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S. HRG. 113–869 

EBOLA IN WEST AFRICA: A GLOBAL CHALLENGE 

AND PUBLIC HEALTH THREAT 

JOINT HEARING 

BEFORE THE

COMMITTEE ON HEALTH, EDUCATION, 

LABOR, AND PENSIONS 

UNITED STATES SENATE 

AND THE

SUBCOMMITTEE ON LABOR, 

HEALTH AND HUMAN SERVICES, 

EDUCATION AND RELATED AGENCIES 

OF THE

COMMITTEE ON APPROPRIATIONS 

UNITED STATES SENATE 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

ON

EXAMINING EBOLA IN WEST AFRICA, FOCUSING ON A GLOBAL 

CHALLENGE AND PUBLIC HEALTH THREAT 

SEPTEMBER 16, 2014 

Printed for the use of the Committee on Health, Education, Labor, and Pensions 

( 

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

LIFEBOOK092 with DISTILLER

COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS 

TOM HARKIN, Iowa, Chairman 

BARBARA A. MIKULSKI, Maryland 

PATTY MURRAY, Washington 

BERNARD SANDERS (I), Vermont 

ROBERT P. CASEY, JR., Pennsylvania 

KAY R. HAGAN, North Carolina 

AL FRANKEN, Minnesota 

MICHAEL F. BENNET, Colorado 

SHELDON WHITEHOUSE, Rhode Island 

TAMMY BALDWIN, Wisconsin 

CHRISTOPHER S. MURPHY, Connecticut 

ELIZABETH WARREN, Massachusetts 

LAMAR ALEXANDER, Tennessee 

MICHAEL B. ENZI, Wyoming 

RICHARD BURR, North Carolina 

JOHNNY ISAKSON, Georgia 

RAND PAUL, Kentucky 

ORRIN G. HATCH, Utah 

PAT ROBERTS, Kansas 

LISA MURKOWSKI, Alaska 

MARK KIRK, Illinois 

TIM SCOTT, South Carolina 

DEREK MILLER, Staff Director 

LAUREN MCFERRAN, Deputy Staff Director and Chief Counsel 

DAVID P. CLEARY, Republican Staff Director 

(II) 

LIFEBOOK092 with DISTILLER

(III) 

COMMITTEE ON APPROPRIATIONS 

BARBARA A. MIKULSKI, Maryland, Chairman 

PATRICK J. LEAHY, Vermont 

TOM HARKIN, Iowa 

PATTY MURRAY, Washington 

DIANE FEINSTEIN, California 

RICHARD J. DURBIN, Illinois 

TIM JOHNSON, South Dakota 

MARY L. LANDRIEU, Louisiana 

JACK REED, Rhode Island 

MARK L. PRYOR, Arkansas 

JON TESTER, Montana 

TOM UDALL, New Mexico 

JEANNE SHAHEEN, New Hampshire 

JEFF MERKLEY, Oregon 

MARK BEGICH, Alaska 

CHRISTOPHER A. COONS, Delaware 

RICHARD C. SHELBY, Alabama 

THAD COCHRAN, Mississippi 

MITCH MCCONNELL, Kentucky 

LAMAR ALEXANDER, Tennessee 

SUSAN COLLINS, Maine 

LISA MURKOWSKI, Alaska 

LINDSEY GRAHAM, South Carolina 

MARK KIRK, Illinois 

DANIEL COATS, Indiana 

ROY BLUNT, Missouri 

JERRY MORAN, Kansas 

JOHN HOEVEN, North Dakota 

MIKE JOHANNS, Nebraska 

JOHN BOOZMAN, Arkansas 

CHARLES E. KIEFFER, Staff Director 

WILLIAM D. DUHNKE III, Minority Staff Director 

SUBCOMMITTEE ON LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND

RELATED AGENCIES

TOM HARKIN, Iowa, Chairman 

PATTY MURRAY, Washington 

MARY L. LANDRIEU, Louisiana 

RICHARD J. DURBIN, Illinois 

JACK REED, Rhode Island 

MARK L. PRYOR, Arkansas 

BARBARA A. MIKULSKI, Maryland 

JON TESTER, Montana 

JEANNE SHAHEEN, New Hampshire 

JEFF MERKLEY, Oregon 

JERRY MORAN, Kansas, Ranking 

THAD COCHRAN, Mississippi 

RICHARD C. SHELBY, Alabama 

LAMAR ALEXANDER, Tennessee 

LINDSEY GRAHAM, South Carolina 

MARK KIRK, Illinois 

MIKE JOHANNS, Nebraska 

JOHN BOOZMAN, Arkansas 

Professional Staff 

ADRIENNE HALLETT

MARK LAISCH

LISA BERNHARDT

MICHAEL GENTILE

ROBIN JULIANO

KELLY BROWN

LAURA A. FRIEDEL (Minority) 

JENNIFER CASTAGNA (Minority) 

CHOL PAK (Minority) 

M.V. YOUNG (Minority) 

Administrative Support 

TERI CURTIN

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C O N T E N T S 

STATEMENTS 

TUESDAY, SEPTEMBER 16, 2014 

Page 

COMMITTEE MEMBERS

Harkin, Hon. Tom, Chairman, Committee on Health, Education, Labor, and 

Pensions, opening statement ............................................................................... 1 

Alexander, Hon. Lamar, a U.S. Senator from the State of Tennessee, opening 

statement .............................................................................................................. 3 

Moran, Hon. Jerry, a U.S. Senator from the State of Kansas, opening statement ...................................................................................................................... 4 

Reed, Hon. Jack, a U.S. Senator from the State of Rhode Island ....................... 32 

Burr, Hon. Richard, a U.S. Senator from the State of North Carolina ............... 34 

Murray, Hon. Patty, a U.S. Senator from the State of Washington ................... 36 

Isakson, Hon. Johnny, a U.S. Senator from the State of Georgia ....................... 38 

Casey, Hon. Robert P., Jr., a U.S. Senator from the State of Pennsylvania ...... 40 

Boozman, Hon. John, a U.S. Senator from the State of Arkansas ...................... 42 

Bennet, Hon. Michael F., a U.S. Senator from the State of Colorado ................. 43 

Whitehouse, Hon. Sheldon, a U.S. Senator from the State of Rhode Island ...... 46 

Durbin, Hon. Richard J., a U.S. Senator from the State of Illinois .................... 47 

Mikulski, Hon. Barbara A., a U.S. Senator from the State of Maryland, 

opening statement ................................................................................................ 49 

WITNESSES—PANEL I 

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

Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 

Atlanta, GA ........................................................................................................... 5 

Prepared statement .......................................................................................... 7 

Fauci, Anthony S., Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD ......................................... 11 

Prepared statement .......................................................................................... 13 

Robinson, Robin A., Ph.D., Director, Biomedical Advanced Research and Development Authority, Deputy Assistant Secretary for Preparedness & Response, U.S. Department of Health and Human Services, Washington, DC .. 23 

Prepared statement .......................................................................................... 25 

WITNESSES—PANEL II 

Brantly, Kent, M.D., Former Medical Director, Samaritan’s Purse Ebola Care 

Center in Monrovia, Liberia, Ebola Survivor, Fort Worth, TX ........................ 52 

Prepared statement .......................................................................................... 55 

Charles, Ishmael Alfred, Program Manager, Sierra Leone Healey International Relief Foundation, Freetown, Sierra Leone ........................................ 59 

Prepared statement .......................................................................................... 61 

(IV) 

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(V) 

ADDITIONAL MATERIAL 

Statements, articles, publications, letters, etc.: 

Response by Beth P. Bell, M.D., MPH to questions of: 

Senator Casey ............................................................................................ 70 

Senator Bennet .......................................................................................... 71 

Senator Whitehouse .................................................................................. 72 

Senator Shaheen ....................................................................................... 74 

Senator Baldwin ........................................................................................ 76 

Senator Warren ......................................................................................... 77 

Senator Alexander ..................................................................................... 80 

Senators Alexander and Burr .................................................................. 83 

Senator Moran ........................................................................................... 84 

Senator Cochran ........................................................................................ 86 

Senator Shelby ........................................................................................... 87 

Senator Burr .............................................................................................. 88 

Senator Kirk .............................................................................................. 91 

Senator Enzi .............................................................................................. 92 

Response by Anthony S. Fauci, M.D., and Robin A. Robinson, Ph.D., 

to questions of: ..............................................................................................

Senator Casey ............................................................................................ 94 

Senator Bennet .......................................................................................... 95 

Senator Whitehouse .................................................................................. 96 

Senator Baldwin ........................................................................................ 97 

Senator Warren ......................................................................................... 98 

Senator Alexander ..................................................................................... 99 

Senator Moran ........................................................................................... 101 

Senator Shelby ........................................................................................... 102 

Senator Cochran ........................................................................................ 103 

Senator Burr .............................................................................................. 104 

Senator Kirk .............................................................................................. 105 

Response by Ishmael Alfred Charles to questions of: 

Senator Casey ............................................................................................ 107 

Senator Warren ......................................................................................... 108 

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(1) 

EBOLA IN WEST AFRICA: A GLOBAL 

CHALLENGE AND PUBLIC HEALTH THREAT 

TUESDAY, SEPTEMBER 16, 2014 

U.S. SENATE JOINT HEARING, 

COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS, 

AND

APPROPRIATIONS SUBCOMMITTEE ON LABOR, HEALTH AND

HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES, 

Washington, DC. 

The committees met, pursuant to notice, at 2:52 p.m. in room 

SH–216, Hart Senate Office Building, Hon. Tom Harkin, chairman 

of the committee and the subcommittee, presiding. 

Present: Senators Harkin, Mikulski, Alexander, Moran, Murray, 

Casey, Franken, Bennet, Whitehouse, Baldwin, Warren, Durbin, 

Reed, Pryor, Burr, Isakson, Cochran, Johanns, and Boozman. 

OPENING STATEMENT OF SENATOR HARKIN

The CHAIRMAN. The Committee on Health, Education, Labor, and 

Pensions and the Appropriations Subcommittee on Labor, Health 

and Human Services, Education and Related Services will come to 

order. 

In March of this year, public health officials reported an outbreak of Ebola virus in the West African country of Guinea. Unlike 

past Ebola outbreaks that have been efficiently and effectively 

stopped, this outbreak has spread in ways that are potentially catastrophic for the world. Due to the gravity of the situation and the 

danger it poses not only to the affected region, but also to our country, I have taken the unusual step of calling together this joint 

hearing of both the authorizing committee I chair and the Appropriations subcommittee, which I also chair. We’ve come together 

today to learn all we can so we can work together effectively over 

the coming weeks to stop this deadly plague. 

The extent of this epidemic is tragic and it grows more serious 

with each passing day. The death toll is already far greater than 

all other previous Ebola outbreaks combined. The World Health 

Organization estimates that 20,000 people may become infected by 

December if current control efforts are not strengthened, and we 

know the fatality rate, the mortality rate, is close to 50 percent, 40 

to 50 percent. 

We have other estimates that are much higher. And of course, 

the constant concern that as this virus spreads it could also start 

to mutate and become even more deadly or have other means of 

transmission other than through bodily fluids. 

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2 

Ebola is just one example of a threat from infectious disease. 

Others include Avian flu, and the Middle East Respiratory Syndrome, or MERS. In today’s globalized system of air travel and 

trade, health threats easily crisscross the planet. That’s why I’ve 

worked hard to strengthen, all of us on both of these committees, 

to strengthen investments in public health preparedness and response capabilities at home. 

Last year the bipartisan Pandemic and All-Hazards Preparedness Reauthorization Act was signed into law. That came through 

this committee, and of course I see Senator Burr here, who led a 

lot of effort on that on his side. Senator Alexander, Senator Enzi, 

Senator Casey all worked very hard on this bill. It advances national health security by strengthening CDC’s public health preparedness response capabilities and ensuring that the Biomedical 

Advanced Research and Development Authority, BARDA, has the 

authority it needs to support the development of critical treatments 

and vaccines. 

In the Appropriations Committee, we have worked together for 

years to secure additional funding at CDC to set up a network of 

disease detection centers across the globe. We now have 10, including three in Africa. We need one in every country in Africa. It is 

these centers that are now deploying trained epidemiologists and 

other staff to help in epidemic areas and those at high risk, and 

we’ll have more discussion on that when we get to our witnesses 

with CDC. 

I hope and expect that in the next day or two the Senate will 

vote in favor of the $88 million that Senator Moran and I worked 

to secure in the continuing resolution (CR) to do just that. This is 

a crucial investment that will enable 100 CDC scientists to continue working in West Africa. It will keep the ZMapp and vaccine 

candidates moving quickly through clinical trials. 

But, as important as this is, it’s just a first step. I hate to say 

this, but Ebola will not be conquered in the 10-weeks of the continuing resolution. When we come back to negotiate the fiscal year 

2015 appropriations bills, the fight to contain Ebola must continue 

to be an urgent priority. 

The subcommittee passed a Senate Labor-HHS bill that includes 

a new $40 million global health security initiative. We must carefully consider the size and goals of this initiative in light of the 

Ebola outbreak, while maintaining our commitment to CDC staff 

in the field. As this crisis illustrates, we must stop chasing diseases 

after the fact and start building public health systems around the 

globe capable of detecting and stopping diseases before they cross 

borders. 

Last year, with the help of Senator Moran, we were able to start 

a new global initiative called the National Public Health Institute 

to do just that. This program needs to be expanded in light of this 

epidemic. 

With these big challenges ahead of us, today’s hearing is absolutely critical. We have a distinguished group here to educate us 

and advise us. 

I will now turn to Senator Alexander and also to Senator Moran, 

but before that I request the record be kept open for 10 days for 

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3 

Senators to submit statements and questions. With that, I’ll recognize Senator Alexander. 

OPENING STATEMENT OF SENATOR ALEXANDER

Senator ALEXANDER. Thanks, Mr. Chairman, and thanks to the 

witnesses for coming here today. 

We must take the dangerous, deadly threat of Ebola as seriously 

as we take ISIS. Let me say that again, we must take the dangerous, deadly threat of the Ebola epidemic as seriously as we take 

ISIS. I think I have a reputation as a Senator who’s not given to 

overstatement. I don’t believe that’s an overstatement. 

The spread of this disease deserves a more urgent response from 

our country and other countries around the world than it’s now getting. This is one of the most explosive, deadly epidemics in modern 

time if we do not do what we know how to do to control it. It will 

require a huge and immediate response. There is no known cure. 

There is no vaccine. Half of those who get sick die. Each sick person, according to the Centers for Disease Control and Prevention, 

could infect 20 or more others, including caregivers, friends, and 

family. 

Samantha Power, the U.N. Ambassador, said to me earlier this 

week in a briefing that she’s trying to get other countries to view 

this with the same urgency that we do. This is an instance, she 

said, when we should be running toward the burning flames with 

our fireproof suits on. Ebola is killing people in West Africa at 

alarming rates and picking up speed. 

It’s hard to say exactly what the number of cases is. There is an 

official number, a little less than 5,000 Ebola cases in Guinea, Liberia, and Sierra Leone. But the worry is that one-half of those 

cases were reported in the last 3 weeks. You don’t have to know 

very much about mathematics to know that, whatever the number, 

if it doubles every 3 weeks, that very soon we have an out of control epidemic. And we can see easily what would happen if a single 

infected traveler reaches another country and begins to infect others in that country. 

We’ll learn more today about what we know how to do. We’ll 

hear from a doctor who has contracted Ebola and who has recovered from it and who is here to talk about it. It’s not like the flu. 

It can only be spread by bodily fluids, often contracted by caring 

for someone who’s sick or through burial practices. 

But with global travel, we’re only one airplane ride away from 

a person exposed to Ebola getting on a plane to the United States 

and then becoming sick once they arrive, and then the mathematics of that infection could begin to develop in this country. 

There’s human tragedy in Africa, but it affects the rest of the 

world and it affects the United States. Our State is known as the 

Volunteer State and Dr. Brantly, who will testify here, is an Ebola 

patient. He was working for Samaritan’s Purse. He’s not a Tennessean, but his parents are graduates of Lipscomb University, 

which is in Nashville. He, like many Americans, go on mission 

trips around the world to help people who need help. 

I will support the Administration’s request for the $30 million 

Senator Harkin talked about, for the $58 million for the Biomedical 

Advanced Research and Development Authority. That’s for vaccines 

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4 

and cures and treatments. That should pass this week. There is a 

request to address $500 million of reprogramming in the Defense 

Department. Some have asked, why should our military be involved? Because they have to be involved if we want to deal with 

the problem. There’s no way for the doctors and the nurses and the 

health care workers to deal with it. 

I’m pleased that on both sides of the aisle we have leaders who 

are beginning to recognize the severity of this epidemic. Dr. 

Frieden and United Nations Ambassador Power are taking the 

lead. We look forward to learning all we can about the severity of 

the epidemic and what we must do to control it. But I’ll end where 

I started, we must take the deadly, dangerous threat of the Ebola 

epidemic as seriously as we take ISIS. 

The CHAIRMAN. Thank you, Senator Alexander. 

Senator Moran. 

OPENING STATEMENT OF SENATOR MORAN

Senator MORAN. Mr. Chairman, thank you very much. I very 

much appreciate you and your leadership, working with the Senator from Tennessee and me together, to make certain that this 

hearing take place. 

It’s very discouraging to see and know what’s taking place in Africa, but it’s very encouraging to know that we have the ability to 

make a significant difference in the outcome of what’s occurring. 

Sometimes we face problems and we don’t know exactly what to do. 

While I realize we haven’t invented and discovered all the cures 

and treatments, we know a lot can be done that will save people’s 

lives and prevent the spread of Ebola to other places in Africa and 

around the globe. 

The encouraging thing to me is that this is an example of something where the U.S. Senate or the Congress and the President can 

come together and actually make a difference, something that we 

ought to take some satisfaction in if we are able to accomplish that. 

I appreciate the leadership here today. We need to declare a war 

on Ebola. It’s real and yet it’s something that, with that war, with 

that campaign, we have the ability to change the people’s lives who 

are affected and to diminish the number of people whose lives are 

affected in the future. This requires a global response and the 

United States needs to provide the necessary leadership to make 

certain that the war is won. 

Mr. Chairman, thank you very much. 

The CHAIRMAN. Thank you, Senator Moran. 

We have a distinguished panel, our first panel. I’ll introduce 

them and then we’ll move ahead with the statements. First is Dr. 

Beth Bell, Director of the National Center for Emerging and 

Zoonotic Infectious Diseases at the Centers for Disease Control and 

Prevention. Dr. Bell is responsible for CDC’s efforts in responding 

to a broad range of emerging and established threats. Since March, 

Dr. Bell has helped lead CDC’s response to the Ebola outbreak in 

West Africa. Previously, Dr. Bell served in multiple leadership 

roles at CDC, including during the agency’s response to the 2001 

anthrax attacks and the 2009 H1N1 influenza pandemic. 

Dr. Anthony Fauci, Director of the National Institute of Allergy 

and Infectious Diseases at the National Institutes of Health, a posiLIFEBOOK092 with DISTILLER

5 

tion he’s held since 1984, for 30 years, and has provided outstanding leadership there. At NIH Dr. Fauci oversees a wide portfolio of basic and applied research to improve our understanding of 

infectious diseases and applying this knowledge to develop new detection, prevention, and treatment strategies. 

Dr. Fauci serves as one of the key advisers to the White House 

and Department of Health and Human Services on initiatives to 

bolster medical and public health preparedness against emerging 

infectious disease threats. 

Finally, we extend the committee’s welcome to Dr. Robin Robinson, Director of the Biomedical Advanced Research and Development Authority, BARDA, in the Office of the Assistant Secretary 

for Preparedness and Response at the Department of Health and 

Human Services. Dr. Robinson is responsible for the advanced development and acquisition of innovative medical countermeasures, 

including vaccines, drugs, and diagnostic tools, to protect against 

both man-made and naturally occurring health threats. BARDA 

has played a key role in ensuring the ongoing research and development of experimental Ebola treatments, and we thank you also 

for being here today, Dr. Robinson. 

I would just ask consent that all of your statements be made a 

part of the record in their entirety. 

Dr. Bell, we’ll start with you. I know we’re going to have a lot 

of questions from Senators, so if you sum up in 5 to 7 minutes we’d 

sure appreciate it. 

STATEMENT OF BETH P. BELL, M.D., MPH, DIRECTOR, NATIONAL CENTER FOR EMERGING AND ZOONOTIC INFECTIOUS DISEASES, CENTERS FOR DISEASE CONTROL AND 

PREVENTION, ATLANTA, GA 

Dr. BELL. I will. Good afternoon, Chairman Harkin, Ranking 

Members Alexander and Moran, and members of the committees. 

I am Dr. Beth Bell, Director of the National Center for Emerging 

and Zoonotic Infectious Diseases at the CDC. I appreciate the opportunity to be here today to discuss the current epidemic of Ebola 

in West Africa, which illustrates in a tragic way the need to 

strengthen global health security. 

Dr. Frieden has asked me to extend his sincere regret for not 

being here in person and also to express his appreciation for your 

continuing support for CDC, enabling us to build and sustain the 

capacity to respond to health threats like Ebola. 

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

that has been recognized in West Africa and the biggest and most 

complex Ebola epidemic ever documented. As of last week, the epidemic surpassed 4,400 cumulative reported cases, including nearly 

2,300 documented deaths, though we believe there is considerable 

underreporting and expect that the actual numbers would be two 

to three times higher. 

We have now also seen cases imported into Nigeria and Senegal 

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

similar exportations as the outbreak grows. There is an urgent 

need to help bordering countries to better prepare for cases now 

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6 

and to strengthen detection and response capabilities throughout 

Africa. 

The secondary effects of this outbreak now include the collapse 

of the underlying health care systems, resulting, for example, in an 

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

non-health impacts such as economic and political instability and 

increased isolation of this area of Africa. These impacts are intensifying and not only signal a growing humanitarian crisis, but also 

have direct impacts on our ability to respond to the Ebola epidemic 

itself. 

There is a window of opportunity to control the spread of this 

disease, but that window is closing. If we do not act now to stop 

Ebola, we could be dealing with it for years to come, affecting larger areas of Africa. Ebola is currently an epidemic, the worst Ebola 

outbreak in history, but we have tools to stop it and an accelerated 

global response is urgently needed. 

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

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

the United States is to stop the outbreak in West Africa. But it is 

possible that an infected traveler might arrive in the United 

States. Should this occur, we are confident that our public health 

and health care systems can prevent an Ebola outbreak here and 

recognize that the authorities in investments provided by your committees have put us in this strong position. 

Many challenges remain, particularly since there is currently no 

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

need to strengthen the global response, which requires close collaboration with the World Health Organization, additional assistance from international partners, and a strong and coordinated 

U.S. Government response. 

CDC has over 100 staff in West Africa currently and hundreds 

of additional staff are supporting this effort from Atlanta. CDC will 

continue to work with our partners across the U.S. Government 

and elsewhere to focus on five pillars of response: 

• establishing effective emergency operations centers in countries; • rapidly ramping up isolation and treatment facilities; • helping promote safe burial practices; • strengthening infection control and other elements of the 

health care systems; and • improving communication about the disease and how it can be 

contained. 

Controlling the outbreak will be costly and will require sustained 

effort by the United States and the world community. Within HHS, 

the administration recently proposed that the Congress provide $30 

million for CDC’s response during the continuing resolution period 

and for efforts to develop countermeasures, which my colleagues 

will describe. And last week the President indicated that the 

unique logistics and material capabilities of the U.S. military would 

be engaged in this response, and we are working across the U.S. 

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

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

LIFEBOOK092 with DISTILLER

7 

will take meticulous work and we cannot take shortcuts. As CDC 

Director Tom Frieden has noted, fighting Ebola is like fighting a 

forest fire. Leave behind one burning ember, one case undetected, 

and the epidemic could reignite. Ending this epidemic will take 

time and continued intensive effort. 

This tragedy also highlights the need for stronger public health 

systems around the world. There is worldwide agreement on the 

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

can have widespread impact if not stopped at the source. As you 

are aware, the fiscal year 2015 President’s budget includes an increase of $45 million to strengthen fundamental public health capacities around the globe. If these people, facilities, and labs had 

been in place in these countries currently battling Ebola, the early 

outbreaks would not have grown to what we are facing today. Stopping outbreaks where they occur is the most effective and least expensive way to protect people’s health. 

I know that many of you have traveled to Africa to see our work 

in global health, as have I, and we all come away with an appreciation of the enormous challenges many people and countries face. 

These may never have been more evident than in the current Ebola 

epidemic. Each day of the past several months, I have been in personal contact with our teams in the field. Their experiences reinforce the dire need and put real stories and faces on a tragedy that 

can’t simply be reduced to numbers and facts. But these stories 

from the field also reinforce the unique and indispensable role that 

CDC and our partners are playing and the sense that with an intensified global focus we can make a real difference. 

Thank you again for the opportunity to appear before you today 

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

threats possible. 

[The prepared statement of Dr. Bell follows:] 

PREPARED STATEMENT OF BETH BELL, M.D., MPH 

Good afternoon Chairman Harkin, Ranking Members Alexander and Moran, and 

members of the Health, Education, Labor, and Pensions and Appropriations Committees. Thank you for the opportunity to testify before you today and for your ongoing support for the Centers for Disease Control and Prevention’s (CDC) work in 

global health. I am Dr. Beth Bell, Director of the National Center for Emerging and 

Zoonotic Infectious Diseases at the CDC. I appreciate the opportunity to be here 

today to discuss the current epidemic of Ebola in West Africa, which illustrates in 

a tragic way the need to strengthen global health security. 

We do not view Ebola as a significant public health threat to the United States. 

It is not transmitted easily, does not spread from people who are not ill, and cultural norms that contribute to the spread of the disease in Africa—such as burial 

customs—are not a factor in the United States. We know how to stop Ebola with 

strict infection control practices which are already in widespread use in American 

hospitals, and by stopping it at the source in Africa. There is a window of opportunity to tamp down the spread of this disease, but that window is closing. CDC 

is committing significant resources both on the ground in West Africa and through 

our Emergency Operations Center here at home. But this is a whole of Government 

response, with agencies across the U.S. Government committing human and financial resources. 

To date, the U.S. Government has spent more than $100 million to address the 

Ebola epidemic, and just last week the U.S. Agency for International Development 

(USAID) announced plans to make available up to $75 million in additional funding. 

In addition, we have just proposed that the Congress provide an additional $88 million through the continuing resolution process. This funding would allow us to support development and manufacturing of Ebola therapeutic and vaccine candidates 

LIFEBOOK092 with DISTILLER

8 

for clinical trials and to send additional response workers from CDC as well as lab 

supplies and equipment. If the Congress includes this additional funding, it would 

bring our total commitments to date to over $250 million. Last week, the President 

indicated the need to engage the unique logistics and materiel capabilities of the 

U.S. military on this response. 

We need to, and are, working with our international partners, to scale up the response to the levels needed to stop this epidemic. 

Ebola is a severe, often fatal, viral hemorrhagic fever. The first Ebola virus was 

detected in 1976 in what is now the Democratic Republic of Congo. Since then, outbreaks have appeared sporadically. The current epidemic in Guinea, Liberia, and Sierra Leone is the first that has been recognized in West Africa and the biggest and 

most complex Ebola epidemic ever documented. We have now also seen cases imported into Nigeria and Senegal from the initially affected areas, which is of concern. 

Ebola has an abrupt onset of symptoms similar to many other illnesses, including 

fever, chills, weakness and body aches. Gastrointestinal symptoms such as vomiting 

and diarrhea are common and severe, and can result in life threatening electrolyte 

losses. In approximately half of cases there is hemorrhage—serious internal and external bleeding. There are two things that are very important to understand about 

how Ebola spreads. First, the current evidence suggests human-to-human transmission of Ebola only happens from people who are symptomatic—not from people 

who have been exposed to, but are not ill with the disease. Second, everything we 

have seen in our decades of experience with Ebola indicates that Ebola is not spread 

by casual contact; Ebola is spread through direct contact with bodily fluids of someone who is sick with, or has died from Ebola, or exposure to objects such as needles 

that have been contaminated. While the illness has an average 8–10 day incubation 

period (though it may be as short as 2 days and as long as 21 days), we recommend 

monitoring for fever and signs of symptoms for the full 21 days. Again, we do not 

believe people are contagious during that incubation period, when they have no 

symptoms. Evidence does not suggest Ebola is spread through the air. Catching 

Ebola is the result of exposure to bodily fluids, which we are seeing occur in West 

Africa, for example, in hospitals in weaker health care systems and in some African 

burial practices. Getting Ebola requires exposure to bodily fluids of someone who is 

ill from—or has died from—Ebola. 

The early recorded cases in the current epidemic were reported in March of this 

year. Following an initial response that seemed to slow the early outbreak for a 

time, cases flared again due to weak systems of health care and public health and 

because of challenges health workers faced in dealing with communities where critical disease-control measures were in conflict with cultural norms. As of last week, 

the epidemic surpassed 4,400 cumulative reported cases, including nearly 2,300 documented deaths, though we believe these numbers may be under-reported, by a factor of at least two- to threefold. The effort to control the epidemic in some places 

is complicated by fear of the disease and distrust of outsiders. Security is tenuous 

and unstable, especially in remote isolated rural areas. There have been instances 

where public health teams could not do their jobs because of security concerns. 

Many of the health systems in these countries are weak or have collapsed entirely, and do not reach into rural areas. Health care workers may be limited (for 

example, we are aware of one nurse for 90 patients in one hospital in Kenema, Sierra Leone), or may not reliably be present at facilities, and those facilities may 

have limited capacity. Poor infection control in routine health care, along with local 

traditions such as public funerals and cultural mourning customs including preparing bodies of the deceased for burial, make efforts to contain the illness more 

difficult. Furthermore, the porous land borders among countries and remoteness of 

many villages have greatly complicated control efforts. The secondary effects now 

include the collapse of the underlying health care systems resulting for example, an 

inability to treat malaria, diarrheal disease, or to safely deliver a child, as well as 

non-health impacts such as economic and political instability and increased isolation 

in this area of Africa. These impacts are intensifying, and not only signal a growing 

humanitarian crisis, but also have direct impacts on our ability to respond to the 

Ebola epidemic itself. 

There are three key things which we need to respond to this epidemic. The first 

is resources—this epidemic will take a lot of resources to confront. That is why the 

U.S. Government is putting our resources into this effort and asking the Congress 

for your assistance. The United Nations believes the cost of getting supplies needed 

to West African countries to get the Ebola crisis under control will be at least $600 

million. I personally believe that to be an underestimate. The second is technical 

experts in health care and management to assist in country. Last, is a coordinated, 

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global unified approach, because this is not just a problem for Africa. It’s a problem 

for the world, and the world needs to respond. 

Fortunately, we know what we must do. In order to stop an Ebola outbreak, we 

must focus on three core activities: find active cases, respond appropriately, and prevent future cases. The use of real-time diagnostics is extremely important to identify 

new cases. We must support the strengthening of health systems and assist in 

training healthcare providers. Once active cases have been identified, we must support quality patient care in treatment centers, prevent further transmission through 

proper infection control practices, and protect healthcare workers. Epidemiologists 

must identify contacts of infected patients and followup with them every day for 21 

days, initiating testing and isolation if symptoms emerge. And, we must intensify 

our use of health communication tools to disseminate messages about effective prevention and risk reduction. These messages include recommendations to report suspected cases and to avoid close contact with sick people or the deceased, and to promote safe burial practices. In Africa, another message is to avoid bush meat and 

contact with bats, since ‘‘spillover events,’’ or transmission from animals to people, 

in Africa has been documented through these sources. 

Many challenges remain. While we do know how to stop Ebola through meticulous 

case finding, isolation, and contact tracing, there is currently no cure or vaccine 

shown to be safe or effective for Ebola. We need to strengthen the global response, 

which requires close collaboration with WHO, additional assistance from our international partners, as well as a coordinated U.S. Government response. At CDC, we 

activated our Emergency Operations Center to respond to the initial outbreak, and 

are surging our response. One of the surge objectives was initial deployment of 50 

disease-control experts in 30 days to the region to support partner governments, 

WHO, and other partners working in the region. We surpassed that goal, and as 

of last week, CDC has over 100 staff in West Africa, and more than 300 staff in 

total have provided logistics, staffing, communication, analytics, management, and 

other support functions. CDC will continue to work with our partners across the 

U.S. Government and elsewhere to focus on five pillars of response: 

• Effective incident management—CDC is supporting countries to establish national and sub-national Emergency Operations Centers (EOCs) by providing technical assistance and standard operating procedures and embedding staff with expertise in emergency operations. All three West African countries at the center of the 

epidemic have now named and empowered an Incident Manager to lead efforts. 

• Isolation and treatment facilities—It’s imperative that we ramp up our efforts 

to provide adequate space to treat the number of people afflicted with this virus. 

• Safe burial practices—Effectively shifting local cultural norms on burial practices is one of the keys to stopping this epidemic. CDC is providing technical assistance for safe burials. 

• Health care system strengthening—Good infection control will greatly reduce 

the spread of Ebola and help control future outbreaks. CDC has a lead role in infection control training for health care workers and safe patient triage throughout the 

health care system, communities, and households. 

• Communications—CDC will continue to work on building the public’s trust in 

health and government institutions by effectively communicating facts about the 

disease and how to contain it, particularly targeting communities that have presented challenges to date. 

The public health response to Ebola rests on the same proven public health approaches that we employ for other outbreaks, and many of our experts are working 

in the affected countries to rapidly apply these approaches and build local capacity. 

These include strong surveillance and epidemiology, using real-time data to improve 

rapid response; case-finding and tracing of the contacts of Ebola patients to identify 

those with symptoms and monitor their status; and strong laboratory networks that 

allow rapid diagnosis. 

CDC’s request for an additional $30 million for the period of the continuing resolution will support our response and to allow us to ramp up efforts to contain the 

spread of this virus. More than half of the funds are expected to directly support 

staff, travel, security and related expenses. A portion of the funds will be provided 

to the affected area to assist with basic public health infrastructure, such as laboratory and surveillance capacity, and improvements in outbreak management and infection control. Should outbreaks recur in this region, they will have the experience 

and capacity to respond without massive external influx of aid, due to this investment. The remaining funds will be used for other aspects of strengthening the public health response such as laboratory supplies/equipment, and other urgent needs 

to enable a rapid and flexible response to an unprecedented global epidemic. CDC 

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will continue to coordinate activities directly with critical Federal partners, including USAID and non-governmental organizations. 

Though the most effective step we can take to protect the United States is to stop 

the epidemic where it is occurring, we are also taking strong steps to protect Americans here at home. For example, it is possible that infected travelers may arrive in 

the United States, despite all efforts to prevent this; therefore we need to ensure 

the United States’ public health and health care systems are prepared to rapidly 

manage cases to avoid further transmission. We are confident that our public health 

and health care systems can prevent an Ebola outbreak here, and that the authorities and investments provided by your committees have put us in a strong position 

to protect Americans. To make sure the United States is prepared, as the epidemic 

in West Africa has intensified, CDC has: 

• Assisted with extensive screening and education efforts on the ground in West 

Africa to prevent ill travelers from getting on planes. 

• Developed guidance for monitoring and movement of people with possible exposures, and guidance and training for partners (including airlines, Customs and Border Protection officers, and Emergency Medical Systems personnel). 

• Provided guidance for travelers, humanitarian organizations, and students/universities. 

• Advised United States’ health care providers to consider Ebola if symptoms 

present within 3 weeks of a traveler returning from an affected area. 

• Provided guidance for infection control practices in hospitals to prevent further 

spread to United States health care workers and communities. 

• Developed response protocols for the evaluation, isolation and investigation of 

any incoming individuals with relevant symptoms. 

• Expanded the capacity of our Laboratory Response Network to rapidly test suspected cases so that appropriate measures can be taken. 

Working with our partners, we have been able to stop every prior Ebola outbreak, 

and we will stop this one. It will take meticulous work and we cannot take short 

cuts. It’s like fighting a forest fire: leave behind one burning ember, one case undetected, and the epidemic could re-ignite. For example, in response to the case in Nigeria, 10 CDC staff and 40 top Nigerian epidemiologists rapidly deployed, identified, 

and followed 1,000 contacts for 21 days. Even with these resources, one case was 

missed, which resulted in a new cluster of cases in Port Harcourt. 

Ending this epidemic will take time and continued, intensive effort. The fiscal 

year 2015 President’s Budget includes an increase of $45 million to strengthen lab 

networks that can rapidly diagnose Ebola and other threats, emergency operations 

centers that can swing into action at a moment’s notice, and trained disease detectives who can find an emerging threat and stop it quickly. Building these capabilities around the globe is key to preventing this type of event elsewhere and ensuring 

countries are prepared to deal with the consequences of outbreaks in other countries. We must do more, and do it quickly, to strengthen global health security 

around the world, because we are all connected. Diseases can be unpredictable— 

such as H1N1 coming from Mexico, MERS emerging from the Middle East, or Ebola 

in West Africa, where it had never been recognized before—which is why we have 

to be prepared globally for anything nature can create that could threaten our global 

health security. 

There is worldwide agreement on the importance of global health security, but as 

the Ebola epidemic demonstrates, there is much more to be done. All 194 World 

Health Organization Member States have adopted the International Health Regulations (IHR). Progress has occurred over the past years, but 80 percent of countries 

did not claim to meet the IHR capacity required to prevent, detect, and rapidly respond to infectious disease threats by the June 2012 deadline set by WHO. No globally linked, inter-operable system exists to prevent epidemic threats, detect disease 

outbreaks in real-time, and respond effectively. Despite improved technologies and 

knowledge, concerning gaps remain in many countries in the workforce, tools, training, surveillance capabilities, and coordination that are crucial to protect against the 

spread of infectious disease, whether naturally occurring, deliberate, or accidental. 

The technology, capacity, and resources exist to make measurable progress across 

member countries, but focused leadership is required to make it happen. If even 

modest investments had been made to build a public health infrastructure in West 

Africa previously, the current Ebola epidemic could have been detected earlier, and 

it could have been identified and contained. This Ebola epidemic shows that any 

vulnerability could have widespread impact if not stopped at the source. 

Earlier this year, the U.S. Government joined with partner governments, WHO 

and other multilateral organizations, and non-governmental actors to launch the 

Global Health Security Agenda. Over the next 5 years, the United States has comLIFEBOOK092 with DISTILLER

11 

mitted to working with at least 30 partner countries (with a combined population 

of at least four billion people) to improve their ability to prevent, detect, and effectively respond to infectious disease threats—whether naturally occurring or caused 

by accidental or intentional release of pathogens. As part of this Agenda, the President’s fiscal year 2015 Budget includes $45 million for CDC to accelerate progress 

in detection, prevention, and response, and we appreciate your support for this investment. The economic cost of large public health emergencies can be tremendous—the 2003 Severe Acute Respiratory Syndrome epidemic, known as SARS, disrupted travel, trade, and the workplace and cost to the Asia-Pacific region alone $40 

billion. Resources provided for the Global Health Security Agenda can improve detection, prevention, and response and potentially reduce some of the direct and indirect costs of infectious diseases. 

Improving these capabilities for each nation improves health security for all nations. Stopping outbreaks where they occur is the most effective and least expensive 

way to protect people’s health. While this tragic epidemic reminds us that there is 

still much to be done, we know that sustained commitment and the application of 

the best evidence and practices will lead us to a safer, healthier world. With a focused effort and resources proposed in the fiscal year 2015 President’s Budget, we 

can stop this epidemic, and leave behind strong systems in West Africa and elsewhere to prevent Ebola and other health threats in the future. 

Thank you again for the opportunity to appear before you today. I appreciate your 

attention to this terrible outbreak and I look forward to answering your questions. 

The CHAIRMAN. Thank you very much, Dr. Bell. 

Dr. Fauci, welcome. Please proceed. 

STATEMENT OF ANTHONY S. FAUCI, M.D., DIRECTOR, NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES, NATIONAL INSTITUTES OF HEALTH, BETHESDA, MD 

Dr. FAUCI. Thank you very much, Mr. Chairman, Ranking Member, members of the committee. I appreciate the opportunity to be 

able to speak to you today about the role of the National Institute 

of Allergy and Infectious Diseases in research addressing the Ebola 

virus disease. I have some handouts that your staff has put in front 

of you and it’s on the visuals there. 

The involvement of the NIH and NIAID in Ebola really dates 

back to the tragic events of 9–11–2001, which was followed closely 

by the anthrax attacks through the mail in letters to United States 

Senators as well as to members of the press, because this led to 

a broad, multi-agency endeavor to develop what we call biodefense 

against threats, not only of deliberate threats, but of unexpected 

naturally emerging and reemerging threats. 

As you see on the right-hand side of this, there was an agenda, 

a research agenda involving what we called category A agents. 

They’re listed there and they’re familiar to you. They’re anthrax, 

botulism, plague, smallpox, tularemia, and on the bottom bullet 

you see a category called the viral hemorrhagic fever viruses, which 

are Ebola, as well as Marburg, Lassa, and others. 

The reason why these viral hemorrhagic fever viruses were so 

important and so deadly and so in need of countermeasures is that, 

as you mentioned in your introductory remarks, as have the other 

Senators, they have a high degree of lethality and infectivity. Unfortunately, the therapy is essentially mostly supportive, without 

specific antiviral drugs directed against the microbes in question. 

As we know, a vaccine for any of these is not available at present. 

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

filovirus, given the name because of the filamentous appearance 

that it has when one looks at it. 

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The NIH’s Countermeasure Research and Development Program 

is ongoing and has been for several years. But before I even mention that, I wanted to underscore something that Dr. Bell said, is 

that right now today the best way to contain this epidemic, this 

outbreak, is by intensifying infection control capabilities, what 

we’re seeing now evolve and what we’ve seen for some time, the 

ability to isolate, identify, contact trace, and protect our health care 

workers with personal protective equipment. 

But if we want to be prepared in a durable way, we need countermeasures, and that’s what I’m going to spend the next couple of 

minutes telling you about. What we do is basic and clinical research, but we also supply the resources for researchers in industry 

and in academia to get to our end game, which is better diagnostics 

and, of course, therapeutics and vaccines. 

The product development pipeline is not unidimensional. The 

NIH is fundamentally responsible for developing the early concepts, 

doing what we call preclinical studies and early clinical studies, 

which I’ll mention in a moment. We partner with our colleagues 

from BARDA, which you mentioned, who are involved in the advanced development to hand the baton over to industry for commercial manufacturing, with ultimate regulation and approval by 

the U.S. FDA, among other regulatory agencies, and you’ll hear 

from Dr. Robinson shortly. 

Let me spend a moment outlining some of the promising therapeutics. You mentioned and you’ve heard of ZMapp from Mapp Biopharmaceuticals. This is a combination of three artificially produced antibodies directed against the Ebola virus. It has been 

shown to be very promising in an animal model and, as you will 

hear from the next witnesses when Dr. Brantly speaks, that this 

was given for the first time in humans. 

It is very, very important that we understand whether it truly 

works, how well it works, what’s the proper dose, and is it safe. Anecdotal, we have determined that it looks like under circumstances 

it could be beneficial, but we don’t know that, and it’s our job to 

prove it so that we can have it readily available for larger numbers 

of people. 

On this slide there’s another couple among several interventions, 

one by the company BioCryst, which we’re collaborating with, 

which is one of several novel drugs that interfere with the reproductive process of the virus. Then our Department of Defense is in 

collaboration with a company called Tekmira to get a drug which 

is actually a small inhibitory molecule, again interfering with the 

replication of the virus. 

As I mentioned, ZMapp has been administered to seven individuals. This is probably, when you look at the animal model, a very 

encouraging result that we’ve seen in the animals. As we know, 

this has the potential, because it can block the virus, to do something that we hope we will be able to capitalize on, again with research ahead. 

Then finally, there’s the issue of vaccines. This is something that 

traditionally in infectious diseases has been the stalwart of preventing and protecting people. We have been working on an Ebola 

vaccine for several years in an iterative process that we’ve improved upon. We have favorable results in an animal model using 

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13 

one of a few candidates, and the one I will mention in closing is 

the NIAID GlaxoSmithKlein candidate, which was developed at the 

NIH in collaboration with GlaxoSmithKlein and looked very good 

in an animal study. But as I have told you, Mr. Chairman and others on the committee, many times, the proof is in the pudding to 

show scientifically that it works. 

We have actually started that process. On September 2d at the 

NIH Clinical Center in Bethesda, we started the first phase I study 

of this vaccine, aimed at vaccinating 20 normal volunteers. So far 

10 of the 20 volunteers have been vaccinated and thus far there 

have been no red flags. Following this, which will likely end at the 

end of November, the beginning of December, we will expand these 

studies to try and prove in fact that we have a safe and effective 

vaccine. 

In closing I’d like to reiterate what I refer to as the dual mandate of NIH and NIAID research when it comes to infectious diseases. It’s our responsibility to maintain a robust basic and applied 

research portfolio in microbiology and infectious diseases. But also 

we have the other mandate, to have to respond rapidly and efficiently to emerging and reemerging infectious diseases with the 

kinds of countermeasures that would prevent morbidity and mortality and would have our citizens feel safe both home and abroad, 

and clearly Ebola is one of the most daunting of those reemerging 

infectious diseases. It’s our aim over the next months to years to 

make sure that we do have the countermeasures to prepare us to 

address this problem. 

Thank you very much, Mr. Chairman. 

[The prepared statement of Dr. Fauci follows:] 

PREPARED STATEMENT OF ANTHONY S. FAUCI, M.D. 

Mr. Chairman and members of the committees, thank you for the opportunity to 

discuss the National Institutes of Health (NIH) response to the global health emergency of Ebola virus disease. I direct the National Institute of Allergy and Infectious 

Diseases (NIAID), the lead institute of the NIH for conducting and supporting research on infectious diseases, including viral hemorrhagic fevers such as those 

caused by Ebola virus infection. 

For over six decades, NIAID has made important contributions to advancing the 

understanding of infectious, immunologic, and allergic diseases, from basic research 

on mechanisms of disease to applied research to develop diagnostics, therapeutics, 

and vaccines. NIAID has a dual mandate that balances research addressing current 

biomedical challenges with the capacity to respond quickly to newly emerging and 

re-emerging infectious diseases, including bioterror threats. Critical to these efforts 

are NIAID’s partnerships with academia, pharmaceutical companies, international 

organizations such as the World Health Organization, and collaborations with other 

Federal entities, particularly the Centers for Disease Control and Prevention, the 

Food and Drug Administration (FDA), the Biomedical Advanced Research and Development Authority (BARDA), and the Department of Defense (DoD). 

OVERVIEW OF EBOLA VIRUS DISEASE

Viral hemorrhagic fevers are severe illnesses that can be fatal and are caused by 

a diverse group of viruses including Marburg virus, Lassa virus, and Ebola virus. 

Infection with Ebola virus typically causes fever, severe vomiting, diarrhea, rash, 

profound weakness, electrolyte loss, impaired kidney and liver function, and in some 

cases internal and external bleeding. Since the discovery of Ebola virus in 1976, outbreaks of hemorrhagic fever caused by Ebola virus have had fatality rates ranging 

from 25 percent to 90 percent, depending on the species of virus and the availability 

of medical facilities to care for infected patients. West Africa is currently experiencing the most severe Ebola epidemic ever recorded. As of last week, the epidemic 

surpassed 4,400 cumulative reported cases, including nearly 2,300 documented 

deaths according to CDC. The ongoing Ebola epidemic in Guinea, Liberia, Sierra 

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Leone, Nigeria, and Senegal has generated more cases and deaths than the 24 previous Ebola outbreaks combined. 

The ongoing public health crisis in West Africa demands a major amplification of 

efforts to identify and isolate infected individuals, perform contact tracing, and provide personal protective equipment for healthcare workers involved in the treatment 

of infected individuals. This still remains the time-proven approach to controlling 

and ultimately ending the epidemic. However, there is also a critical need to develop 

improved diagnostics, as well as safe and effective therapeutics and vaccines for 

Ebola since there are no such FDA-approved interventions available at this time. 

In this regard, NIAID has a longstanding commitment to advancing research to 

combat Ebola while ensuring the safety and efficacy of potential medical countermeasures such as treatments and vaccines. 

HISTORY OF NIAID EBOLA VIRUS RESEARCH: RELATIONSHIP TO BIODEFENSE RESEARCH

The ability to safely and effectively prevent and treat Ebola virus infection is a 

longstanding NIAID priority. Since the 2001 anthrax attacks, NIAID has vastly expanded its research portfolio in biodefense and naturally emerging and re-emerging 

infectious diseases. This research targets pathogens that pose high risks to public 

health and national security. NIAID has designated pathogens with high mortality 

such as anthrax, plague, smallpox, and Ebola virus as NIAID Category A Priority 

Pathogens to highlight the need for medical countermeasures against these dangerous microbes. 

NIAID’s expanded efforts in biodefense and emerging and re-emerging infectious 

diseases were undertaken with specific objectives. The first is to advance basic and 

translational research and facilitate development of effective products to combat 

deadly diseases such as Ebola. The second is to employ innovative strategies, such 

as broad spectrum vaccines and therapeutics, to prevent and treat a variety of related infectious diseases. The third is to strengthen our partnerships with biotechnology and pharmaceutical companies to help accelerate the availability of needed products for affected and at risk individuals. 

Since 2001, NIAID’s biodefense research has supported the development and testing of numerous candidate products to prevent or treat viral hemorrhagic fevers, including those caused by Ebola and other related viruses. The progress we have 

made with candidate vaccines, therapeutics, and diagnostics for Ebola virus would 

not be possible had we not made this important investment. 

DEVELOPMENT AND TESTING OF EBOLA MEDICAL COUNTERMEASURES

In response to the Ebola public health emergency in West Africa, NIAID is accelerating ongoing research efforts and partnering with governments and private companies throughout the world to speed the development of medical countermeasures 

that could help control the current epidemic and future outbreaks. NIAID research 

on Ebola virus focuses on basic research to understand how Ebola virus causes illness in animals and in people as well as applied research to develop diagnostics, 

vaccines, and therapeutics. 

DIAGNOSTICS

Accurate and accessible diagnostics for Ebola virus infection are needed for the 

rapid identification and treatment of patients in an outbreak because the symptoms 

of Ebola can be easily mistaken for other common causes of fever in affected areas, 

such as malaria. NIAID continues to provide resources to investigators attempting 

to develop Ebola diagnostics. With NIAID support, Corgenix Medical Corporation is 

developing diagnostics for Ebola virus using recombinant DNA technology. NIAID 

also is advancing development of diagnostics, including those using novel technologies, which are capable of detecting multiple viruses including Ebola. Such innovative approaches can provide information critical to the creation of point-of-care 

diagnostics that could be distributed and used in areas where Ebola virus outbreaks 

occur. Intramural scientists from NIAID’s Rocky Mountain Laboratories (RML) in 

Hamilton, MT, and Integrated Research Facility in Frederick, MD, have responded 

to the epidemic by providing technical diagnostic support in Liberia. 

THERAPEUTICS

Currently, supportive care, including careful attention to fluid and electrolyte replacement, is the only effective medical intervention for patients with Ebola virus 

disease; no drugs are available specifically to treat Ebola virus infection. Experts 

are now evaluating whether drugs licensed or approved for the treatment of other 

diseases should be reevaluated for potential treatment of patients with Ebola in the 

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current epidemic on an emergency basis. In parallel, NIAID is supporting the development of novel therapeutics targeting Ebola virus. These investigational candidate 

therapeutics could possibly be used in clinical trials in the current epidemic and 

hopefully will prove to be safe and effective; if so, such treatments could be more 

widely available for future outbreaks. It is important to note that NIAID-supported 

candidate therapeutics are in early development and are currently available only in 

limited quantities. 

NIAID has provided support to and collaborated with Mapp Biopharmaceutical, 

Inc., to develop MB–003, a combination of three antibodies that prevents Ebola 

virus disease in monkeys when administered as late as 48 hours after exposure. An 

optimized product derived from MB–003, known as ZMapp, has shown to be substantially more effective in animal models than earlier combinations and protected 

monkeys from death due to Ebola virus up to 5 days after infection, according to 

Mapp Biopharmaceutical, Inc. NIAID’s preclinical services are now being used to 

provide pivotal safety data to support the use of ZMapp for clinical trials in humans. 

Mapp Biopharmaceutical, Inc., has announced that ZMapp was recently administered to humans for the first time as an experimental treatment to several Ebolainfected patients, including two Americans. It is not possible at this time to determine whether ZMapp benefited these patients. NIAID is working closely with partners at DoD, BARDA, and FDA to advance development and testing of ZMapp to 

determine whether it is safe and effective. BARDA has recently announced plans 

to optimize and accelerate the manufacturing of ZMapp so that clinical safety testing can proceed as soon as possible. 

NIAID also has funded BioCryst Pharmaceuticals to develop and test BCX4430, 

a novel drug that interferes with the reproductive process of the virus and has activity against a broad spectrum of viruses. According to BioCryst, BCX4430 has protected animals against infection by Ebola virus and the related Marburg virus. 

BioCryst has announced that a Phase 1 clinical trial of this drug is expected to 

begin in late 2014 or early 2015. 

In related work, NIAID intramural scientists at RML are working on therapeutics 

that might be effective against all hemorrhagic fever viruses including the 

filoviruses Ebola and Marburg and the arenavirus Lassa. Ribavirin, a drug currently used to treat hemorrhagic fever viruses such as Lassa virus, is being examined for its potential use in combination therapy to treat Ebola virus infection. 

NIAID scientists also are studying human interferons as Ebola therapies. Other 

therapeutics being examined by scientists at RML are in early stages of study and 

if successful, will advance to animal model testing. 

VACCINES

A safe and effective Ebola vaccine could be a critically important tool to help prevent Ebola virus disease and help contain future outbreaks. The hope is that such 

a vaccine could be licensed and used in the field to protect frontline healthcare 

workers and individuals living in areas where Ebola virus exists. Two Ebola vaccine 

candidates are entering Phase 1 clinical testing this fall. NIAID will play a critical 

role in advancing these Ebola vaccine candidates. The results of these Phase 1 studies will inform essential discussions about whether and how such vaccines could be 

of use in the current epidemic or future Ebola outbreaks. 

The NIAID Vaccine Research Center (VRC) has a robust viral hemorrhagic fever 

vaccine development program. Since 2003, the VRC has evaluated three early generation Ebola vaccine candidates and one Marburg vaccine candidate in Phase 1 

clinical trials at the NIH campus. An additional Phase 1 clinical trial was conducted 

in Kampala, Uganda, in collaboration with DoD. None of the early generation candidates raised safety concerns in these small trials; however, they did not elicit the 

level of immune response thought to be needed to provide protection against exposure to the virus. The data from those trials have contributed directly to the VRC’s 

current Ebola vaccine collaboration with the pharmaceutical company 

GlaxoSmithKline (GSK). VRC and GSK have developed an experimental vaccine 

that uses a chimpanzee virus (similar to the common cold virus), Chimp Adenovirus 

3 (CAd3), as a carrier, or vector, to introduce Ebola virus genes into the body; these 

genes code for Ebola proteins that stimulate an immune response. The vaccine candidate has shown promising results in animal models against two Ebola virus species, including the Zaire Ebola species responsible for the current epidemic in West 

Africa. A small Phase 1 study to examine the safety and ability of this candidate 

to induce an immune response in humans began on September 2, 2014, at the NIH 

Clinical Center in Bethesda, MD. Results from the study are anticipated by the end 

of this calendar year, and will help inform future development of the vaccine. 

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Additional Phase 1 clinical trials of Ebola vaccine candidates are expected to 

launch before the end of 2014. In October, testing will begin in the United States 

on a vaccine candidate derived from the CAd3-vector designed to protect against a 

single Ebola virus species, the Zaire Ebola virus. NIAID and GSK also will donate 

doses of this vaccine candidate to enable testing by NIAID partners in the United 

Kingdom and the West African country of Mali, where existing NIAID research infrastructure will support the vaccine trial. Also this fall, NIH is collaborating with 

DoD and NewLink Genetics Corporation on Phase 1 safety studies of an investigational Ebola vaccine based on vesicular stomatitis virus (VSV). The VSV vaccine will 

serve as a vector or carrier for an Ebola gene similar to how the Chimp adenovirus 

served as a vector or carrier as described above for the NIAID/GSK vaccine. This 

vaccine candidate was developed by and licensed from the Public Health Agency of 

Canada. 

In addition to these Ebola candidates entering Phase 1 trials in 2014, NIAID supports a broad portfolio of Ebola vaccine research, including partnering with biopharmaceutical companies. NIAID also makes preclinical services such as animal 

testing to advance product development available to researchers in academia and 

industry. More than 30 different filovirus vaccine formulations have been evaluated 

through NIAID’s preclinical services since 2011 using animal models and assays 

that NIAID has developed over many years. 

NIAID has supported the biopharmaceutical company Crucell to develop a recombinant adenovirus-vectored Ebola vaccine. In animal studies, this vaccine candidate 

protected against filovirus infection, including Ebola virus. NIAID has played an instrumental role in the recent announcements by Johnson & Johnson (parent company of Crucell) and Bavarian Nordic that they will collaborate on a two dose 

(prime-boost) vaccination regimen that will begin Phase 1 testing in 2015. 

NIAID intramural scientists are collaborating with Thomas Jefferson University 

investigators to produce a vaccine candidate based on an existing rabies vaccine. 

The researchers aim to generate immunity to Ebola, Marburg, and rabies viruses, 

important diseases in certain regions in Africa. The investigators plan to pursue a 

version of the vaccine for human and veterinary use as well as a version for use 

in African wildlife. The wildlife vaccine could help prevent transmission of Ebola 

virus from animals to humans. The vaccine candidate for use in humans is undergoing preclinical testing and has demonstrated protection against infection by rabies 

and Ebola viruses in animal models. NIAID is currently partnering with DoD to 

produce sufficient quantities of the vaccine candidate to begin clinical testing in 

early 2015. 

NIAID also is supporting the biotechnology company Profectus BioSciences, Inc., 

to investigate a second recombinant VSV-vectored vaccine candidate against Ebola 

and Marburg viruses. Profectus is pursing preclinical testing of the vaccine in preparation for a future Phase 1 clinical trial. Additionally, NIAID is collaborating with 

the Galveston National Laboratory & Institute for Human Infections and Immunity 

at the University of Texas Medical Branch at Galveston to further progress made 

by NIAID intramural scientists on a paramyxovirus-based vaccine against Ebola 

and Marburg viruses. 

Other NIAID-supported efforts include Ebola virus vaccine candidates in early development, such as a DNA vaccine targeting Ebola and Marburg viruses, an 

adenovirus–5-based intranasal Ebola vaccine, and a combination virus-like particle/ 

DNA vaccine targeting Ebola and Marburg viruses to be delivered by microneedle 

patch. Knowledge gained through these studies will further the goal of the ultimate 

deployment of a safe and effective vaccine that will prevent this deadly disease. 

CLINICAL TRIALS

It is important to balance the urgency to deploy investigational medical countermeasures in an emergency such as the current Ebola outbreak with the need to ensure the maximal safety and to determine the efficacy of candidate drugs and vaccines for Ebola. We will do this with the strictest attention to safety considerations, 

established scientific principles, and ethical considerations and compassion for and 

realization of the immediate needs of the affected populations. The U.S. Government, working in partnership with industry, has an established mechanism for testing and reviewing the safety and efficacy of potential medical interventions. We also 

have an emergent crisis in West Africa that demands a quick and compassionate 

response. 

NIAID is committed to working with our partners to evaluate candidate drugs 

and vaccines for safety and efficacy. We are working to generate the evidence to 

show whether potential interventions are safe and effective to reassure affected communities that we are pursuing the tools needed to prevent and treat this deadly disLIFEBOOK092 with DISTILLER

17 

ease. Our partnerships with industry will be critical to move these products expeditiously along the development pipeline into clinical trials. NIAID is currently working to accelerate the vaccines discussed above into Phase 1 clinical trials in healthy 

volunteers. The data from these trials will help demonstrate whether candidate 

Ebola vaccines are safe in humans and are capable of generating the desired immune response. Candidate Ebola treatments will be similarly evaluated for safety 

and markers of potential efficacy. If successful, these candidates will be advanced 

to further testing in larger numbers of people. As we proceed through clinical testing, we will continue to work with our partners in the FDA to accelerate development of and speed access to the products, while also protecting the safety and rights 

of study volunteers. 

CONCLUSION

While NIAID is an active participant in the global effort to address the public 

health emergency occurring in West Africa, it is important to recognize that we are 

still in the early stages of understanding how infection with the Ebola virus can be 

treated and prevented. As we continue to expedite research while enforcing high 

safety and efficacy standards, the implementation of the public health measures already known to contain prior Ebola virus outbreaks and the implementation of 

treatment strategies such as fluid and electrolyte replacement are essential to preventing additional infections, treating those already infected, protecting health care 

providers, and ultimately bringing this epidemic to an end. We will continue to work 

with biopharmaceutical companies and public health agencies throughout the world 

to develop and distribute medical countermeasures for Ebola virus disease as quickly as possible. NIAID remains committed to fulfilling its dual mandate to balance 

research on current biomedical challenges with the capability to mobilize a rapid response to newly emerging and re-emerging infectious diseases. 

ATTACHMENTS

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18 

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9/11 Attacks 

2001 Anthrax 

Attacks 

.t ~~}$:~. w.... ~ ........... u. ,.,l•·•#•l --~

Category A pathogens 

• Anthrax (Bacillus 

anthracis) 

• Botulism (Clostridium 

botulinum toxin) 

• Plague ( Yersinia pestis) 

• Smallpox 

• Tularemia (Francisella 

tularensis) 

• Viral hemorrhagic fever 

viruses (e.g., Ebola, 

Marburg, Lassa and 

Machupo) 
19 

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Viral Hemorrhagic Fever Viruses 

• High degree of lethality and high infectivity 

• Therapy: Mainly supportive 

• Vaccine: Not available at present 

Ebola Virus 

Source: CDC 
20 

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~ Vaccines 

Basic ~ Research 

Therapeutics ~ 

Diagnostics 

Resources for 

Researchers/ 

Industry to 

Advance 

Product 

Development 

Product Development Pipeline 

Early concept 

and product Advanced Commercial Regulatory development development manufacturing review 
21 

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NIAID Ebola Therapeutics in 

Development 

• ZMapp (Mapp Biopharmaceutical) 

-Combination of 3 artificially produced antibodies 

directed against the Ebola virus 

• BCX4430 (BioCryst) 

-A novel drug (nucleoside analogue) that interferes 

with the reproductive process of the virus 

• TKM-Ebola (Tekmira Pharmaceuticals) 

-Small inhibitory RNA molecule that interferes with 

the replication of the virus (supported by the 

Department of Defense) 

ZMapp Administered to Several 

Individuals 

August 21, 20 14 

DAILY[@NEWS 

Did Experimental Therapy 

Drug ZMapp Cure Two 

Americans with Ebola? 

Experts Can't Say, Yet 

M Engel 

Liberia: Two Ebola 

Patients Given All Clear 

after ZMapp Treatment 

August 27, 2014 

Newsweek 

UK Ebola Victim Treated 

with Experimental Drug 

Zmapp 

THE WALL STREET JOURNAL 

August 13, 2014 

Ebola Virus: Infected 

Priest Has Died in Spain 

M Moffett 
22 

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NIAID Ebola Vaccines in or 

Approaching Phase I Trials 

• NIAID/GSK (chimp 

adenovirus vector) 

Phase I trials initiated 

September 2014 at the NIH 

• Newlink (VSV vector) Phase 1 trials expected fa/12014 

• Crucell (adenovirus vector) Phase I trials expected fall 2015 

Other vaccines in development: Profectus (VSV vector); 

Bavarian Nordic (MVA vector); NIAID Intramural, 

Thomas Jefferson Univ. (rabies vector) 

National Institute of Allergy and Infectious 

Diseases (NIAID) 

Nationallnstitufl'S of Hea lth September 2014 

NIAID/GSK Ebola Vaccine Trial 

·'-~'L 

~ 

• 20 volunteers to receive 

vaccine to determine safety 

• First volunteer received 

vaccine on Sept. 2 

• Thus far, 1 0 of the 20 

volunteers in the study have 

received vaccine 
23 

The CHAIRMAN. Thank you, Dr. Fauci. 

Dr. Robinson, please proceed. 

STATEMENT OF ROBIN A. ROBINSON, PH.D., DIRECTOR, BIOMEDICAL ADVANCED RESEARCH AND DEVELOPMENT AUTHORITY, DEPUTY ASSISTANT SECRETARY FOR PREPAREDNESS AND RESPONSE, UNITED STATES DEPARTMENT OF 

HEALTH AND HUMAN SERVICES, WASHINGTON, DC 

Mr. ROBINSON. Good afternoon. Thank you, Chairman Harkin, 

Ranking Members Alexander and Moran, and other distinguished 

members of the committee. We thank you for your generous appropriations over the years and the opportunity to speak with you 

today about our government’s Ebola response efforts. I’m Dr. Robin 

Robinson, BARDA Director and ASPR Deputy Assistant Secretary 

in HHS. 

BARDA, which was created by the Pandemic and All-Hazards 

Preparedness Act in 2006, is the government agency responsible for 

supporting advanced development and procurement of novel and 

innovative medical countermeasures, such as vaccines, therapeutic 

drugs, diagnostics, and medical devices for the entire Nation. 

BARDA exists to address the medical consequences of biothreats 

and emerging infectious diseases. BARDA has supported medical 

countermeasure development for manmade threats on a routine 

basis under Project Bioshield and responded to emerging threats 

like the HIN1 pandemic in 2009 and the Avian H7N9 outbreak last 

year with CDC, FDA, and NIH. 

Today we face Ebola, which is simultaneously a biothreat and a 

material threat determination by the Department of Homeland Security in 2006 and an emerging infectious disease. As Dr. Fauci 

and Dr. Bell have said, when it comes to Ebola as a biothreat the 

best way to protect our country is to address the current epidemic 

in Africa, the worst in history. 

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BARDA works with its Federal partners to transition medical 

countermeasures from early development at NIH and Department 

of Defense and to advance development toward ultimate FDA approval. Since 2006 we have built an advanced development pipeline 

of more than 150 medical countermeasures for chemical, biological, 

radiological, and nuclear threats, and pandemic influenza. Seven of 

these products have received FDA approval in just the last 2 years. 

Today we are transitioning several promising Ebola vaccine and 

therapeutic candidates from early development under NIH and 

DoD support to advanced development. 

BARDA, in concert with our Federal partners, utilizes public-private partnerships with industry to ensure that we have countermeasures to protect our citizens. Over the past 5 years, BARDA, 

with NIH, CDC, and FDA and industry partners, we have built a 

flexible and rapid response infrastructure to develop and manufacture medical countermeasures. 

As a result of the Pandemic and All-Hazards Preparedness Reauthorization Act, an improved framework of medical countermeasures development has been afforded to Federal and industry 

partners. Indeed, last year we utilized these partnerships to design, 

develop, manufacture, test, and stockpile five vaccine candidates in 

record time for the H7N9 outbreaks in China. 

In the current Ebola response, we are working with a wider 

array of partners, including Canada, the U.K., West African countries, the World Health Organization, the Gates Foundation, and 

many others to make and test these Ebola product candidates. 

BARDA has established a medical countermeasures infrastructure to assist product developers on a daily basis and to respond 

immediately in a public health emergency. Today we’re using our 

Animal Studies Network to conduct critical animal challenge studies, our Centers for Innovation in Advanced Development and Manufacturing to expand production of Ebola monoclonal antibodies, 

and our Fill-Finish Manufacturing Network to fill Ebola antibody 

and vaccine products into vials. 

Additionally, our Modeling Division, which develops computer 

models of the medical consequences of manmade threats on a routine basis, is coordinating international and Federal modeling efforts on the current Ebola epidemic and possible impacts of nonmedical and medical interventions. Last, BARDA supports a largescale production of medical countermeasures as a response measure for public health emergencies. 

BARDA led the vaccine manufacturing responses in the H1N1 

pandemic in 2009 and the H7N9 outbreak in 2013. Today we are 

assisting the Ebola vaccine and therapeutic manufacturers with 

scaled-up manufacturing. Specifically, we are supporting the development and manufacture of the ZMapp monoclonal antibody therapy for clinical studies at one manufacturer; additionally, expanding overall manufacturing capacity of ZMapp by enlisting the help 

of other tobacco plant-based manufacturers; and third, seeking alternative Ebola monoclonal candidates to expand the production capacity. 

Additionally, BARDA is working with the NIH and DoD and industry partners to scale up the manufacturing of two promising 

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Ebola candidates, one of which Dr. Fauci talked about, for clinical 

studies in Africa next year. 

The fiscal year 2015 continuing resolution and appropriations are 

needed now to fund investments in these medical countermeasures 

candidates. BARDA faces challenges in the coming weeks and 

months with the manufacturing of these medical countermeasures, 

but the bottom line is that BARDA, with our Federal and industry 

partners, will use our collective capabilities to address today’s 

Ebola epidemic and to be better prepared for future Ebola outbreaks or bioterrorism events going forward. 

We thank the committee and subcommittee for your generous 

and continued support and the opportunity to testify, and I look 

forward to your questions. Thank you. 

[The prepared statement of Mr. Robinson follows:] 

PREPARED STATEMENT OF ROBIN A. ROBINSON, PH.D. 

Good afternoon. Chairman Harkin, Ranking Members Alexander and Moran, and 

other distinguished members of the committees, thank you for the opportunity to 

speak with you today about our Government’s Ebola epidemic response efforts. I am 

Dr. Robin Robinson, Director of the Biomedical Advanced Research and Development Authority (BARDA) and Deputy Assistant Secretary to the Assistant Secretary 

for Preparedness and Response (ASPR) of the Department of Health and Human 

Services (HHS). 

In 2006, the Pandemic and All-Hazards Preparedness Act (PAHPA) created 

BARDA and its parent organization, ASPR. Two years ago, the Pandemic and AllHazards Preparedness Reauthorization Act (PAHPRA) established the Public Health 

Emergency Medical Countermeasures Enterprise (PHEMCE). BARDA is the Government agency mandated to support advanced research and development and procurement of novel and innovative medical countermeasures such as vaccines, antimicrobial drugs, diagnostics, and medical devices for the entire Nation to address 

the medical consequences of chemical, biological, radiological, and nuclear agents of 

terrorism (‘‘biothreats’’) and naturally occurring and emerging threats like the H1N1 

pandemic, the H7N9 influenza outbreak last year, and the current Ebola epidemic. 

BARDA exists to address the medical consequences of these threats and to bridge 

the gap between early development and procurement of medical countermeasures 

for novel threats. Ebola is simultaneously a biothreat (with a Material Threat Determination issued in 2006 by the Department of Homeland Security) and an emerging 

infectious disease. The current Ebola epidemic is the worst on record. As CDC has 

said, we do not view Ebola as a significant public health threat to the United States. 

The best way to continue to protect our country from any domestic threat posed by 

Ebola is to take action to address the epidemic in Africa. 

BARDA works with our PHEMCE partners in HHS and other Federal agencies 

to transition medical countermeasures from early development into advanced development and ultimately to Food and Drug Administration (FDA) regulatory review 

and approval. Advanced development includes critical steps needed for a product to 

be ready to use, such as optimizing manufacturing processes so products can be 

made in quantity to scale, creating and optimizing assays to assure product integrity, conducting late-stage clinical safety and efficacy studies, and carrying out pivotal animal efficacy studies that are often required for approval. Since 2006, BARDA 

has managed the advanced development of more than 150 medical countermeasures 

for chemical, biological, radiological, and nuclear threats and pandemic influenza. 

Seven of these products have received FDA approval in the last 2 years alone. 

Over the last decade, the PHEMCE has supported basic research and early stage 

development of numerous Ebola and Marburg virus medical countermeasure candidates. Now, as a result of this work, several promising Ebola vaccine and therapeutic candidates have matured enough for BARDA to transition them rapidly from 

early development to advanced development. Our aim is to have products we can 

use in time to make a difference in the current Ebola epidemic. We seek to have 

FDA-approved medical countermeasures as soon as it is feasible. Specifically, 

BARDA is now providing assistance for the development and scaled-up manufacturing of the ZMapp monoclonal antibody therapeutic and two Ebola vaccine candidates, early development of which has been supported by the National Institutes 

of Health’s (NIH) National Institute of Allergy and Infectious Diseases (NIAID) and 

the Department of Defense’s (DoD) Defense Threat Reduction Agency (DTRA). 

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Working in conjunction with PHEMCE partners, BARDA uses public-private partnerships with industry to ensure that we have the medical countermeasures to protect the emergency health security of the United States. Over the past 5 years, 

BARDA—with NIH, CDC, FDA, and industry partners—has built a flexible and rapidly responsive infrastructure to develop and manufacture medical countermeasures. 

Last year, for example, in response to the H7N9 influenza outbreaks in China, the 

PHEMCE mobilized these partnerships to design, develop, manufacture, clinically 

evaluate, and stockpile several vaccine candidates in record time. In the current 

Ebola response, the PHEMCE is working with a wider array of partners in addition 

to our Federal partners. They include other countries, specifically the affected and 

at-risk African countries; the World Health Organization (WHO); the Bill and 

Melinda Gates Foundation; and others. These expanded partnerships are critical to 

our efforts to address the current Ebola epidemic. 

BARDA has established a medical countermeasure infrastructure to assist product 

developers on a daily basis. The medical countermeasure infrastructure also allows 

for BARDA to respond immediately in a public health emergency. Today, BARDA 

is using this infrastructure to respond to the current Ebola epidemic by helping to 

develop and manufacture several investigational Ebola therapeutics and vaccines. 

BARDA’s Animal Studies Network is conducting critical animal challenge studies 

for promising investigational Ebola therapeutic candidates. BARDA’s Centers for Innovation in Advanced Development and Manufacturing, established in 2012, are positioned to accelerate production of Ebola monoclonal antibodies, like those in 

ZMapp, in tobacco plants and mammalian cells if clinical trials demonstrate that 

ZMapp is safe and effective. BARDA will monitor ZMapp throughout the development cycle, and, if necessary, can shift funds to test other candidate therapeutics. 

Our Fill-Finish Manufacturing Network, established last year for pandemic preparedness, stands ready to formulate and fill Ebola antibody and vaccine products 

into vials for studies and other uses. The investments we have made to create this 

infrastructure over the past 4 years are helping us respond to the current epidemic. 

BARDA also supports large-scale production of medical countermeasures as a response measure for public health emergencies. BARDA led the manufacturing of 

vaccine and antiviral drugs in response to the H1N1 pandemic in 2009 and of vaccines as a preparedness measure for H7N9 in 2013. In the current Ebola epidemic, 

BARDA is providing assistance to vaccine and therapeutic manufacturers to scale 

up production from pilot scale, in which a handful of doses can be made, to commercial scale. For ZMapp, we are currently supporting the manufacture of enough doses 

for clinical safety studies, but we need to start now to expand the number of domestic manufacturers who can produce Ebola monoclonal antibodies using tobacco 

plants. Therefore, the Administration is requesting funding for this purpose through 

an anomaly to the fiscal year 2015 continuing resolution. Additionally, we are looking at alternative Ebola monoclonal antibody production systems, including those 

used for similar families of products in the commercial market, as a means of further expanding production capacity for this product. With respect to vaccines, 

BARDA is working with NIH/NIAID, DoD/DTRA, and industry partners to scale 

up the manufacturing of the two promising investigational Ebola vaccine candidates. To enable the conduct of clinical efficacy studies for investigational Ebola 

therapeutics and vaccines in Africa throughout the next year, we need appropriations to fund investments in these medical countermeasure candidates now as proposed through the continuing resolution anomaly. 

BARDA faces significant challenges in the coming weeks and months with the 

manufacturing of these medical countermeasures. The major challenge is being able 

to provide sufficient quantities soon enough to support clinical studies. BARDA is 

prepared to meet those challenges and provide resources, expertise, and technical 

assistance for other promising investigational Ebola vaccine and therapeutic candidates. We are working with our U.S. Government partners, new and existing industry partners, the WHO, non-governmental organizations, African countries, and 

others to meet these challenges. 

In conclusion, BARDA has established a solid track record in developing medical 

countermeasures. With the rest of the PHEMCE, we are using all of our capabilities 

to address the Ebola epidemic in Africa, and have identified crucial additional steps 

that can be supported through the fiscal year 2015 continuing resolution. BARDA’s 

investments today into Ebola medical countermeasures will address not only the 

current epidemic and any future Ebola outbreaks, but they will also help the United 

States to become better prepared for bioterrorism. Again, I would like to thank the 

committee and subcommittee for your generous and continued support, and for the 

opportunity to testify. I look forward to your questions. 

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The CHAIRMAN. Thank you very much, Dr. Robinson. Thank you 

all for your very succinct summations of your statements. We’ll 

start a round of 5-minute questions. I’m going to ask people to try 

to adhere to that. We have another panel that’s going to be very 

interesting also, Dr. Brantly, who is a survivor, and Ishmael 

Charles, who is a worker on the ground in western Africa. We 

would like to get to that panel this afternoon. 

I’ll start a 5-minute round. Dr. Bell, these disease outbreaks 

seem to be becoming more common because of the close proximity 

of humans and animals, because of the close proximity of humans. 

Travel is common, and what’s happened in West Africa I believe is 

due to a failure of the public health system or the nonexistence of 

a public health system in those countries. 

A couple of years ago, in traveling through Africa with Dr. 

Frieden it occurred to me that in some of these countries they need 

a CDC. They need an entity that is culturally sensitive, that involves people of that country, that can detect these early, do the 

epidemiological work, isolate and control at the beginning. And 

they need to be connected with our CDC so that we can work together. Last year, Senator Moran and I put money in the appropriations bill—I forget how much it was, $10 million or something 

like that—to start expanding this. 

Would you speak to this, and how important is it for these other 

countries to create their own version of the CDC so that these outbreaks can be controlled right from the beginning? In other words, 

every country having their own CDC. 

Dr. BELL. Yes, thank you, Senator. You make some very important points. There are some fundamental capabilities that we at 

the CDC almost take for granted because they’re so fundamental, 

that are really absent in many of these countries: basic laboratory 

capacity, rapid response teams, some understanding of what it 

takes to investigate an outbreak, emergency operations centers 

where we understand the structure that one needs in order to control, to identify and control an outbreak, telecommunications systems, some very basic capabilities. 

These are capabilities that we agree with you really need— 

they’re fundamental and really every country needs these capabilities. In many ways, that’s what the Global Health Security Agenda 

is about. 

I might give you an example from another country in Africa by 

way of contrast. We’re in the midst now of the largest and extremely challenging Ebola outbreak, but we at the CDC have actually been investigating and stopping Ebola outbreaks in East Africa 

for actually quite a long time. One of the countries in which we’ve 

been working is Uganda. If you look at the list of Ebola outbreaks 

of the past, you’ll see that many of them were in Uganda, some of 

the largest ones involving hundreds of people, which of course at 

that time we thought was a lot. 

Over the last decade or so, we’ve been working with Uganda, 

with the Ministry of Health and with the Uganda Virus Research 

Institute to build capacity there. They now have a laboratory, 

which allows them to do their own testing and detect Ebola and 

other viral hemorrhagic fevers. They have a transportation network, which allows them to move specimens around the country 

LIFEBOOK092 with DISTILLER

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and get them to the laboratory. They have rapid response teams 

that know how to find Ebola outbreaks and stop them. 

Consequently, what we’ve seen in Uganda over the last few years 

is more outbreaks being detected, which is good because we know 

that they’re going on, and then they’re much smaller, to the point 

where a year or two ago there was an outbreak of Ebola which involved one person. They were able to stop it after one person. Most 

of these are small clusters which are stopped quickly. 

This is an example of building the kind of capacity that you’re 

talking about, which is of benefit to the country. It helps the country solve some very fundamental health problems that they have. 

This is an example of the kind of thing that we think, we agree 

with you, really needs to be built in every country. 

The CHAIRMAN. I hope this Congress and the one to follow—I 

won’t be here, but the one that follows—will really take this up. We 

have spent lots of taxpayers’ dollars in shoring up military operations around the globe so people could defend themselves against 

insurgencies, could defend themselves. Yet on this one aspect we 

have been woefully inadequate. It’s like we expect our CDC to do 

everything. It can do a lot, as we’ve shown, but we need those other 

CDC’s in those countries out there. Think about those as forward 

outposts where people can defend themselves and in turn defend 

us from the rapid transmission of these viruses. 

I thank you very much. I thank Dr. Frieden and all of you down 

there for your great leadership. I hope that in the next few years 

we can see CDC replicated in countries around the globe. 

Thank you, Dr. Bell. 

Senator Alexander. 

Senator ALEXANDER. Dr. Bell, you and the other witnesses have 

carefully explained that we know what to do about Ebola and we’ve 

demonstrated that it can be controlled. However, in talking with 

you and Dr. Frieden, without putting words in your mouth, I can 

tell you feel like this epidemic, this outbreak, is a very, very serious problem that we ought to jump all over. 

Let me try to put that into some perspective. You said a moment 

ago that a few hundred cases would have been a big outbreak. 

Today the official report says you have identified a little less than 

5,000 cases, correct? But it might be higher than that. Is that 

right? What are the chances that that’s underreporting the number 

of cases in West Africa? 

Dr. BELL. Quite likely, Senator. 

Senator ALEXANDER. Quite likely higher. It’s also true that, of 

those cases that you reported, half of them were reported in the 

last 3 weeks, is that correct? 

Dr. BELL. More or less, yes, sir. 

Senator ALEXANDER. So if the number were 10,000 or 15,000 instead of 5,000, perhaps half those cases would have been reported 

in the last 3 weeks. 

Dr. BELL. Quite possibly. 

Senator ALEXANDER. The danger is the rapid infection. Why such 

a worry? Is it that the infection spreads more rapidly? Is that the 

concern? We’ve had many kinds of epidemics, but why such a grim 

outlook about this epidemic? Why does CDC say it may be the most 

dangerous epidemic of modern times if it’s not controlled? 

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29 

Dr. BELL. Yes, sir. Thank you, Senator. As you’ve heard, Ebola 

actually is not easily transmitted. It isn’t transmitted through the 

air and it requires direct contact with bodily fluids, with dead bodies. But what we’re seeing in this outbreak is, because of right now 

insufficient capacity to isolate patients with Ebola, we are seeing 

these chains of transmission. You can imagine, as the number of 

cases grows, the number of contacts for each case, that these 

chains of transmission continue to propagate. That’s how the number of cases grows and continues to grow faster as the number of 

cases increase. 

It’s really a matter of arithmetic, and it brings me to the point 

of what is the critical issue right now, especially in Liberia, but 

really in all of these countries. That is that we must come up with 

some ways to effectively isolate and treat Ebola patients. Right 

now our capacity—— 

Senator ALEXANDER. But first you have to find them, right? You 

have to chase down every infected person or person who might be 

infected, right? 

Dr. BELL. Right now, Senator, certainly in Liberia there are patients that we know about and there are no Ebola treatment units 

in which to house them. So yes, we must do meticulous contact 

tracing. We must identify all the potential cases, isolate them, 

check their temperatures for 21 days to make sure that they’re not 

infected. But right now, especially in Liberia, the problem that we 

have is that we don’t have measures to effectively isolate cases that 

we do identify. That’s right now the limiting factor, I would say, 

in Liberia. 

Senator ALEXANDER. So the new cases seem to appear to double 

in 3 weeks, and half those infected die? 

Dr. BELL. Right now it appears that’s the mortality rate, that’s 

right, sir. 

Senator ALEXANDER. Dr. Fauci, I have one question for you. Dr. 

Bell pointed out that you don’t catch Ebola by breathing on someone. It’s bodily fluids, usually when someone is infected and has 

symptoms. 

Dr. FAUCI. Right. 

Senator ALEXANDER. Or someone is dead. And those two instances are most of the infections. You were quoted recently as saying it’s not likely that Ebola will change how it’s transmitted, 

which produces an even more serious set of possibilities. Are you 

tracking the virus in this outbreak as it affects more and more people to see if in fact it’s mutating and changing in the way it’s transmitted, so that we’re not deceived by that? 

Dr. FAUCI. Very important question, Senator. So let me just first 

answer the question and then I’ll tell you what we’re doing to make 

sure we’re on top of this. Right now the Ebola virus is not transmitted by the respiratory route. There has been some discussion 

that since the virus replicates a lot—whenever you have an RNA 

virus, the more it replicates the greater the possibility of it mutating is. And most mutations are irrelevant mutations. They’re not 

associated with a biological change or a biological function. So even 

though you see a lot of mutations, it is unlikely that there will be 

a change, but there’s a possibility that there will be a change. 

LIFEBOOK092 with DISTILLER

30 

Usually when you have a change in function it could get a little 

bit more virulent, a little bit less virulent, be efficiently spread in 

the way it usually is spread or less efficient. It is an unusual situation where a mutation would completely change the way a virus is 

transmitted. It’s not impossible, but it would be unlikely. 

We never take anything like that lightly, we follow it very, very 

carefully. In fact, in direct answer to your first question, we have 

an arrangement with one of the best microbial sequencing groups 

in the world at the Broad Institute in Boston that is getting samples and looking at the evolution of the mutations to try and make 

sure that mutations are not occurring that would have an important impact on what we call a biological function, like transmissibility. 

The reason I made that comment is that I wanted to make sure 

that people understand that changing transmissibility so that it 

could be transmitted by the respiratory route is obviously something that could be a frightening thing. I want to make sure that 

people understand that we’re watching that carefully, but that’s an 

unlikely event, not an impossible event, unlikely. 

What is likely is that if we don’t do what we’re doing now in the 

sense of a major ramping up of infection control capabilities, including what we’re hearing about getting the military heavily involved with all of the things they bring to the table, it is very likely 

if we don’t stop this epidemic it’s just going to get worse and worse, 

the way Dr. Bell said. That’s the more likely phenomenon, so that’s 

the reason why we concentrate on getting it under control so you 

don’t give it the opportunity to mutate any more. 

A virus that doesn’t replicate can’t mutate. So if we just put the 

lid on this, that’ll be it. 

Senator ALEXANDER. Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you. 

I will recognize Ranking Member Moran next, and in order of appearance I have here, I have then Senator Warren, Senator Burr, 

Senator Reed, Senator Isakson, Senator Murray, Senator Cochran, 

Senator Casey, Senator Johanns, Senator Bennet, Senator Boozman, and then Senator Whitehouse, Senator Pryor, and Senator 

Durbin. 

Senator Moran. 

Senator MORAN. Chairman Harkin, thank you. 

Dr. Bell, thank you to you and Dr. Frieden for the visit we had 

in Atlanta a few days back and for the visit I had with Dr. Frieden 

in my office this week. At that point in time, I expressed to Dr. 

Frieden my request that he express gratitude on behalf of me and 

all of us in this country for the efforts by the people who work at 

CDC, who are working now globally, trying to contain and change 

lives. We’re very grateful for what you have undertaken. 

Let me ask first a question. Dr. Fauci just indicated about the 

potential response of use of the military. Is there something that 

you can say to the American people that assures them that our 

military men and women will be safe and secure from Ebola in the 

new tasks that they’re now being asked to undertake? 

Dr. BELL. Thank you, Senator, and thank you for the kind words 

about the CDC. 

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31 

The CDC already has more than 100 people in the field, and this 

question of safety and security of our own staff or any staff or any 

members of the U.S. Government or many of our colleagues here, 

their safety and security is really our No. 1 priority. We’ve been actually paying a lot of attention to this issue, certainly, as I say, 

starting with our own staff, with making sure that the staff understands what the situation is like on the ground before they go, having them understand very clearly what are the interventions that 

they need to take, making sure they have the right kind of personal protective equipment, that they understand some basic strategies in terms of distancing, and that they know what to look for 

should they start to feel ill. 

I think that the bottom line here is that it is a very dire situation. We are concerned about safety and security. We are taking 

that very seriously and have taken a lot of steps to do everything 

that we can to minimize the risk. But it is a very difficult situation 

and this is something that I worry about certainly every day with 

my own staff that are out there on the front lines. 

Senator MORAN. Let me expand my expression of gratitude to the 

private religious charitable organizations and health care organizations that are working globally, at significant risk to themselves. 

What kind of coordination, education, training, do you understand either has taken place in regard to our military and their 

preparation for this assignment? 

Dr. BELL. Senator, I don’t have any specific information about 

the preparation of the Department of Defense, but I will say that 

this is one of the areas that we at CDC have actually been working 

quite closely on, that being in training. Next week we’ll be hosting 

a course in Aniston, AL, at the FEMA facility there, which is a 3- 

day safety training for health care workers who are planning to deploy to work for nongovernmental organizations in Liberia, Sierra 

Leone, or Guinea. 

This is a course that our colleagues at Medecins Sans Frontieres, 

Doctors Without Borders, helped us develop, and the precise purpose is to explicitly teach—these are health care workers; they already know, supposedly, about infection control—but explicitly 

teach them about the important principles that they need to know 

in order to safely care for Ebola patients. There’s a mock facility 

there and, as I say, we’re hoping to actually have this course weekly over the next period of months. Our first course is actually completely full. There’s a lot of interest. And we think that this kind 

of training is really pivotal before Americans deploy to work in 

treatment facilities in the region in order, to your point, to make 

sure that they can care for patients safely. 

Senator MORAN. Dr. Bell, let me ask a broader question. How 

would you describe the best case scenario in regard to Ebola and 

its spread and consequences and the worst case scenario, and what 

is the difference—what is the item that makes the worst case scenario not happen, and the best case scenario to occur? 

Dr. BELL. The best case scenario is that over the coming months 

we’re able to effectively isolate and treat Ebola patients, we’re able 

to effectively trace all of the contacts, make sure they’re all followed for 21 days, and we’re able to do something about safe burial 

practices so that we don’t have bodies in the street and people are 

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able to respectfully bury their dead and not put themselves at risk, 

so that over a period of the coming months we’re able to interrupt 

chains of transmission and start to see this increase in cases that 

Senator Alexander was talking about, bend that curve in the other 

direction. 

The worst case scenario is that we continue to see the exponential rise in cases that we’re currently seeing. An important corollary of that is exportation to other countries. As I mentioned, 

we’ve already had exportation to Nigeria and Senegal. I will say 

that the situation in Nigeria was one that we were extremely concerned about. You could imagine, in a country like Nigeria, should 

we have Ebola get out of control how incredibly dangerous this 

would be. It was an enormous effort in order to get the situation 

in Nigeria to the point that it is today, which is that, while we’re 

not completely out of the woods, we do not think that there’s uncontrolled transmission happening in Nigeria. 

But just for an example, this involved following up on thousands 

of contacts, hundreds of people working in the emergency operations center in Lagos and then in Port Harcourt. So one exportation like that, it requires an enormous amount of work. 

If this outbreak spirals out of control, we can expect many more 

of these exportations to other countries. Each one of those, as I say, 

requires a huge amount of work, and we have no guarantee that 

we’ll be successful. You could imagine the outbreak spreading outside of the borders of the countries that are currently affected as 

certainly part of a worst case scenario. 

Senator MORAN. Thank you, Dr. Bell. 

The CHAIRMAN. I’m going to recognize Senator Reed. Before I do 

it, I just have one clarification. Dr. Fauci, you said this was nonrespiratory communicable. But what if someone sneezes on somebody? 

Dr. FAUCI. Mr. Chairman, there is no evidence, with a lot of experience over multiple outbreaks, including the current outbreak, 

that respiratory spread occurs, or if it does it’s extraordinarily rare. 

You never say never in biology, but people who have been in situations in which that particular phenomenon would have been noticed clearly indicate that that’s not the case. 

The CHAIRMAN. Got it. Thank you. 

Senator Reed. 

STATEMENT OF SENATOR REED

Senator REED. Thank you very much, Mr. Chairman. 

Let me first thank you and your colleagues for your extraordinary service to the Nation and to the world. One of the reasons 

that this issue is so important in Rhode Island is that we have a 

large Liberian community, probably the largest Liberian community per capita in the United States, and they are hardworking and 

they are terribly concerned about their families in Liberia. 

I want to thank, Dr. Bell, you and Dr. Moro, because Dr. Moro 

actually participated in a conference call with our Liberian leaders. 

Senator Whitehouse and I were both involved in setting it up. 

Thank you very, very much. 

I also want to join Senator Moran in saluting those volunteers. 

We have two doctors on the Brown University faculty, Dr. Tim 

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Flanagan and Adam Levine, who are in the country giving their 

skills and courageously working on behalf of the people of Liberia. 

Thank you for that. 

One other point I’ll make, and this is something of an aside. A 

number of the Liberians in Rhode Island and across the country 

are here legally on a status of deferred enforced departure, but let 

me make the point: That status expires September 30th unless the 

President extends it. I would hope that he would do so because to 

send people back to this, literally, danger would be I think inappropriate. 

But let me ask Dr. Fauci and Dr. Robinson, you talked about a 

vaccine. Do you have sort of a sense of how fast this could be deployed in West Africa? And second, would you reach the point 

where you basically said, it’s a huge risk, but it has to be done, 

even if you don’t have all of the usual protocols completed? 

Dr. FAUCI. Excellent question, Senator Reed. The standard way 

of implementing a vaccine in the field and deploying it is to go 

through a series of steps of what I just described—phase I, show 

is it safe and does it or does it not induce unexpected reaction, a 

hypersensitivity reaction or whatever; then find out what the right 

dose is and does it induce the right immune response. Then you go 

to larger numbers of people, because now you’re pretty sure it’s 

safe, you can do larger numbers of people in what’s called a phase 

IIA or IIB. 

Then, depending on the disease, you can go out in the field and 

test if it works, because the worst thing that you’d want is have 

a vaccine that you’re deploying that you think works, but it doesn’t 

work, or even one that would be even more terrible is a vaccine 

that actually makes things worse. 

So we have to consider all of that. But when you have an emergent situation like this, where you have the desire to get people 

protected if in fact the vaccine is protective, there are ways to get 

the answers, not as definitively as if you did a pristine type of a 

trial, but if you would then employ the people who are needing the 

vaccine as part of the clinical trial, where you either compare one 

vaccine against another or one dose against another, so that you 

accomplish two things. You try and determine if it’s safe and effective, even though it isn’t as definitive as the pristine trial, but at 

the same time by getting people into these expanded trials you actually make it available. 

Right now the thought is once we get this situation where we can 

say we know what the dose is and we know it’s safe, to have an 

expanded trial and within the context of that trial more people 

would get the opportunity to be vaccinated. 

I might say that the target of the vaccinations is clearly directed, 

among others, to the health care workers, the people on the front 

line, the emergency responders, because those are the ones that 

put themselves at risk, as did Dr. Brantly, in taking care of individuals. 

Senator REED. So if you can prove, which is what you’re trying 

to do right now, that it’s safe, but I don’t know if it’s effective, you 

can try to prove its effectiveness by inoculating the health care 

workers and others. 

Dr. FAUCI. Right. 

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34 

Senator REED. It’s better than nothing, but it’s not quite definitive. 

Dr. FAUCI. Right. Fully knowing that you’re not going to get a 

definitive answer. But still, when you’re in an emergent situation 

you’ve got to do the best with what you have. 

Senator REED. Briefly, any further comments, Dr. Robinson? 

Mr. ROBINSON. Commensurate with those clinical trials that Dr. 

Fauci is talking about is that we have to have the product there, 

the vaccines, to be made available. Part of that is taking these 

products that are very early in development, that are pilot scale, 

and making sure we can go to commercial scale and produce those 

in large quantities, so that these studies can be done and after 

that, if they are shown to be well tolerated and immunogenic and 

protective, that there’s more vaccine available. 

Senator REED. Thank you all for your extraordinary work, and 

please thank your colleagues, particularly those who are in the 

field at risk. 

Thank you. 

The CHAIRMAN. Thank you very much. 

Senator Burr. 

STATEMENT OF SENATOR BURR

Senator BURR. Mr. Chairman, thank you. 

Thank you to this panel, the next panel, and thousands who will 

be called into action over the next weeks and months, hopefully not 

years. 

Dr. Bell, you said if we don’t act now. Can you define ‘‘now’’ for 

me from the standpoint of a time line? At what point will we have 

reached where we said we’ve missed our opportunity? How long is 

that? 

Dr. BELL. Senator, I wish I had a crystal ball and could tell you 

precisely the answer to that. But the situation is quite fluid and 

I think it’s quite hard to predict with any kind of precision. I certainly can say that speed and scale is of the essence. 

Senator BURR. You used the term several times ‘‘controlling the 

outbreak.’’ Is controlling the outbreak the same or do you use that 

the same way you do ‘‘containment’’? 

Dr. BELL. Yes, sir, more or less, yes. 

Senator BURR. How do you achieve containment on a disease 

that’s already broken the containment? 

Dr. BELL. You can think of this as bending a curve. A curve is 

going in one direction. We want to make it go in the other direction. In order to do that, what we have to do is break these chains 

of transmission. The way we break the chains of transmission is by 

having effective ways, to isolate patients so that they can’t transmit and to make sure that there isn’t ongoing transmission happening, for example in health care facilities or from unsafe burial 

practices. 

Senator BURR. Let’s just take Liberia as an example, 1,383 cases 

in the last 21 days, and we’re surging through DoD the capacity 

for 1,700 beds in a country where they have zero now. My math 

is not great, but my math says we’re going to be behind the 

eightball on day one because we won’t have enough beds. 

LIFEBOOK092 with DISTILLER

35 

Dr. Fauci, I’m told the most infectious tool or method in these 

countries today is the back of a cab, where individuals ride with 

their family to find that there are no beds in the clinic and they 

ride home. Let me ask you, how long can the virus survive, whether it’s on a cab seat or whether it’s on a sheet or whether it’s on 

a table? How long can it infect somebody? 

Dr. FAUCI. There have not been definitive studies giving a timeframe. It is not very durable, it’s somewhat of a fragile virus. But 

we do know that people get infected from touching the dead bodies 

of people who have the virus—probably contaminated with blood or 

bodily fluids. It certainly is within the timeframe of when someone 

dies to a funeral, because that’s when people have been documented to get infected. 

I don’t think we could go, Senator Burr, beyond, giving you days, 

weeks, or whatever. But it clearly is not instantaneous, where once 

the virus gets out of the body it’s gone, because we know people 

have been infected at funerals by touching the body. 

Senator BURR. I understand on previous Ebola outbreaks we’ve 

seen five generations of transmission. How many generations of 

transmission have we seen so far with this epidemic and how many 

mutations are we seeing as the virus continues to spread with each 

chain of transmission? 

Dr. FAUCI. I can’t give you a number on that, but when you have 

an RNA virus it notoriously is a bad reproducer. It makes mistakes, and when it makes mistakes it mutates. Most of the 

mutations don’t mean anything. They’re just irrelevant. They’re 

called synonymous mutations. They don’t mean anything. 

Some of them, rarely, do mean something. Sometimes it means 

that it kills the virus. Other times it maybe modifies some of its 

biological function. 

I can’t tell you how many generations, but that could mathematically likely be figured out on the basis of a paper that just came 

out about a couple of weeks ago from Boston, where they looked at 

78 people and the virus taken from them, and if you did a mathematical computerized informatics you’d be able to say how many 

replications. I don’t have that number for you now, but you can determine that. 

Senator BURR. If you’d get that to us, I’d appreciate it. 

Dr. FAUCI. I will. 

Senator BURR. Dr. Bell, in recent days there have been reports 

of modeling that suggest we could see 20,000 cases a month and 

that the outbreak may last 12 to 18 months, which would calculate 

to roughly 360,000 cases. Again, I think we continue to be a step 

behind up until this point, this response point. On what projected 

number of cases and period of outbreak did the administration base 

its response strategy to date and the latest actions announced 

today? 

Dr. BELL. As you say, Senator, there have been a number of models out there and we ourselves have been working on a model, and 

I think it is certainly true that a number of these models predict 

without additional effective interventions that we could see hundreds of thousands of cases. So all of those modeling exercises I 

think have certainly been taken into account as we’ve been calling 

for additional interventions in these countries. 

LIFEBOOK092 with DISTILLER

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I think the critical point here is that those models for the most 

part, as I say, are based on not scaling up and what we’re doing 

right now is scaling up. In addition to all the things that the U.S. 

Government is doing to scale up, including the announcements 

from the Department of Defense, there are also many other international partners who are also scaling up—the World Health Organization, other countries, many nongovernmental organizations, 

some of our colleagues here that will be testifying in the next 

panel. There’s also more financing that’s become available, for example from the World Bank. The United Nations is becoming involved. 

I think that it’s fair to say that there is a general mobilization 

of forces here and what we’re looking for is, with that mobilization 

of forces, these models, what they’re predicting is not in fact what 

we’re going to see happen. 

Senator BURR. Dr. Bell, I appreciate that and follow it very closely, and I know the mobilization of most other countries and the 

United Nations is not near the timeframe that ours is, and that’s 

why it scares me to death. 

Mr. Chairman, thank you for your generosity, but let me ask Dr. 

Robinson, does BARDA have the resources it needs? 

Mr. ROBINSON. To begin the medical countermeasure development or advanced development, yes, for this fall. We don’t have 

going forward for Ebola next year to produce more vaccines and 

more therapeutics if we actually want to do more than just Zmapp 

for therapeutics. There are others that we have under consideration that Dr. Fauci has talked about. So we and others will need 

more funding, there’s no doubt about that. 

Senator BURR. Thank you. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you. 

Senator Murray. 

STATEMENT OF SENATOR MURRAY

Senator MURRAY. Thank you very much to the panel and Mr. 

Chairman for having this hearing. 

I’m very proud to represent a State that is producing some truly 

incredible research in the biomedical field, including several ongoing studies and efforts that are aimed at curing Ebola. We’ve got 

World Vision, which is supporting the Ministries of Health, the Geneva Foundation, which is working on a treatment drug. Washington State University’s Paul G. Allen School for Global Animal 

Health, they’re looking at some culturally appropriate ways to prevent further transmissions; and of course the University of Washington Katz Lab which is looking at some vaccines and drug development. We’re doing a lot out there. 

But the reality is that we all have to do more. I think it’s important to mention that one of the reasons I fought so hard to roll 

back sequestration in the Bipartisan Budget Act was to provide 

certainty for organizations like NIH and CDC, which have had to 

deal with, as we all know, some very steep and harmful budget 

cuts. I believe it’s going to be very critical that we continue to focus 

on rolling back this trend of disinvestment in research and development so we can ensure that our country continues to produce the 

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kind of live-saving, world-changing research that we know we’re capable of. But I am very concerned—I just need to say this—that fiscal austerity and the return of sequestration is going to continue 

to weaken our ability to respond to needs like this. 

Dr. Fauci, while you’re here, I wanted to ask you, can you talk 

a little bit about how the lack of budget certainty and sequestration 

and the budget fights of the last 2 years have really impacted the 

U.S.’s ability to respond to the Ebola situation? 

Dr. FAUCI. Thank you for the question, Senator Murray. I’d have 

to tell you, honestly, it’s been a significant impact on us, as you 

well know, and I know you’ve been fighting for us for quite a long 

period of time. Our budget has been flat since the end of the doubling in 2003, with the 2-plus percent inflationary index, that over 

a 10-year period we’ve lost about 22 percent in our purchasing 

power. 

That was the left hook. The right cross was the sequestration that came in and pulled out a significant amount of money, $1.5 

billion, of which we got reconstituted not all of it. We try to preserve the fundamental basic research of the investigators, the 

bright ideas that people have. If you want to preserve that, the 

money that you have for initiatives such as the development of vaccines and the development of drugs suffers, because it’s a balance. 

There’s programmatic initiatives and there’s investigator-initiated 

awards, and when you shrink the budget or don’t give even an inflationary increase all of that starts to whittle away and you get 

even secondary effects, like disincentives of getting bright people 

involved from your State or any State, who feel that there’s a disincentive to get involved. 

It has both in an acute and in a chronic insidious way eroded our 

ability to respond in the way that I and my colleagues would like 

to see us be able to respond to these emerging threats. In my Institute particularly, that’s responsible for responding on the dime to 

an emerging infectious disease threat, this is particularly damaging. 

Senator MURRAY. I hope that all of us keep that in mind moving 

forward. 

Again, I’m proud of the folks in my State. The Bill and Melinda Gates Foundation gave $50 million to scale up emergency operations. Paul G. Allen Foundation has contributed $9 million to 

open emergency operations sites in three of the most affected countries. 

Dr. Robinson, Director Bell, knowing that the Gates and Allen 

Foundations have stepped up that way and the money that is going 

to be included in this CR—thank you to our Appropriations chair 

who’s sitting next to me—is that enough money and global support 

to stop this outbreak? 

Dr. BELL. I’ll answer, Senator, for the CDC. We do appreciate the 

$30 million that’s in the CR. That amount of money is enough to 

keep us operating through the end of the continuing resolution on 

December 11th. It will allow us to keep our people in the field, to 

pay for our staff, and to begin to scale up in a way that we think 

is necessary. 

We will be kind of considering over the time period of the CR 

what additional resources we will need for the rest of the fiscal 

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year in order to fulfil our responsibilities and response to the Ebola 

outbreak in the way that we need to. 

Senator MURRAY. Dr. Robinson. 

Mr. ROBINSON. The $50 million that we requested will get us 

through this fall. If we want more vaccines and more therapeutics, 

there will have to be more funding for us to go forward. 

Senator MURRAY. Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you, Senator Murray. 

Senator Isakson. 

STATEMENT OF SENATOR ISAKSON

Senator ISAKSON. Thank you, Mr. Chairman. 

Dr. Bell, I want to echo what Senator Moran, Senator Harkin, 

Senator Alexander, and Senator Reed said about how proud we are 

of CDC. As one of Georgia’s two Senators, however, I want to add 

how proud we are of Emory University and Dr. Jim Wagner and 

the staff there—I know Dr. Brantly would probably feel the same 

way—as well as Phoenix Air, which I believe was the contractor 

from Bartow County, Georgia, that brought the patients back from 

Liberia to the United States. That was a tremendous effort. 

For the committee’s benefit, Saxby was gone when this happened, so I was the only Senator reachable by the press the day 

it was announced they were coming to Emory University. The press 

immediately looked for the wisdom in bringing an Ebola patient 

back to the United States, whether or not we had the capability of 

preventing the disease from spreading while we were treating 

Ebola patients. Emory University and the CDC did a marvelous job 

of making those transfers seamless and complete and proving to 

the media, that was trying their best to start a riot, I think, that 

the Ebola virus was going to be safely contained, that they were 

in the best place in the world. So you deserve a tremendous 

amount of credit. I just wanted to say that. I just wanted to say 

that publicly to you. 

Dr. BELL. Thank you, Senator. 

Senator ISAKSON. Tell me. You said this is by far the worst outbreak you’ve ever seen. What was the next worst before it in terms 

of numbers? 

Dr. BELL. Let’s see. 

Dr. FAUCI. Uganda in 2000. 

Dr. BELL. Yes. That was about 400 and some cases. 

Senator ISAKSON. Here’s my question, what makes this one so 

different? 

Dr. BELL. There are a number of factors, Senator, that has made 

this one quite a bit different. No. 1, this is the first time we’ve seen 

Ebola in a large urban setting. Our previous experience with Ebola 

outbreaks has been primarily in rural areas, and there are many, 

many different factors that come into play when you have Ebola in 

a situation with people packed very closely together in a large city. 

That’s one thing. 

Another issue that has been challenging is that the area, the sort 

of three-country area where the outbreak sort of began and has 

been propagating from, is an area with communities that are sometimes not very receptive to interventions by either government or 

by public health officials. 

LIFEBOOK092 with DISTILLER

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A third point is that these are countries with very, very weak infrastructure to start with. They’ve just been emerging from decades 

of war. They have very weak health systems and very little capabilities, to Senator Harkin’s point about public health capabilities, 

but even health care capabilities, so very little with which to battle 

this outbreak from the beginning. 

Senator ISAKSON. I’ve traveled extensively in West Africa and 

I’ve seen firsthand exactly—they’re almost bereft of health care facilities, of anything close to what we would consider to be reasonable. 

Which brings me to this question. When you described containment, you described a very labor-intensive process. You talked 

about people taking temperatures for 21 days to see if somebody 

who’s been exposed had been infected. You talked about monitoring. You talked about isolating. We’re sending 3,000 American 

troops to West Africa as I understand it. We’ve got 100 CDC personnel. We have NGO’s and other volunteers. But it seems like to 

me it’s going to take a lot bigger labor force just to contain the disease at its current level; am I correct? 

Dr. BELL. Yes, sir. There’s lots of different settings that we can 

talk about, but for example in the Ebola treatment units 90 percent 

of the staff are local. I think it is important to remember that the 

governments, the people in the countries and the governments 

themselves, are stepping up and, with assistance from those of us 

that have the technical capabilities, are really able to fill many of 

these roles and responsibilities. As I say, some of the work in the 

treatment units, much of this going out into communities every day 

and checking in with contacts to see how they’re doing, these are 

roles that the people themselves, the local people themselves in 

these countries, can undertake, as I say, with some technical guidance from some of us that have this experience. 

This is not to minimize the scale of the human resources that 

will be needed to contain this. But as I say, I think that there are 

many of these sorts of functions that we’re already seeing the local 

people help with. There’s also other groups around Africa, the African Union, many of our field training programs from around Africa, 

that are also stepping up. 

It is an enormous job, but it’s a job where I think there are lots 

of different sectors and parts of the local community in addition to 

the international community that can work together to address 

this. 

Senator ISAKSON. I know my time’s up, but I wanted to make a 

comment. At the Africa Summit, which was here just about a 

month ago, I had the privilege of participating in a lot of that with 

some of the West Africa leaders. I noted how they were begging— 

not begging, but they were wanting so much American knowledge, 

CDC, NIH, all the technology, but they seemed very—even the bordering countries seemed like they were very willing to provide 

manpower, but they badly needed leadership in terms of health 

care. Is that correct? 

Dr. BELL. Yes, sir. We’ve actually made quite a bit of progress 

in that regard over the last month or so and are working very 

closely with the African Union to have them deploy staff to the 

area. 

LIFEBOOK092 with DISTILLER

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Senator ISAKSON. Thank you very much. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you. 

Before I recognize Senator Casey, you mentioned all these different entities. Addressing this we have CDC, USAID, State Department, World Health Organization, and Doctors Without Borders. Can you tell us who’s in charge of coordinating our government’s response effort in Africa? 

Dr. BELL. Yes, sir. In terms of the U.S. Government, in each of 

the countries there is the Disaster Assistance Response Teams, the 

DART. This is a USAID umbrella under which all of the U.S. Government efforts are coordinated. We are quite well coordinated 

with the USG organizations. 

In the larger sort of undertaking, in each of these countries people are getting organized, generally speaking with the government. 

The CHAIRMAN. The USAID is in charge intra-country, in a country. But overall who is in charge of coordinating? 

Dr. BELL. The three countries together are all under the umbrella of the USAID DART. 

Senator MIKULSKI. Of USAID? 

Dr. BELL. Yes. 

The CHAIRMAN. I’m startled to find that out, that USAID would 

be in charge of coordinating. 

Dr. BELL. Well, it’s a disaster. When a disaster is declared—I 

don’t know; as we scale up, I’m sure that there’ll be other mechanisms for the various parts of the government to collaborate and 

coordinate with each other. But there is this kind of structure on 

the ground which is meant to—— 

The CHAIRMAN. I think this requires further looking into by this 

committee, by both these committees. 

Senator Casey. 

Senator MIKULSKI. I would concur, Mr. Chairman. 

The CHAIRMAN. Thank you. 

STATEMENT OF SENATOR CASEY

Senator CASEY. Mr. Chairman, thank you very much. 

I want to thank the members of the panel, Dr. Bell, Dr. Fauci, 

and Dr. Robinson, for being here. I also want to note the good work 

that’s been done by this committee and members of this committee 

for a lot of years, the chairman, Chairman Harkin, Senator Mikulski as well with her experience; grateful to work with them; Senator Burr, who has spent a lot of time on this and a lot of time 

on these issues and has become such a leading voice on this. 

I don’t want to plow ground that’s already been plowed through. 

I apologize for having to juggle two hearings. But I wanted to ask 

Dr. Bell. I know that one of the fundamental questions you’re 

asked is what’s the threat to the United States, if any, and how 

you articulate that. Let’s just say—for purposes of process and the 

mechanics of confronting this kind of a threat were it to arise 

here—pick a town in Pennsylvania. I won’t pinpoint one, but if 

there was a patient at a hospital in that town and they tested positive for Ebola, what would be the steps that would be undertaken 

at that point? 

LIFEBOOK092 with DISTILLER

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Dr. BELL. Yes, thank you, Senator. We have been working quite 

closely here in the United States to prepare for this sort of eventuality that you describe. As we’ve mentioned, Ebola really is not easily transmitted. 

I think in terms of helping to understand the context to answering this question, I just want to say a word or two about what a 

hospital in these countries in Africa looks like, as a way of contrasting. When we think of a hospital, we think of a shiny, clean 

building with lots of equipment. Most of the hospitals in this region, as many of you that have traveled to this area are aware, oftentimes there’s no running water, there is no soap, there may not 

even be beds. There may be mattresses on the floor. Every health 

care worker is caring for a large number of patients. There’ll be 

beds around them. They may not have the appropriate personal 

protective equipment, like gloves and gowns and masks. 

That’s the environment in Africa where Ebola is currently raging. In the United States, by contrast, we have many, many protocols in place, and with these protocols most hospitals that can isolate a patient in a private room with their own bathroom and can 

follow very strict and meticulous infection control practices which 

have been well outlined and which health care workers are quite 

aware of, can safely take care of Ebola patients. 

I’ll mention that, while we haven’t taken care of any Ebola patients prior to this outbreak here in the United States, we have 

safely cared for at least five patients in recent years who have had 

other viral hemorrhagic fever, what we call Marburg virus and 

Lassa fever. In each of these circumstances, these patients were 

cared for quite safely in our hospitals around the country and we 

didn’t see any ongoing transmission. 

While this is certainly something to be taken quite seriously and 

we’re doing a lot to educate health care workers, to educate laboratory workers, and to answer people’s questions, to sensitize them 

to these issues, really most hospitals in the United States with 

these sort of basic capabilities should be able to safely care for 

Ebola patients. 

Senator CASEY. Thank you, doctor. 

I have limited time, but I wanted to ask Dr. Fauci one question. 

You noted in your testimony there are a number of Ebola therapeutics and vaccines in development. Recognizing that all these 

products are still rather early in their development, do any of them 

have clear advantages or disadvantages over the others? Can you 

make that assessment yet? 

Dr. FAUCI. No, I don’t think, honestly, Senator Casey, we can say 

that, because apart from ZMapp and one other perhaps, they have 

not really been in humans. We have in the past had experience 

where things look really good in an animal and then when they get 

into the human for one reason or other it doesn’t work or it’s too 

toxic. 

It would be premature—I can say that there are a number of 

candidates that look favorable enough in an animal model that 

we’re enthusiastic about moving them into a phase I and then beyond that. So there are a number of candidates that have a favorable profile in an animal model. But I think it would be unwise to 

LIFEBOOK092 with DISTILLER

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say this one looks a little better than this one, because it just is 

too premature to do that. 

Senator CASEY. I know I’m out of time, but I hope there’s nothing 

that the Congress has not done, not been able to achieve, that 

would be an impediment for you to be able to answer that question 

down the road and to be able to make the progress you want to 

make on these developments, because we have an obligation, I believe, to fund NIH and to fund this research in a manner that leads 

to the result that we hope. I think that’s a bipartisan obligation 

and I say it for the record. 

Thanks, doctor. 

Dr. FAUCI. Thank you. We appreciate it very much, sir. 

Senator CASEY. Thank you. 

The CHAIRMAN. Thank you, Senator. 

Senator Boozman. 

STATEMENT OF SENATOR BOOZMAN

Senator BOOZMAN. Thank you, Mr. Chairman, and thank you 

very much for having this hearing, you and the rest of the leadership on both sides. This is so important. 

To you all, we appreciate you being here. All of you have just 

sterling, excellent reputations and we appreciate the fact that 

you’re working very, very hard to keep us safe. 

From what I’ve read and from the testimony, it seems like speed 

is important, education is important, coordination is important. We 

have the CDC involved. We have the NIH. We have the DoD. We 

have the Department of State. Samantha Power is calling the Security Council for the first time ever in an event like this. 

I would like to get into this a little deeper—we heard that 

USAID was distributing stuff over there. Who’s in charge of all of 

that at the Washington level? Who’s taking this on so that we can 

get coordination, so we can get speed and get the education component done? Is that CDC? Are you doing that, Ms. Bell? Dr. Bell, 

I’m sorry. 

Dr. BELL. That’s OK. We at CDC have the lead on the public 

health aspects of the response. The DoD and USAID have the lead 

on logistics and material. The National Security Council is coordinating, certainly from Washington, and it’s really important that 

we draw on all of our assets from all of the different agencies working in our particular lanes and coordinating all together. 

There is very strong inter-agency coordination. The NSC is deeply involved in bringing all the agencies together, and we at CDC 

take the lead in the public health aspect. 

Senator BOOZMAN. Good. I hope we get this worked out where we 

actually have somebody that we can point to, an individual that’s 

kind of in charge of coordinating, because the same thing that’s 

going on on the ground, that needs to be going on over there, is 

simply not going to happen without that happening here. 

One thing that’s happened, Dr. Bell, Dr. Fauci, there’s an Ebola 

outbreak going on in the Democratic Republic of the Congo. Is that 

related to this or is this a whole separate thing that we’ve seen in 

the past? 

Dr. BELL. I’ll say something. I’m sure Dr. Fauci can add. This 

outbreak is not related to what we’re seeing in West Africa. As you 

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43 

say, Senator, this area of DRC is an area in which we’ve seen many 

Ebola outbreaks in the past, and this outbreak is of a strain that’s 

quite similar to those outbreaks. So while we are taking it very seriously, and actually CDC have sent a team into that area, we 

don’t think that that outbreak is at all connected. We’re actually 

aware of the individual case that began that outbreak and it had 

no relationship to what’s been going on in West Africa. 

Dr. FAUCI. I agree with Dr. Bell that that will be determined. It 

does not look like it’s the same. The extraordinary ability to do 

rapid deep sequencing of the genome of these viruses can actually 

pinpoint whether or not they’re related. It’s very interesting that 

the study that was done and published very recently showed the 

exact point introduction of what we’re seeing in West Africa and 

how it went from Guinea to Sierra Leone to Liberia, and it doesn’t 

look like the strain that is in the Democratic Republic of the Congo 

is in that lineage, even though it’s the same general strain. 

Senator BOOZMAN. Dr. Bell, can you reassure the—I know the 

public is concerned about bringing it into the country. Can you talk 

to us a little bit about the steps with helping those that are at the 

airports and identifying people that possibly have the virus? 

Dr. BELL. Yes, Senator. It’s certainly quite understandable why 

people would be concerned. The images that we’re seeing are quite 

alarming. As you know, we have been working in the countries to 

improve their abilities to do exit screening. We have teams in each 

of the countries and we’ve really been able to help them improve 

their capability to do exit screening considerably over the last 

month or so and are quite pleased with the progress in these countries. 

They have equipment. They understand what they’re supposed to 

do. They have the protocols in place and they are really moving forward. 

In addition, I’ll mention that we also have been doing a lot of 

work with our own border agencies, so with the TSA and with the 

CBP, to train them so that they understand what to look for and 

they understand when they need to call on us—as you know, CDC 

has quarantine stations in the major airports around the country— 

so that they also are sensitized to what needs to be done. 

Then the final point I guess I would make on this topic to Senator Casey’s point is that we’ve done a lot of work here in the 

United States with health care providers, even with just citizens, 

so that they know what to look for, to remember to ask for a travel 

history. There are a number of our Laboratory Response Network 

laboratories around the country who now have the capacity to test 

for Ebola, and then the health care facilities themselves are very 

tuned into the appropriate isolation methods that would be needed 

should they have a suspected Ebola patient. 

Senator BOOZMAN. Thank you, Mr. Chairman. 

Thank you. 

The CHAIRMAN. Thank you, Senator Boozman. 

Senator Bennet. 

STATEMENT OF SENATOR BENNET

Senator BENNET. Thank you, Mr. Chairman. Thank you very 

much for holding this hearing. 

LIFEBOOK092 with DISTILLER

44 

Dr. Bell, you mentioned in your opening comments a particular 

problem in Liberia of there being a lack of isolation capacity. I wonder if you could describe for us—if everything actually worked the 

way it’s supposed to work to make the decision, to make these 

fundings, first of all, what the experience of somebody today who’s 

infected with Ebola is in Liberia if they don’t have access to an isolation chamber; and then second, what you would expect to be the 

progress points we need to see in order to know that we’re actually 

creating an infrastructure that really can change the outcomes, the 

course of the disease? 

Dr. BELL. Yes, thank you, Senator. As you mentioned, there are 

not enough treatment facilities, isolation facilities, in Liberia right 

now to take care of all of the cases. Because of that, there is ongoing transmission that’s occurring because we can’t isolate them. So 

we’re working on this in a number of fronts. 

First, as many of the Senators have mentioned, we will be building more Ebola treatment units, and in addition a number of other 

entities, including the government of Liberia, are also building 

Ebola treatment units. So there will be a scale-up of Ebola treatment units. Medecins Sans Frontieres is building another. There’s 

a number of groups that are actually working to scale it up. 

In the mean time, there are a number of interim measures that 

we’re also going to be taking so that people can be isolated safely 

not in a treatment unit. So there’s a number of ways to approach 

that. There are community sort of holding centers, for lack of a better term, where people can be isolated safely with one caregiver 

and that caregiver can be provided with the appropriate personal 

protective equipment that they need to prevent transmission to 

themselves. 

There are also some efforts afoot to do that in households, where 

a caregiver in a household would be given a kit which provided all 

the equipment that the person would need to protect themselves 

and also some of the medications, such as oral rehydration for example, Tylenol to help with fever, that the patient themselves 

could use during their illness. 

There’s a number of different kinds of interim measures that 

we’re working to scale up now at the same time as we’re working 

on building additional isolation facilities in Liberia. 

Senator BENNET. How are you or with whom are you working to 

make sure that that work is actually happening, rather than just 

being thought about? 

Dr. BELL. There is actually quite a bit going on right now. Actually, USAID has been working with a number of nongovernmental 

organizations, including MSF. They’ve actually produced tens of 

thousands of these kits and have a plan in place to scale them up 

to hundreds of thousands in the near future. 

Senator BENNET. Thank you. In his first question or one of his 

first questions the chairman talked about the need to have a CDC 

or something like it in every country, and that is something I think 

we ought to aspire to. We have a long way to go to get there. I just 

wondered if you could talk a little bit about the efforts that you’re 

making to create a more global, interoperable network of real-time 

detection of diseases and collaboration among these various countries in our response? 

LIFEBOOK092 with DISTILLER

45 

Dr. BELL. Yes. Part of our response here is to buildup these basic 

capacities in these countries. In addition, right now as an urgent 

matter we’re working to buildup these capacities in the bordering 

countries—laboratory capacity, emergency operations centers, rapid 

response teams, beginning planning on what they would need to do 

in terms of isolation should they need to do that, working on culturally appropriate burial practices. 

In those bordering countries that’s an urgent priority for us. 

Then across the rest of Africa we’re also working to harden the 

countries’ ability to be able to recognize imported cases, to know 

who is the incident manager, how is their emergency operations 

center going to work, and what are the steps that they would take 

in order to respond to an additional case. Do they know how to do 

contact tracing? Who would be responsible for the contact tracing? 

Where would they isolate the patients? These are all things that 

we’re working on now in the context of this outbreak. 

In the bigger picture, these are basic capabilities that the Global 

Health Security Agenda, for example, has been calling for. As you 

probably know, we at CDC have been working with a number of 

countries in a pilot kind of way over the last couple of fiscal years 

to show the proof of principle of what global health security can 

mean, to detect, to respond, and to prevent these outbreaks with 

basic capabilities around laboratory capacity, around communications strategies, around emergency operation centers, basic epidemiology. 

These are all fundamental capabilities that country by country 

we really need to build if we want to prevent this kind of thing 

from happening again in the future. 

Senator BENNET. Thank you. I appreciate that testimony. Thank 

you for your testimony. 

Thank you, Mr. Chairman. 

The CHAIRMAN. I would say to my colleague from Colorado that 

last year the Appropriations Committee put in $6 million to start 

this process of establishing CDC’s in key countries designated by 

CDC. I understand that some time this fall, the CDC will announce 

those initial grants. 

We put $10 million in the appropriations bill this year to continue that effort. In light of the Ebola outbreak and others, I am 

hopeful that maybe we can take a second look at this if in fact we 

do have an omnibus appropriations bill that we can do, that we 

might want to put some more in there, understanding of course you 

can’t do it all at once, but still so that the pipeline is there, that 

we can start bringing people to train them, train them in laboratory procedures, start buying the equipment they need, to kind of 

get a jump start on even more countries next year. 

Senator BENNET. I appreciate that. I think there are a number 

of us that would love to work with you and the chair of the Appropriations Committee on this. 

The CHAIRMAN. We need the money, that’s right. Thank you very 

much. 

Senator Whitehouse. 

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46 

STATEMENT OF SENATOR WHITEHOUSE

Senator WHITEHOUSE. Two questions. I’m not expert in epidemics 

and I don’t know if there are accepted stages in the acceleration 

of an epidemic, when it goes from just an outbreak to a full epidemic to a raging out of control forest fire. If there are, what are 

the red flags that we should be looking for that this epidemic has 

gone to the next stage in terms of the threat that it presents? 

Dr. BELL. There are some key indicators that we use. It sort of 

depends on the situation what the indicators are. In this situation, 

certainly there are some basic indicators, like the number of cases 

and the number of cases per week, as Senator Alexander has discussed. There are other indicators, for example the number of cases 

in health care workers. We should not be seeing cases in health 

care workers if our infection control interventions are working. 

After that, I think that we are working to track things like 

whether patients that need to be isolated have a way to be appropriately isolated, whether or not we stop seeing bodies that can’t 

be picked up in a timely fashion, and a number of different sort of 

indicators like that that we use to help us understand if in fact 

we’re bending the curve and whether it’s going in the right direction. 

Senator WHITEHOUSE. When you consider the existing effort, 

which has been heroic, but measured against the threat has obviously not kept it from accelerating, how many multiples of the existing level of effort do you think are required to be able to get 

ahead of this and bring it back under control? Ten times the effort, 

a hundred times the effort? 

Dr. BELL. I would say a very large increase in the effort, and also 

a very large increase in the effort with a sense of urgency, so that 

the increase happens very quickly. It’s hard to say how many multiples, but there needs to be—and I think we can safely say that 

there is—— 

Senator WHITEHOUSE. We’re not even close to meeting the threat 

right now? 

Dr. BELL. I would say that the sorts of interventions and scaleup that we’ve been hearing about in recent days is the sort of scale 

that we need in order to address this outbreak, this epidemic. 

Senator WHITEHOUSE. Dr. Fauci I guess might be the best person 

to answer this question. Is this a virus that is capable of being manipulated by humans? Could one go into it if one had a sample of 

the Ebola virus and meddle with a portion of the DNA strain that 

relates to how it’s transmitted? Could somebody up to mischief try 

to make something that was more transmittable out of this existing 

virus? 

Dr. FAUCI. Theoretically, you can manipulate almost any virus to 

change it any way you want. That’s a question that always raises 

red flags about it, but the fact is yes. The only trouble is it wouldn’t 

be easy for somebody to do that in their laboratory backyard. They 

would probably kill themselves doing that. 

Senator WHITEHOUSE. It would take a nation State to do that? 

Dr. FAUCI. Yes, it would take a state-type thing. I don’t know 

whether you were here when I made my opening presentation, Senator Whitehouse, but I mentioned that our getting involved in the 

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47 

hemorrhagic fever viruses was part of a biodefense agenda because 

way back during the cold war it was clear from intelligence and 

proven that the Soviets were stockpiling hemorrhagic fever viruses 

and things like that for just the purpose that you make. 

So it would have to be a State thing. I don’t think you’re going 

to get some rogue person being able to do that. 

Senator WHITEHOUSE. Senator Burr and Senator Casey and others and I, would love to work with you on trying to explore that 

further. Thank you very much. 

The CHAIRMAN. Thank you, Senator. 

Senator Durbin. 

STATEMENT OF SENATOR DURBIN

Senator DURBIN. Dr. Bell, is CDC working with the World Health 

Organization? 

Dr. BELL. Yes, we are, Senator, very, very closely. 

Senator DURBIN. It is my understanding that the President submitted the name of Dr. Frieden from the CDC to be our representative to the World Health Organization in July of this year and it 

is still lost somewhere in the U.S. Senate. I would hope before this 

week ends and we return home that we might consider bringing 

this to the floor on a bipartisan basis and expedite the appointment 

of Dr. Frieden, whom we know well and we have studied, we know 

his background, so that he can be with the WHO and not wait for 

2 months or more for us to return and consider that nomination. 

I’d like to suggest that to the chairman and see if we can get that 

done. 

I’d like to ask a second question of Dr. Fauci, following up on 

what Senator Casey said, which was: 

‘‘I hope that there’s nothing that’s been done on a budgetary 

basis that has slowed down the development of an Ebola vaccine or a response that might be helpful.’’ 

You’ve talked about a 22 percent decline in the funding in NIH research over the last 10 years and the impact of sequestration. Has 

there been to your knowledge any shortage of funds which has led 

to a delay in testing or development of an Ebola vaccine? 

Dr. FAUCI. I think one could say honestly, Senator, that everything really over the last several years, with few exceptions, has 

been at a level less productive than we would been, purely on the 

basis of significant constraints. I don’t think we can say that 

there’s been a serious delay in this particular vaccine. I think that 

would be an overexaggeration. I would have to put it under the 

umbrella of the entire effort that we’ve been putting forth over the 

last several years have had to be muted somewhat by a budget that 

in real dollars is shrinking. 

Senator DURBIN. It’s my understanding, based on WHO statistics 

that I’ve read, about the physicians per capita that in my home 

town of Springfield, IL, with about a population of 100,000, there 

would be expected to be 240 physicians, in Sierra Leone two physicians for 100,000 people, and in Liberia one physician for 100,000 

people. 

That I think is an indication, at least a few years ago, a snapshot 

of the scarcity of medical professionals at the highest level, doctors 

LIFEBOOK092 with DISTILLER

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and such. I have been working and we included in the immigration 

bill which passed the U.S. Senate a provision which provided in 

one respect if you are medically trained in Africa and have promised to serve in Africa for a certain period of time before going anywhere else that we would honor that, respect that, and not allow 

people to be recruited into the United States when they still had 

an obligation to their country; and second, that doctors in the 

United States would be able to serve in these crisis situations overseas without jeopardizing their immigration status. That passed 

the Senate. That was in the immigration bill. It was never called 

for consideration in the House of Representatives. 

Speak to, not just the terrible infrastructure when it comes to 

hospitals, but the medical professionals and the health workers 

available in these countries that are facing this. 

Dr. BELL. Yes, Senator, you’re right that the number of doctors 

in Liberia and in Sierra Leone is extremely small. In Liberia I 

think the number of doctors before the outbreak numbered in the 

hundreds, as you say. Tragically, because of sort of the lack of infection control and the very, very poor conditions in the health care 

facilities and the inability of the health care workers to recognize 

Ebola patients when they came with a fever, and you think it’s malaria, it turns out it’s Ebola, and the fact that the health care workers were not able to protect themselves, tragically, a lot of these 

sort of scarce health care workers have died in the context of the 

Ebola outbreak. 

Many of these facilities now, that already were very rudimentary, are closed. This is one of the things that we need to do, 

is to train in infection control, provide appropriate personal protective equipment, and get the facilities back up and running safely, 

so that we don’t continue this spiral of not only the Ebola outbreak, 

but also many other conditions that are actually not getting treated 

right now in these countries. 

Senator DURBIN. We’ve learned the hard way that these countries with very few medical resources, when they face this kind of 

epidemic challenge, are only a 10-hour plane ride away from the 

United States. 

Thank you. 

The CHAIRMAN. Senator Durbin, I must say that when you talked 

about Dr. Frieden’s nomination I thought that we’d dropped the 

ball on this. How could we have dropped the ball on something like 

this? I just found out that it does not come to this committee, but 

to the Foreign Relations Committee. So hopefully, hopefully—— 

Senator ALEXANDER. Mr. Chairman, the information we have is 

the President didn’t nominate him until the end of July. We were 

gone in August. The Foreign Relations Committee staff is meeting 

with him tomorrow. They’re doing that in a bipartisan way. They 

could move him. I heard Senator McConnell say on the floor this 

morning that he supported President Obama’s proposals to deal 

with Ebola. I know of no reason why the Majority Leader and the 

Whip couldn’t work with Senator McConnell and bring it up before 

we leave. 

I would hope so, and I would be glad to support that, as I imagine the chairman would. 

LIFEBOOK092 with DISTILLER

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The CHAIRMAN. I would support him. I’m not on the committee, 

but you know, one of those little meetings in back of the Senate 

floor, like we do all the time; get that job done in a hurry. 

Our wonderful chairman of the full Appropriations Committee, 

Senator Mikulski. 

OPENING STATEMENT OF SENATOR MIKULSKI

Senator MIKULSKI. Thank you very much, Mr. Chairman. First 

of all, thank you for organizing this hearing of both the authorizing 

and the appropriations committee, and to my colleagues for such 

strong bipartisan participation in this. 

I want to thank the people at the head table and all who work 

behind them for the outstanding job they’re doing to organize the 

American government’s response to this, and also to Dr. Brantly 

and Mr. Charles, representatives of the people who are really in Africa trying to help people in this most horrific of challenges facing 

not only the countries, but the people, and particularly the workers 

who are there that must be facing just incredible stress. 

This is such a grim, horrific proportion, and they’re working 36- 

hour days, just as you are. We want to acknowledge that and thank 

them. 

Mr. Charles, it’s wonderful to have you here. Dr. Brantly and 

Mrs. Brantly, good to see you. What’s so great about seeing you, 

Dr. Brantly, is, one, that you’re well enough to be here, you were 

well enough to travel here, and you’re well enough that we’re not 

afraid to have you here. We can smile, but this is a stunning, stunning, stunning accomplishment. But again, we’re glad to see you. 

Mrs. Brantly, you look so much like Samantha Power, I said, 

what is Samantha Power doing sitting next to Dr. Brantly? We 

could send you to the U.N. and I bet you’d have a lot to say that 

would shake them up in helping them respond. We’re glad that 

you’re here. 

I want to make a couple of comments and then a few questions 

if I could. First of all on this issue of who’s in charge that was 

raised by both Senator Harkin and Senator Boozman, I think 

USAID is in charge of responding in a disaster—an earthquake, in 

Haiti, the many disasters—and they’re to be acknowledged for their 

ability to do that. But the size and scope and multiple government 

agencies involved in this I think needs a higher authority that actually can command personnel and organize, working with us on, 

again, a bipartisan basis, for the kind of resources to do this, because just listening to what we’re doing today, we need the HELP 

Committee, we need Labor. Now go to the Appropriations Committee. We’re going to need Foreign Ops and we’re going to need 

DoD. Within the Labor-HHS subcommittee, it’s CDC, it’s NIH, it’s 

FDA. 

Mr. Chairman, working across the aisle, we should ask the President, through whatever mechanism they’re going to say, we need 

a point person in addition to OMB, which will be here, to do this. 

Dr. Bell, do you want to comment? 

Dr. BELL. I thank you, Senator. I just wanted to make sure that 

I didn’t create a misconception in what I said about the DART. 

What I meant was on-the-ground coordination in the middle of that 

area USAID is coordinating. But I take your point and I think—— 

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Senator MIKULSKI. Well, here is my point. 

Dr. BELL. Yes, ma’am. 

Senator MIKULSKI. That presuming that there is a bipartisan 

group and there is the will here—we have one of the leading Senators within the Republican Party. Senator Burr has been one of 

the leading experts on biohazards. We worked together to create 

BARDA. If we wanted to meet with the person in charge, who 

would be the person in charge? AID? Frieden? Dempsey? Kerry? 

Dr. BELL. I take your point, Senator. 

Senator MIKULSKI. Dr. Rice? We want to maximize and leverage 

everything we have and also create that sense of urgency. 

Let’s talk about resources. I’ll be leaving shortly, so, Dr. Brantly, 

if you see me go before you give your testimony it’s because I’m 

going to work on the continuing resolution so we can, on a bipartisan basis, bicameral basis, pass that. 

But I’m looking ahead to December 11th and also the 2016 fiscal 

year. So the CR is really a down payment to keep your current response functioning, but it is not of the size and scope that you need 

to respond in Africa and prevent it from spreading globally. Am I 

correct in that? 

Dr. BELL. From the CDC perspective, yes. The CR will allow us 

to continue our field operations through the end of the CR, but the 

situation is very fluid and we’re assessing what we would need for 

the rest of the year. 

Senator MIKULSKI. Dr. Bell, when did you have to submit to 

OMB your fiscal 2016 request? 

Dr. BELL. I’m sorry, Senator. I don’t know the answer to that 

question. 

Senator MIKULSKI. Well, let me tell you. 

Dr. BELL. I thought you might be able to. 

[Laughter.] 

Senator MIKULSKI. It was a few months ago. So whatever Dr. 

Frieden told OMB and the White House that he needed for CDC, 

it is really 3 to 5 months behind. As we get ready to work, we’re 

encouraging OMB—this is our administration here—to go back and 

say, what is it that you need for the CR and omnibus, which I hope 

we can achieve, but also a look ahead at fiscal 2016, presuming we 

can find a way to cancel sequester. 

I would say to all of the agencies involved, look at that and revisit that. And it’s our job to get OMB to give you the latitude to 

come back because of this new need. 

Dr. Fauci, wherever there’s been an infectious disease crisis 

you’ve been in the forefront of trying to find solutions for 30 years, 

since AID to now. We’re so lucky to have you in all of these. But 

you spoke to us eloquently a few years ago about a pandemic, that 

when you have a global infectious disease crisis you need to have 

an infrastructure to be able to respond. Am I correct? 

Dr. FAUCI. Correct. 

Senator MIKULSKI. This is contained to one continent and one 

part of a continent. Do you think we’re heading to a pandemic with 

this? 

Dr. FAUCI. No, I don’t, Senator Mikulski, because, as we have 

mentioned, the spread of this in the West African countries is really a reflection of the extraordinary disparity of lack of health care 

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51 

infrastructure—to be able to handle an outbreak, to get the people 

isolated, taken care of, contact traced, so that you don’t have essentially unfettered spread. 

In a country like the United States and other developed countries, we may, and it’s entirely conceivable, have someone get on 

a plane infected in a West African country, be asymptomatic and 

land in Washington or New York or Paris or London, get out of the 

plane, get sick, and perhaps go to an emergency room, and even infect a person or two because someone didn’t take a travel history. 

But at that point, once it’s recognized, the kinds of capabilities we 

have would make it almost impossible to have the kind of outbreak 

that you’re seeing in a country in which the outbreak is driven by 

a lack of ability to handle infection control, and we have that. 

Senator MIKULSKI. Well then, let’s go to the disease. If this disease mutates, would mutation be of concern to you? And if it would 

mutate, do the current suggested treatments, possible treatments, 

become ineffective because it’s a new disease, and then could it 

even become airborne? 

Dr. FAUCI. Any hypothetical you say, we’d have to say it’s not impossible, though I think as a person who’s been dealing with viruses for so long, do I think that this is likely that this is going 

to happen? No. You never rule anything out, Senator. You always 

keep an eye out on it, and we are following the genetic moveability 

or mutation of this very, very carefully. 

When people ask me this question, I say what I know will happen, not hypothetical, is that unless we get control of this it will 

continue to not only devastate, but it will be much more difficult 

to ultimately get in control. So although we always in the back of 

our mind are concerned about mutations, right now today, in September 2014, mutation is not the problem. The problem is the full 

court press we need to put on getting this under control by standard classical infection control methods. 

Senator MIKULSKI. Which is a public health infrastructure—— 

Dr. FAUCI. Exactly. 

Senator MIKULSKI [continuing]. In this country and helping other 

countries? 

Dr. FAUCI. Quite correct. 

Senator MIKULSKI. Thank you very much, Mr. Chairman. 

The CHAIRMAN. Thank you very much, Senator Mikulski. 

I want to thank this panel. We’re running very late, but it’s been 

very informative. We thank you all very, very much for your great 

leadership, and the record will remain open, as I said, for 10 days, 

and I hope that we can continue to call upon you for advice and 

consultation as we move ahead on this. 

Dr. FAUCI. Thank you. 

The CHAIRMAN. Thank you, Dr. Fauci. 

Dr. BELL. Thank you very much. 

The CHAIRMAN. Thank you, Dr. Bell. 

Mr. ROBINSON. Thank you, chairman. 

The CHAIRMAN. Now we’ll call our second panel, Dr. Kent 

Brantly and Ishmael Charles. Dr. Brantly served as the Medical 

Director for the Samaritan’s Purse Ebola Care Center in the Liberian capital of Monrovia. In July, Dr. Brantly’s life changed abruptly when he contracted the Ebola virus while treating patients in LiLIFEBOOK092 with DISTILLER

52 

beria. We’re thankful that he’s recovered and is feeling well enough 

to offer his unique insight as both a provider and a patient. Dr. 

Brantly, as Senator Mikulski pointed out, is joined today by his 

wife Amber and we welcome you here also. Dr. Brantly, thank you 

for being here. 

Ishmael Charles is a survivor of Sierra Leone’s 11-year brutal 

civil war. He is a Program Manager for Healey International Relief 

Foundation in Sierra Leone. In that capacity he manages and monitors all Healey International Relief Foundation projects in Sierra 

Leone, including an Ebola awareness and prevention project in 11 

communities in the rural western district of Sierra Leone. Thank 

you, Mr. Charles, also for being here today. 

We’ll start again with Dr. Brantly. Dr. Brantly, your statement 

will be made a part of the record in its entirety, as will yours, Mr. 

Charles. Again, I apologize for the long period, but, as you can tell, 

people here are very interested in what’s happening with Ebola, 

and you do bring a very unique perspective. You had, you’ve contracted Ebola. You’re alive and well today. You are a provider. Dr. 

Brantly, welcome. Please proceed as you so desire. 

STATEMENT OF KENT BRANTLY, M.D., FORMER MEDICAL DIRECTOR, SAMARITAN’S PURSE EBOLA CARE CENTER IN 

MONROVIA, LIBERIA, AND EBOLA SURVIVOR 

Dr. BRANTLY. Chairman Harkin, esteemed Senators, guests of 

this committee, I’m grateful for the opportunity to testify before 

you today about the unprecedented Ebola virus outbreak that’s occurring in West Africa, that has already claimed thousands of lives 

and threatens to kill tens of thousands more. 

Let me also take this opportunity to thank each and every one 

of you. I know there were many people, maybe some of you on this 

committee, who helped play a role in bringing me home when I was 

so sick, and I just want to say thank you. 

On October 16, 2013, I moved to Liberia with my family to serve 

as a medical missionary at ELWA Hospital in the capital city of 

Monrovia. I worked as a physician to support the woefully inadequate health care system in a country that is still struggling to 

recover from a brutal civil war. In late March of this year, we 

learned that there were cases of Ebola in our region and we began 

preparing our staff as well as our facility to be ready to care for 

patients in the safest way possible should that need arise. 

Three months later in June, our hospital had the only available 

Ebola treatment unit in southern Liberia and I was one of only two 

physicians to treat the first infected individuals in that area. From 

June 11th when we received our first patient until July 20th, the 

number of cases continued to grow at an incredible rate. The disease was spiraling out of control and it was clear that we were not 

equipped to fight it effectively on our own. We began to call for 

more international assistance, but our pleas appeared to fall on 

deaf ears. 

As the Ebola virus continued to consume my patients, I witnessed the horror that this disease visits upon its victims, the intense pain and humiliation of those who suffer with it, the irrational fear and superstition that pervades communities, and the violence and unrest that now threatens entire nations. 

LIFEBOOK092 with DISTILLER

53 

Then, on July 23d I fell ill. Three days later, I learned that I had 

tested positive for Ebola virus disease and I came to understand 

firsthand what my patients had suffered. I was isolated and unsure 

if I would ever see my family again. Even though I knew most of 

my caregivers, I could see nothing but their eyes through their protective goggles when they came to treat me. I experienced the humiliation of losing control of my bodily functions and I faced the 

horror of vomiting blood, a sign of the internal bleeding that could 

have led to my death. 

I’m grateful to the team that worked tirelessly to keep me alive 

in Liberia, despite a severe lack of medical resources. They were 

courageous. 

I was then evacuated to Emory University Hospital, where I 

eventually became one of the few to recover from Ebola. As a survivor, it is not only my privilege, but it is my duty, to speak out 

on behalf of the people of West Africa who continue to face unspeakable devastation because of this horrific disease. 

This unprecedented outbreak received very little notice from the 

international community until those events of mid-July when 

Nancy Writebol and I became infected. Since that time, there has 

been intense media attention and increased awareness of the situation on the ground in West Africa. The response to date, however, 

has remained sluggish and unacceptably out of step with the scope 

and the size of the problem that is now before us. The U.S. Government has been closely following these events in West Africa since 

that time, if not before, and only now are we seeing a significant 

commitment to a solution. 

I had the privilege and honor of meeting with President Obama 

this morning and we discussed his commitment of more military 

and medical resources to fight this epidemic. He has also requested 

increased funding for the CDC. I thanked him for entering into this 

battle with us in a larger way. Now it is imperative that these 

words are backed up by immediate action. 

To control this outbreak and save the lives of thousands of West 

Africans and possibly many Americans, we need the promised 

Ebola treatment units, the surge in health care workers, the U.S. 

military regional command and control center, and we need it immediately. We also need the 400,000 home treatment kits that 

have been committed to be sent without delay. 

There is no time to waste if we are to contain Ebola and adequately care for the thousands of people that epidemiologists are 

now predicting will fall victim in just the next few weeks. The U.S. 

military must establish and maintain an air bridge to deliver critically needed personnel and medical supplies and to continue bringing in more resources in the future. We cannot turn the tide of this 

disease without regular flights of personnel and large cargo loads 

of equipment and supplies. 

I am grateful to the President for his decision to send tens of 

thousands of Ebola test kits to the region, but these will only be 

helpful if we also deploy all available mobile laboratories and increase funding for more to be built as quickly as possible. During 

my time in Liberia, the laboratory we used to confirm Ebola virus 

infection in patients was 45 minutes away from our hospital and 

it was inadequately staffed. The turnaround time to positively idenLIFEBOOK092 with DISTILLER

54 

tify an Ebola case was anywhere from 12 to 36 hours after the 

blood was drawn. If a patient is not infected with the virus, that 

can be a life-threatening delay. More kits are not effective unless 

we have the facilities and the staffing to use them. 

As the first human being to ever receive the experimental drug 

ZMapp, I am a strong advocate for the CDC and the NIH as they 

research vaccines and drugs, as we’ve just heard about, and these 

drugs can give patients hope for recovery. I’m deeply grateful to the 

personnel at Mapp Biopharmaceuticals who, even before this outbreak, dedicated their lives to combating Ebola. 

We cannot wait, however, for a magic bullet to halt the spread 

of this virus in West Africa. The current epidemic is beyond anything we have seen before and it’s time to think outside the box. 

I realize that home health care interventions can be controversial. 

However, we know that many Ebola-positive people are staying at 

home and even hiding after they become infected. Because of fear 

and superstition, their families either abandon them or they lovingly care for them in ways that almost always result in infection 

of the caregivers. This is a major contributor to the spread of Ebola 

and we cannot contain the disease without addressing this problem 

head on. 

Caregivers must be trained in safety measures and supplied with 

basic protective equipment so they can care for their loved ones 

while protecting themselves. As the number of survivors increases, 

these individuals should be mobilized to help educate and support 

their own communities. They would be a powerful witness that the 

disease is not 100 percent fatal and they could provide much-needed support to those who are trying to do what is best for their family members. 

Admittedly, home care is less ideal than treatment in an isolation unit. In the home it’s impossible to administer IV fluids and 

other supportive medical interventions. However, there are not 

enough beds in the Ebola treatment units right now and many infected people are choosing to suffer and die at home. The least we 

can do is try to give their caregivers the information and resources 

they need to protect themselves from this deadly virus. 

All of these interventions that are needed to stop this horrendous 

transnational outbreak require significant funding and budgets 

must be adjusted appropriately. This is not simply a matter of providing humanitarian aid. It is very much a national security concern. 

One of my patients in Liberia was a man named Francis. Like 

most patients, at first he was fearful. But eventually he shared the 

story of how he contracted the disease. He said to me: 

‘‘Doc, I remember who the man was that I got this infection 

from. He was sick at home and his condition worsened, and 

when he began vomiting blood everyone around him fled.’’ 

But his wife was determined to get him to the hospital. Since no 

one else was around to help, Francis went to this man’s house and 

helped carry him out of the house and put him in a taxi. On the 

way to the hospital, that man died. 

If someone had come alongside Francis and given him a little bit 

of education and provided him with the personal protective equipLIFEBOOK092 with DISTILLER

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ment he needed, his family would still have their father and their 

son and their brother, and the world might still have this good samaritan. But unfortunately, Francis fell victim to Ebola and died. 

Many, including one of the Senators today, used the analogy of 

a fire burning out of control to describe this unprecedented Ebola 

outbreak. Indeed, it is a fire. It is a fire straight from the pit of 

hell. We cannot fool ourselves into thinking that the vast moat of 

the Atlantic Ocean will protect us from the flames of this fire. Instead, we must move quickly and immediately to deliver the promises that have been made and to be open to practical, innovative 

interventions. This is the only way to keep entire nations from 

being reduced to ashes. 

Thank you very much, Mr. Chairman. 

[The prepared statement of Dr. Brantly follows:] 

PREPARED STATEMENT OF KENT BRANTLY, M.D. 

SUMMARY

Background 

In July of this year, my organization, Samaritan’s Purse, took over responsibility 

for all direct clinical care of those infected with Ebola in the Nation of Liberia. I 

was appointed Medical Director of what would become the only isolation unit in the 

Monrovia area. 

On July 26, I learned that I had tested positive for Ebola Virus Disease. Eventually, I was evacuated to Emory University Hospital where I was given world-class 

medical treatment and beat the odds to become one of the few who recover from 

Ebola. 

As a survivor of this horrific disease, I feel it is my duty to speak out on behalf 

of the people of West Africa. The response of the international community is still 

unacceptably out-of-step with the size and scope of the problem now before us. The 

only way to combat this unprecedented outbreak is for the U.S. Government to take 

the lead. 

Key Points 

• The United States must begin providing large treatment facilities, skilled personnel, medical supplies, logistical support, mobile laboratories, and security. This 

will require the deployment of military personnel and other assets. Congress must 

also increase funding for the Centers for Disease Control and other agencies. 

• We have to consider the role of home-based care and other 

outside-of-the-box methods as critical community interventions. Those caring for 

family members at home must be trained and given basic equipment—gloves and 

masks at a minimum—to protect themselves. The United States should provide advisors and experts and support the delivery of supplies to affected areas. 

• The U.S. military is the only global force with the capacity to immediately mobilize the kind of support needed to defeat the scourge of Ebola. If we do not deploy 

military assets now, the situation could quickly become a matter of U.S. national 

security—whether that means a regional war in West Africa or the spread of Ebola 

into America. 

Closing 

Many have used the analogy of a fire burning out of control to describe this unprecedented Ebola outbreak. Indeed it is a fire—a fire straight from the pit of hell. 

We cannot fool ourselves into thinking that the vast moat of the Atlantic Ocean will 

keep the flames away from our shores. Instead, we must take the lead and mobilize 

the resources needed to keep entire nations from being reduced to ashes. 

Chairman Harkin, esteemed Senators, and fellow guests of this committee, I am 

grateful for the opportunity to testify in front of you today about the unprecedented 

Ebola virus outbreak that has already claimed thousands of lives in West Africa and 

threatens to kill tens of thousands more. 

On October 16, 2013, I moved to Liberia with my family to serve as a medical 

missionary at ELWA Hospital in the capital city, Monrovia. I worked as a physician 

to support the woefully inadequate healthcare system of a country still struggling 

LIFEBOOK092 with DISTILLER

56 

to recover from a brutal civil war. Resources were limited, and we often saw patients die of diseases that would be easily treatable in the United States. It was a 

challenging job to provide quality care even before the Ebola virus tore through the 

country. 

In late March, we learned that there were cases of Ebola in our region, and we 

began preparing our staff and the ELWA facility so that we would be ready to care 

for patients in the safest way possible should the need arise. Three months later, 

our hospital had the only available Ebola Treatment Unit, also known as an isolation center, and I was one of two physicians to treat the first Ebola-infected individuals in southern Liberia. 

From June 11 to July 20, the number of Ebola patients we saw increased exponentially. During that time, my organization, Samaritan’s Purse, took over responsibility for all direct clinical care of those infected with the disease. I was appointed 

Medical Director of what would become the only isolation unit in the Monrovia area. 

We opened a new, larger Ebola Treatment Unit and brought in patients from the 

government hospital. During that time, the number of cases continued to grow at 

an incredible rate. Within days, our 20-bed facility was housing 30 patients, and 

there was no end in sight. The disease was spiraling out of control, and it was clear 

that we were not equipped to fight it effectively on our own. We began to call for 

more international assistance, but our pleas seemed to fall on deaf ears. 

As the Ebola virus continued to consume my patients, I witnessed the horror that 

this disease visits upon its victims—the intense pain and humiliation of those who 

suffer with it, the irrational fear and superstition that pervades communities, and 

the violence and unrest that now threatens entire nations. 

Then on July 23, I started to feel ill. Three days later, I learned that I had tested 

positive for Ebola Virus Disease. I became a patient, and I came to understand firsthand what my own patients had suffered. I was isolated from my family, and I was 

unsure if I would ever see them again. Even though I knew most of my caretakers, 

I could see nothing but their eyes through their protective goggles when they came 

to treat me. I experienced the humiliation of losing control of my bodily functions 

and faced the horror of vomiting blood—a sign of the internal bleeding that could 

have eventually led to my death. 

I received the best care possible in Liberia, and I am grateful for the team that 

worked tirelessly to keep me alive despite a severe lack of medical resources and 

other limitations. I was then evacuated to Emory University Hospital where I was 

given world-class medical treatment and eventually beat the odds to become one of 

the few who recover from Ebola. As a survivor, it is not only my privilege but also 

my duty to speak out on behalf of the people of West Africa who continue to face 

unspeakable devastation because of this horrific disease. 

This unprecedented outbreak began 9 months ago but received very little attention from the international community until the events of mid-July when my friend 

and colleague, Nancy Writebol, and I became infected. Since that time, there has 

been intense media attention and therefore increased awareness of the situation on 

the ground in Liberia, Guinea, Sierra Leone and neighboring countries. The response, however, is still unacceptably out-of-step with the size and scope of the problem now before us. 

On September 7, President Obama committed U.S. military support in the fight 

against Ebola in West Africa. He also is requesting an additional $88 million for 

the Centers for Disease Control to send in more personnel, equipment, and laboratory supplies. This is great news, and I applaud his willingness to enter into this 

battle with us. Now it is imperative that these words are backed up by immediate, 

decisive action. We need more than just a 25-bed Ebola Treatment Unit and training for local security forces. To control this outbreak and save the lives of thousands 

of West Africans—and possibly even more Americans—we need the United States 

to take the lead in providing large treatment facilities, skilled personnel, medical 

supplies, logistical support, mobile laboratories, and security. We also need to implement innovative community programs to stop the spread of the virus. 

In a recent Washington Post op-ed, the International President of Doctors Without 

Borders, Joanne Liu, called for a ‘‘large-scale deployment of highly trained personnel 

who know the protocols for protecting themselves against highly contagious diseases 

and who have the necessary logistical support to be immediately operational.’’ She 

went on to say, ‘‘Private aid groups simply cannot confront this alone.’’ I agree with 

her assessment of the desperate need for medical boots on the ground. 

Treating Ebola patients is not like caring for other patients. It is grueling work. 

The personal protective equipment (PPE) we wore in the Ebola Treatment Unit becomes excruciatingly hot, with temperatures inside the suit reaching up to 115 degrees. It cannot be worn for more than an hour and a half. Because of the elaborate 

safety protocols involved in treating an Ebola patient, each one takes an average 

LIFEBOOK092 with DISTILLER

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of 30 minutes of time from a team of three to five people. It is easy to see that a 

significant influx of medical personnel will be needed to adequately care for the 

thousands of people that epidemiologists now are predicting will fall victim to the 

disease in the coming weeks. 

The U.S. military also must establish an ‘‘air bridge’’ for the delivery of critically 

needed personnel and supplies. Right now, those who are fighting this disease are 

forced to rely on commercial airlines even as flights into and out of the affected 

countries are scarce and unreliable. Our military is the only global force with the 

capacity to immediately and effectively mobilize this kind of logistical support. We 

cannot turn the tide of this disease without regular flights of personnel and large 

cargo loads of equipment and supplies. 

The use of our military is a legitimate and defensible request because if we do 

not do something to stop this outbreak now, it quickly could become a matter of U.S. 

national security—whether that means a regional war that gives terrorist groups 

like Boko Haram a foothold in West Africa or the spread of the disease into America. Fighting those kinds of threats would require more from the Department of Defense than what I am asking for today. 

A surge in medical treatment capacity also must include the deployment of all 

available mobile laboratories and increased funding for more to be built as quickly 

as possible. During my time in Liberia, ELWA Hospital was the only Ebola Treatment Unit for all of Monrovia and the surrounding area—serving a population of 

more than 1 million. The laboratory we used to confirm Ebola Virus Disease in patients was 45 minutes away and inadequately staffed. A patient would arrive at our 

center in the afternoon, and their blood specimen would not be collected until the 

following morning. We would receive results later that night at the earliest. This 

means that the turn-around time to positively identify Ebola cases was anywhere 

from 12 to 36 hours after the blood was drawn. If a patient is not infected with the 

virus, that can be a life-threatening delay. 

I remember one patient who presented with symptoms of Ebola—fever, diarrhea, 

and vomiting. She was in our unit 36 hours before we received confirmation that 

she was not infected with the virus. We were then able to determine that she was 

actually suffering from diabetic ketoacidosis. Her treatment had been delayed for a 

day and a half because of inadequate laboratory support. Amazingly, she survived, 

but she was in a coma for 3 weeks. That didn’t have to happen. 

These laboratory delays can have an even greater—and deadlier consequence. The 

longer it takes to confirm a positive result, the longer an Ebola-infected patient is 

left in the ‘‘suspected’’ side of the isolation unit. Every precaution is taken to protect 

people in that part of the facility from cross-contamination, but there is always the 

potential that those without the disease can become infected if they are in close 

proximity to an Ebola-positive person. 

As you have heard today, I am a strong advocate for sending large numbers of 

medical personnel and supplies to increase capacity for Ebola treatment. I also believe we must do more to support the Centers for Disease Control and the National 

Institutes of Health as they research vaccines and drugs that can give patients hope 

for recovery. I am deeply grateful to the personnel at Mapp Biopharmaceuticals who 

even before this outbreak had devoted their lives to combating Ebola. I hope that 

the devastating impact of the current epidemic will result in new discoveries for 

treatments and vaccines in the future, but we cannot wait for a magic bullet to halt 

the spread of Ebola in West Africa. The current epidemic is beyond anything we 

have ever seen, and it is time to think outside of the box. 

Historically, Ebola outbreaks have been contained through the identification and 

isolation of suspected cases, and this has worked extremely well to stop the disease. 

Today, however, the number of cases and rate of transmission are surpassing the 

ability of these traditional interventions to bring the situation under control. Intensive medical care is important, but it is given only to patients in isolation units. We 

know that the virus is being spread primarily by those who are unwilling or unable 

to go to an Ebola Treatment Unit. 

Many Ebola-positive people are staying at home and even hiding when they become ill. Because of fear and superstition, their family members either abandon 

them or lovingly tend to them in ways that almost always result in the infection 

of the caregivers. We have to consider the role of home care as we seek to stop the 

transmission of Ebola. 

Caregivers must be trained in safety measures and supplied with basic protective 

equipment—gloves and masks at a minimum—so that they can care for their loved 

ones while protecting themselves. As the number of survivors increases, these individuals should be mobilized to help educate and support their own communities. 

They would be a powerful witness that this disease is not 100 percent fatal and proLIFEBOOK092 with DISTILLER

58 

vide much-needed support to those who are trying to do what is best for their loved 

ones. 

Survivors are sometimes unable to return home because of stigma in their communities, but the great majority of them are looking for ways to be useful to society 

again. They can be given important roles in educating home caregivers and disseminate the facts about Ebola with their communities. 

These are just normal people. Yes, sometimes they are doctors and nurses, but 

they are also uneducated day laborers and children. Mothers and other respected 

members of society can play an especially critical role. They have to be trained and 

given resources. 

To effectively execute this strategy, a technical and logistical infrastructure would 

have to be put in place. The United States should provide advisors and experts to 

train survivors and others and support the delivery of supplies to affected areas. We 

must also ensure the personal safety of these outreach workers so that they can do 

this potentially life-saving job confidently. That may require security forces to protect them. I am not suggesting that we have troops staring people down with guns. 

They have seen too much of that in their recent history. We just need to make sure 

that these community workers are safe. 

Admittedly, homecare is less ideal than the treatment provided in an isolation 

unit. It would be impossible to administer I.V. fluids and provide other supportive 

medical interventions. However, there are not enough beds in the Ebola Treatment 

Units, and many infected people are choosing to suffer and die at home anyway. The 

least we can do is to try to give their caregivers the information and resources to 

protect themselves from this deadly virus. 

The World Health Organization has laid out a roadmap similar to what I have 

just described, but they are so bound up by bureaucracy that they have been painfully slow and ineffective in this response. Their recommendations for home care 

were made August 28, and I am not aware of any significant progress in the implementation of their plan to date. It is imperative that the United States take the lead 

instead of relying on other agencies. 

The U.S. military is highly trained with a clear chain of command. They are experienced in responding to complex international crises such as what we are facing 

now. I believe they are the only force capable of mounting an immediate, large-scale 

offensive to defeat this virus before it lays waste to all of West Africa. 

All of the interventions needed to stop this horrendous transnational outbreak 

also require significant funding, and budgets must be adjusted appropriately. This 

is not simply a matter of providing humanitarian aid, it is very much a national 

security concern. 

One of my patients in Liberia was a man named Francis. Initially, the lab told 

us that he was positive for Ebola, but the written report we received said ‘‘Negative.’’ Everything about his clinical case said that he was infected, so we made plans 

to retest him. We then received word that there was a typo on the first report and 

that his test was indeed positive. 

Like most patients at first, he was fearful, but he eventually shared the story of 

how he contracted the disease. ‘‘Doc, I remember who the man was,’’ he said. ‘‘His 

condition worsened in his home, and his wife made the decision to take him to the 

hospital. Everyone around them fled, so I helped his wife carry him to the taxi.’’ 

On his way to the hospital that man died. Had someone come alongside Francis 

with training and some basic personal protective equipment, his family might still 

have their husband, father, and son, and the world might still have this Good Samaritan. 

Many have used the analogy of a fire burning out of control to describe this unprecedented Ebola outbreak. Indeed it is a fire—a fire straight from the pit of hell. 

We cannot fool ourselves into thinking that the vast moat of the Atlantic Ocean will 

keep the flames away from our shores. Instead, we must mobilize the resources 

needed to keep entire nations from being reduced to ashes. 

The CHAIRMAN. Thank you, Dr. Brantly. Thank you for your 

courage and for being here, being an example. Thank you. 

We’ll get on to questions, but, Mr. Charles, welcome and please 

proceed. 

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STATEMENT OF ISHMAEL ALFRED CHARLES, PROGRAM MANAGER, SIERRA LEONE, HEALEY INTERNATIONAL RELIEF 

FOUNDATION, FREETOWN, SIERRA LEONE 

Mr. CHARLES. Thank you very much. Chairman Harkin, honorable Senators, Dr. Kent Brantly, and fellow guests of this committee, thank you for the opportunity to allow me to come all the 

way from West Africa and testify in front of you today. 

My name is Ishmael Alfred Charles, a resident of Freetown, Sierra Leone. I’m married and a father of two children, two girls, 9 

months and 10 years. I arrived yesterday morning around 2 a.m. 

to share with you what my country is currently dealing with on a 

daily basis with the current Ebola outbreak, while still trying to rebuild from the brutal civil war. Unlike the civil war, in Sierra 

Leone the outbreak creates more fear to the entire population at 

one go. In the civil war it was at a time a certain population would 

be afraid of the attack. Today the general atmosphere in my country and among all Africans within the West African region, they 

are afraid of fear—the biggest crisis that we have ever faced, bigger 

than even the civil war. 

As a former child soldier, I was able to survive the war. But I 

fear that this is going to be worse than the war. 

The Healey International Relief Foundation, based in Lumberton, NJ, supports the rebuilding of health care services in Sierra 

Leone and provided relief and other supports to war-torn countries 

like Sierra Leone, and they have been working in Sierra Leone for 

more than 12 years. The foundation’s mission is to invest and support families and individuals affected by disaster, war, and adverse 

socioeconomic conditions, through the delivery of health care, food, 

and training and other kinds of programs. Hence, the mandate is 

to empower communities and build the capacity to become self-sustaining. 

The foundation partners with Caritas Freetown, which I am 

placed with, and Caritas Freetown runs all the foundation’s 

projects in Sierra Leone. Caritas Freetown, whose mission is to 

eradicate poverty, corruption, injustice, improve equality, advance 

good governance, and achieve peace and human rights, empower 

women and the disabled. 

As the spokesperson for the Healey International Relief Foundation in Sierra Leone, I feel privileged to share with you our experience on the ground in the war front. As it is today, Sierra Leone 

is considered to be a war front, and so is Liberia, Guinea, and the 

other West African countries that are threatened. Since the outbreak, we have been implementing the Ebola Outbreak Response 

Project in the western area rural and urban districts. We work 

closely with the Ministry of Health and Sanitation, Ministry of Social Welfare, and the Emergency Operations Centers. 

What this essentially shows is that small organizations with 

lower human capacity and budgets are able to make impacts at the 

lowest community level because they live within the community 

and they understand the reality on the ground. 

As part of this project, we have been working with a number of 

communities in the western area rural districts with a catchment 

of about 219,000 people, raising awareness, providing chlorine, 

which serves as a detergent to kill the virus, soap and buckets to 

LIFEBOOK092 with DISTILLER

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police stations and police posts. In addition, we have a strong national media campaign in collaboration with our counterpart 

Caritas organizations in the other regions of the country. 

The growing number of cases recorded on a daily basis has made 

the situation in Sierra Leone very scary. Each day the situation becomes worse and the effect of Ebola cannot be overemphasized, as 

Dr. Brantly has painted a picture very clearly for you to see. 

When I was about to leave, my 10-year-old daughter asked me, 

she said: 

‘‘Dad, are you going to leave us in this country and go to 

America, where they say there is no Ebola?’’ I stared at her for 

a minute and said, ‘‘Maa’’—as I call her—‘‘my trip is for the 

general good of the family and for your future. I will be back 

in 2 weeks.’’ And she said again, ‘‘Are you sure, because every 

day flights are being canceled?’’ 

As I speak, there are only two flights going to Sierra Leone or Liberia. 

Similarly, my wife said: 

‘‘Dear, the money you used to leave normally when you travel is not going to be enough this time around, because the price 

of commodities has tripled.’’ 

What I’m trying to say in essence, the situation in Sierra Leone 

is getting very difficult every day, and so it is in the other countries 

that have been faced with the current outbreak challenge. And the 

economic burden is getting very heavy on a number of people. 

As I was about to leave, my biggest stress was in the situation 

if anyone gets sick behind me, the health system is not functional. 

When you go to a hospital, the doctors are not there any more. And 

even when they are there, they deny that they are doctors, because 

they are afraid that they might be infected and they’re not sure 

what sort of sickness a patient might have come in with. 

The Ebola phobia is increasing. Even people who do not have 

Ebola are being stigmatized. We have suffered equally, not to talk 

about those who have tested positive. 

The State is overwhelmed and unable to coordinate effectively 

the Ebola response. People are losing their confidence every day. 

The Ebola crisis has escalated into widening economic situations 

and has damaged further the health care systems, which are not 

prepared to manage such a difficult situation. 

Harvests have been canceled because too many farmers are 

dying. In the capital, Freetown, hotels have very few number of 

guests. A very big hotel that might have the capacity to house 300 

guests will only have 4 guests or even less. And these hotels keep 

dropping their staff every day because they don’t have the money, 

the resources, to take care of the staff. And this staff that they’re 

dropping are parents who have families they need to take care of. 

In a country with 70 percent illiteracy, schools have been closed 

indefinitely because of Ebola. We have no idea when we’re going 

to reopen schools. Our country has a high orphan population and 

Ebola is increasing that on a daily basis. Through the foundation, 

we are able to make donations to the Ministry of Social Welfare 

and support the Ministry of Social Welfare, who are currently taking care of the Ebola orphans, while we are also very careful that 

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these orphans will be stigmatized and at the same time could be 

positive. It’s a very delicate situation. 

People do not have the free will to bury their loved ones any 

more and show the compassion and care and emotional love to 

those who are sick which normally help people to recover very fast 

when you know that you have a social support around you. 

Flights have been canceled. The economic situation is getting 

worse every day. As a result, households are struggling. Not just 

the Ebola is killing people in Sierra Leone. Poverty, hunger, lack 

of medical facilities. Families go hungry when the breadwinner dies 

or gets sick or loses their job, which is happening on a daily basis. 

With the support of the United States, the international community, and the spirit of Sierra Leoneans, we believe we will put 

Ebola at our back. However, a decade’s progress will have been 

lost, especially so when already the health facilities were in bad 

shape before the outbreak. 

I plead to this house and to the United States and the international community not to leave Sierra Leone when the outbreak 

may subside. We will need help investing in Sierra Leone so that 

we can be able to be self-reliant again because we will not need to 

continue to rely on international support. But if we are self-sustainable, we will be able. 

I’ve heard about the CDC report that Dr. Bell spoke about. She 

gave a number of incidents or instances specifically talking about 

Liberia. Every picture that she painted is equally as devastating in 

Sierra Leone and probably even worse. The numbers that the government gives on a daily basis of infected people, is definitely much 

less than what is really happening on the ground, for various reasons, and the health facilities or the support that we have currently does not really match with the number of infections that we 

have. 

Last, I want to thank this house for listening to me, and please, 

we will look forward to the continued support of the United States 

in Sierra Leone. I thank you very much for your attention and for 

the privilege you give me in listening to me. Thank you. 

[The prepared statement of Mr. Charles follows:] 

PREPARED STATEMENT OF ISHMAEL ALFRED CHARLES

Good afternoon, my name is Ishmael Alfred Charles, a resident of Freetown, Sierra Leone, married and a father of two children, 9 months and 10 years. I arrived 

yesterday morning to share with you what my country is dealing with on a daily 

basis with the current Ebola outbreak, while still rebuilding after a brutal civil war; 

unlike the civil war, the outbreak creates more fear to the entire population. 

Today there is a general atmosphere of fear. This is the biggest crisis we have 

faced since the end of our civil war. 

As a former Child soldier, I was able to survive the war, and now I fear, ‘‘This 

is going to be worse than the war.’’ 

The Healey International Relief Foundation, based in Lumberton, NJ, supports 

the rebuilding of Sierra Leone’s healthcare system and has provided relief services 

to our country since the end of our civil war, over 12 years ago. 

The Foundation Mission is to invest and support families and individuals affected 

by war, disaster and adverse socio-economic conditions through the delivery of 

healthcare, clean water, food, training and other programs, hence it’s mandate is to 

empower communities and build their capacity to become self-sustaining. 

The foundation partners with Caritas Freetown on all its projects in Sierra Leone. 

Caritas Freetown whose mission is to eradicate poverty, corruption, and injustice; 

to improve equality, advance good governance, achieve peace and human rights, empower women, youth and the disabled. 

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As the spokesperson for the Healey International Relief Foundation in Sierra 

Leone, I feel privileged to share with you our experience. Since the outbreak, we 

have implemented the ‘‘Ebola Outbreak Response Project’’ in the rural and urban 

districts of Sierra Leone. We work closely with the Ministry of Health and Sanitation, Ministry of Social Welfare and the Emergency Operation Center. 

As part of this project, we have been working in a number of communities within 

the Western Area Districts with a catchment area of about 219,000 people, raising 

awareness and providing chlorine, soaps and tap buckets to all police stations and 

posts. In addition we have a strong national media campaign in collaboration with 

our counterpart Caritas organizations in the other regions. 

The growing number of cases recorded on a daily basis has made the situation 

in Sierra Leone very scary. Each day the situation becomes worse and the effects 

of the Ebola cannot be over emphasized. When I was about to leave, my 10-yearold daughter asked ‘‘Dad are you leaving us here in this difficult situation with this 

Ebola, they said there is no Ebola in America, why can’t you take us along?’’ I 

starred at her for a minute and said ‘‘Maa,’’ as I call her, ‘‘my trip is for the general 

good of all our family and your future. I will be back in 2 weeks.’’ She asked again, 

‘‘Are you sure when flights are being cutoff daily?’’ 

Similarly, my wife said, ‘‘Dear the money you normally leave when traveling will 

not be enough as the cost of commodities has tripled.’’ This was another difficult 

situation. 

As I leave, my biggest stress is if anyone gets sick while I am away, the health 

system is not functional. 

The Ebola phobia is increasing. Even people who do not have Ebola are being stigmatized, not to talk about those who are tested positive. 

The state is overwhelmed and unable to effectively coordinate the Ebola response 

and people are losing their confidence. The Ebola crisis has escalated quickly and 

has led to the widespread fallout of the healthcare system: 

• Harvests are being canceled because so many farmers had died; 

• In the capital, Freetown, patrons are sparse at hotels and restaurants especially 

those catering to the expatriates. Hotel occupancy rates have dropped and large hotels have only 4 guests and these hotels are laying off staff daily; 

• In a country with 70 percent illiteracy, schools are closed indefinitely; 

• Our country’s high orphan population, is increasing every day; 

• People do not have the free will to bury their loved ones, and even the sick ones 

are deprived of the emotional care from their family needed to recover; 

• Many companies are laying off staff amidst the slowdown in commerce, restrictions on travel and decrease in other economic activity. 

As a result, households are struggling with food shortages and increase costs due 

to panic buying. 

Families go hungry when the bread winner dies, gets sick or loses his or her jobs. 

With the support of the United States, the International Community and the survival spirit of the people of Sierra Leone, I am confident we will defeat this deadly 

virus. However, a decade of progress will be lost, especially so when the health care 

was already in bad shape before the outbreak. 

I plead not to leave once the crisis is over and help us rebuild our country physically and economically by investing in Sierra Leone to empower our people to become self-reliant. 

I thank you for your attention. 

The CHAIRMAN. Thank you, Mr. Charles. It’s always important to 

put a human face on matters like this. I think people read about 

it, you get the numbers, you say it’s horrible. But one has to understand the human impact and what this is doing to families in your 

country, in Liberia, and other countries, and the nature that I am 

now beginning to understand is, if we don’t get it controlled soon, 

it will spiral out of control and it will have the devastating effects 

that Mr. Charles is talking about. No more people will go there. 

Business will end. The whole economy will start grinding to a halt. 

Dr. Brantly, I’m sure I can speak for many in America and 

around the world when I say thank you. Thank you for being such 

an example for all of us on how to serve others. We regularly thank 

our soldiers for marching into harm’s way, rightfully so. Let me say 

this is no different. You and others like you run toward the risk 

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to help those standing in the path of this terrible disease. So I 

want to include you and others like you in that pantheon of American heroes. You do us proud, real proud. 

I have so many questions, but I know we’re running out of time. 

Dr. Brantly, what I would ask you first is, with all that you know, 

and you’ve been there with your family, you know what the situation is like, give me one, two, three, what’s the most important 

thing we could do now? What’s the most important response that 

we could do now? 

Dr. BRANTLY. Thank you, Mr. Chairman. 

The CHAIRMAN. If you were in charge and you had a magic wand, 

what would you do with it? 

Dr. BRANTLY. I think one of the most important points is in your 

very question. We have to do it now. This has been in the eye of 

the government for months. We can’t afford to wait months or even 

weeks to take action, to put people on the ground, to begin opening 

those logistical bridges and pathways, to begin going out into the 

communities and educating caregivers. 

It’s not that we’re trying to keep people at home, but we need 

to increase the capacity to care for them in facilities. And that 

means not only creating more beds, but having the staff to care for 

them in those beds. Putting them in a bed may keep them from 

giving the disease to someone else, but it does nothing to improve 

their chances of survival unless they’re receiving good quality supportive care. 

So we need more capacity in Ebola treatment units, but we must 

have the staff for those units as well. And we need to start educating people right now in their communities about how to safely 

care for their family members who are hiding at home and dying 

from Ebola and ashamed or scared of their own situation. 

The CHAIRMAN. You must have a valuable perspective on Liberian culture and society, having been there. We send in a lot of 

people. Maybe they’re not culturally sensitive. I don’t know exactly 

what I mean by that, but they don’t understand the situation; and 

could people actually become more afraid of the workers that we 

send in if they’re not adequately trained and equipped? 

Dr. BRANTLY. I think that’s a very real possibility, Mr. Chairman. I think that, yes, Liberia’s civil war ended 10 years ago, but 

think about the situation in the United States 10 years after our 

own Civil War. There was still a lot of tension, and in Liberia there 

is still a lot of tension between people, groups, and society in general, and there’s a sense of distrust, distrust of government, distrust of authority, distrust of foreigners. 

So yes, people will be resistant to help. But I think because of 

the devastation of this outbreak even those people who have been 

resistant to help are starting to see the need for some assistance. 

I think that’s why it’s important that we don’t just march in there 

with our military and take over, but we partner with the NGO’s, 

like Doctors Without Borders and Samaritan’s Purse, and the Ministry of Health of Liberia, so that it’s a partnership and we’re using 

people like the survivors from Ebola. 

There are more and more survivors every day in places where 

they can get good, supportive care, and those survivors are the 

ones who can go out and, in what you refer to as a culturally apLIFEBOOK092 with DISTILLER

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propriate way, educate and support the communities and distribute 

the needed personal protective equipment to protect those home 

care providers. I think that is very much an important part of the 

strategy. 

But again, it has to start now. It has to start in a matter of days. 

From the time I fell sick just less than 2 months ago, the death 

toll has tripled. If we take 2 months to get our response up and 

going, even if we only maintain that rate of growth, we’re looking 

at thousands and tens of thousands. And 9 months down the road, 

we’re looking at hundreds of thousands of not only cases of Ebola, 

but deaths. And we can’t afford that. 

The CHAIRMAN. That’s where I hope our military airlift capability 

will come in and start moving material and personnel over there. 

Senator Alexander. 

Senator ALEXANDER. Dr. Brantly, Mr. Charles, let me thank you 

both. Mr. Charles, thank you for your work in prevention and 

bringing awareness here. Dr. Brantly, thanks for your being a good 

samaritan. We greatly admire what you’ve done. 

You’re a survivor of Ebola. Is that like cancer? Is that in remission, or are you cured, or do you know? 

Dr. BRANTLY. Thank you, Senator. I’m cured from Ebola. 

Senator ALEXANDER. So you don’t have it—it’s gone from you? 

Dr. BRANTLY. Yes. When a person survives Ebola, when they recover they’re not a carrier of the virus. Dr. Ribner at Emory University was very clear to say that Nancy Writebol and I posed no 

public health risk. So there’s no risk to the public from a survivor. 

There’s a lot of stigma attached to being a survivor of Ebola, but 

we—— 

Senator ALEXANDER. Can an Ebola survivor become infected once 

again, or are you immune then from Ebola? 

Dr. BRANTLY. In theory and I think in practice, I am immune to 

the strain of Ebola that I was infected with. But there are five different strains of Ebola, so if I went to the Democratic Republic of 

the Congo I may not be immune to the strain that’s causing the 

outbreak there. 

Senator ALEXANDER. You talk about how you treated a lot of patients. Would you say it’s accurate that about half the patients who 

are infected died, or is it higher or lower than that? 

Dr. BRANTLY. Unfortunately, Senator, in my experience we did 

not have a 50 percent mortality rate of 50 percent survival rate in 

our facility. As we saw patients early on in the outbreak, they were 

usually showing up very late in their course, and in the month and 

a half that I was treating Ebola patients we had one survivor. 

Senator ALEXANDER. From the time you discover an infection 

until death, how long is that typically? 

Dr. BRANTLY. That varies greatly depending on how early the 

person seeks care. We had some people who came and died in a 

matter of hours from the time they presented, and we had others 

who were under our care for a matter of days, 4 or 5 or 6 days, 

before they passed away. 

Senator ALEXANDER. But it’s not months? 

Dr. BRANTLY. No. The illness generally is a 2-week course, and 

by the end of 2 weeks the person has either died or they’re on the 

road to recovery. 

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Senator ALEXANDER. Which is one reason there’s such concern, 

because it’s so explosive, it moves so rapidly. Is that right? As I listen to you, I hear you talking about lots of people at home sick for 

a variety of reasons. We’ve heard the official statistics say there 

are less than 5,000 infections. It sounds to me like there might be 

many more. 

Dr. BRANTLY. I think that’s very accurate, sir. As many of the 

witnesses today have said, those numbers are based on the cases 

we have tested and identified or are housing in isolation units. But 

there are many, many more at home. 

Senator ALEXANDER. So there are many more, and what you’re 

saying is the course of the disease might run a couple of weeks and 

you’re either dead or a survivor after that period of time. In your 

experience, all but one died. Others, they say half. The official statistics say the cases have doubled over the last 3 weeks. So you 

don’t have to do much math to see that the numbers, as you say, 

can quickly go to tens of thousands, hundreds of thousands, if we 

don’t get control. 

Am I correct that the home health kits are primarily for the benefit of the caregivers, that it’s to keep the infection from spreading? 

Does it make the home sort of a hospice for the infected person 

with Ebola? 

Dr. BRANTLY. I think that’s a fair way to look at it. As I said, 

you can’t carry out complicated medical interventions in a home, 

but you can give people oral rehydration solution. You can give 

them Tylenol to help with their fever and pain. But the most important part of that kit is the part that offers protection to the 

caregiver, because without that we’re not stopping transmission, 

and that’s what has to happen to control this epidemic, is to stop 

the transmission of this disease. 

Senator ALEXANDER. You took a great risk in going there and it’s 

obvious from the testimony of you and Mr. Charles and others that 

we’ll need hundreds, thousands of people, in addition to the soldiers who are going. What would you say to others, people like 

yourself? We have a tradition in this country of Doctors Without 

Borders, Samaritan’s Purse, of which you were a part. What would 

you say to Americans who are seeing this and trying to decide 

whether to go to West Africa to help control this disease? 

Dr. BRANTLY. Thank you, Senator. This is a topic very dear to 

my heart. I think the International President of Doctors Without 

Borders said it very well in a recent article. She said, 

‘‘Comparing Ebola to a fire, this is not the time to run away; 

this is the time to put on our protective gear and run into the 

burning building.’’ 

Physicians and health care professionals, even if it’s just symbolic, have taken an oath. In many institutions they still take the 

Hippocratic Oath, and that oath is to the service of mankind. I 

think if we can help people overcome the fear of facing a deadly 

disease and remember that this is not just a disease, these are people who need help, societies that are collapsing because of the 

weight of this burden, we just need people to go help. 

The CHAIRMAN. Senator Burr. 

Senator BURR. Thank you, Mr. Chairman. 

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Dr. Brantly, Mr. Charles, thank you for being here. Mr. Charles, 

when you go back and see your daughters, I hope you’ll share with 

them that the purpose of this committee is to try to make sure we 

can process enough fact to make sure that we can provide what’s 

needed from a standpoint of the resources. There are other parts 

of government that has the responsibility to get them there, to 

train, to equip. But we have to make sure that we have the resources. And what you’ve shared with us, both of you, is invaluable 

from a standpoint of how we look at it. As I think both Senators 

said, to see the human face behind the issue is absolutely crucial 

to those of us who sit on this committee and in this institution and 

ask taxpayers to in turn fund things for people that they’ll never 

meet. 

But I do have a couple of questions. Dr. Brantly, are you convinced that ZMapp played a role in your cure? 

Dr. BRANTLY. Thank you, Senator Burr. My opinion—— 

Senator BURR. I take for granted that from a standpoint of good 

supportive care, since you knew them, you were getting it. 

Dr. BRANTLY. I was receiving the best care that they could afford 

to give me in Liberia. 

My own opinion is that ZMapp, I believe, had a beneficial effect 

in my treatment. But, as Dr. Fauci very clearly said, this is an experimental drug, that my story is an anecdote and, while a very 

convincing one, it’s just one. And it really requires more extensive 

testing of an experimental drug to prove whether or not it is beneficial on a large scale. I’m very thankful for Mr. Zetland and all the 

people at Mapp Biopharmaceuticals because I think it was helpful 

to me, and I think it will be helpful in future Ebola outbreaks, because there will be more Ebola outbreaks. 

Senator BURR. Let me say, Dr. Brantly, when the chairman said 

he was concerned this might spiral out of control, I think we’ve already spiraled. I think we’re in that spiral now. I think had we had 

more time with Robin Robinson we would understand that we’re 

probably January at the earliest for therapy, and that’s without extensive clinical trials, as you can imagine. We’re January, first 

quarter, with potentially some vaccine product, and that’s with— 

doctor, you know, if we’re talking about a 5-month clinical trial 

process, we have accelerated it greatly. 

We’re going to break every fail-safe that exists at the FDA, just 

like they did in the decision to administer ZMapp to you. And because that’s jurisdictionally under this committee, it’s important 

that we all understand. We’re going to sort of recreate the wheel, 

because this is an extraordinary circumstance. 

I guess I’m asking for your medical opinion and your opinion as 

somebody that knows the folks that are being affected. If we choose 

to go before we know everything with some type of therapeutic response, is that the best course for us to follow, or should we be prudent and take longer, knowing that we know a little more about 

the therapy or the vaccine? 

Dr. BRANTLY. I think WHO came out with a statement several 

weeks ago saying they believe it’s ethical to use experimental drugs 

in circumstances such as this. I would agree with them that if we 

know—in my case, we didn’t even know if it would be harmful or 

not. I think if you’re going to start giving it to people who don’t 

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have the background to be able to give really understood informed 

consent, it’s important that we know that what we’re giving them 

is safe and potentially beneficial. 

But I think those types of drugs, especially vaccines—I think the 

other panelists spoke to that better than I can, but I think they 

would have a role, especially if we don’t have this thing under control by January. 

Senator BURR. The numbers that we look at suggest for every infected individual that they will infect somewhere between 5 and 20 

additional individuals. The multiples are huge. I think I heard both 

of you say that when we look at Sierra Leone, 1,620 cases, 653 in 

the last 21 days, Liberia 2,407, 1,383, you think those are woefully 

understating the size of the problem. Did I hear both of you correctly? 

Mr. CHARLES. Yes, Senator. 

Senator BURR. OK. 

Dr. BRANTLY. Senator, may I speak just a moment on that? 

Senator BURR. Sure. 

Dr. BRANTLY. I think those numbers may be underestimated for 

sure, but I think what you’re seeing is a representation of how 

quickly this thing is growing when you compare what the numbers 

were to how fast they’re growing now. And those experimental 

drugs don’t have anything to do with the transmission. That’s why 

we need to intervene in the communities to disrupt the transmission of this disease. 

Senator BURR. When CDC said act now, I sort of agree with your 

definition of ‘‘now.’’ ‘‘Now’’ is like tomorrow. I’m not sure that we’ve 

ever had that type of turnaround out of government. So facing the 

reality of what’s in front of us is also important. 

Last question, and you’ve been very patient to stick with us as 

long as you have. What are the possibilities of using social media 

as our communication tool in West Africa, and can that be effective? 

Mr. CHARLES. Yes, the use of social media has a lot of effects in 

Sierra Leone specifically, especially among young people who are 

literate, maybe the school-going population and those who also 

have access to mobile phones. But the cost of communication is tremendously expensive compared to what I can access in America on 

my cellphone at the cost and what I can access in Sierra Leone on 

a monthly basis for the same cellphone. It’s very expensive. But it 

definitely has a very big impact because a lot of information is 

being—it’s sometimes misleading also. That’s another negative aspect. But the fact is a lot of this information, good information, is 

also being transmitted and communicated through WhatsApp and 

Facebook especially. 

Senator BURR. Dr. Brantly, you agree? 

Dr. BRANTLY. I agree. I think even up until this point Liberia has 

been using social media and radio and print media to reach the 

population. There’s even a really catchy tune that they play on the 

radio about Ebola, reminding people that Ebola is real and they 

need to protect themselves and protect their families, and that 

talks about how the disease is spread. I think it’s a very important 

means of reaching people. 

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Senator BURR. I want to thank both of you. I especially want to 

thank Samaritan’s Purse. Whenever you have a tragedy somewhere 

in the world, they are certainly there. They’re part of the story. I 

think a lot of the presence in North Carolina and I think a lot of 

Franklin and the vision and the commitment. Not to say that we 

don’t have a lot of good NGO’s around the world that respond, but 

they’re certainly consistently there, and for that we’re grateful. 

I thank you both. 

Dr. BRANTLY. Thank you. 

Senator ALEXANDER. Thanks to both of you for coming. We’re at 

the end and Senator Harkin will end this in a minute. But I want 

to make sure I understood something you said. You said you began 

to treat patients on June 11 and became ill on July 20, is that 

right? 

Dr. BRANTLY. July 23d, yes. 

Senator ALEXANDER. You became ill on July 23d. About how 

many patients did you treat? 

Dr. BRANTLY. I believe during that time we had about 45 or 50 

patients come through our unit. Not every one of those was positive 

for Ebola, but even many of them who were negative for Ebola died 

because of the severe illness they came to our hospital with. 

Senator ALEXANDER. So of the 45 or 50, all but one died? 

Dr. BRANTLY. No, sir. There were some who tested negative and 

we discharged them from the unit. 

Senator ALEXANDER. Of those 45 or 50, some had Ebola? 

Dr. BRANTLY. I can’t remember the numbers exactly, but I would 

say of those 45 probably 20 of them had Ebola and probably 10 or 

12 of them were tested negative and discharged. So that would 

leave another five or so who came to us with something other than 

Ebola, but unfortunately died because of the severity of their illness. 

Senator ALEXANDER. Now, you became ill on July 23d. You were 

tested on July 26th. You said something about a 2-week course. 

Does that mean that within 2 weeks you know whether you’re 

going to recover or die if you have Ebola? Is that right? 

Dr. BRANTLY. In general. Most people with Ebola, they usually, 

if they die from it, they die between days four and ten. But it can 

be a 14 or 16-day illness. So you can’t just say, oh, you’re on day 

ten, you’re out of the woods. That’s not the case. It was day nine 

when I was the sickest and almost died. 

Senator ALEXANDER. So you become infected, you don’t infect others until you have symptoms, correct? 

Dr. BRANTLY. Correct. 

Senator ALEXANDER. So there’s a period of time of about maybe 

2 weeks, a week or two, when you can infect other people, plus the 

time after—if you die, there’s that period of time. 

Dr. BRANTLY. Correct. You contract the virus and you have a 2 

to 21-day window before you become symptomatic. Once you become symptomatic, your illness may run from 3 days, where you 

die after 3 days, or you may be sick for 2 weeks. In my case, I was 

sick for almost 4 weeks before the CDC decided that my test was 

negative enough consecutive times that they could discharge me 

from the hospital. 

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So you’re correct, people are infectious during their illness and 

usually that is less than a 2- or 3-week period. 

Senator ALEXANDER. So what’s really different about this epidemic is how fast it moves, is that right? 

Dr. BRANTLY. The virus moves—it kills quickly. Like Dr. Fauci 

and Dr. Bell said, it’s not so contagious like the flu virus that 

someone will get it by sitting near you. But it kills its victims 

quickly. 

Senator ALEXANDER. So within that 2-week period or so of infection, to use Senator Burr’s figures, one might infect 5 to 20 other 

people. They have an incubation period of 2 to 21 days and then 

they may have a 2-week period of infection during which they 

might infect 5 to 20 more people. So that all happens very, very 

rapidly if it happens. 

Dr. BRANTLY. Yes, sir. 

Senator ALEXANDER. Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you, Senator Alexander. Senator Burr, 

thank you. 

Again, both of you, thank you very much for being here, for your 

patience, and for sharing with us your personal stories. 

The Obama administration is moving rapidly on this. Today 

President Obama went to the CDC. We are ourselves working here 

to do everything we can to rapidly respond and to support the 

President in this effort. I think you’re right, time is of the essence, 

but it has to be done correctly rather than rushing in and doing 

things that may even make it worse. Certainly we need to get the 

equipment there, the personal protection gear for home health and 

health care workers in these countries. We need to do a rapid series of educational programs so that the local populace begins to 

know what to do and how to respond and not to be afraid. That 

needs to be done rapidly. 

I trust that there are NGO’s like the one you are with, Mr. 

Charles, there are NGO’s there that could be very helpful on this, 

I believe, and who have been there for some time and who have 

good relations with people in these countries. I’m hopeful that as 

we do this rapidly, we will learn from, lean on, ask the help of the 

NGO’s that are in these countries. They can be extremely helpful. 

Do you concur with that? We need to really ask them for their help. 

Thank you very much, and I hope and trust, Mr. Charles, that 

your wife and your daughters are safe, and if they hear any of this 

at all I want to assure them that you’re going to be back home and 

you’ll be safe. 

Mr. CHARLES. Thank you very much. 

The CHAIRMAN. Thank you. And thank you, Dr. Brantly, again 

for your great example. 

The record will remain open for 10 days. Thank you very much. 

We’ll stand adjourned. 

[Additional material follows.] 

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1 Note: Content accurate as of October 15, 2014. Responses do not reflect enactment of the 

$1.777 billion for CDC in emergency funding to prevent, detect, and respond to the Ebola Epidemic. 2For more information about travel notices to the West Africa region and other countries, 

please visit CDC’s Travelers’ Health website. 

ADDITIONAL MATERIAL 

RESPONSE BY BETH P. BELL, M.D., MPH TO QUESTIONS OF SENATOR CASEY, SENATOR BENNET, SENATOR WHITEHOUSE, SENATOR SHAHEEN, SENATOR BALDWIN, 

SENATOR WARREN, SENATOR ALEXANDER, SENATORS ALEXANDER AND BURR, SENATOR MORAN, SENATOR COCHRAN, SENATOR SHELBY, SENATOR BURR, SENATOR

KIRK, AND SENATOR ENZI 1

SENATOR CASEY

Question 1. What is the CDC’s plan to communicate with the public regarding the 

current threat posed by Ebola, and how will these communications change should 

Ebola reach the United States? 

Answer 1. CDC educates Americans on ways to protect themselves when traveling 

in numerous ways, such as: 

• Issuing travel health notices advising U.S. citizens to avoid nonessential travel 

and to take enhanced precautions if they are visiting the affected West African nations.2 The recommendation to avoid nonessential travel is intended to help control 

the outbreak and prevent continued spread by: 

1. Protecting U.S. residents who may be planning travel to the affected areas, 

and 

2. Enabling the government of the affected countries to respond most effectively 

to contain this outbreak. 

• Working closely with Customs and Border Protection (CBP) in the Department 

of Homeland Security (DHS) and other partners to enhance practices at U.S. ports 

of entry to use routine procedures to identify travelers who show signs of infectious 

disease. In response to the outbreak, these procedures have been enhanced through 

guidance and training. CDC’s quarantine station staff respond as needed, for example by evaluating ill travelers identified by CBP officers. 

• Providing comprehensive information to travelers at U.S. ports of entry through 

airport messaging to outbound and inbound travelers, CDC website, and social 

media. Ebola-specific travel messages have been developed for electronic monitors 

and posted to reach travelers from West Africa, and posters have been displayed in 

Transportation Security Administration (TSA) screening areas of airports to reach 

outbound travelers. Furthermore, CDC maintains detailed and updated actions for 

travelers to take before international travel on the CDC website, including Ebolarelated recommendations. 

• Developing interim guidance to provide public health authorities and other 

partners with a framework for evaluating people’s level of exposure to Ebola and 

initiating appropriate public health actions on the basis of exposure level and clinical assessment. Specifically, CDC developed ‘‘Interim Guidance about Ebola Virus 

Infection for Airline Flight Crews, Cleaning Personnel, and Cargo Personnel,’’ As 

well as ‘‘Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure.’’ 

• Issuing advice for colleges, universities, and students about study abroad, foreign exchange, and other education-related travel, as well as advice for students 

who have recently traveled from a country in which an Ebola outbreak is occurring. 

• Developing guidance for humanitarian aid organizations whose employees or 

volunteers are working in countries where an Ebola outbreak is occurring. Humanitarian aid workers play a vital role in the Ebola outbreak response, and CDC encourages them to continue the important work being done to stop the disease’s 

spread at its source. 

CDC will continue to update its communication products and webpages with new 

information on the Ebola outbreak for the general public and specific audiences to 

share credible, factual information and to dispel misconceptions about Ebola. 

Question 2. You noted in your testimony that there are three key things that we 

need to respond to this epidemic: resources, technical experts, and a coordinated, 

global unified approach. Which of these things do you feel we are currently doing 

well? Which of them do you feel we are currently doing poorly, and how do you suggest we improve our efforts? 

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Answer 2. We are continuously evaluating all three of these areas. On resources, 

we continue to work across the U.S. Government to determine the resource needs 

to ramp up the response and stop this epidemic globally while protecting the United 

States. The U.S. Government also is actively coordinating with other donors to support these efforts. For technical expertise, CDC has been fighting this disease for 

decades, and along with our partners, we have the technical expertise to stop this. 

We need to transfer some of that expertise to countries experiencing the epidemic 

and those at risk, so that our pool of experts is larger and is on the ground when 

outbreaks occur. Global coordination continues to improve. We are doing our best 

to respond to the current epidemic both by working intensively in the countries currently experiencing the epidemic as well as by preparing nearby countries to be 

ready to respond to imported cases. CDC has identified 11 countries at high risk 

for importation and potential outbreaks and is working intensively with these countries to improve their surveillance, laboratory, and other pivotal capabilities. 

Question 3. Is there a sufficient supply of personal protective equipment (PPE) 

available (or capable of being procured) to supply the affected West African nations? 

Do we also have a sufficient supply of PPE available should Ebola reach the United 

States? 

Answer 3. CDC is aware that challenges remain with the supply of PPE in West 

Africa. The United Nations Logistics Cluster has been activated to assist with PPE 

needs and supplies. WHO and MSF also communicate directly with the largest PPE 

manufacturers to ensure that they can produce the necessary PPE for the response. 

Thus far, the manufacturers have not had problems producing PPE supplies in sufficient quantities; however, procurement and distribution remain challenging. 

In the United States, as of October 15, 2014, there have been no reported shortages of PPE. Hospitals have reported sufficient quantities for health care workers 

who might treat suspect or confirmed patients with Ebola virus disease (EVD). 

Moreover, as we understand it, manufacturers are aware that there may be increased demand, and they are preparing for that demand. 

SENATOR BENNET

Question 1. Dr. Bell, in your testimony you say that ‘‘the technology, capacity, and 

resources exist to make measurable progress across member countries, but focused 

leadership is required to make it happen.’’ Can you expand upon what kind of focused leadership you think is needed here? 

Answer 1. The importance of having a well-functioning incident management system in an Emergency Operations Center (EOC) in each affected country cannot be 

overemphasized. It is critical that there be strong coordination and communication 

among countries, with clear delineation of responsibilities. For its part, CDC has activated its EOC to help coordinate technical assistance and control activities with 

partners. On August 6, 2014, CDC elevated the EOC to a Level 1 activation, its 

highest level, because of the significance of the outbreak. CDC supports countries 

in establishing their own national and sub-national EOCs. Each of the three West 

African countries at the center of the epidemic now have an Incident Manager, reporting to the President of the country, to lead response efforts. 

Question 2. There are many charities and volunteers here that want to help end 

this outbreak and care deeply about the outcome. For example, in my home State, 

the Centennial-based Project CURE has been working with local volunteers and 

high schools, like Valor Christian High School in Highlands Ranch, to send medical 

supplies to West Africa. They have already sent four large containers of supplies for 

medical workers there. They want to know that their government is showing a coordinated response to this effort, and that their work will not be in vain. Can you 

give them and other volunteers across the country some peace of mind that their 

work is helping and you all are doing everything you can to coordinate an effective 

response to this outbreak? 

Answer 2. The U.S. Government’s goal is to enable the most effective and coordinated international response possible, using our governmentwide capabilities to 

fight the Ebola epidemic on a regional basis. In September 2014, President Obama 

announced a scaled-up U.S. response to the crisis, building on a whole-of-government response across the U.S. Agency for International Development (USAID), the 

Department of Defense (DoD), Department of State, CDC, and other Federal Departments and Agencies. The United States also is working intensively on this effort 

with the United Nations, the governments of the affected countries, and other donor 

partners.

We continue to appreciate the efforts of the Congress and concerned American 

citizens to raise awareness and get involved in the response to this crisis. USAID 

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3For further information on the organizations working to combat the crisis, additional ways 

to volunteer or contribute, or more information on the response, please visit USAID’s Center 

for International Disaster Information website. 

is coordinating all kinds of donations and volunteers, and suggests a list of charities 

for the public at http://www.usaid.gov/ebola. These efforts make a tremendous difference.3

Question 3. Given the emergence of Ebola as a significant public health threat— 

and the level of funds understandably being allocated in response—I am concerned 

about our ability to respond to other emergencies, such as pandemic influenza, 

which are far more common threats. In particular, I’m concerned that we are jumping from crisis to crisis and failing to adequately budget for rapid response capabilities to public health pandemics, like Ebola, pandemic influenza, and MERS. Just 

earlier this month, for instance, a DHS OIG report highlighted that our pandemic 

influenza stockpiles have not been effectively managed, and I’m concerned that we 

may be falling behind on these other types of preparedness issues. How are you assuring that we are adequately prepared and not compromising our ability to rapidly 

respond to address other public health crises, like pandemic influenza, in addition 

to emerging threats like Ebola? 

Answer 3. The emergence of a novel, pandemic strain of influenza represents a 

continued threat to global health. To address this threat, CDC has developed plans 

and capabilities to respond to pandemic influenza at any time, regardless of other 

ongoing response activities. Since the 2009 H1N1 pandemic, we have enhanced our 

capabilities with more robust domestic and international surveillance systems, improved communication with partners, and increased public health laboratory capacity at the State, local and international levels. CDC is prepared to address public 

health crises, but the agency would be concerned about the ability to respond effectively to multiple, large-scale, concurrent events. 

With respect to the referenced report by the DHS Office of the Inspector General, 

CDC cannot speak to the work product of another department. However, it is important to note that this report encompasses a review of DHS preparedness to continue 

critical operations of DHS activities during an influenza pandemic. This report does 

not evaluate the nationwide preparedness to respond to such a pandemic. 

SENATOR WHITEHOUSE

Question 1. Several commentators have cited distrust of health care officials by 

people in affected regions as one of the barriers to receiving care. What steps has 

CDC taken to overcome this mistrust? How are CDC and the World Health Organization partnering with trusted local leaders and communications outlets to disseminate information? 

Answer 1. CDC has deployed several teams of public health experts to the West 

Africa region to work directly with local leaders and stakeholders who can inform 

on the best ways to foster trust and reach communities. CDC’s health promotion 

teams, consisting of health communicators and public health advisors deployed to 

Guinea, Liberia, and Sierra Leone, are working closely with country embassies, 

UNICEF, WHO, ministries of health, and nongovernment organizations to develop 

public health messages and implement social mobilization activities. In all three 

countries, CDC health communicators are meeting with local community leaders beyond capital cities. 

Question 2. In Rhode Island, public health officials at the Department of Health 

and elsewhere are working with local residents from West Africa to help them communicate to their family and friends on ways to stay safe. Do you recommend outreach and education efforts of this kind? Will you be supporting and spreading this 

approach to other States that are part of the Liberian diaspora in the United States 

like Minnesota, Pennsylvania, Maryland, Georgia, and Washington, DC? 

Answer 2. CDC has engaged and continues to engage in outreach directly to West 

African communities and organizations serving the West African diaspora across the 

country, including groups in Dallas/Dallas County, Rhode Island, California, Minnesota, and the Bronx. CDC’s specific activities include: 

• CDC is helping counter stigma during the Ebola response and encourages our 

public health partners to do so as well. CDC has developed messaging on avoiding 

stigma in West African populations in the United States and shared it with all State 

health departments and others. CDC has also created guidance for social service 

and community-based organizations in the United States serving immigrant communities, including additional guidance on preventing stigma for sharing with the population they serve. 

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• CDC has hosted several calls for West African community groups to provide the 

most up to date information on Ebola and opportunities for these groups to support 

Ebola response efforts, delivery of key health messages and CDC resources, and securing CDC speakers for special events. Participants have included faith-based 

groups and national organizations serving Liberians, Sierra Leoneans, and Guineans in the United States. For example, two calls were held on September 30, 2014 

with groups representing the West African diaspora population. One call was organized by Congressman David Cicilline’s office for the diaspora in Rhode Island, and 

the other call was open to diaspora groups and individuals across the country. CDC 

is planning to continue this type of outreach on an ongoing basis.

• CDC is collaborating with a private partner, AudioNow, to deliver PSAs on 

their call-to-listen platform popular with West African communities in the United 

States. Several PSAs have been developed targeting this group, with a focus on how 

to inform relatives in the West African region about Ebola, and travel related issues 

(e.g., visitors coming from and traveling to the region). These are in production now 

in four languages for 72 radio stations that are identified as reaching large groups 

of West Africans in the United States. CDC has also worked with President Jimmy 

Carter and the Carter Center to develop some specific messages, building on their 

existing relationships and portfolio of work in Liberia. 

CDC will continue to take measures to ensure that geographic areas with large 

West African populations receive timely information and make available resources 

as needed. CDC has a cadre of experts who have experience reaching immigrant 

populations, including individuals that speak Hausa and Fulani, two of the major 

non-English and non-French languages in the region, to provide consultation on linguistic and cultural issues.

Question 3. What do you advise State and local health officials to do to protect 

their populations? What additional resources are needed at the State and local level 

to insure that Ebola from any imported case is not spread? 

Answer 3. CDC has created plans outlining its course of action for when a laboratory-confirmed Ebola diagnosis occurs in the United States and continues to work 

with other Federal, State, and local health governments and private organizations 

to strengthen U.S. readiness for detecting and preventing Ebola cases. 

Recognizing that even a single case of Ebola diagnosed in the United States is 

a concern, CDC is working with medical and public health professionals and health 

care facilities across the country to prepare and respond and to safely manage a patient with suspected Ebola Virus Disease. This includes engagement in the following 

activities: 

• Enhancing surveillance and laboratory testing capacity to detect cases domestically; 

• Developing guidance and tools, such as checklists for health departments, hospitals, emergency medical services, and health care coalitions to conduct public 

health investigations; 

• Providing recommendations for health care infection control and other measures 

to prevent disease spread; 

• Providing guidance for flight crews, emergency medical units at airports, and 

U.S. CBP officers about reporting ill travelers to CDC; 

• Coordinating with maritime authorities to assess the potential risk to the 

United States from cargo vessels from the four affected West African countries; and 

• Disseminating up-to-date information about the epidemic to the general public, 

international travelers, and public health partners. 

Since July, CDC’s Health Alert Network has issued seven notices on Ebola, reaching hundreds of thousands of clinicians and others. 

CDC also is working to prepare U.S. healthcare facilities for safe management of 

patients with suspected Ebola virus and to educate health care professionals across 

the country about important precautionary measures related to Ebola. CDC communicates with health care workers on an ongoing basis through the HAN, Clinician 

Outreach and Communication Activities, and a variety of other existing tools and 

mechanisms. 

In regards to what private health organizations can do to prepare for such a public health emergency, CDC recommends the following steps to assist in any potential 

response: 

• Health care organizations can encourage U.S. hospitals to be prepared to identify and initially manage patients with Ebola; 

• Health care providers can increase their understanding of Ebola, using the latest healthcare guidance; and 

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• Health care organizations can support health care provider requests to work in 

West Africa assisting those affected by the Ebola epidemic. USAID provides information on volunteer needs on its website. 

Finally, CDC has issued advice for colleges, universities, and students about study 

abroad, foreign exchange, and other education-related travel, as well as advice for 

students who have recently traveled from a country in which an Ebola outbreak is 

occurring. CDC advises that all non-essential travel, including education-related 

travel, to Guinea, Liberia, and Sierra Leone be postponed until further notice. Students, faculty, and staff who have recently traveled to countries where the Ebola 

outbreaks are occurring should consult with school authorities on what instructions 

to follow, and monitor their health for 21 days after returning. CDC advises colleges 

and universities to identify students, faculty, and staff who, within the past 21 days, 

have been in countries where Ebola outbreaks are occurring and conduct a risk assessment for each person to determine his or her level of risk exposure, as well as 

the appropriate public health response and medical care based on CDC’s Interim 

Guidance for Monitoring and Movement of Persons with Ebola Virus Disease Exposure. 

SENATOR SHAHEEN

Question 1. How can we apply the lessons we are learning in the current global 

emergency response to better leverage our resources to support a long-term local 

epidemiologic infrastructure operated and staffed by local scientists and public 

health officials? 

Answer 1. The global response to Ebola underscores the need for well-functioning 

and effective health and public health systems across the world. The current response shows that capacities outlined in the Global Health Security (GHS) Agenda 

to prevent, detect, and respond to public health emergencies are critical in a country’s ability to lessen the impact of infectious disease outbreaks. Several components 

of the immediate response to Ebola are key areas for GHS implementation—an 

EOC, laboratory capacity, surveillance, and workforce development. 

In this epidemic, we have seen that some countries, even with nascent detection 

and response capacities, were able to successfully contain and eradicate the outbreak after experiencing cases in their countries. An example is Nigeria, which used 

its existing EOC developed for the polio response and Field Epidemiology Training 

Program to monitor operations, conduct surveillance and contact tracing, showing 

that improvements to core public health systems are critical to responding to emerging threats. 

Some of the work we are currently doing for the response, including surveillance, 

information systems, workforce strengthening, EOC development, and laboratory 

services, will serve as the foundation for longer term GHS strengthening. 

Question 2. Among the various challenges that we face with this ongoing epidemic 

is collecting real time data in a rapidly changing situation. Further, sharing this 

information between corroborating agencies in an international context is challenging. How is CDC keeping pace with the data and making sure that decisionmakers have the best up to date information available to inform their planning? 

Answer 2. CDC has activated its EOC to help coordinate technical assistance and 

control activities with partners. On August 6, 2014, CDC elevated the EOC to a 

Level 1 activation, its highest level, because of the significance of the outbreak. CDC 

supports countries in establishing their own national and sub-national EOCs. Each 

of the three West African countries at the center of the epidemic now has an Incident Manager, reporting to the President of the country, to lead response efforts. 

Hundreds of CDC staff members have provided logistics, staffing, communication, 

analytics, management, and other support functions for the response. CDC has deployed several teams of public health experts to the West Africa region. CDC staff 

are deployed to Guinea, Liberia, Nigeria, Senegal, and Sierra Leone to assist with 

response efforts, including surveillance, contact tracing, data management, laboratory testing, and health education. CDC continues to send additional public health 

experts to the affected and neighboring countries. CDC experts have been deployed 

to non-affected border countries, including Cote d’Ivoire, to conduct assessments of 

Ebola preparedness in those countries. 

Through the Disaster Assistance Response Team (DART), led by USAID with 

CDC staff embedded, and regular communication with on-the-ground staff, the CDC 

EOC maintains daily interaction to obtain the most up-to-date data from the field. 

This data feeds directly to each Ebola response team to shape plans and allow for 

nimble changes in tactics to address evolving situations in each affected country. 

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In the United States, CDC has data collection and tracking mechanisms in place 

to monitor any potential case of the disease. CDC, along with other Federal agencies, has created and implemented a response plan to manage a laboratory-confirmed case of EVD in the United States, and is providing guidance to health care 

facilities about how to safely manage a patient with suspected EVD. This includes 

engagement in the following activities: 

• Enhancing surveillance and laboratory testing capacity to detect cases domestically. • Developing guidance and tools for health departments to conduct public health 

investigations. • Providing recommendations for healthcare infection control and other measures 

to prevent disease spread. • Providing guidance for flight crews, emergency medical units at airports, and 

U.S. CBP officers about reporting ill travelers to CDC. • Coordinating with maritime authorities to assess the potential risk to the 

United States from cargo vessels from the four affected West African countries. • Disseminating up-to-date information about the outbreak to the general public, 

international travelers, and public health partners. 

Question 3. Is CDC employing the latest mobile technologies and software to 

record and disseminate information? 

Answer 3. CDC employs extensive surveillance and sophisticated modeling techniques to gather, analyze and act on data and information, in cooperation with global partners. 

The Department of Health and Human Services (HHS), and in particular CDC, 

is working closely with the World Health Organization (WHO), the United Nations, 

the Ministries of Health in affected countries, and other international partners to 

respond to the current Ebola outbreak in West Africa. CDC receives regular updates 

of morbidity and mortality to evaluate the spread of the disease and combines this 

information with reports from CDC’s staff deployed to the area. Hundreds of CDC 

staff members have provided logistics, staffing, communication, analytics, management, and other support functions for the response. CDC continues to commit significant staffing and financial resources to the international Ebola response both on 

the ground in West Africa and through its domestic EOC. CDC’s health promotion 

teams, consisting of health communicators and public health advisors deployed to 

Guinea, Liberia, and Sierra Leone, are working closely with country embassies, 

UNICEF, WHO, ministries of health, and nongovernment organizations to develop 

public health messages and implement social mobilization activities. CDC is 

partnering with major telecommunications companies in the affected countries to 

disseminate messages across the countries (ORANGE and Cellcom in Guinea; 

Africell in Sierra Leone; and Cellcom and Lonestar in Liberia). CDC engaged with 

UNICEF and Focus 1000 in the development of a Knowledge, Attitudes, and Practices study and preliminary report in Sierra Leone and is using this report to inform 

future message strategies. 

CDC continues to update its communication products and webpages with new information on the Ebola outbreak for the general public and specific audiences. CDC 

is using social media as a way to share credible, factual information and to dispel 

misconceptions about Ebola. 

Question 4. Our Nation’s intensive care units are at the forefront of caring for the 

most critically ill patients including during times of widespread medical emergencies 

such as pandemics. While we know that Ebola is not affecting a large number of 

Americans today, we do know that the next pandemic could be just around the corner and we need to ensure that our critical care system is equipped to respond. Dr. 

Bell and Dr. Robinson, does our hospital system currently have the necessary critical care infrastructure in place for this type of virus, such as appropriate critical 

care containment rooms? 

Answer 4. Any U.S. hospital should be prepared to identify, assess and isolate a 

patient with Ebola. CDC developed guidance documents and checklists to help U.S. 

hospitals prepare for, test, and treat patients with Ebola, and works to keep the 

health care system informed of new developments. CDC uses its HAN to provide information and guidance to U.S. healthcare workers and hospitals regarding EVD. 

CDC distributed a HAN notice August 1, 2014, and five updates have followed. The 

most recent HAN notice about Ebola was distributed on October 2, 2014. 

CDC created and implemented an operational plan outlining the course of action 

for the first 72 hours to manage a laboratory-confirmed Ebola diagnosis in a patient. 

Plan activities include rapid dissemination of news regarding the Ebola case(s) to 

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tions; providing current and timely information to State, local, and territorial public 

health departments; and coordinating critical issues management regarding State 

and local needs for the CDC EOC incident manager and other response task force 

teams.

CDC has redoubled its efforts to educate American health care workers about how 

to isolate patients and how to protect themselves from infection, including developing and disseminating resources, hosting informational calls, and creating 

trainings. CDC has: 

• Hosted Clinician Outreach and Community Activity calls for clinical professionals to provide information about what U.S. hospitals need to know to prepare 

for EVD. 

• Created guidance about EVD for clinicians in U.S. health care settings. 

• Posted a Medscape Expert Commentary for healthcare providers whose patients 

are travelers with concerns about Ebola. The commentary includes information 

about the Ebola outbreak in West Africa, the transmission Ebola virus, and how to 

talk to travelers about their risk. 

• Created guidance for U.S. healthcare workers on ‘‘Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola 

Hemorrhagic Fever in U.S. Hospitals.’’ 

• Developed a checklist for hospitals to aid in Ebola preparedness that can be 

found on the CDC website. 

• Built a Safety Training Course for Healthcare Workers Going to West Africa in 

Response to the 2014 Ebola Outbreak. The primary purpose of the course is to ensure that clinicians intending to provide medical care to patients with Ebola have 

sufficient knowledge of the disease and its transmission routes to work safely and 

efficiently in a well-designed Ebola Treatment Unit (ETU). 

• Collated the Top 10 Ebola Response Planning Tips: Ebola Readiness Self-Assessment for State and Local Public Health Officials to help guide planning and 

readiness for Ebola response at State and local levels and assist health officials in 

assessing their jurisdictions’ level of readiness for a potential Ebola response. 

SENATOR BALDWIN

Question. The President recently outlined a comprehensive response to combat 

this epidemic that includes the efforts of an estimated 3,000 U.S. forces and a strong 

partnership with the United Nations and our other international partners. The first 

cases of Ebola were reported in March; it is now October and the Ebola crisis is 

only worsening. Why did we not initiate this response in March? In hindsight, what 

should have been the United States’ first action item when cases were first reported, 

and what can we learn from this to prevent the world from seeing such tragedy 

again? 

Answer. CDC is incorporating lessons learned as the response evolves, and, as is 

done after all large-scale responses, the agency will conduct a comprehensive ‘‘afteraction’’ review to learn additional lessons that will prepare the agency to better respond to future events. 

CDC initiated the first stages of response in March 2014 when it activated its 

EOC to help coordinate technical assistance and control activities with partners. On 

August 6, 2014, CDC elevated the EOC to a Level 1 activation, its highest level, 

because of the significance of the outbreak. CDC supports countries in establishing 

their own national and sub-national EOCs. Each of the three West African countries 

at the center of the epidemic now has an Incident Manager, reporting to the President of the country, to lead response efforts. 

Hundreds of CDC staff members have provided logistics, staffing, communication, 

analytics, management, and other support functions for the response. CDC has deployed several teams of public health experts to the West Africa region. CDC staff 

are deployed to Guinea, Liberia, Nigeria, Senegal, and Sierra Leone to assist with 

response efforts, including surveillance, contact tracing, data management, laboratory testing, and health education. CDC continues to send additional public health 

experts to the affected and neighboring countries. CDC experts have been deployed 

to non-affected border countries, including Cote d’Ivoire, to conduct assessments of 

Ebola preparedness in those countries. 

Through the Global Disease Detection (GDD) program, CDC develops and 

strengthens global capacity to rapidly detect, accurately identify, and promptly contain emerging infectious disease and bioterrorist threats that occur internationally. 

The GDD Operations Center, implemented in 2007, is a surveillance system that enables the ongoing, systematic collection, management, analysis, interpretation, and 

dissemination of health-related data. 

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SENATOR WARREN

Question 1. If the Global Security Agenda had been launched 5 years ago, and 

we already had these pieces in place, would this epidemic have been better contained? 

Answer 1. The global response to Ebola underscores the need for well-functioning 

and effective health and public health systems across the world. The current response shows that capacities outlined in the Global Health Security Agenda (GHSA) 

to prevent, detect, and respond to public health emergencies are critical in a country’s ability to lessen the impact of infectious disease outbreaks. Had these capacities been developed, the course of this outbreak would likely have resulted in earlier containment, fewer deaths and decreased economic ramifications. 

Several components of the immediate response to Ebola are key areas for GHSA 

implementation—EOC, laboratory capacity, surveillance, and workforce development. In this epidemic, we have seen that some countries, even with nascent detection and response capacities, were able to successfully contain the outbreak after experiencing cases in their countries. An example is Nigeria, which used its existing 

EOC and Field Epidemiology Training Program to monitor operations, conduct surveillance, and conduct contact tracing, proving that even basic improvements to public health systems can be effective in responding to emerging threats. 

Some of CDC’s work in this response, including surveillance, information systems, 

workforce strengthening, EOC development, and laboratory services will serve as 

the foundation for longer-term, broad, global health security strengthening. 

Question 2. How will the Agenda help to address the challenges of political instability, the lack of infrastructure, and the lack of basic health care resources that 

have all played a huge role in the continued spread of this epidemic? 

Answer 2. The vision of the Global Health Security Agenda is a world safe and 

secure from global health threats posed by infectious diseases—where we can prevent or mitigate the impact of naturally occurring outbreaks and intentional or accidental releases of dangerous pathogens, rapidly detect and transparently report outbreaks when they occur, and employ an interconnected global network that can respond effectively to limit the spread of infectious disease outbreaks in humans and 

animals, mitigate human suffering and the loss of human life, and reduce economic 

impact. 

Ebola is the most tangible—and tragic—example so far for why the global community must work together to make the world safer from infectious disease outbreaks. 

The Ebola crisis in West Africa is precisely the kind of complicated disease eruption 

the Global Health Security Agenda is designed to address. The GHSA will help prevent, detect and respond to infectious disease outbreaks in the following ways: 

• Coordination and communication among nations will be strengthened and 

streamlined, allowing disease outbreaks to be discovered and characterized at the 

earliest possible moment. 

• Laboratory capacity will be increased and operating standards strengthened so 

that potential diseases can be accurately and precisely identified. Then treatment 

protocols can be established more quickly to effectively treat patients and protect 

health care workers. 

• New disease detectives will be trained around the world and deployed to close 

gaps in surveillance and provide early detection. 

• More countries will be equipped with networked EOCs governed by a universal 

set of standards and rules that will allow a unified and effective response. 

• The availability of more detailed information sooner will allow a more unified 

response and, if needed, the ability of partner countries to surge experts to affected 

areas so disease outbreaks are contained at the earliest possible moment and while 

they are still small in scope. 

Ultimately, having better information around disease detection and response enables more timely and accurate communication with the public. This can help limit 

unease and panic that affects commerce, travel, political stability and public health. 

Question 3. How would the effectiveness of the Agenda be maximized by investments to improve the basic healthcare infrastructure of developing nations? 

Answer 3. The GHSA outlines nine objectives to accelerate progress toward a 

world safe and secure from infectious disease threats in partnership with other nations, international organizations and public and private stakeholders. Several of 

these address the investments related to improve health care systems: 

• Reduce the number and magnitude of infectious disease outbreaks. Establish effective programs for vaccination against epidemic-prone diseases and for nosocomial 

infection control. 

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• Train and deploy an effective disease surveillance workforce. Build capacity for 

trained and functioning biosurveillance workforce, with trained disease detectives 

and laboratory scientists. • Improve global access to medical and non-medical countermeasures during 

health emergencies. Strengthen capacity to produce or procure personal protective 

equipment, medications, vaccines, and technical expertise, as well as the capacity 

to plan for and deploy non-medical countermeasures. Strengthen policies and operational frameworks to share public and animal health and medical personnel and 

countermeasures with partners. 

Question 4. Who do you think should be ultimately responsible for the international coordination and financing of outbreak responses when local governments 

are unable to do so? 

Answer 4. To respond adequately to a major crisis such as the Ebola Outbreak 

in West Africa, multiple actors are needed and, in fact, are now responding. They 

include U.N. agencies (such as WHO, UNICEF, World Bank), the U.S. Government, 

other countries, NGO’s (such as MSF and the International Red Cross), as well as 

other entities within the private sector. Within the West Africa region affected by 

the Ebola outbreak, USAID continues to lead the United States’ overseas response, 

while the Department of Defense, CDC, Department of State, and other departments and agencies are supporting the whole-of-government approach to this national security priority. USAID has deployed a DART to coordinate planning, operations, logistics and other components of the interagency effort. CDC staff is working with Ministries of Health to improve surveillance, contact tracing, laboratory capacity, emergency operations planning and other critical capabilities. 

HHS, and in particular CDC, is working closely with the World Health Organization (WHO), the United Nations, the Ministries of Health in affected countries, and 

other international partners to respond to the current Ebola outbreak in West Africa. The Ebola epidemic reminds us that our global efforts to build the capacity to 

prevent, detect, and rapidly respond to infectious disease threats like EVD have 

never been more vital.

In February 2014, the United States came together with nations around the world 

to launch the Global Health Security Agenda (GHSA) as a 5-year effort to accelerate 

action. On September 26, 2014, President Obama met with leaders of 40 nations as 

well as top Administration officials to advance progress in the GHSA. 

CDC receives regular updates of morbidity and mortality to evaluate the spread 

of the disease and combines this information with reports from CDC’s staff deployed 

to the area. Hundreds of CDC staff members have provided logistics, staffing, communication, analytics, management, and other support functions for the response. 

CDC continues to commit significant staffing and financial resources to the international Ebola response both on the ground in West Africa and through its domestic 

EOC. 

CDC has activated its EOC to help coordinate technical assistance and control activities with partners. CDC supports countries in establishing their own national 

and sub-national EOCs. Each of the three West African countries at the center of 

the epidemic now has an Incident Manager, reporting to the President of the country, to lead efforts. 

CDC continues to send additional public health experts to the affected countries. 

CDC staff are assisting with setting up an emergency response structure, contact 

tracing, providing advice on exit screening and infection control at major airports, 

and providing training and education in the affected countries. 

The below mechanisms for coordination have been developed to direct their support to the target population in West Africa. At the international level, the United 

Nations has established its Mission for Ebola Emergency Response (UNMEER) in 

Ghana, and is serving as a regional hub for logistics and coordination of the U.N. 

Bodies (including WHO, UNICEF, and others), while working closely with the Governments of Guinea, Liberia and Sierra Leone. 

WHO-AFRO has established a Regional Outbreak Coordination Center in 

Conakry, Guinea. 

Within countries, through their country offices, WHO is coordinating support to 

the national operational plans. The United States has established DARTs in each 

of the affected countries for coordination of U.S. Government planning, operations, 

logistics, administrative issues and other critical areas related to the U.S. Government interagency response. These efforts are all done in direct coordination with national governments, given that they have responsibility for coordinating their respective national response efforts. 

Private sector resources also may be called upon to support lead agencies and directly impacted areas. For the private sector, this includes companies lending their 

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core competencies and assets on the ground as well as providing financial resources 

to support other priorities. The private sector also can contribute by maintaining operations in impacted countries/regions as they are an important part of local economies. 

Question 5. What is the ideal design for an international response system for future outbreaks? 

Answer 5. The International Health Regulations (IHR, 2005) provide the legally 

binding framework for the coordination of the management of events that may constitute a public health emergency of international concern. IHR aims to improve the 

capacity of all countries to detect, assess, notify, and respond to public health 

threats. While IHR was signed by the 194 member states of the World Health Organization, fewer than 20 percent of those countries reported in 2012 that they have 

fully achieved compliance with IHR and are fully prepared to detect and respond 

to disease threats. The aim of the Global Health Security Agenda is to close this 

gap. 

The Global Health Security Agenda (GHSA) is an effort by nations, international 

organizations, and civil society to accelerate progress toward a world safe and secure 

from infectious disease threats; to promote global health security as an international 

priority; and to spur progress toward full implementation IHR and other relevant 

global health security frameworks. 

Question 6. What is the ideal design for our national response system for future 

international outbreaks? 

Answer 6. CDC is fully supportive of the National Response Framework (updated 

in 2013) and the National Incident Management System (NIMS) outlined within it. 

The guiding principles of NIMS are: engaged partnership; tiered response; scalable, 

flexible, and adaptable operational capabilities; unity of effort through unified command; and readiness to act. 

The National Response Framework works best when State and local health departments are fully staffed and well trained and have robust surveillance and laboratory capacity. Strong clinical networks that local health departments can link 

into for novel or unfamiliar global infectious disease outbreaks and a stockpile of 

medical countermeasures are also important as scalable resources. Another scalable 

resource that is needed for international and domestic outbreaks is a cadre of highly 

trained public health workers, including disease detectives, capable and ready to respond. CDC supports these goals domestically through the Public Health Emergency 

Response (PHEP) and Epidemiology and Laboratory Capacity (ELC) cooperative 

agreements, the Strategic National Stockpile (SNS), and support for the Laboratory 

Response Network (LRN) as well as internationally through programs such as the 

Field Epidemiology Training Program (FETP), Global Disease Detection Centers, 

and the Global Health Security Agenda. 

Question 7. How would long term investments to improve the basic healthcare infrastructure of developing nations help to improve our ability to respond to new outbreaks and epidemics? 

Answer 7. Health care services are a part of every nation’s public health system, 

and they play a crucial role. There are linkages between Global Health Security and 

health care services. The Global Health Security Agenda takes a public health, or 

systems-level approach. Through the Agenda, the United States commits to working 

with at least 30 partner countries (containing at least 4 billion people) to prevent, 

detect and effectively respond to infectious disease threats, whether naturally occurring or caused by accidental or intentional releases of dangerous pathogens. The objectives of the agenda emphasize systems-level interventions in the three areas: Prevent, Detect, and Respond. Select activities include: 

• Prevent: Countries will have systems, policies and procedures in place to prevent or mitigate avoidable outbreaks. 

• Detect: Countries will have real-time biosurveillance and effective modern 

diagnostics in place that are able to reliably conduct at least five of the 10 core 

tests. 

• Respond: Countries will have a public health EOC functioning according to minimum common standards. 

Investing in global health security means investing in public health systems, and 

systems such as these provide critical information needed to inform health care 

practice. For instance, reliable nation-wide laboratory networks are needed for the 

detection of priority pathogens. These same networks also are needed for the accurate diagnosis of priority pathogens in individuals. In addition, information gathered 

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through public health surveillance can help inform decisions about how limited 

healthcare resources could be targeted to be most impactful. 

Question 8. How are the United States and international aid organizations helping to take care of health care needs besides Ebola in the epidemic regions? 

Answer 8. The U.S. Government is making investments in the region to address 

multiple health issues such as HIV and AIDS, maternal and child health, nutrition, 

malaria, and vaccine preventable diseases, including polio. Relationships on the 

ground, nurtured in part by CDC’s work in the region have proven to be important 

assets in addressing the current Ebola outbreak. CDC also continues to support priority activities in the region as well. 

The United States and international organization partners continue to support 

the President’s Malaria Initiative in the epidemic regions ensuring that planned malaria prevention activities, such as long-lasting insecticide treated bed net distributions, health indicator surveys, and healthcare working trainings are minimally disrupted. CDC is sending staff to support in-country national malaria control programs while the Resident Advisors are engaged in the Ebola response. Recently, 

CDC/WHO revised guidance for the diagnosis of malaria in Ebola countries to respond to the needs of the healthcare workers and partner organizations by recommending treatment options for specific populations in the Ebola affected areas to reduce the incidence of febrile illnesses. 

CDC plays a critical role in helping Ministries of Health in partner countries 

build strong, sustainable programs that respond effectively to the HIV/AIDS epidemic. CDC provides support to more than 60 countries as a key partner in the U.S. 

President’s Emergency Plan for AIDS Relief (PEPFAR). CDC through PEPFAR, is 

working to achieve that inspiring goal through proven science, smart investments, 

and shared responsibility with partner countries. 

CDC also is continuing immunization activities in the region. CDC is working 

with partners at WHO and UNICEF to maintain high levels of polio immunity there 

as part of the global effort to eradicate polio. CDC also supports measles vaccination 

and related immunization activities there. The worsening epidemic has slowed immunization activities in Ebola affected areas; however, the networks established by 

immunization activities are being used to provide education and information about 

stopping the spread of Ebola. 

In addition, CDC’s expertise in responding to the polio epidemic in Nigeria was 

leveraged to assist in establishing emergency response operations in that country 

to stop the spread of Ebola. The threat to Nigeria posed by the arrival in Lagos of 

a patient acutely ill with Ebola was potentially enormous, but the virus does not 

appear to have been widely spread there. The limited spread against the backdrop 

of the large, dense, urban environment suggests early response efforts were successful. CDC provided key guidance, and leadership, in a variety of areas, including incident management, contact tracing, public messaging and information, and port security to encourage a quick and effective response. 

SENATOR ALEXANDER

Question 1. The United States has pledged support to help fight Ebola, and there 

are other countries stepping up to the plate as well. How are these efforts being 

coordinated and is it effective? Who is on the flagpole? 

Answer 1. Within the West Africa region affected by the Ebola outbreak, USAID 

continues to lead the United States’ overseas response, while CDC, the Department 

of Defense, Department of State, and other Federal Departments and Agencies are 

supporting the whole-of-government approach to this national security priority. 

USAID has deployed a DART to coordinate planning, operations, logistics and other 

components of the interagency effort. CDC staff is working with Ministries of Health 

to improve surveillance, contact tracing, laboratory capacity, emergency operations 

planning and other critical capabilities.

HHS, and in particular CDC, is working closely with the World Health Organization (WHO), the United Nations, the Ministries of Health in affected countries, and 

other international partners to respond to the current Ebola outbreak in West Africa. The Ebola epidemic reminds us that our global efforts to build the capacity to 

prevent, detect, and rapidly respond to infectious disease threats like EVD have 

never been more vital. In February 2014, CDC came together with nations around 

the world to launch the GHSA as a 5-year effort to accelerate action. On September 

26, 2014, President Obama met with leaders of 40 nations as well as top Administration officials to advance progress in the GHSA. 

CDC receives regular updates of morbidity and mortality to evaluate the spread 

of the disease and combines this information with reports from CDC’s staff deployed 

to the area. Hundreds of CDC staff members have provided logistics, staffing, comLIFEBOOK092 with DISTILLER

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munication, analytics, management, and other support functions for the response. 

CDC continues to commit significant staffing and financial resources to the international Ebola response both on the ground in West Africa and through its domestic 

EOC. 

CDC has activated its EOC to help coordinate technical assistance and control activities with partners. CDC supports countries in establishing their own national 

and sub-national EOCs. Each of the three West African countries at the center of 

the epidemic now has an Incident Manager, reporting to the President of the country, to lead efforts. 

CDC continues to send additional public health experts to the affected countries. 

CDC staff are assisting with setting up an emergency response structure, contact 

tracing, providing advice on exit screening and infection control at major airports, 

and providing training and education in the affected countries. 

Question 2. Dr. Frieden cautioned that, ‘‘The window of opportunity to stop Ebola 

from spreading widely through Africa and becoming a global threat for years to 

come is closing, but it is not yet closed.’’ Is that window still open? What do we need 

to be doing to keep that window open? 

Answer 2. CDC continues to increase our efforts, and strongly encourage global 

partners, to ‘‘keep the window open.’’ The global community still has an opportunity 

to reverse the course of the epidemic in the three affected countries and prevent the 

spread of Ebola to other countries in Africa and throughout the world, but coordinated leadership and unwavering support must be brought to bear. HHS, and in 

particular CDC, is working closely with the World Health Organization (WHO), the 

United Nations, the Ministries of Health in affected countries, and other international partners to respond to the current Ebola outbreak in West Africa. 

CDC continues to commit resources at never-before seen levels to support the U.S. 

Government response to the Ebola outbreak. CDC has activated its EOC to help coordinate technical assistance and control activities with partners. CDC supports 

countries in establishing their own national and sub-national EOCs. Each of the 

three West African countries at the center of the epidemic now has an Incident 

Manager, reporting to the President of the country, to lead response efforts. CDC 

is also: 

• Providing hundreds of CDC staff members for logistics, staffing, communication, 

analytics, management, and other support functions for the response. CDC has deployed several teams of public health experts to the West Africa region. CDC staff 

are deployed to Guinea, Liberia, Nigeria, Senegal, and Sierra Leone to assist with 

response efforts, including surveillance, contact tracing, data management, laboratory testing, and health education. CDC staff are assisting with setting up an emergency response structure, contact tracing, providing advice on exit screening and infection control at major airports, and providing training and education in the affected countries. CDC experts have also been deployed to non-affected border countries, including Cote d’Ivoire, to conduct assessments of Ebola preparedness in those 

countries. 

• Working with airlines, airports, and ministries of health in West Africa to provide technical assistance for developing exit screening and travel restrictions in the 

countries where Ebola outbreaks are occurring. 

• With CBP, conducting enhanced entry screening to detect possible cases of 

Ebola in travelers who have traveled to the United States from or through Guinea, 

Liberia, and Sierra Leone. Enhanced entry screening at five U.S. airports (New 

York-JFK, Washington-Dulles, Newark, Chicago-O’Hare, and Atlanta) will evaluate 

travelers from the affected countries in West Africa. 

• Redoubling its efforts to educate U.S. healthcare workers on how to isolate patients and how to protect themselves from infection. Resources for U.S. healthcare 

workers are available on the CDC website. Over the coming days and weeks, CDC 

will be working with other Federal, State, and local governments and private organizations to strengthen U.S. readiness for the detecting and preventing additional 

cases of Ebola in this country. These efforts include the aforementioned enhanced 

entry screening at five U.S. ports of entry and enhanced outreach to healthcare 

workers and hospitals to improve their infection control practices and policies. 

Question 3. How is this outbreak testing the boundaries of what we know? In 

what manner will we need to alter the response given the different characteristics 

of this epidemic? 

Answer 3. The epidemic is unprecedented in size, scope, and complexity, but the 

fundamental risk factors and primary modes of transmission are the same as in previous Ebola outbreaks. The core public health interventions that have worked to 

stop previous Ebola outbreaks—surveillance, case identification and contact tracing, 

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isolation and treatment, safe burials—will work to stop this epidemic. CDC along 

with other parts of the U.S. Government and global partners are working on multiple fronts to expand capacity to meet this challenge. 

Question 4. We know that there is desperate need for doctors and nurses to care 

for people sick with Ebola. Estimates suggest a facility treating 70 Ebola patients’ 

needs a minimum of 250 health care staff, but Liberia didn’t even have that many 

doctors in its country even before the outbreak. The United States Agency for International Development has created a website where health professionals can sign up 

to help with the Ebola response. 

How are you coordinating with USAID? What are you doing to prepare these volunteers? Please describe any training provided to these volunteers. 

Answer 4. Within the West Africa region affected by the Ebola outbreak, USAID 

continues to lead the United States’ overseas response, while CDC, the Department 

of Defense, Department of State, and other Federal Departments and Agencies are 

supporting the whole-of-government approach to this national security priority. 

USAID deployed a DART to coordinate planning, operations, logistics and other 

components of the interagency effort. USAID is the lead Agency for recruiting and 

coordinating volunteers for the response. 

Humanitarian aid workers play a vital role in the Ebola outbreak response, and 

CDC encourages them to continue the important work being done to stop the disease’s spread at its source. CDC developed guidance for humanitarian aid organizations whose employees or volunteers are working in countries where an Ebola outbreak is occurring to help them plan for safe deployment. The recommendations include steps to take before departure, during travel, and upon return to the United 

States. 

CDC also created a Safety Training Course for healthcare workers going to West 

Africa in response to the 2014 Ebola outbreak. The primary purpose of the course 

is to ensure that clinicians intending to provide medical care to patients with EVD 

have sufficient knowledge of the disease and its transmission routes to work safely 

and efficiently in a well-designed Ebola Treatment Unit (ETU). In addition, CDC 

developed an introductory training course for licensed clinicians (e.g., nurses, physicians, and other healthcare providers) intending to work in an ETU in Africa to ensure that these clinicians have sufficient knowledge of the disease and its transmission routes to work safely and efficiently. The 3-day course is being given weekly 

and is already full for the next few months. 

Question 5. Since the hearing, we have had a patient land in the United States 

one airplane ride away from a person who was exposed to Ebola landing in the 

United States and becoming ill. What is the Department of Health and Human 

Services doing to prepare? 

There are four specialized medical isolation units in the United States that have 

been reported to be available to treat Ebola patients. Three of these have been used 

to treat the patients or exposed individuals brought back to the United States. If 

these fill to capacity and other individuals sick with Ebola are in need of care, how 

prepared are our hospitals to take care of Ebola patients? 

Answer 5. CDC has created plans outlining its course of action for when a laboratory-confirmed Ebola diagnosis occurs in the United States. The operational plans 

include assistance to State, tribal, territorial and local officials and the domestic 

health care community, and leverage CDC’s expertise and resources in epidemiology, surveillance, coordination of laboratory testing, health promotion and communication, healthcare and infection control, traveler health and screening. 

CDC’s response to a diagnosed case follows three key public health tenets: prevention, detection and response. The concept of prevention focuses on actions which can 

affect the spread of the disease. Detection centers on activities to find the disease 

through surveillance and contact tracing. CDC’s response efforts include its agencywide incident management and response capabilities in support of domestic requirements. CDC, along with other Federal agencies, has created and implemented a response plan to manage a laboratory-confirmed case of EVD in the United States and 

is providing guidance to health care facilities about how to safely manage a patient 

with suspected EVD. This includes engagement in the following activities: 

• Enhancing surveillance and laboratory testing capacity to detect cases domestically. 

• Developing guidance and tools for health departments to conduct public health 

investigations. 

• Providing recommendations for healthcare infection control and other measures 

to prevent disease spread. 

• Providing guidance for flight crews, emergency medical units at airports, and 

CBP officers about reporting ill travelers to CDC. 

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• Coordinating with maritime authorities to assess the potential risk to the 

United States from cargo vessels from the four affected West African countries. 

• Disseminating up-to-date information about the outbreak to the general public, 

international travelers, and public health partners. 

CDC has developed guidance documents and checklists to help U.S. hospitals prepare for, test, and treat patients with Ebola, and works to keep the health care system informed of new developments. CDC uses its Health Alert Network (HAN) to 

provide information and guidance to U.S. healthcare workers and hospitals regarding EVD. A HAN notice was distributed by CDC on August 1, 2014, and five updates have followed. The most recent HAN notice about Ebola was distributed on 

October 2, 2014. 

CDC has redoubled its efforts to educate American health care workers about how 

to isolate patients and how to protect themselves from infection, including developing and disseminating resources, hosting informational calls, and creating 

trainings. CDC has: 

• Hosted Clinician Outreach and Community Activity calls for clinical professionals to provide information about what U.S. hospitals need to know to prepare 

for EVD. 

• Created guidance about EVD for clinicians in U.S. health care settings. 

• Posted a Medscape Expert Commentary for healthcare providers whose patients 

are travelers with concerns about Ebola. The commentary includes information 

about the Ebola outbreak in West Africa, the transmission of the Ebola virus, and 

how to talk to travelers about their risk. 

• Created guidance for U.S. healthcare workers on ‘‘Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola 

Hemorrhagic Fever in U.S. Hospitals.’’ 

• Developed a checklist for hospitals to aid in Ebola preparedness, which can also 

be found on the CDC website. 

• Built a Safety Training Course for Healthcare Workers Going to West Africa in 

Response to the 2014 Ebola Outbreak. The primary purpose of the course is to ensure that clinicians intending to provide medical care to patients with Ebola have 

sufficient knowledge of the disease and its transmission routes to work safely and 

efficiently in a well-designed ETU. 

• Collated the Top 10 Ebola Response Planning Tips: Ebola Readiness Self-Assessment for State and Local Public Health Officials to help guide planning and 

readiness for Ebola response at State and local levels and assist health officials in 

assessing their jurisdictions’ level of readiness for a potential Ebola response. 

CDC also is working with additional hospitals to ready their facilities for additional patients with Ebola. Any U.S. hospital should be prepared to identify, assess 

and isolate a patient with Ebola. CDC developed guidance documents and checklists 

to help U.S. hospitals prepare for, test, and treat patients with Ebola, and works 

to keep the health care system informed of new developments. CDC uses its HAN 

to provide information and guidance to U.S. healthcare workers and hospitals regarding Ebola. CDC distributed a HAN notice August 1, 2014, and five updates 

have followed. The most recent HAN notice about Ebola was distributed on October 

2, 2014. 

CDC created plans outlining its course of action for when a laboratory-confirmed 

Ebola diagnosis occurs in the United States. The operational plans include assistance to State, tribal, territorial and local officials and the domestic health care community, and leverage CDC’s expertise and resources in epidemiology, surveillance, 

coordination of laboratory testing, health promotion and communication, healthcare 

and infection control, traveler health and screening. 

CDC’s response to a diagnosed case follows three key public health tenets: prevention, detection and response. The concept of prevention focuses on actions which can 

affect the spread of the disease. Detection centers on activities to find the disease 

through surveillance and contact tracing. CDC’s response efforts include its agencywide incident management and response capabilities in support of domestic requirements. 

SENATOR ALEXANDER AND SENATOR BURR

Question. You State in your testimony, ‘‘We do not view Ebola as a significant 

public health threat to the United States.’’ Could you please reconcile this statement 

with the fact that in 2006 then Secretary of Homeland Security Michael Chertoff 

determined, pursuant to Section 319F–2 of the Public Health Service Act that the 

Ebola virus presents a material threat against the United States population sufficient to affect national security, and that in August of this year the Secretary used 

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this determination to authorize emergency use of a diagnostic for identification of 

Ebola virus. 

Answer. The difference between the two statements is that the former deals with 

the natural transmission of Ebola as a public health concern, whereas the latter primarily has to do with Ebola’s potential for harm if artificially disseminated in a bioterrorist attack. In the United States, while there may be secondary cases among 

contacts of an imported Ebola case, the public health system will stop Ebola before 

an outbreak occurs. From a public health perspective, we know how to contain 

Ebola and we have the systems to do so. A DHS Material Threat Determination is 

made based on the risk of a terrorist using Ebola as a bio-weapon. DHS has determined that in certain scenarios the intentional use of the Ebola virus as a weapon 

could affect national security, even recognizing the public health system’s ability to 

control outbreaks. CDC is working closely with the Food and Drug Administration 

(FDA) to approve Emergency Use Authorizations (EUAs) that make available diagnostic and therapeutic medical devices to diagnose and respond to public health 

emergencies, whether of natural or deliberate origin. As a result, FDA has enacted 

several EUAs for laboratory tests to aid in detecting the Ebola virus. 

SENATOR MORAN

Global Health Security 

Question 1. Dr. Bell, the Administration requested a new Global Health Security 

Initiative in fiscal year 2015. This Initiative would strengthen the capacity to prevent the introduction and spread of global health threats in 12 countries: Uganda, 

Vietnam, India, Kenya, South Africa, Kazakhstan, Georgia, Thailand, Tanzania, 

Jordan, Philippines, and Ethiopia. Given the need for this kind of program in West 

Africa, would the list of 12 countries change given the Ebola outbreak? 

Answer 1. As part of the Ebola response, CDC is working to build key components 

of the Global Health Security Agenda (GHSA), but the scope and impact is much 

greater than just stopping the Ebola outbreak. The vision of the Global Health Security Agenda is to create a world safe and secure from global health threats posed 

by infectious diseases—where we can prevent or mitigate the impact of naturally 

occurring outbreaks and intentional or accidental releases of dangerous pathogens, 

rapidly detect and transparently report outbreaks when they occur, and employ an 

interconnected global network that can respond effectively to limit the spread of infectious disease outbreaks in humans and animals, mitigate human suffering and 

the loss of human life, and reduce economic impact. 

We want to be sure to increase country capacity throughout the world so that another Ebola-like crisis can be averted. We don’t know where the next public health 

emergency will occur, so it is imperative to assist as many countries as possible to 

be able to prevent, detect and respond to emerging threats. 

We are expanding our efforts in West Africa and exploring opportunities to engage 

with Ministries of Health on GHSA once the acute needs of the Ebola response are 

met. 

Question 2. If so, which countries will receive funding in fiscal year 2015 if the 

Global Health Security Initiative is funded? 

Answer 2. The requested funding will reduce risks to Americans by enhancing capacity for vulnerable countries to prevent disease outbreaks, detect them early, and 

swiftly respond before they become epidemics that threaten our national security. 

We will prioritize urgently needed investments in vulnerable nations, transport 

hubs, and States without the capacity to prevent global spread of Ebola or stem the 

tide of future threats. It is important to maintain the flexibility to make adjustments given the dynamic national and global health security environment in these 

countries. We also expect that other key donor partners will leverage this effort 

under the Global Health Security Agenda to complement our funding. 

Ebola Response Plan 

Question 3. Dr. Bell, what is the plan for a U.S. Government response? How do 

we help get the Ebola outbreak under control? Which agency is in charge of the response efforts? 

Answer 3. Public health knows how to stop the spread of communicable diseases. 

To halt the spread of Ebola, the links of transmission between people must be interrupted. Public health does that by making sure that every person with Ebola is 

promptly diagnosed and promptly isolated and that their contacts are identified and 

actively monitored every day for 21 days. If any of the contacts develop symptoms 

or fever, we follow the same process again. That is how public health authorities 

have stopped every Ebola outbreak in history except the one currently in West Africa. 

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HHS, and in particular CDC, is working closely with the World Health Organization (WHO), the United Nations, the Ministries of Health in affected countries, and 

other international partners to respond to the current Ebola outbreak in West Africa. CDC receives regular updates of morbidity and mortality to evaluate the spread 

of the disease and combines this information with reports from CDC’s staff deployed 

to the area. Hundreds of CDC staff members have provided logistics, staffing, communication, analytics, management, and other support functions for the response. 

CDC continues to commit significant staffing and financial resources to the international Ebola response both on the ground in West Africa and through its domestic 

EOC. 

CDC is working closely with U.S. Agency for International Development (USAID) 

and its Office of Foreign Disaster Assistance (OFDA) to support the deployment to 

Liberia of a DART, which is overseeing the U.S. Government’s Ebola response in 

West Africa. 

CDC, in partnership with WHO’s Global Outbreak Alert and Response Network 

and the U.S. National Institutes of Health (NIH), provided a field laboratory to Liberia to increase the number of specimens being tested for Ebola. The lab is currently operating at full capacity and is only the second site in Liberia capable of 

testing specimens from patients with suspected Ebola. CDC has also deployed a second laboratory in Sierra Leone. 

CDC has activated its EOC to help coordinate technical assistance and control activities with partners. On August 6, 14, CDC elevated the EOC to a Level 1 activation, its highest level, because of the significance of the outbreak. CDC supports 

countries in establishing their own national and sub-national EOCs. Each of the 

three West African countries at the center of the epidemic now has an Incident 

Manager, reporting to the President of the country, to lead response efforts. 

Hundreds of CDC staff members have provided logistics, staffing, communication, 

analytics, management, and other support functions for the response. CDC has deployed several teams of public health experts to the West Africa region. CDC staff 

are deployed to Guinea, Liberia, Nigeria, Senegal, and Sierra Leone to assist with 

response efforts, including surveillance, contact tracing, data management, laboratory testing, and health education. CDC continues to send additional public health 

experts to the affected and neighboring countries. CDC experts have been deployed 

to non-affected border countries, including Cote d’Ivoire, to conduct assessments of 

Ebola preparedness in those countries. 

Risk to Americans 

Question 4. Dr. Bell, what is the risk of Ebola spreading from West Africa to the 

United States? 

Answer 4. In response to the case of Ebola in the United States, teams from CDC 

are deployed to Dallas to assist with the investigation. They are supported 24/7 by 

CDC’s EOC and Ebola experts at CDC’s Atlanta headquarters. Teams work closely 

with State and local health departments in finding, assessing, and assisting everyone who came into contact with the Ebola patient. Although the risk spread of Ebola 

in the United States is very low, CDC and partners are taking precautions to isolate 

any cases of Ebola and prevent the spread of the disease. CDC recognizes that even 

a single case of Ebola diagnosed in the United States raises concerns and that when 

a case is imported into the United States, secondary cases resulting from transmission from that case may occur. CDC and partners are taking precautions to contain any cases of Ebola and prevent the spread of the disease. 

Every day, CDC works closely with partners at U.S. international airports and 

other ports of entry to look for sick travelers with possible contagious diseases. CDC 

has enhanced its outreach with DHS and other partners at ports of entry (primarily 

international airports) to use routine procedures for identifying and reporting travelers who show signs of infectious disease. CDC and DHS are conducting enhanced 

entry screening at five U.S. airports (New York’s JFK International, WashingtonDulles, Newark, Chicago-O’Hare, and Atlanta) for all U.S.-bound air travelers who 

have been in Guinea, Liberia, or Sierra Leone. CDC provides interim guidance for 

monitoring people potentially exposed to Ebola and for evaluating their intended 

travel, including the application of movement restrictions when indicated. 

The virus is not transmitted easily, does not spread from people who are asymptomatic, and the United States has effective infection control measures in place to 

prevent the spread of the disease in the United States. Medical and public health 

professionals across the country have been preparing to respond, and any U.S. hospital should be prepared to identify, assess and isolate a patient with Ebola. 

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SENATOR COCHRAN

Border Security and Ebola 

Question 1. Dr. Bell, it is my understanding that the Centers for Disease Control 

and Prevention is working closely with U.S. Customs and Border Protection and 

other partners at our ports of entry, particularly international airports, to identify 

travelers who show signs of infectious disease. While this is an important step, I 

am hopeful that we are also paying close attention to our land border as a potential 

entry location. Can you specifically speak to the contingencies that are being deployed in the event Ebola arrives from our Nation’s Southwest border? 

Answer 1. We defer to the DHS with regard to contingencies at U.S. borders. We 

do note that CDC and partners are taking precautions to prevent the spread of 

Ebola to other countries. The U.S. Southwest border is not a major route of entry 

for people coming from the affected countries in West Africa. CDC has issued a 

Warning Level 3 (the highest level) travel notice for the three countries where the 

Ebola outbreak is severe. U.S. citizens should avoid all nonessential travel to Guinea, Liberia, and Sierra Leone. CDC is assisting with exit screening and communication efforts in West Africa to prevent sick travelers from boarding commercial 

planes, buses, trains, or ships. CDC also has issued interim guidance about Ebola 

virus infection for airline flight crews, cleaning personnel, and cargo personnel. This 

is part of a layered approach that includes exit screening and standard public health 

practices such as patient isolation and contact tracing in countries with Ebola outbreaks. Successful containment of the recent Ebola outbreaks in Nigeria and the 

Democratic Republic of Congo demonstrate the effectiveness of this approach. Increasing awareness and preparedness here in the United States to rapidly identify 

and isolate potential Ebola patients and ensuring ready access to diagnostic testing 

through the Laboratory Response Network are additional components of this approach. Ultimately, the best way to protect Americans from Ebola is to stop the outbreak in West Africa. 

Response from International Community 

Question 2. Thank you for coming in today to describe efforts by the U.S. Government to respond to the Ebola outbreak in West Africa. I am hopeful that the United 

States can play a leadership role in addressing this humanitarian crisis, but I am 

also curious about the contributions of international organizations and our partner 

nations. Will you please describe efforts by the international community to stop the 

Ebola epidemic? 

Answer 2. Generating increased international support for the response is a top 

priority for the U.S. Government. As the United States expanded our response (scaling from 20 to over 100 personnel from CDC, deploying the largest DART in 

USAID’s history and then establishing the Joint Force Command), agencies and departments have been engaged in a steady campaign to mobilize contributions of resources and personnel from other countries, including direct outreach to international counterparts by principals. 

Pressing other countries to increase their responses to the Ebola epidemic has 

been a feature of nearly all bilateral engagements, and we have also used the announcement of the Joint Task Force deployment on September 16, 2014, the U.N. 

Security Council session hosted by the United States on September 18, 2014, and 

the U.N. Secretary General’s High-Level Meeting on September 25, 2014, to mobilize increased engagement and investment from other governments. The U.N. Secretary General initiated the United Nations Mission for Ebola Emergency Response 

(UNMEER), and the Mission was approved unanimously by the U.N. General Assembly on September 18, 2014. 

The Mission’s overall aim is to reinforce government leadership and for a rapid 

and coherent response focused on five strategic priorities—stop the spread of the 

disease; treat the infected; ensure essential services; preserve stability in affected 

communities; and prevent the spread to neighboring countries and beyond. The immediate focus is on getting treatment units built, staffing them, and tracing contacts 

of those infected with Ebola to isolate and treat them if they come down with the 

disease. 

To date, more than 35 donor countries have contributed and pledged upwards of 

$690 million to the response. Highlights include:

• Following the announcement of the Joint Force Command, the United Kingdom, 

which had previously committed to establish a hospital in Sierra Leone to care for 

infected health workers, announced that it will stand up 700 Ebola treatment beds 

in Sierra Leone and establish a military command center there. 

• France has announced additional resources, and that it will provide a hospital 

facility in Guinea.

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• Germany has pledged to build additional Ebola treatment units, will provide C– 

160 transport aircraft to support the air bridge in West Africa, and is mobilizing 

volunteers to support the response. • The World Bank has committed $400 million, and the African Development Bank has committed $150 million. • The European Union has committed to providing $180 million and to expanding 

its response effort. • The IMF Executive Board approved $130 million expansion of zero-interest 

loans for the three affected West African nations. • South Africa has committed to build and staff an Ebola treatment unit as well. • Others, including China, Cuba, India, Japan, Canada, Sweden, Australia, Norway, Switzerland, South Korea, Thailand, Ghana, Malaysia, Denmark, Spain, Ireland and the African Union, are providing significant financial and in-kind support. 

Ebola Protection and Control 

Question 3. Do you believe the additional $88 million that has been requested by 

the President to respond to this Ebola crisis will provide you with the resources required to protect against the potential spread of Ebola in the United States and to 

address needs abroad? 

Answer 3. The Congress appropriated $30 million for CDC through the continuing 

resolution. These resources will support CDC for period of the continuing resolution, 

allowing us to ramp up efforts to contain the spread of this virus. More than half 

of the funds are expected to directly support staff, travel, security and related expenses. A portion of the funds will be provided to the affected area to assist with 

basic public health infrastructure, such as laboratory and surveillance capacity, and 

improvements in outbreak management and infection control. Should outbreaks 

recur in this region, they will have the experience and capacity to respond without 

massive external influx of aid, due to this investment. 

The remaining funds will be used for other aspects of strengthening the public 

health response such as laboratory supplies/equipment, and other urgent needs to 

enable a rapid and flexible response to an unprecedented global epidemic. CDC is 

working to identify our potential resource needs for the rest of the fiscal year, and 

possibly further, as we deal with this evolving public health emergency. 

Capacity for Drugs or Vaccines 

Question 4. Do you believe the capacity we have to approve, produce, and distribute drugs and vaccines here in the United States is sufficient to contain an infectious disease such as Ebola should it make its way here to the United States? 

Answer 4. The United States has the capacity to approve, produce, and distribute 

drugs and vaccines in the United States for many infectious diseases for which there 

are commercial products (e.g., pandemic influenza) to prevent or treat these diseases 

or there are late-stage product candidates in the pipeline (e.g., H7N9 avian influenza). However, we, like other industrialized countries, must depend initially on a 

high quality healthcare system to provide supportive care for infectious diseases 

where the drug and vaccine development pipeline is comprised of very early stage 

product candidates like Ebola or there are no candidates at all in the pipeline like 

MERS-CoV; the domestic development and manufacturing infrastructure established over the past 5 years (e.g., CIADMs) is engaged and rapidly responding with 

the advanced development and manufacturing of new experimental drugs and vaccines. This infrastructure is being utilized today in the Ebola response by 

transitioning early stage drug and vaccine candidates into advanced development by 

conducting clinical trials and scaling up manufacturing to commercial scale, leading 

to an accelerated availability of these product candidates from several years to less 

than 1 year. 

SENATOR SHELBY

Auburn Canine Program 

Question 1. Dr. Bell, today, canines are trained to detect explosives, drugs, chemical changes in people with diabetes and epilepsy, and even certain cancers quicker 

and more effectively than any mechanism available to us. Researchers at Auburn 

University are currently using decades of research and development in canine detection to train dogs to instantly detect viruses like Ebola in the field. While this research area is new, its foundation is based on decades of research that has proven 

the canine nose to be one of the greatest detection devices in the world. This would 

provide first responders and medical professionals in the field a much more effective 

method to detect a virus in a person or on materials and surfaces that could spread 

the deadly virus. The possibilities are limitless in diagnoses, triage, and containment. It would also establish a baseline capability that would have applications 

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across the spectrum of disease prevention. Are you familiar with this concept and 

would this type of effort fit within your purview and capability to support and fund? 

Answer 1. Efforts of this kind are outside of CDC’s scope of responsibility and expertise; however, CDC is open to exploring rigorously evaluated and proven innovations as they emerge from private or public partners. 

Components to a Response 

Question 2. Dr. Bell, you have stated that there are 4 necessary components to 

the Ebola response: 

• Case identification and prompt isolation and treatment of patients; 

• Identify contacts, monitor them for 21 days, isolate if they become sick, and 

identify and monitor their contacts; 

• Infection control in health care facilities; and 

• Safe burial practices. 

How much of this has been occurring in the affected countries? 

Answer 2. CDC is employing a variety of strategies in the affected countries. The 

success of multiple approaches to halting an outbreak has been borne out by Nigeria. Multiple partners are working in each of the three affected countries to implement each component of the response. Progress is being made, but significant challenges remain on all fronts. 

Question 3. In particular, how important and difficult is it to perform adequate 

contact tracing in this region when many of the citizens do not have regular access 

to phone and Internet? 

Answer 3. Contact tracing is a challenge in the affected countries. In some settings where the number of cases is very large or there are security concerns, contact 

tracing is incomplete, but CDC teams and partners continue to support contact tracing in most settings. CDC teams in the affected countries report that cell phones 

are generally not being used to reach people. Home visits are the most common 

method of contact tracing. 

Training American Health Workers for Ebola Care in West Africa 

Question 4. Dr. Bell, the U.S. Government does not provide direct care to Ebola 

patients in West Africa. With a significant deficit of trained health workers to provide care in these countries, how is the United States contributing to help address 

this issue? 

Answer 4. CDC has taken several steps to provide training and guidance to health 

care workers to respond to cases of Ebola. CDC has a lead role in infection control 

training for health care workers and safe patient triage throughout the health care 

system, communities, and households in Liberia, Sierra Leone and Guinea. In addition, CDC created a Safety Training Course for Healthcare Workers Going to West 

Africa in Response to the 2014 Ebola Outbreak. The primary purpose of the course 

is to ensure that clinicians intending to provide medical care to patients with Ebola 

have sufficient knowledge of the disease and its transmission routes to work safely 

and efficiently in a well-designed Ebola Treatment Unit. 

The U.S. Agency for International Development (USAID) is managing the recruitment of health care workers interested in volunteering in West Africa. More information about their efforts can be found on the USAID website. 

SENATOR BURR

Question 1. What are the current mortality rates associated with the Ebola outbreak for each country in Africa with an Ebola outbreak? How have these mortality 

rates changed since the outset of the outbreak in each country? Have these countries experienced a change in the mortality rates since additional support has been 

provided by the international community? If so, how have these mortality rates 

changed over the course of the outbreak? 

Answer 1. CDC’s ability to calculate case fatality rates is limited by the available 

data. While CDC can calculate crude case fatality rates from the data provided in 

the situation reports shared by Guinea, Liberia, and Sierra Leone, these likely do 

not reflect the true case fatality rates in each country because of limitations in reported data. These limitations include unknown clinical outcomes as well as underreporting of both cases and deaths. Reporting differs across country, resulting in differences in crude case fatality rates that are unlikely to reflect true differences. 

In Guinea, as of October 14, there are a reported 1,243 cases and 748 deaths, corresponding to a crude case fatality rate of 60.2 percent. In Liberia, as of October 

4, 2014, there are a reported 3,929 cases and 2,210 deaths, corresponding to a crude 

case fatality rate of 56.2 percent. In Sierra Leone, as of October 6, 2014, there are 

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4WHO Ebola Response Team. Ebola Virus Disease in West Africa—The First 9 Months of the 

Epidemic and Forward Projections. N Engl J Med. 2014 Sep 22. [Epub ahead of print] PubMed 

PMID: 25244186. 

a reported 2,823 cases and 880 deaths, corresponding to a crude case fatality rate 

of 31.1 percent. 

In a report in the New England Journal of Medicine, the World Health Organization authors reported a case fatality rate based on only a subset of cases with a 

known clinical outcome. They report, ‘‘This analysis shows that by September 14, 

2014, a total of 70.8 percent (95 percent confidence interval [CI], 68.6 to 72.8) of 

case patients with definitive outcomes have died, and this rate was consistent 

among Guinea, Liberia, and Sierra Leone.’’ 4 Because of the limitations of the data, 

we are unable to report on the change in case fatality rates over time. Observed 

changes over time in the crude case fatality rates—like the reported differences between countries—are likely artifacts of reporting. 

Question 2. Will the United States’ response to the current outbreak, including 

the CDC, change if Ebola becomes endemic to West Africa? If so, how will the current strategies to reduce the rate of transmission, and ultimately break the chains 

of Ebola transmission, change in the event the Ebola virus becomes endemic to West 

Africa? 

Answer 2. Strategies to control Ebola and break transmission chains will not 

change if Ebola transmission becomes more widespread in Africa. However, the 

magnitude and complexity of the effort to reverse the trend will be much greater, 

further stretching the limited capacities of countries and the international community and making success that much harder to achieve. Further, the risk of multiple 

exportations of cases from affected countries will increase. It is for these reasons 

that it is so critical to stop the outbreak in the three currently affected countries. 

Question 3. How would point of care rapid diagnostics change the current trajectory of the Ebola outbreak? How would identifying an infected individual before the 

onset of symptoms change the current response strategy being deployed overseas in 

Africa? How quickly could CDC deploy point of care rapid diagnostics in the field 

clinics in West Africa should such diagnostic tools become available? Could this 

length of time be further reduced, and if so, what steps need to be taken to ensure 

that the time it would take to deploy and utilize such diagnostics is as short as possible, including as part of either a domestic or international response?

Answer 3. There is not currently an approved test that can determine if a person 

is ill with Ebola before symptoms appear although there are products under investigation. CDC is not aware of any that have been approved by recognized governmental bodies comparable to FDA. Rapid diagnostics allow for testing for Ebola in 

a non-laboratory environment, such as in a health care facility. In health care facilities, patients suspected to be ill with Ebola wait, often for days, for symptoms to 

present; inevitably there are individuals that are ill with Ebola as well as many individuals who have other diseases with Ebola-like symptoms (e.g., malaria). While 

waiting in these areas, the latter often become infected with Ebola from those that 

are actually ill with the disease. Rapid tests would allow for a quicker discernment 

of those very ill with Ebola in these waiting areas, thus reducing the spread of 

Ebola to those who are not ill with the disease. However, the current rapid tests 

in development require a high amount of virus to be present in a person’s blood, 

far more than the longer, standard polymerase chain reaction tests require. 

CDC is partnering with companies to review and assess experimental new tests 

so that these technologies can be refined and produced quickly in the United States, 

thereby streamlining the procurement process and speeding deployment of new 

products to West Africa. The deployment process from the United States to the outbreak region can be undertaken as quickly as three to 5 days. However, transportation and distribution in the affected countries remains a significant challenge. 

Question 4. How will the distribution of Ebola medical countermeasures, both vaccines and therapeutics, be prioritized when they become available?

Answer 4. CDC would not be making a determination of prioritizing investigational therapeutics; however, the Department of Health and Human Services is in 

ongoing discussions with global partners such as WHO on this issue. 

No specific therapeutics for patients with EVD are approved. Furthermore, CDC 

cannot influence the requests made by clinicians for investigational new drugs or 

therapies for emergency or compassionate use. To ensure efficacy and safety, controlled clinical trials need to be implemented. 

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Several investigational Ebola vaccine candidates have been developed. NIH has 

begun initial clinical studies to assess the safety and immune response of a candidate vaccine to prevent EVD. The Department of Defense (DoD) has also begun 

clinical studies for a different candidate vaccine. In addition, two companies, 

Tekmira and BioCryst Pharmaceuticals, received funding from the DoD to develop 

potential drugs to treat Ebola. BioCryst, with NIH support, is working to develop 

an antiviral drug to treat Ebola; the first phase of (human) safety testing is expected to begin later this year. 

Question 5. Please outline in detail how CDC is partnering with USAID and DoD 

in the training and deployment of medical personnel for the countries impacted by 

the current Ebola outbreak? 

Answer 5. In response to this unprecedented humanitarian crisis, CDC created a 

first-ever domestic Ebola Treatment Unit Safety Training Course. This course provides both didactic as well as extensive hands-on education regarding the multiple 

complex issues faced by care providers when working in Ebola Treatment Units 

(ETUs). The course was designed specifically for U.S. personnel deploying to provide 

care in ETUs within West Africa. We have worked closely with the Department of 

Defense to ensure that their personnel who require this training are enrolled in this 

course. We have offered technical advice regarding the Department of Defense’s mission to establish an ETU safety training course in-country and have shared CDC’s 

ETU Safety Training course curriculum materials. We have also hosted several discussions with DoD regarding additional training coordination in Liberia. USAID has 

established a website where persons interested in deploying to provide care in 

ETU’s may register. Links are provided on this website to the registration page for 

the CDC ETU Safety Training Course. 

Question 6. There have been media reports that U.S. health care facilities that 

have provided treatment to patients infected with Ebola in the United States have 

had difficulty in disposing of the medical waste associated with this treatment. 

Please outline in detail how CDC is working with individual health care facilities, 

and other Federal and State partners, to resolve the issue of proper disposal of medical waste associated with the treatment of Ebola patients in the United States.

Answer 6. CDC, in collaboration with the U.S. Department of Transportation 

(USDOT) and the Occupational Safety and Health Administration (OSHA), have 

issued guidance on the disposal of medical waste from patients with Ebola to help 

States and hospitals coordinate for safe management of waste. Ebola-associated 

waste disposal is subject to State and local regulations. Notably, Ebola-associated 

waste that has been appropriately inactivated or incinerated is no longer infectious. 

Medical waste generated in the care of patients with known or suspected EVD is 

subject to procedures set forth by local, State and Federal regulations. Basic principles for spills of blood and other potentially infectious materials are outlined in 

the OSHA Bloodborne Pathogen standard, 29 CFR 1910.1030. Medical waste contaminated with Ebola virus is a Category A infectious substance regulated as a hazardous material under USDOT’s Hazardous Materials Regulations (HMR; 49 CFR, 

Parts 171-180). The HMR apply to any material USDOT determines is capable of 

posing an unreasonable risk to health, safety, and property when transported in 

commerce. For offsite commercial transport of Ebola-associated medical waste, strict 

compliance with the HMR is required. 

The inactivation or incineration of Ebola-associated medical waste within a hospital system may be subject to State, local and OSHA regulations. 

• Onsite inactivation 

• Ebola-associated medical waste can be inactivated through the use of appropriate autoclaves. Other methods of inactivation (e.g., chemical inactivation) 

have not been standardized and would need to consider worker safety issues, 

as well as the potential for triggering other Federal safety regulations. 

• Onsite incineration 

• Ebola-associated medical waste can be incinerated. The products of incineration are not infectious and can be transported and disposed of in accordance 

with standard protocols for hospital waste disposal. 

Question 7. Who at the National Security Council is responsible for coordinating 

the inter-agency response to the Ebola outbreak in West Africa? Is this individual 

responsible for coordinating the inter-agency response for domestic Ebola efforts as 

well? If not, who is? 

Answer 7. The U.S. Government response to the Ebola epidemic in West Africa 

is a whole-of-government effort that draws on the capabilities and expertise of numerous government departments and agencies. Similar to other crisis response and 

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humanitarian emergencies around the world, USAID leads and coordinates the U.S. 

response in the field. Many agencies are working closely on domestic Ebola preparedness and response, including HHS, CDC, and DHS, in coordination with the 

Assistant to the President for Homeland Security and Counterterrorism. 

SENATOR KIRK

Question 1. The CDC has determined that $30 million was needed for additional 

response efforts. It is estimated that this outbreak could last another 12–18 months. 

Will more assistance be needed or do you anticipate the $30 million covering the 

next year and a half? 

Answer 1. Congress appropriated $30 million for CDC through the continuing resolution. These resources will support CDC for period of the continuing resolution, 

allowing us to ramp up efforts to contain the spread of this virus. More than half 

of the funds are expected to directly support staff, travel, security and related expenses. A portion of the funds will be provided to the affected area to assist with 

basic public health infrastructure, such as laboratory and surveillance capacity, and 

improvements in outbreak management and infection control. The remaining funds 

will be used for other aspects of strengthening the public health response such as 

laboratory supplies/equipment and other urgent needs to enable a rapid and flexible 

response to an unprecedented global epidemic. CDC is working to identify our potential resource needs for the rest of the fiscal year, and possibly further, as we deal 

with this evolving public health emergency. 

Question 2. With all the different agencies involved, which one is leading the efforts against Ebola? What coordinated efforts are happening between the agencies? 

What are other nations doing to contribute? 

Answer 2. Within the West Africa region affected by the Ebola outbreak, USAID 

continues to lead the United States’ overseas response, while CDC, the Department 

of Defense, Department of State, and other Federal Departments and Agencies are 

supporting the whole-of-government approach to this national security priority. 

USAID has deployed a DART to coordinate planning, operations, logistics and other 

components of the interagency effort. CDC staff is working with Ministries of Health 

to improve surveillance, contact tracing, laboratory capacity, emergency operations 

planning and other critical capabilities. 

HHS, and in particular CDC, is working closely with the World Health Organization (WHO), the United Nations, the Ministries of Health in affected countries, and 

other international partners to respond to the current Ebola outbreak in West Africa. The Ebola epidemic reminds us that our global efforts to build the capacity to 

prevent, detect, and rapidly respond to infectious disease threats like EVD have 

never been more vital. In February 2014, CDC came together with nations around 

the world to launch the GHSA as a 5-year effort to accelerate action. On September 

26, 2014, President Obama met with leaders of 40 nations as well as top Administration officials to advance progress in the GHSA. 

CDC receives regular updates of morbidity and mortality to evaluate the spread 

of the disease and combines this information with reports from CDC’s staff deployed 

to the area. Hundreds of CDC staff members have provided logistics, staffing, communication, analytics, management, and other support functions for the response. 

CDC continues to commit significant staffing and financial resources to the international Ebola response both on the ground in West Africa and through its domestic 

EOC. 

CDC has activated its EOC to help coordinate technical assistance and control activities with partners. CDC supports countries in establishing their own national 

and sub-national EOCs. Each of the three West African countries at the center of 

the epidemic now has an Incident Manager, reporting to the President of the country, to lead efforts. 

To date, more than 35 donor countries have contributed and pledged upwards of 

$690 million to the response. Highlights include:

• Following the announcement of the Joint Force Command, the United Kingdom, 

which had previously committed to establish a hospital in Sierra Leone to care for 

infected health workers, announced that it will stand up 700 Ebola treatment beds 

in Sierra Leone and establish a military command center there. 

• France has announced additional resources and that it will provide a hospital 

facility in Guinea. 

• Germany has pledged to build additional Ebola treatment units, will provide C– 

160 transport aircraft to support the air bridge in West Africa, and is mobilizing 

volunteers to support the response.

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• The World Bank has committed $400 million and the African Development 

Bank has committed $150 million.

• The European Union has committed to providing $180 million and to expanding 

its response effort. 

• The IMF Executive Board approved $130 million expansion of zero-interest 

loans for the three affected West African nations.

• South Africa has committed to build and staff an Ebola Treatment Unit as well.

• Others, including China, Cuba, India, Japan, Canada, Sweden, Australia, Norway, Switzerland, South Korea, Thailand, Ghana, Malaysia, Denmark, Spain, Ireland and the African Union, are providing significant financial and in-kind support. 

SENATOR ENZI

Question 1. In previous communications with CDC, it was indicated that there are 

only a few facilities specially equipped to deal with highly contagious diseases, such 

as Emory University Hospital in Atlanta. What will be the policy for treatment of 

patients diagnosed within the United States? Will they be transported to these facilities or cared for onsite or in other designated facilities? 

Answer 1. CDC is working with additional hospitals to ready their facilities for 

additional patients with Ebola. Any U.S. hospital should be prepared to identify, assess and isolate a patient with Ebola. CDC developed guidance documents and 

checklists to help U.S. hospitals prepare for, test, and treat patients with Ebola, and 

works to keep the health care system informed of new developments. CDC uses its 

Health Alert Network (HAN) to provide information and guidance to U.S. healthcare 

workers and hospitals regarding Ebola. CDC distributed a HAN notice August 1, 

2014, and five updates have followed. The most recent HAN notice about Ebola was 

distributed on October 2, 2014. 

CDC created plans outlining its course of action for when a laboratory-confirmed 

Ebola diagnosis occurs in the United States. The operational plans include assistance to State, tribal, territorial and local officials and the domestic health care community, and leverage CDC’s expertise and resources in epidemiology, surveillance, 

coordination of laboratory testing, health promotion and communication, healthcare 

and infection control, traveler health and screening. 

CDC’s response to a diagnosed case follows three key public health tenants—prevention, detection and response. The concept of prevention focuses on actions which 

can affect the spread of the disease. Detection centers on activities to find the disease through surveillance and contact tracing. CDC’s response efforts include its 

agency-wide incident management and response capabilities in support of domestic 

requirements. 

CDC has redoubled its efforts to educate American health care workers about how 

to isolate patients and how to protect themselves from infection, including developing and disseminating resources, hosting informational calls, and creating 

trainings. CDC has: 

• Hosted Clinician Outreach and Community Activity calls for clinical professionals to provide information about what U.S. hospitals need to know to prepare 

for Ebola. 

• Created guidance about Ebola for clinicians in U.S. health care settings. 

• Posted a Medscape Expert Commentary for healthcare providers whose patients 

are travelers with concerns about Ebola. The commentary includes information 

about the Ebola outbreak in West Africa, the transmission Ebola virus, and how to 

talk to travelers about their risk. 

• Created guidance for U.S. healthcare workers on ‘‘Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola 

Hemorrhagic Fever in U.S. Hospitals.’’ 

• Developed a checklist for hospitals to aid in Ebola preparedness, which can be 

found on the CDC website. 

• Built a Safety Training Course for Healthcare Workers Going to West Africa in 

Response to the 2014 Ebola Outbreak. The primary purpose of the course is to ensure that clinicians intending to provide medical care to patients with Ebola have 

sufficient knowledge of the disease and its transmission routes to work safely and 

efficiently in a well-designed Ebola Treatment Unit (ETU). 

• Collated the Top 10 Ebola Response Planning Tips: Ebola Readiness Self-Assessment for State and Local Public Health Officials to help guide planning and 

readiness for Ebola response at State and local levels and assist health officials in 

assessing their jurisdictions’ level of readiness for a potential Ebola response. 

Question 2. What steps are being taken by CDC to ensure adequate coordination 

across agencies to, identify any new cases of Ebola quickly, facilitate treatment, and 

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to contain any spread of the disease? Please identify all of the agencies involved, 

the departments that are working on them, the steps taken to ensure coordination, 

and the plans for updating Congress on the activities. 

Question 3. Since the beginning of the Ebola outbreak in West Africa, the CDC 

continually indicated a low probability of a case occurring in the United States. 

What are the CDC screening and monitoring processes for travelers who are likely 

to come into contact with the Ebola virus? Please identify the specific steps involved, 

coordinating agencies, and the data used to make claims of the low probability of 

occurrence in the United States. 

Answer 2 and 3. Although the risk of an Ebola outbreak in the United States is 

very low, HHS and its sister Departments are taking steps to protect Americans 

from the Ebola virus. To ensure the United States is prepared to respond to an 

Ebola epidemic, the CDC has detailed response plans in place for once an Ebola case 

is confirmed to respond to Ebola cases in the United States. The plans include: instructions to rapidly disseminate information about the Ebola case(s) to key public 

health, health care system, and emergency management partner organizations; providing current information to State, local, and territorial public health departments; 

and coordinating critical issues management regarding State and local needs for the 

CDC EOC incident manager and other response task force teams. CDC has also developed a web-based document, for use in State and local planning that identifies 

rapidly emerging CDC guidelines for public health preparedness national standards 

regarding Ebola. 

Additional CDC efforts include: 

• Preparing providers, hospitals, State and local health departments and others 

involved in public health preparedness and response for the possibility of an Ebola 

case in the United States, including guidance documents on the identification and 

treatment of an Ebola patient, infection control guidelines, laboratory testing and 

other recommendations necessary to protect U.S. health care workers and the general public. Over the coming days and weeks, CDC will be working with other Federal, State, and local governments and private organizations to strengthen U.S. 

readiness for detecting and preventing additional cases of Ebola in this country. 

These efforts include the entry screening at U.S. ports of entry and enhanced outreach to healthcare workers and hospitals to improve their infection control practices and policies. • Providing funding and assistance to State and local health departments for allhazards preparedness, including an infectious disease outbreak. This funding and 

assistance helps public health departments develop capabilities that are applicable 

to responding to many public health threats. • Developing guidance for laboratory technicians and other health care personnel 

who collect or handle specimens in the United States. • Working closely with DHS’s CBP and other partners at U.S. ports of entry to 

conduct enhanced entry screening to identify travelers who show signs of infectious 

disease. CBP is conducting entry screening at five U.S. airports (New York-JFK, 

Washington-Dulles, Newark, Chicago-O’Hare, and Atlanta), that receive 94 percent 

of travelers from the Ebola-affected nations of Guinea, Liberia, and Sierra Leone, 

as of October 11, 2014. If a potentially sick traveler is identified during or after a 

flight, the traveler will be immediately isolated, and CDC will conduct an investigation and work with the airline, Federal partners, and State and local health departments to notify them and take any necessary public health action. Entry screening 

is part of a layered process that includes exit screening and standard public health 

practices, such as patient isolation and contact tracing in countries with Ebola outbreaks. Successful containment of the recent Ebola outbreaks in Nigeria and the 

Democratic Republic of Congo demonstrate the effectiveness of this approach. • Assisting with exit screening and communication efforts in West Africa to prevent sick travelers from boarding commercial planes, buses, trains, or ships. CDC 

also has issued interim guidance about Ebola virus infection for airline flight crews, 

cleaning personnel, and cargo personnel. 

In addition to CDC’s efforts relating to prevention, detection, and response, FDA 

is investigating what types of medical products could be used to address the Ebola 

epidemic in West Africa and in the United States. Currently, there are no treatments or vaccines that have been shown to be safe or effective against the Ebola 

virus, and products currently under development are in the very early stages of investigation. FDA is using its regulatory mechanisms to enable access to investigational medical products to facilitate appropriate access to investigational Ebola medical products under an appropriate regulatory mechanism to support preparedness 

and response efforts to help protect people of the United States from the Ebola 

virus. 

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1 Note: Content accurate as of October 15, 2014. Responses do not reflect enactment of the 

$238 million for NIH in emergency funding to support clinical trials in response to the Ebola 

Epidemic. 

Additionally, under the FDA’s Emergency Use Authorization (EUA) authority, 

FDA can allow the use of an unapproved medical product—or an unapproved use 

of an approved medical product—for a larger population during certain types of 

emergencies, when, in addition to other factors, there is no adequate, approved, and 

available alternative. FDA has authorized the use of an Ebola diagnostic test, developed by DoD, under an EUA to detect the Ebola virus in laboratories designated 

by DoD. This test has been made available to 14 laboratories within the United 

States to support the rapid diagnosis of any suspected cases of Ebola infection and 

to monitor patients already infected with the Ebola virus. These sites are located 

close to ports-of-entry where travelers from West Africa frequently arrive in the 

United States or in locations where infected U.S. patients are currently being treated. In addition, FDA has issued EUAs authorizing the use of Ebola diagnostic tests 

developed by CDC and is working with U.S. and non-U.S. commercial diagnostic 

test developers to clarify EUA regulatory requirements and provide support in order 

to increase the supply of available diagnostic tests for Ebola infection in the United 

States and West Africa. 

NIH and Biomedical Advanced Research and Development Authority (BARDA), 

along with DoD, are supporting the development and manufacturing of early stage 

Ebola vaccine and therapeutic candidates. Key animal challenge efficacy studies and 

human safety and immunogenicity studies are or will be underway in the United 

States and other countries for several of these candidates. The results of these initial human safety studies will inform expanded clinical studies in affected African 

countries early next year. Scaled up manufacturing of several of these product candidates has started as well to achieve commercial scale manufacturing capacity next 

year. 

RESPONSE BY ANTHONY S. FAUCI, M.D. AND ROBIN A. ROBINSON, PH.D. TO QUESTIONS OF SENATOR CASEY, SENATOR BENNET, SENATOR WHITEHOUSE, SENATOR

BALDWIN, SENATOR WARREN, SENATOR ALEXANDER, SENATOR MORAN, SENATOR

SHELBY, SENATOR COCHRAN, SENATOR BURR, AND SENATOR KIRK 1

SENATOR CASEY

Question. In addition to vaccines and treatments that are specific to Ebola, are 

there any broad antiviral products being considered for development, that could be 

used against either Ebola or other known novel viruses? 

Answer. Guided by our Strategic Plan and priorities, the National Institute of Allergy and Infectious Diseases (NIAID) supports the fundamental research needed to 

better understand infectious agents in order to develop broad-spectrum antibiotics 

and antivirals—drugs that can prevent or treat diseases caused by multiple types 

of bacteria or viruses. In addition, NIAID has intensified its efforts to develop new 

technologies that can be broadly applied to more efficiently develop diagnostics and 

vaccines against a wide variety of infectious agents, including pandemic influenza 

viruses, methicillin-resistant Staphylococcus aureus (MRSA), 

extensively drug-resistant Mycobacterium tuberculosis, dengue, chikungunya, and 

filoviruses such as Ebola. 

NIAID is funding BioCryst Pharmaceuticals to develop and test BCX4430, a novel 

drug with broad-spectrum antiviral activity including against Ebola viruses. To 

date, BCX4430 has shown some activity in animal infection models for Ebola and 

Marburg viruses. A Phase I trial is expected to begin in late 2014 or early 2015. 

NIAID is also funding in vivo studies of brincidofovir, a broad-spectrum antiviral 

developed by Chimerix, Inc., for use against other viral diseases, including smallpox. 

In addition, NIAID offers in vitro testing as part of its suite of preclinical research 

services available to the scientific community and private industry to test products 

for antiviral activity against Ebola viruses. NIAID is using this screening program 

to assist investigators who have antiviral candidates that may be effective against 

Ebola viruses. 

Intramural scientists at NIAID’s Rocky Mountain Laboratories (RML) in Hamilton, MT, are working on therapeutics that might be effective against all hemorrhagic fever viruses including the filoviruses Ebola and Marburg and the arenavirus 

Lassa. Ribavirin, a drug currently used to treat hemorrhagic fever viruses such as 

Lassa virus, is being examined for its potential use in combination therapy to treat 

Ebola virus infection. NIAID intramural scientists are investigating broad antiviral 

therapies that target host cell proteins essential to viral replication. One such 

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antiviral currently being evaluated for hepatitis C treatment has shown activity 

against Ebola virus in vitro and will be further assessed. NIAID scientists also have 

screened a small collection of broad-spectrum antivirals that are in development 

against influenza and other RNA viruses; this screening has generated two potential 

lead compounds for further evaluation. 

NIAID’s pursuit of broad-spectrum therapies effective against entire classes of 

pathogens aims to maximize the investment in research on emerging and re-emerging infectious diseases. NIAID will continue to pursue broad-spectrum antiviral 

drugs for use against a variety of viruses including Ebola virus. 

SENATOR BENNET

Question 1. There are many charities and volunteers here that want to help end 

this outbreak and care deeply about the outcome. For example, in my home State, 

the Centennial-based Project CURE has been working with local volunteers and 

high schools, like Valor Christian High School in Highlands Ranch, to send medical 

supplies to West Africa. They have already sent 4 large containers of supplies for 

medical workers there. They want to know that their government is showing a coordinated response to this effort, and that their work will not be in vain. Can you 

give them and other volunteers across the country some peace of mind that their 

work is helping and you all are doing everything you can to coordinate an effective 

response to this outbreak? 

Answer 1. NIAID defers to other witnesses. 

Question 2. Given the emergence of Ebola as a significant public health threat— 

and the level of funds understandably being allocated in response—I am concerned 

about our ability to respond to other emergencies, such as pandemic influenza, 

which are far more common threats. In particular, I’m concerned that we are jumping from crisis to crisis and failing to adequately budget for rapid response capabilities to public health pandemics, like Ebola, pandemic influenza, and MERS. Just 

earlier this month, for instance, a DHS OIG report highlighted that our pandemic 

influenza stockpiles have not been effectively managed, and I’m concerned that we 

may be falling behind on these other types of preparedness issues. How are you assuring that we are adequately prepared and not compromising our ability to rapidly 

respond to address other public health crises, like pandemic influenza, in addition 

to emerging threats like Ebola? 

Answer 2. NIAID has a dual mandate that balances research on current biomedical challenges with the capacity to respond quickly to emerging and re-emerging infectious threats. Since the 2001 anthrax attacks, with the support of the Congress, NIAID has vastly expanded its research portfolio in biodefense and naturally 

emerging and re-emerging infectious diseases, focusing its efforts on pathogens that 

pose high risks to public health and national security, including pandemic influenza, 

MRSA, Mycobacterium tuberculosis, dengue, chikungunya, and filoviruses such as 

Ebola. 

To improve our preparedness for numerous infectious threats, whether naturally 

occurring or deliberately introduced, NIAID has adopted a flexible strategy to encourage the development of broad spectrum therapeutics effective against whole 

classes of pathogens. To encourage this process, NIAID ‘‘de-risks’’ the development 

of new and improved therapeutics by providing early stage research resources to 

academia, biotechnology firms, and industry. For example, NIAID offers in vitro and 

in vivo screening and evaluation of candidate countermeasures against a broad 

array of infectious pathogens including bacteria, fungi, viruses, and parasites. These 

preclinical research services, coupled with NIAID’s strong support for basic and applied research, have enhanced our ability to ultimately address a variety of global 

infectious disease threats. 

NIAID research includes the development of new and improved vaccines against 

a variety of infectious disease threats to global public health. As part of this effort, 

the NIAID Vaccine Research Center (VRC) is pursuing design strategies to facilitate 

the development of vaccines for emerging public health threats such as Middle East 

Respiratory Syndrome (MERS), chikungunya, pandemic influenza, and Ebola viruses. The VRC is currently applying the results of its longstanding preclinical vaccine research program to accelerate clinical studies of a chimpanzee adenovirusbased Ebola vaccine candidate developed in collaboration with GlaxoSmithKline. 

Phase I clinical studies of this vaccine are ongoing at the National Institutes of 

Health Clinical Center, and additional studies are planned for sites around the 

world. 

In response to the public health threats posed by seasonal and pandemic influenza, NIAID VRC and extramural researchers are engaged in a broad range of basic 

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and applied research on influenza virus. NIAID is supporting research and development of new therapies, diagnostics, and vaccines for both seasonal and pandemic influenza strains. For example, during the 2009 H1N1 influenza pandemic, VRC researchers utilized advanced genetic sequencing and gene-based vaccine technology 

platforms to develop and test an experimental 2009 pandemic H1N1 influenza vaccine within 4 months. In addition, NIAID-supported clinical research units quickly 

determined the safe and effective doses of the 2009 H1N1 influenza vaccine for the 

elderly, children with asthma, and individuals with compromised immune systems. 

The development of a ‘‘universal’’ influenza vaccine is a key goal of the NIAID infectious diseases research program. A ‘‘universal’’ influenza vaccine would induce a 

potent immune response to the common elements of the influenza virus that undergo few changes from season to season and from strain to strain. Such a vaccine 

could protect against multiple strains of the virus over several years and help provide protection in the event of an influenza pandemic. NIAID VRC and extramural 

researchers are working with the conserved stem region of influenza proteins to 

stimulate broader, more universal protection against multiple influenza strains and 

to develop nanoparticle vaccine platforms to improve the potency and breadth of influenza protection. 

NIAID remains committed to fulfilling its dual mandate to balance research on 

infectious and immune-related diseases with the capability to mobilize a rapid response to newly emerging and re-emerging infectious diseases. 

SENATOR WHITEHOUSE

Question. The severity of the current Ebola outbreak has led to the use of stillexperimental treatments, such as ZMapp—which Dr. Brantly received. How can we 

encourage the development of treatments and vaccines that treat incredibly deadly, 

but rare diseases, like Ebola? How have our Federal health care agencies, including 

NIH, CDC, and FDA, coordinated to help expand access to experimental treatments 

in a safe and ethical way? 

Answer. The 2001 anthrax attacks underscored the importance of a national strategy for the development of medical countermeasures to combat deadly infectious disease threats, whether man-made or naturally occurring. Since that time, NIAID has 

greatly accelerated its biodefense research program to rapidly respond to known and 

possible future threats. NIAID supports basic research, identification of drug and 

vaccine targets, preclinical testing, and clinical trials in order to move candidate 

medical countermeasures along the product development pipeline. Critical to this effort are NIAID’s public-private partnerships with organizations including non-profits, academic institutions, and biotechnology and pharmaceutical companies. 

Equally important to the development of medical countermeasures for deadly diseases such as anthrax, smallpox, and Ebola virus disease, is NIAID’s collaboration 

with Federal agencies such as the Centers for Disease Control and Prevention, the 

Food and Drug Administration (FDA), the Biomedical Advanced Research and Development Authority (BARDA), and the Department of Defense (DoD). For example, 

NIAID coordinates with its partners through the Public Health Emergency Medical 

Countermeasures Enterprise to ensure that the results of NIAID-supported research 

can be translated rapidly into safe and effective medical countermeasures. In particular, NIAID transitions the advanced research and development of high-priority 

medical countermeasures to BARDA, with the goal of FDA approval, licensure, 

clearance, or emergency use authorization and, if appropriate, possible inclusion in 

the Strategic National Stockpile. 

Efforts to date have included early stage development of a smallpox vaccine candidate and two smallpox drug candidates to complement the vaccines that currently 

exist, as well as anthrax vaccine and therapeutic candidates. 

In response to the current Ebola outbreak in West Africa, the NIAID Vaccine Research Center (VRC) worked closely with FDA colleagues to expeditiously move 

CAd3, an Ebola candidate vaccine developed by the NIAID VRC and 

GlaxoSmithKline, into clinical studies while still maintaining rigorous safety, ethical, and regulatory standards. Proactive communication and partnership enabled 

FDA to review VRC’s Investigational New Drug (IND) application in less than 1 

week, leading to acceleration of the clinical study start date. Ongoing discussions 

among NIAID VRC, BARDA, and industry partner GlaxoSmithKline will accelerate 

development of CAd3 through additional vaccine manufacturing and clinical trials 

to further determine safety and immune response. In addition, the NIAID VRC is 

collaborating with the DoD Walter Reed Army Institute of Research on plans to 

evaluate safety and immunogenicity of the candidate vaccine in healthy adults in 

Uganda. 

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NIAID will continue its longstanding investment in research to develop tools to 

prevent, diagnose, treat, and control deadly diseases such as Ebola. To effectively 

bring a concept from the earliest stages of basic research to a finished product requires that we rigorously evaluate safety and efficacy along the product development pipeline and leverage public-private partnerships between academia, non-profit organizations, private industry, and government agencies around the world. 

SENATOR BALDWIN

Question 1. Dr. Fauci, one of your NIH colleagues and an Ebola expert recently 

argued that scientists must share data, like diagnosis and detection data, with their 

colleagues in real-time to improve the public health response to the Ebola outbreak. 

Can you please explain why this is so critical, what is NIH’s role in this data exchange, and how similar information sharing has helped address prior outbreaks 

like influenza and SARS? 

Answer 1. The National Institutes of Health (NIH) has a longstanding commitment to make scientific data publicly available in a timely manner. This was exemplified by the Human Genome Project, an international research project that required rapid and comprehensive data release during its mapping and sequencing of 

the full human genome. Recently, NIH has expanded this commitment to sharing 

important genomic data by implementing a policy requiring NIH-funded large scale 

genome projects to include data sharing plans. For the past 10 years, NIAID has 

endorsed this commitment, and contributes to several publicly accessible and 

searchable international data bases, such as NIH’s GenBank, a collection of all publicly available DNA sequences. 

Publicly released data, including datasets generated and released by NIAID, serve 

as critical resources for scientists around the world, and are essential to enable the 

advancement of research and surveillance of infectious diseases. For example, in 

early April 2009, a novel influenza virus was isolated from a patient in California; 

by the end of April 2009, the genome of the H1N1 influenza virus was sequenced 

and the data released into the public domain. The genetic characterization of this 

virus revealed that it was a novel strain, gave clues to its drug sensitivity and resistance, and was instrumental in production of effective diagnostics and vaccines 

used in the subsequent 2009 H1N1 influenza pandemic. Ongoing NIAID sequencing 

efforts and resources seek to provide additional information about the Ebola virus 

strain currently circulating in West Africa. This information, shared in real-time, 

can help researchers to understand how the virus is transmitted and causes disease, 

as well as guide strategies for developing new therapeutics, vaccines, and 

diagnostics. 

Although there is no rapid, point-of-care diagnostic test for Ebola virus currently 

available, real-time data sharing is an increasingly important aspect of collaborative 

research and could critically influence both patient care and epidemic management 

of the current Ebola virus outbreak. The ability to rapidly and accurately detect and 

report the presence of Ebola virus in blood samples would allow healthcare providers to more quickly isolate and care for patients with Ebola virus disease. Importantly, rapid diagnosis and reporting would also help to identify patients who have 

symptoms consistent with Ebola virus disease but actually have a disease caused 

by another pathogen. Upon testing negative for Ebola, these patients could minimize 

their contact with Ebola patients and be given appropriate treatment for their disease. In addition, real-time data sharing is critical to guiding the public health response because it allows for a more accurate understanding of sources of infection, 

new outbreak locations, and the scope and rate of transmission. Rapid data sharing 

is also important for assessing the utility of diagnostic tests and the significance of 

viral gene mutations. Established diagnostic assays that detect specific gene sequences of a virus may not be as effective in detecting viruses with genetic variants. 

Real-time generation and sharing of genetic sequence data, including mutations, is 

crucial to ensuring these molecular diagnostic tests remain valid. 

Question 2. Dr. Fauci, in the absence of an approved therapeutic treatment for 

Ebola, can you please discuss the importance of highly effective and efficient 

diagnostics in controlling this outbreak, and what steps we are taking to develop 

and implement such tools? In August, the FDA authorized the emergency use of a 

diagnostic test developed by the Department of Defense in the affected region. Can 

you provide an update on how this test is working and being used on the ground? 

Answer 2. Accurate and accessible diagnostics for Ebola virus infection are needed 

for the rapid identification and treatment of patients in the current Ebola outbreak 

because the symptoms of Ebola can be easily mistaken for other common causes of 

fever in West Africa, such as malaria. Point-of-care, or onsite, Ebola virus 

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fected patients in order to isolate them and minimize additional exposures to the 

virus. 

NIAID provides resources for investigators developing Ebola diagnostics. With 

NIAID support, Corgenix Medical Corporation is developing rapid 

immunodiagnostics for Ebola virus using genomic technology to produce recombinant viral proteins. NIAID is advancing development of additional diagnostics, including those using novel technologies such as microfluidics, optofluidics and 

nanophotonics, which are capable of detecting multiple viruses including Ebola. 

Such innovative approaches can provide information critical to the creation of pointof-care diagnostics that could be distributed and used in areas where Ebola virus 

outbreaks occur. In addition, intramural scientists from NIAID’s Rocky Mountain 

Laboratories in Hamilton, MT, and NIAID’s Integrated Research Facility in Frederick, MD, have responded to the ongoing epidemic in West Africa by providing 

technical diagnostic support on the ground in Liberia. 

NIAID defers to CDC regarding the emergency use of diagnostics in West Africa. 

Question 3. The President recently outlined a comprehensive response to combat 

this epidemic that includes the efforts of an estimated 3,000 U.S. forces and a strong 

partnership with the United Nations and our other international partners. The first 

cases of Ebola were reported in March; it is now October and the Ebola crisis is 

only worsening. Why did we not initiate this response in March? In hindsight, what 

should have been the United States’ first action item when cases were first reported, 

and what can we learn from this to prevent the world from seeing such tragedy 

again? 

Answer 3. NIAID defers to other witnesses. 

SENATOR WARREN

Question 1. Fighting epidemics in developing countries presents unique challenges. Despite all the attention that’s being paid to the Ebola outbreak, serious 

health problems have gripped these countries for years. In Liberia, for example, 17 

percent of deaths are due to Malaria, and Sierra Leone has one of highest rates of 

infant and maternal mortality in the world. Countries currently dealing with Ebola 

have a poor healthcare infrastructure and very few healthcare workers—and are 

barely able to provide basic care, much less handle an epidemic. 

How would long-term investments to improve the basic healthcare infrastructure 

of developing nations help to improve our ability to respond to new outbreaks and 

epidemics? 

How are the United States and international aid organizations helping to take 

care of health care needs besides Ebola in the epidemic regions? 

Answer 1. NIAID defers to other witnesses regarding investments to improve 

basic healthcare infrastructure of developing nations, and regarding how United 

States and international organizations are helping to take care of health care needs 

besides Ebola in the epidemic regions. 

Question 2. Each time a new disease or disease threat appears, we see a spike 

in public attention and an avalanche of government support to address the immediate crisis. Congress has no problem spending billions of dollars combating SARS, 

pandemic flus, MERS, and now Ebola, one outbreak at a time. When there is a crisis, of course we should act. But over the same time period, Congress has slashed 

the purchasing power of America’s flagship research agencies—the agencies that do 

the work to make sure that we are ready for these crises before they occur. 

The National Institutes of Health has nearly 25 percent less purchasing power 

today than it did a decade ago. When asked last week about Ebola vaccine development, Francis Collins said, ‘‘If we had just been able to have basically equivalent 

purchasing power over these 10 years, we would have been at least a year ahead 

of where we are now.’’ After years of stable reserve fund support, the budget for 

BARDA is now subject to the tumultuous appropriations process. A company in 

Cambridge, MA, received a Department of Defense grant in 2010 to develop an 

Ebola treatment, and the company developed a drug with promising trials. We still 

don’t know if that treatment might be effective because the funding was cut in 2012 

because of shrinking Federal support. 

How can investments in basic research and in development help to prepare our 

Nation to deal with known and unknown contagious disease threats? 

Answer 2. NIAID is the lead institute at NIH for conducting and supporting basic 

research on biodefense, including chemical, biological, radiological, and nuclear 

threats as well as emerging and re-emerging infectious diseases. Basic research supported by NIAID contributes to a comprehensive understanding of the scientific and 

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medical aspects of these potential threat agents and informs the development of 

medical countermeasures. 

The NIAID research portfolio includes basic research to understand the biology, 

immune response, and pathogenesis of potential bioterror agents and emerging and 

re-emerging infectious diseases, including plague, smallpox, Ebola virus disease, and 

influenza. This research provides insight into how these agents cause disease and 

reveals potential targets for the development of medical countermeasures to diagnose, treat, and prevent disease. NIAID also supports translational-research and 

product-development efforts to capitalize on basic research discoveries and to advance candidate medical countermeasures through the product development pipeline. These efforts help to ensure our Nation’s preparedness to respond to public 

health threats posed by emerging and re-emerging diseases. 

NIAID’s basic research investment helps inform development of products that can 

gain Food and Drug Administration (FDA) approval, licensure, clearance, or emergency use authorization and, if appropriate, be considered for inclusion in the Strategic National Stockpile. If candidate countermeasures show promise in proof-of-concept animal studies or early human testing, NIAID transitions these candidates to 

the Biomedical Advanced Research and Development Authority (BARDA) for advanced development. Examples of recent successful transitions from NIAID to 

BARDA include vaccines and therapies for anthrax and pandemic influenza—a nextgeneration treatment for chemical exposure; two smallpox antiviral drugs; and, in 

partnership with DoD, the candidate Ebola therapeutic ZMapp. NIAID also supported clinical trials, advanced development, and manufacturing services leading up 

to the BARDA’s procurement of Bavarian Nordic’s smallpox vaccine, IMVAMUNE®, which has been accepted into the Strategic National Stockpile. Results from recent 

NIAID studies have supported the procurement of NEUPOGEN® and Leukine® for 

the Strategic National Stockpile to treat Acute Radiation Syndrome. The progress 

of these successful products into advanced development and procurement to ensure 

the Nation’s preparedness would not have been possible without NIH/NIAID’s important investments in basic and applied research on biodefense and emerging and 

re-emerging diseases. 

SENATOR ALEXANDER

Question 1. You mentioned that you have an arrangement with the Broad Institute in Boston, MA to track the genetic changes of the virus. Please describe this 

arrangement and how it allows you to track the genetic changes of the virus as the 

outbreak continues, including changes that could result in increased transmissibility 

or other changes with respect to the virus. Are there plans for additional arrangements to facilitate further study of the Ebola virus circulating in the current outbreak in West Africa in order to inform research on vaccines, treatments, 

diagnostics, including point-of-care, as well as any characteristics of the virus that 

could improve our public health response? 

Answer 1. For the last 10 years, NIAID has supported the Genomic Center for 

Infectious Diseases at the Broad Institute to genetically characterize viruses that 

cause infectious diseases such as dengue fever and Lassa fever. Their work has expanded to include the genomic sequencing and analysis of Ebola viruses isolated 

from patients in West Africa. One project, the results of which were recently published in Science magazine, characterized nearly 100 Ebola virus genomes from patients in Sierra Leone, allowing researchers a clearer view of how the virus can 

change over the course of an epidemic. The researchers at the Broad Institute currently are leveraging existing partnerships in Sierra Leone and Nigeria to obtain 

additional samples for genomic sequencing and analysis. 

Findings from these studies will inform investigations into the species of Ebola 

virus causing the current outbreak. The goal of these investigations is to identify 

and track genetic variations over time and at multiple locations and to monitor potential genetic signals of transmissibility or other changes in the biology of the 

virus. The research team at the Broad Institute also has allowed the scientific community immediate access to its findings by releasing the full-length genome sequences on the National Institute of Health’s National Center for Biotechnology Information (NCBI) genome sequence data bank. This data sharing encourages collaboration among the global scientific and public health communities to accelerate 

discoveries about Ebola virus transmissibility and adaptation. NIAID will continue 

to support the efforts of the Broad Institute in enhancing and guiding strategies for 

Ebola therapeutics, vaccines, and diagnostics. 

Question 2. NIAID and BARDA are funding studies and clinical trials for several 

candidates for Ebola therapies and vaccines. How are you coordinating together to 

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search supported by NIH to some of the later advanced research and development 

supported by BARDA? How are you coordinating with the Department of Defense 

on the research supported by them? Please also describe your coordination with the 

Food and Drug Administration with respect to these drug and vaccine candidates. 

Answer 2. A core component of NIAID’s mission is to conduct and support basic 

and applied research on potential biothreat agents, including newly emerging and 

re-emerging infectious agents such as Ebola virus. NIAID aims for our basic research investment to inform development of products that can gain Food and Drug 

Administration (FDA) approval, licensure, clearance, or emergency use authorization and, if appropriate, be considered for inclusion in the Strategic National Stockpile. If candidate medical countermeasures against biothreats show promise in 

proof-of-concept animal studies or early human testing, NIAID transitions these 

candidates to BARDA for advanced development. NIAID’s longstanding and successful collaborations with BARDA, FDA, CDC, and the Department of Defense (DoD) 

are critical to accelerating efforts to develop treatments and vaccines for Ebola virus 

disease. 

In partnership with BARDA, DoD, and FDA, and others, NIAID is working to accelerate the development of medical countermeasures for Ebola virus. NIAID has 

worked closely with FDA to advance testing of the CAd3 Ebola vaccine candidate 

developed by NIAID in partnership with GlaxoSmithKline. This candidate uses a 

chimpanzee virus as a carrier to introduce Ebola virus genes into the body in order 

to stimulate an immune response. NIAID is currently conducting Phase I clinical 

trials of the CAd3 candidate vaccine at the National Institutes of Health Clinical 

Center in Bethesda, MD and additional testing at the University of Maryland and 

Emory University. Proactive communication and partnership enabled FDA to review 

NIAID’s Vaccine Research Center’s Investigational New Drug (IND) application in 

less than 1 week, leading to acceleration of the clinical study start date. CAd3 will 

also be evaluated in the United Kingdom and the West African country of Mali, and 

further clinical trials are under consideration should the vaccine prove safe and indicate an ability to generate an immune response. 

NIAID and DoD are currently coordinating efforts to accelerate the production of 

two Ebola vaccine candidates. NIAID and DoD are collaborating with NewLink Genetics on an investigational recombinant vesicular stomatitis virus (VSV)-based vaccine candidate developed and licensed by the Public Health Agency of Canada. 

NIAID has worked with FDA to enable this candidate to begin Phase I safety studies in the fall of 2014 at Walter Reed Army Institute of Research in Silver Spring, 

MD, and at the NIH Clinical Center in Bethesda, MD. Another project aims to 

produce a vaccine candidate based on an existing rabies vaccine that could protect 

against Ebola and rabies, important diseases in certain regions in Africa. NIAID 

and DoD are partnering with researchers at Thomas Jefferson University to produce 

sufficient quantities of this candidate to begin clinical testing in early 2015. 

In addition, NIAID is partnering with DoD and BARDA to advance the development and testing of the Ebola therapeutic candidate ZMapp. ZMapp, developed by 

Mapp Biopharmaceutical, Inc., with support from NIAID and DoD, is a combination 

of three monoclonal antibodies that can protect monkeys from death due to Ebola 

virus when administered up to 5 days after infection. NIAID is working closely with 

partners at DoD, BARDA, and FDA to help determine whether ZMapp is safe and 

effective. BARDA currently is working with Mapp Biopharmaceuticals to accelerate 

the manufacturing of more ZMapp for additional testing. 

NIAID is an active participant in the Public Health Emergency Medical Countermeasure Enterprise (PHEMCE), an interagency effort led by the Department of 

Health and Human Service’s Office of the Assistant Secretary for Preparedness and 

Response that coordinates Federal activities to increase preparedness against chemical, biological, radiological, and nuclear threats, including Ebola viruses. As an active member of the PHEMCE, NIAID participates in multiple teams and committees 

to ensure coordination of scientific activity with PHEMCE partners, including 

BARDA, FDA, and DoD. In addition, NIAID participates in the Ebola Medical Countermeasures Senior Steering Group, coordinated by the White House Office of 

Science and Technology Policy. Senior staff from all agencies participating in the 

Ebola response meet twice weekly to discuss medical countermeasures for Ebola 

virus in the context of the U.S. response to the Ebola epidemic. 

NIAID will continue to play an active role in the PHEMCE and work with 

BARDA, DoD, FDA, and other partners to advance the development of diagnostics, 

therapeutics, and vaccines for Ebola virus. 

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SENATOR MORAN

Blood Transfusions 

Question 1. Dr. Fauci, the World Health Organization has endorsed the use of 

blood transfusions from recovered Ebola patients into sick patients; however there 

doesn’t appear to be much scientific information showing that this works. What is 

your professional judgment on this form of treatment? 

Answer 1. The ability to safely and effectively prevent and treat Ebola virus infection is a longstanding priority of the National Institute of Allergy and Infectious 

Diseases (NIAID). However, it is important to balance the urgency to deploy investigational medical countermeasures in an emergency such as the current Ebola outbreak with the need to ensure the safety, determine the efficacy of candidate therapeutics, and avoid inadvertent harm. NIAID will do this with careful attention to 

safety, established scientific principles, ethical considerations, and the urgent, pressing needs of the affected populations. 

Some patients infected with Ebola and hospitalized in facilities across the United 

States and affected countries in West Africa received so-called ‘‘convalescent serum’’ 

in addition to other medical care. The rationale behind use of convalescent serum 

is that it contains antibodies generated by the immune system of an Ebola survivor 

during the course of infection. These antibodies may help newly infected patients 

to fight Ebola virus. However, more must be known about the safety and effectiveness of plasma (‘‘convalescent serum’’) transfusions from those who have recovered 

from Ebola virus infection. 

Blood and plasma transfusions have been used as treatment against many infectious diseases, and the scientific rationale behind ‘‘convalescent serum’’ therapy suggests that it could be a potential treatment for Ebola virus infection. However, there 

are limited data from patients who have undergone this procedure, and further research is required before a determination is made that this therapy is a safe and 

effective treatment for Ebola virus infection. 

Note that an alternative mechanism to deliver antibodies that may help to treat 

the Ebola virus would be to artificially manufacture these antibodies and deliver 

them as a drug. This is the principle on which the therapeutic candidate ZMapp, 

a combination of three monoclonal antibodies, is based. A drug like ZMapp contains 

only the most potent neutralizing antibodies and its manufacture is standardized 

and regulated. The Department of Health and Human Services is vigorously supporting manufacturing and further evaluation of ZMapp. 

Question 2. Is there the necessary infrastructure in-country to make sure this 

technique is done safely? I am particularly concerned that Liberia, Guinea, and Sierra Leone do not have the proper blood screening procedures in place to ensure 

that they will not be spreading other diseases, like HIV. 

Answer 2. Proper blood screening from donors and blood typing of donors and recipients are essential for safe transfusions and to avoid dangerous transfusion reactions. In order to safely implement blood transfusions to treat Ebola in West Africa, 

there must be an infrastructure capable of identifying survivors, collecting their 

blood, identifying blood type of donor and recipient, and processing the blood to 

screen it for other infectious agents common to the region, such as malaria and hepatitis C. The limited health care infrastructures in the nations seriously affected by 

Ebola would make it challenging to ensure that blood transfusions were consistently 

administered safely and to collect data appropriate for clinical research on this 

intervention. 

Trial Infrastructure 

Question 3. Dr. Fauci, the World Health Organization announced that it would 

accelerate the use of experimental therapies and vaccines to contain the expanding 

Ebola epidemic. In addition, it has endorsed the controversial treatment of blood 

transfusions. As these treatments are deployed, how do we tell whether they are effective? Is there infrastructure in place to track effectiveness? 

Answer 3. NIAID is committed to working with partners to evaluate candidate 

drugs and vaccines for safety and efficacy. The U.S. Government, working in partnership with industry, has an established mechanism for testing and reviewing the 

safety and efficacy of potential medical interventions. Randomized controlled clinical 

trials remain the ‘‘gold standard’’ for the evaluation of candidate drugs and vaccines 

because they represent the most efficient way to prove efficacy and lack of an unexpected harmful effect. 

It is important to balance the urgency to deploy investigational medical countermeasures in an emergency such as the current Ebola outbreak with the need to ensure the maximal safety and to determine the efficacy of candidate Ebola theraLIFEBOOK092 with DISTILLER

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peutics. Blood transfusions, other Ebola-specific, blood-related products such as plasma from convalescent patients or processed serum from either convalescent patients 

or hyperimmune serum from vaccinated individuals, and other candidate interventions will be considered as potential experimental Ebola therapeutics. These potential therapies will undergo the same rigorous testing and evaluation with regards 

to safety and efficacy as other candidate Ebola treatments. As these treatments are 

deployed for emergency use and clinical evaluation, NIAID will continue to work 

with its partners, including non-profit organizations, biotechnology and pharmaceutical companies, Federal agencies such as the Centers for Disease Control and 

Prevention, the Biomedical Advanced Research and Development Authority, and the 

Food and Drug Administration, to support the clinical trials infrastructure necessary to determine the safety and effectiveness of medical countermeasures for 

Ebola. 

SENATOR SHELBY

Ebola Drug Candidate 

Question 1. A university in my State is pioneering a drug, with your support at 

NIAID, that would reactivate the body’s immune system after Ebola or other viruses 

deactivate it. What promise do you see in this line of drug discovery? 

Answer 1. NIAID supports a broad portfolio of basic research to better understand 

Ebola viruses and applied research to develop diagnostics, therapeutics, and vaccines against Ebola viruses. This research includes efforts to design and develop 

drugs to treat Ebola virus disease that would inhibit viral replication and its deleterious effects on the human immune system. One promising approach is the development of nucleoside derivative drugs. These drugs interfere with the reproductive 

process of the virus and may have activity against a broad spectrum of viruses. 

NIAID currently is supporting preclinical studies on promising drugs for the treatment of Ebola, and nucleoside derivatives are among the candidates that may enter 

clinical testing to evaluate their safety and markers of efficacy in the near future. 

In complement to NIAID’s ongoing development of drugs that directly target 

Ebola viruses, NIAID is supporting research that may provide significant insights 

into the mechanisms that govern the immune response to viruses. These insights 

could be used to design highly effective and long-lasting vaccines and inform studies 

on the development of novel therapeutic interventions that would enhance human 

responses to viral infections. NIAID will continue to support promising approaches 

to the development of drugs to treat Ebola virus disease and enhance the immune 

response to combat Ebola virus infection. 

NIH Research on Ebola 

Question 2. Dr. Fauci, NIH has several Ebola vaccines and therapies in development. Could you talk about the prospects for these treatments and give your professional judgment on which is the most promising approach? 

Answer 2. NIAID supports and conducts basic, translational, and clinical research 

on novel therapeutics and vaccines targeting emerging and re-emerging infectious 

diseases, including Ebola viruses. The ongoing NIAID response to the current Ebola 

outbreak focuses on working with non-profit, private industry, and government partners around the world to advance the development of medical countermeasures 

against the disease, including evaluating the use of drugs licensed or approved to 

treat non-Ebola diseases as a potential treatment for patients infected with Ebola. 

This approach has led to the generation of multiple therapeutic and vaccine candidates across the different stages of the product development pipeline. 

While NIAID is an active participant in the global effort to address the public 

health emergency in West Africa, it is important to recognize that we are still in 

the early stages of understanding how infection with the Ebola virus can be treated 

and prevented. The most promising therapeutic and vaccine approaches will be identified through further research, including evaluation of candidates at the preclinical 

and clinical stages. 

Some of the candidate vaccines and therapeutics currently in development with 

NIAID support are described below. 

Vaccines. The NIAID Vaccine Research Center collaborated with the pharmaceutical company GlaxoSmithKline to develop an experimental vaccine based on 

Chimpanzee Adenovirus 3. The vaccine candidate has shown promising results in 

animal models against two Ebola virus species, including the Zaire Ebola species responsible for the current outbreak. A small Phase I study to examine the safety and 

ability of this candidate vaccine to induce an immune response in humans began 

on September 2, 2014, at the NIH Clinical Center in Bethesda, MD, with results 

anticipated by the end of the calendar year. Additionally, NIH is collaborating with 

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DoD and NewLink Genetics on Phase I safety studies of another vaccine candidate 

based on a recombinant vesicular stomatitis virus. 

An additional vaccine candidate being developed by a team of NIAID intramural 

scientists and Thomas Jefferson University investigators is based on an existing licensed rabies vaccine and aims to protect against Ebola and rabies viruses. The vaccine is currently undergoing preclinical testing and NIAID is partnering with DoD 

to produce sufficient quantities of the vaccine candidate to begin clinical testing in 

2015. 

Therapeutics. A combination of three antibodies known as ZMapp has been shown 

to protect monkeys from death due to Ebola virus when administered up to 5 days 

after infection. ZMapp was developed by Mapp Biopharmaceutical, Inc., with support from NIAID and DoD. NIAID’s preclinical services are now being used to provide preliminary safety data to support the use of ZMapp for clinical trials in humans. NIAID also has funded BioCryst Pharmaceuticals to develop and test BCX4430, 

a novel drug that interferes with the reproductive process of the virus. BCX4430 has 

activity against a broad spectrum of viruses and has shown some activity in animals 

against infection by Ebola virus and the related Marburg virus. Additionally, NIAID 

scientists are working on therapeutics that may be effective against multiple hemorrhagic fever viruses including Ebola and Marburg filoviruses and the arenavirus 

Lassa. Ribavirin, a drug currently used to treat viral hemorrhagic fevers such as 

Lassa fever, is being examined for its potential use in combination therapy to treat 

Ebola virus infection. 

Candidate therapeutics are being considered for future clinical trials to evaluate 

their safety and efficacy. NIAID will continue to work with biopharmaceutical companies and public health agencies around the world to advance development of 

promising candidates and increase access to safe and effective medical countermeasures for Ebola virus disease as quickly as possible. 

SENATOR COCHRAN

Response from International Community 

Question 1. Thank you for coming in today to describe efforts by the U.S. Government to respond to the Ebola outbreak in West Africa. I am hopeful that the United 

States can play a leadership role in addressing this humanitarian crisis, but I am 

also curious about the contributions of international organizations and our partner 

nations. Will you please describe efforts by the international community to stop the 

Ebola epidemic? 

Answer 1. NIAID defers to colleagues coordinating the Ebola outbreak response. 

Ebola Protection and Control 

Question 2. Do you believe the additional $88 million that has been requested by 

the President to respond to this Ebola crisis will provide you with the resources required to protect against the potential spread of Ebola in the United States and to 

address needs abroad? 

Answer 2. NIAID defers to recipients of supplemental funding. 

Capacity for Drugs or Vaccines 

Question 3. Do you believe the capacity we have to approve, produce, and distribute drugs and vaccines here in the United States is sufficient to contain an infectious disease such as Ebola should it make its way here to the United States? 

Answer 3. NIAID defers to other witnesses. 

Prioritization of Funding 

Question 4. Dr. Robinson and Dr. Fauci, NIH receives approximately $1.7 billion 

per year for biodefense and emerging infectious diseases and BARDA receives $415 

million. How does HHS prioritize the utilization of this funding to address known 

and emerging threats? 

Answer 4. NIAID is the lead institute at NIH for conducting and supporting basic 

and applied research on biodefense, including chemical, biological, and radiological/ 

nuclear threats, and emerging and re-emerging infectious diseases. This research 

provides the foundation for developing medical products and strategies to diagnose, 

treat, and prevent a wide range of biodefense threats and infectious diseases, 

whether those diseases emerge naturally or are deliberately introduced as an act of 

bioterrorism. 

Since the 2001 anthrax attacks, with the support of the U.S. Congress, NIAID has 

vastly expanded its research portfolio in biodefense and emerging and re-emerging 

infectious diseases. NIAID’s biodefense research is guided by its Strategic Plan for 

Biodefense Research, which has been developed and updated in consultation with 

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biodefense research experts. NIAID’s research also aligns with the priorities of the 

interagency Public Health Emergency Medical Countermeasures Enterprise 

(PHEMCE). NIAID’s pathogen priority list is periodically reviewed and is subject to 

revision in conjunction with our Federal partners, including the Department of 

Homeland Security, which determines threat assessments, the Centers for Disease 

Control and Prevention, which prepares for and responds to emerging pathogen 

threats in the United States, and the Biomedical Advanced Research and Development Authority, with which we collaborate to transition promising medical countermeasures for advanced development. 

Guided by our Strategic Plan and priorities, NIAID supports the fundamental research needed to better understand infectious agents in order to develop broad-spectrum antibiotics and antivirals—drugs that can prevent or treat diseases caused by 

multiple types of bacteria or viruses. In addition, NIAID has intensified its efforts 

to develop new technologies that can be broadly applied to more efficiently develop 

diagnostics and vaccines against a wide variety of infectious agents, including pandemic influenza viruses, MRSA, extensively drug-resistant Mycobacterium tuberculosis, dengue, chikungunya, and filoviruses such as Ebola. 

NIAID’s biodefense research portfolio includes investigator-initiated research as 

well as targeted research initiatives to capitalize on new scientific opportunities, 

provide critical research resources, and stimulate research in high-priority areas. All 

NIAID research, whether investigator-initiated or solicited, undergoes peer review. 

Scientific experts evaluate the scientific and technical merit of proposed research, 

and funding decisions are based on scientific and technical merit of proposed 

projects, availability of funds, and relevance to program priorities. NIAID’s research 

funding process provides the flexibility needed to respond rapidly to address known 

and emerging disease threats. 

SENATOR BURR

Question 1. How is NIAID structuring the clinical trials with respect to both 

Ebola vaccine and therapeutic candidates, including with respect to enrolling clinical trial participants in West Africa? Are there aspects of the current Ebola clinical 

trials that are unique given the state of the outbreak overseas? 

Answer 1. NIAID is consulting with experts around the world to plan clinical 

trials of Ebola medical countermeasures that will enroll participants in West Africa. 

An important part of these ongoing discussions is an evaluation of whether candidate vaccines and therapeutics are available in sufficient quantities for testing 

and whether early clinical testing has indicated they are safe and can generate the 

desired response. 

With respect to vaccines, the NIAID Vaccine Research Center (VRC) plays a leading role in the evaluation of safety and immunogenicity of candidate Ebola vaccines. 

Currently, the VRC is conducting and supporting Phase I clinical trials of CAd3, an 

experimental vaccine developed by NIAID and GlaxoSmithKline which has shown 

promising results in animal models against two Ebola virus species, including the 

Zaire Ebola species responsible for the current outbreak in West Africa. NIAID and 

GlaxoSmithKline plan to share doses of the vaccine candidate with an international 

consortium comprising Oxford University, the Wellcome Trust, and the World 

Health Organization in order to enable other planned clinical trials. With respect 

to therapeutics, only limited clinical use of Ebola therapeutic candidates under expanded access mechanisms has occurred so far. Plans for systematic clinical testing 

are under active discussion at this time. 

Aspects of the planned Ebola clinical trials unique to this outbreak include the 

rapid establishment of complex technology transfer arrangements, the facilitation of 

expedited regulatory reviews, and the extraordinary deployment of NIAID resources 

and infrastructure to safely provide clinical materials to international partners. 

NIAID is committed to advancing candidate Ebola vaccines and therapeutics while 

ensuring the maximal safety of clinical trial participants. 

Question 2. Are there vaccine and therapeutic candidates that we should be pursuing that are not already in the pipeline? 

Answer 2. There are a number of promising vaccine and therapeutic candidates 

for Ebola virus currently in the development pipeline, and additional approaches are 

constantly being investigated and considered for further development. NIAID employs multiple approaches to identify and develop potential Ebola virus medical 

countermeasures. NIAID supports a strong foundation of basic research to better 

understand Ebola virus and to identify biological targets to inform the development 

of diagnostics, therapeutics, and vaccines. NIAID is actively examining these targets 

to assess scientific concepts and to advance promising approaches along the development pipeline. 

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NIAID employs a multifaceted and interdisciplinary approach to ensure a robust 

pipeline of candidate medical countermeasures for Ebola virus. In collaboration with 

our partners in government and industry, we will continue to evaluate novel ideas 

and pursue promising candidates. Currently NIAID is actively engaging scientists 

around the world who have come forward to discuss their candidate Ebola 

diagnostics, therapeutics, and vaccines. NIAID also makes resources available to 

academic and industry researchers, such as in vitro and in vivo screening, to help 

evaluate potential medical countermeasures and advance promising candidates. For 

example, since 2011, over 30 different vaccines, formulations, or dosing schedules 

against filoviruses, the virus family that includes Ebola viruses, have been evaluated using NIAID’s preclinical services. Seven qualified for further testing and five 

are currently in the product development pipeline. NIAID is fully committed to engaging its resources to identify and evaluate promising vaccines and therapeutics. 

SENATOR KIRK

Question 1. Dr. Fauci and Dr. Robinson, are there medical countermeasures in development to support the current Ebola outbreaks? I believe that Ebola was identified as ‘‘threat sufficient’’ to affect national security in 2006. How does HHS 

prioritize investments to address known and emerging threats? 

Answer 1. NIAID defers to other witnesses on HHS prioritization of investments. 

NIAID supports a broad portfolio of intramural and extramural basic research to 

better understand Ebola viruses and applied research to develop diagnostics, therapeutics, and vaccines against Ebola viruses. NIAID has supported a number of medical countermeasures currently in development. As described below, medical countermeasures for Ebola virus disease currently in advanced development include 

therapeutic candidates ZMapp, CMX001 (brincidofovir), BCX4430, T–705 

(favipiravir), TKM-Ebola, and vaccine candidates CAd3 and VSV-EBOV. It is important to note that these products are still in development and have not been shown 

to be safe and effective in Ebola patients. So far, only limited clinical use of these 

products under expanded access mechanisms has occurred in patients with documented or suspected Ebola virus infection. 

Vaccines 

CAd3. The NIAID Vaccine Research Center and pharmaceutical company 

GlaxoSmithKline have developed an experimental vaccine that uses the chimpanzee 

adenovirus 3 (CAd3) as a vector to introduce Ebola virus genes into the body, stimulating an immune response. This vaccine candidate has shown promising results in 

animal models against two Ebola virus species, including the Zaire Ebola species responsible for the current outbreak in West Africa. A small Phase I study to examine 

the safety and ability of this candidate to generate an immune response began on 

September 2, 2014, at the National Institutes of Health (NIH) Clinical Center in Bethesda, MD. Results from the study are anticipated by the end of 2014, and will 

help inform future development of the vaccine. 

VSV-EBOV. The Public Health Agency of Canada has developed VSV-EBOV, an 

investigational recombinant vesicular stomatitis virus Ebola vaccine subsequently licensed to NewLink Genetics. NIAID is collaborating with DoD in support of efforts 

by NewLink Genetics to conduct Phase I safety studies for VSV-EBOV. These studies are planned for the fall of 2014 at Walter Reed Army Institute of Research in 

Silver Spring, MD, and the NIH Clinical Center in Bethesda, MD. 

Therapeutics 

ZMapp. NIAID supported Mapp Biopharmaceutical, Inc., to develop MB–003, a 

combination of three antibodies that provides some protection from Ebola virus disease in monkeys when administered within 48 hours of exposure. An optimized 

product derived from MB–003, known as ZMapp, has protected monkeys from death 

due to Ebola virus up to 5 days after infection. NIAID’s preclinical services are now 

being used to gather safety data for the use of ZMapp in clinical trials. ZMapp was 

recently administered to several patients with Ebola virus disease as an experimental treatment, although it is not possible at this time to determine whether 

ZMapp benefited these patients. BARDA is implementing plans to optimize and accelerate the manufacturing of ZMapp so that clinical safety and efficacy testing can 

proceed as soon as possible. NIAID will continue to work closely with partners at 

BARDA, DoD, and FDA to advance development and testing of this therapeutic candidate. 

CMX001 (brincidofovir). NIAID is evaluating therapeutics in development or licensed for the treatment of other diseases for activity against Ebola virus. One of 

these investigational agents is brincidofovir, an antiviral originally targeting smallpox that has had NIAID support for parts of the development program conducted 

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by Chimerix, Inc. Currently, brincidofovir is in advanced clinical testing for use 

against cytomegalovirus and adenovirus infections. In vitro screening suggested 

some activity against Ebola virus and the candidate is now undergoing NIAID-funded in vivo testing against Ebola virus disease. 

BCX4430. NIAID has funded BioCryst Pharmaceuticals to develop and test 

BCX4430, a novel drug that interferes with the reproductive process of the virus 

and has activity against a broad spectrum of viruses. In preclinical testing, 

BCX4430 has shown some activity in animals against infection by Ebola virus and 

the related Marburg virus. A Phase I clinical trial of this drug is expected to begin 

in late 2014 or early 2015. 

T–705 (favipiravir). NIAID funded early screening of T–705, or favipiravir, a 

broad-spectrum antiviral against RNA viruses. T–705 is owned by Toyama Chemical 

of Japan and licensed by MediVector for development in the United States. This 

drug is licensed in Japan for pandemic influenza; in the United States, it is undergoing DoD-supported Phase III clinical trials for use against influenza. Pilot studies 

funded by DoD are underway to test the effectiveness of favipiravir against Ebola 

virus in nonhuman primates. 

TKM-Ebola. DoD has supported development of TKM-Ebola by Tekmira Pharmaceuticals. TKM-Ebola is a small, inhibitory RNA molecule that interferes with Ebola 

virus replication. Tekmira Pharmaceuticals began Phase I trials of TKM-Ebola in 

January 2014. The trial in healthy uninfected volunteers is currently on a partial 

clinical hold; however, the FDA has allowed use of TKM-Ebola under an expanded 

access mechanism in individuals with suspected or confirmed Ebola virus infection. 

Question 2. Dr. Bell and Dr. Fauci, with all the different agencies involved, which 

one is leading the efforts against Ebola? What coordinated efforts are happening between the agencies? What are other nations doing to contribute? 

Answer 2. NIH supports foundational research and facilitates interagency partnerships that lead to the development of new and improved medical countermeasures for biodefense and emerging and re-emerging infectious diseases. NIAID 

is the lead component of the NIH for research and development of medical countermeasures against Ebola virus. Basic and applied research supported by NIAID contributes to a comprehensive understanding of the scientific and medical aspects of 

Ebola virus and aims to advance development of diagnostics, therapeutics, and vaccines against this deadly disease. Critical to these efforts are NIAID’s collaborations 

with other Federal entities, particularly CDC, FDA, BARDA, and DoD. 

NIAID has responded to the current Ebola virus outbreak in West Africa by 

leveraging longstanding and productive partnerships to accelerate ongoing research 

efforts. For example, NIAID is working closely with partners at DoD, BARDA, and 

FDA, along with the product developer, Mapp Biopharmaceutical, Inc., to advance 

development and testing of this Ebola therapeutic candidate ZMapp to determine 

whether it is safe and effective. ZMapp is a combination of three antibodies developed with support from NIAID and DoD. ZMapp has shown promising results in 

studies with monkeys, and NIAID is partnering with BARDA and FDA to accelerate 

manufacturing and additional testing of ZMapp. NIAID will continue to work closely 

with BARDA to transition additional therapeutic candidates for advanced development as appropriate. NIAID’s ongoing coordination with FDA will help to advance 

promising therapeutics into clinical testing to determine their safety and efficacy. 

In addition, NIAID and DoD are coordinating efforts to accelerate the production 

of Ebola vaccine candidates. One project aims to generate immunity to Ebola and 

rabies viruses using a vaccine candidate based on an existing rabies vaccine. NIAID 

and DoD are currently partnering with researchers at Thomas Jefferson University 

to produce sufficient quantities of the candidate to begin clinical testing in early 

2015. NIAID and DoD also are collaborating with NewLink Genetics on an investigational recombinant vesicular stomatitis virus (VSV)-based vaccine candidate developed by the Public Health Agency of Canada and licensed to NewLink Genetics. 

This candidate has begun Phase I safety studies in fall 2014 at Walter Reed Army 

Institute of Research in Silver Spring, MD, and at the NIH Clinical Center in Bethesda, MD. 

NIAID will work closely with FDA to evaluate the safety and immunogenicity 

data from this trial as well as from NIAID’s ongoing Phase I clinical trial of the 

chimpanzee adenovirus-based Ebola vaccine (CAd3), developed in collaboration with 

GlaxoSmithKline. 

NIH also participates in the Ebola Medical Countermeasures Senior Steering 

Group, led by the White House Office of Science and Technology Policy and comprising senior staff from all Federal agencies participating in Ebola response activities. Through this and other mechanisms, NIAID will continue its efforts to accelerate the development of safe and effective countermeasures against Ebola virus by 

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leveraging existing partnerships with industry and other Federal agencies including 

CDC, FDA, BARDA, and DoD. 

NIAID defers to other witnesses regarding which Agency is leading efforts against 

Ebola and other nations’ contributions against Ebola. 

RESPONSE TO QUESTIONS OF SENATOR CASEY AND SENATOR WARREN BY

ISHMAEL ALFRED CHARLES

SENATOR CASEY

Question 1. You stated that stigma surrounding Ebola is a problem for combating 

the current outbreak. What message do you think needs to be articulated to help 

fight that stigma? 

Answer 1. Well over the period with the current outbreak we have practically 

seen how stigmas and discrimination have torn apart more people almost as much 

as the outbreak. At community level, it is important to use our religious leaders and 

community volunteers to preach about acceptance and the fact that those who have 

survived Ebola cannot transfer the virus or cannot get anyone sick. Also at the regional and international level people need to get more education on how Ebola 

spreads, for example in the United States, institutions like CDC and NIH need to 

engage the wider society that Ebola is not an African outbreak. It can take place 

anywhere. It is more serious in Africa because of the bad leadership and poor health 

infrastructures and system. Also that Ebola does not spread by merely seeing someone but only through bodily contact, as the lack of sufficient information is also creating more confusion. 

Stigma is degrading attitude of the society that brings not only shame and disgrace, but also discredits a person or a group because of an attribute to an outbreak 

like Ebola. 

Stigma leads to people not being treated with dignity and respect and promotes 

hate and disunity which is socially unacceptable. 

Question 1a. Which people in local communities do you feel would be best able 

to communicate that message? 

Answer 1a. There are community stakeholders who also are the opinion leaders 

of the community. 

The following are examples: Religious leader (e.g., Imam, Pastors and Rev. Fr.), 

Traditional Heads, popular sports/soccer players, musicians/comedians and influential personalities. 

Question 2. In your testimony, you stated that schools in Sierra Leone are closed 

indefinitely, while the illiteracy rate is 70 percent. How can the international community help affected countries fill in this education gap for their children and improve literacy? 

Answer 2. Prior to the Ebola outbreak, the basic survival of the ordinary citizen 

was difficult. The outbreak has undoubtedly compounded the already worse situations. 

The cost of the basic school or learning materials increased just before the outbreak and the outbreak has stopped all economic activities such as trading and 

movement. Schools are closed to avoid contact among pupils and students. 

The following interventions may help: 

(1) Take care of the education of the orphans of Ebola victims. 

(2) Help the government to provide affordable education at all levels for the citizens (e.g., Free tuition for secondary schools and reduction in college and university 

fees.) 

(3) Reintroduce school feeding programs in primary schools to augment the post 

Ebola recovery. 

(4) Support the universities directly with their needs including subsidies. 

Clearly we realized that in a post conflict country only recovering from the aftermath of the war has not helped the situation at all. Schooling was badly disrupted 

and it has only further damaged the educational development of the country, a 

country with 70 percent illiteracy. Schools have closed indefinitely, and this is exposing many young girls to teenage pregnancy and further increasing the burden. 

My suggestion is for us to ensure that these children who will be pregnant after 

Ebola will need to be enrolled in a special school to ensure that they don’t become 

drop outs. 

Also there is a need for a recap type of school. Post war era, we had a schooling 

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gram. We will need a similar program in the post Ebola era, so that the school pupils will be able to recap and catch up with what they have lost. 

SENATOR WARREN

Question 1. Fighting epidemics in developing countries presents unique challenges. Despite all the attention that’s being paid to the Ebola outbreak, serious 

health problems have gripped these countries for years. In Liberia, for example, 17 

percent of deaths are due to Malaria, and Sierra Leone has one of highest rates of 

infant and maternal mortality in the world. Countries currently dealing with Ebola 

have a poor healthcare infrastructure and very few healthcare workers—and are 

barely able to provide basic care, much less handle an epidemic. 

How would long term investments to improve the basic healthcare infrastructure 

of developing nations help to improve our ability to respond to new outbreaks and 

epidemics? 

Answer 1. Any attempt to address the health care problems in developing countries, like Sierra Leone should focus on sustainable infrastructure and a strong system that is in rhythm with international best practice(s). 

Our current health care facilities including the Infrastructure do not address the 

needs/demands of most of the recent outbreaks and epidemics. 

In addition to the substandard provisions, there are no improving systems that 

will implement and monitor the effective and efficient use of the health care facilities. 

The following are recommended: 

1. Establishment of a Centre for Diseases Control (CDC) in every country, especially those that were badly affected by Ebola. 

2. Strengthening of health care systems. 

3. Ensure a vibrant disease surveillance network within West Africa. 

Question 2. How are the United States and international aid organizations helping to take care of health care needs besides Ebola in the epidemic regions? 

Answer 2. The international aid organizations and U.S. organizations are helping 

in diverse ways which include provision of food and nonfood items to people as hunger and starvation is on the increase. This support is not enough, hence there is 

a huge need for more support to the community people across the country, especially 

in the badly hit areas of the country. 

[Whereupon, at 5:45 p.m., the hearing was adjourned.] 

Æ 

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