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COMBATING THE EBOLA THREAT

HEARING

BEFORE THE

SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH, 

GLOBAL HUMAN RIGHTS, AND 

INTERNATIONAL ORGANIZATIONS

OF THE

COMMITTEE ON FOREIGN AFFAIRS 

HOUSE OF REPRESENTATIVES

ONE HUNDRED THIRTEENTH CONGRESS

SECOND SESSION

AUGUST 7, 2014

Serial No. 113–209

Printed for the use of the Committee on Foreign Affairs

(

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

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

(II)

COMMITTEE ON FOREIGN AFFAIRS 

EDWARD R. ROYCE, California, Chairman 

CHRISTOPHER H. SMITH, New Jersey 

ILEANA ROS-LEHTINEN, Florida 

DANA ROHRABACHER, California 

STEVE CHABOT, Ohio 

JOE WILSON, South Carolina 

MICHAEL T. MCCAUL, Texas 

TED POE, Texas 

MATT SALMON, Arizona 

TOM MARINO, Pennsylvania 

JEFF DUNCAN, South Carolina 

ADAM KINZINGER, Illinois 

MO BROOKS, Alabama 

TOM COTTON, Arkansas 

PAUL COOK, California 

GEORGE HOLDING, North Carolina 

RANDY K. WEBER SR., Texas 

SCOTT PERRY, Pennsylvania 

STEVE STOCKMAN, Texas 

RON DESANTIS, Florida 

DOUG COLLINS, Georgia 

MARK MEADOWS, North Carolina 

TED S. YOHO, Florida 

SEAN DUFFY, Wisconsin 

CURT CLAWSON, Florida 

ELIOT L. ENGEL, New York 

ENI F.H. FALEOMAVAEGA, American 

Samoa 

BRAD SHERMAN, California 

GREGORY W. MEEKS, New York 

ALBIO SIRES, New Jersey 

GERALD E. CONNOLLY, Virginia 

THEODORE E. DEUTCH, Florida 

BRIAN HIGGINS, New York 

KAREN BASS, California 

WILLIAM KEATING, Massachusetts 

DAVID CICILLINE, Rhode Island 

ALAN GRAYSON, Florida 

JUAN VARGAS, California 

BRADLEY S. SCHNEIDER, Illinois 

JOSEPH P. KENNEDY III, Massachusetts 

AMI BERA, California 

ALAN S. LOWENTHAL, California 

GRACE MENG, New York 

LOIS FRANKEL, Florida 

TULSI GABBARD, Hawaii 

JOAQUIN CASTRO, Texas

AMY PORTER, Chief of Staff THOMAS SHEEHY, Staff Director

JASON STEINBAUM, Democratic Staff Director 

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

INTERNATIONAL ORGANIZATIONS

CHRISTOPHER H. SMITH, New Jersey, Chairman 

TOM MARINO, Pennsylvania 

RANDY K. WEBER SR., Texas 

STEVE STOCKMAN, Texas 

MARK MEADOWS, North Carolina 

KAREN BASS, California 

DAVID CICILLINE, Rhode Island 

AMI BERA, California 

(III)

C O N T E N T S 

Page

WITNESSES 

Tom Frieden, M.D., Director, Centers for Disease Control and Prevention ....... 8

Ariel Pablos-Me ́ndez, M.D., Assistant Administrator, Bureau for Global 

Health, U.S. Agency for International Development ........................................ 22

The Honorable Bisa Williams, Deputy Assistant Secretary, Bureau of African 

Affairs, U.S. Department of State ...................................................................... 30

Mr. Ken Isaacs, vice president of program and government relations, Samaritan’s Purse ............................................................................................................ 51

Frank Glover, M.D., missionary, SIM .................................................................... 66

LETTERS, STATEMENTS, ETC., SUBMITTED FOR THE HEARING 

Tom Frieden, M.D.: Prepared statement ............................................................... 14

Ariel Pablos-Me ́ndez, M.D.: Prepared statement .................................................. 25

The Honorable Bisa Williams: Prepared statement ............................................. 34

Mr. Ken Isaacs: Prepared statement ..................................................................... 57

Frank Glover: Prepared statement ........................................................................ 68

APPENDIX 

Hearing notice .......................................................................................................... 78

Hearing minutes ...................................................................................................... 79

Written responses from the Honorable Bisa Williams to questions submitted 

for the record by the Honorable Frank Wolf, a Representative in Congress 

from the Commonwealth of Virginia .................................................................. 80

The Honorable Edward R. Royce, a Representative in Congress from the 

State of California, and chairman, Committee on Foreign Affairs: Prepared 

statement .............................................................................................................. 83

(1)

COMBATING THE EBOLA THREAT 

THURSDAY, AUGUST 7, 2014

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON AFRICA, GLOBAL HEALTH,

GLOBAL HUMAN RIGHTS, AND INTERNATIONAL ORGANIZATIONS,

COMMITTEE ON FOREIGN AFFAIRS,

Washington, DC. 

The subcommittee met, pursuant to notice, at 2 o’clock p.m., in 

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

Smith (chairman of the subcommittee) presiding. 

Mr. SMITH. The subcommittee will come to order, and good afternoon to everyone. 

I have called this emergency hearing today during recess to address a grave and serious health threat which has in recent weeks 

gripped the mass media and heightened public fears of an epidemic, the Ebola virus. What we hope to gain from today’s hearing 

is a realistic understanding of what we are up against while avoiding sensationalism. 

Ebola is a severe, often fatal disease that first emerged or was 

discovered in 1976 and has killed 90 percent of its victims in some 

past outbreaks. Since March of this year there have been more 

than 1,700 cases of Ebola, including more than 900 fatalities in 

Guinea, Liberia, Sierra Leone, and Nigeria. This time, the average 

fatality rate in this outbreak is estimated at 55 percent, ranging 

from 74 percent in Guinea to 42 percent in Sierra Leone. The disparity in mortality rates is partially linked to the capacity of governments to treat and contain the disease and per capita health 

spending by affected governments. 

There is also concern that given modern air travel and the latency time of the disease, the virus will jump borders and threaten 

lives elsewhere in Africa and even here in the United States. In my 

own State of New Jersey, at CentraState Hospital in Freehold, just 

a few hundred yards from my district office, precautions were 

taken. A person who had traveled from west Africa began manifesting symptoms, including a high fever. He was put in isolation. 

Thankfully, it was not Ebola, and the patient has been released. 

New Jersey Health Commissioner Mary O’Dowd reiterated to me 

yesterday that New Jersey hospitals have infection control programs in which they train and are ready to deal with potentially 

infectious patients that come through their doors. She also told me 

that physicians and hospital workers follow very specific protocols 

prescribed by the CDC on how to protect themselves, as well as 

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2

cerns, which includes protocols like managing a patient in isolation 

so that they are not around others who are not appropriately protected. 

The commissioner also underscored that the Federal Government 

has U.S. quarantine stations throughout the country to limit introduction of any disease that might come into the United States at 

ports of entry like New Jersey’s Newark Liberty International Airport. 

I also hope our distinguished witnesses today will confirm whether sufficient resources are available and are being properly deployed to assist victims and contain the Ebola disease. Are there 

gaps in law and policy that Congress needs to address? To the government witnesses especially, my pledge to you is that, if legislation is needed, I will work, and I know I will be joined by colleagues on both sides of the aisle, with you to write those new policies. 

As you know, key symptoms of Ebola include fever, weakness, 

head, joint, muscle, throat, and stomach ache, and then vomiting 

and diarrhea, rashes and bleeding. These symptoms are also seen 

in other diseases besides Ebola, which make an accurate diagnosis 

early on uncertain. 

Earlier today I had a full briefing, a lengthy briefing with the 

deputy chief of staff of the President of Guinea, President Conde, 

Ibrahima Khalil Kaba, who said that the virus has masked many 

other diseases, including Lassa fever, so many of the doctors, especially those who have never seen Ebola in this part of the world 

before, it has been in other parts of Africa, but not in west Africa, 

just simply didn’t think this would be Ebola. Many of them have 

died. 

Ebola punches holes in blood vessels by breaking down the vessel 

walls, causing massive bleeding and shock. The virus spreads 

quickly, before most people’s bodies can fight the infection effectively, breaking down the development of antibodies. As a result, 

there is massive bleeding within 7 to 10 days after infection that 

too often results in the death of the affected person. 

Fruit bats are suspected of being a primary transmitter of Ebola 

to humans in west Africa. The virus is transmitted to humans 

through close contact with the blood, secretions, organs, or other 

bodily fluids of infected animals. Some health workers, such as the 

heroic American missionary aid workers, Dr. Kent Brantly and 

nursing assistant Nancy Writebol, had contracted the disease despite taking every precaution while helping Ebola patients. Both of 

them are now being treated at Emory Hospital in Atlanta, Georgia, 

in an isolation unit after being flown to the U.S. in a specially 

equipped air ambulance. 

While there is no known cure for Ebola, both Dr. Brantly and 

Ms. Writebol have been given doses of an experimental antiviral 

drug cocktail called ZMapp developed by a San Diego company 

called MAP Biopharmaceutical. They are reportedly both feeling 

stronger after receiving the drug, but it is considered too early to 

tell whether the drug itself caused improvement in their conditions. 

MAP Biopharmaceutical has been working with the National Institutes of Health and the Defense Threat Reduction Agency, an 

arm of the military responsible for countering weapons of mass deVerDate 0ct 09 2002 15:43 Oct 14, 2014 Jkt 000000 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 F:\WORK\_AGH\080714\89385 SHIRL
3

struction, to develop an Ebola treatment for several years. The 

drug, which attaches to the virus cells, much like antibodies their 

compromised immune systems would have produced, has never 

been tested on humans before Dr. Brantly and Ms. Writebol, who 

gave their consent to be the first human trials. 

There will be hope, great hope if ZMapp works in the two Americans who bravely agreed to test it and it has a positive effect. Still, 

it won’t mean that it will be produced in great quantities quickly 

and sent to affected people in west Africa. It is still an experimental drug. Those who use it might be given complete information 

on its use again, but that still is something that our experts I hope 

will address. 

There is also promising research being done by Tekmira Pharmaceuticals. They have come up with a drug, a process, and one of the 

comments that has been made, that it has never been tested on humans, that it has provided 100 percent protection from an otherwise lethal dose of Zaire ebolavirus, but again not in humans, it 

has been done in others, nonhumans. 

Unfortunately, there are other issues that impact the ability of 

the international community to assist the affected governments in 

meeting this grave health challenge. Some of the leading doctors in 

their countries have died treating Ebola victims. The nongovernmental and medical personnel who are there say they are besieged 

not only because they are among the only medical personnel treating this exponentially spreading disease, but also because they are 

under suspicion by some people in these countries who are unfamiliar with this disease and they fear that doctors who treat the 

disease may have brought it with them. Of course, it is not true, 

but again myths do abound. 

The current west African outbreak, as we all know and as Dr. 

Frieden has said, is unprecedented. Many people are not cooperating with efforts to contain the disease. There is an information 

gap. Despite the efforts through cell phones and radio to get the 

message out, of course there is still a learning curve. 

As we consider what to do to meet this health challenge, I do 

suggest we reconsider the funding levels for pandemic preparedness, and this message is to us in Congress and to the executive 

branch. In the restricted budget environment in which our Government operates, funding to meet these pandemics has fallen from 

$201 million in Fiscal Year 2010 to an estimated $72 million in 

2014. The proposed budget for Fiscal Year 2015 is $50 million, and 

we mustn’t shortchange vital efforts to save the lives of people in 

these developing countries. 

Dr. Tom Frieden, one of today’s expert witnesses, has tried to assure the American public that our Government is doing what we 

can do to address the Ebola crisis. He has announced the dispatch 

of at least 50, perhaps more, public health experts to the region 

within the next 30 days. USAID, WHO, the World Bank, the British Development Agency, African Development Bank, and many 

others are also joining in and trying to meet this crisis. 

To those who say we have no plan, I would say that planning is 

definitely underway, and it is being done so very aggressively. Still, 

there is much more that needs to be done. 

4

I would just say finally, I have introduced legislation that is 

known as the End Neglected Tropical Diseases Act, which establishes the policy of the U.S. to support a broad range of implementation of research and development activities to achieve cost-effective and sustainable treatment control and, where possible, elimination of the neglected tropical diseases. 

Ebola is not on WHO’s list of the top 17 neglected tropical diseases, but it does fit the definition of an infection caused by pathogens that disproportionately impact individuals living in extreme 

poverty, especially in developing countries. Ebola had been thought 

to be limited to isolated areas where it could be contained. We now 

know that is no longer true. We need to take seriously the effort 

to devise more effective means of addressing this and all neglected 

tropical diseases. 

I now yield to my good friend and colleague, the ranking member, Ms. Bass. 

Ms. BASS. Mr. Chairman, thank you for your leadership and for 

calling today’s emergency hearing to give us an opportunity to 

learn about and work to address the current Ebola outbreak in 

west Africa. I look forward to hearing directly from our witnesses 

today on the work their agencies and organizations are doing to 

combat the deadly outbreak and how they have coordinated with 

the governments of impacted countries. I appreciate their efforts 

and outreach to keep Congress informed on this ever-evolving and 

devastating situation. 

This outbreak comes as nearly 50 African heads of state join us 

here in Washington, DC, this week as part of the first in history 

U.S.-Africa Leaders Summit. I have been honored to join my African and American colleagues as we have worked together to reach 

the full capacity and promise of the African continent. We have had 

several productive sessions that further cemented the relationship 

between the U.S. and African nations and highlighted areas of opportunity for us to continue to work together. 

Despite the meaningful dialogue and collaboration that occurred 

this week, there is still work to be done. The development of 

healthcare capacity and global health security is just one area of 

collaboration for the U.S. and African nations. I do have to say that 

I was a little dismayed that with all of the activities that happened 

this week around the summit, obviously the crisis we are dealing 

with today is very, very important, but when it came to coverage 

on Africa, the coverage centered pretty much solely around Ebola. 

I want to commend the steps being taken by the Governments 

of Liberia, Sierra Leone, Guinea, Nigeria, and the U.S., and the 

great work of the many health professionals from throughout the 

world who are doing everything they can to help people who have 

contracted this awful disease. With over 1,700 suspected and confirmed cases and over 900 deaths since March, the current Ebola 

outbreak we know is the longest lasting, widestspread, and deadliest outbreak ever recorded. This is also the first Ebola outbreak 

ever in west Africa and the first outbreak to be spreading in both 

rural areas and capital cities. 

The unique nature of this outbreak has made combating the disease particularly difficult. West Africa has not faced this disease 

before, and communities, government, and health professionals in 

5

the nations do not have the expertise and capacity to address the 

scale, spread, and proper treatment of the Ebola outbreak. 

This lack of logistical expertise, healthcare workforce, and supplies has hindered the ability of governments to quickly identify, 

track, and isolate new cases and properly care for those infected. 

Officials have also had to fight against fear of the disease and cultural unfamiliarity with proper treatment, which have really contributed to the spread and kept people from seeking care. 

Yesterday, I had the privilege to speak to President Ellen Johnson Sirleaf on the impact of the outbreak on her country and the 

work they have done to fight the disease. I asked her what more 

we could be doing, and one of the things she talked about was the 

need for logistical support, the need for training of their healthcare 

workforce so that they would know how to prevent the disease. I 

am sure Dr. Frieden, and I spoke with him yesterday, also is going 

to say that we do know how to prevent the spread of the disease, 

but that is where our efforts need to be directed. 

The other thing that the President said was that the problem, of 

course, with the outbreak is all of the resources are centered toward the outbreak, and then just routine medical care has really 

suffered because there hasn’t been the workforce to be able to handle both. 

So President Sirleaf called for increased international assistance 

to provide food and water to impacted communities. She said that 

the communities that were most heavily impacted were quarantined and that there needed to be food and water brought into 

the areas. Especially in situations like this you have a concern that 

civil unrest could be an outbreak, especially in areas that are quarantined that feel that they do not have access. And so she felt that 

that was one of the ways that the United States could help the 

best. 

It is obviously in our interest and in the world’s interest to assist 

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

outbreak and work to develop and strengthen their healthcare systems. Healthcare is a human right, and we must ensure that countries have the ability to address this outbreak and we are able to 

move forward and prevent future health epidemics from occurring. 

Both the chairman and I have introduced legislation to respond 

to this crisis, and I look forward to your testimonies, and I am interested in hearing from all of you about what more Congress can 

do to assist your efforts to combat the disease outbreaks and support international efforts to improve healthcare systems around the 

world. 

Thank you. 

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

I would just like to recognize in the audience, Zainab Bangura, 

who is the Special Representative to the Secretary General of the 

U.N. on Sexual Violence in Conflict. Thank you for joining us 

today. 

I would like to now yield to the distinguished chairman of the 

Commerce, Justice, Science, and Related Agencies Subcommittee of 

the Appropriations Committee, Congressman Frank Wolf, who has 

had a 34-year career of tremendous support for the weakest and 

the most vulnerable. As a matter of fact, the genesis of this hearing 

6

was a conversation with Ken Isaacs from Samaritan’s Purse last 

week. We were planning on a hearing on the Ebola virus for September, and the sense of urgency—and Chairman Wolf was the one 

who set up that conference call—the sense of urgency was so great 

that the thought was that it is better now, and we can have more 

hearings in the future and more action plans and the like. So I 

want to thank the chairman for his tireless efforts on behalf of the 

weak and vulnerable. 

Chairman Wolf. 

Mr. WOLF. Thank you, Mr. Smith. 

I want to thank my good friend Chairman Chris Smith for pulling together today’s hearings on such a short notice amid the escalating outbreak of Ebola across west Africa countries, including Liberia, Sierra Leone, Guinea, and now Nigeria. I also appreciate 

him inviting me to join today’s hearing. Although not a member of 

the Foreign Affairs Committee, I do serve on the State and Foreign 

Operations Appropriations Subcommittee, which funds the State 

Department and foreign aid programs. 

I would also say to the witnesses, too, if you need extra money, 

you ought to ask for reprogramming. You ought not to be waiting 

until September, October, November, and December. You should 

ask for it immediately, and I am confident that the appropriate 

committees up here will allow it. But if in doubt, there should be 

the request for the reprogramming. 

The current Ebola epidemic has claimed over 900 people since it 

was first detected earlier this year. It has proven to be the world’s 

worst outbreak of the virus ever recorded. It now appears that this 

alarming contagious disease could be on the verge of spreading. 

On July 28, I received a call from Ken Isaacs with Samaritan’s 

Purse, one of the witnesses here today. Let me say, Samaritan’s 

Purse and Doctors Without Borders have done more to help the 

poor and the suffering in many places than almost any other 

groups around, so I want to commend Samaritan’s Purse, and I 

also want to commend Doctors Without Borders. Wherever you will 

go in Africa, they will be there when other groups have long, long 

gone. 

Samaritan’s Purse was on the front line working to curtail the 

Ebola outbreak. The outlook, absent immediate action from the 

United States, was bleak. It appears that both the international 

health organizations and the Obama administration underestimated the magnitude and the scope of the epidemic. Despite wellintentioned efforts by local and international aid workers, doctors 

and nurses working on the ground, it seems the international community and the U.S. had been noticeably absent in helping these 

west African countries to get out in front of the spread of this epidemic. For the first part of the epidemic, the international community simply let three of the most impoverished countries in the 

world deal with the Ebola threat essentially on their own. It should 

be no surprise that the health systems in Liberia, Guinea, and Sierra Leone do not have the resources or the capacity to deal with 

this epidemic on their own. 

Despite early warnings from those NGOs working on the ground, 

there was little action taken to get out in front of this problem, and 

now we are seeing the consequences. Nothing can bring back the 

7

lives that were lost, and even the money and personnel deployed 

to help may not be enough to contain the epidemic. 

I spent much of last Monday, on July 28, on the phone with the 

White House, State Department, CDC, and HHS trying to understand just what, if anything, the U.S. was doing both to help contain the outbreak in west Africa and prevent the spread of Ebola 

to the U.S. I was concerned that no one could tell me who was in 

charge within the administration on this issue, and no one could 

explain what actions are being taken to ensure the U.S. was prepared to respond. Although more progress has been made over the 

last week since these conversations, it is clear that the government 

is still trying to catch up. 

This grave situation requires immediate and coordinated efforts 

across agencies and countries. France, Great Britain, and many of 

the countries in Europe who are very experienced in Africa should 

also be brought in. 

It also has come to my attention there needs to be an immediate 

response to the existing deficiencies in CDC planning, procedures, 

and protocols in response to the Ebola threat. As Mr. Isaacs will 

share today, and I have read his testimony, when its two 

healthcare workers were confirmed with Ebola, Samaritan’s Purse 

struggled to get guidance on protocols for dealing with returning 

healthcare workers from the region. It soon became apparent that 

there were significant gaps in existing procedures for dealing with 

this. The CDC had no available registry of medical facilities capable of treating Ebola patients in the United States. There are no 

quarantines or travel restrictions in place. And there was concern 

about these gaps in the protocols and how you deal with them. 

I appreciate very much, and I want to thank Dr. Frieden, for taking the call, as he was getting on an airplane. I want to publicly 

thank you, Doctor, I am very appreciative that you are here today 

and hope you will talk about any deficiencies and how they can be 

addressed by the government and also by the Congress. 

In closing, I want to thank again Chairman Smith for calling this 

hearing during the August recess. I also want to recognize the men 

and women of the CDC and other international response groups 

who are on the ground and will soon be on the ground in Africa, 

as well as the doctors and nurses helping the two patients in Atlanta. I want to thank them because this is very dangerous, what 

they will be doing, and what people who we do not know their 

names will be doing. I think we should tell them that we are appreciative. 

I also want to thank the State Department and the Department 

of Defense for their invaluable assistance as this situation has 

taken place. This is important and serious work, and I know the 

American people, if they knew what these folks were doing and had 

been done, would appreciate their tireless efforts. 

This should be a very top priority of the White House, the political leadership of the Nation. We know the career people, what 

they are going to do, but of the White House because the American 

people deserve to know what their government leadership is doing 

to prevent the spread of this epidemic and keep the country safe. 

With that, Mr. Chairman, I again thank you and yield back. 

Mr. SMITH. Chairman Wolf, thank you so very much. 

8

I would like to now introduce our first panel of two panels, beginning first with Dr. Tom Frieden, who has been Director of the Centers for Disease Control and Prevention, CDC, since June 2009, 

and has worked to control infectious and chronic diseases in the 

United States and globally. He led New York City’s program that 

controlled tuberculosis and reduced multidrug resistance cases by 

80 percent and worked in India for 5 years, helping to build a tuberculosis control program that has saved nearly 3 million lives. As 

the commissioner of New York City’s Health Department, Dr. 

Frieden led programs that reduced illness and death and increased 

life expectancy substantially. He is the recipient of numerous 

awards and honors and has published more than 200 scientific articles and has previously testified before this subcommittee on drugresistant diseases, as well as other very important health topics. 

Thank you, Doctor, for being here. 

I then would like to introduce Dr. Ariel Pablos-Me ́ndez, who is 

the Assistant Administrator for Global Health at USAID, a position 

he assumed in August 2011. Dr. Pablos-Me ́ndez joined USAID’s 

leadership team with a vision to shape the Bureau for Global 

Health’s programmatic efforts to accomplish scaleable, sustainable, 

and measurable impact on the lives of people living in developing 

countries. Prior to joining USAID, he worked on global health 

strategy and transformation of health systems in Africa and Asia. 

He also served as Director of Knowledge Management at the World 

Health Organization. Dr. Pablos-Me ́ndez is a board-certified internist and until recently was practicing as a professor of clinical medicine and epidemiology at Columbia University. 

And then we will hear from Ambassador Bisa Williams, a career 

member of the Senior Foreign Service with the rank of Minister 

Counselor and currently Deputy Assistant Secretary in the Bureau 

of African Affairs at the U.S. Department of State. Ambassador 

Williams has served as Ambassador to the Republic of Niger from 

2010 to 2013. She has also served in U.S. Embassies in Mauritius, 

France, Panama, and Guinea. Ambassador Williams’ postings have 

also included Director for International Organizations in the National Security Council at the White House and adviser at the U.S. 

Mission to the United Nations in New York. 

Dr. Frieden, the floor is yours. 

STATEMENT OF TOM FRIEDEN, M.D., DIRECTOR, CENTERS 

FOR DISEASE CONTROL AND PREVENTION 

Dr. FRIEDEN. Thank you so much, Chairman Smith, Ranking 

Member Bass, Congressman Wolf, for your interest in global 

health, for your interest in Ebola, and for calling this hearing at 

this really critical and pivotal time. 

I think, first, let’s remember the lives and the faces of the men, 

women, and children who are affected by the Ebola outbreaks in 

the four countries currently affected, especially the healthcare 

workers, who account for a substantial proportion of cases. Those 

are the people who we must focus on, those are the people who we 

must support, and it is in Africa that we can stop this outbreak 

and protect not only these countries, but ourselves as well. 

We focus on what works, and I am incredibly proud of the staff 

of the Centers for Disease Control and Prevention, and I think 

9

every American who would know the expertise, dedication of the 

disease detectives, laboratory experts, disease intervention specialists who have been on the ground in the past few weeks and 

months and who are now surging for our response would be proud 

to know what we are doing there. 

I want to start with the bottom line, three basic facts. First, we 

can stop Ebola. We know how to do it. It will be a long and hard 

fight, and the situation in Lagos, Nigeria, is particularly concerning, but we can stop Ebola. Second, we have to stop it at the 

source in Africa. That is the only way to get control. And, third, 

that we have to stop it at the source through tried and true means, 

the core public health interventions that work and that I will go 

through in a few moments. 

By way of background, Ebola is one of several viral hemorrhagic 

fevers. There are others, but Ebola is the most feared in part because it had a movie made about it. There are others that are just 

as deadly. The first Ebola virus was identified in 1976 in what is 

now the Democratic Republic of the Congo, and there have been 

sporadic outbreaks since. The natural reservoir is not known but 

is believed to possibly be bats, which then pass it to primates and 

other forest-living mammals, and humans may come in contact 

with them by eating bush meat or contact with bats. That is a theory, there is increasing evidence for it, but we are not certain of 

it. 

What we are certain of is that when Ebola gets into human populations it spreads by two routes. First, to people who are giving 

care to individuals who are sick with Ebola. Ebola does not spread 

from people who have been infected but are not yet sick. So it is 

only the sick people who transmit it. And, second, it is transmitted 

only by close contact with exchange of body fluid, so a healthcare 

worker or a family caregiver who comes into contact with a patient 

who is very ill, may be bleeding or have other body fluids that get 

on to that individual. 

That is how Ebola spreads, and in the outbreaks in Africa there 

have been two main drivers: Healthcare settings and other 

caregiving settings, including the family, and burial practices, 

where there may be practices that involve contact with a recently 

deceased person. Those are the drivers of Ebola in Africa. 

Again, Ebola only spreads from people who are sick and only 

spreads through contact with infectious body fluids. It does not 

spread through casual contact, it is not an airborne disease that it 

spreads in nature, doesn’t spread through water or food, and the 

incubation period is usually between 8 and 10 days from exposure 

to onset of illness. It can be possibly as short as 2 days and possibly as long as 21 days, but in that period it is essential that any 

contact be very closely monitored to determine if they have developed the symptoms of Ebola, and if they have, are followed up. 

We do know how to stop Ebola: Meticulous case finding; isolation; and contact tracing and management. We, with our partners, 

have been able to stop every Ebola outbreak to date, and I am confident that if we do what works, we will stop this one also, but it 

won’t be quick and it won’t be easy. It requires meticulous attention to detail, because if you leave behind even a single burning 

ember, it is like a forest fire, it flares back up. One patient not isoVerDate 0ct 09 2002 15:43 Oct 14, 2014 Jkt 000000 PO 00000 Frm 00013 Fmt 6633 Sfmt 6633 F:\WORK\_AGH\080714\89385 SHIRL
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lated, one patient not diagnosed, one healthcare worker not protected, one contact not traced, each of those lapses can result in another chain of transmission and another flare of the outbreak. 

To control the outbreak, we have to work effectively. The challenge really isn’t the strategy. The challenge is the implementation 

of that strategy. Mr. Chairman, we have provided to the committee 

this basic information on how Ebola can be controlled, and if you 

would permit me, I will just go very quickly through this because 

I think it is important to get the fundamentals out there. 

First, to find patients and diagnose them. That means fever or 

other symptoms. The only way to diagnose Ebola is with a laboratory test. That is generally done by a blood test in Africa, and we, 

working with partners from the Department of Defense, from the 

Pasteur Institute of France, from other countries, and the countries 

where the disease is present, are scaling up the ability to diagnose 

patients. So the first, that diagnosis, is suspect it with fever, test 

with blood, get it tested in the lab. That is a critical first step. 

The second step is to respond to those individual cases. We do 

that by putting patients in isolation, by interviewing them and eliciting their contacts, and then by following each and every contact 

every day for 21 days, and if a contact develops fever, begin that 

process all over again, interview them, isolate them, find out who 

their contacts are. It is laborious, it is hard, it requires local knowledge and local action, but it is how Ebola is stopped. 

And, third, prevent it. Prevent it through infection control in 

health care, safe burial practices, and reducing the consumption or 

unsafe consumption of bush meat and contact with bats. 

The current outbreak is a crisis. It is unprecedented, and it is 

unprecedented in five different ways. First, it is the largest outbreak ever. In fact, at the current trend within another few weeks 

there will have been more cases in this outbreak than in all previous recognized outbreaks of Ebola put together. 

Second, it is multicountry, and one of the biggest challenges is 

that one of the epicenters is on the confluence of three different 

countries. And cases have moved between countries. One country 

gets control and then patients come in from another country, so 

that tricountry area is a critical challenge. 

Third, this is the first outbreak in west Africa. This was a disease that was unknown, as far as we know, in that area before, 

and because of this, it has been a particular challenge, and the 

health systems in these countries are quite weak, and this also is 

a challenge. 

Fourth, many of the cases have been in urban areas, and there 

has been spread in urban areas, and this is something we have not 

seen to this extent before. From everything we know to date, this 

doesn’t appear to be a change in the virus, but it is a new development in how and where the virus is spreading, and it makes control much more difficult. 

And, fifth, it is the first time we are having to deal with it here 

in the United States, and that is not merely because of the two 

people who became ill caring for Ebola patients and were brought 

back to the U.S. by their organization. That is primarily because 

we are all connected, and inevitably there will be travelers, American citizens and others, who go from these three countries, or from 

11

Lagos, if it doesn’t get it under control, and are here with symptoms. Those symptoms might be Ebola or something else. So we are 

having to deal with Ebola in the U.S. in a way that we have never 

had to deal with it before. 

The U.S. is working in a coordinated way to support partner governments and the World Health Organization. I have activated the 

CDC Emergency Operations Center at Level 1 for this outbreak. 

This is our highest level of response. It doesn’t mean that there is 

an increased risk to Americans, but it does mean that we are taking an extensive effort to do everything we can to stop the outbreaks. 

We can’t do it alone. There are many partners throughout the 

U.S. Government who we are working with. The World Health Organization, the World Bank, partner governments around the 

world, as well as, most importantly, people in-country will be key 

to stopping the outbreak. 

We will send, as I have said, at least 50 staff to the region. Within the next week or two actually we will have reached that 50 number. But I think it is important to understand that the 50 in-country are supported at our home base in Atlanta by a much larger 

group. As of today, even before the full surge in activation, we have 

more than 200 staff working on this outbreak response, and we will 

increase that number substantially in the coming days and weeks. 

You will hear more about the work we are doing with the U.S. 

Agency for International Development, where we are using an unprecedented model to work together in a collaborative way to rapidly identify and call in for reinforcements and assistance. When 

we finish this response, we are determined to not only stop the outbreak, but leave behind strong systems that will be better at finding the disease and other threats, at stopping it before it spreads, 

at preventing it in the first place. In fact, if those systems had been 

there in the first place, we wouldn’t be here today. The outbreak 

would have been over already. 

We don’t know how to treat Ebola, and we don’t know how to 

vaccinate, we don’t have medications that cure it, but we do know 

how to care for patients with Ebola. You may have seen a lot of 

press coverage about experimental treatment, and the plain fact is 

that we don’t know whether that treatment is helpful, harmful, or 

doesn’t have any impact, and we are unlikely to know from the experience of two or a handful of patients whether it works. 

We do know that supportive care for patients with Ebola makes 

a big difference. Supportive care saves people’s lives, giving them 

fluid, making sure they are not over or under their fluid balance, 

giving them supplemental oxygen if it is needed, treating other infections that occur, providing good quality healthcare. 

We are currently coordinating with NIH, FDA, the Department 

of Defense, and others to see whether there can be new treatments 

and whether these treatments can be effective and available. But 

there is a lot we don’t know about that yet. It is important that 

we keep in mind that we do know, even without medicines that are 

specific to Ebola or a vaccine, we do know how to control it, and 

we can stop it. 

I want to spend a moment on what we are doing to protect people in this country. First off, the single most important thing we 

12

can do is to stop the outbreaks, to stop it at the source. The second 

issue that we are working on is to help these countries do a better 

job screening people who are leaving their countries so that they 

will screen out people who are ill or who may be incubating Ebola. 

And, third, because we recognize that we are interconnected, we 

are working closely with State and local health departments and 

health providers throughout the United States so that they are 

aware that there could be people who come from these three countries who have been there in the last 3 weeks, if they come in with 

fever or other symptoms, they should think that it could be Ebola, 

immediately isolate them in the hospital, and get them tested at 

CDC. 

We have issued a Level 3 travel advisory against all nonessential 

travel to Guinea, Sierra Leone, and Liberia. We have issued a 

Level 2 travel advisory about enhanced precautions on Nigeria, and 

we will reassess the Nigerian situation daily or more frequently as 

needed. 

There is strict infection control possible in hospitals in the U.S., 

and there has been some misconception about this. Ebola is not as 

highly infectious as something like influenza or the common cold. 

What is so concerning about Ebola is that the stakes are so high, 

that a single lapse in standard infection control could be fatal. That 

is why the key is to identify rapidly and strictly follow infection 

control guidance. 

It is certainly possible that we could have ill people in the U.S. 

who develop Ebola while here after having been exposed elsewhere. 

It is possible that they could spread it to close family members or 

to healthcare workers if their infection is not rapidly identified. But 

we are confident that there will not be a large Ebola outbreak in 

the U.S. We are confident that we have the facilities here to isolate 

patients, not only at the highly advanced ones like the one at 

Emory, but really at virtually every major hospital in the U.S. 

What is needed is not fancy equipment. What is needed is standard infection control rigorously applied. We have released guidance 

for doctors and other healthcare providers in the U.S. on identifying, diagnosing, and treating patients, and guidance for airline 

flight crews, cleaning personnel, and cargo personnel. 

Fundamentally, to end here, we have three roads before us. We 

can do nothing and let the outbreak rage, and I don’t think anyone 

wants to do that. We can focus on stopping these outbreaks, and 

that is something that we will certainly do. Or we can focus not 

only on stopping these outbreaks, but also on putting in place the 

laboratories, the disease detective, the emergency response systems 

that will find, stop, and prevent future outbreaks of Ebola and 

other threats. 

We do face in this country a perfect storm of vulnerability with 

emerging infections like Ebola, resistant infections like the ones we 

discussed in our last hearing, intentionally created infections, 

which remain a real threat. But we have unique opportunities to 

confront them with stronger technology, more political commitment, and success stories on real progress from around the world. 

Earlier this year the U.S. joined with the World Health Organization and more than two dozen other countries to launch a Global 

Health Security Agenda. That Global Health Security Agenda is exVerDate 0ct 09 2002 15:43 Oct 14, 2014 Jkt 000000 PO 00000 Frm 00016 Fmt 6633 Sfmt 6633 F:\WORK\_AGH\080714\89385 SHIRL
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actly what we need to make progress not only in stopping Ebola, 

but in preventing the next outbreak. 

And the second document that we provided for you provides a 

summary of what the mapping is between what we launched back 

in February before this outbreak was known or reported to have 

started and what is needed to stop the Ebola outbreak, and they 

are closely aligned. 

The President’s budget includes a request of $45 million to CDC 

to accelerate progress in the detection, prevention, and response. 

A former Under Secretary of State for Africa said to me, citing 

his decades of work, that CDC is the 911 for the world. And though 

I was happy to hear that, I realized that really what we want to 

make sure is that every country, or at least every region, has its 

own public health 911. That will be good for them, it will be good 

for us in terms of safety, it will improve economic and social stability, and expanding that type of work, strengthening global 

health security, will allow us to not only stop this outbreak, but 

also prevent future outbreaks and stop them faster if they do occur. 

Thank you so much for your interest in this topic. 

Mr. SMITH. Dr. Frieden, thank you very much for that very comprehensive and incisive testimony. 

[The prepared statement of Dr. Frieden follows:]

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Mr. SMITH. I would like to now yield to Dr. Pablos-Me ́ndez. 

STATEMENT OF ARIEL PABLOS-ME ́ NDEZ, M.D., ASSISTANT ADMINISTRATOR, BUREAU FOR GLOBAL HEALTH, U.S. AGENCY 

FOR INTERNATIONAL DEVELOPMENT 

Dr. PABLOS-ME ́ NDEZ. Thank you very much, Chairman Smith, 

Ranking Member Bass, Chairman Wolf. Thank you for this opportunity, very timely, to allow the U.S. Agency for International Development to present to you an update on where we are with the 

work on this tragic and alarming outbreak of Ebola in western Africa. You have been a longstanding supporter of this area, and 

Member Bass quite so for Africa, so we couldn’t have better champions in this emergency. 

The epidemic of Ebola in western Africa is historic because both 

the magnitude is unprecedented, as well as because it has never 

really occurred in this region or, as we heard from Tom, spreading 

to cities and the risk of spread beyond the region. 

I am, like many of you, saddened to see the devastation of the 

loss of lives caused by this outbreak, but also the broader socialeconomic disruption that this is inflicting in the region, what is 

really a set of fledgling democracies in western Africa. 

The good news, as we have heard, is we know how to deal with 

Ebola. Since 1976 there have been about 30 or so outbreaks in central Africa, and each of those, of course, have been contained. The 

systems don’t have to be perfect. The basics have to be in place. 

Systems have to be familiar. 

Uganda has a track record that is worth noting. In the year 2000 

they had about 425 cases during that outbreak. The support that 

we provided allowed that outbreak to be contained. Subsequent 

outbreaks in 2008 only saw 149 cases, a two-thirds reduction, and 

in the last outbreak in the region, 2011–2012, the number was only 

32. So systems can learn, can prepare, can deal with this outbreak. 

We have done it many times, and as Tom has said, we know exactly what to do. 

USAID, with the support that you gave us all along, provides 

routine funding to both CDC, the World Health Organization in 

Geneva and in Africa to have preparedness planning and response, 

and indeed that has been part of the machinery that has been put 

in place here. We support about 22 laboratories in 18 countries in 

Africa and Asia where almost 500 new viruses have been detected 

just in the last 5 years. So there is a lot of activity going all the 

time. 

This particular virus of Ebola is, again, familiar to us, and as far 

as we can tell from a biological, genetic point of view, it is really 

the same virus. It is not that it is a new mutant virus that has 

taken on new powers. It is the same virus we are familiar with, 

but it has entered a new region and has entered perhaps, as we 

speculate, because bats that have been tested positive in central 

Africa are now also tested positive in western Africa. 

This ecological dimension of the work that we do has to be kept 

in mind, and because of the novelty of this, neither the new systems or the people in western Africa and other health systems were 

experienced in dealing with the outbreak, which has helped contribute to the dimensions of this. 

23

USAID has also targeted in this year the response in western Africa. We started earlier this year supporting with a $2.1 million investment to WHO, to UNICEF, and has been reinforced now with 

$12.4 million to support CDC, the WHO, and the like. 

Indeed, it is important to note, to Chairman Wolf’s comments, 

that the outbreak in Sierra Leone and in Liberia probably started, 

in retrospect, we now with regard to verbal autopsies can see that 

earlier on, but the cases were identified in late March and for a 

couple of weeks we have had this outbreak that then went down. 

So that in the spring the initial outbreaks went down, as Tom 

Frieden has pointed out, but if you allow one case in these remote 

areas, one case can reignite the whole thing, and indeed that is 

what we have seen with a secondary spike that has been truly difficult to control. 

These investments have allowed us to work with WHO and 

UNICEF to allow to deploy 30 or so technical experts, provide additional operational support, including 35,000 sets of personal protective equipment and supplies. Also the basics, soap, water, that sort 

of thing is also very important in this type of situation, and it is 

taking place as we speak. 

USAID is closely coordinating its response to Ebola with the Departments of State, Health and Human Services, and Defense, as 

well as with WHO. The CDC has the lead in the response to the 

Ebola outbreak, but the coordination—and I have been part of 

many other interagency efforts—has been truly exemplary, and I 

want to really point that out. It has been something the last couple 

of weeks that that coordination has been working just to make sure 

that we actually support those countries to stop this outbreak. 

USAID, in addition, has activated a Disaster Assistance Response Team, a DART, something that you are familiar with that 

we have deployed in other emergencies, from Fukushima typhoons 

to Haiti earthquakes, and this provides the architecture for the response of the U.S. Government once the U.S. Ambassador on the 

ground has declared an emergency. And this has indeed occurred, 

and the DART is now deployed, and the team, the team leaders 

and the deputy team leaders are in place. CDC is responsible for 

the health and medical part of this response, but there is plenty 

of other activities in planning, in operations, in communications, 

engaging not only in the USG, but with the other local governments and with the other partners that I mentioned before. 

I spoke with our mission director in Liberia where we have a 

large platform for health work that works very closely with the 

Minister of Health. We have only one or so health staff in Sierra 

Leone regular in Guinea, and in Sierra Leone we did not have a 

mission. And so it has been we are building out of this DART and 

working with the CDC and others to have the required staff and 

experts on the ground to facilitate the report. 

I want to report that the morale is high in our teams. Although 

the family members have been ordered to leave the country, our 

teams are staying put, working with the CDC, working with MSF, 

working with others, taking all the precautions to ensure their 

safety, but also supporting them to work effectively against this 

outbreak. 

24

And this reminds us, of course, that an outbreak requires also 

prevention, not only in the acute setting to avoid the growth of this 

epidemic, but also the global vigilance that we must maintain since 

these viruses know no borders. 

In the short term it is a humanitarian imperative and a national 

security priority to contain this Ebola outbreak as quickly as possible. It will take probably months to end it, but I think we can 

turn around these tables in the next couple of weeks if the proposed response that has been mounted is deployed and executed as 

planned. The U.S. Government is fully engaged in the response, 

and we are confident that we can stop the epidemic. As I said, it 

will not be easy and it might take several months. 

In the long term we must assist developing countries in strengthening their own health systems, both those dedicated to infectious 

diseases like this, but also the overall capability of the systems to 

deal, because it is about the front line health workers in primary 

care settings, in communities, and this time is Ebola in western Africa. We have seen H1N1 coming from Mexico, we didn’t expect 

that, or MERS coming from South Africa. These pathogens can 

jump anywhere, and health systems need to be prepared to deal 

with these things as they occur. 

With your support, USAID will continue to make this a priority 

in our global health investments in Africa, and as Tom Frieden has 

alluded also, the administration is working on the Global Health 

Security Agenda for which we look to work with you in the plans 

because they will require support in the future, and we look forward to working with you on that. Thank you very much for giving 

me this opportunity, and I look forward to your questions. 

Mr. SMITH. Doctor, thank you very much for your testimony and 

for your leadership. 

[The prepared statement of Dr. Pablos-Me ́ndez follows:]

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Mr. SMITH. I would like to note we have been joined by Augustine Ngafuan, who is the Foreign Minister of Liberia. 

Thank you for being with us today, Mr. Minister. 

And now I would like to yield to Ambassador Williams. 

STATEMENT OF THE HONORABLE BISA WILLIAMS, DEPUTY 

ASSISTANT SECRETARY, BUREAU OF AFRICAN AFFAIRS, U.S. 

DEPARTMENT OF STATE 

Ambassador WILLIAMS. Thank you very much, Chairman Smith, 

Ranking Member Bass, Chairman Wolf, and members of this subcommittee, for the chance to testify before you on this very important topic. 

The evolving Ebola crisis in Guinea, Liberia, Sierra Leone, and 

now Nigeria is one of the most daunting challenges those countries 

and the region have faced in decades. To date, more than 1,600 

suspected and confirmed cases of Ebola have been reported, including over 900 total deaths. 

Although these affected countries are home to many heroic and 

dedicated health workers, the rapid spread of the disease reflects 

the lack of national capacity, particularly in the three epicenter 

countries of Liberia, Guinea, and Sierra Leone, to limit the spread 

of the disease and to treat patients. The NGO community, which 

has played a significant role in the response effort by providing 

front line medical care to patients, is hard-pressed to continue to 

provide care in all affected regions. 

Compounding the issue, affected populations’ lack of understanding of the virus and widespread mistrust of healthcare providers and treatment methods have further hampered response efforts. In significant portions of the affected regions, local traditions, 

such as public funerals and cultural mourning customs, including 

preparing bodies of the deceased for burial, have contributed to the 

spread of the virus and have led locals to block access to patients 

and in some places have led to attacks on healthcare workers. Following one such incident in Liberia, major care providers like Samaritan’s Purse have begun pulling out of the region due to concerns for the safety of their staff. 

Thus, in addition to proper medical care, there is an urgent need 

for effective health messaging campaigns and public outreach as an 

integral and crucial component of these response efforts. We are 

reaching out to ensure our response is coordinated with the WHO 

and other countries that can assist both through our representatives at WHO headquarters in Geneva and through direct discussion with other governments. 

Guinea, Liberia, and Sierra Leone are still rebounding from 

lengthy conflict. These conflicts destroyed lives, institutions, and 

infrastructure. This was especially acute in Liberia and Sierra 

Leone, where the fighting went on for years. These countries have 

taken important steps to reverse the effects of deterioration and neglect and to build lasting security and stability. Border control and 

other factors key to checking Ebola’s spread also are challenging 

for the countries in this region. 

Aside from our interest in making sure this Ebola virus does not 

spread to the United States or farther in Africa, we do not want 

the virus to erode the capacity of African countries to address other 

31

important national and regional challenges. We want to ensure 

these countries remain strong, strategic allies to the United States 

in a region facing serious development and security challenges. 

Sadly, this virus already has impacted peacekeeping in Somalia. 

The African Union cancelled a planned deployment of Sierra 

Leonean peacekeeping force due to fears that the virus could be introduced into the country. 

Given the critical importance of this issue, we are fully committed to doing everything possible to shore up each government’s 

efforts to combat the viral outbreak and control its spread. We are 

confident that through the concerted and coordinated efforts of our 

Government and our international partners we can contain and 

stop this virus. In fact, Mr. Chairman, the Department has established a monitoring group on the humanitarian situation in west 

Africa to monitor and coordinate information. The task force may 

be reached at the following email address, that is taskforce5@state.gov. 

Since the beginning of the crisis the Department has maintained 

close contact and coordination with the governments of all of the 

affected countries and has closely monitored their operational plans 

to combat the viral outbreak. In Sierra Leone, President Koroma 

directed government officials to make containment of the virus 

their top priority and set up a Presidential task force to lead the 

government’s efforts. In Guinea improved messaging to the populace helped healthcare providers gain access to infected regions. 

And in Liberia, President Johnson Sirleaf announced a national 

task force to combat the spread of the virus. 

On August 1, the three Presidents detailed their collective strategy for eradicating the virus in a joint communique following a 

meeting of them of the Mano River Union. We commend all three 

countries for taking this outbreak seriously and for taking concrete 

steps to address it. 

This week’s news of new cases in Lagos, Nigeria, a city of over 

20 million people, makes the need for an effective, well-supported, 

and well-coordinated national plan and international response 

more important than ever. In fact, Mr. Chairman, I just met today 

with President Blaise Compaore of Burkina Faso and with Dr. 

Kadre Ouedraogo, who is president of the ECOWAS Commission, 

who told me that the health ministers of the three affected states 

will meet again, they will meet in Conakry at the end of this week 

on August 11 through 14, and that following that the health ministers of all of the ECOWAS states will meet in Accra, Ghana, on 

August 28. The intensified attention of the health ministers of the 

entire region is a good sign, and it demonstrates that the whole region is seized with this crisis. 

Assistant Secretary Linda Thomas-Greenfield has spoken to the 

Presidents of Guinea, Liberia, and Sierra Leone to express support 

and to assure them of our assistance to stop the spread of the 

virus. On August 4th, the Department hosted and moderated a 

meeting on Ebola on the sidelines of the U.S.-Africa Leader Summit to discuss the next steps for controlling and ending the virus. 

HHS Secretary Sylvia Burwell, CDC Director, my colleague here, 

Dr. Tom Frieden, and NIH Director, Dr. Francis Collins, USAID 

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Me ́ndez, and President Alpha Conde of Guinea, the Liberian Minister for Foreign Affairs, Sierra Leone’s Ambassador to the United 

States, and Professor Tomori Oyewale, the president of the Nigerian Academy of Science, participated in the meeting. Representatives from DOD, from the NSC, the World Bank, as well as private 

partners like the GE Foundation and Becton, Dickinson and Company, also joined. In addition to emphasizing the need to focus on 

detection, isolation, and adequate training for health workers in 

the field, we also emphasized our long-term commitment to building the health care capacities of individual west African nations beyond this immediate crisis intervention. 

We continue to work with our international partners and the 

WHO to assess what is needed to properly treat patients and to 

mount a sustainable response. Such support has included providing 

financial and technical assistance to properly equip treatment centers and supporting communication efforts to help healthcare workers access affected communities. The WHO Sub-Regional Coordination Center opened in Conakry on July 23rd and is coordinating all 

surveillance efforts, harmonizing technical support, and mobilizing 

resources being provided to the affected countries. The organization 

has also launched a $100 million emergency response plan to surge 

resources to mount a more effective response. We are in continuous 

discussions to find new ways to provide assistance. 

The Department of State has no higher priority than the protection of U.S. citizens. We extend our deep sympathies to the family 

of Patrick Sawyer, a U.S. citizen who died in Nigeria after contracting the virus in Liberia. At least two additional citizens affiliated with the response organizations have been infected in Liberia 

and are currently undergoing treatment. We are in close contact 

with the sponsoring organizations of those two individuals, and our 

thoughts and prayers go out to them and to their families. 

U.S. Embassies in the affected countries have disseminated security messages, including the CDC’s warnings, to resident and traveling U.S. citizens. We continue to take steps to educate citizens 

about the virus, to dispel rumors, and to provide information on 

preventive measures. 

We also take the safety and well-being of our staff very seriously. 

To that end, the Department’s Chief of Infectious Disease traveled 

to west Africa to provide Embassy staff with assistance regarding 

protection measures and case recognition. Additionally, Embassies 

in the affected region have organized regular town hall meetings 

to answer questions and concerns of mission personnel and U.S. 

citizens. 

Embassies in neighboring countries like Mali, Senegal, and Togo 

have also held meetings to assess the capabilities of their host governments and to make contingency plans for Embassy personnel 

and resident citizens in the event of an outbreak. 

In closing, Mr. Chairman, I would like to reiterate and assure 

this committee that the Department of State takes the Ebola threat 

very seriously and we are fully dedicated to working with our governmental and non-governmental allies, the interagency community and host governments in the affected countries to respond to 

this crisis, prevent its spread and to restore stability to the region. 

33

I thank you for your attention to this issue, and I look forward 

to answering your questions. 

[The prepared statement of Ambassador Williams follows:]

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Mr. SMITH. Thank you so very much, Ambassador Williams. 

I do have a few questions I would like to pose to our distinguished panel, beginning first with Dr. Frieden. As you said, supportive services are important. With no effective vaccine or drug 

treatment, you outlined how important those services are, including hydration and, I am sure, antibiotics to deal with some of the 

other co-infections. 

Now, I wonder if you could just tell us, is there any 

disproportionality in result when it comes to whether or not we are 

talking about a frail elderly person, a woman, a man, a child, a 

woman who happens to be pregnant, or any of the others who has 

a compromised immune system? What has been the MO of that, if 

you could? 

Secondly, I know that treatment centers, for example, in Guinea—there are some three to four treatment centers, but, again, it 

is very hard for people in that country as well as the others—Liberia and Sierra Leone as well—to get to those treatment centers. It 

is a long trek. Very often with the ride, the person is very sick, others could come in contact with him or her. There seems to be an 

overwhelming need. 

One of the points that I think needs to be underscored that is 

under-appreciated in many places is that, in dealing with someone 

who is dying, especially in those—that part of the world, there is 

a psychological trauma with being alone. So it almost exacerbates 

the spread of the disease because people want to be around, near, 

touching and, when that person is highly infectious, that is when 

family members and others might get it. If you could, speak to 

that. 

The lack of testing, testing areas, whether they be, you know, as 

part of the treatment centers where there is a testing lab—it is my 

understanding, especially since this masks and parallels what 

other—you know, it looks like other things, but it is Ebola—but unless you get that test back—how long does it take to do the test? 

And, again, is there any way of standing up labs? 

I know for a fact that—you know, especially through the work of 

Bush’s PEPFAR program, which has been followed up with Obama 

doing the same thing—and, you know, the idea that building 

health capacity and labs in Africa is a very high priority, and now 

we are seeing where inadequate labs or lack of labs leads to people 

being sick and not even knowing it. 

The courage of the healthcare workers I think needs exclamation 

points. I know you are there as well and you go on the front line 

yourself and go into—all three of you—into contagious areas. But 

Dr. Brantly and Ms. Writebol and others who put their lives on the 

line, motivated so often by faith, in the case of Dr. Brantly and—

I mean, I have read some of the things his wife has put out, the 

prayers that are being offered up not just for him, but for all of the 

victims. 

In Liberia, there have been 60 healthcare workers infected. 35 

are dead. In Guinea, 33 healthcare workers affected. 20 are dead. 

How does a country now attract or retain healthcare workers 

who say, ‘‘If I go into that arena, the prospects of me getting this 

are very real’’? Is there enough protective equipment, you know, 

the gowns, the plastic, to mitigate the possibility of transfer? 

38

And, finally—and I do have other questions, but I will yield to 

my colleagues—there are a number of, I said in my opening, promising drugs. ZMapp is one of them. TKM—Ebola, which was in 

Phase I trials; yet, the FDA has a hold on it. They were contracted 

by the Department of Defense. 

From what I have read—and it is only from what I have read, 

you know, the available data, it was showing promise. And I am 

wondering if there is any way to accelerate, knowing that you don’t 

want to obviously put something out there that is risky—because 

Ebola is not 100 percent fatal, as we all know. We don’t want to 

keep people getting sick from the remedy or supposed remedy. 

What about accelerating that? Is there an effort to do that? 

And my final question is about the safety of airline flight. Many 

people have contacted my office to ascertain, you know, how safe 

it is to fly perhaps next to somebody who has maybe changed 

flights en route to the United States coming from Liberia, for example. 

And are the efforts at the airports, particularly where there is a 

large diaspora population—I don’t know if you have enhanced efforts there where people from west Africa are more likely to go. 

But, you know, are they up to the task of detecting at point of embarkation of passengers who might be sick from Ebola? 

Dr. FRIEDEN. So let me try to quickly give you clear answers to 

all of those questions. 

The first is the relative case fatality rate of different groups. And 

in the current outbreak, the data is still too foggy for us to give 

you clear data. There is not the kind of robust data that we will 

have eventually, but don’t have now to give you, what we would 

call a case fatality rate for different groups. 

But there is one very intriguing historical fact which I think is 

worth mentioning. In 1967, there was a laboratory accident in 

Marburg, Germany. The Marburg virus was then identified. 

Marburg has a similar fatality rate to Ebola, if anything, a little 

higher. It is around 80 percent. The outbreaks have been in the 80 

percent range in Africa. 

The case fatality rate in Germany in the Marburg outbreak was 

23 percent. Now, that might have been because of the better supportive care—there was no specific antiviral treatment—or it might 

have been because people were healthier going in. We don’t know. 

But we do know that it was dramatically different, and I think 

that is an important point. Good supportive healthcare is a proven 

way of saving lives, and we should never lose sight of that. 

Second, in terms of treatment centers, you are absolutely correct 

that there is a challenge in getting to treatment centers. And that 

is one of—that is, in fact, the number one priority for the DART 

team, which USAID is convening and CDC is leading the medical 

public health aspects of, which is on the ground today in Liberia 

to assess. 

And the biggest challenge is both in the city of Monrovia, where 

there continue to be chains of transmission, and in that tri-country 

area. So looking at whether one facility or multiple facilities and 

where the facilities would be, that is a critical issue for us to determine in the coming days. 

39

Treatment centers, as you point out, are very important to support. I was speaking with the American Charge from Sierra Leone, 

who was speaking very movingly about the patients and their isolation in the treatment centers and simple things like giving them 

cell phones so they could talk to their family or things that they 

could do while there was very important. And if patients don’t believe that they are going to be well-treated in the treatment centers, they won’t come in and they may continue to spread it in the 

community. So good quality care is very important. 

In terms of testing, you are absolutely correct. As you know, Mr. 

Chairman, with support from PEPFAR, the CDC has helped create 

the African Society for Laboratory Medicine, and that has for the 

first time ever had high-quality laboratories established all over Africa. These countries have not been PEPFAR-focused countries; so, 

they have limited activities in that area. 

But scaling up laboratory testing is important. We will do that 

in two ways, first, by finding laboratories—this isn’t simple laboratory tests. This is a realtime PCR. The results come back within 

a day, but false contamination, false positives, are possible if you 

are not scrupulously careful. And that would be a real problem. 

So we will scale up the labs that can do testing. We are working 

with international partners on this, who are involved and with the 

Defense Department, which has a very active program, for example, in Sierra Leone and is providing services there, and with the 

National Institutes of Health, which has been very helpful. 

We will also establish safe specimen transport means. We have 

done this in Uganda, where we can very safely transport. Hard to 

get a lab out all over, but quite possible to get transport into the 

lab. And that is what we will establish in the coming days. 

In terms of the courage of healthcare workers, I certainly agree 

with you. And it is an issue not just for healthcare workers, it is 

an issue for patients. We have heard that, with healthcare systems 

less functional, problems like malaria may become more deadly. 

So the impacts of Ebola aren’t just Ebola. There are the other 

conditions that aren’t treated because of Ebola. So responding is so 

very important, and protecting the responders is so very important. 

So a key aspect that we are working on with the World Health 

Organization, with the countries, with USAID and others is making sure that there is effective personal protective equipment there 

for healthcare workers. We believe it is possible to take care of 

Ebola patients, even in Africa, safely, but it takes meticulous attention to detail. 

In terms of the promising drugs, I can assure you that the U.S. 

Government is looking at this very carefully and will look at any 

way to try to expedite development or production, but I don’t want 

any false hopes out there. Right now we don’t know if they work 

and we can’t, as far as we know, have them in any significant numbers. We hope that that might change. 

But these medicines that have been used in the experimental 

cases, as far as I understand it, are not easy to use. They require 

infusion. They may have adverse events. And basic supportive care 

needs to be in place as a prerequisite to giving many of these treatments. 

40

So whatever else we do, we have to do the basics right. And we 

might or might not have effective and available treatment in 3 

months or 6 months or 1 year or 5 years, but we today have the 

means to stop the outbreaks. 

And, finally, in terms of airline flights, we do have teams in the 

affected countries who are working with the equivalent of their border protection services, helping them to do screening at the airports. It is not a simple measure. It is key first to reduce the number of cases. That is what is going to be the safest. 

And there are other things that can be done at airports in terms 

of questions to be asked or temperatures to be taken or lists to be 

cross-matched against known patients and known contacts, but all 

of those procedures do take time to set up. But we do have teams 

working on them now. 

Mr. SMITH. Dr. Frieden, if I could ask you, if somebody is in 

proximity to a sneeze or a cough, is that a mode of transmission? 

Dr. FRIEDEN. In medicine, we often say, ‘‘Never say never.’’ So, 

in general, the way we have seen the disease spread is by close 

contact with very ill people. 

As you know, the individual who traveled from Liberia to Lagos 

did become ill on the plane, and we have assisted those countries 

to track the travelers who traveled with him and, as of now, have 

not identified illness in any of them. 

But, in general, it is not from a sneeze or a cough. In general, 

it is from close contact with someone who is very ill, but we do 

have concerns that there could be transmission from someone who 

is very ill. 

Mr. SMITH. So at the fever stage, if somebody is onboard, that 

wouldn’t be construed to be very ill? You are not likely to get it 

from somebody who is at fever stage? 

Dr. FRIEDEN. You are not going to get it from someone who is 

not sick with Ebola. So if they are just clearing their throat or 

sneezing or coughing, but they don’t have a fever, they have not 

become ill with Ebola, they are not infectious to others. But if 

someone became ill on the plane and was having fever or started 

bleeding, then, for example, that might present a risk to those who 

came in contact with that and didn’t take appropriate precautions. 

Mr. SMITH. Is there a way of advising airline personnel, particularly flight attendants who, again, might be in very close proximity 

to the whole plane and there could be someone on there? Does CDC 

advise them and the airlines, like Delta, which flies numerous 

flights to the region? 

Dr. FRIEDEN. Yes. We have provided detailed advice to the airlines. 

Mr. SMITH. Let me just ask you, Ambassador Williams, very 

quickly. 

You spoke—and I think it was a very good insight—about the 

handling for funeral arrangements and just generally sensitivity to 

the culture. 

I know it is part of the public information campaign in Guinea—

for example, some 9 million cell phones are being used and text 

messages are being sent with a number for the Red Cross, and one 

of the text messages says, ‘‘The bodies of Ebola victims are very 

contagious. Do not manipulate. Call the Red Cross.’’

41

Now, I am wondering if there is any thought being given—I remember after Operation Provide Comfort, when the Kurds made 

their way fleeing Iraq after Saddam Hussein—I was there about 5 

or 6 days after that, and our military was on the ground and they 

were using PSYOPS to educate and leafleting that was done in a 

way that we would use in a not-so-benign situation. In this case, 

it was to get food out and Meals Ready to Eat, and it was amazing 

how that kind of information made the Kurds who were at great 

risk of the elements and starvation, very aware of what they needed to do. 

Is there any thought of helping the Liberians and the other countries with a benign PSYOPS effort to make people aware? I know 

that radio is being used, but it seems to me that more needs to be 

done. Any thoughts? 

Ambassador WILLIAMS. Thank you, Chairman. 

I can’t say that we have moved to the point of PSYOPS, but I 

think you are hitting a very, very important issue, which is that 

culture makes a difference and you have to adjust your messaging 

and do the campaign according to the sensitivities and the routines 

and the practices per culture. 

What was extremely effective in Guinea was not only what you 

mentioned, Mr. Chairman, but the fact that they started talking 

about survivors and the survivors came on the radio. They went 

around and said: ‘‘Look, I was sick, but this and this and this happened to me. I did such and such, and I am still alive. You should 

go get treatment. You should isolate. You should make sure people 

know you have this.’’ So that is very, very important. 

Our military right now is helping in the ways that have already 

been described as far as with logistics and making sure that we can 

get in body bags, protective equipment for the healthcare providers. 

And that—that is where we are so far. 

But we are relying upon the host governments to help explain to 

us what is most effective, what the sensitivities are, and what messaging needs to get out. And then we were helping with the means 

of the communication, but not the actual message, because they 

know best what the people need. 

Mr. SMITH. Thank you. 

I yield to Ms. Bass. 

Ms. BASS. Thank you very much, Mr. Chairman. 

This is for the doctors. I wanted to know if you could talk a little 

bit more about the disease. We all know about fevers, but having 

spent a number of years working in emergency rooms, I can imagine what is happening in our emergency rooms around the country. 

Everybody with a fever is running in, being concerned. 

And I was wondering if you could talk a little bit more about 

what are the other symptoms of the disease and maybe if you have 

any thoughts of why some folks are surviving, since my understanding of part of the disease is that it interferes and takes over 

with the immune system. 

Dr. FRIEDEN. So the fevers can be one symptom, but chills, weakness, nausea, vomiting, diarrhea are other symptoms. In about 45 

percent of cases, there is bleeding, both internal and external, and 

that is a feared complication. So these are symptoms which, as you 

both pointed out, are not specific to Ebola. 

42

And that is why the laboratory testing is so important. It is also 

why it is not the case that someone will know they have Ebola and 

go to a special Ebola unit and why it is so important that health 

facilities who are there think of the risk of Ebola and then rapidly 

isolate people. 

In this country, what we have told healthcare workers to do is 

take a travel history: Has the person been in one of these countries 

in the past 21 days? If yes and if they have fever or other symptoms, then do tests. 

We have already had five people in different parts of the U.S. 

who come in with a travel history to one of these countries in the 

past 21 days. All five have turned out not to have Ebola. Two had 

malaria, one had influenza, and two had something else. 

So we expect this to happen. In fact, we want there to be a highlevel index of suspicion so that doctors will rapidly isolate the person and then rapidly test them. 

Ms. BASS. And how do you screen? Just as the chairman asked—

and I know, you know, again, what is in the press is that, if someone on an airline sees someone with a fever—and I mentioned to 

you yesterday when we spoke there are these pictures in the news 

of the wands or they are doing some type of screen, and I think 

you pointed out—and maybe you could talk about that is really not 

effective. 

So how does one screen, short of a blood test in a medical facility, 

that like an airport worker might do? 

Dr. FRIEDEN. There is no way to diagnose Ebola without a laboratory test. So if someone has fever and they may have been exposed, they have been in one of these countries, they need be isolated and tested. 

For people within the U.S., currently both we have a test that 

is accurate and relatively quick—a few hours once the specimen 

gets to our lab—and the Department of Defense also has a test. 

And we are working in collaboration with them to see if we can 

over the next couple of weeks get that test out to what is called 

the Laboratory Response Network, or LRN. This is a network that 

CDC coordinates of laboratories at mostly health departments 

around the country to test for dangerous pathogens. 

Ebola is not in their usual network; so, this would be a new procedure. But either through the Defense Department’s assay or our 

own, we will look into getting that available so not all of the tests 

have to come to CDC Atlanta and they can be tested locally. We 

also have safe ways for specimens to be transported to CDC if they 

need to be transported. 

Ms. BASS. One of the other things that we have touched on a couple of times today is the ZMapp. I think that is what it is called. 

And I would like for you to talk a little bit about that because there 

is a lot of concern that maybe we have access to this and are not 

providing that access. And one of the things that I think was a 

mention that maybe you could elaborate is that there might only 

be just a couple of doses that—that were even made. 

Dr. FRIEDEN. So, first, I really would need to refer you to the National Institutes of Health, which would be the lead on developing 

new treatments and vaccines against Ebola. The information I have 

on that medication is quite indirect. 

43

What I understand is that it is a combination of different 

monoclonal antibodies—this is part of what the body does to respond to an infection—and that there is some evidence from at 

least one animal study that it may have some effect on the illness. 

However, I think I would caution that we really don’t know. I 

think that has to be emphasized. Even whatever happens with 

these two individuals—and we hope that they and every other person with Ebola will get better, as some people do. But we will not 

know from their experience whether these drugs work. 

Antibodies are only one part of our response to an illness. There 

are many different parts of the immune response. In some other 

conditions, antibodies can actually make the disease course worse. 

So we don’t know until it is rigorously studied scientifically. 

I also cannot tell you definitively how many such courses there 

are. I have heard that there are a handful, fewer than the fingers 

of one hand, but I have no direct information on that. Other manufacturers are coming forward to say that they have some or could 

make some. We have heard from some companies that it would 

take months to make even a few dozen courses. 

So I think this is rapidly changing information. I don’t have definitive information and would refer you to the National Institutes 

of Health. 

But let’s always go back to the basics, that we know now how 

to stop Ebola and, if a person has Ebola, we know how to support 

them to reduce their risk of death in proven ways by treating and 

preventing other infections that they can get when they are sick by 

providing hydration, fluids, careful management of their health 

condition, blood transfusions if they need them. These are proven 

things. 

If there is a new treatment, we will do everything we can to help 

get it out to those who need it most. We would also be very interested in a vaccine. If there were an effective vaccine, we would 

offer it with full informed consent to healthcare workers as a way 

of helping them protect themselves. 

But right now we are months or at least a year away, from everything I have seen and heard, from significant quantities of either drugs or a vaccine, even if everything goes well and we are 

able to develop them. That could change, but that is the information as of now. What is available to us today right now is the 

means to stop the outbreaks in Africa. 

Ms. BASS. It is not helped when it is reported that the one individual had a miraculous turnaround and was able to walk out of 

the ambulance because he had gotten the treatment. You know, 

that leads to the belief that there is some kind of cure out there 

that we know about that we are not sharing. 

In looking at the death rates at the different countries, there is 

a difference. In Guinea, it is 74 percent; Sierra Leone, 42; and Liberia, 55. 

And I wanted to know from the panelists, what do you see as 

causing the difference? And is it a situation where each of the 

countries have addressed the outbreak differently? Capacity? Commitment? What is the difference? 

Dr. FRIEDEN. I think, in terms of the death rates, the data is still 

very fluid and it is not clear that each of those rates is actually 

44

comparable, given the different ways cases are diagnosed and 

counted and reported. 

What is the case is that, for each of the countries, they have 

their own challenges. I would say that the country of Guinea is 

probably furthest along in responding. They have reduced their 

number of cases. But there, too, they have continued spread in 

healthcare facilities. 

And that tri-border area, that area seems to be a core epicenter. 

And security problems in Liberia, for example, have led to treatment facilities not being available in Liberia, patients moving over 

to Guinea and then re-importing the disease there. 

So it really is a regional response that is needed for the three 

countries, and that also will be a core first deliverable of the DART 

team that USAID is leading and CDC is leading the public health 

healthcare medical aspects of to identify in that region what can 

be provided rapidly to assist with caring for patients to allow us 

to reverse the outbreak. 

Dr. PABLOS-ME ́ NDEZ. Just, if I may add, in addition to the difficulty in establishing the denominator to calculate the percentages 

that Tom is referring to, the fact is that across, nonetheless, even 

if there were more cases that we have not recognized, that is more 

likely to be recognize the cases. And so the percentage can vary in 

that. 

But, on the whole, we are seeing that the disease is indeed quite 

deadly, but not universally fatal. And that is very important. 

And, in Guinea, it has been a very important part of the study 

of educating the public because, if people think that you are going 

to get it, you are going to die, then there is no motivation to go to 

the services, to protect the families. And so the education has been 

paramount. 

And, in Guinea, we have seen a plateau of the outbreak. In the 

last month or two, there is still some, especially because of the border area. But, on the whole, the response that Guinea has implemented and the education in this case has been very important 

both for the patients, again, and for the health workers. 

We are now doubling up to 70,000 the personal protective equipment will be available. We had already in storage in Ouagadougou 

in the region, and that is what we got going through the spring. 

We are having more now equipment that is to be prepared to protect those health workers. 

And it was raised before and I want to emphasize, health workers are trying to do their best to save lives of other people. And so 

the 120-plus of them who have already died in this outbreak are 

true heroes. And I think that support for the health workers is 

really paramount, and I think that we are very committed to doing 

that. 

When we mentioned earlier the State Department has advised 

the families of our staff to leave the countries, it is not so much 

because they are in immediate risk, but because the health system’s already so overwhelmed that, if you had anything else, there 

is nowhere for you to go to. 

And, in addition, for many of those, if I may add, also, is that 

kids who will start school soon, the schools may not be opening. So 

45

asking the family members to leave is wise, not because they are 

in immediate danger. 

Ms. BASS. You know, Dr. Pablos-Me ́ndez, I think you have mentioned a couple of different figures, and maybe I have confused 

them. 

I think you said 70,000 and 35,000 pieces of protective gear. And 

I was wondering if those have reached the affected—well, number 

one, what was the difference? Did I get them mixed up? Or maybe 

it was at different times. 

And then, two, has it reached the area? Because I mentioned yesterday earlier speaking to President Johnson and she was very concerned and expressed the need for additional units of protective 

gear. 

Dr. PABLOS-ME ́ NDEZ. Thank you. 

The 35,000 units were indeed part of the first batch that we mobilized early on in the epidemic. We already had some of them in 

strategic storage locations, one in the region, in Ouagadougou, that 

has been made available now. 

The question is the logistics of distribution, and that is where 

our DART team now deployed will support the countries to make 

sure that they reach all the front line workers that would require 

it. But with the additional resources we are mobilizing now, we will 

reach 70,000 of such; these are spacesuits that you have seen. 

Ms. BASS. Right. 

Dr. PABLOS-ME ́ NDEZ. It is the production part, and they have to 

be prepared. They don’t come just ready to use. And that is where 

we are right now. But we expect to reach 70,000 of such PPEs, as 

we call them, to reach where important. 

We have also in every countries some of this training. We have 

some of those available to them just at least to become familiar in 

case that we need to scale up. 

And we have all along model how this could spread. Indeed, as 

Nigeria has been one of the nodes, Ghana has been another that 

we are paying attention because, in our models, that suggest that 

that could be a route where the airlines flights could allow this to 

escape the countries that we have even today. So we are preparing 

and we have trainings and we have some of the equipment already 

available there. 

Ms. BASS. Thank you. 

Ambassador Williams. 

Ambassador WILLIAMS. Yes. Thank you. 

I just wanted to clarify. As I said earlier, we are continuously 

monitoring the situation in all of the affected countries. And our 

primary responsibility, our primary concern is the health and welfare of American citizens abroad, our Embassy staff as well as residents. 

We have not, in fact, ordered the departure of our family members from any of our places, although we are—it is—of course, it 

is one of the things that occurs to people. It is one of the things 

under consideration. But at this time we haven’t. 

And I know that, since we do have an interagency coordinating 

committee that has been talking about a number of things, it has 

been among the things we have been considering, but——

Ms. BASS. So USAID has had the——

46

Ambassador WILLIAMS. No American personnel. No American official personnel or their families have been ordered. It is one of 

the—it is one of the options under consideration, but we are continuing to look. 

As was stated, you know, our families, our dependents, follow the 

government officers all over. We are on the front lines every day 

all over in very dangerous places. 

And bearing in mind the stresses in the various countries now 

and the concerns, the anxiety levels, among some of our families, 

it is something that has been discussed. 

But at this point we have not ordered the departure of any of our 

family members. I just wanted to make sure you understand. 

Ms. BASS. Okay. And the last question is—I think it might have 

been—one of the panelists referred to the security issues in Liberia, 

and, you know, when I spoke to President Johnson yesterday, she 

didn’t mention that. 

But when I was watching the news this morning, there were—

you know, the text messages that come across the news said that 

she was very concerned about it. 

And I wanted to know if maybe you could address—what are the 

security—what is happening? Is this something new? What are we 

talking about? 

Ambassador WILLIAMS. What I was trying to stress is putting it 

in a framework. You know, these things happen in a context. And 

it is one thing to have this health crisis, but, in fact, the country 

was already still trying to build itself up from a rather torturous 

past. 

Ms. BASS. Okay. 

Ambassador WILLIAMS. So the President of Liberia did declare a 

disaster in her country as a result of this crisis because she really 

wants the international community to pay attention and she is trying to also explain to her people why she is mobilizing an intensified force to specifically focus on Ebola, but there is no new security 

external threats. 

Ms. BASS. Okay. Thank you. 

Thank you, Mr. Chairman. 

Mr. SMITH. Chairman Wolf. 

Mr. WOLF. I thank you, Mr. Chairman. 

In what country did this first begin? 

Dr. FRIEDEN. The first cases were reported from Guinea, but it 

is really possibly—we don’t really know at this point—or I don’t 

know at this point the history of it. But the epicenter is that forested area that has the confluence of the three countries. 

Mr. WOLF. Ambassador Williams, over the years, we have heard 

from Ambassadors and Embassy staff that Washington does not 

take cables from them seriously. 

When did the State Department in the District of Columbia in 

Washington first get a cable notification from the Embassies of Sierra Leone, Guinea and Liberia about the Ebola crisis? 

Ambassador WILLIAMS. Chairman Wolf, if you don’t mind, I am 

going to look through my notebook to see if I have the exact date. 

I am not sure I have the exact date. So if you could just give me 

a second. 

Mr. WOLF. Sure. 

47

Ambassador WILLIAMS. Mr. Chairman, I am going to have to look 

up the cable. I don’t have the cable traffic. 

I will say, however, we are in daily communication with our Embassies and, if not through cables, through emails, through telephone. We are in constant control. But I will find the specific answer to your question and get it back to you. 

Mr. WOLF. You were an Ambassador. It is often we hear—and, 

as you know, my district in northern Virginia, we have many. 

They say that sometimes the cable gets sent and they wonder if 

they are taken seriously. I would like to know when the cables 

were sent. And, secondly, how high in the State Department were 

the concerns raised, at what level and what time? 

Ambassador WILLIAMS. Thank you. 

And I will take the question. I have to find the exact date. We 

have been aware of this for a while now and we are working on 

it. 

And as having come out of the region as an Ambassador—as it 

was stated, I was our Ambassador to Niger up until the end of 

2010. 

In covering west Africa in the Bureau of African Affairs, I am 

seized with this. I am paying close attention to what the Embassies 

are saying. I know what Ambassadors and the people there are 

going through. And I will get the answer to your question as soon 

as possible. 

Mr. WOLF. You mentioned the work in response of USAID and 

State and others. 

What other donor nations have gotten involved in the efforts? 

And what exactly are they doing? Can you give us a list of the 

countries? 

You said, Dr. Frieden, you have 40 to 50 people coming. 

Can you tell us what Great Britain is doing and what France is 

doing. Can you give us some specification as to numbers and how 

they are cooperating. It all cannot be the United States. What are 

our European allies and others doing, in numbers, if you can? 

Dr. FRIEDEN. I think it would probably be best if we got back to 

you with details. It is something of a moving target. 

I can tell you that the French, through the Institut Pasteur, have 

been very active. They have laboratory services and other services 

there. 

The British have also been very active and have provided both 

resources and people on the ground. We had an announcement earlier this week from the World Bank of a commitment of $60 million 

to $70 million for emergencies as well as the emergency response 

as well as a longer-term response. 

The World Health Organization, as you may be aware, issued an 

appeal recently for $100 million to respond to the outbreaks. And 

we have been in close coordination with many of our colleagues 

around the world. 

Mr. WOLF. Has the White House asked them to be involved? For 

instance, the Germans have a history in Africa. The French have 

a history in Africa. The British have a history in Africa. Has there 

been a formal request by the White House to the heads of those 

governments that they participate to help your effort? 

48

Dr. FRIEDEN. We have had intensive conversations with multiple 

other countries. 

Were you going to say something, Dr. Pablos-Me ́ndez? 

Dr. PABLOS-ME ́ NDEZ. The answer is yes. The Ambassadors in Geneva had met from the various countries. 

And, as you pointed out, there are many historical linkages, the 

British Government particularly supporting the response in Sierra 

Leone, France supporting the response in Guinea. 

We have a strong presence, really, hand-in-glove, with the Ministry of Health in Liberia. So our response has been particularly 

important there, as Tom has mentioned. 

The emergency plan that WHO put forward just over a week ago 

is for $103 million. They originally got about $30 million of that 

covered to begin moving, including some of the support that we 

have been providing. 

With the World Bank coming through, also, just this week with 

an announcement of $200 million, that will allow us to fill the gap 

in the WHO plan for the immediate response, but, in addition, will 

invest in the months to come in strengthening the systems in that 

part of the world. 

So many of these pieces and, as we speak, many of these things 

are moving very fast. So we are trying to continue that conversation. But in Geneva it has been a focus for the various donor countries to be having periodic updates as to how much more resources. 

But that geographical location of division of labor, if I can put it 

that way, is already underway, even though CDC’s presence is in 

all of these countries. 

Mr. WOLF. Is the African Union engaged? 

Dr. PABLOS-ME ́ NDEZ. The African Union has been engaged. The 

African Regional Office of the World Health Organization, in particular, has been engaged. 

And to your earlier question, in Liberia, March 27 was when the 

first cases were reported. There was only a dozen or so of cases and 

then the outbreak fizzled. And this is typical of these outbreaks in 

central Africa. And for a month, there were not many new cases. 

So, in fact, the early behavior of the outbreaks was light to begin, 

as we have seen in previous outbreaks, and it was only as it was 

rekindled again in this three-border area that we have seen the expansion, particularly in Sierra Leone and Liberia, whereas, in 

Guinea, it has been after the initial outbreak more a sense of containment. 

Mr. WOLF. Are the Chinese involved? The Chinese Government 

has historically invested in soccer stadiums in Africa? Are they involved? 

Dr. FRIEDEN. We would have to get back to you about their involvement. 

Mr. WOLF. Madam Ambassador, can you tell us? You are with 

the State Department. 

Ambassador WILLIAMS. Yes. I will have to look into that. I 

haven’t heard about the Chinese involvement at this point, but I 

will check. 

But I would like to reiterate—you were asking about the African 

Union—as I mentioned earlier, the ECOWAS states, the subset of 

49

the regional governments, are very seized with this and they are 

meeting this week and then again in 10 days after that. 

Mr. WOLF. The last question, Mr. Chairman. 

If someone wanted to raise a question or call somebody, do something, had a great idea, who do they call? Is there one person? Is 

it the CDC? Is it the Secretary of State? Is it USAID? 

For our friends here in the United States, but abroad, is there 

one person and one place and one number that someone can call? 

Because on the 28th, it was very difficult, bouncing from here to 

there. 

And let me just say again to Dr. Frieden. Thank you for taking 

the call, even as you were traveling. 

Is there one place that we would go to or someone would go to? 

Dr. FRIEDEN. For response to any potential case or problem here, 

that is the CDC. That is the——

Mr. WOLF. And what about if a nation abroad wanted to contribute, wanted to be involved, had an idea? Who do they contact? 

Dr. FRIEDEN. In terms of the global collaboration, the key there 

is to support the World Health Organization, which really is the 

lead for the overall response. 

Mr. WOLF. And is there an individual there at the World Health 

Organization who is responsible, that is your person to contact? 

Dr. FRIEDEN. Yeah. That would be Dr. Keiji Fakuda. 

Mr. WOLF. Okay. Good. 

Thank you, Mr. Chairman. 

Mr. SMITH. Before we go to the our next panel, if Ms. Bass has 

any additional questions, I will recognize her for that. 

How accurate is the data? Data in even the best and most pristine of situations often is very hard to obtain. But here we are talking about proximity issues, difficulty of ascertaining what is really 

going on. 

There was a report on CBS News that suggested that there may 

be as much as a 50 percent higher prevalence of Ebola. And I am 

wondering if you might want to comment on that. Is there any 

underreporting? And that is both of cases as well as fatalities. 

And then, secondly, I know that the FDA is notoriously slow and 

notoriously comprehensive. And I don’t want to either exaggerate 

or understate. But, ZMapp, TKM-Ebola and that one, again, was 

contracted by our own Department of Defense to work on that, and, 

yet, those clinical trials have been halted, Phase I. 

And I am just wondering if there is any effort to rethink that. 

Because this could take off—you know, those who have lost their 

lives and are sick is a tragedy beyond words, but many more could 

become sick and die as a result. 

Is there an interagency effort to say, ‘‘Let’s relook at that’’? There 

might be some reason to lift that Phase I trial’s halt to see if we 

ought to get at it. 

And, finally, in his testimony today, Mr. Isaacs of Samaritan’s 

Purse, again, the man with whom I and Congressman Wolf spoke 

to last week who had a profound sense of urgency and thought that 

we needed all to be doing more—he said it took two Americans getting the disease in order for the international community and the 

United States to take serious notice of the largest outbreak of the 

disease in history. Yesterday the President of Liberia declared a 

50

state of emergency in the nation. This declaration, he goes on, is 

at least a month late. 

And I am wondering, not only with the countries that are already 

now affected, the four of them, what might be the fifth or the sixth? 

Is there a sense that there is a heightened concern about another 

nation, particularly one that might be contiguous with these four? 

Dr. FRIEDEN. So in answer to your first question, yes, we think 

that the data are not as accurate as we would like. There may be 

cases counted as Ebola that are not, and there may well be many 

cases not counted that are. 

The lack of treatment facilities, lack of laboratory facilities, make 

it so that the data coming out—it is kind of a fog of war situation, 

if you will. And that is one thing that we want to try to resolve 

quickly by getting laboratory, epidemiologic. But if there aren’t 

treatment facilities, the patients won’t come forward and we won’t 

be able to do the control activities. 

In terms of the FDA, there are calls at least once, sometimes four 

or five times a day on coordination. I can tell you that they are 

leaning very far forward on this and they are quite willing and 

quite constructive and productive in thinking of how to get things 

out there sooner if there is anything available. 

I think, on the one hand, we have to do everything we can to try 

to find new tools. On the other hand, we have to recognize that we 

have the tools today to save lives and stop the outbreak. 

And in terms of future countries, we can’t predict where that 

might be, but we do know that an outbreak anywhere is a threat 

everywhere. 

And one of the reasons we have focused on the global health security program is that we have the international health regulations, which require countries to report outbreaks and new diseases 

so that we can all, as a global community, work together because 

it is in all of our best interests not only to protect health, but to 

protect the economy, to strengthen our work in this area. 

Mr. SMITH. I want to thank our very distinguished panelists for 

your extraordinary service for the sick and at risk and for being 

here today and helping to enlighten our subcommittee and, by extension, many other Americans who are tuning in and watching 

this. Thank you so very, very much. 

Dr. FRIEDEN. Thank you. 

Ambassador WILLIAMS. Thank you. 

Mr. SMITH. I would like to now introduce our second panelists, 

beginning first with Mr. Ken Isaacs, who serves as the vice president of programs and government relations for Samaritan’s Purse. 

Ken Isaacs has served as the director of the Office of Foreign 

Disaster Assistance within USAID. He coordinated the U.S. Government’s response to the Indonesian tsunami, the Pakistani earthquake, humanitarian relief efforts in both Darfur and South Sudan, 

as well as the Niger and Ethiopian emergency responses. 

Mr. Isaacs has more than 27 years experience working in the relief and disaster response fields and has led major efforts in dozens 

of countries, including the ones I just mentioned. He is currently 

leading the Samaritan’s Purse organization’s efforts in Liberia in 

response to the Ebola epidemic. 

51

We will then hear from Dr. Frank Glover, who is the director of 

the Urology Institute and Continence Center in the Urology Institute Ambulatory Surgery Center. 

His discovery of the world’s highest rate of prostate cancer in Jamaica has been internationally recognized and published in numerous journals and textbooks. He and his wife founded SHIELD, or 

Strategic Healthcare Initiative Emphasizing Local Development, 

which is dedicated to building a medical school in Liberia, training 

resident doctors in various medical and surgical specialties, and 

providing loan forgiveness for Liberian doctors that have trained in 

the United States and who would like to go back and be involved 

in teaching doctors and serving patients in Liberia. Dr. Glover has 

been involved in efforts to treat Ebola in Africa since the early 

1990s. 

Mr. Isaacs, please proceed. 

STATEMENT OF MR. KEN ISAACS, VICE PRESIDENT OF PROGRAM AND GOVERNMENT RELATIONS, SAMARITAN’S PURSE 

Mr. ISAACS. Thank you. 

Chairman Smith, esteemed members of the council and fellow 

guests of this subcommittee, I am privileged to testify before you 

today on the developments of the Ebola outbreak in west Africa 

and Samaritan’s Purse experience in response there. 

I am going to read this first page so I don’t overlook any of the 

things that I really want to say, and then I am going to put the 

script away and I am going to say the things that I feel like need 

to be said. 

Samaritan’s Purse is an international NGO with 38 years of experience, dedicated to humanitarian relief. We have worked in over 

100 countries, including Afghanistan, North Korea, South Sudan, 

Sudan, Syria, and Liberia. 

As an organization, we have responded to medical emergencies, 

such as the cholera epidemic in Haiti, and we have provided medical care to the people of Bosnia, Rwanda, and Sudan during the 

genocides in those countries. 

The Ebola outbreak has had a profound impact on our organization, and I would like to share with you about our experience in 

Liberia. I want to take this opportunity to thank the United States 

Government, particularly the Department of State and the Department of Defense, for assisting Samaritan’s Purse in the evacuation 

of our sick personnel from Liberia. We could not have done it without them. 

And we would especially like to call to attention and thank Kathleen Austin-Ferguson of the Department of State, Dr. William Walters of the Department of State, Phil Skotte of the State Department, Mr. Dent Thompson, and Congressman Wolf and yourself. 

We would also like to thank certain staff members of the CDC 

and the National Institutes of Health for bringing to our attention 

and obtaining the experimental medication as a treatment option 

for our two infected staff members. 

As an organization, we have worked to contain the growing Ebola 

crisis in Liberia and we were devastated to discover that two of our 

personnel had contracted the deadly virus while trying to assist 

others. 

52

The support that the U.S. Government has shown to our organization is tremendous, and Samaritan’s Purse thanks you for helping us bring the two of them home in the face of incredible challenges. 

The Ebola crisis was not a surprise to us at Samaritan’s Purse. 

We saw it coming back in April. Our epidemiologists predicted it. 

By the middle of June, I was having private conversations with 

senior government leaders and, by July, I was writing editorials in 

the New York Times saying that this was out of control. 

In the 32 years since the disease was discovered, as I believe Dr. 

Frieden said a moment ago, there were a total of 2,232 known infections, which killed 1,503 people. Easily, this present outbreak is 

going to surpass that in fatalities as well as overall cases. 

It is clear to say that the disease is uncontained and it is out of 

control in west Africa. The international response to the disease 

has been a failure, and it is important to understand that. 

A broader coordinated intervention of the international community is the only thing that will slow the size and the speed of the 

disease. Currently, WHO is reporting 1,711 Ebola diagnoses and 

932 deaths in west Africa. Our epidemiologists and medical personnel believe that these numbers represent 25 to 50 percent of 

what is happening. 

The Ministries of Health in Guinea, Liberia, and Sierra Leone 

simply do not have the capacity to handle the crisis in their countries. If a mechanism is not found to create an acceptable paradigm 

for the international community to become directly involved, then 

the world will be effectively relegating the containment of this disease that threatens Africa and other countries to three of the poorest nations in the world. 

I know that a part of community and development philosophy is 

to work with your local partner and build capacity. The capacity 

that is needed in the nations that are fighting Ebola should have 

been built 3 to 5 years ago. But in the times of crisis, I believe that 

the attention needs to be put on the crisis and the building of the 

capacity should be a secondary function. 

We undertook a massive public awareness campaign in Liberia 

starting in April and we have had over 435,000 people go through 

that training, but there are 3.6 million people there and the majority of them are illiterate. It is not going to be easy to change the 

way that people think and what their cultural mores are. 

In the first months, we were able to provide support to the World 

Health Organization, the CDC, the Ministry of Health and Doctors 

Without Borders, also known as MSF, with our two aircraft, the 

only two aircraft in Monrovia, in Liberia, that were flying support. 

We flew personnel, supplies, and specimens back and forth across 

the country. It makes a difference from the triangulation area that 

Dr. Frieden was talking about, also known as Foya, to Monrovia. 

It reduces it from a 16-hour road trip to a 40-minute helicopter 

flight. 

I do want to take this moment to recognize and thank our coworkers in Doctors Without Borders for standing in the trenches 

with us. They are still in Sierra Leone. They are in Guinea. And 

they are now filling the gap for us in Liberia, as we have had to 

pull back while we re-plan what we are going to do next. 

53

If there was any one thing that needed to demonstrate a lack of 

attention of the international community on this crisis, which has 

now become an epidemic, it was the fact that the international 

community was comfortable in allowing two relief agencies to provide all of the clinical care for the Ebola victims in three countries, 

two relief agencies, Samaritan’s Purse and Doctors Without Borders. 

It was not until July 26, when Ken Brantly and Nancy Writebol 

were confirmed positive that the world sat up and paid attention. 

Today we are seeing headlines every day of Ebola fears. There is 

a man who has bled to death, evidently, in Saudi Arabia. And the 

Saudi Government has confirmed it was a hemorrhagic fever, and 

he came from Sierra Leone. 

There was a man, a Liberian-American, who came to ELWA Hospital with one of the most prominent physicians in Liberia, and 

that physician openly mocked the existence of Ebola. He tried to 

go into our isolation ward with no gloves, no protective gear. It is 

not an issue of gloves and a mask. It is an issue of no millimeter 

of your skin can be exposed or you will get sick and most likely die. 

That is sort of the reality of it. 

Those two men left our hospital. They went to the JFK Hospital 

in downtown Monrovia, where the doctor did examine Ebola patients, and he was dead 4 days later. The other man was dead 5 

days later, but not before he went to Nigeria. And now there are 

cases of death from Ebola in Nigeria and there are eight more people in isolation. 

Our epidemiologists believe that what we are going to see is a 

spike in the disease in Nigeria and then it will go quiet for about 

3 weeks and then, when it comes out, it will come out with a fury. 

As I am talking to you today, we are making preparations for a 

hospital that we support 263 miles north of Lagos on what they are 

going to do when Ebola comes to them. 

To fight Ebola, I have identified four levels of society that need 

intensive instruction because they simply do not understand what 

is going on. One is the general public. The custom that they have 

of venerating the dead by washing the body—I am going to be 

graphic because I think people need to know—a part of that is kissing the corpse. 

In the hours after death of Ebola, that is when the body is the 

most infectious because the body is loaded with the virus. Everybody that touches the corpse is another infection. 

We have encountered violence against us on numerous occasions 

by people in the general public when we have gone out at the request of the Ministry of Health to sanitize a body for a proper burial. This is going to be a tough thing to do. So you have got this 

general awareness in the general public. 

The number two area that needs to be addressed is community 

health workers. The entire international community has built a 

medical system around community health workers, which is essentially a moderately educated person who is given a few simple medical supplies, an algorithm chart, ‘‘If it hurts here—,’’ ‘‘Are you 

passing blood?,’’ ‘‘Do you have a temperature?,’’ ‘‘Give them this 

color pills,’’ ‘‘The doctor can talk about this more than I, but I think 

54

generally I am getting this right.’’ They do not have the information to understand what Ebola is. 

Friday—3 weeks ago this Friday at ELWA we had 12 patients 

with Ebola present. Eight of them were community health workers. 

Every one of those health workers had seen a patient, had diagnosed them for whatever they thought they had, and then they saw 

other patients. We have no way of knowing how many other people 

they have come in contact with. 

The third level of society is actually medical professionals. Something needs to be done with a focused attention on medical professionals because, when I hear reports that prominent physicians 

who are educated and credentialed and respected denied the disease, I think they need a little bit more education. 

And then the fourth level is leadership and politics, academics 

and religion. I don’t know how to make those things happen, but 

those are the four stratas that I see to turn the disease back. 

I think the entire fight on the disease has to be focused on containment. To contain it means you need to identify it. The previous 

panel up here was saying that it could be contained, that we have 

the information. Okay. 

Liberia, Sierra Leone, and Guinea are poor. Like all countries, 

they have their problems with pointless bureaucracy, disfunction, 

and corruption. I know for a fact that, in Foya, the second largest 

center where Ebola is manifesting in Liberia, the workers at the 

Ministry of Health clinic were not paid for 5 months, even after the 

European Union had put money forward. The money just didn’t get 

downstream. 

Again, I will say that Ebola is out of control in west Africa, and 

we are starting to see panic now around the world. People want to 

know. I don’t know about you folks. I look at the Drudge Report. 

It can drive a lot of panic. 

And, you know, there is a guy in New York, there is a woman 

in England, there is—six people have been tested in the United 

States. There are reports that there are 340 Peace Corps workers 

coming back. 

I greatly appreciate the help of the CDC. They have, in fact—Dr. 

Frieden and I personally have spoken, and they have, in fact, 

helped articulate their procedures and protocols for Americans returning into this country, and we are grateful for that. 

While our Liberian office remains open doing public awareness 

campaigns, we have, in fact, suspended all other program activity. 

I would say that we are in the process right now of backing up, replanning, and reloading. We intend to come back and we intend to 

fight the disease more, but we have found some things that are 

needed. 

One of the things that I recognized during the evacuation of our 

staff is that there is only one airplane in the world with one chamber to carry a Level 4 pathogenic disease victim. That plane is in 

the United States. There is no other aircraft in the world that I 

could find. That means that the United States does not have the 

capacity to evacuate its citizens back in any significant mass unless 

the Defense Department has something, the DoD has something 

that I am not aware of. 

55

It was not easy to get the plane back, but one thing that is important is that if the United States, and I believe the United States 

is going to have to take the lead on this. It may not be popular for 

us to take the lead today, but I think that we need to take the lead. 

If we are going to expect people, including the CDC people, to go 

abroad and put their life on the line, there has to be some assurance that we are able to care for them if they are sick. That may 

be a regional healthcare facility that is exclusive to those citizens, 

and those workers, or that may be a demonstrated capacity to get 

them home. But one airplane with one chamber to get them back 

is a bit of a slow process. 

Lastly, I think I want to say, it is a necessary thing that more 

laboratories be set up just in Liberia. The one laboratory now is at 

JFK Hospital. There is another one up over in Guinea in 

Gueckedou, and it can take us sometimes 30 hours to get a sample 

back. I have had discussion with the CDC about this. I think that 

is under consideration, but I would ask you if you could lean into 

that and question that, that would be very helpful. 

The problem is, if you have six people that come in and three of 

them or four of them are suspected, you have to put them in a 

semi-quarantine area and you are holding that area of your case 

management center until you get a positive or a negative back on 

them and it takes time. 

I understand that the World Bank has just committed $200 million to fight the disease. That is fine. That is good. It is a little late. 

It is good. As somebody with 26 years of experience, including 

being the director of OFDA running many DARTs around the 

world, interacting with governments on multiple levels, I have 

some practical questions. I would like to know where the money 

will go. I would like to know what it will actually produce and I 

would like to know what it will actually buy. I fear that money 

alone cannot solve this problem. 

I disagree with earlier testimony that there is PPE in Liberia. 

That is inaccurate. I have an email that I have just received in the 

last 90 minutes from our hospital, the hospital that—the SIM hospital at ELWA. They are asking us for more personal protection 

gear. This is a problem everywhere. I am in touch daily with the 

headquarters of MSF, and Brussels. We are working hand-in-glove. 

I appreciate them so much for the way that they are stepping in 

and fighting this. The biggest challenge that we all have is the 

logistical support to get the materials and the supplies on the 

ground to fight this disease. As one of you quoted something that 

I said earlier, if we do not fight and contain this disease in west 

Africa, we will be fighting this disease and containing it in multiple 

other countries around the world, and the truth is, the cat is most 

likely already out of the bag. 

I want to thank my staff, and recognize them for who have been 

there, and have done a valiant job at great risk to their own lives 

and I want to let you know that the reintegration back into their 

country is awkward, people are afraid to get around them. Their 

husbands and their wives don’t know if it is safe to hug them. 

Their communities may ostracize them. We are doing everything 

that we can in the staff care way to give them a safe place to be, 

to protect their privacy, but I just want you to know how difficult 

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it is for American citizens, and in fact citizens of all countries we 

have people on that team that came from more than six countries 

maybe seven countries. They all suffer these issues. 

I believe that this is a very nasty bloody disease. I could give you 

descriptions of people dying that you cannot even believe. But I 

think that we have to fight this disease and we have to fight it 

now. We are going to fight it here or we are going to fight it somewhere else. I am talking about here in west Africa, but I do believe 

that an international coordinated response something significantly 

more is needed. 

Thank you. 

Mr. SMITH. Thank you very much, Mr. Isaacs, for that testimony. 

[The prepared statement of Mr. Isaacs follows:]

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Mr. SMITH. And again, I think, underscoring your experience as 

head of the Office of Foreign Disaster Assistance, I mean, you have 

lived it and I don’t think your resume tells the full story, all of 

those years of dedication. 

So, again, thank you, and we will take extraordinarily serious 

your recommendations and the questions you have posed. And I 

thank you for it. 

Dr. Glover. 

STATEMENT OF FRANK GLOVER, M.D., MISSIONARY, SIM 

Dr. GLOVER. Thank you, Mr. Chairman, and Members of Congress, for the opportunity to share with you. 

My name is Dr. Frank Glover and I am a board certified urologist. I earned my M.D. degree at Johns Hopkins and also a Doctor 

of Public Health in International Health (Health Systems). I have 

also done some work as a research fellow at Johns Hopkins in epidemiology. I am also a medical missionary working with SIM, 

which is a Christian missions organization with works in over 60 

countries. 

In addition to working with SIM, I am the President of SHIELD 

In Africa, a U.S.-based NGO working in Liberia. My first experience in Liberia was in 1988, when as a medical student, I spent 

2 months doing medical missionary work in an SIM hospital called 

ELWA (Eternal Love Winning Africa). For the past 3 years, I have 

spent 4 months per year working in various hospitals throughout 

Liberia. I have taken teams of up to 50 doctors and nurses several 

times per year. During this time period, we have taken care of 

thousands of medical and surgical patients. I have spent time rendering services of teaching, training, and patient care in most of 

the counties in Liberia. I have, therefore, had the opportunity to 

assess many of the hospitals and clinics throughout Liberia. 

In every case, the hospitals were understaffed and lacking in 

many basic essentials and pharmaceuticals. This Ebola outbreak in 

Liberia has exposed the country’s inherently weak health system. 

Less than 200 doctors existed in this country of 4 million prior to 

this epidemic. After the outbreak in March of this year, that number plummeted to only 50 doctors. This occurred as a result of the 

exodus of 95 percent of the expatriate doctors. 

Prior to the Ebola outbreak, the nurses went on strike or slowed 

down work throughout the country due to work grievances. This 

was true in Lofa, Bong, Bomi, and Montserrado Counties, which 

have been hit hardest by the epidemic. These nurses returned to 

work after negotiations with the Ministry of Health just before 

Ebola entered the country. After the outbreak began claiming the 

lives of the nurses who did not have protective gear, the nurses fled 

the hospitals. 

After a second Liberian doctor died of Ebola, all of the government hospitals shut down. The patients are too terrified to enter 

the buildings. The nurses have stated they will not return to work 

unless they are issued adequate protection including gloves, gowns, 

and goggles. At the ELW hospital in conjunction with Samaritans 

Purse, doctors and nurses continue to treat Ebola patients. There 

are 5 doctors and 77 nurses and aides. This is the only place in 

Monrovia where treatment for Ebola takes place. Currently, there 

67

is only enough space for 25 patients in the isolation center. Initial 

attempts to expand the unit were met with protests from the local 

community which did not want Ebola patients coming from all over 

Liberia into their community. Having allayed the fears of the community, Samaritan’s Purse will complete an 80-bed unit in the next 

2 weeks. 

The only other treatment center in Liberia is a 40-bed unit in 

Lofa County. The case fatality rates range from 80 to 90 percent 

at both facilities, owing in part to the delays in people seeking 

treatment. Many patients die within 24 hours of presentation. 

ELWA is the only functioning hospital in Montserrado County, a 

population of nearly 1 million people where Monrovia is located. 

Many patients are dying with Ebola in their communities in part 

because there is simply no open health facilities. 

This creates problems because whole families are getting infected 

and dying. There is no way to count all of the people dying of Ebola 

in the villages and in the remote areas. The cause of death is often 

unknown and there exists a lot of suspicion toward Western and 

government health workers. As a result, information is often withheld from health workers. Advice on safe burial practices or abstaining from eating bats and monkeys is oftentimes met with resistance and even violence against health workers. 

To complicate matters further, usual illnesses such as malaria, 

typhoid, pneumonia, and surgical emergencies result in death as 

there are no functioning facilities at this time. The death toll will 

undoubtedly reach into the tens of thousands in Liberia unless immediate actions are taken to: 1) Increase the capacity to treat patients in isolation. 2) Create an effective means of quarantine for 

those suspected of having been exposed to Ebola. 3) Provide protective gear to all healthcare workers, and those involved in disposing 

of the bodies of patients that have expired. 

Given the episodic nature of Ebola, we must begin investing in 

healthcare system strengthening as we prepare to deal with future 

outbreaks. SIM and SHIELD stand ready to assist in the building 

of capacity of west Africans by training and producing more African 

healthcare professionals. Thank you. 

Mr. SMITH. Thank you so very much for your life-long commitment and for building up capacity and doing it yourself, and working with others at SIM. 

[The prepared statement of Dr. Glover follows:]

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Mr. SMITH. Let me ask you a just a few questions because your 

testimonies I think were very comprehensive. 

You said, Mr. Isaacs, that the international response you deemed 

it a failure and of course, no failure need be a failure in perpetuity. 

And I am wondering if there has been a turn of the corner; again, 

inspired by the tragedy of two of your workers being affected by the 

Ebola virus. 

And secondly, could you tell us how are they doing; how are their 

spirits; whether or not there is a sense, even if it is not fully 

backed by science yet that the drug ZMapp may have had an impact? I think, you know, one of the things, one of the questions I 

asked of the earlier panel, if some of these interventions proved to 

be efficacious, delay is denial if you have Ebola and since this 

seems to be ramping up and not ramping down currently, your 

thoughts on an aggressive FDA working in cohort with and in conjunction with the other agencies of Government to get, based on an 

opt-in, certainly recognizing the risks as Dr. Brantly certainly did, 

and Ms. Writebol? 

Mr. ISAACS. So on the failure aspect, I would say that I think the 

full international impact of Ebola has not been realized. I believe 

that Ebola threatens the stability of the three countries where it 

is effected right now. My staff met with the President of Liberia 

for almost 6 hours last Wednesday. They described to me that the 

atmosphere in the room was somber because she realized the full 

gravity of it. 

If you read the Ministry of Health status reports that come out 

every day from Liberia, I don’t mean to be dramatic, but it has an 

atmosphere of ‘‘Apocalypse Now’’ in it. There are bodies lying in the 

street. It is on the front page of the Wall Street Journal, and today, 

there are gangs threatening to burn down hospitals, and this is essentially a society that is, let us say, a generation from everybody 

had Posttraumatic Stress Disorder from a horrible war. They can 

go from a normal conversation to a fistfight, to sticks in the flash 

of an eye. So they have a lot of temperament and they have a lot 

of investment in what is going on. There is a lot of emotion. But 

it isn’t just Liberia. It is Sierra Leone, it is all of these countries. 

What would happen, you know, I don’t want to, I mean, you can 

use your own imagination in Nigeria, Lagos, what could happen 

there? And I believe that this disease has the potential to be a national security risk for many nations. And I think it will have an 

impact even on our national security. It has been a failure because 

it is now jumped another country because the epidemiologists have 

totally misread the magnitude of the disease and because there are 

not resources on the ground. 

The status of the two patients, I can say that I hear from Emory 

the same thing everybody does. They seem to be getting a little better every day. I do not think this will be a fast process. After that 

medicine was administered, after it was brought to us by the NIH 

people, and Dr. Brantly was very much involved in giving his informed consent to it. He understood as did Nancy Writebol. There 

was improvement, and I think as the doctors were saying here, I 

am not a doctor, you know, I don’t want to guess at science, but 

I will say that they seem to have gotten better. They got home, 

they are at Emory. We appreciate Emory, they are getting good 

72

treatment there and we just pray that they survive and can recover 

their health. 

Mr. SMITH. Let me ask you, you pointed out four different areas: 

Kissing the corpse, community health workers, medical professionals, as three of those. 

Now let me ask you about the community health workers. You 

have pointed out that in one cluster of infected individuals 8 out 

of 12 were community health workers. Now, doctors obviously have 

a higher degree of training, they understand the essential importance of protective garb, and community health workers might not 

have that same level of indoctrination about how important that is. 

In your view, are they much more at risk because they are more 

rudimentary in what they do and therefore they are not taking the 

precautions? 

Mr. ISAACS. So in my view, yes, they are more at risk. It is not 

just to do with the personal protective gear, but it is also due to 

the lack of education. If you look at the symptoms of the disease, 

fever, joint pain, vomiting, and diarrhea, I am going to guess that 

probably covers 50 percent of all the diseases that present to them. 

That puts them in an untenable and weak position of being exposed to the disease, and not exactly knowing what it is. 

I just am saying that I think that there needs to be focused education efforts on these four levels of society: General public awareness, community health workers, medical professional, and national leaders. I don’t think putting a poster up on the wall saying 

‘‘Ebola kills’’ is going to do it. I think that there has to be a programmatic approach to each one of these stratums of society to get 

the essential information that they need to encourage people from 

their position and to deal with the things that come to them. 

Mr. SMITH. Doctor, please. 

Dr. GLOVER. I would have a slightly different take on it. I believe 

that community health workers, if properly trained, can get the 

same outcome of coverage as physicians. What we have to understand is that people, health workers, don’t get Ebola because of 

carelessness, necessarily, or because of lapses in sterile technique. 

In the case of these workers, for example, it is very likely that 

they contracted Ebola from other workers who were at the hospital 

who may have gotten the disease from the community. So if you 

are working alongside someone and they happen to have Ebola, 

then you get it from the staff and so there are a number of documented cases of staff infecting staff. In fact, just yesterday there 

was a report in the Kakata, in Margibi County where four nurses 

died and 11 more were infected. And so there is a lot about the infectivity that we don’t realize in terms of how it happens. 

Mr. SMITH. Let me just, in terms of getting the message out in 

a way that will be most likely received so that people understand 

the catastrophic nature of the disease, my understanding is that 

Guinea today is recruiting retired doctors, nurses, and midwives, 

authority figures, older rather than younger, to convey this message. 

Have you heard that and are the other countries, the other two 

countries and perhaps even Nigeria, too, looking to do that so that 

authority figures convey, again, the paramount importance of, for 

example, burial practices and the like? 

73

Dr. GLOVER. One of the challenges we have in Liberia is after 

this 14-year brutal civil war, during that period of time people did 

not go to school. So you have a large population of illiterate people 

and many of the languages in Liberia are not scripted, so you can’t 

write something. So there needs to be language-appropriate messaging in each dialect in a way that each community can understand it, so they can get the message. 

So it requires people that are seen as authority figures, but also 

people that are able to communicate in the person’s spoken language so they are able to get the message. So as he says, putting 

a poster up is not going to help someone when you have got an illiteracy rate of 75 percent. 

Mr. SMITH. Finally, just let me ask, Mr. Isaacs, if you could, you 

said that the President of Liberia was a month late. Is it too late? 

And what would have happened had that state of emergency been 

declared a month ago? 

Mr. ISAACS. The month statement was not a scientific statement. 

It is just an opinionated statement, and when I don’t have knowledge, I always have opinions, rightly or wrongly. But I do think 

that Liberia would have been better served had a status of emergency been declared earlier. 

Now, I don’t know all of the actual mechanisms that will go 

along with that declaration, but it is clear to me that Liberia is in 

a severe crisis that I believe threatens the stability of the society 

as it exists today and I think that as you see the disease spread 

in Freetown and in Conakry, hopefully it has peaked there, and in 

Monrovia you are going to see more instability and insecurity. 

Mr. SMITH. Then we do ask about the question of testing and you 

heard the exchange earlier with Dr. Frieden and other members of 

the panel about the lack of labs, lack of testing capability. You 

might want to comment on that. But even in the best of circumstances, say in New York, or New Jersey, how long does it take 

to get a test back? Because this does move very fast. 

Dr. GLOVER. Well, we have special tests in the U.S. so in just a 

matter of a few hours. 

Mr. SMITH. Hours. 

Dr. GLOVER. But logistically, when you look at the infrastructure 

of these countries, to go from one point to the other on a map, it 

may look like, ‘‘Oh, it is just 50 miles.’’ That 50 miles could take 

you 8 hours because you can only drive 3 miles an hour through 

roads that are impassable. 

So a lot of logistical problems exist here, but I believe the number one cause of healthcare worker infections in Liberia is the lack 

of the protective gear. You are asking people to go to work, to take 

care of patients, and they don’t have simple gloves. And to me this 

is unconscionable. So if we are going to put people on the line, the 

brightest and the best people in the country on the line, we owe 

it to them to give them a fighting chance. 

Even in this country, no matter how well-trained a doctor is, if 

an Ebola patient comes up to him before he or she knows what he 

has, he has already been infected. 

Mr. SMITH. Mr. Isaacs, you asked the question earlier, where will 

the money go? What will it buy? Where in your opinion should the 

money go and what should it buy? 

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Mr. ISAACS. I think that international personnel are needed. I 

frankly do not think that the Ministry of Health of Liberia can 

fight this. They do not have the case investigation capacity. I 

talked with a senior person in CDC, I won’t name her, but she is 

a well-known person. She told me that in the United States if there 

was one person that had a Level 4 infectious disease, they would 

have many hundreds of contacts to run down. There are no contacts being run down in Liberia. 

I don’t believe that the Liberian Government, as well intentioned 

as they are, and I do believe that they are well intentioned, I just 

do not think that they have the capacity. I am all for building the 

capacity, but I think there needs to be something to augment their 

capacity. I think that there needs to be some kind of a coordination 

unit. I have heard here today that the World Health Organization 

has the lead; maybe, maybe not. I think that probably something 

perhaps with a bit more of an operational edge to it is called for. 

I don’t know what that could be, but more is needed. 

And I think that if we leave this situation up to the Ministries 

of Health, I mean, you have a unique situation where you have 

three poor countries that have a communicable, infectious, and lethal disease, that clearly don’t have the capacity to contain it, and 

is the world willing to allow the public health of the world to be 

in their hands while they try to contain the disease? I think that 

is the essential question. 

Mr. SMITH. Thank you. And finally, Dr. Glover, you had worked 

on the DRC outbreak of Ebola, what, some 20 years ago? 

Dr. GLOVER. Actually, I was, at that time I was working in Zaire. 

I was in Zaire, in Kinshasa, but the outbreak was in Kikwit, so I 

was there during the outbreak, but I wasn’t actually working with 

Ebola. 

Mr. SMITH. How does this compare to that outbreak? 

Dr. GLOVER. There is no comparison because back then it was a 

very sparsely populated rural area, where it could essentially burn 

itself out. 

But you have so many people in Liberia that have moved to the 

city, so that they are living in very close spaces—if you look at a 

taxicab or a bus, you wonder how could they get so many people 

jam packed in there or how many people live in a house, for example. At the Phebe Hospital, the administrator came down with the 

virus, and he infected his 8 children, and his wife and all 10 of 

them died. 

So the close proximity in which the people are living, the concentration of the population, means that as this epidemic, no matter what we do, unfortunately, there is going to be tremendous loss 

of life just by the nature of this disease. 

Mr. SMITH. Well, I thank you both. 

Is there anything you would like to add before we conclude the 

hearing? 

Mr. ISAACS. I would just say that I think much more—I am certain there is much more than I know of, but this concept of research and development for a vaccine and a cure is very important. 

I agree with Dr. Glover. I think we are going to see death tolls in 

numbers that we can’t imagine right now. That is potential and 

also, I will tell you that we are now at Samaritan’s Purse in the 

75

process of distributing Ebola-readiness information to all missionary hospitals across Africa. 

Mr. SMITH. Dr. Glover, any final words? 

Dr. GLOVER. No final words. 

Mr. SMITH. Thank you. 

I want to thank both of you, again, for your extraordinary service 

to mankind and especially to the sick, and at risk, and disabled, 

and those who are suffering this terrible outbreak of Ebola. 

And we look forward if you could stay in touch with our subcommittee, this is the first of a series of hearings. We are looking 

to make sure that whatever we need to do as a Congress, and as 

a subcommittee, and me personally, and my colleagues, we want to 

do and again, your guidance is absolutely essential. 

Thank you for sharing your wisdom and insights, and incisive 

commentary to the subcommittee. The hearing is adjourned. 

Mr. ISAACS. Thank you. 

Dr. GLOVER. Thank you. 

[Whereupon, at 4:23 p.m., the subcommittee was adjourned.] 

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