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GLOBAL EFFORTS TO FIGHT EBOLA

HEARING

BEFORE THE

SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH, 

GLOBAL HUMAN RIGHTS, AND 

INTERNATIONAL ORGANIZATIONS

OF THE

COMMITTEE ON FOREIGN AFFAIRS 

HOUSE OF REPRESENTATIVES

ONE HUNDRED THIRTEENTH CONGRESS

SECOND SESSION

SEPTEMBER 17, 2014

Serial No. 113–239

Printed for the use of the Committee on Foreign Affairs

(

Available via the World Wide Web: http://www.foreignaffairs.house.gov/ or

http://www.gpo.gov/fdsys/

(II)

COMMITTEE ON FOREIGN AFFAIRS 

EDWARD R. ROYCE, California, Chairman 

CHRISTOPHER H. SMITH, New Jersey 

ILEANA ROS-LEHTINEN, Florida 

DANA ROHRABACHER, California 

STEVE CHABOT, Ohio 

JOE WILSON, South Carolina 

MICHAEL T. MCCAUL, Texas 

TED POE, Texas 

MATT SALMON, Arizona 

TOM MARINO, Pennsylvania 

JEFF DUNCAN, South Carolina 

ADAM KINZINGER, Illinois 

MO BROOKS, Alabama 

TOM COTTON, Arkansas 

PAUL COOK, California 

GEORGE HOLDING, North Carolina 

RANDY K. WEBER SR., Texas 

SCOTT PERRY, Pennsylvania 

STEVE STOCKMAN, Texas 

RON DESANTIS, Florida 

DOUG COLLINS, Georgia 

MARK MEADOWS, North Carolina 

TED S. YOHO, Florida 

SEAN DUFFY, Wisconsin 

CURT CLAWSON, Florida 

ELIOT L. ENGEL, New York 

ENI F.H. FALEOMAVAEGA, American 

Samoa 

BRAD SHERMAN, California 

GREGORY W. MEEKS, New York 

ALBIO SIRES, New Jersey 

GERALD E. CONNOLLY, Virginia 

THEODORE E. DEUTCH, Florida 

BRIAN HIGGINS, New York 

KAREN BASS, California 

WILLIAM KEATING, Massachusetts 

DAVID CICILLINE, Rhode Island 

ALAN GRAYSON, Florida 

JUAN VARGAS, California 

BRADLEY S. SCHNEIDER, Illinois 

JOSEPH P. KENNEDY III, Massachusetts 

AMI BERA, California 

ALAN S. LOWENTHAL, California 

GRACE MENG, New York 

LOIS FRANKEL, Florida 

TULSI GABBARD, Hawaii 

JOAQUIN CASTRO, Texas

AMY PORTER, Chief of Staff THOMAS SHEEHY, Staff Director

JASON STEINBAUM, Democratic Staff Director 

SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH, GLOBAL HUMAN RIGHTS, AND

INTERNATIONAL ORGANIZATIONS

CHRISTOPHER H. SMITH, New Jersey, Chairman 

TOM MARINO, Pennsylvania 

RANDY K. WEBER SR., Texas 

STEVE STOCKMAN, Texas 

MARK MEADOWS, North Carolina 

KAREN BASS, California 

DAVID CICILLINE, Rhode Island 

AMI BERA, California 

(III)

C O N T E N T S 

Page

WITNESSES 

The Honorable Nancy Lindborg, Assistant Administrator, Bureau for Democracy, Conflict and Humanitarian Assistance, U.S. Agency for International 

Development ......................................................................................................... 15

Anthony S. Fauci, M.D., Director, National Institute of Allergy and Infectious 

Diseases, National Institutes of Health, U.S. Department of Health and 

Human Services ................................................................................................... 24

Luciana Borio, M.D., Director, Office of Counterterrorism and Emerging 

Threats, Office of the Chief Scientist, U.S. Food and Drug Administration, 

U.S. Department of Health and Human Services ............................................. 42

Beth P. Bell, M.D., Director, National Center for Emerging and Zoonotic 

Infectious Diseases, Centers for Disease Control and Prevention, U.S. Department of Health & Human Services ............................................................. 51

Kent Brantly, M.D., medical missionary, Samaritan’s Purse (survivor of 

Ebola) .................................................................................................................... 81

Chinua Akukwe, M.D., chair, Africa Working Group, National Academy of 

Public Administration .......................................................................................... 92

Mr. Ted Alemayhu, founder & executive chairman, US Doctors for Africa ....... 101

Dougbeh Chris Nyan, M.D., director of the secretariat, Diaspora Liberian 

Emergency Response Task Force on the Ebola Crisis ...................................... 108

LETTERS, STATEMENTS, ETC., SUBMITTED FOR THE HEARING 

The Honorable Christopher H. Smith, a Representative in Congress from 

the State of New Jersey, and chairman, Subcommittee on Africa, Global 

Health, Global Human Rights, and International Organizations: Prepared 

statement .............................................................................................................. 5

The Honorable Nancy Lindborg: Prepared statement .......................................... 18

Anthony S. Fauci, M.D.: Prepared statement ....................................................... 27

Luciana Borio, M.D.: Prepared statement ............................................................. 44

Beth P. Bell, M.D.: Prepared statement ................................................................ 54

Kent Brantly, M.D.: Prepared statement .............................................................. 84

Chinua Akukwe, M.D.: Prepared statement ......................................................... 94

Mr. Ted Alemayhu: Prepared statement ............................................................... 103

APPENDIX 

Hearing notice .......................................................................................................... 118

Hearing minutes ...................................................................................................... 119

Dougbeh Chris Nyan, M.D.: Material submitted for the record .......................... 120

Questions submitted for the record by the Honorable Mark Meadows, a Representative in Congress from the State of North Carolina ............................... 124

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GLOBAL EFFORTS TO FIGHT EBOLA 

WEDNESDAY, SEPTEMBER 17, 2014

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH,

GLOBAL HUMAN RIGHTS, AND INTERNATIONAL ORGANIZATIONS,

COMMITTEE ON FOREIGN AFFAIRS,

Washington, DC. 

The subcommittee met, pursuant to notice, at 10 o’clock a.m., in 

room 2172 Rayburn House Office Building, Hon. Christopher H. 

Smith (chairman of the subcommittee) presiding. 

Mr. SMITH. The subcommittee will come to order and good afternoon, or good morning, I should say, to everybody. We are here 

today to hold our second hearing in just 5 weeks on the Ebola crisis 

in west Africa to underscore just how serious a crisis they are facing and I would say we are facing—an international pandemic 

which threatens to balloon unless confronted head on. 

I spoke yesterday to Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention and the lead witness at our 

August 7 emergency hearing during recess on Ebola, and he said 

that this is the worst health crisis he had ever seen. 

He said, I have never seen anything like this in my life, and coming from the head of the CDC that was an extraordinarily powerful 

statement. 

Since our August emergency hearing, we are seeing a constant 

movement upwards in the number of actual cases as well as the 

predictions of how many people may contract the disease and what 

potentially the number of fatalities might indeed be. 

The numbers range. Yesterday the President was talking about 

hundreds of thousands. I read a German doctor who said something on the order of 5 million. 

That, hopefully, is way overinflated but it underscores that nobody really knows and we are talking about a pandemic that even 

if it stays contained in the west African countries is doing unbelievable damage and imposing unbelievable sorrow. 

The World Health Organization estimated we would see as many 

as 20,000 cases of Ebola before it has ended and, again, the numbers have now begun to exceed that in terms of estimates. 

We are holding this hearing to take stock of where our intervention efforts stand, particularly in light of the President’s decision 

to commit U.S. Military personnel to Liberia to fight this disease. 

Liberian President Ellen Johnson Sirleaf, with whom I spoke 

yesterday, has conceded that the Ebola epidemic has overwhelmed 

her country, her ability to treat. 

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She said this in a letter that she sent to the President: ‘‘The 

virus is spreading at an exponential rate and we a have limited 

time window to arrest it.’’ She pointed out that well over 40 percent 

of the total cases have occurred in the last 18 days alone. 

She said the treatment centers are overwhelmed and that at this 

rate we will never break the transmission chain and the virus will 

overwhelm us—an ominous statement from the distinguished 

President of Liberia. 

We are also holding this follow-up hearing this morning to determine if there is a reasonable hope for vaccines, treatments, or detection strategies in time to help with this health emergency. 

I hesitate to provide figures for the number of people who have 

died but I think the estimates are something on the order of 2,500 

people who have passed away and that is probably an underestimation of the actual number. 

Ebola, which was mostly unknown in west Africa until now, presents itself early in the infection like usually non-fatal diseases 

such Lassa fever, malaria, or even the flu. 

The temperature seen in the early stages might even be brought 

down with regular medicines. Therefore, many people may not believe or may not want to believe that they have contracted this 

often fatal disease. 

If someone is in denial or unknowledgeable about this disease, 

they may not seek treatment until it is too late, both for them and 

for the people they unknowingly infect. Families in Africa tend to 

help each other in times of need, an admirable trait that unfortunately increases the risk of infection. 

The sicker a person gets with Ebola, the more contagious they 

are and never more so than when they die. So burials that don’t 

involve strict precautions to avoid direct contact with highly contagious remains of victims make transmission of this deadly disease almost inevitable. 

Burial traditions make avoidance of infection problematic. The 

porous lightly-monitored borders in west Africa lend themselves to 

cross-border transmission as people go back and forth along welltraveled roads and into marketplaces where hundreds of people 

also travel and make contact with those who are infected. 

Patrick Sawyer, a Liberian-American, reportedly was caring for 

his dying sister a few weeks ago. After she died, apparently of 

Ebola, he left Liberia on his way to his daughter’s birthday party 

in Minnesota. He collapsed at the Lagos airport in Nigeria and died 

within days. 

Had he left Liberia a week or even days earlier, he might have 

made it home to Minnesota but he likely would have infected people along the way, including his own family. 

We can say that because Sawyer infected several people in Nigeria, which led to Ebola being transmitted to health care workers 

and then to dozens of other people. 

We will never know now if Mr. Sawyer realized that he had contracted Ebola and just wanted to go home for treatment or whether 

he thought his symptoms were from some other illness. 

Many people are just like him, however, and they are spreading 

this disease even to places where they have been brought under 

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control. For example, the Macenta region of Guinea on the Liberian 

border was one of the first places where this disease surfaced. 

But by early September, no new cases had been seen for weeks. 

Doctors Without Borders closed one of its Ebola treatment centers 

to focus on harder-hit areas. Infected people leaving Liberia for better treatment than Guinea have once again made Macenta a hot 

spot for the disease. 

The U.S. Centers for Disease Control and Prevention has established, as we know, teams in Guinea, Liberia, Sierra Leone, and 

Nigeria to help local staff do fever detection and to administer 

questionnaires on potential troublesome contacts. The agency also 

was helping to establish sites at airports for further testing and/

or for treatment. 

Liberia and Sierra Leone are the hardest hit so far by this Ebola 

outbreak. This is undoubtedly partly because of the weak infrastructures of the two countries emerging from long conflicts. 

However, post-conflict countries also have significant segments of 

the population who don’t trust the central government. The unfortunate mishandling by the Liberian Government of an attempted 

quarantine in the capital demonstrates why trust has been so difficult to come by. 

The Liberian Government, as we know, established barriers to 

block off the West Point slum area where, after a holding center 

for Ebola victims was ransacked and contaminated materials were 

taken. 

This quarantine was done without fully informing its 80,000 inhabitants or consulting with the health care workers. Not only did 

this prevent people from pursuing their livelihoods or bringing in 

much-needed supplies, this move created great suspicions of the 

motives of the Liberian Government. 

This suspicion was heightened when the official in charge of the 

area was called to a meeting and was seen leaving just as everyone 

else was trapped behind barriers. The furor over the quarantine 

forced the government to abandon it 10 days into its planned 21-

day term. 

Liberian officials assured us that they have learned from their 

mistakes, that of the quarantine, and has alerted Liberians of the 

reality of the Ebola epidemic. I read many of the newspapers from 

west Africa every single day and it is front-page headlines, sometimes a little bit exaggerated, but certainly front-page headlines, so 

people are becoming more aware through that medium. 

Despite the fact that the drug ZMapp appears to have saved 

some lives including Americans Nancy Writebol and Dr. Kent 

Brantly, who we will hear from in our second panel, there are no 

proven readily available treatments for Ebola. 

The death rate for this disease, once more than 90 percent, is 

now down to 53 percent despite the number of cases growing exponentially. 

In Africa, a few patients apparently have been successfully treated with ZMapp and Dr. Fauci, I am sure, will give us additional 

insights in this, and some others may have been saved using other 

treatment methods, especially when the disease was identified 

early. 

4

Yet there is not now nor will there be in the short term large 

quantities of this medicine or any others. There are other several 

Ebola therapeutics under development but if this outbreak cannot 

be brought under control soon, even the most optimistic timetable 

for the testing and production of these drugs will not be sufficient 

to meet the ever expanding need. 

ZMapp was used with the informed consent of those to whom it 

was given. But how can we guarantee that the many Ebola victims, 

whose most likely salvation would be to use an experimental drug, 

truly understand the risk of using a drug that has not been fully 

tested? 

Lack of faith in national and international systems fighting 

Ebola has impeded the replacement of many Africa health care 

workers who have died from this disease. That is one of the untold 

problems, that people on the front line are dying, as well as their 

families. 

I was talking to a friend who runs an NGO in Sierra Leone who 

works with obstetric fistula and a nurse at his clinic died, and so 

did her six children. So health care workers have borne a disproportionate share of this horrific disease. 

As of late August, 164 Liberian health care workers had contracted Ebola and 78 had died and that number no doubt has increased. African health care workers face an epidemic that threatens to defy control. 

The lack of diagnostic techniques and insufficient supplies of 

safety equipment have put these health care workers at extreme 

risk. These health care workers know that the lack of treatment 

centers and medicines means that those on the front lines of this 

epidemic are most at risk, as I indicated earlier. 

And finally, without objection will put my full statement into the 

record. I will just point out that yesterday’s announcement that 

some 3,000 American service personnel will be deployed. Nancy 

will remember that I traveled right after the typhoon hit in the 

Philippines and if it wasn’t for the military providing food, water, 

shelter, and medicines working with USAID and NGOs like Catholic Relief Services, many more Filipinos would have died as a result 

of Dengue fever and other terrible diseases might have manifested 

in large numbers. 

Same goes for the tsunami. I will never forget a number of us 

went and we saw what was being done in Banda Aceh. Again, 

USAID, working with CDC, NIH, and the military. But this is a 

little bit different and perhaps our witnesses could elaborate on 

this either during the Q and A or in their statements about what 

precautions might be provided to those service members. 

I know they will be likely building beds, which are unbelievably 

lacking, particularly in Liberia. People can’t find a bed when they 

are sick to get treatment or at least to live in until they pass. 

And so it does raise the question of what kind of precautions 

those military personnel will take, whether they will be properly 

suited, what their mission will be, and when will they be deployed. 

A number of questions have arisen, I am sure, by many of us concerning it to ensure their safety. 

I would like to yield to Ms. Bass and then to the chairman of the 

full committee, Mr. Royce. 

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[The prepared statement of Mr. Smith follows:]


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Ms. BASS. Thank you, Mr. Chairman, as always for your leadership and for calling today’s hearing to give us an opportunity to examine the scope of global efforts to address the ongoing Ebola crisis 

in west Africa. 

This is the subcommittee’s second hearing on Ebola in the past 

6 weeks and I look forward to getting updates from our witnesses 

today on how their agencies and organizations continue to combat 

this deadly outbreak, what trends they are seeing both positive and 

negative, and what additional support is needed as they coordinate 

with the governments of the impacted countries. 

I appreciate their efforts and outreach to help keep Congress informed on this evolving and devastating epidemic. Yesterday, I was 

very pleased to see President Obama’s announcement at the CDC 

headquarters in Atlanta where he provided a comprehensive outline of the U.S. support for Liberia and other west African nations 

impacted by the crisis. The President’s commitment totals, as I understand it, over $700 

million over the next 6 months and will include sending 3,000 

American military personnel to the region, AFRICOM’s establishment of a regional intermediary staging base to facilitate the transport of medical equipment, supplies and personnel to affected regions, and the command’s establishment of a medical training site 

to train up to 500 health care providers per week. 

It has been an honor to work with the various U.S. agencies 

seeking sustainable solutions to the Ebola outbreak including the 

CDC, USAID, the Departments of State and Defense, respectively. 

I also want to commend the steps being taken by the Governments of Liberia, Sierra Leone, Guinea, and Nigeria and the great 

work of the many health professionals from throughout the world 

who are doing everything they can to help people who have contracted this disease. 

The U.S. commitment will address the unique nature of this outbreak that has made combating the disease particularly difficult. 

West Africa has not faced this before and communities and governments and health professionals in Guinea, Sierra Leone, and Liberia don’t have the expertise and capacity to address the scale, 

spread, and proper treatment of the outbreak alone. 

The crisis is not just about obvious health concerns, and this is 

a major concern to me and why I was happy with the President’s 

announcement about military support because I am really concerned about the stability of the countries, with post-civil war conflicts. 

These countries have weak institutions and a crisis like this 

could actually lead to a complete destabilization. Although they 

have elected democracies right now, we know that in many of these 

countries, as I mentioned before, you could actually have a collapse 

of the governments. 

Yesterday, I also had the privilege to speak with Liberian President Johnson Sirleaf on the impact of the outbreak in her country 

and the work they have done to fight the spread of the diseases. 

She called to thank me and to express her deep gratitude for 

U.S. assistance and stated that with essential support from the 

U.S. Government, the World Bank, the African Development Bank, 

she actually feels confident now and she sees moving toward a 

10

health recovery, and I will say that this was markedly different 

than the telephone conversation I had with her a few weeks ago, 

and I am sure the chairman and ranking member and Mr. Smith 

had the same type of calls, where she seemed to be particularly 

desperate. So it was nice to have the call yesterday. 

It is in America’s and the world’s interest to continue to assist 

in this crisis and to continue to support nations as they fight this 

outbreak and work to develop and strengthen their health care systems. 

Health care is a human right. We must ensure that countries 

have the ability to address this outbreak and are able to move forward and prevent future health epidemics from occurring. In Congress, there has been consistent activity related to the recent crisis. 

Prior to the August recess, 100 bipartisan members introduced 

House Resolution 701 expressing the sense that the current outbreak is an international health crisis and is the largest and most 

widespread outbreak of the disease ever recorded. 

On August 7, the Foreign Affairs Committee’s Africa Subcommittee held an emergency hearing on the crisis and 77 members have signed a letter to the Committee on Appropriations to 

fulfill the President’s $88 million funding request to fight the crisis. 

And there is also going to be a member meeting tomorrow that 

we are all doing together to brief members who don’t have the opportunity to sit on this subcommittee or the full committee. 

I look forward to your testimony and I am interested in hearing 

from all of you about what more Congress can do to assist your efforts to combat the disease outbreak and support international efforts to improve health care systems around the world. 

Thank you, and I yield back. 

Mr. SMITH. Ms. Bass, appreciate it. 

We are joined by the distinguished chairman of the full committee, Mr. Royce. 

Mr. ROYCE. Thank you, Mr. Chairman. I just guess I would start 

by thanking and welcoming Dr. Kent Brantly who is with us and 

to say that I am very glad that ZMapp is in trials and I am glad 

you are here. 

Our heart goes out to the families of your colleague who also 

tried the ZMapp and did not survive. But we are encouraged by the 

fact you are with us today. We have seen this pandemic in the past 

in the Philippines, in Uganda, in Congo, different strains, and over 

the past in each case the strain has burned itself out. I mean, we 

have had about 2,300 deaths worldwide since 1976 as, time after 

time, different strains of Ebola have been put to rest. 

But in this latest chapter in west Africa, primarily in Liberia and 

the neighboring states, we see a situation where we have already 

had 2,300 deaths, as many as in all the previous cases combined. 

And I spoke yesterday also to President Sirleaf, who contacted 

me about the situation in Liberia. She acknowledged that the 

health system of Liberia has virtually collapsed under the strain of 

this Ebola crisis and she correctly pointed out that this is not just 

a health catastrophe affecting her country. 

It affects the region. It affects the security of the region, threatens the economic growth and food security but, beyond that, affects 

the security of the United States. 

11

The entire global health community must come together and put 

in place a coherent strategy to stem the tide of new infections and 

my hope is that some of our effort here will encourage this in terms 

of the entirety of the world health community. 

We do not have the luxury of time. Infectious diseases like this 

one, they do not recognize borders, they do not discriminate, and 

the time to act is now. 

And I spoke recently with Raj Shah, the Administrator of 

USAID, who shares our concern on this subject. But I really want 

to thank the witnesses for appearing today and we look forward to 

working with them to ensure that the U.S. contribution to the global response to Ebola is robust and is effective. And thank you 

again, Mr. Chairman. 

Mr. SMITH. Thank you very much, Chairman Royce. I would like 

to now yield to the ranking member of the full committee, Mr. 

Engel, of New York. 

Mr. ENGEL. Thank you, Mr. Chairman—Chairman Smith, Ranking Member Bass. Thank you for holding this important hearing on 

the devastating Ebola outbreak in west Africa. 

I want to say at the outset I am very happy that Betty McCollum, our colleague from Minnesota who is a former member of this 

committee is here with us as well. 

Without exception, the global health leaders from around the 

world continue to sound the alarm about the terrible threat posed 

by this Ebola outbreak. It is almost impossible to overstate how 

dire the situation has become in Liberia, Sierra Leone, and Guinea. 

The World Health Organization has called this outbreak 

unparallelled in modern times. Almost 2,500 of the 5,000 individuals infected by Ebola have died. NGOs and humanitarian organizations have shouldered most of the burden in fighting this epidemic for months but their passion and dedication is no match for 

the speed with which this disease is spreading. More government 

involvement is desperately needed. 

The World Health Organization has also said that if the response 

is quickly scaled up, only tens of thousands of individuals will become infected by the time the outbreak is contained. That is the 

best case scenario, believe it or not. The alternative is simply unacceptable. 

The need for more well-trained health care personnel, personal 

protective equipment, and adequate health care facilities is immediate. So I am pleased to see the CDC, USAID, and Department 

of Defense are rapidly scaling up their efforts. I am also glad that 

President Obama has decided to send the U.S. Military to help. 

It is my belief that our response must be well coordinated, sustained, and nimble enough to meet the needs as they evolve. However, the United States cannot contain this disease alone. It is a 

threat to the entire international community and requires a truly 

global response. 

I will be interested to hear from our panelists about what our 

other partners around the world are doing to help with the response and what significant gaps remain to be filled. 

I would also like to take a moment to applaud the courage and 

selflessness of the health workers on the front lines trying to help 

those afflicted to survive. 

12

They put themselves at significant personal risk and are bearing 

the brunt of the infection’s spread, as one of our witnesses, Dr. 

Kent Brantly, can attest to. Their bravery and dedication is simply 

appreciated and a true inspiration to all of us. 

So let me say as the ranking member of the House Foreign Affairs Committee, thank you, Chairman Smith and Ranking Member Bass, for convening this hearing and thank you to our witnesses for coming to talk about this urgent issue. I yield back. 

Mr. SMITH. Thank you very much, Mr. Engel. Mr. Stockman. 

Mr. STOCKMAN. I just want to say a brief note to those that are 

here in attendance today, I was in South Sudan and one of the organizations, Mr. Chairman, that I saw there, of all the other nongovernmental organizations that were there, was Samaritan’s 

Purse, and wherever I travel around the world they are a shining 

light and example of true compassion and sacrifice and it is done 

in silence that most Americans aren’t aware of. 

And Kent’s sacrifice is not just in Africa, but your whole organization is to be commended for the compassion and the heart you 

have and I know Franklin Graham and others have worked tirelessly and has not broadcast that. 

But wherever I went Samaritan’s Purse was there and it is really 

a testimony to the work that you and others have done on behalf 

of the United States and I just want to send a thank you for that. 

Mr. SMITH. Thank you very much, Mr. Stockman. 

Mr. Cicilline. 

Mr. CICILLINE. Thank you, Mr. Chairman. I want to thank you 

and Ranking Member Bass for holding today’s hearing on this very 

serious outbreak of Ebola in west Africa. 

I also want to acknowledge and send thoughts and prayers to all 

of the families who have already been affected by this outbreak and 

I know in my home state of Rhode Island, which is the very proud 

home to a wonderful Liberian community, it has caused considerable heartache and concern. 

I want to particularly offer my gratitude to the witnesses today 

for your testimony and for the really important work that you are 

doing and to the government panel in particular for keeping Congress so well informed with regular updates on the situation on the 

ground. 

In particular, I also want to acknowledge and thank Dr. Kent 

Brantly for joining us on the second panel and for sharing with us 

the work that he has been doing in Africa to fight Ebola and, of 

course, his own personal experience surviving the virus. 

The United States has both a humanitarian responsibility and a 

national interest in doing all that we can to fight this outbreak, 

and in addition to obviously protecting against Ebola within our 

borders, we also have a responsibility to work to help save lives 

and strengthen the economies of our trading partners and maintain 

political stability in the region that has been affected by this outbreak. 

We must all be concerned about the serious issues of civil unrest, 

food insecurity, and the collapse of national health care systems in 

the African countries impacted by this outbreak, and I hope our 

witnesses will share with us ways that we can address this crisis 

13

more effectively and what are the things Congress might do to support an effective response to this crisis. 

And with that I, again, thank the witnesses and yield back, Mr. 

Chairman. 

Mr. SMITH. Thank you, my friend. I would like to yield to Dr. 

Burgess. 

Mr. BURGESS. Well, thank you, Mr. Chairman, and thank you 

and Ranking Member Bass for allowing me to be part of your committee’s activities today and I am anxious to hear from the witnesses that you have assembled and to learn more. 

I am on the Energy and Commerce Committee and we do have 

a healthcare footprint. But, Mr. Chairman, let me just say you 

have taken an outsized role in providing leadership in the Congress 

in having the hearings on this very important outbreak. 

Certainly, Dr. Fauci, for the last 12 years you have been a resource for me whenever infectious disease threatens and, unfortunately, it does and I have always looked to you for your expertise 

and your leadership in this area. 

Dr. Brantly, I just had a chance to meet you for the first time 

today. You are from my part of the world in Fort Worth and I appreciate your service at Samaritan’s Purse and certainly grateful 

that you are with us and I really mean that you are with us today. 

Others have said it so well but more people have died in this outbreak than all of the previous outbreaks of Ebola going back to 

1976. No one expected the outbreak to reach the proportions that 

it did, but it did. 

No one expected it to last the length of time that it has, but it 

has. Now, certainly, whatever criticism there may be for lack of action in the past I am pleased that action is occurring now. 

Just also feel obligated to note that an obstetrician is recovering 

today in Omaha, Nebraska—Dr. Rick Sacra—who was not actually 

treating Ebola patients but was exposed through his work in labor 

and delivery, and it just underscores part of the risk—the accelerated risk that healthcare providers experience in this illness and 

in the countries that are so affected but also the fact that the rest 

of civil society and the healthcare infrastructure is really put under 

strain by this. 

And you can really scarcely devote the resources that are needed 

to treating malaria and accident victims and mothers in labor 

when everything else has to be diverted to taking care of people 

with Ebola. 

So, Mr. Chairman, I thank you for the opportunity to be with you 

today. Thank you for your leadership on this issue and I will yield 

back my time. 

Mr. SMITH. Thank you very much, Dr. Burgess. 

I would like to yield now to the gentlelady from Minnesota, Ms. 

McCollum 

Ms. MCCOLLUM. Well, thank you, Mr. Chair. That is an unexpected surprise. Thank you very much. 

I would also like to extend my thanks to the panels that are here 

today who reflect all the healthcare workers around the world, especially those in Africa who are working so hard and the researchers who are trying to find ways in which to defeat this disease. 

14

Minnesota is my home state. We are a state that is blessed to 

have so many wonderful, wonderful people from all over the world 

who call Minnesota home including a large Liberian population, 

one who is mourning the loss of their own, as Chairman Smith 

pointed out. 

We are also the home to my first state epidemiologist, Mr. 

Osterholm, who sometimes gets accused of talking fire but he is 

saying look where the fire exits are. 

So in my work on the Appropriations Committee and the Department of Defense I am pleased that we are putting boots on the 

ground to fight this disease. Thank you, Mr. Chairman. 

Mr. SMITH. Thank you very much, Ms. McCollum. 

I would like to now introduce our very distinguished panel, beginning first with the Honorable Nancy Lindborg, who is the Assistant Administrator for the Bureau for Democracy, Conflict and 

Humanitarian Assistance at USAID, and she has testified before 

our subcommittee several times and provided very valuable input 

and leadership for her respective portfolio but also great input to 

this subcommittee as to what we ought to be doing to be of assistance. 

Since assuming her office in October 2010, Ms. Lindborg has led 

DCHA teams in response to the ongoing Syria crisis, in the Horn 

of Africa in 2011, the Sahel 2012 droughts, the Arab Spring upheaval, in the aftermath of Typhoon Haiyan in the Phillippines, 

and numerous other global crises. Prior to joining USAID, Ms. 

Lindborg was the president of Mercy Corps where she spent 14 

years. 

We will then hear from Dr. Anthony Fauci, who is Director of the 

National Institute of Allergy and Infectious Diseases at the NIH. 

Since his appointment as NIAID Director in 1984, Dr. Fauci has 

overseen an extensive research portfolio devoted to preventing, diagnosing, and treating infectious and immune-mediated diseases. 

Dr. Fauci has made numerous discoveries related to HIV/AIDS and 

is one of the most cited scientists in the field. 

Dr. Fauci serves as one the key advisors to the White House and 

the Department of Health and Human Services on global AIDS 

issues and he was one of the principal architects of PEPFAR. 

We will then hear from Dr. Luciana Borio, who serves as Assistant Commissioner for Counterterrorism Policy and the Director of 

the Office of Counterterrorism and Emerging Threats in the Office 

of the Chief Scientist, U.S. Food and Drug Administration. 

In this capacity, Dr. Borio is responsible for providing leadership, 

coordination and oversight for FDA’s national and global health security, counterterrorism, and emerging threat portfolios. 

She serves as FDA’s point of entry on policy and planning matters concerning counterterrorism and emerging threats, collaborates across U.S. Government and internationally on actions to advance global health security and U.S. national security. 

And our fourth witness in Panel I will be Dr. Beth Bell, who is 

the Director of the National Center for Emerging and Zoononic Infectious Diseases. 

Most recently, Dr. Bell served as the Associate Director for Epidemiologic Science in the National Center for Immunization and 

Respiratory Diseases. 

15

Dr. Bell has served in leadership roles during CDC responses to 

several major public health events including the 2001 anthrax attacks—and she will recall one of the post offices hit was my own 

in Hamilton Township where we had a number of people who contracted cutaneous anthrax—Hurricane Katrina, and the 2009 

H1N1 influenza pandemic. 

As a member of the senior leadership team for the 2009 H1N1 

influenza pandemic response she provided oversight of policy and 

scientific direction. So four extraordinarily important and, I think, 

great leaders in the field. 

I would like to now go to Ms. Lindborg and then to Dr. Fauci. 

STATEMENT OF THE HONORABLE NANCY LINDBORG, ASSISTANT ADMINISTRATOR, BUREAU FOR DEMOCRACY, CONFLICT AND HUMANITARIAN ASSISTANCE, U.S. AGENCY FOR 

INTERNATIONAL DEVELOPMENT 

Ms. LINDBORG. Thank you. Thank you, Chairman Smith, Ranking Member Bass, members of the subcommittee and other members. 

Thank you for inviting me to testify today on the U.S. response 

to the really unprecedented Ebola epidemic in west Africa and special thanks for your continued support and vital interest in these 

issues. 

I think as a number of you have very articulately laid out, this 

is the largest and most protracted Ebola epidemic in history. Thousands have already been sickened or killed and for the first time 

ever it is being transmitted in densely populated urban areas. 

So we are now seeing a near exponential increase in the transmission of the virus with the potential for a regional spread beyond 

the primary countries of Guinea, Liberia, and Sierra Leone. 

The United States began combatting the epidemic when the first 

cases were reported in March and what began as a public health 

crisis began morphing into a multidimensional public health, humanitarian, and security crisis this summer. 

And so we then significantly expanded our efforts and on August 

5 USAID deployed a Disaster Assistance Response Team, or a 

DART, to the region to oversee and coordinate the U.S. response, 

drawing on critical assets and resources from across the U.S. Government including CDC, USAID, HHS, DoD and the U.S. Forest 

Service. 

We developed a clear four-part government strategy that supports the U.N. and country-led responses. That was first and most 

urgently focused on controlling the epidemic. Next, we are working 

to mitigate the side effects of the crisis. This includes blunting the 

economic, social, and political tolls. 

Third, we are helping to coordinate with the U.N. and enable a 

broader effective global response, and finally, very importantly, we 

will work to fortify the global health infrastructure. 

So we had deployed 120 experts to the region and began airlifting urgent supplies, personal protective equipment for 

healthcare workers, disinfectant backpack sprayers, water treatment, chlorine, body bags, et cetera—the kinds of supplies that are 

absolutely critical. 

16

The team is providing technical guidance to strengthen the local 

response systems, do the contact tracing, and upgrade laboratory 

testing facilities. We have supported the U.N. humanitarian air 

service and we funded those organizations willing to step forward 

to run Ebola treatment units. 

However, we very quickly ran into the reality that there is simply not the global expertise or capacity in the humanitarian or 

health world to respond to this kind of crisis at this scale at the 

rate that it is continuing to increase. 

With the disease transmission rates nearly doubling each week 

there is little time to spare, and as President Obama announced 

yesterday, we are now significantly expanding the response with 

the deployment of the unique capabilities of our military to respond 

with the speed and the scale that is so essential to get ahead of 

this disease. 

So those efforts will essentially provide the backbone for an expanded regional effort that will enable the entire international 

community to contribute. 

It will include the establishment of a joint force command 

headquartered in Liberia, very importantly, a training facility in 

Liberia that will have a tent city and the training facilities to train 

500 workers a week so that we can have a vital pipeline of health 

and management personnel. 

They will include a regional base with lift and logistical capacity 

to expedite a surge of urgently needed equipment, supplies and 

personnel, and include command engineers to help construct the 

Ebola treatment units. 

This is the critical infrastructure, coordination and logistics to 

provide the foundation for an ever greater response as needed so 

that we can bring all our resources to bear and set the lead for our 

international partners. 

The President also announced the launch of our community care 

campaign. This is focused on getting vital information and support 

to families and communities so they can protect themselves and 

their families. 

We will work with local communities and international partners 

to initially target 400,000 of the highest risk households with intensive outreach, information, and important tools for those unable 

to access a bed in a healthcare unit and we will simultaneously 

work on broad information campaigns to reach all of society and 

every household. 

We recognize that a significant number of people in this region 

don’t seek formal healthcare which is why ultimately the virus will 

only be controlled if people have a better understanding of what 

this is and how to prevent transmission. 

We are hearing stories of ordinary west Africans who do not believe that Ebola is real. Show me Ebola, they say. So we are challenged to reverse deeply-ingrained cultural practices even as we 

help the affected communities. 

Cultural funeral traditions, such as washing the body where family members touch and clean the body of the deceased, are contributing to the spread and women are especially vulnerable as even 

those who sometimes know they shouldn’t continue this practice 

are pressured to do so. 

17

Our partners are already saying thank you for the public messaging campaigns, that now people know that this is harmful and 

can spread the disease, even though it goes against their traditions. 

This is a region of fragile states just emerging from decades of 

conflict and poverty, so we are also looking at how to help with economic help, food support, and salaries for health workers. We know 

that tough months lie ahead. 

It will take a coordinated effort by the entire global community 

to stem this terrible crisis, but past outbreaks have been stopped 

and we are confident with this concerted effort we can stop this 

one. 

I want to just add my commendation for the extraordinary courage of the health workers, including Dr. Brantly and the many, 

many west Africans who have sacrificed to provide help for their 

families and their neighbors. 

We are remaining focused on outreach efforts to get additional 

medical workers willing and able to go to west Africa. So we encourage those who are interested in joining this historic response 

to go to our Web site at www.usaid.gov/ebola and we will continue 

to work together and across the international community to stem 

the tide on this disease. 

Thank you very much. 

[The prepared statement of Ms. Lindborg follows:]

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Mr. SMITH. Thank you very much, Nancy. 

I would like to now ask Dr. Fauci if you would proceed. 

STATEMENT OF ANTHONY S. FAUCI, M.D., DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES, NATIONAL INSTITUTES OF HEALTH, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Dr. FAUCI. Ranking Member Bass, members of the committee, I 

appreciate the opportunity to discuss with you today the role of the 

National Institute of Allergy and Infectious Diseases in the research that addresses the Ebola epidemic. 

There are some visuals, I believe, on your screen in front of you 

and I will speak from them if you see them, if we can do that. 

It is very interesting that we became involved in this in an unusual way dating back to the tragic events of 9/11 followed by the 

attacks by mail of anthrax to United States Senators and to the 

press because that triggered a multi agency effort in what we call 

biodefense involving the CDC, the FDA, the NIH, a variety of other 

agencies—including Homeland Security—to develop an agenda to 

be able to be prepared not only against deliberate attacks but 

against natural emerging and reemerging infectious diseases. 

We developed a research agenda against what we call Category 

A agents, which is shown on this visual, including anthrax, botulism, plague, smallpox, tularemia, and notice on the last bullet is 

what we call the viral hemorrhagic fever viruses including Ebola, 

Marburg, Lassa and others. 

These were of particular concern because, as we are painfully 

witnessing now, these viruses have a high degree of lethality and 

infectivity. Unfortunately, therapy consists mainly of supportive 

therapy with no specific anti-viral drugs, and a vaccine, as I will 

get to in a moment, is not yet available. 

This is an electron micrograph of the Ebola virus, a particular 

deadly character, as you know, as we are experiencing. It is a 

member of the filovirus family because of the filamentous look that 

you see on this image. 

Just a very brief word as to what we were referring to as the kinetics or dynamics of the epidemic. This visually shows you the 22 

previous outbreaks, some of which were so small that they don’t 

even fit on the scale. 

If you will look at the far right, the current outbreak, as we have 

all mentioned several times, is more than all of the others combined both in numbers and in deaths. And if you look at the map 

of west Africa, this is a few days outdated but, indeed, even the underestimated numbers show about 5,000 infections and about 2,500 

deaths in the countries involved. 

Now, without a doubt, the approach to this is an intensification 

of the effort of infection control. This next slide is a bit frightening 

because if you look at the red line under Liberia that is a mathematical manifestation of what we call exponential increase. 

Linear and incremental is not a steep slope. When you go up like 

that what you have is an exponential increase at the same time 

that we might be incrementally increasing our response. As we 

know in public health when you put incremental against exponential, exponential always wins and that is really the problem and 

25

why we are so gratified and excited about the President’s initiative 

about really ratcheting up the response in infection control. 

But also supplementing and complementing that is the development of countermeasures and let me just take a minute to outline 

this because we at NIH and NIAID are involved in everything from 

basic to clinical research and also supplying the research resources 

for academic as well as industrial partners to develop the three 

main interventions—diagnostics, therapeutics, and vaccines. 

So a moment on therapeutics. You have heard a lot about 

ZMapp. It is a combination of three artificially-produced antibodies 

directed against the Ebola virus. 

The results in an animal—in this case, monkey model—have 

been really quite striking, and as I will get to in a moment it has 

been given to seven humans, the first time it has been in human. 

It is the responsibility and the mandate of the NIH when more 

of this becomes available to strike the delicate balance of getting 

it to people who need it and at the same time proving that it is 

safe, that it really does work and if it does, how well does it work 

and does it, in fact, hopefully not have any paradoxical harm. 

Also shown on this slide are a couple of other interventions that 

you will be hearing about or have heard about again. All did well 

in an animal model and now are either in or getting ready to go 

into Phase I trials—things like novel drugs that interfere with the 

reproductive process of the virus or small molecules that interfere 

with the replication of the virus. 

This is a series of press releases regarding the ZMapp and you 

know there have been anecdotal data that it works. We are very, 

very pleased and gratified to have our colleague, Dr. Kent Brantly, 

with us today who received this. 

Whether or not that was the deciding factor, we hope so and we 

hope to be able to prove it, but we don’t know that right now and 

that is why a clinical trial is important. 

And then, finally, the issue of vaccines. We have been working 

on vaccines for Ebola for several years and incrementally have 

done better and better in an animal model and even gone into 

Phase I. The most recent one is shown on this first bullet. It is referred to as the NIAID/GlaxoSmithKline candidate. 

It is not the only vaccine candidate but it is the one that we have 

actually just started now, and as I know I have mentioned to this 

committee before, you go from an animal preclinical to a Phase I 

in human. If it is safe and it proves to be immunogenic, you then 

expand the trial to be able to find the important information—A, 

is it safe, B, does it work, and C, does it do no harm. 

And, again, it will be the delicate balance of determining that at 

the same time that we actually make it available to the best extent 

that we can, and in this regard on September the first human received this at the NIH in Bethesda, Maryland in a 20-volunteer 

study. This is a little bit outdated. 

We injected the 13th volunteer about 1 hour and 45 minutes ago 

up at the NIH, and we are hoping to get to 20, and the data will 

be available by the end of November or the beginning of December. 

So in summary, members of the committee, the NIAID research 

has a dual mandate. For years and years, we continually do robust 

26

and basic clinical research to be able to fulfill and determine pathogenic mechanisms and microbiology in infectious diseases. 

Despite this effort every day, every week, every month, we still 

stand prepared at a moment’s notice to respond to surprising 

emerging and reemerging infectious diseases and this is exactly 

what happened with the reemergence of Ebola in west Africa. 

So we stand prepared for this pandemic and, hopefully, for anything in the future. Thank you. 

[The prepared statement of Dr. Fauci follows:]

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Mr. SMITH. Dr. Fauci, thank you so very much for your testimony 

and your leadership. 

Dr. Borio. 

STATEMENT OF LUCIANA BORIO, M.D., DIRECTOR, OFFICE OF 

COUNTERTERRORISM AND EMERGING THREATS, OFFICE OF 

THE CHIEF SCIENTIST, U.S. FOOD AND DRUG ADMINISTRATION, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Dr. BORIO. Good morning, Chairman Smith, Ranking Member 

Bass and members of the subcommittee. Thank you for the opportunity to appear before you today to discuss FDA’s actions to respond to the Ebola epidemic in west Africa. 

This epidemic, with so many lives lost, is heartbreaking and 

tragic. My colleagues and I at the FDA are fully dedicated to doing 

all we can to help end it as quickly as possible. 

The primary approach to containing this epidemic remains standard, tried and true public health measures, but effectively implementing such measures on a broad scale has proven challenging, 

and I know the professionals caring for patients with Ebola are 

doing all they can under very difficult conditions. 

They are operating in a setting of very limited healthcare infrastructure which has made it almost impossible for them to provide 

supportive medical care, such as intravenous fluids and electrolytes, for the large number of patients who need them, and this response is further complicated by the lack of specific treatments or 

vaccines that have been shown to be safe and effective for Ebola. 

In situations like this, the FDA plays a very critical role. We 

have one of the most flexible regulatory frameworks in the world 

and we are working diligently to facilitate and speed the development, manufacturing, and availability of investigational products 

such as vaccines, therapies, and diagnostic tests. 

We are providing FDA’s unique scientific and regulatory expertise to U.S. Government agencies that support medical product development, agencies such as Dr. Fauci’s at NIAID, BARDA, and the 

Department of Defense. 

We are working interactively with companies to clarify regulatory requirements to help expand manufacturing capacity and we 

expedite the review of data as it is received so there is no lag between receiving data and reviewing data. 

As a result, the vaccine candidate being co-developed by the 

NIAID and GlaxoSmithKline began Phase I testing on September 

2 and a second vaccine candidate is expected to begin clinical testing very soon. 

We will continue to work closely with all of these companies, 

again, to speed development of their products. In addition, we are 

collaborating with the WHO and working with several of our international counterparts, including the European Medicine Agencies 

and Health Canada, to exchange information about investigational 

products for Ebola and considerations for their deployment in west 

Africa. 

It is important to note, though, that these investigational products are in the earliest stages of development. For most, only small 

amounts have been manufactured for early testing. This constrains 

43

options for assessing their safety and efficacy in clinical trials and 

for wider distribution and use. 

Access to limited the supplies of investigational products during 

an epidemic like this should be through clinical trials when possible because they provide an ethical means for access while also 

allowing us to learn about product safety and efficacy. 

FDA is working with developers to encourage the conduct of 

practical, ethical, and informative trials so the global community 

can know for sure the risks and clinical benefits of these products. 

But until such trials are established, we will continue to facilitate access to these products when available and when requested 

by clinicians. 

We have mechanisms such as compassionate use which allow patients to access investigational products outside of clinical trials 

when we assess that the expected benefits outweigh the potential 

risks for the patient. 

This epidemic has posed incredible demands on FDA. There are 

more than 200 staff at FDA involved in this response and without 

exception everyone involved has been proactive, thoughtful, and 

adaptive to a complex range of issues that have emerged. 

Developing these products for Ebola is highly complex and will, 

unfortunately, take time. I once again stress that public health 

measures remain the cornerstone of curbing this epidemic and improving the medical infrastructure in the affected countries is critical to save lives. 

Such infrastructure is also essential for advancing product development to meet the global access to vaccines and cures. FDA is 

fully committed to sustaining our deep engagement and aggressive 

response activities. 

Thank you so much. 

[The prepared statement of Dr. Borio follows:]

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Mr. SMITH. Thank you very much for your testimony. 

Dr. Bell. 

STATEMENT OF BETH P. BELL, M.D., DIRECTOR, NATIONAL 

CENTER FOR EMERGING AND ZOONOTIC INFECTIOUS DISEASES, CENTERS FOR DISEASE CONTROL AND PREVENTION, 

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES 

Dr. BELL. Good morning, Chairman Smith, Ranking Member 

Bass, members of the subcommittee and members of other committees. 

I am Dr. Beth Bell. I am the director of the National Center for 

Emerging and Zoonotic Infectious Diseases at the CDC. I appreciate the opportunity to be here today to discuss the current epidemic of Ebola in west Africa, which illustrates in a tragic way the 

need to strengthen global health security. 

I will be updating you on testimony that CDC Director Tom 

Frieden gave before this subcommittee in August when you played 

an important role in calling attention to this emerging epidemic. 

The Ebola epidemic in Guinea, Liberia, and Sierra Leone is ferocious and it is spreading exponentially. The current outbreak is the 

first that has been recognized in west Africa and the biggest and 

most complex Ebola epidemic ever documented. 

As of early September, there were more than 4,500 confirmed 

and suspected cases and over 2,500 deaths, though we believe the 

actual numbers could be at least two or three times higher. 

We have now also seen cases imported into Nigeria and Senegal 

from the initially affected areas and other countries are at risk of 

similar exportations as the outbreak grows. There is an urgent 

need to help bordering countries to better prepare for cases now 

and to strengthen detection and response capabilities throughout 

Africa. 

The secondary effects of this outbreak now include the collapse 

of the underlying healthcare systems resulting, for example, in an 

inability to treat malaria or to safely deliver an infant as well as 

non-health impacts such as economic and political instability and 

increased isolation of this area of Africa. 

These impacts are intensifying and not only signal a growing humanitarian crisis but also have direct impacts on our ability to respond to the Ebola epidemic itself. There is a window of opportunity to control the spread of this disease but that window is closing. 

If we do not act now to stop Ebola, we could be dealing with it 

for years to come, affecting larger areas of Africa. Ebola is currently an epidemic, the worst Ebola outbreak in history, but we 

have the tools to stop it and an accelerated global response is urgently needed and underway, as the President announced yesterday. 

It is important to note that we do not view Ebola as a significant 

public health threat to the United States. The best way to protect 

the U.S. is to stop the outbreak in west Africa. But it is possible 

that an infected traveler might arrive in the U.S. 

Should this occur, we are confident that our public health and 

healthcare systems can prevent an Ebola outbreak here and recogVerDate 0ct 09 2002 13:17 Feb 26, 2015 Jkt 000000 PO 00000 Frm 00055 Fmt 6633 Sfmt 6633 F:\WORK\_AGH\091714\89811 SHIRL
52

nize that the authorities and investments provided by the Congress 

have put us in this strong position. 

Many challenges remain, particularly since there is currently no 

therapy or vaccine shown to be safe and effective against Ebola. We 

need to strengthen the global response which requires close collaboration with WHO, additional assistance from international partners and a strong and coordinated United States Government response. 

CDC has over 100 staff in west Africa and hundreds of additional 

staff are supporting this effort from Atlanta. CDC will continue to 

work with our partners across United States Government and elsewhere to focus on five key strategies to stop the outbreak: Establishing effective emergency operations centers in countries, rapidly 

ramping up isolation and treatment facilities, helping promote safe 

burial practices, strengthening infection control and other elements 

of healthcare systems, and improving communication about the disease and how it can be contained. 

Controlling the outbreak will be costly and require a sustained 

effort by the U.S. and the world community. Within HHS the administration recently proposed that the Congress provide $30 million for CDC’s response during the continuing resolution period and 

for efforts to develop countermeasures. 

Yesterday the President was briefed at CDC on the epidemic and 

announced that the unique logistics and materiel capabilities of the 

U.S. Military will be engaged as part of an urgent and intensified 

U.S. Government response. 

As my colleagues can attest, we are working across United States 

Government to assess the full range of resources that can be leveraged to change the trajectory of this epidemic. 

Working with our partners, we have been able to stop every previous Ebola outbreak and we are determined to stop this one. It 

will take meticulous work and we cannot take shortcuts. 

As CDC Director Tom Frieden has noted, fighting Ebola is like 

fighting a forest fire—leave behind one burning ember, one case 

undetected, and the epidemic could reignite. Ending this epidemic 

will take time and continued intensified effort. 

The tragedy also highlights the need for stronger public health 

systems around the world. There is worldwide agreement on the 

importance of global health security but the Ebola epidemic demonstrates that there is much more that needs to be done. 

In Dr. Frieden’s previous testimony, he outlined new investments 

we are seeking to strengthen fundamental public health capabilities around the globe. If these people, facilities, and labs had been 

in place in the three countries currently battling Ebola, the early 

outbreaks would not have gotten to what we are facing now. 

Stopping outbreaks where they occur is the most effective and 

least expensive way to protect people’s health. I know many of you 

have travelled to Africa to see our work in global health, as have 

I, and we all come away with an appreciation for the enormous 

challenges many people and countries face. 

These may never have been more evident than in the current 

Ebola epidemic. Each day for the past months I have been in personal contact with our teams in the field. Their experiences reinVerDate 0ct 09 2002 13:17 Feb 26, 2015 Jkt 000000 PO 00000 Frm 00056 Fmt 6633 Sfmt 6633 F:\WORK\_AGH\091714\89811 SHIRL
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force the dire need and put real stories and faces on a tragedy that 

can’t simply be reduced to numbers and charts. 

But these stories from the field also reinforce the unique and indispensable role that CDC and our many partners are playing and 

the sense that with an intensified global focus we can make a real 

difference. 

Thank you again for the opportunity to appear before you today 

and for making CDC’s work on this epidemic and other global 

threats possible. 

[The prepared statement of Dr. Bell follows:]

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Mr. SMITH. Thank you very much, Dr. Bell. 

Let me just begin the questioning and then I will yield to my colleagues for their questions. I will throw out a few questions and 

if you wouldn’t mind jotting them down because I do have about 

100. I exaggerate a little bit. 

There has been a lot of criticism about who is in charge. Is it the 

health ministers in country? WHO puts out a lot of press releases. 

Dr. Brantly made an observation, and I think it is a very good 

one, that

‘‘Agencies like the World Health Organization remain bound 

up by bureaucracy. Their speeches, proposals, and plans—

though noble—have not resulted in any significant action to 

stop the spread of Ebola. The U.S. Government must take the 

lead immediately to save precious African lives and protect our 

national security.’’

You know, I know that you might be loathe to criticize WHO but 

we need to know who is actually in charge on the ground. 

Secondly, if I could, the deployment of 3,000 members of the U.S. 

Military obviously, that was weeks, certainly, days in preparation. 

Interagency coordination had to have been a part of that for that 

announcement to be made. I am just wondering if you could tell us 

who will be deployed. 

I will never forget making a trip to the border of Iraq and Turkey 

immediately after the Kurds flocked to that border, and many were 

dying from exposure and disease and Operation Provide Comfort 

was established. 

Within about 5 days a group of us went over there to take a look 

at it and to talk to people, and if it wasn’t for the Special Forces 

and the work they did, and they handed the baton eventually to 

NGOs and others who helped those individual Kurds, but for about 

a month had it not been for the Special Forces, particularly the 

military doctors and others that were there, hundreds if not thousands would have died. So my question is how that force will be 

configured. 

Will it be made up of a significant portion of MDs, nurses, and 

others? I know that we have heard that they will be constructing 

or, I believe, that is one thing they are going to do in Liberia, you 

know, hospital beds or at least places where people can find refuge 

and get help. 

But what will that configuration look like? Dr. Brantly, again, in 

his testimony makes an excellent point, ‘‘For too long, private aid 

group have been confronting this Ebola epidemic without adequate 

international support.’’ Then he says these organizations cannot go 

it alone. 

‘‘A significant surge in medical boots on the ground must happen 

immediately to support those already working in west Africa’’ . . . 

and he goes on in his testimony. How many medical personnel are 

needed? 

How many have been deployed and will this deployment of 3,000 

of our service members be significantly made up of medical personnel? On force protection—and Dr. Fauci, you might want to 

speak to this as well—obviously, when you are dealing with an epidemic and people can contract this disease it gives new meaning 

65

to force protection, you know, all the usual. How many protective 

suits will be needed? 

Do you have adequate access to those suits and gear? You know, 

as Dr. Brantly points out, he took every precaution and he still got 

Ebola. So the question would arise, and I am sure for the individual service members being deployed and their families: Will 

there will be adequate protections? 

Is more money needed? You know, as my friend and colleague pointed out at the Rules Committee the other day, $88 million is 

in the supplemental: Is that enough? 

You know, we should leave no stone unturned to make sure that 

people are protected and hopefully safe from this hideous disease 

but when putting many more Americans into harm’s way, no stone 

should be left unturned in making sure they are protected as well. 

If there are any gaps there, please speak to that. Let me also ask 

you: How do you attract medical personnel to be deployed? You 

know, if they are ordered by way of military, that is one thing. 

But how do you incentivize it? Many of the faith-based groups go 

there and risk their lives, as do the non-faith based, out of pure 

love of African people or wherever it is that they are deployed. 

But now they are dealing with a pandemic. How do you 

incentivize and are people coming forward to go? The range of the 

estimates of infections and, Dr. Fauci, I want you to speak to this, 

is there a possibility or probability that this could mutate into an 

airborne, you know, infection? 

Right now we are told that is not the case but is that a possibility and, again, if you could put any kind of number on how many 

medical personnel are needed to be deployed. You know, I have 

been trying—I read everything I can on Ebola, talk to people nonstop about it. 

I still don’t know how many people—because so much of the infrastructure, as we all know, in west Africa for healthcare has been 

decimated as well as the NGOs that were there early on where 

their personnel have been hurt as well. 

And finally, to Dr. Borio, if you could, at our last hearing I raised 

the issue of TKM-Ebola and the FDA’s suspension of the trials. 

Has that changed? 

I remember reading the company’s information and they were 

kind of surprised. But has that been reversed on that particular 

drug? Ms. Lindborg. 

Ms. LINDBORG. Yes. 

Mr. SMITH. Okay. Dr. Fauci, if you could. 

Dr. FAUCI. No. Actually, Ms. Lindborg was going to, I think, take 

the first question. There were several you asked me for which I will 

be happy to answer but I think Ms. Lindborg is going to take the 

first question. 

Ms. LINDBORG. Let me also offer, Chairman Smith, that it might 

be helpful to come and do a more—even more detailed walkthrough since that seems to be something that is of great interest. 

What I will say is that there is a two-star, General Williams, 

from AFRICOM who arrived in Monrovia yesterday and is already 

beginning to work closely with the DART on detailing out the exact 

configuration of the mission. It will come out of the African Command. 

66

There will be a large contingent of logisticians and engineers, 

medical planners, planners, that will be setting up the fundamental nerve center that will be able to support this overall response. 

There will also be 60 medical trainers who will be operating the 

training facility and critical barriers in moving forward a more robust response have been several key constraints. 

First is there has not been confidence that people could get in 

and out of the region. Therefore, we are looking at laying down the 

significant lift capacity that will serve the entire region. 

Secondly, people are worried because they have been uncertain 

about Medevac in the event that they are ill, and so we are working to increase the reliability and availability of Medevac services 

for health workers. 

Thirdly, they have been concerned about lack of healthcare for 

the health workers, which is why the military is bringing in a 25-

bed hospital for healthcare workers. 

It will be staffed by public health workers, teams of 65 at a time 

out of HHS, and the first of the 13 plane loads bringing that hospital in arrive on Friday in Monrovia. So that will be set up. 

Then finally is the lack of training. It is not so much that you 

need high-level medical expertise so much as there needs to be rigorous, very disciplined infection control. 

Most urgently is a large cadre of basic care workers and part of 

what this training will seek to do is create a pipeline of healthcare 

workers who understand how to minimize the infection and how to 

run a clinic that is absolutely rigorous in following the right kind 

of procedures, and we will be working with MSF to adopt their 

training so that that is available to a larger cadre. 

Finally, there are doctors needed both for the Ebola treatment 

units but also for the larger revitalization of the health systems. 

As Dr. Bell mentioned, this is a problem throughout the country 

and it is training those healthcare providers and those clinics also 

on rigorous infection control because of the stories that we have 

heard of people coming in and being treated for other problems and 

end up you have transmission of the Ebola virus. 

So there is that whole package of issues that when we address 

those, the goal is to unlock greater capacity of organizations and 

healthcare workers who can come in, augmented by this extraordinary capability that the U.S. Military is bringing. 

Mr. SMITH. And we do have sufficient moneys allocated? I mean, 

is there——

Ms. LINDBORG. DoD has requested a $500 million——

Mr. SMITH. Reprogramming? 

Ms. LINDBORG [continuing]. Reprogramming previously and I believe today they will be submitting an additional $500 million. 

Mr. SMITH. Now, is that request being based on what they think 

can be gotten or is it to really get the job done? 

You know, we know that U.N. agencies notoriously underestimate what the cost will be because they think when they put out 

their request to other nations—donor nations—they think that is 

all they are going to get rather that what is the need and then we 

fight like the devil to get that money allocated. 

67

I have had that argument with them for 30 years in Geneva. Ask 

for what is really needed even if we don’t reach it so we know the 

true need. Is what you are asking for what is needed? 

Ms. LINDBORG. Well, that is for the military’s budget. 

Mr. SMITH. Yes, I mean—but also, like, the $88 million——

Ms. LINDBORG. The $88 million, and USAID has allocated $100 

million from our budgets. We think so for at least the initial response but this is unprecedented. This is new territory for all of us. 

And so as we lay down this urgent scaled response we will be 

closely monitoring to see what impact it makes and what else we 

might need. 

Mr. SMITH. Gotcha. Dr. Fauci. 

Dr. FAUCI. So let me answer the question about this potential 

scope, which is important because there is a lot of confusion about 

that. 

So the issue is—the question that is asked and that sometimes 

frightens people: Is it possible that this virus would mutate and 

then by the mutation completely change its modality of transmission, mainly going from a virus that you get by direct contact 

with bodily fluids to a virus that is aerosolized, so if I am talking 

like this I can give it to Ms. Lindborg or to Dr. Borio? So let me 

explain to you how that possibly could happen and why I think it 

is unlikely, but not impossible. 

Ebola is an RNA virus and when it replicates it replicates in a 

sloppy way. It makes a lot of mistakes when it starts trying to duplicate itself. Those mistakes are referred to as mutations. 

Most mutations in this particular situation are irrelevant. Namely, they don’t—they are not associated with a biological function 

that changes anything. 

They just mutate and it is meaningless. Every once in a while, 

rarely, a mutation, which is called a nonsynonymous mutation—

that is what scientists call it—does have a change in biological 

function. 

That change, if it occurs—if you historically look at viruses that 

mutate, it generally, if it changes the function, modifies an already 

existing function. It makes it either a bit more virulent or a bit less 

virulent. 

It makes it a little bit more efficient in spreading the way it usually spreads or a little less efficient. What it very, very rarely does 

is completely change the way it is transmitted. So although this is 

something that is possible, and I need to emphasize because whenever I try to explain it people might think I am pooh-poohing it. 

I am not. It is something we look at very carefully and we actually have grants and contracts with organizations like the Broad 

Institute in Boston which very carefully follow the sequential evolution of the virus to alert us if in fact this is happening. 

So A, we take it very seriously, B, it is something that we look 

at and that we follow closely. But we don’t think it is likely to happen. So I would rather that I lose sleep and Dr. Borio and Ms. 

Lindberg and Dr. Bell lose sleep over that, but not the American 

public lose sleep over that because we are watching it very carefully. 

Having said that, what is likely, and this gets to everything we 

are talking about, is that if this virus keeps replicating and keeps 

68

infecting more and more people, you are going to give it more of 

a chance to mutate. 

So the best possible way that we can take that off the table is 

to actually shut down this epidemic and if we do, as I always say, 

a virus that doesn’t replicate doesn’t mutate. So if you shut it down 

then that thing is off the table. I hope that was clear. 

Mr. SMITH. And your best case estimate on September 17th, 

what this could evolve into? I mean, exponential was used several 

times during your statement. 

Dr. FAUCI. Well, Mr. Chairman, the estimate is going to be directly related to our response because it is kind of a race. 

If our response is like this and Ebola is going like that, as I said, 

this is going to win all the time and that is the reason why we are 

excited and pleased to hear that the President came out and said 

what he did and we are going to see the things that Ms. Lindborg 

and others have been talking about because once you get over that 

curve then you start to see the epidemic coming down. 

Now, that could be within a period of a few months if we really 

put a full court press on. If we fall behind, it could go on and on. 

So it is almost impossible to predict without relating it to the degree of your response. 

Mr. SMITH. Dr. Brantly calls for a surge of medical boots on the 

ground. How many U.S. medical personnel are now in the impacted 

areas and how many do you think will be there in the next month, 

how many the next several months? I have been trying to get a 

handle on that for some time. 

Ms. LINDBORG. So one of the things we are doing is supporting 

a worldwide call, this is really going to be an all hands on deck response. 

The African Union has mobilized 100 health keepers, which is 

doctors, nurses, and other health clinicians, and the U.S. is supporting their mobilization. Their advance team is on the ground 

right now led by a Ugandan doctor who led the Ebola response in 

Uganda. 

The Chinese have mobilized medical personnel and the U.K. and 

EU are both contributing facilities, labs and funding. So we will 

continue to mobilize. One of the questions is how many of these 

Ebola treatment units we will need. 

Each Ebola treatment unit, according to the MSF model, takes 

about 216 people, the majority of whom are basic healthcare providers, basic care providers, augmented by, you know, a chief medical officer, a lot of infection control logistics, water sanitation—

those kinds of management capabilities. 

So what we are seeking to do is to create a pipeline of the 

trained medical care providers with this 500-a-week training facility augmented by additional support, training and direct provision 

of that management infection control piece because ultimately the 

most important thing is it is rigorous, disciplined, almost command 

and control of the——

Mr. SMITH. All right. If I could just get back to that. How many 

medical boots on the ground do we have as of today—U.S.? 

Ms. LINDBORG. We have—we are focused right now not on the direct care but rather on providing the system that can enable a fullthroated response. 

69

We have supported organizations like International Medical Care 

and we are in discussions with several other organizations that will 

bring—International Medical Care has a 60-bed unit that they 

have stood up and it is a combination of medical and other personnel that are needed to make each one of these Ebola treatment 

units functioning. 

Mr. SMITH. But we do have doctors and nurses on the ground? 

Ms. LINDBORG. Correct. 

Mr. SMITH. Could you get back to us if you can find that number? 

Because, you know, I understand the training component and that 

is extraordinarily important. 

But we know that there must be, including in the military deployment, a number of doctors and nurses that will be a part of 

that. Just to know what our commitment is on that side of it. 

Ms. LINDBORG. Yes. And it is part of a much larger number. We 

will get you—we will get you the break out of what the 25 percent 

are, the 115 people already in the region and the 3,000 who are 

being mobilized. 

Mr. SMITH. And anyone else? Yes, Dr. Bell. 

Dr. BELL. I was—thank you, Chairman Smith, and I actually just 

wanted to mention that I led the field team in New Jersey during 

the 2001 anthrax attack so I know your district, actually, quite 

well from the old days. 

I just wanted to say a couple of other things about this training 

pipeline, to build on what Nancy was saying and to make a couple 

of these important points—that the majority of the workers are 

local workers but there is a need for some nurses and doctors and 

more higher-trained healthcare workers and we have at CDC, 

working with MSF, established a training program which will be 

held in Anniston, Alabama, every week. 

It is a 3-day program which is meant to build a pipeline of U.S. 

healthcare workers that are getting ready to deploy to the region. 

Our first training, will begin next week and is already full at something like 40 healthcare providers. 

So, as Nancy says, we need sort of a very multifaceted and multi 

disciplinary approach to addressing the problem and at our end 

here at CDC we have had the—we will have these series of classes 

every week for the foreseeable future to help build that pipeline. 

Mr. SMITH. Just two final questions. The deployment of 3,000, 

when will the full contingent be actually in theater and, again, to 

reassure not only those who will be deployed but their families, will 

they have the protective gear in adequate numbers from masks and 

the like to ensure that they do not contract the disease? 

And, Dr. Borio, if you could, speak to the issue of the TKM-Ebola 

and whether or not the suspension has been lifted so that the trial 

can continue. 

Dr. BORIO. So, Mr. Chairman, I am unable to discuss the specific 

product today but what I can tell you is that clinical hold issues 

it is based on our assessment of the benefit risk profile for a proposed clinical study. 

So whereas a product may be on clinical hold for a specific study, 

it may not be on hold for different types of studies. 

For example, sometimes the dose or frequency proposed in a 

study does not allow us to believe the benefits will outweigh the 

70

risks. In addition, sometimes we put a study on hold because of adverse events that are identified immediately after, you know, using 

the drug in the first few volunteers. 

Another reason for a study to be on hold has to do with the patient population that is being studied on that particular proposed 

study. So there are many reasons for a study to be on hold. 

It is rare that we are not—well, in situations where a study is 

on hold we will work the company very closely, especially in a situation like this with Ebola, to be able to make sure that we can design the studies where the benefit-risk balance would be more appropriate. 

Mr. SMITH. Again, are there cross conversations? You mentioned 

how flexible FDA is, like with NIH and others. I was shocked when 

that hold was placed because I read a lot about the drug. 

It doesn’t make me an expert, but there were some encouraging 

signs and when you only have three or so drugs in the pipeline that 

is not a large universe. 

Dr. BORIO. We are working very closely with our colleagues at 

the NIH, at BARDA, DoD, as well as all the different companies 

that have products of interest to the U.S. Government to do all we 

can to move the development programs forward as fast as we can. 

Mr. SMITH. Okay. Again, Ms. Lindborg, do we know when the 

3,000 will actually be there? You know, I know they will be going 

in components but when fully will they be deployed? 

Ms. LINDBORG. They are going in components and I will just 

quote General Dempsey, who said they will move as fast as they 

possibly can until they hit the laws of gravity. 

Mr. SMITH. Okay. 

Ms. LINDBORG. So they are fully seized and deployed. 

Mr. SMITH. And fully protected? 

Ms. LINDBORG. Yes, and if—I just want to underscore one other 

point in response to your questions and that is we are continuing 

to conduct outreach efforts so that we can find other medical workers—doctors, nurses, and physicians assistants—who are interested 

in working with organizations who are responding and that is the 

Web site, usaid.gov/ebola, and with the training that is available 

and the pipelines of this critical gear that the response will provide 

of PPE, et cetera. 

Mr. SMITH. Thank you. Dr. Bell. 

Dr. BELL. Mr. Chairman, just to your point about will the force 

be adequately protected, I just wanted to say that, you know, at 

CDC we have over 100 young trainees, many of them in the field, 

and so we have worked very hard on the sort of information people 

need ahead of time—very, very clear delineation of the sorts of protective equipment, things to do to protect yourself, and what to do 

when you are in a situation that you think is perhaps not as safe 

and secure as it should be. 

And so this is the sort of information that I think we have 

spent—actually, quite a while now we have had people in the field 

sort of perfecting and it is the sort of thing, I think, that can be 

used with the military. 

We all want to make sure that people are as safe as humanly 

possible. The other thing I see off of my list of questions I just 

wanted to address your question about the funding and to just say 

71

from the CDC perspective that the $30 million is enough to get us 

through the continuing resolution and allow us to keep our people 

in the field but that we are going to be considering during the period of the CR, what additional funding we might need for the rest 

of the year. 

Mr. SMITH. Thank you, Dr. Bell. You know, in a conversation I 

had with the President of Guinea, who has deployed his military, 

I was concerned about how well-protected they were, you know, 

when they rush in to be of assistance and then all of a sudden they 

find themselves contracting the disease. 

So and I am very concerned about our military as well. I would 

like to yield to Ms. Bass. 

Ms. BASS. Thank you, Mr. Chair, and I would like to begin by 

asking a question on behalf of my colleague, Mr. Cicilline, who had 

to leave and in his opening statement he mentioned that many of 

his constituents are from Liberia. 

So his question is the current extension of deferred enforced departure for Liberians living legally in the U.S. is scheduled to expire at the end of the month and apparently this summer several 

Senators sent a letter to President Obama asking him to end the 

uncertainty, especially given the current crisis. 

And so even though this is an issue under the jurisdiction of 

USCIS, he was wondering if you know whether the administration 

is really taking into account the health crisis if many of these individuals would have to return home. 

Dr. BELL. Thank you, Congresswoman Bass. As I testified yesterday before the Senate HELP Committee and Senator Reed asked 

a similar question, as you say, this is an important issue in Rhode 

Island and other parts of the country as well, and actually my deputy participated in a number of briefings and town hall meetings 

on this topic. 

This is a humanitarian issue, we agree, but we don’t have any 

further information about what is happening from the perspective 

of the Immigration Service on this topic. Do you have any information, Nancy? 

Ms. LINDBORG. We will take that question. We are coordinating 

closely across the interagency that is a State Department question. 

We will take it and get back to you. 

Ms. BASS. Okay. All right. Thank you. And then I, in speaking 

to a number of my colleagues yesterday as we were preparing for 

this member briefing tomorrow, several of them mentioned to me 

their concerns about the virus mutating and becoming airborne, 

and I am not sure if those came up in the questions before. Oh, 

they did? 

Mr. SMITH. They did. 

Ms. BASS. Yes. You raised it? Okay. Well, maybe you could explain why that is not a concern. 

Dr. FAUCI. Well, I wouldn’t say it is not a concern but it is not 

an overwhelming concern. 

Ms. BASS. Okay. 

Dr. FAUCI. As I mentioned, and I will just very briefly summarize 

what I said when you were out, Ms. Bass, that this is a virus that 

continually replicates and makes a lot of mistakes. 

72

It mutates, and the overwhelming majority of the mutations are 

irrelevant. They are not associated with any change in function of 

the virus. Rarely, occasionally, you will get a mutation that actually does have a biological function. 

Now, that could be that it evades the diagnostic or the mutation 

makes it a little bit more virulent or a little bit less virulent. It 

makes it a little bit more efficient in being transmitted or a little 

bit less efficient. But it would be distinctly unusual, underline, not 

impossible——

Ms. BASS. Right. 

Dr. FAUCI [continuing]. For it to completely change the way it is 

transmitted. In fact, of the many, many viruses like HIV that replicate in millions and millions of people and mutate a lot, you don’t 

see a change in the way it is transmitted. 

Now, having said that, we have contracts and grants with organizations that do continuing phylogenetic sequencing which means 

they trace the evolution. 

So we are looking at that very, very carefully and thus far with 

all of the infections and all the mutations we have not seen any 

indication of any modification of biological function associated with 

the mutations. 

So, again, although it is not something you can completely rule 

out, it is not something that I would put at the very top of the 

radar screen and say this is something that is occupying all of my 

concern. Having said that, the easiest way to avoid that is to stop 

the infections which will then stop the mutations and then you 

won’t have to have the discussion we are having right now. 

Ms. BASS. So it is safe to say that in previous outbreaks that has 

never happened? 

Dr. FAUCI. Right. Right. 

Ms. BASS. Okay. Thank you very much. I yield back my time. 

Mr. SMITH. Dr. Burgess. 

Mr. BURGESS. Thank you, Mr. Chairman. And Dr. Fauci, along 

those lines, now 10 years ago in the language of avian flu I remember the discussion was genetic drift and genetic shift—genetic drift 

being why we have to have a new flu shot every year because there 

are little changes that occur and then genetic shift would be one 

of those major changes that would occur in—say avian flu, the 

transmissability from human to human where it hadn’t been occurring before. 

Is that the same sort of thing you are talking about here? 

Dr. FAUCI. A bit different, Dr. Burgess. It is a bit different because when we talk about a drift we are talking about the immune 

response that the body has made to previous viruses and when it 

drifts a bit it doesn’t change much in its fundamental way that it 

is transmitted. 

How it changes is that it evades your already existing immune 

response or the immune response that a particular vaccine might 

induce. A little bit it drifts. It doesn’t change. 

A shift is that it is so different than the previous virus that you 

don’t have any background immunity to it. So when you have a 

new pandemic like the H1N1 2009 influenza, except for people who 

were alive and well back in the late 1960s, early 1970s, mid-1970s, 

most of the young people never had seen a virus like that. 

73

So they didn’t have any background immunity. Did that mean it 

changed the way it was transmitted? No. Flu is a respiratory-borne 

virus whether it is a pandemic flu or a seasonal flu. 

The actual shift means that it was so different than anything 

else that you experienced that you don’t have any background immunity which makes it much easier for it to turn into a pandemic. 

Mr. BURGESS. Okay. Thank you for the clarification. 

Now, we have got CDC, FDA, NIH, and USAID today because we 

understand from yesterday’s speech by the President, Department 

of Defense is involved and we have heard Department of State 

mentioned today. 

So I guess my question is, and this may be fundamentally naive 

as far as the function of government, but who is in charge? Who 

is in charge of our response to what is happening in Western Africa? 

Is it the CDC? Is it the State Department? Is it now going to be 

Department of Defense? Who is our go-to agency as far as who is 

in charge? 

Ms. LINDBORG. So the U.S. Military is working in support of 

USAID on the ground. This is very similar to the approach that 

Chairman Smith noted. We worked in the Philippines just recently. 

There are task forces in each of the critical agencies that are enabling CDC, HHS, State Department, USAID to organize across 

our agencies to mobilize for the best response. 

USAID is leading the U.S. interagency response as part of the 

worldwide efforts led by the U.N. in support of sovereign nations—

Liberia, Guinea, and Sierra Leone—working very closely across 

those task forces and with the NSC. 

Mr. BURGESS. So things are already—things are already tough. 

If they get a lot tougher USAID is who we call? If things go really 

bad, who do we pick up the phone and call? 

Ms. LINDBORG. Yes. 

Mr. BURGESS. USAID? All right. So noted. I will put you on 

speed dial. 

You know, we heard through some of the discussion—I guess, Dr. 

Fauci, this will be to you is that, you know, previous episodes this 

virus has burned itself out. Is there still a possibility, even with 

your rather frightening exponential graph that you showed us, is 

it still possible that at some point this episode will burn itself out? 

Dr. FAUCI. It is more than possible. That is what we are all striving for. The escalation—it was very clear that the rate of increases 

of cases that we were seeing, particularly in the densely populated 

areas where instead of two or three contacts you have 30, 40, 50, 

70 or 100 contacts, that the growth of it was outstripping even our 

ability to increase it at incremental levels. 

So that is the reason why, as I mentioned, Dr. Burgess, when the 

President made this announcement that it is going to be a sea 

change. It is not going to be an increment, it is going to be a major 

change in how we approach this with a considerable amount of resources—not only direct resources of healthcare but home kits, 

home care components, education components. 

It is a very comprehensive package that the President announced 

at the CDC yesterday. So if we implement that, which I believe we 

will—I hope we will—I think there is a very good chance that it 

74

is not going to happen tomorrow and it is not going to happen next 

month but that we are going to turn this around. But it is going 

to require that really accelerated effort that the President spoke 

about yesterday. 

Mr. BURGESS. Well, Dr. Fauci and Dr. Borio, let me ask you as 

well, being representatives for the Food and Drug Administration, 

Dr. Fauci, I have been to the Galveston National Laboratory. 

I remember right after Hurricane Ike going down there to make 

certain they were okay and hearing about the work they were 

doing on Ebola. Then I was down there I think it was less than 

a year ago. 

So there has been ongoing work. I mean, this—you have known 

of the risk and there has been ongoing work. I guess I am just a 

little disappointed, Dr. Borio, to hear about a clinical hold—I don’t 

know that I had heard that term before. 

I mean, we knew this was out there. We knew this was percolating. U.S. taxpayer resources were being put toward the research 

and development and I guess my question is what does it take to 

get us over that obstacle to where we can put these things in the 

field and begin—and begin clinical trials. Instead of talking about 

clinical holds let us talk about clinical trials. Let us talk about 

breakthrough designation. Let us talk about making things available. Can either of you speak to that? 

Dr. BORIO. Absolutely, Dr. Burgess. So for the vaccines, for example—I will give an example—you know, even though they have 

been in development for a number of years when this outbreak—

epidemic began we did not have any of the INDs filed with the 

FDA for the vaccines. 

So I think what you are hearing is really an unprecedented level 

of engagement by the FDA to facilitate the applications for these 

vaccines and to be able to begin clinical trials in record time. 

I can tell the reviewers review the applications in a matter of a 

few days and in addition prior to the application being received we 

work intensely with the sponsors to be able to get them ready for 

this—for the submission. 

So I hope that I conveyed that, you know, so that there is no 

doubt that we are doing all we can to be—to exert not only maximum flexibility but also to speed development and to engage very 

actively with all the developers, government partners, and the companies. 

So the clinical hold that—the clinical hold situation that I was 

asked, again, all of our decisions are based on the science we have 

available and with the interest of public health in mind and we are 

working with every one of the developers to move their programs 

forward. 

But there are situations where if the risk is believed to outweigh 

the benefits based on the available science we—it is called a clinical hold. We basically tell the sponsor that the study cannot proceed in volunteers at this moment until some adjustments are 

made and the benefit-risk profile is more favorable. 

Mr. BURGESS. There is a broad understanding at the Food and 

Drug Administration that this is no ordinary time, correct? 

Dr. BORIO. Absolutely. I think, as I mentioned in my testimony, 

there are more than 200 people at the FDA who are engaged in 

75

this response and working very actively with the developers. There 

is no question in my mind that it is all hands on deck and everybody is very aware of the gravity of the situation and very determined to do all they can to help mitigate it. There is no question 

about that. 

Mr. BURGESS. Mr. Chairman, I realize that I am a guest on your 

committee and I wasn’t going to bring this up but you did—you 

said you were loathe to criticize the World Health Organization but 

then you went ahead. 

So, Dr. Bell, not really a criticism but observation and then, of 

course, this goes back several years—if it were not for the CDC the 

global outreach and response network of the World Health Organization would be pretty thin. 

Now, I talked to the folks at the CDC right at the end of July. 

Someone there told me you had 30 people that were getting ready 

to deploy to western Africa. 

I believe I have that number correct. And Chris Smith talked 

about, you know, the surge of people that are needed in the 

healthcare field. But we also recognize healthcare personnel are 

under special risk in this outbreak. 

Are you all the go-to people for that preliminary training for people who are going to western Africa to mitigate that risk somewhat 

and to minimize that risk to the extent that it can be minimized? 

Does that fall to CDC or is that actually a World Health Organization jurisdiction? 

Dr. BELL. Thank you, Dr. Burgess. I think, as Nancy mentioned, 

the scale of this problem is such that we are going to need many, 

many different partners assisting. 

On the topic of training and infection control, I think, first of all, 

the good news is I think because of the leadership of MSF we have 

actually a very clear and very tried and true protocol or method for 

minimizing risk to healthcare workers when they are treating 

Ebola patients. 

I believe that there is something like 450 MSF workers who have 

been working in west Africa and we have seen no infections so far, 

thank goodness, in those healthcare workers. 

So it is impossible to drive the risk to zero, obviously. There are 

extremely difficult conditions but we do have, I think, a good 

framework for training. As I mentioned, we at CDC we sort of have 

the public health lead, as you well know, in this response and in 

many others and given the importance of infection control as part 

of the public health response we have been ramping up our efforts 

in many spheres around infection control as we work to stop the 

outbreak and one of them is to have taken a leadership role among 

others to build this pipeline of training in safe—how to work safely 

in an Ebola treatment unit. 

As I mentioned, we have this course that we have put together 

in collaboration with MSF which we think will help with building 

a pipeline of U.S. healthcare workers who are going to be deploying 

to the region. 

But as Nancy said, there are many other groups that I think will 

be helping to gather people together to sort of bring to bear the resources that we need to bring to bear in the region. 

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I do think that we have the sort of training that is necessary in 

order to minimize that risk and that is a training that can actually 

be sort of spread and propagated in any other venues where training might occur. 

The same is true in-country. As Nancy mentioned, there is a very 

large need for basic infection control in healthcare facilities. As I 

mentioned, the healthcare system is really completely collapsed 

and this was largely because healthcare workers were seeing patients who turned out to have Ebola. They didn’t realize that. They 

have no protective equipment. 

They have no understanding of infection control. They don’t know 

what safe triage means and therefore, tragically, many of them got 

infected and the facilities closed. So this is another large priority 

on the topic of infection control that we and many other groups are 

working together. 

We would like to see an infection control practitioner in every facility in Liberia, for example, similar to the way we deal with infection control here in U.S. hospitals. 

Mr. BURGESS. Mr. Chairman, fascinating panel. You have been 

most courteous. I will yield back. 

Mr. SMITH. Thank you very much, Doc. Ms. McCollum. 

Ms. MCCOLLUM. Thank you. We hopefully will have someone 

from the Department of Defense who can maybe inform members 

more at the co-briefing we are doing with the Global Health Caucus along with you and Ms. Bass to have maybe some of those 

questions answered. 

But my understanding is, first and foremost, we need staging 

areas. We need, you know, places where people can be treated and 

so the DoD is bringing in a wave of engineers and those engineers 

for the most part will not be coming into contact with patients or 

people who are ill, and the DoD has a great medical staff. 

I mean, infectious disease is something that they are—they have 

their own research. They collaborate with the CDC, the NIH, everybody—the Department of Health. They all work together on 

this. 

So I am fairly confident that AFRICOM has a good handle on the 

first wave that is going to come in because if we don’t have the infrastructure, and that is the boots on the ground—it is building, 

the framing up the hospitals and all that will be really, really important and then our soldiers will get really excellent training before going in. 

But the first wave going in for a lot of what we are talking about 

they are not going to be coming in contact, and you are all kind 

of shaking your heads yes. So I just wanted to kind of say that DoD 

knows when it is trained to this. 

And so one of the things that I think you pointed out as, you 

know, you all kind of have a hierarchy. You have your own special 

responsibilities. You are getting together. This is an emergency and 

you are talking amongst yourselves quite a bit. 

But I want to just kind of talk about some secondary impacts. 

We touched on a little bit about what is, you know, happening with 

maternal-child health, what is happening with people who maybe 

have been diagnosed with cancer, tuberculosis, HIV/AIDS—all of 

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those critical resources in healthcare systems that we have been 

working to make better in these countries. 

Now people are not being able to access that kind of a treatment 

especially in some of the countries where the Ebola has gone. So, 

for example, in Guinea, Sierra Leone, and Liberia are large poor 

populations, limited access to clean drinking water, basic infrastructure, other public health services. 

One of the things that has come up time and time again—how 

farmers are not out in the field, how we are expecting a major food 

crisis—this is already—many countries, as I pointed out, with some 

of the very poor people whose health is fragile as it is what are 

some of the things we should be looking from the international 

community to supplement the work that you are doing from the 

World Bank, from the African Development Bank, from the, you 

know, World Food Programme? What are some of the things that 

we should be thinking of next step? 

Ms. LINDBORG. Great. Thank you. And I would just fully agree 

with you and reiterate that what DoD is fundamentally bringing is 

their unique capability of having a scaled, fast response that sets 

that framework up, as you said. 

On the second order impacts, this is very important to pay attention to and we are coordinating closely with the World Bank, IMF, 

African Development Bank, all of which are preparing economic 

support packages. 

We are also looking at ensuring that health workers’ salaries are 

paid during this critical period where you need people to continue 

to come to work at a time where there is the threat of total collapse. We are working throughout the region on preparedness. 

Countries that border throughout west Africa are increasingly 

concerned and so we have teams working to help them strengthen 

their health systems and be more prepared in the event that there 

is a case that appears. 

Malaria, especially as we come into the rainy season, is a particular threat so there is an increased effort among all of the agencies—UNICEF, USAID, CDC—who participate—WHO—who participate in the stop malaria efforts to ensure that there is a redoubled effort and a coordinated effort to get bed nets into the most 

affected areas. 

One of the most important issues is, first of all, controlling the 

outbreak and as a part of that enabling people to have the kind of 

information that can reduce the fear level because they are better 

equipped to protect themselves. 

Since it isn’t an airborne disease, there are measures that families and communities can take to protect themselves so that commerce and regular activities can resume, borders can stay open, 

and economic activity is not brought to a standstill. 

So these are all part of that secondary impact piece of the strategy that we are very focused on, working with these global partners. 

Ms. MCCOLLUM. Thank you. 

Mr. Chair, much has been said about vaccines and having a vaccine is critically important. But making sure that we go through 

the same clinical trials that we would for anyone in the United 

78

States or in Europe, for that matter, before a vaccine is widely disbursed is critically important. 

To rush into this and not have it tested by sex, age, health condition, and blanketly using a vaccine that is not ready to go will discredit and make people more fearful of some of the vaccines and 

preventions that we currently have in the field and there is—there 

is grave concern from some in Africa, and I have heard it from 

some of the population here, that Africa not be a testing ground, 

that their African brothers and sisters and relatives have stuff that 

has been safely vetted to the best of scientific ability. 

There is always going to be, you know, human error and things 

that don’t go the way we quite planned. So I know that there is 

a lot of pressure but I, for one, think it is really important that we 

follow the science and that we do this safely so it could be done 

effectively. Thank you, Mr. Chair. 

Mr. SMITH. Thank you very much. Before yielding to Mr. Wolf, 

I would just point out that TKM-Ebola is a treatment and we have 

such a limited universe of treatments available. Even Dr. Brantly 

took a risk in taking ZMapp. I am not suggesting that we bypass 

the safety, and the efficacy remains an open question, but I am still 

bewildered as to why TKM-Ebola has this hold. I would like to 

yield to the distinguished chairman of the Subcommittee on Commerce, Justice, Science, and Related Agencies Congressman Frank 

Wolf. 

Mr. WOLF. Thank you, Chairman Smith. 

One, I want to thank Mr. Smith for having this hearing and 

being really one of the first here in Congress doing it at the end 

before the Congress went away. The other thing I just felt like saying as I was listening at the other hearing too, two groups—MSF, 

every time they travel everywhere you go they are there. 

They are in little villages, they are in places and Samaritan’s 

Purse, which is a Christian group run by Franklin Graham who, 

quite frankly, I think at one time was even disinvited from an 

event that this administration had somewhere because he might 

have wanted to pray at a prayer breakfast—I forget what it was—

two groups, MSF and the Samaritan’s Purse, have been out in the 

front before our Government was and I want to personally thank 

MSF, all of their people. 

They—and I think we should be thanking them, all of them, and 

also Samaritan’s Purse and all of their people for what they have 

done because they have been out in front of everyone and, Mr. 

Smith, and Samaritan’s Purse people calling and having a hearing 

back in the summer and I think we should recognize them. 

I know you kept referencing MSF. Thank God for MSF. Thank 

God for Samaritan’s Purse. I think Dr. Burgess made an interesting point. I think you need one person—I want to thank all of 

you for what you do—I think you need one person in the administration so that there is a central point. 

You have the State Department. You have the Health Department. You have the Defense Department. I think Ms. McCollum 

was right—Agriculture would be involved. It would be very difficult 

if you don’t have one person who is the person that they can—not 

that they will do it all, but one place to go to call. 

79

I also think, and that leads me to the question, you probably 

need someone to travel the world the same way that Secretary 

Kerry is, to his credit, asking for people to support the effort that 

is going to be taking place with regard to ISIL and Syria and 

places like that. When I listen to the testimony and read all the 

articles, I only have America and reference periodically to one or 

two other countries. 

Are the other countries giving commensurate with what we are 

giving based on their size and population? China, the Saudis, 

Qatar, Germany, France, England—are they stepping up the same 

way that President Obama stepped up the other day? 

Is Cameron stepping up in England doing that? Is the French 

Government stepping up? Are the Scandinavians stepping up? Are 

the Saudi princes stepping up? Is the Chinese Government stepping up? 

Are they stepping up to the same degree, and I am not going to 

try and embarrass each and every country but are they all cooperating and have they all been asked to do as much as we are? 

Ms. LINDBORG. This is a very important point and what we know 

is that when America leads it sets the frame for others to make a 

bolder and more aggressive response as well. So on the heels of 

yesterday’s announcement there are calls this morning. 

Secretary Kerry has been having meetings as a part of his Paris 

conversations. There will be a U.N. meeting tomorrow on Thursday 

and during the U.N. General Assembly next Thursday there will 

also be a meeting on Ebola. The hope and the goal is that, inspired 

by the response that the U.S. announced yesterday, there will be 

a ramped up response from a large number of international actors. 

We are already seeing some additional more forward leaning responses from the UK. We expect them to make an announcement 

any day now that is quite larger. 

As I mentioned earlier, the African Union has mobilized what 

they call health keepers of 100 health workers who will be travelling to Liberia and we are supporting that effort. The European 

Union has pledged $180 million and there will be more. 

There will be more efforts as a part of the mobilization. So over 

the next week watch for the global response, which we anticipate 

will continue to ramp up. 

Mr. WOLF. Okay. And I would assume, unless you differ with me, 

that you all agree with me with regard to MSF and Samaritan’s 

Purse. 

Ms. LINDBORG. Absolutely, and, you know, we support Samaritan’s Purse in many countries around the globe and are very aware 

of the heroic efforts of Samaritan’s Purse and of MSF, who are on 

the front lines of so many crises globally. 

What is particular about this outbreak is that Ebola has not been 

this kind of a challenge before. There have been small, relatively 

contained outbreaks so there hasn’t been a requirement for largescale global capacity to address Ebola and that has been one of the 

challenges as this particular outbreak jumped borders and went 

into urban areas in countries that were absolutely ill equipped to 

deal with that level of transmission. 

So this will—this will be a sea change in how the global community understands and responds to Ebola. 

80

Mr. WOLF. Thank you, and I want to thank all of you and your 

people, too, the CDC that are on the front lines, and thank all of 

your people for what they are doing and what I know they will be 

doing. 

With that, Mr. Chairman, I yield back. Thank you very much. 

Mr. SMITH. Thank you very much, Chairman Wolf. Just one final 

very brief question. Whose idea was it for this surge? Did it come 

in from an interagency recommendation or was there one person 

who said this is what has to be done? 

Dr. FAUCI. There have been intensive discussions going on at 

various levels and it became apparent to us all that we really needed to have a sea change and that is how it evolved. 

Ms. LINDBORG. So I would say that, as I mentioned earlier, 

USAID through our DART and our Office of Foreign Disaster Assistance is responsible for coordinating the U.S. Government response to disasters overseas. 

Each of the critical agencies here in Washington has a task force 

and we are using that whole of government approach to draw from 

critical resources from across the government and there has been 

a concerted effort working together to identify both the need and 

then the kind of response that is necessary to get ahead of the 

transmission, which has resulted in yesterday’s announcement. 

Mr. SMITH. Thank you for your leadership. Thank you for spending time this morning with us, now afternoon, and we look forward 

to work with you going forward. Thank you. 

I would like to now welcome our second panel, beginning with 

Dr. Kent Brantly, who is a family medicine physician who has 

served since October 2013 as a medical missionary at a hospital in 

Monrovia, Liberia. 

In the spring of 2014, Dr. Brantly found himself fighting on the 

front lines in the battle against the deadliest Ebola outbreak ever 

to occur and was appointed as medical director for what would become the only Ebola treatment unit in all of southern Liberia. 

On July 26, he was diagnosed with Ebola, became the first person to receive the experimental drug ZMapp and the first person 

with Ebola to be treated in the United States. Thank you, Doctor, 

for being here. 

We will then hear from Dr. Chinua Akukwe, who is an Academy 

Fellow and chair of the Africa Working Group of the National 

Academy of Public Administration. 

The Africa Working Group is the leading NAPA’s effort to forge 

lasting partnerships in governance and public administration reform efforts in Africa with the U.S. and African stakeholders. Dr. 

Akukwe was the technical advisor in the design of two continentwide initiatives in Africa, the Communicable Disease Guidelines for 

the Africa Development Bank and the Framework for Achieving 

Universal Access to HIV/AIDS, Tuberculosis and Malaria Services 

for the African Union. He has written extensively on health and development issues and we welcome Dr. Akukwe to the subcommittee. 

We will then hear from Mr. Ted Alemayhu, who is the founder 

and executive chairman of U.S. Doctors for Africa, a non-profit organization that is dedicated to providing support to the continent 

of Africa with regard to volunteer healthcare professionals, donaVerDate 0ct 09 2002 13:17 Feb 26, 2015 Jkt 000000 PO 00000 Frm 00084 Fmt 6633 Sfmt 6633 F:\WORK\_AGH\091714\89811 SHIRL
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tions of medical supplies and equipment, as well as hosting highlevel healthcare seminars involving African First Ladies and panAfrican medical doctors. He is also founder of the African First Ladies Health Summit as well as a key contributor to the formation 

of the African Union Foundation. 

Then we will hear from Dr. Dougbeh Chris Nyan, who is a medical doctor and a biomedical research scientist of Liberian origin. 

He specializes in infectious disease diagnostics and his expertise 

focuses on developing simple and rapid diagnostic tests for detecting blood-borne infections and pathogens. Dr. Nyan is currently a 

scientist at the FDA but he is testifying here in this capacity as 

the head of the Diaspora Liberian Emergency Response Task Force 

on the Ebola Crisis, a conglomeration of Liberian professionals and 

Diaspora organizations in the fight against the Ebola outbreak in 

Liberia and in the region. 

If you could begin, Dr. Brantly, and then we will go to each of 

the distinguished physicians. 

STATEMENT OF KENT BRANTLY, M.D., MEDICAL MISSIONARY, 

SAMARITAN’S PURSE (SURVIVOR OF EBOLA) 

Dr. BRANTLY. Thank you very much, Mr. Chairman. Chairman 

Smith, Ranking Member Bass and fellow guests of this committee 

and fellow witnesses, thank you for allowing me to testify here 

today on behalf of those suffering in west Africa as a result of the 

Ebola outbreak there. 

I would also like to take this opportunity to express my deep 

gratitude to the U.S. Government, particularly to the State Department, and everyone else involved in my evacuation. Thank you for 

bringing me home when I was sick. 

I am a little torn because I have this prepared testimony and my 

personal story and there are so many questions and issues that 

were just raised in the previous panel that I want to address. But 

let me first present my prepared testimony here for you today. 

I began work as a medical missionary, a missionary doctor at 

ELWA Hospital in Monrovia, Liberia in October 2013, as you said. 

Even before Ebola came to our area we worked long hours in challenging conditions to provide quality healthcare to support the 

country’s struggling medical infrastructure. 

Missionary facilities like ours provide between 40 and 70 percent 

of healthcare in sub-Saharan Africa. So it is easy to see why we 

were one of the first to join in the fight against Ebola as it made 

its deadly march into Monrovia. 

In June, we received our first Ebola patients and the numbers 

quickly and steadily increased from that time on. My organization, 

Samaritan’s Purse, took over responsibility for direct clinical care 

of Ebola patients for all of Liberia the following month. 

MSF had been present in Liberia but because of the growth of 

the outbreak in Guinea and Sierra Leone their resources had been 

stretched and they were unable to provide personnel at that time 

for the outbreak in Liberia. 

Ebola is a scourge that does not even allow its victims to die with 

dignity. Most of them suffer a lonely horrifying death. I came to 

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flicts in an even more personal way when I was diagnosed with 

Ebola virus disease on July 26. 

I had isolated myself 3 days earlier when I first felt ill. I had a 

dedicated team of medical professionals who cared for me in Liberia. But even their best efforts could not prevent the virus from 

racking my body with sustained fever, excruciating pain, and vomit 

and diarrhea filled with blood. 

Like the dozens of Ebola patients I had treated, I found myself 

suffering alone, and the men and women who cared for me were 

wearing protective personal equipment that looked like space suits 

and all I could see were their eyes through their protective goggles. 

The only human contact I had came through double layers of 

medical gloves. While in Liberia I became the first human being to 

receive the experimental drug ZMapp. Shortly after receiving 

ZMapp, I was evacuated to Emory University Hospital in Atlanta. 

As a survivor of Ebola, it is not only my privilege but my duty 

to be a voice for those who continue to suffer devastation from this 

horrible disease in west Africa. 

When Nancy Writebol and I were diagnosed with Ebola at the 

end of July 2014, the global media began feverishly reporting on 

the grave situation in west Africa. 

I am grateful for that coverage but it is unfortunate that thousands of African lives and deaths did not warrant the same global 

attention as two infected Americans. Even after this attention, 

when my colleague, Rick Sacra, arrived in Liberia 2 weeks after my 

diagnosis, it was impossible to buy a box of medical gloves in the 

city of Monrovia. 

Agencies like the World Health Organization, as has been mentioned, remained bound up by bureaucracy. Their speeches, proposals and plans, though noble, have not resulted in any significant 

action to stop this Ebola outbreak. 

I was honored to meet with President Obama yesterday and I am 

pleased that the U.S. has now committed to take the lead and provide military and medical resources to fight against Ebola. 

Now we must make those promises a reality if we are to accurately represent the compassion and generosity of the American 

people and reduce the suffering and death in west Africa. 

Just this week, I saw a report that the 160-bed isolation unit at 

my hospital in Liberia is turning away an average of 30 infectious 

patients every day because they don’t have beds. 

Those with other life-threatening diseases are also suffering, as 

Liberia’s already substandard healthcare infrastructure continues 

to collapse under the weight of this epidemic. 

The military assets that have been committed must be mobilized 

as quickly as possible to set up larger treatment facilities, to send 

in skilled personnel and provide logistical support. 

It is also imperative that our Government response be conducted 

in close partnership with nongovernmental organizations that have 

been on the front lines of this epidemic as well as other governmental organizations like the health ministries of the countries 

that are affected and other countries who wish to join in the fight. 

These NGOs that have been involved in the fight, as was mentioned by the Congressman earlier, specifically MSF and SamariVerDate 0ct 09 2002 13:17 Feb 26, 2015 Jkt 000000 PO 00000 Frm 00086 Fmt 6633 Sfmt 6633 F:\WORK\_AGH\091714\89811 SHIRL
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tan’s Purse, are now taking the lead in finding creative interventions to halt the spread of Ebola. 

Past outbreaks have been contained through the identification 

and isolation of infected patients and the tracing of their contacts. 

But the rate of transmission for this current outbreak has rendered 

this approach nearly impossible. 

A large part of the problem is that Ebola-infected people are 

choosing to stay at home because of overwhelming fear and superstition. Family members are caring for these sick individuals at 

home and therefore contracting the disease themselves. 

We now have to educate and equip these home caregivers for 

their own protection. They must be trained in safety measures and 

supplied with basic equipment to protect themselves. 

Ebola survivors can be instrumental in reaching their communities with critical information and resources. As the number of 

survivors increases, employing them as educators and community 

health workers can make them champions in this fight and help restore their dignity while tearing down the walls of fear and stigma 

attached to this disease. 

Admittedly, home-based care is less ideal than treatment provided in an isolation unit. However, Ebola treatment units are 

overcrowded and unable to take new patients at this time. 

If we do not provide education and protective equipment to caregivers now, we will be condemning countless numbers of mothers 

and fathers and brothers and sisters to death simply because they 

don’t want to let their loved ones die alone. 

There is no time to waste in implementing this home-based care 

strategy in addition to the deployment of the resources the President has promised. 

As the current outbreak is on the verge and maybe already over 

the edge of becoming a significant threat to our national security, 

in societies where fear and distrust of authority are the norm many 

still deny that Ebola is real and they actively seek other explanations for the deaths of their loved ones. 

I had one patient in early July who died after 2 days in our isolation unit. As we tried to explain to the family the cause of her 

death, some of her family members, with the help of a witch doctor, 

determined that her death was caused by a curse placed on her by 

her best friend. The family was bent on getting revenge and that 

meant the death of the person they believed had caused the curse 

on their loved one. 

There is a palpable sense of tension on the streets that is 

priming the pump of society for skirmishes that could quickly lead 

to war. The world cannot afford to allow more conflict in this region 

that is home to dictators-in-hiding and terrorist groups. 

This epidemic must be brought to a halt as soon as possible to 

regain order and reestablish confidence in local governments. This 

is a global problem and the U.S. must take the lead immediately. 

The longer we wait the greater the cost of the battle both in dollars 

and in lives. 

We must act immediately and decisively to bring healing and 

stability to the people of west Africa, the African continent, the 

United States and the world. 

Thank you, Mr. Chairman, for allowing me to testify today. 

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[The prepared statement of Dr. Brantly follows:]


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Mr. SMITH. Dr. Brantly, thank you for providing this committee 

the honor of hearing your testimony and for your very significant 

recommendations, particularly in the home healthcare, which has 

not been focused upon enough. 

During Q and A hopefully you will elaborate on some of your answers to some of the questions raised early. 

Dr. Akukwe, thank you for being here. 

STATEMENT OF CHINUA AKUKWE, M.D., CHAIR, AFRICA WORKING GROUP, NATIONAL ACADEMY OF PUBLIC ADMINISTRATION 

Dr. AKUKWE. Thank you, Chairman Smith, and Ranking Member 

Bass and other members of the subcommittee. I think that this is 

a great honor and a privilege to be part of this hearing in the global fight against Ebola, and I must say that it is also a honor to 

share this podium with Dr. Kent because when I saw him walk out 

of that ambulance and into the hospital, I knew that he had sent 

a very powerful message that you can actually survive from Ebola. 

So thank you, Dr. Kent, for all your wonderful efforts. 

While I listened to the first panel I think a lot of what I had intended to discuss have been touched in various ways because my 

discussion is around the idea that we can use this threat of Ebola, 

the global outbreak of Ebola, to strengthen health systems in Africa. 

I think for many of us who spent more than 20 years working 

on HIV/AIDS in Africa, one of the things we learned within the 

first decade is that you cannot really make any dent in the effort 

against HIV/AIDS without addressing some parts of the healthcare 

system and the thing about Ebola, as I have already mentioned, is 

that if you look at the three main countries, two of them just came 

out of war. 

But if you look at all indices of health, Liberia, Sierra Leone, and 

Guinea are always dominate the laggards. They are always among 

the worst ranked for the past two decades, even before the wars 

started, and it is getting worse since the onset of civil war and now 

they are trying to emerge from the civil war. 

And if you look at other indices of human development, Liberia, 

Sierra Leone, and Guinea also have very poor rankings and if you 

look at indices of health systems, Africa really has multiple challenges. 

Liberia, Guinea, and Sierra Leone have very difficult challenges, 

always coming up among the worst ranked, and we do know that 

WHO about 5 years ago indicated that Africa has 24 percent of the 

global burden of disease with only 3 percent of the global workforce. 

So we are dealing with 25 percent disease burden and you only 

have 3 percent of the global workforce. So what you have in the 

situation in Africa is that we have Ebola today. We have 

HIV/AIDS. 

Tomorrow we are going to have another outbreak. So no matter 

what you are doing now, you know, send in people, boots on the 

ground, trying to contain the epidemic, if you don’t address some 

of the lingering issues of a poor health system then you are going 

93

to come back again with this kind of emergency response within 

the next few years as other epidemics come up. 

And we do know that in the late 1970s and 1980s the global coalition that included USAID, U.N. agencies, World Bank, they came 

together and from that infrastructure development had a primary 

healthcare system. 

In many African countries, physically, the only existing health 

systems that you find are those health systems that were built as 

primary healthcare centers, medical centers in the 1970s. 

Not much has changed, and I think what I am calling for is to 

use the opportunity of the Ebola outbreak to reevaluate how we 

can assist Africa to become part of this global health architecture 

that both the Obama administration and the Bush administration 

have actually spent significant amounts of money trying to have a 

situation where all regions in the world are part of this global 

health architecture taking care of emerging diseases and other outbreaks. 

And I agree with what has been expressed today that we need 

to go beyond WHO. We need to make sure that we put together a 

coalition that includes African governments, multilateral agencies, 

global foundations, the academia, organized private sector to look 

at the best ways to address healthcare systems in Africa. 

In my book on healthcare services we did find out that it is not 

easy for Africans on their own to deal with this problem. You probably need a lot of technical assistance—not just money but technical assistance to change the sort of health systems. 

Let me use an example. Technical capacity at continental and regional level—we are happy that the Africa Union set up the health 

keepers program. 

But we do know that Africa needs a lot of leadership at the continental and the regional economic levels to provide technical assistance for some of these very poor African countries that will never 

have the capacity to manage some of these outbreaks like we are 

seeing in Sierra Leone, Guinea and Liberia. 

And in closing, I think that in 2000 the U.S. Congress, the 106th 

Congress, when we were all paralyzed by the response to 

HIV/AIDS, came up with the Global AIDS Trust Fund that 

jumpstarted the global response to HIV/AIDS. It wasn’t a lot of 

money, about $50 million. 

But what it did was that it now allowed the World Bank and 

other multilateral agencies and other stakeholders to begin the 

process of looking at HIV/AIDS from a totally different perspective 

from the regular way of doing things. 

And I think that this is what we probably need at this time from 

the Congress in order to help African health systems be rebuilt in 

such a way that they could become part of the global health architecture. 

Thank you so much. 

[The prepared statement of Dr. Akukwe follows:]

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Mr. SMITH. Dr. Akukwe, thank you very much for your testimony 

and your leadership. 

Dr. Alemayhu. 

STATEMENT OF MR. TED ALEMAYHU, FOUNDER & EXECUTIVE 

CHAIRMAN, US DOCTORS FOR AFRICA 

Dr. ALEMAYHU. Thank you, Mr. Chairman. First and foremost, I 

would like to thank you and Congressmember Bass. You both have 

been the true soldiers for the continent of Africa. 

Every time there has been a pressing need you have been on the 

forefront calling for hearings and showing mutual leadership. So I 

am truly grateful for that. Also, I want to thank my colleagues here 

at the table. Let me read my statement, Mr. Chairman, if you don’t 

mind. 

Members of the United States Congress, it is my deepest honor 

and privilege to come before you this morning in order to show, in 

order to share what I know and what should be done to assist 

Ebola-affected nations in west Africa. 

I, first, wanted to express my sincere gratitude to you, Members 

of Congress, and to the entire Government of the United States for 

giving your fullest attention for this deadly crisis. I would also like 

to thank Dr. Kent Brantly for his extraordinary service for the people of Africa. We are delighted to see him well and alive. 

Mr. Chairman, Members of Congress, I have come before you this 

morning as a son of Africa and a proud citizen of the United States. 

As a son of Africa, I am deeply concerned and heartbroken to see 

my people once again suffer from another deadly virus. 

As you may recall, the HIV/AIDS virus has murdered millions of 

Africans across the continent. I am terribly scared and terrified as 

to what could happen now if we do not act rapidly and decisively 

to stop this deadly virus. 

Mr. Chairman, the Ebola virus does not discriminate. It is killing 

babies. It is killing mothers. It is killing fathers, doctors, and 

nurses and anyone else that is in its way. 

The World Health Organization reports that over 2,400 of my fellow Africans have been murdered by this disease. If we do not act 

rapidly and decisively we could potentially witness tens of thousands of dead bodies across west Africa and possibly even beyond. 

What is happening on the ground, particularly in the Republic of 

Liberia, Sierra Leone, and Guinea is simply heartbreaking. The 

governments of these nations are screaming for help and we must 

respond to their call immediately. 

We must still deploy some of our basis healthcare resources and 

accessories, medical supplies, and equipment immediately because 

they are needed and needed badly on the ground. Items such as 

protective gears, hospital beds, gloves, and masks and gowns are 

in dire need. 

Local healthcare workers are threatened to quit their service if 

their safety is not ensured with the delivery of these items. And 

who really can blame them? According to the World Health Organization, approximately 301 healthcare workers were infected by this 

virus and half of them are dead. 

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fected by this virus. I am speaking averaging one doctor per 50,000 

people or more. This is what I call a perfect remedy for massive 

disaster. 

Once again, the World Health Organization has called for an additional 500 healthcare professionals to be deployed on the ground 

in order to assist effectively with this crisis. 

Mr. Chairman, I can tell you that U.S. Doctors For Africa and 

our partners are ready to help. In partnership with the AFYA 

Foundation of America—the president and chairman is right behind me—and many other strategic partners we are able to mobilize medical supplies and equipment worth tens of thousands of 

dollars and ready for shipment. 

We are also looking into actively recruiting medical doctors and 

nurses to be deployed to Africa. U.S. Doctors for Africa has access 

to medical clinics, telemedicine technology, emergency care units, 

and other personnel. They look to do all of this and can deploy 

them to Africa. 

Mr. Chairman, we need strategic assistance and the sponsors to 

deliver these units on the ground. Thank you, sir. 

[The prepared statement of Dr. Alemayhu follows:]

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Mr. SMITH. Dr. Alemayhu, thank you very much for your leadership as well and later on I will ask you about actively recruiting 

doctors and how well that is going. 

I would like to now ask Dr. Nyan if you could present your testimony. 

STATEMENT OF DOUGBEH CHRIS NYAN, M.D., DIRECTOR OF 

THE SECRETARIAT, DIASPORA LIBERIAN EMERGENCY RESPONSE TASK FORCE ON THE EBOLA CRISIS 

Dr. NYAN. Thank you, Mr. Chairman, and members of this august committee, distinguished panelists, specifically Dr. Kent 

Brantly, to whom on behalf of the people of Liberia and also Sierra 

Leone and Guinea we pay you our deepest respect and to other 

healthcare workers who did not make it through as a result of the 

infection. 

Members of the fourth estate, ladies and gentlemen, I would like 

to thank the organizers of this hearing for the invitation extended 

to Diaspora Liberia Emergency Response Task Force on the Ebola 

crisis to testify on the situation of the current Ebola epidemic in 

Liberia and the subregion. 

We in the Liberia task force from the Diaspora believe that 

through this medium U.S. policymakers will have the first opportunity of hearing about the outbreak from the Liberian perspective 

primarily. 

The Diaspora task force is an umbrella organization which conglomerates Liberian healthcare professional organizations, community organizations, individuals of varying professional expertise including medical doctors, nurses, public health practitioners, pharmacists, biomedical research scientists and engineers, journalists, 

et cetera. 

From the inception of its nationhood in 1847, Liberia has always 

maintained a very special link to the United States of America and 

have always played a major role on the world stage. Also, Liberia 

was always a trusted Cold War ally of the United States. 

Cognizant of this relationship, Liberians have always turned to 

the United States for rescue in times of problems be it economic, 

social or political, now medical. Today, Liberia, along with countries of the Mano River subregion find itself in a situation that is 

occasioned by the current Ebola outbreak. 

This epidemic is dissipating lives, breaking up families as well 

as stigmatizing and traumatizing the country and its people. It is 

no secret that the Liberian healthcare system, as has been discussed over and over, completely collapsed under the pressure of 

the Ebola outbreak while also the leadership and local health authorities demonstrated an incapability of dealing with the outbreak. 

Most hospitals are still closed due to the lack of basic medical 

supplies. Healthcare workers lack the necessary protective gear to 

go in the field to perform their duties. 

Although there have been massive input of medical support and 

supplies from countries of the global community like China and 

India and the United States, we have yet to see a logistic plan put 

in place for the proper distribution and delivery of materials to intended clinics and hospitals. 

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There is also the issue of mistrust and confidence between citizens and government authorities, as have been discussed over and 

over, and a total breach of confidence. The crisis have been deepened also by the appointment of unqualified personnel, particularly 

nonmedical personnel, as spokespeople to lead government’s fight 

against the Ebola outbreak. 

And this has led to wrong decisions of government grossly contradicting public health disease control measures. Also, the unprofessional utterances from some nonmedical officials have engendered widescale disbelief in the general population that the Ebola 

virus is not real. 

Additional challenges include the lack of trained medical personnel in specialized areas of epidemiological infectious disease 

control. 

On the side of the Diaspora efforts, coordination of logistics 

across the United States has been difficult due the lack of financial 

resources. In Liberia, reduction of air flights into the country and 

the lack of clear policy on duty-free process for Ebola equipment 

and supplies have hampered anti-Ebola efforts from the Diaspora 

community. 

These are among a few examples of the looming challenges in the 

fight against Ebola in Liberia and the subregion as a whole. 

Notwithstanding, Diaspora Liberians and, as we have met with 

others from the subregion, Guineans and Sierra Leonians, have 

since embarked on massive mobilizations of medical supplies and 

materials as well as food, and continue to send these items to Liberia and the other countries on a revolving basis. 

For example, partnering with other organizations and foundations, the Diaspora Liberia Emergency Response Task Force recently airlifted about 4,000 pounds of medical supplies to Liberia 

on August 27, 2014, set up its own distribution mechanism that 

was very much independent of government’s control, and effectively 

delivered directly to healthcare facilities that were serving impoverished communities. 

One of those communities was the West Point community which 

was locked down, and in this service we utilized organized community involvement. It is important to note that Guinea, Liberia, and 

Sierra Leone were ravished by civil wars and this damaged the little infrastructure that these countries had. 

Yet, at the onset of the prevailing crisis there were some miscalculations also on the part of the international community. First, 

the international community should have had the inclination that 

these three Mano River Union countries of Guinea, Sierra Leone, 

and Liberia did not have the professional and technical capacity to 

control the outbreak of Ebola virus, a WHO-classified risk group 

four or biosafety level four or category A virus. 

Second, the international community failed to understand the 

cultural and traditional ties that exist among the people living in 

the common geographic region that connects Guinea, Sierra Leone, 

and Liberia. 

In that geographic triangle resides common ethnic groups, example the Kissi and Mandingo, that cannot be separated by political 

or colonial boundaries. 

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Third, the response of the international community was seemingly uncoordinated. After looking for a while, the French Government quickly went into Guinea with scientists, doctors and medical 

supplies to help out. 

Then the British Government followed suit, helping Sierra Leone 

alone. Liberia was left alone for a little while, left alone, and by 

the mercy of Samaritan’s Purse and Doctors Without Borders—we 

take our hats off to you again—Liberia was being cared for. 

As if British and the French Government were saying to Liberia, 

well, you have got America—let America come to your aid. True to 

this, in the last several days the U.S. Government has begun taking significant steps toward helping Liberia fight the Ebola crisis. 

As the WHO has since declared the Ebola outbreak as a humanitarian crisis and called for a coordinated response, in this regard 

the Diaspora Liberia Emergency Response Task Force on the Ebola 

Crisis will kindly call for the following. 

One, that Britain, France, and the United States create a triangular coordination of their assistance to the region for Guinea, 

Sierra Leone, Liberia, and Nigeria. 

Two, that the international community, mainly the United States 

of America, with the WHO should take immediate control of the 

healthcare system of Liberia and the subregion in order to resuscitate its capacity building. 

Three, that the fight against Ebola be conducted through a community-based approach and community empowerment through 

nongovernmental institutions as civic groups, churches, and community organizations have demonstrated competence and experience in service delivery during the war crisis at a time. 

An example will be the Catholic Church through the Catholic Relief Services and now we can make the Diaspora task force as an 

example and civic society groups that have already organized themselves in Liberia presently. Their acronym is called CASE. These 

will be viable partners for U.S. Government and international donors. 

Four, that the U.S. Government actively and practically supports 

the proposal of the Diaspora Liberia Emergency Response Task 

Force for the establishment of a national institute of disease control and prevention in Liberia to conduct disease surveillance and 

prevent future outbreaks of Ebola and other related diseases and 

establish a west African institute for disease control and prevention 

so as to create a network of infectious disease professionals again 

in Liberia, Nigeria, and Sierra Leone as well as the subregion to 

conduct disease surveillance and prevent future outbreak of Ebola 

and other related diseases. 

Six, that the United States Government or its aid agencies kindly provide assistance to the Diaspora Liberian, Guinean, and Sierra 

Leonian initiatives that are aimed at sending Diaspora healthcare 

professionals among whom are doctors, nurses, public health practitioners, et cetera, to their respective countries on a revolving 6-

week basis. 

Seven, that the United States Government kindly increase its civilian medical expertise at about 1,000 in the region in Liberia to 

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trol, the National Institute of Health, and the Food and Drug Administration. 

On this note, we would like to thank the Government of the 

United States of America and the Obama administration for the 

concrete steps it is taking in fighting against Ebola outbreak in Liberia and the subregion. 

Thank you, Mr. Chairman. 

[A prepared statement was not submitted by Dr. Nyan.] 

Mr. SMITH. Dr. Nyan, thank you very much and for your very 

specific recommendations to the subcommittee and hopefully by extension to the administration and to the rest of Congress. 

Just a few questions and, Dr. Akukwe, when you talked about 

watching Dr. Brantly walking on his own and what a sense of hope 

that sent to you, that sense of hope is felt here on Capitol Hill in 

a huge way that Ebola isn’t necessarily a death sentence, that 

some intervention may work. 

And my first question to all of you and to Dr. Brantly maybe in 

particular since he was on the ground dealing with Ebola patients: 

How do you incentivize doctors and healthcare personnel, other 

than those who might be ordered to be there as part of a military 

deployment, how do you incentivize people to take up that huge, 

not only responsibility, but to incur that risk that comes with it? 

I know for you, and I watched your press conference when you 

were with the doctors who had assisted in your recovery, and I was 

awed by your statement of faith in Jesus Christ, your sense of that 

motivating you to do what you did in helping those who were suffering so immensely, especially when the Ebola crisis hit, and you 

might want to elaborate on that because I think it goes unrecognized that even people in governments, even people who are a part 

of a military deployment, very often it is their faith that is the 

prime motivator for their tremendous acts of love, compassion, and 

altruism. If you could maybe elaborate on that. 

Dr. BRANTLY. Thank you, Mr. Chairman. I think there are a lot 

of practical things that people want if they are going to respond to 

a situation like this. 

They want to know that they are going to be safe, that they are 

going to have the support they need, they will have all the protective equipment they need. But none of that provides motivation. 

I think the only way to get volunteers to go serve in these situations, to go serve the people of Liberia and Guinea and Sierra 

Leone in the midst of this terrible Ebola outbreak, is for people to 

have some internal motivation and for a lot of us that is our religious faith. 

You know, Jesus instructed us, taught us to love your neighbor 

as yourself, and he told ‘‘The Parable of the Good Samaritan’’ and 

when he was asked the question: ‘‘Who is your neighbor?’’ the answer is ‘‘Whoever is in need; that is who your neighbor is.’’

So for a lot of people that is and could be and should be their 

motivation. But even for people who don’t hold a close religious 

faith, for medical professionals—I spoke to the Senate yesterday 

and said healthcare workers take oaths such as the Hippocratic 

Oath and all of us from the time we write our application essays 

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ple, we want to serve people—everybody’s application essay says 

that—but it has to be true. 

You have to have a sense of compassion on your fellow man and 

an internal urge to serve your neighbor, to serve people in need, 

and I think healthcare workers in this country and other countries 

need to remember that that was their motivation for getting into 

the practice of medicine in the first place, and when they have that 

assurance that they will be supported and provided with the necessary protective equipment that they—many people don’t want to 

make a personal sacrifice—so if they can be compensated for their 

lost work or they can have someone fill in in their practice to be 

sure that their patients don’t suffer because of their service to others, those things are all helpful. But people have to be motivated 

from their hearts to go serve. 

Mr. SMITH. In your service would you, others—yes, Doctor. 

Dr. AKUKWE. Thank you, Chairman Smith. I agree with what 

Kent said. But there are a couple of other things that we have 

learned because I served as the first executive chairman of the Africa Diaspora Health Initiative is that there are a series of things 

that are very critical when you are talking of professionals going 

into ‘‘what they may consider hardship.’’

First one is about, in addition to faith and commitment, is logistics. They want to be sure that they are going to be safe and that 

there is an organizing platform. You were asking this morning who 

is in charge. That is one of the first questions that a typical professional will ask. 

Who is, what is the coordinating authority or coordinating body 

and then while they are in the host country the issue of safety and 

then, are they going to have basic supplies in order to do their 

work? 

We found out a lot of people, when they do not receive very specific assurances of that, they will not like to deploy. And then, of 

course, the issue of compensation. Not necessarily getting paid for 

what they are earning in United States but some form of compensation so they can take care of their families. 

And I think also the issue of nonprofits MSF and Samaritan’s 

Purse. The more people get to know what they are doing and they 

are successful in deploying people in some of these countries, the 

more you are going to get volunteers. 

And then finally, with respect to Africa, the issue of Africans and 

the Diaspora, when we see what the Indians are doing, what the 

Chinese are doing in China, the issue of Africans and Diaspora, 

there are thousands of healthcare professionals. 

The National Medical Association has over 25,000 medical doctors. I know they have a program on the Diaspora but that is not 

well funded. So you do have to help prepare professionals within 

the Diaspora who with some kind of incentives, perhaps they will 

be more inclined to deploy to Africa. 

Mr. SMITH. Excellent point. Yes, Doctor. 

Dr. ALEMAYHU. Thank you, Mr. Chairman. I guess the short answer to your question is really what is the mission of being a medical professional. 

I think most doctors and healthcare providers that I know of 

their mission is very simple. It is to save lives. It may have been 

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in different very, very difficult situations in the past with the war 

zones, floods, earthquake disasters, you name it, and every step of 

the way they go they take a huge risk. 

And this is just another challenge and it is not so much of what 

is in it for them but I think it is so much of what they can do for 

others and that is—actually that is their mission. 

With regards to Africa for a moment, just 1 second, Mr. Chairman, the African Union is doing its best, you know, despite all 

these tremendous challenges and a lack of resources and everything else. 

Currently, they are assembling volunteer medical professionals 

from across the continent. Apparently, there are about 100 of them 

are being mobilized and being trained in Ethiopia at the African 

Union headquarters and supposedly they will be deployed in the 

next 48 hours or so. 

So the African Union does need a lot of help because ultimately 

I certainly don’t want to come before you, and I am sure none of 

us want to come before this subcommittee, 5 years or 10 years from 

now. 

What we would like to see is hopefully an Africa taking care of 

Africa’s business and challenges, and I think the work could be 

done as despite what we think about the situation on the ground, 

the African Union and the African governments should be supported in every effort they are out to accomplish. 

And so such as the African CDC is something that the President 

of the United States mentioned and the African Union is pursuing 

and the Ethiopian Government introduced this, and I think they 

are doing fantastic work but they do require a lot of supports. 

Thank you, sir. 

Mr. SMITH. Let me just ask—we are going to have to leave at 1 

o’clock because there is another hearing that will have to be convened. But let me just ask the question—Dr. Brantly, you pointed 

out that a significant surge of medical boots on the ground must 

happen immediately and I asked that question and it was right 

from your testimony to our distinguished witnesses in Panel I and 

I, frankly—I still don’t have a sense—the subcommittee members 

don’t have a sense: What is the critical mass that is necessary? 

It is hard to build up and build out capacity if you don’t know 

what is needed. You also make an excellent point. I read a couple 

of articles about how people are getting in taxis and they can’t find 

a bed anywhere and the taxis are actually getting hot—at least 

that is the way the author of the article put it—you know, potentially putting people at risk who get into the taxi. 

And you mentioned that your 120-bed isolation unit in ELWA is 

turning away as many as 30 infectious disease individuals every 

day. Where do they go? And again, this idea of home healthcare—

can that be set up? 

Do you think that is part of the plan? I wish I would have asked 

that of the earlier panel but I didn’t but I will because that ought 

to be incorporated and integrated, I would think, to a response. 

Dr. BRANTLY. Thank you. Let me answer this in an orderly way. 

The Ebola treatment units are absolutely necessary for handling 

this outbreak but right now they are insufficient. That is where the 

home care comes in. 

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People are staying at home. There are not enough beds and it 

takes time to construct new units and put beds in them and provide adequate staff. 

A unit with beds but without the staff is just a place for people 

to die and that is more incentive for people to stay home where at 

least they are with their family. So we have—also have to have the 

staff, which is—goes to your question as well. 

The home healthcare strategy, I believe, has been addressed by 

the President in his plan when he—I think he committed 400,000 

home care kits to be delivered and they have to be delivered without delay and those kits—I am not sure what is contained in them 

but it has to be not only things like oral rehydration solution and 

Tylenol to help treat the patient with that supportive care—and 

there are other types of supportive care that are not possible at 

home like intravenous fluids and other more technical medical 

interventions—but we can do some basic things like try to keep 

people hydrated with oral rehydration and ease their pain or their 

fever with small doses of Tylenol. 

But the more important part of that kit is the equipment to protect the caregiver and that is going to require education of those 

caregivers as well and that is where I think implementing, employing survivors to help reach their own communities. 

You know, survivors are stigmatized and many times can’t return to their communities safely. But if they can return to their 

communities with the support of the authorities with some safety 

and security to be able to do this lifesaving work of educating their 

communities, of helping those caregivers provide good care to their 

patients, their family members in a safe way, I think that is very 

important and that can be mobilized more quickly than we can 

build new units. The two have to happen together. But I think the 

home healthcare needs to start immediately. 

As for numbers of medical boots on the ground, Mr. Chairman, 

obviously I can’t give you an exact number but let me give you an 

idea of what is required to run a unit. 

The treatment team is made up of a doctor, two or three nurses 

or PAs or paramedics and two or three what we call hygienists. 

The hygienist does not have to be a medical professional. 

They have to be safety conscious people who are able to follow 

instructions and who are willing to do dangerous and difficult 

work. Those are the people who spray the unit with the chlorine 

to keep everything sanitized. They take care of the bodily waste of 

the patients and they deal with the dead bodies when patients pass 

away. 

So if you have this team of five or six individuals it would be one 

doctor, two or three other healthcare professionals which can be 

nurses, physician’s assistants, paramedics, and then two or three 

of the hygienists, those people can care for maybe ten patients before—maybe not even that many—maybe five patients before they 

have to leave the unit because of the difficulty of wearing the personal protective equipment in the heat and you can’t drink when 

you are wearing that equipment; there is a time limitation for how 

long you can stay in the unit. 

I think MSF has or WHO has estimated that for a 100-bed unit 

you have to have 200 personnel with that breakdown of, you know, 

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six nurses, PAs, and paramedics for every three hygienists for 

every one doctor. 

So if you had 1,000 patients that needed to be cared for you 

would need roughly 600 healthcare workers, 100 physicians, and 

300 hygienists and that is for people that work 12-hour shifts with 

no days off. 

It requires half of that again to work 12-hours shifts and give 

people a day off every once in a while. So we are talking about for 

every 100 patients, 200 personnel or 300, if you want people to be 

able to take a break and not be burned out after a few days of 

working. 

So it is large numbers but it is not that we need 10,000 doctors. 

It is that we would need 1,200 nurses, 600 hygienists, and 200 doctors for 2,000 patients. Those are roughly the kinds of numbers we 

are looking at. 

So if we are looking at 10,000 patients in the next few weeks you 

can see the numbers of healthcare professionals and other volunteers that we would need to treat them. 

Dr. AKUKWE. Let me say—in Guinea, Liberia, and Sierra Leone 

there are lots of trained community health workers who are either 

out of work, have retired, or have left the healthcare industry. 

So as part of work Kent is talking about on home health. It is 

easy to remobilize these individuals who benefited from very rigorous training 10, 15, 20 years ago—hundreds of them. 

Dr. BRANTLY. And Mr. Chairman, may I also say I am not suggesting that all of these people would have to be deployed from the 

United States of America. There are lots of Liberians in Liberia 

who can help in this response and in fact there are units—isolation 

units, Ebola treatment units—that are being run entirely by Liberians. 

There is one on the ELWA campus, which we refer to as ELWA 

II, being headed up by Dr. Jerry Brown and they are having phenomenal success by providing supportive care to patients, nutritional supplementation, vitamins, and providing compassionate 

care to them, and just in the last couple of days they had 50 patients and they have released 19 survivors. 

In the month of August they released 51 survivors. So supportive 

care works but you just have to have the personnel to provide it. 

Mr. SMITH. Before we conclude, is there anything else you would 

like to add? Any answers to the questions that might have been 

posed earlier to Panel I that you think you would like to address? 

Anybody? Yes, Doctor. 

Dr. ALEMAYWU. Just quickly, Mr. Chairman. What one key piece 

that I have not heard us talking about is the psychological part of 

this whole thing. I am delighted to be joined by Dr. Judy 

Kuriansky from Columbia University—she is also a board member—it is unthinkable what is going on now with regards to the 

psychological challenge and the fear, and, of course, we have forgotten one huge piece in this which is the traditional healers—the traditional doctors, if you can call them that—because the locals, 

whether we like it or not, they believe who they know and who 

they trust, not so much of the outside forces coming to save them. 

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And I think getting those elements in place and letting them be 

a part of the solution making process is absolutely key. Thank you, 

sir. 

Dr. AKUKWE. And you need to know, from the earlier discussion—the problem is that I think in long term beyond the immediate response to Ebola, the next few years you are going to have 

another outbreak. So what is the best way to assist African countries and manage these outbreaks on their own in the future? 

Mr. SMITH. I would like to thank all four of our distinguished 

panelists for your tremendous insight, your recommendations. I 

think it will help not only Congress but it will help the administration with your guidance and your wisdom. 

And, again, thank you for your leadership. It is extraordinary. 

The hearing is adjourned. 

[Whereupon, at 1:01 p.m., the committee was adjourned.] 

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A P P E N D I X 

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