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94–053 PDF 2015

THE EBOLA CRISIS: COORDINATION OF A MULTI– 

AGENCY RESPONSE 

HEARING 

BEFORE THE

COMMITTEE ON OVERSIGHT 

AND GOVERNMENT REFORM 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

OCTOBER 24, 2014 

Serial No. 113–163 

Printed for the use of the Committee on Oversight and Government Reform 

( 

Available via the World Wide Web: http://www.fdsys.gov 

http://www.house.gov/reform 
(II) 

COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM 

DARRELL E. ISSA, California, Chairman 

JOHN L. MICA, Florida 

MICHAEL R. TURNER, Ohio 

JOHN J. DUNCAN, JR., Tennessee 

PATRICK T. MCHENRY, North Carolina 

JIM JORDAN, Ohio 

JASON CHAFFETZ, Utah 

TIM WALBERG, Michigan 

JAMES LANKFORD, Oklahoma 

JUSTIN AMASH, Michigan 

PAUL A. GOSAR, Arizona 

PATRICK MEEHAN, Pennsylvania 

SCOTT DESJARLAIS, Tennessee 

TREY GOWDY, South Carolina 

BLAKE FARENTHOLD, Texas 

DOC HASTINGS, Washington 

CYNTHIA M. LUMMIS, Wyoming 

ROB WOODALL, Georgia 

THOMAS MASSIE, Kentucky 

DOUG COLLINS, Georgia 

MARK MEADOWS, North Carolina 

KERRY L. BENTIVOLIO, Michigan 

RON DESANTIS, Florida 

ELIJAH E. CUMMINGS, Maryland, Ranking 

Minority Member 

CAROLYN B. MALONEY, New York 

ELEANOR HOLMES NORTON, District of 

Columbia 

JOHN F. TIERNEY, Massachusetts 

WM. LACY CLAY, Missouri 

STEPHEN F. LYNCH, Massachusetts 

JIM COOPER, Tennessee 

GERALD E. CONNOLLY, Virginia 

JACKIE SPEIER, California 

MATTHEW A. CARTWRIGHT, Pennsylvania 

TAMMY DUCKWORTH, Illinois 

ROBIN L. KELLY, Illinois 

DANNY K. DAVIS, Illinois 

PETER WELCH, Vermont 

TONY CARDENAS, California 

STEVEN A. HORSFORD, Nevada 

MICHELLE LUJAN GRISHAM, New Mexico 

Vacancy 

LAWRENCE J. BRADY, Staff Director 

JOHN D. CUADERES, Deputy Staff Director 

STEPHEN CASTOR, General Counsel 

LINDA A. GOOD, Chief Clerk 

DAVID RAPALLO, Minority Staff Director 
(III) 

C O N T E N T S 

Page 

Hearing held on October 24, 2014 .......................................................................... 1 

WITNESSES 

The Hon. Michael Lumpkin, Assistant Secretary of Defense, Special Operation/Low-Intensity Conflict, U.S. Department of Defense 

Oral Statement ................................................................................................. 7 

Written Statement ............................................................................................ 9 

The Hon. John Roth, Inspector General, U.S. Department of Homeland Security 

Oral Statement ................................................................................................. 17 

Written Statement ............................................................................................ 19 

The Hon. Nicole Lurie, M.D., Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services 

Oral Statement ................................................................................................. 60 

Written Statement ............................................................................................ 62 

Ms. Deborah Burger, R.N., Co-President, National Nurses United 

Oral Statement ................................................................................................. 71 

Written Statement ............................................................................................ 73 

Mr. Rabih Torbay, Senior Vice President, International Operations, International Medical Corps 

Oral Statement ................................................................................................. 80 

Written Statement ............................................................................................ 82 

APPENDIX 

2014–10–16 Texas Health Resources Ebola Update ............................................. 155 

CRS HHS Annual Funding Preparedness and Response ..................................... 157 

2014–10–23 WSJ There’s Plenty of Money to Fight Ebola .................................. 158 

FY2014 HHS Appropriations Overview ................................................................. 161 

2014–10–20 WP Beating Ebola Through a National Plan ................................... 164 

2014–10–24 AAPS U.S. Public Health Response to the Ebola Outbreak ........... 166 

(1) 

THE EBOLA CRISIS: COORDINATION OF A 

MULTI-AGENCY RESPONSE 

Friday, October 24, 2014 

HOUSE OF REPRESENTATIVES, COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM, WASHINGTON, DC. 

The committee met, pursuant to notice, at 9:30 a.m. In Room 

2153, Rayburn House Office Building, Hon. Darrell E. Issa (chairman of the committee) presiding. 

Present: Representatives Issa, Cummings, Mica, Turner, 

McHenry, Jordan, Chaffetz, Walberg, Amash, Gowdy, Farenthold, 

Massie, Collins, Bentivolio, DeSantis, Maloney, Tierney, Lynch, 

Cooper, Connolly, Cartwright, Kelly, Davis, and Lujan Grisham. 

Staff present: Will L. Boyington, Deputy Press Secretary; Molly 

Boyl, Deputy General Counsel and Parliamentarian; Lawrence 

Brady, Staff Director; Ashley H. Callen, Deputy Chief Counsel for 

Investigations; Sharon Casey, Senior Assistant Clerk; Steve Castor, 

General Counsel; John Cuaderes, Deputy Staff Director; Adam P. 

Fromm, Director of Member Services and Committee Operations; 

Linda Good, Chief Clerk; Elizabeth Gorman, Professional Staff 

Member; Frederick Hill, Deputy Staff Director for Communications 

and Strategy; Christopher Hixon, Chief Counsel for Oversight; 

Caroline Ingram, Counsel; Michael R. Kiko, Legislative Assistant; 

Mark D. Marin, Deputy Staff Director for Oversight; Emily Martin, 

Counsel; Ashok M. Pinto, Chief Counsel, Investigations; Laura L. 

Rush, Deputy Chief Clerk; Jessica Seale, Digital Director; Andrew 

Shult, Deputy Digital Director; Katy Summerlin, Press Assistant; 

Rebecca Watkins, Communications Director; Tamara Alexander, 

Minority Counsel; Meghan Berroya, Minority Chief Investigative 

Counsel; Aryele Bradford, Minority Press Secretary; Courtney 

French, Minority Counsel; Jennifer Hoffman, Minority Communications Director; Una Lee, Minority Counsel; Juan McCullum, Minority Clerk; Suzanne Owen, Minority Legislative Director; and Dave 

Rapallo, Minority Staff Director. 

Chairman ISSA. The committee will come to order. 

Without objection, the chair is authorized to declare a recess of 

the committee at any time. 

The Oversight Committee exists to secure two fundamental principles. First, Americans have a right to know that the money 

Washington takes from them is well spent. And, second, Americans 

deserve an efficient, effective government that works for them. 

Our duty on the Oversight and Government Reform Committee 

is to protect these rights. It is our solemn responsibility to hold 

government accountable to the taxpayers. Taxpayers want to be 
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safe. Taxpayers want to know that our government is prepared. In 

this case, we leave no stone unturned in ensuring today that America is planning for tomorrow. 

Beginning in March 2014, in the West African Nation of Guinea, 

the world first learned about yet another new outbreak of the 

Ebola virus. Due to poor detection, it is possible the outbreak started late last year. By August, Ebola had spread to Sierra Leone, Liberia, and Nigeria. 

According to the U.S. Center for Disease Control and Prevention, 

the 2014 Ebola epidemic is the largest in history and, sadly, the 

virus has claimed at least 4,000 lives to date. 

By the end of September, the CDC confirmed the diagnosis of the 

first travel-associated case of Ebola in the United States. The situation is rapidly developing and changing; and Americans are understandably worried, worried about their government’s response to 

the outbreak and, in particular, the steps we are taking to contain 

the spread of Ebola. 

With the high fatality rates—as much as 70 percent—and no 

FDA approved vaccines or medicines, Ebola is a serious threat to 

public health around the world. An outbreak in an American city 

or any major city of the world could be very costly to contain and 

could have major economic impacts. Yesterday’s news was a doctor 

in New York City tested positive for Ebola, and this is particularly 

distressing. 

There is certainly some good news to report on our effort to contain the outbreak. No new Ebola cases have been reported in Nigeria in 46 days. Over 40 people who came into contact with the 

Ebola patient, Thomas Eric Duncan, in Dallas have now gone 

through the 21-day monitoring period without demonstrating any 

symptoms. And perhaps that means that our preventive systems of 

those in contact is good, even though, as we will see today, not perfect. 

We have the world’s most advanced healthcare system undeniably in America. We spend the most money to have that system. 

And as long—sorry—as long as our response is well coordinated 

and officials use common sense, there is an ability to contain this 

disease, but we are not out of the woods yet. 

Today we will examine efforts to coordinate Federal agencies 

tasked with responding to an Ebola outbreak. This examination follows a series of Statements and actions that have eroded public 

confidence in our response. 

An infected traveler from Liberia made it through the Department of Homeland Security screening and arrived at international 

travelers and into the Dallas/Fort Worth area. When the same individual exhibited clear signs of Ebola—symptoms of Ebola, a hospital turned him back into the community and offered an evolving 

account of how this happened. 

Without evidence, the director of the CDC declared that a nurse 

at this hospital who became infected with Ebola must have contracted it through, ‘‘a breach of protocol.’’ Medicine is not done over 

the telephone. It is not done over the television. Medicine is, in 

fact, the business of looking at a patient, evaluating a patient, 

measuring a patient, and questioning a patient, not, in fact, guessing how someone became a patient. 
3 

A separate nurse who contracted Ebola at that hospital was 

cleared by the CDC to board a commercial airline flight, even 

though she reported having fever and contact with the patient, Mr. 

Duncan. 

The news of that medical doctor returning from Guinea—the 

news that a medical doctor returning from Guinea now has tested 

positive for Ebola has raised even more questions about procedures 

and treating patients and risks to Americans responding with great 

courage and generosity from here to the infected areas. 

We need to know why there have been breakdowns and if our 

system for responding to such serious crisis is working properly. 

That was a line I was supposed to read. I think we all know that 

the system is not yet refined to where we could say it is working 

properly. 

How effective are our efforts at containing the disease in West 

Africa? Are the—are the training and equipment that frontline 

healthcare workers and military personnel received in the past or 

will receive in the future adequate? Isn’t airport screening that 

went into effect 2 weeks ago reliable? Are government agencies 

doing everything they can do to foster the development of Ebola 

treatments? What threat does Ebola pose to international trade 

and America’s—Americans traveling abroad? 

When a situation like this arises, government is supposed to rely 

on prior planning and rapid, effective response that can identify 

mistakes quickly and correct them. Congress has recognized and 

considered the threat of an outbreak on a bipartisan basis. The 

bumbling we have seen comes despite concerted efforts by Congress 

to ensure protocols and funding were in place to avoid the very 

mistakes we have already seen. 

President Obama’s appointment of Ron Klain to serve as the 

Ebola czar sadly, in my opinion, shows the administration has, on 

one hand, recognized the missteps and, on the other hand, is not 

prepared to put a known leader in charge or, in fact, a medical professional in charge. 

That does not make it a political decision, but it makes it a decision in which we have to ask and we will ask today: Is the interagency coordination already in place and he is simply overseeing 

it or, in fact, are we expecting Mr. Klain to put together interagency coordination to show the leadership to make it happen, to 

sift through conflicting claims that science and medicine have already reached conclusions versus the reality that those conclusions, 

at least in several cases, have proven wrong. 

We did invite the President’s new czar, Mr. Klain, to testify, and 

we are very disappointed that he was not able to. But we understand he has just started, and we do not expect that that would 

be repeated if there is a followup hearing. 

Let me just say, in my role in this committee and others, I have 

traveled to the World Health Organization’s headquarters. I have 

seen them saying to us, as visitors, that pandemics are, in fact, already planned for. And although they talk about the inevitability 

of a pandemic, we have also invested, as Americans, billions of dollars to, in fact, be prepared for them. 

Let me just say before anyone pulls the trigger on either a political or denouncing medicine that, in fact, this is not a new problem. 
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Nearly 100 years ago, in 1918–1919, the influenza pandemic known 

as the Spanish flu killed more people than any other outbreak of 

disease in history. It claimed at least 20 million people—oh, thank 

you—around the world. 

In that pandemic, an American base, one that I was stationed at, 

Fort Riley, Kansas, proved to be the source of the first-known outbreak. The flu spread fast around the base and other bases and 

eventually worldwide. Famously, ‘‘The Big Red One’’ is well aware 

that not only was the outbreak critical, but, in fact, soldiers were 

put on ships and sent out from there further—not recognizing that, 

in fact, we were simply adding to the disease and the suffering. 

The Asian flu of 1957-’58, which originated in the Far East, 

spread to the U.S. and caused at least 70,000 deaths. The Hong 

Kong flu of 1968-’69 also spread to the United States and caused 

an estimated 34,000 deaths. 

It would be a major mistake to underestimate what Ebola could 

do to populations around the world, and any further fumbles, bumbles or missteps or relying on postulate, certainties told to us by 

people who, in fact, cannot defend how that certainty came to be 

and when it fails to be correct how they could have been so wrong, 

can no longer be tolerated. 

I look forward to hearing from this panel of witnesses in an effort 

not to solve a problem, but to take the problem appropriately seriously, recognize that what we don’t know could kill us. 

With that, I recognize the ranking member for his opening Statement. 

Mr. CUMMINGS. Thank you very much, Mr. Chairman. And I 

thank you again and again for holding this hearing. 

I think this is the reason why we have an Oversight Committee, 

to address those problems that our Nation and, in this case, the 

world face. 

Yesterday, Dr. Craig Spencer, a physician working for Doctors 

Without Borders, tested positive for Ebola. We are still getting additional details. 

But based on information from New York and Federal officials so 

far, it appears that healthcare authorities have come a long way 

in preparing for Ebola since Thomas Duncan first walked into a 

Texas hospital last month. New York had been preparing for this 

possibility for weeks, and about 5,000 healthcare workers were 

drilled on protocols and procedures just this past Wednesday. 

A special team with full protective gear transported Dr. Spencer 

to Bellevue Hospital, which is specifically designated to handle 

Ebola. They placed him directly into an isolation unit. They began 

treating him as soon as possible. And they started tracing his contacts immediately. 

As New York officials said last night, they had hoped they would 

not have to face an Ebola case, but they did. They were also realistic, and they worked diligently and professionally over the last 

month to prepare themselves for this day. 

There are many questions about this new case, but we cannot assume it will be the last. And I remind all of us this is our watch. 

Of course, we must continue to be vigilant, and we need to continually reevaluate our protocols and training procedures to protect 

our healthcare workers, many of whom are here today. 
5 

And to those healthcare workers, on behalf of a grateful Congress 

and grateful Nation, I thank you for what you do every day. 

I want to express our thanks to Nina Pham and to Amber Vinson, the two nurses from Texas who contracted Ebola when they 

treated Mr. Duncan. By now, we have all seen their pictures, two 

brave young women who risked their lives to simply do their jobs 

and to feed their souls, just like nurses across this country, every 

single day, 24/7, 365 days a year. I understand that Ms. Pham’s 

condition has been upgraded and Ms. Vinson has now been cleared 

of the virus. We thank them for their bravery and their commitment. 

This new case in New York should also demonstrate that we can 

no longer ignore the crisis in West Africa. We can no longer ignore 

it. Nearly 10,000 people have died from this disease or are battling 

with it as we speak, many in the most gruesome conditions imaginable. 

I firmly believe we have a fundamental, moral, and humanitarian obligation to address the crisis in Africa. We are the richest 

Nation in the world, and we have the resources and expertise to 

make the biggest difference. However, for those who may not agree 

that we have a moral obligation to help, they must understand that 

addressing the Ebola crisis in Africa is also in our self-interest as 

a Nation. 

Public health experts warn that, to protect Americans here at 

home, we need to address this outbreak at its source in Africa. The 

longer the outbreak continues, the more likely it will spread to the 

rest of the world, including more cases right here in the United 

States of America. And if we do not take strong action now, it will 

cause much, much more in the long run. The encouraging news is 

that healthcare experts know how to fight this disease. They know 

how to do that. 

This week the World Health Organization declared Nigeria and 

Senegal free of Ebola. This is a tremendous accomplishment that 

was achieved through a combination of early diagnosis, contract— 

contract tracing, infection control, and safe burial. But we still face 

grave challenges in Sierra Leone, Guinea, and Liberia where the 

public health infrastructure is deficient and new cases are increasing at an alarming rate. 

Last month the United Nations Security Council unanimously 

adopted a resolution declaring the Ebola outbreak ‘‘a threat to 

international peace and security.’’ The U.N. established a mission 

for Ebola emergency response. They set forth more than a dozen 

mission-critical actions and they provided a 6-month budget request for $988 million. 

However, they are hundreds of millions of dollars short. They 

definitely need funding for treatment beds, training for healthcare 

workers, and supplies to prevent infection. They need resources for 

things as basic as food and vehicles and fuel. 

As the head of the United Nations mission warned the Security 

Council just last week, ‘‘We need to stop Ebola now or we face an 

entirely unprecedented situation for which we do not have a plan.’’ 

There have already been several congressional hearings on how 

to prepare ourselves here in the United States. So today I intend 

to ask our witnesses what they believe, in their expert views, are 
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the most significant, concrete, and constructive steps our Nation 

can take to address this outbreak at its source. 

I am particularly grateful to Mr. Torbay from the International 

Medical Corps for agreeing to be here today to provide his on-theground assessment of what his group and others on the front lines 

need to stop the spread of Ebola. 

Mr. Torbay, I know you must feel great empathy for Dr. Spencer, 

who tested positive yesterday. I have asked my staff to place your 

testimony on our Website. It is some of the best testimony explaining what is going on in Africa, things that work, and I think the 

public should have an opportunity to read all 10 pages. 

He was—Mr. Spencer—Dr. Spencer was one of your compatriots, 

battling Ebola in West Africa, and I am sure his situation is one 

that all of your healthcare workers must fear on a daily basis. But 

the truth is that Dr. Spencer and your group and many others are 

doing one of the only things that will truly ensure the world will 

be free of Ebola. We need to support you as much as we urgently 

can, and we must do it forcefully. And we have to convince the rest 

of the world to do the same. Again, I say this is our watch. 

And to my fellow committee members and the members of this 

great Congress, it is not a time for us to move to common ground. 

We have no choice but to move to higher ground. 

And so, with that, Mr. Chairman, I look forward to the testimony 

today. And, with that, I yield back. 

Chairman ISSA. I thank the gentleman. 

All members will have 7 days to submit opening Statements for 

the record. 

And, with that, we go to our panel of witnesses. 

The Honorable Michael Lumpkin is the Assistant Secretary of 

Defense for Special Operations and Low-Intensity Conflict at the 

United States Department of Defense. 

Major General James Lariviere—or—close enough—is the Deputy Director of Politico-Military Affairs in—let’s see—Affairs in Africa at the United States Department of Defense. 

The Honorable John Ross—sorry. I just got off a flight. I apologize. The Honorable John Roth is the Inspector General for the 

United States Department of Homeland Security. 

The Honorable Nicole Lurie is the Assistant Secretary for Preparedness and Response at the U.S. Department of Health and 

Human Services. 

Ms. Deborah Burger is the co-president of the National Nurses 

United. 

And Mr. Rabih Torbay is the Senior Vice President of International Operations at the International Medical Corps. 

Ladies and gentlemen, pursuant to the rules of the committee, 

would you please all rise, raise your right hands, and take the 

oath. 

Do you solemnly swear or affirm that the testimony you are 

about to give will be the truth, the whole truth, and nothing but 

the truth? 

Chairman ISSA. Please be seated. 

Let the record reflect that all witnesses answered in the affirmative. 
7 

As you all can see, we have a large panel. And I know, from the 

dais, there will be many questions. So I would ask that you realize 

that your entire opening Statements will be in the record and that 

you limit your oral testimony in your opening to 5 minutes. 

WITNESS STATEMENTS 

STATEMENT OF HON. MICHAEL LUMPKIN 

Chairman ISSA. With that, Mr. Lumpkin. 

Mr. LUMPKIN. Chairman Issa, Ranking Member Cummings, and 

distinguished Members of the committee, thank you for the opportunity to be here this morning regarding the Department of Defense’s role in the United States’s comprehensive Ebola response effort, which are a national security priority in response to a global 

threat. 

Due to the U.S. military’s unique capabilities, the Department 

has been called upon to provide interim solutions that will allow 

other departments and agencies the time necessary to expand and 

deploy their own capabilities. U.S. military efforts may also galvanize more robust and coordinated international effort, which is essential to contain this threat and to reduce human suffering. 

Before addressing the specific elements of DOD’s Ebola response 

efforts, I would like to share my observations of the evolving crisis 

and our increasing response. After visiting Liberia, which I returned from several weeks ago, I was left with a number of overarching impressions that are shaping the Department’s role supporting USAID: 

First, our government has deployed a topnotch team experienced 

in dealing with disasters and humanitarian assistance. 

Second, the Liberian Government is doing what it can with its 

very limited resources. 

Third, the international response is increasing regionally due to 

our government’s response efforts. 

Fourth, I traveled to the region thinking we faced a healthcare 

crisis with a logistics challenge. In reality, what I found was that 

we face a logistics crisis focused on a healthcare challenge. 

Fifth, speed and scaled response matter. Incremental responses 

will be outpaced by a rapidly growing epidemic. 

Finally, the Ebola epidemic we face is truly a national security 

issue. Absent our government’s coordinated response in West Africa, the virus’s increasing spread brings the risk of more cases here 

in the United States. 

And now I would like to turn to DOD’s role of our overall wholeof-government response in West Africa. 

In mid-September, President Obama ordered the Department to 

undertake military operations in West Africa in direct support of 

USAID. Secretary Hagel directed that U.S. military forces undertake a twofold mission: First, support USAID in the overall U.S. 

Government efforts and, second, respond to Department of State 

request for security or evacuation assistance if required. 

Direct patient care of Ebola-exposed patients in West Africa is 

not part of DOD’s mission. Secretary Hagel approved unique mili-
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tary capabilities falling under four lines of effort: command and 

control, logistics support, engineering support, and training. 

In the last 6 weeks, DOD has undertaken a number of synchronized activities in support of these line of efforts, to include 

designating a named operation, Operation United Assistance; establishing an intermediate staging base in Dakar, Senegal; providing strategic and tactical airlift; constructing a 25-bed hospital 

in Monrovia; constructing up to 17 Ebola treatment units, also 

known as ETUs, in Liberia; and preparing to train local and thirdcountry healthcare support personnel, enabling them to serve as 

the first responders in these Ebola treatment units throughout Liberia. 

I would like to reiterate that the U.S. military personnel will not 

provide direct care to Ebola patients in West Africa. 

In addition to the activities of Operation United Assistance, the 

Department continues two enduring programs in the region: Operation Onward Liberty, partners with armed forces of Liberia to improve their professionalism and capabilities; and we are expanding 

the regional efforts of the Department’s cooperative biological enhancement program to provide robust enhancements to biosafety, 

biosecurity, and biosurveillance systems in West Africa. 

In all these circumstances, the protection of our personnel and 

the prevention of any additional transmission of the disease remain 

paramount planning factors. There is no higher operational priority 

than protecting our Department of Defense personnel. 

In conclusion, we have a comprehensive U.S. Government response and, increasingly, a coordinated international response. The 

Department of Defense’s interim measures are an essential element of the U.S. response to lay the necessary groundwork for the 

international community to mobilize its response capabilities. Now 

it is the time to devote appropriate U.S. resources necessary to contain the threat and to establish the processes for better future responses. 

With that, I would like to introduce my colleague from The Joint 

Staff, Major General Lariviere. And we look ready to answer your 

questions and appreciate the opportunity to be here. 

[The prepared Statement of Mr. Lumpkin follows:] 
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Chairman ISSA. Thank you. 

And I understand, General, you do not have a separate opening 

Statement. 

General LARIVIERE. No, sir, I do not. But I stand ready to answer 

any questions you might have. 

Chairman ISSA. Thank you. 

Mr. ROTH. 

STATEMENT OF HON. JOHN ROTH 

Mr. ROTH. Good morning, Chairman Issa, Ranking Member 

Cummings, and Members of the committee. Thank you for inviting 

me to testify about DHS’s management of pandemic supplies. 

DHS must have the ability to continue its operations in the event 

of a pandemic. In 2006, Congress appropriated $47 million in supplemental funding to DHS for them to plan, train, and prepare for 

potential pandemic. 

We recently conducted an audit of those efforts, focusing on the 

Department’s preparations to continue operations in achieving its 

mission should a pandemic occur. The report of our audit is attached to my written testimony that I have submitted to this committee. 

In short, our audit concluded that DHS mismanaged their program in three ways. First, we found that DHS did not adequately 

conduct a needs assessment before purchasing protective equipment and antiviral drugs. 

As a result, we could not determine the basis for DHS’s decisions 

regarding how much or what types of pandemic supplies to purchase, store, or distribute. As a result, DHS may have too much of 

some equipment and too little of others. 

For example, we found that DHS has a stockpile of about 

350,000 white coverall suits and 16 million surgical masks, but 

hasn’t been able to demonstrate how either fits into their pandemic 

preparedness plans. It has a significant quantity of antiviral drugs. 

But, again, without a full understanding of the Department’s needs 

in the event of a pandemic, we have no assurance that the quantity 

of drugs will be appropriate. 

Second, DHS purchased much of the equipment and drugs without thinking through how these supplies would need to be replaced. 

The material DHS has purchased has a finite shelf life. 

For example, TSA’s stock of pandemic protective equipment includes about 200,000 respirators that are beyond the 5-year 

usability date guaranteed by the manufacturer. In fact, the Department believes that their entire stockpile of personal protective 

equipment will not be usable after 2015. 

Likewise, the antiviral drugs DHS purchased are nearing the 

end of their effective life. DHS is attempting to extend that shelf 

life of these drugs through an FDA testing program, but the results 

of that are not guaranteed. 

Third, DHS did not manage its inventory of drugs or equipment. 

As a result, DHS did not readily know how much protective equipment and drugs it had on hand or where it was being stored. Drugs 

and equipment have gone missing. And, conversely, our audit has 
18 

found drugs in the DHS inventory that the Department thought 

had been destroyed. 

We visited multiple sites and found drugs that were not being 

stored in a temperature-controlled environment. Because DHS cannot be assured that they were properly stored, they are in the process of recalling a significant quantity of them because they may not 

be safe or effective. 

We made 11 separate recommendations. DHS has concurred with 

all of them. One of those recommendations has been fully implemented, and the Department is taking action to implement the remaining ten recommendations. We will continue to keep this committee informed about the Department’s progress. 

Mr. Chairman, that concludes my prepared Statement. I welcome 

any questions. 

[The prepared Statement of Mr. Roth follows:] 
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Chairman ISSA. Dr. Lurie. 

STATEMENT OF HON. NICOLE LURIE, M.D. 

Dr. LURIE. GOOD MORNING, CHAIRMAN ISSA, AND RANKING MEM- BER CUMMINGS, AND OTHER DISTINGUISHED MEMBERS OF THE COMMITTEE. 

I am Dr. Nicole Lurie, the Assistant Secretary for preparedness 

and response at the U.S. Department of Health and Human Services. I am also a primary care doctor. 

I appreciate the opportunity to talk with you today about the 

steps that HHS and other agencies have taken since the Ebola outbreak began in West Africa. We are working 24/7 to control the epidemic there and to ensure that we are prepared to prevent and curtail the spread of disease here at home. 

Thanks to the foresight of the Congress, the leadership of this 

and prior administrations, the dedicated work of HHS and the 

interagency whole-of-government approach we are taking, we are 

better positioned than ever before to respond to Ebola as well as 

a range of other threats that may affect this country. 

I serve as the Assistant Secretary. I serve as the principal advisor to the Secretary on all matters related to public health and 

medical preparedness in response to emergencies. Since my confirmation in 2009, we have worked hard to ensure that we have the 

tools necessary to prepare for and respond to any disaster with 

public health consequences. 

I have led the modernization of the Medical Countermeasure Enterprise, created new opportunities for coordination among State 

and local public health and healthcare systems, and strengthened 

our ability to make better decisions before, during, and after an 

emergency. Our all-hazards approach allows us to be flexible and 

nimble in response to known and unknown threats. 

As you know, four cases of Ebola have been detected in the 

United States. Our hearts go out to the family of Mr. Duncan, the 

nurses who have been infected, as well as the physician in New 

York. We are pleased that the nurses are doing so well and wish 

them and the physician a speedy recovery. 

We are extremely serious in our focus on protecting America’s 

health security. The best way to do that is to end Ebola epidemic 

in West Africa. At the same time, we are expediting the development of medical countermeasures and preparing our systems to 

deal with any potential cases in this country. 

So, not long after this epidemic began, I convened the Federal 

medical countermeasures stakeholders to see what could be accomplished as quickly as possible. Thanks to past investments, we 

have leveraged U.S. Government-wide assets to urgently speed the 

development and testing of vaccines and therapeutics for Ebola. 

These advances are allowing us to create Ebola countermeasures in 

record time so that we will have products to use as soon as we have 

the necessary proof of efficacy. 

Our strategic investments in the countermeasure infrastructure, 

including our Centers for Innovation in Advanced Development and 

Manufacturing established in 2012 and newly established Fill Fin-
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ish Manufacturing Network, will be used to get Ebola vaccines and 

therapeutics into vials for use. We are also leveraging our strong, 

ongoing relationships with industry and public-private sector partners to scale up vaccine manufacturing. 

In addition, our public health and healthcare systems must be 

prepared to deliver safe care at a moment’s notice. Investments in 

the hospital preparedness program and the public health emergency preparedness program have meant that healthcare systems 

and State and local public health departments are prepared to respond to public health emergencies. 

Since the epidemic began, we have been using these programs to 

educate healthcare systems stakeholders and ensure surveillance 

in laboratory capacities were in place. We have launched a very aggressive national outreach and education program to promote the 

safe and effective detection, isolation, treatment of Ebola patients. 

The system we now have in place is based on changes and lessons learned from each emergency, including those I have confronted, as the Assistant Secretary. 

Based on the first U.S. Cases, HHS has already made adjustments to minimize the spread of Ebola. These include tightened 

guidance for the use of personal protective equipment, an expanded 

aggressive national education campaign for healthcare workers, 

and screening and active monitoring of passengers entering the 

United States now funneled through five airports. 

We have been working collaboratively with our interagency partners, including on transport of contaminated waste with the Department of Transportation, medical evacuation with the Department of State, deployment of military personnel with the Department of Defense, and worker and workplace safety with OSHA and 

NIOSH. 

Mr. Chairman and Members of the committee, I understand why 

you and yours constituents are concerned. We take domestic preparedness very seriously. Our top priority is protecting the health 

of Americans. 

I can assure you that my team, the Department and our partners 

have been working and continue to work long hours to prepare our 

Nation for threats like this. With lessons learned from this new 

challenge, we are making efficient use of the investments provided 

and we have made tangible, meaningful progress since you first 

created this office in 2006. As a result, HHS has been able to provide crucial health and medical support to our States and communities. 

I thank you again for this opportunity to address these issues 

and welcome your questions. 

[The prepared Statement of Dr. Lurie follows:] 
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Chairman ISSA. Ms. Burger. 

STATEMENT OF DEBORAH BURGER, R.N. 

Ms. BURGER. Thank you, Mr. Chairman and Members of the 

committee. I am Deborah Burger, a registered nurse and—— 

Chairman ISSA. Could you pull the mic just slightly closer. 

Thank you. 

Ms. BURGER. Thank you. 

—and co-president of the National Nurses United, representing 

190,000 members in the largest organization of nurses in the 

United States. 

The Ebola pandemic and the exposure of healthcare workers to 

Ebola in Texas and the real threat that it could occur elsewhere 

in the U.S. represent a clear and present danger to public health. 

Every R.N. Who works in a healthcare facility could be Nina 

Pham or Amber Vinson, both of whom contracted Ebola while 

treating Thomas Eric Duncan at Texas Presbyterian Hospital in 

Dallas. One patient diagnosed and dead in this country. Two 

nurses infected so far. 

And our survey of over 3,000 nurses from over 1,000 hospitals in 

every State, D.C., and the Virgin Islands reveals 85 percent of the 

nurses say they are not adequately trained and the level of preparation for Ebola in our facilities is insufficient. 

68 percent of R.N.s still say they have not—their hospital has not 

communicated any policy for admission of a potential Ebola patient. 84 percent still say their hospitals have not provided Ebola 

education with the opportunity to interact and ask questions. 

44 percent say their hospitals lack sufficient supplies of eye protection now. 46 percent say there are insufficient supplies of fluidresistant impermeable gowns in their hospital. 41 percent say their 

hospitals do not have plans to equip isolation rooms. 

Initially, the nurses who interacted with Mr. Duncan wore nonimpermeable gowns, three pairs of gloves with no taping around 

the wrists, surgical masks with the option of N95s and face shields, 

leaving their necks exposed. Two of them became infected. This is 

what happens when guidelines are inefficient and voluntary. 

The new CDC guideline that protective equipment leave no skin 

exposed is a direct testament to the courage of Dallas whistleblower Briana Aguirre who first spoke to us. 

We have called on President Obama to invoke his executive authority and urged Congress legislatively to mandate uniform optimal national standards. 

These include full-body HazMat suits that meet the ASTM F1670 

standard for blood penetration and the ASTM F1671 standard for 

viral penetration, which leaves no skin exposed or unprotected; 

NIOSH-approved air-powered purifying respirators with an assigned protection factor of at least 50 or higher standard as appropriate; at least two direct-care R.N.s for each Ebola patient and the 

additional—and no additional patient care assignment; continuous 

onsite interactive hands-on teaching with the R.N.s and updates responsive to the changing nature of the disease. 
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The precautionary principle must be utilized when developing 

public health policy designed to protect patients, the public, nurses, 

and all healthcare workers who may be exposed to potentially infectious patients. 

Lest we forget the risk of exposure to the population at large 

starts with the frontline caregivers. It does not end there. As we 

have seen with school closures in Ohio and Texas and the quarantining of airline passengers, improper protection and inadequate 

protocols in hospitals can lead to public exposure. 

The response to Ebola from U.S. hospitals and governmental 

agencies has been dangerously inconsistent and inadequate. The 

lack of mandates and shifting guidelines from agencies and reliance on voluntary compliance has left caregivers uncertain, severely unprepared, and vulnerable to infection. 

Our experience with U.S. hospitals is they will not act on their 

own to secure the highest standards of protection without a specific 

directive from our Federal authorities by an act of Congress or potential Presidential executive order. 

The new CDC guidelines represent progress with improved 

standards for training, as we have been demanding for months. 

The CDC guidelines are still unclear on the most effective protective equipment, specifically allowing hospitals to select protective 

equipment based on availability and other factors. 

We are your first line of defense. No nation would ever contemplate sending soldiers into the battlefield without armor and 

weapons. Give us the tools we need. All we ask from President 

Obama and Congress is not one more infected nurse. Thank you. 

[The prepared Statement of Ms. Burger follows:] 
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Chairman ISSA. Thank you. 

Mr. TORBAY. 

STATEMENT OF RABIH TORBAY 

Mr. TORBAY. Chairman Issa, Ranking Member Cummings, and 

distinguished Members of the committee, on behalf of International 

Medical Corps, one of the few agencies in the world to be treating 

Ebola patients, I would like to thank you for inviting me to testify 

today and for your leadership in convening this critically important 

hearing. We would also like to express our appreciation to the U.S. 

Government for their pivotal action and generous support for the 

response. 

Our response to the Ebola outbreak has been robust. By the end 

of November, I anticipate we will have a total of about 800 staff 

in Liberia and Sierra Leone. Approximately 70 of these will be expatriots. International Medical Corps has been operational in West 

Africa since 1999. 

Our Ebola response started in late June with community education and sensitization in Sierra Leone. In late July and after we 

realized the epidemic has reached out-of-control levels, we deployed 

our emergency response teams to both Sierra Leone and Liberia 

and decided to get involved in treatment of Ebola cases. 

When our emergency teams arrived in Liberia in August, what 

we found on the ground confirmed that urgent action was required. 

In a few short months, fallout from the Ebola outbreak had 

brought the country’s already fragile healthcare system to the 

brink of collapse. 

Many were dying. Most were afraid. Previously busy hospitals 

and clinics were empty, with both staff and potential patients too 

frightened to go there for the fear of being infected with the virus. 

Rather than risk infection, mothers shunned lifesaving vaccinations for their children and, if their child became ill, even seriously 

ill, all too many believed the safer option was not to seek treatment 

at all. 

With funding from USAID, we opened up our first 70-bed Ebola 

treatment unit in Bomi County in Liberia as we admitted our first 

patients on September 15. Currently, we have 53 beds occupied 

and staffed by a team of 17 ex-patriots and 161 Liberian nationals. 

To date, this issue remains one of just two in Liberia operating outside of Monrovia. 

Within the next 6 weeks, we expect to open three additional 

Ebola treatment units, one in Liberia in Margibi County and two 

in Sierra Leone’s Northern Province, specifically in Lunsar and 

Makeni. 

Within the next 3 weeks, we expect to open a training center in 

Bung County to train other NGO staff on case management protocols. In this center, which will be adjacent to our Ebola treatment 

unit, we will offer a fast-paced, 7-to 12-day training for those that 

will be involved in the treatment of Ebola patients. 

We will open a similar center in Sierra Leone in the near future 

as well. Such hands-on training is the key to protecting healthcare 

workers who must operate in an environment where all know the 
81 

Ebola virus is present. Strong guidelines and regulations are important, but they must be combined with hands-on training to be 

truly effective. 

Mr. Chairman, I would like to briefly share some of what we 

know works. This will help highlight several key areas to focus as 

well as what is needed going forward. 

First and foremost, we need to contain the disease at its source. 

For that to happen, we have learned that several factors need to 

be in place. 

This includes having operational Ebola treatment units that are 

staffed by well-trained health professionals, a robust referral system between community care centers and Ebola treatment units as 

well as between Ebola treatment units themselves to take advantage of available bed capacity in certain areas. 

Limiting the spread of the virus in the community is essential to 

containment plan. Therefore, the focus on community sensitization, 

including education, awareness, and outreach are critical. Finally, 

contact tracing and burial teams are critical to limit transmission. 

I would like to conclude by offering some recommendations to the 

committee for consideration. More detailed recommendations can 

be found in our written testimony. 

First, one of the most critical lessons learned from this response 

has been the importance of having the human resources ready and 

prepared to address an outbreak of infectious disease. 

Cadres of healthcare workers need to be well trained and supported to staff the treatment units and care centers in the affected 

countries, as well as to prepare other countries in the region for 

any potential future outbreaks. 

Second, ensure availability of appropriate personal protective 

equipment. 

Third, ensure clear protocols for evacuating healthcare workers. 

This is essential for our recruitment, training, and retaining of 

health staff in Liberia and Sierra Leone. 

Fourth, open air space to and from the Ebola-affected countries 

must be maintained. The growing restrictions on travel to and from 

West Africa will only isolate the affected countries further, compromise the supply chain, and inhibit efforts to recruit qualified 

staff. These factors will further enable the severe outbreak to continue. 

Fifth, we need to accelerate and support the production of vaccines and innovative technologies. 

Finally, in developing and implementing recovery efforts and a 

long-term strategy, we must focus on building stronger healthcare 

systems in the region. 

Mr. Chairman, there is no doubt that we will stop this outbreak 

and the death and, if done correctly, build the tools to prevent another outbreak of such proportions. International Medical Corps 

looks forward to working with you to make this happen. 

Once again, thank you, Mr. Chairman and Ranking Member 

Cummings, for allowing me to present this testimony. I would be 

glad to answer any questions the committee might have. 

[The prepared Statement of Mr. Torbay follows:] 
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Chairman ISSA. Thank you. I would like to thank all our witnesses. 

I am going to withhold my questioning at this time and go—let 

Mr. Turner go first. 

The gentleman from Ohio is recognized for 5 minutes. 

Mr. TURNER. Mr. Chairman, I greatly appreciate that. I am 

under a time constraint, having to return back to my district, and 

I greatly appreciate the Chairman doing that. 

Tuesday I had the opportunity to talk to Secretary Hagel about 

the Ebola mission. And I believe that he takes this very seriously 

and he is very concerned both about the effects on our men and 

women in uniform and, also, on the effects of protecting the American public. 

I am very concerned about the protocols of protecting the American public. And since I only get one question, my question is going 

to be about that, although I, too, am very concerned, as all the 

American public is, about the protection of our men and women in 

uniform. 

I am very skeptical of the DOD protocols, and I think the American public is very skeptical. We have basically two threats: one, 

Ebola coming here; or two, individuals who have been exposed to 

Ebola falling ill to Ebola. 

We have had four cases. Two came here. Two are the result of 

people being exposed to Ebola here and then falling ill. Three were 

healthcare providers. 

Now, the American public is very concerned that individuals who 

have been exposed to the Ebola virus have had significant public 

access after being exposed. This is during a period while they were 

falling ill to Ebola. 

Now, on October 10, Ebola came to visit Ohio. Amber Vinson 

traveled from Dallas, Texas, to Cleveland. While she was in Cleveland, she visited local businesses. Of course, she flew on a flight 

there. Almost 300 people had contact with her while she was falling ill to Ebola. 

Fortunately, Ohio doesn’t have a report at this time of a case of 

Ebola. But on October 20, the entire Ohio congressional delegation, 

on a bipartisan basis, sent a letter to the CDC challenging their 

protocols with respect to people who have been known to have been 

exposed to Ebola. 

Now, we all know the stories: trying on wedding dresses, flying, 

going on a cruise, bowling, riding the subway. Although some of 

these issues are personal responsibility, they do go to the issue of 

protocols. 

And if you look at the October 10 Department of Defense guidelines, in paragraph 4, it says that a commander has authority, 

which means they may—they don’t have to—quarantine someone 

up to 10 days if they are concerned about an individual who has 

been exposed. Now, we all know that the doctor in New York fell 

ill, apparently, after 11 days. 

And then it goes on to say that no known exposure—now, it 

doesn’t mean they weren’t exposed—it means no known exposure— 

that there is a 21-day monitoring period, but it suggests that the 

individuals return to routine daily activities. Well, those routine 
93 

daily activities would include going on cruises, flying, wearing wedding dresses, bowling, and riding the subway. 

So I think I am very concerned, as the American public is, as to 

the multiplier effect of the contacts that could occur in the public. 

And as we are learning, as we have looked at, in light of what has 

happened, I believe that both the CDC rules and perhaps the DOD 

guidance should be revised. 

General, in light of what we now know and what we are seeing 

and our concerns of the multiplier effect, again, of three healthcare 

providers who had significant public contact while falling ill to the 

Ebola virus, do you believe that this October 10 DOD guidance 

should be revised? 

And, Mr. Lumpkin, I would like your answer, too. 

Mr. LUMPKIN. I think the first thing I would like to say is to 

make sure—as I mentioned in my opening Statement, is that we 

at DOD in West Africa are not doing direct patient care. So our operations in support of USAID are focused on those lines of effort 

of the command and control, the logistics, the—— 

Mr. TURNER. But, Mr. Lumpkin, as you know, that does not 

mean that no one is going to be exposed to the virus. I mean, I understand what you are saying about the distinction between 

healthcare providers and non-healthcare providers. But the gentleman who flew here first, Patient 1 in the United States, was not 

a healthcare provider either. 

Mr. LUMPKIN. Very true. 

But I want to make sure you understand that, because we are 

not—we have different categories of risk. And I would like to turn 

it over to my Joint Staff colleague here to explain the risk categories and the mitigation strategies for each one of them. 

General LARIVIERE. Mr. Turner, thank you for the question. 

The protocols that we have put in place, we think, exceed the 

CDC standard. As you mentioned, we will be testing personnel 

twice a day while they are deployed, take their temperature, and 

to ensure that they—that, if they were exposed and they did become infected, we could isolate them effectively. 

The 0-to 10-day timeline that you discussed is the timeline that 

will take place in country. Commanders will have the authority to 

remove their personnel,—— 

Mr. TURNER. But, General, as we already know from the doctor 

in New York, he indicated, if the news reports are correct, that his 

symptoms occurred at 11 days. 

General LARIVIERE. Yes, sir. 

Mr. TURNER. So is it you are 10 days too short? 

General LARIVIERE. Yes, sir. Well, the 10 days were in country. 

The 21 days can’t start until they are actually out of the affected 

area. So the 21-day monitoring period will take place—— 

Mr. TURNER. Which means they could be traveling on day 11 and 

no longer isolated? 

General LARIVIERE. They could be traveling on day 11, but they 

will—the 21—— 

Mr. TURNER. Which would result in additional exposure? 

General LARIVIERE. No, sir. We will try to limit their exposure 

prior to their departure. But the 21-day timeline won’t start until 

they are back in the United States—— 
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Mr. TURNER. Well, my time is up. 

But I want to indicate I am highly skeptical. The American public is worried. I believe these need to be revised. The Ohio delegation sent to CDC, they believe theirs need to be revised. 

The American public is concerned that people who are exposed 

are having too much contact with the American public and raising 

the risk to the United States citizens. 

Thank you, Mr. Chairman. I appreciate it. 

Chairman ISSA. Thank you. 

And, General, I just want to make sure, as the ranking member—I just want to make sure that you are clear in what you are 

saying and what Mr. Turner was asking. 

If someone like the doctor in New York who just tested positive 

is, in fact, held for 10 days, leaves on a commercial airplane—if one 

of your gunnery sergeants leaves on an airplane, arrives in New 

York and on the 11th or 12th day goes positive, your 10 days will 

have done nothing and you won’t get that opportunity to have them 

outside—you know, in other words, the quarantine of 21 days after 

you get back doesn’t matter. 

And I think that is what Mr. Turner was very much asking, is 

the example he gave of a doctor from just yesterday tells, I think, 

all of us that 10 days isn’t long enough if that person then travels 

on a commercial airplane where they then can infect the passengers on the airplane. 

Is that your question, Mr. Turner? 

Mr. TURNER. Correct, Mr. Chairman. 

Chairman ISSA. Thank you. 

Do you have any further clarification? 

General LARIVIERE. Perhaps I am—perhaps I am not being clear. 

The 10 days is to attempt to limit their possibility for exposure 

while they are in country in Liberia. 

They will then be screened for temperature and possible exposure prior to getting on a government contract or U.S. military aircraft to be returned to their unit back in the United States. 

Once they have flown back to their unit in the United States, 

they will be given a 21-day monitoring period where they will be 

required to come into the unit twice a day for medical checks by 

U.S. military medical personnel at their unit where they will have 

their temperature taken and looked in the eye by a medical professional to see how they are doing. That will take place for 21 days 

back—back in the rear area to ensure they that do not become infected. 

They will never be more than 12 hours from possibly spiking a 

fever. If they did exhibit symptoms and spike a fever once they 

were back in the United States during one of those medical checks, 

they would immediately be taken to a treatment facility and begin 

the isolation process. 

Chairman ISSA. Mr. Cummings. 

Mr. CUMMINGS. Yes. 

Mr. Torbay, I want you to remember what was just Stated and 

I want you to comment on that in a minute. I am going to—I am 

really curious as to what you—you deal with this every day. So— 

what you think of it. But I want to go through some other things 

first. 
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I know your organization is incredibly busy, but your input is 

very crucial. In addition to your very detailed written Statement, 

you provided some pictures, and I am hoping you can explain what 

we are seeing. 

First, I believe this picture is an Ebola treatment center. Can 

you briefly describe what we have seen here. And where is that? 

Mr. TORBAY. Absolutely. This is in Bomi County in our Ebola 

treatment unit. This is the isolation unit. What you see, the two 

health workers in yellow suits with a hood and a mask are actually 

inside the restricted area. Nobody is allowed to go in there without 

full personal protection, equipment, and training. 

And outside they are taking notes. There is a supervisor to make 

sure that proper protocols are taking place as they are entering the 

Ebola treatment unit. 

Mr. CUMMINGS. And, in your testimony, you said you need about 

840 of these suits every week. You also said this, ‘‘The current demand far exceeds the supply. There are currently two main manufacturers for our acceptable overalls, and they are producing at full 

capacity.’’ You go on to say, We estimate that at the current stage, 

they will meet around 35 percent of the demand. Is that right? 

Mr. TORBAY. That’s correct. 

Mr. CUMMINGS. And so what can we do to help provide more protective gear? 

Mr. TORBAY. Absolutely. First of all, I would like to clarify that 

it is 840 PPEs for a 60-bed hospital. That is for one Ebola treatment unit; it is not for the entire operation. What we need to do 

is encourage those manufacturers to increase the supply line and 

make sure that anybody who has the capacity or has some of those 

PPEs in stock to release them, because a lot of them are in stock 

in areas that are not actually endemic, and they need to be released for those that are treating patients. 

Mr. CUMMINGS. Now going back, let me go to another picture. 

Mr. Torbay, in this picture there is a little truck in the background, and it has some kind of tarp on a flatbed. Can you tell us 

what the truck is used for? 

Mr. TORBAY. This is a makeshift ambulance. There is a lack of 

ambulances in Liberia. So we took a flatbed truck, we put a mattress in it, and we covered it with a tarp. And this is what we take 

to get patients from the community to the Ebola treatment unit. 

Mr. CUMMINGS. In your written Statement. You said, ‘‘Put simply, we need three things, people, commodities, and money. By 

commodities, I mean everything from PPEs, to disinfectant, to vehicles for transportation, mattresses and beds and clothing.’’ So is 

this what you are talking about in additional vehicles to transport 

patients? Is that what you are talking about? 

Mr. TORBAY. Absolutely. To transport patients. Additional vehicles for burial teams. Ambulances that could go out to the communities, to the community care centers and transfer patients to the 

Ebola treatment unit for treatment. 

Mr. CUMMINGS. Now let me go to the next picture. This is not 

a picture you provided, but one from a hospital in Sierra Leone. 

There are people on the floor. There is fluid everywhere. And there 

is a team of people in full protective suits that appear to be remov-
96 

ing a dead body. Can you please explain why it is so important to 

have proper burial procedures? 

Mr. TORBAY. Absolutely. The viral load in a dead body is at its 

highest. This is when it is most contagious. So it is extremely important to have proper burial procedures. The way we go about it, 

when a person succumbs to the disease, we spray them with disinfectant, chlorinated water. We put them in a body bag; we spray 

them again. We spray the body bag again. We put them in a second 

body bag’, we spray the body bag again. And a third body bag, and 

we spray them before we transfer them to the burial ground. So it 

is extremely important that proper burial procedures are followed 

all the time. 

Mr. CUMMINGS. And would more resources help with that process 

that you just described? 

Mr. TORBAY. Absolutely, sir. 

Mr. CUMMINGS. And how so? 

Mr. TORBAY. We need more burial teams. The burial teams on 

the ground in the three countries are not enough. They possibly 

contribute probably a third of the need. We need body bags. We 

need training for the burial teams, as well as vehicles for transportation of dead bodies. 

Mr. CUMMINGS. Mr. Chairman, with the committee’s indulgence, 

I would like to play a very short video clip, showing how the final 

stage of this process, the burials, is currently being handled. 

[Video shown.] 

Mr. CUMMINGS. Thank you, Mr. Chairman. 

Mr. Torbay, right now there are a lot of people watching this 

hearing. And many of them do not know the extent of the crisis in 

West Africa. They do not know the urgency of the need. You have 

a microphone in front of you. You have an opportunity to reach millions of people this morning. If there is one thing you want to tell 

the American people, what would that be? 

Mr. TORBAY. Thank you, Mr. Cummings, for giving me this opportunity. We need to deal with the Ebola virus at its source in 

West Africa. Steps can be taken in order to deal with this. We need 

to immediately increase treatment capacity by deploying and training proper health personnel. We need commodities, as we discussed, PPEs, ambulances. We need financial resources. We need 

further containment at the community level as well. It is not just 

about treatment; we need to contain it at the community level. This 

is a global issue. It is not just a West Africa issue. We all need to 

work together as one team to tackle this deadly disease and put an 

end to this outbreak. 

Once we do so, we need to continue the investment in rebuilding 

the health care system in West Africa, as well as preparedness in 

other countries. We need to make sure that this outbreak doesn’t 

reoccur. The U.S. has and is playing a pivotal role. I am proud to 

say that the U.S. has led the way and continues to answer the call, 

and other countries are following the lead of the U.S. 

Mr. CUMMINGS. Just one last thing. Mr. Turner asked, I thought, 

a great question. And the chairman tried to get some clarification 

about military folks. What was your reaction to—you deal with this 

disease. We have got health care workers in the back of you, and 

the American people are looking on. I mean, do you feel that that 
97 

is an appropriate way to address this? And should the American 

people be concerned? I mean, we have got people going over to Africa to try to help out. 

Mr. TORBAY. I would like to clarify one thing. If there are no 

symptoms, there is no transmission. That is the first thing. Unless 

the patient develops symptoms, the patient cannot transmit the 

Ebola virus. So monitoring temperature is critical, because as long 

as the patient is asymptomatic, there is no risk of transmitting the 

disease. We follow a slightly different protocol, but it is very much 

in line with what the General said, as well as with the CDC. 

There is no risk, which means somebody who hasn’t been exposed to the Ebola virus; he hasn’t been in contact with somebody—in fact knowingly infected with Ebola. We bring them on a 

commercial airline. They monitor their temperature for 21 days 

twice a day. We contact them to make sure it happens. 

There is low risk or some risk. And those people, we do not allow 

them to actually travel on commercial airlines. We ask them to 

stay out of the risk area, even in West Africa, but out of the risk 

area for 21 days to make sure that actually they have no symptoms 

before we allow them back. 

And there is high risk. Those are people that have knowingly 

been exposed to the virus. Those will be quarantined and monitored. And the minute they develop symptoms, they will be tested 

for Ebola and admitted. 

Mr. CUMMINGS. Thank you, Mr. Chairman. 

Chairman ISSA. Thank you. 

And I want to followup on the ranking member at that point. So 

if I heard you correctly, the fact is the 10-day waiting period has 

absolutely no value, that, in fact, the only real question, the only 

real way to ensure that someone is not contagious or not going to 

become contagious is for them to be outside the risk area for 21 

days, not exposed to other people who exhibit symptoms for 21 

days. Is that correct? 

Mr. TORBAY. I think where the 10 days comes from is that the 

majority of symptoms appear within 7 to 10 days after—— 

Chairman ISSA. Or 11 in the case of the gentleman from New 

York. 

Mr. TORBAY. Absolutely. I said majority. There are exceptions. 

The incubation period is 2 to 21 days. That is why it is important 

to wait for 21 days after the last known exposure to the virus. 

Chairman ISSA. Again, known exposure. That is correct. 

Now, General, you are going to be operating some seven labs. 

You said you are not doing medicine, but anyone who works in 

those labs, takes materials out of those labs, has secondary exposure to, if you will, liquids and so on, in fact, is in a direct risk, 

aren’t they? The testing labs, because we have already had that in 

Dallas, is, in fact, a point of transmission. It’s not just the individual, but, in fact, the materials that come out of that individual. 

Isn’t that correct? 

General LARIVIERE. So the military personnel who are working in 

the labs are infectious disease specialists who do this—— 

Chairman ISSA. I don’t want to know who they are. I want to 

know are they exposed. 
98 

General LARIVIERE. They are considered actually low risk because they actually have the entire suite of protective equipment 

and the extensive training. 

Chairman ISSA. You know, one of my problems, General, very little time, and I want to be pleasant through this whole thing. But 

we have the head of CDC, supposed to be the expert, and he has 

made Statements that simply aren’t true. 

Doctor, you can get Ebola sitting next to someone on a bus if 

they, in fact, throw up on you. Can’t you? That is reasonable. 

Dr. LURIE. The way you get Ebola is by exposure to body fluids, 

yes. 

Chairman ISSA. OK. So when the head of the CDC says you can’t 

get it with somebody on the bus next to you, that is just not true. 

When the head of the CDC says you cannot in fact—that we 

know what we are doing, but, in fact, health care professionals, 

wearing what they thought was appropriate protective material, 

got it, then that means he is wrong. When the head of the CDC 

goes on television and says, sometimes less protection is more—is 

better, and then has to reverse the protocols so that we no longer 

have nurses, Ms. Burger, who have their necks exposed, that was 

just wrong, isn’t it? Ms. Burger? 

Ms. BURGER. That their necks were exposed? 

Chairman ISSA. I mean the fact is the head of the CDC gave 

false information, basically saying it was OK to have your neck 

area exposed, when, in fact, if somebody threw up on you that 

could be—— 

Ms. BURGER. I honestly don’t know that those nurses were instructed that their necks were OK to be exposed. I know that—— 

Chairman ISSA. The head of the CDC, when asked about whether 

you had to have full body suits versus simply the mouth, said 

sometimes less is—you know, more is not necessarily better. So the 

head of the CDC was wrong. We are relying on protocols coming 

from somebody who has been proven not to be correct. Isn’t that 

true? 

Ms. BURGER. Those nurses were not protected. Correct. 

Chairman ISSA. Mr. Roth, I don’t want to belabor waste, fraud, 

and abuse at this hearing, even though that is a lot of what this 

committee looks for. But if I understand correctly, you have—your 

report shows that they didn’t know what they were buying and 

why particularly well. They bought large amounts without a recognition that it was going to essentially expire and without a plan 

to rotate it or in some other way put those materials into good use 

the way DOD normally does in order to prevent items from expiring that have secondary use. Is that all correct? 

Mr. ROTH. That’s correct. 

Chairman ISSA. And although I know you can’t reach every conclusion, in your material, did you discover that, for example, the 

face masks, that instead of buying them they simply could have 

had a rotating inventory that they could have drawn from that 

would have allowed the vendor to maintain a stockpile but rotate 

it so they would only take possession—which is also done at DOD 

on occasions—they would only take possession when they need it, 

and, in fact, they wouldn’t have to buy it but rather rent the avail-
99 

ability of it. Did you look into that at all or did they look into that 

at all? 

Mr. ROTH. They did not look into that at all. Certainly when we 

make our recommendations, one of the things that we ask them to 

do is explore the types of options that you talk about. 

Chairman ISSA. So all of those options are going to need to be 

looked at, evaluated, and available to Members of Congress before 

we start writing checks for large stockpiles. Wouldn’t that be correct? 

Mr. ROTH. That’s obviously up to Congress to decide. And certainly now the Department is starting to do the kinds of planning 

that we had recommended. 

Chairman ISSA. I will close with Mr. Torbay. The pictures that 

the ranking member showed and the situation in Africa is certainly 

desperate. And I know my constituents are most worried about 

what comes here. But realizing that 4,000 there versus less than 

one handful here certainly shows us where the problem is. And I 

think you said that very well. But, in fact, medical personnel that 

are dispatched from here go there and, in more than a few cases, 

find themselves infected. Isn’t that true? 

Mr. TORBAY. Correct. 

Chairman ISSA. So I want to just ask—it might be both—but is 

that primarily because of the conditions under which those doctors 

and nurses and other health care professionals find themselves 

working, or is it for lack of training? Is it more one or the other? 

Mr. TORBAY. Mr. Chairman, it is a combination of both. Our 

medical staff, they are heroes, doctors and nurses. They work in 

probably 95-degree temperature wearing those PPEs that you have 

seen. Our rotations are every hour. We get them out every hour because they are dehydrated. 

Chairman ISSA. So they are capable of not getting infected if they 

were in a good facility dealing with one patient rather than questionable facilities, endlessly, for 24 hours a day, trying to deal with 

an onslaught of patients. Is that correct? 

Mr. TORBAY. I would say in our facility—it’s a 70-bed facility— 

we have 230 staff members. And their only job is actually to look 

after the patients that are infected with Ebola. 

Chairman ISSA. To the greatest extent possible, I am going to ask 

one last question that I would like to have people say a yes or no. 

Ebola is a 35-year-old disease. It is not new. It was discovered a 

long time ago. And we have spent money looking into it, planning 

for it. The various flus, the influenzas, going back to at least 1918, 

are not new, and they have a similarity in that they can be transmitted and they kill. Since this is a hundred-year-old process of 

dealing, at least, with modern infectious diseases, is there inherently a similarity in that, whether it’s Ebola or, in fact, a pandemic, that we in Congress should be looking at the planning and 

the prevention and the training somewhat homogenously? 

In other words, today we are looking at Ebola. Should we be 

looking at infectious diseases, the training, the prevention, the handling, the emergency? Should we on this side, the nonmedical professionals, look at this as a failure of not just Ebola, but infectious 

diseases of this entire sort that we could have and should have 
100 

been more prepared for? And to the extent you can, I would appreciate a yes or no. Doctor? 

Mr. TORBAY. Yes. 

Chairman ISSA. Ms. Burger. 

Ms. BURGER. Yes. 

Chairman ISSA. Doctor? 

Dr. LURIE. It is a somewhat more complicated question. Ebola 

and flu are very different. And they are spread very differently. 

Chairman ISSA. Well, I was using infectious diseases and the isolation, the maintenance, and so on. I wasn’t trying to say that 

those which can be aspirated or in some other way transmitted. 

The point, though, is AIDS and lots of other diseases—AIDS being 

much more similar to Ebola as far as fluid transmission—we have 

had these for a long time. We are now seeing failures. 

In your opinion, Doctor, are these failures to a certain extent the 

fact that we said we were planning to deal with infectious disease, 

prepare our health care system, and our doctors and nurses, and, 

in fact, it appears as though we trained them but not trained them 

to the level we should? Yes or no. 

Dr. LURIE. I think that our failures largely relate to the fact that 

we are learning some new things about Ebola. Ebola has never 

been in this hemisphere before. And as we are learning those 

things, we are tightening up our policies and procedures as quickly 

as possible. 

Chairman ISSA. Mr. Roth. 

Mr. ROTH. To the extent that the viruses transmit in the same 

way, when we looked at the logistics, the acquisition management, 

I would say the answer would be yes. 

Chairman ISSA. Doctor? Or Mr. Lumpkin. 

Mr. LUMPKIN. This is outside of our purview and lane. 

Chairman ISSA. OK. 

With that, I will go to the gentlelady from New York. 

Mrs. MALONEY. Thank you. 

And I first would like to thank all of our distinguished panelists 

for coming today during what is a critical time in the Federal Government’s response to an urgent global crisis. 

First, I would like to take a moment to commend the health care 

professionals in New York City for their outstanding response yesterday to our first case of Ebola. New York City has been working 

with New York State, the Centers for Disease Control, to prepare 

for this. And our Nation’s largest city, based on what we know now, 

I believe they have responded and done absolutely everything right. 

A young physician had returned from West Africa 10 days ago, 

where he had been working on the Ebola crisis with the Doctors 

Without Borders. Upon arrival into the United States, the doctor 

was flagged by the CDC and Customs and Border Patrol, and reported to New York City health officials. Yesterday, when he reported he had a 103-degree temperature and was experiencing pain 

and nausea, the New York City health care system sprang into action. The patient was immediately transported to a specially 

trained Haz-Tac Unit, wearing personal protective equipment, to 

Bellevue Hospital. The hospital had previously been designated for 

the isolation, identification, and treatment of potential Ebola patients by the city and State officials. 
101 

Governor Cuomo has designated eight special hospitals in New 

York City. Earlier this week, a specially trained CDC team visited 

Bellevue and determined that the hospital has been trained in 

proper protocols and is well prepared to treat patients. 

I must say that I respond to your concerns about nurses. And at 

the hospital, there were clear protocols in place established by the 

health department to ensure that nurses and all staff caring for the 

patient followed the strictest safety guidelines and protocols. Contact teams were ready to quickly identify, notify, and, if necessary, 

quarantine any contacts the patient may have had on his three 

trips on subway, visit to a restaurant, and a ride in a taxi cab. The 

health department is now working with the HHC leadership, Bellevue’s clinical team, and the New York State Department of Health. 

And the CDC is assisting us daily in this effort. They are in close 

communications with the New York City Health Department, 

Bellevue Hospital, I would say all elected officials, and they are 

providing technical assistance and resources. 

The CDC already had a team of Ebola experts in New York City. 

They were already there to help. Three members I am told were 

flown in last night from the CDC’s so-called CERT team to join 

their colleagues already on the ground. And we are told that more 

CDC professionals will come in if needed. The CDC Ebola Response 

Team will arrive within 24 hours to any location in the United 

States where a case is reported. And so far, this is absolutely true, 

it is what has happened in New York City. 

This week, CDC named New York City and State as one of six 

States who will begin active post-arrival monitoring of travelers 

whose travel originates in either Liberia, Sierra Leone, or Guinea, 

and arrive at one of the five airports in the United States doing 

enhanced screening. Active post-arrival monitoring means that 

travelers without fever or symptoms consistent with the Ebola 

symptoms will be followed up daily by State and local health departments for 21 days from the date of their departure from West 

Africa. And active post-arrival monitoring will begin on Monday, 

October 27. 

I want to reiterate that Ebola is not airborne. Someone infected 

with Ebola can only transmit the virus if they are experiencing 

symptoms, bodily fluids in direct contact, vomiting, blood, saliva, 

diarrhea. There are over 9,000 reported cases and over 4,000 

deaths. I am told that the American health system is now actively 

reviewing two vaccines. They are in clinical trials. And we are responding. 

My question really is to you, Dr. Lurie, about the hospital preparedness program. But, first, I would like to request that this 

Statement that was prepared by the Trust for America’s Health, a 

nonprofit—— 

Chairman ISSA. Without objection, that will be placed in the 

record. 

Mrs. MALONEY. It talks about the need for enhanced funding, 

that our funding is not up to the threat that our country faces. 

I would like to ask you, how does the program help to ensure 

that our hospitals that are so designated across America are prepared to respond in a health emergency? And I would like to thank 
102 

your program for the help that you gave to the great city of New 

York. Thank you. 

Chairman ISSA. The gentleman gentlelady’s time has expired, but 

you, of course, can answer. 

Dr. LURIE. Well, thank you so much. And we were very gratified 

last night to see the kudos to the program and kudos to New York 

City for their tremendous job in responding. Our program gives 

money to States—and, in the case of New York City, directly to 

New York City—to help the health care system become prepared. 

It is defined as a set of eight basic things that every health care 

facility needs to do and provides the funding for training, for exercising, for planning, for the purchase of personal protective equipment, and other things necessary for hospitals and other health 

care facilities to be prepared. It is, in fact, one of the reasons that 

Bellevue and I believe other hospitals in New York City have been 

able to do such a tremendous job getting ready for this. And we 

will continue to support them through this program and others as 

they move forward. 

Chairman ISSA. Thank you. 

The gentleman from Florida, Mr. Mica. 

Mr. MICA. Well, first off, I have to take sort of a point of personal 

privilege. The chairman missed a word in his opening Statement 

and apologized for being on a plane. 

The committee should know, you know, the country faces two incredible threats right now. One is ISIS, or this threat we face from 

terrorism we have seen this week. It threatens not only the United 

States, but the world and our allies. But Mr. Issa, and I accompanied him, and we had a Democrat Member from the Foreign Relations Committee, was in Iraq. We were in Iraq last night. We left 

there at 6 o’clock in the evening and flew all night. And this is how 

dedicated he is, to make sure that we are prepared over there. You 

would be so proud of our troops that we saw. Incredible. 

And General, too, you get called on to do some tough stuff. But 

I saw our men and women. They are just awesome. And we had 

a chance to meet with some of our allies to get them to step up to 

the plate. But we face that threat nationally, domestically, and 

internationally. 

We face Ebola, a very serious threat. Dr. Torbay, this ain’t going 

away any time soon, is it? 

Mr. TORBAY. We are hoping that we could contain it. If all steps 

that are being put in place are followed, it will be contained. 

Mr. MICA. Here is a report I read on the plane last night. It says, 

‘‘Experts warn the infection rate could reach 10,000 a week by 

early December.’’ Ten thousand a week. Is that semi accurate? 

Mr. TORBAY. That is what the—— 

Mr. MICA. The way things are going now. This is a report I got 

on probably the people that are most at risk are health care workers, whether they are there or here. Would that be correct? This 

isn’t up to date, but you had 404 cases of Ebola in health care 

workers; 232 died. Pretty high fatality rate, right, Doctor? 

Mr. TORBAY. That is correct. 

Mr. MICA. OK. 
103 

Thank you, Ms. Burger, for representing the nurses. Do we know 

how those nurses were infected or exposed, how they caught Ebola, 

for sure? 

Ms. BURGER. Thanks to the whistleblowing efforts of Briana 

Aguirre, we know that the nurses did not have optimal standards 

for personal protection. 

Mr. MICA. OK. So we know that they weren’t properly protected. 

Ms. BURGER. Or trained on protocol. 

Mr. MICA. Or trained. OK. All right. 

Dr. Lurie, you said that we are putting additional protocols in 

place, guidance. Right? When was the most recent? 

Dr. LURIE. The most recent—— 

Mr. MICA. A week ago? A month ago? 

Dr. LURIE. The most recent guidance on personal protective 

equipment has been in the last couple days. 

Mr. MICA. And what about—OK. 

Dr. LURIE. It was changed in response—it was changed in response to the situation at Dallas Presbyterian. 

Mr. MICA. OK. So in the last couple of days. You said airport 

screening. When was that instituted, the new guidelines? 

Dr. LURIE. I can’t recall exactly the date that it started. 

Mr. MICA. A week ago. 

Dr. LURIE. The funneling into the five airports was in response 

in the last week. 

Mr. MICA. Last week. I can tell you, it is not working. OK? All 

we got to do is look at Craig Spencer. He was tested there. It is 

not working. 

Now, he is a medical professional. He reported himself. 

And then you see cases where, again, we are not prepared still. 

The whole part of this hearing is all about Mr. Roth’s report. This 

is the inspector general’s report, right, Mr. Roth? 

Mr. ROTH. Yes. 

Mr. MICA. We spent millions of dollars getting prepared, right? 

Mr. ROTH. Correct. 

Mr. MICA. OK. Didn’t you just testify that in fact—and it is in 

this, I think page 7 here—200,000 of our pandemic respirators 

have gone beyond their 5-year manufacturer warranty? 

Mr. ROTH. The ones that TSA—— 

Mr. MICA. On page six, don’t you testify that—this is a bottle of 

hand sanitizer. You tested it. Eighty-four percent of the hand sanitizer is expired that you tested. Is that right? 

Mr. ROTH. That is correct. 

Mr. MICA. So how do I tell the American people that we are prepared, that we spent millions of dollars for a pandemic—and here 

it happens to be Ebola. And you just heard testimony how important it is to have the right protections. The equipment, almost all 

the equipment you cited in this report in fact is either out of date, 

it was—the purchasing made no sense. We don’t know the inventory. We don’t know who has got it. We don’t know who is going 

to get it. Is that right, Dr. Roth? 

Mr. ROTH. Mr. Roth, but thank you for the promotion. 

Mr. MICA. OK. I upgraded you. 

Mr. ROTH. Yes. You are correct. 
104 

Chairman ISSA. The gentleman’s time has expired, but if you call 

everyone ‘‘doctor,’’ you will do very well. 

Mr. MICA. Your report is correct. And I thank you. I have additional questions. Thank you. 

Chairman ISSA. Thank you. 

The gentleman from Massachusetts, Mr. Tierney. 

Mr. TIERNEY. Thank you very much, Mr. Chairman. 

Thank the members of the panel for their testimony here today 

and for the work that they do on a regular basis. I think folks here 

that don’t already know may be pleased to know that the news was 

just released that the Presbyterian Hospital Nita Pham is Ebolafree, according to the National Institute of Health. And she will be 

released today. I think that is good news on one front on that. 

I think also a little bit of good news, and Mr. Torbay was mentioning it, is that the United States has taken the lead in the international response to this. And I think we don’t often give credit 

where it is due on that. I think we should all be proud that this 

country at least recognizes that not only do we have issues within 

our own country here that we have to deal with in terms of people 

that may be exposed or come down with the disease and come to 

this country, or be here when they are treating somebody, but that 

you do have to go to the source with a shock-and-awe type of approach as if you were in some sort of battle. We are losing lives. 

And we are losing situations that could then endanger the entire 

international community. So we need a shock and awe, all the 

things that Mr. Torbay talked about. Do we have a large enough 

response? Is it coordinated accurately? Are the people that go there 

supplied and trained and equipped sufficiently to get the job done? 

So my first question might be to Mr. Lumpkin and Dr. Lurie and 

Mr. Torbay, is the international effort now, in fact, large enough? 

Is it being well enough coordinated? Is there sufficient training and 

equipment for those that are involved in it? And if not, what remains to be done and by whom? So Mr. Lumpkin. 

Mr. LUMPKIN. In West Africa, U.S. leadership is galvanizing support on the international front. So what we have seen is that since 

the—we have gone in with speed and scale that the international 

community is coalescing to come together in order to fight the 

Ebola epidemic. 

Mr. TIERNEY. Dr. Lurie, is that coordinated enough? Are the people well trained and equipped enough? Is the response sufficient 

enough? Who should be responsible for what remains to be done, 

if anything? 

Dr. LURIE. So I would agree with Mr. Lumpkin’s assessment of 

the situation in West Africa. It has taken time to get the resources 

in place there. U.S. leadership has been incredibly welcomed and 

incredibly important. As a result of that, we are finally seeing 

many other countries of the world step up to put resources in place 

in West Africa. 

Mr. TIERNEY. So, Mr. Torbay, maybe you can help me. Is the response adequate enough? Are people that are now involved trained 

enough and equipped enough? Is it well enough coordinated to be 

able to start containing the situation and then hopefully wrestling 

it to the ground? 
105 

Mr. TORBAY. The U.S. and the UK have stepped up. Now it is 

time for the rest of the world to follow suit. The training is picking 

up. The DOD started their training. We started our training. The 

minister of defense in the UK is starting their training in Sierra 

Leone. I think, within the next 3 to 4 weeks, the training would 

be up to speed, which is critical. Supplies, PPEs are coming in. The 

different levels of PPEs, they are coming in. We hope that the pipeline will continue to come in. I think the other countries need to 

step up. We cannot forget about Guinea and containment of the 

Ebola in Guinea. This is where it started. Businesses need to get 

involved more. The economical toll of this outbreak is just phenomenal. We need to think about that. We need to think about 

technology as well. The development of vaccine is critical, but also 

technology companies need to start thinking about creative ways to 

monitor people when they are coming back, monitoring the temperature instead of having to rely on patients checking their temperature twice a day. And I think if the interventions, the international interventions continue at the same pace that it is now, I 

think it will be contained within the next 4 to 6 months. 

I would also like to thank the Department of Defense, the U.S. 

Navy, for putting a lab actually in Bong County, right next to our 

ETU. This has cut down the testing time from 3 to 5 days to 5 to 

7 hours of Ebola patients. So we are accepting patients, testing 

them, releasing them if they are negative, and avoiding infections 

by them staying in the isolation ward. 

Mr. TIERNEY. Thank you. This isn’t the hearing for it, but Mr. 

Roth, thank you for your work. I am also amazed that agencies like 

DHS don’t go to the Government Accountability Office or somebody 

in advance to learn how to set up a protocol as opposed to waiting 

until they get audited later and find out that they didn’t do it correctly. 

But Mr. Chairman, I suspect we will hear that later. 

Dr. Lurie, last question. This is not new. Ebola has been around 

a while. Obviously, people think that we could have been a lot further along in terms of vaccination or some other type of treatment 

or medicine on that. But there has been no profit motive sufficiently involved on that. What are we doing—not just with Ebola, 

but anything along the situation line with the chairman’s question 

earlier—what are we going to do to make sure that we have the 

kind of forward thinking that if the free market and the profit motive isn’t going to resolve these things and get them done, what are 

we going to be able to do as a public policy? 

Dr. LURIE. I this is a great question, and I thank you for it. Were 

it not for the investments in biodefense and getting going with 

Ebola vaccines and therapeutics, we would be nowhere near where 

we are now with the safety testing of two promising vaccine candidates going on and soon to be testing some therapeutics. So we 

do need to think about emerging diseases. We do need to think 

about developing products, countermeasures for them now. And we 

have appreciated the support from Congress for BARDA, the Biomedical Advanced Research and Development Authority, both 

through its direct funding and through the Project Bioshield Special Reserve Fund that have helped us ensure that there is a mar-
106 

ket, ensure that product developers and manufacturers will step up 

to the plate and work on these important threats. 

Mr. TIERNEY. So you are talking about public financing being 

used to establish those markets on that as opposed to just the private industry on its own going out and trying to work with the free 

market aspect? 

Dr. LURIE. We have been talking about some very positive publicprivate partnerships and some tremendous models that we have 

developed over the past several years, whether it’s been about biothreats or whether it’s been about pandemic flu, and now with 

Ebola, that are really making that possible, yes. 

Mr. TIERNEY. Thank you. 

Thank you, Mr. Chairman. 

Chairman ISSA. Thank you. 

The gentleman from North Carolina. 

Mr. MCHENRY. Thank you, Mr. Chairman. 

My questions are for the Assistant Secretary and—the Assistant 

Secretary and for the General. We have our men and women in 

uniform that are now in regions that are severely affected by 

Ebola. To their parents, their mothers and fathers of these men 

and women, do you have every confidence that they have every bit 

of the equipment and training that they need to be protected, to 

be safe, and to return home healthy? 

Mr. Lumpkin? 

Mr. LUMPKIN. The safety of our servicemembers—— 

Mr. MCHENRY. The right answer is yes. 

Mr. LUMPKIN [continuing]. Is absolutely paramount. And while 

you can never mitigate risk to zero, I think we have taken all the 

steps to mitigate the risk. So my answer is yes. 

Mr. MCHENRY. General? 

General LARIVIERE. Sir, the combatant commander and the services are making every effort to ensure that the troops have the 

proper training and proper equipment they need for this mission 

so that they can return home safely. 

Mr. MCHENRY. Mr. Lumpkin, you said in your opening Statement that if infected, if someone contracts Ebola in country, they 

will be returned back to the United States and cared for in a CDC 

facility. Is that correct? 

Mr. LUMPKIN. I did not say that in my opening Statement. 

Mr. MCHENRY. But you mentioned a CDC facility where treatment would be given. Then let me ask you a question: If somebody 

comes down ill in country, how would they be cared for? Will they 

be cared for in country, or will they be returned to the United 

States? 

Mr. LUMPKIN. They will be returned to the United States. But I 

would defer to my Joint Staff counterpart on the specifics. 

General LARIVIERE. Thank you for the question. So to take care 

of the troops in country, there will be two Role 2 hospitals; one established in Monrovia, one established in Sierra Leone. The medical personnel there will be trained in how to treat Ebola victims 

if a U.S. uniformed military person does, in fact, contract it. To answer your question whether they will be treated in country or sent 

home, the answer is obviously both. If they are identified for some 

reason of having high risk of exposure, or if they actually do start 
107 

to exhibit symptoms, they will be cared for initially in country, and 

then they will be moved home. If they are asymptomatic, they will 

do what we call a controlled movement, which will be an individual 

movement on a DOD aircraft. 

Mr. MCHENRY. How many aircraft are outfitted to move these individuals out of country in the event that this happens? 

General LARIVIERE. So, for controlled movement, any aircraft can 

do, because as has been pointed out, they are asymptomatic and 

not contagious at that point. So any aircraft could do. At the 

present time, the only aircraft that can move the symptomatic patients is the State Department’s Phoenix Air Contract, which you 

have seen moving the other Ebola patients. 

Mr. MCHENRY. How many patients can that aircraft hold? 

General LARIVIERE. The aircraft can hold one at a time, and can 

do four movements a week at this point. 

Mr. MCHENRY. Four movements a week? 

General LARIVIERE. Yes, sir. 

Mr. MCHENRY. Is that sufficient? 

General LARIVIERE. Given the number of Ebola patients that the 

United States has had in total at the present time, it is sufficient. 

However—— 

Mr. MCHENRY. But that is not how these epidemics work. 

General LARIVIERE. Right. So, at this time, the Department of 

Defense has an urgent U.N. Statement that is being worked 

through the system with TRANSCOM to put together an isolation 

pod that can carry multiple persons for C–17 aircraft. Testing will 

begin in October—or I am sorry, development will begin in October, 

testing in December. Procurement will begin in January. 

Mr. MCHENRY. In January? 

General LARIVIERE. In January. 

Mr. MCHENRY. In January. And how many individuals will be 

able to be transported? 

General LARIVIERE. Fifteen at a time. 

Mr. MCHENRY. Fifteen at a time. What is the turnaround time 

for the plane? How many movements a week? 

General LARIVIERE. We hope to procure a number of these systems so that they can be put on any C–17, so if we had—so we 

could move multiple C–17s to—— 

Mr. MCHENRY. So, at current State, we can take less than 10 

people out of country in a week’s time. 

General LARIVIERE. If they are symptomatic. 

Mr. MCHENRY. So this is not at all sufficient. 

General LARIVIERE. We don’t know—at the current time, we expect we will not be doing direct patient care. And so we anticipate—— 

Mr. MCHENRY. I understand. But how many American troops 

will we have in the region by the end of the year? What is our maximum? 

General LARIVIERE. In the vicinity of 3,000. 

Mr. MCHENRY. Of 3,000. 

General LARIVIERE. Yes, sir. 

Mr. MCHENRY. This is very disconcerting. Is it a question of— 

Mr. Lumpkin, is it a question of resources? Does Congress need to 

appropriate funds so that we can actually get more planes, more 
108 

logistical support here so that we can have the capacity if something absolutely horrible happens to our fighting men and women 

in country? 

Mr. LUMPKIN. Well, we clearly have an identified requirement. 

And as we develop the capacity, I would like to take that one for 

the record just to make sure I get you—because I am not familiar 

with the acquisition and the process or the actual requirements 

that would—— 

Mr. MCHENRY. I think you should get familiar with the acquisition process if we currently have one plane that is controlled by the 

State Department. I am asking the Department of Defense, with 

the mass number of airplanes, equipment, and training capacity 

that we have, nearly—spending nearly half a trillion dollars annually on the Department of Defense. If you need it, you will get it. 

We will demand it. Because if we are putting these men and 

women in harm’s way, potentially where they can contract Ebola, 

the idea that we have one airplane as the United States to get 

these men and women out of country in a safe manner if they contract what is absolutely horrible, which we want to control, which 

we absolutely want to control, the idea that you are coming before 

us and giving this type of testimony raises great concerns. 

I know you have been asked to do a lot. And I absolutely respect 

that. But we are asking you in the legislative branch to tell us 

what you need, and we will get it. Because we don’t want to put 

our men and women in harm’s way without any capacity to care 

for them. Our veterans, our fighting men and women deserve the 

best health care in the world, the best training in the world. And 

they have it. But it means the proper protocols at the top level are 

there to make sure they are protected. And if something bad happens, they are immediately taken out of harm’s way, cared for, and 

returned back to their normal State. 

And, with that, Mr. Chairman, I yield back. 

Chairman ISSA. I thank the gentleman. 

We now go to the second gentleman from Massachusetts, Mr. 

Lynch. 

Mr. LYNCH. Thank you, Mr. Chairman. 

And I thank the ranking member, Mr. Cummings, for holding 

this hearing. 

And I thank the panel. You have been very helpful. 

As a matter of fact, there have been some marked contrasts between the testimony here this morning. And I want to drill down 

on that a little bit, because sometimes that is helpful when people 

on the panel disagree. 

Dr. Lurie, you testified, and it is in the written testimony, that 

we are better prepared than ever and that you have a comprehensive response on the ground. 

On the other hand, Mr. Roth, our inspector general, you were 

commenting how the analysis done by—I think you were talking 

about DHS in your testimony, how the equipment purchases are 

not adequate, in some cases the wrong equipment; in other cases 

the usefulness of the equipment or drugs are beyond the expiration 

date. Dr. Lurie, you testified that you have a very aggressive system in place. 
109 

And, on the other hand, President Burger from National Nurses 

United said that they have done a survey. They have done a survey 

of 3,000 nurses from every State in the Union and the District of 

Columbia. And 85 percent of those nurses say that they have not 

been trained to deal with Ebola, and that preparedness is, and this 

‘‘woefully insufficient and dangerously inadequate.’’ 

So those are two different stories of what is going on here. Now 

I understand we don’t want to panic people. But we also don’t need 

happy talk in terms of what we are dealing with. And maybe it is 

just me, but lately, when a government agency comes before this 

committee especially and tells me there is nothing to worry about 

and we have got this, that is when I start to worry. 

Now, as to who to believe, I think the nurses—and I know I have 

got some nurses here from the Massachusetts nurses association as 

well, I know how hard they work. They are on the ground. They 

are our front lines in this battle against Ebola. They are our 

ground troops. They are the people who are doing this work every 

day. They are exposing themselves, and perhaps their families, perhaps their families, if things go wrong, if they don’t have the adequate equipment. So when they tell me that they are not prepared, 

I tend to believe them. I think those are facts. Those are facts. And 

we need to make sure that we get them the equipment and the 

training they need to protect themselves and to protect our communities and to protect their own families. 

There are a couple of facts that we have gotten in the briefings 

from the various panelists. One fact is that the CDC estimates that 

by this January, there will be up to 1.2 million people in West Africa afflicted with Ebola—1.2 million. The estimate by DOD is 1.2 

million, 1.2 million in January. Now, they were done at different 

times, so the difference might be just the period of time that they 

were taken, if things go as they are right now, 1.4 million. So we 

have got a real and present danger to the people of West Africa and 

to the people in the United States, who I am pledged to protect. 

Now, I understand that the current approach is to use what they 

call a post-arrival approach so that we are going to have these hospitals, and that as people arrive from West Africa, we are going to 

begin an analysis and a quarantine and checking them and making 

sure that they are not carrying Ebola. 

But it seems to me—and I listened, and Mr. Torbay, you have 

given some very powerful testimony, a lot of it written, quite frankly, and you haven’t had a chance to talk about it, but you were saying that the focus should be on West Africa. And what we are setting up here right now with this post-arrival in the U.S. approach 

is we are going to set up these hospitals, all this equipment, everything here in the United States, and wait for those folks to arrive. 

And I believe that we should be doing just the opposite. Well, we 

should be doing that, but we should also be doing something else, 

and that is pre-departure. Pre-departure. We know that we are 

about to have 1.2 million, 1.4 million people in West Africa afflicted 

with Ebola. We ought to be on the ground there. We ought to 

have—instead of the restriction here in the United States after 

they come in of 21 days, there should be a 21-day pre-approval. 

When they say they want to travel to the United States, they need 

to present themselves and report in person 21 days before they get 
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on that plane. And we can take their temperature and a blood sample, if necessary, so that 21 days later, when they appear to travel, 

we can test them again. Now we have got two contact points on 

that person before they fly to the U.S., and we can also do that 

post-arrival check as well. 

But we are not taking this seriously enough. We are not. And, 

you know, we need to help, you know, our brothers and sisters in 

West Africa, absolutely. But we have got to use—we have got to 

have a fact-based approach to this. This can’t be just about ideology 

and happy talk. You know, we have to look at this very seriously 

and have a scientific-based approach to what we are going to do 

about this problem. And I don’t think it helps to say we have got 

an aggressive thing on the ground, everything is good. Because I 

have got a feeling, in a couple of months, you are going to come 

back here and give us a whole different story. We have heard that 

before. So we have got to approach this in a very deliberate manner, and take it much more seriously than what I am hearing here 

today. And, you know, we owe that—we owe that to the citizens 

that we represent here in the United States as well as to those individuals in West Africa, who we obviously want to support as well. 

But Mr. Torbay, let me just ask a question, wrapping up here. 

Your focus, you were saying that you want to make that containment effort in West Africa. Wouldn’t it be—think about this. If we 

were putting our folks from all over the world, you know, medical 

personnel on the ground, you know, in Monrovia or at Freetown, 

wouldn’t it be better, wouldn’t it strengthen the infrastructure 

there on the ground in West Africa, as opposed to just having a 

post-arrival process here in the United States? 

Mr. TORBAY. Thank you for your question, Mr. Lynch. You know, 

as I mentioned, it needs to be contained at the source in West Africa. This is where the majority of the investment needs to take 

place. This is where training needs to take place. This is where 

equipment and supplies need to take place. And this is where most 

of the investment needs to take place. 

Now, that said, we cannot just focus on one without the other. 

What we are doing here in the U.S., we are treating the symptoms 

of the outbreak in West Africa. We need to deal with the root cause 

of the outbreak, of the problem, and that is actually at the community level in West Africa. I believe pre-departure there are some 

tests, temperatures being taken for anybody actually departing any 

of those countries before they board the flight. 

Mr. LYNCH. At the time of the flight, yes, they get tested before 

they get on the plane. What I am talking about is doing something 

21 days before, so that you have got two contact points that you 

can have measurements on. It is not foolproof. But having two contact points there in West Africa before you arrive in the United 

States—— 

Mr. JORDAN [presiding]. The gentleman can respond. 

Mr. LYNCH. OK, Mr. Chairman. Thank you for your indulgence. 

I know I am way over. 

Mr. JORDAN. Do you have a quick response, Mr. Torbay? 

Mr. TORBAY. One thing that we worry about in terms of 21 days, 

we are having difficulties recruiting health personnel from the U.S. 

to go and work there because there is a minimum requirement of 
111 

6 weeks. If we impose an additional 21 days, that is 9 weeks. And 

it is extremely difficult for any hospital or university to allow doctors and nurses to take off for 9 weeks before they come back. 

Again, we cannot completely wrap ourselves in a bubble here. People will go from Guinea or Sierra Leone to Senegal, will wait a 

week, take a flight to Europe, wait a couple of days, then come 

here, and there is not much we can stop it from doing that. So the 

preparedness needs to take place at both ends. 

Mr. LYNCH. With all due respect, though, there is only a few 

flights, there is only a couple of flights out of there. You can actually do this. 

Mr. JORDAN. We have to move on. I thank the gentleman for his 

good points. 

Dr. Lurie, when you were in front of Congress in 2011 back during the debate on the reauthorization of the Pandemic Act, the act 

that created your agency and your position, you had an exchange 

with Mr. Rogers, a colleague of ours, from Michigan. He said this: 

‘‘There is a point person, somebody that makes the decision, somebody that is absolutely in charge. It’s not CDC. It’s not NIH. It’s 

not FDA or anyone else. It’s you.’’ Your response was, ‘‘That’s 

right.’’ So you are the key person. Right? 

Dr. LURIE. My role is to be the principal adviser to the Secretary 

on these matters, yes. 

Mr. JORDAN. You are the key person in the government for medical preparedness, public health emergencies; you are the key person in the U.S. Government. 

Dr. LURIE. In HHS. 

Mr. JORDAN. Got it. Let’s go to the first slide, if we could. I just 

want to put up a couple slides. This is straight from your Website, 

just to be clear. It says you are the person, your agency, the Assistant Secretary for Preparedness and Response to lead the Nation in 

preventing, preparing for, and responding to the adverse health effects of public health emergencies and disasters. 

Further down, the Secretary of HHS delegates to you the leadership role of all health medical services, support, function in health 

emergency and public health events. You are the key person. Correct? 

Dr. LURIE. That’s what the legislation says, yes. 

Mr. JORDAN. No, that is not the legislation. That is your Website. 

Dr. LURIE. That is my role. 

Mr. JORDAN. Yes, that’s the Website. The legislation definitely 

says that. Your Website confirms that. 

Dr. LURIE. That is my role. 

Mr. JORDAN. You are the key person. Have you met with Ron 

Klain, the new Ebola response coordinator? 

Dr. LURIE. Yes, I met with him his first day, and I had several 

conversations and an in-person meeting with him yesterday. 

Mr. JORDAN. Have you met with Tom Frieden, Dr. Frieden at the 

CDC? 

Dr. LURIE. I meet with and talk to Dr. Frieden almost every day. 

Mr. JORDAN. Good. We would expect that to be taking place. Are 

you familiar with the story that Ms. Harrington did in the Washington Beacon I think, the story that says $39 million worth of NIH 
112 

funding that could have gone to an Ebola vaccine. Are you familiar 

with that story? 

Dr. LURIE. I am not familiar with the story. But if you familiarize me on the specifics, I would be happy to respond. 

Mr. JORDAN. I am going to do that. Are you familiar with the fact 

that $275,000 on a restaurant intervention to develop new children’s menu was spent of NIH dollars? Are you familiar with that? 

Are you familiar with the fact that $2 million were spent to encourage the elderly to join choirs? Money from the NIH. Are you familiar with that? 

Dr. LURIE. I am not familiar with the details of grant programs 

at NIH—— 

Mr. JORDAN. $53,000 on a project studying sighs. Are you familiar with that? Are you familiar with the fact that $39 million of 

NIH funding was spent for all kinds of things that—I mean that 

I guess cut to the chase. One of the things you learn in your first 

economics class. Not that I was a great student, but I did study a 

little economics. One of the things they tell you is the term opportunity costs. Right? When you spend and allocate resources for one 

thing, you by definition can’t use those resources for something 

else. And so here is what I think a lot of American people want 

to know: Why, in fact, did we spend so much money on, for example, $374,000 to host fruit and vegetable puppet shows for preschoolers when, in fact, some of this money, as catalogued by the 

press account and by staff, totaling $39 million, could have been 

used to help with treatment for something like Ebola and potentially a vaccine? Are you involved in the decisions that NIH makes 

when they are deciding how to allocate some of that money? 

Dr. LURIE. I am involved in the decisions related to our biodefense and our preparedness programs for emerging infectious diseases, yes. The NIH, the CDC, the FDA, my office, DOD, DHS, the 

VA, and the Department of Agriculture all work together on those 

issues. 

Mr. JORDAN. But aren’t you the point person in coordinating all 

of that? 

Dr. LURIE. Yes. 

Mr. JORDAN. So, at some point, you have to sign off and say it’s 

OK that $374,000 is used for puppet shows instead of potentially 

being used—losing the opportunity to use that money to develop a 

vaccine to deal with something like Ebola. 

Dr. LURIE. So, with respect, sir, I think you have—I would like 

do a little bit of clarification here. I think there is a little misunderstanding about how the NIH budget is allocated. But that is not 

my responsibility and my purview. So I suspect we should—— 

Mr. JORDAN. Let me go back to that same exchange you had with 

Congressman Rogers just a couple years ago, when we were reauthorizing the act that created your position and made you the key 

person. Mr. Rogers says this—you said this when you responded to 

Mr. Rogers—how can we improve functions at HHS to ensure that 

you are, in fact, in charge—that you are the person in charge? NIH 

is in HHS, right? 

Dr. LURIE. Yes. 

Mr. JORDAN. Yes. So you are the key person at HHS. How can 

we improve, Mr. Rogers asked you. You said, ‘‘I have found through 
113 

experience that indeed I have the authority that I need to be in 

charge.’’ You followup by saying, ‘‘And I find that the collaboration 

with sister agencies and HHS, I don’t think it has ever been better. 

We are working extremely close together. I think they recognize 

and respect the fact that we provide policy direction and are in 

charge. And I think all the efforts that we have undertaken to coordinate across HHS have done that.’’ So you told Mr. Rogers, 

when we were discussing whether we were going to reauthorize 

this act to keep your position, that, in fact, everything was working 

great. You were the person in charge. You were working within 

HHS coordinating policy, direction, and you were in charge and 

working closely together. 

Dr. LURIE. And I would stand by that Statement. 

Mr. JORDAN. So back to the key question. Might we be a little 

closer to having a vaccine today if you weren’t allowing all this millions of dollars—$39 million to be spent on what many Americans 

view as questionable uses for their tax dollars, particularly in light 

of the fact we have an Ebola outbreak in the United States? 

Dr. LURIE. Thanks to the investments that we have had in biodefense and our focus and Department of Defense’s focus on this 

critical issue over the past decade, we now have two vaccines in 

safety testing and at the NIH and Walter Reed. 

Mr. JORDAN. Dr. Lurie, that’s my point. Might they be further 

than safety testing if you hadn’t wasted $39 million on a bunch of 

other things that most taxpayers think are ridiculous? 

In fact, one of your specific charges is, in your—can we put up 

the second slide? 

The second slide specifically mentions—this is again from your— 

Ebola. You are supposed to get ready for this. Might we be more 

ready if you hadn’t spent $39 million of hard-earned taxpayer 

money on puppet shows for preschoolers instead of invested that in 

treatment and vaccines for Ebola? 

It is a ‘‘yes’’ or ‘‘no.’’ You can—might we be further along if that 

money had not been spent someplace and could have been applied 

to the question at hand? 

Dr. LURIE. I don’t believe that would be the case. 

Mr. JORDAN. You don’t think $39 million would have helped us 

get closer to a vaccine? 

Dr. LURIE. You know, the development of a vaccine is a long and 

complicated process. It takes years—— 

Mr. JORDAN. Is it a costly process, too? 

Dr. LURIE. It is. And it—— 

Mr. JORDAN. It’s a costly process? 

Dr. LURIE [continuing]. Takes years and years and years to do 

that. 

Mr. JORDAN. $39 million could have been used for it. You are the 

person in charge who works closely to direct policy direction. Those 

are your words, not mine. Might we have been better off if, in fact, 

it had been used to develop a vaccine? 

Dr. LURIE. I am not in a position to comment on the overall NIH 

budget. 

Mr. JORDAN. The gentleman is recognized. 

Mr. COOPER. I thank the chair. 
114 

I think the main public health message of this hearing is probably counterintuitive: that, at least for U.S. citizens, we face probably more risk from the flu. So hopefully everyone will be getting 

their flu shot after hearing this hearing. There are many other 

public health precautions we could be taking, such as 

handwashing, things like that, which are too often neglected. 

Back to Ebola, the public is concerned that we are doing too little 

too late, so I would like to explore some of the gating factors that 

might limit an appropriate response. 

Mr. Torbay was very specific in his testimony, mentioning that 

probably we are meeting—our manufacturers—there are only two, 

apparently—are going to be able to meet only 35 percent of the estimated demand for the appropriate type of coverall. Could you 

name those two manufacturers? And we could perhaps explore 

what could be done to augment the supply of those essential coveralls. 

Mr. TORBAY. First of all, I would like to clarify that those manufactures manufacture the specific type that we use. It is different 

than types other organizations use. 

And I do not remember the manufacturers, but I will be more 

than happy to provide it to the committee in writing after the testimony. 

Mr. COOPER. For the record. 

Mr. COOPER. There are some other gating factors. Of course, we 

all hope on the committee that we don’t get to the point where we 

need augmented emergency flights by DOD to, you know, ship our 

soldiers back home, but Mr. McHenry asked an appropriate question. Because our men and women in uniform and their families 

want to know that there will be sufficient capacity to get them 

back home. 

I think one of the concerns of the public is that three health 

workers have been infected in the U.S. and one actually overseas 

returning. And I think we are all looking for the right sort of response. 

This doctor in New York—and we all hope and pray for his safe 

recovery, but when he felt sluggish on Tuesday, perhaps it would 

have been more appropriate to limit his contact with others, you 

know, since he had been exposed to some of the worst of the infections in Africa. But that gap from Tuesday to Thursday, that will 

take an extraordinary taxpayer effort—contact tracing, all sorts of 

things—to try to limit the risk of exposure. 

What is the appropriate protocol for people who are known to be 

at risk during this crucial 10-day period, 11-day period, 21-day period to try to limit contacts? Like, everyone would have to feel sorry 

for his fiance or his girlfriend or the other folks, you know, he was 

close to, when he is a skilled medical professional who presumably 

should have known, well, it is getting a little dicey here, and to call 

in when he has a 103-degree temperature. Is there a better response than that? 

For any of the panelists. 

Ms. Burger? 

Ms. BURGER. I think it is unrealistic to expect that any 

healthcare professional that is working under extremely stressful 

situations, including Tina and Amber and several doctors—you 
115 

have to remember that they are humans. You can’t expect them to 

use their common sense at that point because they are patients. 

They need a team that they report to, that checks on them, as Mr. 

Torbay has indicated, that follows them and makes the decisions 

for them so that they are no longer healthcare workers, they are 

patients that need our protection and care. 

And so, to that end, it would make sense to have a professional 

team monitoring them and making the recommendations so they 

can actually relax and not have to worry that they are contaminating or exposing anyone unduly to the infectious disease. 

And I think that that would really help in making sure that everybody that volunteers to take care of these patients and puts 

their own families’ lives at risk actually is well taken care of after 

their service. 

Mr. COOPER. So you are suggesting that Dr. Spencer should have 

been viewed as a patient earlier than on Thursday and should have 

had a team of counselors to advise him because his judgment could 

not really be trusted at that point? 

Ms. BURGER. Exactly. Exactly. 

Mr. COOPER. Well, that is a pretty bold recommendation. 

As far as international response is concerned, Mr. Torbay mentioned that U.S. and U.K. have stepped up. We have had some individuals in America—Paul Allen, Mark Zuckerberg—who have 

given more money individually than many nations have given. So 

that is an astonishing response. 

But what can we do to get more nations involved? I am thinking, 

for example, of France that has had involvement in that area traditionally. What are these other nations—what should we expect of 

them? 

Mr. TORBAY. I think an all-hands-on-deck approach is really necessary. I think a realization that this is, again, not a West African 

problem, it is a global problem that could hit any country anywhere 

around the world, especially with travel being the way it is. People 

need to realize the threat, and they need to realize that any contribution that they can make actually will make a difference. 

As you mentioned, private foundations and corporations here 

contributed more than some countries did. And I think the U.S. 

Government should continue to put pressure on those countries to 

actually contribute to the cause. 

Mr. COOPER. Thank you, Mr. Chairman. I see that my time has 

expired. 

Mr. CHAFFETZ [presiding]. I thank the gentleman. 

I now recognize the gentleman from Michigan, Mr. Walberg, for 

5 minutes. 

Mr. WALBERG. Thank you, Mr. Chairman. 

General, thank you for your service. 

Probably the number-one question or concerned phone call I have 

been getting on this issue in the past several weeks comes from 

family members of our military, whether it be Active, National 

Guard, Reserve troops—a concern that what they have seen go on 

in places where they expect their family members to potentially 

have a death sentence as a result of being proud members of the 

military and signing on for that and committed to their efforts. Yet 

there are concerns that the way it is carried out at times, their 
116 

loved ones haven’t been given the necessary tools, armaments, 

rules of engagement, and all the rest to handle what they have 

been trained for, trained to do. That is a concern for them. 

But the biggest concern that they are conveying to me on those 

phone calls or meetings in public is that this is a potential—a 

death sentence, being sent in to combat a virus, and with great uncertainty because of the multitude of changes in protocol, at least 

perceived by them, coming from what they hear in the news, hearing from leaders in this administration, with responsibilities, and 

also the lack of information coming from the military on what they 

are doing. 

Let me ask if you would just briefly walk us through a daily routine of one of the soldiers that has been sent over to West Africa. 

General LARIVIERE. Congressman, thank you for the question. I 

have spoken to the commander on the ground, and I have talked 

to the folks at AFRICOM, and this question comes up quite a bit, 

actually. 

The protocols for an individual on the ground for your average 

soldier—and, again, I would like to emphasize first: None of the 

military personnel will be providing direct patient care. We have 

four lines of effort: command and control, logistics, engineering, 

and training. So we are not—the protocols for treating patients is 

not something that individual soldiers will be doing. 

Mr. WALBERG. But they do come in contact with contractors, with 

aid—— 

General LARIVIERE. Absolutely. And so the protocols in place over 

there, as Mr. Lumpkin can testify to since he has recently returned, there is a no-touch policy over there. There is a 3-feet separation when you are talking to local nationals over there. And that 

is being enforced both on the Liberian and U.S. military side quite 

strictly. 

In your average day for a soldier over there, it would be, obviously, getting up, eating chow, doing the usual morning routine, 

get your temperature taken first thing in the morning, and then go 

out to whatever task you are going to do. Again, if you are in the 

command center, that involves going from your building directly 

over to the command center and sitting at a computer terminal or 

working on the generators or whatever it is that you are doing inside the command center. 

If it would involve—it involves eating only food from approved 

sources, drinking mostly bottled water, or exclusively bottled water, 

and washing your hands in chlorine solution virtually everywhere 

you go. 

You go through your day. At the end of the day, every time you 

come back in the compound, at the end of the day, wherever you 

are living, you get your temperature taken again—again, more 

chlorine wash—in order to ensure that you stay Ebola-free. 

Mr. WALBERG. Will the U.S. military personnel have ZMapp or 

any other experimental drugs available to them on the ground? 

General LARIVIERE. There will not—there will not be any—I will 

have to take that for the record. 

General LARIVIERE. I am not aware that there will be any ZMapp 

available on the ground. 
117 

The personal protective equipment will be issued to them, depending on their level of expected exposure. For the vast majority 

of people, that will include surgical gloves, overgloves, boots, and 

a Tyvek suit. Obviously, for the medical personnel, it will be more 

along the lines we talked about here for the healthcare providers. 

Mr. WALBERG. OK. 

Dr. Lurie, in 2005 the Bush Administration proposed a rule 

change that would allow the CDC broad powers to confine individuals that are believed to be infected with deadly pathogen-like—the 

pandemic flu. President Obama withdrew this rule in 2010. 

Do you believe the CDC needs or should have this authority to 

ensure an infectious disease outbreak like Ebola is contained and 

controlled? 

Dr. LURIE. Thank you for that question. 

You know, I think, with every situation, we are always reviewing 

and taking a look at whether we have all the authorities we need 

to do the job. In our system of government, right now that authority rests with the States, and they have authority to do that when 

they think it is necessary. 

Mr. WALBERG. But CDC shouldn’t have that authority that they 

did have? And it could be flexible. There was certainly authorization. They didn’t have to. Don’t you think that would be a valuable 

authority to have? 

Dr. LURIE. So what I would say is I think that we are always 

learning and adjusting based on our experience, and that is one of 

the things I think we will probably be looking at as we move forward. 

Mr. WALBERG. Well, I hope so. We are sure learning right now. 

I am not sure we are adjusting as rapidly as possible. 

And I am not—I am certain we are not giving any type of security to our medical workers, nurses, including our citizens out 

there, that we have a solid policy in place that is first and foremost 

protecting our citizens against these type of problems. And I think 

it is evident by the hearing today and hearings that will go on that 

you are not bringing us a sense of security. 

And as a Member of Congress representing a district, I am expressing that point of view from my citizens, who believe that we 

are less secure than we ought to be if we had used the policies that 

had been put into place. 

Mr. Chairman, I yield back. 

Mr. CHAFFETZ. I thank the gentleman and will now recognize the 

gentleman from Virginia, Mr. Connolly, for 6 minutes in the spirit 

of equal time. 

Mr. CONNOLLY. I thank the chair. 

It seems to me that, based on what we know and what we are 

hearing today on the panel, the United States’ objectives have to 

be twofold. Domestically, it is to protect and prevent. And that goal 

cannot be successful if we don’t address the second goal, which is 

to deal with the disease at the source in West Africa. The two go 

hand-in-glove. 

And especially given the fact that we are potentially looking at 

an explosion of infection that is exponential in a very short period 

of time, the next 2 months, it seems to me there is enormous ur-
118 

gency in the latter, not to diminish at all the need to address the 

former. 

Now, we had some good news today. A nurse, Ms. Pham, has 

been declared Ebola-free. Thank God. But as Ms. Burger points 

out, dealing with the first part, protect and prevent, it wasn’t 

thanks to the protective gear and the protocols and the guidelines 

that were in place at her hospital. While CDC was giving us assurances how hard it was to contract the disease, ‘‘We’re pretty confident we’ve got things in place,’’ and so forth, two healthcare workers, including Ms. Pham, came down with it. 

Dr. Lurie, in retrospect, do you think perhaps, not intentionally 

of course, but in a zeal to reassure the public, CDC misstepped? 

Dr. LURIE. You know, I think that CDC has said that some 

missteps have been made. But they have taken a quick, hard 

look—— 

Mr. CONNOLLY. But isn’t it—— 

Dr. LURIE [continuing]. At the experience. They have pivoted, as 

you see—— 

Mr. CONNOLLY. Dr. Lurie, I am asking—I am asking a public information, public health question. I have had to deal with that in 

my county, when I was the head of my county, during anthrax attacks. And one rule I had was: Never reassure the public when you 

don’t know. Never do that. Because when you do that, you damage 

your credibility. 

And you heard it here today from some of the questioning on the 

other side of the aisle. It gave them an opening to attack the credibility of the administration by extension because the CDC was not 

capable of saying, ‘‘Not yet. We don’t know. We’re still—it’s a work 

in progress.’’ 

What is so horrible about doing that? 

Dr. LURIE. I think right now, if we look at the situation, we see 

that it is a work in progress. And what you see is that we are taking constant steps to adjust as we learn more. 

Mr. CONNOLLY. Ms. Burger, you indicated that you would welcome a law establishing—if not an Executive order, but preferably 

a law because that codifies it—establishing uniform guidelines, uniform protocols, so we don’t have this up-and-down myriad of procedures at hospitals depending on where you live. Is that correct? 

Ms. BURGER. You left out one critical word, which is mandatory 

optimal standards—— 

Mr. CONNOLLY. Yes. 

Ms. BURGER [continuing]. For personal protection. 

Mr. CONNOLLY. Yes. I—— 

Ms. BURGER. The CDC guidelines are merely guidelines, and all 

5,000 hospitals in the USA get to pick and choose what part of the 

guidelines they implement and—— 

Mr. CONNOLLY. I take—— 

Ms. BURGER [continuing]. The personal protection. 

Mr. CONNOLLY. I take your point. 

Dr. Lurie, would the administration welcome such legislation? 

And/or is the President contemplating such Executive action? 

Dr. LURIE. So one of the things I think to keep in mind is that 

the Federal Government does not license or regulate hospitals in 

this way. Hospitals are licensed and regulated primarily by the 
119 

States. But I think it is fair to say at this point that no hospital 

wants to see its healthcare workers infected. 

The CDC guidelines now provide a couple of options for safe personal protective equipment in large part because there is probably 

not a one-size-fits-all solution. It is important for people to be able 

to practice in the equipment that they are using and comfortably 

using day-to-day, provided that it meets the safety standards that 

CDC has articulated. 

Mr. CONNOLLY. OK. I am not sure what that means in terms of 

whether the administration is contemplating an Executive order or 

whether you would welcome some legislation that would make it 

mandatory, as Ms. Burger suggests. But we will be in touch, I am 

sure. 

Final set of questions. 

Mr. Torbay, in the United States, there are 245 doctors per 

100,000 population; in Liberia, 1.4; in Guinea, 1—10; Sierra Leone, 

2.2. Health spending per capita, $8,895 here in the United States; 

$65 in Liberia; $32 in Guinea. 

CDC says if we don’t achieve 70 percent of isolation of existing 

Ebola victims in the affected countries, the number of victims or 

people with Ebola in these areas could reach—could reach—1.4 

million by January 20th, the day roughly around when the President gives his State of the Union address. That is astounding. And 

whatever problems we have with the relatively limited number of 

Ebola patients in the affected regions, obviously it becomes enormously magnified when you are looking at that kind of number. 

How in the world do we contain this before it becomes explosive? 

It is already the largest Ebola epidemic ever recorded, but to go 

from roughly 10,000 or so to 1.4 million in the next 2 1/2 months 

is very—I mean, it is jaw-dropping. 

Mr. TORBAY. Thank you for your question. 

There are steps that could be taken and that are being taken to 

contain this and to hopefully never achieve that 1.4 million number. And that includes isolation of patients, quick isolation of patients the minute we know that they develop symptoms, treatment, 

referral to the Ebola treatment units, such as the one that International Medical Corps is running in Bong County—— 

Mr. CONNOLLY. And if I could interrupt you—and, Mr. Chairman, I promise I am done after Mr. Torbay. 

CDC says if you isolate 70 percent now, you achieve complete 

abatement of Ebola in the affected regions. I mean, in other words, 

then we are on a path to the complete reversal of the progress of 

the disease. But if we don’t do that, we are headed in the opposite 

direction. 

Sorry. 

Mr. TORBAY. In addition to treatment, community awareness and 

education is critical. 

But, also, we cannot forget the need for regional preparedness 

outside of those three countries. We know of one patient in Mali 

already. Yesterday, a 2-year-old girl was taken into a hospital in 

Mali. 

Regional preparedness is critical. And that includes training of 

teams that could actually treat Ebola, detect, burial teams, contact 

tracing. It includes consistent community messaging so there are 
120 

no two conflicting messages that go out, as well as stocking of supplies that are needed in case of an outbreak. This is critical, as 

well, and this is an area that is being ignored in terms of preparedness. 

Mr. CONNOLLY. Thank you. 

And, Mr. Chairman, thank you for generousness. 

Mr. CHAFFETZ. I thank the gentleman. 

I now recognize the gentleman from South Carolina, Mr. Gowdy. 

Mr. GOWDY. Thank you, Mr. Chairman. 

I want to start, Mr. Chairman, by thanking nurses and doctors, 

hospital workers, soldiers, and others for their courage and their 

service and their sacrifice. Most of us, Mr. Chairman, in life run 

away from danger and disease and risk, and very few people are 

willing to run toward it. So I want to start by thanking that group 

of people. 

Dr. Lurie, I want to read you a quote, and you tell me if you can 

tell me who the author of this quote is. 

‘‘Beginning with the development of a strategy, my role can be 

defined as helping our country to be ready for any kind of adverse 

public health event, including a response to any challenges the future may bring.’’ 

Do you know who said that? 

Dr. LURIE. Yes, I do. 

Mr. GOWDY. Who? 

Dr. LURIE. I did. 

Mr. GOWDY. You did. That is exactly right, in a Penn Medicine 

article. 

And your bio page says that you are the Secretary for Preparedness and Response, and your work has included evaluating public 

health preparedness, conducting 32 tabletop exercises on hypothetical crises, such as smallpox, anthrax, botulism, plague, pandemic influenza. 

Another story on you and your career, which is an incredibly 

commendable career, said your job is to plan for the unthinkable. 

‘‘A global flu pandemic? She has a plan. A bioterror attack? She’s 

on it. Massive earthquake? Yep.’’ She’s got a plan. It’s a mission 

that includes both science and a communication strategy. 

So I was sitting there, Dr. Lurie, thinking, here we have a doctor 

with an incredible background in medicine, who also happens to 

have planned for crises like Ebola, whose job description also includes communication strategy. So why in the hell did the President pick a lawyer to be the Ebola czar and not you? 

Dr. LURIE. So I appreciate your questions. Before I answer your 

question, can I take just one moment to clarify my answer about 

the quarantine question? Because I think I didn’t understand it 

fully. 

CDC has ample quarantine authority to do what it needs to do. 

I think the—and it has used those authorities many, many times. 

The proposed regulation would have refined the process we have 

used, but the underlying statute already gives CDC the authority 

that is needed. 

Mr. GOWDY. OK. You—— 

Dr. LURIE. So with that clarification, I just wanted to—— 

Mr. GOWDY. So the record is now complete with respect to—— 
121 

Dr. LURIE. Thank you. 

Mr. GOWDY [continuing]. Your position on—— 

Dr. LURIE. Right. 

Mr. GOWDY [continuing]. On quarantine. 

Now I want the record to be complete on why in the world the 

President picked a dadgum lawyer to head the Ebola crisis instead 

of somebody with your vast and varied background. 

Dr. LURIE. And I appreciate the vote of confidence. 

The role of the Ebola coordinator in the White House is a wholeof-government coordination role. 

Mr. GOWDY. Well, I appreciate that, Dr. Lurie. But Mr. Klain is 

not a doctor. He is not an osteopath. He is not a nurse. He is not 

an epidemiologist. He doesn’t have a background in communicable 

disease. He doesn’t have a background in infectious disease. He 

doesn’t have a background in West Africa. 

So how in the world is he the best person to be the Ebola czar 

and not you or—and I don’t want to hurt her career, I do not want 

to hurt Secretary Burwell’s career, and I fear that I will by complimenting her. But she is an incredibly bright person. One of the 

more capable people I have met in the last 10 years is your boss, 

the Secretary of HHS. Now, we disagree, in fairness to her, on lots 

of policy, but she actually has a background, through her work, The 

Gates Foundation, in global health. 

You are a doctor. I mean, if this were an outbreak of people who 

don’t have wills in West Africa or if this were an outbreak on contested elections in West Africa, then I would say, yes, go hire Mr. 

Klain, but it is not. It is a medical crisis. So why not you? 

Dr. LURIE. So right now I have a full-time job doing my job in 

the Department of Health and Human Services. I really appreciate 

the vote of confidence. And I have a lot of confidence in Mr. Klain. 

Mr. GOWDY. Well, how about another doctor? How about somebody who is an expert in infectious disease or an expert in West 

Africa or the delivery of health care? I mean, God forbid we pick 

somebody with a background in medicine instead of a dadgum lawyer. And in the interest of full disclosure, I am one. But—— 

Dr. LURIE. So, with respect, I think that the role of the coordinator at the White House doesn’t require a doctor. It requires 

somebody who is really expert at coordination and bringing the 

parts of government together to enhance the coordination. 

Mr. GOWDY. Well, I am going to make you this promise, OK? And 

I want you to hold me to it, OK? The next time there is an opening 

on the Supreme Court, I want you to see whether or not the President considers a doctor or a dentist for that job. 

And we actually are about to have a vacancy for our Attorney 

General, and I want you to consider or be mindful of whether or 

not he considers maybe, like, a tattoo artist to be our next Attorney 

General. I promise he will not. He will pick a lawyer for the Supreme Court, and he will pick a lawyer to be the head of the Attorney General—Department of Justice. 

I am just lost as to why he wouldn’t pick somebody with a medical or healthcare background to be the Ebola czar. I mean, can you 

understand why people might possibly think this could perhaps be 

a political pick instead of a medical/science/health pick? Can you 

understand how people might be just a little bit suspicious? 
122 

Dr. LURIE. I can understand the public’s concerns about a whole 

variety of issues. I believe that Mr. Klain has tremendous experience in doing the job that he was chosen to do. 

Mr. GOWDY. Well, cite me all his medical background then. I was 

going to let you go, but you said he has tremendous experience. 

Cite me all of his medical, infectious disease, communicable disease, healthcare delivery background. 

Dr. LURIE. You know, one of the terrific things about the way the 

government works together is that experts come together all the 

time. There is tremendous knowledge—— 

Mr. GOWDY. I am going to take that answer as that he has none. 

Dr. LURIE. There are a tremendous number of doctors that he 

has at his disposal. He has me, he has Dr. Frieden, he has Dr. 

Fauci, he has Dr. Collins. You could go on and on and on. 

Mr. GOWDY. Yes, and it would just make—but you know what? 

We had access to all those people before we had Mr. Klain. All 

those people worked for the government before the President hired 

Mr. Klain, didn’t they? 

Dr. LURIE. And—— 

Mr. GOWDY. So why pick a lawyer to head our response to Ebola? 

It just—you know, color me cynical, it just appears to be political. 

But, with that, Mr. Chairman, I would yield back—— 

Mr. CONNOLLY. Would my friend yield? 

Mr. GOWDY. Of course I will yield to the gentleman from Virginia. 

Mr. CONNOLLY. Well, I just wanted to join my friend in calling 

for a nonlawyer appointment to the Supreme Court. It would be 

the healthiest damn thing we have had in the last 50 years. Thank 

you. 

Mr. GOWDY. Are you applying? Are you interested? 

Mr. CONNOLLY. No. 

Mr. CHAFFETZ. I thank the gentleman. 

I will now recognize the gentlewoman from Illinois, Ms. Kelly, for 

5 minutes. 

Ms. KELLY. Thank you, Mr. Chair. 

Dr. Lurie, are you trying to say that we need someone good at 

coordinating and managing and really cutting through a lot of the 

BS? 

Dr. LURIE. That is exactly right. 

Ms. KELLY. Thank you. 

I want to thank the panel for meeting with our committee to discuss this important health crisis issue. 

And I want to let you know that my thoughts and deep appreciation are with all the healthcare professionals dealing with this crisis and those in the audience. And because I represent Illinois, a 

special shout-out to those from Chicago, the Chicagoland area. 

My questions are about the DOD’s role in West Africa. 

Secretary Lumpkin, I know there are some that have commented 

that there is no reason to involve the U.S. military in this type of 

humanitarian crisis. Why is the U.S. military so critical to getting 

the epidemic under control in West Africa? 

Mr. LUMPKIN. Thank you for the question. 

Again, we are in direct support of USAID and their whole-of-government efforts. USAID came to us because of our speed and their 
123 

scale with response. We can mobilize quickly. We can instill command and control, provide the infrastructure. We have the ability 

to do logistics. We do it very well, both strategically and tactically, 

to move supplies. 

The one thing you have to keep in mind, within Liberia, they get 

about 200 inches of rain a year. When we were there, it was raining, you know, 6 to 8 hours a day some days. In that time, many 

of the roads are impassable except by foot. And what goes by foot 

is the Ebola virus, as well. So there was inaccessibility to the various areas. We have the ability to reach and get those areas and 

to support USAID. 

We have the ability to do construction and to build these Ebola 

treatment units. When I was there, I had a chance to get on the 

ground and talk to some U.S. Navy Seabees who were building the 

Monrovia medical unit. And working through the rain with the 

equipment there to get what looks to be impossible, they make possible. 

Then the final piece is we can do scaled training. We can bring 

a boot-camp-like training to train up to 500 healthcare workers per 

week to man and to staff these Ebola treatment units. And so we 

bring the capacity in order to do that. 

So, again, we are an interim solution as we roll in there to support USAID until the international community can mobilize in 

order to take over our efforts. 

Ms. KELLY. So you feel you have extensive experience in conducting humanitarian efforts like this. 

Mr. LUMPKIN. Well, we have supported USAID on numerous occasions. We did it in Haiti. We have done it in places—Japan just 

several years ago, the Philippines most recently. The team on the 

ground we have worked with before. The team lead from the Disaster Assistance Response Team has extensive experience working 

with the Department of Defense. And we are very tightly lashed 

up, and I would say it is seamless. 

Ms. KELLY. OK. Thank you. 

General, can you provide us with a status update on the operations in the region and let us know what your biggest challenges 

are? 

General LARIVIERE. Yes, ma’am. Thank you for the question. 

As Mr. Lumpkin said, we were asked to do this mission because 

of our unique capabilities. As we are here today, we have 698 personnel on the deck, split between Liberia and Senegal. We are expecting here, in the next 24 hours, the 101st Airborne Division will 

complete its movement into country and we will begin a rotation 

for them to take over the command and control piece of this. Equipment continues to flow through our immediate staging base in 

Dakar, Senegal. 

As Mr. Lumpkin said, we were asked to do engineering. USAID 

asked us to be prepared to buildup to 17 Ebola treatment units. We 

have actually been asked to build 12, and 3 are currently under 

construction. 

And as for the training effort, we have identified the Paynesville 

National Training Center in Monrovia as the site where we will 

bring in military trainers to begin training healthcare workers here 

in the next couple of weeks. 
124 

Ms. KELLY. For both of you, if this epidemic is not contained and 

it spreads further over the continent, do you agree that this really 

affects international security? 

Mr. LUMPKIN. Again, to reiterate my opening comments, this is 

a national security priority for the United States that truly has 

global impacts. 

So we have an opportunity right now to flood the zone, to make 

sure we have the capabilities in country, working as a whole of government, and mobilize the international community to respond 

while it still is at a point, while dire—if it gets worse, it is going 

to be harder to manage. So we need to take this opportunity we 

have right now. 

Ms. KELLY. General, did you have anything? 

General LARIVIERE. Nothing additional. 

Ms. KELLY. Well, I want to thank you both for your testimony 

and for your service to the country. 

And, again, a deep appreciation to all the healthcare professionals. 

Thank you. I yield back. 

Mr. CHAFFETZ. I thank the gentlewoman. 

I will now recognize myself for 5 minutes. 

And I want to thank the six of you for your dedication and commitment to fighting this and for the efforts here in the United 

States of America. 

And to the men and women who serve on the front lines, those 

healthcare workers and first responders, I join with Mr. Gowdy in 

thanking those that will actually run to the sounds of the guns in 

the crisis that happens. They are amazing individuals, and they 

have our thoughts and our prayers and our hearts behind them. 

I have a few questions, particularly on the military side of 

things. I don’t know whether to start with Mr. Lumpkin or the 

General. But help me understand their proximity to the challenge 

here. How many USAID personnel are they supporting? 

Mr. LUMPKIN. I don’t have that number off the top of my head, 

and I want to be accurate. So I would like to take that back—— 

Mr. CHAFFETZ. Do you have a range? I mean, is it hundreds? Is 

it—— 

Mr. LUMPKIN. It is so integrated—the disaster—— 

Mr. CHAFFETZ. OK. If you will get back to me. 

Mr. LUMPKIN. I will be able to do that. 

Mr. CHAFFETZ. My understanding, Doctor—we’ve got one doctor 

here on the panel—is that there is a 21-day window in which a person who may have been exposed to Ebola will actually potentially 

come down with Ebola and start to show signs of having this virus. 

Is that correct, 21 days? 

Dr. LURIE. That is correct. 

Mr. CHAFFETZ. So, General, why do we only hold our troops for 

10 days before we release them to bring them back to the United 

States? 

General LARIVIERE. Yes, sir. Thanks for the question. And I can 

understand the confusion on this, but let me—let me see if I can 

make it clear. 

To start, the 21-day period for monitoring has to take place outside the infection zone. For us, that will be in the United States. 
125 

Out of an abundance of caution, prior to departure—in order to 

reduce their risk, commanders will be allowed to remove their personnel from whatever jobs they were doing for up to 10 days prior 

to departure from Liberia just to limit their exposure and provide 

an extra layer of protection. However—— 

Mr. CHAFFETZ. I am going to need further explanation on 

this—— 

General LARIVIERE. Right. 

Mr. CHAFFETZ [continuing]. Because I don’t understand the 10 

days when the science says the 21 days, but—— 

General LARIVIERE. Well, the 21 day takes place—well, the 21- 

day monitoring for U.S. Military personnel will take place Stateside after they have left in order to ensure that they are Ebola-free, 

just as was described previously for other healthcare workers. 

Mr. CHAFFETZ. Let me understand, Doctor. The written materials 

that I do see out there talk about fever, which is monitored twice 

a day in the case of the military, and other symptoms. What are 

the other symptoms? 

Dr. LURIE. Other symptoms might include nausea, diarrhea, red 

eyes, muscle aches, fatigue. 

Mr. CHAFFETZ. So any one of those symptoms could be happening 

and not have a fever and you could have the Ebola virus, correct? 

You could have fatigue, for instance, before you have a fever. 

Dr. LURIE. That is correct, but you really only transmit the disease when you are febrile. 

Mr. CHAFFETZ. So if you have one of these symptoms and you are 

coming through Customs and Border Patrol, for instance, is one of 

my deep concerns. We’ve got about a million people a day that 

come through the United States border. We’ve got these Customs 

and Border Patrol agents and officers that—they are wonderful 

people. I mean, they are dedicated and committed at a tough and 

difficult job. And we are asking them to make an assessment of 

somebody in about a minute or so as to whether or not this person 

potentially has Ebola. 

How in the world are we going to train them so that they can 

have these assessments? 

Dr. LURIE. So let’s be clear about what’s happening now. First, 

all travelers are funneled—from West Africa are funneled to five 

major airports, where people are specially trained to do tightened 

screening. If, in fact, they have symptoms of Ebola or they have a 

fever, then they get referred to secondary screening. And then, additionally, they are—— 

Mr. CHAFFETZ. But that didn’t work. 

Dr. LURIE [continuing]. Interviewed by staff—— 

Mr. CHAFFETZ. It didn’t work. Are you telling me that it worked? 

Did it work in the case of Dr. Spencer? Did it work? 

Dr. LURIE. So the reason that we now have moved to active monitoring of all people that come back from these countries to the 

United States is exactly for this reason, so that if people don’t have 

a fever when they come—— 

Mr. CHAFFETZ. You see where we lack some confidence, right? 

Dr. LURIE. If people don’t have a fever when they come 

through—when they come through the CBP, Customs and Border 
126 

Patrol, stations, we still believe they need to be actively monitored 

for 21 days. That is exactly what happened. 

Mr. CHAFFETZ. But active—this active—— 

Dr. LURIE. And Dr. Spencer took his temperature. At the earliest 

moment, as I understand it, he called authorities and was isolated 

very expeditiously. 

Mr. CHAFFETZ. So you don’t think he was contagious those 48 

hours before? 

Dr. LURIE. From what we understand, people are infectious when 

they have a fever, not beforehand. 

Mr. CHAFFETZ. So why did you close the bowling alley? Why did 

they—why did they, you know, put other people in quarantine? If 

he is not contagious because he barely showed a fever and he is 

a doctor and he says he didn’t have a fever until that morning, why 

did you have to shut down the bowling alley? 

Dr. LURIE. You know, it is a good question, and I think it gets 

to your issue of confidence. We really want to move in an abundance of caution. The bowling alley is closed so that it be cleaned 

and decontaminated out of abundance of caution. And I expect it 

will be open and people will be bowling—— 

Mr. CHAFFETZ. So he could have gotten—— 

Dr. LURIE [continuing]. In the not-too-distant future. 

Mr. CHAFFETZ. He could have gotten sweaty, right, and you can 

transfer this via sweat, right? That secretion could actually hold 

the Ebola virus for some time, correct? 

Dr. LURIE. So the bowling alley is being cleaned out of an abundance of caution, yes. 

Mr. CHAFFETZ. I just don’t have the confidence that we are dealing with people who have a known—we are talking about people 

who have come in direct contact with Ebola patients. Why we 

wouldn’t hold them for a 21-day period to make sure that their 

loved ones, themselves, the people of this country—I don’t understand why we wouldn’t put that travel restriction in place, why we 

don’t get a little bit more strict in putting quarantines—the selfquarantine didn’t work. It didn’t work in the case of Dr. Spencer, 

and he is one of the great people of this earth. I mean, he went 

to go help save people’s lives, and he is an emergency room physician, my understanding. 

So that is the concern. That is—— 

Mrs. MALONEY. Will the gentleman yield? 

Mr. CHAFFETZ. Sure. 

Mrs. MALONEY. Thank you. 

I would like a clarification from the Major on one of your responses to the chairman’s questions. You said that the quarantine 

cannot happen in the country of origin or the country of infection 

and that you would quarantine him, as I understand from your answer, 10 days in, say, Liberia before you would allow them to come 

to the United States. 

My first question is, why can’t you quarantine—— 

Mr. CHAFFETZ. We don’t have first questions. Ask the question. 

Mrs. MALONEY. Clarification. 

Mr. CHAFFETZ. We have to yield. People have flights—— 

Mrs. MALONEY. Clarification. 

Mr. CHAFFETZ. Yes. 
127 

Mrs. MALONEY. Clarification. Why can’t you quarantine in the 

country of infection, particularly if we are sending over military 

that could build a quarantine unit? 

General LARIVIERE. Ma’am, I will defer to the doctors. But what 

our infectious disease personnel tell us, in order to be absolutely 

certain that everybody is Ebola-free, it has to be outside the infection zone. And for all intents and purposes, the entire country of 

Liberia is an infection zone. But I would defer to the doctor for 

clarification. 

Mr. CHAFFETZ. Go ahead. 

Dr. LURIE. So the CDC’s guidelines right now indicate that if you 

have no risk, if you have been in—if you have not been exposed to 

other people, you haven’t touched other people, you haven’t 

cared—— 

Mr. CHAFFETZ. Her question was about military personnel who 

are in the infection zone who did have contact. 

Dr. LURIE [continuing]. You haven’t cared for sick Ebola patients, 

and if you are in personal protective equipment, you haven’t had 

a breach of personal protective—you haven’t had a breach of your 

personal protective equipment, that, depending on the category, 

you are at low or no risk. 

Mr. CHAFFETZ. I am not buying it. I am just not buying it. 

Dr. LURIE. Well—— 

Mr. CHAFFETZ. My time has expired. 

Dr. LURIE. OK. 

Mr. CHAFFETZ. We will go to the gentleman from Pennsylvania, 

Mr. Cartwright, for 5 minutes. 

Mr. CARTWRIGHT. Thank you, Mr. Chairman. 

I want to followup on that. 

And thank you for joining us today, Secretary Lumpkin and 

Major General Lariviere. 

But, you know, the expression ‘‘an abundance of caution’’ has 

been used here in this room here today. And what I am wondering 

specifically—and I will open that up to either of you gentlemen— 

is there any reason why this proposal—you know, Mr. Lynch 

brought it up, Mr. Connolly brought it up, Mrs. Maloney brought 

it up, I believe Mr. Chaffetz brought it up. Is there any reason why 

we wouldn’t just want to use a 21-day waiting period in West Africa before we bring people back to the United States? 

Mr. LUMPKIN. Our 21-day monitoring process is done at the unit. 

It is done twice a day, as far as where they have direct contact 

with a healthcare professional for everybody that comes home. And 

it is commensurate with guidelines that other organizations are following. So we are following the same guidelines as the—that CDC 

and others recommend. 

Mr. CARTWRIGHT. When you say ‘‘in the unit,’’ you mean in the 

unit whether it’s in West Africa or in the United States. 

Mr. LUMPKIN. No, no. Well, there is in-country monitoring, and 

there is monitoring once they return home. 

Mr. CARTWRIGHT. OK. 

Mr. LUMPKIN. So once they return back to the continental United 

States or their port of origin, so to speak, they will go through a 

21-day process where twice a day, 12 hours apart, they will report 

to their unit and do positive discussion with the healthcare pro-
128 

vider and have their temperature taken to see if—to make sure 

that they don’t become febrile or show any symptoms. 

But keep in mind, going back to the risk of the Department of 

Defense personnel in country, because we are not providing direct 

health care to Ebola patients, our risk is much, much lower than 

those that do to begin with. 

Mr. CARTWRIGHT. All right. And you are telling—you are answering my question with what we are doing, and I am asking you, why 

couldn’t you do it a little differently? Why couldn’t you do the 21- 

day waiting period in country just to be extra careful that we are 

not bringing this virus back to the United States? 

General LARIVIERE. Yes, sir. Again, everybody in country will be 

monitored twice a day for their temperature. So, for all intents and 

purposes, we are checking—we are basically doing what the CDC 

recommends every single day while we are in country by having 

their temperature taken twice a day. 

Immediately prior to departure, we will have personnel—we will 

go through a questionnaire to find out if, in the last few days right 

before they left, if they have been in more—possibly could have 

come into contact and be anything other than a low-risk category 

before we transport them home to start the 21 days in CONUS. 

The 10-day period, which is causing all the confusion, was merely 

an additional period in which case they would be at a—be removed 

from whatever jobs they were doing, if they were out and about the 

town, in order to further reduce their possible risk. 

Mr. CARTWRIGHT. Well, General, I thank you for that answer, 

but, again, you are telling me what the plan is right now. And I 

am asking you, why couldn’t you be a little more careful with the 

plan, go a little more overboard with the protection and extend the 

in-country waiting period to 21 days rather than the 10 days? 

And it seems to me that you gentlemen are deferring to the CDC 

on this. Are you? 

General LARIVIERE. Well, sir, it is the CDC; it is also the U.S. 

military infectious disease doctors who, in consultation with their 

interagency partners, are the ones that—— 

Mr. CARTWRIGHT. Well, let me cut it short, then. May I ask you 

gentlemen to please consult with those sources and ask them to 

consider a 21-day in-country waiting period just to be in a real 

abundance of caution? 

Mr. LUMPKIN. We will do that. 

Mr. CARTWRIGHT. I thank you for that. 

I also wanted to ask: You know, we have heard about this terrible potential for the spread of this disease in West Africa. What 

did we say? By January, a million infections or more. The suffering, the horror there. 

And one question I have is, No. 1, is 3,200 American service men 

and women enough to properly train to defeat this Ebola enemy? 

Mr. LUMPKIN. Based on the requirements that have been asked 

of us from USAID, who we are supporting in country, the answer 

is yes. 

Mr. CARTWRIGHT. And then the next question is, are there 

enough trainees, are there enough healthcare workers in West Africa that we can train enough people to take care of the problem? 
129 

Mr. LUMPKIN. That is a question I would have to defer to the 

USAID and their expertise on the ground to—— 

Mr. CARTWRIGHT. Would anyone on the panel like to take that 

question? 

Mr. TORBAY. There are health workers, not necessarily from Sierra Leone and Liberia, from the U.S., from other African countries, from Asia, that we are bringing to the country, as well, to 

help with the treatment and the containment. And we are hoping, 

with the training that is being provided and the supplies and the 

momentum that is actually now ongoing, that actually that should 

be sufficient. 

That being said, for the time being, it is still really difficult to 

encourage people to go and work in West Africa, given the conditions on the ground but also given the conditions that they might 

actually stay in West Africa for a longer period, as well. So this is 

why we are trying to balance it in terms of going there but, at the 

same time, make sure that they can actually leave and go back 

home when they can. 

Mr. CARTWRIGHT. Well, my time has expired. I thank you. 

Mr. CHAFFETZ. All right. I thank the gentleman. 

Quickly, Mr. Lumpkin, are there any United States personnel, 

military or USAID, that have any symptoms of Ebola? 

Mr. LUMPKIN. Not to my knowledge. 

Mr. CHAFFETZ. Thank you. 

I now recognize the gentleman from Texas, Mr. Farenthold. 

Mr. FARENTHOLD. Thank you, Mr. Chairman. 

I want to followup, before I go into my line of questioning, with 

Dr. Lurie. 

You talked about an overabundance of caution as to why we 

closed the bowling alley, as to why the airline took out the seats 

and reupholstered and recarpeted. We are hearing a lot about an 

overabundance of caution. 

From a purely health standpoint, wouldn’t an overabundance of 

caution include an air travel ban, complete, to the affected countries, like we have seen in some European countries? 

Dr. LURIE. No, I don’t believe it would. 

Mr. FARENTHOLD. All right. I am going to respectfully disagree. 

Now, I am glad we are having this hearing today. This is my second hearing on Ebola, and I was actually really disturbed during 

the first hearing that the Homeland Security Committee had in 

Dallas to see the CDC pointing fingers at CBP, CBP pointing fingers at the National Institutes of Health. 

It is one of the reasons I said we needed to appoint somebody to 

be the point person, someone where the buck stops. And the President chose Mr. Klain. I am going to join with Mr. Gowdy in being 

a little skeptical of putting a lawyer instead of a doctor in. 

But Josh Earnest told reporters ultimately it will be his responsibility to make sure that all the government agencies who are responsible for aspects of this response, that their efforts are carefully integrated. He will also be playing a role in making sure decisions get made. 

I think one of the key things in that role is working with Congress, and I think he should be here today or at a hearing to be 

called very soon. We are the ones that sign the checks. We’ve al-
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ready signed a $750 million check to fight this Ebola. I think he 

needs to be here. 

I also—part of the finger-pointing we saw was the CDC saying 

the nurses in Texas broke protocol, when I think they were following, to the best of their ability, what they were able to do. I 

think it was entirely inappropriate they threw the nurses under 

the bus. My wife is a nurse, and she and I were both—were individually hurt and offended by that. I think these nurses were doing 

the best they could. 

And, listen, an Ebola patient isn’t always going to present at an 

Ebola center. They are going to show up at their local hospital 

when they show symptoms. Every hospital needs to be trained. 

And, Ms. Burger, am I correct in saying your testimony is—what 

was the percentage that weren’t prepared? 

Ms. BURGER. I believe it’s 85 to 86 percent. But you have to remember these are voluntary guidelines; they are not mandates. 

And until there is a mandate from Congress or the President, we 

will continue to have issues. 

Mr. FARENTHOLD. I was thinking maybe—you know, I am not a 

big fan of big government regulation—maybe the joint commissions 

or the States. 

Mr. Chairman, I would also like to enter for the record a Statement from Texas Health Resources. They were also thrown under 

the bus, and this is one of their responses to that. So I’d like to 

enter that for the record. 

Mr. CHAFFETZ. Without objection, so ordered. 

Mr. FARENTHOLD. Now, we have talked about who is not here. 

I want to talk—since we do have Mr. Lumpkin and the General 

here, I wanted to ask a couple of quick questions about our military 

involvement. 

General, why did you join the military? 

General LARIVIERE. To serve my country. And my dad was a Marine. 

Mr. FARENTHOLD. And, traditionally, the military’s job has been 

to serve and protect this country with guns and bombs. I understand the mission is expanding and you all are out now building 

health facilities in Ebola-plagued areas. Very laudable, but is this 

really what the military was designed for? 

It seems like if you wanted to build healthcare facilities and help 

countries, you would have joined the Peace Corps and not the—or 

USAID and not the military. 

General LARIVIERE. Sir, as Mr. Lumpkin Stated, this is a national security threat. And, as has been Stated previously, the idea 

has been to fight this overseas so it doesn’t further come back 

here—— 

Mr. FARENTHOLD. But isn’t—— 

General LARIVIERE [continuing]. On our—I’m sorry. 

Mr. FARENTHOLD. All right. And is the military the only organization that can build hospitals, morgues, and treatment facilities? 

Aren’t there thousands, if not hundreds of thousands, of contractors 

worldwide that can do that? 

General LARIVIERE. Absolutely. But we were asked to use our 

unique capabilities, as was Stated earlier, to jumpstart this process, get it in place, so we could turn it over to those organizations. 
131 

Mr. FARENTHOLD. And so are these facilities going to be near existing facilities for Ebola patients? Are they going to be greenfield 

facilities or brownfield facilities? Are the locations nearby where 

patients are going to be congregating? 

General LARIVIERE. We have been asked to build treatment units 

in locations that were coordinated between USAID and the Government of Liberia. 

Mr. FARENTHOLD. So very possibly you could be working on an 

expansion to an existing hospital that is treating Ebola victims 

within those guidelines. 

Mr. Lumpkin, you look like you want to jump in. 

Mr. LUMPKIN. No, of the ones we’ve been asked to construct per 

USAID, none of those are expansions. They are all unique, new—— 

Mr. FARENTHOLD. OK. And—— 

Mr. LUMPKIN [continuing]. Ebola treatment units. 

Mr. FARENTHOLD. So, then, you talked a little about PPE. What 

personnel would be wearing PPEs? I mean, you’ve got 80-degreeplus, highly humid conditions in these countries, and the natural 

inclination is going to be, why do I need to wear this Tyvek suit? 

General LARIVIERE. That is a great question. 

So the protocols that will be followed are that all U.S. military 

personnel will be issued a basic set of PPE that they will have with 

them in country, but because of the temperatures and because, 

quite frankly, of the jobs they will be doing, they will not be required to wear it all the time. 

Mr. FARENTHOLD. OK. 

And I’ve got one quick last question. There has been a lot of confusion about this 10 days and then 21 days. After the 10 days in 

Africa, they are going to come back to the United States and go to 

their unit and be monitored in the unit. Between the 12 hours that 

they are not being monitored by their unit, are they going to be 

able to ride the subway, see their girlfriend, go to a bowling alley, 

and take an Uber? 

General LARIVIERE. They will be on the military facility. They 

will be allowed to go home, either to the barracks or to their families. But, obviously, every 12 hours will limit their ability—having 

to report to the unit every 12 hours will limit their ability to travel 

much further off base than you could go in order to get back for 

evening formation. 

Mr. FARENTHOLD. But you will be—all right. Thank you very 

much. My time has expired. 

Mr. CHAFFETZ. And I thank the gentleman. 

I now recognize the distinguished gentleman from Illinois, Mr. 

Davis, for 5 minutes. 

Mr. DAVIS. Thank you very much, Mr. Chairman. 

And I want to thank Chairman Issa for calling this hearing. I 

think it has been very instructive, very helpful. 

And I want to thank all of the witnesses for appearing and being 

with us. 

With O’Hare Airport being one of the busiest in the world and 

with Chicago, where I live, being an absolute transportation hub, 

where millions of people come to and through our city each and 

every week, I first of all want to commend our public health officials, under the leadership of the Illinois Department of Public 
132 

Health, and our city officials and Homeland Security for what they 

have done in terms of preparation to screen individuals as they 

come, to have places they can go should anything be detected. Our 

hospitals have been fully cooperative, and I commend all of them. 

I also want to commend all of our health workers who are the 

frontline individuals. Because while others can stand and cheer 

from the sidelines, you are in the arena. You are actually there; 

you are not the spectators. 

I have heard a great deal of information—and I am delighted to 

live in a country that is willing to use some of its resources to be 

available in such a way that it does play and understands an international role. So I want to thank AID and our military for being 

in West Africa. 

I agree with those who recognize that we don’t have enough resources there to actually do all that we can and all that is needed 

to be done. But I commend us for the effort, and I commend us for 

what we are indeed doing. 

I think I have a little more confidence and a little more faith in 

the CDC and our health professionals because every day, as I understand it, our protocols are under review, that whatever has been 

established, that’s for right now, but with every incident, we are 

learning new approaches, new techniques, and we are putting 

those into play. And so I am not sure that I have as much gloom 

and doom, because we have had crises before and we’ve found a 

way, and we will find a way to stay ahead of this one. 

Mr. DAVIS. Dr. Lurie, let me ask you, notwithstanding the advances that we have made in medical science, infectious disease 

continues to cause millions of deaths every year throughout the 

world. And we know that the primary strategy has been vaccination, developing vaccines. Let me ask, are there other strategies 

and other approaches that are being used relative to human behavior activity? I always remember my mother, who didn’t have any 

medical training, but she always told us that an ounce of prevention was worth much more than a pound of cure. Are we able, and 

are we doing things that can help prevent and arrest the impact 

of these infectious diseases? 

Dr. LURIE. I very much appreciate your question, Congressman. 

As a primary care doctor, I see—every time I see a patient—how 

important communication is, both with my patients and with my 

community. One of the challenges of dealing with this outbreak in 

West Africa has been that there are a lot of deeply held beliefs. 

There has not been sufficient information about how one contracts 

this disease or how to prevent oneself from getting it. And I believe 

that there has been a tremendous effort at public education. And 

I expect that that’s going to continue in the days and weeks and 

months ahead. 

Here at home as well, there have been efforts to educate the public, but many of those have centered on the populations whose heritage is in West Africa. And in the areas of the country where those 

populations exist, State and local health departments have shown 

tremendous leadership in reaching out to those populations, helping them understand how to recognize and protect themselves here, 

and importantly helping them provide information for their families in West Africa, whether it’s on the Internet, whether it’s by 
133 

Skype, whether it’s by text, whatever. There is certainly much 

more public education and outreach to do, both in West Africa and 

likely here. But I really applaud your observation because it is centrally important to anything that we do in medicine or public 

health. 

Mr. DAVIS. Thank you very much. 

Thank you, Mr. Chairman. I know that my time has expired. But 

I would just like to say to my colleagues who are concerned about 

the czar, you know, it occurred to me that there are those of us 

who know things, but then there are those who know how to make 

things happen and how to get things done. And I think the President may have had that in mind as he made the appointment. I 

yield back. 

Mr. CHAFFETZ [presiding]. I thank the gentleman. 

I now recognize the gentleman from Kentucky, Mr. Massie. 

Mr. MASSIE. Thank you, Mr. Chairman. 

Mr. Lumpkin and Major General Lariviere, as you already know, 

there are members of Kentucky’s Air National Guard in country. 

And so I hope you will understand that my first questions will be 

focused on their safety and training and well-being. 

But I need to ask Dr. Lurie a question first. Are you familiar 

with the treatment of the three patients in the United States, the 

treatment regimen that they have received? We heard in the press 

that they received ZMapp and also perhaps blood transfusions. Is 

that true? 

Dr. LURIE. So there have been more than three patients treated 

in the United States, but I have some familiarity with their treatment, yes. 

Mr. MASSIE. Right. So does it include blood transfusions and 

ZMapp? 

Dr. LURIE. So my understanding is that some patients certainly 

early on received ZMapp when it was available, and some of the 

patients have received blood transfusions. 

Mr. MASSIE. So the best minds that we have, the best doctors 

that we have in this country, their consensus was that that would 

be the best treatment for them. 

Major General, my question to you is can you assure us that the 

best treatment available in this country will be available to our soldiers in the unfortunate circumstance that any of them contracts 

Ebola? 

General LARIVIERE. Yes, sir, absolutely. As I Stated earlier, 

both—there will be a Role 2 hospital both in Monrovia and in Senegal, where your Kentucky National Guardsmen will be stationed 

that is there to exclusively take care of U.S. military personnel. 

Mr. MASSIE. And when they return Stateside, will they have access to ZMapp and blood transfusions if that’s what the doctors 

prescribe? 

General LARIVIERE. Whatever the doctors prescribe, they will 

be—it will be available for them. 

Mr. MASSIE. OK. Thank you very much. Mr. Torbay, you seem 

to be sort of where the commonsense resides here, because you 

have been on the front fighting Ebola. And I really appreciate what 

you have done over there. And clearly, our futures are linked with 

West Africa. We want to see it solved. We want to see it cured over 
134 

there. In some of the things that you have mentioned today about 

gradiating people into no risk, low risk, and high risk, and then 

treating them differently instead of a one size fits all makes a lot 

of sense to me. My question to you is, is it possible—not likely, but 

is it possible to contract Ebola by sitting next to somebody who is 

exhibiting symptoms on a bus? 

Mr. TORBAY. Thank you for your question. First of all, for the 

record, I am not a doctor, so I cannot be very specific when it comes 

to that. From what we learned, unless there is contact with bodily 

fluid—— 

Mr. MASSIE. Would that include perspiration? 

Mr. TORBAY. That could include perspiration. 

Mr. MASSIE. And do you have to contact the skin or could you 

touch somewhere where that an Ebola victim has touched? 

Mr. TORBAY. I can’t answer that. My understanding is it has to 

be through broken skin, but I am not really sure about that. 

Mr. MASSIE. So do your protocols—but would you say it’s possible 

even if it’s not likely? Your protocols that you described before say 

that somebody who has a classification of low risk is prevented 

from taking public transportation. So surely you foresee that somebody—it is maybe not likely, but is it possible that somebody could 

catch Ebola on a bus? 

Mr. TORBAY. We haven’t experienced that. You know, with Ebola, 

it could be possible. There is no scientific evidence that proves it 

or proves against it. 

Mr. MASSIE. There is no scientific evidence that it can be transmitted through saliva, vomit, perspiration? 

Mr. TORBAY. Saliva, vomit, perspiration, yes. 

Mr. MASSIE. OK. Does it live on surfaces? Can it live for more 

than 15 minutes on a surface? 

Mr. TORBAY. I can’t answer that. 

Mr. MASSIE. You can’t answer that? 

Mr. TORBAY. I do not know the answer to that. 

Mr. MASSIE. Maybe Dr. Lurie can. Can Ebola survive outside of 

a patient on an inert surface for any period of time? 

Dr. LURIE. It can survive on an inert surface for variable periods 

of time depending on the—— 

Mr. MASSIE. OK. Then let me ask you is it possible—I am not 

asking you is it likely—is it possible that somebody could contract 

Ebola sitting on a bus next to somebody who has it? Can you imagine a way that could happen? Is it possible? 

Dr. LURIE. One would have to have been in contact with the body 

fluids of the person. 

Mr. MASSIE. Does that include perspiration? 

Dr. LURIE. It does include perspiration. 

Mr. MASSIE. OK. Major General, I want to get back to our soldiers here. You have assured us that they have been adequately 

trained in avoiding the contraction of Ebola. If a soldier came to 

you and said, Major General, is it possible, not likely, is it possible 

to contract Ebola sitting next to somebody on a bus who has it, 

what would your answer be to them? And I trust you are going to 

give us a straight answer. 

General LARIVIERE. So I would defer to the medical professionals, 

as the doctor just said. It can be transmitted through sweat. Bodily 
135 

fluids has been noted. And I would say that, you know, that is why 

we have the 3 feet separation, that is why we don’t shake hands. 

Mr. MASSIE. So if I am a soldier and I ask you that, sir, what 

would your answer be? 

General LARIVIERE. Well, I guess my answer would be it’s a hypothetical. 

Mr. MASSIE. It could certainly happen. 

General LARIVIERE. It could possibly happen. 

Mr. MASSIE. I am asking you to answer a hypothetical then. 

General LARIVIERE. You are asking to ask me to answer a hypothetical. 

Mr. MASSIE. OK. 

General LARIVIERE. So it could possibly happen, but I would 

defer and say, low likelihood, and you need to follow the procedures 

that you were taught in your training session. 

Mr. MASSIE. I am hoping they are getting the best training possible. And I am concerned if they are being told they can’t catch 

it on a bus. Can you tell me what your answer to the soldier would 

be if he said, Sir, can I contract Ebola? 

General LARIVIERE. So, for the record, they are not getting on 

buses with Liberian citizens. And your Kentucky Guardsmen are 

actually in Senegal, so—— 

Mr. MASSIE. Understood. We have other members from Kentucky 

serving in the military. 

General LARIVIERE. Absolutely. 

Mr. MASSIE. They are going to be, as I understand it, hot zones. 

General LARIVIERE. And Fort Campbell folks will be there obviously. But they won’t be betting on buses with Liberian personnel 

either. I would tell them to go ahead and follow their protocols. 

Mr. MASSIE. So, just quickly, our confidence has been shaken in 

the CDC because we get conflicting answers. And when I first 

heard the military was going overseas to combat Ebola, I was skeptical. But then, on second thought, I said that’s where our competency in the government resides, where the confidence resides of 

the American public is with our military and their ability to focus 

on a mission. 

Today you have answered some questions where you deferred to 

CDC guidance, for instance whether they should be quarantined for 

10 days in country or 21 days in country. What I am asking you, 

for the safety of the soldiers and for the safety of the public, is to 

use your own judgment. We trust the military actually more than 

the CDC on this. So please use that to guide you. 

General LARIVIERE. Absolutely. And that’s why I reiterate that 

once they return, we are having not the self-monitoring, but we are 

actually exceeding CDC standards because we are the military and 

having those individuals monitored by their units once they are 

back. 

Mr. MASSIE. And the public, by the way, would like to see them 

stay on the base for the 21 days after they are back. 

General LARIVIERE. And I understand their concern. But again, 

this is—we think that it’s prudent to have them checked twice a 

day on base, but be able to return to their loved ones in the 

evening. 
136 

Mr. MASSIE. What we appreciate is your mission is and always 

has been to protect this country. And we appreciate your service. 

General LARIVIERE. Thank you. 

Chairman ISSA [presiding]. I thank the gentleman. 

And we now go to the gentlelady from New Mexico. 

Ms. LUJAN GRISHAM. Thank you, Mr. Chairman. 

Clearly, with the arrival of Ebola in the United States we are all 

in this committee really concerned about whether or not our emergency preparedness systems are effective, and whether our public 

health system is an effective response mechanism. And I think I 

share with everyone on this committee that we are concerned that 

we have seen protocols have to be adjusted, that we wish we had 

better training, that we are concerned about hospital responses. I 

would just add, particularly after the last Statements, and I don’t 

disagree that we want the highest standard of response, but a multitude of responses that are not based on scientific evidence and 

best practices. If they are not—if they aren’t sound, then we create 

even more confusion and more panic by individuals, and we can’t 

really manage a public health or an emergency system’s response. 

Those are clear lessons that I learned as the secretary of health 

dealing with—I wasn’t there to deal with hantavirus in New Mexico, but we had those experts certainly there. But I was there for 

SARS, for potential pandemics, for not having enough flu vaccine. 

And I am still there dealing with one of the worst hepatitis C 

issues in the United States. So, unfortunately, in New Mexico we 

know how important it is to have a good, solid, strong public health 

and emergency response system. 

To that end, I know that we have been both critical and we have 

recognized that whether or not Congress invests sufficient resources in the CDC and the NIH and all of our other partners that 

have a response to emergency preparedness, we expect that there 

is still in place a robust response. But I want to be clear that has 

the fact that these policymakers have failed Congress to invest appropriately and have cut funding, has that had a negative—Dr. 

Lurie, has that had a negative impact on our ability to respond not 

only to Ebola, but all public health crises? 

Dr. LURIE. No. I think that, you know, we have seen an erosion 

in support for public health at several times in our country’s history. And each time that happens, we look back through the 

retrospectoscope and wish we had done something different. 

Ms. LUJAN GRISHAM. So I am not sure I understand your answer. 

So you don’t think that having reduced resources targeted at these 

issues has had any negative impact? 

Dr. LURIE. So we actually just had the opportunity to survey—— 

Ms. LUJAN GRISHAM. Because I will tell you that my public 

health team will say it is. My hospital association says it is. That 

individual hospitals around the country say it is. And the fact that 

you have a decentralized public health system—so even if you had 

the authority to mandate, you don’t have a system that you could 

do a mandate. And I don’t know that I agree, although I really respect my colleague, Mr. Connolly, that you want a mandate here, 

but we have another issue in this country, which is we do not have 

a centralized public health system. Your ability to manage State by 

State by State by State, and I have a poor State with a centralized 
137 

system, fairly effective, but I can tell you even there, it was hard 

for us to manage all of our county emergency response partners in 

a crisis. 

Dr. LURIE. No, you are absolutely correct. And certainly we are 

hearing a lot from States that they are very concerned about the 

reductions in support for public health and for public health preparedness. And many of them are really looking hard at how they 

are going to have to cope with the latest rounds of reductions. 

Ms. LUJAN GRISHAM. And are you prepared now to really think 

about best practices and more centralized approaches, and requiring maybe a different protocol for our public health emergency response systems in this country? I think if we did that even when 

Congress doesn’t do its job to adequately fund for these public 

health issues so that we only react when there is a crisis instead 

of—and I appreciate someone talking about precautionary principles, that we ought to be proactive in as many cases as we can 

where the evidence is sound about being proactive in that particular manner. But, in fact, I do expect that the Federal Government, even with limited resources, does everything it can to identify what those best practices are and to regularly identify what 

the risks are if you don’t adequately fund, and what the impact is 

to States who also find themselves without adequate resources to 

prepare and be trained effectively. 

Dr. LURIE. I so much appreciate your passion for public health 

and for the resourcing of public health. It’s so important. The way 

public health is organized in this country by law is that the Federal Government by and large can provide guidance and tools and 

best practices, but the implementation of other aspects of public 

health is either at a State or local level. And as I think you know 

well, it’s organized differently in different States. 

Ms. LUJAN GRISHAM. That’s my point. Is it may be time to think 

about whether or not that in and of itself is an effective strategy 

in this country. 

Dr. LURIE. I think it’s a very interesting idea. 

Ms. LUJAN GRISHAM. Thank you. 

I yield back. 

Chairman ISSA. The gentlelady’s time has expired. I thank the 

gentlelady. I now ask unanimous consent that page 172 of the CRS 

report entitled Funding of the HHS Assistant Secretary for Preparedness and Response in millions of dollars be placed in the 

record. Additionally ask—without objection. 

Chairman ISSA. Additionally ask that the Wall Street Journal article in the opinion section, entitled ‘‘There is Plenty of Money to 

Fight Ebola,’’ be placed in the record. 

Without objection. 

Chairman ISSA. Last, I would ask that the Fiscal Year 2014 HHS 

appropriations overview by CRS be placed in the record at this 

time. 

Without objection, so ordered. 

Chairman ISSA. We now go to the gentleman from Michigan, Mr. 

Bentivolio. 

Mr. BENTIVOLIO. Thank you very much, Mr. Chairman. 
138 

And thank all of you for coming today and testifying before this 

committee on a very important subject. A great deal of importance 

to the people in my district. 

And Mr. Roth, a quick question. What is the Federal Government’s present readiness status to handle a pandemic or other 

emergency where there is a surge in medical needs in a specific region? 

Mr. ROTH. I can only speak to the DHS component, which is 

what we studied. 

Mr. BENTIVOLIO. OK. Are you familiar with—do you have any 

idea how many mobile hospitals are in the inventory to be deployed 

at a reasonable amount of time, meaning 1 day to 3 days, to a region that is experiencing a surge in medical needs? And that’s for 

any reason whatsoever, another Katrina, HAZMAT emergency, 

pandemic, earthquake, tornado. 

Mr. ROTH. We did not look at that in the audit that I testified 

about. 

Mr. BENTIVOLIO. OK. In 14 months being in office, or since I 

have been in office for the last 14 months, my office has been investigating that need. So our first responsibility is to protect this country. And I haven’t found any in the inventory. So there is no mobile 

hospitals available, no mobile isolation units deployable that could 

be deployed within hours or days of an emergency. 

And Ms. Burger, I have a question. You are a nurse. How long 

have you been a nurse? 

Ms. BURGER. Forty-three years. 

Mr. BENTIVOLIO. Forty-three years. My wife has been a nurse for 

37 years. So thank you very much for your service. Now, I have a 

question. When a person has any type of infectious disease, whether it is Ebola or the flu, I know they are transmitted differently, 

but for each step that an infected person makes, does it or does it 

not increase the risk of its spreading exponentially? 

In other words, give you an example. If somebody came down 

with the flu, it’s quite possible that, you know, well, if they stay 

in their home, the only people that are probably going to get sick 

or infected from that flu is those people that are in the home. But 

if any member of that household leaves that house, goes to the 

drug store, goes to the supermarket, whatever the case may be, 

does the potential to infect others increase? 

Ms. BURGER. Well, if it’s the flu, if you know you are—— 

Mr. BENTIVOLIO. Airborne. 

Ms. BURGER. And they also have good hand washing, so if you 

are not in direct contact with the airborne virus going into your 

eyes by yourself putting your hands into your eyes or something, 

that is not likely. 

But what we are talking about here today is the Ebola preparedness in this country. 

Mr. BENTIVOLIO. I understand. 

Ms. BURGER. And it’s completely different in this country because 

there are about 5,000 hospitals in this country and 5,000 ways to 

manage this disease. 

Mr. BENTIVOLIO. How many of those hospitals have an isolation 

unit that is capable of containing the Ebola virus? 
139 

Ms. BURGER. Well, according to what the hospitals report on a 

daily basis in the newspapers is that they are all ready and they 

can isolate patients at a moment’s notice. But what we just got reported to us yesterday was a nurse that thought she—from Kansas 

City who has a, quote, negative pressure room which was nonoperable. 

Mr. BENTIVOLIO. OK. That is one negative pressure room. It is 

very important, especially with Ebola, correct, to have that capability? 

Ms. BURGER. Correct. 

Mr. BENTIVOLIO. OK. Now, what I am trying to get at is if a patient walks in with flu-like symptoms, the first thing they will do 

when they go to a hospital is they will visit an administrative clerk 

that does some triage, asks some insurance questions. Is that not 

correct? 

Ms. BURGER. Well, if they have got the flu, most of the time, they 

are at home in bed. 

Mr. BENTIVOLIO. Well, OK. That’s not always the case. They 

could be experiencing fever and they—you know, they do come to 

the emergency room. 

Ms. BURGER. If they are seriously ill from—— 

Mr. BENTIVOLIO. If they are seriously ill with flu-like symptoms. 

So is it possible—what is the protection that an administrative 

clerk that meets you at the hospital, the receptionist that asks, you 

know, what are your symptoms, why are you here, what is your insurance? What is the chances of them being infected by an Ebola 

virus? 

Chairman ISSA. The gentleman’s time has expired. She can answer. But I just—you are not talking—you are saying flu-like 

symptoms, but you are assuming that the person has Ebola? 

Mr. BENTIVOLIO. Correct. Correct. 

Chairman ISSA. The gentlelady can certainly answer. 

Ms. BURGER. OK. Again, as I say, several, 5,000 hospitals all 

have different protocols on how they handle Ebola. Some security 

officers are now asked to step in. They are given little Ebola kits 

that have a gown, some gloves, and a surgical mask. But I think 

that that’s what we are talking about is that everybody, everybody 

needs to be trained and prepared and educated on how to handle 

a potential Ebola patient so that that clerk is also not exposed to 

unnecessary virus from Ebola. 

Mr. BENTIVOLIO. Thank you very much. 

Chairman ISSA. I thank the gentleman. 

We now go to the other gentleman from Michigan, Mr. Amash. 

Mr. AMASH. Thank you, Mr. Chairman, and thank you to this 

panel for being here today. Earlier this month several airlines, including Kenya Airways, British Airways, Air Cote D’Ivoire, and Nigeria’s Arik Air, suspended flights to and from certain affected 

countries in West Africa. Our own State Department issued travel 

warnings to our citizens, urging them to delay nonessential travel 

to Liberia and Sierra Leone. And recent reports suggest that more 

than two dozen countries have restricted entrance to persons who 

have traveled to West Africa. 
140 

So my question is to Dr. Lurie and to Mr. Torbay. Under what 

circumstances, if any, do you think a travel ban or increased travel 

restrictions would be appropriate to safeguard Americans? 

Dr. LURIE. So I thank you for that question. Over the past week, 

we have increased and tightened up our screening measures for individuals traveling from the three affected countries. You know 

they are all now being funneled through the five major airports. 

They get screened before they leave. They get screened when they 

come. Every passenger coming from an affected country now has 

their information given to the State and local health authorities. 

And they will be actively monitored for 21 days. So we have really 

tightened that up quite a bit, and I believe it should be sufficient. 

Mr. AMASH. How about a travel ban? Is there any circumstances 

in which you would support a travel ban? 

Dr. LURIE. We think a travel ban would be incredibly unproductive or counterproductive. 

Mr. AMASH. In what ways? 

Dr. LURIE. Well, first of all, right now, we have a really good 

mechanism to identify and track every single person coming now 

from affected countries. If you were to put a travel ban in effect, 

for example, you would have people coming into this country who 

we wouldn’t know were here, we wouldn’t even know how to find 

them or monitor them. And that would become a serious problem. 

Mr. AMASH. But if someone is flying commercial, for example, 

and they don’t exhibit symptoms, but they have been in a region 

that’s infected, how are you going to know that they are infected? 

Or that they might have been infected? 

Dr. LURIE. I think the whole point of doing the exit screening 

and then the screening when they come to the United States, and 

then following them for 21 days, taking their temperature twice a 

day, is exactly so that we can see them through the end of the incubation period and, if necessary, be on top of that within hours of 

them exhibiting a fever. 

Mr. AMASH. Mr. Torbay, same question. 

Would you support a travel ban under any circumstances? 

Mr. TORBAY. No. We don’t. A travel ban, first of all, we have to 

recognize there are no direct flights from those three West African 

countries to the U.S. The majority of people actually transit 

through Europe. So a travel ban will have to include flights coming 

from Europe, which I don’t think would be feasible at this stage. 

But even with that, we can’t, because if we are talking about fighting Ebola at its source, we need health professionals to be able to 

travel in and out of the country. We need supplies to be able to be 

flown into the country in order for us—— 

Mr. AMASH. Do they predominantly travel through commercial 

airlines? 

Mr. TORBAY. Absolutely. 

Mr. AMASH. Would it be prohibitive to require them to travel 

through charter jets? 

Mr. TORBAY. It would be very expensive. 

Mr. AMASH. The question, a followup question, you had said earlier and the doctor had said that if there is no symptoms, there is 

no risk to other people. What if someone were to get onto an airplane with no symptoms, but you have an 8-hour flight to the 
141 

United States from a European country, let’s say, and they have 

been in West Africa and then Europe to the United States. Couldn’t 

they exhibit symptoms on the flight? And isn’t that a risk? 

Dr. LURIE. I very much appreciate your question and concern. 

And I think that is exactly why now all of the planes are being 

routed through the five airports, and why by the time a plane 

lands on the ground, both Customs and Border Patrol and the CDC 

quarantine office are notified about whether there are any sick passengers on the plane. When they get off the plane, they are asked 

the same questions again, and they are given information about 

the symptoms of Ebola and what to do if they have any. 

Mr. AMASH. Thanks. 

I am going to yield my remaining time to the gentleman from 

Florida, Mr. Mica. 

Mr. MICA. Thank you. 

First of all, what you have got in place has failed. The doctor, 

the New York doctor just came through, and he got the temperature thing and all of that. But it failed. He self-reported. I think 

basically what you have is a 21-day period from where they have 

been subject to the infection, and people need to be quarantined 

coming out of those countries. You don’t need a travel ban. You 

need to go to the people who pose a risk. 

I understand it is only 80 to 150 coming out of those countries 

right now entering the United States a week. Is that right? Approximate? That’s what I am told. But you quarantine them. My grandparents, when they came into Ellis Island, were subject to quarantine. We quarantine lots of people. I will take you up to where 

we did it. Or they self-quarantine themselves. They pose a risk. 

Every traveler doesn’t. But people need to be identified. 

We just came through the airport today at Dulles. And, again, we 

didn’t come from one of those countries, but we didn’t have to. You 

just said transited. They can transit. 

Chairman ISSA. The gentleman’s yielded time has expired. If you 

could wrap it up. 

Mr. MICA. Well, again, just some common sense that doesn’t prevail around here or anywheres. You have 21 days. Look at this guy 

again. Learn by his example. He flew out, the 12th was his last day 

there. You count 21 days forward. So he should have been subject 

to quarantine, not exposing himself on the subway or other places. 

Then your guidance finally on—— 

Chairman ISSA. I will do a second round. I will come back. 

Mr. MICA. Let me just finish because others went over. 

Chairman ISSA. I ask unanimous consent the gentleman have an 

additional minute. 

Mr. MICA. OK. Just an additional minute. Here is a picture. I 

don’t know if it’s true. It’s New York. Your workers and how you 

spread this stuff. The nurses, it was either taking this their things 

off or exposure to the skin. We don’t know. 

Do you know, Ms. Burger? No. 

We don’t know. OK. Here is a picture I saw. My wife told me 

about this. She saw it on TV. These are New York police first responders. Do you have a memo to first responders on how to deal 

with this stuff? 
142 

Dr. LURIE. We do. We put out guidance for first responders. We 

had a—— 

Mr. MICA. This is a press account. Just a video. I don’t know if 

it is true. But it shows them putting their gloves and other stuff 

and tape from the area of New York into a public trash can. So, 

again, what you have got to do, you have got to make sure first responders, nurses, all the protective things in place where we have 

exposure. And we have exposure. 

And the testing at the airport is not working. We need a quarantine in place period for those coming out there or you are not 

going to stop this. The doctor was a very responsible, educated individual. Thank you. 

Chairman ISSA. I thank the gentleman. 

I ask unanimous consent the ranking member have 1 minute. 

Without objection. 

Mr. CUMMINGS. Thank you. Mr. Torbay, the quarantine. Can you 

talk about that? I know you are interested in what is happening 

in Africa, but I know you are also interested in what is happening 

here. Can you just comment on that? 

Mr. TORBAY. You know, as I mentioned, one of the main pillars 

for actually fighting Ebola in West Africa is the ability to take staff 

and bring them back home. We cannot recruit staff from the U.S. 

or anywhere else in the world if there is a chance that they might 

not be able to come back home to their families and to their duties, 

to their other duties. 

And putting people in quarantine actually goes against our ability to recruit and to retain. And therefore, it will go against our 

ability to fight the virus in West Africa. 

Mr. CUMMINGS. Thank you, Mr. Chairman. 

Chairman ISSA. I thank the gentleman. 

We now go to the gentleman from Florida for 5 minutes. 

Mr. DESANTIS. Thank you, Mr. Chairman. 

Dr. Lurie, as I understand it, Congress in 2006 passed the Pandemic All Hazards Preparedness Act. We reviewed that and reauthorized it in this Congress. And one of the key points in that was 

establishing an Assistant Secretary for Preparedness and Response, which is of course you. And this was supposed to be the 

focal point for these responses. You were quoted previously as saying that you have responsibility for getting the Nation prepared for 

public health emergencies, whether naturally occurring disasters or 

manmade, as well as for helping it respond and recover. It is a 

pretty significant undertaking, end quote. 

And it just occurs to me I am glad to see you here, but I have 

not seen you out front. I know communications is supposed to be 

part of what you do. So have you been appearing at public meetings over the last several weeks in conjunction with Ebola? Have 

you been participating in any briefings for the public? 

Dr. LURIE. So let me start by saying and repeating something I 

said in my testimony, that back in the spring, when we first 

learned about Ebola in West Africa, our whole office activated to 

start taking action on behalf of the country and on behalf of West 

Africa—— 

Mr. DESANTIS. I appreciate that. But can you speak since this 

has become heightened with the American people in the last 3 or 
143 

4 weeks, it seems like your profile has been a lot lower than some 

of the other folks even though your office is a key one. So how 

would you respond to that? 

Dr. LURIE. So I think one of the things we know about dealing 

with public health emergencies is the public does better if there are 

one or two consistent spokespeople. Dr. Frieden has played the 

major role in that because the CDC has the lead for the public 

health aspects of the response. What I can tell you is—— 

Mr. DESANTIS. What would you say about this? I appreciate that. 

Let me ask you this. The President had what were billed in the 

press as emergency Ebola meetings at the White House. One last 

Friday and then a week ago tomorrow on Saturday, after I guess 

he played a round of golf. Did you attend either of those meetings? 

Dr. LURIE. Our Secretary attended those meetings. And I have 

met with her every single day since we got involved in this response. 

Mr. DESANTIS. Did you attend? 

Dr. LURIE. No, I did not. 

Mr. DESANTIS. OK. And so has the White House or the Secretary 

of HHS instructed your office to stand down as being the point office in favor of this new Ebola czar? 

Dr. LURIE. Not at all. 

Mr. DESANTIS. OK. So here is an issue. Thomas Eric Duncan, he 

brought Ebola to the U.S. Your office is clearly what was envisioned in this legislation. And yet he was able to bring the disease 

here. So what would you—were you guys prepared in your office for 

Thomas Eric Duncan, or did you drop the ball, and could you have 

done some things better? 

Dr. LURIE. So what happened with Mr. Duncan required a whole 

system to work, right? It required the Federal components to be in 

place. It required State and local health departments to be in place. 

It required hospitals to be in place. And it required individual 

health providers, doctors or nurses, all to be able to do their job. 

Certainly there were some breakdowns in links in the chain. Do 

I think that we have done a good job preparing hospitals and the 

health care system in our country for disasters? Yes, I do. Do I 

think we are being very aggressive now about preparing health 

professionals and health care providers and institutions to be able 

to recognize, treat, and isolate cases of Ebola? I think we are being 

very, very aggressive about that. 

Mr. DESANTIS. So how would you—explain to me then, so the 

Pandemic Act seemed to have your office being kind of a point person in HHS. Now we have this Ebola czar. So how does the chain 

of command work in terms of how we are confronting Ebola at this 

stage? Is the HHS assets, is everyone reporting to Ron Klain now 

and then Klain is directly reporting to the President? What is your 

understanding of this? 

Dr. LURIE. So Mr. Klain’s role and responsibility is to coordinate 

all the different aspects so that we are increasingly working in a 

whole of government response. It’s to make sure that all the parties 

are working together on a day-to-day basis to make decisions. 

Mr. DESANTIS. Isn’t that in your job description anyways? I mean 

aren’t you kind of a czar to deal with these pandemics? 
144 

Dr. LURIE. So I have responsibility for dealing with medical and 

public health emergencies, particularly domestically. And the other 

thing that I think is really important to recognize is that the bulk 

of this response is a global health response. It’s not a domestic response. My office has been active, along with the CDC, the NIH, 

the FDA, in meeting with the Secretary since the beginning of this, 

as I said, almost every day. 

Mr. DESANTIS. Well, I appreciate that. I know that the chairman 

invited Mr. Klain here. I wish he would have come so we can ask— 

some people, as Mr. Gowdy pointed out, may have some reason to 

question whether this is the right individual to actually execute the 

medical component of this, or whether this is more for political reasons. I would have liked to have been able to ask him some questions to try to probe that further. 

Chairman ISSA. Would the gentleman yield? 

Mr. DESANTIS. Yes. 

Chairman ISSA. For the record, we did invite him. We had hoped 

he would be here. 

We also invited the World Health Organization representative. 

And as you know, we fund about half of their entire budget. 

And their answer to us was that basically they don’t do congressional hearings. So I am sending a letter to the appropriators, letting them know they don’t do congressional hearings about how 

they are spending our money and how they are going to fight something like this. 

But it is an area of concern. As you say, you have got an attorney 

who has been hired to do this as a czar, you have the World Health 

Organization, and neither wanted to appear. 

I yield back. 

We now go to the gentleman from Georgia for 5 minutes, Mr. 

Collins. 

Mr. COLLINS. Thank you, Mr. Chairman. 

I appreciate you each being here and the sense. And there is a 

lot that has concerned me from this hearing. Actually, I came into 

this hearing hoping—in some ways, we got some assurance, but in 

also other ways very concerned about some of the answers that 

were given. And I may get to that in a moment. 

But I want to focus on—being from Georgia, I want to focus on 

a positive note. And I want to focus on something that was really— 

because back when Dr. Brantly and Ms. Writebol, which seems like 

an eternity ago now, were brought to the United States, they came 

to the—really, the constituents, my constituents started feeling 

fear. A lot of people were concerned this is something that we don’t 

understand and how you get it. And then in the weeks and days 

after that, the conflicting and inaccurate public Statements that 

followed the arrival from CDC, others, and as it just went ahead 

have caused even more panic. In fact, today in one of my local 

press outlets there is a—basically just an opinion poll that people 

can click in—and said 75 percent believe that the CDC’s information from the beginning of this was just inaccurate and not helpful. 

You have a level of trust that is gone with many people. But what 

happened here was really time to switch gears and say that, frankly, from my perspective Georgia got it right. Emory got it right. Nebraska has got it right. There are some places that have got it 
145 

right. And what I want to know is as we continue this process, as 

we look at the precautions, as we look at the things that are going 

on, is focus on the protocols for Ms. Burger and the nurses and the 

folks who come into the very front stages of this, they do it in a 

way that they follow protocol, they have the protocols in place and 

have the equipment in place. And I think this is what I want to 

commend Emory University in Atlanta for being able to be the first 

hospital to successfully treat an Ebola patient. And actually the 

fourth, Amber Vinson, is our understanding is still recovering at 

Emory and has been declared Ebola free. That is a good thing. 

Emory did this because they were set up with the CDC on those 

levels that we heard about your, Dr. Lurie, on the table tops. They 

worked with CDC. They are one of those outlets in case something 

happened, which the CDC is in Georgia as well, most of which I 

am so proud of, except some of the public Statements by the director, who has really lost confidence of many on this Hill and many 

in the country by the Statements that were made and the actions 

that he took. For him to be the face is really a concern of this. 

So the question I have is in looking at this, Emory has put out 

a lot of great stuff. And, with unanimous consent, Mr. Chairman, 

I would like to add the editorial from John Fox, who is the president and chief executive officer of Emory Health Care, Beating 

Ebola Through a National Plan. 

Chairman ISSA. Without objection, the entire article will be 

placed in the record. 

Mr. COLLINS. And I do appreciate that, because I think this is 

a national response. You said something just a moment ago, Dr. 

Lurie, that I am not going to focus on, but you said this was not 

a domestic, this was a global issue. Well, aren’t we part of global? 

So what part would you be missing in understanding of how that 

would affect us? In fact, when your main concern was if it was 

something overseas, when we have places like Emory and Nebraska doing it right, we have those doing the protocols that were 

not forced upon them, they had it ready to go, was it not—shouldn’t 

it not have been a part of your job? 

Dr. LURIE. Maybe you misunderstood what I was trying to convey. What I was trying convey is—— 

Mr. COLLINS. Very quickly enlighten me. 

Dr. LURIE. OK. So I have domestic responsibilities for preparedness. In fact, one of the things that I was reflecting on when I was 

listening to your comments is that, prior to taking this job, I had 

an opportunity to go around to every county in Georgia with your 

Georgia public health officials and do those table top exercises for 

biopreparedness. I spoke to the leadership at Emory yesterday. 

And we are very grateful for their incredible response and their 

leadership, not only in taking care of patients at Emory but now 

helping us and helping the rest of the country as we build out and 

develop a regional strategy for taking care of—— 

Mr. COLLINS. I appreciate that. Because I do want to be—at least 

let’s accentuate the positive, health care workers that are getting 

it right. But I share Ms. Burger’s concern, and there was some 

other discussions lately, is let’s say they did switch planes. There 

is not a tracking. They don’t fly into one of the five airports. They 

come in in different ways and then present at an emergency room, 
146 

which by the way in my area, a lot of times poor areas, they do 

go to the emergency room with flu-like symptoms all the time. All 

the time. It is part of the problem we have got. And it is going to 

get worse. So the people who do ask those questions, having them 

trained and having them adequately prepared. And I think this is 

the part that concerns me. 

You made this Statement, and I just want to end here because 

there is the concern out there is for the people to understand what 

is done right. Emory University, Nebraska, and those kind of 

things that have done what it took to follow protocols and be prepared. That is the No. 1. 

From the CDC level and the spokesman level, there has been a 

disastrous failure at that. There has been now with Mr. Klain a 

disastrous failure in at least perception that we are taking this 

health care seriously, not just an administrative assistant. We 

needed someone else that has the credentials that you have or others. 

But here is my problem. After we discussed everything on when 

they actually got here, the doctor in New York, which I was in New 

York, just came back last night and came this morning, up there 

seeing what is going on. Here is your response. And it is the response that the American people cannot hear anymore. And that 

is after it happened, out of an abundance of caution, we cleaned the 

bowling alley. Out of an abundance of caution, we went back. The 

American people need to see the abundance of caution beforehand. 

That is your job. That is the job of the CDC and the job of preparedness. And they wanted to see the abundance of caution before 

our health care workers were put at risk, before our system was 

bun, and that is where the abundance of caution needed to come. 

And from that, from a very positive Statements from Emory University and Nebraska and others who did it right, and I want to 

congratulate them, I want to also highlight that an abundance of 

caution should have started a while back, not after the fact. 

And with that, Mr. Chairman, I yield back. 

Chairman ISSA. I thank the gentleman. 

We now go to the gentleman from Florida, Mr. Mica. 

Mr. MICA. Well, a perfect lead in. Now, you sat here and told us 

you are responsible for both domestic preparedness and a global response. 

Dr. LURIE. No. 

Mr. MICA. What are you doing? 

Dr. LURIE. No, my responsibility is a domestic responsibility primarily. 

Mr. MICA. OK. So you have nothing to do with the global response? More from this article about WHO, who wouldn’t come 

here today. First of all, this is the worst Ebola outbreak in history. 

Is that right? Is that not right? 

Mr. TORBAY. Yes. 

Mr. MICA. OK. And it says the World Health Organization said 

today it would probe complaints that it had been too slow to wake 

up the scale of Ebola. Then it says critics have questioned why 

WHO only declared an international health emergency in August, 

8 months after the epidemic began. Did the administration or any-
147 

one in a position of authority from the United States, where we 

spend millions of dollars into WHO, ask them to proceed? 

Dr. LURIE. So let me—— 

Mr. MICA. Did they? 

Dr. LURIE. Let me put a finer point on this. 

Mr. MICA. Do you know if they did? You can say you don’t know. 

Dr. LURIE. So I don’t know if they did what? 

Mr. MICA. If we did anything. Is there a letter? Anything? Did 

we go after WHO? This is a global—— 

Dr. LURIE. We have been—— 

Mr. MICA [continuing]. Disaster. We spend lots of money on the 

World Health Organization. And this isn’t my stuff. I am just reading you what I am telling you that people are coming after. 

OK. This isn’t a panic. It is to be prepared. Now, are you in 

charge of being prepared? 

Dr. LURIE. I am in charge of being prepared. 

Mr. MICA. OK. Then I think you need to turn your resignation 

in. Have you read this report? Have you read this report about preparedness that the IG? Do you have some authority over preparedness at DHS? 

Dr. LURIE. I have no authority over preparedness at DHS. 

Dr. LURIE. Then you don’t have the authority to do the job. Who 

has the authority to do the job? He has just prepared for this committee; it is dated the 24th. He says the stuff they bought, nobody 

knows even the inventory where it’s gone. You have got equipment 

to protect people that is out of date; it won’t protect them. They 

even put up hand sanitizer, they looked at 84 percent of them are 

expired. Is that your job or somebody else? 

Dr. LURIE. DHS—— 

Mr. MICA. And if it isn’t your job, isn’t it the new czar’s job? 

Whose job is it to protect the American people? 

Dr. LURIE. First, let me clarify that DHS has responsibility to 

buy personal protective equipment for its—— 

Mr. MICA. Have you been over there to see what they have? Have 

you been over there to see what they are doing and have? Have you 

seen this report? Folks, staff, make sure she gets a copy of this report. This is a scathing report. Page after page, the inventory outdated, stuff that we bought, we spent millions of dollars, and we 

aren’t prepared. 

Let me ask you another question. Having been here a while, I 

was through the bird flu. This is transmitted even by an individual. And if it takes inconvenience—first of all, you should quarantine the health care workers. 

You are wrong, Mr. Torbay. They are the most exposed to this. 

So anyone who has been exposed, for 21 days coming into the 

United States, must be quarantined. I don’t care if it’s inconvenient. They should recognize their own risks, too. And we should 

watch those people. You had one guy come in yesterday. He got to 

his what, 18th day or something, came down with it. OK. So I 

think—and it may not be that many health care workers. But they 

are the most exposed, unless you are burying the people like you 

just saw with the photo from him. If you are burying people or you 

are in the medical, you quarantine those people for their own risk, 

even if we pay for it, to keep this thing from spreading. 
148 

Right now we are lucky. OK. We don’t know what infected the 

nurses. We don’t know, again, if there will be other cases. But you 

have to take steps in an emergency situation like this. 

She claims she doesn’t have the authority to see what DHS has 

to keep us prepared. Somebody needs to see that we are prepared. 

Again, this isn’t panic. 

Last question. OK. Bird flu. I was involved in bird flu. These people are coming by planes. When some plane comes from Africa or 

transit through and it has passengers from there, what are we 

doing with it? The plane. 

Dr. LURIE. With the plane itself? 

Mr. MICA. Yes, the plane. They have been on the plane. They 

might have barfed in the plane. There might be excrement. There 

may be vomit. There may be a body fluid. They sat in a seat. We 

don’t know. We don’t know if those nurses got it from taking off 

equipment incorrectly or if it touched their skin. 

Dr. LURIE. There are protocols for cleaning the plane. 

Mr. MICA. You just testified earlier that perspiration would do it. 

Dr. LURIE. There are protocols for cleaning the plane. 

Mr. MICA. I want to know the protocols they have in place. I 

have seen the equipment that we have, and Centers for Disease 

Control actually got some then. And we could bring up—it is a 

heating device that heats the plane to 140 degrees to kill the 

germs. That is what we used in the bird flu. Are we doing anything 

like that to make sure those planes aren’t little Ebola transporters? 

Dr. LURIE. Mr. Mica, you sound upset. And I am sorry for that. 

Mr. MICA. I am not upset. I am a happy boy. 

Dr. LURIE. We will make sure that you get the protocols for 

cleaning the plane. 

Mr. MICA. But I am not happy with, again, you told me you are 

responsible for preparedness. Now, if that is not your responsibility, is it the new guy’s—does he have the ability to go in and 

make certain that we are prepared? It hasn’t hit here yet. But 

what you want to do is be prepared. The Boy Scouts marching 

song. Be prepared. We spent millions of dollars, and this inspector 

general of the United States of America has gone in at our request 

and looked at what one agency is doing to be prepared, and it is 

a scathing report we are not prepared. 

So you go back to the other guy who didn’t show up today, the 

new czar. We want to work with you. We don’t want the American 

people at risk. We have already been through this, as I said, with 

bird flu. Are those planes being properly sterilized? Because this 

can spread. OK? It hasn’t spread. We aren’t at risk right now. And 

then the protocols. You give to the committee and put in the 

record—— 

Chairman ISSA. The gentleman’s time has expired. 

Mr. MICA. I want to see the first responders’ direction. Then I 

will put these pictures of the videos from New York disposing of 

the gloves and the masks. 

Chairman ISSA. Without objection, they will be placed in the 

record. 

Mr. MICA. Thank you. 

Dr. LURIE. We would be happy to get you those protocols and the 

protocol for cleaning the plane. And I very much look forward to 
149 

working with you and other Members of Congress as we move forward with this. 

Mr. MICA. Thank you. 

Chairman ISSA. Thank you. 

Mr. MICA. I have a plane to catch. 

Chairman ISSA. I thank you. And have a safe flight. It will be 

about your 12th in 4 days. 

I am not going to ask a second round of questioning. But I do 

want to ask just one question, and then we will go to Mr. 

Cummings for his close. 

There was a Statement made just it seems like an eternity ago, 

but about maybe 15 minutes ago, about following people for 21 

days after they land. 

Dr. Lurie, currently there is no visa restriction or law that gives 

you specific authority. Do you believe you have the authority under 

existing public health laws to force followup daily temperature 

checks and the like? Let’s just assume for a moment we take the 

gentleman from Florida’s analysis that a plane comes in, a person 

tests—let’s just say elevated temperature for a moment—they test 

positive later or not, for the other people on the plane, do you have 

the authority then to compel them to go to be tested, or is it just 

hope for the best that they will recognize a high temperature and 

report it? 

Dr. LURIE. No, I believe that we have the authorities that we 

need. But you know, we are constantly looking at and updating our 

policies based on the situation at the time. And so we will continue 

to look and be sure we have the authorities that we need. 

Chairman ISSA. OK. In addition to asking for those protocols, 

which you have already said you are willing to give us, I am going 

to direct the committee to, in fact, ask questions of you and other 

areas and, of course, our new czar as to specific authorities you 

may have that would support requiring people. There has been a 

lot of discussion about restrictions on people’s travel. 

And I agree, quite frankly, with many of the people here that it 

sounds like a great idea; it’s a great sound bite, but then when you 

actually try to figure out how you would stop somebody from leaving Sierra Leone, going to Paris, spending a day there and then 

booking a flight here, the practical reality could well be that it 

would be circumvented. 

However, the question of a planeload of people coming in—and 

I came in today into Washington, DC, I came in with a Marine 

major. I came in with a Marine major who has a cold and who has 

many of the symptoms. And he did not go through a check. They 

are not doing temperatures. If he later reports, the whole question 

from a public health standpoint of, are we prepared to locate and 

to mandate surveillance on people so that after the fact, we can accurately do a containment is one that I am directing the committee 

to ask a series of questions. 

And Doctor, your organization obviously would be a part of it. 

Dr. LURIE. We would be happy to. Would you give me a moment, 

since you talked about the guy with a cold, to do a quick educational sound bite? 

Chairman ISSA. This will be your closing Statement, Doctor. 
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Dr. LURIE. Sure. Anybody who has a fever or flu-like symptoms 

during this season ought to be asked to provide a travel history, 

to look at whether they have been out of the United States in the 

past 21 days, and whether they have been in one of the affected 

countries. 

Chairman ISSA. I couldn’t agree with you more. And if I get a 

fever, having been in Iraq, Kuwait, Saudi Arabia, UAE, and, well, 

additional places, meeting with people, many of whom have traveled to Africa recently, I will be the first to rush to the hospital to 

report. 

With that, we go to the gentleman from Maryland, Mr. 

Cummings. 

Dr. LURIE. We will take care of you. 

Mr. CUMMINGS. Thank you very much, Mr. Chairman. 

First of all, I want to thank all of our witnesses for being here 

today. And I must tell you that I can understand the emotion of 

the American people. When there is an issue of life and death, and 

when you have people who put their lives on the line to take care 

of the sick, not knowing whether they will become sick themselves, 

that’s serious business. When you have our military going across 

the sea to try to make a difference, as I always say, change the trajectory of somebody’s destiny, and the idea that they may come 

back with a disease that could possibly kill them, that’s serious 

business. 

So, you know, as I listen to you, Mr. Lumpkin, you, Major General, I have absolutely no doubt that you will do everything in your 

power to protect our military. I have no doubt about that. And I 

think that if you find that as you go through the procedures that 

you have in place, if you feel those procedures need to be changed 

or even tweaked so as you might be more effective and efficient in 

that goal, you will do that. Is that correct? 

Mr. LUMPKIN. That is correct. 

Mr. CUMMINGS. And you, Dr. Lurie, I want to thank you for what 

you are doing. 

And one of the things I guess that really concerned me, you 

know, when I looked at all, Dr. Lurie, and I saw all those health 

workers, nurses I guess it was, and then I see Ms. Burger sitting 

next to you, and then I hear about people not being not trained in 

the hospitals, I think it would be almost legislative malpractice for 

me not to ask the question—and it may have been asked before 

when I was out of the room—how do we make sure that those folks 

receive the training? They are not just running around saying— 

just complaining to be complaining. They want to be the best. They 

don’t mind—they don’t mind putting their lives in danger. But they 

want to know that everything possible to make sure that they are 

safe, they want to make sure those things are in place. And I am 

so glad that Ms. Pham, Nurse Pham, has been found to be Ebola 

free now. But how do we make sure that they know that? 

And Ms. Burger talked about an Executive order, and then the 

chairman was asking you about, Dr. Lurie, whether you had all the 

things you need to be able do what you need to do. I just got to 

ask you when you listen to Ms. Burger—and Ms. Burger, I watched 

you on television. I know your passion. No, I am serious. I feel it. 
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It’s contagious. And it is strong. And I know you care about the 

people that you represent. No doubt about it. 

So how do we do that, Dr. Lurie? Help me. 

Dr. LURIE. Sure. First, let me say, Ms. Burger and I, and probably every nurse in America share the same goal, to keep them 

safe, to be sure that they are trained, to be sure that if they are 

front line providers that they have the education, the knowledge, 

the adequate PPE, the training, and the exercises to stay safe. So 

I can tell you a little bit about what we have been doing. We have 

been reaching through the top—we have got a very comprehensive 

now national education program going on. We have reached 

through the top for all the hospital associations, through all the 

hospitals, through the nursing associations. I was on the phone 

with 10,000 nurses the other night. And there were more that 

wanted to get on the phone. And we have said to them all, Please, 

if you are a hospital, conduct a medical and a nursing grand 

rounds. Do first patient training—do first patient drills and exercises. Make sure that your nurses are trained and your front line 

nurses have to practice putting on PPE to proficiency. OK. Have 

policies, plans, and protocols in place, and drill and exercise them. 

We have said to the nurses and other front line health professionals, Here is the guidance. Please be sure that the checklists 

and other things are posted in your places of front line care. Please 

ask your hospitals and your administrators to be sure there are 

plans, practices, and policies in place, and that you have the PPE 

required to do your job. 

We have said to State and local health departments, We would 

like you to call every hospital in your jurisdiction, find out if they 

put those plans in place, find out if those exercises are in place, 

find out if that PPE is in place, and report back to us. 

And we will continue to be reaching out with material, with 

training, with education opportunities until we have got this done. 

Mr. CUMMINGS. Ms. Burger, this is your moment. This is your 

moment. Dr. Lurie just talked about—I hope you don’t mind, Mr. 

Chairman, this is important. 

Chairman ISSA. Not at all. 

Mr. CUMMINGS. Dr. Lurie just talked about what they are going 

to do and what they are doing. Those ladies that were behind you 

today, they want to know—some of them left now—but they want 

to know that they are going to be protected. Now, you heard what 

she just said. Can you just react? Maybe you might want to give 

her some advice as to what you all—and I am not trying to be 

smart, I am serious. This is a critical moment. Go ahead. 

Ms. BURGER. The nurses that were here have legislative visits. 

They are getting fully engaged in this hearing, and they appreciate 

the opportunity to be here. But—and what I would like to say is 

that until the CDC guidelines and training and education and personal protective gear at an optimal level are mandatory, no matter 

how good the guidelines are, no matter how good the intentions 

are, we need to ask Congress to step up and do what is right for 

the United States of America and its citizens by making sure the 

frontline caregivers have mandatory optimal standards for protective gear and training and education. 
152 

Mr. CUMMINGS. So there is a gap, Dr. Lurie. Am I right? Based 

upon what she just said—in other words, you may be saying all 

these things, but then it’s a whole other thing for the hospitals to 

provide the things that you tell them they need to go and get. Am 

I right? 

Dr. LURIE. I think Ms. Burger and I share the same goal, and 

I share the same goal, as I said, with most nurses and nursing organizations around the country, and look forward to working with 

them and moving forward so that we can be sure that nurses 

across this country, who put themselves on the line of fire every 

single day with other front line health care providers, are safe. 

Mr. CUMMINGS. As I close, I just want to thank you, Mr. Torbay, 

for your testimony. 

And I want to say to all of us, it goes back to we have to address 

the issue here in America. No doubt about it. But we also have to 

go back to the source. We have got to do that. 

And I think, Mr. Torbay, your testimony about some basic things 

that are needed, such as food, vehicles, fuel, staff, supplies, resources, things that can be—that will allow us to try to stop this 

in Africa so that it does not continue to come to our shores is so 

very, very important. And I just hope that the Congress is listening 

to you. And I realize that there are—we need more international 

partners—I think that’s what you just told us—people coming in 

and helping this. Because this does not just affect Africa or the 

United States, it affects the world. And so I don’t know how we 

convince folks to—that is other countries to do more to get up to 

that $988 million figure, but we have got to figure out a way to do 

that. Would you agree? Then I will close. I will close. 

Mr. TORBAY. Absolutely. I fully agree with you. 

I think the whole world needs to realize that we are all in this 

fight together and the resources need to be available until we get 

this virus under control. 

And, at the same time, I would like to thank the committee for 

its leadership on this issue as well as the U.S. Government and its 

agencies for taking the lead and responding to the Ebola crisis. 

They have been doing a tremendous job, and we are very proud to 

be part of it. 

Mr. CUMMINGS. Thank you, Mr. Chairman. 

Chairman ISSA. Thank you. I want to thank all of our witnesses 

here today. 

In closing, I am going to make a comparison. And I think it is 

an important comparison for the American people to put it in perspective. 

As was alluded to earlier, I just came back from what has become a theater of operation in Iraq where ISIS now, like an ugly, 

resilient virus or infection, has shown up again and Islamic terrorism is murdering people far away. 

While I was there, there was a murder in Canada. And around 

the globe, small, but significant, events occur in which we realize 

that terrorism does not stay in the country that we think it begins 

in or is predominantly in. 

In the war on terror, we rely on the Department of Defense and 

our U.S. military as our primary way to eliminate that—those actors in faraway places, like Iraq, Afghanistan, and Syria. 
153 

We also rely on the Department of Homeland Security to deal 

with a comparatively small risk, small event, here in the United 

States, whether it is 9/11, which was horrific, or—and led to its 

founding, or the occasional lone actor or small group that try to 

conduct terrorism here in the United States. 

It is that teaming of the large effort at the source and, in fact, 

an equally important effort at home for the relatively isolated cases 

that come through that seem to be so close to the problem we are 

facing with Ebola. 

Ebola is, in fact, a disease that has periodically reared its ugly 

head for more than three decades. It will, in fact, until there is a 

cure, rear its head again. Like many diseases in which a virus, 

eventually we find a cure. That cure is only good if everyone takes 

it. 

The idea that we are going to find a shot in a country—in a continent of a billion people living mostly in poverty means that, even 

when we find it, it may, in fact, be there for generations, and like 

smallpox, tuberculosis, and others, they never seem to be completely gone. 

Our effort and the effort that all of you articulated very well 

today has to be, first of all, in Africa, at the source. There World 

Health Organizations, USAID and, once again, the United States 

military have and are taking up the fight against this dreaded disease. 

Mr. Roth, your testimony and the testimony that I believe we 

will have following this that the Department of Homeland Security 

has an obligation, a unique obligation, one in which they were 

formed to deal with things which threaten the home front, Ebola 

and particularly the movement of people who may be infected fall 

squarely within their jurisdiction, and they seem to have not been 

prepared. 

So, as we conclude here today, it is my view that we will be doing 

both public and nonpublic investigation in the weeks and months 

to follow, looking for transparency—and, Dr. Lurie, you said this 

very well—transparency to the American people. What we tell 

nurses and doctors and healthcare professionals we need to tell the 

public. 

Because unlike some things where the first responder is, in fact, 

the greatest threat, the first responder with Ebola is not the first 

to come in contact with the infected individual. 

Almost in every case there will be a cab driver, a bus driver, family, friends, and others who will already have had an unprotected 

contact by the time a first responder is aware that there may be 

a problem. By the time that person suits up, he or she already will, 

in fact, be exposed. 

So as we begin looking at the protocols, I think we have to understand one thing: There is no perfect solution. There is no way 

that every American is going to place themselves in a HazMat suit 

from morning until night. 

To deal with this disease, we will have to go to its source. We 

will have to work together with our partners around the world to 

eradicate it in Africa, because, ultimately, like terrorism has been 

to the American people for more than a decade, this disease will 

not, in fact, be eradicated if we wait until it comes to our shore. 
154 

So I thank you. I believe this was a worthwhile hearing. 

I thank Mr. Cummings and the tremendous turnout of members 

who came back on the eve of their elections for this important 

hearing. 

And, with that, we stand adjourned. 

[Whereupon, at 1:34 p.m., the committee was adjourned.] 
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