the
safety of our troops.
Mr. Lumpkin. If I may add one more piece. Please keep in
mind again DoD personnel are not doing direct patient care.
Ambassador Williams. And for personnel that are under
chief-of-mission authority at our Embassy services in the
affected areas, we are following the CDC guidelines and the
regular protocol. Our people are going to be screened before
they depart post. They will be screened at whatever is the
transit point, and they will be screened again upon entry to
the United States. And then, unless the State where they are
going has a specific protocol, they will be following the
health authorities' protocols, which will self-monitoring and
temperature checks twice a day. This is in close coordination
between MED at State Department and MED's coordination with
whatever is the home state of our transferring personnel.
Ms. Ros-Lehtinen. Thank you.
And, Mr. Smith, the chair allowed you great latitude
because it is within your jurisdiction. Thank you, Mr. Smith.
I am now pleased to yield to Mr. Brad Sherman, ranking
member of the Subcommittee on Terrorism, Nonproliferation, and
Trade.
Mr. Sherman. Ebola is a great issue, not only for
development in Africa, but for the American people. It sweeps
across Africa. Then, every week, someone with Ebola will come
into the United States if this becomes an endemic problem not
only for three African countries but for all African countries.
And it would be a challenge for our public health system if,
every week, someone arrives in the United States with Ebola.
With that in mind, I will ask each person on the panel what
do you need from Congress? What can we do to help? I will start
with Major General West and go straight down.
General West. Thank you, sir, for that question. I
appreciate the support that DoD has been given and continues to
be given from committees such as this and from the general
support in general. But, again, I believe DoD and, with Mr.
Lumpkin as our lead, we have been given the resources that we
need. So I think for now we have got the resources that we need
to accomplish our mission. Thank you.
Mr. Sherman. I don't know if I need to hear from the rest
of DoD if you pretty much match--Mr. Lumpkin?
Mr. Lumpkin. I would offer that the emergency funding
request is what we need. There is a portion of that that is a
DoD request for $112 million to do advance vaccine research for
DARPA. That would be working in conjunction with NIH and the
Defense Threat Reduction Agency. So that would be helpful, but
I think across the whole of government, that emergency funding
request is phenomenal.
Mr. Sherman. Ambassador, anything to add?
Ambassador Williams. I, too, was going to say we really
need the funding of the emergency supplemental request. Part of
that for the State Department is going to be focused on the
immediate response but also for building up our capacity within
MED to be able to effect evacuations and respond to the health
emergencies, repatriation of people. So, yes, we need funding
of this. It is all explained in our request.
Mr. Sherman. Mr. Shah?
Mr. Shah. Thank you. I would highlight three things. First
is the $6.2 billion resource request, which I would point out,
while Ebola is far more complex and our responsibilities to
respond in west Africa are far more significant than what
previously took place with H1N1 or H5N1, this request is geared
to be roughly at the same level as Congress provided in 2006
and 2009 in those contexts. So we really do require these
resources to be successful, and, frankly, we will not succeed
without them.
Second, there are specific authorities, including the
transfer authority and the notwithstanding authority, in the
request that I think are absolutely essential. Because this is
a fast-moving and adaptable viral epidemic, we need to be fast-
moving and adaptable in our response. It will ultimately save
money, time, lives, and threat.
And then, third and finally, this committee and your
leadership has helped us establish a much more robust effort to
food, agriculture, and avoiding hunger. And the number one
nonhealth consequence of this challenge is going to be a
widespread food crisis in this region. Any support the
committee can offer for Feed the Future legislation and efforts
to reform the way we provide food assistance is much
appreciated.
Mr. Sherman. Let me get to one more question. And that is,
Administrator Shah, have we or our partners produced a video in
all relevant languages that will explain to healthcare workers
how to put on and take off the suits, perhaps other important
points for Ebola health corps workers, given the fact that a
very significant portion of those getting the disease are the
healthcare workers? And, again, is that video available in all
relevant languages? And have we deployed the hardware so that
we can show this? No use having a disk if you don't have a DVR,
et cetera, or an iPad or whatever. Go ahead.
Mr. Shah. Thank you, Congressman. I think that is an
excellent suggestion. I know there are videos. I don't know if
they are in all relevant languages. I will say that, in all
three countries now, there are large-scale training programs,
and I want to commend the Department of Defense for using its
program of instruction to help create a protocol for training
healthcare workers. And I think 70 of the first trained workers
have come out of that system in Liberia, and it just shows the
interagency cooperation. But that is an outstanding
recommendation that we will take back and share with our
colleagues.
Mr. Sherman. Because I believe it is like one-fifth of
those with Ebola are the healthcare workers themselves. I have
never seen a disease that had that configuration.
Mr. Shah. That percentage is now coming down, and the rate
of infection for healthcare workers in part because this
response has focused on effective training is coming down
significantly, but it is absolutely a concern that we are
focused on.
Mr. Sherman. I yield back.
Mr. Poe [presiding]. The Chair recognizes himself for 5
minutes.
Thank you, you all for being here. It is always great to
see you.
Administrator Shah, again, who is in charge of this Ebola
epidemic in the United States? Who is the main person that is
in charge?
Mr. Shah. Ron Klain is the Ebola coordinator and brings all
of us together. Each agency has its own discrete
responsibility.
Mr. Poe. But he is in charge? All these other agencies
which you all are sum of. Is that a fair statement?
Mr. Shah. I think that is a fair statement. If you need an
answer to a question, Ron is a good source to go to.
Mr. Poe. He was asked to be here today. And he is not here.
But you are here, so I can't ask him those questions. He did
say yesterday on MSNBC--I mean, he doesn't come to Capitol
Hill, but he did say that there will be more Ebola cases in the
United States.
I will ask, General West, since you are a medical doctor,
do you agree with that statement?
General West. Sir, thank you for the question. Sir, I
believe there is always a potential that an additional case
might enter the United States, so I think his comment was based
upon the fact that we have already had one gentleman, Mr.
Duncan, who did arrive on the shores of the U.S. with Ebola,
though asymptomatic, so it is conceivable that there might be
an additional case.
Mr. Poe. Conceivable is different than there will be. The
possibility is a different answer. Conceivable, to me, is
different than an answer is there will be more Ebola cases in
the United States.
Let's assume he is correct about that. I personally think
we need a visa ban.
In all due respect, Ambassador, I don't believe in the
philosophy that if we tighten the rules to get into the United
States that with encourage people to come illegally. Then why
have any rules for all of the countries in the whole world if
that is going to occur?
I was raised, I was taught by folks that, my grandmother,
if you are sick don't get around healthy people. And if you are
sick, don't let healthy people get around you. But be that as
it may, it is assumed that Mr. Klain is correct. The United
States' response to this, I think, is we should, for a
temporary period, keep folks from the United States with a visa
ban.
Dr. Shah, let me ask you this. Are people who are being
treated in Africa for Ebola, are any of them being brought to
the United States?
Mr. Shah. Not at this time. Part of the rationale for
investing in and building out a 25-person world class hospital
in Monrovia, called the Monrovia Medical Unit, and staffed by
U.S. public health service personnel just recently completed
and built by the Department of Defense is to have the capacity
to provide world class care in west Africa. We have worked with
the British to build a similar 12-bed unit in Kerry Town
outside of Freetown.
Mr. Poe. But are there any plans to bring folks to the
United States that are being treated or may have Ebola in
Africa? That is the question.
Mr. Shah. Well, I think if medically indicated from that
unit, if an American healthcare worker requires a special
treatment----
Mr. Poe. I am not talking about healthcare workers. I am
talking about African citizens.
Mr. Shah. No. Any special services are focused on
healthcare workers powering the response.
Mr. Poe. So the treatment is taking place in the African
countries that are affected, and it is not a plan of the United
States to bring those folks to treat them in the United States,
except for workers from the United States, maybe the military?
Mr. Shah. Exactly.
Mr. Poe. Okay. I just wanted to make that clear as well.
How many Americans are currently travelling from the United
States to west Africa? Do we know that number? Not counting
military and aid workers, humanitarian workers, but how many
other folks are travelling? Do we have number of that,
Ambassador Williams or Administrator Shah?
Mr. Shah. We do. Maybe Ambassador Williams will add to
this. I would just note that Secretary Johnson is responsible
for those issues of travel and homeland, and so I don't want to
speak on his behalf. I have heard him go through the numbers in
a lot of detail. I just don't want to get them wrong as I
repeat them to you.
Mr. Poe. Ambassador Williams is raising her hand. You don't
have to raise your hand in here to talk. I will recognize you
anyway.
Ambassador Williams. I don't have the numbers here. I know
they are available. I don't have them with me so I can take the
question. I am sorry.
Mr. Poe. All right. Is anyone besides the military having a
21-day quarantine when they return to the United States?
Mr. Shah. The medical protocol is, depending on what
category of risk you are upon return, you slot into a different
protocol. So when I came back from my trip, I was on a 21-day
active monitoring, which I cleared a few days ago.
Mr. Poe. Thank you.
Mr. Shah. So I was in daily contact with my Washington, DC,
public health service person, but I was also not in the highest
level of risk. Those who are are dealt with as required.
Mr. Poe. All right. Thank all of you all.
The Chair will recognize the ranking member of the
Subcommittee on the Middle East and North Africa,
Representative Deutch, from Florida.
Mr. Deutch. Thank you, Mr. Chairman. And thanks to the
distinguished committee for being here. Each of your agencies
is playing a vital response to this crisis, and I would
especially like to express our gratitude to the military
personnel and the aid workers who are in west Africa assisting
in this crisis.
I wanted to circle back to the numbers. More than 14,000
people have been infected. More than 5,000 have died. Now there
are some reports, there were reports yesterday, the WHO said
that they believe that in Guinea and Liberia, that there has
been some, I think they said that there has been moderating of
the number of infections, but they have also said, the WHO had
said previously that the actual number of cases may be
dramatically higher than currently reported. Our own CDC has
said that the toll can be two to four times the WHO's numbers.
There was an estimate earlier that there could be as many as
5,000 to 10,000 new infections per week by December. Can you
address where we are in terms of what the actual numbers are
and what you anticipate they may spike to?
Mr. Shah. Thank you. Thank you, first, for our comments
about our military service personnel and the aid workers who
are doing really extraordinary work. I would note, when I note
that there are about 3,000 current active cases in the region,
that that is a data point that as best we can accounts for
potential underreporting of data. And it also tracks against
the reality that over the last 8 weeks, we have seen a
reduction in the number of new cases in Liberia, which had been
the epicenter of the epidemic. The driver of that reduction has
been kind of community-based efforts that have handled the
management of deceased persons more effectively so that you
don't transmit from dead bodies to others in that instance.
Now, it is hard to estimate what future numbers could be or
would be. Today, even in Liberia, we see as many as 20 small or
micro epidemics throughout the country, and any one of them
could become a cluster that then leads to exponential growth.
Mr. Deutch. I am sorry, Administrator. I was going to ask
about that, but since you brought it up, can you tell us what a
micro epidemic is and how it might turn into a broader epidemic
throughout the country?
Mr. Shah. Sure. I was just on the phone yesterday with
colleagues from Samaritan's Purse, and they were describing
this. They go into a rural community where they think there
might be a case or got a report, and they find that in seven or
eight homes, people are housing patients that look like they
have symptoms and are afraid to come out or are not seeking or
reporting care or are not presenting at an Ebola treatment
unit. And all of a sudden, that cluster of cases could quite
quickly, because those patients are not isolated and they are
getting symptoms like vomiting and diarrhea in a highly dense
populated home environment, all of a sudden, you can have very
rapid growth from that.
And I would point out that back in the spring, this looked
like a standard Ebola outbreak, and it, in fact, was burning
out. I mean, we all thought it was going away as a problem
because the numbers got so small, and then it just exploded in
urban Monrovia. So we cannot say with confidence that despite
the huge success we have had in the last 6 to 8 weeks at
turning the tide in Liberia, that, in fact, we can be confident
that we are not going to have an exponential outbreak in any of
these settings in the first instance, which is why we are
mounting a significant response through next year and why the
emergency request provides the resources for that kind of a
responsible, evidence-based response.
Mr. Deutch. Do you know, can you estimate how many of these
micro epidemics exist throughout the region?
Mr. Shah. Well, these are just clusters of cases, so, you
know, there are as many as 20 independent clusters of cases in
parts of rural Liberia. I don't have the numbers off the top of
my head, but I do know that the strategy developed is now to
have really responsive systems that can go quickly stand up an
Ebola treatment unit that is much smaller and more focused,
probably less visible but highly important to rapid response.
Mr. Deutch. And just, finally, before my time expires,
there have been reports of an unrelated outbreak in Congo that
has claimed at least 49 lives. Can you talk about that and your
concerns about the possibility of that spreading?
Mr. Shah. Well, in the DRC, we have seen actually cases
being handled quite effectively, and they have managed that. In
Mali, there is now a case--cases that have come we think from
Guinea into Mali. And there is a significant cluster of cases
there that now needs to be dealt with as of yesterday. I am not
aware of 49 cases in the first, right now in the DRC, unless
that happened this morning, and I would have to----
Mr. Deutch. It is a report that I read this morning.
Mr. Shah. We will look into that.
Mr. Deutch. Thank you.
Mr. Smith [presiding]. The Chair recognizes the gentleman
from Florida, Mr. Yoho.
Mr. Yoho. Thank you, Mr. Chairman.
I appreciate you all being here. Let's see. I think you
just answered the question I had, Dr. Shah, about the number of
outbreaks or the number of cases. Are they increasing or
decreasing, in the last 6 to 8 weeks?
Mr. Shah. In Liberia, the number of new cases are
decreasing, but the number--and in Sierra Leone and Guinea,
they are increasing quite significantly.
Mr. Yoho. All right. So we are seeing focal outbreaks?
Mr. Shah. I am sorry?
Mr. Yoho. Focal outbreaks, we are seeing, small outbreaks?
Mr. Shah. Yeah.
Mr. Yoho. What is the expected cost in the next year to
treat and contain if things stay pretty static the way they are
or, you know, the predicted growth of this, what would you
predict that cost would be?
Mr. Shah. Well, the $6.2 billion request includes
approximately $2 billion or so for the response in west Africa
against the main element of the strategy, which is controlling
the outbreak, and that will provide funding for personnel that
need to be trained and deployed. It will provide funding for
Ebola treatment units and community care centers, the logistics
required to do that. And it will provide funding for the huge
amount of product supply, personal protective equipment, oral
rehydration solution, intravenous materials, to provide a
large-scale response throughout that region.
Mr. Yoho. Okay. I am a veterinarian by background, and we
deal with outbreaks all the time in animals. And we have got
some commonsense things we do. And what I see is there is the
fear factor from the Ebola outbreak, the tide of fear. And I
know the news spreads this, and there is a lot of
misconceptions by people without a medical background that
think this is Al Pacino in that move with the virus coming out.
And it is, it is a deadly virus, but yet it is a virus. We have
got hundreds of years of virus, how to deal with these things
and how to quarantine them.
And Dr. West, you being a medical doctor also, the response
that we are doing, the commonsense thing to me is when you have
an outbreak, you have short-term things you do and you have
long-term things that we should do. The short-term is the
diagnostic, the treatment, the quarantine that we would do in
an animal population. And we should do those same things in
this, like travel restrictions. I think that is totally--should
be acceptable. It shouldn't be a political thing, and I would
just like to hear your thoughts on travel restrictions.
I know the Army is doing a great job on that. We know the
incubation is 3 to 21 days. But, unfortunately, viruses don't
read the manual. I think they ought to extend that to 30 days
just to be safe and do testing, you know, whether it is an
ELISA test or an SN test or a PCR test, to do that. And I would
like to hear your thoughts on that for the short-term attack on
this virus.
General West. Sir, thank you for the question. As far as
travel restrictions, I really can't comment specifically on
that. I do concur with your thoughts on how to best tackle it
as far as preventative measures once you recognize it to
rapidly diagnose and treat; and then, long term, you know, put
in measures to prevent, bolster the public health system so if
there is another outbreak or similar, it can be identified
early and then those treatment and isolation recommendations
can be done early on.
Mr. Yoho. Okay. What I have seen here is we have got five
hospital areas in the United States. I think we ought to have
one hospital that is a quarantine area or treatment area
instead of spreading it throughout the country. Just, again,
from an epidemiological standpoint, it would make more sense to
contain it in a smaller area. I know you are doing that in
Africa.
And on the long-term strategy--and this goes back to Dr.
Shah, and I would like to get your opinion, too, Doctor. We
have known about this virus since the 1970s. And we had the
Marburg virus that broke out in Germany. It was rapidly
contained. It is a relative of the Ebola virus in the same
viral family. Yet we contained it very early because of the
testing. And we have got vaccines that are on the shelves that
have been approved--or they have been shown effective. They
have not been approved--for over 10 years. Why have we not
followed up since the role of our Government is to be prepared
for the next epidemic or the pandemic, to be prepared with
these vaccines. The money that we are spending in the research
and development, why has that vaccine not been approved and
ready to go so that when we diagnose and treat the individual
and we do the quarantine, we can be vaccinating a population
that is susceptible? Why has that not happened?
Mr. Shah. Well, Congressman, actually, the resources in the
emergency request will actually allow----
Mr. Yoho. No. I want to know why it hasn't happened because
we have known about this since 1970. This is not a new virus.
This is something we should have been prepared for as a
government, and we have dumped billions of dollars into
research and development. Why have we not done that?
Mr. Shah. Well, let me just describe one thing that is very
specific to west Africa and the vaccines. The committee has
supported the USAID to create something called the Global
Development Lab. And through that, we have worked with Dr.
Fauci at NIH and are accelerating the introduction of the
vaccine in Liberia for rapid clinical phase II and III testing.
That I believe is the Canadian vaccine.
Mr. Yoho. We are starting at a point today. I mean, the
horse is already out of the barn, and we have known the horse
is out. We should have been prepared for this, and I look at
your organization as something that should be ready, not just
for this one but for the next one, too. That is foresight. That
is oversight. We are doing hindsight. I know you guys will get
control of this, and I look forward to helping you and
assisting you on this.
And with that, I am out of time, and I yield back.
Mr. Smith. Thank you.
The Chair recognizes Mr. Higgins, the gentleman from New
York.
Mr. Higgins. Thank you, Mr. Chairman.
For Administrator Shah, the USAID coordinates the
international response with the Department of Defense and
State. And the United States is the principal responder in
Liberia. It was stated at the outset of this hearing by the
chairman that the objective is breaking the chain of
transmission. You can't do that without fundamentally dealing
with the problems in the countries of origin, that being the
inadequate hygiene and sanitation systems and also the lack of
or the poor healthcare infrastructure. So specific to USAID in
Liberia, what is being done specifically to address those
issues, and is there a time frame within which those projects
would be undertaken and completed?
Mr. Shah. Thank you, Congressman.
I think really there are two ways to address that. One is
in the context of our ongoing longer-term developmental
investments in Liberia in particular, we have been working to
build out their health system to improve access to water
sanitation and hygiene and to, frankly, get a lot of kids in
school. This is a country where 58 percent of the population
lives on a dollar and a quarter per day; 80 percent of total
disposable income per person is spent on food. So when food
prices go up, as they have almost doubled, you see children and
women in particular going without enough adequate nutrition. We
have been working on those issues and will continue to.
In the context of this response, I believe that some of the
rapid reduction in transmission we have seen in Liberia has
come from those types of community interventions. The fact
that, even when I was there, you wash your hands with
chlorinated water before going into any building. People have
stopped shaking hands and touching each other. The more that
those behavioral practices become the new norm in rural
communities, the safer those communities will be from this
outbreak, and, frankly, over the long-term, the more you will
see a reduction in very deadly diarrheal disease that still,
unfortunately, kill a lot of children who don't need to die in
these types of countries.
Mr. Higgins. Like any health crisis, this one exacts an
economic price on these communities as well. All three of these
countries, Liberia, Sierra Leone, and Guinea, were projected to
grow pretty impressively. According to the World Bank, because
of this crisis, the economic decline in those countries will go
from anywhere between 3 percent to 12 percent. Does this
undermine the ability of those countries themselves to make
investments toward alleviating this problem?
Mr. Shah. Absolutely. In fact, I think even the World Bank
now believes that those initial 3 to 12 percent estimates are
underestimates of the true consequence. The public budgets will
be down anywhere from 20 to 40 percent. The economic activity
will most likely contract by as much as a third. I had a chance
to meet with business leaders in each of the three countries
who described not being able to continue to employ their
personnel and their staff and having largely ceased operations.
Expatriate staff have often left the country. So it is a very
difficult economic situation that will greatly compound our
efforts over the course of the next year to get the epidemic
under control.
Mr. Higgins. Final question. Infectious diseases
notoriously are unpredictable, meaning that the virus entering
one person may be genetically different from the virus entering
another person. We have been told repeatedly that you can only
get Ebola through direct contact with bodily fluids. Could the
Ebola virus mutate to become transmissible through the air?
Mr. Shah. Well, I think it is hard to say no to an event
that is a potential event with a low likelihood of happening,
but most of the experts we have consulted, and Dr. Fauci and
others who have offered their guidance on this, suggest we have
to watch for what the genetic mutations are, but that it is
unlikely that this will become airborne in the short term.
There are a very high number of mutation events because we have
never before seen so much transmission of this particular
virus, and so we don't make any commitments on that.
Mr. Higgins. It would seem to me that that is something
that public health officials should be looking at very closely
because a lot of this originated from rural areas. Now we are
in cities where contact is much more prevalent, and the spread
and the change in mutations is much more likely.
So I yield back. Thank you.
Mr. Smith. Thank you, Mr. Higgins.
Before yielding to Mr. Meadows, I want to thank Mr.
Meadows. Meeting in the anteroom just a moment ago was the
Foreign Minister of Sudan, Ali Ahmed Karti and Mr. Meadows led
the effort that led to the release of Meriam Ibrahim, and I
want to publicly thank him again for that extraordinary
leadership. Hopefully, a dialogue will ensue with the Sudanese
on religious freedom issues.
Thank you, Mr. Meadows.
The Chair recognizes, Mr. Meadows.
Mr. Meadows. Thank you, Mr. Chairman, for your kind words
and certainly thank you for your efforts in leading on not only
that particular issue but a number of humanitarian issues.
And so I thank each one of you for your testimony here
today.
Dr. Shah, let me go to you. I know we have requested a lot
of money. You feel like the plan that we have in place is a
good one, and so I want to direct our attention and focus in on
the ETU units and the diagnostic units because right now, it is
my understanding there is only two diagnostic units that are
put in the same proximity with the treatment units. And what we
are seeing is a great delay with regards to the diagnostic side
of things as they get to put in the warm units. Are we making a
change to that? Will we be putting those diagnostic units along
with the ETU units?
Mr. Shah. Thank you. I would just highlight three things.
One is, on ETUs, we have, in fact, already scaled up the
capacity of ETUs in all three countries.
Mr. Meadows. Yeah. I am talking about specifically
diagnostics, not ETUs.
Mr. Shah. Yeah. I think the labs--I think we have put in
place now nine additional labs across the three countries in a
certain amount of time. I think four or five are from DoD, and
they have made a huge difference.
Mr. Meadows. I understand that. My question specifically is
why are we not co-placing those along the ETU units? Because
what you have is you have people----
Mr. Shah. You transport issues.
Mr. Meadows. You have transport. You have got delays in
terms of the diagnostics. You put them in warm zones. They
could be with other infected patients. You have got just this
whole laborious process. And we, with the most sophisticated
healthcare system in the world, have found logistical problems
with just a few patients here. Why would we not put the
diagnostic units along with the ETU units, so we don't have the
cross contamination probabilities?
Mr. Shah. I think the real answer is we want to do that as
much as possible. There are some constraints, and there is a
conversation right now about how do we project out that lab
capability.
Mr. Meadows. So what would be those constraints? You have
only got 2 of the 20 right now where they are co-located
together in Liberia.
Mr. Shah. Right. So, for example, in Monrovia if you can
get from site to site pretty quickly, you may not need to stand
up labs at every one of the ETUs. And what might be the
priority is getting more lab capacity that can project into
rural communities and elsewhere.
Mr. Meadows. That doesn't make logistical sense. In your
testimony just a few minutes ago you talked about malaria and
how we have these potentials. So you have potentially a malaria
patient who is coming into an area with other infected Ebola
patients, who could be contracting Ebola, and yet time is not
our friend here. So why would you not have the diagnostic units
along with the ETU units?
Mr. Shah. I think we want to have that as much as possible.
I will have the team figure out----
Mr. Meadows. So you haven't addressed that?
Mr. Shah. Well, we have. We have actually--we are looking
both at a whole range of----
Mr. Meadows. Mr. Lumpkin, let me shift to you. You are
building these units. Are you building diagnostic units along
with the ETU units?
Mr. Lumpkin. At this juncture, there is more----
Mr. Meadows. Yes or no?
Mr. Lumpkin. I think it is more complex than that. You hit
the nail on the head when you said it is a logistics challenge
when you work this. So when you have more ETUs than you have
diagnostic capabilities, sometimes it is better from a
logistics perspective to centrally locate a diagnostic
capability----
Mr. Meadows. And so it is better to wait 3 or 4 days----
Mr. Lumpkin. No, no, no----
Mr. Meadows [continuing]. For the diagnostics, because that
is what is happening. That is the intel that we are getting.
They are having to wait 3 or 4 days to figure out whether they
have got it and then travel a long distance to get there. So
why would that be a logistical problem? If you are building
these units, why would you not put the diagnostics along with
the treatment unit?
Mr. Lumpkin. Because it takes longer to get a diagnostic
capability in country to have a robust laboratory capability
than it does to get an ETU running. To get it configured,
trained and everybody in, it takes time.
Mr. Meadows. So what you are saying is we are not going to
collocate these.
Mr. Lumpkin. That isn't what I am saying at all. I am
saying, from my experience on the ground, the goal is always to
get them as close as possible. But if you can't get one at each
one, if there are two ETUs that are 15 miles away, if you can
get it in the middle, you do, in order to make that limited
resource of these diagnostic capabilities go as far as
possible.
Mr. Meadows. So do you concur that is the best plan, Dr.
Shah?
Mr. Shah. I think the best plan is to have as much
laboratory capability as possible.
Mr. Meadows. Well, we are asking for $7 billion here, and
diagnostics--that that component of it is a very minute
component of that. And so if you are asking for $7 billion, why
could you not collocate?
Mr. Shah. We will--I will get back to you with a more
specific answer about going forward, but right now, we have
three that are collocated, one in Lofa County, one in Bong
County, and one in Monrovia, and those collocations----
Mr. Meadows. Out of how many treatment units?
Mr. Shah. That are operational? I think seven are
operational in that area right now.
Mr. Meadows. Well, I show 20 ETU units in Liberia. Is that
not correct?
Mr. Shah. They are not operational. You have seven
operational ETUs.
Mr. Meadows. So we have seven operational, three that are
collocated----
Mr. Shah. Three----
Mr. Meadows. But when the others come on line, they will--
--
Mr. Shah. Our goal will be to get as much lab capacity
projected, and we have a synchronization matrix. I will have
the team go through and identify how many will have
collocated----
Mr. Meadows. Okay, I am out of time, but I would ask you to
get back to this committee on why we can't do that.
Mr. Shah. It is an excellent point. Both the assistant
secretary and I agree with the basic point.
Mr. Meadows. All right. Thank you.
I yield back. Thank you, Mr. Chairman.
Mr. Smith. Thank you, Mr. Meadows.
I know Ambassador Williams has to depart at noon for a
flight. Thank you for your leadership and your participation
today.
Ambassador Williams. Thank you, Mr. Chairman, I appreciate
that.
Mr. Smith. I would like to now recognize the ranking member
of the Africa, Global Health, Global Human Rights, and
International Organizations Subcommittee, a woman with whom I
work very closely with and am very proud to do so, Ms. Bass of
California.
Ms. Bass. Thank you. Thank you very much, Mr. Chairman.
I have several questions, most of them are unrelated, but I
am just going to go through a little list. For Dr. Shah, you
were mentioning changes in protective gear, and I was just
wondering if we have been able to improve the temperature
monitor. You know, I know that scan is not that accurate, and
so I am wondering if there is any improvements to that.
I also wanted to ask, I know that UNICEF has reported that
there are nearly 4,000 orphaned children, and I was just
wondering if you could give us, anybody on the panel could give
us a status report as to what is happening with the children,
and then one of the--part of the consequences of the epidemic
has been an impact on the economy, which my colleague was
mentioning, and I wanted to ask specifically about the cocoa
industry in Cote d'Ivoire that hasn't even been hit by Ebola,
but yet it has been impacted severely. So maybe various
panelists could answer this question, whoever would like to.
Mr. Shah. Let me try. On the protective equipment, one of
the things we have done through our global development lab is a
grand challenge on Ebola, and we have seen more than 1,200
proposals come in, including I think more than 50 percent of
proposals are for improved protective equipment, so, in the
next 2 days, they are actually assessing the top 25 proposals.
This has been a real focus for the President, and Motorola has
been working with us on a temperature monitor for the suits,
and as you point out, we are also working on cooling systems
for the suits, breathability, and improved infection control.
Ms. Bass. That is great. Actually, I wasn't thinking about
that. I was thinking about that handheld scan.
Mr. Shah. Oh, the handheld scanner, yes.
Ms. Bass. That you have testified and other people have
previously that it is not that great.
Mr. Shah. Yeah, they are a little low I think. We are
looking into that. And there are, I think, a series of existing
products that are better than what they are using in west
Africa now that we will be able to help support and deploy.
On orphanages, we have and are conducting a review. In
particular, when I was in Liberia, I visited an orphanage, and
not just the increase in the numbers, but also the lack of
access to food, which has been the main constraint for those
orphanages, so we are expanding the Food for Peace investment
as part of this effort going forward and starting with looking
at vulnerable populations, including orphans, to make sure they
have enough food.
And on cocoa and the industry, it is true across the board,
you know, shipping costs have gone through the roof. You have
seen a 70-percent reduction in commercial flights to the
region. Transportation is much, much, much more difficult, so
any business, local or export oriented, is facing really severe
challenges, which is why we are launching a major regional Feed
the Future effort to get these industries operational again,
and it is one of the reasons we seek the Congress' support for
the Feed the Future authorizing legislation to really allow
this to be successful.
Ms. Bass. I think it is important that we talk about that
because it might be, Mr. Chairman and Mr. Ranking Member, it
might be something that we could really try to expedite during
the lame duck. I was going to ask you about the transfer
authority and how soon you needed that to happen. If those are
priorities, maybe we could get them done.
Mr. Shah. I know we would appreciate the transfer authority
as soon as possible. This is a very fast moving epidemic, and
just as we note, I think we are every day learning more about
which communities need what type of support. And it is not just
immediate disease control but also dealing with these secondary
consequences of the epidemic to avoid kind of state collapse
and fragility from becoming the defining reality of all three
places.
Ms. Bass. You know, I spoke a couple of weeks ago with the
President of Liberia, and she took major issue with the numbers
that are projected, and I was wondering if you had anything to
say about that. The other thing that she raised was that they
had just celebrated, and this was 2 or 3 weeks ago, they had
just celebrated the 1,000th person in Liberia who survived. We
are not really talking about that; we are only talking about
the death rates. But what about the survival rates in
countries, in particular, in Liberia?
Mr. Shah. Well, I have spoken with President Sirleaf a lot
as well, and she makes the point, and I fully agree, that we
should be reporting current active cases and investing in real
time data systems, which we are doing, to get better
information about how many active cases are there. What you
read in the press when they say 14,000 cases includes people
who have died, unfortunately. It also includes people who have
survived, and then that number doesn't really give you a sense
of where is the immediate crisis because it is this big
aggregated number over time and geography. So we have a team
that we sent a whole team of epidemiologists from Johns
Hopkins, from CDC, and we have a group going to help give first
responders the right handheld devices to collect immediate data
and reflect it in real time, and President Sirleaf I think
values the fact that we want to stay focused on real data and
information as opposed to modeled predictions that might or
might not send the right message to folks.
Ms. Bass. In closing, if you could give us some better
numbers, it would be great, especially to disaggregate the
14,000 would be great. Thank you.
Mr. Smith. Thank you, Ms. Bass.
The Chair recognizes Mr. Clawson, the gentleman from
Florida.
Mr. Clawson. Okay. When I review you all's bios and
accomplishments, I am very impressed with what you have done
for our country, not just now, but leading up until now, and
you could have done a lot of other things with these kind of
capabilities, made a little bit more money, but you chose to
serve our country, and I want to express to you deep
appreciation for that.
I also think that helping people is never--nonpartisan, and
so I am here to help, and I heard your earlier question, I
heard I think it was Representative Sherman earlier say, ask if
you got everything you need, and I heard the answer being yes,
so I look at the group sitting in front of me and that answer,
and I feel a little bit better, but anything that I can do or
that we can do to help because we are always interested in
doing so.
I do have a couple questions that you all can help me with.
Number one is when I look at the other countries in the region
in Western Africa, it seems to me, if we back up a step, that
this is a disease that preys on lack of health infrastructure
and also particularly dangerous if there is an urban area where
people are living close to each other. If you look at kind of
when we looked at doctors per, you know, 100,000 residents or
inhabitants in the other countries--Senegal, Mali, these kind
of places, Ivory Coast--it is not a lot better than where we
have an outbreak now. So am I drawing a correct conclusion in
saying we have similar circumstances in neighboring countries
that could lead to a crisis? And then secondarily to that, do
we have enough of a firewall, or are we close to more disasters
coming here?
Mr. Shah. Well, first, Congressman, let me thank you for
your initial comments and also point out that in my response to
Representative Sherman, I did not intend to indicate that we
have what we need. We desperately need these emergency funding
resources. My team is very focused on the fact that we will
literally be shutting down famine prevention programs in places
like South Sudan if we don't get these resources.
Mr. Clawson. Okay.
Mr. Shah. Because we have overspent aggressively and
quickly because of the nature of the epidemic and to keep it
from getting to be in an exponential phase in order to power
this response. We also do seek the authorities and support for
the food reform package, including Feed the Future
authorization.
In terms of the global health security, I would just note I
think you are exactly right that the neighboring countries have
weak and fragile health systems. Where they have been
successful, like Nigeria, it has been in part because of great
leadership there and also strong support from CDC and others
that have helped them do an extraordinary amount of contact
tracing fast. But we are looking right now at cases in Mali.
You can't really build firewalls. I was in Senegal, and
they said, well, we are cutting off the border with Guinea. All
that really does is people cross the border and then don't get
traced and are not part of a system where you can identify who
is crossing and what their temperature is and are they at risk,
and they get lost in the population. So it is very hard to
build a firewall in west Africa across west African countries.
Mr. Clawson. So should we have more resources going into
these neighboring countries?
Mr. Shah. Absolutely. And this emergency request includes
resources for a set of activities we call global health
security, where we have worked together with 43 other
countries, including other countries that will provide funding,
so we can co-invest in building global health security in the
region, and it is important that we do that now to protect
ourselves for the long term.
Mr. Lumpkin. If I may add just one piece about the
resourcing and having what we need to do, the business we need
to do here and eradicate Ebola is that the defense committees
were very kind to us in the end of Fiscal Year 2014 that
allowed us to do a reprogramming within the Department of
Defense of unobligated Overseas Contingency Operations funds of
$1 billion, so we could put against this requirement in order
to make sure we are fully supporting USAID. So the Congress has
been very generous. This has allowed us to get where we are
today and to continue our support over the coming months.
Mr. Clawson. One more question relative to support. Are our
allies doing enough, and does the U.N. give quotas to folks in
Europe? I mean, I know we are asking, but if you look at where
the money comes from, it seems like most of it comes from us,
and are specific requests made to our allies that have historic
relationships in Africa?
Mr. Shah. Yes, and those requests have been made by
President Obama directly with counterpart heads of state. They
have been made by Secretary Kerry, by Secretary Burwell, I have
called my counterparts regularly, and the result of that is we
have seen now $800 million committed from a range of other
donors, and we welcome that, and we are tracking to make sure
that it actually arrives and it is not just a verbal
commitment.
In terms of the U.N., the UNMEER mission is assessed based
on contribution percentages, so it is an allocation, and the
standard U.N. percentages will apply to the cost of that
mission.
Mr. Clawson. Thank you.
Yield back.
Mr. Smith. Mr. Clawson, thank you very much.
The Chair recognizes Mr. Cicilline.
Mr. Cicilline. Thank you, Mr. Chairman.
And thank you to the witnesses for your expertise and for
sharing your experiences with the committee today. I think it
is very important that you have established clearly that the
United States has a national security interest and a
humanitarian responsibility to respond to this outbreak and
that the best way to respond to this, the best way to protect
against Ebola here within our own borders is of course to work
with our international partners to help save lives, strengthen
the economies of our trading partners, maintain political
stability in these countries and stop Ebola at its source, and
I thank all of you for the work that you are doing and the
agencies you represent.
I also want to just take a moment to acknowledge the
extraordinary contributions of our local and international
health workers and military personnel who have really helped to
combat this outbreak. Experts have stated that the greatest
barrier to ending the outbreak in west Africa is an
insufficient number of health workers. And today I will
introduce a resolution along with my colleague Congresswoman
Bass expressing a sense of Congress that health workers
responding to the Ebola crisis deserve our profound gratitude
and deep respect. And I just want to say that here at this
hearing.
Dr. Shah, I want to just start with you. I want to build a
little bit on Mr. Clawson's question, but rather than building
a firewall, I about a year ago with Mr. Kinzinger visited
Liberia and was struck by the lack of a healthcare system
infrastructure and can only imagine what the impact is on
combating this outbreak with that kind of a frail, very fragile
healthcare system. So as you think about this global health
security, do we--is the United States really helping to lead
kind of a comprehensive plan to kind of assist countries in
developing this capacity after this epidemic is concluded,
recognizing that is a huge undertaking, but, you know, are
there some strategies that we should be looking for to invest
in that will help build the capacity not only in the three
affected countries but in the region and countries that are
particularly vulnerable to an outbreak of an infectious
disease?
Mr. Shah. Well, thank you, Congressman, and thank you for
your resolution in particular. That has special meaning for our
folks on the ground and our partners, and we really want to say
thank you for your leadership.
In terms of global health security over time, President
Obama actually started this effort as an international
partnership before the Ebola outbreak, and frankly, before the
outbreak, President Sirleaf had a very coherent plan for
training, hiring, and deploying a few thousand community health
workers, building out laboratory capacity, improving the
physical infrastructure of the more than 460 primary care
facilities throughout the country, many of which we have helped
build over the years and stock and supply, and so this has been
devastating to the system initially because of all of those
initial healthcare worker infections and people no longer
coming to work and the consequence of that.
But we do have clear plans in country for what it means to
build health system security. It builds off the baseline of our
global health investments that have helped to build out this
infrastructure. And one of the elements that was not considered
before, because it was pre-Ebola, that will now be considered
is how we make sure we get protective equipment and training to
all of those primary healthcare workers that, you know,
previously wouldn't have been thinking about Ebola but now need
to make sure they can protect themselves in a setting like
that.
The last thing I would say about this is we have worked
with 43 other countries. At the end of September, there was a
meeting at the White House. Those countries came and made
pledges and commitments, so this will take a while to build
into the system but is I think particularly important given the
crisis that we are dealing with right now.
Mr. Cicilline. So one of the other things I wanted to
follow up on is the number of young children that are being
orphaned as a result of this outbreak and whether we are
developing strategies to help deal with this real crisis in
terms of psychological services, placement, et cetera,
particularly in Liberia.
Mr. Shah. Uh-huh. Yes, we absolutely will. This emergency
funding request and the transfer authority will give us the
capability to deal with this crisis at scale, and, you know, it
is a devastating reality. I have seen children who are unable
to communicate or be with their mother because she is infected
and in a treatment unit, and they are separated, so it is a
tragic reality of this epidemic, and these resources will help
us address that.
Mr. Cicilline. Thank you.
Mr. Lumpkin, I just have one question. It appears that the
Department of Defense has a policy in place now for a 21-day
quarantine, regardless of the risk because these are
individuals who are not having direct contact with patients.
That protocol seems to be at odds or at least not the same
protocol as the CDC. So is that correct? And why is the
Department of Defense doing a quarantine for people that may
not be at any risk and certainly are, some of them, not even
having direct contact with patients? It seems an odd practice
that is quite different from the CDC protocol, and I would love
Dr. Shah and Mr. Lumpkin both to respond to that if you would.
Mr. Lumpkin. Well, Secretary Hagel approved the 21-day
controlled monitoring program that you just discussed at the
recommendation of the chairman of the Joint Chiefs of Staff as
well as the service chiefs--senior leadership in uniform, and
it was done for operational reasons based on how we reinnervate
our force, and I will let Major General Lariviere kind of go
over the guiding principles with, as far as the service chiefs
and the chairman.
General Lariviere. Thank you, sir. And, again, it was an
operational decision, not a medical decision, and I will let
General West talk about the medical advice that was given to
the chairman which was very similar to the CDC guidance, but
because we have got a young and large population, youngest and
largest responding to this epidemic, the chairman felt because
of the unique role and responsibility of the military and the
scale of deployment and the responsibility he has for the
personnel and for the families that this was a prudent measure
to take, again based on the recommendation of the Joint Chiefs,
recognizing that it is not--it is more conservative than the
CDC guidelines.
Mr. Shah. I would just add for USAID employees and staff
and partners, you know, we are following the CDC guidelines
that do involve direct active monitoring for people that come
back from the region and more extensive measures if there is a
specific exposure per the guidelines.
Mr. Cicilline. Thank you.
I thank you, Mr. Chairman. I yield back.
Mr. Smith. Thank you.
Mr. Keating of Massachusetts.
Mr. Keating. Thank you, Mr. Chairman, ranking member for
having this important hearing. I want to thank our witnesses,
not only their own personal involvement but on behalf of their
agencies for the fine work they have done and how important it
is worldwide and for our country here.
One of the most concerning reports of the impact of the
outbreak in the region is the marginalization of members of
vulnerable populations, including the LGBT community. In the
Liberian capital of Monrovia, for example, we have heard
numerous incidents of harassment, physical altercation, direct
targeting of individuals based on their sexual orientation
after some religious leaders claimed the outbreak was a
punishment from God. This not only affects these vulnerable
populations but also our overall ability to control and stem
this outbreak.
How are USAID and the State Department working to ensure
that the LGBT community is receiving unobstructed care and how
are your agencies working to protect all vulnerable groups from
discrimination based on gender, disability or sexual
orientation?
And I guess, Administrator Shah, you could respond to that
first I guess.
Mr. Shah. Well, thank you for the question. It is an
important issue in particular because of, as you identify in a
context of fear and lack of information, prejudices can often
become defining of behavior, and so, for that purpose and
because it is central to the epidemic response, we have had a
widespread public messaging campaign throughout all three
countries to communicate Ebola is real, how you get it, what it
is not, and to avoid those concerns. In addition, our Disaster
Assistance Response Team has a special focus on integrating
protection concerns for vulnerable populations, including LGBT
populations into the grants and programs they are pursuing
because this is such an important issue, and it will continue
to be our policy, especially with respect to how the services
are provided, that everyone has equal access to be a
beneficiary of our programs and that this response is driven by
science and evidence and not prejudice and fear.
Mr. Keating. Great.
Do any of the other witnesses want to comment on that? No?
With that, Mr. Chairman, I will yield back my time, and
again thank the chair, ranking member, and the members of the
committee and our witnesses for their time.
Mr. Smith. Thank you very much to our very distinguished
witnesses for your leadership, for providing insight and
counsel to the committee. We all, on both sides of the aisle,
deeply appreciate it and look forward to working with you going
forward.
The hearing is adjourned.
[Whereupon, at 12:24 p.m., the committee was adjourned.]
A P P E N D I X
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